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.

When we whittle early intervention down to its core, I think it’s all about interactions. Interactions between the child and caregiver, first and foremost…interactions between the child and the environment (toys, sofa cushions, spoons and cups, buttons on the TV remote, the family dog)…interactions between the EI practitioner and caregiver that facilitate positive interactions with the child in the natural environment. See where I’m going here? It’s all related to positive, reciprocal, contingent interactions.

Translating our Super Powers

The Division for Early Childhood (DEC) Recommended Practices provide our field with a list of five interaction practices that we can use to “promote specific child outcomes” (p 14) when working with families. As early interventionists, we often have super powers related at using these practices – we know how to use our voices and language to engage children, how to observe behavior and encourage reciprocal communication, and how to help children sustain interactions and respond to the environment. Our use of our super powers won’t ever be enough, though. We have to use what we know to help others interact with the child in ways that boost development and learning. When caregivers use recommended practices for interaction, the child has more opportunities to develop social skills, communication, cognition, and independence throughout the day. Those daily interactions are what really matter.

Helping Caregivers Use the DEC Interaction Practices

Let’s consider the first three practices, which focus on promoting social and communicative interactions.

INT1. Practitioners promote the child’s social-emotional development by observing, interpreting, and responding contingently to the range of the child’s emotional expressions.

Early interventionists are great resources for caregivers in helping them observe and interpret their child’s behavior. This is especially helpful with children who communicate in ways that are harder to understand, such as children who may have autism or those with multiple disabilities. The interventionist can help the caregiver notice the child’s attempts to engage and communicate. Then, they can figure out how the caregiver can respond in ways that help the child learn the benefits of engaging others.

Example: An educator sees a child’s tendency to stroke his mother’s hair as an attempt to engage the mother and feel close to her. The mother originally found the “hair pulling” slightly annoying, but when she sees the possibility that it represents affection from her child, she can respond to the child with a warm smile and voice, encouraging rather than discouraging the interaction.

INT2. Practitioners promote the child’s social development by encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support.

Early interventionists can help caregivers seek out opportunities for the child to interact by observing typical routines, especially those that the caregiver and child enjoy together. By asking the caregiver open-ended questions (“What makes your child laugh? What do you like to do together? When do you do to spend time together? What would you like to do together?), the interventionist can identify activities to target for intervention.

Example: An occupational therapist (OT) observes the morning dressing routine, during which a mother plays peek-a-boo and tickle games with her infant. The OT coaches the mother to use an expectant look and extra wait time to facilitate her child’s engagement and teach her child how to take turns, make sounds, and perhaps pull the blanket from the mother’s face to keep the game going.

INT3. Practitioners promote the child’s communication development by observing, interpreting, responding contingently, and providing natural consequences for the child’s verbal and non-verbal communication and by using language to label and expand on the child’s requests, needs, preferences, or interests.

Rather than being the communication partner for the child for most of the visit, the interventionist can coach the caregiver in how to respond contingently, use words that are just above the child’s language level, and expand on what the child says. This works well during play and other routines.

Example: A speech-language pathologist coaches a father in how to expand a child’s gestural request for his cup to be filled with water. The child hands his cup to his father and walks away. Through modeling and practicing simple prompts, the father can learn to label the child’s request (“More water?”), hold the cup up near his own mouth to draw the child’s attention to the word being said, and wait before meeting the need so that the child has a chance to imitate the model. The father and child can then practice this interaction whenever this request is made, which is likely to be often – more often than if the therapist used this strategy 2-3 times on a single visit.

These are just a few examples of how we can implement the Interaction Recommended Practices through the caregiver-child interaction.  Our knowledge of how to facilitate interactions can translate into the strategies we share and practice with families. Using those parent-interventionist interactions to facilitate parent-child interactions in natural environments – that’s what it’s all about!

Next week, we’ll continue this discussion by looking at the next two practices, which focus on facilitating cognitive skills. In the meantime:

Why is it important that early interventionists translate these practices for use with families?

How have you use these practices on visits? With child care providers?

Share your thoughts and examples of implementing these practices by leaving a comment 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 – Interaction (Part 1) appeared first on Early Intervention Strategies for Success.

