Remember with me. You are a young child—in your elementary years—and you find yourself in an ice-cream shop. Let’s call it Baskin Robbins for the sake of nostalgia. You can barely see over the freezers but as you gaze up and down the line at all the different flavors to choose from, your excitement and childlike wonder is interrupted by… stress. You feel that flicker of overwhelm becoming increasingly more intrusive because you know you have to narrow it down and that you have to order and that people are waiting on you and that you want it ALL but that you can’t possibly have all 31 flavors and…

Phew. Still with me? Now, imagine that there were only ever just 3 flavors. How does this change the way you would feel peering over the freezers? How might your decision-making process feel different? Many parents in early intervention may empathize with this young child’s anxiety around making decisions from a multitude of possibilities.

So Many Important Decisions

While we, as service coordinators and providers, place parent engagement and empowerment at the forefront of our practices, it may be prudent to consider how this can be felt from the parent’s perspective. For example, the development of the IFSP (especially right after assessment for service planning) might evoke a sense of uncertainty from parents. How? Hearing the assessment report and being asked to participate in the child outcome summary process using may elicit a range of emotions on the grief spectrum. Denial, sadness, anger, rejection, guilt, shame, and hopelessness are a few of the emotions that parents may feel, especially when hearing their child be described by strangers in an unexpected way. By the same token, parents who received the news they were expecting (i.e. that their child qualifies for the program) may be trying to reconcile feelings of being validated and heard with guilt for being “right” about something they did not want to be “right” about. Nonetheless, grief counseling suggests that important decisions should be avoided while someone is experiencing grief.

Similarly, discussing a joint plan with a provider at the beginning or end of a session might do the same. Parents may question themselves: Who’s to say I’m the expert? Am I picking the right thing to work on? What if I tell her what I really want and it’s the wrong answer? What if I’m wasting the time I have with the provider by picking the “wrong” thing to work on? Surely, we all can empathize with this hesitancy when it comes to wanting to make the best decisions on behalf of those we love. Our task is to help parents feel confident in their own ability to make those decisions, eventually without our help.

Where Do We Start?

Use active listening at all times to capture the essence of the parent’s message. What things have they kept mentioning? What are they saying would make life easier for them? What stresses do they mention over and over? What are things that bring them joy? Think about some other ways to engage in and practice active listening with those in your personal circle.

Use cues from the parent during your interactions with them to guide conversations about what things would be helpful to address. Maybe you notice that the dad has repeatedly mentioned that he cuts his 33-month-old son’s food up into very small pieces when asked about meal-time. Perhaps the mom has intentionally turned the TV on and situated the baby in front of it before giving him the bottle. You may notice a parent look nervously towards the back of the house where her other children are during your meetings. Maybe the dad prefers to stand at the kitchen counter during sessions rather than in the same area as you or the child. What questions could you ask after noticing some of these cues from parents?  How can you tailor your questions to get more clarity about these behaviors’ driving forces?  

Make sure you understood them correctly. Use reflective and judgement-free language to flesh out concepts they’re sharing with which you may be unfamiliar. Use phrases such as “I’m hearing…; you mentioned…; I thought I heard something about…; it seems like ___ is very important to you…; can you tell me more about what _____means and/or looks like in your daily life…; would you like to share more about ____…, etc.” Active listening may involve jotting down notes, which can be referenced before the next meeting with the family.

Got It. Now what?

It is the responsibility of the service coordinators and providers to scaffold decision-making as warranting situations arise to help the family feel confident and at ease, not only with the decisions they are tasked to make in those moments, but also with the process of how to critically and confidently think them through.

Share your thoughts below in chat!

Be sure to check out the first post this series:

Get the Backstory: Validating and Valuing Family Input

The post Baskin Robbins: How Do I Decide? appeared first on Early Intervention Strategies for Success.

Imagine: you are sharing your deepest wishes with a trusted friend. You are sharing a cup of coffee on the couch and you feel led to begin a conversation about your goals for the coming New Year. You share your regrets from the past year and your hopes and dreams about how you envision this New Year. You are deep in thought and passionate about articulating these ambitions out loud. Your friend’s response, much to your surprise, is superficially supportive. You sense judgement but you can’t put your finger on it. Why is she being short? Why does her smile look fake? Does she realize her eyebrows just did that? You begin to wonder what her thoughts are and to feel… Vulnerable. Embarrassed. Insecure.

