The presence of an engaged service coordinator who understands the role and skillfully conducts the  many responsibilities of the position ensures a well-coordinated approach to EI service delivery. It is widely acknowledged in the EI field that families have the right to high-quality, individualized EI services; our field must commit to including service coordination in this acknowledgement by ensuring that the professionals who provide this service receive the attention, understanding, respect, and resources they need and deserve. (DEC and ITCA, 2020, p 10)

Wow. This quote is from the summary of the Service Coordination and Early Intervention – Division for Early Childhood (DEC) and IDEA Infant & Toddler Coordinators Association (ITCA) Joint Position Statement which was recently released in December 2020. It’s a powerful message for our field that’s intended to help us leave behind the unfortunate idea of service coordinators as simply paper pushers. It signals to leaders, administrators, and team members, including families, that service coordinators (SCs) are vitally important professionals who play key roles in the delivery of quality early intervention (EI). It’s about time. I’m proud to have been a part of the development of this statement and eager to spread the word.

A Joint Call to Action

The statement was written, reviewed, and finalized as a collaboration between DEC and ITCA. It represents the voice and beliefs of EI professionals from multiple disciplines who are members of DEC and Part C coordinators across the country. Together, these groups came to the conclusion that we needed a strong Call to Action in support of service coordinators and specific information about the knowledge, skills, beliefs, expertise, roles, and responsibilities of professionals who provide service coordination to encourage consistency across our field.

What Can You Do?

Let’s break down the four recommendations in the Call to Action and consider how to move the dial forward.

#1: States and local programs should review and align current competencies to the indicators in the Knowledge and Skills for Service Coordinators (KSSC) document.

In an appendix, the KSSC outlines six knowledge and skill areas that are essential for service coordinators, including: infant and toddler development, family-centered practices, leadership and teaming, coordination of services, transition, and professionalism. Take some time to read it and compare it to guidance or competencies your program uses when hiring and training SCs. If you don’t have program-level competencies, consider adopting these.

#2: Leaders who hire, supervise, and mentor service coordinators must have a thorough understanding of the expertise and needs of these professionals. This understanding is essential to ensure that compensation aligns with the level of responsibility expected of service coordinators. Service coordinators also should have appropriate administrative support, reflective supervision, and resources to successfully manage the workload, navigate changes in policies and procedures, and, most importantly, partner with families.  

This recommendation focuses on leadership and administrative support, which traditionally varies greatly across EI programs. If you are a leader, be honest with yourself and reflect on what you understand. Can you specifically explain what the SCs in your program do and what they need? If you find holes in your knowledge or how your program functions, make a plan to address them starting today. A few ideas:

• Ask your SCs what they need and how your program can meet this recommendation, then work together to set goals.
• Schedule regular meetings with service coordinators to touch base, identify needs, and collaborate toward goals.
• Provide specific info about policy changes and what they mean. Invite input and be flexible when you can.
• Check in regularly about workloads.
• Be available for regular planned and unplanned reflective supervision.

#3: States and programs must consider multiple factors when determining workload size to ensure that service coordinators can manage the roles and responsibilities outlined in this joint position statement. The factors to consider include (1) the number of families served per service coordinator, (2) the varying levels of need experienced by families, (3) the model of service coordination implemented in the state/program, (4) the need for administrative support and supervision, and (5) the level of responsibility, educational background, and any specific expertise required of service coordinators in a given state or program.

This recommendation strongly encourages programs to use a multi-factorial view when determining workloads for service coordinators, rather than simply relying on “caseload” numbers which often fail to reflect the complexity and individualized nature of the work. If you are a leader, take a hard look at how your program operates, check in with your staff, and make adjustments to make the work more manageable. If you are a service coordinator, examine your workload and talk with your supervisor about what is going well and where you need support. Bring your creative ideas to the meeting and work together to tackle this recommendation. You might not be able to change the number of referrals coming in, but there are often smaller changes that can be made to improve the situation.

#4. Additional research is needed to identify recommended practices specific to service coordination, which could be guided by the KSSC document. Research also needs to address how these practices would be implemented with families and how service coordinators would be trained to use these practices during preservice and inservice training.

This might sound like a recommendation for academics, but academics need EI programs to work with to conduct research. Reach out to your local university to initiate conversations about research and service coordination. Encourage faculty to share the position statement with their students. Building partnerships with faculty not only benefits the students you may share during field placements, but could also have a positive impact on the field if you work together to learn more about best practices.  