Last month, we considered the first five DEC Recommended Practices under the Assessment strand. Now, let’s look at practices A6-A11. These practices encourage early interventionists to consider information from a variety of sources about the child’s skills and abilities across different routines, activities, and settings and to do this on an ongoing basis. These practices really remind us to consider the big picture – how the child functions in his everyday life.

Let’s Consider an Example…

During Liam’s assessment, the occupational therapist and speech-language pathologist gather information from his parents and his grandmother, who cares for Liam while his parents are at work. While observing Liam’s attempts to complete assessment activities, they also ask his caregivers about what goes well at home and out in the community for Liam and what is challenging. They often ask for more details so that they can understand particular activities Liam enjoys and those that he struggles with. Because of Liam’s significant motor limitations due to his cerebral palsy, he’s unable to complete some of the assessment activities that require fine motor coordination (such as placing shapes in a puzzle), but he often shows his understanding through his gaze. The therapists use their informed clinical opinion to make some determinations about age equivalencies, in addition to using the information they gather from their assessment tools. They explain this when they report the assessment findings and try to help Liam’s caregivers understand the connection between their observations based on the assessment tool and his functional abilities in his everyday activities. The service coordinator summarizes this information and then helps the team use it during the development of IFSP outcomes and the discussion about services. Once The IFSP is written, the service provider who sees Liam and his family can use this information to provide meaningful support and monitor progress through the ongoing assessment that will continue throughout service delivery.

DEC Recommended Practices for Assessment

This sounds like a pretty good assessment, right? Let’s look at six more assessment practices from the DEC Recommended Practices and consider how this example illustrates these practices.

A6. Practitioners use a variety of methods, including observation and interviews, to gather assessment information from multiple sources, including the child’s family and other significant individuals in the child’s life.

Professionals on assessment teams often have two choices. They can rely solely on what they observe during the child’s performance of assessment tasks prescribed by the tool they are using. Or, they can integrate these observations with what they learn from talking with caregivers about the child’s abilities and challenges in everyday life. Relying on the child’s performance alone can be necessary, depending on the tool being used, but it is always important to remember that one tool, or even a child’s performance of discrete tasks, can never truly tell you all you need to know about a child’s abilities. Plus, Part C of IDEA requires that we use more than one method/tool to determine a child’s developmental status. The law also requires that we use our informed clinical opinion to make sense of assessment findings and consider the child’s functional abilities in multiple settings. Child development happens everywhere a child goes and with every interaction; the best assessments take all of this into account.

A7. Practitioners obtain information about the child’s skills in daily activities, routines, and environments such as home, center, and community.

While it’s not always possible to observe a child across daily routines, activities, and environments, it sure would be an awesome way to conduct assessments if we could. If you can’t observe it, you certainly can ask about it. Liam’s team was mindful of this and asked about what he and his family enjoy, what they like to do, and what they would like to do. All of this information informs the IFSP outcomes and helps the ongoing service provider know when and where to provide support.

A8. Practitioners use clinical reasoning in addition to assessment results to identify the child’s current levels of functioning and to determine the child’s eligibility and plan for instruction.

As already mentioned, Part C of IDEA requires that we use informed clinical opinion to individualize the assessment. It’s important to help families like Liam’s understand this, especially when pure assessment results reported as age equivalents can be disheartening. A child like Liam, who is limited in what his body can do, can appear to be extremely delayed just according to test scores, but when functional abilities are taken into account, a more accurate and encouraging picture of development can emerge.

A9. Practitioners implement systematic ongoing assessment to identify learning targets, plan activities, and monitor the child’s progress to revise instruction as needed.

After Liam’s assessment, the ongoing service provider will use the information gathered initially and the IFSP outcomes to inform service delivery. He or she will also conduct ongoing assessment to plan for intervention, revise outcomes as needed with the rest of the team, and monitor the child’s progress. Ongoing assessment may be a less formal process, but it is equally important to ensure that EI services are meeting the child’s and family’s needs.

A10. Practitioners use assessment tools with sufficient sensitivity to detect child progress, especially for the child with significant support needs.

Hopefully, the therapists on Liam’s team used assessment tools that allowed items to be adapted for children with significant motor needs. Some tools provide this guidance, while others require that adaptations are just noted and reported. Using the right tool matters because an assessment that results in findings that are not meaningful or reflective of the child’s abilities really isn’t very useful at all, and can be frustrating for families as well.

