Remember with me. You are a young child—in your elementary years—and you find yourself in an ice-cream shop. Let’s call it Baskin Robbins for the sake of nostalgia. You can barely see over the freezers but as you gaze up and down the line at all the different flavors to choose from, your excitement and childlike wonder is interrupted by… stress. You feel that flicker of overwhelm becoming increasingly more intrusive because you know you have to narrow it down and that you have to order and that people are waiting on you and that you want it ALL but that you can’t possibly have all 31 flavors and…

Phew. Still with me? Now, imagine that there were only ever just 3 flavors. How does this change the way you would feel peering over the freezers? How might your decision-making process feel different? Many parents in early intervention may empathize with this young child’s anxiety around making decisions from a multitude of possibilities.

So Many Important Decisions

While we, as service coordinators and providers, place parent engagement and empowerment at the forefront of our practices, it may be prudent to consider how this can be felt from the parent’s perspective. For example, the development of the IFSP (especially right after assessment for service planning) might evoke a sense of uncertainty from parents. How? Hearing the assessment report and being asked to participate in the child outcome summary process using may elicit a range of emotions on the grief spectrum. Denial, sadness, anger, rejection, guilt, shame, and hopelessness are a few of the emotions that parents may feel, especially when hearing their child be described by strangers in an unexpected way. By the same token, parents who received the news they were expecting (i.e. that their child qualifies for the program) may be trying to reconcile feelings of being validated and heard with guilt for being “right” about something they did not want to be “right” about. Nonetheless, grief counseling suggests that important decisions should be avoided while someone is experiencing grief.

Similarly, discussing a joint plan with a provider at the beginning or end of a session might do the same. Parents may question themselves: Who’s to say I’m the expert? Am I picking the right thing to work on? What if I tell her what I really want and it’s the wrong answer? What if I’m wasting the time I have with the provider by picking the “wrong” thing to work on? Surely, we all can empathize with this hesitancy when it comes to wanting to make the best decisions on behalf of those we love. Our task is to help parents feel confident in their own ability to make those decisions, eventually without our help.

Where Do We Start?

Use active listening at all times to capture the essence of the parent’s message. What things have they kept mentioning? What are they saying would make life easier for them? What stresses do they mention over and over? What are things that bring them joy? Think about some other ways to engage in and practice active listening with those in your personal circle.

Use cues from the parent during your interactions with them to guide conversations about what things would be helpful to address. Maybe you notice that the dad has repeatedly mentioned that he cuts his 33-month-old son’s food up into very small pieces when asked about meal-time. Perhaps the mom has intentionally turned the TV on and situated the baby in front of it before giving him the bottle. You may notice a parent look nervously towards the back of the house where her other children are during your meetings. Maybe the dad prefers to stand at the kitchen counter during sessions rather than in the same area as you or the child. What questions could you ask after noticing some of these cues from parents?  How can you tailor your questions to get more clarity about these behaviors’ driving forces?  

Make sure you understood them correctly. Use reflective and judgement-free language to flesh out concepts they’re sharing with which you may be unfamiliar. Use phrases such as “I’m hearing…; you mentioned…; I thought I heard something about…; it seems like ___ is very important to you…; can you tell me more about what _____means and/or looks like in your daily life…; would you like to share more about ____…, etc.” Active listening may involve jotting down notes, which can be referenced before the next meeting with the family.

Got It. Now what?

It is the responsibility of the service coordinators and providers to scaffold decision-making as warranting situations arise to help the family feel confident and at ease, not only with the decisions they are tasked to make in those moments, but also with the process of how to critically and confidently think them through.

Share your thoughts below in chat!

Be sure to check out the first post this series:

Get the Backstory: Validating and Valuing Family Input

The post Baskin Robbins: How Do I Decide? appeared first on Early Intervention Strategies for Success.

An important and ongoing part of a service coordinator’s job is gathering information from families about their child and how that child fits into the daily routines of their life. This information ebbs and flows, changing as children and parents develop together over time. By gaining insight into these routines service coordinators can facilitate an IFSP rich with meaningful outcomes and goals and can aim to provide services that best meet the needs of the child and family. Come walk a mile with me as we step through a day in the life of a family. Simple though it may seem, let’s start in the very beginning…

It’s time to wake up.

There’s so much information that can be gained by simple, open-ended questions about how a child moves through his/her day. Does a child wake up like a ray of sun or a storm cloud? Does the 7-day forecast call for sunshine or partly cloudy skies? Ask questions about what constitutes a child’s daily routines. Also ask how that child is participating in their day within those routines. If a child starts their day in tears, does it continue to pour or are there rainbows?

