Let’s get right to the point. You are not trying to engage an infant or toddler on video for 45-60 minutes during your virtual visit. Re-read that last sentence and let it sink in. Take a deep breath in and breathe out any expectation you may have had about playing with the baby you see on video. When we step back and let our anxiety about tele-intervention settle, it’s easier to realize that there is very little chance of a 2-year old interacting with you on video for more than a moment or two – and that’s okay. You can still do early intervention without that interaction when you focus on engaging the parent (or other caregiver) who will then engage the child. If you think about coaching and the Mission of EI, that’s where your focus should be anyway. You’ve probably already been doing this and if not, you can do it now.
Okay, you might be asking yourself: If I’m not interacting with the child, what do I do instead?
Let’s answer that question.
What Do You Do?
Now, more than ever, early interventionists are using their coaching skills to engage parents during virtual visits conducted using video conferencing technologies. Interventionists have been thrust into the world of tele-intervention (you might know it as telepractice or telehealth) with often little preparation or experience. The whole world has shifted and it feels like EI practice has shifted along with it (and they have).
Here’s what hasn’t changed, though: You are still a coach to the parent/caregiver. Your primary mission is to support caregivers so they learn ways to interact with their children during everyday routines and activities to encourage development. Whether you are sitting in their home or yours, you are still a coach. You did not coach the child before tele-intervention; you coached the parent. You probably did spend time playing with and engaging the child, practicing stretches, prompting for sounds, and challenging the child’s problem-solving or social skills. You probably modeled the use of strategies in these activities for the parent. Now, you have to figure out how to let go of your need to directly interact with the child and embrace the golden opportunity you have to support the parent’s learning.
Here are 10 strategies for focusing on parent/caregiver learning during tele-intervention. You can do this!
10 Strategies for Engaging Parents during Tele-Intervention
Before the Visit:
1. Prepare with the parent – Touch base by phone before the virtual visit to discuss technology needs and answer questions. Plan for how to connect, what device the parent will use, and how it will be positioned so the parent can see you and you can observe the parent-child interaction. Plan for how the parent will access the link you will send to the virtual meeting platform. Consider different types of devices and how access might look different (a quick google search for instructions can be helpful if needed).
2. Prepare yourself – Before the virtual visit, collect your thoughts. Remember that you don’t need toys because you are not trying to engage the child. You may need a prop, such as a doll or teddy bear to model movements for the parent, but you can put your bubbles away.
3. Preparing for what to do – Chat with the parent about ideas for what to do during the visit. Be prepared to follow the parent’s lead and let her know she can take you with her in whatever she and her child do during the visit. You can also plan for activities, like if you are going to work together on the child’s feeding or encourage play skills with siblings who are also home. Just like any visit, though, preparing can go right out the window if another opportunity arises or the family needs the visit to go in a different direction. Prepare when you can, but go with the flow when you need to.
During the Visit:
4. Take time to check in – Just like any other visit, touch base on how the family is doing and check in on child progress. This check in time may take longer now and that’s okay. Remember that everyone is adjusting to the new normal so approach this relationship-building time with ease.
5. Use your voice to join in (instead of your body) – Join the activity you planned or search for opportunities based on what you see. Observe that feeding session, watch the siblings play, and use your coaching skills to share your observations, ask reflective questions, and provide verbal guidance on how to use intervention strategies. You have to use your voice to join in so be gentle with your suggestions and always ask the caregiver what she thinks, how it feels, etc.
6. Be descriptive and specific – When you provide guidance, share observations, or give feedback, be specific and describe what you see and what you suggest. Following verbal directions might be harder to process for the parent who is used to watching you, so take it slow and check in frequently.
7. Be flexible – If the visit is a little shorten than usual, that’s okay. Be sure to document why. If what you planned with the parent falls flat, try something else. If you end up discussing development more than observing it, especially on your first visit, that’s okay. Use the “show me…” prompt to move from discussion to observation and support; it’s a great tool on an in-person visit and it’s your best tool now.
8. Keep your focus on the parent, who facilitates learning for the child – This is key. This is also best practice in EI whether you are face-to-face or on video. What you can help the parent practice during the visit with the child is more likely to continue between visits. Use your coaching skills to keep the focus on parent learning, which extends learning to the child.
9. Write down the joint plan – Plan with the parent as you always do, but create a written version of the joint plan at the end or after the visit. Email or text the plan to the parent as a reminder and follow-up on that plan at the start of your next visit.
