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

Realities

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

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

The Internal Struggle

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

Complexities

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

Use the Struggle to Help You Grow

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

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

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

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

Share your insights in the comments below.

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

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

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

5 Strategies for Responding to Discomfort

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

Here are 5 responsive strategies to help you manage discomfort:

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

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

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

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

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

How Much Discomfort is Okay?

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

What do you do when a parent seems uncomfortable? 

Share your experiences and strategies in the comments below!

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

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.

Rosemary, speech therapist, has been seeing Caleb for five months and it is time for his annual IFSP next month. She is worried she does not have enough information to provide developmental age ranges for the annual IFSP. According to the practice manual (Chapter 6, page 2), ongoing assessment is defined as:

“Assessment that occurs as a routine part of service delivery based on observation of the child’s functioning and skills across all developmental domains and indicator areas. The purpose of ongoing assessment is to give the provider and the IFSP team, including the family, information on the child’s progress on the IFSP outcomes and short-term goals being addressed by the current activities and to assist in identify any emerging concerns in other areas of development. No assessment tool is required; but, when needed, the service provider may use an assessment tool as a reference point, especially for areas of development outside his/her area of expertise.”

Rosemary reflects back on past visits and reads her progress notes. She pulls out the initial protocol (or assessment form) used for Caleb and updates it accordingly. Rosemary begins to feel more confident as she realizes she has seen Caleb performing during a variety of activities and routines including the park, car, grocery store, meals, and playtime with his brother and family. Rosemary realizes she has more than enough information to update Caleb’s progress in the three child outcome areas. She also uses the protocol as an anchor tool to provide developmental ranges as part of ongoing assessment.

A Deeper Look at the Definition of Ongoing Assessment

When you read the state’s definition, what key words related to the process of ongoing assessment do you notice?

Observation, functioning, progress, and emerging concerns are key words to ongoing assessment. Ongoing assessment is the continuous observation process you use to monitor a child’s progress, notice any emerging concerns, and discuss them with your team as needed. When we look at the whole child’s development across time, we are ensuring we are monitoring progress and routinely individualizing services throughout the process.

Three Strategies to Improve Ongoing Assessment Practices

Ongoing assessment is something you are probably already doing during each visit with the family. Here are some simple tips to feel confident before your next annual IFSP review.

• Document ongoing assessment in your contact notes. Contact notes should clearly reflect a child’s progress since ongoing assessment is a part of the contact note requirements (page 9) (PDF, New Window). Sometimes, there will not be as much progress week to week, but it is still important to document what the family and child did (current progress), so that progress will be clearer when something happens in the future. Ongoing assessment helps you identify progress towards IFSP outcomes/short-term goals and also any new functional skills in the three child outcome areas. Updates about progress in the three outcome areas are fundamental information that should be documented in your contact note.
• Read your records before your next visit. We can easily get in the routine of just going from visit to visit. A simple glance over your last contact note may help guide you during your discussions with families. Check in with the family and compare what you learn to your protocols. Some service providers regularly update their protocols throughout the time they see a child. This helps providers think about the whole child versus just their specialized area. You might also want to review the IFSP narrative and note differences in the child’s skills since the IFSP was developed. What has changed? What other activities or routines do you want to observe?
• Visit the family within different routines and activities including going out in the community. This will help you observe skills in a variety of settings. Observing the child in a variety of settings will help you ensure the information you gather during ongoing assessment is not only accurate, but also identifies learning opportunities throughout the child’s early intervention experience.

In the scenario above, Rosemary was able to see other ways Caleb was functioning. She walked with the family to the car to see what strategies Caleb’s mom was already using to help Caleb communicate. She observed them talking about the weather when they walked outside and using words like “up” when he was climbing into the car. However, there was so much more going on than just using words. Caleb walked down the steps holding his mom’s hand and transitioned from the grass to the sidewalk when she told him to “stop” and “come here” as he tried to run to the tree in the middle of the yard. There was a neighbor outside and Caleb waved after seeing his mom wave at the neighbor. Once he was in his seat, he wanted to try to buckle himself which was a puzzle all on its own. Caleb was determined and able to use his fingers to push the buckle down. He was focused and proud of himself once he did this on his own.

