On a given day, you might have anywhere from 2-6 visits with families. If you step back and reflect, how do these visits typically work? There may be a similar way you begin or end your visits. You may find yourself conducting visits in the same parts of the home across visits or asking similar questions of families. Would you say that there is a “culture” to how you practice EI?
The article below challenged me to look at EI from a cultural point of view. We talk all the time about how individualized EI must be in order to be most effective, but the reality is that the way in which home visits are conducted is often similar across providers. Having a similar framework for visits doesn’t preclude individualizing; it seems to me that this could be fine line, though. Visits could be conducted in such a similar, even predictable manner that the ability to individualize to child interests, family routines, or changing priorities becomes challenging. Or, having a similar, cultural framework across visits could provide the stability needed to allow the provider to individualize. Read on and see what you think.
Research: What Do We Know?
Brorson (2007) conducted a qualitative study of one EI program to examine how services were delivered. Four families and seven service providers participated in the study. Families and providers participated in multiple videotaped observations of visits and multiple interviews. A review of program documents was also conducted. Results revealed information about the structure of a typical home visit, values and beliefs of providers, and program philosophy.
Typical Home Visit – Brorson noted that the typical home visit included eight parts: 1) planning, 2) greeting, 3) activities, 4) observation, 5) demonstration, 6) shared knowledge, 7) follow-up, and 8) scheduling.
Beliefs of Providers – Providers espoused a belief in collaborative, family-centered interactions with parents, but this was not seen in observations of visits, interviews, or in the reviewed documents. Instead, providers were observed to educate rather than reciprocally collaborate with parents.
Program Philosophy – Brorson described five assumptions that appeared to guide staff in the delivery of services. These assumptions were:
- Structured activities provide the frame for the visit and the means through which the family learns what to expect.
- The culture of a home visit is stable across families, providers, treatment techniques, etc. This stability is established by how the provider conducts visits, which tends to be similar across families though does allow for individualizing.
- Delivery of EI services “is in a constant state of change requiring therapists to become perpetual learners.” (p. 64)
- Providers play a leadership role during visits in educating families about the culture of visits.
- Providers have their own individual definitions of family-centeredness (rather than a shared understanding and implementation).
Because this study only focused on a single program and a small sample of families and providers, generalization is not really possible. However, insights learned from this study can be used by providers and program administrators to reflect on the culture of how EI is provided in their programs.
Practice: How Can You Use What You Know?
Yes, this article is older now, but I think that the insights learned in this small study are fascinating. Let’s think about these insights and how they might apply today:
Typical Home Visit – These 8 parts of a visit look very familiar to me, especially when I think of a more traditional model. When I compare these parts to more recent thinking related to caregiver coaching and collaboration, a few important pieces appear to be missing – the opportunity for the caregiver to be in the lead and practice using strategies with the child, reciprocal reflection and feedback, and joint planning for what happens between visits. Spending a few minutes reflecting on which of these parts and pieces of a visit typically happen on YOUR visit could help you identify your strengths and where you’d like to improve.
Beliefs of Providers – We all are pretty sure we understand family-centered practices, but do our understandings match with the literature? Do we practice what we preach? On your visits tomorrow, pay attention to how much you actually collaborate with the parent. Are you doing most of the talking and the work during the visit, or are you sharing the conversation and collaborating to support parent-child interaction?
Program Philosophy – If we accept that we play a leadership role with teaching families how to interact during visits, then that reminds us that families probably don’t start out knowing what they are supposed to do. Remember to take the time on your first few visits to help them learn how the process works. Educate them in the importance of their active participation and practice during and between visits. You may do this the same way across families, but does that mean that all visits should basically look the same? I don’t think so. Your methods may be similar, and your underlying philosophy maybe similar across families, but the activities of the visit should look different – if you are individualizing to child and family interests, environments, and priorities and joining family routines.
So here are the questions I’d like you to consider in the comments below:
Is it okay for your visits to basically work the same way across families? Why or why not?
If you espouse family-centered intervention beliefs, are you implementing them?
How would you describe the culture of visits in your program? In your individual practice? Does it match with Brorson’s findings? If not, how is it different?
Disclaimer – I’m a big believer in calling visits “intervention visits” rather than “home visits.” This reflects the evolution of practices in our field from focusing on the home as the location for EI to focusing on intervention, which can happen anywhere. I used “home visit” in this post to match the language used in the Brorson (2007) article, but in my happy little world, we’re moving away from that phrase to something more reflective of recommended practices. 🙂