On May 1, 2021, Governor Northam proclaimed May as Early Intervention Awareness Month in Virginia. Many EI programs use this month to raise awareness and build relationships with referral sources, physician offices, other community programs, and of course, families. The video What is Early Intervention in Virginia? is often shared widely because it provides an overview explaining what EI is, what it looks like, and how it works. One of the things I love about this video is the opportunity to see and hear from families who have experienced EI. I think family stories are perhaps the most powerful “tools’ we have to build awareness of what EI has to offer. They can help us reach new families and invite them into partnerships with us. Family stories also remind us about why we do what we do. With that in mind, I’m going to share several videos you can use to spread the word about EI from the perspectives of families. If you have other videos you love too, please share the links by leaving a comment below. Here we go!

Reflections during the Final Visit (CO Dept of Education, runtime 5:46)

This video features a mother reflecting on her relationship with the physical therapist who visited her home to support her and her daughter. I think that perhaps, showing what happens at the end of EI, like you’ll hear and see in this video, can help open a doorway to the beginning of EI for another family.

Liam’s Story: A Mother’s Voice (VEIPD, runtime 5:15)

This video also features a mother telling the story of her family’s experience with EI. This story is a powerful reminder of the impact of this work on the daily lives and relationships of families. As an early interventionist, you never know what you might say or do that can have a lifelong impact. EI Awareness Month can be a nice reminder about that too.

Dream Big: A FIT Family Story (FIT FOCUS Video Library, runtime 5:27)

In this video, you’ll hear from a mother and father about how EI worked for them. They explain the emphasis on helping the family help the child. They also describe about how coaching helped them to use strategies in their home during the things they already do rather than adding extra things to do. They also share advice for families to “dream big for your child.” (Due to permission settings, you’ll need to click the “Watch on Vimeo” button below. This video is definitely worth the extra click.)

Parents and Early Intervention (EITP Illinois, runtime 7:59)

I featured this video in another recent post because it’s new. I think it’s worth mentioning again as another resource to share a family’s story. Even though this isn’t a family in VA, I think this family’s message is universal.

That’s just a few of the fantastic family story videos that are floating around the web. If you’d like to see more videos of families in EI, check out the Early Intervention Video Library and look for Families’ Experiences in EI in the menu. You might also find the Early Intervention – General page helpful for sharing info about EI with others.

So what are you doing to celebrate EI Awareness Month? What is your favorite EI family story video?

Share your thoughts, ideas, and video links in the comments below!

The post EI Awareness Month in VA – The Power of Family Stories appeared first on Early Intervention Strategies for Success.

During the past year, our world has overturned with public health concerns, teleworking from home, social distancing, and childcare facility closures.  As this shift has occurred, we as EI providers have naturally adjusted to our new reality. However, some of these exact safety measures meant to keep the public safe has created a daunting reality of under-reported cases of child abuse or neglect.

Statistics show a drastic decline of child abuse reports since the start of the pandemic:

According to The Washington Post, “In the nation’s capital, hotline reports of abuse and neglect between mid-March and mid-April were 62 percent lower than in the same period last year, according to the D.C. Child and Family Services Agency. Reports to child protective services in Maryland have fallen just as far, and in Virginia, referrals from school staffers have dipped by 94 percent.” (Schmidt & Natanson, 2020)

It is easy to overlook such a scenario, because decreased child abuse reports are a good thing, right? On the contrary, experts will tell you otherwise. Children without routine encounters from childcare providers, health professionals, and other social advocates lead to emergency room visits due to severe injuries from abuse. Fewer cases are brought in for immediate medical attention until the severity of their injuries are no longer concealable.   

As EI providers, we must be more alert towards the signs of abuse and neglect in our client’s homes. For some families, our tele-therapy sessions are their only lifelines for social support.

How Can We Help?

How can we help those children who are isolated, cut off from childcare providers, social contacts, or protection services?

As mandated reporters, we have a duty to uphold when we see suspected abuse or neglect in the children we serve. During this time when face to face visits are at a halt or at limited capacity, it is even more important to check in with our families through virtual sessions or over the phone.

What to do if you witness a parent display abusive or aggressive behavior towards a child during a telehealth session?

• Avoid judging remarks or facial expressions
• Re-direct and diffuse the conversation in a positive manner not to escalate the situation
• Discuss what positive behaviors that you have observed from the child to highlight their strengths
• Offer positive reinforcement strategies for challenging behaviors
• Check in with the parent to see if they are in need of community support or other resources

If you suspect or witness child abuse or neglect, call your local department of social services or child protective services. If there is evidence of immediate harm or threat to the child and/or family member, CALL THE POLICE.

Share some strategies or tips below in the comments about how you check in with the child and family’s wellbeing during your EI telehealth visits. 