Rosemary realizes ongoing assessment occurs naturally. She has integrated this as a standard practice by documenting ongoing assessment in her contact notes, reviewing records before her visit, and seeing families within different routines and activities. She has all of the information she needs about Caleb’s communication and other areas of development and is ready to update the IFSP.

What practices do you find helpful during ongoing assessment?

Please share any tips you may have in your local program.

For more information, please check out:

Decision Tree Seeds for Success: Functional Assessment is Not the Same Thing as Testing (PDF, New Window)

The post Ongoing Assessment Occurs Naturally 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.

Your tire just went flat. You pull over to the side of the road, in the middle of nowhere, to try to accomplish something you’ve never done before. No, it’s not call AAA…you’re going to change the tire yourself. Thank goodness you have a good signal out here because you use your phone to look up a YouTube video on changing tires first. You also read through your owner’s manual for instructions. Once you’ve watched an example and read step-by-step instructions, you should be ready, right? Wrong. First, just getting the tire out of your trunk is an ordeal, then getting the jack hooked up is challenging. You fit the wrench to the lug nuts and go to turn them (which looked easy when the guy in the video did it) but yours seem to have been put on by Superman. They are so tight you have to stand on the wrench to get them loose. After about 45 min of trying, you finally get the tire changed, put the old tire in the trunk, and get back in the driver’s seat. You slowly pull away, thinking “I have no idea if I really did that right.” Whew!

So what’s the problem with this learning opportunity? You just struggled through a brand new experience, having never done it before. It was stressful, scary and SO different from how easy it looked on the video. Now, compare this experience with that of families in early intervention. They often have plenty of opportunities to watch someone who is very skilled intervene with their children and it looks so easy. They can read a handout which makes intervention sound easy too. Then, the service provider leaves the home and they have to use the same strategy they just watched, but now they have to do it without support. The parent has no previous experience with the strategy and isn’t sure how to adapt the strategy if it doesn’t work. Imagine how frustrating this could be, having watched someone do it successfully and then not being able to get it to work. What could make the difference here, between a frustrated parent and one that feels confident with using a strategy between visits?

Adult Learning Principles #3: Adults learn best through actively participating and practicing what they are learning.

Adults learn best through experience, through feeling and doing a new task with support and feedback from others. We need to try it out, problem-solve in the moment if something goes south, and reflect on our practice. Practicing a new task engages multiple senses, which stimulates multiple neural pathways that support memory. It is through active practice and participation that we really learn HOW to do something, and helping caregivers learn HOW to use intervention strategies is what EI is all about.

In a fascinating meta-analysis of four adult learning methods, Trivette, Dunst, Hamby, & O’Herin (2009) (PDF, New Window) found that active participation was a key feature of adult learning that contributed to positive outcomes for the learner. Getting the caregiver actively involved in all aspects of the EI visit is more likely to result in confidence with using intervention strategies between visits. Let’s think about how we can do this!

How Can We Use This Principle?

Think of the intervention visit as a practice session for the caregiver – This is a big shift in thinking for many of us. Keep your eye on the prize – EI should build the capacity of the caregiver to interact with the child in ways that enhance development during and between visits so practice during visits will prepare families for real life between visits!

Explain to the parent why his/her participation during the visit is key – You set the tone for how visits work so you can help families understand the importance of their active participation. Talk about how EI visits work, what the expectations are and who will do what from the very first contacts with families. They often don’t know what to do during visits so you can support their participation and help them understand how the visit works.

Always follow modeling with practice – If you demonstrate a strategy, talk to the parent about what you’re doing and why, then turn the activity over to the parent so he/she can take the lead. Build practice time into each visit.