Little Sammy wakes up with the sun with tears in his eyes. He calls out “mommy” while sitting in his toddler bed. After a few minutes of snuggles he’s ready to start the day. When his mom asks what he wants to wear today he pulls open the dresser drawer and says “Paw Patrol” while pulling out his shirt. He lays down on the bed in anticipation of having his diaper changed. He grabs it and says “peepee.” As soon as he is dressed and dry he runs out the door calling out for “daddy” and tells him he’s ready for “a snack” (aka breakfast). He pulls over the kitchen stool to the pantry. He gives a “bar” to dad for help opening the package.

This small part of Sammy’s morning routine alone contains a wealth of information. He has a healthy attachment to his parents. He is growing in independence. Sammy recognizes the routines in his day and participates in dressing. He is showing early signs of readiness for toilet training. Sammy calls out to his family by name. He is using words to tell others what he needs and to identify when he needs help. He is using nice problem solving to figure out how to get something himself. What other things can we ascertain about Sammy from the first 15 minutes of his day?

The days are long, but the years are short.

Most of us are probably familiar with this little adage but unless you are still in those days, then it can be all too easy to forget just how long the days can be. As the family talks about the ins and outs of their daily routines, ask follow-up questions about the child’s likes and dislikes, what do they love to play with and how do they play with it, and what happens when it’s time to stop doing that activity. Are there times of the day the family dreads? The family’s answers can provide a valuable insight into what direction to take with the providers as you plan for the assessment and segues smoothly into the conversation about the family’s concerns and priorities. It can also help you identify challenges within the day the family might not recognize as a challenge.

Service Coordinator: Does your son take a nap?

Mom: Yes, after lunch.

Service Coordinator: How long are his naps?

Mom: Usually about an hour and a half.

In this interaction we’ve established that Sammy takes a nap but a few follow-up questions might reveal that Sammy can easily take up to an hour (or more) to fall asleep and will only stay asleep with his mom next to him. It’s a challenge and frustration for his mom because she doesn’t have that time free to get a few things done around the house. Meanwhile, at daycare he’s the only child in the room that doesn’t nap. His teachers have given up rubbing his back and he now spends the 2 hours lying still in his cot not allowed to talk or move. He has come to associate daycare with being forced to lie still for 2 hours and now drop-off has become a challenge, filled with tears and begging not to go. Take a moment to reflect on how you frame questions to families about their child’s routines. Challenge yourself to think more reflectively and capture the quality of the routines.

Pulling it all together.

The benefits of delving more deeply into daily routines and activities during the development of the IFSP are numerous. Those benefits include a broader knowledge of the child’s natural environments and possible locations for services to take place in the future, capturing challenging moments in the day that might not have been reported at the initial referral, and identifying naturally-occurring routines that can be used to develop richer, more meaningful outcomes and goals for the child and family, only to name a few. Empathy and open-mindedness are useful tools that will enable you to meet a family where they are. Using those tools to gather information from families about their child and how their child fits into the daily routines of their life lends itself naturally to capturing a true picture of a child’s development and functioning that enables us to move beyond our assessment tools. Early intervention supports and services are bound to be more successful when they’re meaningful to the family and embedded naturally into the child’s daily activities and routines.

While we walk alongside a family in the direction of their rainbow, what questions can you ask to better understand how to walk a mile in their shoes?

Share your ideas in the comments below.

Kimberly Morse, MS, CFCS-HDFS, EIP, lives and works in Chesapeake, VA. She holds a BA in Psychology and MS in Child Development and Family Relations. She began working in Early Intervention for the State of North Carolina in December of 2008. She relocated with her family to Virginia in 2015 and resumed working in Early Intervention first through the Infant and Toddler Connection of Norfolk and currently through the Infant and Toddler Connection of Chesapeake. Kimberly and her husband Matthew have 2 little boys, ages 2 and 6. Days spent as their mother are filled with loving memories, a few tears, and a healthy dose of humility and perspective. Kimberly can be reached at kimberly.morse@chesapeakeibh.net.

The post Take a Walk with Me appeared first on Early Intervention Strategies for Success.

Logan’s annual IFSP review is underway and you are excited to celebrate his progress. You’ve been working with his family for a year so you’ve seen the steady pace at which Logan continues to develop. When he first entered early intervention, he was only two months old and doing most of the things a two-month-old needed to do. Now that he’s 14 months old, his delays appear more significant but you want his parents to remain hopeful so you and your colleagues explain the assessment results, celebrating his gains and acknowledging the next skills to come.

