Many of you have been providing early intervention services via virtual visits for nine months now. That’s a long time….I probably don’t need to tell you that because you are living it. It’s been a long time since you sat in a family’s living room, since you held a baby, since you blew bubbles with a toddler, since you guided a parent’s hands as she helped her baby learn to stand, or since you got one of those amazing toddler hugs. Many of you have become grounded in tele-intervention and, while you undoubtedly miss in-person visits, you have embraced this incredibly unique opportunity to grow as professionals.

What Are You Thankful For?

Take a deep breath, look out of a window, and pause. Think about the past nine months and ask yourself: “What has this experience of providing tele-intervention given me? What am I thankful for?” Somedays, you might answer that this experience has given you a headache from staring at the computer screen all day long. Other days, you might find yourself joyfully celebrating progress you got to see by “joining” a family during an activity you might never have been able to observe before.

While I am not seeing families via tele-intervention, here are a few things I’m thankful for when I reflect on our field’s experience this year:

#1: I’m thankful for the new door we’ve opened.

Being launched into tele-intervention as the only way of reaching families has likely changed our field forever and in a positive way. Many states are advocating for the flexibility to continue to offer tele-intervention as an option to families. Being able to offer tele-intervention to families who prefer it for privacy, flexibility, distance, or other personal family reasons… having the option available to support families of some of our most medically-fragile children…offering virtual visits in areas with provider shortages – all of these could really be game changers. I’m grateful for the door that’s opened so we might be able to continue to leverage technology to further individualize EI services and reach more families.

#2: I’m thankful for the coaching practices that were already in place to help us *really* support caregivers.

I’ve heard over and over that practitioners who were already using coaching practices found the shift to tele-intervention more natural – still challenging and still with a healthy learning curve, but overall, a more natural fit. I’m grateful that we have been practicing coaching and routines-based, family-centered intervention here in VA for years now. Sure, what this looks runs the gamut, but the adoption of this practice made it easier for practitioners to support caregiver and child learning from the other side of a webcam. No one said it was easy to make the shift to virtual visits, but having some great practices in your back pocket seems to have helped.

#3: I’m thankful for you.

Yes, that might sound cliche but hear me out. I’m thankful for EI practitioners and leaders like you who embraced virtual visits when you had no other choice. You put new policies in place, built new systems of support and payment, adopted new technology, and walked families through how to login with kindness and patience. I’m thankful that you pushed through the awkward transition of figuring out where to place the camera and how to manage audio, how to observe and manage silence during visits, and how to teach a parent without being able to model like you’re used to. I’m grateful for the EI teams who experimented and figured out how to use technology to conduct eligibility determinations and assessments, who shared their screens so families could understand their rights and see the IFSP as they joined team members to write it. For all of you who continue to dedicate your time, energy, and bandwidth to children and families receiving early intervention, I see you and I am proud to be part of a field with you in it.

Now it’s your turn. What are you thankful for?

Share your thoughts by leaving a comment below.

For more information about tele-intervention, visit these resources:

COVID-19 and EI Tele-Intervention Updates (VEIPD)

Provider and Educator Use of Technology (ECTA Center)

The post Tele-Intervention Has Made Me Thankful For… 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.

Technology is great when it works, right? It’s such an embedded part of most of our lives when we are not in the throws of a global pandemic that many of us hardly think about it. Now, though, when early interventionists are chin deep in trying to navigate tele-intervention, figuring out how to connect through technology is essential.

I’ve been picking the brains of amazing EI practitioners and local system managers to find out what they are doing to make the technology work, not only for themselves but also for the families they support. I’ve organized some of the great ideas I’ve heard into the list below.

A big THANK YOU to the practitioners and leaders from Fairfax, Norfolk, Prince William, Danville-Pittsylvania, Southside, Roanoke Valley, Rockbridge Area, Central VA, Cumberland Mountain, Middle Peninsula-Northern Neck and others who shared their experiences with me!

7 Technology Tips

Here are 7 tips for managing technology when preparing for or providing tele-intervention:

1. Prepare yourself first – Before you contact the parent, make sure you have an understanding of what tele-intervention is. Watch the TelePractice in Early Intervention webinar for a fantastic overview and tons of strategies. Watch a video such as A Home Visit with Zander, Providing Early Intervention Services through Distance Technology, or Tele-Intervention – Coaching during Family Chore-Laundry to see how coaching works during tele-intervention. Educate yourself about the technology so you can answer parents’ questions as best you can. Larry Edelman has prepared a great resource document about technology: Planning for the Use of Video Conferencing for Early Intervention Home Visits during the COVID-19 Pandemic (PDF, New Window)– check it out!

2. Touch base the “usual way” – Reach out to the parent using your typical means of communication – phone, email, or text, depending on what’s permitted in your program or preferred by the family. Check in about the family’s welfare first, then ease the conversation into virtual options for connecting.

