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

Helping Caregivers Identify & Use Everyday Learning Opportunities

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

What Does This LOOK LIKE in Practice?

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

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

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

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

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

Now it’s your turn:

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

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

References:

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

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

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

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

I’ve been thinking a lot about routines-based intervention lately. In particular, I’ve been thinking about (and experiencing) what happens when a family doesn’t invite you into their daily routines. What do you do when the space the family makes available to you is small? Not physical space, but family life space. When the only activity you have access to is playtime in the living room floor? What do you do when the parent clearly states that he doesn’t want to do something else, or when she cringes every time you ask to join another activity? We could dig into why this might be happening, and that’s a valuable discussion which has been covered in other posts. For this post, though, I want to think about the realities and complexities of this work and how that can affect us as practitioners.

Realities

Just this morning, a colleague told me that the reality is this: families are letting us into their very personal spaces. They decide how far to let us in and how much to reveal. We are guests in their homes and in their lives. We can never truly know what a parent is thinking about this “intrusion.” Of course, we do our best to be friendly and nonthreatening so parents see us as allies and partners rather than intruders. We have to acknowledge the fact, though, that we are a foreign body in their universe. That’s not good or bad; it is just part of the reality of EI.

To become less foreign, we build relationships, nurture trust, and share the emotional experience of helping the child so that families learn to feel safe with our presence in their personal space. Most of us do this really well, but then our own professional reality encourages us to go further. It’s not enough to just be a safe and encouraging presence. To achieve our field’s Mission (PDF, New Window)and implement our Key Principles (PDF, New Window), we have to reach beyond that. EI practitioners are tasked with finding ways to help the family practice and embed intervention in daily activities so the child is receiving as much intervention from caregivers throughout the day and the week as possible. That requires that we try our best to join activities beyond the living room floor, where the real parent-child interactions happen most often. It also requires that families let us in. That decision is purely up to them.

The Internal Struggle

Sometimes, the realities of home visiting and meeting the mission of EI can feel like a struggle, an internal conflict that can cause us to question our skills as early interventionists. Some internal struggle can be healthy. I worry, though, that this ongoing internal struggle that practitioners in our field (me included) continue to feel is making it harder to do the overall work of EI. When it’s too hard, we fall back on traditional practices (like playing with the child while the parent watches) and wrestle with ourselves for it. We know better. We go to trainings, watch webinars, and take online courses. Then, we go out on visits and struggle to do what we know we are supposed to do. Why? I think we have to be careful not to answer this question by blaming the family: “They won’t let me into their routine,” or “They are hard to engage,” or “She isn’t interested.” Sure, any of these could be true, but I believe that the reason why we struggle is often much deeper than this.

Complexities

We struggle because the work is complex. It is deeply worthy work, but it can be hard. Every family is different. Every visit is different. Every interaction is different. We have to take what we know and adapt it in a thousand different ways. Yes, sometimes you will work with families without the struggle, with whom you feel the partnership and who embrace their pivotal role in facilitating their children’s development during and between visits. You’ll also work with families facing personal circumstances that interfere with how they take advantage of EI. You’ll work with families who are eager to have you enter their space, and others for whom your presence is a constant reminder that something is wrong. You will meet most of the families who are somewhere in between. No judgement there, it’s just reality again. It’s also a reality that you might support all of these families in a single day with very little interaction or support from peers or supervisors. The complexities of the work plus the complexities of joining families in their emotional and physical spaces can all make for a professional struggle…or a breathtaking experience of personal growth.

Use the Struggle to Help You Grow

When the struggle feels deep, and you are questioning what you do, take a step back and remember those magical moments when you’ve had the privilege of celebrating with a parent when a toddler achieve a well-earned outcome. Pause and reflect on the time you witnessed a mother playfully engage her child after weeks of your own uncertainty about whether or not you were reaching her. Reach out to your network of fellow interventionists who know the struggle and can remind you of your own worth and the value of what you do. You are part of something important. You might struggle. You might forget. You will feel the complexities of EI and when you do, focus on those experiences and connections that remind you why you do this work.

The work is complex. The realities are different for each family. You are the constant so use the struggle to help you grow.

What are your thoughts about the realities, complexities, and struggles of this work?

What do you do when the complexities of supporting families in their personal spaces and fulfilling your mission seem to conflict? 

