Maybe you’ve felt this before…you are on a visit and it’s the parent’s turn to practice using an intervention strategy. Perhaps you just modeled it, or you and the parent came up with an idea and want to give it a try. When you ask the parent if she’d like to try it, she averts her gaze and answers “I guess so,” with an uncomfortable look on her face. Perhaps when the parent tries to engage her child, you sense her discomfort then too. In turn, you feel uncomfortable and wonder…what do I do?

Early intervention is all about building a parent’s capacity to facilitate her child’s development. In the best case scenario, the parent is eager to learn, confident with engaging her child, and interested in trying new things. In the worst case scenario, the parent doesn’t even want you in the home. In reality, most parents are somewhere in between, on a looooong continuum of parent-child engagement, comfort level, interest and readiness.

5 Strategies for Responding to Discomfort

As an early interventionist, you work hard to build rapport and trust and get to know the family in a way that lays the foundation for how you’ll work together. Again, that’s easier sometimes than others. A key aspect of getting to know families really involves being responsive – responsive to their needs, interests, priorities, and feelings. Responsivity is a critical skill to use in the situation described above.

Here are 5 responsive strategies to help you manage discomfort:

Acknowledge what you sense – Ask the parent how she feels as soon as you sense discomfort. Be specific: “I’m wondering if you’re feeling a little uncomfortable?” or “How do you feel about using that strategy?” You could be wrong about what you sense, but you won’t know until you ask. Let her know that how she feels is okay and that she can decide whether or not to proceed – give her the choice.

Ask her how that felt – After trying the strategy, check in again. Be specific: “How comfortable are you with that strategy? How did that feel? What did you think about that?” Be responsive to her answer and make it safe for her to be honest. Don’t insist on using a strategy just because you think it’s a good one. If a parent feels uncomfortable, she’s less likely to use that strategy when you aren’t there.

Ask if she would like to do something differently – Invite the parent’s input and problem-solve together. Maybe she has an idea of how to tweak the strategy or situation to make it easier or more comfortable. Flexibility is a hallmark of good early intervention.

Try to build on what she and her child already do – Before even introducing a new strategy, find out what they already do or have already tried. Observe the parent and child first doing what they naturally do. Model the strategy first, if that helps the parent. Brainstorm how the strategy might be used during the activity, then coach the parent in how to use it during a familiar interaction. Seize the opportunities as they happen and be sure to provide feedback when the parent uses the strategy successfully. Remember your role as a facilitator of the parent’s learning too.

Step back, reassess, and consider options – Sometimes you and the parent have to try a strategy to figure out it’s not the right one. Use the conversation to help you reassess whether or not the strategy is appropriate for the child, parent, and situation. If it is and the parent is okay, then proceed. If not, step back and reassess. There is always another route to the outcome so be open to it.

How Much Discomfort is Okay?

Now, this raises the question of how much discomfort is acceptable? To me, the answer lies in your conversations with families. EI can push parents out of their comfort zone as they learn to use new strategies with their children. It can be uncomfortable to try something new with an unpredictable toddler in front of someone who is perceived as having expertise. The trick here is to have the courage to acknowledge the discomfort and talk about it so you and the parent can figure out what to do next. Options might include tweaking the strategy, modeling it again for the parent, trying it again a few times, letting the parent try it between visits on her own, or simply ditching the strategy all together…and all of these options are okay. Being responsive to what the parent is feeling will help you know what to do next.

What do you do when a parent seems uncomfortable? 

Share your experiences and strategies in the comments below!

The post The Parent Seems Uncomfortable…What Do You Do? appeared first on Early Intervention Strategies for Success.

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.

The post But Everyone Else Still Brings Toys… appeared first on Early Intervention Strategies for Success.

Have you ever taken a yoga or dance class? If you haven’t, let me tell you about my experiences. In either class, I’ve always found myself in a big room in front of wall-sized mirrors facing an instructor. While soft music played, the teacher would call out the names of poses I was supposed to imitate. I’d try my hardest to get my body to cooperate, and found myself struggling with new poses that I’d never done before. I’d do my best to copy the instructor or even the person next to me (while praying I kept my balance). As far as I could tell, I was doing pretty well. It was only when the teacher came over and gently helped me hold my arm in the right position or reminded me to straighten my back that I really knew where I was in space and whether I was doing the pose correctly. With feedback on my performance, I was able to improve on what I was doing. Without feedback, I might have never figured out how to really do a grand plié because watching someone else only went so far. I needed to try the pose out myself, experience it, adapt it to what my muscles could do, and receive feedback from someone who knew about it. That feedback was an integral part of my learning. (Could I do a grand plié now without falling over…well, that’s another story… 🙂 )

Adult Learning Principle #5 – Feedback is How We Grow

Just like with ballet or yoga, adults who are learning something new need feedback on their learning and performance. Feedback is like a barometer we use to help us know whether or not we have understood something accurately or whether we are performing a new skill as intended. Without feedback, we only have our own perspective, which isn’t always accurate. While we may not always like the feedback we receive, we typically crave knowing if we are on the right track.