3. Explore and explain options – Without making any assumptions about family preferences or capability, explore the available options for video visits or phone contacts for service delivery. Explain how each option could work and paint a picture of what it might look like. If the parent is interested (or even unsure), share a link to the video, A Home Visit with Zander, so he/she can watch a visit and hear from a parent about how tele-intervention can work. Be sure to invite the parent to ask questions, share any worries, and think through the possibilities with you.

4. Share your vulnerability – It’s okay to let the parent know that this is new for you too. Assure the parent that you will figure it out together and that, if the parent chooses the high tech option (aka video confererencing) and something goes wonky, you always have a low tech option as Plan B (aka phonecall).

5. Schedule a tech check – Before the actual video visit, schedule a 15 minute tech check. This may be a non-billable activity, but it’s worth it. Send the parent the video conferencing link with detailed instructions about how to connect. Get online together, check video, audio, lighting, etc. and talk about where the device will be positioned so you can see the family the best. Plan together for what the parent wants to do during the actual visit and how the technology can be used so you can observe and collaborate. If you or the parent has tech problems, remember the #1 rule of thumb with troubleshooting: when in doubt, back out and try again. Log out of the video conference and try to log back in. If that doesn’t work, log out and restart the computer. If that still doesn’t work, try another browser. Persistence will pay off, I promise.

6. Problem-solve Wifi issues – Here’s where practitioners are getting creative. I’ve heard of folks parking in the family’s driveway for the video visit so the family can access the practitioner’s hotspot, then holding the visit using technology with the practitioner parked outside. What an idea! Some schools are offering hotspots for older children – can the family use that connection for the visit? If there are limitations on data or bandwidth, schedule the visit at a time when issues should (hopefully) be at a minimum, like in the afternoon after older children are finished with online learning.

7. Let the parent decide – If a parent is unsure about either option, encourage him/her to try a phone or video visit then evaluate how it went. If the parent declines, that’s okay. Parents can put their services on hold at any time; just be sure that they fully understand their options, privacy, and the support you can provide. Be sure to document your discussion and check back in with the family often in case they change their minds.

Once everything is in place and your fingers are firmly crossed, schedule that first visit and go for it. Take a deep breath before you connect with the parent and enter the video call with confidence. Expect some hiccups, be flexible, practice your patience, and exercise your sense of humor. This will get easier and both you and the family will adjust, together.

You’ve got this.

What strategies are you using to prepare families for tele-intervention?

What creative ideas are you using to help families manage technology needs?

Let’s hear your best ideas! Share them in the chat and let’s continue to support one another. J

For more information, videos, webinars, and online training related to tele-intervention, visit these sites:

COVID-19 and EI Tele-Intervention Updates – VA EI Professional Development Center

Coronavirus Disease (COVID-19) – ECTA Center

The post 7 Technology Tips for Tele-Intervention appeared first on Early Intervention Strategies for Success.

We are all in this together. Early interventionists are exploring and learning new telehealth options. For many, this may mean learning new technology platforms, navigating limited wifi access, and simultaneously focusing on providing exceptional service delivery through telehealth. Teleflections©, a new resource, provide reflections from early interventionists who share their own experiences including their successes and challenges. Each week new videos are posted.

There are a variety of ways to access the Teleflections© series. Follow us on:

• Facebook
• Instagram
• Twitter
• YouTube (Teleflections© Playlist)

During this time of uncertainty, it helps to normalize our experiences and laugh (maybe sometimes cry) about them together. You can also check out the COVID-19 and EI Tele-Intervention Updates page for the latest resources.

Let’s take a look at some of the recent Teleflections©.

In Teleflections© 2, Julie Vaughn (SLP) was honestly states, “I won’t lie. It’s not my thing. It’s just not my thing, but I am making the best of it. I have learned a lot this week about computers and technology.” Coming out soon, Julie shares a new video with her successful update on how she has grown over the past two weeks. This is something new and we have to give ourselves time and patience as we all learn together.

In Teleflections© 4, Missy Rose (PT) shares her experiences as a physical therapist who relies on her hands to gain information about a child. Make sure you do not miss her fancy doll she uses to support families learning different positioning techniques. Many of us are nervous about not being in the home, but we are all learning we can still coach families to support their child’s development in naturally occurring routines and activities. We have even heard so many successes about coaching families and seeing a larger variety of routines as we navigate this together.

In Teleflections© 5, Stacie Jackson (LSM and SC) shares her experience waking up at 3:45 the morning of her first intake. It is safe to say many of us have experienced restlessness or disrupted sleep. After all, we’re all experiencing similar responses together.

The latest Teleflections© 6, Dana Carroll (OT) shares her experience from a mother who was really nervous at first. Dana describes the mother as being “over the moon” by the end of the session. Many families may be worried about how they will continue to support their child’s development during this time and it is a great way to remind them that we are all in this together.

Check out Teleflection©s by following our social media. We would love to hear about your experiences.

What has been your biggest success (or challenge)?

Share your experiences in the chat below!

