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

It’s time to wake up.

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

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

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

The days are long, but the years are short.

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

Service Coordinator: Does your son take a nap?

Mom: Yes, after lunch.

Service Coordinator: How long are his naps?

Mom: Usually about an hour and a half.

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

Pulling it all together.

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

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

Share your ideas in the comments below.

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

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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.

When we whittle early intervention down to its core, I think it’s all about interactions. Interactions between the child and caregiver, first and foremost…interactions between the child and the environment (toys, sofa cushions, spoons and cups, buttons on the TV remote, the family dog)…interactions between the EI practitioner and caregiver that facilitate positive interactions with the child in the natural environment. See where I’m going here? It’s all related to positive, reciprocal, contingent interactions.

Translating our Super Powers

The Division for Early Childhood (DEC) Recommended Practices provide our field with a list of five interaction practices that we can use to “promote specific child outcomes” (p 14) when working with families. As early interventionists, we often have super powers related at using these practices – we know how to use our voices and language to engage children, how to observe behavior and encourage reciprocal communication, and how to help children sustain interactions and respond to the environment. Our use of our super powers won’t ever be enough, though. We have to use what we know to help others interact with the child in ways that boost development and learning. When caregivers use recommended practices for interaction, the child has more opportunities to develop social skills, communication, cognition, and independence throughout the day. Those daily interactions are what really matter.

Helping Caregivers Use the DEC Interaction Practices

Let’s consider the first three practices, which focus on promoting social and communicative interactions.

INT1. Practitioners promote the child’s social-emotional development by observing, interpreting, and responding contingently to the range of the child’s emotional expressions.

Early interventionists are great resources for caregivers in helping them observe and interpret their child’s behavior. This is especially helpful with children who communicate in ways that are harder to understand, such as children who may have autism or those with multiple disabilities. The interventionist can help the caregiver notice the child’s attempts to engage and communicate. Then, they can figure out how the caregiver can respond in ways that help the child learn the benefits of engaging others.

Example: An educator sees a child’s tendency to stroke his mother’s hair as an attempt to engage the mother and feel close to her. The mother originally found the “hair pulling” slightly annoying, but when she sees the possibility that it represents affection from her child, she can respond to the child with a warm smile and voice, encouraging rather than discouraging the interaction.

INT2. Practitioners promote the child’s social development by encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support.

Early interventionists can help caregivers seek out opportunities for the child to interact by observing typical routines, especially those that the caregiver and child enjoy together. By asking the caregiver open-ended questions (“What makes your child laugh? What do you like to do together? When do you do to spend time together? What would you like to do together?), the interventionist can identify activities to target for intervention.

Example: An occupational therapist (OT) observes the morning dressing routine, during which a mother plays peek-a-boo and tickle games with her infant. The OT coaches the mother to use an expectant look and extra wait time to facilitate her child’s engagement and teach her child how to take turns, make sounds, and perhaps pull the blanket from the mother’s face to keep the game going.

INT3. Practitioners promote the child’s communication development by observing, interpreting, responding contingently, and providing natural consequences for the child’s verbal and non-verbal communication and by using language to label and expand on the child’s requests, needs, preferences, or interests.

Rather than being the communication partner for the child for most of the visit, the interventionist can coach the caregiver in how to respond contingently, use words that are just above the child’s language level, and expand on what the child says. This works well during play and other routines.

Example: A speech-language pathologist coaches a father in how to expand a child’s gestural request for his cup to be filled with water. The child hands his cup to his father and walks away. Through modeling and practicing simple prompts, the father can learn to label the child’s request (“More water?”), hold the cup up near his own mouth to draw the child’s attention to the word being said, and wait before meeting the need so that the child has a chance to imitate the model. The father and child can then practice this interaction whenever this request is made, which is likely to be often – more often than if the therapist used this strategy 2-3 times on a single visit.

These are just a few examples of how we can implement the Interaction Recommended Practices through the caregiver-child interaction.  Our knowledge of how to facilitate interactions can translate into the strategies we share and practice with families. Using those parent-interventionist interactions to facilitate parent-child interactions in natural environments – that’s what it’s all about!

Next week, we’ll continue this discussion by looking at the next two practices, which focus on facilitating cognitive skills. In the meantime:

Why is it important that early interventionists translate these practices for use with families?

How have you use these practices on visits? With child care providers?

Share your thoughts and examples of implementing these practices by leaving a comment 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 – Interaction (Part 1) appeared first on Early Intervention Strategies for Success.

