Wyatt is a happy 19-month old child who was recently released from the hospital, where he lived for the first 17 months of his life. Wyatt was born very prematurely and has been diagnosed with a visual impairment and cerebral palsy. You want to conduct an assessment to learn about Wyatt’s strengths and needs, especially related to communication, which is a priority for his family. When you look at the assessment tools, you worry that Wyatt is likely to score much lower than his chronological age. You wonder – Is this is good test to use? How do I get meaningful information that will help our team write good goals?

Thinking Beyond the Test Scores

From experience, we know that young children with multiple disabilities often perform much lower than their chronological or adjusted age on our developmental assessments. We walk into an assessment bracing ourselves for how to tell a family that their 19-month old son has the skills of a 4-7 month old infant. We struggle because we don’t want to hurt a parent’s heart with this difficult news. We also struggle because I think, on a deeper level, we realize that this information really isn’t all that meaningful. While we can quantify that Wyatt can or cannot do certain tasks on the test, we also know that qualitatively, Wyatt has had more experiences than a 4 or 7 month old infant. Wyatt may be just starting to roll over, hold a toy, and make babbling noises but he is not an infant.

Establishing a developmental age is something we have to do when children enter EI and annually to help us track progress. We can’t avoid it, and shouldn’t, because it is helpful when considering what will come next developmentally for Wyatt. Perhaps our more important task, then, is to think about how to gather meaningful information about Wyatt’s functional abilities, including how he communicates and engages others, acquires and uses knowledge, and takes actions to meet his needs.

Tips for Assessing Young Children Who Have Multiple Disabilities

I recently came across a great resource that prompted me to think more deeply about how we assess very young children with multiple disabilities: Assessing Communication and Learning in Young Children Who are Deafblind or Who Have Multiple Disabilities (Rowland, 2009) (PDF, New Window). This document includes some great tips that we could use if we really were conducting Wyatt’s assessment, such as:

Plan for extra time – It takes time to get to know the child and learn how to read his cues, how to position him, how to offer assessment materials, etc. Assessing Wyatt would involve more than observation and conversation with his caregivers; it would also be a process of experimentation to figure out what he can do and how to support him in doing it. Wyatt may also need extra time to complete activities and/or extra rest time between them.

Select appropriate assessment tools – Look for tools that include info about how to adapt assessment items for children with sensory or motor disabilities. The Carolina Curriculum for Infants and Toddlers and the Assessment, Evaluation, and Programming System for Infants and Children (AEPS) are two examples.

Gather information about Wyatt’s everyday life – Prepare a list of specific questions you want to ask, such as:

• How does Wyatt react when you talk to him?
• What cues do you notice that tell you what Wyatt wants/needs?
• What does Wyatt like to do/not like to do?
• How does he use his vision?
• What would you like for Wyatt to be able to do?
• What would make things easier for you/for Wyatt? 

Ask the caregiver to “show” you how she plays with Wyatt, positions him, and engages him. Find out about Wyatt’s interests, preferences, what motivates and alerts him, and what tires him out.

Do a “head to toe inventory” when assessing communication – Look for the child’s movements, reactions, and sounds and consider which appear to be voluntary and which have communicative intent. If you aren’t sure, keep observing throughout the assessment to see if you notice the behavior or sound again. Watch for patterns and take careful notes.

Always assess sensory and motor skills too – The presence of hearing, visual, and motor disabilities will affect how Wyatt communicates. He could have cognitive skills closer to his adjusted age, but his difficulties with movement and vision could make it really hard for him to show you what he knows.

Rather than approaching Wyatt’s assessment with the worry that he’ll score low, the author of the resource encourages us to approach it as a “process of discovery.” You will use all of your tools – the test results, specific observations, conversation with the family, insights from other team members – to try to discover what Wyatt can do now and what comes next for him. Helping Wyatt be an active participant in his daily life is our goal, regardless of whether his skills are at the 4-7 or 19-month levels.

What strategies do you keep in mind when assessing an infant or toddler with multiple disabilities?

How do you share assessment info with families?

Add your comments below!

Want more information? Visit our VEIPD topic pages on Motor Delays & Disabilities, Multiple Disabilities, and Visual Disabilities.

