Comments on: EI Research to Practice Brief #4 – Participation-based Practices Result in More Engaged Children and Caregivers

By: Dana Childress, M.Ed.

Dana Childress, M.Ed. — Thu, 30 Oct 2014 15:30:56 +0000

This is a fantastic reflection, Nancy. What a great opportunity to think about the differences between traditional therapy and early intervention using natural learning environment practices. I love it that you saw the natural learning opportunities that happened even in the clinic. What advice do you have for providers trained in a traditional medical model who are making the same transition to participation-based practices? Is there one nugget of advice you would share?

By: Emilie Mulholland

Emilie Mulholland — Fri, 24 Oct 2014 18:32:05 +0000

Something I’ve been trying to work on lately is letting go of what I think I might be working on with the family that day. (I actually had to go back and delete what I originally wrote, working with the child!). I’ve been trying to shift my focus on asking how things have been going, if they have concerns right now, or if there’s something the parent would like to work on, whether it’s a skill or a routine. Sometimes letting go just means following whatever the parent and child are doing when I’m there. For this reason, I keep the child’s IFSP outcomes with me at each visit to review before going into each visit, so I can help the parent brainstorm how to meet these goals, or point out things they are already doing to meet those goals.
I agree with Pamela Lang that a good assessment will make a good plan. I think it’s important to include information regarding the family’s priorities/routines/child interests within that assessment in order to make it a well rounded assessment. That is helpful when first going into the family’s home for home visits.

By: Nancy Brockway

Nancy Brockway — Thu, 23 Oct 2014 13:08:35 +0000

I had the opportunity to observe a traditional therapy session in a rehab facility yesterday and was overwhelmed with how far we have evolved in Early Intervention. Yesterday, as I observed a very skilled therapist work with a child (whom I follow through EI), with the parent sitting off to the side and not participating, I found myself mentally calculating the number of natural occurring opportunities in which the family was already incorporating what the therapist was doing during her session during their routines and activities. There was quite an imbalance with natural opportunities far exceeding what was achieved in the hour of therapy. I trained and worked in a traditional medical model and my transition to participatory-based intervention was not without a little resistance and a few bumps in the road, but I’m happy to say that I’m a true convert now!

By: Dana Childress, M.Ed.

Dana Childress, M.Ed. — Fri, 11 Apr 2014 19:47:49 +0000

In reply to Janet Hammond.

Great question, Janet! You might want to head over to another post, the EI Research to Practice Brief #1, because we have a PT who just posted about this and I’ve asked her for her advice. Hopefully she’ll share some insights that you can pass along. You might want to look up more of Phillipa Campbell’s work in participation-based practices. She is an OT and she talks alot about collaborating with families around adaptations. M’Lisa Shelden, one of the gurus of coaching in EI, is at the Family Infant Preschool Program in NC and is also a PT so you might check with her for ideas too. Her work, and Pip Campbell’s, both offer great ideas. Folks in our staff are finding Rush and Shelden’s book, The Early Childhood Coaching Handbook, to be of great use and are doing book studies with it following training with the authors. If you need help finding articles, just shoot me an email and I’ll see what I can do (dcchildress@vcu.edu).

By: Dana Childress, M.Ed.

Dana Childress, M.Ed. — Thu, 10 Apr 2014 13:36:13 +0000

In reply to Pamela Lang.

Great point, Pam! I so appreciate your insight. When I was thinking of letting go of assessment skills, I was thinking that we shouldn’t be “teaching to the test.” I absolutely agree with you that what we really need is to know what is important and how to use that relevant info during intervention. Assessment is important and does support a good plan when we translate what we learn from it into functional terms. Thanks for taking this point a little deeper! Hope your doc study is going well! 🙂

By: Pamela Lang

Pamela Lang — Thu, 10 Apr 2014 01:38:31 +0000

Hello Dana:
Thank you for bringing this study forward. I am a big fan of Dr. Campbell, having study under her back in 1995 when she was teaching “programming within activities and routines.” My commentary is to suggest that instead of letting go of assessment skills, we need to determine what is the most valuable information that should be gathering during the initial (and subsequent) assessment phase(s). Relevant information should carry directly over into program planning and help to identify the unique learning opportunities available within each family structure. This will set the stage beautifully for embedding strategies into routines. I believe this may actually help practitioners shift more easily from traditional to participation-based intervention. A good assessment makes a good plan. Your thoughts?

By: Janet Hammond

Janet Hammond — Wed, 09 Apr 2014 22:49:37 +0000

From the numbers shared in this article, our team is not alone in struggling with this issue as well as capitalizing on daily routines.

Our therapists say they don’t know how to do participation-based intervention and so continue with the traditional therapy with which they are comfortable. I have researched, and found a great deal of information for communication, but not for OT/PT.

I am also not sure how EI policy dictates therapists to intervene for NICU grads with medical needs such as aspiration, trachs, enteral nutrition, and craniofacial anomalies such as cleft palates (my caseload – haha). Some sources claim that EI is ONLY developmental, but I see many medically fragile NICU grads. The nearest pediatric facilities are hours away, requiring parents risk job loss for time off.

Are there readers who can provide links or comments about how OT/PT is intervening for babies and toddlers with impairments using participation-based practices?

I am heading over to “Build the Blog” to make some suggestions….