The post Introducing Teleflections©: We Are All in This Together appeared first on Early Intervention Strategies for Success.

Let’s get right to the point. You are not trying to engage an infant or toddler on video for 45-60 minutes during your virtual visit. Re-read that last sentence and let it sink in. Take a deep breath in and breathe out any expectation you may have had about playing with the baby you see on video. When we step back and let our anxiety about tele-intervention settle, it’s easier to realize that there is very little chance of a 2-year old interacting with you on video for more than a moment or two – and that’s okay. You can still do early intervention without that interaction when you focus on engaging the parent (or other caregiver) who will then engage the child. If you think about coaching and the Mission of EI, that’s where your focus should be anyway. You’ve probably already been doing this and if not, you can do it now.  

Okay, you might be asking yourself: If I’m not interacting with the child, what do I do instead?

Let’s answer that question.

What Do You Do?

Now, more than ever, early interventionists are using their coaching skills to engage parents during virtual visits conducted using video conferencing technologies. Interventionists have been thrust into the world of tele-intervention (you might know it as telepractice or telehealth) with often little preparation or experience. The whole world has shifted and it feels like EI practice has shifted along with it (and they have).

Here’s what hasn’t changed, though: You are still a coach to the parent/caregiver. Your primary mission is to support caregivers so they learn ways to interact with their children during everyday routines and activities to encourage development. Whether you are sitting in their home or yours, you are still a coach. You did not coach the child before tele-intervention; you coached the parent. You probably did spend time playing with and engaging the child, practicing stretches, prompting for sounds, and challenging the child’s problem-solving or social skills. You probably modeled the use of strategies in these activities for the parent. Now, you have to figure out how to let go of your need to directly interact with the child and embrace the golden opportunity you have to support the parent’s learning.

Here are 10 strategies for focusing on parent/caregiver learning during tele-intervention. You can do this!

10 Strategies for Engaging Parents during Tele-Intervention

Before the Visit:

1. Prepare with the parent – Touch base by phone before the virtual visit to discuss technology needs and answer questions. Plan for how to connect, what device the parent will use, and how it will be positioned so the parent can see you and you can observe the parent-child interaction. Plan for how the parent will access the link you will send to the virtual meeting platform. Consider different types of devices and how access might look different (a quick google search for instructions can be helpful if needed).

2. Prepare yourself – Before the virtual visit, collect your thoughts. Remember that you don’t need toys because you are not trying to engage the child. You may need a prop, such as a doll or teddy bear to model movements for the parent, but you can put your bubbles away.

3. Preparing for what to do – Chat with the parent about ideas for what to do during the visit. Be prepared to follow the parent’s lead and let her know she can take you with her in whatever she and her child do during the visit. You can also plan for activities, like if you are going to work together on the child’s feeding or encourage play skills with siblings who are also home. Just like any visit, though, preparing can go right out the window if another opportunity arises or the family needs the visit to go in a different direction. Prepare when you can, but go with the flow when you need to.

During the Visit:

4. Take time to check in – Just like any other visit, touch base on how the family is doing and check in on child progress. This check in time may take longer now and that’s okay. Remember that everyone is adjusting to the new normal so approach this relationship-building time with ease.

5. Use your voice to join in (instead of your body) – Join the activity you planned or search for opportunities based on what you see. Observe that feeding session, watch the siblings play, and use your coaching skills to share your observations, ask reflective questions, and provide verbal guidance on how to use intervention strategies. You have to use your voice to join in so be gentle with your suggestions and always ask the caregiver what she thinks, how it feels, etc.

6. Be descriptive and specific – When you provide guidance, share observations, or give feedback, be specific and describe what you see and what you suggest. Following verbal directions might be harder to process for the parent who is used to watching you, so take it slow and check in frequently.

7. Be flexible – If the visit is a little shorten than usual, that’s okay. Be sure to document why. If what you planned with the parent falls flat, try something else. If you end up discussing development more than observing it, especially on your first visit, that’s okay. Use the “show me…” prompt to move from discussion to observation and support; it’s a great tool on an in-person visit and it’s your best tool now.

8. Keep your focus on the parent, who facilitates learning for the child – This is key. This is also best practice in EI whether you are face-to-face or on video. What you can help the parent practice during the visit with the child is more likely to continue between visits. Use your coaching skills to keep the focus on parent learning, which extends learning to the child.

9. Write down the joint plan – Plan with the parent as you always do, but create a written version of the joint plan at the end or after the visit. Email or text the plan to the parent as a reminder and follow-up on that plan at the start of your next visit.

During and Between Visits:

This last strategy might be the most valuable right now:

10. Cultivate patience for the parent and yourself – Providing intervention this way might feel wobbly nowand that’s okay. Both you and the parent are in the midst of significant change, and not just for the EI visit. Being patient with the family will help them feel comfortable with this new way of interacting with you. Being patient with yourself means giving yourself permission to feel nervous and stumble, laugh about it, learn, pat yourself on the back, and try again next week.