A11. Practitioners report assessment results so that they are understandable and useful to families.

Finally, the therapists shared assessment findings by relating them to Liam’s everyday activities so that they were easy to understand for his family. Helping families understand what discrete assessment tasks tell us about development and how that relates to what they see everyday with the child is one of the most important tasks of the professional team members. Assessments should not be an event where the “experts” talk “at” the parents. Instead, assessments should be a mutual and reciprocal sharing of information so that everyone learns more about the child.

It’s your turn now! Take some time to review these two checklists to reflect on your own assessment skills. Consider how you use what you know to really get an accurate picture of a child’s development.

Informed Clinical Reasoning Checklist (PDF, New Window)

Authentic Child Assessment Practices Checklist (PDF, New Window)

Keep an eye out for next month’s post on the Environment Practices. In the meantime, consider…

How does an early interventionist develop clinical reasoning? How do you know when you’ve got it?

What strategies do you or your assessment team members use to gather information about a child’s functional abilities in everyday activities – including those that you might not typically see during a formal assessment? 

What tools or practices do you use when conducting ongoing assessment? How do you document when a child is making progress?

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: Assessment (Part 2) appeared first on Early Intervention Strategies for Success.

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

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

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

The Interim IFSP

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

Requirements for the Interim IFSP

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

Using an Interim IFSP

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

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

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

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

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

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

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

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.

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.

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.

During the assessment, the professional team members notice some soft neurological signs in Seiko’s development, such as an indwelling thumb, slight scissoring of her legs, and low muscle tone in her trunk. Seiko was referred to early intervention by her pediatrician because she is 14 months old and not yet sitting or crawling. According to her parents, the pediatrician told them that Seiko was delayed because she was born early but that she’ll probably catch up. As the professional team members talk to the parents about the assessment findings, you can tell that they are trying to be gentle with describing the significant concerns they see. The parents look rather stunned and ask you a tough question: “Why didn’t our pediatrician catch these signs earlier?”

What Do You Do?

What a difficult situation to be in. Have you been there? Imagine being the parents, hearing these findings from relative strangers who have just met their daughter for the first time. These findings, which can sounds pretty frightening or confusing, understandably make them wonder why the pediatrician they trust never brought this up. Before jumping to conclusions about the pediatrician, consider these two questions:

Do the parents always see the same pediatrician, or do their well-child and sick visits rotate through whichever doctor or nurse practitioner is available?

Do the parents routinely take their daughter to the doctor? How long has it been since the child has been seen by the pediatrician?

If the child isn’t seen regularly or has seen different doctors for brief visits, it’s possible that these signs were missed. Possible, but not necessarily the only explanation.

Answering the Tough Question in the Moment

You might not know all of these answers, and you certainly don’t want to answer their question by immediately asking more questions. You do, however, need to address the elephant in the room and provide some guidance. First, it’s okay to be honest and admit that you don’t know why the doctor hadn’t addressed these signs before but that he referred them to early intervention which is a good start. You can assure the family that you will help them communicate with their pediatrician by sharing a copy of the IFSP (with their permission) and making a phone call to discuss the findings in detail if that’s helpful. You can also discuss an additional referral to a specialist, such as a neurologist or developmental pediatrician, who can provide another opinion. Always ask the parents if they have any questions and how you can help before you jump in and make calls or referrals.

After you’ve provided some reassurance, I think asking a few more investigative questions can be very appropriate to help you problem-solve those next steps together, such as:

Have they noticed these signs before? – If not, I’d wonder if these signs represent a new problem. Or maybe they’ve always been there but the parents didn’t know that they were red flags, which is okay. These things aren’t always easy to notice when you don’t know to look for them.

What has the pediatrician said about Seiko’s legs, hand, or muscle tone? – It’s quite possible that the doctor mentioned these signs and that he has been monitoring them. It’s possible that a “wait and see” approach is at play here. (I know this makes us early interventionists cringe but it does happen.)

Has the doctor ever mentioned seeing a specialist? – It’s possible that a referral was suggested or made to the neurologist but the family wasn’t ready to see the specialist, preferred to wait, or didn’t understand why it was suggested so didn’t keep the appointment.