I encourage you to take the time to read the full position statement and share it (or the Executive Summary) with at least two other people. Share it with your staff or with colleagues, other SCs, contractor agencies, leadership, families, and higher education faculty. Start thinking about how you can use it in your program or state.

Let’s answer the call for action by dedicating some intentional time and energy to our service coordinators. They deserve it.

How can you use the position statement in your program? Who will you share it with?

The post Call to Action! Service Coordination and Early Intervention – DEC/ITCA Position Statement appeared first on Early Intervention Strategies for Success.

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

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

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

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

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

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

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

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

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

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.

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

Embedding the DEC Recommended Practices in How We Explain EI

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The post DEC Recommended Practices: Teaming and Collaboration appeared first on Early Intervention Strategies for Success.

Last month, we considered the first five DEC Recommended Practices under the Assessment strand. Now, let’s look at practices A6-A11. These practices encourage early interventionists to consider information from a variety of sources about the child’s skills and abilities across different routines, activities, and settings and to do this on an ongoing basis. These practices really remind us to consider the big picture – how the child functions in his everyday life.

Let’s Consider an Example…

During Liam’s assessment, the occupational therapist and speech-language pathologist gather information from his parents and his grandmother, who cares for Liam while his parents are at work. While observing Liam’s attempts to complete assessment activities, they also ask his caregivers about what goes well at home and out in the community for Liam and what is challenging. They often ask for more details so that they can understand particular activities Liam enjoys and those that he struggles with. Because of Liam’s significant motor limitations due to his cerebral palsy, he’s unable to complete some of the assessment activities that require fine motor coordination (such as placing shapes in a puzzle), but he often shows his understanding through his gaze. The therapists use their informed clinical opinion to make some determinations about age equivalencies, in addition to using the information they gather from their assessment tools. They explain this when they report the assessment findings and try to help Liam’s caregivers understand the connection between their observations based on the assessment tool and his functional abilities in his everyday activities. The service coordinator summarizes this information and then helps the team use it during the development of IFSP outcomes and the discussion about services. Once The IFSP is written, the service provider who sees Liam and his family can use this information to provide meaningful support and monitor progress through the ongoing assessment that will continue throughout service delivery.

DEC Recommended Practices for Assessment

This sounds like a pretty good assessment, right? Let’s look at six more assessment practices from the DEC Recommended Practices and consider how this example illustrates these practices.

A6. Practitioners use a variety of methods, including observation and interviews, to gather assessment information from multiple sources, including the child’s family and other significant individuals in the child’s life.

Professionals on assessment teams often have two choices. They can rely solely on what they observe during the child’s performance of assessment tasks prescribed by the tool they are using. Or, they can integrate these observations with what they learn from talking with caregivers about the child’s abilities and challenges in everyday life. Relying on the child’s performance alone can be necessary, depending on the tool being used, but it is always important to remember that one tool, or even a child’s performance of discrete tasks, can never truly tell you all you need to know about a child’s abilities. Plus, Part C of IDEA requires that we use more than one method/tool to determine a child’s developmental status. The law also requires that we use our informed clinical opinion to make sense of assessment findings and consider the child’s functional abilities in multiple settings. Child development happens everywhere a child goes and with every interaction; the best assessments take all of this into account.

A7. Practitioners obtain information about the child’s skills in daily activities, routines, and environments such as home, center, and community.

While it’s not always possible to observe a child across daily routines, activities, and environments, it sure would be an awesome way to conduct assessments if we could. If you can’t observe it, you certainly can ask about it. Liam’s team was mindful of this and asked about what he and his family enjoy, what they like to do, and what they would like to do. All of this information informs the IFSP outcomes and helps the ongoing service provider know when and where to provide support.

A8. Practitioners use clinical reasoning in addition to assessment results to identify the child’s current levels of functioning and to determine the child’s eligibility and plan for instruction.

As already mentioned, Part C of IDEA requires that we use informed clinical opinion to individualize the assessment. It’s important to help families like Liam’s understand this, especially when pure assessment results reported as age equivalents can be disheartening. A child like Liam, who is limited in what his body can do, can appear to be extremely delayed just according to test scores, but when functional abilities are taken into account, a more accurate and encouraging picture of development can emerge.