Consider this: Your relationship to early intervention and with the parent has changed because of the pandemic and tele-intervention, but maybe that change is for the better. This way of supporting parents (and children) might make you a better coach. Give it time, approach intervention with openness, and take a deep breath. We will all be okay.

What strategies are you using before or using your tele-intervention visits to engage parents?

What’s working well? What’s challenging you?

Share your tips and experiences in the chat below and let’s support each other. 🙂

For information, videos, webinars, and online training related to tele-intervention, visit these sites:

COVID-19 and EI Tele-Intervention Updates – VA EI Professional Development Center

Coronavirus Disease (COVID-19) – ECTA Center

For technology tips and links to video reflections about tele-intervention, check out these posts:

7 Technology Tips for Tele-Intervention

Introducing Teleflections©: We’re All In This Together

The post 10 Strategies for Engaging Parents (not Children?) during Tele-Intervention appeared first on Early Intervention Strategies for Success.

Ever been in a home visit with a parent who is simultaneously using his/her phone while discussing the child with you? There are lots of ways that phones and screen time show up during visits. For instance, parents hand their child a phone to keep him quiet or distract other children in the home. Parents may pull out their phones to take down notes about interventions or the next appointment. They show us videos and pictures of exciting progress in milestones, or to ask a question about something going on with their child.

Cell phones and all other forms of screens are such a huge part of life today, including children’s lives starting as early as infancy and toddlerhood. As service coordinators and providers, we can choose to resist or ignore these changes, and feel frustrated with how they impact early intervention outcomes. OR, we can step up to the challenge of employing phones and technology as tools in our interventions and interactions with families.

AAP Screen Time Recommendations

The American Academy of Pediatrics has made a formal statement of recommendations for use of technology for children of all ages in their Media and Young Minds Policy (2016). Some specific advice for ages 0-3 includes:

• For children younger than 18 months, discourage the use of screen media other than video-chatting.
• For parents of children 18 to 24 months of age who want to introduce digital media, advise that they choose high-quality programming/apps and use them together with children, because this is how toddlers learn best. Letting children use media by themselves should be avoided.
• In children older than 2 years, limit media to 1 hour or less per day of high-quality programming. Recommend shared use between parent and child to promote enhanced learning, greater interaction, and limit setting.
• Recommend no screens during meals and for 1 hour before bedtime.

Parents often express guilt to providers over undesirable screen time issues with their child, and look to us for support. Advice from author, Lisa Guernsey, recommends that families and early childhood professionals consider the “Three C’s” when determining when and how to use various technologies: content, context and the individual child. Together with families, we can consider the following questions to begin supporting them in implementing the AAP’s recommendations, while keeping technology as a tool on our side.

• We can ask how does the content help children learn, engage, express, imagine, or explore?
• What kinds of social interactions are happening before, during, and after the use of the technology? Does it complement, and not interrupt, children’s learning experiences and natural play patterns?
• Does this technology match with this child’s needs, abilities, interests, and development stage? (Guiding Principles for Use of Technology with Early Learners, 2016)

7 Ways to Support Families and Outcomes Using Technology

Once we’ve evaluated the values of technology per each child’s situation, we can consider employing some of the following strategies for intervention and improvement.

1. Parents can use video chats as a new and exciting way for children to use their language and imitation skills with a variety of people.
2. Show parents how they can engage in an app or screen time activity together with their child to promote quality interactions.
3. At the end of a visit, encourage parents to set a reminder alert in their phone to practice certain strategies or focus on a specific interaction with their child.
4. Recommend apps that educate and support parents in understanding child development, such as: CDC’s Milestone Tracker, VROOM, and HelloJoey.
5. Educate parents about how to evaluate apps/programs for developmental appropriateness.
6. Coach parents in setting boundaries with screen time and managing challenging behaviors that may arise from this. Help them determine specific “screen free” routines throughout the day.
7. Remind parents that no “educational” technology or program is better for their child’s development than regularly engaging in interaction, exploration, and play everyday!

Share your thoughts and experiences below by leaving a comment:

How have you seen screens and technology impacting Early Intervention visits?

Have families ever asked for advice about apps or programs to help their child? How do you or would you respond?

Please share any great technology resources that you have found in the comments too!

References

Guiding Principles for Use of Technology with Early Learners. (2016). Retrieved from https://tech.ed.gov/earlylearning/principles/.

Radesky, J., and Christakis, D. (2016). Media and young minds. Journal of the Academy of Pediatrics, 138(5), doi:10.1542/peds.2016-2591.

Rachel Todd lives in Northern Utah and has worked as a Service Coordinator for the Up to 3 Early Intervention Program since 2017. She has a Bachelor’s degree in Family, Consumer, and Human Development emphasizing in child development and worked with families in Early Head Start programs before joining EI. She is also a graduate student in the Instructional Technology & Learning Sciences program at Utah State University and loves professional development of all forms. Rachel and her husband have a one-year-old son and a spoiled fur baby and love to get outside in the mountains together every chance they get! You can reach Rachel at
rachel.todd@usu.edu

The post Technology and Toddlerhood appeared first on Early Intervention Strategies for Success.