A Parent’s Perspective

Now, imagine that instead of talking to a dear friend, you are talking to a complete stranger in an intake meeting, no coffee involved. Instead of freely sharing your priorities for the New Year, you are being asked to name priorities you have for your most precious hope in the world—your child.

Will I be judged for what’s important to my family and me? Was that the right thing to say? Is that the kind of answer they’re looking for? Geez, I have so many I can’t even put them in order. I need help sorting this out in my head and I am entirely overwhelmed but I don’t want the lady to think I don’t care if I am too vague. Is it okay to breastfeed in here?

These are just some of the thoughts that ran through my head as a parent as I began the early intervention process with my, then, 8 month old. Some deep reflection led me to the following conclusion: From my team, I needed my priorities validated and valued so that I could begin to trust them and their input into our lives.

Building Rapport, Being Curious, and Cultivating Relationships

As service coordinators and providers, it is our job to give up control for the sake of building rapport and trust so that deeper and more meaningful impacts can be achieved during the entire early intervention journey. You might be thinking, But, I don’t control interactions! I help the family with guiding questions to get them to a point where both the clinical/developmental priorities and family priorities are aligned. We have all been there. It can be challenging to reconcile the priorities that are indicated through family and formal assessments with what the family is sharing as their priorities. However, a family’s priorities can and should be discussed informally, too, starting with the first contact you have with them.

To ponder: What barriers to active listening and getting the backstory have you experienced in your relationships and interactions with families?

How?

Be genuinely curious about families, their daily lives, and their backgrounds. Ask for the sake of truly learning, and not documenting. Repeat back what you hear them say often to check that you are understanding their meaning. Validate them when you sense uncertainty, stress, or when they share about topics that are clearly close to their hearts. Use your intuition. Ask open ended questions—not the kind that indicates you are checking off a list, but the kind you would ask when something someone has just said has genuinely sparked your interest. Once you have a truer understanding of where a person is coming from, you can begin to introduce how early intervention can help facilitate and highlight these priorities in the family’s life using the family’s everyday routines and priorities.

To ponder: How might these initial and ongoing interactions inform your practice as you continue to cultivate a relationship with the family throughout the EI process?

So, where does that leave us? For anyone, the first step to making changes is acknowledging that change would bring an added benefit to your quality of life. Seeking help, self-referring, taking a random number that the PCP handed them and calling, showing up to appointments, answering the phone to unknown numbers– these are all indications that a family is open to change. As providers and service coordinators, the most important part of our job is to cultivate relationships that are conducive to productive and meaningful change. We begin that cultivation that by simply listening— getting the backstory so that you can truly walk alongside the family as they continue developing the rest of their early intervention narrative.   

Share with us! What are your go-to questions/conversation-starters that you have in your toolbox to help you ease into this informal approach of getting the backstory?

Micaela is a former early intervention service coordinator and developmental services provider. She holds a master’s degree in Early Childhood and Family Development and her passion is helping families astound themselves with all they can achieve. She is, most importantly, the mother of a beautiful little boy. She and her family have been receiving the support and services of EI since her son was 7 months old. Micaela and her husband are excited to be welcoming a little girl into the world this spring. Through this blog series, Micaela hopes to merge the distinct perspectives of a parent, a service coordinator, and a provider into a unique cultivation of meaningful insight and conversation.

The post Get the Backstory: Validating and Valuing Family Input appeared first on Early Intervention Strategies for Success.

On May 1, 2021, Governor Northam proclaimed May as Early Intervention Awareness Month in Virginia. Many EI programs use this month to raise awareness and build relationships with referral sources, physician offices, other community programs, and of course, families. The video What is Early Intervention in Virginia? is often shared widely because it provides an overview explaining what EI is, what it looks like, and how it works. One of the things I love about this video is the opportunity to see and hear from families who have experienced EI. I think family stories are perhaps the most powerful “tools’ we have to build awareness of what EI has to offer. They can help us reach new families and invite them into partnerships with us. Family stories also remind us about why we do what we do. With that in mind, I’m going to share several videos you can use to spread the word about EI from the perspectives of families. If you have other videos you love too, please share the links by leaving a comment below. Here we go!