When the team discusses the child outcomes summary process, the service coordinator uses the Decision Tree (PDF, New Window) as a guide. Because of his age and slow but steady progress, Logan is showing very early skills when compared to his same age peers, which sounds very different from the discussion the team had last year. You want to help Logan’s parents understand why this is, but then another team members drops this question:

“So what do we think? Is Logan a 1 or a 2 now?”

“OMG,” you think, “Logan is NOT a number!” Now what do you do?

Children are Not Numbers on the Decision Tree

This is an important point that ALL team members need to understand. The discussion about the child outcomes and the Decision Tree (PDF, New Window) should never include labeling a child with a number. It should be about using the information you have to make an informed decision as a team that describes Logan’s development according to the three global child outcomes (“global” because these are outcomes we’d like to see for all children during their early childhood years).

During the meeting, the team describes the child’s development using summary statements on the Decision Tree, not numbers (see the Child Outcomes Booklet (PDF, New Window) for more info). The numbers on the Decision Tree can be thought of as categories that describe skill development related to the child outcomes – not categories of children. For example, “Category 1” includes a summary statement (or description) that tells us that Logan has “very early skills in this area. This means that [Logan] has the skills we would expect for a much younger child.” This does NOT mean that “Logan is a 1.” While the service coordinator does have to report a number for each outcome in documentation back at the office, and these numbers are referred to as “child ratings” according to the Office of Special Education Programs (OSEP), it’s a really good idea to let go of the idea that the child outcomes discussion results in a number for the child. Let. It. Go.

Here’s why: If you hold this belief, even an underlying belief in linking a child to a number, then you will convey this belief to the family. No parent wants their infant or toddler rated or numbered. It can be hard enough for a parent to hear the age equivalency scores from the assessment tool. Parents must be involved in the child outcomes discussion, and we want them to understand the process – a process that, admittedly, can be hard to explain.

The Words You Use Matter – Tips for Developing Your Script

The words you use to explain this process matter. Yes, some parents may be mentally exhausted by the time you get to this discussion, but that does not mean you should sugarcoat it, skip it, or hurry through it, which can be tempting to do. It can also be tempting to let the professional team members discuss the process without much explanation for the parent. To avoid this, try these tips:

1. Write down a sample script for how you can explain the process to all team members (including and especially the parent) without assigning the child a number, then let a colleague read it and give you feedback.
2. Read it out loud to yourself and see how it sounds.
3. Listen to how others explain the process and “borrow” their words.
4. Ask families who are already enrolled in your program what they understood about the child outcomes discussion from their initial or annual IFSP meeting.

Here’s a big one: Dig in a bit and reflect – Are you the team member who asked about a child’s “number” at an assessment or IFSP meeting? If you are, then it’s a good thing to recognize that now and commit to a change in thinking for your next assessment or IFSP meeting.

There is No Need to Pick a Number at the Meeting

How you explain the process will likely differ from your colleague’s script and that’s okay. The words you use may change a bit with each meeting depending on your style, the team with whom you work, the family’s understanding and learning needs, etc. The important point here is to think about the message you (and your team members) convey with the child outcomes process. There is no need to “pick a number” for a child during the meeting, but there is a need to be accurate, respectful, and sensitive while helping all team members understand, participate in the process, and identify summary statements to describe the child’s development.

Open the door for this discussion with your team members using the questions here, or share your thoughts by adding a comment below:

How do you explain the child outcomes discussion process to families? What are your go-to phrases to help all team members understand?

If a team member tries to pick a number at the meeting, what could you say in response?

For more information, check out these resources:

Virginia’s Child Outcomes Booklet (PDF, New Window)

Virginia’s System for Determining Child Progress (OSEP Child Outcomes)

Decision Tree Tutorial Video

The post Logan is Not a Number! – Explaining the Child Outcomes Process appeared first on Early Intervention Strategies for Success.

Think about the following perspectives during the Assessment for Service Planning and IFSP development process:

Team Members Arrive

SC: I arrive to facilitate the assessment for service planning and IFSP development for Jacoby. I meet Franklin, occupational therapist, and Maria, developmental specialist. We all walk in and I introduce Marilyn and Kevin (Jacoby’s mother and father) to Franklin and Maria.

