We are at the end of our discussion on the levels of awareness of parent of young children with disabilities. We have explored the ostrich phase – a time when a parent has a lack of awareness about disabilities and may not recognize the characteristics of a disability displayed by his or her child. Additionally, we have examined the phase of special designation – the stage at which parents have, through some transformational experience, recognized that their child indeed has a disability, and will require some additional assistance from a service provider to maximize his or her personal potential. Last month, we reviewed the normalization phase when a parent minimizes differences between the child and his or her typically developing classmates and siblings.

Fourth Level of Awareness: Self-Actualization

Today, we are going to explore a parent’s fourth and final level of awareness – Self-Actualization. In this level of awareness, a parent fully recognizes that his or her child with disabilities need supports. Not only does a parent at this level recognize the need for support, but by this time in a parent’s journey, based on the experience of raising and loving the child, the parent has his or her own perspectives on how these needs should be met.

During the time of parenting their child with disabilities, the parent has developed an expertise on a subject – his or her child.

Parents of children with disabilities have been described as practical scientists, and co-therapists, who take an active role in educating and raising their children while becoming skilled at selecting appropriate interventions. Parents may not have the fancy words that you as an early intervention professional have based on your knowledge of the content. However, they are doing some of the same things that you are doing in your practice at home. The interventions just look a little differently.

A self-actualized parent is ready to exercise his or her role as your partner in moving the child’s growth and development forward. And at this point of development, the parent is incapable of being a silent parent. The self-actualized parent is vocal and active. At times, the strong opinion and confidence that develop during and after the self-actualization phase can be met with a bit of resistance from service providers. However, this new found parental authority, when discussing the needs of the child, should be met with a listening ear and an open heart. The parent is now fully capable of exercising and expressing expertise regarding who his or her child is and what the child needs.

The Magic is About to Happen!

As early interventionists, you are in a help-giving profession. Thus, you want to ensure that you are offering families help that is relevant to the family’s needs

How can you achieve that goal?

By listening to your partner – the parent.

The phase of self-actualization is a reflective space. The parent has had the opportunity to think about the child, think about his or her parenting, think about what he or she feels will be the best way forward for the child and family. The self-actualized parent is ready and fully expects to be your partner.

However, this partnership will require a respectful reciprocal relationship between you and the parent.

True Partnerships are Comprised of Two Equals

You can’t be in partnership if, as the service provider, you walk into the relationship and take the lead. That’s not a partnership. The parent is asked to follow your lead in that situation. However, if the relationship is approached with the understanding that you are the expert on the professional knowledge and the parent is the expert on the child and how the disability manifests itself in the child, you can begin to respect and acknowledge the parent as a true partner.

Also, it is critical to remember that, as early interventionists, the goal is to improve children’s outcome. Therefore, you want to empower and enable parents, because no matter how great of a service provider you are or how much you love a child, your time with that child will expire. Parents and caregivers are forever. So, take this time to strengthen your partner.

Therefore, instead of striving to have a parent say you were best service provider the child ever had, you want a parent to say, “While working Ms. Angela, I learned strategies that I use with Molly to this day.”

That self-actualized parent is primed to receive the knowledge you have to give. However, self-actualized parents require and expect that you recognize and accept the knowledge and input they have to offer, as well.

This Child is Their LIFE!

These parents have now fully owned their role as parents of a child with disabilities. They are no longer in a state of not knowing. They are no longer looking for someone to “fix” their child. They are no longer comparing their child to other children.

They just see their most precious child – uniquely different, but not less than.

Unfortunately, as professionals who works with young children and their families, you may not witness a parent move through all of these levels of awareness during your time with a family. However, you must trust the process, not rush the process. And remember a parent’s time of being a parent is 22 years +. And just like the children you serve, parents too take time to develop.

When you commit the time to truly partnering with a parent and assist in that parent’s development as a parent of a child with disabilities, your legacy lives on in that family forever. You become the gift that keeps on giving.

So, be the gift that keeps on giving! We’re counting on YOU!

Have you had the opportunity to partner with a parent who you believed reach the self-actualization phase of awareness?

How did that experience compare to partnering with parent in the ostrich, special designation, or normalization phases?