During and Between Visits:
This last strategy might be the most valuable right now:
10. Cultivate patience for the parent and yourself – Providing intervention this way might feel wobbly nowand that’s okay. Both you and the parent are in the midst of significant change, and not just for the EI visit. Being patient with the family will help them feel comfortable with this new way of interacting with you. Being patient with yourself means giving yourself permission to feel nervous and stumble, laugh about it, learn, pat yourself on the back, and try again next week.
Consider this: Your relationship to early intervention and with the parent has changed because of the pandemic and tele-intervention, but maybe that change is for the better. This way of supporting parents (and children) might make you a better coach. Give it time, approach intervention with openness, and take a deep breath. We will all be okay.
What strategies are you using before or using your tele-intervention visits to engage parents?
What’s working well? What’s challenging you?
Share your tips and experiences in the chat below and let’s support each other. 🙂
For information, videos, webinars, and online training related to tele-intervention, visit these sites:
COVID-19 and EI Tele-Intervention Updates – VA EI Professional Development Center
Coronavirus Disease (COVID-19) – ECTA Center
For technology tips and links to video reflections about tele-intervention, check out these posts:
7 Technology Tips for Tele-Intervention
I like the idea of writing down a joint plan after the visit and send it to the families as a reminder. My biggest take away from this blog is giving myself permission to feel nervous and stumble on top of everything else that has changed
Yes, I’m so glad you have that take away, Deb! How are your visits going so far? Let me know how the written joint plan works for you. Thanks for joining the conversation! 🙂
Here’s a great comment I received by email from Betsy Donoghue MSW, Developmental Therapist/Service Coordinator from the Rural Infant Services Program (sharing with her permission):
Thanks, Dana, for a timely blog to help us through this transition!
It took me some time to get comfortable with the technology and to coach the families through the technology. I am pleasantly surprised at how well it is all going and we are all adapting to a world where everything seems different.
I am interested to see that some children are quite used to doing FaceTime with their grandparents and will interact well with me through the screen!
In other cases, I find that it is counterproductive to have the child looking at the screen, because they want to hold the phone and play a game on it. Instead, I ask the parents to give them a toy to play with nearby and then I can hear the child in a more natural conversation and can coach the parent.
We have been doing successful assessments this way, with the parent prepared by having blocks, paper and crayons, shape sorters, etc., nearby. Sometimes we have been asking parents to send us a little video clip of their child before the assessment or session. We can then see the child in a more relaxed situation and less “on-the-spot” which is helpful! Parents are taking videos of their kids anyway!
It’s going much more smoothly this week. If you had talked to me two weeks ago, I was pulling my hair out!
As always, Dana, your calm, logical, informative approach sets the bar! Thanks for a great blog and great links to resources.
Thanks Cori! 🙂
“If I’m not interacting with the child, what do I do instead?” I am so glad that you started this conversation as it has come up often in recent conversations with providers and even families. For those of us that have been around awhile, we had a similar unsteadiness at the thought of ditching our toy bags. “What will we play with?” “How will we get them to engage without my super cool farm animals?” Well, we did it and we will do this too.
First, I agree that it’s super important to give ourselves a break and laugh with the family about wonky technology glitches, admit that this is new and different, you’re in this together, and maybe be ok with an awkward pause or two. The parents are going to buy in to telehealth based on how we present it to them. We need to place value on our services and in our ability to coach and support the family through the screen. We need to meet them right where they are that day. We need to be flexible. Last week I was doing a feeding session with a 10 month old. The mom had the perfect set up with a variety of foods ready and the laptop at just the right angle for me. After a few minutes the mom said that she was eating so much differently because she was so distracted by me. Lightbulb…I said let’s just turn the screen around. I need to see her but she certainly doesn’t need to see me and it might work much better. Mom was asked if that would still be a visit but quickly realized that me coaching her without her daughter hearing AND seeing me was so much better. Also, this way MOM could see me when I was modeling food placement and mouth movements and when mom was modeling biting she able to just focus on mom not both of us.