Have and show confidence in the parent’s abilities – After all, he/she is going to be there with the child for many many more hours than you are. The parent can do intervention well with the child; he/she might need to do it differently from how you do it and that’s okay. Your one-hour-a-week doesn’t change a child’s development…the parent’s interactions with the child do that.

Consider Two Examples:

Think about these two examples and the different experiences for the family.

Example #1: Jenna is worried about how her son, Trent, is drinking from a bottle. He takes 45 min each feeding and often falls asleep. When he feeds, she notices a steady stream of formula dribbling out of the corner of his mouth. When she asks the OT, Elaine, about this, Elaine asks if she can feed Trent. While she feeds Trent, Elaine talks with Jenna about how to hold the bottle, how to hold Trent’s cheeks to help him suck, and how to position him to make feeding easier. Trent takes the bottle in about 25 min with much less spillage. While Jenna is happy that Trent can do it, she feels really bad that she can’t feed her son like Elaine can. When Elaine leaves, a few hours later Trent gets hungry and when Jenna tries to do what she watched Elaine do, it just doesn’t work and she starts to cry.

Example #2:  When Elaine hears about Jenna’s struggle, Elaine asks if she can watch Jenna feed Trent. After watching for a few minutes, Elaine and Jenna talk about how to help Trent feed more successfully. Elaine coaches Jenna in how to position Trent, how to hold his cheeks while she feeds him the bottle, and how to angle the bottle to help him suck most efficiently. Elaine even puts her hands over Jenna’s sometimes to help Jenna feel the proper positioning. After receiving Elaine’s support, Jenna practices feeding Trent the rest of his bottle while Elaine watches. Elaine gives Jenna a few more pointers, then they talk about how feeding went when Trent is done. Jenna feels nervous about trying these techniques when Elaine leaves but she feels like she can do it since she’s had some practice.

As you’ve read, example #2 offered Jenna the opportunity to practice feeding her son while using strategies and getting immediate feedback and support from Elaine. One of the best results of example #2 and the biggest differences between examples is Jenna’s feelings of confidence. We want families to feel prepared and confident with learning and using strategies when we aren’t there – and practice during the visit is likely to be a key to making this happen!

What strategies do you use now to encourage families to be active participants during visits?

What do you do when families are reluctant to practice using strategies while you’re there?

Share your tips for implementing this adult learning principle in the comments below!

Be sure to check out the other posts about adult learning principles:

Adult Learning Principle #1: Making Intervention Immediately Relevant

Adult Learning Principle #2: Linking New Learning to Prior Knowledge

Adult Learning Principle #4: Practicing Intervention Strategies in Real-Time

Adult Learning Principle #5: Feedback is How We Grow

The post Adult Learning Principle #3: Active Practice and Participation are Key! appeared first on Early Intervention Strategies for Success.

It is hard to believe but it is almost May!  The final Talk of the two-part series, entitled “Ditch the Animal Sounds: Writing Appropriate Outcomes that Lead to Effective Implementation,” will be presented live on May 5^th!  In anticipation of the upcoming webinar, I am excited to share with you just a few of the key points that I will be presenting in the session

In my first two blog posts on articulation and addressing language development, I talked specifically about how important it is to remember that functional services should be based on the appropriate diagnoses of the young children with whom we work.  These kids DO need services—but when we are diagnosing appropriately and accurately, our services for infants and toddlers will typically be based on a diagnosis of a language disorder versus a speech sound disorder. With that in mind, we should, therefore, be providing services that focus on language development rather than on speech sound development…or better yet, we should be using best practices by coaching families to facilitate speech sound development within (rather than separate from) activities that target functional communication by and with the child!

Sounds easy enough to do, right?!

Outcomes – Focusing on What’s FUNCTIONAL

When we are working with a child who is really struggling to get his basic needs or wants met because he does not have the LANGUAGE, focusing specifically on and teaching a child to produce a bunch of animal sounds is really not a FUNCTIONAL choice.  So a child learns to ‘moo’ or ‘meow.’  Does that really help him get a drink of milk or call his mom when he needs her?!  Those sounds can be fun…and for most children, they really do grab their attention and make them smile…if not even eventually imitate.  But what about those children for whom language is a challenge?  When writing outcomes, animal sounds, environmental sounds, and silly sounds are just not functional.