Check out El’s archived webinar: Mama Bear: Using Parent Narratives and Experience to Improve Engagement Practices

Be sure to read the other posts in this series:

Emerging Parenthood: Trust the Process – Don’t Rush the Process

Levels of Awareness: The Ostrich Phase

Special Designation: The Parent’s Aha Moment

Normalization – The Hope Phase

El is an educator, entrepreneur, author, and PhD candidate specializing in Early Childhood Education/Early Childhood Special Education at George Mason University. Prior to leaving the traditional classroom, El served as an Elementary and Early Childhood Educator in the United States, Japan, and South Korea. She is the founder of KinderJam, an Early Childhood Education care, enrichment, and training agency. Above all, El is the proud mother of an 11-year-old son on the autism spectrum, affectionately known as SuperDuperKid (SDK). El can be reached at elbrown@kinderjam.com.

The post Self-Actualization: Hello, I am the Parent of a Child with Disabilities appeared first on Early Intervention Strategies for Success.

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.

In last week’s post, which was Part 1 in this series, I began trying to translate the DEC Recommended Practices for Interaction into practices we can use with caregivers. Rather than focusing on how we can implement these practices with children, we need to really think about how to help parents, child care providers, siblings, and other interaction partners in a child’s life learn how to engage children to promote development. So much of the development of social-emotional, communication, and cognitive skills occur within the context of these important relationships. We are typically pretty fantastic at interacting with young children, but we do our best work when we share what we know about how to engage them with caregivers so that they can use those practices everyday, between visits.

Helping Caregivers Use the DEC Interaction Practices (continued)

In the previous post, I provided descriptions and examples of how we can help caregivers implement intervention practices that focus on promoting children’s social and communication skills. Now, let’s wrap up this series by thinking about interaction practices that promote cognitive development and the use of problem-solving skills.

INT4. Practitioners promote the child’s cognitive development by observing, interpreting, and responding intentionally to the child’s exploration, play, and social activity by joining in and expanding on the child’s focus, actions, and intent.

Early interventionists can be partners in promoting cognitive and social play. Through the parent-child-practitioner triad, the interventionist and parent can practice play strategies that expand the child’s ability to focus, problem-solve, and persist.

Example: While observing play with a shape sorter, a physical therapist (PT) notices how the child throws the shapes rather than trying to insert them. The PT coaches the child’s older sister through using hand-over-hand guidance to help the child feel successful. The PT then helps the sister learn how to gradually reduce how much guidance she provides so that her sibling learns to complete the action of finding and inserting the shape with less help. They talk about how this same strategy could be used when the siblings take turns feeding their baby dolls.

INT5. Practitioners promote the child’s problem-solving behavior by observing, interpreting, and scaffolding in response to the child’s growing level of autonomy and self-regulation.

Example: An educator observes a child and mother at lunchtime to look for opportunities for the child to practice problem-solving and using his hands together. She and the mother brainstorm ways to challenge the child without upsetting him. They come up with the idea to offer him “seconds” on his Goldfish crackers by putting the crackers in a small plastic container. At first, they offer the child the container with the lid closed, and the child cannot open it. They scaffold the activity by opening the lid just enough that the child can more easily remove it next time. They use this activity to motivate the child and help him learn persistence and how to request help from his mother when needed.

These examples remind us that, in order to do our best work, we need to work within the context the caregiver-child relationship. Sure, we will still interact with the child, but we do it for the purpose of supporting the caregiver in learning new strategies he/she can use with the child during the week. Implementing these practices requires a sensitive balance of interacting with caregivers and children in ways that build their capacity to engage each other when we aren’t there. Take a moment to reflect on how you do this, who you primarily interact with during visits, and whether your practices match the examples in this post.

If you want to reflect further, check out the DEC Recommended Practices Products for Interaction. You’ll find checklists you can use for self-assessment and practice guides for you and for families (also available in Spanish). Here’s an example:

Adult-Child Interaction Checklist (PDF, New Window)

Access this checklist and share a comment about it below. Consider this:

How could you use this checklist and these practices to guide your interactions with families?