Family: I open the door and immediately feel intimidated and outnumbered as Tamira, our service coordinator, walks in with two other people. She introduces them, but I already forgot their name and discipline. I am not even sure what they do exactly.

Assessment

SC: I begin to explain what to expect over the next couple of hours. I update the team and check in with the Marilyn and Kevin on any new updates or concerns. Franklin and Maria begin the assessment for service planning, engaging Marilyn and Kevin in questions and Jacoby in play. This is going to take a long time. Jacoby keeps running away. I have a lot of paperwork to get signed and we still need to develop the IFSP.

Family: Jacoby runs away the moment he sees everyone. I hope he cooperates throughout the visit. I am feeling anxious about what to expect. They are asking us a lot of questions. Maybe I should have been paying more attention to Jacoby because I do not know all the answers. I really wish Jacoby would sit down and play with them. He is getting fussy. I bet he wants a snack. I guess he will have to wait.

IFSP Development

SC: I facilitate the IFSP development. When we begin to write outcomes, I begin the discussion by asking Marilyn and Kevin, “What would you like to see Jacoby doing?” 

Family: Jacoby is really becoming upset right now. They are the experts. Just tell me what to do.

Remember the Family Perspective

Assessment for service planning and IFSP development are complex processes which require several tasks be completed by the EI team (including the family). Juggling these tasks can lead all team members to feel some level of stress or anxiety. Parents may feel unsure about what to expect. They may also feel anxious about how to manage their child’s participation and care during the meeting. Marilyn and Kevin were hoping to find answers, support, and future guidance on how to help Jacoby. Tamira, Franklin, and Maria have set tasks to complete during this time and are hoping to complete everything in a timely manner. How can Tamira, Franklin, and Maria provide support to Marilyn and Kevin during this time? Here are some easy tips to support parents.

Be mindful. Before going in the home, take a couple deep breaths and reflect on what this visit means to the family. It can be easy to forget about the parents’ perspective. Remember, the words and actions within each family interaction can impact their perspective of early intervention. Remain aware of feelings that lose focus on the family such as thinking, “I need to hurry before my next visit.” Hurrying may make parents feel unimportant and unheard. Mindfulness allows professionals to be conscious of the caregiver’s feelings and needs.

Check-in periodically with families. Throughout the process, pay attention to the caregiver’s nonverbal cues. Check-in to see if they need a break or have any questions. Caregivers may need a moment to feed their child, change their child’s diaper, use the restroom, or simply step away to quietly process all of the information given. Caregivers may feel like they will interrupt the process. Let caregivers know it is okay to take a break if needed.

Explain. Explain. Explain. Explain what you are doing and why you are doing it. Try not to use acronyms or jargon that may be unfamiliar to the family. Read a caregiver’s nonverbal cues while you explain to see if you need to pause and check for understanding.

In the scenario above, Kevin and Marilyn are experiencing an array of emotions. They are looking to the early interventionists for guidance and understanding. Tamira, Franklin, and Maria can support the family by being mindful, checking in with them, and explaining the process to alleviate some of the family’s worries.

How do you stay focused and present during your interactions with families? 

What are some strategies you use to check-in with families?

What could Tamira, Franklin, and/or Maria do to ease Kevin and Marilyn’s worries throughout the visit?

What other tips would you add to support families?

Add your tips and strategies to the comments below!

The post Don’t Forget the Family’s Perspective appeared first on Early Intervention Strategies for Success.

Teaming and collaboration are what we DO, right? We use teaming practices everyday as we connect with other professional team members to support the family in achieving their goals for their child. We understand that we’ll do our best work when we collaborate with caregivers as equal team members, valuing their perspectives and priorities on every aspect of the EI process. We know this because we do it everyday, but it’s important to consider that families might not know how to participate on the EI team. They might not know how they fit in. When we explain the EI process, we need to make sure that our words reflect the importance of a collaborative approach so that all team members, including the family, know what to expect and what to do.

Embedding the DEC Recommended Practices in How We Explain EI

Let’s check in with the Division for Early Childhood (DEC) Recommended Practices (RPs) on Teaming and Collaboration to see how we can connect each practice to what we say:

TC1. Practitioners representing multiple disciplines and families work together as a team to plan and implement supports and services to meet the unique needs of each child and family.

When explaining how EI works, we can say: Early intervention uses a team approach, which means that each child has a team of people available to support his/her development. This team includes you (the parent), the service coordinator, and a service provider (like a speech therapist, developmental service provider, etc.). We are all equal partners and will work closely together to help you help your child meet the goals that are important to your family.