A9. Practitioners implement systematic ongoing assessment to identify learning targets, plan activities, and monitor the child’s progress to revise instruction as needed.

After Liam’s assessment, the ongoing service provider will use the information gathered initially and the IFSP outcomes to inform service delivery. He or she will also conduct ongoing assessment to plan for intervention, revise outcomes as needed with the rest of the team, and monitor the child’s progress. Ongoing assessment may be a less formal process, but it is equally important to ensure that EI services are meeting the child’s and family’s needs.

A10. Practitioners use assessment tools with sufficient sensitivity to detect child progress, especially for the child with significant support needs.

Hopefully, the therapists on Liam’s team used assessment tools that allowed items to be adapted for children with significant motor needs. Some tools provide this guidance, while others require that adaptations are just noted and reported. Using the right tool matters because an assessment that results in findings that are not meaningful or reflective of the child’s abilities really isn’t very useful at all, and can be frustrating for families as well.

A11. Practitioners report assessment results so that they are understandable and useful to families.

Finally, the therapists shared assessment findings by relating them to Liam’s everyday activities so that they were easy to understand for his family. Helping families understand what discrete assessment tasks tell us about development and how that relates to what they see everyday with the child is one of the most important tasks of the professional team members. Assessments should not be an event where the “experts” talk “at” the parents. Instead, assessments should be a mutual and reciprocal sharing of information so that everyone learns more about the child.

It’s your turn now! Take some time to review these two checklists to reflect on your own assessment skills. Consider how you use what you know to really get an accurate picture of a child’s development.

Informed Clinical Reasoning Checklist (PDF, New Window)

Authentic Child Assessment Practices Checklist (PDF, New Window)

Keep an eye out for next month’s post on the Environment Practices. In the meantime, consider…

How does an early interventionist develop clinical reasoning? How do you know when you’ve got it?

What strategies do you or your assessment team members use to gather information about a child’s functional abilities in everyday activities – including those that you might not typically see during a formal assessment? 

What tools or practices do you use when conducting ongoing assessment? How do you document when a child is making progress?

Share your ideas in the comments below!

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

The post DEC Recommended Practices: Assessment (Part 2) appeared first on Early Intervention Strategies for Success.

Jenni began working with a new EI program a few weeks ago. She’s really happy in this new position and one of the reasons is the great leadership. Her supervisor is a wonderful resource for how to implement best practices. He’s current in his knowledge and skills and supports his staff, including Jenni, in growing their practices. Jenni regularly meets with him for supervision to reflect on her practices and discuss expectations, which makes Jenni’s job easier. He regularly observes visits, which at first was intimidating but turned out to be a good opportunity to receive feedback for Jenni. He makes sure the staff have access to current resources and dedicates time for staff to get together to discuss and plan for how to use what they learn in their work with families. He also monitors service delivery by touching base with Jenni and the other staff often, reviewing IFSPs and giving constructive feedback, and inviting feedback from staff about how to improve services. He uses this feedback to help determine professional development needs and supports training efforts to build staff knowledge and skills. He makes his expectations clear: that all staff will use best practices because children and families deserve the highest quality supports and services. He understands that his role in leading the charge is an important one, and Jenni thinks he does it very well!

Leadership in Early Intervention

Not all EI leaders do all of these things…but wouldn’t it be great if they did? I know how reality can set in with so much to do – supervision, hiring, quality monitoring, budget management, administrative meetings, and maybe even seeing a family or two (or three, or ten) for those leaders who are also practitioners. Determining how to lead can be tricky too. Fortunately, the Division for Early Childhood (DEC) of the Council for Exceptional Children has developed a set of Recommended Practices that outline practices associated with leadership. These practices can be a resource for leaders in helping them make sure that they are leading the charge successfully.

DEC Recommended Practices for Leadership

Let’s take a look at a few of these practices and think about what they might look like for an EI leader:

L1. Leaders create a culture and a climate in which practitioners feel a sense of belonging and want to support the organization’s mission and goals.

The leader sets the tone for how the program works. Creating a culture of best practice that cultivates practitioners’ knowledge and skills is the leader’s responsibility. Having clear expectations about how practitioners can support the organization’s mission and goals, and the field’s Mission and Key Principles (PDF, New Window), is essential. Leaders need to help practitioners know what it “looks like” when all of these goals are met. Leaders also need to ensure that the climate is responsive to the needs of practitioners and helps them fill gaps in their knowledge and skills.