In Part 1 of this series, you learned about the first intervention, which focuses on the caregiver’s awareness and interpretation of his or her own actions. This first intervention emphasizes (to us and the caregiver) the power the caregiver has to positively impact the child’s development through interaction and action. In Part 2, we’re going to dive a little deeper and think about the context of those actions and interactions – where and when learning occurs.

Helping Caregivers Identify & Use Everyday Learning Opportunities

Our second intervention emphasizes the importance of helping caregivers identify and use everyday learning opportunities to enhance child development (Dunst & Trivette, 2009; Mahoney, 2009; Swanson, Raab, & Dunst, 2011). This intervention reminds us that the context for most of the learning a child will do is within his or her interactions with the people and the environment that are most familiar and most constant. We can collaborate with caregivers by respecting what is already happening in the natural environment and helping them notice and take advantage of interactions and opportunities that help the child learn or practice using a skill. When learning is situated in a naturally occurring, familiar context, there are more opportunities for the child and caregiver to practice what they are learning together every day beyond the EI visit. The cognitive load is also decreased since the context is familiar, hopefully making it easier to use a new intervention strategy (for the caregiver) and learn a new skill (for the child). Practice during infant and toddler development is essential so the more opportunities we can help the caregiver provide, the better!

What Does This LOOK LIKE in Practice?

Here are a few excellent strategies you can use to implement this intervention. These strategies were suggested by EI service providers in conference sessions on this topic:

Use the unique interests of the child and the caregiver as your guide. Ask caregivers what they enjoy doing with the child. Ask about the typical flow of the day. Ask about what makes the child laugh (or feel frustrated, excited, engaged, motivated, etc.). Find out what they would like to be able to do together and what that would look like if it worked well. Build on what you find out by observing those activities and routines, talking about the learning opportunities you see, and helping the caregiver learn to seize them.

Individualize IFSP outcomes and goals by including specific learning opportunities that already exist for the family. Ground the outcomes in the context of everyday activities. If the outcome describes how the child will learn to move about independently, place the measurement of the outcome in a typical activity. For example, let’s say that the child will move about her home independently by crawling or walking 10 feet from the kitchen to the family room after each meal. When she can do this consistently across time, we’ll know she’s met the outcome. Plus, the family can see the progress because they can practice the movement strategies in a frequently occurring context that’s natural for them. Including context in outcomes helps families identify with their important role in intervention from the beginning. Individualizing outcomes is a great place to start with building awareness (our first intervention) too.

Observe and join different activities and routines to help the caregiver look for the learning opportunities. There is nothing as effective as “seeing it.” Whenever you can, sit back and observe parent-child interactions and specific routines that are meaningful, problematic, or just typical for the family. Point out learning opportunities that you see. Reflect with caregivers to help them create their own ideas. Encourage them to try out the strategies that come from these conversations while you observe again, provide support, problem-solve, and share feedback.

After the caregiver practices using a strategy, talk about how to extend the use of the strategy in other routines to create more learning opportunities. You can facilitate this thinking process by asking, “When do you think you can use this strategy outside of the visit today? What other times of the day might work for using the strategy?” If needed, ask about other routines you know about and help the caregiver think about how the strategy could be embedded. Have the conversation and land on a joint plan. By doing this, you may be expanding the caregiver’s thinking, which again, overlaps with our first intervention. See, this is powerful stuff.

Now it’s your turn:

What’s your favorite way of helping caregivers identify and use natural learning opportunities? What did this look like on your last visit?

Share your ideas and examples in the comments below! And don’t miss Part 3, the final post in this series!

References:

Dunst, C. J., & Trivette, C. M. (2009). Using research evidence to inform and evaluate early childhood intervention practices. Topics in Early Childhood Special Education, 29(1), 40-52.

Mahoney, G. (2009). Relationship-focused intervention (RFI): Enhancing the role of parents in children’s developmental intervention. International Journal of Early Childhood Special Education, 1(1), 79-94.

Swanson, J., Raab, M., & Dunst, C. J. (2011). Strengthening family capacity to provide young children everyday natural learning opportunities. Journal of Early Childhood Research, 9(1), 66-80.

The post 3 Interventions Every Early Interventionist Needs to Know – Part 2 appeared first on Early Intervention Strategies for Success.

In evidence-based early intervention, our primary aim is to coach, rather than to “do therapy” ourselves. We teach families how to help their children. The most challenging part of coaching can be finding effective ways to invite parents to participate and join in the interactions with their child.

