We are nearing the end of our discussion on the levels of awareness of parents of young children with disabilities. We have explored the ostrich phase – a time when a parent has a lack of awareness about disabilities and may not recognize the characteristics of a disability displayed by their child. Additionally, we have examined the phase of special designation – the stage at which parents have, through some transformational experience, recognized that their child indeed has a disability, and will require some additional assistance form a service provider to maximize their personal potential.

Third Level of Awareness: Normalization

Today, we are going to explore and discuss a parent’s third level of awareness – Normalization. As the extremely proud mother of a pre-teen on the autism spectrum, who amazes me daily, I think of normalization as the “Hope Phase.” In this third phase of awareness, the parents minimize differences between their child and his or her typically developing classmates and siblings. They emphasize the need for normalization in their child’s life so that it begins to look like that of other children their age.

At first glance, the normalization phase may look like a step backward, given the fact that the parent fought for special services and accommodation during the previous stage, special designation. However, this attempt to “normalize” the child is simply a part of the process.

Imagine this.

A family is blessed with a child with disabilities. Then, the parents must face all that they don’t understand about their child’s disability and how to raise and care for a child with additional needs. Then, the parents must accept and recognize they need help in providing their child all that he needs to maximize his personal potential. Finally, they realize that having a child with a disability is not a short-term episode. Instead, this is their life, their new normal.

That’s a lot to process.

How does one begin to merge the values, beliefs, hopes and dreams of their family’s “old normal” with their family’s “new normal” of loving, raising, and caring for a child with disabilities?

Trust me. It takes a lot of faith and hope.

Faith and hope that one day your family will again achieve homeostasis and some semblance of smooth sailing or normalcy.

A Parent’s Theory of Hope

After living in the triage and fight modes indicative of the ostrich phase and special designation, things are beginning to calm down during the normalization phase. The parent is beginning to find her rhythm. She is beginning to visualize her version of the future for her child. She is beginning to think, “My child and our family just might be okay.” Therefore, in her mind hope develops – hope for her child and hope for her child’s future.

Now, she must have the faith to test her theory of hope.

The clearest example of this stage of hope was detailed to me during a discussion with service providers at one of my workshops in Atlanta, GA.

The preschool team and parents had worked together with a four-year-old who required some assistance to walk. The preschooler got a walker and had confidently learned how to maneuver about the school with her walker. However, for preschool graduation, her mom was adamant that her child was not to use the walker to walk across the stage. Instead, she wanted her daughter to walk across the stage with the assistance of a teacher.

The preschool team pushed back.

But the mom didn’t budge.

The preschool team saw this as denial.

But this was actually normalization.

One the greatest motivators of parents of young children with disabilities is hope. In that moment, that mother may have needed to see her child walk across the preschool stage with assistance, but without the walker, to envision her child walking across the stage for graduation from high school or college. Regardless of if you see the goal or hope as unrealistic, don’t squelch hope. That hope will power a parent forward long after your time with that family has expired.

How Can You Help?

If parents don’t have the faith to test hope, how can we expect them to keep working with their child to assist their child in maximizing his or her personal potential?

If parents don’t believe gaps can be minimized, what is there to motivate a parent to continue to advocate for inclusion and opportunities for his or her child with disabilities?

During the normalization phase, parents are strengthening their advocacy and cheerleading voices for their child and their families. You can help with this. How? Simply give a parent a small win that will offer huge motivation. If, as a team, you try it and it doesn’t work yet, at least you have shown the parents that you listened to their hopes for the child and you support and encourage the family and their goals for the child’s future.

I cannot say it enough. Hope is the single greatest motivator for a parent’s continued work with his or her child with disabilities. Hope gets us up in the morning. Hope propels us to try new things with our children. While “normalization” is the word that is used, my interpretation of this phase is the onset of hope for quality of life and well-being for my child with disabilities in a world where he is in a marginalized population. And because of my faith to test my hope, my child AMAZES me daily!

Have you ever encountered parents who had, what you would consider, unrealistic developmental goals for their child with disabilities?