Assessments continue to evolve in a variety of settings including the medical and educational fields. Though these assessments look and feel different, there is one very large commonality.  True individualization is ultimately valued. As we move toward conducting functional assessments, we have to learn how to gather information differently. Rather than interviewing the parent straight from the assessment tool, going item by item, we know that we can gather richer information by having a conversation with the parent about the child’s daily life. Sure, we still need to observe the child and complete the items on the protocols, but these conversations help us relate what we observe to the child’s everyday life – his/her functional development. This helps us individualize assessment, and provide services, in a meaningful, functional way.

What does a functional assessment look like?

One simple way is to start with the parents’ concerns and any new updates, including medical information, since the intake. This is a fantastic role for the service coordinator because they have the information from the intake and can explain what the parents can expect during the assessment process.

Then, begin to ask open-ended questions with the start of a child’s day to bedtime, covering sleep, mealtime, playtime with others and self, naps, community outings, bath time, car rides, and any other relevant routines to the family. This will help trigger any concerns about the child’s day the caregiver may have previously forgotten. Analyzing the caregiver’s responses to the questions can lead into deeper questions and discussion. Try to wait to complete any protocols until the majority of the questions have been asked and the play is completed. This will help the parent feel more open to discussing details of their personal life. This is a vulnerable time and listening and observing help make this process more comfortable. Take a few minutes after the assessment to take the protocols out and complete them prior to reporting out in the three outcome areas. This may feel uncomfortable at first, not having the protocols in front of you. Practicing and understanding the reasoning behind the questions in protocols helps this become a more natural process.

Here are some practical strategies to move toward functional assessment.

1. Ask open-ended questions centered on a child’s day.

The key is to ask open-ended questions during an assessment that are centered on a child’s routines and activities to gain meaningful information. Open-ended questions strengthen the relationship with the caregiver because we are actively listening and creating rich conversations in order to understand the whole picture of the child’s development within the context of the family’s life. We see the meaning behind the child’s behaviors versus simply identifying behaviors. Consider these questions: What do yes or no answers from an assessment tool really tell us about the child? Can these questions feel intimidating to parents? How can we truly gain a deeper understanding of the dynamics that affect a child’s development? Understanding the dynamics surrounding a child’s life is essential.

Please follow this link (PDF, New Window) for an example of how a functional assessment might flow, including examples of open-ended questions to ask.

2. Teaming

Functional assessments still include observation, clinical opinion, parent report, and any protocols. Each locality may be set up differently, in terms of who conducts assessment, what tools are used, etc. As long as the teams are communicating information, this should still look similar across localities. The service coordinator facilitates the assessment and supports the family and providers throughout the process. One of the service providers may focus on asking open-ended questions while the other provider facilitates play with the child.

One strategy to increase teaming is to communicate each person’s role in the assessment. After the assessment, discuss what went well and areas to grow. It is important to not be judgmental as this is a learning process for all of us. Communication is the most effective way to build stronger teams. Respect the perspective each person brings to the table and ensure everyone participates in the assessment. Remember, parents play a huge role in our team.

3. Practice makes perfect.

Incorporating functional assessment into your existing assessment process is easier than expected with practice. Each locality has different processes that need to be individualized to serve the same purpose of a functional assessment. How can we gain a clear picture of a child’s life in order to help provide quality services? Some providers may have set assessment slots that provide a multitude of opportunities to practice and strengthen their knowledge and confidence in conducting functional assessments.

Practice during assessments by asking more open-ended questions and relying less on the protocols being in front of you. During assessments, practice viewing development from a functional perspective looking at how the child will use skills to be successful in his daily life. Role-playing is another way to practice with a colleague. Take turns asking questions as the provider while the other acts as the caregiver.

Every assessment has different variables that may add additional stressors such as a barking dog or siblings. The functional assessment process gains rich information while providing opportunities to consider each child’s interests and family dynamics. In the end, we gain an understanding of the child’s personality, relationship to the caregivers and other people, temperament, learning style, and participation in daily routines and activities. Functional assessments are thorough and help us to receive valuable information to help us create a truly individualized plan for each child.

I would love to hear your own strategies for functional assessments.  Please share your tips on completing functional assessments in your locality.

What are some of your favorite strategies to ask open-ended questions, practice, and/or collaborate as a team?

What are some challenges you encounter when implementing functional assessments?

The post Enhancing Quality Functional Assessments for Each Individual Family 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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How much do I value families’ everyday routines in being able to positively influence children’s development? So very much. Yet… how often do I find myself on a home visit either: 1) only talking with a family about their routines, or 2) engaging with the family in only the routine of play? Too often!

