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.

You know the feeling…wishing you could speak the family’s language so you can build that strong relationship that’s so important in early intervention (EI). It can be challenging to coach a family when you have a language barrier, but a good interpreter can help you overcome that challenge. I recently met a new colleague with a background in language interpretation who told me that a sign of a good interpreter is when he/she is “invisible.” This really made an impression on me because when you think about it, the interpreter offers a bridge for communication and in his/her role, is invisible as an outside contributor to the interaction. The interpreter should be sure that the people on either side of the bridge fully understand each other without adding extraneous information or taking over the interaction. Understandably, that must be hard for the interpreter, but remaining that invisible bridge is important so that he/she doesn’t actually end up being a roadblock in the relationship-building between the family and the interventionist.

VIDEO: Collaborating with Language Interpreters – Information for Home Visitors

Take 5 minutes and watch this video:

One of my favorite phrases from this video is: Add nothing, omit nothing, change nothing. I like this phrase because I think this is what early interventionists want. We want to know exactly what the parent said and we want the parent to know exactly what we said. Yes, the actual words interpreted may change to ensure the meaning is conveyed, but that’s okay. It is when information is added, omitted, or changed that the relationship is affected. Here are some of the other key take-aways from the video that can have a positive effect on building the interventionist-parent relationship:

Speak with the interpreter before the visit – Get to know each other and explain what will happen on the visit. Review the purpose of the meeting and roles during the meeting. Share any guidelines from your program for how to work together.

Allow for additional time – Be patient and plan ahead so you have enough time for the extra communication involved.

Sit in a triangle – You should face the parent, and the interpreter should sit so he/she can see and speak with both you and the parent.

Always look at and speak directly to the parent – This is often the hardest one for interventionists. It can feel a bit awkward, but you should be sure to look at the parent when you speak to him/her. Remember the invisible bridge. If you speak and look directly at the interpreter, he/she is no longer invisible.

Keep it short and remember to pause – This one is also hard because shortening your sentences and remembering to pause may not be how you normally talk. It can take some getting used to and requires a mindful approach to communication, but makes it easier for the interpreter to accurately share everything you say.

Collaborating with the interpreter as an invisible bridge takes its own relationship-building, between you and the interpreter. Once that relationship is established, you will have a wonderful resource and partner who is essential in helping you help families.

What strategies do you use to build relationships with families when collaborating with a language interpreter? 

What are your thoughts on the idea of the interpreter being an invisible bridge?

Share your comments below!

For information you can share with interpreters, visit the VEIPD Cultural Competence topic page and look under the Handouts/Documents tab for links to Resources for Interpreters Working in Early Intervention (EITP, University of Illinois).

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

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

5 Strategies for Responding to Discomfort

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

Here are 5 responsive strategies to help you manage discomfort:

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

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

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

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

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

How Much Discomfort is Okay?

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

What do you do when a parent seems uncomfortable? 

Share your experiences and strategies in the comments below!

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

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

True Confessions

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

Here’s the Challenge…

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

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

4 Strategies to Help You Stay in Your Lane

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

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

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

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

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

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

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

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

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

On the blog, we often speak from the perspective of the EI professional. Switching up this “voice” a bit is not only fun, but it may help us understand more about the culture of some of our families. The tips I will share are from the millennial parent’s viewpoint in hopes of using their interpretation to help us reach them more effectively. As an Early Intervention professional of 10 years, an Educator to teens and an individual born sandwiched in the middle of the Millennials and the Generation-X’ers, I must say that the two groups communicate completely differently from one another. At times, without proper insight, it can cause a bit of frustration among both groups. Understanding the “why” behind some of the cultural variances is the foundation to building great, impactful relationships. Due to my unique perspective, I’ve noted 11 Things a Millennial Parent Wished a Generation-X EI Provider Knew.

My List

1. Sorry to make you feel uncomfortable but texting me is best. If you want to reach me, text first, email next, call last. I’m more apt to respond.

2. When explaining EI, connect coaching with something that I’m interested in such as sports. It’s more likely to stick.

3. I learn a lot by demonstration. Watching YouTube videos have taught me to watch first then imitate what I see. Use the media to your advantage.

4. Show me child friendly apps to help my little one learn. Because we are often on the phone and tablet, what better way to coach me than to use apps that are readily available.

5. Help me to write goals to include mention of my favorite shows, apps or songs. My little one is often inundated with my culture so barking like a dog because we use the snapchat lens/filter is right up my alley.

6. If you arrive and I’m texting, know that I have mastered multi-tasking. Don’t get offended, I’m not ignoring you.

7. Remind me to put our next appointment in my phone as an alarm or reminder. Writing on the back of a card or on a piece of paper is so outdated.

8. I’m very relaxed so coming in with suits may make me feel uncomfortable. It will be harder to build a coaching relationship with you because now I look at you as an authority figure. Relax, I’ll receive you better this way.

9. Video me suggestions or even send me website or app links like this one from the CDC . I’m sure to use them. It’s even fun to engage me with one during our session. Coaching me this way is fun. I look at visual apps all day so this is definitely speaking my language.

10. If I send you a social media request, take it as a compliment. I must really like you. Don’t ignore it because it effects rapport. Instead let me know your policy. I’ll understand.

11. My communication is often short and to the point. It doesn’t mean I’m not engaged or interested in our dialogue but texting has taught me not to participate in much small talk.

I hope this blog post helps all of us understand Millennials and how they communicate. Let me know if you believe these tips were helpful. If you have any other advice to add from the perspective of a Millennial or you’ve provided services to this generation and believe you have some great information to share, I want to hear from you! Share your thoughts below!