Given the new information you have about the normalization phase, how would give that parent reliable information about the characteristics of the child’s disability while nurturing parental hope?

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

Be sure to read the other posts in this series:

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

Levels of Awareness: The Ostrich Phase

Special Designation: The Parent’s Aha Moment

Self-Actualization: Hello, I am the Parent of a Child with Disabilities

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

The post Normalization – The Hope Phase appeared first on Early Intervention Strategies for Success.

In our previous discussion about the levels of awareness for parents of young children with disabilities, we explored the ostrich phase – a time when a parent has a lack of awareness about disabilities and may not recognize the characteristics of a disability displayed by their child.

Today, we are going to explore and discuss a parent’s second level of awareness – Special Designation. As a parent of a child with disabilities, I like to think of Special Designation as the “Aha Phase.” In this second stage of awareness, parents have, through some transformational experience, recognized that their child indeed has a disability and will require additional assistance from a service provider to maximize his or her personal potential. This transformational experience may come in the form of a quiet realization. Or, a question is asked by a teacher, trusted friend, or family member, such as, “Johnny isn’t talking yet. What do you think about that?”

During this phase, the parent may begin seeking guidance from service providers. “Sally is not walking yet and she is almost two. Her sister started walking before she was one. I’m worried. What should I do?” The parent’s rationale during Special Designation is if there is a “problem” with my child’s development, then surely there are professionals who can fix this problem. At this time in the parent’s journey, the parent is looking for support from a more knowledgeable other in the area of disabilities.

That more knowledgeable other is you.

My Experience in Special Designation

Let me share with you my own experience in Special Designation as a new parent of a child with disabilities.

In 2008, I found myself home alone with my 17-month son. My husband was deployed to Iraq and I busied myself caring for our son in his absence. Early during the deployment, I had experienced what would be my third and final miscarriage. After the miscarriage, I chose to stay home with my baby and try to process the sorrow I was feeling. Therefore, I didn’t engage with friends and neighbors for playdates and outings. My son and I had always been extremely social. Since he was four weeks old, we attended Parent and Me classes, enjoyed daily outings with friends, and went on weekend excursions with Dad. Language was all around us. People were always talking. I was always talking. I was always narrating for him. So, in my mind, he was talking, too. We had an intuitive language, Therefore, without realizing it, I compensated for the words my son never spoke.

However, with the absence of people and talking around us, I began to notice something that I had not fully acknowledged before. My son wasn’t talking. If I wasn’t talking, there was complete silence. There was absolutely no conversation in the house. None at all. I talked, and my baby listened, at least I thought he was listening. But I knew for certain, he wasn’t making any attempts to speak to me. This was my single greatest “Aha” moment as a parent of child with disabilities and the catalyst for action.

Unsure of what to do or how I felt about my son’s lack of language, I made an appointment with my son’s pediatrician. When I took him to the doctor, I said, “My son’s not speaking. He has a couple of words that he says, like ‘hi,’ ‘bye,’ and ‘touchdown,’ but he’s not making any attempts to communicate with me.” The pediatrician examined my son—healthy eyes, ears, and heart. The pediatrician then said to me, “Children develop at different rates. Just keep doing what you’re doing, mom—you’re doing a great job.” Then he gave us a sticker.

I was devastated. Do you know how much strength it took for me to make that appointment, ask for help, and say out loud to someone that I think there is something going on with my child that I don’t know how to fix?

A lot.

Fortunately, I had the skill set and agency to advocate for my son and his needs immediately and I didn’t stop until I found service providers who could best support my child and his needs.

What You Can Do

However, parents come to service providers from different pathways. It is essential as service providers take the time to listen to parents so that every parent has the opportunity to share the details of their concerns. And while a disability cannot be “fixed”, you can assure parents that you are here to walk with them through this journey and together you, with the family’s input, will figure out a way forward.

Special Designation is a step forward as the parent is actively looking for help. Consequently, this phase requires patience and a listening ear from service providers as the parent processes the realization that their most precious child has a disability. Special Designation is a turning point that parents reach before the family begins to establish their “new normal” as a family of a child with disabilities.