The post Assessing Children with Multiple Disabilities – Tips and a Great Resource! 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.

Nicholas visits with Mia and her grandmother, Mrs. Wilson, during breakfast. Mrs. Wilson loves to cook and would like to involve Mia but she isn’t sure how. When she’s tried, Mia pulls her hand away or arches her back instead of touching the ingredients. Mrs. Wilson knows that she should help Mia touch different textures since Mia can’t see them, but Mia doesn’t seem to like it. Nicholas notices that Mia is learning to the side in her highchair due to her low muscle tone, which makes it difficult to use her hands or feel secure exploring. He sees lots of great learning opportunities in this environment so begins to think about how he can help.

How do the Environment RPs fit with EI?

We talk A LOT about the environment in early intervention. We are federally mandated to provide services in “natural environments,” which for us means more than just the location. “Natural environments” also refers to what we do in those locations, how we interact with the child and parent, and perhaps most importantly, how we support their interactions with each other during their routines and activities. The DEC Recommended Practices (RPs) match well with our concept of natural environments when they describe “environmental practices” as “aspects of the space, materials (toys, books, etc.), equipment, routines, and activities that practitioners and families can intentionally alter to support each child’s learning across developmental domains.” The authors of the RPs go on to describe these practices as encompassing three aspects of the environment: “the physical environment (e.g., space, equipment, and materials), the social environment (e.g., interactions with peers, siblings, family members), and the temporal environment (e.g., sequence and length of routines and activities).” These three aspects can really guide our approach to developing intervention strategies that fit with families; they remind us to think about “environment” is much more than just a place.

Time to Apply the RPs!

Let’s consider how Nicholas could apply the environmental RPs in his work with Mia and Mrs. Wilson:

E1. Practitioners provide services and supports in natural and inclusive environments during daily routines and activities to promote the child’s access to and participation in learning experiences.

Nicholas is off to a great start. He’s joining Mia and her grandmother during a routine that’s important to them. He’s there to help Mrs. Wilson find ways to help Mia participate in breakfast preparation, which will give her access to textures, smells, materials, and interactions that she doesn’t have access to now. His collaboration with Mrs. Wilson could open up a whole new learning opportunity for Mia.

E2. Practitioners consider Universal Design for Learning principles to create accessible environments.

Nicholas should consider the what, how and why of learning during this routine. He can help Mrs. Wilson present materials to Mia in different ways (the what) by letting Mia use her fingers to touch when she’s comfortable or use a spoon to stir ingredients when she’s not. He can help Mrs. Wilson read Mia’s cues (the how) to find out what she likes. Her arching and pulling away may be a function of her positioning, so once they find a way for her to feel stable in sitting, they can reassess her reactions to find out what she thinks and wants to do. They can also experiment with different textures, smells, temperatures, and types of foods to see what motivates Mia to explore (the why).

E3. Practitioners work with the family and other adults to modify and adapt the physical, social, and temporal environments to promote each child’s access to and participation in learning experiences.

Nicholas can help Mrs. Wilson consider these three aspects when planning for intervention. They need to find a way to improve Mia’s positioning in her high chair. They need to see what materials in the kitchen might make exploring more comfortable. Perhaps Mrs. Wilson could use her voice inflection, volume, or the amount of words she uses to facilitate interactions between herself, Mia, and the ingredients. They might reflect on the sequence and length of the meal prep routine to see how Mia could participate. Maybe Mia could help Mrs. Wilson stir the pancake batter, then munch on scrambled eggs while the pancakes are cooking, rather than wait to present all of the food at the same time when Mia is too hungry to take the time to explore it.

E4. Practitioners work with families and other adults to identify each child’s needs for assistive technology to promote access to and participation in learning experiences.

E5. Practitioners work with families and other adults to acquire or create appropriate assistive technology to promote each child’s access to and participation in learning experiences.

Nicholas’s observations can help identify the need for AT to improve Mia’s positioning. He can brainstorm with Mrs. Wilson about how to use low-tech options, such as towel rolls beside Mia to keep her stable. If she needs more than that, they can discuss more high-tech options and contact the service coordinator for assistance. Similarly, Mia might benefit from a spoon with a built-up handle to make holding it easier. Or, perhaps having a mat on the high chair tray that provides more color contrast would make it easier for Mia to see the food. These are all things good early interventionists consider; the trick is to remember that not all of these needs have to be solved by something from a catalog. Always consider low-tech, aka stuff already found in the home, first.