Location, Location, Location

As therapists, it is natural for us to think about our relationship with the child in service. After all, we are teaching the child. That’s what we are trained to do. Right? Not exactly. We’re teaching the parent, so that the parent can teach the child. That changes the relationship. Our relationship with the parent, and the parent’s relationship with the child suddenly become much more important when we look at them through this lens. As coaches, we know that the interactions that the parent has with the child are primary and we work to keep those interactions at the forefront. I’ve learned to place myself behind a child rather than in front of him during an activity, or to create a triangle between myself, the mom, and the child. This breaks up the traditional child-therapist pair and gives the parent a space to join in. Locations other than the living room floor that can make this easier include the couch, a high chair, a table, or wherever the parent and child typically spend time together.

Start with Routines

Keep in mind that unless parents have been involved with coaching before, they’re probably expecting traditional therapy. All parents want to be involved and want to help their children, but they may not know how to step in and participate, especially during playtime. Coaching phrases like, “Do you want to try this?” or “Can I model that for you?” can feel awkward to deliver if you aren’t used to them. And we all know, if you feel awkward, it will be awkward.

Rather than starting with an activity that we initiate, we can set the stage for authentic parent involvement by observing the family’s natural routines first. I sometimes ask parents what they would be doing if I wasn’t there. Is it snack time? Does little Joey need a diaper change? This leads naturally into a mutual discussion about ways to increase interaction and language in everyday activities. If it is snack time and Joey heads for the refrigerator or brings us his cup, we have a perfect opportunity to introduce a word or sign for “eat” or “drink”, model and practice offering choices to build language, or encourage eye contact as a first way of requesting. Snack time, diaper changes, and dressing are activities that parents generally do so they are more likely to take the lead and give us a chance to support and encourage, rather than waiting for us to lead an activity.

When You Have to Play

If parents seem more inclined to hang back, say that their child normally plays by himself while they do other things, or are otherwise hesitant, we may have to fall back on some more traditional therapy or play activities. This is when we are most likely to lose parent interaction if we don’t keep it at the forefront. If we are looking at a book, rolling a ball, working on a puzzle, blowing bubbles, or doing any other traditional therapy activity, it is very easy to let the focus drift back to us and the child. I have to work to consciously keep the parent-child interaction at the forefront, rather than my interaction with Joey. If we are looking at a book and working on pointing out pictures, I stand or sit behind him and put the parent in front of us or next to Joey on the couch to ask those, “Where’s the…?” questions and help him point out the pictures. This tends to feel much more natural and I find it less intimidating for everyone. It also increases the chance that the next time Joey brings a book to his mom, she will point out a few pictures rather than reading complicated text because we’ve practiced this together.

If I’m rolling a ball or car back and forth, once Joey is into the game I roll or throw the ball to his mom and have her join the game that way. If Joey is having trouble getting into the game, I sit behind him and help him throw the ball to his mom, rather than encouraging him to throw the ball to me. I find that most parents want to participate with us, we just have to invite them in. The responsibility for not pushing parents out is with us, even when we are working with more traditional play activities.

Stepping Back in Trust

Once we have used location, positioning, routines, and a bit of creativity to get parents engaged and interacting with the child, this is when the magic happens. Once we have the parents involved, our job is to get out of the way. When I am in a visit, I feel this as a continual sense of stepping back from the parent-child dyad, maybe most during those times when I really want to get involved. If they are engaged in a social game or activity, the last thing I want to do is get in the way. I may give a suggestion of something to try, but I often stop myself from even doing that much.

Wait It Out

Instead, I tend to smile and nod encouragingly and wait. The last thing we want to do after the parent gets involved is to pull her back out of the activity again and put the attention on us rather than on Joey and the interaction. Generally, it lasts a few minutes and then the child is off to something else. This is my time to open a discussion, starting with, “Wow, he loved that game and he was really engaged with you.” From there we might reflect together and move to brainstorming strategies. If parents struggle with coming up with a strategy I might share some expertise with ideas like, “Next time you play that game with him, wait a little bit longer for him to look at you.” Having parents reflect first gives them an opportunity to think about how an activity went before I add to their thoughts. This encourages them to seek out and capitalize on opportunities for interaction during the time when I’m not in the home.

While it can be challenging to encourage parents to join in on the interactions during visits, paying attention to our words and actions can help us to create space for parents to actively participate rather than watching us play.

What strategies have you found for encouraging parents to join in during intervention visits?

Share your strategies in the comments below!

Stacy Zogheib has been a Developmental Specialist in Arizona since 2006. She has a Bachelor’s degree in Elementary and Special Education from Wittenberg University, and a Master’s degree in Early Childhood Education from Northern Arizona University. Stacy has a passion for supporting and empowering families with young children who have delays or disabilities. You can reach her at: stacypro@yahoo.com

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Okay, when you read that title, maybe you were curious, wondering if you were going to learn about three new discoveries that will make your job easier. Or, maybe you did a quick eyeroll, thinking “Here we go, the next big ‘thing’ that I need to do.” Either way, I’m glad you’re here. While I’m not sure that these three interventions will make your job easier, I do think they can make your work more effective. No, these interventions aren’t new or the next big “thing,” but they are based on the evidence we have about what early interventionists do that has a positive impact on child and family outcomes – meaning child development is enhanced, children learn and participate in everyday activities, families understand how to help their children, and quality of life is improved. One of the key aspects of these three interventions is YOU – how you interact with families and what you do to support parent-child interaction. You are a key, so read on and learn what you can do on your next visit to have that positive impact.