Feedback can come in different forms. It can be physical, as when a OT uses hand-over-hand guidance to help a father position a child for safe feeding. It is most often verbal, as when the SLP points out that the way the child care provider modeled the sign for “cow” beside the picture of the cow will really help the toddler understand what the sign means. Feedback might only come from the interventionist or from the caregiver, but is often more beneficial when it is a reciprocal, reflective process between both adults.

How Can We Use This Principle?

Ask for permission to provide feedback – As you talk with families about how EI works, encourage them to share their feedback and let them know that you will do the same. When you need to provide feedback, ask for permission first until you have developed a relationship where you can move into feedback easily.

Invite the parent’s feedback first – Ask the parent what she thinks about what she just did with her child – how it felt, what worked, what didn’t work, what she’d like to do next time – before you provide feedback. Inviting her to share first is probably more powerful because it facilitates her own reflection, which we know is so important for adult learning.

Be specific – Always use specific descriptors when sharing feedback. Rather than saying “you did a great job!,” specifically describe what went well and how you know it went well. If the parent’s use of an intervention strategy had a positive effect on the child, first ask the parent what she noticed about the child’s reaction. Then, you can share your observations as feedback; you might say something like “when you supported him at his hips, he was able to bear weight on his flat feet for longer this time.”

Be honest, positive and constructive – Feedback won’t always be an affirmation, but it can still be positive and helpful. Adult learners typically appreciate your honesty, and I think parents are really good at knowing when we aren’t being honest or when we’re uncomfortable. Be mindful of the verbal and body language you use and remember to convey your feedback in a way that supports the parent’s learning. Instead of “You didn’t support his head correctly” you could say “Did you notice how his head feel back? Let’s try again but this time, see if you can pick up him with your hand under his neck to keep his head up.”

Consider Two Examples

During Lacey’s visit, she coaches Michelle in how to help Tommy learn to roll over. She models how to hold a toy just out of Tommy’s reach while moving it around past his ear. She also shows Michelle how to place her hand on Tommy’s hip to guide him in rolling over. She suggests that Michelle watch what Tommy’s body does and how he shifts his weight during rolling. When it’s Michelle’s turn, Lacey notices that Michelle moves the toy very quickly and helps Tommy roll so much that he really doesn’t have to work at all.

Example #1: Lacey tells Michelle, “You really need to move the toy slower and let him help you with rolling. Let me show you again.” Lacey models again hoping Michelle will see how to do it this time. Michelle feels like Lacey thinks she isn’t listening or watching but she is.

Example #2: Before providing feedback, Lacey wants to see what Michelle thinks so she asks “How did you think that went?” Michelle responds that she thinks she did everything a little too fast because Tommy didn’t roll on his own at all. She wants to try again but isn’t sure how slow to go. Lacey said that she noticed the same thing. Michelle tries again and says that it’s too hard to move the toy and move Tommy’s hip at the same time. Lacey asks her which one she’s like to learn to do first. Since Michelle wants to learn to move Tommy’s hip, Lacey offers to move the toy. They work together, going slowly, until Michelle gets the hang of how to help Tommy move. Once she’s got it, she tries to move the toy too and gets excited when he rolls onto his belly for her.

When you use coaching, action/practice, reflection, and feedback are all often intertwined. When you share feedback, it’s often a means of sharing your expertise and facilitating reflection while wrapping it around the current practice activity. On your next visit, pay attention to how you share feedback and how the caregiver receives it. Also, reflect on how you receive the caregiver’s feedback – are you open to feedback about the strategies you suggest? Remember that feedback helps all of us grow so how you share it – and how you receive it – really matter!

As you can see in Example #2, Lacey welcomed Michelle’s feedback and made it safe for her to share her perspective. Lacey also responded to Michelle’s feedback by making it “okay” that she learn each step separately. Lacey didn’t have to share much direct feedback in this example because Michelle’s reflection did that for her.

Had Michelle not noticed that she was going too fast, what could Lacey do? How could she have shared feedback in a positive, constructive manner?

Don’t miss the rest of the posts in this series:

Adult Learning Principle #1: Making Intervention Immediately Relevant

Adult Learning Principle #2: Linking New Learning to Prior Knowledge

Adult Learning Principle #3: Active Practice and Participation are Key!

Adult Learning Principle #4: Practicing Intervention Strategies in Real-Time

The post Adult Learning Principle #5 – Feedback is How We Grow appeared first on Early Intervention Strategies for Success.

Your tire just went flat. You pull over to the side of the road, in the middle of nowhere, to try to accomplish something you’ve never done before. No, it’s not call AAA…you’re going to change the tire yourself. Thank goodness you have a good signal out here because you use your phone to look up a YouTube video on changing tires first. You also read through your owner’s manual for instructions. Once you’ve watched an example and read step-by-step instructions, you should be ready, right? Wrong. First, just getting the tire out of your trunk is an ordeal, then getting the jack hooked up is challenging. You fit the wrench to the lug nuts and go to turn them (which looked easy when the guy in the video did it) but yours seem to have been put on by Superman. They are so tight you have to stand on the wrench to get them loose. After about 45 min of trying, you finally get the tire changed, put the old tire in the trunk, and get back in the driver’s seat. You slowly pull away, thinking “I have no idea if I really did that right.” Whew!