E6. Practitioners create environments that provide opportunities for movement and regular physical activity to maintain or improve fitness, wellness, and development across domains.

Nicholas could consider how Mia gets to and from her high chair for breakfast. Perhaps there are opportunities to increase her independent mobility around this routine.

Sometimes, we might look at the DEC RPs and think “I don’t do that” or “I only do that in certain settings.” For example, E2 sounds like something you would do mainly in a group setting. As you can see with Nicholas, these practices can be implemented even in a family’s kitchen. How we think about the environment, and these practices, makes all the difference.

Do you have an example of how you’ve considered the three aspects of the environment described in the RPs: physical, social, and temporal?

How do you implement Universal Design for Learning during EI visits?

What other ideas do you have to help Mrs. Wilson include Mia in the breakfast prep routine? What else should Nicholas consider?

Share your ideas in the comments below.

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

The post DEC Recommended Practices: Environment appeared first on Early Intervention Strategies for Success.

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.

Abby has significant motor delays. Her mother asks you some version of this question during every visit: “Is it my fault that Abby isn’t walking yet?” or “What did I do to cause this?” The question itself makes you uncomfortable, because you can’t really answer it well and because you feel like you’ve tried to answer it for the past several weeks. Each time Abby’s mother asks, you say that you don’t really know what is causing Abby’s delay but what’s important is that we keep supporting Abby’s development so that she can learn to move. You and Abby’s mother both recognize that this is the best one you’ve got…so why does she keep asking?

Emotional Questions Matter

It can be incredibly challenging to manage the emotions that pop up during EI visits – both with parents and within ourselves. When we see a parent struggling with guilt over her child’s developmental delay or disability, it can be difficult for us to know what to do or how to help. With a question like this about fault, it can be especially challenging because we really don’t have the answer. In most situations, the child will have a delay and we won’t know what caused it. It might be easy to think, well, it doesn’t really matter what caused it…what matters is what we do now. However, it probably matters ALOT to the parent.

When a parent asks a question like this, it’s important that we have an honest and appropriate answer. It’s also important to recognize (and say so) that sometimes we don’t have the answer but we can still acknowledge the emotions behind it. Abby’s mother is not hoping that her service provider will place the blame on her shoulders; instead, she may be hoping to share her anxiety and fear with someone she trusts. You may be the person she’s chosen to voice her fear to…what do you do then?

Answering this Tough Question

Here are a few things to consider when a parent asks you if it’s her fault:

Be honest and be kind

In most cases, the answer is that you really don’t know what caused the delay. Most likely, it wasn’t something the parent did, and you can say that too. If you DO think it was something that happened (or didn’t happen) in the child’s environment, like when a child has experienced neglect or there is a history of substance abuse, you can be gentle about this and redirect the focus of the conversation to what the parent is doing well now. I remember working with a parent who struggled to interact with her child during the day because she had so much else to do. Honestly, I felt that the lack of interaction had probably affected the child’s communication and interaction skills. Rather than answer “yes, not paying attention to him contributed to this delay” – which I would never say because how do I really know? – we talked about the changes she’d made since she found out that he needed more interaction and I praised her efforts. It was a tricky conversation because she did have a learning curve, but as she began to feel more like she was making a positive impact on her child’s development, the guilt she felt about the past seemed to lessen.

Acknowledge the parent’s feelings

I think it’s very appropriate to ask the parent to tell you more about how she’s feeling. You might invite it by saying something like “You’ve asked me that question several times on the last few visits. We can talk more about how you’re feeling about Abby’s development if you like.” You can open the door and see if she decides to share more. Inviting this discussion can also be tricky, though, because what comes through the door could be more than you can handle. Since most interventionists are not counselors, follow your instincts. If you suspect that the parent could benefit from more professional support, or maybe even another parent to talk to, offer to make that connection or see if the service coordinator can help. Sometimes, interventionists are afraid to have these conversations because they might distract from the “real” work of the visit. I would suggest to you that the real work might not be possible, or be unnecessarily challenging for the parent, if these feelings are left unacknowledged.