Values versus Actions

What we know about early interventionists is that they tend to have values that align with current recommended practices about the importance of providing services that focus on families’ everyday routines. However, we also know that even with those values, our services tend to focus heavily on having discussions with families, or when we do participate in routines with them and their children, that routine tends to be play-based.

As the saying goes: ‘It’s easier to talk the talk, than walk the walk.’

Neither of these things, discussions or a focus on play, are problematic. Yet we know that our services have much greater potential to be useful to families and supportive of their children when they focus on the typical, everyday parts of their lives.

Therefore, if we want to be most supportive of families and their children, our actions during home visits need to align with our beliefs about the importance of all types of family routines!

Get Back to Walking the Walk

Many of us may be stuck in the ‘talk the talk’ portion of this – we know and value families’ routines. We may talk and brainstorm with families about many routines each time we see them. But how often are these routines themselves the focus of our visits?

Now may be the time to say to ourselves: “It’s time to get back to walking the walk!” That may mean doing some active observation of a particular family routine and providing strength-based feedback, or it may mean being part of the routine with the family (such as going on a walk to the park together). If we want to get back to ‘walking the walk’ of routines based services, one way to do this is to take a moment to evaluate your visits with families. Pause. Reflect. Be generous with yourself and notice your strengths. Be willing to notice the routines you struggle to be part of with families. Take the time to think about the barriers that either you or the family may face.

You are likely very knowledgeable about recommended practices in early intervention. Therefore, one of the most powerful ways to shape who you are as a continually developing professional is to simply reflect on what you do. Self-reflection can be a great step in the right direction for us as professionals by using it to first identify where we are now, and then set goals about where we’d like to be heading.

A Resource for Self-Reflection

This resource, Self-Reflection Worksheet on Home Visiting, can help you to do some self-reflection. Open up the link and take a moment to yourself, or discuss the questions with a trusted colleague. What do you notice when you reflect on the services you provide? For example:

• How do you spend time with families and their children during your visits?
• What routines could you incorporate into your visits with families in order to move past discussion?
• What are the barriers that you or the families you work with are facing that may make this challenging?
• What are your greatest strengths based on these questions, and what are the areas you hope to improve upon?

Share something you learn from this self-reflection by leaving a comment below!

Kalli is an Assistant Professor of Early Childhood Education & Child Services at Montana State University where her research focuses on early intervention services. Kalli also works part time as a Family Support Specialist through Family Outreach, a nonprofit agency in Bozeman, Montana. As a Family Support Specialist Kalli provides early intervention through home visiting services for infants and toddlers with delays or disabilities and their families.

The post “Walk the Walk” of Routines Based Services through Self-Reflection appeared first on Early Intervention Strategies for Success.

In Part 1 of this series, we met Phoebe, a service coordinator, and Wyatt’s family. Wyatt had just been referred to early intervention, and his family was eager to begin services but feeling overwhelmed by the process and their son’s new diagnosis of cerebral palsy. We began the discussion about the DEC Recommended Practices (2014) under the Family strand, illustrating how Phoebe used them when supporting Wyatt’s family from intake through service delivery. Take a moment now and review the Part 1 blog post to catch up.

Now, let’s consider how Phoebe and Noelle, the physical therapist, implemented the last five family practices.

DEC Recommended Practices: Family (continued)

F5. Practitioners support family functioning, promote family confidence and competence, and strengthen family-child relationships by acting in ways that recognize and build on family strengths and capacities.

When Phoebe joined a visit, she was happy to see Noelle coaching Wyatt’s mother in how to help Wyatt learn to support himself in sitting. Wyatt’s older sister was keeping Wyatt entertained by holding his favorite musical toy in front of him and singing songs. Wyatt was smiling and working hard to keep his head in mid-line so he could see his sister. Wyatt’s sister loved helping him learn and was his greatest cheerleader. One of his family’s biggest goals was helping Wyatt learn to sit so that he could more easily participate in playtime, bath time, and meals which were social, fun times for the family.

F6. Practitioners engage the family in opportunities that support and strengthen parenting knowledge and skills and parenting competence and confidence in ways that are flexible, individualized, and tailored to the family’s preferences.

