So far in this series, you’ve learned about the importance of two interventions associated with positive outcomes for children and families. In Part 1, we explored strategies that emphasize caregivers’ awareness and interpretation of their own actions. In Part 2, you learned how to help caregivers identify and use everyday learning opportunities to enhance child development. Now, let’s focus on the third intervention: supporting caregivers’ responsiveness to their children (Dunst & Trivette, 2009; Mahoney, 2009; Swanson, Raab, & Dunst, 2011). For some caregivers, responsiveness comes naturally, especially when there is naturally a good fit between how the child interacts and communicates and how the caregiver parents. When it doesn’t come naturally or the caregiver struggles with responsiveness, it can have a significant impact on the parent-child relationship and the child’s development. Let’s think more about what this looks like and what you can do to support responsive interactions.

Supporting Caregivers’ Responsiveness to their Children

Responsiveness – how a parent or caregiver responds to and meets the needs of a child – has been found to have significant connections to communication and social-emotional development during early childhood (Mahoney, 2009). Responsiveness is one of those concepts that we know when we see it. We know it when we see a mother who reads her child’s cues, even the subtle ones, like when he shifts his gaze to make a choice about which book he wants her to read. We see it when a father hears his baby cry and immediately picks her up, bounces her and pats her back while soothing her with his voice. We see it when a childcare provider uses a warm expression and voice to calm a toddler then invite him into a turn-taking game of blowing bubbles. All of these interactions teach young children that they are important, that adults care, and that their attempts to communicate and engage with others and the environment have meaning.   

Responsiveness is also something that jumps right out at us when it’s not there. Think of the grandmother who ignores her grandson’s vocalizations because he “doesn’t make sense” and who swats him when he acts out from frustration. Think about the mother who misreads her daughter’s arching back and gaze aversion as a personal offense, which negatively impacts their attachment to each other. Or, consider the father whose depression makes it hard for him to respond to his child’s needs consistently or at all. There are many factors that can interfere with a caregiver’s ability to be responsive, and truthfully, we are not always able to mitigate them. We can, however, keep our eyes on responsiveness and encourage it, celebrate it, teach it, and praise it whenever we have the opportunity.

What Does This LOOK Like in Practice?

Here are a few strategies you can use to support responsive interactions between caregivers and children:

Label it when you see it – When you notice a parent being responsive, talk about it. Describe what you saw the parent do and how the child responded. Ask the parent questions to help her identify responsiveness and the impact, such as “What did you do that made Elena smile?” or “What did Elena do after you smiled at her?” Point out the delight the child showed when her parent interacted with her and praise the parent’s efforts.

Model and facilitate contingent interactions – In the context of interacting with the parent and the child together, model contingent interactions that are responsive to the child’s communication and social cues. Talk about what you are doing and why. Coach the parent to notice the child’s communication attempts, movements, or behaviors and help him/her interpret them with meaning. Point out what the child did before and after the interaction and talk about what the parent could do to respond, keep the interaction going, help the child be successful, etc. Just be careful to turn the interaction back over to the parent after modeling so he/she can practice engaging the child. You may be great at using a responsive strategy but that only matters if the parent can learn from you and use the strategy successfully with the child.

Use your voice and facial expressions – Affect is an important part of responsiveness (Mahoney, 2009). Using a warm voice and expressive facial expressions that convey that you are present, engaged, interested, and enjoying the child send an important message. Talk about the importance of affect and provide specific feedback to parents when they are using their affect in responsive ways. This is especially important when interacting with children who struggle with social-communication or who have sensory differences.

Encourage imitation and turn-taking – Use imitation and turn-taking as the vehicles for building responsiveness. When a caregiver struggles with responsiveness, help her understand the back-and-forth nature of interactions and communication. Use simple turn-taking games to entice the parent and child into interactions. Look for turn-taking games that they can enjoy and sustain (for a reasonable amount of time depending on the child’s age and developmental level). Start small, with the parent imitating the child’s actions or sounds, and shape these interactions into turn-taking. Help the parent look for ways he can take a turn whenever the child does something and vice versa. Encourage the parent to expect, wait for, and prompt the child to respond whenever there is an opportunity. Responsiveness is reciprocal but the parent sets the tone.