I would also really encourage everyone to not have a plan. Yes, have a plan such as items to discuss from the previous sessions (Joint Plan) and that you planned to do lunch with them or meet during the time that the family reads books but not a PLAN for how the session will go and all that you will do. Just like when we went into the home we didn’t have a plan of what it was going to look like. This is no different. If it does feel and look different for you then your coaching muscles are going to get stretched a bit and that is a good thing! Embrace this opportunity to grow! You are in early intervention because you love kids and want to make a difference. You are creative and playful and engaging. Just be YOU, but you with a screen 😉
Wow, I just LOVE this, Dana! Yes, coaching muscles will be stretched and yes, just be YOU! Thanks so much for sharing your lighbulb moment. What a great example of being flexible in the moment and keeping your focus on what benefits the family the most. You also make a powerful point about how families will understand and adapt to telehealth depending on how it is presented. I’m hearing so many positive comments about how collaborations with families are going – things like the family was so flexible and understanding, they were so glad to still receive the support, and even that some families seem to like this kind of support even better than what they were getting before. 🙂
Thank Dana for your “10 strategies for engaging parents…” and for the valuable insight from Dana Carroll. It is a different world that we now explore. I said to someone a few weeks ago that my goal during tele visits is to improve my observation skills and my coaching skills. I do feel that we are engaging even more with the parent and in many ways the parent is more empowered in the situation. It’s a more cautious road as I receive new referrals and don’t have a history with the family, and no hands-on information about why the infant is posturing in a certain way. Taking it slow, stepping back and providing simple guidance is key!
Wow, what a great point, Laura. I can imagine that not having that background info could make it more challenging when you jump into tele-intervention with new families but you have a great perspective. I really appreciate your commitment to growing your own skills; looking for the natural learning opportunities for yourself here really is the way to go. Yes, take it slow, be patient with yourself and the family, and whenever you can, ask the family to “take you along” as they do what they do. You’ve got this! 🙂
If you give a man a fish , he eats for a day. If you teach a man to fish, he eats for a lifetime. Now more than ever .
Yes, so true! Thanks for adding to the conversation, Ruth!
This was a very timely article! As we all move forward into what is supposed to be our new normal for at least the time being, it is interesting to reflect on the changes in our sessions. If nothing else, telepractice and “engaging the parents” makes for a much better coaching opportunity! It limits what WE can do and empowers the family to tackle more. I had an experience yesterday where a new family (second visit) was in distress because she felt like she couldn’t get her 3 month old to enjoy/tolerate tummy time and she didn’t know how to help her learn to move. By using my voice and my doll, Mom had such a successful appointment and was elated with HER results! She was beaming from ear to ear by the end of the session as she had learned to help her daughter roll from tummy to back and back to tummy consecutively and lo and behold- she stayed on her tummy for 3-4 minutes cooing and talking!! As much as I would have loved to be there in person to assist her, I realized that I didn’t have to “be’ there, I was effective anyway.
Oh wow, Bonnie, what a fantastic example of success! I love what you said about telepractice making for better coaching. You have to “up the ante” for coaching now and it sounds like you are rising to the occasion! Thanks for sharing an example of working with a new family too. I was hosting a webinar yesterday and someone expressed worries about using telepractice with new families with whom she hadn’t yet gotten to know well. Your example is reassuring. Do you have any suggestions for people who share those worries? What’s working for you with supporting new families at a distance?
What a wonderful article! Cultivating patience is so important and something to be mindful of these days. I am an SLP for Fairfax and have began telepractice with new families that I have never met in person! It is amazing how resilient families are and everyone is just trying their best to care for their loved ones at this time. I think that this model of therapy emphasizes the key concepts of coaching and has empowered families to see that they are making a world of difference for their little ones, without a therapist ever needing to step foot in their homes. Great strategies, thank you!
You’re welcome, Abby! What a powerful statement you just made about how tele-intervention is empowering families to see that THEY can make the difference. Do you have any strategies you’ve found helpful for getting to know families now when you haven’t met them in person?
This is a very informative article! For someone who isn’t technologically savvy, I found that this information will be helpful for me to hold on to as teleworking and telepractice is becoming our new normal. With the COVID-19 Pandemic on the rise, there are changes daily and I strongly believe this is going to impact the way we do therapy virtually and in person.
In the beginning, this was a bit of a challenge for me and for some of the parents I work with. It was actually, a little overwhelming. But after gathering my thoughts, and getting creative on how to do these practices virtually, the parents and I began brainstorming ideas on what was ideal for them. This allowed me to coach them in a way that was understanding to them, and with patience and collaboration the teletherapies have been a huge success.
That’s wonderful to hear, Olga! I really appreciate you sharing your own feelings. I’m sure you are among friends in the EI world who also felt and may still feel overwhelmed as they adjust to the new normal. Your statement about gathering your thoughts and thinking creatively is great advice for anyone tackling tele-intervention right now.
This article was so helpful and contained valuable information that can be used to engage parents during telepractice services, as well as in-person visits! I am a speech-language pathologist with ITC in Fairfax-Falls Church. I think that having the basis of coaching already established has been extremely helpful in supporting families using telepractice.
