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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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

The post Logan is Not a Number! – Explaining the Child Outcomes Process appeared first on Early Intervention Strategies for Success.

Teaming and collaboration are what we DO, right? We use teaming practices everyday as we connect with other professional team members to support the family in achieving their goals for their child. We understand that we’ll do our best work when we collaborate with caregivers as equal team members, valuing their perspectives and priorities on every aspect of the EI process. We know this because we do it everyday, but it’s important to consider that families might not know how to participate on the EI team. They might not know how they fit in. When we explain the EI process, we need to make sure that our words reflect the importance of a collaborative approach so that all team members, including the family, know what to expect and what to do.

Embedding the DEC Recommended Practices in How We Explain EI

Let’s check in with the Division for Early Childhood (DEC) Recommended Practices (RPs) on Teaming and Collaboration to see how we can connect each practice to what we say:

TC1. Practitioners representing multiple disciplines and families work together as a team to plan and implement supports and services to meet the unique needs of each child and family.

When explaining how EI works, we can say: Early intervention uses a team approach, which means that each child has a team of people available to support his/her development. This team includes you (the parent), the service coordinator, and a service provider (like a speech therapist, developmental service provider, etc.). We are all equal partners and will work closely together to help you help your child meet the goals that are important to your family.

TC2. Practitioners and families work together as a team to systematically and regularly exchange expertise, knowledge, and information to build team capacity and jointly solve problems, plan, and implement interventions.

When explaining EI service delivery, we can say: We’ll all work together to share ideas and information and come up with intervention strategies you can use to encourage your child’s development everyday. During visits, your service provider will work alongside you as you practice using strategies with your child to help him/her learn to… We’ll problem-solve and plan together so that you feel comfortable using strategies between visits too. The purpose of the EI team is really to support you. 

TC3. Practitioners use communication and group facilitation strategies to enhance team functioning and interpersonal relationships with and among team members.

You can use this practice to explain how the IFSP meeting works: When we meet to develop the Individualized Family Service Plan (or IFSP), we’d like to hear from you about what you’d like your child to be able to do – your goals for your child. Then, we’ll have a conversation as a team about service options. You are a part of this decision-making process, so feel free to share your thoughts with the other team members about what you’d like to see, how often you’d like to have the provider visit, and where you’d like visits to happen.

TC4. Team members assist each other to discover and access community-based services and other informal and formal resources to meet family-identified child or family needs.

When explaining service coordination, we can say: Your service coordinator collaborates with everyone on the team to make sure that early intervention is meeting your child’s and family’s needs. Feel free to let us know if there is something you need or your child needs and we can work together to find resources that can help. 

TC5. Practitioners and families may collaborate with each other to identify one practitioner from the team who serves as the primary liaison between the family and other team members based on child and family priorities and needs.

If a child and family will receive more than service, one team member might be chosen to keep the rest of the team informed about child and family needs and progress. For example, let’s say that a child will receive physical therapy weekly, and developmental services monthly. You might explain it to the family this way: Since the PT will be meeting with you more frequently, he will let other team members know when your child makes progress (so we can all celebrate), when a new need or question pops up (so we can work together to address it), and when we need to meet to discuss changes to the plan. He can also make sure you are comfortable using intervention strategies suggested by the developmental specialist, and if there are questions, he can problem-solve with her to come up with alternatives that work better. You’re always welcome to call/text any other team member too. The PT will just make sure everyone is aware of how things are going. The service coordinator helps team members collaborate too.

When you explain these processes, you might use different wording, and that’s okay. Take a moment, though, and check in with yourself. Listen to yourself over the next week and make sure that what you say reflects these practices. Our words have power, so it’s important to make sure that when we explain what we do, we are helping all team members, including the family, understand the value of teaming and collaboration in early intervention.

How do you explain the EI team to families? To other service providers?

If you could make one important point about teaming and collaboration, what would it be?

To read more about how to implement other DEC Recommended Practices, be sure to check out the rest of this series by searching for “DEC Recommended Practices” using the search feature at the top of the page.