All three of the interventions you’ve learned about in this series have responsiveness at their core. When caregivers are more aware of how important their own actions and interactions are, understand the learning opportunities they can facilitate during daily interactions, and recognize how to engage and respond to their children to facilitate development, you increase the chances of intervention happening everyday. You also help build stronger parent-child relationships that last well beyond EI. Like I said before, that’s powerful stuff.

Now it’s your turn.

What is your favorite strategy for supporting caregiver responsiveness?

Share your ideas in the comments below!

References:

Dunst, C. J., & Trivette, C. M. (2009). Using research evidence to inform and evaluate early childhood intervention practices. Topics in Early Childhood Special Education, 29(1), 40-52.

Mahoney, G. (2009). Relationship-focused intervention (RFI): Enhancing the role of parents in children’s developmental intervention. International Journal of Early Childhood Special Education, 1(1), 79-94.

Swanson, J., Raab, M., & Dunst, C. J. (2011). Strengthening family capacity to provide young children everyday natural learning opportunities. Journal of Early Childhood Research, 9(1), 66-80.

The post 3 Interventions Every Early Interventionist Needs to Know – Part 3 appeared first on Early Intervention Strategies for Success.

In Part 1 of this series, you learned about the first intervention, which focuses on the caregiver’s awareness and interpretation of his or her own actions. This first intervention emphasizes (to us and the caregiver) the power the caregiver has to positively impact the child’s development through interaction and action. In Part 2, we’re going to dive a little deeper and think about the context of those actions and interactions – where and when learning occurs.

Helping Caregivers Identify & Use Everyday Learning Opportunities

Our second intervention emphasizes the importance of helping caregivers identify and use everyday learning opportunities to enhance child development (Dunst & Trivette, 2009; Mahoney, 2009; Swanson, Raab, & Dunst, 2011). This intervention reminds us that the context for most of the learning a child will do is within his or her interactions with the people and the environment that are most familiar and most constant. We can collaborate with caregivers by respecting what is already happening in the natural environment and helping them notice and take advantage of interactions and opportunities that help the child learn or practice using a skill. When learning is situated in a naturally occurring, familiar context, there are more opportunities for the child and caregiver to practice what they are learning together every day beyond the EI visit. The cognitive load is also decreased since the context is familiar, hopefully making it easier to use a new intervention strategy (for the caregiver) and learn a new skill (for the child). Practice during infant and toddler development is essential so the more opportunities we can help the caregiver provide, the better!

What Does This LOOK LIKE in Practice?

Here are a few excellent strategies you can use to implement this intervention. These strategies were suggested by EI service providers in conference sessions on this topic:

Use the unique interests of the child and the caregiver as your guide. Ask caregivers what they enjoy doing with the child. Ask about the typical flow of the day. Ask about what makes the child laugh (or feel frustrated, excited, engaged, motivated, etc.). Find out what they would like to be able to do together and what that would look like if it worked well. Build on what you find out by observing those activities and routines, talking about the learning opportunities you see, and helping the caregiver learn to seize them.

Individualize IFSP outcomes and goals by including specific learning opportunities that already exist for the family. Ground the outcomes in the context of everyday activities. If the outcome describes how the child will learn to move about independently, place the measurement of the outcome in a typical activity. For example, let’s say that the child will move about her home independently by crawling or walking 10 feet from the kitchen to the family room after each meal. When she can do this consistently across time, we’ll know she’s met the outcome. Plus, the family can see the progress because they can practice the movement strategies in a frequently occurring context that’s natural for them. Including context in outcomes helps families identify with their important role in intervention from the beginning. Individualizing outcomes is a great place to start with building awareness (our first intervention) too.

Observe and join different activities and routines to help the caregiver look for the learning opportunities. There is nothing as effective as “seeing it.” Whenever you can, sit back and observe parent-child interactions and specific routines that are meaningful, problematic, or just typical for the family. Point out learning opportunities that you see. Reflect with caregivers to help them create their own ideas. Encourage them to try out the strategies that come from these conversations while you observe again, provide support, problem-solve, and share feedback.

After the caregiver practices using a strategy, talk about how to extend the use of the strategy in other routines to create more learning opportunities. You can facilitate this thinking process by asking, “When do you think you can use this strategy outside of the visit today? What other times of the day might work for using the strategy?” If needed, ask about other routines you know about and help the caregiver think about how the strategy could be embedded. Have the conversation and land on a joint plan. By doing this, you may be expanding the caregiver’s thinking, which again, overlaps with our first intervention. See, this is powerful stuff.