Resources:

Virginia Department of Social Services

Virginia Child Protective Services: 1-800-552-7096

Out-of-State Child Protective Services: 804-786-8536

SCAN of Northern Virginia (Stop Child Abuse Now)

Reference:

Schmidt, S., & Natanson, H. (2020, April 30). With kids stuck at home, ER doctors see more severe cases of child abuse. The Washington Post.

Sarah Kim has been an occupational therapist for over 12 years. She currently works in early intervention for the Infant and Toddler Connection of Fairfax- Falls Church. She also volunteers as a Court Appointed Special Advocate for SCAN (Alexandria/Arlington). Email Sarah at: sarah.kim2@fairfaxcounty.gov

The post The Unspoken Realities of Child Abuse during a Pandemic appeared first on Early Intervention Strategies for Success.

Despite not being able to meet in person, tele-intervention (telehealth) has brought new opportunities to think about how we are talking about the child outcome summary process. Let’s be completely honest. Tele-intervention forces us to use good teaming practices because there cannot be any side conversations among professionals and everyone is only able to see and hear the same information. This helps us think outside of the box to ensure that all team members have the exact same information so caregivers can make the best decisions for their child.

After completing tele-assessments, I have experienced great success incorporating the caregivers in the Child Outcomes Summary (COS) discussion. The COS process summarizes a child’s functional development in three child outcome areas: positive social-emotional skills (including social relationships), acquire and use knowledge and skills (including early language/communication), and use of appropriate behaviors to meet their needs. The Decision Tree can be a helpful tool to facilitate the COS process.

All caregivers participate in the COS discussion using the Decision Tree. This includes deciding with the team which rating statement represents their child’s functioning compared to other kids of the same age. (Click here for more information about the Decision Tree and Virginia’s COS Process). Before even going through the process, it is most helpful to discuss who will facilitate the discussion with the caregiver and the rest of the team members. This includes sharing the screen to show the Decision Tree.   This can be the service coordinator or a provider. Here are 6 steps you can use throughout the process that I have found beneficial.

6 Steps for Engaging Caregivers during the COS Process

1. Explain the caregiver’s role as a team member.

This is an important step. Caregivers need to understand their role in the process and how they can participate. When they are unsure of what to do, they may be more reluctant to participate. Encourage their voices by involving them throughout process, giving thorough explanations, and asking open-ended questions to receive more in-depth answers.

2. Explain each outcome area and the use of the Decision Tree.

The second page of the Decision Tree shows the Infant & Toddler Connection of Virginia Child Outcomes Summary handout. This handout was specifically designed to support the caregiver’s understanding of the process. It is helpful to send this handout to caregivers prior to the meeting and share the screen with the document pulled up while discussing and highlighting different outcome areas. This will also encourage caregivers’ participation when they fully understand what is being discussed and why.

3. Discuss each outcome area with individualized examples.

During the Assessment for Service Planning, the team discusses functional development within each outcome area based on parent report, observation, clinical opinion, etc. Functional child development focuses on what matters in the family’s daily life, showing how the child is engaging, initiating, and participating throughout their day. It has little meaning to a caregiver if a child can stack blocks, so a functional example would be, “During bath time, Sydney enjoys lining her plastic blocks on the bathtub ledge before knocking them off and laughing. Her mother commented Sydney enjoys playing this game the entire time.” Embedding functional information like this contributes rich examples to the Decision Tree discussion that help all team members understand the child’s abilities and needs. During the discussion, it is also helpful to share the screen to show each outcome area on the IFSP as it is discussed. Screen sharing gives the parent the opportunity to follow along.

4. Review typical functional development.

This is an important step and not to be missed. It truly helps each team member, including the caregiver, understand what is typical for the child’s age within that given child outcome area. This will help each team member understand whether or not the child has “age-expected” functional skills. Utilize your resources for typical development. This can include a combination of resources such as the Act Early Milestones, Functional Development, Age-Expected Snapshots of Development, etc. Again, sharing the screen to show this information and/or sending the info prior to the meeting is beneficial to all team members.

5. Use the Decision Tree discussing each question and prompt.

Again, sharing the screen and/or sending the Decision Tree to the family prior to the meeting can be really helpful. Screen sharing allows each team member (including the caregivers) to look at the same information and follow along accordingly. Ask each question out loud for each decision point. Pause for discussion or examples. When choosing between two items at the decision point, read it and reflect with the caregiver and other team members about specific examples to reach an agreement on the best possible choice. By this point, caregivers should feel empowered to help make the best decision based on the information given to them and understand the importance of their voice.

6. Decide as a team the best statement.

Everyone has a voice. Check in with each person to make sure everyone is in agreement including the caregiver. Discuss specific examples if there is a difference of opinion at any given point in time.