The post DEC Recommended Practices: Teaming and Collaboration appeared first on Early Intervention Strategies for Success.

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

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

DEC Recommended Practices: Family (continued)

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

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

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

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

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

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

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

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

F9. Practitioners help families know and understand their rights.

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

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

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

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

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

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

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

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

How have YOU implemented these practices today? 

To read more about how to implement other DEC Recommended Practices, be sure to check out the rest of this series by searching for “DEC Recommended Practices” using the search feature at the top of the page.

The post DEC Recommended Practices: Family (Part 2) appeared first on Early Intervention Strategies for Success.

Service coordinators, the early intervention (EI) team members who lead the transition process, often have questions about how to ensure that all of the required transition steps are followed and documented. Individualizing the process while accurately documenting the required steps is an important balance for service coordinators. There are a lot of details to attend to, but service coordinators should keep in mind that these requirements are there to ensure timely, supportive transition experiences for families. Documenting transition and managing requirements are also important for local and state compliance with federal regulations because, as service coordinators know, transition is closely monitored.

Like all parts of the IFSP, the transition pages in Section VII must be individualized and completely filled out to accurately document the process for each child and family. It is the service coordinator’s responsibility to keep the transition pages updated throughout the process. To help service coordinators ensure that they are accurately documenting transition, three brief tutorials are now available on the Transition page on the Virginia Early Intervention Professional Development Center site. Service coordinators are encouraged to watch these tutorials in the following order:

Transition: A Series of Family Decisions (run time 6:05)

During this first tutorial, transition is introduced as a process for all families of children enrolled in EI. The first two boxes in Section VII: Transition Planning (of Virginia’s IFSP) are explained. Guidance is provided about the information that is documented in these boxes and how this information helps the EI team determine timelines and plan for the child’s transition.

Transition: Developing the Plan and Documenting the Steps (run time 13:16)

This second tutorial begins by stating that the federal law, Part C of the Individuals with Disabilities Education Act (2004), requires that transition planning occur on the IFSP for all children receiving Part C EI services. This planning must begin at least 90 days and up to 9 months before the child will transition out of the program. Requirements for the IFSP meeting and documentation related to transition planning are discussed, including how to complete the Parental Prior Notice form (PDF, New Window). The six “Transition Steps/Activities” in Section VII are also reviewed in depth so that service coordinators understand how to document transition planning on the IFSP.

Transition in Action: Scenarios (run time 10:08)

The final tutorial is designed to help service coordinators put into practice what was discussed in the other tutorials. Three scenarios are discussed and documented on each child’s transition plan in the IFSP. The scenarios demonstrate how to document transition for: 1) a child who’s family is interested in transition options including early childhood special education (ECSE) and another community preschool; 2) a child who’s family is not interested in ECSE and wants the child to continue in her current day care setting; and 3) a child who is no longer showing any developmental delays by age three and needs no further services.

If you have questions about how to complete the transition planning section of the IFSP, be sure to watch these three tutorials. You can also review Chapter 7 in the Infant & Toddler Connection of VA Practice Manual for instructions on completing the IFSP and Chapter 8 for guidance about transition. If you continue to have questions, remember that your Supervisor, Local System Manager, and your Technical Assistance and Monitoring Consultants at the state office are available to assist.

What feedback do you have about these new transition resources? 

How could you use/share them with your staff and colleagues?

The post Got Questions about Transition and the IFSP? – There’s a Tutorial for That! appeared first on Early Intervention Strategies for Success.

As the idea of conducting functional assessment takes root here in Virginia, there have been some worries about what it means. Does it mean that we won’t do our more traditional assessment anymore? How will we determine a child’s age-equivalency? How will we get all of the information we need? Who will do the functional assessment? When will we do it? How will we find the time to do both???

