Early Intervention Strategies for Success

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  • “Can You Stay a Few Extra Minutes?”…What Do You Do?(current)

With 3 minutes left to the visit, Mikaela’s mother, Delia, asks “Can you stay a few extra minutes today?” She says she really needs your advice. Yesterday, the child care center Hand on doorknobdirector called because Mikaela bit another child. They threatened to expel Mikaela and Delia isn’t sure what to do. You pause because you know that your next visit starts in 15 min and it takes you that long to drive there. However, Delia’s question is important and you want to help. What do you do?

The Last Minute Question

Have you been there before? You know, being the receiver of the zinger that comes your way during those last wrap-up minutes at the end of an intervention visit. Or maybe it’s not a zinger and not even related to a problem, like being asked if you have a few minutes to give your opinion on paint colors for the den. Whatever the last minute question is, it requires a split second decision – Do I stay and risk my schedule for the rest of the day? Or, do I say “no, I sorry but I can’t stay” and try to address the issue later?

Option A: “Sure, I can stay…”

If you decide to stay, you must know that you are making a choice. You can’t “blame” the parent for making you late to your next visit. Taking just a second to pause and think about your choice is important. You might weigh the last minute question with its relative importance and how long it will take to answer. Addressing the child care problem will almost certainly take a while (not a 5 min conversation). Giving a quick opinion on paint colors might only take a few minutes. This also depends on how talkative the parent tends to be too. Lots of factors to consider in your split second choice.

Option B: “No, sorry, I can’t stay…”

This decision to decline is also affected by the same factors. If the question is really immediate, like with the child care issue, it can be hard to say “no.” Sometimes I think that these difficult last minute questions come up when they do because parents don’t want to interrupt the regular session or take away from what they perceive as the child’s time and their own time to learn. It might also be that the parent is reluctant to ask the question and works up the nerve at the last minute. I can remember several times when I was asked a question like “do you think he has autism?” as I was walking out the front door. These hard questions are scary and take courage to ask. Weighing the immediate situation and what you really can do with the parent’s need for support in that moment are so important – for you to balance your work needs and the support needs within parent-provider partnership. Saying “no” can have repercussions for your relationship, but saying “yes” every time can too.

What Do You Do?

Here are a few strategies you might consider when faced with the last minute question:

Define how long you can actually stay – If you chose Option A, you could say that you only have 5 minutes and ask the parent if she thinks that’s enough time to talk. Then, you stick to the decision. You really do leave after 5 minutes or you really do follow-up later.

Give choices – If you chose Option B, you could ask the parent what other options the two of you might have to get her question answered. Maybe you can call her later? Maybe you plan for a little extra time during the next visit?

Plan for wiggle room – If you know that a family often asks you to stay longer, or the visit just tends to go beyond your allotted time, plan ahead. If possible, plan for more of a cushion between that visit and your next one. Stick to the length of time written on the IFSP, but have that cushion there if you need it.

Talk with the service coordinator – If your visits are always running longer, talk with the service coordinator. He/she might be able to step in to provide additional support to the family so that the time you spend with them is focused on addressing the IFSP outcomes.

Talk with the family & set boundaries – Be honest. If the last minute question comes up a lot, let the parent know that you’d like to help but it’s also important that you honor the appointment times you have with other families. Tell her that, in the future, you’d be happy to take a moment to look at paint colors at the beginning of the visit instead of the end. It’s really up to you to set and maintain boundaries for what you can reasonably do during visits.

You help the parent learn how early intervention visits work. You do this through a combination of being friendly, flexible, and professional. You can do all of these while coaching the parent through solving a major problem or offering friendly advice on less pressing matters, even at the last minute. Good, honest communication is the key.

So what do you do when asked if you can stay a little longer? How have you handled this situation? What do you do when the caregiver needs more of your time than you can reasonably give?

6 comments on ““Can You Stay a Few Extra Minutes?”…What Do You Do?

  • Ryan W says:

    This is a really great topic for various reasons and I like the suggestions. This may carry with it significant potential depending on the rapport between the service provider and the family or one that has not yet been established at all. The heavy last minute question i.e. the child care example given or do you suspect she has Autism?, does take some level of courage to ask. However, if “you” the service provider chooses to leave, respectfully, then believe it or not this may actually come as a relief to the parent, and both parties may have been let off the hook so speak. Waiting to the last minute may really reflect that the parent may not truly want the real answer at that particular time anyways. So a service provider should be OK with deferring to wait until another visit or phone call at another time.

    • That’s a really interesting perspective, Ryan. I hadn’t thought of that – that asking at the last minute might just be testing the waters, not really searching for a concrete answer. You are so right when you say that asking these hard questions (like about diagnoses) takes courage. Hopefully, as you said, the service provider will have built a good relationship with the parent and be able to judge what kind of response is needed in the moment and or later on. I think we have to be honest too – in saying that we don’t know, aren’t sure, or need to time think about how to answer, if this is the case. It was my experience that parents appreciated this kind of honesty and were understanding, even when I couldn’t provide an answer or stay those few extra minutes. I also found that these tough questions often didn’t go away. They came up again later, which was maybe a sign that the parent was becoming more and more ready to discuss the issue. Thanks for adding a different perspective!

  • michelle says:

    In the past when I have done home visits, with new parents I have encourage them to keep a notebook to jot down questions for either myself or for their physician. I also was up front with the parents on the first couple visits that I would save 5 minutes at the end of the visit to answer questions. If it was going to be a longer conversation with the parent, I then asked if I could schedule a time to call the parent to discuss their question. Setting the boundaries I found from the beginning with parents was helpful. Also I have a clinical background in counseling, if I had a parent who wanted to ask a question or had a situation they needed some feedback on, I would use one of the following 2 phrases “If you went to bed and woke up, what would be different or how would you know what changed? Or the other question, if you had a magic wand how do think the issue/problem be resolve, I think this approach provides the families with the ability to problem solve and helps them see the issue /problem in a different light. I feel that this process builds the parent confidence and self esteem.
    My apologies for being long winded.

    • No worries, Michelle! I really like your idea of suggesting that families keep a notebook to record questions, then ensuring that there is time at teach visit to discuss them. How do you handle it when a question pops up during the visit (rather than at the end)? I’ve found that some questions need to be addressed immediately because if they aren’t, then the parent might struggle to get the most out of the rest of the visit with the question hovering between you. Maybe knowing that there is always time at each visit for questions would help avoid this. What’s been your experience?

      I also love the two examples of reflective questions you provided. You’ve placed your confidence in the parent’s ability to solve her own problem. Plus, the answers to the questions help you understand what outcome the parent envisions. Any suggestions you provide are much more likely to fit or be meaningful because now you share the same vision as the parent.

      • michelle says:

        Dana, in the past I had some parents that would ask a lot of questions, during the visit. What I have done is to help the parent prioritize their questions, such as what were the most important to less importance. I would ask the parent if we could perhaps make a phone time to answer the questions they had and then have a longer conversation but still mindful of time being spent on the phone with the parent. If there were questions that came up immediately, I would address them and try to keep conversation short but saying to the parent, I can provide an answer to you but if you want further input, let’s schedule a time so we can discuss. This way it does not take away from the time I spend with the child and family.


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