TC2. Practitioners and families work together as a team to systematically and regularly exchange expertise, knowledge, and information to build team capacity and jointly solve problems, plan, and implement interventions.

When explaining EI service delivery, we can say: We’ll all work together to share ideas and information and come up with intervention strategies you can use to encourage your child’s development everyday. During visits, your service provider will work alongside you as you practice using strategies with your child to help him/her learn to… We’ll problem-solve and plan together so that you feel comfortable using strategies between visits too. The purpose of the EI team is really to support you. 

TC3. Practitioners use communication and group facilitation strategies to enhance team functioning and interpersonal relationships with and among team members.

You can use this practice to explain how the IFSP meeting works: When we meet to develop the Individualized Family Service Plan (or IFSP), we’d like to hear from you about what you’d like your child to be able to do – your goals for your child. Then, we’ll have a conversation as a team about service options. You are a part of this decision-making process, so feel free to share your thoughts with the other team members about what you’d like to see, how often you’d like to have the provider visit, and where you’d like visits to happen.

TC4. Team members assist each other to discover and access community-based services and other informal and formal resources to meet family-identified child or family needs.

When explaining service coordination, we can say: Your service coordinator collaborates with everyone on the team to make sure that early intervention is meeting your child’s and family’s needs. Feel free to let us know if there is something you need or your child needs and we can work together to find resources that can help. 

TC5. Practitioners and families may collaborate with each other to identify one practitioner from the team who serves as the primary liaison between the family and other team members based on child and family priorities and needs.

If a child and family will receive more than service, one team member might be chosen to keep the rest of the team informed about child and family needs and progress. For example, let’s say that a child will receive physical therapy weekly, and developmental services monthly. You might explain it to the family this way: Since the PT will be meeting with you more frequently, he will let other team members know when your child makes progress (so we can all celebrate), when a new need or question pops up (so we can work together to address it), and when we need to meet to discuss changes to the plan. He can also make sure you are comfortable using intervention strategies suggested by the developmental specialist, and if there are questions, he can problem-solve with her to come up with alternatives that work better. You’re always welcome to call/text any other team member too. The PT will just make sure everyone is aware of how things are going. The service coordinator helps team members collaborate too.

When you explain these processes, you might use different wording, and that’s okay. Take a moment, though, and check in with yourself. Listen to yourself over the next week and make sure that what you say reflects these practices. Our words have power, so it’s important to make sure that when we explain what we do, we are helping all team members, including the family, understand the value of teaming and collaboration in early intervention.

How do you explain the EI team to families? To other service providers?

If you could make one important point about teaming and collaboration, what would it be?

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: Teaming and Collaboration appeared first on Early Intervention Strategies for Success.

Service coordinators, the early intervention (EI) team members who lead the transition process, often have questions about how to ensure that all of the required transition steps are followed and documented. Individualizing the process while accurately documenting the required steps is an important balance for service coordinators. There are a lot of details to attend to, but service coordinators should keep in mind that these requirements are there to ensure timely, supportive transition experiences for families. Documenting transition and managing requirements are also important for local and state compliance with federal regulations because, as service coordinators know, transition is closely monitored.

Like all parts of the IFSP, the transition pages in Section VII must be individualized and completely filled out to accurately document the process for each child and family. It is the service coordinator’s responsibility to keep the transition pages updated throughout the process. To help service coordinators ensure that they are accurately documenting transition, three brief tutorials are now available on the Transition page on the Virginia Early Intervention Professional Development Center site. Service coordinators are encouraged to watch these tutorials in the following order:

Transition: A Series of Family Decisions (run time 6:05)

During this first tutorial, transition is introduced as a process for all families of children enrolled in EI. The first two boxes in Section VII: Transition Planning (of Virginia’s IFSP) are explained. Guidance is provided about the information that is documented in these boxes and how this information helps the EI team determine timelines and plan for the child’s transition.

Transition: Developing the Plan and Documenting the Steps (run time 13:16)

This second tutorial begins by stating that the federal law, Part C of the Individuals with Disabilities Education Act (2004), requires that transition planning occur on the IFSP for all children receiving Part C EI services. This planning must begin at least 90 days and up to 9 months before the child will transition out of the program. Requirements for the IFSP meeting and documentation related to transition planning are discussed, including how to complete the Parental Prior Notice form (PDF, New Window). The six “Transition Steps/Activities” in Section VII are also reviewed in depth so that service coordinators understand how to document transition planning on the IFSP.