As an early interventionist, you are in an opportune position to work with parents during the Special Designation phase as you empower and equip parents with useful skills and strategies that will enable them to best assist the continued development of their young child with disabilities.

Have you ever encountered a parent who had the expectation for you to “fix” their child?

Given the new knowledge you have about Special Designation, how would you respond to that parent now?

Be sure to read the other posts in this series:

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

Levels of Awareness: The Ostrich Phase

Normalization – The Hope Phase

Self-Actualization: Hello, I am the Parent of a Child with Disabilities

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

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

The post Special Designation: A Parent’s Aha Moment appeared first on Early Intervention Strategies for Success.

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

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

5 Strategies for Responding to Discomfort

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

Here are 5 responsive strategies to help you manage discomfort:

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

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

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

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

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

How Much Discomfort is Okay?

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

What do you do when a parent seems uncomfortable? 

Share your experiences and strategies in the comments below!

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

As an early interventionist, you are in a help giving profession and you want to ensure that you are offering families help that is relevant to the family’s needs. You can achieve that goal by meeting parents where they are when you first engage with them and build from there.

A large component of meeting parents where they are is being able to identify and understand what you are seeing when you engage with the parent. When you work with parents of young children with disabilities, you are operating in a very intimate space in a family’s life.

You have been granted the privilege to witness some very raw and real emotions. As early interventionists, you spend time with parents who are processing and adapting to life during and after the traumatic parental experience of discovering their child requires additional assistance to maximize their personal potential. Most seasoned early intervention professionals are skilled at identifying these emotions, which are often tied to a process known as the stages of grief. However, the emotions that you witness during a parent’s evolution through this emotional development walk hand in hand with a parent’s progression of knowledge and understanding of characteristics of their child’s disability and the support needed to assist their child’s development. This process of knowing is identified as a parent’s levels of awareness.

Levels of Awareness

Parents of children with disabilities have four levels of awareness (Ulrich & Bauer,2003):

1. The Ostrich Phase
2. Special Designation
3. Normalization
4. Self-actualization

In this post, we are going to discuss the first level of awareness, The Ostrich Phase.

What do ostriches do?

Stick their heads in the sand, unaware of the surroundings.

The first level of awareness is actually a lack of awareness. Parents, who spend time in The Ostrich Phase, typically had very little experience with disability when they were growing up and may have little or no information about disabilities as an adult.

Remember, as the professional, you have the content knowledge. You have a pretty solid idea of what you are looking at, regarding development characteristics. However, parents may not initially have the information or awareness that allows them to identify characteristics in their child that seem very apparent to you. Some parents are completely unaware of the characteristics of disabilities in young children. They have been gifted with this precious child and they really don’t know what they are looking at just yet.

It is common for professionals to identify this level of awareness as denial, as it is at times paired with comments such as the following:

“My mother in law said my husband didn’t speak until he was five years old, and he’s fine now. He’s a doctor. She’s a slow starter like her dad.”

“He plays well with his brothers. He’s just hasn’t warmed up to preschool yet.”

“He’s just super active. So, he may not be stimulated by the activities offered at the preschool. I think he’s bored and acting out.”

“It’s a phase. We are just going to give her time to grow out of it.”

“Are you implying that there is something wrong with my kid? He’s just fine.”

While it may appear that parents are denying “the truth” or evidence and characteristics that seem apparent to you, they are simply operating on a level of awareness that has not exposed them to the information that you have. During The Ostrich Phase, parents are not yet able to see their child through the lens that your content knowledge enables you to see the developmental characteristics of their child. Therefore, the parent’s truth is based on the information they have. Consequently, the parent may truly believe “everything is just fine.”

So, sometimes it isn’t denial you are witnessing, but simply the evidence of things unknown – a lack of awareness.

Be Patient…It’s the Process

You may get a little push back during this phase, if you bring a parent information about the child that he or she had not yet considered.

Be prepared.
It’s not you.
It’s not the parent.
It’s the process.