Now it’s your turn:

What’s your favorite way of helping caregivers identify and use natural learning opportunities? What did this look like on your last visit?

Share your ideas and examples in the comments below! And don’t miss Part 3, the final post in this series!

References:

Dunst, C. J., & Trivette, C. M. (2009). Using research evidence to inform and evaluate early childhood intervention practices. Topics in Early Childhood Special Education, 29(1), 40-52.

Mahoney, G. (2009). Relationship-focused intervention (RFI): Enhancing the role of parents in children’s developmental intervention. International Journal of Early Childhood Special Education, 1(1), 79-94.

Swanson, J., Raab, M., & Dunst, C. J. (2011). Strengthening family capacity to provide young children everyday natural learning opportunities. Journal of Early Childhood Research, 9(1), 66-80.

The post 3 Interventions Every Early Interventionist Needs to Know – Part 2 appeared first on Early Intervention Strategies for Success.

Okay, when you read that title, maybe you were curious, wondering if you were going to learn about three new discoveries that will make your job easier. Or, maybe you did a quick eyeroll, thinking “Here we go, the next big ‘thing’ that I need to do.” Either way, I’m glad you’re here. While I’m not sure that these three interventions will make your job easier, I do think they can make your work more effective. No, these interventions aren’t new or the next big “thing,” but they are based on the evidence we have about what early interventionists do that has a positive impact on child and family outcomes – meaning child development is enhanced, children learn and participate in everyday activities, families understand how to help their children, and quality of life is improved. One of the key aspects of these three interventions is YOU – how you interact with families and what you do to support parent-child interaction. You are a key, so read on and learn what you can do on your next visit to have that positive impact.

Here we go. Interventions that:

1. Emphasize caregivers’ awareness and interpretation of their own actions,
2. Help caregivers identify and use everyday learning opportunities to enhance child development, and
3. Support caregivers’ responsiveness to their children

have been found to be most effective in positively impacting child outcomes (Dunst & Trivette, 2009; Mahoney, 2009; Swanson, Raab, & Dunst, 2011). That’s big stuff. In this post, I’ll tackle what the first intervention looks like in practice. I’ll discuss the other two interventions in Parts 2 and 3.

Emphasize Caregivers’ Awareness and Interpretation of their own Actions

When you implement this intervention, you go deeper than just modeling or teaching caregivers intervention strategies. You approach intervention from the perspective of expanding how the caregiver thinks about her (or his) capabilities, her impact on her child’s development, and the positive effects of her everyday interactions with her child. Some caregivers come to EI already embracing their influence as the parent, but many are in the vulnerable position of being a new parent or a parent of a child with strengths and needs that are different from what they expected or previously experienced with other children. Early intervention can be a new window through which to see a child’s potentialities, and we can open that window with how we approach the support we provide.

I truly believe that it’s not enough to tell families that “you are the expert on your child.” Those can be empty words if we don’t back them up with support that builds on what caregivers already know and do. We need to convey, through practice and intentional interactions, that the parent is just the right person to help her child grow and learn, she is enough, and what she does really matters. She may not have entered the program knowing how to stretch her child, how to prompt her child to increase vocabulary, how to teach her child to sign, or how to regulate herself so that her child learns to manage his emotions – and that’s all okay. We are there to teach, guide, and help the caregiver become aware of, embrace, and learn to interpret the link between her actions and her child’s behaviors, interactions, and learning. That’s a deeper level of engaging families, a level at the core of who a parent is. Full disclosure – I don’t think this is easy (often it’s not), but I completely believe that if we walk in the door of every visit with the perspective that we are there to look for opportunities to build the caregiver’s awareness of her own actions and help her learn to interpret that impact, what we do and how we do it changes – for the better.

What Does This LOOK LIKE in Practice?

Here are some strategies I’ve learned from EI practitioners in recent conference sessions where we talked about this intervention:

Use open-ended questions to help the caregiver reflect and think about what she (or he) is doing and why. Ex: What did you notice…? What did you see Jack do when you…? Why do you think that happened? 
What did you do differently that time? What could you do differently next time to help Jack learn to…?

