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

The post 7 Technology Tips for Tele-Intervention appeared first on Early Intervention Strategies for Success.

Alice (service coordinator) joins Jodie (therapist) on an intervention visit to see Max and his mother. When they walk into the home, Jodie reminds Max’s mother that Alice is here and says, “She’s just here to do the paperwork.” Alice keeps the smile on her face as she greets the family, but inside is cringing and thinking, “Wait, did she really just say that?!”

Ever Been in Alice’s Shoes?

Ever had a moment like this during a visit? Maybe a colleague described your job in a less-than-professional light? Or a parent introduced you to someone else in a way that left you feeling like he or she really didn’t understand what you do? Unfortunately, this is not an uncommon occurrence for many service coordinators when their team members struggle to understand their role or the importance of service coordination.

Understanding the Service Coordinator’s Role

Service coordinators are valuable team members who lead early intervention (EI) teams. They bring unique expertise to the team that is often misunderstood. It is easier to recognize how a physical therapist brings expertise about motor development or how a speech-language pathologist brings expertise in communication. We tell families all the time that they bring expertise about their child, their daily routines, and how their family works. Because the role of service coordinator is unique to EI, it can be less obvious what that role brings. Other team members may see the service coordinator as primarily a “paper-pusher” responsible for documentation and getting forms signed. (In fact, many service coordinators have reported this.) Or, perhaps, families may see the service coordinator as the voice on the phone who calls each month to ask how things are going. If that is all they see or hear, then you can undersatnd how it can be hard to really understand the role of a service coordinator and the value in this work. Because the service coordinator role is less familiar, it’s really important for program supervisors, and service coordinators themselves, to help others understand what they do.

Tips for Helping Others Understand the Value of Your Role

Make Sure YOU Know Your Own Value – If you are a service coordinator, make sure you can articulate what you bring to the team. Write it down. Come up with a phrase you can use when faced with situations like the one described above. Embrace your role and its importance. What you think about yourself will shine through, especially when you first meet parents (PDF, New Window) and other team members. Here’s how Alice explained her role when she first met Max’s family:

Example: I’m your service coordinator, which means I am the person who will guide you through the early intervention process. I’m also a resource for you when you want to learn about what’s available in the community to help you and your child. I make sure that your EI services are addressing what’s important to you. I’ll check in regularly to see how things are going and I’m here for you to ask questions anytime.

If you’re the supervisor, make sure you can explain the roles of all of your staff and that you educate new staff, contractors, and community partners so they understand the value of all team members.

Explain Your Role Using the Three Family Outcomes – I heard this tip on a service coordination webinar and it’s a great one. Describe your role to families and others in terms of the three Office of Special Education (OSEP) family outcomes, which include helping families: 1) know their rights; 2) effectively communicate their child’s needs; and 3) help their child develop and learn. Here’s another example of how Alice could explain her role using the family outcomes:

Example: It’s my job to make sure you are aware of your rights as a parent involved in our program. I am also here to help you communicate with the rest of the team anything you want to share, including what you think your child and family need, what’s important to you, and what you would like to accomplish by being in our program. We will work together, with other members of your EI team, to make sure you are learning ways to encourage your child’s development throughout the day.

Speak Up and Share Your Value – Don’t be afraid to speak up and share your value. Try not to take it personally when someone incorrectly explains what you do; most likely, the jab was unintentional. If you find yourself in Alice’s shoes, speak up! Use a friendly, professional tone of voice and remind the provider and family of what you do. When you speak up, you educate everyone present, which can be a wonderful thing. Here’s what Alice could say in this situation:

Example: Yes, we do have some paperwork to do but I’m here for more than that. I’m looking forward to seeing how Max is doing with learning to sit up on his own. I also love seeing how physical therapy is going and talking with you both about any updates or changes needed to Max’s IFSP. I’m responsible for making sure that EI services are working for your family and that you are getting what you and Max need. If there are any questions, I’m here to help with that too.