Be patient with your families, as parents of young children with disabilities are developing in preparation for a lifelong journey of parenting their precious child. You have the honor of assisting them in this most sacred space.

Is there a time in your practice that you believe you may have mistook The Ostrich Phase for denial?

If so, considering your new knowledge, how would you engage differently during a similar encounter with a family now?

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

Be sure to read the other posts in this series:

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

Special Designation: The Parent’s Aha Moment

Normalization – The Hope Phase

Self-Actualization: Hello, I am the Parent of a Child with Disabilities

Reference:
Ulrich, M. E., & Bauer, A. M. (2003). Levels of awareness: A closer look at communication
between parents and professionals. Teaching Exceptional Children, 35(6), 20-24. Retrieved from https://search-proquest- com.mutex.gmu.edu/docview/201180599?accountid=14541

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

The post Levels of Awareness: The Ostrich Phase appeared first on Early Intervention Strategies for Success.

While working through the emotions that come with parenting a child with disabilities, there was also a steep learning curve. A journey of awareness that I had to go through in preparation to parent my child. As the mother of a child with disabilities, my journey has included emotions that many professionals would easily recognize as elements in the stages of grief. However, while navigating that spectrum of emotions, I also experienced a continuum of awareness as I gained knowledge about my child and how the disability manifested itself in my child for a lifetime.

My journey of awareness included teaching, nurturing, and advocating for my son. In later years, with additional research, I learned that this process of awareness that I experienced was not an experience that was specific to me. It was a process that emerging parents of children with disabilities experience at the onset of their parenting journey. This process is referred to as a parent’s levels of awareness.

Making Plans for the New Baby

When a family discovers a new baby is on the way, it can be the happiest of times. So much hope, so many dreams for the future of this new life. A baby, while still in the womb, becomes very real to the parents.

They begin to make plans for their child. Not just plans for the immediate future, but visions of long term endeavors dance through the minds of parents. They choose a name, then decide the type of person their child will be. They dream about what sport or extracurricular activity the child will participate in…how many friends the child will have…who the child will take to the prom…what college the child will attend…what profession the child will select. Some parents even dream of when their child will be old enough to have a family of his own, so the parents can enjoy being retired and grandparents.

That’s a lot of promise placed on an unborn child. But we, as parents, do it every day. We cast our hope and dreams of the future on very small children. The vision of these hopes and dreams are very real to us.

Discovering the Child’s Disability

Now fast forward three years later and the same parents, who held these very real hopes and dreams for their child in their hearts, find out that their little one is going to need special support, support for needs that will alter the parents’ original vision. This occurrence can throw even the most prepared parent for a loop. Discovering your child has a disability is a parental trauma.

Even for veteran parents, parenting a first child with a disability is a completely new experience. Additionally, if a parent has limited or no prior experience with disabilities, parenting a child with disabilities is unchartered territory with a steep learning curve. However, with support, parents can develop patterns of positive adaptation that will aid in the process of confidently parenting a child with disabilities.

Understanding the Parent’s Journey

That’s where you as early interventionists, come in. You can best assist the families you serve by understanding that this journey of parent understanding and skill building takes time.

In the coming weeks, we will discuss and explore the levels of awareness that emerging parents of children with disabilities experience, as they develop their parenting self-efficacy. This knowledge will help you, as service providers, better understand the process that the parents you serve experience at the beginning of their parenting journey.

Sometimes, early interventionists want parents to hurry up and see the world and their child the way that the interventionist does. I understand. I was guilty of trying to rush my spouse through this process. However, appreciating each stage in a parent’s levels of awareness will illuminate your ability to trust the process – not rush the process.

Remember a parent’s journey of parenting their child with disabilities spans a lifetime. Just like the children you serve, parents, too, take time to develop.

How do you view the role you play in assisting with the development of emerging parents of young children with disabilities?

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

Be sure to read the other posts in this series:

Levels of Awareness: The Ostrich Phase

Special Designation: The Parent’s Aha Moment

Normalization – The Hope Phase

Self-Actualization: Hello, I am the Parent of a Child with Disabilities

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

The post Emerging Parenthood: Trust the Process – Don’t Rush the Process appeared first on Early Intervention Strategies for Success.