Look for moments to build awareness and interpretation. Keep your eyes and ears open for opportunities to point out those moments when the caregiver interacts with the child in ways that enhances development. Adult learners typically want to know if they are doing something “right” so reinforcing positive interactions helps caregivers know they are on the right track.

Provide specific feedback that points out what the caregiver did, what the child did, and the relationship between the two actions. Help the caregiver make the connection, then ask what she thinks about it. Ex: When you waited before helping Emma stand up, she reached up for the pack ‘n play bar to try to stand herself up. What did you think about that?

Use video recordings to build awareness and interpretation. Record the caregiver using a strategy with her child using her cell phone. Then, watch the video together and process it using reflection and feedback. Share what you notice and ask the caregiver about her observations and feelings. Problem-solve if the strategy or interaction can be tweaked to help the caregiver get closer to her goal for the child. You can also encourage the caregiver to record short videos between visits to watch together during the next visit. These videos can become joint plans and records of progress too, so their value (and the learning opportunity) expands beyond the reflection point that happens during your visit.

Now it’s your turn:

What strategies have you used to build caregivers’ awareness and ability to interpret their own actions? What did this look like on your last visit?

Share your ideas and examples in the comments below!

In Part 2, I’ll dig into the second intervention to explore how to help caregivers identify and use every day learning opportunities…and what to do when this is hard. In the meantime, pay attention to how you build awareness on your next visit. Use this series to help you celebrate when it goes well and problem-solve when you need help. Let’s learn together!

References:

Dunst, C. J., & Trivette, C. M. (2009). Using research evidence to inform and evaluate early childhood intervention practices. Topics in Early Childhood Special Education, 29(1), 40-52.

Mahoney, G. (2009). Relationship-focused intervention (RFI): Enhancing the role of parents in children’s developmental intervention. International Journal of Early Childhood Special Education, 1(1), 79-94.

Swanson, J., Raab, M., & Dunst, C. J. (2011). Strengthening family capacity to provide young children everyday natural learning opportunities. Journal of Early Childhood Research, 9(1), 66-80.

The post 3 Interventions Every Early Interventionist Needs to Know – Part 1 appeared first on Early Intervention Strategies for Success.

Once upon a time, a local EI system manager was planning her staff meeting and thinking, “I wish I had a quick staff development activity to help my staff reflect on their intervention practices.” Then, she looked at the time and, with a sigh, realized she didn’t have time to come up with something or search the VA Early Intervention Professional Development Center site or the internet for ideas.

“Oh well,” she thought, “maybe next time.” Except that next time the same thing happened. Good intentions but limited time to pull together staff training – that was her reality.

Does this sound familiar? Don’t worry, we’ve got you covered.

In response to a request from a local system manager here in Virginia, we have created a group of free, easy-to-implement staff development activities called Learning Bytes. These activities are relatively short in duration (depending on your group size, how talkative your group is, etc.) and designed to address training needs expressed by supervisors. Each learning byte has everything you need to pull off an effective – and brief – training activity during a staff meeting or inservice. Each pdf includes a purpose statement, list of materials you’ll need, detailed step-by-step instructions, handouts, links to online resources, and answer keys (as appropriate) with guidance on how to debrief. The learning bytes are organized by topic tabs, and so far include: Assessment, EI Service Delivery, IFSP Outcomes, Interest-based Learning, Professional Responsibilities & Considerations, Service Coordination, and Substance Exposure. As of today, we have posted 33 learning bytes and more are on their way!

So next time you find yourself wishing or searching for a quick activity to help your staff brush up on their skills, reflect on their practices, or learn something new, be sure to check out our Learning Bytes page. You can find it from the VEIPD homepage under EI Topics & Tools!

What activity ideas to you have? What does your staff need to learn? 

How could YOU use a learning byte at your next staff meeting?

Share your thoughts in the comments below and we might build a new learning byte with your idea!

The post Learning Bytes: Activities YOU Can Use for Staff Development appeared first on Early Intervention Strategies for Success.

On a given day, you might have anywhere from 2-6 visits with families. If you step back and reflect, how do these visits typically work? There may be a similar way you begin or end your visits. You may find yourself conducting visits in the same parts of the home across visits or asking similar questions of families. Would you say that there is a “culture” to how you practice EI?