What is your favorite strategy for helping caregivers interact with their children to encourage problem-solving skills? Communication? Playful engagement?

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 2) 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.

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.

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.

I will admit it.  When I see a friend whose toddler is rocking the paci all day every day, I struggle not to judge.  This, from a mom whose 7-year-old climbs in her bed with her each night.  Parenting is a series of tough choices, choosing the battles worthy of fighting and those you can win, all while under the scrutiny of others like me who feel so strongly about the evidence regarding what is best for young children.  When I see a young child at the store at night, my first thought is, “oh, poor little guy, should be home in bed.”  And then I check myself.  I have no idea what that child’s day is like regarding schedule, family routines or priorities.  I know I am not alone, though.  I know there are many of us who struggle to honor families who make choices contradictory to what we believe to be best for young children.

Check Your Biases

There are many “hot topics” in parenting and early childhood development.  It’s arguably the period of development best supported by research and most flooded with tips and tools for navigating.  Popular sites like Babycenter cover all these topics including sleep, feeding, potty training, play, technology, and behavior with listicles for solving all your parenting struggles.  As early interventionists, we are only one source of parenting support, and we may not always be able to compete with grandma, environment, and the internet.  So, how do we strive to honor families who make child rearing choices in conflict with our professional beliefs?  I have developed my own listicle to add to the mix!

1. Check Your Biases. Is this a safety issue?  If the answer is no, consider your biases.  We hold our professional beliefs dear, as we should!  However, truly family centered practices build on family strengths and priorities.  If the 2-year-old’s pacifier is not a priority or concern for the family, it does not need to be one for us either.
2. Understand The Why. Talking with families about what motivates their decision making provides us with insight into why others do what they do.  Why does the family choose co-sleeping?  Are there enough sleeping spaces in the house for all family members?  Is co-sleeping standard practices in the family’s culture?  Listening first allows us to present the facts in a way that may support the family need while also addressing the concern, particularly if it is a safety concern.
3. Broaden Your Lens. There is no one right way.  Truly family centered practices trust families to be the expert on their own needs which simultaneously requires professionals to follow families’ leads.  If we approach each unique family with our own narrow lens for what is best, we miss the opportunities each family presents to problem solve together, to extend our views, and to find strategies that work.

I know it isn’t easy.  I know our professional and personal experiences have led us to these beliefs for good reasons, with a grounding in evidence and in best practices.  The challenge, then, is in how we make ourselves available for the beliefs of the family, particularly when they are contradictory to our own.

How do you honor families in your work who make choices that conflict with what you know to be true?

For more info on this topic, be sure to watch Jen’s archived webinar, Unpacking our Biases in Early Intervention, on the Virginia Early Intervention Professional Development Center’s 2017 Talks on Tuesdays Recordings page.

Jen Newton is an Assistant Professor of Early Childhood/Early Childhood Special Education in the School of Education at Saint Louis University. She worked as an early interventionist with infants and toddlers with disabilities or at risk for school failure in home settings before entering the classroom as an inclusive prekindergarten teacher in North Carolina’s More At Four program and later as a parent educator on an Early Reading First grant. She earned a doctorate in Special Education from the University of Kansas in 2011 and spent four years preparing inclusive educators at James Madison University prior to joining faculty at SLU. Her research examines inclusive teaching and learning, early childhood teacher preparation, and university/school partnerships.

The post True Confessions: Checking My Biases with Family Centered Practices appeared first on Early Intervention Strategies for Success.

Sofia just coordinated the worst assessment ever. With her head spinning, she takes a moment in her car to reflect on just what went wrong so that she can prevent it from happening again. In a nutshell, here’s what happened:

Sofia had originally met with Max’s father for the intake, who had planned to attend the assessment because he spoke English more fluently than his wife. Sofia had coordinated the assessment time slot with him, but when she arrived, she found the mother to be the only parent home. Concerned about the 45-day timeline and knowing that the family was eager for services to begin, Sofia decided not to cancel the assessment. One of the service providers conducting the assessment knew some very basic Spanish, so they all agreed to continue too. Unfortunately, each provider conducted the assessment by observing Max’s development and scoring the assessment protocols separately with minimal input from his mother. They focused on his performance on the test without consideration for how that performance translated into Max’s functional abilities in everyday activities. When they reported the results, both focused on what Max was not able to do today without consideration for his interests or his significant shyness. Max’s mother often shook her head in agreement but Sofia wasn’t confident that she had a clear understanding of the process or the results. Before moving to developing the IFSP, Sofia suggested that they wait to develop it another day when either the father would be home or an interpreter could be present. Not too long after the assessment had started, she realized she should have made this call much earlier. Whew, what an assessment.