Please note: When I share my screen, I already have these resources pulled up and ready to share as they are discussed: Decision Tree and the Infant & Toddler Connection of Virginia Child Outcomes Summary handout, the child’s IFSP, and information about typical functional development (See #4 above).

What are your top tips to engage families during the Child Outcome Summary Process?

How do you help facilitate the discussion?

Share your tips and ideas by leaving a comment below!

For more information about the COS process and the Decision Tree, check out these resources:

Decision Tree Tutorial

Virginia’s Child Outcomes Booklet: Team Engagement in the Child Outcomes Summary Process

The Decision Tree: A Tool for Teaming and Family Engagement – Parts I and II

ECTA COS Completion: When Teams Can’t Meet in Person

Extra! Extra! Read All About….Integrating the Decision Tree

Logan is Not a Number! – Explaining the Child Outcomes Process

COS Completion – When Teams Can’t Meet in Person

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The presence of an engaged service coordinator who understands the role and skillfully conducts the  many responsibilities of the position ensures a well-coordinated approach to EI service delivery. It is widely acknowledged in the EI field that families have the right to high-quality, individualized EI services; our field must commit to including service coordination in this acknowledgement by ensuring that the professionals who provide this service receive the attention, understanding, respect, and resources they need and deserve. (DEC and ITCA, 2020, p 10)

Wow. This quote is from the summary of the Service Coordination and Early Intervention – Division for Early Childhood (DEC) and IDEA Infant & Toddler Coordinators Association (ITCA) Joint Position Statement which was recently released in December 2020. It’s a powerful message for our field that’s intended to help us leave behind the unfortunate idea of service coordinators as simply paper pushers. It signals to leaders, administrators, and team members, including families, that service coordinators (SCs) are vitally important professionals who play key roles in the delivery of quality early intervention (EI). It’s about time. I’m proud to have been a part of the development of this statement and eager to spread the word.

A Joint Call to Action

The statement was written, reviewed, and finalized as a collaboration between DEC and ITCA. It represents the voice and beliefs of EI professionals from multiple disciplines who are members of DEC and Part C coordinators across the country. Together, these groups came to the conclusion that we needed a strong Call to Action in support of service coordinators and specific information about the knowledge, skills, beliefs, expertise, roles, and responsibilities of professionals who provide service coordination to encourage consistency across our field.

What Can You Do?

Let’s break down the four recommendations in the Call to Action and consider how to move the dial forward.

#1: States and local programs should review and align current competencies to the indicators in the Knowledge and Skills for Service Coordinators (KSSC) document.

In an appendix, the KSSC outlines six knowledge and skill areas that are essential for service coordinators, including: infant and toddler development, family-centered practices, leadership and teaming, coordination of services, transition, and professionalism. Take some time to read it and compare it to guidance or competencies your program uses when hiring and training SCs. If you don’t have program-level competencies, consider adopting these.

#2: Leaders who hire, supervise, and mentor service coordinators must have a thorough understanding of the expertise and needs of these professionals. This understanding is essential to ensure that compensation aligns with the level of responsibility expected of service coordinators. Service coordinators also should have appropriate administrative support, reflective supervision, and resources to successfully manage the workload, navigate changes in policies and procedures, and, most importantly, partner with families.  

This recommendation focuses on leadership and administrative support, which traditionally varies greatly across EI programs. If you are a leader, be honest with yourself and reflect on what you understand. Can you specifically explain what the SCs in your program do and what they need? If you find holes in your knowledge or how your program functions, make a plan to address them starting today. A few ideas:

• Ask your SCs what they need and how your program can meet this recommendation, then work together to set goals.
• Schedule regular meetings with service coordinators to touch base, identify needs, and collaborate toward goals.
• Provide specific info about policy changes and what they mean. Invite input and be flexible when you can.
• Check in regularly about workloads.
• Be available for regular planned and unplanned reflective supervision.

#3: States and programs must consider multiple factors when determining workload size to ensure that service coordinators can manage the roles and responsibilities outlined in this joint position statement. The factors to consider include (1) the number of families served per service coordinator, (2) the varying levels of need experienced by families, (3) the model of service coordination implemented in the state/program, (4) the need for administrative support and supervision, and (5) the level of responsibility, educational background, and any specific expertise required of service coordinators in a given state or program.

This recommendation strongly encourages programs to use a multi-factorial view when determining workloads for service coordinators, rather than simply relying on “caseload” numbers which often fail to reflect the complexity and individualized nature of the work. If you are a leader, take a hard look at how your program operates, check in with your staff, and make adjustments to make the work more manageable. If you are a service coordinator, examine your workload and talk with your supervisor about what is going well and where you need support. Bring your creative ideas to the meeting and work together to tackle this recommendation. You might not be able to change the number of referrals coming in, but there are often smaller changes that can be made to improve the situation.

