Early social and emotional development includes the ability for young children to “form close and secure adult and peer relationships; experience, regulate, and express emotions in socially and culturally appropriate ways; and explore the environment and learn — all in the context of family, community, and culture” (Yates et al., 2008, p. 2). This describes the way infants and toddlers understand and communicate their emotions to build healthy relationships with those closest to them.

When you think about social and emotional development, all of the words above may come to mind. Each word is a critical component of social and emotional development. In early intervention, all practitioners play a key role in supporting the emotional well-being of every young child and their family.

Why and What You Can Do

“Social and emotional experiences with primary caregivers as well as interactions with other children and adults early in life set the stage for future academic and personal outcomes, and undergird other areas of development” (Darling-Churchill & Lippman, 2016, p. 2). You have a unique opportunity to nurture the connection between the caregiver and child and promote successful outcomes for each child you serve.

Here are eleven easy strategies you can implement to support social and emotional development:

1. Boost the parents’ confidence. This is a hard time for many parents. Parents may feel responsible for their child’s developmental delay. Building their confidence empowers them to feel competent. When someone feels good, it makes them happy. This helps promote positive parent-child interactions.

2. Support the child’s self-esteem. Children tend to avoid difficult tasks. After all, nobody likes failing. Boosting a child’s self-esteem gives him/her confidence to explore and try new things.

3. You can never give too much information. Explain what you are doing and why you are doing it. This helps parents understand the reasoning behind the intervention strategies you suggest or model.” Give parents plenty of opportunities to ask questions.

4. Focus on increasing positive parent-child interactions. Many children may resist demands placed on them. A positive parent-child interaction removes the feeling of a demand and makes the interaction playful and fun. It enhances the bond between the caregiver and child.

5. Read cues and intervene before a child is in his/her red zone. There are four stress responses a child may experience: Green zone, red zone, blue zone, or combo zone. Click here to read the checklist that identifies different behaviors associated with each zone. Positive emotions are associated with the green zone and negative emotions are associated with the other stress responses. Children are more likely to come back and stay in the green zone when parents are attuned to their moods and feelings. Becoming a detective for your child’s stress cues can be a great tool to improve attunement.

6. Model the behaviors you wish to see. We can help parents learn to model behaviors they want to see in their children as they grow into adults. Children learn how to manage big feelings in large part by watching their adults manage big feelings.

7. Explain the importance of comfort. Comfort is a big part of secure attachment. So often parents get mixed messages about comfort from society – sometimes it seems as if comfort is the same as creating a weak child. We can bust that myth by sharing the information we know about the role of comfort in early brain development.

8. Provide structure and routine. Routines are the safe walls around a child’s day. There is no RIGHT kind of routine but whatever it is, the more predictable for the child, the better. Routines that are repetitive for a child help them make sense of the world. They will always have another chance to practice the things they struggle with most.

9. Use positive behavior supports. A positive and proactive approach to supporting behaviors helps reduce parental stress and increase positive behaviors in children as they aim to please their parents. These strategies decrease reactivity and should be individualized for each child and situation.

10. Label emotions. Language is a major learning tool for children and during the young toddler and preschool years, we learn and use language as a way of making sense of the world. Putting words to feelings helps children learn that feelings are generally transient and aren’t a permanent state of being. This is something we should be regularly talking about with our parents.

11. Increase parent responsiveness. Parent responsiveness nurtures a safe, secure attachment allowing a child to explore and thrive in their environment as the child becomes more resilient and independent. Wonder with the parents about what their child may be feeling or thinking so they can respond in an intentional and positive way. 

What challenges or barriers do you face as an early interventionist supporting social and emotional development?

What other strategies would you add to support each child’s social and emotional development?

Additional Resources:

DEC Child Social-Emotional Competence Checklist

Supporting Social and Emotional Development: What ALL Early Interventionists Can Do Handout

References

Darling-Churchill, & Lippman, L. (2016). Early childhood social and emotional development: Advancing the field of measurement. Journal of Applied Developmental Psychology, 45, 1–7. https://doi.org/10.1016/j.appdev.2016.02.002 

Yates, T., Ostrosky, M., Cheatham, G., Fettig, A., Shaffer, L., & Santos, R. (2008). Research synthesis on screening and assessing social–emotional competence. Retrieved from Center on the Social Emotional Foundations for Early Learning http://csefel.vanderbilt.edu/documents/rs_screening_assessment.pdf

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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

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Imagine: you are sharing your deepest wishes with a trusted friend. You are sharing a cup of coffee on the couch and you feel led to begin a conversation about your goals for the coming New Year. You share your regrets from the past year and your hopes and dreams about how you envision this New Year. You are deep in thought and passionate about articulating these ambitions out loud. Your friend’s response, much to your surprise, is superficially supportive. You sense judgement but you can’t put your finger on it. Why is she being short? Why does her smile look fake? Does she realize her eyebrows just did that? You begin to wonder what her thoughts are and to feel… Vulnerable. Embarrassed. Insecure.

