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.

The post 3 Key Strategies for Building Relationships with Dads appeared first on Early Intervention Strategies for Success.

Let’s get right to the point. You are not trying to engage an infant or toddler on video for 45-60 minutes during your virtual visit. Re-read that last sentence and let it sink in. Take a deep breath in and breathe out any expectation you may have had about playing with the baby you see on video. When we step back and let our anxiety about tele-intervention settle, it’s easier to realize that there is very little chance of a 2-year old interacting with you on video for more than a moment or two – and that’s okay. You can still do early intervention without that interaction when you focus on engaging the parent (or other caregiver) who will then engage the child. If you think about coaching and the Mission of EI, that’s where your focus should be anyway. You’ve probably already been doing this and if not, you can do it now.  

Okay, you might be asking yourself: If I’m not interacting with the child, what do I do instead?

Let’s answer that question.

What Do You Do?

Now, more than ever, early interventionists are using their coaching skills to engage parents during virtual visits conducted using video conferencing technologies. Interventionists have been thrust into the world of tele-intervention (you might know it as telepractice or telehealth) with often little preparation or experience. The whole world has shifted and it feels like EI practice has shifted along with it (and they have).

Here’s what hasn’t changed, though: You are still a coach to the parent/caregiver. Your primary mission is to support caregivers so they learn ways to interact with their children during everyday routines and activities to encourage development. Whether you are sitting in their home or yours, you are still a coach. You did not coach the child before tele-intervention; you coached the parent. You probably did spend time playing with and engaging the child, practicing stretches, prompting for sounds, and challenging the child’s problem-solving or social skills. You probably modeled the use of strategies in these activities for the parent. Now, you have to figure out how to let go of your need to directly interact with the child and embrace the golden opportunity you have to support the parent’s learning.

Here are 10 strategies for focusing on parent/caregiver learning during tele-intervention. You can do this!

10 Strategies for Engaging Parents during Tele-Intervention

Before the Visit:

1. Prepare with the parent – Touch base by phone before the virtual visit to discuss technology needs and answer questions. Plan for how to connect, what device the parent will use, and how it will be positioned so the parent can see you and you can observe the parent-child interaction. Plan for how the parent will access the link you will send to the virtual meeting platform. Consider different types of devices and how access might look different (a quick google search for instructions can be helpful if needed).

2. Prepare yourself – Before the virtual visit, collect your thoughts. Remember that you don’t need toys because you are not trying to engage the child. You may need a prop, such as a doll or teddy bear to model movements for the parent, but you can put your bubbles away.

3. Preparing for what to do – Chat with the parent about ideas for what to do during the visit. Be prepared to follow the parent’s lead and let her know she can take you with her in whatever she and her child do during the visit. You can also plan for activities, like if you are going to work together on the child’s feeding or encourage play skills with siblings who are also home. Just like any visit, though, preparing can go right out the window if another opportunity arises or the family needs the visit to go in a different direction. Prepare when you can, but go with the flow when you need to.

During the Visit:

4. Take time to check in – Just like any other visit, touch base on how the family is doing and check in on child progress. This check in time may take longer now and that’s okay. Remember that everyone is adjusting to the new normal so approach this relationship-building time with ease.

5. Use your voice to join in (instead of your body) – Join the activity you planned or search for opportunities based on what you see. Observe that feeding session, watch the siblings play, and use your coaching skills to share your observations, ask reflective questions, and provide verbal guidance on how to use intervention strategies. You have to use your voice to join in so be gentle with your suggestions and always ask the caregiver what she thinks, how it feels, etc.

6. Be descriptive and specific – When you provide guidance, share observations, or give feedback, be specific and describe what you see and what you suggest. Following verbal directions might be harder to process for the parent who is used to watching you, so take it slow and check in frequently.

7. Be flexible – If the visit is a little shorten than usual, that’s okay. Be sure to document why. If what you planned with the parent falls flat, try something else. If you end up discussing development more than observing it, especially on your first visit, that’s okay. Use the “show me…” prompt to move from discussion to observation and support; it’s a great tool on an in-person visit and it’s your best tool now.

8. Keep your focus on the parent, who facilitates learning for the child – This is key. This is also best practice in EI whether you are face-to-face or on video. What you can help the parent practice during the visit with the child is more likely to continue between visits. Use your coaching skills to keep the focus on parent learning, which extends learning to the child.