Show Your Value – This is an important one. Demonstrate the value you bring to the team, to the visit, and to any interactions with the family and other team members. Be fully present when joining visits. Get involved, share ideas, make observations, and offer feedback. This always needs to be balanced with avoiding “taking over” or disrupting the visit, but you have valuable insight to share. You know about child development too. You are an expert in the EI process. You demonstrate your value when you actively participate, guide the EI team, and do what you say you will do, meaning that you follow through on your commitments. What you do, as well as what you say, shapes what others know about your work!

How do you share and show your value as a service coordinator?

How would you handle the situation described above? What would you do or say to help your team members understand your role?

Share you insights in the comments below!

Check out these two videos about the importance of service coordination:

How Service Coordinators Support Service Providers

The Importance of Service Coordination

The post Service Coordinators: Speak Up and Share Your Value! appeared first on Early Intervention Strategies for Success.

I’ve been thinking a lot about routines-based intervention lately. In particular, I’ve been thinking about (and experiencing) what happens when a family doesn’t invite you into their daily routines. What do you do when the space the family makes available to you is small? Not physical space, but family life space. When the only activity you have access to is playtime in the living room floor? What do you do when the parent clearly states that he doesn’t want to do something else, or when she cringes every time you ask to join another activity? We could dig into why this might be happening, and that’s a valuable discussion which has been covered in other posts. For this post, though, I want to think about the realities and complexities of this work and how that can affect us as practitioners.

Realities

Just this morning, a colleague told me that the reality is this: families are letting us into their very personal spaces. They decide how far to let us in and how much to reveal. We are guests in their homes and in their lives. We can never truly know what a parent is thinking about this “intrusion.” Of course, we do our best to be friendly and nonthreatening so parents see us as allies and partners rather than intruders. We have to acknowledge the fact, though, that we are a foreign body in their universe. That’s not good or bad; it is just part of the reality of EI.

To become less foreign, we build relationships, nurture trust, and share the emotional experience of helping the child so that families learn to feel safe with our presence in their personal space. Most of us do this really well, but then our own professional reality encourages us to go further. It’s not enough to just be a safe and encouraging presence. To achieve our field’s Mission (PDF, New Window)and implement our Key Principles (PDF, New Window), we have to reach beyond that. EI practitioners are tasked with finding ways to help the family practice and embed intervention in daily activities so the child is receiving as much intervention from caregivers throughout the day and the week as possible. That requires that we try our best to join activities beyond the living room floor, where the real parent-child interactions happen most often. It also requires that families let us in. That decision is purely up to them.

The Internal Struggle

Sometimes, the realities of home visiting and meeting the mission of EI can feel like a struggle, an internal conflict that can cause us to question our skills as early interventionists. Some internal struggle can be healthy. I worry, though, that this ongoing internal struggle that practitioners in our field (me included) continue to feel is making it harder to do the overall work of EI. When it’s too hard, we fall back on traditional practices (like playing with the child while the parent watches) and wrestle with ourselves for it. We know better. We go to trainings, watch webinars, and take online courses. Then, we go out on visits and struggle to do what we know we are supposed to do. Why? I think we have to be careful not to answer this question by blaming the family: “They won’t let me into their routine,” or “They are hard to engage,” or “She isn’t interested.” Sure, any of these could be true, but I believe that the reason why we struggle is often much deeper than this.

Complexities

We struggle because the work is complex. It is deeply worthy work, but it can be hard. Every family is different. Every visit is different. Every interaction is different. We have to take what we know and adapt it in a thousand different ways. Yes, sometimes you will work with families without the struggle, with whom you feel the partnership and who embrace their pivotal role in facilitating their children’s development during and between visits. You’ll also work with families facing personal circumstances that interfere with how they take advantage of EI. You’ll work with families who are eager to have you enter their space, and others for whom your presence is a constant reminder that something is wrong. You will meet most of the families who are somewhere in between. No judgement there, it’s just reality again. It’s also a reality that you might support all of these families in a single day with very little interaction or support from peers or supervisors. The complexities of the work plus the complexities of joining families in their emotional and physical spaces can all make for a professional struggle…or a breathtaking experience of personal growth.