Some level of anxiety is very normal as a new process is introduced and we strive to figure out how it fits into what we already do. An important thing to remember is that functional assessment actually fits beautifully with the principles and best practices of early intervention. Think about it this way…we’ve always known that viewing a child’s development from a functional point of view is best practice. We’ve always known that traditional assessment provides us with just a snapshot of what a child can and cannot do. We’ve also always known that the results of a traditional assessment, while they may help us confirm eligibility, don’t otherwise mean much unless they are translated into what they mean for a child’s interactions and participation in activities that are relevant to everyday life. These are things we can agree on. The difference now is, our state (and many others) is looking to ensure that we always have a functional perspective and use it with each child to ensure that early intervention truly is individualized and appropriate.

Authentic Assessment

Just this morning, I read a great article entitled “Authentic Assessment – What’s It All About?” Sometimes the terms “authentic” is used to describe the type of assessment we are working towards – authentic meaning that we consider development in the context of the child’s experiences in naturally occurring activities and routines. The authors of this article made a powerful point – that we don’t have to use one type of assessment over another, that we don’t have to worry that this is an either/or discussion. Instead, they suggest that this can be a both/and decision. There is a place for traditional assessment, especially in the early intervention context. Learning about a child’s development, as it compares to other children, is useful in helping us confirm eligibility (like when it can’t be determined from medical records). It helps us figure out why an infant or toddler is struggling when we find gaps in skills or atypical developmental patterns. We can then use that information to focus on how these differences impact the child’s everyday experiences and interactions – the functional assessment piece. Knowing about the child’s developmental status in combination with an understanding of how the child participates in daily routines like bath time, meals, playtime with others, and going out in the community will lead to better IFSP outcomes, more individualized EI services, and hopefully intervention that improves child and family quality of life. That’s what EI is really all about. Yes, we still have to figure out the answers to some of the above questions, and I’ll be exploring them in future blog posts, but the good news is that we are going to do that together.

How do you feel about combining traditional and functional assessment? What do you think it’ll look like in your system?

What questions do you have about implementing functional assessment? 

If you are already using it (and many of you are), share what it looks like and how you’ve woven it in to your assessment and intervention processes.

Share your thoughts by leaving a comment below!

Check out a few other great resources from the ECTA Center and DEC to learn more:

Authentic Child Assessment (practice guidelines) (PDF, New Window)

Authentic Child Assessment Practices Checklist

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

Concerns and Priorities – What’s the Difference?

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

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

Why It Matters

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

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

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

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

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

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

Share your comments below!

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

Marco was recently referred to early intervention (EI) due to suspected global delays. His family is living in a homeless shelter and only has one more week left before they must leave. His father is trying hard to find employment but is challenged by his lack of childcare. He is the sole caregiver for three children under the age of four.

Nellie was discharged from the hospital three days ago following a very lengthy stay of 16 months. She is a preemie with many medical complications. Weight gain has been a challenge for her and will need to be closely monitored now that she is home. Her family is eager to get EI in place to assist with Nellie’s feeding skills and encourage her overall development.

For both Marco and Nellie, time is of the essence. Both families are newly referred to EI, and both would benefit from immediate support. But wait…the assessment calendar is full and it might take the whole 45 days allowed for the timeline to assess these children and develop their IFSPs. Can they wait that long??

The Interim IFSP

Both situations are examples of when writing an interim IFSP would be very appropriate. Interim IFSPs aren’t written very often. They can be viewed as sort of an emergency measure for eligible children who need supports and services to begin immediately. In Marco’s case, his family could benefit from service coordination to help them find housing immediately. A service coordinator may also be able to link Marco’s father locate child care options so that he is able to find employment. Because of Nellie’s extensive medical history and current feeding needs, initiating services for her is of utmost importance. Both families are in need of support, Both children are eligible for EI – Marco, based on his developmental delays and Nellie, based on her extended NICU stay, prematurity, and delays. Fortunately for them, you don’t have to wait until the assessment calendar is open to get the ball rolling.

Requirements for the Interim IFSP

An interim IFSP is a relatively simple document. Only four pieces of information are required: the name of the child, the name of the service coordinator, the service the child will receive, and the parent’s signature. The corresponding pages of the IFSP form can be used for the interim IFSP, with the words “Interim IFSP” written at the top of the first page. With the interim IFSP in place, services can begin immediately. It’s extremely important to remember that having an interim IFSP in place does NOT extend the 45-day timeline. A full IFSP must still be in place within 45 calendar days after the date of referral.