9. Write down the joint plan – Plan with the parent as you always do, but create a written version of the joint plan at the end or after the visit. Email or text the plan to the parent as a reminder and follow-up on that plan at the start of your next visit.

During and Between Visits:

This last strategy might be the most valuable right now:

10. Cultivate patience for the parent and yourself – Providing intervention this way might feel wobbly nowand that’s okay. Both you and the parent are in the midst of significant change, and not just for the EI visit. Being patient with the family will help them feel comfortable with this new way of interacting with you. Being patient with yourself means giving yourself permission to feel nervous and stumble, laugh about it, learn, pat yourself on the back, and try again next week.

Consider this: Your relationship to early intervention and with the parent has changed because of the pandemic and tele-intervention, but maybe that change is for the better. This way of supporting parents (and children) might make you a better coach. Give it time, approach intervention with openness, and take a deep breath. We will all be okay.

What strategies are you using before or using your tele-intervention visits to engage parents?

What’s working well? What’s challenging you?

Share your tips and experiences in the chat below and let’s support each other. 🙂

For information, videos, webinars, and online training related to tele-intervention, visit these sites:

COVID-19 and EI Tele-Intervention Updates – VA EI Professional Development Center

Coronavirus Disease (COVID-19) – ECTA Center

For technology tips and links to video reflections about tele-intervention, check out these posts:

7 Technology Tips for Tele-Intervention

Introducing Teleflections©: We’re All In This Together

The post 10 Strategies for Engaging Parents (not Children?) during Tele-Intervention appeared first on Early Intervention Strategies for Success.

In evidence-based early intervention, our primary aim is to coach, rather than to “do therapy” ourselves. We teach families how to help their children. The most challenging part of coaching can be finding effective ways to invite parents to participate and join in the interactions with their child.

Location, Location, Location

As therapists, it is natural for us to think about our relationship with the child in service. After all, we are teaching the child. That’s what we are trained to do. Right? Not exactly. We’re teaching the parent, so that the parent can teach the child. That changes the relationship. Our relationship with the parent, and the parent’s relationship with the child suddenly become much more important when we look at them through this lens. As coaches, we know that the interactions that the parent has with the child are primary and we work to keep those interactions at the forefront. I’ve learned to place myself behind a child rather than in front of him during an activity, or to create a triangle between myself, the mom, and the child. This breaks up the traditional child-therapist pair and gives the parent a space to join in. Locations other than the living room floor that can make this easier include the couch, a high chair, a table, or wherever the parent and child typically spend time together.

Start with Routines

Keep in mind that unless parents have been involved with coaching before, they’re probably expecting traditional therapy. All parents want to be involved and want to help their children, but they may not know how to step in and participate, especially during playtime. Coaching phrases like, “Do you want to try this?” or “Can I model that for you?” can feel awkward to deliver if you aren’t used to them. And we all know, if you feel awkward, it will be awkward.

Rather than starting with an activity that we initiate, we can set the stage for authentic parent involvement by observing the family’s natural routines first. I sometimes ask parents what they would be doing if I wasn’t there. Is it snack time? Does little Joey need a diaper change? This leads naturally into a mutual discussion about ways to increase interaction and language in everyday activities. If it is snack time and Joey heads for the refrigerator or brings us his cup, we have a perfect opportunity to introduce a word or sign for “eat” or “drink”, model and practice offering choices to build language, or encourage eye contact as a first way of requesting. Snack time, diaper changes, and dressing are activities that parents generally do so they are more likely to take the lead and give us a chance to support and encourage, rather than waiting for us to lead an activity.

When You Have to Play

If parents seem more inclined to hang back, say that their child normally plays by himself while they do other things, or are otherwise hesitant, we may have to fall back on some more traditional therapy or play activities. This is when we are most likely to lose parent interaction if we don’t keep it at the forefront. If we are looking at a book, rolling a ball, working on a puzzle, blowing bubbles, or doing any other traditional therapy activity, it is very easy to let the focus drift back to us and the child. I have to work to consciously keep the parent-child interaction at the forefront, rather than my interaction with Joey. If we are looking at a book and working on pointing out pictures, I stand or sit behind him and put the parent in front of us or next to Joey on the couch to ask those, “Where’s the…?” questions and help him point out the pictures. This tends to feel much more natural and I find it less intimidating for everyone. It also increases the chance that the next time Joey brings a book to his mom, she will point out a few pictures rather than reading complicated text because we’ve practiced this together.