Use the Struggle to Help You Grow

When the struggle feels deep, and you are questioning what you do, take a step back and remember those magical moments when you’ve had the privilege of celebrating with a parent when a toddler achieve a well-earned outcome. Pause and reflect on the time you witnessed a mother playfully engage her child after weeks of your own uncertainty about whether or not you were reaching her. Reach out to your network of fellow interventionists who know the struggle and can remind you of your own worth and the value of what you do. You are part of something important. You might struggle. You might forget. You will feel the complexities of EI and when you do, focus on those experiences and connections that remind you why you do this work.

The work is complex. The realities are different for each family. You are the constant so use the struggle to help you grow.

What are your thoughts about the realities, complexities, and struggles of this work?

What do you do when the complexities of supporting families in their personal spaces and fulfilling your mission seem to conflict? 

Share your insights in the comments below.

The post An Early Interventionist’s Internal Struggle appeared first on Early Intervention Strategies for Success.

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

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

5 Strategies for Responding to Discomfort

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

Here are 5 responsive strategies to help you manage discomfort:

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

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

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

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

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

How Much Discomfort is Okay?

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

What do you do when a parent seems uncomfortable? 

Share your experiences and strategies in the comments below!

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

Oliver’s mother calls you and tells you, with a shaky voice, that he’s been “kicked out” of his third child care center. The center director told her that his behavior has become “more than we can handle” and “a safety concern for the other children.” You’ve been working with this family for several months now on IFSP outcomes related to reducing Oliver’s acting out behavior and increasing his ability to communicate using words. You’ve been struggling because whenever you’ve tried to discuss positive discipline techniques and share other information about social emotional health, Oliver’s mother tells you that she doesn’t believe in disciplining her children. She wants them to grow up with freedom to become who they are and she feels that they will have their whole lives to have boundaries. At the same time, she needs for Oliver to attend child care while she works part-time.

What do you do?

How Can You Support Oliver’s Mom?

What do you do when there’s a difference between what you believe you know about child development and a parent’s beliefs and style of guiding his/her child’s social-emotional development? In Oliver’s scenario, it can feel like you are bumping up against a wall. You might think the “wall” is this difference between your beliefs and the parent’s beliefs, but really, the wall is probably your own approach to the situation. It can be very tempting to judge Oliver’s mother’s beliefs and think that she should be parenting differently, but we have to remember that it is not our role to judge her. We are there to provide support and share what we know about development in a way that supports her and Oliver. This usually requires lots of active listening, observation, collaborative problem-solving, and maybe most importantly, keeping an open mind. Instead of trying to change how Oliver’s mom thinks or “make” her see things our way, it can be helpful to step back and revisit our coaching skills to think about how we can provide the right kind of support.

Here are a few strategies to consider when preparing to support Oliver’s family:

Pause and Reflect – This is always the place to begin, especially when there is a disconnect between what you think and what the parent believes. It’s easy to imagine feeling frustrated and judgmental. Keep in mind that it’s your job to learn about Oliver’s family and how he behaves at home and at child care so that you can figure out how to support him and his caregivers in both environments. Sometimes, putting your feelings aside can help clear the way for progress.

Help her Reflect on her Goals – Check in with Oliver’s mother to find out how you can help and what she would like to see happen. Don’t take it for granted that you know these answers. Ask her what she thinks is contributing to Oliver’s struggles and what she thinks she can do at home to help him be more successful in child care. Find out about her goals and encourage her to voice them.

Ask about What She Knows about Discipline – Find out how she defines “discipline” and “boundaries.” Be sure that you both are speaking the same language. You could find out that “discipline” means spanking to her, and she is unwilling to spank. Get specific so that you both understand.