#4. Additional research is needed to identify recommended practices specific to service coordination, which could be guided by the KSSC document. Research also needs to address how these practices would be implemented with families and how service coordinators would be trained to use these practices during preservice and inservice training.

This might sound like a recommendation for academics, but academics need EI programs to work with to conduct research. Reach out to your local university to initiate conversations about research and service coordination. Encourage faculty to share the position statement with their students. Building partnerships with faculty not only benefits the students you may share during field placements, but could also have a positive impact on the field if you work together to learn more about best practices.  

I encourage you to take the time to read the full position statement and share it (or the Executive Summary) with at least two other people. Share it with your staff or with colleagues, other SCs, contractor agencies, leadership, families, and higher education faculty. Start thinking about how you can use it in your program or state.

Let’s answer the call for action by dedicating some intentional time and energy to our service coordinators. They deserve it.

How can you use the position statement in your program? Who will you share it with?

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You’ve worked really hard this year. You’ve stretched to fit into a mold of providing early intervention (EI) that was unlike any you’d ever experienced before. You struggled, you persisted, and you succeeded. You did it because you love what you do. You also did it because you love the families.

This new video, Parents and Early Intervention, from the Early Intervention Training Program at the University of Illinois is like a gift to all EI practitioners for the hard work you’ve done this year. It reminds us about the power of high quality intervention and how important our partnership with families can be. I know you know this, but it sure is nice to hear it from a family. Now, take 7:59 minutes to meet the Warren family and hear their story. I guarantee it’ll make your day.

See, doesn’t that do your heart good?

So yes, this may have been one of the most challenging years we’ve faced as a field, but when other businesses and services closed, EI did not. You continued to support families, reaching them virtually, checking on them by phone, and working together in ways that were new, different, creative, and inspiring. Now, as you reflect on this past year, ask yourself:

When you think of families you have supported, what do you hope they say about their EI experience?

Type your reflections in the comments below.

*Thank you to EITP and the Warren Family for sharing their story!*

For more videos featuring families’ experiences, visit the Families’ Experiences in EI page on the EI Video Library.

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When talking to parents and caregivers, it can be helpful to ask them what they know about temperament and assess their understanding of how their temperament matches (or doesn’t match!) their child’s. Parents may be able to talk about their child’s response to different environments, sensory preferences or reaction to change and may not have thought about their own response. Parents and caregivers may not be able to recognize ways in which their own temperaments impact the behavior of their child.

What is Temperament?

Temperament is generally defined as consistent individual differences in behavior that are biologically based and are relatively independent of learning, system of values and attitudes. One key concept to remember is that temperament is biologically based, not made up of characteristics that are chosen. As such, an individual does not have the ability to change their temperament but rather use their knowledge to adapt to the environment. As an example, for individuals who become overwhelmed by noise, the volume of the television or radio could be turned down, voice tones can be adapted and strategies for calming in loud environments can be taught. Conflict can arise in the parent-child relationship when a parent perceives a child is acting in a particular way “on purpose” or “to make them (the parent) upset.” It is important to recognize that a child’s behavior is often a reflection of his or her temperament. Like many other developmental skills, parents need to be able to teach their children how to appropriately respond to their internal triggers.

Parent and caregiver understanding of how to support a child’s temperament style is crucial in the development of social-emotional skills. When parents can help children adapt to their environment and understand their own preferences, children will be better prepared to adapt to different environments using coping skills and resources available.

Having Conversations about the Parent’s Temperament

I often get questions about how to have conversations with parents and caregivers about temperament. Beginning by asking questions can be a good place to start. Helping parents to gain insight about their own temperament can help them to be more in tune with the actions of their child. Oftentimes, parents have insight into their child but may not have thought about their own preferences or strengths. Parents may not recognize the role that their temperament plays in the dynamic of the relationship with their child. Some questions that could be helpful to ask parents include:

• How do you manage your emotions?
• What are your sensory preferences (e.g. light, sound, etc.)?
• How do you respond to change?
• How do you communicate your wants and needs?

When parents and children have mismatched temperaments, strain in the parent-child relationship can be magnified. Parents may incorrectly attribute differences in interaction style to a child’s developmental delay, ascribing intent behind behavior or believing a child can simply change his or her temperament. Parents may not be aware of their own needs or have the capacity to understand how to adjust in order to have their needs met. When mismatched temperaments are not understood, parents may expect more of their child or believe that their child can change their behavior independently. This can lead to frustration and increased stress for parents. In addition, parents may feel as though they do not have the ability to meet their child’s needs or parent effectively. Children rely on their parents to be emotional co-regulators. This means that especially when children are young, they look to their parents to model how to manage uncomfortable emotions, changes to routine and internal triggers. When parents are calm, children can de-escalate more quickly. As children learn to understand their own temperaments, they can build their abilities to navigate different situations and interactions and become more effective in developing social-emotional regulation.