Using an Interim IFSP

Let’s check in on both situations to see how developing an interim IFSP helped:

Marco – Once Marco was found eligible, an interim IFSP was developed with Marco’s father to initiate more intensive service coordination to assist the family. The service coordinator completed other required documentation with Marco (such as procedural safeguards and release of information forms so she could speak with the social worker at the homeless shelter), and began the process of arranging the assessment for service planning and IFSP meeting. Marco’s father and the service coordinator worked together closely, talking almost everyday. The service coordinator helped obtain a one month extension with the homeless shelter. Within two weeks, though, Marco’s father had accessed several programs through his local Department of Social Services for rent assistance and a subsidy for child care so that he could look for employment.

Nellie – Following the intake, Nellie was found eligible for EI based on a review of her medical records. An interim IFSP was written and physical therapy began three days later. The physical therapist was able to assist Nellie’s parents and her nurse in determining positioning options for safe feeding. A speech-language pathologist also began seeing Nellie and worked closely with her family and nurse to monitor her caloric intake and begin working on oral motor exercises to help Nellie learn oral feeding. Nellie’s assessment for service planning was held about a month later and a full IFSP was developed. The PT and SLP continued to support Nellie’s family, and were happy to report at the assessment that Nellie was gaining weight and holding her head in midline better during feeding times.

The interim IFSP allowed both families to receive immediate support that helped to stabilize their challenging situations. While this type of IFSP is not used very often, it can be an important tool that allows eligible children and their families to receive the support they need right away.

Have you written an interim IFSP before? How did you know that it was the right thing to do? 

Share you experiences using an interim IFSP in the chat below. Be sure to protect family confidentiality if you share a specific experience. 🙂

The post Writing an Interim IFSP appeared first on Early Intervention Strategies for Success.

Have you been sitting in an IFSP meeting and heard another team member say “Wait…isn’t that outcome too specific?” or “If we put one specific routine in there, does that mean that’s the only way we work on this outcome?”

If these questions sound familiar, then read on (or watch the video blog on this topic) because by the end of this post, I hope you’ll have an ah-ha moment and gain a tip you can share with your reluctant colleagues!

The Answer: No! Being Specific is Important!

When early interventionists are learning to write more specific, measurable, individualized IFSP outcomes, this is a common worry – that making the outcome TOO specific and individualized limits the scope of service delivery. This is not true and here’s why: Including a specific routine in the body of an outcome only provides you with the context in which that outcome will be measured.  Read that again. 🙂

Consider the following outcome:

Elise will use ten two-word phrases to request or label her favorite things to do (e.g., down slide, my ball, sand box) while playing in the backyard with her cousin  three afternoons a week for two weeks.

This outcome is very specific. It is individualized to include a favorite and frequent activity that Elise enjoys. It is measurable in that, when Elise is consistently using two-word phrases during backyard play (“consistently” is defined as using 10 phrases during three afternoons a week for two weeks), we can assume that she is using two-word phrases during other activities as well. Inserting the context of having Elise use phrases during backyard play only provides the IFSP team, including the family, with a meaningful way to measure progress. It does not mean that early intervention services should only be provided in the backyard, nor that intervention strategies should only be practiced in the backyard. Rather, services should be provided to support Elise’s caregiver in using intervention strategies across a variety of routines. When Elise is talking with her cousin in this one familiar routine, though, we can feel confident that she has accomplished the “big picture” outcome of expanding her vocabulary and combining words to get her wants and needs met. This last phrase, “get her wants and needs met” might look familiar…

Let’s compare Elise’s outcome with one that is quite common on IFSPs:

Elise will use two word phrases to get her wants and needs met during daily routines.