A Parent’s Perspective

Now, imagine that instead of talking to a dear friend, you are talking to a complete stranger in an intake meeting, no coffee involved. Instead of freely sharing your priorities for the New Year, you are being asked to name priorities you have for your most precious hope in the world—your child.

Will I be judged for what’s important to my family and me? Was that the right thing to say? Is that the kind of answer they’re looking for? Geez, I have so many I can’t even put them in order. I need help sorting this out in my head and I am entirely overwhelmed but I don’t want the lady to think I don’t care if I am too vague. Is it okay to breastfeed in here?

These are just some of the thoughts that ran through my head as a parent as I began the early intervention process with my, then, 8 month old. Some deep reflection led me to the following conclusion: From my team, I needed my priorities validated and valued so that I could begin to trust them and their input into our lives.

Building Rapport, Being Curious, and Cultivating Relationships

As service coordinators and providers, it is our job to give up control for the sake of building rapport and trust so that deeper and more meaningful impacts can be achieved during the entire early intervention journey. You might be thinking, But, I don’t control interactions! I help the family with guiding questions to get them to a point where both the clinical/developmental priorities and family priorities are aligned. We have all been there. It can be challenging to reconcile the priorities that are indicated through family and formal assessments with what the family is sharing as their priorities. However, a family’s priorities can and should be discussed informally, too, starting with the first contact you have with them.

To ponder: What barriers to active listening and getting the backstory have you experienced in your relationships and interactions with families?

How?

Be genuinely curious about families, their daily lives, and their backgrounds. Ask for the sake of truly learning, and not documenting. Repeat back what you hear them say often to check that you are understanding their meaning. Validate them when you sense uncertainty, stress, or when they share about topics that are clearly close to their hearts. Use your intuition. Ask open ended questions—not the kind that indicates you are checking off a list, but the kind you would ask when something someone has just said has genuinely sparked your interest. Once you have a truer understanding of where a person is coming from, you can begin to introduce how early intervention can help facilitate and highlight these priorities in the family’s life using the family’s everyday routines and priorities.

To ponder: How might these initial and ongoing interactions inform your practice as you continue to cultivate a relationship with the family throughout the EI process?

So, where does that leave us? For anyone, the first step to making changes is acknowledging that change would bring an added benefit to your quality of life. Seeking help, self-referring, taking a random number that the PCP handed them and calling, showing up to appointments, answering the phone to unknown numbers– these are all indications that a family is open to change. As providers and service coordinators, the most important part of our job is to cultivate relationships that are conducive to productive and meaningful change. We begin that cultivation that by simply listening— getting the backstory so that you can truly walk alongside the family as they continue developing the rest of their early intervention narrative.   

Share with us! What are your go-to questions/conversation-starters that you have in your toolbox to help you ease into this informal approach of getting the backstory?

Micaela is a former early intervention service coordinator and developmental services provider. She holds a master’s degree in Early Childhood and Family Development and her passion is helping families astound themselves with all they can achieve. She is, most importantly, the mother of a beautiful little boy. She and her family have been receiving the support and services of EI since her son was 7 months old. Micaela and her husband are excited to be welcoming a little girl into the world this spring. Through this blog series, Micaela hopes to merge the distinct perspectives of a parent, a service coordinator, and a provider into a unique cultivation of meaningful insight and conversation.

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

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

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

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

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

How Can We Help?

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

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

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

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

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

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

Resources:

Virginia Department of Social Services

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

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

SCAN of Northern Virginia (Stop Child Abuse Now)

Reference:

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

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

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

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

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

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

6 Steps for Engaging Caregivers during the COS Process

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

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

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

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

3. Discuss each outcome area with individualized examples.

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

4. Review typical functional development.

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

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

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

6. Decide as a team the best statement.

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

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

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

How do you help facilitate the discussion?

Share your tips and ideas by leaving a comment below!

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

Decision Tree Tutorial

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

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

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

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

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

COS Completion – When Teams Can’t Meet in Person

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

What is Temperament?

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

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

Having Conversations about the Parent’s Temperament

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

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

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

Talking about the Child’s Temperament

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

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

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

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

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

Share your ideas by leaving a comment below!

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

Foundations of Social Emotional Development: Temperament – Part II

Foundations of Social Emotional Development: Attachment – Part I

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

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

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

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

3 Key Strategies for Building Relationships with Dads

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

Talk side to side rather than face to face.

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

Explicitly invite dads into therapeutic activities.

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

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

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

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

Leave a comment and let us know!