Talking about the Child’s Temperament

As providers, when parents talk about the ways in which they interact with their children, we can then begin to ask questions to help identify children’s temperament styles and explore which interventions are available to build family capacity. Once a parent can begin tuning in to the child’s unique temperament, the parent can then work to develop strategies for supporting the child’s needs. Here are some questions that you could help the parent to consider when trying to understand their child’s temperament:

• How does my child express their feelings?
• How does my child engage in play?
• How does my child respond when they experience discomfort?
• How does my child react to change?
• What does my child do when going through transitions?

When parents are in tune with their child’s temperament, they are able to support their child’s behavior more effectively. Parents can then understand their child’s needs to provide opportunities for learning new coping skills.

When children are young, it is important for parents to give a lot of support in helping their work through challenges. As children get older and can understand their own temperament style and what they need to be successful, the interactions become more balanced. When parents and caregivers are able to understand the ways in which temperament plays a role in the behavior and interactions of their children, stress is reduced and successful intervention strategies can be realized.

Now that you have some more tools to understand temperament, how can you help parents recognize and respond to their child’s unique characteristics?

Share your ideas by leaving a comment below!

For more information about this topic, check out Naomi’s 2-part webinar series on the VA Early Intervention Professional Development Center:

Foundations of Social Emotional Development: Temperament – Part II

Foundations of Social Emotional Development: Attachment – Part I

Also, be sure to visit the Social-Emotional Development topic page!

Naomi Grinney, LCSW has worked in early intervention for the past five years. Prior to working in EI, Naomi worked as a community-based mental health crisis response provider, as social worker in a psychiatric hospital and as a behavioral interventionist at a residential treatment center. Naomi is passionate about supporting the social emotional development of children and building family capacity and has worked with kids and families for twenty years. As the parent of a child who received Early Intervention services, Naomi brings a unique perspective to her role in providing tools and resources to empower parents in supporting their child’s development. Naomi can be reached at naomi.grinney@fairfaxcounty.gov. 

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Many of you have been providing early intervention services via virtual visits for nine months now. That’s a long time….I probably don’t need to tell you that because you are living it. It’s been a long time since you sat in a family’s living room, since you held a baby, since you blew bubbles with a toddler, since you guided a parent’s hands as she helped her baby learn to stand, or since you got one of those amazing toddler hugs. Many of you have become grounded in tele-intervention and, while you undoubtedly miss in-person visits, you have embraced this incredibly unique opportunity to grow as professionals.

What Are You Thankful For?

Take a deep breath, look out of a window, and pause. Think about the past nine months and ask yourself: “What has this experience of providing tele-intervention given me? What am I thankful for?” Somedays, you might answer that this experience has given you a headache from staring at the computer screen all day long. Other days, you might find yourself joyfully celebrating progress you got to see by “joining” a family during an activity you might never have been able to observe before.

While I am not seeing families via tele-intervention, here are a few things I’m thankful for when I reflect on our field’s experience this year:

#1: I’m thankful for the new door we’ve opened.

Being launched into tele-intervention as the only way of reaching families has likely changed our field forever and in a positive way. Many states are advocating for the flexibility to continue to offer tele-intervention as an option to families. Being able to offer tele-intervention to families who prefer it for privacy, flexibility, distance, or other personal family reasons… having the option available to support families of some of our most medically-fragile children…offering virtual visits in areas with provider shortages – all of these could really be game changers. I’m grateful for the door that’s opened so we might be able to continue to leverage technology to further individualize EI services and reach more families.

#2: I’m thankful for the coaching practices that were already in place to help us *really* support caregivers.

I’ve heard over and over that practitioners who were already using coaching practices found the shift to tele-intervention more natural – still challenging and still with a healthy learning curve, but overall, a more natural fit. I’m grateful that we have been practicing coaching and routines-based, family-centered intervention here in VA for years now. Sure, what this looks runs the gamut, but the adoption of this practice made it easier for practitioners to support caregiver and child learning from the other side of a webcam. No one said it was easy to make the shift to virtual visits, but having some great practices in your back pocket seems to have helped.

#3: I’m thankful for you.

Yes, that might sound cliche but hear me out. I’m thankful for EI practitioners and leaders like you who embraced virtual visits when you had no other choice. You put new policies in place, built new systems of support and payment, adopted new technology, and walked families through how to login with kindness and patience. I’m thankful that you pushed through the awkward transition of figuring out where to place the camera and how to manage audio, how to observe and manage silence during visits, and how to teach a parent without being able to model like you’re used to. I’m grateful for the EI teams who experimented and figured out how to use technology to conduct eligibility determinations and assessments, who shared their screens so families could understand their rights and see the IFSP as they joined team members to write it. For all of you who continue to dedicate your time, energy, and bandwidth to children and families receiving early intervention, I see you and I am proud to be part of a field with you in it.