There are many possibilities in this scenario so be careful what you assume. It is absolutely possible that the doctor missed these signs, but it’s also possible that there’s more to the story. Regardless of the reason for why Seiko is 14 months old with possible signs of cerebral palsy, the most important thing now is to help the family find the resources they need to support her development. When the family is ready, the team should proceed with writing a meaningful IFSP, initiating services as soon as possible, and connecting the family with an additional referral to help them find answers.

How have you handled this situation? What words would you use to preserve the pediatrician-parent relationship?

If the parents consent, how would you handle communication with the pediatrician after the assessment?

The post Why Didn’t Our Pediatrician Catch This Earlier?? appeared first on Early Intervention Strategies for Success.

From the first time we meet a family or begin working with a child, we need to be thinking about how we can fade ourselves out of the picture. This seems like an oxymoron because we’re there for a reason – to help. There’s such a fine line between helping and creating dependence, and I know that I have often not even realized that I created dependence when I though I was helping. Take this example:

I Helped Too Much

I’d worked with this family as their service coordinator and educator most of their child’s life and the day came for our last visit. We had discussed transition many times but they had not been interested in any services following early intervention, no preschool or private therapy. On the last visit, the mother became anxious and asked how to get her child into physical therapy. I explained that there was typically a wait list with the therapy agency so the best thing to do was call and get on the list. I found the therapy office number in my planner for her. She went and got the phone and she handed it to me. I looked at her and handed the phone back and started to read the number. She interrupted me and said “aren’t you going to set it up for me?” That was one of those moments when I thought, “I did not do my job and prepare her for how to do this on her own.” I’d been so eager to help over the previous two years that I had created a dependence that I’m not sure either of us really realized was there. The story ends with me encouraging and coaching her through the phonecall and her next steps, which included getting a prescription from her doctor. I walked away from that apartment thinking about how I could have done things differently. The truth is that I don’t know for sure if the outcome would have been different in terms of transition planning had I helped less directly and coached more, but I think what I did do was make myself too much of a requirement in the family’s life.

Our Two Choices

I think we easily have two choices in early intervention: to develop dependence or independence. Walking that fine line is often quite challenging because it’s different for each family. I learned that, as a service coordinator and an educator, I needed to keep the end goal in sight at all times: independence. The family’s independence was best supported when I was there to provide as much support as was needed to help them make decisions, find resources, and encourage their child’s development. This perspective also worked with teaching children too.

What a Little Toddler Attitude Taught Me

I can also remember one child I loved working with because he always surprised me. He had multiple disabilities, including ataxic movements that made controlling his arms really challenging. It was so easy for his grandmother and for me to just take his hand and help him do whatever we wanted him to do. He was incredibly smart and knew what he wanted to do and it was hard for us to see him struggle. Once his toddler attitude set in (which was a wonderful thing) we quickly learned that he didn’t always want this help. Together, his grandmother and I figured out that when he had support at his elbows to keep his arms stable, he could more independently aim his hands to do what he wanted. We learned that he could communicate what he knew using his eyes, looking at where the puzzle piece went in the puzzle or at the choices we offered. When we assumed that he needed us to help him by using pretty physically invasive assistance, we weren’t actually able to see his potential.

Two Strategies for Fading Yourself Out & Keeping Your Perspective

These families taught me to always look for ways to fade out my assistance. This was easier in some situations than others, but keeping this perspective in mind helped me release my role. It also helped families feel ownership of the amazing things they could teach their children. Here are two things I learned:

1. Before assuming you need to jump in and help, ask first. This is a great coaching technique. Ask the family questions about what they have already done to address the issue, what they would like to do, and what help they need. Let them define what to do and if they even think they need your help. Just because you think you know the answers doesn’t mean that you need to be the one to “fix” a problem. Remember that you won’t be there to fix the problem forever.

2. Similarly, observe the child first before jumping in. Always set up the situation for the child to be successful with as little assistance as possible. If a child needs full assistance with rolling over, for example, help the parent move the child just enough for the child to be able to help move himself. Encourage the parent to give just a little less assistance next time so the child feels what it’s like to do it himself. If a child needs physical assistance with feeding himself, start there, then fade back to only providing support under his wrists, then at his forearms, elbows, etc. Back yourself out of the activity and celebrate the child’s independence.

We are helpers in early intervention. There’s nothing wrong with that. Just remember that, in many cases, the best way to help someone is to help them help themselves. I know that sounds like a lot of helping, but it only starts with you. It ends with the parent’s and child’s independence.