Provide Information Linked to her Goals – Share information about social emotional health and discipline techniques as they link to what’s important to Oliver’s mother. If she says she doesn’t agree or doesn’t want to use those techniques, ask if she’s open to trying something new. Her answer will inform you about whether or not this is an issue about which you can actually help her.

Consider this: you may not have all the information you need you figure out what to do next…

First, what questions arise for you? What else do you need to know??

Once you have all the info, consider:

Option 1: What would you do if Oliver’s mother says that she is not open to a new strategy?

Option 2: What would be your next move be if she replied that she did want to try something new?

How do you support a parent when his/her parenting style is different from what you know/believe about social emotional development? 

Share your experiences in the comments below.

The post You and Oliver’s Mom have Different Beliefs about Discipline…What Do You Do? appeared first on Early Intervention Strategies for Success.

You are visiting Mason at his child care center for the first time today. When you arrive, you find the classroom to be super busy, with eight toddlers and two adults. After introducing yourself to the lead teacher and the assistant, you explain how EI visits usually work and ask how you can help. You try to join the art activity and talk with the teacher more, but the teacher answers in short sentences as if it’s hard for her to concentrate on the children and on your questions. Eventually, the teacher mentions that the classroom next door is empty and asks you if you’d like to go work with Mason in there.

What do you do?

Strategies for Working with the Child Care Provider & Child IN the Classroom

So what do you do when you walk in the classroom and are told to walk right out? Asking you to pull the child out into another room could indicate several things about what the child care provider may be thinking. Here are some strategies for dealing with the possibilities:

Possibility #1 – She doesn’t understand the purpose of your visit. 

The child care provider may think that you are there to provide therapy to Mason. She may not want to get in the way or have the other children distract you or him. Take the time to reiterate your roll as a support to her. Tell her that you are there to work together with her and her assistant to find ways to encourage Mason’s development during the activities that they do everyday. Let her know that you’d like to explore what they’ve already tried and what they’d like to do with Mason. Explain that if you pull Mason out of the classroom for therapy for one hour a week, then he’s not really getting much intervention. However, if you work with her and she’s able to implement intervention strategies throughout the week, he’ll get much more intervention, which is ultimately the goal of your visit. Don’t forget to ask how this sounds to her, if it is “doable.” What she thinks really matters.

Possibility #2 – She doesn’t know what to do with you.

This is just as likely in a child care center as it is in a home. Caregivers often don’t know their role in the collaborative partnership. Describe how you can work together. Ask her if she is okay with the first few visits focusing on getting to know her classroom and how Mason behaves there. Let her know that you will spend a lot of time talking with her and helping her and her assistant try out strategies with Mason during the activities in the classroom. You’ll help her come up with ideas, try them out, then reflect on them and problem-solve so she feels confident using them when you’re not there.

Possibility #3 – She doesn’t think there is any real reason for you to be there.

Sometimes, child care providers disagree with families about the child’s development. Maybe she thinks Mason will talk when he’s ready. Maybe he talks more at school than he does at home. Before you jump into strategies, find out her thoughts on his development. Tap into her expertise. If she doesn’t think he needs intervention, then ask how his communication (or motor development, or social skills, etc.) compares to other children in the room. Ask about what goes well for Mason and what challenges him – and what challenges her during the day with Mason. Maybe she doesn’t think Mason needs to talk yet, but the fact that he drops into a tantrum ten times a day is a big challenge. Find out about her day and determine how you can help – same as you would with a parent. After that, if you still don’t have her “buy in,” talk to the service coordinator and the parent about what to do next.

Possibility #4 – This is just not a good time for your visit.

It could be as simple as art time is usually chaos with eight toddlers so is not a great time for a visitor. Ask the question. Maybe another time of day would be better. Outside play time is often a great time to see the child move about, interact with others, and still be able to snag the teacher’s attention. If she needs you to come at a certain time of day and you don’t have that available in your schedule, you may need to contact the service coordinator to discuss changing providers. Working in child care requires a great deal of flexibility – even being flexible enough to realize that you may not be the best match for the situation, and that’s okay too.

