Are you Service Provider A or Service Provider B?
Service Provider A always brings a bag of toys to each visit because this allows her to plan ahead. Having a toy bag ensures that she has the materials that she knows will work, which is great because many children she sees don’t have many toys. The children like the toys too and pay attention better when she brings new things into the home.
Service Provider B used to bring toys, but now does what he calls “bagless therapy”. Rather than bringing toys into the home, he focuses his time with the family on helping them figure out how to use what they already have to encourage the child’s development. Provider B’s visits don’t revolve around toy play; instead he joins the parent and child in different daily routines which may or may not involve toys. He often teaches playfulness during these routines, and helps the parent practice using intervention strategies to motivate the child. The visits are less predictable than when he used to bring toys, but he finds that his intervention is more individualized now.
Which Provider are You?
Take a moment and reflect – which provider are you? Sometimes the line is not so clear cut. You might not bring a toy bag but you still bring a bottle of bubbles. Or maybe you do “bagless therapy” but you still primarily focus on playing with the child’s toys. These fuzzy lines are common because we have developed habits for how we work, we have to adapt to different environments, and frankly, it’s not always easy to purely practice as Service Provider A or B. Despite the difficulties with a black and white perspective, it’s important to step back and reflect on our practices. Are we truly using the practices that reflect the evidence-base for our field? Are the practices we use fully supporting the parent’s confidence and competence…or are we taking toys out to the home so that we feel secure and in control of the visit?
A Team Challenge
Another challenge to consider is this: What if you’re like Service Provider B but your other team members are more like Provider A? This can be extremely hard because one family can be receiving intervention from providers who use practices that look very different. And let’s be honest – a parent could very well prefer the toy bag version because her child enjoys it and she can step away to take a break while Provider A entertains her child. While this may be fun for the child and a relief for the parent, our evidence-base no longer supports this type of intervention as the best way to build the parent’s capacity to promote the child’s development. When some providers bring materials to the home and others don’t, or when some providers provide child-centered intervention as opposed to family-centered, routines-based intervention, the messages can be confusing for families. We are all on the same team, and when we provide services that follow a similar, evidence-based approach, everyone benefits.
When it’s all said and done, we all have a responsibility to provide intervention that’s grounded in our field’s best, evidence-based practices, and our literature supports routines-based intervention that focuses on supporting parent-child interaction. We get the best “bang for our buck” when we work with children and their caregivers in ways that prepare them for how to use intervention strategies throughout the week, when we aren’t there. Spending our time primarily playing with the child only helps the parent so much, and focusing only on toy play may help even less because toy play itself is probably a relatively small part of most families daily lives.
Strategies for Making It Easier
So what do you do? How do you evolve your practices from those of Service Provider A to B? Here are a few tips to consider:
Reflect on the toy bag as your security blanket – We are in control of a visit with a toy bag; we have to relinquish some control without it. But, when we do that, we are free. We are open to following the family’s lead and using our skills in more flexible, individualized ways. We also see that the family owns intervention and the child’s progress, and that’s what it’s all about.
Wean yourself one toy at a time – Maybe you can’t go cold turkey, and maybe you shouldn’t. Take one less toy to each visit to help wean yourself and the family from this approach. Replace the focus on toy play with a more broad focus to include and explore other routines as well.
Prepare families for bagless therapy – Either start this new approach with new families, or explain to current families that you want to support them in routines other than toy play. Spend a visit or two finding out what else they do with their child…then plan to join that.
Talk with the family at the first visit about why you don’t bring toys – This is especially important if you don’t but your colleagues still do. Help the family understand why you work this way because otherwise, they won’t know.
Talk to your leadership – If you struggle with working on teams with both types of Service Providers, talk to your supervisor. Maybe additional training could be offered to the entire team. Maybe you could shadow your colleagues and they could shadow you on visits, then you could share feedback about similarities and differences in your approaches. Stir up some communication about this topic, because it’s often an elephant in the room.
Whichever type of Provider you identified more with, I hope you’ll take the time to reflect on your practices. You’re probably doing great work, but we can always do just a little bit better. Remember to keep the focus on what the parent can do with the child when you are not in the home. When you do, it’s so much easier to leave the toys at the office and work as a true team.
Which provider did you identify with?
How do you manage the challenges of working on teams with a mix of these types of provider practices?
Share you thoughts in the comments below.