The article below challenged me to look at EI from a cultural point of view. We talk all the time about how individualized EI must be in order to be most effective, but the reality is that the way in which home visits are conducted is often similar across providers. Having a similar framework for visits doesn’t preclude individualizing; it seems to me that this could be fine line, though.  Visits could be conducted in such a similar, even predictable manner that the ability to individualize to child interests, family routines, or changing priorities becomes challenging. Or, having a similar, cultural framework across visits could provide the stability needed to allow the provider to individualize. Read on and see what you think.

Source: Brorson, K. (2007). The culture of a home visit in early intervention. Journal of Early Childhood Research. 3(1), 51-76. (PDF, New Window)

Research: What Do We Know?

Brorson (2007) conducted a qualitative study of one EI program to examine how services were delivered. Four families and seven service providers participated in the study. Families and providers participated in multiple videotaped observations of visits and multiple interviews. A review of program documents was also conducted. Results revealed information about the structure of a typical home visit, values and beliefs of providers, and program philosophy.

Typical Home Visit – Brorson noted that the typical home visit included eight parts: 1) planning,  2) greeting, 3) activities, 4) observation, 5) demonstration, 6) shared knowledge, 7) follow-up, and 8) scheduling.

Beliefs of Providers – Providers espoused a belief in collaborative, family-centered interactions with parents, but this was not seen in observations of visits, interviews, or in the reviewed documents. Instead, providers were observed to educate rather than reciprocally collaborate with parents.

Program Philosophy – Brorson described five assumptions that appeared to guide staff in the delivery of services. These assumptions were:

• Structured activities provide the frame for the visit and the means through which the family learns what to expect.
• The culture of a home visit is stable across families, providers, treatment techniques, etc. This stability is established by how the provider conducts visits, which tends to be similar across families though does allow for individualizing.
• Delivery of EI services “is in a constant state of change requiring therapists to become perpetual learners.” (p. 64)
• Providers play a leadership role during visits in educating families about the culture of visits.
• Providers have their own individual definitions of family-centeredness (rather than a shared understanding and implementation).

Because this study only focused on a single program and a small sample of families and providers, generalization is not really possible. However, insights learned from this study can be used by providers and program administrators to reflect on the culture of how EI is provided in their programs.

Practice: How Can You Use What You Know?

Yes, this article is older now, but I think that the insights learned in this small study are fascinating. Let’s think about these insights and how they might apply today:

Typical Home Visit – These 8 parts of a visit look very familiar to me, especially when I think of a more traditional model. When I compare these parts to more recent thinking related to caregiver coaching and collaboration, a few important pieces appear to be missing – the opportunity for the caregiver to be in the lead and practice using strategies with the child, reciprocal reflection and feedback, and joint planning for what happens between visits. Spending a few minutes reflecting on which of these parts and pieces of a visit typically happen on YOUR visit could help you identify your strengths and where you’d like to improve.

Beliefs of Providers – We all are pretty sure we understand family-centered practices, but do our understandings match with the literature? Do we practice what we preach? On your visits tomorrow, pay attention to how much you actually collaborate with the parent. Are you doing most of the talking and the work during the visit, or are you sharing the conversation and collaborating to support parent-child interaction?

Program Philosophy – If we accept that we play a leadership role with teaching families how to interact during visits, then that reminds us that families probably don’t start out knowing what they are supposed to do. Remember to take the time on your first few visits to help them learn how the process works. Educate them in the importance of their active participation and practice during and between visits. You may do this the same way across families, but does that mean that all visits should basically look the same? I don’t think so. Your methods may be similar, and your underlying philosophy maybe similar across families, but the activities of the visit should look different – if you are individualizing to child and family interests, environments, and priorities and joining family routines.

So here are the questions I’d like you to consider in the comments below:

Is it okay for your visits to basically work the same way across families? Why or why not?

If you espouse family-centered intervention beliefs, are you implementing them?

How would you describe the culture of visits in your program? In your individual practice? Does it match with Brorson’s findings? If not, how is it different?