Are you Service Provider A or Service Provider B?

Service Provider A always brings a bag of toys to each visit because this allows her to plan ahead. Having a toy bag ensures that she has the materials that she knows will work, which is great because many children she sees don’t have many toys. The children like the toys too and pay attention better when she brings new things into the home.

Service Provider B used to bring toys, but now does what he calls “bagless therapy”. Rather than bringing toys into the home, he focuses his time with the family on helping them figure out how to use what they already have to encourage the child’s development. Provider B’s visits don’t revolve around toy play; instead he joins the parent and child in different daily routines which may or may not involve toys. He often teaches playfulness during these routines, and helps the parent practice using intervention strategies to motivate the child. The visits are less predictable than when he used to bring toys, but he finds that his intervention is more individualized now.

Which Provider are You?

Take a moment and reflect – which provider are you? Sometimes the line is not so clear cut. You might not bring a toy bag but you still bring a bottle of bubbles. Or maybe you do “bagless therapy” but you still primarily focus on playing with the child’s toys. These fuzzy lines are common because we have developed habits for how we work, we have to adapt to different environments, and frankly, it’s not always easy to purely practice as Service Provider A or B. Despite the difficulties with a black and white perspective, it’s important to step back and reflect on our practices. Are we truly using the practices that reflect the evidence-base for our field? Are the practices we use fully supporting the parent’s confidence and competence…or are we taking toys out to the home so that we feel secure and in control of the visit?

A Team Challenge

Another challenge to consider is this: What if you’re like Service Provider B but your other team members are more like Provider A? This can be extremely hard because one family can be receiving intervention from providers who use practices that look very different. And let’s be honest – a parent could very well prefer the toy bag version because her child enjoys it and she can step away to take a break while Provider A entertains her child. While this may be fun for the child and a relief for the parent, our evidence-base no longer supports this type of intervention as the best way to build the parent’s capacity to promote the child’s development. When some providers bring materials to the home and others don’t, or when some providers provide child-centered intervention as opposed to family-centered, routines-based intervention, the messages can be confusing for families. We are all on the same team, and when we provide services that follow a similar, evidence-based approach, everyone benefits.

When it’s all said and done, we all have a responsibility to provide intervention that’s grounded in our field’s best, evidence-based practices, and our literature supports routines-based intervention that focuses on supporting parent-child interaction. We get the best “bang for our buck” when we work with children and their caregivers in ways that prepare them for how to use intervention strategies throughout the week, when we aren’t there. Spending our time primarily playing with the child only helps the parent so much, and focusing only on toy play may help even less because toy play itself is probably a relatively small part of most families daily lives.

Strategies for Making It Easier

So what do you do? How do you evolve your practices from those of Service Provider A to B? Here are a few tips to consider:

Reflect on the toy bag as your security blanket – We are in control of a visit with a toy bag; we have to relinquish some control without it. But, when we do that, we are free. We are open to following the family’s lead and using our skills in more flexible, individualized ways. We also see that the family owns intervention and the child’s progress, and that’s what it’s all about.

Wean yourself one toy at a time – Maybe you can’t go cold turkey, and maybe you shouldn’t. Take one less toy to each visit to help wean yourself and the family from this approach. Replace the focus on toy play with a more broad focus to include and explore other routines as well.

Prepare families for bagless therapy – Either start this new approach with new families, or explain to current families that you want to support them in routines other than toy play. Spend a visit or two finding out what else they do with their child…then plan to join that.

Talk with the family at the first visit about why you don’t bring toys – This is especially important if you don’t but your colleagues still do. Help the family understand why you work this way because otherwise, they won’t know.

Talk to your leadership – If you struggle with working on teams with both types of Service Providers, talk to your supervisor. Maybe additional training could be offered to the entire team. Maybe you could shadow your colleagues and they could shadow you on visits, then you could share feedback about similarities and differences in your approaches. Stir up some communication about this topic, because it’s often an elephant in the room.