If I’m rolling a ball or car back and forth, once Joey is into the game I roll or throw the ball to his mom and have her join the game that way. If Joey is having trouble getting into the game, I sit behind him and help him throw the ball to his mom, rather than encouraging him to throw the ball to me. I find that most parents want to participate with us, we just have to invite them in. The responsibility for not pushing parents out is with us, even when we are working with more traditional play activities.

Stepping Back in Trust

Once we have used location, positioning, routines, and a bit of creativity to get parents engaged and interacting with the child, this is when the magic happens. Once we have the parents involved, our job is to get out of the way. When I am in a visit, I feel this as a continual sense of stepping back from the parent-child dyad, maybe most during those times when I really want to get involved. If they are engaged in a social game or activity, the last thing I want to do is get in the way. I may give a suggestion of something to try, but I often stop myself from even doing that much.

Wait It Out

Instead, I tend to smile and nod encouragingly and wait. The last thing we want to do after the parent gets involved is to pull her back out of the activity again and put the attention on us rather than on Joey and the interaction. Generally, it lasts a few minutes and then the child is off to something else. This is my time to open a discussion, starting with, “Wow, he loved that game and he was really engaged with you.” From there we might reflect together and move to brainstorming strategies. If parents struggle with coming up with a strategy I might share some expertise with ideas like, “Next time you play that game with him, wait a little bit longer for him to look at you.” Having parents reflect first gives them an opportunity to think about how an activity went before I add to their thoughts. This encourages them to seek out and capitalize on opportunities for interaction during the time when I’m not in the home.

While it can be challenging to encourage parents to join in on the interactions during visits, paying attention to our words and actions can help us to create space for parents to actively participate rather than watching us play.

What strategies have you found for encouraging parents to join in during intervention visits?

Share your strategies in the comments below!

Stacy Zogheib has been a Developmental Specialist in Arizona since 2006. She has a Bachelor’s degree in Elementary and Special Education from Wittenberg University, and a Master’s degree in Early Childhood Education from Northern Arizona University. Stacy has a passion for supporting and empowering families with young children who have delays or disabilities. You can reach her at: stacypro@yahoo.com

The post Coaching from the Outside appeared first on Early Intervention Strategies for Success.

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

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

5 Strategies for Responding to Discomfort

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

Here are 5 responsive strategies to help you manage discomfort:

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

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

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

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

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

How Much Discomfort is Okay?

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

What do you do when a parent seems uncomfortable? 

Share your experiences and strategies in the comments below!

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

You are committed to helping families practice using intervention strategies during your visits. You truly believe that’s an important part of the intervention process. You’re very aware of your own interactions during visits and try hard not to “hog” all of the child’s attention. You redirect the child’s attention from you back to the parent whenever you can, use intentional modeling, and encourage the parent to engage her child. You know how to do this…but you still feel like it’s a struggle sometimes to stay in your lane.

True Confessions

Okay, true confessions time. The “you” here is actually me. Recently, I’ve been working with some wonderful families and am trying hard to be sure that they have opportunities to practice using intervention strategies. It’s hard, though, when the children behave as if they prefer to play with the biggest new toy in the room – me. I’m pretty good at making kids laugh, keeping their attention, and prompting them for words or actions. Plus, it’s just fun. However, I know that my strengths are not the totality of what’s needed here. Sure, I’m visiting to help the child learn and achieve the outcomes on the IFSP, but that’s not the whole reason I’m there. I absolutely believe that my actions on the visit will make the biggest impact if I use them to help the parent learn strategies she can use when I’m not there. I know what to do…it’s just the implementation part that can be hard.

Here’s the Challenge…

Here’s the challenge – we take what we “know” and “believe” and then have to use it in different homes with different families who have different ways of interacting with one another. They also likely have different understandings of how EI works, different ideas about why their child has a delay, different ideas about what will help, and different expectations for visits. We have to adjust what we do and how we do it to adapt to these differences.

As our field has evolved, we’ve learned that the best way to impact the child’s development is through the parent. We have to find ways to share what we know so the parent can confidently use that information between visits, when we aren’t there. Sure, we can just play with the child while the parent watches and hope he/she “gets” it. Or, we can use the visit to really partner with the parent to develop and practice intervention strategies with the child that match how they learn and interact. We can spend our time together reflecting on what the parent and child do together. We can problem-solve, plan, and practice strategies during the visit to help them achieve their goals. This requires us to stay in our lane – meaning that we remember our roles as coaches, consultants, and supports to parents, not just play partners and “teachers” of children.