…Think about this for just a minute…

Is the family’s goal for this child really to produce animal sounds or to imitate the sound of an airplane or a car engine?!

When we work with young children who are struggling with language development, we recognize that they need to be able to produce sounds in order to produce words.  Those sounds, however, need to be addressed within functional, natural contexts.  Addressing a child’s ability to obtain needs and wants by learning how to label desired objects or to make a verbal request…THESE are functional outcomes.  In order to request a drink, or to ask for more, or to label the boots that a little boy wants to wear to play in the snow, he needs to be able to produce an approximation of the words “milk”…and “more”…and “boots”.  While the outcome itself is not to produce the /m/ or the /b/ sounds specifically, the production of these sounds can and should certainly be EMBEDDED into the intervention itself.

What should these outcomes look like?  Need examples of functional outcomes for a toddler who presents with an expressive language delay or disorder?  How can or should we select target words to include within a child’s outcomes? Join me for the May 5^th Talk on Tuesday to answer these and other questions you may have about writing outcomes!

Intervention: What Does It Look Like?!

When I work with families, I always keep a few key considerations in mind…and these considerations—or TIPS—tend to form the foundation by which I coach the parents and the caregivers on ways that they can embed speech sound development into their everyday activities and routines.  Each of these tips is intended to help families embed speech sounds into play-based or routines-based, language rich activities while they are engaged with their children. By now, we are all aware of the fact that children need to be able to make sense of stimuli in order to learn from it.  In order for a child to process information, it needs to be presented within a normal, naturally occurring event or opportunity in his or her own environment.  Using flashcards to teach sounds or words, or creating superficial teaching opportunities like pushing a child to imitate sounds, is not going to work.  Infants and toddlers truly do NOT learn, and ultimately develop, speech or language through artificial methods.

Instead, their verbalizations—their LANGUAGE–should be based on models that we have provided within the natural routines and activities—these are the opportunities that will have meaning, and positively impact learning, for, a child. Young children will naturally imitate the speech sounds that are embedded within the language that they can, and want, and need to use within their everyday lives–even those who are struggling with their language.  They do NOT, however, tend to imitate sounds that do not have a place within naturally occurring, everyday activities and routines—and those are the opportunities in which we can encourage and coach families to embed sounds in language.

So…anyone want to know what these fancy tips are?  Again, be sure to tune in to the May 5^th Talk on Tuesday to learn more about how to work with families and coach caregivers to embed speech sound development into everyday routines and activities. 

Do you have some tried-and-true strategies that you use to embed speech sounds into natural learning opportunities with the families with whom you work? 

Share your ideas here!

If you missed either of Corey’s webinars, visit the Talks on Tuesdays 2015 recordings page on the VA Early Intervention Professional Development Center, or click below:

It’s Almost Never Apraxia: Understanding Appropriate Diagnoses of Speech in Early Intervention

Ditch the Animal Sounds: Writing Appropriate Outcomes that Lead to Effective Implementation

If you’d like to catch up on all of the posts in this series, visit:

What’s the Bottom Line Regarding Articulation in EI?!

Address the Language: The Speech Will Follow!

ICD-10 Codes and Insurance Reimbursement in EI: The Fun Stuff?!?

The post Ditch the Animal Sounds! – Who’s Ready for the Next Talks on Tuesday?! appeared first on Early Intervention Strategies for Success.