L2. Leaders promote adherence to and model the DEC Code of Ethics, DEC Position Statements and Papers, and the DEC Recommended Practices.

Visit the DEC website to review these resources and see how they fit into your program’s mission and goals.

L7. Leaders develop, refine, and implement policies and procedures that create the conditions for practitioners to implement the DEC Recommended Practices.

Once a leader knows about the DEC Recommended Practices, it could be useful to consider whether or not program policies, procedures, and expectations reflect the practices that have been identified as best for effective service delivery. Same goes for practice guides from other disciplines. Visit the Implementing Supports & Services page on the VEIPD site and scroll down to find links to the positions statements for OTs, PTs, and SLPs. You’ll find that they all have a lot in common!

L9. Leaders develop and implement an evidence-based professional development system or approach that provides practitioners a variety of supports to ensure they have the knowledge and skills needed to implement the DEC Recommended Practices.

This could look differently depending on the priorities and resources of the program. Maybe the leader facilitates inservice training during staff meetings or provider meetings. Maybe speakers are invited in. Maybe staff are encouraged to participate in webinars and other online resources. Maybe a monthly discussion group is formed to discuss articles, books, or other resources. Maybe a mentoring network is established to support the implementation of best practices. There are lots of options and they all take commitment and coordination but the responsibility can be shared across staff or programs.

L12. Leaders collaborate with stakeholders to collect and use data for program management and continuous program improvement and to examine the effectiveness of services and supports in improving child and family outcomes.

Without knowing the impact of service delivery on child and family outcomes, it’s really hard to ensure that best practices are used as intended. Data could be collected through family surveys, phone calls to families to check in on their satisfaction with services, monitoring IFSPs, reading contact notes, etc. Equally important is sharing the results of this data collection with staff so they can help with planning how to improve program practices. When staff are involved in program planning, leadership is easier because everyone shares the responsibility for success.

L13. Leaders promote efficient and coordinated service delivery for children and families by creating the conditions for practitioners from multiple disciplines and the family to work together as a team.

Leadership is key in making teaming happen. Setting expectations for teaming and collaboration, building in time for teams to gather and collaborate, and appreciating the contribution of all team members is so important. While a leader can’t really be expected to keep track of what is happening with each team or each family all the time, staying abreast of how teams function, whether or not they are working well, and intervening when teams needs outside help can make a great difference. Again, the leader sets the climate!

If you’re an EI leader, take a moment to compare your leadership activities with the recommended practices described here. Does your leadership look similar to how Jenni’s supervisor operates? Take time to think about and plan for how you can be the best leader you can be!

If you’re like Jenni, think about what you can do to contribute to a positive climate in your program. Leaders aren’t just supervisors…think about what you can do to promote the use of recommended practices too!

How do you cultivate a climate that supports practitioners’ professional growth?

What happens in your program that supports the implementation of best practices?

What are your best leadership strategies for leading the charge?

Share your experiences as a leader or as a practitioner in the comments below!

Be sure to check out my other posts on applying the DEC RPs to early intervention:

DEC Recommended Practices: Assessment (Part 1)

DEC Recommended Practices: Assessment (Part 2)

DEC Recommended Practices: Environment

DEC Recommended Practices: Family

The post DEC Recommended Practices: Leadership in EI appeared first on Early Intervention Strategies for Success.

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

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

Be sure YOU understand first

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

Wait to build rapport

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

Explain why

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

Make space for the parent to read

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

Check in often and stay up-to-date

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

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

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

Share your tips and strategies in the chat below!

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

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

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

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

The Interim IFSP

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

Requirements for the Interim IFSP

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

Using an Interim IFSP

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

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

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

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

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

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

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

Although shocking to many, the sippy cup is NOT a developmental milestone.  Nor is sucking on a pacifier, for that matter.  But why do we (therapists, parents and caregivers) celebrate these acquired “skills” as developmentally appropriate achievements?  Why do we allow these “skills” to happen for much longer than they should?  Is it just easier to always have a pacifier (aka mute button) in the baby/toddler’s mouth?  Sippy cups are so easy to take along with us everywhere, how can it be harmful if a preschooler continues to exclusively drink from one?