4 Strategies to Help You Stay in Your Lane

Here are a few strategies that might help you stay in your lane:

Explain how the practice component of EI works at your first visit – Set the tone for good early intervention by explaining how you will work together with the child. Share your goal of using the visit as a practice session for the parent and child to try out intervention strategies, with your support, so they can use them between visits, when most of the learning will occur. Prepare the parent and she’s more likely to feel comfortable jumping in.

Take time to learn together – Let parents (and children) have time to warm up. Find out what they like to do, what they want help with, how they like to learn, and what is motivating for them.  This doesn’t mean that coaching has to wait…but sometimes it might take a few visits before the family is comfortable enough to be coached. During this warm-up time, you both are learning how to work together and that’s okay.

Be intentional – Go into the home with the mindset that you are there to help the parent and the child – not just the child. Be intentional about asking open-ended questions about what’s going well and where the struggles to find out how to help. Look for and seize parent-child interaction opportunities when the parent can practice using an intervention strategy. Be intentional in facilitating interaction, reflecting on it, sharing feedback, problem-solving and planning together.

Stay in your lane – Be mindful of what you’re doing in the moment. Pay attention to where you place yourself, what you do, and how you do it. Use your knowledge and skills to help the parent engage her child. Yes, you will use modeling. Yes, you will playfully engage the child. When you veer out of your coaching lane and find yourself as the biggest toy in the room for too long, swerve back into your lane and refocus.

The truth is that, even with these strategies, every visit is different and some will be awesome, while others will leave you feeling glad you have a do-over next week. We have to be patient with ourselves and with families, remembering that we are partners who are growing and learning together. Walking in the door with the intention to stay in your lane and make room for parents to practice using strategies with their children is a great place to start.

When you’ve swerved out of your lane for too long, what do you do?

How do you keep your focus on facilitating parent-child engagement and practice during your visits?

The post 4 Strategies to Help You Stay in Your Lane During EI Visits appeared first on Early Intervention Strategies for Success.

It’s Thursday afternoon and I’m banging my head on the steering wheel after my home visit. Why? Because I’ve spent the last hour coaching this family to stop giving their two year old a bottle when she can drink from a sippy cup, straw, and an open cup. It’s not like we haven’t worked on this IFSP goal every week for the last 4 months. It is such a struggle for me–what is the point of me going if they aren’t going to follow through?

WAIT! The struggle isn’t about me.

I recently came across this video about leadership and coaching that used a butterfly emerging from a cocoon as an illustration. The man watching saw the butterfly struggling and finally decided to help. Unfortunately, the struggling is important for the butterfly’s wings and body to correctly form. By helping, the man caused more harm than good.

This made me ask myself: Am I helping this family by sharing my experience and knowledge with child development or am I harming them by not coaching them to solve the problem themselves?

The following coaching strategies recommended in this video shaped the next few visits I had with this family.

Ask Questions – I asked more questions about the bottle. I learned that the issue isn’t the little girl drinking from a bottle, but being consoled in the middle of the night when she cries too loud and wakes up other family members.

Explore the Situation – I was able explore the family’s bedtime routine and brainstorm with the family possible replacement behaviors for the bottle to soothe the little girl.

Have Patience – It has been two more months since I began viewing this struggle differently. The little girl is still taking the bottle, but the family is trying some of the strategies we come up with during visits. More importantly, they have shared other challenges and ways they have tried to work through them (they don’t wait for me).

The struggle is still real, but I now realize how important it is for the family and I can see the beautiful results emerging!

What are some of the problems your families have struggled with?

Are you coaching to solve their problem for them or coaching them to solve problems themselves?

Laura Harrell is an Early Interventionist and Early Intervention Resource Agency Manager with Prospect. She has provided developmental therapy to families just east of Nashville for the last three years. Laura previously worked for ten years in Alabama with Early Intervention, Childcare Enhancement with a Purpose, and Assistive Technology. She can be reached at: Lharrell@prospectinc.com

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Ever had one of those experiences where you realize that, while you think you did your best, you completely forgot what you were supposed to do? Ever had that experience on an intervention visit?