Now it’s your turn. What are you thankful for?

Share your thoughts by leaving a comment below.

For more information about tele-intervention, visit these resources:

COVID-19 and EI Tele-Intervention Updates (VEIPD)

Provider and Educator Use of Technology (ECTA Center)

The post Tele-Intervention Has Made Me Thankful For… appeared first on Early Intervention Strategies for Success.

Several years ago, I found that my EI caseload included a couple of families with stay-at-home dads. This was a first for me, and I found myself struggling to connect with family caregivers, which hadn’t happened to me since I was new to the field.  Both men were quite nice, but I stumbled when I tried to make conversation to build rapport.  What did I have in common with these men? With moms, I could build rapport around so many shared experiences being moms and women.   One dad was a former football player and the other was a fitness expert.  My idea of working out was to walk from the couch to the bookshelf. 

So, I did what I always do when I’m unsure- I read and researched.  I searched and searched for good information on working with dads.  I found almost nothing except for a few articles on how men and women communicate differently.  I had to muddle through mostly on my own, but we all made it through together.  These experiences helped shaped my later academic research. 

3 Key Strategies for Building Relationships with Dads

Here are some of the key strategies I used to build successful relationships with dads.

Talk side to side rather than face to face.

I can’t remember the source anymore, but the one tip I did garner from searching for books and articles was that men are socialized to talk with each other and others while they are engaged in a task or standing side by side, while woman are socialized to look at each other while talking. This strategy was immediately helpful! When the fitness expert dad offered to make me a fancy coffee, I took that opportunity of having his back to me to ask some deeper questions about what his hopes for his daughter were and what he wanted from EI.  It worked! This became part of our weekly routine.  He would make me a fancy coffee and I would use this time while he wasn’t looking at me to chat and build rapport.  With the other dad, I started positioning my body angled from him instead of looking directly at him.  This also worked immediately.  He opened up a little more when we weren’t looking directly at each other and I realized we could connect over our similar senses of humor.  He hasn’t been a client in years, but our relationship became strong enough that he sends updates on his son’s progress several times a year. 

Explicitly invite dads into therapeutic activities.

I learned to do this based on anecdotes from my own work in EI and the dads in my research verified it’s really important.  Many dads aren’t sure about what EI is supposed to be, especially if they aren’t the primary caregivers of their children. They hang back and watch or wait for their wife or partner to give them a summary of what happened.  Extend a direct invitation by saying, “Hey, we’re going to work on motor skills.  Come on over and help me make an obstacle course with the couch cushions” or “One of our outcomes that your kiddo can communicate her wants and needs.  Let’s take her in the kitchen and work on some strategies to get her communicating for snack time.” This signals that the dad is an important part of what’s happening and that you want him to participate. 

Be really clear about what you are doing and why.  Provide this information in writing, too.

Both the dads I worked with and the dads in my research wanted clear explanations of why their EI providers were giving them and their children specific tasks.  They wanted to know exactly how doing an obstacle course was related to motor development or how giving a choice of two items at snack time helped with communication development. For many of EI providers this information is so much a part of what we do, that we don’t think to explain the connection.  The dads in my research didn’t always feel comfortable asking providers these questions or they asked the questions but didn’t remember the answers after the provider left.  Make sure to provide written explanations that address the what and the why.  Remember, a quick text (if allowed by your program) counts as being in writing (just make sure you send it to mom AND dad).

Have you tried any of these strategies? Have one we haven’t thought of? Or maybe want some advice about a tricky situation with a dad?

Leave a comment and let us know!

For more information about working with dads, you can check out the Dads Matter! Webinar Series (external website) on the VA Early Intervention Professional Development Center (external website) site. Scroll down on the page to find both archived webinars.  

Megan has over a decade of experience working with fathers as an early intervention developmental specialist. Currently, she is an assistant professor at Salem State University, where she teaches future early interventionists and researches dads’ experiences working with early intervention programs. Megan lives in Salem, MA, with her husband, daughter, and two exceptionally naughty cats.

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Amanda and I met while working at a special education charter school as an Assistive Technology specialist and special education teacher. Somehow, several years later, we have both ended up working in EI. Amanda currently works as a Speech-Language Pathologist providing EI services and AAC evaluations in DC and I am a Developmental Therapist in Arlington County.

As EI providers, we know that communication creates the opportunity to learn about and understand the world around us. Yet, often children wait until they receive school services before they have consistent access to robust AAC (Augmentative and Alternative Communication) systems. When working with toddlers who are not using verbal language to communicate functionally throughout their day, it is important to offer information and have conversations about the benefits of AAC with the family.