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

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

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

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

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

Myth #1: Toddlers Are Too Young  

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

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

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

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

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

Myth #3: High-Tech Comes at High Cost  

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

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

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

What Next?   

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

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

Share your strategies in the comments below!

References:

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

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

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

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

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

Worries and Successes

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

New Resource Alert! – EI Tele-Assessment Video Chats

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

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

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

Strategies for Tele-Assessment

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

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

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

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

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

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

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

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

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

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

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

Coronavirus Disease (COVID-19) – ECTA Center

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Technology is great when it works, right? It’s such an embedded part of most of our lives when we are not in the throws of a global pandemic that many of us hardly think about it. Now, though, when early interventionists are chin deep in trying to navigate tele-intervention, figuring out how to connect through technology is essential.

I’ve been picking the brains of amazing EI practitioners and local system managers to find out what they are doing to make the technology work, not only for themselves but also for the families they support. I’ve organized some of the great ideas I’ve heard into the list below.

A big THANK YOU to the practitioners and leaders from Fairfax, Norfolk, Prince William, Danville-Pittsylvania, Southside, Roanoke Valley, Rockbridge Area, Central VA, Cumberland Mountain, Middle Peninsula-Northern Neck and others who shared their experiences with me!

7 Technology Tips

Here are 7 tips for managing technology when preparing for or providing tele-intervention:

1. Prepare yourself first – Before you contact the parent, make sure you have an understanding of what tele-intervention is. Watch the TelePractice in Early Intervention webinar for a fantastic overview and tons of strategies. Watch a video such as A Home Visit with Zander, Providing Early Intervention Services through Distance Technology, or Tele-Intervention – Coaching during Family Chore-Laundry to see how coaching works during tele-intervention. Educate yourself about the technology so you can answer parents’ questions as best you can. Larry Edelman has prepared a great resource document about technology: Planning for the Use of Video Conferencing for Early Intervention Home Visits during the COVID-19 Pandemic (PDF, New Window)– check it out!

2. Touch base the “usual way” – Reach out to the parent using your typical means of communication – phone, email, or text, depending on what’s permitted in your program or preferred by the family. Check in about the family’s welfare first, then ease the conversation into virtual options for connecting.

3. Explore and explain options – Without making any assumptions about family preferences or capability, explore the available options for video visits or phone contacts for service delivery. Explain how each option could work and paint a picture of what it might look like. If the parent is interested (or even unsure), share a link to the video, A Home Visit with Zander, so he/she can watch a visit and hear from a parent about how tele-intervention can work. Be sure to invite the parent to ask questions, share any worries, and think through the possibilities with you.

4. Share your vulnerability – It’s okay to let the parent know that this is new for you too. Assure the parent that you will figure it out together and that, if the parent chooses the high tech option (aka video confererencing) and something goes wonky, you always have a low tech option as Plan B (aka phonecall).

5. Schedule a tech check – Before the actual video visit, schedule a 15 minute tech check. This may be a non-billable activity, but it’s worth it. Send the parent the video conferencing link with detailed instructions about how to connect. Get online together, check video, audio, lighting, etc. and talk about where the device will be positioned so you can see the family the best. Plan together for what the parent wants to do during the actual visit and how the technology can be used so you can observe and collaborate. If you or the parent has tech problems, remember the #1 rule of thumb with troubleshooting: when in doubt, back out and try again. Log out of the video conference and try to log back in. If that doesn’t work, log out and restart the computer. If that still doesn’t work, try another browser. Persistence will pay off, I promise.

6. Problem-solve Wifi issues – Here’s where practitioners are getting creative. I’ve heard of folks parking in the family’s driveway for the video visit so the family can access the practitioner’s hotspot, then holding the visit using technology with the practitioner parked outside. What an idea! Some schools are offering hotspots for older children – can the family use that connection for the visit? If there are limitations on data or bandwidth, schedule the visit at a time when issues should (hopefully) be at a minimum, like in the afternoon after older children are finished with online learning.

7. Let the parent decide – If a parent is unsure about either option, encourage him/her to try a phone or video visit then evaluate how it went. If the parent declines, that’s okay. Parents can put their services on hold at any time; just be sure that they fully understand their options, privacy, and the support you can provide. Be sure to document your discussion and check back in with the family often in case they change their minds.

Once everything is in place and your fingers are firmly crossed, schedule that first visit and go for it. Take a deep breath before you connect with the parent and enter the video call with confidence. Expect some hiccups, be flexible, practice your patience, and exercise your sense of humor. This will get easier and both you and the family will adjust, together.

You’ve got this.

What strategies are you using to prepare families for tele-intervention?

What creative ideas are you using to help families manage technology needs?

Let’s hear your best ideas! Share them in the chat and let’s continue to support one another. J

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

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

Coronavirus Disease (COVID-19) – ECTA Center

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