Two weeks later, Wyatt’s mother called Phoebe, asking for ideas on how to help Wyatt participate in the local baby gym program. She’d taken Wyatt to a free class but was disheartened that he struggled with many activities. Phoebe suggested that they hold an IFSP review meeting to revisit Wyatt’s outcomes and goals and discuss how to help him at the baby gym. Phoebe called Noelle to update her and schedule the meeting in the early evening so that Wyatt’s father can attend, as he also wanted  to take Wyatt to weekend classes. During the meeting, the baby gym is added as a location for physical therapy and goals are reviewed. After the IFSP review was completed, Noelle discussed the activities at the baby gym class with Wyatt’s parents and they came up with several ideas to help Wyatt have fun.

F7. Practitioners work with the family to identify, access, and use formal and informal resources and supports to achieve family-identified outcomes or goals.

Noelle attended the next two baby gym classes to help Wyatt’s family access and use the play equipment. She helped Wyatt’s parents and the baby gym instructor problem-solve how to encourage Wyatt’s motor development while he played and interacted with the other children. He especially enjoyed playing with the parachute and popping bubbles, but needed assistance sitting upright during these activities. Wyatt’s parents used the strategies they practiced at home to help him with sitting, and determined that the bolsters at the gym could provide him with support when sitting or lying on his tummy. After these visits, Wyatt’s parents felt much more comfortable in the class. 

F8. Practitioners provide the family of a young child who has or is at risk for developmental delay/disability, and who is a dual language learner, with information about the benefits of learning in multiple languages for the child’s growth and development.

One day, Wyatt’s mother called Phoebe to tell her that she would begin working full-time soon. Her mother would be providing childcare and primarily spoke Spanish when at home, though she was bilingual. Wyatt’s mother was concerned that hearing both languages would interfere with his language development. Phoebe discussed the benefits of Wyatt learning a second language, and offered to email his mother information about encouraging Wyatt’s learning of both languages. She assured Wyatt’s mother that Noelle would continue to monitor all areas of Wyatt’s development too. Phoebe called Noelle to fill her in, and services began alternating between the grandmother’s home and periodic visits in the early evening with Wyatt’s parents.

F9. Practitioners help families know and understand their rights.

When it was time for Wyatt’s annual IFSP review, Phoebe reviewed the family rights and procedural safeguards again to ensure that Wyatt’s parents were aware of their rights.  She offered a document explaining these rights, and completed documentation of the discussion.  By then, Wyatt’s parents were very familiar with this information, as Phoebe had discussed rights often throughout the past year, especially at IFSP reviews. 

F10. Practitioners inform families about leadership and advocacy skill-building opportunities and encourage those who are interested to participate.

Phoebe has been pleased to see how Wyatt’s family has grown from being overwhelmed with the process to feeling confident in their role on the IFSP team. This growth led her to ask Wyatt’s mother if she would be interested in being a resource to new families as they enter the program. Wyatt’s mother happily agreed. When an opportunity to serve on a local board that oversees community services for children with disabilities became available, Phoebe also asked Wyatt’s family about their interest, and his father decided to volunteer. Where they were once eager to get services started, Wyatt’s parents are now eager to help other families and participate in community activities that build strong supports for their son and other children.

As you’ve just read, the DEC Family Practices can be used as a guide for supporting families throughout the EI process. These practices help service coordinators and service providers build family confidence and competence from the first contacts throughout service delivery.  What we do in early intervention matters…but it is HOW we do it, how we support families, that really makes the difference.

Be sure to check out these Family Practice Guides for Practitioners from the ECTA Center:

Family Capacity Building in Early Childhood Intervention (PDF, New Window)

Supporting Family Member Informed Decision Making (PDF, New Window)

Now, pick one practice guide and forward it on to your colleagues/staff.

How have YOU implemented these practices today? 

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: Family (Part 2) appeared first on Early Intervention Strategies for Success.

Nicholas visits with Mia and her grandmother, Mrs. Wilson, during breakfast. Mrs. Wilson loves to cook and would like to involve Mia but she isn’t sure how. When she’s tried, Mia pulls her hand away or arches her back instead of touching the ingredients. Mrs. Wilson knows that she should help Mia touch different textures since Mia can’t see them, but Mia doesn’t seem to like it. Nicholas notices that Mia is learning to the side in her highchair due to her low muscle tone, which makes it difficult to use her hands or feel secure exploring. He sees lots of great learning opportunities in this environment so begins to think about how he can help.

How do the Environment RPs fit with EI?