So what’s the problem with this learning opportunity? You just struggled through a brand new experience, having never done it before. It was stressful, scary and SO different from how easy it looked on the video. Now, compare this experience with that of families in early intervention. They often have plenty of opportunities to watch someone who is very skilled intervene with their children and it looks so easy. They can read a handout which makes intervention sound easy too. Then, the service provider leaves the home and they have to use the same strategy they just watched, but now they have to do it without support. The parent has no previous experience with the strategy and isn’t sure how to adapt the strategy if it doesn’t work. Imagine how frustrating this could be, having watched someone do it successfully and then not being able to get it to work. What could make the difference here, between a frustrated parent and one that feels confident with using a strategy between visits?

Adult Learning Principles #3: Adults learn best through actively participating and practicing what they are learning.

Adults learn best through experience, through feeling and doing a new task with support and feedback from others. We need to try it out, problem-solve in the moment if something goes south, and reflect on our practice. Practicing a new task engages multiple senses, which stimulates multiple neural pathways that support memory. It is through active practice and participation that we really learn HOW to do something, and helping caregivers learn HOW to use intervention strategies is what EI is all about.

In a fascinating meta-analysis of four adult learning methods, Trivette, Dunst, Hamby, & O’Herin (2009) (PDF, New Window) found that active participation was a key feature of adult learning that contributed to positive outcomes for the learner. Getting the caregiver actively involved in all aspects of the EI visit is more likely to result in confidence with using intervention strategies between visits. Let’s think about how we can do this!

How Can We Use This Principle?

Think of the intervention visit as a practice session for the caregiver – This is a big shift in thinking for many of us. Keep your eye on the prize – EI should build the capacity of the caregiver to interact with the child in ways that enhance development during and between visits so practice during visits will prepare families for real life between visits!

Explain to the parent why his/her participation during the visit is key – You set the tone for how visits work so you can help families understand the importance of their active participation. Talk about how EI visits work, what the expectations are and who will do what from the very first contacts with families. They often don’t know what to do during visits so you can support their participation and help them understand how the visit works.

Always follow modeling with practice – If you demonstrate a strategy, talk to the parent about what you’re doing and why, then turn the activity over to the parent so he/she can take the lead. Build practice time into each visit.

Have and show confidence in the parent’s abilities – After all, he/she is going to be there with the child for many many more hours than you are. The parent can do intervention well with the child; he/she might need to do it differently from how you do it and that’s okay. Your one-hour-a-week doesn’t change a child’s development…the parent’s interactions with the child do that.

Consider Two Examples:

Think about these two examples and the different experiences for the family.

Example #1: Jenna is worried about how her son, Trent, is drinking from a bottle. He takes 45 min each feeding and often falls asleep. When he feeds, she notices a steady stream of formula dribbling out of the corner of his mouth. When she asks the OT, Elaine, about this, Elaine asks if she can feed Trent. While she feeds Trent, Elaine talks with Jenna about how to hold the bottle, how to hold Trent’s cheeks to help him suck, and how to position him to make feeding easier. Trent takes the bottle in about 25 min with much less spillage. While Jenna is happy that Trent can do it, she feels really bad that she can’t feed her son like Elaine can. When Elaine leaves, a few hours later Trent gets hungry and when Jenna tries to do what she watched Elaine do, it just doesn’t work and she starts to cry.

Example #2:  When Elaine hears about Jenna’s struggle, Elaine asks if she can watch Jenna feed Trent. After watching for a few minutes, Elaine and Jenna talk about how to help Trent feed more successfully. Elaine coaches Jenna in how to position Trent, how to hold his cheeks while she feeds him the bottle, and how to angle the bottle to help him suck most efficiently. Elaine even puts her hands over Jenna’s sometimes to help Jenna feel the proper positioning. After receiving Elaine’s support, Jenna practices feeding Trent the rest of his bottle while Elaine watches. Elaine gives Jenna a few more pointers, then they talk about how feeding went when Trent is done. Jenna feels nervous about trying these techniques when Elaine leaves but she feels like she can do it since she’s had some practice.

As you’ve read, example #2 offered Jenna the opportunity to practice feeding her son while using strategies and getting immediate feedback and support from Elaine. One of the best results of example #2 and the biggest differences between examples is Jenna’s feelings of confidence. We want families to feel prepared and confident with learning and using strategies when we aren’t there – and practice during the visit is likely to be a key to making this happen!

What strategies do you use now to encourage families to be active participants during visits?

What do you do when families are reluctant to practice using strategies while you’re there?

Share your tips for implementing this adult learning principle in the comments below!

Be sure to check out the other posts about adult learning principles:

Adult Learning Principle #1: Making Intervention Immediately Relevant

Adult Learning Principle #2: Linking New Learning to Prior Knowledge

Adult Learning Principle #4: Practicing Intervention Strategies in Real-Time

Adult Learning Principle #5: Feedback is How We Grow

The post Adult Learning Principle #3: Active Practice and Participation are Key! appeared first on Early Intervention Strategies for Success.