Figuring out your role in these conversations as an EI provider, as well as how to support a family with their AAC journey, can be challenging. Below, we have listed a few common myths and misconceptions about AAC as well as examples of toddlers we know who have started their journeys with AAC. We hope you can use this as a resource as you continue to expand your knowledge about AAC as a primary provider.   

Myth #1: Toddlers Are Too Young  

We are never too young for language exposure. Most AAC relies on a different language system than what we are exposed to from birth. If children are going to use AAC functionally, they need to hear everyone in their lives use the same system to talk to them. Waiting to provide children with the opportunity to use AAC until they are “old enough” can deprive them of months and years of language input that is necessary when learning to effectively communicate. The earlier a child has access to language, the faster he or she will learn to use it and be able to engage more with the world (American Speech and Hearing Association, n.d.). There are no prerequisites to begin using AAC. While there are considerations as to the mode of access and system used, these are determined as part of an evaluation.   

Amanda: Earlier this year, I had a conversation with the parents of a 15-month-old with limited vocalizations.  We had an honest discussion about his diagnosis and the likelihood that he may not verbally speak for a while.  Within the month, several low tech AAC systems (paper-based choice boards) and a GoTalk32 (recordable, fixed 32 cell device) were introduced.  Before he was two, he started using a high-tech dynamic display (digitized display changes based on user actions) device and by two he was using phrases to communicate.  By providing AAC from an early age, this child has the chance to continue his expressive language development at a rate similar to his typically developing peers.  

Myth #2: AAC is for Speech Language Pathologists (SLPs)  

While it is always challenging to talk about something that feels like it’s out of your area of expertise, the conversation about language development and ACC can come from any knowledgeable provider! SLPs are great resources about AAC, but remember that all providers can talk about communication. This is especially important when we think about babies and toddlers with complex bodies, who may also have complex communication needs. These children are much more likely to see a motor therapist as their primary service provider due to family priorities. Within their role, the PT or OT is also engaging in discussions and ongoing assessment in all areas of development with a family. This is the perfect opportunity to offer information about options for communication for a child who may not begin to develop verbal language in the same way as their peers.   

Lauren: A few years ago, I began as a secondary service provider for a family, when the PT working with them began this very discussion. Due to his diagnosis, this child was not likely to begin speaking within his toddler years. Although his parents were concerned about his future communication, they did not know that there were options for him to begin using words at the same time as his peers. This PT provided the family with information about an AAC clinic hosted by the local infant and toddler program. Through this process, insurance covered a high-tech device that allowed the child to communicate using eye-gaze.   

Myth #3: High-Tech Comes at High Cost  

This statement is both true and false. Dedicated, high-tech AAC devices (those with digitized displays that change based on user actions) can cost tens of thousands of dollars. It is false that these devices always come at a high out-of-pocket cost. In fact, public and private insurance will cover a variety of devices. It is important to have a knowledgeable specialist provide a thorough AAC evaluation and report.  This website from a device company provides some additional information about funding.

Amanda: I’ve been doing AAC evaluations for EI in Washington, DC for the past three years and have had many AAC devices covered by insurance including mid tech, high tech, eye gaze, and mounting accessories.  Though coverage varies by insurance plan (some private insurances require a copay or deductible, but Medicaid and Medicare typically cover AAC at 100%), there are also grants and programs available to help cover the cost of AAC. 

Lauren: Just this month, one of the toddlers I see received a device through insurance just in time to use it on his family trip to Disney World! 

What Next?   

You do not need to know everything about AAC to begin the conversation. Before you talk with families, though, make sure you have some knowledge of AAC. If you are interested in learning more general information about AAC, there is a fantastic Talks on Tuesday as well as a free AAC 101 Course to get you started.  We have only covered a few of the myths and misconceptions about AAC here. You can find more information and the supporting research through the American Speech-Language-Hearing Association.  Another great step is becoming knowledgeable about the resources for ACC evaluation in your area. Begin by reaching out to local children’s hospitals, rehab centers, and speech therapy clinics in your area to find out if they offer AAC evaluations. Where are they? How can a family contact them? What public or private insurances do they accept?  With this information, you’ll be better prepared to help families begin to explore AAC options and boost communication. 

What are some of the strategies or resources you have used in your professional journey with AAC?  

Share your strategies in the comments below!

References:

American Speech-Language-Hearing Association. (n.d.) Key Issues, AAC Myths and Realities.