I had that experience recently…I was on a first visit with a family and was planning to set the stage for how we would work together. I was going to talk about what good early intervention looks like and how we would work together doing things the family naturally does or would like to do. I was going to stay firmly planted in my role as a consultant and coach for the parent. But, before I knew it, I was instead firmly planted on the floor by an adorable, funny toddler who was pulling out all of her tricks to get me to interact with her. After a few minutes (okay, more than a few), I realized that I was in the lead, the parent was watching, and I had gone off track. I relocated back to the couch and re-engaged the parent, and yet, before I knew it, I was up playing another game with the child. I just kept getting pulled in. In fact, I felt pulled in two directions and both of them were worthy. After the visit, I got in my car and realized that I felt like I had completely forgotten what I intended to do on the visit, which was focus on the parent-child interactions.

Was What I Did Wrong?

So that’s the question that came up for me…was what I did wrong? By spending time engaging the child, did I break the code of evidence-based early intervention, which focuses on supporting parents and children during their interactions in the context of their routines and activities? Honestly, I don’t think so, but what I did probably wasn’t the best way to help the parent know how to use intervention strategies with her child when I wasn’t there. Yes, she watched…yes, she talked about how she could use the strategies during the day…and yes, we developed a joint plan. What I could have done much better was remember to offer her the opportunity to practice using the strategy with her child. That was what I forgot.

So the more I reflected, the more I realized that I’m not sure that we were ready for the practice piece. It was a first visit and we were still getting to know each other. Even if I had remembered and offered practice opportunities, I’m not sure that she would have been comfortable yet. In typing that, I realized that it sounds like an excuse…well, she wasn’t ready so we didn’t do it. No – that is my assumption and it could be incorrect. I did not offer her the chance to try to strategy so how did I really know whether or not she was ready? Just thinking through that reminds me of what I’ve heard so many parent advocates say: “Don’t make decisions about what we need or what we want to do. Give us the information, provide the opportunities, and let us decide.” That was where I goofed.

Developing the Partnership that Facilitates the Practice

I do think that the close partnership between an early interventionist and a parent takes time to develop. Offering the parent the opportunity to take the lead, be observed, receive feedback, and decide which strategies he/she wants to use are activities that don’t need to wait until we have a certain level of rapport built. However, I think understanding that as the relationship builds, BOTH of us will feel more comfortable in our roles and those easy back-and-forth interactions of reflection, practice, and feedback should happen more fluidly. It has to start somewhere, though, and if I don’t remember my role in facilitating it, it may not happen. I set the tone of the visit, and I want that tone to be that I am there to support the family, not to just play with and teach the child.

Reflection is hard, but we don’t have to be hard on ourselves. I’ll go into the next visit with a greater awareness of what I need to do and how I hope to help the family. Yes, I’ll still likely get pulled right in by an amazing toddler, but next time, I will remember to pause and invite the parent along for the fun. Or better yet, maybe I can join their fun instead!

Have you ever felt like this? What did you do?

How do you balance engaging the parent and the child? What do you do to keep yourself on track?

The post Oops…Guess What I Forgot? appeared first on Early Intervention Strategies for Success.

When we whittle early intervention down to its core, I think it’s all about interactions. Interactions between the child and caregiver, first and foremost…interactions between the child and the environment (toys, sofa cushions, spoons and cups, buttons on the TV remote, the family dog)…interactions between the EI practitioner and caregiver that facilitate positive interactions with the child in the natural environment. See where I’m going here? It’s all related to positive, reciprocal, contingent interactions.

Translating our Super Powers

The Division for Early Childhood (DEC) Recommended Practices provide our field with a list of five interaction practices that we can use to “promote specific child outcomes” (p 14) when working with families. As early interventionists, we often have super powers related at using these practices – we know how to use our voices and language to engage children, how to observe behavior and encourage reciprocal communication, and how to help children sustain interactions and respond to the environment. Our use of our super powers won’t ever be enough, though. We have to use what we know to help others interact with the child in ways that boost development and learning. When caregivers use recommended practices for interaction, the child has more opportunities to develop social skills, communication, cognition, and independence throughout the day. Those daily interactions are what really matter.

Helping Caregivers Use the DEC Interaction Practices

Let’s consider the first three practices, which focus on promoting social and communicative interactions.

INT1. Practitioners promote the child’s social-emotional development by observing, interpreting, and responding contingently to the range of the child’s emotional expressions.

Early interventionists are great resources for caregivers in helping them observe and interpret their child’s behavior. This is especially helpful with children who communicate in ways that are harder to understand, such as children who may have autism or those with multiple disabilities. The interventionist can help the caregiver notice the child’s attempts to engage and communicate. Then, they can figure out how the caregiver can respond in ways that help the child learn the benefits of engaging others.