Whichever type of Provider you identified more with, I hope you’ll take the time to reflect on your practices. You’re probably doing great work, but we can always do just a little bit better. Remember to keep the focus on what the parent can do with the child when you are not in the home. When you do, it’s so much easier to leave the toys at the office and work as a true team.

Which provider did you identify with?

How do you manage the challenges of working on teams with a mix of these types of provider practices? 

Share you thoughts in the comments below.

The post But Everyone Else Still Brings Toys… appeared first on Early Intervention Strategies for Success.

You’re back at work and facing a daunting task…making up all the visits missed on the previous two snow days. Three of your families live on small back roads that probably won’t see a plow for days. Two others love the snow so you can expect that they’ll want to you to come ready to build a snowman. You also have an assessment to make up, which means you need to touch base with the other team members to coordinate schedules, but they work for a private agency that isn’t back in the office yet. Sigh…lots to manage, all because of the weather.

Tips for EI Visits after a Snow Storm

Many of you here in Virginia are in the midst of digging out from under an impressive snow storm. For some of you, this is the most snow you’ve seen in years (almost 3 feet in more northern parts of the state!). For others, snow is just a part of life this time of year so this snow storm is no big deal. I’m lucky – where I live in Virginia rarely sees any substantial snow, which is fine by me. When snow falls, it can really disrupt life as an early interventionist. It can mean missed days at work, make up visits, and dangerous drives to intervention visits. How do you manage when recovering from weather like this? Here are a few tips to keep in mind as you carry on!

Clean ALL of the snow off of your car before you leave, including the hood. This also keeps others on the road safe. Don’t think ice flying off of cars is a danger? Watch the first 6 seconds of this video: Ice Sheet Destroys Windshield

Keep a bag of kitty liter in your car. You can use it for traction if your tires get stuck in a snowy driveway. Another great idea: you can also use your car’s floor mats for traction too. (Thanks to Stacie at the ITC of Staunton-Waynesboro for this one!)

Call each family before heading out the door. Make sure their road is plowed, there is somewhere for you to park, and that they still want the visit.

Offer the family a make up visit if you have to cancel. According to the I&TCVA Practice Manual (PDF, New Window), “sessions cancelled by the provider (including those cancelled due to severe weather) and sessions that fall on holidays must be made up, unless the family states that they do not wish to make up the missed session.” Be sure to offer the family the option to make up a visit. If they decline, document their preference in the record. Remember that visits can be made up either by scheduling an extra visit or by adding time to another visit. For example, you can add 15 min to the next three visits to make up the 45-min visit that was missed, if this is okay with the family.

Don’t insist on driving to visits if your agency says you’re grounded. Some agencies follow school schedules, so if the schools are closed, there will be no home visiting. Others make the decision for their own staff based on road conditions and other safety factors. Follow the advice of your supervisor. If you go out and something happens – like you get stuck or worse, get in an accident – your agency may not be willing or able to provide assistance.

Get out and play in the snow! Dress appropriately so that if you do make a visit, you’re prepared to take advantage of the natural learning opportunities for the child that are presented out in the snow. Join the family outside, build a snowman, make a snow angel. Enjoy the fun because it’ll be melted before you know it!

What are your best tips for managing early intervention visits in the snow?

Share your ideas below!

For more info, visit:

Guidance for making up visits: I&TCVA Practice Manual: Chapter 8 – IFSP Implementation and Review (pgs 8-9) (PDF, New Window)

Safe Winter Driving Tips

The post Making EI Visits in the Snow appeared first on Early Intervention Strategies for Success.

I recently spoke with a mother who is a highly educated, early childhood professional and who received early intervention (EI) for her child. She shared this insight with me: she loved when the therapist came to her home and looked forward to the visits because she was so eager to help her child. She also felt equally frustrated after each visit because the therapist would leave and she wasn’t sure how to use the intervention strategies during her daily routine. She paid close attention at each visit, and she and the therapist would discuss and practice what to do, but each time she was basically “left hanging,” unsure about how to intervene with her child’s development between visits. Think about this…here’s a mother who has professional expertise in early childhood, who is knowledgeable about EI, but who still struggled to use what she was learning. This insight reminded me that we really can do better to support all families during visits so they know what to do between visits.