I loved the point in this article about joining the visit with your voice (not your body), with everything being virtual. This platform has given me opportunities to explain strategies and the rationale behind them in new ways to parents. More surprisingly, participating in this capacity has also allowed me to observe and appreciate silences more during therapy visits. I had a first visit with a family last week, who was initially hesitant to participate in telepractice. During the visit, I was placed on the counter, to limit distraction from the technology. I was able to observe the child eat and play with play-dough with mom and his brother. Since I was not participating in person, mom seemed more empowered to participate in the activities with the child and practice new strategies. His observed attention to the activity, exploration with the different texture, and motor imitation, were due to mom offering him this activity and participating with him! Therefore, I am continuing to wait longer, before jumping in to offer additional strategies, which is sometimes even more tempting using this platform.
Thanks so much for jumping into the conversation, Ashley! You’ve added another great strategy here: Waiting a bit longer while observing to see what happends before jumping in with a suggestion. I’m hearing from other interventionists that they are noticing what a golden opportunity tele-intervention is for observing rich parent-child interactions that they might not have seen before. Plus, since the interventionists is not physically present in the same way, the interactions are better facilitated by the parent who might have sat back and let the interventionist do the heavy lifting before tele-intervention. It sounds like your coaching skills are serving you well!
Great article. I really like the way you broke the 10 strategies into before, during and after the visit. I have been using “practice” sessions to make sure that the technology works but also because I work with a diverse population and have several families that were very wary of this technology. They either did not think it would work or that they would not be able to handle it.
One of the families is a mom of twins who did not think it would work since her twins are obsessed with her phone anytime it is on video (although they will leave her alone when she is talking on the phone) and she was positive we would get nothing accomplished to the point she notified the service coordinator she thinking of refusing services. I convinced mom to give it a try and to talk on the phone while having the camera turned outward away from her. We had a wonderful session and I was able to see the boys the entire time. Mom felt so much more comfortable after that and we are now doing sessions with me getting to see her and the boys. I also love the “show me” transition I definitely need to use that more.
Thanks for sharing your experience, Michele! This is a great example for anyone who is collaborating with a parent who is hesitant to try tele-intervention. You’ve added a wonderful strategy here – encourage the parent to give it a try at least once, with plenty of support from you, then touch base about how the visit went. Keep me posted on how using the “show me” prompt works for you. 🙂
This was a great post. The idea of cultivating patience really hit home for me. I have learned to be more patient with the process as the families and I figure out this “new normal” together. Diving headfirst into telepractice has given me opportunities to fine tune my coaching skills in ways that I didn’t expect. I love that during my session I can have notes and reminders around me that I can refer to as I interact with families. I have been keeping some coaching prompts/questions near by so I can push myself to practice some new ways of engaging families in our sessions.
Thanks again for sharing these ideas!
You’re welcome, Kerry! I’m glad you are being patient with yourself and the process. What kind of coaching prompts/questions are you using? If you don’t mind sharing, they might be useful to others. 🙂
Hi Kerry, Thanks for sharing more about your experience. I could relate to what you shared! Cultivating patience for the parent and yourself resonated with me too. For example, prior to a telepractice, I taped on my wall all sorts of questions, some typed in font and colors I liked. Some examples included, “how did you feel that worked?”, “What did you notice?”, “Tell me more about that”, “what do you notice about his attention when he _______?”, “How did that feel?”, “What do you think about that?”. The first family I called, after this preparation, after the Joint Plan was reviewed, when I asked what they would like support to focus on today, said “I don’t know, can we just watch him play together for a little bit and then I can decide?”. Getting all geared-up for the session this beautiful statement that left me feeling humbled. I am not sure if it was the honesty, reflective nature, or what, but there we were, the father with his phone, me watching the child in silence. There was a moment when I really saw the value of deeply appreciating this child and family meeting them where they were. There were opportunities for me to have prompted the father with questions, but deferring, waiting together felt like we really were in-fact working together to understand this beautiful child and that neither one alone had all the answers. It was a big step for me because I also felt like I was leaving more space for him to lead and step into by saying “sure, that sounds great”. I also felt like it allowed me to trust him, that he will know what feels right, which he did. It reminded me about the reciprocal learning inherent in coaching. I noticed things in the child and his environment I had not before. Taking this quiet moment together for ten minutes was powerful for me and emphasized the value of patience, flexibility, giving a chance for what is most meaningful a given moment to float to the surface.