Lynn meets Devon and his mother, Janae, at the grocery store for their visit this week. When she arrives, she finds them trying to walk into the store. They are struggling because Devon is having a tantrum and Janae is trying to carry him while he kicks and screams. Lynn goes up to them and asks if she can help. Janae puts Devon down and says she doesn’t know what to do. She reminds Lynn that this is why they decided to meet at the store, so that Lynn could help with this problem. Lynn asks if she can try something, and Janae agrees. Lynn takes Devon’s hand and plays a game with him, pretending to be tigers, rabbits, and birds trying to get across the parking lot. Janae follows them and says “I wish you could come to the store with us every week because he won’t do that for me.”

Is the Problem Solved?

Lynn has had the awesome opportunity to observe a natural routine for Devon and his mother. Rather than just hearing about the struggles walking in to the grocery store, she has wisely scheduled to join the family during their weekly trip. Rather than sitting back at the family’s home and spouting out tons of “have you tried…?” ideas, she is able to problem-solve with Janae in the moment. Lynn is able to get Devon into the store without a tantrum, so…is the problem solved?

No, not by a long shot.

Lynn demonstrated a technique that involved playfully distracting Devon during an activity that he doesn’t like or typically cooperate in. She was successful at dodging the typical tantrum, but it really doesn’t matter because she won’t be there the next time the family goes to the store. She is probably assuming that Janae watched her and would pick up how to play the games she played with Devon. From Janae’s comment, though, you can get a sense that she watched, but she doesn’t think she can do it. If that’s what Janae feels, then Lynn’s modeling did not accomplish the real goal, which was to help Janae learn ways to get Devon into the store without a tantrum.

If we just rely on modeling or demonstration for families, we are not very likely to truly build the parent’s capacity to manage similar real-life situations in the future. In fact, it could have a detrimental effect because the parent could see someone else being successful when she herself cannot. Without a more intentional approach to supporting the Janae’s learning, Lynn could do more harm than good.

Three Ways to Use Modeling to Support Parent Learning

Let’s consider how Lynn could wrap the following three steps around her modeling to better support Janae’s learning. Here’s the same situation, but with Lynn more actively helping Janae participate in her son’s success:

Model with Intention – Before trying her strategies with Devon, Lynn asks Janae to watch for what she (Lynn) does to distract Devon and make the trip into the store fun for him. She also asks Janae to watch Devon’s reaction.

Model with Narrative – While playing the pretending game with Devon, Lynn narrates what she is doing for Janae. She says she’s trying to make the walk more enjoyable as a way to help Devon learn that the trip into the store can be fun.

Model with Reflection – After they get about half way to the store, Lynn asks Janae what she observed so far. They talk about Devon’s different reaction and why he didn’t tantrum. They reflect on the specific activities Lynn used and which of those Janae wants to try.

After modeling, it’s ALWAYS good to remember to hand the reins over the parent. Giving the parent the opportunity to try what she has just observed and make that strategy her own is really when the learning happens!

Here’s what happened next for Lynn and Janae:

After establishing a few specific strategies that might work for Janae, Lynn steps back and Janae takes Devon’s hand. He starts to squirm and fuss but Janae says “Let’s jump like a kangaroo into the store!” and takes Devon’s hands to help him jump. When they reach the entrance, they stop and reflect about how that went. Devon made it into the store with his mom without incident. Success!

Consider, though, who is responsible for Devon’s success? At this point, both Lynn and Janae are, but Janae feels more capable because she has experienced her own ability to use the strategy. She is more likely to own this new strategy now. When the strategy becomes hers, and she’s able to use it when Lynn isn’t there for support – that’s when they’ll know that intervention worked!

How have you used modeling to support caregiver learning? 

For those of you who are using coaching interactions with families, what could Lynn have done differently before and after her modeling to make this activity even more successful?

Share your insights about how we can improve this interaction in the comments below!

The post Watch Me! – Using Modeling as a Caregiver Teaching Tool appeared first on Early Intervention Strategies for Success.

Think about it. How did you learn to drive? Sure, you read the driving manual, went to a driver’s ed class, and you probably talked about driving a lot. Before getting behind the wheel, you’d observed people driving for years. Was reading, talking about the new skill, and observing someone doing it enough to prepare you for using what you learned? No way! You really learned to drive by getting behind the wheel and practicing it…with the real-time support of the (possibly terrified) adult in the passenger seat!

Keep this in mind: Adults learn and remember best when what they are learning is practiced in real-time and in the context in which the new knowledge or skill will be used.

You learned to drive by driving. Parents in early intervention (EI) are much more likely to learn and remember how to interact with their children in developmentally enhancing ways by doing it – by trying out strategies and problem-solving in real-time, during the activities that they do everyday. The adult who taught you to drive would’ve been minimally helpful sitting on the sidelines continuing to talk about what you should be doing. Same goes for an EI service provider. We’re going to be much more successful achieving the mission of early intervention, which is to enhance the family’s capacity to meet their child’s needs, when we get in there, ride beside the parent, and work together with the child.

How Can We Use This Principle?

Join In – Rather than just talking about family activities, ask if you can join them. Explain this principle and get the family’s permission to practice strategies in real-time. If the parent mentions an activity that doesn’t usually happen during the visit, plan to come when it happens next time.