Have you ever been in a situation where you helped too much? What tips do you have for fading yourself out and keeping your perspective?

The post Fading Yourself Out of the Picture… appeared first on Early Intervention Strategies for Success.

Examples of using pausing to encourage development are more powerful than me describing why this technique works so let’s start with a few examples from real intervention visits:

Sandy

One day on a visit with Sandy and her nurse, we played with Sandy’s favorite toy and assisted her as she activated it.  Sandy had multiple disabilities and difficulty with communication. After she played a little by touching buttons to turn on music, I turned Sandy’s toy off and asked her if she wanted to play again. She sat there, unmoving, so I asked her to show me that she wanted to play. After pausing longer than I ever had before, and watching her entire body for clues that she was communicating, she raised her left arm up off of her wheelchair tray. I instantly turned on her toy and praised her, asking if she was saying she wanted to play. After a short play period, I turned of the toy again. By now her nurse thought I was just being mean but I explained how I thought Sandy was communicating by raising her arm. I asked Sandy to tell me again if she wanted to play more and I waited. Within a few seconds, she lifted her arm again. This was her first “word.” When I showed her mother on the next visit, her mother cried and said that she’d never had a way to communicate with her daughter until now.

Alex

Alex had cerebral palsy and found coordinating purposeful movement extremely difficult. This led to people (including me) either doing things for him or using hand over hand support to “help” him with everything. One visit, I was amazed that he was able to put a shape into his puzzle with the piece placed in his hand and his mother providing support at his elbow. It took him easily a long 30-40 seconds to coordinate the movement but he was able to do it. If his mother hadn’t tried waiting him out, we would have taken his hand and “helped” him do it like we usually did. When we waited, we learned that he could do it himself. He knew more than we had given him credit for, and with waiting, he was able to show us what he knew.

Jackson

Jackson was trying out his new gait trainer in his mother’s kitchen. He was smiling and happy to be upright but struggling to move his legs. After practicing moving his legs with the PT’s help, we decided to wait him out to see what he could do. After looking at us like “why aren’t you helping me?” and watching as we encouraged him, Jackson dragged one toe forward, clearly attempting to walk. This step was the first of many.

One more example:

Devon

When Devon wanted to go outside, he would go to the door that led to the backyard and whine. He did this one day during a visit and his mother automatically got up to open the door. I hopped up too and we decided to use this as an opportunity to help Devon learn a word. Devon’s mother and I talked and she decided to teach him to say “out.” I suggested she move down to his eye level, prompt him for “out” by enunciating the word, pointing to her mouth, and pause with an expectant look on her face for him to imitate. She prompted him a few more times before he made an “o” with his mouth which we happily took as his attempt to say “out.” By the next visit, his mother had taught him to say “ow” instead of whining to go outside to play.

How to Use Pausing

Using pausing requires two things: patience and respect for a child’s efforts, whatever they look like. Pausing doesn’t always work the first time you try it. It usually requires that you teach the child what you expect him to do by repeating the routine, maybe using hand over hand prompting or verbal prompting, then fading out that support. Using the same 1-3 word prompts helps too so that the child associates your direction with what he’s learning to do. Some children can take up to 45 seconds to process what you say and respond so be patient. I don’t remember where I learned about waiting this long, but it worked well over the years, especially with children with more significant developmental needs. Some children will have shorter wait times, and you have to figure how how long to wait before they lose interest or become too frustrated, and before you or the parent provides help. Waiting until the child is completely upset is never effective, but pausing long enough that the child is motivate to act can work well. It’s a balance that you’ll figure out through trial and error.

Teach parents about pausing. It’s often easy to forget to pause and wait for the child to show you what he can do, especially in the busy-ness of everyday life. Learning to pause helps the parent create the expectation that the child will do something, whether it be look, make a sound, approximate a word, or move a body part. This expectation is critical to the development of independence, self-confidence, and communication. A simple pause can make a world of difference!

Do you have more examples of how you’ve used pausing with children? How do you teach parents about pausing? Share your ideas and examples by leaving a comment below. Be sure to follow the comments so you don’t miss out on other’s ideas!

The post Using Pausing to Encourage Development: Examples from Real Visits appeared first on Early Intervention Strategies for Success.