Example: An educator sees a child’s tendency to stroke his mother’s hair as an attempt to engage the mother and feel close to her. The mother originally found the “hair pulling” slightly annoying, but when she sees the possibility that it represents affection from her child, she can respond to the child with a warm smile and voice, encouraging rather than discouraging the interaction.

INT2. Practitioners promote the child’s social development by encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support.

Early interventionists can help caregivers seek out opportunities for the child to interact by observing typical routines, especially those that the caregiver and child enjoy together. By asking the caregiver open-ended questions (“What makes your child laugh? What do you like to do together? When do you do to spend time together? What would you like to do together?), the interventionist can identify activities to target for intervention.

Example: An occupational therapist (OT) observes the morning dressing routine, during which a mother plays peek-a-boo and tickle games with her infant. The OT coaches the mother to use an expectant look and extra wait time to facilitate her child’s engagement and teach her child how to take turns, make sounds, and perhaps pull the blanket from the mother’s face to keep the game going.

INT3. Practitioners promote the child’s communication development by observing, interpreting, responding contingently, and providing natural consequences for the child’s verbal and non-verbal communication and by using language to label and expand on the child’s requests, needs, preferences, or interests.

Rather than being the communication partner for the child for most of the visit, the interventionist can coach the caregiver in how to respond contingently, use words that are just above the child’s language level, and expand on what the child says. This works well during play and other routines.

Example: A speech-language pathologist coaches a father in how to expand a child’s gestural request for his cup to be filled with water. The child hands his cup to his father and walks away. Through modeling and practicing simple prompts, the father can learn to label the child’s request (“More water?”), hold the cup up near his own mouth to draw the child’s attention to the word being said, and wait before meeting the need so that the child has a chance to imitate the model. The father and child can then practice this interaction whenever this request is made, which is likely to be often – more often than if the therapist used this strategy 2-3 times on a single visit.

These are just a few examples of how we can implement the Interaction Recommended Practices through the caregiver-child interaction.  Our knowledge of how to facilitate interactions can translate into the strategies we share and practice with families. Using those parent-interventionist interactions to facilitate parent-child interactions in natural environments – that’s what it’s all about!

Next week, we’ll continue this discussion by looking at the next two practices, which focus on facilitating cognitive skills. In the meantime:

Why is it important that early interventionists translate these practices for use with families?

How have you use these practices on visits? With child care providers?

Share your thoughts and examples of implementing these practices by leaving a comment below!

To read more about how to implement other DEC Recommended Practices, be sure to check out the rest of this series by searching for “DEC Recommended Practices” using the search feature at the top of the page.

The post DEC Recommended Practices – Interaction (Part 1) appeared first on Early Intervention Strategies for Success.

Jenni has two options on every intervention visit:

Option 1: She can work directly with the child while the child’s caregiver observes nearby, or

Option 2: She can provide instruction to both the caregiver and the child by facilitating their interactions with each other during naturally occurring, developmentally enhancing activities.

The first option is probably easier, because in grad school, Jenni was mostly trained to teach infants and toddlers so she really knows how to help them learn. The second option, though, is more in line with the mission of early intervention and the field’s key principles (PDF, New Window). Unfortunately, Jenni just isn’t sure how to implement Option 2 so when she really reflects on her practices, she finds herself slipping back in to Option 1.

What Can Jenni Do?

The first thing that Jenni is doing well is reflecting on her practices. She is aware of her struggle and how it often leads her to slip back into practices that are not aligned with our mission. That’s an important step, but it’s not enough to help her change her practices. For that, she has to dig deeper, think about how to change, and then do it, every day, on every visit, with every family.

One place Jenni can go to help her dig deeper is the DEC Recommended Practices, Instruction strand. This strand focuses on practices that “are intentional and systematic strategies to inform what to teach, when to teach, how to evaluate the effects of teaching, and how to support and evaluate the quality of instructional practices implemented by others” (DEC Recommended Practices, 2014, p. 12) (PDF, New Window). Thirteen practices are listed that describe what Jenni should do. While this is very helpful for interventionists to read what they should do, we have to keep in mind that we are not the only one providing instruction. A key responsibility of early interventionists is to provide support to the caregiver as he/she engages the child using instructional (or intervention) strategies that promote development. We share the role of “providing instruction to a child” with the caregiver. With that in mind, let’s look at the some of the Instructional practices through the lens of early intervention.