What’s A Joint Plan?

One of the simplest and most effective things you can do during a visit to prepare a parent to know what to do and how to do it between visits is develop a joint plan. The joint plan is a key component of early childhood coaching as described by Rush and Shelden (2011). It’s also been called an intervention plan in other literature. The whole idea of the joint plan is to intentionally help the parent plan for how to use a strategy between visits when the provider is not present to provide support. It’s specific, individualized, and involves problem-solving and purposeful planning. It doesn’t have to be complicated and shouldn’t be very long. It may be a verbal or written agreement. It’s a simple technique that is usually easily integrated into your practice and one that helps parents remember what to do and how to do it. The hard part for providers is often just remembering to do a joint plan at each visit and follow-up on it at the next visit…once you’ve got that down, you’re half way there!

Watch this 30 sec video to hear from a different mother who explains the goal of early intervention. Her words will help you understand why developing a joint plan is so important!

6 Key Ideas for Joint Planning

Here are a six key ideas that will help you develop joint plans with the families you support:

1. Joint planning is NOT the same thing as prescribing homework – Homework is typically something we prescribe after the parent has watched us intervene with the child and often involves generic handouts. In contrast, the joint plan is a reciprocal process, with the parent equally and actively contributing ideas for how she/he plans to use what has been learned. The plan is also specific to a routine or activity that’s already a part of the family’s everyday life.

2. Joint planning begins with one simple question – And that question is: “Based on what we’ve practiced today, what would you like to do with your child between now and our next visit?” This question gives the parent permission to pick the thing that she thinks she can work into her day. This question facilitates reflection and gives you a sense of what she has understood, what is relevant to her, and what she thinks she can do. It also helps you focus the plan on something doable.

3. It is perfectly fine if the joint plan only focuses on 1-2 strategies – It’s been my experience that, when asked, most parents only picked 1-2 things to work on. In the past, many times I gave parents a laundry list of strategies and ideas, somehow expecting them to soak them all up. What I probably really did was completely overwhelm them. If the parent can really get the hang of a strategy or two and use it frequently with success, that’s a total win!

4. Make sure the joint plan is very specific and includes steps and a Plan B – The more specific the plan is, the easier it will be for the parent to know what and how to do it when you aren’t there. Specific doesn’t mean complicated, though. Rather than saying “prompt him for a word during lunch,” you and the parent could walk through the specific steps for how she will prompt the child using his favorite foods, in his kitchen, etc. I think it’s also a great idea to develop a Plan B. If the child doesn’t respond to the prompt, make sure the parent knows what else to try. Maybe she prompts just the first sound of the word or maybe she offers a choice next. A Plan B can help the parent feel successful when one strategy is less successful that expected because she has an alternative up her sleeve.

5. Writing the joint plan down on paper may be even better – I’ve a big fan of writing the plan down so that the parent doesn’t have to rely on her memory alone. Either you or the parent can actually do the writing. The written plan could be posted on the frig or shared with other family members. It’s also something concrete to come back to next week. Parents can take notes on it during the week of things they want to ask you or successes and challenges they experienced. It’s also a great way to track progress. My written plans had a column for the strategy steps, who will implement it, and why it’s important (like what the child will learn from this activity). Simple and very effective.

6. Following-up on the joint plan is absolutely essential – The joint plan provides a bridge for the parent between visits as well as a launching point for the next visit. You should always follow-up at the beginning of the next visit to see how it went, what worked well, and what was challenging. You can problem-solve from there, adjusting the strategy or trying something different. Following up also helps the parent understand her important role in intervention. I heard a parent once say that the plan held her accountable because she knew the therapist would refer back to the plan each time. I actually think the joint plan holds everyone accountable (us too).