Acknowledge your own feelings & examine your own response

If a parent asks a question like this over and over, it could be because she is not getting an adequate answer. If you avoid answering, she may sense that and think you really do think it’s her fault. While we can’t be in control of how a parent interprets what we say, we can be mindful of the messages we send. Reflecting on your tone of voice, the words you choose, and your body language are important.

Follow your answer with encouragement

The question might really be a cry for hope and encouragement. A parent who asks this question may be very worried about the future. Follow your best answer by pointing out what the parent is doing well, how it’s a wonderful thing that she’s involved in early intervention, and that the child is making progress (if this is the case). Offer genuine reassurance and help the parent see that, regardless of why or what happened in the past, she has the opportunity now to make a big difference in her child’s life and you are there to help her do that.

There will be times when answering Abby’s mom’s question are easier than others. Just remember that this question is probably harder for the parent to ask than for you to answer. Answering it as best you can and following it with encouragement for what’s to come can be just what is needed.

How have you answered this question before?

What do you do when a parent expresses fear or anxiety over the child’s delay or disability?

Share your insights and suggestions below in chat.

The post Abby’s Mother Asks Again: “Is it my fault?” appeared first on Early Intervention Strategies for Success.

Meet Chris – He and his family have moved 7 times since he was born and are now staying with friends. Chris was referred to your program by his mother at the suggestion of her friend’s mom. The referral said that Chris was 29 months old and not walking. When you arrive for the screening, you see that Chris’s legs are scissoring and he’s experiencing high muscle tone. Turns out that Chris hasn’t been to a doctor since he was 5 months old and living in another state.

Meet Aliyah – Aliyah was taken to the doctor regularly but saw a different medical professional each time, rotating through whoever was available. She is 33 months old and is using mostly “ah” sounds to mean many things. She makes great eye contact and is very social and very bright. Recently, her child care provider completed a screening at her mother’s request, which resulted in a referral to EI. Her mother was frustrated because she’s been worried for a while. Because Aliyah is so social and “so smart,” she’d been repeatedly told by many people that Aliyah would eventually talk so to just wait a little longer…

Sigh…Why’d It Take So Long to Find Chris and Aliyah?

Okay, I know I’m preaching to the choir. We’re early interventionists…early screening and identification are what we DO. Yes, we know all about it, but do others? I think an important job of every early interventionist is to help spread the word about the importance of early screening to our community partners. We want our choir to grow to include more home visiting program staff, medical partners, child care providers, social services folks, and of course families!

The reality is that no early identification system is perfect. There are so many variables that influence whether or not a child is identified early and appropriately referred for evaluation. Family preferences or instability, screener error, the “wait and see” approach, follow-through after the referral is made (by the family and the receiving program) – so many cracks in the system. We can’t fix all of the cracks but we can do our best to be sure that the information is available to those who are helping us find children who may benefit from early intervention.

Spread the Word about these Early Identification Resources!

Rather than going on about the importance of finding children and families early, I thought I’d highlight some wonderful resources. Check out these links and please, share them with your community partners!

Birth to 5: Watch Me Thrive – A federal effort to support families and providers in celebrating milestones, accessing universal developmental and behavioral screenings, increasing early identification of delays and concerns, and enhancing developmental supports.

Centers for Disease Control and Prevention (CDC) Resources – The CDC website has a plethora (love that word!) of resources for early developmental screening, too many to list, really. Check out these pages for a start:

• Child Development – Tons of resources about screening tools, research, recommendations, etc. Includes info for medical providers about how to manage screenings in their practices. You can also order lots of free materials to support your screening efforts! One interesting fact – according to the CDC site, did you know that only 1 in 5 parents report that their child has received a developmental screening??
• Learn the Signs. Act Early. – Great resources for early screening and identification of children with autism spectrum disorder.
• Hearing Loss – This is one example of a topic page that’s full of info about screening and diagnosis. Be sure to search for other similar topics too.
• Facts about Vision Loss (PDF, New Window) – This is one example of a fact sheet that community partners can use during screenings. The CDC site has lots of other fact sheets so search the site for other topics.

Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening (AAP) – Share this resource with your local medical partners to get a conversation started about how to support screening and referral.

Developmental Screening and Assessment Instruments with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five (NECTAC) (PDF, New Window) – This booklet includes info about many screening tools, including a description, age range, time frame, scoring, psychometric info, and who may administer. A great place to start if you’re looking for good tools.

Infant/Toddler Development, Screening,and Assessment (Zero to Three)(PDF, New Window) – This training module/booklet is designed to be used with child care providers to support their knowledge.

Talking to Families of Infants and Toddlers about Developmental Delays (NAEYC) – This handout is another resource to help community partners start that conversation with families when there is a developmental concern. (The link I have for this doc is acting a little funny today but I wanted to include the handout anyhow. Try searching by the title another day to get to the handout. It’s a great one.)

There are tons of other screening resources out there. Even though we know about them, we need to continue the effort to get the word out in our communities. Let’s grow our choir and help others know about the benefits of early screening for children and families. Let’s help our community partners make sure children like Chris and Aliyah get what they need as early as possible!

Share your favorite screening and early identification resource in the comments below and let’s see if we can add to this list! Share your experiences and struggles with early screening and identification – have you met a child like Chris or Aliyah? I know I have…

You can also find more info about Screening and Assessment on the Virginia Early Intervention Professional Development Center website.

The post Preaching to the Choir about Early Screening Resources – Spread the Word! appeared first on Early Intervention Strategies for Success.

Jackie receives a call from Tate’s mother, Mrs. Comer. Mrs. Comer is really frustrated because she feels like she’s not benefiting from her visits with the physical therapist. She tells Jackie that she feels like all Alex (the PT) does is ask her questions. She says “I don’t want to just be asked questions that I don’t know the answer to. I’m here to learn how to help Tate. I need Alex to show me what to do!”

Have you been in this situation? Are you Alex or Jackie?

The Transition to Using Coaching

I’m hearing more and more from service coordinators and providers about the struggles and successes with integrating a coaching style of interaction into their practices with families. In Virginia, as in many other states, our EI providers are in the midst of a transition, evolving their practices from a more traditional approach to providing routines-based, collaborative intervention. We’ve worked hard to learn about coaching, having provided training across our state, and now our practitioners are hard at work implementing what they’ve learned. As with any paradigm shift, many are struggling with the transition, especially when it’s a very different way of interacting with families and sharing expertise than what they’re used to.

Let’s think about how Jackie and Alex might handle the situation above. We’ll consider the perspectives of all three people: Alex, Mrs. Comer, and Jackie.

Service Provider: Alex

Alex has been a PT for 6 years. He’s very open to using coaching but is struggling to integrate it into his practice, feeling unclear about whether or not he’s “allowed” to share his expertise or handle the child during visits. He really likes the reflective questions and understands the value of reflection as an adult learning strategy, and wants to build the family’s capacity to support their child’s development. Tate has mixed cerebral palsy, with high muscle tone in his extremities and lower tone in his trunk. Alex’s first inclination is to use the intervention visit time to stretch Alex. Instead of doing that, Alex has been trying to ask Mrs. Comer what she’s been doing with Tate and what she thinks she should do.

Parent: Mrs. Comer

Mrs. Comer has 3 children and Tate’s the youngest. She has high expectations for Tate and really wants him to be an equal and active part of their family’s life . She’s reading everything she can about CP and understands the importance of positioning, stretching, and adapting activities for him. What she’s struggling with is HOW to do these things. Recently, she asked Alex how to help Tate be able to help with getting himself dressed in the morning. She was frustrated because Alex responded by asking Mrs. Comer, “What do you think you could do?”

Service Coordinator: Jackie

Jackie is learning about coaching too and wants to support her providers in making this transition. She also wants to make sure the children and families are getting what they need. When Mrs. Comer shares her concern, Jackie listens closely. Mrs. Comer says that she likes Alex and thinks that it would work better if Alex spent more time showing her how to help Tate learn to sit, move and play. Jackie says she’ll talk to Alex and plan to join the next visit so that they can discuss this as a team.

