Hi Lizzy – I’m glad you found the blog! Yes, One researcher who is also an OT that you might be interested in is Phillipa Campbell. She writes about participation-based early intervention. I recently presented a webinar called “Let Go of the Toy Bag and Get Off the Floor: Tips for Best Practices in Early Intervention” that you could share with your colleagues. Also, on the VA Early Intervention Professional Development Center website, you might like to visit our Implementing Supports and Services page where you’ll find lots of free resources about recommended practices. For instance, we have a set of videos all about Routines-based EI (this link will take you to the first of three videos). It can be very frustrating to be trying to use these practices and see others doing more traditional, clinical work because it can muck up the waters and be confusing for families. Keep up the good work and check out these resources. Share with your colleagues to maybe get a discussion going! 🙂

Great question, Benny. I’ve been surprised by how often I’ve heard the same comment – that these practices won’t work for kids with significant disabilities. I think that providers will use a combination of practices, including some direct hands-on intervention to model strategies plus coaching to help the parent or caregiver practice those same strategies too. Observation of what the parent is already doing is so important too, because the research tells us that families are already quite good at adapting their routines and activities to include their children, including those with significant needs. It’s been my impression that because these children have multiple needs, we often get overwhelmed and think they need lots of special techniques and services. They do often need more than, say, a child with an expressive delay, but the intervention does not have to be completely clinical. Finding out about what interests the child, what he/she finds stimulating and what captures her attention can offer great motivators when working on key functional ability areas such as movement, communication, engagement and attention. Thinking about family routines and how to help the child participate in them is absolutely appropriate and natural, but can actually push a provider beyond the typical suggestions for toddlers. I think it’s helpful to step back and keep the child’s development in the context of his/her everyday family life. Balancing teaching the parent how to stretch, position, and engage the child with helping them find ways to weave these activities into the daily routine are the key. My advice would be to target a particular routine for each visit and see how it can be used to support the child’s development towards the IFSP outcomes. I’d love to hear other suggestions too. This sounds like a great topic for another blog article! 🙂

Dana,

I was just wondering what advice would you give or resources may you have for those who would have the objection that routines based activities may not be feasible for some children who have more profound delays?

Hmmm…good idea, Cori! I’ll see if I can pull a few more together and post them in the coming months. I love the thought of these types of posts helping students.

And Benny, the questions you asked of yourself were fantastic!

Wow, Benny, I couldn’t have gotten a better compliment! 🙂 It’s so exciting to know that this work is helping other practitioners. You are so right about providers almost having to take a leap of faith in adopting a routines-based model. For many of us, it really is a big shift and does push us beyond our comfort zone. It’s just easier to do the intervention ourselves – and that’s what most of us where trained to do. Plus, playing with babies and feeling directly responsible for their progress makes us feel good too. Shifting gears to being a coach and consultant isn’t easy but it is so effective and so rewarding when we see the family making the difference!

Thanks for sharing the reflective questions you ask yourself. I think these will be really useful to others. As you clearly know, the key to evolving your own practices is reflection. It sounds like you are doing a wonderful job of it!

As I myself began my transition to a more family- centered approach many years ago, I found myself asking were my practices at that time reflective of my core beliefs? Did I exemplify through my actions with families my confidence in their abilities to make positive changes in their children’s lives? Did I build capacities in these families? I continue to ask myself these questions as I continue to grow and refine my skills. It was wonderful to read this article and build my confidence that I am on the right track and also remind me that there is much more I can do and learn. The resources that are attached are amazing and I will certainly share them with my peers and colleagues. Keep up the amazing work! This blog is having ripple effects more than you know!