Here we go. Interventions that:

1. Emphasize caregivers’ awareness and interpretation of their own actions,
2. Help caregivers identify and use everyday learning opportunities to enhance child development, and
3. Support caregivers’ responsiveness to their children

have been found to be most effective in positively impacting child outcomes (Dunst & Trivette, 2009; Mahoney, 2009; Swanson, Raab, & Dunst, 2011). That’s big stuff. In this post, I’ll tackle what the first intervention looks like in practice. I’ll discuss the other two interventions in Parts 2 and 3.

Emphasize Caregivers’ Awareness and Interpretation of their own Actions

When you implement this intervention, you go deeper than just modeling or teaching caregivers intervention strategies. You approach intervention from the perspective of expanding how the caregiver thinks about her (or his) capabilities, her impact on her child’s development, and the positive effects of her everyday interactions with her child. Some caregivers come to EI already embracing their influence as the parent, but many are in the vulnerable position of being a new parent or a parent of a child with strengths and needs that are different from what they expected or previously experienced with other children. Early intervention can be a new window through which to see a child’s potentialities, and we can open that window with how we approach the support we provide.

I truly believe that it’s not enough to tell families that “you are the expert on your child.” Those can be empty words if we don’t back them up with support that builds on what caregivers already know and do. We need to convey, through practice and intentional interactions, that the parent is just the right person to help her child grow and learn, she is enough, and what she does really matters. She may not have entered the program knowing how to stretch her child, how to prompt her child to increase vocabulary, how to teach her child to sign, or how to regulate herself so that her child learns to manage his emotions – and that’s all okay. We are there to teach, guide, and help the caregiver become aware of, embrace, and learn to interpret the link between her actions and her child’s behaviors, interactions, and learning. That’s a deeper level of engaging families, a level at the core of who a parent is. Full disclosure – I don’t think this is easy (often it’s not), but I completely believe that if we walk in the door of every visit with the perspective that we are there to look for opportunities to build the caregiver’s awareness of her own actions and help her learn to interpret that impact, what we do and how we do it changes – for the better.

What Does This LOOK LIKE in Practice?

Here are some strategies I’ve learned from EI practitioners in recent conference sessions where we talked about this intervention:

Use open-ended questions to help the caregiver reflect and think about what she (or he) is doing and why. Ex: What did you notice…? What did you see Jack do when you…? Why do you think that happened? 
What did you do differently that time? What could you do differently next time to help Jack learn to…?

Look for moments to build awareness and interpretation. Keep your eyes and ears open for opportunities to point out those moments when the caregiver interacts with the child in ways that enhances development. Adult learners typically want to know if they are doing something “right” so reinforcing positive interactions helps caregivers know they are on the right track.

Provide specific feedback that points out what the caregiver did, what the child did, and the relationship between the two actions. Help the caregiver make the connection, then ask what she thinks about it. Ex: When you waited before helping Emma stand up, she reached up for the pack ‘n play bar to try to stand herself up. What did you think about that?

Use video recordings to build awareness and interpretation. Record the caregiver using a strategy with her child using her cell phone. Then, watch the video together and process it using reflection and feedback. Share what you notice and ask the caregiver about her observations and feelings. Problem-solve if the strategy or interaction can be tweaked to help the caregiver get closer to her goal for the child. You can also encourage the caregiver to record short videos between visits to watch together during the next visit. These videos can become joint plans and records of progress too, so their value (and the learning opportunity) expands beyond the reflection point that happens during your visit.

Now it’s your turn:

What strategies have you used to build caregivers’ awareness and ability to interpret their own actions? What did this look like on your last visit?

Share your ideas and examples in the comments below!

In Part 2, I’ll dig into the second intervention to explore how to help caregivers identify and use every day learning opportunities…and what to do when this is hard. In the meantime, pay attention to how you build awareness on your next visit. Use this series to help you celebrate when it goes well and problem-solve when you need help. Let’s learn together!

References:

Dunst, C. J., & Trivette, C. M. (2009). Using research evidence to inform and evaluate early childhood intervention practices. Topics in Early Childhood Special Education, 29(1), 40-52.

Mahoney, G. (2009). Relationship-focused intervention (RFI): Enhancing the role of parents in children’s developmental intervention. International Journal of Early Childhood Special Education, 1(1), 79-94.

Swanson, J., Raab, M., & Dunst, C. J. (2011). Strengthening family capacity to provide young children everyday natural learning opportunities. Journal of Early Childhood Research, 9(1), 66-80.