Benefits of the Pacifier and Sippy Cup

The pacifier is a great thing for infants. It meets a physiological need to suck and allows baby a way to comfort himself. It may reduce the risk of SIDS as it appears to allow baby’s airway to remain more open and prevent baby from falling into a deeper sleep. Not to mention the other fringe benefits like quieting rowdy babes, helping them sleep longer and making outings and car rides more enjoyable for all.  It certainly has a “place” in an infant’s world!  And the sippy cup is an awesome convenience must-have.  Drinks can be toted everywhere with baby/toddler and a sippy’s use means less spills to stain the carpet!  Beautiful!

Risks of Over-Use

But aside from these benefits, there are risks associated with the over-use of both.  Pediatricians and family physicians recommend weaning or stopping pacifier use in the second six months of life.  Shocking I know considering how many toddlers we see with pacifiers in their mouths!  The sippy cup can be skipped all together if natural development is occurring with no issue.  Created for convenience, the sippy cup now has an entire market (and aisle in most stores) devoted to it!  However a baby can transition to a straw (as early as 9 months) or open cup just as easily and drinking from both of these IS developmentally appropriate.

Key Points to Keep in Mind

As trusted resources on development, it is our job as early interventionists to inform families of both the positives and negatives of (prolonged) sucking.  Some points to keep in mind as you discuss these “milestones” with parents and caregivers:

Prolonged sucking on a pacifier puts children at (a higher) risk for misaligned teeth. As those tiny white pearls are erupting, the pressure of the nipple of the pacifier can cause teeth to move around and shift. Also, the pressure can cause their hard palate, the roof of their mouth directly behind the front teeth, to change. It can push the palate forward, again changing the position of the teeth. In his research, J. Poyak concludes, “The greater the longevity and duration of pacifier use, the greater the potential for harmful results.”

A sippy often allows access to drinks all day long for a toddler.  Not necessarily a bad thing, depending on what is in the sippy.  If it is a sugary drink, the sugar increases the risk of developing cavities.  The Medline Plus article titled, “Tooth decay – early childhood” states, “When children sleep or walk around with a bottle or sippy cup in their mouth, sugar coats their teeth for longer periods of time, causing teeth to decay more quickly.” Also, if a sippy is the only way a child gets liquids the developmentally appropriate skills of drinking through a straw and open cup are inhibited.

If children are allowed to have a drink (in a sippy or other cup) all the time, they may fill up on liquids and not eat meals as well, negatively impacting their nutrition.

Although inconsistent, research suggests a relationship between prolonged sucking and speech delays.  Barbosa et al. (2009) concluded in their research of 128 Patagonian preschoolers that, “The results suggest extended use of sucking outside of breastfeeding may have detrimental effects on speech development in young children.” When speech sound development is negatively impacted, so is the child’s intelligibility of speech making it difficult for others to understand them.

Sucking on a pacifier increases a child’s risk of developing otitis media (ear infection).  The AAP (American Academy of Pediatrics) and AAFP (American Academy of Family Physicians) advocate for limited to no use of the pacifier in the second six months of the child’s life to decrease this risk.

A pacifier or sippy cup that is always in the mouth of a child, even when the child is walking around, puts him/her at a higher risk for mouth injuries.  A 2012 study by Dr. Sarah Keim of Nationwide Children’s Hospital in Columbus, found that “a young child is rushed to a hospital every four hours in the U.S. due to an injury from a bottle, sippy cup or pacifier.”  When little ones are just learning to walk, doing two things at once requires a bit more coordination than they are capable of!

Besides the physical risks, beyond the age of 1 a stronger emotional attachment to the pacifier (or sippy cup) makes it increasingly difficult for the child to detach. The pacifier/sippy goes from meeting a physiological need during infancy to providing emotional comfort to the toddler when scared, upset or sleepy.

However, it is our job to know and respect the individuality of each child.  Therefore it is best practice to reassure parents that we recognize they know their child best.  We all want our children to be happy and if using a pacifier and/or sippy is what’s best for them and their family, that is okay.  Our job is to inform the families we serve the best we can.  Equipping them with knowledge on why prolonged sucking may be detrimental to their child allows the family to make the final call.  Education and Support, that’s what we are there for.

Have you ever had the “prolonged sucking” discussion with any of the families you serve? 

How might you begin this conversation with a family?

Today’s blog is Part I of a two-part series on prolonged sucking and what we can do to educate families about it.  Stay tuned for “Part II – What to do When the Convenience Becomes a Hard to Break Habit” next week featuring ideas you can share with families who are ready to wean their child off of the pacifier or sippy!