Jackie calls Alex and first asks how he thinks intervention is going. It turns out that Alex is also frustrated because he wants to model positioning and stretching but wasn’t sure that he should. He struggles with helping Mrs. Comer reflect when she really doesn’t have the prior knowledge of what to do with Tate. They discuss Mrs. Comer’s concerns and her request for more demonstration. Jackie asks if Alex is okay with her joining the next visit and he says “of course!”

The Next Intervention Visit

On the next visit, Jackie facilitates a discussion that airs everyone’s frustrations in a kind and professional manner. Then, to focus the discussion on how to move forward, she helps Alex and Mrs. Comer revisit the family’s need to have Alex actively participate in getting himself dressed. She asks Mrs. Comer to describe what she’s already doing now with dressing and explains why she’s asking – to help her (Jackie) and Alex know what’s worked well or not worked so far. Mrs. Comer shares that getting Tate’s arms through his sleeves is really hard because of his tone. Alex asks if he can see how she dresses Tate so he can help develop some strategies with Mrs. Comer.

Everyone moves to Tate’s bedroom, where Mrs. Comer usually dresses Tate. She removes his clothing and redresses him while Alex observes. Together, Alex and Mrs. Comer try a few strategies and problem-solve together. Alex asks if he can show Mrs. Comer how to help manage Tate’s muscle tone and stretch him before dressing. While he models these strategies, he suggests Mrs. Comer watch for how he positions Tate, where he puts his hands while stretching Tate, and how Tate reacts. They figure out that Tate can help push his arms through the sleeves easiest if he’s in a sitting position, so Alex coaches Mrs. Comer in how to help Tate sit on her lap during dressing. He shows her how to slowly break up Alex’s muscle tone so that Tate can bend his elbows and then straighten his arms through his sleeves. They talk about how this activity helps Tate practice controlling his movement, how stretching before dressing loosens his tone, and how being playful and counting “1-2-3!” before Tate pushes his arm through his sleeve can make the dressing routine motivating for Tate. Mrs. Comer is happy with the strategies and plans to use them in the morning when getting Alex dressed and in the evening after bath time.

At the end of the visit, Jackie asks Mrs. Comer and Alex how they thought things went. Both seemed happy with the visit and the joint plan. Jackie encourages them to continue focusing on how Tate can participate in everyday activities and routines like they did today because they make a great team.

What Do You Think?

If you’re a service coordinator like Jackie, how might you handle a similar situation? How’s your team doing with implementing coaching strategies?

If you’re a provider like Alex, how are you feeling about implementing coaching? What would you do if a family was frustrated with the way intervention was going?

Share your insights by leaving a comment below!

The post Coaching: It’s About More than Just Asking Questions! appeared first on Early Intervention Strategies for Success.

“Come look at his knees,” a concerned parent asked me.

The toddler climbed off the couch and ran, no, barreled towards me.

“Look! When he stands, his knees are touching!  What’s wrong with his legs?”

“He’s 2-years-old, right?” I asked.

“Yes,” said the mom.

“Nothing, this is typical knee alignment for his age.  Let me explain…”

Parents are most concerned about bowlegs (genu varum) and knock- knees (genu valgum) in their children. As early intervention providers, we are in a unique position to educate parents and caregivers about the normal development of hip and knee alignment, as well as assist families in deciding when it is appropriate to seek the expertise of an Orthopedist.

As a child grows, from infancy to childhood, the alignment of the knee also changes. At birth, newborns are bowlegged (genu varum).  The infant’s legs slowly straighten and between 12-24 months old, the legs reach a neutral alignment. It has been suggested that the alignment of the knees improves as weight bearing increases during standing activities between 12-24 months. Knock-knees (genu valgum) reach its peak between the ages of 2 and 4 years-old and then gradually decreases. The final knee position differs depending upon the gender of the child. Sixteen-year-old females tend to have slight knock-knees as their pelvises are wider. Sixteen-year-old males tend to have slight bowlegs as their pelvises are narrower.

It makes sense then, that the reason the greatest number of referrals to Orthopedists of children between the ages of 2 and 4 years-old are for concerns of knee alignment. That’s when knock-knees reaches its peak! The change from straight (or neutral) legs to knock-knees can be disconcerting for parent.