Reflections during the Final Visit (CO Dept of Education, runtime 5:46)

This video features a mother reflecting on her relationship with the physical therapist who visited her home to support her and her daughter. I think that perhaps, showing what happens at the end of EI, like you’ll hear and see in this video, can help open a doorway to the beginning of EI for another family.

Liam’s Story: A Mother’s Voice (VEIPD, runtime 5:15)

This video also features a mother telling the story of her family’s experience with EI. This story is a powerful reminder of the impact of this work on the daily lives and relationships of families. As an early interventionist, you never know what you might say or do that can have a lifelong impact. EI Awareness Month can be a nice reminder about that too.

Dream Big: A FIT Family Story (FIT FOCUS Video Library, runtime 5:27)

In this video, you’ll hear from a mother and father about how EI worked for them. They explain the emphasis on helping the family help the child. They also describe about how coaching helped them to use strategies in their home during the things they already do rather than adding extra things to do. They also share advice for families to “dream big for your child.” (Due to permission settings, you’ll need to click the “Watch on Vimeo” button below. This video is definitely worth the extra click.)

Parents and Early Intervention (EITP Illinois, runtime 7:59)

I featured this video in another recent post because it’s new. I think it’s worth mentioning again as another resource to share a family’s story. Even though this isn’t a family in VA, I think this family’s message is universal.

That’s just a few of the fantastic family story videos that are floating around the web. If you’d like to see more videos of families in EI, check out the Early Intervention Video Library and look for Families’ Experiences in EI in the menu. You might also find the Early Intervention – General page helpful for sharing info about EI with others.

So what are you doing to celebrate EI Awareness Month? What is your favorite EI family story video?

Share your thoughts, ideas, and video links in the comments below!

The post EI Awareness Month in VA – The Power of Family Stories appeared first on Early Intervention Strategies for Success.

Despite not being able to meet in person, tele-intervention (telehealth) has brought new opportunities to think about how we are talking about the child outcome summary process. Let’s be completely honest. Tele-intervention forces us to use good teaming practices because there cannot be any side conversations among professionals and everyone is only able to see and hear the same information. This helps us think outside of the box to ensure that all team members have the exact same information so caregivers can make the best decisions for their child.

After completing tele-assessments, I have experienced great success incorporating the caregivers in the Child Outcomes Summary (COS) discussion. The COS process summarizes a child’s functional development in three child outcome areas: positive social-emotional skills (including social relationships), acquire and use knowledge and skills (including early language/communication), and use of appropriate behaviors to meet their needs. The Decision Tree can be a helpful tool to facilitate the COS process.

All caregivers participate in the COS discussion using the Decision Tree. This includes deciding with the team which rating statement represents their child’s functioning compared to other kids of the same age. (Click here for more information about the Decision Tree and Virginia’s COS Process). Before even going through the process, it is most helpful to discuss who will facilitate the discussion with the caregiver and the rest of the team members. This includes sharing the screen to show the Decision Tree.   This can be the service coordinator or a provider. Here are 6 steps you can use throughout the process that I have found beneficial.

6 Steps for Engaging Caregivers during the COS Process

1. Explain the caregiver’s role as a team member.

This is an important step. Caregivers need to understand their role in the process and how they can participate. When they are unsure of what to do, they may be more reluctant to participate. Encourage their voices by involving them throughout process, giving thorough explanations, and asking open-ended questions to receive more in-depth answers.

2. Explain each outcome area and the use of the Decision Tree.

The second page of the Decision Tree shows the Infant & Toddler Connection of Virginia Child Outcomes Summary handout. This handout was specifically designed to support the caregiver’s understanding of the process. It is helpful to send this handout to caregivers prior to the meeting and share the screen with the document pulled up while discussing and highlighting different outcome areas. This will also encourage caregivers’ participation when they fully understand what is being discussed and why.