Transition in Action: Scenarios (run time 10:08)

The final tutorial is designed to help service coordinators put into practice what was discussed in the other tutorials. Three scenarios are discussed and documented on each child’s transition plan in the IFSP. The scenarios demonstrate how to document transition for: 1) a child who’s family is interested in transition options including early childhood special education (ECSE) and another community preschool; 2) a child who’s family is not interested in ECSE and wants the child to continue in her current day care setting; and 3) a child who is no longer showing any developmental delays by age three and needs no further services.

If you have questions about how to complete the transition planning section of the IFSP, be sure to watch these three tutorials. You can also review Chapter 7 in the Infant & Toddler Connection of VA Practice Manual for instructions on completing the IFSP and Chapter 8 for guidance about transition. If you continue to have questions, remember that your Supervisor, Local System Manager, and your Technical Assistance and Monitoring Consultants at the state office are available to assist.

What feedback do you have about these new transition resources? 

How could you use/share them with your staff and colleagues?

The post Got Questions about Transition and the IFSP? – There’s a Tutorial for That! appeared first on Early Intervention Strategies for Success.

As the idea of conducting functional assessment takes root here in Virginia, there have been some worries about what it means. Does it mean that we won’t do our more traditional assessment anymore? How will we determine a child’s age-equivalency? How will we get all of the information we need? Who will do the functional assessment? When will we do it? How will we find the time to do both???

Some level of anxiety is very normal as a new process is introduced and we strive to figure out how it fits into what we already do. An important thing to remember is that functional assessment actually fits beautifully with the principles and best practices of early intervention. Think about it this way…we’ve always known that viewing a child’s development from a functional point of view is best practice. We’ve always known that traditional assessment provides us with just a snapshot of what a child can and cannot do. We’ve also always known that the results of a traditional assessment, while they may help us confirm eligibility, don’t otherwise mean much unless they are translated into what they mean for a child’s interactions and participation in activities that are relevant to everyday life. These are things we can agree on. The difference now is, our state (and many others) is looking to ensure that we always have a functional perspective and use it with each child to ensure that early intervention truly is individualized and appropriate.

Authentic Assessment

Just this morning, I read a great article entitled “Authentic Assessment – What’s It All About?” Sometimes the terms “authentic” is used to describe the type of assessment we are working towards – authentic meaning that we consider development in the context of the child’s experiences in naturally occurring activities and routines. The authors of this article made a powerful point – that we don’t have to use one type of assessment over another, that we don’t have to worry that this is an either/or discussion. Instead, they suggest that this can be a both/and decision. There is a place for traditional assessment, especially in the early intervention context. Learning about a child’s development, as it compares to other children, is useful in helping us confirm eligibility (like when it can’t be determined from medical records). It helps us figure out why an infant or toddler is struggling when we find gaps in skills or atypical developmental patterns. We can then use that information to focus on how these differences impact the child’s everyday experiences and interactions – the functional assessment piece. Knowing about the child’s developmental status in combination with an understanding of how the child participates in daily routines like bath time, meals, playtime with others, and going out in the community will lead to better IFSP outcomes, more individualized EI services, and hopefully intervention that improves child and family quality of life. That’s what EI is really all about. Yes, we still have to figure out the answers to some of the above questions, and I’ll be exploring them in future blog posts, but the good news is that we are going to do that together.

How do you feel about combining traditional and functional assessment? What do you think it’ll look like in your system?

What questions do you have about implementing functional assessment? 

If you are already using it (and many of you are), share what it looks like and how you’ve woven it in to your assessment and intervention processes.

Share your thoughts by leaving a comment below!

Check out a few other great resources from the ECTA Center and DEC to learn more:

Authentic Child Assessment (practice guidelines) (PDF, New Window)

Authentic Child Assessment Practices Checklist

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I have to admit…talking about financial stuff was one of the most uncomfortable parts of my job as a service coordinator. Asking families about their income and even their tax information to assess their ability to pay for EI services…not fun for me or them. As with many aspects of service coordination, I found that it was all about how I approached the topic and how I presented the information. I could either make my discomfort clear by squirming or apologizing for even having the ask the questions, which would most likely increase the family’s discomfort too. Or, I could approach it professionally and sensitively, explaining why the information was needed while ensuring that the family was aware of their rights. I think that’s the important part…balancing the need to know with the family’s rights and comfort level.