Thank you so much for writing this Dana and for all of the very practical, helpful and important strategies you shared. As a mental health clinician, during this pandemic, I have seen a rise in anxiety and other symptoms which can impact the parents’ ability to be present with and engage their child. Many of the strategies you wrote about provide opportunities to give concrete support for parents which can be grounding for them when much feels uncertain. As providers have adapted to this new way of working and interacting with families; flexibility, patience and reflection are key components of continuing to build impactful therapeutic relationships. Thank you again for your words of wisdom!
I loved this blog post. While I’ve been attempting to do visits for the past month now (I struggle in between feeling like it’s been that long already, and it’s ONLY been that long?!), I am learning new things. I am having to cultivate a lot of patience. I have also been asking parents to have some patience with me as well as I learn with them how we can make this work for the family. I did have one family who initially did not want to try this out when the SC reached out, but when I reached out, she gave it a try. That first session helped both mom and I realize how much I was doing the modeling, and now mom really is involved. When we reflected at the end, mom shared something that I’ve been trying to help her understand for awhile now. The more SHE interacts with her child directly, the more language he is using with mom, which is our goal! It was a good wake up call for both of us.
I just had an a first telepractice visit with another family, and they asked exactly what toys to bring, set up etc. I asked to have the first visit to be more of a conversation of expectations between the two of us. We both acknowledge that we have no idea how successful it will be, but through the conversation I was able to help mom understand that I am going to be more the voice on her shoulder rather than trying to directly interact with the child. She still felt unsure, so I shared I would have some similar toys on my end to directly model a strategy to MOM if needed, and this seemed to help her feel better Otherwise, I’m resisting the urge to make my kitchen table office become my new toy box….
Moving to telepractice has allowed me to practice my observation and coaching skills. It has also allowed me to pause before I ask a question or provide feedback, to ensure that what I am going to say is as clear as possible. Don’t get me wrong, there have also been times where I have had to stop, rewind, and rephrase what it is I am trying to communicate. This leads right into what you talked about with being patient with yourself, and the family. This is unlike anything we have experienced before, so of course there are going to be some bumps along the way. By being patient, we are allowing ourselves and our families that flexibility I think we all need and appreciate currently.
I also really enjoy your point of writing down the joint plan and following up with the parent via text or email. I find myself writing down important points of the session for both notes and to look back on before the next session. It can be especially helpful when I have had sessions that have needed to end a little early due to an upset child or a sibling that needs attention, and the parent may have been somewhat distracted while coming up with the joint plan. It can also be helpful if only one caregiver was present during the session as well. It can help to ensure all caregivers are on the same page in terms of the joint plan. This can be applied to in-person sessions, once those resume.
So well said, Katie! You give some great reasons for why writing down the joint plan can be helpful. Thank you!
Thanks for a wonderful read, Dana!
I admit I was excited about using telepractice to enhance my coaching skills and encourage families to use the same applied improvisation I usually bring to their homes, and it’s been a good experience so far! I’m glad to see how many of my families are embracing this method of intervention. They are more willing to move from room to room so I can see more of the action and I feel less like I’m “stalking” them in their home, they are being creative about other ways to try strategies, and are, I think, surprising themselves with their capacity to teach their children new skills.
I find myself appreciating #7 for another reason. Not only am I being flexible with what happens in the session, I’m finding its been a positive experience being able to be more flexible scheduling sessions at times of the day that we had difficulty arranging before due to conflicts on my calendar or the challenge of fighting northern VA traffic. I’m seeing that this also contributes to families being more adventurous in asking me to support them in a variety of activities.
Good for you, Carolyn! I love what you said about how families are surprising themselves. You really give people hope that tele-intervention is a positive thing! And yay for not having to fight traffic!
[…] Specific ideas for working with families through telehealth […]
In this type of strategy, having a way to communicate is key. My experience as a Special Education Teacher in a school setting, it makes me think and compare the strategies of being able to work more closely with the parent when trying to get students to demonstrate growth or improvement.
In observing the videos when focusing on the parent, a sense of support was shown when communication between the “small team” was engaged. I never really stop to think of the preparation and what all goes into having someone come into home to support a Special Needs child. I would like to eventually make Early Childhood Special Education a near future choice as I learn more about strategies and techniques. I have been an Educator for approximately 20 years and have worked in k – 12. Learning what it takes for Early Childhood and Pre School Special Needs children, may help me to really recognize a true beginning to the end of a Special Needs child.
Yes, early intervention and early childhood special education offer such a great opportunity to start working with children and families at the very beginning. What we all do at the beginning certainly impacts the rest of the child’s and family’s journey – especially when we focus on the family communicate well with the parent, as you mentioned. Best of luck with your journey into ECSE!
[…] Specific ideas for working with families through telehealth […]