DEC Recommended Practices: Instruction

INS1. Practitioners, with the family, identify each child’s strengths, preferences, and interests to engage the child in active learning.

INS2. Practitioners, with the family, identify skills to target for instruction that help a child become adaptive, competent, socially connected, and engaged and that promote learning in natural and inclusive environments.

Jenni’s role here is clear – she will work with the family to learn about what the child likes to do, doesn’t like to do, what he does well, what’s challenging, and what the family would like to do. This information will help them work together to identify the outcomes the family wants for the child and the skills and abilities the child needs to learn to reach the outcome. All of this information will provide the context for intervention.

INS4. Practitioners plan for and provide the level of support, accommodations, and adaptations needed for the child to access, participate, and learn within and across activities and routines.

INS5. Practitioners embed instruction within and across routines, activities, and environments to provide contextually relevant learning opportunities.

Here, Jenni’s role gets a little murky. If she follows Option 1, she would be directly providing the support and accommodations to the child. If she follows Option 2, she will be providing this support using methods that support the child’s caregivers in helping the child “access, participate, and learn…” Sure, she might still work directly with the child to try out new intervention strategies, model them for the caregivers, etc. Her end goal, though, would be to help the caregiver know how to use those strategies with the child so that instruction is embedded “within and across routines, activities, and environments,” both during the visit and most importantly, between visits when Jenni is not in the home.

INS6. Practitioners use systematic instructional strategies with fidelity to teach skills and to promote child engagement and learning.

INS7. Practitioners use explicit feedback and consequences to increase child engagement, play, and skills.

Here again, we have to check our options against the mission of early intervention. Jenni has the skills to promote child engagement, learning, and play, but she will see greater results if she shares her expertise with the caregiver so that the caregiver learns how to promote the child’s learning whenever opportunities arise. For instance, Jenni could read books to a toddler and model common words in the story for the child to repeat. Or, she could coach the caregiver in how to do this during book reading and other playful routines so that when the caregiver and child find themselves walking to the mailbox, in the cereal aisle at the grocery store, or playing in the bath tub, the caregiver knows how to encourage communication anytime. Helping the caregiver learn how to use instructional strategies and feedback requires that Jenni use what she knows in different ways. This is often where the struggle between Option 1 and 2 lies…in how to translate what we know how to do into strategies we can teach others to use.

INS10. Practitioners implement the frequency, intensity, and duration of instruction needed to address the child’s phase and pace of learning or the level of support needed by the family to achieve the child’s outcomes or goals.

INS13. Practitioners use coaching or consultation strategies with primary caregivers or other adults to facilitate positive adult-child interactions and instruction intentionally designed to promote child learning and development.

These strategies provide Jenni with guidance on how to overcome her struggle. She needs to work closely with her team to determine how much support is needed by the family to help the child achieve the IFSP outcomes. She doesn’t have to decide that by herself (and in fact, shouldn’t). Once the frequency, intensity, and duration of services is determined, she can begin providing services using coaching and consultation strategies that build the capacity of the caregivers to promote the child’s learning and development. Jenni’s next step, after reading these practices, could be to learn more about coaching and consultation. She’ll want to learn, watch videos, observe others who are skilled at coaching and consulting with families, complete self-assessments, and continually reflect on her practices.

Providing good early intervention is an ongoing process. Jenni will never be there, at the place where she is an expert and is finished learning. Instead, she can hope to reach a place where she only finds one option – to share her expertise in ways that promote caregiver-child engagement, learning, play, and positive interactions. How she does this will be different for each child and family, but her underlying practices will be the same.

What have you done to help you evolve your instructional practices from Option 1 to Option 2?

What strategies have you found most helpful when sharing your expertise with caregivers?

Share your thoughts, ideas, and best strategies in the comments below!

To help you reflect on the Instructional Practices, check out these resources on the Recommended Practices Products: Instruction page:

• Systematic Instructional Practices Checklist (PDF, New Window)
• Child Learning Comes Naturally (PDF, New Window)
• Encouraging Child Learning in Everyday Activities (PDF, New Window)

If you are like Jenni and want to grow your practices, check out this new module on the ECTA Center site:

Family Capacity-Building Module

To read more about how to implement other DEC Recommended Practices, be sure to check out the rest of this series by searching for “DEC Recommended Practices” using the search feature at the top of the page.

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