There is good news! Eighty percent (80%) of children with bowlegs before age 2 years-old and knock-knees before age 6 years-old, will improve knee alignment spontaneously. There are various opinions about when or if knock-knees and bowlegs warrant treatment. Research has found that twister cables and other conservative, non-operative treatments are unsuccessful. Evidence suggests that therapists should measure hip range of motion every 6 to 12 months to document femoral anteversion (inward rotation of the femur; resultant knee turning inward).

Children should be referred to an Orthopedist if they have:

– Excessive knock-knees or bow legs

– One leg is more or less knock-kneed or bow legged than the other (asymmetrical)

– Knock-knees or bowlegs progressively increase

– Pain with putting weight on their legs

– One leg longer or shorter than the other leg

– Knock-knees or bowlegs persist beyond 7-8 years-old

– Position of the knees create significant cosmetic and functional disability

How have you addressed this concern with the families you work with?

References

Cheng JCY, Chan PS, Chiang SC, HUI PW.  Angular and rotation and profile of the lower limb in 2,630 Chinese children.  Journal Of Pediatric Orthopedics.  1991; 11:154-161.

Heath CH, Staheli LT.  Normal limits of knee angle in white children – Genu varum and genu valgum.  Journal of Pediatric Orthopedics.  1993; 13:259-262.

Staheli LT.  Fundamentals of pediatric orthopedics.  4^th ed.  Philadelphia: Wolters Kluwer, Lippincott Williams & Wilkins; 2008.

Campbell S, Vander Linden DW, Palisano RJ.  Physical Therapy for Children.   3rd ed.  Missouri: Saunders Elsevier; 2006.

Effgen S.  Meeting the physical therapy needs of children.  2^nd ed.  Philadelphia: FA Davis Company; 2013

Sass P, Hassan G.  Lower Extremity Abnormalities in Children.  American Family Physician.  2003; 68(3):461-468.

Ganger R.  Lower Limb Development.   www.scribd.com/doc/55666675/Lower-Limb-Development-Ganger.  Published 2011.  Accessed August 2, 2014.

The post Bowlegged? Knock-knees? Oh My! – Knee Alignment in Infancy & Childhood appeared first on Early Intervention Strategies for Success.

About 30 min into your first visit with Mason’s family, his father asks “Will he ever walk?” Mason had a stroke shortly after he was born which affected the left side of his body. He is just under two years old and is beginning to sit with very little support. His father is an athlete and dreamed of having a son who would love to play sports as much as he does. How do you answer this hard question?

Your 3 Options

There really are 3 options for responding to his question. Let’s consider each:

“Sure he will!” – This is the “yes” option, where you assure the father that Mason is young and has lots of time ahead of him to learn this skill. When you answer like this, you’re usually trying to think positively and keep the parent’s dreams alive. Consider these questions, though: How do you know? Can you know now? Is it fair to Mason’s father to answer with such confidence? What if you’re wrong? It’s been my experience that it is very difficult to know for sure that an infant or toddler with a significant neurological condition affecting his motor abilities will one day walk.

“No, I don’t think he will.” – Did you hear that? Pop! You just burst Mason’s father’s bubble, shut down his dreams for his young son and himself as a father. Consider the same questions: How do you know? Can you know now? Is it fair to answer with such confidence? What if you’re wrong? Remember that Mason isn’t even 2 yet. In most circumstances, we really don’t know for sure that a child will or won’t walk. It’s just too early to tell. The exception might be for children with multiple, significant disabilities but even then, how do we know for sure?

“I don’t know.” – This is the middle option, less certain and probably more true. No parent really wants such a serious question answered with such a wishy-washy answer, but sometimes that’s the best we can give them. I’m a firm believer that honestly saying “I don’t know” is a good answer when it’s sincere (and not an effort to ignore a hard topic) and followed by further explanation, using some of the strategies below.

Strategies for an Honest Answer

Relate Mason’s current abilities to future mobility – Point out how important having the balance and trunk control for sitting is to later walking.

Set shorter-term goals – Set very short-term goals that are important to the father that relate to his priority, like maybe having Mason sit by himself by his 2nd birthday or take a few steps with his hands held by the time the family goes on vacation.