We talk A LOT about the environment in early intervention. We are federally mandated to provide services in “natural environments,” which for us means more than just the location. “Natural environments” also refers to what we do in those locations, how we interact with the child and parent, and perhaps most importantly, how we support their interactions with each other during their routines and activities. The DEC Recommended Practices (RPs) match well with our concept of natural environments when they describe “environmental practices” as “aspects of the space, materials (toys, books, etc.), equipment, routines, and activities that practitioners and families can intentionally alter to support each child’s learning across developmental domains.” The authors of the RPs go on to describe these practices as encompassing three aspects of the environment: “the physical environment (e.g., space, equipment, and materials), the social environment (e.g., interactions with peers, siblings, family members), and the temporal environment (e.g., sequence and length of routines and activities).” These three aspects can really guide our approach to developing intervention strategies that fit with families; they remind us to think about “environment” is much more than just a place.

Time to Apply the RPs!

Let’s consider how Nicholas could apply the environmental RPs in his work with Mia and Mrs. Wilson:

E1. Practitioners provide services and supports in natural and inclusive environments during daily routines and activities to promote the child’s access to and participation in learning experiences.

Nicholas is off to a great start. He’s joining Mia and her grandmother during a routine that’s important to them. He’s there to help Mrs. Wilson find ways to help Mia participate in breakfast preparation, which will give her access to textures, smells, materials, and interactions that she doesn’t have access to now. His collaboration with Mrs. Wilson could open up a whole new learning opportunity for Mia.

E2. Practitioners consider Universal Design for Learning principles to create accessible environments.

Nicholas should consider the what, how and why of learning during this routine. He can help Mrs. Wilson present materials to Mia in different ways (the what) by letting Mia use her fingers to touch when she’s comfortable or use a spoon to stir ingredients when she’s not. He can help Mrs. Wilson read Mia’s cues (the how) to find out what she likes. Her arching and pulling away may be a function of her positioning, so once they find a way for her to feel stable in sitting, they can reassess her reactions to find out what she thinks and wants to do. They can also experiment with different textures, smells, temperatures, and types of foods to see what motivates Mia to explore (the why).

E3. Practitioners work with the family and other adults to modify and adapt the physical, social, and temporal environments to promote each child’s access to and participation in learning experiences.

Nicholas can help Mrs. Wilson consider these three aspects when planning for intervention. They need to find a way to improve Mia’s positioning in her high chair. They need to see what materials in the kitchen might make exploring more comfortable. Perhaps Mrs. Wilson could use her voice inflection, volume, or the amount of words she uses to facilitate interactions between herself, Mia, and the ingredients. They might reflect on the sequence and length of the meal prep routine to see how Mia could participate. Maybe Mia could help Mrs. Wilson stir the pancake batter, then munch on scrambled eggs while the pancakes are cooking, rather than wait to present all of the food at the same time when Mia is too hungry to take the time to explore it.

E4. Practitioners work with families and other adults to identify each child’s needs for assistive technology to promote access to and participation in learning experiences.

E5. Practitioners work with families and other adults to acquire or create appropriate assistive technology to promote each child’s access to and participation in learning experiences.

Nicholas’s observations can help identify the need for AT to improve Mia’s positioning. He can brainstorm with Mrs. Wilson about how to use low-tech options, such as towel rolls beside Mia to keep her stable. If she needs more than that, they can discuss more high-tech options and contact the service coordinator for assistance. Similarly, Mia might benefit from a spoon with a built-up handle to make holding it easier. Or, perhaps having a mat on the high chair tray that provides more color contrast would make it easier for Mia to see the food. These are all things good early interventionists consider; the trick is to remember that not all of these needs have to be solved by something from a catalog. Always consider low-tech, aka stuff already found in the home, first.

E6. Practitioners create environments that provide opportunities for movement and regular physical activity to maintain or improve fitness, wellness, and development across domains.

Nicholas could consider how Mia gets to and from her high chair for breakfast. Perhaps there are opportunities to increase her independent mobility around this routine.

Sometimes, we might look at the DEC RPs and think “I don’t do that” or “I only do that in certain settings.” For example, E2 sounds like something you would do mainly in a group setting. As you can see with Nicholas, these practices can be implemented even in a family’s kitchen. How we think about the environment, and these practices, makes all the difference.

Do you have an example of how you’ve considered the three aspects of the environment described in the RPs: physical, social, and temporal?

How do you implement Universal Design for Learning during EI visits?

What other ideas do you have to help Mrs. Wilson include Mia in the breakfast prep routine? What else should Nicholas consider?

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: Environment 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.

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

Concerns and Priorities – What’s the Difference?

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

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

Why It Matters

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

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

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

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

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

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

Share your comments below!

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