Sure, I suppose you could say that these outcomes are very similar. They both sort of reflect the big picture. What this outcome is missing, though, is important. This outcome is not measurable. How it will be measured is so nebulous that each IFSP team member could assume something different. Will Elise meet the outcome when she can use two phrases? What will she talk about? If she’s using a phrase or two once or twice a day, is that good enough to say that she’s achieved the outcome? Based on how this outcome is written, we have no idea.

Which Outcome Looks Familiar to You?

Take a moment and reflect on the outcomes your team wrote during your most recent IFSP meeting. Which outcome is closer? How might you help your team understand the importance of writing outcomes that are truly individualized, routines-based, and measurable? Sharing this post might be a first step!

Are you wrestling with the dilemma mentioned in the title of this post?

What have you done to help your team members write better outcomes?

Share your insights in the comments below! And don’t forget to check out our new Video Blogs page too and let us know what you think!

The post Wait…Isn’t that Outcome TOO Specific? appeared first on Early Intervention Strategies for Success.

If someone had asked me this question when my son was a toddler, it would have instantly made me smile. Just thinking about his belly laugh, the way his eyes twinkled, made me feel good inside and conjured up fun times. I could have listed many things because we laughed a lot. Whenever we played with a soft cloth ball, he would cackle whenever he missed catching it and it bonked him in the forehead. He laughed when he was ticked, whenever he saw a dog run by, and when he heard a raspberry sound. Just with this simple question, anyone who asked could have learned a lot about us…that we liked to laugh, we played together, we weren’t afraid to be silly, that my husband was an important caregiver, and that my son was motivated by balls, funny noises, tickling and animals.

Simple Questions Can Yield Great Information

Using simple questions like these can be very effective in helping you get to know the a new family or child care provider. You can find out about the parent-child relationship and the parent’s perceptions of the child. The answers can also help you find a direction for intervention. Maybe most importantly, a question like this can help make a timid parent feel more comfortable by inviting her to talk about something she knows a great deal about.

What To Do with What You Know

Now think about how you, as an early interventionist, could use the simple information I described about my son. You know that he tries to catch a ball when thrown to him but misses. He engages with others, hears well enough to hear the raspberry, can visually follow or at least notice the movement of an animal, isn’t overwhelmed with the sensation of tickling, and may be beginning to understand early turn-taking. What you now know could be used when completing the IFSP, specifically related to our daily routines and activities, functional info for the assessment, and context for outcomes. You also have knowledge you can access during intervention visits to engage my son and me, and more importantly, to help me engage him in ways that help us address our goals.. Lots of info in a simple question, huh?

…But What If the Answer Doesn’t Come?

On the other hand, what if I had replied “I don’t know.” or “Well, he really never laughs.” These answers also telling. When a parent doesn’t know what makes her child happy, that should give you pause.

You might wonder: Is the mother the child’s primary caregiver? Who else is involved in the child’s care and how does he react with them? Do the mother and child have a healthy attachment? What does the child’s “laugh” look like (because maybe you and the mother are thinking about different behaviors)? Some children produce a belly laugh from the first giggle, others laugh with a quiet smirk, and still others laugh silently with their eyes, especially if the child has neurological or muscle tone concerns.

If the parent says the child never laughs, you might wonder: How does he show emotion? What are possible reasons for why he doesn’t laugh? Answers like these also spawn additional questions that inform the next steps in the EI process. I’ve met children who have troubled attachments, who have undiscovered visual impairments, who have muscle tone issues in the face, or who struggle with engaging and responding to others – all who appeared to never really laugh. It might be easy to stop digging when you get answers like these, but in fact, digging deeper is really the key.

Sometimes these simple questions can open doors, like when parents struggle to share information or know what to say.  When a simple question or its answer makes you pause, then there’s information to be gleaned there too.

What simple questions do you ask to help you learn about families and their children?

What are your “go-to” questions to get the conversation started?

For more ideas for simple and effective questions, visit the IFSP & Outcome Development page on the Virginia Early Intervention Professional Development Center site. Scroll down and look for the “Good Questions” series of handouts and the “Tell Us About Your Child” handout (PDF, New Window).

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