Discuss early brain development – Talk about how busy Mason’s brain is now and how much learning he has yet to do. Emphasize the importance of giving Mason good opportunities for movement to help him learn to coordinate his body, get stronger, and even learn to compensate for his developmental differences.

Explore what “walking” really means for the father – This is important. Walking might mean walking on two feet. Or, it might really mean Mason being able to move about independently, however that happens. Mason’s father might be wondering how long he will have to carry Mason around, if Mason will be able to play on a playground, or if he’ll ever play baseball. Exploring his question a little more will help you understand what underlies this tough question. It’ll also help make sure he knows you are addressing what is so important to him, even though it might not look like walking yet.

Let Mason’s Dad Keep his Dreams

Mason’s father has a right to his dreams for his son, and Mason is much too young for those dreams to be pushed aside. The question he’s asked is a real one that is packed with emotions, hopes, and fears. It was probably harder for him to ask than it is for you to answer it. Use this opportunity to explore Mason’s families hopes and dreams for him, which will help you focus his intervention plan around what is really important to them. Having conversations about Mason’s abilities and needs can help his family prepare for his immediate future. Celebrate Mason’s progress and revel in the fact that that future is wide open!

How have you answered this tough question? Share your insights in the comments below!

The post Will Mason Ever Walk? appeared first on Early Intervention Strategies for Success.

It’s Thursday, the week’s almost over, and I bet you were just thinking…man, I sure wish I had a few ideas to help (insert child’s name) use his hands to play! 🙂

You may be supporting an infant or toddler who has cerebral palsy or another neurological condition that causes increased muscle tone. If the child has tightly fisted hands or indwelling thumbs (or both), his opportunities to play and explore can be quite limited. So much of how a baby learns is through touching and manipulating things around him. Actively being able to open and close his hand, grasp toys, and hold them is an important part of early development.

Read on for a few very simple tricks to add to your early intervention toolbox!

Trick #1 – Opening that Little Hand

Here are a few ideas you can teach parents to use to get those little hands ready to explore:

Massage that little hand. Use your thumb to massage the child’s hand from the center of the palm outward using a circular motion to open up the child’s hand and fingers. For an indwelling thumb, massage it open using your thumb.

Wake up the tactile sense. Help the child rub his open hand on the carpet or another texture to wake up those nerves and muscles. Play pattycake. Explore textured books or toys.

Bear weight on those hands. When the child is in a sitting position, use hand-over-hand support to help him lean forward on his hands while they are palm down on the floor. Put the child in a hands and knees position (over your thigh or a pillow) and help him bear weight on his hands.

With these simple activities you are activating and stretching those tiny muscles. You’re also helping the child feel what it’s like to have his hand open and ready to use.

Trick #2 – Releasing a Tight Grasp

Oops, the infant’s hand is tightly fisted in your hair. You don’t want to pull his hand and you’d like to keep your hair intact, but he’s really tangled in there. What can you do?

There’s a very simple yet effective trick that will not only save your hair but is also useful in other ways too: gently bend his little hand at the wrist (palm down) to help him release his grasp. It’s that easy. Once his fingers come open, you can unhook your hair and no harm is done.

So what else is this trick good for?

Teaching grasping – If you have a child with tightly fisted hands, you can use this trick to help her open her fingers enough to slide a rattle into her palm. Try using a rattle with a thin ring or handle. Gently press the rattle into her palm and she will likely close her hand around it. You’ve just helped her move through the motor pattern of opening her hand and grasping a toy, even if she wasn’t able to do it on her own. It’s a great start.

Teaching “give me” – If the infant or toddler has a toy in hand and can’t let go (or won’t let go), you can gently bend her wrist to help her release the toy into her mother’s hand. Pair this action with the command “give me your rattle” to help her learn what the command means. Over time, you might be able to fade out bending her wrist and just touch the back of her hand as a cue to open her fingers.

This is the great thing about early intervention. It doesn’t have to be complicated. Sometimes, the simplest tricks and techniques are the most useful!

What other simple strategies can you suggest for supporting hand use with little ones with fisted hands?

The post 2 Simple Tricks for Tiny Fisted Hands appeared first on Early Intervention Strategies for Success.