3. Discuss each outcome area with individualized examples.

During the Assessment for Service Planning, the team discusses functional development within each outcome area based on parent report, observation, clinical opinion, etc. Functional child development focuses on what matters in the family’s daily life, showing how the child is engaging, initiating, and participating throughout their day. It has little meaning to a caregiver if a child can stack blocks, so a functional example would be, “During bath time, Sydney enjoys lining her plastic blocks on the bathtub ledge before knocking them off and laughing. Her mother commented Sydney enjoys playing this game the entire time.” Embedding functional information like this contributes rich examples to the Decision Tree discussion that help all team members understand the child’s abilities and needs. During the discussion, it is also helpful to share the screen to show each outcome area on the IFSP as it is discussed. Screen sharing gives the parent the opportunity to follow along.

4. Review typical functional development.

This is an important step and not to be missed. It truly helps each team member, including the caregiver, understand what is typical for the child’s age within that given child outcome area. This will help each team member understand whether or not the child has “age-expected” functional skills. Utilize your resources for typical development. This can include a combination of resources such as the Act Early Milestones, Functional Development, Age-Expected Snapshots of Development, etc. Again, sharing the screen to show this information and/or sending the info prior to the meeting is beneficial to all team members.

5. Use the Decision Tree discussing each question and prompt.

Again, sharing the screen and/or sending the Decision Tree to the family prior to the meeting can be really helpful. Screen sharing allows each team member (including the caregivers) to look at the same information and follow along accordingly. Ask each question out loud for each decision point. Pause for discussion or examples. When choosing between two items at the decision point, read it and reflect with the caregiver and other team members about specific examples to reach an agreement on the best possible choice. By this point, caregivers should feel empowered to help make the best decision based on the information given to them and understand the importance of their voice.

6. Decide as a team the best statement.

Everyone has a voice. Check in with each person to make sure everyone is in agreement including the caregiver. Discuss specific examples if there is a difference of opinion at any given point in time.

Please note: When I share my screen, I already have these resources pulled up and ready to share as they are discussed: Decision Tree and the Infant & Toddler Connection of Virginia Child Outcomes Summary handout, the child’s IFSP, and information about typical functional development (See #4 above).

What are your top tips to engage families during the Child Outcome Summary Process?

How do you help facilitate the discussion?

Share your tips and ideas by leaving a comment below!

For more information about the COS process and the Decision Tree, check out these resources:

Decision Tree Tutorial

Virginia’s Child Outcomes Booklet: Team Engagement in the Child Outcomes Summary Process

The Decision Tree: A Tool for Teaming and Family Engagement – Parts I and II

ECTA COS Completion: When Teams Can’t Meet in Person

Extra! Extra! Read All About….Integrating the Decision Tree

Logan is Not a Number! – Explaining the Child Outcomes Process

COS Completion – When Teams Can’t Meet in Person

The post Successfully Engaging Caregivers in the Child Outcomes Summary Process Virtually appeared first on Early Intervention Strategies for Success.

You’ve worked really hard this year. You’ve stretched to fit into a mold of providing early intervention (EI) that was unlike any you’d ever experienced before. You struggled, you persisted, and you succeeded. You did it because you love what you do. You also did it because you love the families.

This new video, Parents and Early Intervention, from the Early Intervention Training Program at the University of Illinois is like a gift to all EI practitioners for the hard work you’ve done this year. It reminds us about the power of high quality intervention and how important our partnership with families can be. I know you know this, but it sure is nice to hear it from a family. Now, take 7:59 minutes to meet the Warren family and hear their story. I guarantee it’ll make your day.

See, doesn’t that do your heart good?

So yes, this may have been one of the most challenging years we’ve faced as a field, but when other businesses and services closed, EI did not. You continued to support families, reaching them virtually, checking on them by phone, and working together in ways that were new, different, creative, and inspiring. Now, as you reflect on this past year, ask yourself:

When you think of families you have supported, what do you hope they say about their EI experience?

Type your reflections in the comments below.

*Thank you to EITP and the Warren Family for sharing their story!*

For more videos featuring families’ experiences, visit the Families’ Experiences in EI page on the EI Video Library.