I love reading your blog (when I have time). You bring up critical topics that I encounter when working with my families. This is one that has recently arisen. I work with families who have children identified with hearing loss. As AVT therapy becomes more common (is this only in my area?), I find that parents expect their services to be child focused. They have an expectation that I will be entering the home to provide one-to-one support for speech/language development with their child. I can feel that they do not feel appropriately “serviced”. I have had this discussion several times with parents, and some are really at odds about it. Honestly, sometimes, I do end up becoming the baby-sitter while mom takes a break. I am NOT a confrontational person. How do I get the parent back involved in the home-visit (NOT therapy session)?
So glad you love it, Michelle! I think I’d recommend taking a look at how you establish the relationship and expectations with the family from your very first contacts with them. It’s so much easier to have a really engaged parent when she knows what her role is supposed to be from the start. If you can help the parent understand that your role during the session is to facilitate her learning and her experience using intervention strategies with her child so she is prepared to use them between visits, this can lay the groundwork. Parents often don’t know this – instead they think they need to get out of our way so that we, as the expert, can work with the child. Make sure that everything you do is done for the purpose of supporting the parent, rather than only focused on teaching the child to hear/talk. Weaving coaching strategies into your AVT therapy may help too. You don’t have to be confrontational at all to keep a routines-based, family-centered approach. It’s hard when the parent doesn’t engage like you want, but keep in mind that she probably doesn’t know what she’s supposed to do. You can teach her that. I’m so glad you asked this question. Please keep me posted on how things go for you!
Like you, I work with families who have infants and toddlers with hearing loss diagnosis’. I am finding that many of the speech therapists working with my same families are bringing in bags and making it hard for me to convince the families that routines-based intervention is better than child-centered. I go through what coaching looks like my first and second sessions and they are fine with it, but then if there is another team member servicing the child who brings in toys or does “special lessons” every week, it makes it very difficult to explain why I don’t do those things.
When you do have to explain, try telling the family that the practices you are using are evidence-based (and explain that that means that the research and practice in our field supports these practices as the most effective). Tell them that we now know that using coaching during routines is a better way to make a bigger difference in the child’s development and is more effective than a provider doing special lessons with a child using toys brought to the home. It’s tricky because you don’t want to say anything negative about another’s practices, but you can justify what you do because it is evidence-based and that’s what families deserve. You may have to adjust the language you use to help a family understand, but helping them see how your role is to support them as they interact with their child during and between visits is super important. A provider doing lessons with the child with toys that will be removed from the home does not necessarily do that.
Dana, you continue to press on relevant issues in early intervention such as toy bags! Our agency went bagless 2 years ago…cold turkey. Later, I learned some of the home visitors “snuck” in a couple toys and others left the toy bag in the car, “just in case”. Old habits are difficult to break. The real problem was that we did not have fully-developed home visiting and coaching strategies to replace the toy bag. That was awkward for the home visitors and the families they served! Your idea of easing off slowly to make a smooth transition is wise. That, coupled with strong professional development on effective replacement home visiting strategies (i.e. coaching interaction style), is what we have found to be the ticket to success.
I couldn’t agree more, David. I think that’s a big part of the struggle – knowing what to do instead of taking toys. It’s scary to relinquish the control of taking your own materials and having to think on your feet in unpredictable situations. Strong professional development is so important, especially when it’s of an ongoing nature that helps practitioners continue to reflect on and build their practices. I’d love to know more about what kind of PD you offered your staff so please let me know!
Three things, Dana: First, Dr Robin McWilliam provided our state with a full-day institute on Support-Based Home Visiting. That helped us exchange the toy bag for a tool bag…cognitive tools to use during home visits. He gave us strategies to rehearse so we could be more convincing with families who see early intervention as a paid professional who will only work with the child (like the example Michelle shared in this string). Second, the following year we brought Dr’s Shelden and Rush to our state for intensive training on Coaching Interaction Style, and they followed up again the next year. This helped immensely, because they use implementation science in making sure skills are embedded into everyday practice. Finally, once a month or so we use your blogs for discussions with staff around the table. This brings rich conversation and synergy with idea-sharing. The challenge of family expectations (you are here to ‘fix’ my child while I take a break) is real and constant. We have found support among fellow early interventionists who actually coach one another in problem-solving….using the same Coaching Interaction Style we use with families. As with families, it helps build our confidence, competence, and capacity.
Thanks, David. I’m always impressed with your commitment to supporting your staff!
This is a great discussion that should be happening more often among professionals. I also like the comments that David left regarding how his agency provided inservice training to support their staff. The skill needed to be provider B is truly a skill that needs to be practiced repeatedly to be more proficient. We need more workshops on support based home visiting and coaching!
I’m glad you found this useful, Linda! Have you seen the new online module, Coaching Families, that was developed by the Texas Early Childhood Intervention system? It is fantastic. It covers the characteristics of coaching and illustrates then with videos. I’d encourage you to check it out!