Lauren Lamore-Chen has worked in EI in the Northern Virginia area since 2016 and currently works as a Developmental Therapist with the Arlington Parent-Infant Education Program. She has a master’s degree in special education and worked as an instructional coach and special education teacher where she developed her passion for all things AAC. You can reach Lauren at llamore-chen@arlingtonva.us

Amanda Soper specializes in working with individuals with complex communication needs who use AAC systems. She works at a special education school and for the early intervention program in DC. Amanda is an adjunct professor at Gallaudet University and has a private practice, providing therapy services for children using AAC. You can reach Amanda at AmandaSoperSLP@gmail.com

The post AAC in EI: Debunking Common Myths and Misconceptions appeared first on Early Intervention Strategies for Success.

Here’s the question: Whoever, in a million years, thought we’d be doing developmental assessments using video conferencing??

Really, when you think about that, it’s equally unnerving and amazing. Unnerving because it can seem like a completely new way of gathering information about a child’s development without even being physically present with the child. Amazing because you are doing it, and from what I hear, doing it well.

Worries and Successes

Over the past few weeks, I’ve been hearing more and more about tele-assessment, with practitioners sharing common worries like: How will I collect the information I need to score my tool? How will we get the toddler to stay where we can see him? What if the technology doesn’t work? These are very real worries, but the great news is that there are programs out there who are figuring this out. After the initial stress response that came with the shift to tele-intervention due to the pandemic, EI practitioners are settling in and finding answers to these questions. I’ve also begun to hear some amazing successes, such as families who are realizing that they can do this, they know their children so well, and they are valued, essential team members who can facilitate activities while the other team members (aka you) observe and share support.

New Resource Alert! – EI Tele-Assessment Video Chats

To get those successful strategies for tele-assessment out there, I recently hosted two video chats with practitioners and leaders from around Virginia. Each chat is between 35-40 min long and includes five different practitioners discussing how to prepare families and other team members, what tele-assessment looks like, and advice for others who are on tele-assessment teams. Block some time in your schedule to sit back and listen. I’m pretty sure you’ll learn something and hopefully feel like you are not alone in your tele-assessment learning process.

A special thank you to the EI practitioners who participated in this chat: Lauren Bernhard, Speech-Language Pathologist and Jen Saddington, Physical Therapist (Infant & Toddler Connection of Fairfax-Falls Church), Sandi Harrington, Local System Manager and Educator (ITC of of Norfolk), Ginny Heuple, Local System Manager and Physical Therapist (ITC of Greater Prince William), and Maria Grady, Physical Therapist and Service Coordinator (ITC of Loudon).

Another huge thank you to the following EI practitioners who participated in this chat: Brandie Kendrick, Service Coordinator, Human Development Professional, and Intake Coordinator (Infant & Toddler Connection of Danville-Pittsylvania), Kathy Phillips, Local System Manager and Developmental Service Provider and Erica Price, Speech-Language Pathologist (ITC of Middle Peninsula-Northern Neck), Stacie Jackson, Local System Manager and Service Coordinator and Kim Sprangel, Service Coordinator and Developmental Service Provider (ITC of Staunton-Waynesboro).

Strategies for Tele-Assessment

Just to get you started, here are a few strategies mentioned in the video chats:

Be sure to do a quick tech check and planning session before the actual tele-assessment – Meet with the family for 10-15 minutes a few days before the tele-assessment to test your technology, help the family connect, and plan together about where to position the device for the best view. Explain what to expect and talk with the family about any routines they might like the assessment team members to observe.

Let go of your stress about the test and toys – This is such an important tip. Acknowledge the fact that you will not have your assessment kit with you and you will not be able to observe every item on the test – and that is okay. Right now, you will use your coaching skills to help the parent facilitate activities that help you see what you need to see. Yes, you do still need to gather information to summarize the child’s developmental strengths and needs, but look at this situation as an opportunity to grow your assessment skills. Sure, you might provide the family with some ideas of items to have handy if possible (please don’t ask for 1-inch blocks!), but be ready to be flexible and…(see next tip)

Use your knowledge of development and informed clinical opinion to help you observe the child’s abilities during natural activities – Think creatively and consider how you can observe the same concepts and abilities in natural activities. Don’t have the tiny pegs and the bottle? That’s okay – ask to see the child pick up cheerios and drop them in a small cup or toilet paper tube. Be sure to watch the video chats for some great discussion about this!

Look through a functional lens – This is a perfect opportunity to practice translating assessment items into their functional equivalents. Pay attention and observe the child, even in the background while you chat with the parent. Ask about what goes well and what’s challenging. How children interact with others in their environment is as important as any item on the ELAP. Now’s the time when you will really be able to appreciate that so be open and get your functional lens ready.

Do the best you can – In most cases, you will be able to learn enough about the child and family to plan for the IFSP. Do your best, follow-up if you need additional information, and lean on your colleagues for ideas and support. You’ve got this!

Ready to keep learning? Watch the video chats for more strategies from your colleagues!

What’s one of your best tips for conducting tele-assessment?

Have an example of a tele-assessment that went well? Share it in the comments below!

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

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