Joey is 25 months old.  He was referred to his local early intervention intake coordinator by his parents secondary to their concerns about his intelligibility and inability to effectively communicate his needs or wants.  They reported that he uses approximately 15 words but “talks in such a garbled manner” that both parents and Joey’s older siblings become frustrated when they don’t know what he is saying or requesting. When asked to describe Joey’s speech, his father noted that it sounds like: “babble-babble-babble-mama-babble-babble-babble, as if he knows he should be talking in longer sentences but he doesn’t have the vocabulary yet to form the actual sentence”.  His mother added that he sometimes sounds like he is humming around his words: “mmmmmmm-ball-mmmmm”.  Joey loves playing with balls.  His family often takes an extra ball with them to Joey’s brother’s soccer practice.  While his brother practices, Joey and his Dad kick the ball. According to Joey’s parents, they find his speech particularly frustrating before meal times; they noted that he loves to help them choose and prepare food for snacktime every day, but that they often don’t understand which foods and/or drinks he is requesting or suggesting.

What to Do? What to Do?!

We see this quite often, don’t we?!  Parents will often come to us with concerns about their child’s intelligibility and “speech skills” because they have difficulty understanding the messages that their children are trying their hardest to convey.  As a speech-language pathologist (SLP), my first goal with this child would be to conduct a comprehensive communication assessment by collecting a speech and language sample.

Within this play-based sample, I would listen for those three speech-related red flags that I presented in the March Talks on Tuesdays webinar and in my previous blog post: 1) initial sound deletions; 2) distortion or consistent difficulty with vowels; and 3) deletion of LOTS of sounds—the child uses only one or two consonant sounds. Ultimately, however, above and beyond my observations regarding Joey’s speech productions, I would assess whether he is using the language skills that are developmentally expected for his age.

Typical Language Development vs. Expressive Language Delay or Disorder

Keep in mind that we expect children to have a vocabulary of at least 15-20 words by 18 months, although typically developing children often have more than 50 words and are beginning to string simple, repetitive 2 word phrases together (e.g. more drink, my juice) by this age.  By 24 months, we expect a children who are typically developing to use AT LEAST 50 words and to combine lots of different phrases. Between 18-24 months, children may still use some jargon to expand their sentence length and to attempt to provide “more information” in their messages.  If you have a child who is 20-24 months and using a lot of jargon and not a lot of words, however, you are probably looking at a child who has an expressive language disorder.

Is It a Language Disorder or a Speech-Related Disorder?

Toddlers who are extremely difficult to understand are often still using a lot of jargon when they speak because they lack vocabulary…or have difficulty with grammatical markers… or struggle to put words together into phrases.  All of these are skills that are expected by two years of age.  We typically expect that jargon (which can be defined as “babbling with intent”) will begin to fade at about 18 months and completely dissipate by 24 months.  If a toddler has an expressive language delay or disorder, his intelligibility will be affected as he will often continue to use a lot of jargon in lieu of words.  Instead of recognizing that the jargon is a substitute for real words or grammar that SHOULD have developed, we often misinterpret the jargon to be speech sound production errors.

In this scenario, Joey’s desire to communicate is there…his speech is continuing to develop…his language skills are not. Therefore, most toddlers, including Joey, who are difficult to understand will be diagnosed with a language disorder—not a speech-related disorder!  It is the language (or lack thereof) that is most likely having the greatest impact on this child’s intelligibility.  Unless Joey presents with any of the speech-related red flags, his speech will most likely continue to develop as his language skills are addressed in early intervention!

Why Not Provide Traditional Articulation Therapy Anyway?

Early speech and language skills are acquired and used primarily for communicating during every day, natural social interactions. Traditional articulation therapy focuses on the repetition and drilling of target sounds…there is nothing natural about this process. Early intervention is intended to be embedded into families’ every day, natural activities and routines to ensure that children are processing the information that they are learning in order to utilize these new skills within their own environment—this is known as authentic learning.  Targeting articulation directly and drilling toddlers to produce speech sounds is the furthest thing from “natural” that there is!