Step Back – Be careful that your “joining in” doesn’t look like “taking over.” Step back, observe things usually work, then coach the parent to think about how to embed an intervention strategy in the activity. You will build the parent’s capacity much more successfully if she has a chance to think about what she’s doing first.

Model if you must – If the parent really needs to see you use the strategy first, that’s fine. Be sure to ask for permission to model and tell the parent what you are doing and what to watch for. Then step back and let her practice. Remember that a key to her learning is HER practicing, not just her watching you practice.

Make room for mistakes – Just like when I ran over a painter’s bucket and broke the fan under my dad’s station wagon when I was learning to drive (yes, that actually happened), give the parent permission to goof up. Making mistakes while practicing is normal and necessary. This also helps prepare the parent for having to adjust how she uses the strategy when you aren’t there. Believe me, I never ran over another bucket again.

Consider Two Examples:

Example #1: Jayne, Liam’s mother, describes how hard it is for her to get him dressed. Liam screams, twists and turns, and has even begun to run away when she mentions getting dressed. Some days, they both end up exhausted and in tears, and other days, they just don’t go anywhere because Jayne doesn’t want to fight the battle. Tristan, the occupational therapist, asks Jayne if she’s tried having Liam wear tagless clothing. When Jayne replies that all of Liam’s clothing is tagless, Tristan asks if she’s tried letting Liam dress himself. Jayne says that he’d probably just stay in his training pants all day. Tristan continues to make suggestions, but Jayne has either already tried them or doesn’t think they’ll work. When Tristan leaves, Jayne feels frustrated that she didn’t receive the help she’d hoped for.

Example #2: At the next visit, Tristan notices that Liam is just wearing his training pants so she asks Jayne how dressing went that morning. Jayne said it was a battle as usual and Liam won. Tristan asks if she can see what happens when Jayne tries to dress Liam. She tells Jayne that she hopes that they can work together to come up with some strategies that might make dressing a little easier. Jayne agrees but is nervous about what will happen. She asks Liam if he’s ready to get dressed and he runs away. She snatches him up and takes him, already struggling, to his bedroom. Jayne places Liam on his toddler bed and turns to get his clothes. He wiggles off the bed and runs away again. Tristan coaches Jayne to consider why Liam might be running away and what they could do differently to make this a more pleasant experience for him. By working together, they come up with ideas such as having the clothes ready on the bed before getting Liam and letting Liam stand on the floor to get dressed rather than having to lie down. Tristan also coaches Jayne in how make dressing playful. Tristan knows that Liam loves stories, so she suggests that Jayne try telling Liam a story while she dresses him. Tristan models how to let Liam chose his own clothing and help with putting it on. Jayne tries it too, letting Liam chose which pants to wear then telling him a funny story about how his feet are going on an adventure. Dressing takes longer than Jayne wants, but she’s able to get Liam dressed with no tears. Afterwards, Tristan and Jayne reflect on what happened, and Jayne identifies three strategies she will try during the week. When Tristan leaves, Jayne is still nervous about dressing Liam without help, but plans to try the strategies tonight when dressing Liam for bed.

It can be so easy for service providers to get in to the “Have you tried…?” habit, avoiding the real-time aspect of this adult learning principle. Using this principle really challenges us to release that habit and, instead, actively problem-solve with the parent in the moment. It’s a very different approach, and one that parents report to be so much more effective.

Seize the moment on your next visit to “get behind the wheel” with the parent and see what happens!

Which example resonates more with you?

Think about your last three visits and your own practices. Did you help the parent practice strategies in real time, in real contexts? If not, why not?

Do you have a great example of successfully joining a real-time activity to help the parent and child learn? Share it below!

For more info on adult learning principles, check out these other two posts:

Adult Learning Principle #1: Making Intervention Immediately Relevant

Adult Learning Principle #2: Linking New Learning with Prior Knowledge

Adult Learning Principle #3: Active Practice and Participation are Key!

Adult Learning Principle #5: Feedback is How We Grow

The post Adult Learning Principle #4: Practicing Intervention Strategies in Real-Time appeared first on Early Intervention Strategies for Success.

*What’s Your Outcome for 2015?? Share it below and maybe you’ll win a free book!*

Some of you might be thinking…oh no, not another post about new year’s resolutions. If that’s you, then breathe easy because this isn’t about resolutions most of us won’t keep. Voicing a resolution really means very little if it doesn’t have a specific plan behind it. Kind of like IFSP outcomes – if we write them using really general language then they are harder to achieve. Think of the outcome 60% of kids in EI could have: Caleb will use words to communicate his wants and needs. It’s not very meaningful without more information that is specific to Caleb and his family. Without the individualized details in our own resolutions, we won’t know how to reach them or how to measure progress and we’re must less likely to be successful. Instead of thinking generally – like “I will exercise more” or “I will spend more time with my family” (sound familiar?) – let’s think specifically, pulling from those strategies we use to write good IFSP outcomes.