Hopefully, after you’ve explored the possibilities with the teacher and helped her understand why you are there, you’ll all be on the same page and ready to work together. The collaboration between you and the child care staff is what will keep you IN the classroom!

What are your best strategies for dealing with these possibilities?

What have you done when asked to pull the child out of the child care classroom?

Share your experiences and ideas in the comments below!

The post The Teacher Wants You to Pull Mason Out of the Classroom…What Do You Do? appeared first on Early Intervention Strategies for Success.

As you get to know Jackie, Teddy’s mother, you learn that she has very high expectations for her son. She expects him to feed himself without getting messy, sit during children’s church on Wednesday and Sunday, and begin potty training – but Teddy is only 19 months old. He’s just learned to walk a few months ago and is eager to move. She tells you that Teddy is just being stubborn when he won’t do these things and she’s feeling really frustrated. Other than mild motor delays, Teddy’s development is typical for his age. He may not qualify for EI services much longer, and you are concerned that Jackie’s expectations are too high to be healthy for Teddy.

What do you do?

High Expectations…or Unrealistic Expectations?

Many parents have high expectations for their children. In fact, having high expectations is generally regarded as a good thing for encouraging children to reach their greatest potential. However, there is a line that can be crossed between having realistic, developmentally appropriate expectations and unrealistic expectations that either push the child too hard or demand that the child behave in ways that just aren’t possible for him yet. Having unrealistic expectations is stressful for the child and the parent – and the early interventionist as well. If you find yourself working with Teddy and Jackie, here are three strategies to try:

Ask about what the parent knows about development– Taking the time to ask the parent what she knows about when children typically achieve these milestones is a great place to start.

Discuss the smaller steps that lead to the milestone – Once you know what the parent knows, you can talk about the smaller steps the child needs to learn to get there, emphasizing what is developmentally appropriate for her child. Individualizing this discussion in important so that the parent feels “heard.”

Explore why these milestones are important to the parent – Sometimes unreasonably high expectations are rooted in a lack of information about development, or a deeper concern about the child’s developmental differences. Rather than judging Teddy’s mother, step back and explore why she wants him to do these things. Maybe his behavior at church embarrasses her and she’s not sure what to do. Maybe she doesn’t like getting messy herself so doesn’t want him messy either. Maybe diapers are so expensive that she is eager for him to potty train. Explore the roots of the expectation and help her find a way to manage them. This could lessen the stress on her, and Teddy too.

High Expectations…or Hopes for the Child’s Future?

Another issue with expectations can crop up when we perceive a parent’s expectations as too high because we aren’t sure if a child will ever achieve a particular developmental ability. For instance, I was part of an IFSP team once where the father’s IFSP outcome for his 10-month old son was to play tee-ball one day. The child had a new diagnosis of cerebral palsy, and quite honestly, we didn’t know when he would be able to run the bases or swing a bat. I participated on another team once where the family adamantly wanted the child to walk independently. The child has multiple, significant developmental delays. In both situations, the professional team members wrestled with what to write on the IFSP. We didn’t want to feel like we were setting the parent up for disappointment by putting something on the IFSP that we didn’t think could happen before the child turned 3 years old, but we also wanted to respect the family’s hopes for their child.

So what did we do? In both cases:

• We talked with the parents about the developmental steps that needed to come before the children would play tee-ball or walk, and we wove those into the outcomes.
• We concluded the outcomes with phrases like “…to prepare Jamie to play tee-ball when he’s older.” or “…to help Brooklyn learn to move on his own.” so that the family knew that we “heard” them and valued what was important to them.
• We tried to balance educating with family about the developmental steps that preceded these major accomplishments while honoring what they wanted for their children.

Expectations are all about working toward a child’s future. Honor a family’s expectations when you can, and educate when the expectations are causing stress, like for Teddy’s family. When you think about it, how do we ever know, as the professional team members, if a child will or won’t meet those expectations eventually? We can’t know, so why not honor the family’s expectations and do what we can during our short time together to work toward outcomes that are important to them?