Optimal early communication intervention services are provided in natural environments, which offer realistic and authentic learning experiences for the child and promote successful communication with the caregivers. Authentic learning can maximize children’s acquisition of functional communication skills and promote generalization of newly mastered behaviors to natural, everyday contexts. In order for a child to process information, it needs to be presented within a normal, naturally occurring event or opportunity in his or her own environment.  Using flashcards to teach sounds or words, or creating superficial teaching opportunities like pushing the child to imitate specific sounds in isolation (e.g. “say /ba/”), is not going to work.  Infants and toddlers truly do not learn speech or language through artificial methods.  For most children, when functional language and communication needs are addressed within the natural environment, speech will develop as well (ASHA, 2008)!

What Would This Look Like for Joey and his Family?

My first suggestion for Joey’s parents is to support and encourage him to continue to produce the sounds and words that he IS producing within the routines that he most enjoys.  If he makes ANY sounds, imitate those. If he uses any word approximations or words, repeat them back to him! Continue to imitate his sounds and words…and then expand on them a bit.  If Joey says “babble-babble -nana-babble-babble-juice” while choosing foods for his snack, repeat his word approximations and words back to him:  “Banana!  Juice!”  Then, I would coach his parents to expand on his verbalizations: “You want bananas and juice for snack today! Let’s have bananas and juice!”  Let him know that what he is attempting to say has been heard and IS important.  I would encourage his parents to provide him with articulate models of his words and to provide a model of a complete sentence in order to facilitate Joey’s expansion of his message.

What other authentic learning opportunities might you use to facilitate Joey’s expressive language development during snack time and ball play during his brother’s soccer practice?

What are some other ways in which you can help Joey’s family incorporate naturally occurring opportunities to embed speech sound development into these experiences along the way?

Reference

American Speech-Language-Hearing Association. (2008). Roles and responsibilities of speech-language pathologists in early intervention: guidelines [Guidelines]. Available from www.asha.org/policy.

If you missed either of Corey’s webinars, visit the Talks on Tuesdays 2015 recordings page on the VA Early Intervention Professional Development Center, or click below:

It’s Almost Never Apraxia: Understanding Appropriate Diagnoses of Speech in Early Intervention

Ditch the Animal Sounds: Writing Appropriate Outcomes that Lead to Effective Implementation

If you’d like to catch up on all of the posts in this series, visit:

What’s the Bottom Line Regarding Articulation in EI?!

ICD-10 Codes and Insurance Reimbursement: The Fun Stuff?!?

Ditch the Animal Sounds! – Who’s Ready for the Next Talks on Tuesday?!

The post Address the Language: The Speech will Follow! appeared first on Early Intervention Strategies for Success.

Lynn meets Devon and his mother, Janae, at the grocery store for their visit this week. When she arrives, she finds them trying to walk into the store. They are struggling because Devon is having a tantrum and Janae is trying to carry him while he kicks and screams. Lynn goes up to them and asks if she can help. Janae puts Devon down and says she doesn’t know what to do. She reminds Lynn that this is why they decided to meet at the store, so that Lynn could help with this problem. Lynn asks if she can try something, and Janae agrees. Lynn takes Devon’s hand and plays a game with him, pretending to be tigers, rabbits, and birds trying to get across the parking lot. Janae follows them and says “I wish you could come to the store with us every week because he won’t do that for me.”

Is the Problem Solved?

Lynn has had the awesome opportunity to observe a natural routine for Devon and his mother. Rather than just hearing about the struggles walking in to the grocery store, she has wisely scheduled to join the family during their weekly trip. Rather than sitting back at the family’s home and spouting out tons of “have you tried…?” ideas, she is able to problem-solve with Janae in the moment. Lynn is able to get Devon into the store without a tantrum, so…is the problem solved?

No, not by a long shot.

Lynn demonstrated a technique that involved playfully distracting Devon during an activity that he doesn’t like or typically cooperate in. She was successful at dodging the typical tantrum, but it really doesn’t matter because she won’t be there the next time the family goes to the store. She is probably assuming that Janae watched her and would pick up how to play the games she played with Devon. From Janae’s comment, though, you can get a sense that she watched, but she doesn’t think she can do it. If that’s what Janae feels, then Lynn’s modeling did not accomplish the real goal, which was to help Janae learn ways to get Devon into the store without a tantrum.