My Outcome for 2015

I have one big goal for the coming year: I want to graduate! I’m in a doctoral program and have just finished my classes (happy dance!). The coming year brings my comprehensive exams (written and oral) and my dissertation research and writing. If I let myself, it feels a little (okay, alot) overwhelming. In order to reach my outcome, I need to first define it. Here’s goes: I will complete my comps by March and dissertation by October so that I can graduate in December 2015. This includes completing the required paperwork by my deadlines, submitting my comps question, writing my exam paper and presenting it, identifying my dissertation committee, developing my prospectus (plan) for my dissertation, presenting and defending that, conducting my research, writing it up, then presenting and defending that. No big deal, right? Sheesh.

In order to reach my outcome, I’ll need to plan out my year, dedicate time each week to working on my outcome, and commit to myself that I will honor my plan. I need to get organized and do the work. I also need to think about how I will balance achieving this outcome with managing the rest of my life. It sounds like a huge undertaking, but when I break it into smaller steps, it’s much less scary and much more manageable. My plan is to chart it all out by actually making myself a checklist to keep track of my requirements (plus I get the joy of checking things off of the list!). This can be a great strategy for achieving any goal – breaking it down into specific achievable steps.

YOUR Outcomes for 2015

So what do you want to accomplish this year? What are the smaller steps you need to take to get there? Take 5 minutes today and write down an outcome for yourself for the coming year. Don’t just write an empty resolution like “I want to exercise more.” Instead, use the other 4 min and 45 sec to map out steps you need to take in your life to make this change. Write down what you need to do, who can help you, when you’ll do the activity/work, and where you will need to be. Imagine that you are writing an IFSP outcome for yourself.

Remember: how you spend your time this year, from the big picture outcome to the minutes of each day, are all up to you!

Share your outcome in the comments below so that your colleagues can draw inspiration from you! Let’s see if we can get 15 outcomes listed for 2015! I’ll randomly draw a name from the list on February 13th and send the winner a free copy of Family Centered Early Intervention: Supporting Infants and Toddlers in Natural Environments.

Happy New Year!

The post Let’s Get 15 Outcomes for 2015! appeared first on Early Intervention Strategies for Success.

Jackie receives a call from Tate’s mother, Mrs. Comer. Mrs. Comer is really frustrated because she feels like she’s not benefiting from her visits with the physical therapist. She tells Jackie that she feels like all Alex (the PT) does is ask her questions. She says “I don’t want to just be asked questions that I don’t know the answer to. I’m here to learn how to help Tate. I need Alex to show me what to do!”

Have you been in this situation? Are you Alex or Jackie?

The Transition to Using Coaching

I’m hearing more and more from service coordinators and providers about the struggles and successes with integrating a coaching style of interaction into their practices with families. In Virginia, as in many other states, our EI providers are in the midst of a transition, evolving their practices from a more traditional approach to providing routines-based, collaborative intervention. We’ve worked hard to learn about coaching, having provided training across our state, and now our practitioners are hard at work implementing what they’ve learned. As with any paradigm shift, many are struggling with the transition, especially when it’s a very different way of interacting with families and sharing expertise than what they’re used to.

Let’s think about how Jackie and Alex might handle the situation above. We’ll consider the perspectives of all three people: Alex, Mrs. Comer, and Jackie.

Service Provider: Alex

Alex has been a PT for 6 years. He’s very open to using coaching but is struggling to integrate it into his practice, feeling unclear about whether or not he’s “allowed” to share his expertise or handle the child during visits. He really likes the reflective questions and understands the value of reflection as an adult learning strategy, and wants to build the family’s capacity to support their child’s development. Tate has mixed cerebral palsy, with high muscle tone in his extremities and lower tone in his trunk. Alex’s first inclination is to use the intervention visit time to stretch Alex. Instead of doing that, Alex has been trying to ask Mrs. Comer what she’s been doing with Tate and what she thinks she should do.

Parent: Mrs. Comer

Mrs. Comer has 3 children and Tate’s the youngest. She has high expectations for Tate and really wants him to be an equal and active part of their family’s life . She’s reading everything she can about CP and understands the importance of positioning, stretching, and adapting activities for him. What she’s struggling with is HOW to do these things. Recently, she asked Alex how to help Tate be able to help with getting himself dressed in the morning. She was frustrated because Alex responded by asking Mrs. Comer, “What do you think you could do?”

Service Coordinator: Jackie

Jackie is learning about coaching too and wants to support her providers in making this transition. She also wants to make sure the children and families are getting what they need. When Mrs. Comer shares her concern, Jackie listens closely. Mrs. Comer says that she likes Alex and thinks that it would work better if Alex spent more time showing her how to help Tate learn to sit, move and play. Jackie says she’ll talk to Alex and plan to join the next visit so that they can discuss this as a team.

Jackie calls Alex and first asks how he thinks intervention is going. It turns out that Alex is also frustrated because he wants to model positioning and stretching but wasn’t sure that he should. He struggles with helping Mrs. Comer reflect when she really doesn’t have the prior knowledge of what to do with Tate. They discuss Mrs. Comer’s concerns and her request for more demonstration. Jackie asks if Alex is okay with her joining the next visit and he says “of course!”