What do you do when working with a caregiver who has expectations that seem really high for the child?

What strategies do you use to educate while honoring the family’s hopes? 

The post The Parent’s Expectations are So High…What Do You Do? 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. 🙂

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You walk into your last visit with Brayden’s family before the holidays. The visit goes well, and as you are wrapping up, Brayden’s mother hands you a wrapped gift and wishes you “Happy Holidays.” On the outside, you’re smiling and thanking her, but on the inside, you’re stumbling because your agency has a policy against employees accepting gifts from families. In that moment, you aren’t sure what to do. Do you graciously accept the gift to avoid offending the family, or do you politely decline, stating that unfortunately, you aren’t allowed to accept gifts.

What do you do?

Two Responsibilities to Keep in Mind

This is a hard one because you can feel torn between two very important responsibilities. First, you don’t want to offend the family, who has been kind enough to think of you during the holiday season. A key aspect of your work is building rapport with families, and you worry that declining their gift will affect this. In giving you a gift, the parent is likely sending you a message of gratitude for the work you do. Knowing this, it can be especially awkward to have to enforce an agency policy to avoid accepting gifts, which you also have a responsibility to follow.

Agency policies against accepting gifts are usually designed to help avoid conflicts of interest. By declaring such a policy, the agency is hoping to protect staff and families from situations where favors are expected for gifts. Just avoiding gifts completely is the policy of choice for many agencies, but following the policy is not always easy in the “real world.”

Considerations around Gift Giving and Receiving

So how do you manage both responsibilities? Consider these strategies:

Find out about the specifics of your agency’s policy – I’ve worked in programs that had blanket “no gift” policies, had loose policies that allowed providers to make the call, or allowed gifts under a certain dollar amount. I’ve also heard of a policy under which all gifts had to be shared program wide. For example, if a family gave a gift certificate to a restaurant, then the provider would use it to buy food for a staff meeting or to take the group out to lunch. Be sure that you know the specific expectations of your agency’s policy because this can guide what you do and help you avoid any problems.

Share the policy expectation with families early – Let families know about this policy early in their enrollment in your program. Put it in writing in the context of expectations for family participation in the program. Get it out in the open from the beginning, so families understand and providers can reference it. It is easier to decline a gift when the first time the parent hears about the policy is not when the gift is exchanging hands.

Be honest in the moment – If you really cannot accept the gift, graciously decline but let the parent know why. Tell her that, while you appreciate her thoughtfulness and are very touched by her generosity, unfortunately your agency policy prevents you from accepting the gift. Yes, it will still be awkward, but if you must decline, do it gracefully.

If you feel you must accept the gift… – If you must accept because you’re concerned about offending the family, accept and then let your supervisor know why you did. If possible, share the gift with your colleagues. If the parent made you cookies, put them in a common area and invite others to enjoy them. If you are given a gift that cannot be shared (like a basket of soaps), ask your supervisor for advice. If you accept a gift and don’t realize it (like I did when I accepted a Christmas card and opened it back in the office to find a gift card inside), let your supervisor know and share it with the program.

From the other perspective, don’t give gifts to families – You may feel generous yourself and want to give the children you work with a small token at the holidays or at birthdays. As a general rule, this is probably not a good idea because your generosity could have side effects such as the parent thinking she needs to reciprocate (but maybe she cannot afford it). Word could get out that you gave certain gifts to certain families, or to some families and not all, etc. Really, the best gift you can give to the child and family is your time, attention, and support, so stick with that. 🙂

How have you handled the gift giving or receiving situation? Do you have an agency policy, or have you had to make the decision for yourself? What did you do?

Share your experiences and thoughts in the comments below!

The post The Family Gives You a Gift…What Do You Do? appeared first on Early Intervention Strategies for Success.