DEC Recommended Practices for Assessment

Ever been in Sofia’s shoes? We’ve all had our worst assessment ever, but we’ve also probably had a best one too. Let’s take a look at the first five DEC Recommended Practices for assessment and think about what Sofia could have done differently.

A1. Practitioners work with the family to identify family preferences for assessment processes.

Sofia did try to work with the father and scheduled the assessment to honor his preference of being present, but as they say, even the best laid plans… When she arrived, Sofia could have asked Max’s mother what she preferred, but given the language barrier, the mother’s ability to understand and express her preference may have been compromised. Other family preferences could have been considered, including the time of day for the assessment, which types of service providers should attend, the location, and perhaps even which of Max’s toys or favorite activities could be included so that he felt as comfortable as possible.

A2. Practitioners work as a team with the family and other professionals to gather assessment information.

There seems to be a significant training need for the service providers conducting the assessment. They need to understand the importance of collaborating with the parent to gather good information and how to do that. The language barrier may have caused them to retreat into more clinical practices, but this is not really appropriate during an early intervention assessment. Perhaps Sofia could have spoken with them beforehand to prepare for how to conduct the assessment as a team. She could have prepared them for Max’s shyness and the family’s language differences. Ultimately, though, it’s not the service coordinator’s responsibility to ensure that team members who conduct assessment are qualified…that responsibility lies with the supervisor and local system manager. Sofia could share her experience with her supervisor, though, which could hopefully trigger the support these providers need.

A3. Practitioners use assessment materials and strategies that are appropriate for the child’s age and level of development and accommodate the child’s sensory, physical, communication, cultural, linguistic, social, and emotional characteristics.

A4. Practitioners conduct assessments that include all areas of development and behavior to learn about the child’s strengths, needs, preferences, and interests.

Both of these practices are essential when the goal of assessment is to arrive at a holistic view of the child’s development, strengths, and needs in his everyday life. Adapting the assessment process to accommodate a child’s preferences, interests, and characteristics ensures a more successful, comfortable experience for the child and family. Adaptations also inform the professional team members about a child’s potential. Qualified assessors know that children aren’t a sum of their developmental parts and use the information they gather to translate assessment findings into functional information that connects to individualized outcomes and successful services. Gathering good information and knowing what to do with it is key.

A5. Practitioners conduct assessments in the child’s dominant language and in additional languages if the child is learning more than one language.

Here’s the big one…this assessment should have never happened. When the father wasn’t present to interpret, Sofia should have cancelled the assessment. This seems like an obvious decision, but it’s not an easy one to make in the moment, especially when the family is eager for services to begin. The 45-day timeline is always important, as is the family’s need for services, but the assessment really can’t be conducted without the family’s active and informed participation. Sofia should have rescheduled when either the father was available or an interpreter could attend. When in doubt, always ensure that the family can be active participants, even if that means rescheduling the assessment.

Now, take some time to consider what assessments look like in your experience. Does what you do match with the DEC Recommended Practices A1-A5? Use this resource to find out:

Engaging Families as Partners in their Child’s Assessment Checklist (PDF, New Window)

Next month, we’ll continue thinking about assessment by illustrating the DEC Recommended Practices A6-A11. In the meantime…

What strategies do you use to implement these assessment practices? 

What did you learn from your worst assessment ever? What was your best assessment like?

What other recommendations do you have for Sofia? What would you have done if you’d been in her shoes?

Share your ideas in the comments below!

Be sure to check out my other post on applying the DEC RPs for Assessment to early intervention:

DEC Recommended Practices: Assessment (Part 2)

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 1) appeared first on Early Intervention Strategies for Success.