Here are a few tips for discussing financial “stuff” with families:

Be sure YOU understand first

Be sure that you understand why this info is needed and what it’s used for. If you haven’t yet, take the time to read the Facts about Family Cost Share section in the Notice of Child and Family Rights document (PDF, New Window)and the Family Cost Share Agreement (PDF, New Window)document. Read Chapter 11 in the Practice Manual (PDF, New Window)for detailed information too.

Wait to build rapport

Take time to get to know the family and help them warm up to the early intervention process before asking sensitive questions. We need to gather info for the Family Cost Share Agreement early in the process, but it doesn’t need to be one of the first things we ask about. Of course, if it IS something the family brings up right away, seize the opportunity. Families may be concerned about how they will afford services, so alleviating their concerns can also be a helpful way to build rapport. Follow their lead when you can, and be patient when it’s your turn to lead.

Explain why

Begin your conversation about financial stuff by explaining why you are even bringing it up. Be confident in your explanation, provide the facts in a way that makes sense to the family, and ask if the parent has any questions. Help families understand the concept of “ability to pay” by ensuring them that you are a resource for them and that they will not be denied EI services due to an inability to pay. Talk about the financial appeal process, confidentiality of EI records, and how insurance can be accessed to pay for services (with parental permission). Take your time explaining why and monitor the family to ensure that they don’t become overwhelmed. Remember that you may need to revisit this information again later to ensure that they have what they need to make informed decisions about EI services.

Make space for the parent to read

Encourage the parent to read the information about the family cost share process. Parents may feel rushed to move forward to eligibility determination and assessment for service planning, but let them know that they can take their time to become informed about the financial stuff before signing any documentation.

Check in often and stay up-to-date

When you do your regular service coordination contacts with the family, check in about any changes in the family’s financial and insurance status. Asking about this can become an expected part of the conversation. The more you keep aware of the financial stuff, the better you will be able to assist the family with managing changes, such as changes to the family cost share agreement, to needs for insurance coverage, or even to new needs for resources like Medicaid waivers. (For info about Virginia Medicaid Waivers, check out the archived Talks on Tuesday webinar: My Life, My Community: Medicaid Waiver Redesign.)

Talking about the financial stuff can be challenging, but the more you know and the more confident you are, the easier the conversation will be for you and for the family.

What strategies do you use to put families at ease with financial conversations? 

Share your tips and strategies in the chat below!

The post Knowing your Financial “Stuff” appeared first on Early Intervention Strategies for Success.

I have a confession…I don’t actually think we should spend so much time talking with families about their concerns. I think we should ask once, so that we have it for Section II of the IFSP, then leave it alone. Instead, I think we should focus much more on the family’s priority for their child’s development. Concerns and priorities are not the same thing, and the difference matters.

Concerns and Priorities – What’s the Difference?

Concerns are often similar from family to family. Think about the many, many toddlers who are referred to early intervention who are not talking. In fact, most of the children we see are not talking as an age-appropriate level. When you ask their parents what they are concerned about, they are likely to say something like, “He’s not talking like other kids his age.” This is a very common, very real concern. Same with children who are late walkers. These concerns are very important because they are what drive a parent to EI, and they are what keep a parent up at night, worrying about her child. We must acknowledge these concerns, and record them on the IFSP, then dig deeper to find out about priorities.

Turning to priorities reframes the discussion to become more individualized, more positive, and more functional. Priorities are the answers to questions like “What would it look like to you if she was able to talk more?” or “How would your day or your child’s day be easier if she could say more words?” Priorities are descriptions of what life would be like for a child and family if things got better. Priorities reflect the family’s vision for the child’s development. Priorities are the foundation for individualized, functional IFSP outcomes.

Why It Matters

It’s really, really hard to write a good IFSP outcome based on concerns alone. When we focus on concerns, we get outcomes that are “cookie-cutter.” You can substitute any child’s name in the body of an outcome like this: Noah will use words to express his wants and needs. All toddlers need to be able to do that – it’s not an individualized outcome. If you focus on priorities for Noah and his family, you’ll find out that life would be grand if Noah could say words to label toys and activities he likes to do when he plays with his siblings after school. Noah loves to play with his blue ball in the back yard, play in the toy kitchen with his sisters, and look at books with his dad. By digging into priorities for Noah and hus family, we learn about how the family works and what’s important to them. This rich information is where you glean what you need to know to write a good outcome. Here’s an example:

Noah will use 50 words to label his favorite toys (ball, cup, book, doggie) and activities (play, outside, kitchen, dinner, books) when playing with his siblings each afternoon after school for two weeks.