I was driving down a narrow back road on my way to a visit when my car simply died. There was no where to pull off the road so, where I stopped was where I stayed. I wasn’t too far from the family’s home so I turned on my emergency flashers and started walking. When I arrived at their home, I sheepishly confessed to why I walked there and asked to use their phone (I’d forgotten mine). I called roadside assistance and was told it would be a while. I was asked for a contact phone number and had no choice but to ask the mother if I could share hers. She easily said “yes” but I felt uncomfortable, knowing that I was supposed to protect her confidentiality. Once the arrangements were made, I decided to go ahead with our visit as normally as possible. At the end, the mother offered for me to wait there, but since my car was out of sight, I ended up walking back to wait with the car. After waiting for what felt like hours, my car was finally towed. In the end, it all felt rather awkward and more than a little embarrassing. I felt unusually vulnerable and questioned if I’d handled the situation correctly.

Ever found yourself in a similar situation? What did you do?

Car Trouble Happens to the Best of Us

Driving is a necessity in our field, and having car trouble is almost inevitable. Where your car decides to die is unpredictable, and how you handle the situation can simply depend on what resources you have available to you in the moment. Of course, doing a much better job of maintaining your car than I did certainly helps. It turned out that my car’s fuel injection system died because I’d driven on almost empty one too many times. Driving agency cars can be a better option when available because they are (hopefully) well-maintained. Even so, you could still find yourself in a break-down situation. Here are a few strategies to keep in mind if you find yourself stuck:

Consider your safety first – When your car breaks down, look around you to assess your safety. Determine if you need to move your car and if you do (or if you can), move it as far away from the road as possible if on a roadway. Park under a streetlight. Keep your doors locked and keep valuables out of sight. Wait somewhere safe – like in a local business office or even in the family’s home. This may feel awkward but your safety is most important.

Keep your mobile phone charged – Great rule of thumb when out in the field…of course for me, the first rule would have been to be sure you BRING your phone with you when out in the field. 🙂

Call your supervisor/your office first – Before you call your family or a friend for help, try to reach your supervisor or a colleague. Someone in the office should always know where you are, and maybe that “someone” can come out to wait with you for the tow truck or pick you up. It’s tempting to call your family or a friend for a ride or to come help, but in order to project the family’s confidentiality, it’s best to call someone in your program or agency first.

Manage offers of assistance from the child’s family carefully – If the child’s family offers assistance, use your best judgment. This can be uncomfortable because you probably aren’t used to accepting the family’s help; you are usually the help-giver, not the receiver. Again, consider your safety and follow your gut. If the parent has mechanical skills and offers to take a look, it’s probably okay but you have to be careful. If it’s a quick fix, then no harm done, but what if your car needs a new part and the parent offers to install it – can you accept it and how will you repay it? What if the parent makes the situation worse? This is a tricky situation and there probably isn’t one right answer. However, when in doubt, it’s okay to politely decline the assistance and find help elsewhere. Avoid accepting assistance that has a monetary value (like taking gas money or having the parent call her own roadside assistance for you). If the parent offers you a ride home, only accept it if you have no other choice because that crosses an important professional boundary. If you do need a ride, try your best to find a professional colleague to pick you up, or as a last resort, accept a ride from the family to a neutral place, like your office or a nearby restaurant where your family member can then pick you up.

Ask for permission before sharing family information and document any confidentiality concerns – If you need to call the tow truck and have to provide the family’s address, ask first. Remember to document the situation in detail in the child’s record when you do finally make it back to the office.

In many cases, the child’s family will want to help so just make the best decision you can at the time. You are likely to feel stressed, so take a moment to step back, consider these tips, and think about what impact your decisions might have in the long-run. Hopefully, car trouble will resolve easily and on your next visit, you’ll just have another thing to laugh about with the family.

Two final words of advice: always keep your phone with you and don’t drive with your gas tank on empty! 🙂

What other strategies would you recommend?

If you’ve had car trouble on a visit, share how you handled it in the comments below!

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