The post A Gift for You – New “Parents and Early Intervention” Video from EITP Illinois appeared first on Early Intervention Strategies for Success.

When talking to parents and caregivers, it can be helpful to ask them what they know about temperament and assess their understanding of how their temperament matches (or doesn’t match!) their child’s. Parents may be able to talk about their child’s response to different environments, sensory preferences or reaction to change and may not have thought about their own response. Parents and caregivers may not be able to recognize ways in which their own temperaments impact the behavior of their child.

What is Temperament?

Temperament is generally defined as consistent individual differences in behavior that are biologically based and are relatively independent of learning, system of values and attitudes. One key concept to remember is that temperament is biologically based, not made up of characteristics that are chosen. As such, an individual does not have the ability to change their temperament but rather use their knowledge to adapt to the environment. As an example, for individuals who become overwhelmed by noise, the volume of the television or radio could be turned down, voice tones can be adapted and strategies for calming in loud environments can be taught. Conflict can arise in the parent-child relationship when a parent perceives a child is acting in a particular way “on purpose” or “to make them (the parent) upset.” It is important to recognize that a child’s behavior is often a reflection of his or her temperament. Like many other developmental skills, parents need to be able to teach their children how to appropriately respond to their internal triggers.

Parent and caregiver understanding of how to support a child’s temperament style is crucial in the development of social-emotional skills. When parents can help children adapt to their environment and understand their own preferences, children will be better prepared to adapt to different environments using coping skills and resources available.

Having Conversations about the Parent’s Temperament

I often get questions about how to have conversations with parents and caregivers about temperament. Beginning by asking questions can be a good place to start. Helping parents to gain insight about their own temperament can help them to be more in tune with the actions of their child. Oftentimes, parents have insight into their child but may not have thought about their own preferences or strengths. Parents may not recognize the role that their temperament plays in the dynamic of the relationship with their child. Some questions that could be helpful to ask parents include:

• How do you manage your emotions?
• What are your sensory preferences (e.g. light, sound, etc.)?
• How do you respond to change?
• How do you communicate your wants and needs?

When parents and children have mismatched temperaments, strain in the parent-child relationship can be magnified. Parents may incorrectly attribute differences in interaction style to a child’s developmental delay, ascribing intent behind behavior or believing a child can simply change his or her temperament. Parents may not be aware of their own needs or have the capacity to understand how to adjust in order to have their needs met. When mismatched temperaments are not understood, parents may expect more of their child or believe that their child can change their behavior independently. This can lead to frustration and increased stress for parents. In addition, parents may feel as though they do not have the ability to meet their child’s needs or parent effectively. Children rely on their parents to be emotional co-regulators. This means that especially when children are young, they look to their parents to model how to manage uncomfortable emotions, changes to routine and internal triggers. When parents are calm, children can de-escalate more quickly. As children learn to understand their own temperaments, they can build their abilities to navigate different situations and interactions and become more effective in developing social-emotional regulation.

Talking about the Child’s Temperament

As providers, when parents talk about the ways in which they interact with their children, we can then begin to ask questions to help identify children’s temperament styles and explore which interventions are available to build family capacity. Once a parent can begin tuning in to the child’s unique temperament, the parent can then work to develop strategies for supporting the child’s needs. Here are some questions that you could help the parent to consider when trying to understand their child’s temperament:

• How does my child express their feelings?
• How does my child engage in play?
• How does my child respond when they experience discomfort?
• How does my child react to change?
• What does my child do when going through transitions?

When parents are in tune with their child’s temperament, they are able to support their child’s behavior more effectively. Parents can then understand their child’s needs to provide opportunities for learning new coping skills.

When children are young, it is important for parents to give a lot of support in helping their work through challenges. As children get older and can understand their own temperament style and what they need to be successful, the interactions become more balanced. When parents and caregivers are able to understand the ways in which temperament plays a role in the behavior and interactions of their children, stress is reduced and successful intervention strategies can be realized.

Now that you have some more tools to understand temperament, how can you help parents recognize and respond to their child’s unique characteristics?

Share your ideas by leaving a comment below!