References

Barbosa, Clarita, Sandra Vasquez, Mary Parada, Juan Carlos Velez Gonzalez, Chanaye Jackson, N David Yanez, Bizu Gelaye, and Annette Fitzpatrick. “The Relationship of Bottle Feeding and Other Sucking Behaviors with Speech Disorder in Patagonian Preschoolers.” BMC Pediatrics. N.p., n.d. Web. 20 Mar. 2015. http://www.biomedcentral.com/1471-2431/9/66

EG, Gois, HC Rubeiro-Junior, MP Vale, SM Paiva, JM Serra-Negra, ML Ramos-Jorge, and IA Pordeus. “Influence of Nonnutritive Sucking Habits, Breathing Pattern and Adenoid Size on the Development of Malocclusion.” Angle Orthod.4 (2008): 647-54. Print. http://www.ncbi.nlm.nih.gov/pubmed/18302463

Guideline on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents (n.d.): n. pag. Web. 18 Mar. 2015. http://www.aapd.org/media/Policies_Guidelines/G_Periodicity.pdf (PDF, New Window)

Hauck, Fern R., MD, MS, Olanrewaju O. Omojokun, MD, and Mir S. Siadaty, MD, MS. “Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis.” PEDIATRICS5 (2005): E716-723. Do Pacifiers Reduce the Risk of Sudden Infant Death Syndrome? A Meta-analysis. PEDIATRICS. Web. 17 Mar. 2015.  http://pediatrics.aappublications.org/content/116/5/e716

Keim, Sarah A., MA, MS, Erica N. Fletcher, MPH, Megan R.W. Tepoel, MS, and Lara B. McKenzie, PhD, MA. “Injuries Associated With Bottles, Pacifiers, and Sippy Cups in the United States, 1991-2010.” N.p., n.d. Web. 19 Mar. 2015. http://pediatrics.aappublications.org/content/129/6/1104.long

Natale, Ruby, PhD, PsyD. “Risks and Benefits of Pacifiers.” American Family Physician79 (2009): 681-85. – American Family Physician. Web. 18 Mar. 2015. http://www.aafp.org/afp/2009/0415/p681.html

Poyak, J. “Effects of Pacifiers on Early Oral Development.” Int J Orthod Milwaukee4 (2006): 13-6. Print. http://www.ncbi.nlm.nih.gov/pubmed/17256438

Regulatory Summary for Pacifier (n.d.): n. pag. U.S. Consumer Product Safety Commission. Web. 18 Mar. 2015. http://www.cpsc.gov//PageFiles/120645/regsumpacifier.pdf (PDF, New Window)

“Tooth Decay – Early Childhood: MedlinePlus Medical Encyclopedia.” S National Library of Medicine. U.S. National Library of Medicine, n.d. Web. 17 Mar. 2015. http://www.nlm.nih.gov/medlineplus/ency/article/002061.htm

Zardetto, CG, CR Rodrigues, and FM Stefani. “Effects of Different Pacifiers on the Primary Dentition and Oral Myofunction Structures of Preschool Children.” Pediatric Dentistry6 (2002): 552-60. Print. http://www.ncbi.nlm.nih.gov/pubmed/12528948

Lacy Morise, M.S. CCC/SLP educates families on the risks involved with over-use of the pacifier and sippy as an early intervention speech-language pathologist in the West Virginia Birth to Three Program.  She guiltily confesses to allowing all of her children to abuse the use of the pacifier!  She owns Milestones & Miracles, LLC a company devoted to educating families about child development and the importance of PLAY!  Check out her website and blog and follow her on Facebook, Pinterest, Twitter and YouTube.

Website:  www.milestonesandmiracles.com

Blog:  www.milestonesandmiraces.com/blog/

Facebook: https://www.facebook.com/milestonesandmiracles

Pinterest: https://www.pinterest.com/milestonesm/

Twitter: https://twitter.com/MilestonesM

YouTube: https://www.youtube.com/watch?v=HmuWPFDcqZ4

The post Milestone or Modern Convenience? – Part I: Overuse of the Sippy Cup & Pacifier appeared first on Early Intervention Strategies for Success.

Happy Early Intervention Awareness Month!