Developing a joint plan is a very concrete strategy that you can start using today. It’s one of those techniques that increases the effectiveness of what you do and it only takes a few minutes at the beginning and end of the visit to make such a big difference!

What’s been your experience with using a joint plan with families?

The post 6 Key Ideas for Joint Planning with Parents appeared first on Early Intervention Strategies for Success.

The outcomes have been written, so now it’s time to determine services. The team sorts through possibilities for Arnold, a two year old with global developmental delays, and his family. Multiple team members recommend multiple services, then Winnie, the service coordinator, suggests they consider a primary service provider (PSP). The team decides that Patrick, the physical therapist, is the most appropriate choice for the PSP. The speech-language pathologist will provide monthly support to both Patrick and Arnold’s family. Other professional team members will also be available for support if needed in the future. The IFSP is signed and everyone goes on their way.

In the car, Patrick wonders what being the primary service provider really means…is he supposed to be the speech therapist, educator, and occupational therapist all rolled into one? Isn’t that expecting more of him than what he can do under his license?

What It Means To Be a Primary Service Provider

Understanding just what it means to be a primary service provider is important for all early interventionists. Let’s think about what being a PSP IS and what it ISN’T:

The PSP is the team member who will be the family’s primary contact for EI services. This means that, while there may be more than one service listed on the IFSP, the PSP is the person who will see the family most often.

The PSP is a collaborative partner who keeps in touch with other providers on the team. The PSP stays in regular contact with all team members, including the service coordinator, to keep everyone updated on progress and family questions.

The PSP is the team member who helps the family address the child’s development from a holistic perspective. One of the hallmarks, and great benefits, of using this approach is that the PSP takes a holistic view of development. The child is not viewed from a discipline-specific or domain-specific perspective – meaning that we don’t compartmentalize the child into developmental pieces. For example, we don’t only address motor skills during a physical therapy visit or communication skills during speech therapy. Instead, Patrick will help the family find ways to address Arnold’s communication and movement during daily activities. He might join the family while they prepare for lunch, helping Arnold’s mother prompt him to use words to request a food choice, then coaching her on how to help Arnold carry his plate to the sink. The PSP helps the family and all team members consider how all aspects of development intersect during the child’s everyday life.

The PSP is not a lone wolf. The PSP practices with the support of other team members. The PSP is not expected to intervene on developmental concerns that he or she is not comfortable addressing. For example, if a developmental services (DS) provider is asked to be the PSP with a child who has global delays and feeding concerns, but the provider has no training in feeding, then using the PSP approach may not be appropriate. OR, that DS provider isn’t the right choice to be the PSP for that child. However, if the DS provider is comfortable monitoring feeding with the support of an OT who joins visits on a regular basis, then it could work well.

The PSP is not the lone decision maker. Just because Patrick is the PSP, this does not give him liberty to make service decisions by himself. He is still part of a team that includes Arnold’s family, Winnie (SC), and the SLP. Decisions regarding the frequency, intensity, type, or end of services are made by the team, with Patrick as an important participant.

With the support of his team, Patrick settles into his role. He realizes that he is an early interventionist first – and an early interventionist is someone who sees the child as a whole and the family as providing the context for the child’s learning. He is an early interventionist with specialized training and expertise in physical therapy. He is an asset to his team, bringing his knowledge and experience and sharing his expertise in a way that builds the family’s capacity to encourage Arnold’s development. As the PSP, he also shares his expertise with other team members so that the team works as a unit to support the family. His role is rich, holistic, and responsive and he is ready.

How do you describe what a primary service provider IS and ISN’T?

When do you use a PSP approach and how do you know when it’s working well?

Share your experiences in the comments below!

The post Primary Service Provider…What Does That Mean? appeared first on Early Intervention Strategies for Success.

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

What to Do? What to Do?!

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

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

Typical Language Development vs. Expressive Language Delay or Disorder

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

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

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

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

Why Not Provide Traditional Articulation Therapy Anyway?

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

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

What Would This Look Like for Joey and his Family?

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

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

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

Reference

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

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

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

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

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

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

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

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

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