For more information about this topic, check out Naomi’s 2-part webinar series on the VA Early Intervention Professional Development Center:

Foundations of Social Emotional Development: Temperament – Part II

Foundations of Social Emotional Development: Attachment – Part I

Also, be sure to visit the Social-Emotional Development topic page!

Naomi Grinney, LCSW has worked in early intervention for the past five years. Prior to working in EI, Naomi worked as a community-based mental health crisis response provider, as social worker in a psychiatric hospital and as a behavioral interventionist at a residential treatment center. Naomi is passionate about supporting the social emotional development of children and building family capacity and has worked with kids and families for twenty years. As the parent of a child who received Early Intervention services, Naomi brings a unique perspective to her role in providing tools and resources to empower parents in supporting their child’s development. Naomi can be reached at naomi.grinney@fairfaxcounty.gov. 

The post Temperament and Social Emotional Development appeared first on Early Intervention Strategies for Success.

Several years ago, I found that my EI caseload included a couple of families with stay-at-home dads. This was a first for me, and I found myself struggling to connect with family caregivers, which hadn’t happened to me since I was new to the field.  Both men were quite nice, but I stumbled when I tried to make conversation to build rapport.  What did I have in common with these men? With moms, I could build rapport around so many shared experiences being moms and women.   One dad was a former football player and the other was a fitness expert.  My idea of working out was to walk from the couch to the bookshelf. 

So, I did what I always do when I’m unsure- I read and researched.  I searched and searched for good information on working with dads.  I found almost nothing except for a few articles on how men and women communicate differently.  I had to muddle through mostly on my own, but we all made it through together.  These experiences helped shaped my later academic research. 

3 Key Strategies for Building Relationships with Dads

Here are some of the key strategies I used to build successful relationships with dads.

Talk side to side rather than face to face.

I can’t remember the source anymore, but the one tip I did garner from searching for books and articles was that men are socialized to talk with each other and others while they are engaged in a task or standing side by side, while woman are socialized to look at each other while talking. This strategy was immediately helpful! When the fitness expert dad offered to make me a fancy coffee, I took that opportunity of having his back to me to ask some deeper questions about what his hopes for his daughter were and what he wanted from EI.  It worked! This became part of our weekly routine.  He would make me a fancy coffee and I would use this time while he wasn’t looking at me to chat and build rapport.  With the other dad, I started positioning my body angled from him instead of looking directly at him.  This also worked immediately.  He opened up a little more when we weren’t looking directly at each other and I realized we could connect over our similar senses of humor.  He hasn’t been a client in years, but our relationship became strong enough that he sends updates on his son’s progress several times a year. 

Explicitly invite dads into therapeutic activities.

I learned to do this based on anecdotes from my own work in EI and the dads in my research verified it’s really important.  Many dads aren’t sure about what EI is supposed to be, especially if they aren’t the primary caregivers of their children. They hang back and watch or wait for their wife or partner to give them a summary of what happened.  Extend a direct invitation by saying, “Hey, we’re going to work on motor skills.  Come on over and help me make an obstacle course with the couch cushions” or “One of our outcomes that your kiddo can communicate her wants and needs.  Let’s take her in the kitchen and work on some strategies to get her communicating for snack time.” This signals that the dad is an important part of what’s happening and that you want him to participate. 

Be really clear about what you are doing and why.  Provide this information in writing, too.

Both the dads I worked with and the dads in my research wanted clear explanations of why their EI providers were giving them and their children specific tasks.  They wanted to know exactly how doing an obstacle course was related to motor development or how giving a choice of two items at snack time helped with communication development. For many of EI providers this information is so much a part of what we do, that we don’t think to explain the connection.  The dads in my research didn’t always feel comfortable asking providers these questions or they asked the questions but didn’t remember the answers after the provider left.  Make sure to provide written explanations that address the what and the why.  Remember, a quick text (if allowed by your program) counts as being in writing (just make sure you send it to mom AND dad).

Have you tried any of these strategies? Have one we haven’t thought of? Or maybe want some advice about a tricky situation with a dad?

Leave a comment and let us know!