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Parenting Style is Similar to How One Would Purchase Eggs

As a parent and a professional who works with a lot of different families, I have noticed that there are two ways that Moms and Dads parent their child(ren) in this day and time. It appears that parenting style is similar to choosing eggs in the store: free range or caged. Personally, my style is caged. When it comes to parenting, and honestly all aspects of my life, I am organized, structured, detail-oriented and a borderline compulsive neat freak. Did I mention that I have two boys who are six and four years old?! Needless to say, caged parenting is often a challenge. I frequently find myself envious of free range parents, because they tend to be more “go with the flow” and be present in the moment and agile. One of my hardest obstacles to overcome, as a parent of a child with a disability, is the lack of control I have in his situation. After four years, I am starting to learn that my son has his own timeline when it comes to development and reaching milestones, and that’s okay. Free range parents may not feel the need to have complete control of a situation and have a nonchalant attitude towards their child meeting developmental milestones in a timely fashion. As service providers, we must learn to adapt to each parent’s environment and style. Let’s talk first about some do’s and don’ts for working with different types of parents.

Cock-A-Doodle-Doo’s and Don’ts

When my son started to receive services, I was slowly making a mental list of what I did and did not like to see from his providers. I have to admit, as I have been able to meet some great professionals in the field my expectations from providers continuously grows. I feel that we have an Olympic team working with us that share our same goals and outcomes for my son. Regardless of being a caged or free range parent, when a provider is completing the initial home visit, I am going to expect for that person to get on the same level as my son-literally. If we are both sitting on the floor playing, guess what, the floor is where you should sit as well. This is imperative if one is trying to establish a bond with the family. Don’t sit on the couch with your laptop shielding your face and start firing off a list of personal questions. To a parent this will come off like you are there to do your job, collect data, and that you do not have any interest in building a rapport with the child or parent. Don’t say things like, “I know what you mean,” “I get it,” “I completely understand.” This is a tactic for a professional to try to relate, but parents who have a child with a disability find this demeaning, frustrating and simply not true. Unless the person has a child with the exact same disability, and even then it is a bit of a stretch, you cannot compare your life to theirs. Instead you may want to say, “I cannot imagine what life is like for you, but I think that you are doing a fantabulous job”.

A free range parent may be more able to “brush things off” and not be as easily offended. They tend to be more reactive (rather than proactive) and may take longer to process, which is not bad. As we know, patience is a virtue and sometimes providers will have to give free range parents more time to respond, even with numerous communication attempts. The sooner the provider understands that you will not be a free range parent’s priority then the easier your working relationship will be. A caged parent, however, has a tendency to perseverate on words and recommendations. He/she tends to be more proactive and impulsive. When dealing with a caged parent, which can -at times- be intimidating, know that sometimes less is more. You do not need to always have an answer for everything and sometimes parents just want you to listen. Do find something to relate to with the parent, and it does not have to be centered around the child. Sports, movies, TV shows or food are all great conversation starters for parents to find a commonality. Do, if you feel comfortable, share some information about yourself. This will help lower the professional wall that is sometimes up.

Don’t Get Your Feathers in a Ruffle

Not everyone gets along, and that is okay! Confrontation is just a conversation; however, we seem to live in a society that avoids it. When I asked several of my free range and caged EI Mama friends about their experiences with their services, 8 out of 10 of them said that they had requested a new therapist or coordinator at one point. We should not view this as a bad thing. Sometimes personalities may not mesh well, and you know that you need to end the relationship sooner rather than later. What if the parent does not share the same educational or developmental philosophy as you?! Caged parents may constantly challenge your methods and thoughts and want you to see their point of view, whereas free range parents may not follow through with important outcomes, therapies or other administrative tasks. It is okay to take a step back and reevaluate. Being able to see a different viewpoint is imperative when working closely with families, so it is paramount to not take things too personally. Everyone is different, and that is what makes life beautiful.

Do remember that this is the parent’s child -their whole heart- first and foremost. Regardless of free range or caged, sometimes parents can be defensive, protective and unrealistic, but it is all coming from a good place of love for their child. And this is why it is important, as a provider, to keep an open mind and not pass judgement when working with families.

Either way the little chicken will cross the road, but how are you going to help them get to the other side?

Katie is the New Path Family Support Coordinator with the Arc of Virginia. She is native to the Richmond area. After receiving her Bachelor of Arts from Virginia Commonwealth University she pursued a career in marketing and sales. It wasn’t until she had her second son, in 2014, that her whole world changed. Unbeknownst to her husband and her, their son was born with a rare chromosomal abnormality. He is the only one in the world with his specific translocation. Although he does present with a developmental delay, he exudes happiness, love, and a tremendous amount of perseverance. In 2015 Katie began working closely with families to help facilitate the consumer directed portion of the Virginia Medicaid waivers. She understands the trials and tribulations of navigating the Medicaid system and this is why it became her personal goal to assist other families in their journey. After working closely with many new parents, Katie realized that her true passion was newborns to early childhood. She understands personally the whirlwind of emotions and the need for support when parents are first introduced to this new life. Email Katie at kwebb@thearcofva.org.

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