If we just rely on modeling or demonstration for families, we are not very likely to truly build the parent’s capacity to manage similar real-life situations in the future. In fact, it could have a detrimental effect because the parent could see someone else being successful when she herself cannot. Without a more intentional approach to supporting the Janae’s learning, Lynn could do more harm than good.

Three Ways to Use Modeling to Support Parent Learning

Let’s consider how Lynn could wrap the following three steps around her modeling to better support Janae’s learning. Here’s the same situation, but with Lynn more actively helping Janae participate in her son’s success:

Model with Intention – Before trying her strategies with Devon, Lynn asks Janae to watch for what she (Lynn) does to distract Devon and make the trip into the store fun for him. She also asks Janae to watch Devon’s reaction.

Model with Narrative – While playing the pretending game with Devon, Lynn narrates what she is doing for Janae. She says she’s trying to make the walk more enjoyable as a way to help Devon learn that the trip into the store can be fun.

Model with Reflection – After they get about half way to the store, Lynn asks Janae what she observed so far. They talk about Devon’s different reaction and why he didn’t tantrum. They reflect on the specific activities Lynn used and which of those Janae wants to try.

After modeling, it’s ALWAYS good to remember to hand the reins over the parent. Giving the parent the opportunity to try what she has just observed and make that strategy her own is really when the learning happens!

Here’s what happened next for Lynn and Janae:

After establishing a few specific strategies that might work for Janae, Lynn steps back and Janae takes Devon’s hand. He starts to squirm and fuss but Janae says “Let’s jump like a kangaroo into the store!” and takes Devon’s hands to help him jump. When they reach the entrance, they stop and reflect about how that went. Devon made it into the store with his mom without incident. Success!

Consider, though, who is responsible for Devon’s success? At this point, both Lynn and Janae are, but Janae feels more capable because she has experienced her own ability to use the strategy. She is more likely to own this new strategy now. When the strategy becomes hers, and she’s able to use it when Lynn isn’t there for support – that’s when they’ll know that intervention worked!

How have you used modeling to support caregiver learning? 

For those of you who are using coaching interactions with families, what could Lynn have done differently before and after her modeling to make this activity even more successful?

Share your insights about how we can improve this interaction in the comments below!

The post Watch Me! – Using Modeling as a Caregiver Teaching Tool appeared first on Early Intervention Strategies for Success.

Think about it. How did you learn to drive? Sure, you read the driving manual, went to a driver’s ed class, and you probably talked about driving a lot. Before getting behind the wheel, you’d observed people driving for years. Was reading, talking about the new skill, and observing someone doing it enough to prepare you for using what you learned? No way! You really learned to drive by getting behind the wheel and practicing it…with the real-time support of the (possibly terrified) adult in the passenger seat!

Keep this in mind: Adults learn and remember best when what they are learning is practiced in real-time and in the context in which the new knowledge or skill will be used.

You learned to drive by driving. Parents in early intervention (EI) are much more likely to learn and remember how to interact with their children in developmentally enhancing ways by doing it – by trying out strategies and problem-solving in real-time, during the activities that they do everyday. The adult who taught you to drive would’ve been minimally helpful sitting on the sidelines continuing to talk about what you should be doing. Same goes for an EI service provider. We’re going to be much more successful achieving the mission of early intervention, which is to enhance the family’s capacity to meet their child’s needs, when we get in there, ride beside the parent, and work together with the child.

How Can We Use This Principle?

Join In – Rather than just talking about family activities, ask if you can join them. Explain this principle and get the family’s permission to practice strategies in real-time. If the parent mentions an activity that doesn’t usually happen during the visit, plan to come when it happens next time.

Step Back – Be careful that your “joining in” doesn’t look like “taking over.” Step back, observe things usually work, then coach the parent to think about how to embed an intervention strategy in the activity. You will build the parent’s capacity much more successfully if she has a chance to think about what she’s doing first.