For more information about working with dads, you can check out the Dads Matter! Webinar Series (external website) on the VA Early Intervention Professional Development Center (external website) site. Scroll down on the page to find both archived webinars.  

Megan has over a decade of experience working with fathers as an early intervention developmental specialist. Currently, she is an assistant professor at Salem State University, where she teaches future early interventionists and researches dads’ experiences working with early intervention programs. Megan lives in Salem, MA, with her husband, daughter, and two exceptionally naughty cats.

The post 3 Key Strategies for Building Relationships with Dads appeared first on Early Intervention Strategies for Success.

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

It’s time to wake up.

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

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

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

The days are long, but the years are short.

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

Service Coordinator: Does your son take a nap?

Mom: Yes, after lunch.

Service Coordinator: How long are his naps?

Mom: Usually about an hour and a half.

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

Pulling it all together.

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

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

Share your ideas in the comments below.

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

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You’ve got 30 minutes until your next visit. Sure, you could pull over in a parking lot and scroll through your email or social media, or maybe return that text that will take you about 10 seconds to type…OR you could listen to the new podcast, EI on the Fly: A Podcast about All Things Early Intervention!

I’m pretty excited about this new project. Podcasting has been a fun new world for me, both to learn about and listen to. Last year, Emily Webb, with the Massachusetts Early Intervention Training Center, emailed me to ask if I’d be interested in collaborating on a podcast. We both work in EI professional development, both have been EI practitioners, and, as it turns out, have both experienced EI from the parent perspective. It sounded like a new adventure so, of course, I said yes!

Our First Series: Functional Assessment

Over the past year, Emily and I have recorded the Functional Assessment series, which will include eight episodes. Episodes will be released monthly on Podbean, but are also available on iTunes and Google Podcasts. Here’s a sneak peak at what’s coming:

Episode 1 – What is Functional Assessment and Why Does It Matter? (Run time: 32:37)
Episode 2 – Intentional Observation (Run time 30:44)
Episode 3 – Asking Meaningful Questions
Episode 4 – Active Listening
Episode 5 – Implicit Bias
Episode 6 – Functional Assessment and the Initial IFSP
Episode 7 – Ongoing Functional Assessment
Episode 8 – What Functional Assessment Means to Supervisors, Practitioners, and Families

We’ve released the first two episodes so far. Episode 1 provides an introduction to functional assessment (FA). We define FA and introduce important concepts (PDF, New Window) such as conducting observation, asking meaningful questions, using active listening, and learning about how children interact and learn during daily activities. We talk about what ongoing FA should look like, compare it to traditional assessment, consider examples, and think about how to integrate it into your work with families.

In Episode 2, we dive into the first component of functional assessment: observation. We define observation in the context of early intervention and consider how it helps us “watch to listen and learn.” We discuss observation during the initial evaluation/assessment and service delivery, emphasizing how observation helps us gather functional information about children, how they interact with family members, and what interests and motivations them – all without inferring meaning or judgement. We’ll also review tips for helping families understand the importance of observation.

The Car’s Great but How Else Can You Use the Podcast?

Here are a few more ideas:

For individual practitioners: Rather than blocking another time slot to get something else done, pair the podcast with another activity. Catch an episode while driving to work, preparing breakfast or dinner, or maybe even while taking a walk or cleaning your house (fun!). It’s easily accessible through apps on your phone, and can be downloaded to listen to later.

For System Managers and Directors of EI programs: Plan for a group discussion during your next staff meeting. Email out the episode link before the meeting with an open-ended discussion question as food for thought. Blast the link out by email to the service coordinators and service providers in your system. It’s another free resource that we hope programs will find easy to use!

I’ll be writing posts about the individual episodes in the coming months to give you additional ideas on how to dig into the topics yourself or with your staff. We hope you’ll subscribe and stay tuned for future episodes.

Teaser: Emily tells some great stories about her experiences as a mom receiving EI that really put FA in context – you won’t want to miss them!

PS: A huge and special thanks to Jeanne (VA) and Laura (MA) who are the technical specialists behind-the-scenes helping us with producing and posting the episodes!