The Next Intervention Visit

On the next visit, Jackie facilitates a discussion that airs everyone’s frustrations in a kind and professional manner. Then, to focus the discussion on how to move forward, she helps Alex and Mrs. Comer revisit the family’s need to have Alex actively participate in getting himself dressed. She asks Mrs. Comer to describe what she’s already doing now with dressing and explains why she’s asking – to help her (Jackie) and Alex know what’s worked well or not worked so far. Mrs. Comer shares that getting Tate’s arms through his sleeves is really hard because of his tone. Alex asks if he can see how she dresses Tate so he can help develop some strategies with Mrs. Comer.

Everyone moves to Tate’s bedroom, where Mrs. Comer usually dresses Tate. She removes his clothing and redresses him while Alex observes. Together, Alex and Mrs. Comer try a few strategies and problem-solve together. Alex asks if he can show Mrs. Comer how to help manage Tate’s muscle tone and stretch him before dressing. While he models these strategies, he suggests Mrs. Comer watch for how he positions Tate, where he puts his hands while stretching Tate, and how Tate reacts. They figure out that Tate can help push his arms through the sleeves easiest if he’s in a sitting position, so Alex coaches Mrs. Comer in how to help Tate sit on her lap during dressing. He shows her how to slowly break up Alex’s muscle tone so that Tate can bend his elbows and then straighten his arms through his sleeves. They talk about how this activity helps Tate practice controlling his movement, how stretching before dressing loosens his tone, and how being playful and counting “1-2-3!” before Tate pushes his arm through his sleeve can make the dressing routine motivating for Tate. Mrs. Comer is happy with the strategies and plans to use them in the morning when getting Alex dressed and in the evening after bath time.

At the end of the visit, Jackie asks Mrs. Comer and Alex how they thought things went. Both seemed happy with the visit and the joint plan. Jackie encourages them to continue focusing on how Tate can participate in everyday activities and routines like they did today because they make a great team.

What Do You Think?

If you’re a service coordinator like Jackie, how might you handle a similar situation? How’s your team doing with implementing coaching strategies?

If you’re a provider like Alex, how are you feeling about implementing coaching? What would you do if a family was frustrated with the way intervention was going?

Share your insights by leaving a comment below!

The post Coaching: It’s About More than Just Asking Questions! appeared first on Early Intervention Strategies for Success.

This is an exciting time of year for many of us. You may be shooing your own children out the door on the first day of school (hooray for 5th grade at my house!). You may be saying goodbye to some families and welcoming others into your program. It’s a great time to reset yourself too, get organized, and think about what you want to accomplish in the coming months. Sure, I could save this post for the new calendar year, but why not check in with yourself now? Think of it as your own IFSP review!

Your IFSP Review

If you wrote an IFSP for yourself, what would it include?

Daily Activities & Routines – How do you spend your day? What’s working well and what would you like to change? Step back for a moment and consider your day in order to reorient yourself to your goals. If you’re happy with how you spend your day, fantastic! If not, what can you change? How? Start by picking one thing you can change and committing to it. Remember that it takes 10 days to establish a new habit so give yourself time.

Suggestions: Start & end your day by getting organized and prioritizing your work. Build in a 15 min walk somewhere in your day to refresh yourself. Do something you enjoy and work on your commitment everyday.

Priorities, Concerns & Resources – What’s important to you right now? Do you have concerns that you need to address? What resources do you have and what do you need? Rather than just thinking about it, start planning to DO something about it.

Suggestions: Ask for regular supervision time with your supervisor so that he/she knows what’s important to you, can provide ongoing support for any concerns or issues, and can celebrate the positives with you. Invite colleagues to share one great new resource at the next staff meeting. Offer to do a staff in-service on a topic of interest so everyone can learn together.

Assessment/Status: How are YOU doing? What do you do really well? How can you improve? Give yourself a pat on the back for a job well done…and a gentle nudge on those things you want to improve.

Suggestions: Take a moment to revisit your professional development and/or performance plan. Ask your supervisor or a colleague to help identify your strengths and think about how to help you grow. Make a list of 2 things you want to do or learn over the next 6-12 months.

Activity: Try this fun activity at a staff meeting to help you/your staff “assess” strengths. Give each staff person a sheet of construction paper, markers, stickers, etc. Instruct them to write their names in big letters on their paper and decorate them. Ask each person to pass his/her sheet to the person on the right. Give everyone 1 min to write a strength or something they appreciate about their colleague on the paper. They can add decorations too. After 1 min, the sheets are passed to the right again. Continue until each person gets his/her own sheet back. Use this activity to open up a discussion about what the group does well and what they’d like to learn or do to help them grow. Record ideas on a flip chart and invite staff to record specific ideas on their own plan. Revisit these plans in a few months and invite staff to share what they’ve learned/accomplished with the larger group.

Outcomes & Goals: What do you want to learn? What new skills do you need to add to your toolbox? How do you want to gain this knowledge and these skills? By when? Don’t just think about these – write them down.

Suggestions: Pick 2 outcomes for yourself. Write out an outcome statement, including specifically what, when/where, and how. Write short-term goals too if that’s helpful. Post your goals where you can see them everyday. If you already have goals written somewhere, jot down a note about your progress. Use this time to reflect, refocus, and reward yourself if you’re on the right track!