Disclaimer – I’m a big believer in calling visits “intervention visits” rather than “home visits.” This reflects the evolution of practices in our field from focusing on the home as the location for EI to focusing on intervention, which can happen anywhere. I used “home visit” in this post to match the language used in the Brorson (2007) article, but in my happy little world, we’re moving away from that phrase to something more reflective of recommended practices. 🙂

The post Research to Practice Brief #6: Home Visiting Beliefs and Practices appeared first on Early Intervention Strategies for Success.

In Virginia, we’ve spent the past few years working hard to learn about and adopt coaching practices. Six regions in our state have completed two levels of coaching training for master coaches and coaching teams. In total, 84 Master Coaches and 278 coaching team members participated in training and follow-up technical assistance with the coaching gurus, Dr. Dathan Rush and Dr. M’Lisa Shelden. We’ve seen impressive regional efforts blossom, led by master coaches and team members who are dedicated to using coaching when interacting with families. Now, we are in a phase of trying to figure out how to sustain this effort, to continue the learning and growth that began, for us, back in 2012.

You Asked For It…

Over the past few years, we’ve repeatedly heard from master coaches and supervisors that they just weren’t sure how to support their colleagues and staff to continuing their coaching work. Folks were concerned that service providers were sliding back into their old ways – playing with the child for the whole visit, giving the parent homework, etc. They asked for more support, PowerPoints or something that they could use in their local programs or regions to keep coaching fresh and continue the learning process. From those discussions, we decided to put together a guide to help these local leaders do just that.

We convened a small workgroup of master coaches who met monthly to brainstorm professional development activities that could be easily implemented as a book study to extend the learning from The Early Childhood Coaching Handbook (Rush & Shelden, 2011). This work culminated in our newest resource, Virginia’s Coaching Facilitation Guide (PDF, New Window). The guide is now posted on the Coaching in Early Intervention topic page on the Virginia Early Intervention Professional Development Center site. Soon, a PowerPoint will also be posted that can be used to provide an orientation to coaching practices for new service providers.

And Here It Is…Virginia’s Coaching Facilitation Guide

The Coaching Facilitation Guide is intended to be used by master coaches and program leaders to facilitate discussion at regular meetings about the use of coaching during EI visits. These could be staff meetings, regional provider meetings, or even at a local community of practice. If your program doesn’t have one of these meetings currently scheduled, you could use the guide to get a regular coaching group meeting off the ground. Or, you could plan to do one activity at a meeting that is already on the books. How you use the guide is up to you!

Here’s a quick peek at the Coaching Facilitation Guide’s contents:

• Introduction and Facilitation Tips
• Section 1 – What is Coaching in Early Intervention?
• Section 2 – Characteristics & Beliefs of EI Practitioners Who Use Coaching
• Section 3 – Interacting with Parents & Caregivers
• Section 4 – Implementing the Components of Coaching during EI Visits
• Section 5 – Coaching Families & Caregivers in Special Situations
• Conclusion

Each section has from 3-9 activities, each of which include specific instructions (including the purpose of the activity, materials needed, length of time, and steps to facilitate the activity), links, handouts, and answer keys. Guidance for what to do before, during, and at the end of each meeting during which you use the activities is also provided. Most of these activities have been piloted at regional coaching groups and edited based on user feedback.

The Coaching Facilitation Guide is free to use, and we would love to hear how you’re using it. We want to know about successes and challenges; any feedback is always welcome. We hope the Guide will help you and your staff avoid the backslide into old practices and extend the coaching work in your program and across the state!

Implementation Project – Get Involved!

We are just beginning an implementation project to support the use of the Coaching Facilitation Guide in Virginia. The project will include 6 months of online implementation support for local leaders who are using the guide in their localities. Local coaching leaders will be meet online 1x/month to discuss related topics for each section of the Guide, process their experiences with using it, and plan for how to use each section with their staff/colleagues. We are currently recruiting Virginia leaders by October 16th who are able to commit to the 6 month support. If you’re interested, please either comment below or email me at dcchildress@vcu.edu.

Questions? Ideas? Thoughts about how you can use the guide in your program?

Let me know in the comments below!

For more detailed information about Virginia’s Coaching Facilitation Guide (PDF, New Window) and the implementation project, check out the archived webinar, 3…2…1…Blast Off! – Launching Virginia’s Coaching Facilitation Guide.

The post VA’s Coaching Facilitation Guide – A New Tool for Local Coaching Leaders 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.

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.

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.