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Logan’s annual IFSP review is underway and you are excited to celebrate his progress. You’ve been working with his family for a year so you’ve seen the steady pace at which Logan continues to develop. When he first entered early intervention, he was only two months old and doing most of the things a two-month-old needed to do. Now that he’s 14 months old, his delays appear more significant but you want his parents to remain hopeful so you and your colleagues explain the assessment results, celebrating his gains and acknowledging the next skills to come.

When the team discusses the child outcomes summary process, the service coordinator uses the Decision Tree (PDF, New Window) as a guide. Because of his age and slow but steady progress, Logan is showing very early skills when compared to his same age peers, which sounds very different from the discussion the team had last year. You want to help Logan’s parents understand why this is, but then another team members drops this question:

“So what do we think? Is Logan a 1 or a 2 now?”

“OMG,” you think, “Logan is NOT a number!” Now what do you do?

Children are Not Numbers on the Decision Tree

This is an important point that ALL team members need to understand. The discussion about the child outcomes and the Decision Tree (PDF, New Window) should never include labeling a child with a number. It should be about using the information you have to make an informed decision as a team that describes Logan’s development according to the three global child outcomes (“global” because these are outcomes we’d like to see for all children during their early childhood years).

During the meeting, the team describes the child’s development using summary statements on the Decision Tree, not numbers (see the Child Outcomes Booklet (PDF, New Window) for more info). The numbers on the Decision Tree can be thought of as categories that describe skill development related to the child outcomes – not categories of children. For example, “Category 1” includes a summary statement (or description) that tells us that Logan has “very early skills in this area. This means that [Logan] has the skills we would expect for a much younger child.” This does NOT mean that “Logan is a 1.” While the service coordinator does have to report a number for each outcome in documentation back at the office, and these numbers are referred to as “child ratings” according to the Office of Special Education Programs (OSEP), it’s a really good idea to let go of the idea that the child outcomes discussion results in a number for the child. Let. It. Go.

Here’s why: If you hold this belief, even an underlying belief in linking a child to a number, then you will convey this belief to the family. No parent wants their infant or toddler rated or numbered. It can be hard enough for a parent to hear the age equivalency scores from the assessment tool. Parents must be involved in the child outcomes discussion, and we want them to understand the process – a process that, admittedly, can be hard to explain.

The Words You Use Matter – Tips for Developing Your Script

The words you use to explain this process matter. Yes, some parents may be mentally exhausted by the time you get to this discussion, but that does not mean you should sugarcoat it, skip it, or hurry through it, which can be tempting to do. It can also be tempting to let the professional team members discuss the process without much explanation for the parent. To avoid this, try these tips:

1. Write down a sample script for how you can explain the process to all team members (including and especially the parent) without assigning the child a number, then let a colleague read it and give you feedback.
2. Read it out loud to yourself and see how it sounds.
3. Listen to how others explain the process and “borrow” their words.
4. Ask families who are already enrolled in your program what they understood about the child outcomes discussion from their initial or annual IFSP meeting.

Here’s a big one: Dig in a bit and reflect – Are you the team member who asked about a child’s “number” at an assessment or IFSP meeting? If you are, then it’s a good thing to recognize that now and commit to a change in thinking for your next assessment or IFSP meeting.

There is No Need to Pick a Number at the Meeting

How you explain the process will likely differ from your colleague’s script and that’s okay. The words you use may change a bit with each meeting depending on your style, the team with whom you work, the family’s understanding and learning needs, etc. The important point here is to think about the message you (and your team members) convey with the child outcomes process. There is no need to “pick a number” for a child during the meeting, but there is a need to be accurate, respectful, and sensitive while helping all team members understand, participate in the process, and identify summary statements to describe the child’s development.

Open the door for this discussion with your team members using the questions here, or share your thoughts by adding a comment below:

How do you explain the child outcomes discussion process to families? What are your go-to phrases to help all team members understand?

If a team member tries to pick a number at the meeting, what could you say in response?

For more information, check out these resources:

Virginia’s Child Outcomes Booklet (PDF, New Window)

Virginia’s System for Determining Child Progress (OSEP Child Outcomes)

Decision Tree Tutorial Video

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