Model if you must – If the parent really needs to see you use the strategy first, that’s fine. Be sure to ask for permission to model and tell the parent what you are doing and what to watch for. Then step back and let her practice. Remember that a key to her learning is HER practicing, not just her watching you practice.

Make room for mistakes – Just like when I ran over a painter’s bucket and broke the fan under my dad’s station wagon when I was learning to drive (yes, that actually happened), give the parent permission to goof up. Making mistakes while practicing is normal and necessary. This also helps prepare the parent for having to adjust how she uses the strategy when you aren’t there. Believe me, I never ran over another bucket again.

Consider Two Examples:

Example #1: Jayne, Liam’s mother, describes how hard it is for her to get him dressed. Liam screams, twists and turns, and has even begun to run away when she mentions getting dressed. Some days, they both end up exhausted and in tears, and other days, they just don’t go anywhere because Jayne doesn’t want to fight the battle. Tristan, the occupational therapist, asks Jayne if she’s tried having Liam wear tagless clothing. When Jayne replies that all of Liam’s clothing is tagless, Tristan asks if she’s tried letting Liam dress himself. Jayne says that he’d probably just stay in his training pants all day. Tristan continues to make suggestions, but Jayne has either already tried them or doesn’t think they’ll work. When Tristan leaves, Jayne feels frustrated that she didn’t receive the help she’d hoped for.

Example #2: At the next visit, Tristan notices that Liam is just wearing his training pants so she asks Jayne how dressing went that morning. Jayne said it was a battle as usual and Liam won. Tristan asks if she can see what happens when Jayne tries to dress Liam. She tells Jayne that she hopes that they can work together to come up with some strategies that might make dressing a little easier. Jayne agrees but is nervous about what will happen. She asks Liam if he’s ready to get dressed and he runs away. She snatches him up and takes him, already struggling, to his bedroom. Jayne places Liam on his toddler bed and turns to get his clothes. He wiggles off the bed and runs away again. Tristan coaches Jayne to consider why Liam might be running away and what they could do differently to make this a more pleasant experience for him. By working together, they come up with ideas such as having the clothes ready on the bed before getting Liam and letting Liam stand on the floor to get dressed rather than having to lie down. Tristan also coaches Jayne in how make dressing playful. Tristan knows that Liam loves stories, so she suggests that Jayne try telling Liam a story while she dresses him. Tristan models how to let Liam chose his own clothing and help with putting it on. Jayne tries it too, letting Liam chose which pants to wear then telling him a funny story about how his feet are going on an adventure. Dressing takes longer than Jayne wants, but she’s able to get Liam dressed with no tears. Afterwards, Tristan and Jayne reflect on what happened, and Jayne identifies three strategies she will try during the week. When Tristan leaves, Jayne is still nervous about dressing Liam without help, but plans to try the strategies tonight when dressing Liam for bed.

It can be so easy for service providers to get in to the “Have you tried…?” habit, avoiding the real-time aspect of this adult learning principle. Using this principle really challenges us to release that habit and, instead, actively problem-solve with the parent in the moment. It’s a very different approach, and one that parents report to be so much more effective.

Seize the moment on your next visit to “get behind the wheel” with the parent and see what happens!

Which example resonates more with you?

Think about your last three visits and your own practices. Did you help the parent practice strategies in real time, in real contexts? If not, why not?

Do you have a great example of successfully joining a real-time activity to help the parent and child learn? Share it below!

For more info on adult learning principles, check out these other two posts:

Adult Learning Principle #1: Making Intervention Immediately Relevant

Adult Learning Principle #2: Linking New Learning with Prior Knowledge

Adult Learning Principle #3: Active Practice and Participation are Key!

Adult Learning Principle #5: Feedback is How We Grow

The post Adult Learning Principle #4: Practicing Intervention Strategies in Real-Time appeared first on Early Intervention Strategies for Success.