Tier-ra Henry is a spunky millennial who has provided Developmental Services with ITC of Hampton-Newport News for 7 1/2 years. She got her start as a Service Coordinator with Norfolk ITC but after drooling over the fun, creative things the therapist did with the kiddos, she made a switch to serve her hometown with more direct services. She is the mother of an AMAZING 11 year old up-and-coming actress. You can find Tier-ra in the city with her trendy clothes, serving her community and building a strong rapport with families while making learning super fun. In her spare time she is a Personal Stylist. She is a strong advocate for families and believes her job as a Developmental Service Provider allows her to use her heart for social justice and creativity to serve children. She holds a Bachelors of Social Work degree from Norfolk State University.

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Wyatt is a happy 19-month old child who was recently released from the hospital, where he lived for the first 17 months of his life. Wyatt was born very prematurely and has been diagnosed with a visual impairment and cerebral palsy. You want to conduct an assessment to learn about Wyatt’s strengths and needs, especially related to communication, which is a priority for his family. When you look at the assessment tools, you worry that Wyatt is likely to score much lower than his chronological age. You wonder – Is this is good test to use? How do I get meaningful information that will help our team write good goals?

Thinking Beyond the Test Scores

From experience, we know that young children with multiple disabilities often perform much lower than their chronological or adjusted age on our developmental assessments. We walk into an assessment bracing ourselves for how to tell a family that their 19-month old son has the skills of a 4-7 month old infant. We struggle because we don’t want to hurt a parent’s heart with this difficult news. We also struggle because I think, on a deeper level, we realize that this information really isn’t all that meaningful. While we can quantify that Wyatt can or cannot do certain tasks on the test, we also know that qualitatively, Wyatt has had more experiences than a 4 or 7 month old infant. Wyatt may be just starting to roll over, hold a toy, and make babbling noises but he is not an infant.

Establishing a developmental age is something we have to do when children enter EI and annually to help us track progress. We can’t avoid it, and shouldn’t, because it is helpful when considering what will come next developmentally for Wyatt. Perhaps our more important task, then, is to think about how to gather meaningful information about Wyatt’s functional abilities, including how he communicates and engages others, acquires and uses knowledge, and takes actions to meet his needs.

Tips for Assessing Young Children Who Have Multiple Disabilities

I recently came across a great resource that prompted me to think more deeply about how we assess very young children with multiple disabilities: Assessing Communication and Learning in Young Children Who are Deafblind or Who Have Multiple Disabilities (Rowland, 2009) (PDF, New Window). This document includes some great tips that we could use if we really were conducting Wyatt’s assessment, such as:

Plan for extra time – It takes time to get to know the child and learn how to read his cues, how to position him, how to offer assessment materials, etc. Assessing Wyatt would involve more than observation and conversation with his caregivers; it would also be a process of experimentation to figure out what he can do and how to support him in doing it. Wyatt may also need extra time to complete activities and/or extra rest time between them.

Select appropriate assessment tools – Look for tools that include info about how to adapt assessment items for children with sensory or motor disabilities. The Carolina Curriculum for Infants and Toddlers and the Assessment, Evaluation, and Programming System for Infants and Children (AEPS) are two examples.

Gather information about Wyatt’s everyday life – Prepare a list of specific questions you want to ask, such as:

• How does Wyatt react when you talk to him?
• What cues do you notice that tell you what Wyatt wants/needs?
• What does Wyatt like to do/not like to do?
• How does he use his vision?
• What would you like for Wyatt to be able to do?
• What would make things easier for you/for Wyatt? 

Ask the caregiver to “show” you how she plays with Wyatt, positions him, and engages him. Find out about Wyatt’s interests, preferences, what motivates and alerts him, and what tires him out.

Do a “head to toe inventory” when assessing communication – Look for the child’s movements, reactions, and sounds and consider which appear to be voluntary and which have communicative intent. If you aren’t sure, keep observing throughout the assessment to see if you notice the behavior or sound again. Watch for patterns and take careful notes.

Always assess sensory and motor skills too – The presence of hearing, visual, and motor disabilities will affect how Wyatt communicates. He could have cognitive skills closer to his adjusted age, but his difficulties with movement and vision could make it really hard for him to show you what he knows.

Rather than approaching Wyatt’s assessment with the worry that he’ll score low, the author of the resource encourages us to approach it as a “process of discovery.” You will use all of your tools – the test results, specific observations, conversation with the family, insights from other team members – to try to discover what Wyatt can do now and what comes next for him. Helping Wyatt be an active participant in his daily life is our goal, regardless of whether his skills are at the 4-7 or 19-month levels.

What strategies do you keep in mind when assessing an infant or toddler with multiple disabilities?

How do you share assessment info with families?

Add your comments below!

Want more information? Visit our VEIPD topic pages on Motor Delays & Disabilities, Multiple Disabilities, and Visual Disabilities.

The post Assessing Children with Multiple Disabilities – Tips and a Great Resource! appeared first on Early Intervention Strategies for Success.

Jenni has two options on every intervention visit:

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

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

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

What Can Jenni Do?

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

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

DEC Recommended Practices: Instruction

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Family Capacity-Building Module

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

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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.

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

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

Authentic Assessment

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

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

What questions do you have about implementing functional assessment? 

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

Share your thoughts by leaving a comment below!

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

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

Authentic Child Assessment Practices Checklist

The post Functional AND (not or) Traditional Assessment 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.