This week, Virginia’s governor released his annual proclamation (external website) that we celebrate early intervention in May. This is a great time of year to try to get the word about about early intervention in your locality. Even if you don’t live in Virginia, consider jumping in with us to try to raise awareness of what EI is and how to access it where you are.

Public awareness of early intervention is always an ongoing effort. Finding the time to do it isn’t easy, between intervention visits, meetings, monitoring the budget, staff supervision…the list goes on and on. I’ve found that purposefully planning several times a year to reach out to my referral sources and circulate info about the program was an easy way to focus my efforts. I’ve taken baskets of tea and chocolates to doctor’s office staff, sent mailings to families, visited child care centers, and manned a booth at child health fairs at the mall and community recreation centers. I’ve known others who periodically speak during physician rounds at the local hospital or meet with office managers at pediatric practices.

To help you in your public awareness efforts this month, I thought I’d share some great free resources that you can use to reach families, physicians, and other key referral sources in your community. Please add to the list by sharing what methods you use to get the word out!

Videos

Everyone loves “seeing it” and hearing from families and providers. If they have closed circuit TV in the waiting room, request that your local pediatrician’s office or social services department show one of these videos. Get an EI video played on your local free access TV station. Check out our video: What is Early Intervention in Virginia? below.

This video is 8.45 min long and features families and EI providers talking about what EI is, what it looks like, and why it works. A letter to community partners (PDF, New Window) and guidance for explaining EI (PDF, New Window) are available. If you need this video on a flashdrive or DVR to share, email me (dcchildress@vcu.edu).

Other states have some fantastic videos too: NYC Health: Early Intervention Program, Early Intervention Home Visits (Connecticut), and Early Childhood Intervention is Key (Texas).

If you need a video to support the importance of early childhood intervention, here are four powerful resources. If you haven’t yet, take a few moments and watch.

Handouts & Brochures

Keep handouts for referral sources short and sweet. They likely have very little time to read what you send, so make it count.

What is Early Intervention? (PDF, New Window) – VA brochure, also available in Spanish (PDF, New Window).

Parents are Often the First to Know When Their Baby Needs a Helping Hand: A Checklist for Your Child’s Development from Birth to Age Three (PDF, New Window) – VA resource. Contact local playgroups, parent support groups, mommy & me groups, child care centers, parenting classes, social services, and preschools and request that they distribute this checklist. Be sure to add a sticker with contact info for your local program.

After the NICU: Promoting Your Premature Baby’s Development at Home (PDF, New Window) – VA brochure, also available in Spanish (PDF, New Window). Contact your local NICU to ask if they will share this with families.

The Importance of Early Intervention for Infants and Toddlers with Disabilities and their Families (PDF, New Window) (NECTAC/ECTA Center) – Share this document with groups who are unfamiliar with EI, such as with funders.

Additional Ideas

Feed your referral sources – Along with your materials, take them a muffin breakfast, a basket of chocolate, or sandwiches for lunch. People love to snack and may warm up easier if you break the ice with a peace offering.

Regularly connect and check-in with key people – Find out who the office manager is and have a face-to-face meeting to discuss making referrals and answer questions. Other key people might include the physician’s nurse, an agency’s referral coordinator, the social workers at CPS or other DSS programs, lead staff at child care centers, social workers at the local hospital nursery or NICU, local substance abuse counselors, etc. Who are the key people in your locality?

Offer free screenings – Contact child care centers and preschools and offer a morning of free screenings once or twice a year. This takes coordination, but can be a great way to raise awareness among families and teachers.

Advertise your program a positive community resource – Sometimes, EI programs can be viewed as the place you send families who have children with challenges, which is true, but can also make people nervous. Advertise your program as a place where families can get info about infant and toddler development, ask questions, connect to resources, and receive support. Participate in community wellness fairs. Seek out collaborative opportunities with other agencies who serve children and families who may benefit from what you do. Let others know that you are happy to screen any child. Have open arms and be a positive presence in your community, and the word will get out!

What specific activities are you planning to celebrate EI and raise awareness? What have you done in the past that worked well?

Share your ideas in the comments below!

Visit the Early Intervention: What It Is and Why It Works and Resources and Info for Families pages on the VA Early Intervention Professional Development Center site for more info you can use. Visit the Infant and Toddler Connection of Virginia for information about VA’s early intervention system.

The post Celebrate! It’s Early Intervention Awareness Month! appeared first on Early Intervention Strategies for Success.