This outcome is individualized to what Noah likes to say and do, includes a context that happens frequently in his home, and includes a measurable criteria that the family can keep track of. If the professionals on Noah’s IFSP team had only focused on his family’s concerns, then they would have missed out on what they really needed to know to ensure that the IFSP was meaningful to Noah’s family. This is important because the IFSP outcomes guide service delivery, and meaningful services are based on what’s important to the family – their priorities for their child.

What do your teams typically focus on – concerns or priorities?

What challenges do you face with finding out about family priorities?

How do you guide the conversation to dig deeper into what’s important to families when writing IFSP outcomes?

Share your comments below!

The post A Priority or a Concern – What’s the Difference and Why it Matters appeared first on Early Intervention Strategies for Success.

Marco was recently referred to early intervention (EI) due to suspected global delays. His family is living in a homeless shelter and only has one more week left before they must leave. His father is trying hard to find employment but is challenged by his lack of childcare. He is the sole caregiver for three children under the age of four.

Nellie was discharged from the hospital three days ago following a very lengthy stay of 16 months. She is a preemie with many medical complications. Weight gain has been a challenge for her and will need to be closely monitored now that she is home. Her family is eager to get EI in place to assist with Nellie’s feeding skills and encourage her overall development.

For both Marco and Nellie, time is of the essence. Both families are newly referred to EI, and both would benefit from immediate support. But wait…the assessment calendar is full and it might take the whole 45 days allowed for the timeline to assess these children and develop their IFSPs. Can they wait that long??

The Interim IFSP

Both situations are examples of when writing an interim IFSP would be very appropriate. Interim IFSPs aren’t written very often. They can be viewed as sort of an emergency measure for eligible children who need supports and services to begin immediately. In Marco’s case, his family could benefit from service coordination to help them find housing immediately. A service coordinator may also be able to link Marco’s father locate child care options so that he is able to find employment. Because of Nellie’s extensive medical history and current feeding needs, initiating services for her is of utmost importance. Both families are in need of support, Both children are eligible for EI – Marco, based on his developmental delays and Nellie, based on her extended NICU stay, prematurity, and delays. Fortunately for them, you don’t have to wait until the assessment calendar is open to get the ball rolling.

Requirements for the Interim IFSP

An interim IFSP is a relatively simple document. Only four pieces of information are required: the name of the child, the name of the service coordinator, the service the child will receive, and the parent’s signature. The corresponding pages of the IFSP form can be used for the interim IFSP, with the words “Interim IFSP” written at the top of the first page. With the interim IFSP in place, services can begin immediately. It’s extremely important to remember that having an interim IFSP in place does NOT extend the 45-day timeline. A full IFSP must still be in place within 45 calendar days after the date of referral.

Using an Interim IFSP

Let’s check in on both situations to see how developing an interim IFSP helped:

Marco – Once Marco was found eligible, an interim IFSP was developed with Marco’s father to initiate more intensive service coordination to assist the family. The service coordinator completed other required documentation with Marco (such as procedural safeguards and release of information forms so she could speak with the social worker at the homeless shelter), and began the process of arranging the assessment for service planning and IFSP meeting. Marco’s father and the service coordinator worked together closely, talking almost everyday. The service coordinator helped obtain a one month extension with the homeless shelter. Within two weeks, though, Marco’s father had accessed several programs through his local Department of Social Services for rent assistance and a subsidy for child care so that he could look for employment.

Nellie – Following the intake, Nellie was found eligible for EI based on a review of her medical records. An interim IFSP was written and physical therapy began three days later. The physical therapist was able to assist Nellie’s parents and her nurse in determining positioning options for safe feeding. A speech-language pathologist also began seeing Nellie and worked closely with her family and nurse to monitor her caloric intake and begin working on oral motor exercises to help Nellie learn oral feeding. Nellie’s assessment for service planning was held about a month later and a full IFSP was developed. The PT and SLP continued to support Nellie’s family, and were happy to report at the assessment that Nellie was gaining weight and holding her head in midline better during feeding times.

The interim IFSP allowed both families to receive immediate support that helped to stabilize their challenging situations. While this type of IFSP is not used very often, it can be an important tool that allows eligible children and their families to receive the support they need right away.

Have you written an interim IFSP before? How did you know that it was the right thing to do? 

Share you experiences using an interim IFSP in the chat below. Be sure to protect family confidentiality if you share a specific experience. 🙂

The post Writing an Interim IFSP appeared first on Early Intervention Strategies for Success.