Services & Supports: What support do you need to help you reach your outcomes/goals? Who can help you? How often? Again, be specific and don’t be shy about asking for help.

Suggestions: Think about how you learn and how to gain what you need. Would you like to go to a conference or take a class? Is there someone who could be your mentor to help you learn a new ability? Get specific – write the meeting times and locations on your calendar. Secure funding if needed (not easy, I know, but if you don’t look, you can’t find). Block time in your calendar to stay organized or read a new resource each week.

Make yourself a priority by taking the time to think about and plan for how to grow your early intervention practice!

Here’s your first step: Share one thing you want to learn more about in the comments below. If I know of a resource that might help you, I’ll let you know! 🙂

The post What if YOU had an IFSP? appeared first on Early Intervention Strategies for Success.

We could call this one the “what’s in it for me?” principle. We know how we are…as adults, we usually pay attention to information that is most relevant to our current situation. We tend to remember information that is most immediately useful, skills that get our needs met, and strategies that we can practice right now. If we apply this principle to early intervention, we can see why it’s important that the IFSP outcomes and intervention strategies address what is important to the family, focusing first on immediate needs.

How Can We Use This Principle??

Find out what’s important right now. Find out from the family what goes well during the day and where the struggles are. It might be important for the child to learn to communicate when he’s “all done” to make mealtime easier for the whole family (and avoid the tossed bowl of mashed potatoes on the wall). Or how about the family who’s chronically sleep-deprived because the toddler wakes up the entire household several times each night? In any of these cases, working on sorting colors instead of addressing one of these immediate needs will be so much less meaningful. On the other hand, helping the toddler (and family) sleep well can improve the family’s quality of life and the child’s readiness to learn and manage his behavior. Much bigger impact.

Practice intervention strategies in real time. Rather than discussing the problematic routine (which is what research indicates we usually do), jump into it. Problem-solve together in real time. Find out how the parent and child interact and design intervention around what’s relevant to their specific interaction.

Weave needed skills into real life activities. I guarantee you that most families of toddlers do not spend time each day stacking one inch cubes or labeling puzzle pieces. They probably do, however, spend time each day putting away toys, building towers of cookies, talking while getting dressed in the morning, or helping the child practice using his fingers to pick up cheerios from the highchair tray. Challenge yourself to figure out how the child can learn a missing skill during the natural activities his family does every day.

Wrap IFSP outcomes around what is immediately relevant. Use the family’s words in the outcomes. Link their priorities to outcomes and weave in functional skills that are needed to address those priorities.

Be flexible and adjust intervention in the moment. You might start a visit thinking you are going to address one outcome, but something comes up that is more immediately important. The two examples you’ll read next will help illustrate this.

Consider Two Examples…

Think about these two examples of the same  family and interventionist:

Today, Jess and Parker’s mom had planned to meet during snacktime to try to weave communication opportunities into that routine. Parker was not very hungry, so only ate a few bites of goldfish crackers. As his mother prepared his snack, she described a current struggle with getting Parker into his car seat. Parker’s mom describes how he thrashes and arches his back when being placed in the car seat. He cries and his mother feels like she has to practically force him into a sitting position.

Example #1:  Jess and Parker’s mom discuss strategies while Parker plays in his highchair, with Jess suggesting things like offering Parker a toy to distract him, singing to him, or letting him crawl into the seat on his own. Parker’s mother agrees to try these ideas later and see how it goes. After the discussion, they decide to go outside in the backyard to practice working on Parker’s expressive language because he loves to play in his sandbox and it’s a beautiful day.

Example #2:  Jess asks if they can take Parker out to the car so that she can see what happens. Parker’s mom agrees and tells Parker it’s time to go for a ride. Once they get out to the minivan, Parker’s mom picks him up and he immediately starts to arch and fuss. Together, they problem-solve and try a few strategies. What ends up working is having Parker’s mom put him down by the door, playfully tell him to “hop in!” and let him crawl into the seat. Once there, he helps with the buckles then picks out a book or toy to hold while his mom gets in the car. During this process, Parker’s mom uses simple 1-2 word phrases to describe what Parker is doing or prompt him, such as open (for the door), buckle up, turn around, book, Mickey (for his favorite toy), and all done. They drive around the block and Parker does well. Getting in the car seat ends up becoming a great natural learning opportunity for Parker to communicate, follow directions, and manage his behavior.

So what do you think?

Which example shows Jess using adult learning principle #1?  How did each example benefit Parker and his mom?

What about when what’s most immediately relevant is completely different from the IFSP outcomes you’re supposed to address?

Think about which example more closely matches your current practices. On your next visit, try to be open to seizing those immediate opportunities and come back and share with us how it went!

Don’t miss the other posts in this series:

Adult Learning Principle #2: Linking New Learning to Prior Knowledge

Adult Learning Principle #3: Active Practice and Participation are Key!

Adult Learning Principle #4: Practicing Intervention Strategies in Real-Time

Adult Learning Principle #5: Feedback is How We Grow

The post Adult Learning Principle #1: Making Intervention Immediately Relevant appeared first on Early Intervention Strategies for Success.