Share your insights in the comments below.

The post An Early Interventionist’s Internal Struggle appeared first on Early Intervention Strategies for Success.

Ever had one of those experiences where you realize that, while you think you did your best, you completely forgot what you were supposed to do? Ever had that experience on an intervention visit?

I had that experience recently…I was on a first visit with a family and was planning to set the stage for how we would work together. I was going to talk about what good early intervention looks like and how we would work together doing things the family naturally does or would like to do. I was going to stay firmly planted in my role as a consultant and coach for the parent. But, before I knew it, I was instead firmly planted on the floor by an adorable, funny toddler who was pulling out all of her tricks to get me to interact with her. After a few minutes (okay, more than a few), I realized that I was in the lead, the parent was watching, and I had gone off track. I relocated back to the couch and re-engaged the parent, and yet, before I knew it, I was up playing another game with the child. I just kept getting pulled in. In fact, I felt pulled in two directions and both of them were worthy. After the visit, I got in my car and realized that I felt like I had completely forgotten what I intended to do on the visit, which was focus on the parent-child interactions.

Was What I Did Wrong?

So that’s the question that came up for me…was what I did wrong? By spending time engaging the child, did I break the code of evidence-based early intervention, which focuses on supporting parents and children during their interactions in the context of their routines and activities? Honestly, I don’t think so, but what I did probably wasn’t the best way to help the parent know how to use intervention strategies with her child when I wasn’t there. Yes, she watched…yes, she talked about how she could use the strategies during the day…and yes, we developed a joint plan. What I could have done much better was remember to offer her the opportunity to practice using the strategy with her child. That was what I forgot.

So the more I reflected, the more I realized that I’m not sure that we were ready for the practice piece. It was a first visit and we were still getting to know each other. Even if I had remembered and offered practice opportunities, I’m not sure that she would have been comfortable yet. In typing that, I realized that it sounds like an excuse…well, she wasn’t ready so we didn’t do it. No – that is my assumption and it could be incorrect. I did not offer her the chance to try to strategy so how did I really know whether or not she was ready? Just thinking through that reminds me of what I’ve heard so many parent advocates say: “Don’t make decisions about what we need or what we want to do. Give us the information, provide the opportunities, and let us decide.” That was where I goofed.

Developing the Partnership that Facilitates the Practice

I do think that the close partnership between an early interventionist and a parent takes time to develop. Offering the parent the opportunity to take the lead, be observed, receive feedback, and decide which strategies he/she wants to use are activities that don’t need to wait until we have a certain level of rapport built. However, I think understanding that as the relationship builds, BOTH of us will feel more comfortable in our roles and those easy back-and-forth interactions of reflection, practice, and feedback should happen more fluidly. It has to start somewhere, though, and if I don’t remember my role in facilitating it, it may not happen. I set the tone of the visit, and I want that tone to be that I am there to support the family, not to just play with and teach the child.

Reflection is hard, but we don’t have to be hard on ourselves. I’ll go into the next visit with a greater awareness of what I need to do and how I hope to help the family. Yes, I’ll still likely get pulled right in by an amazing toddler, but next time, I will remember to pause and invite the parent along for the fun. Or better yet, maybe I can join their fun instead!

Have you ever felt like this? What did you do?

How do you balance engaging the parent and the child? What do you do to keep yourself on track?

The post Oops…Guess What I Forgot? 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.

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

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

Authentic Assessment

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

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

What questions do you have about implementing functional assessment? 

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

Share your thoughts by leaving a comment below!

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

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

Authentic Child Assessment Practices Checklist

The post Functional AND (not or) Traditional Assessment appeared first on Early Intervention Strategies for Success.

You are visiting Mason at his child care center for the first time today. When you arrive, you find the classroom to be super busy, with eight toddlers and two adults. After introducing yourself to the lead teacher and the assistant, you explain how EI visits usually work and ask how you can help. You try to join the art activity and talk with the teacher more, but the teacher answers in short sentences as if it’s hard for her to concentrate on the children and on your questions. Eventually, the teacher mentions that the classroom next door is empty and asks you if you’d like to go work with Mason in there.

What do you do?

Strategies for Working with the Child Care Provider & Child IN the Classroom

So what do you do when you walk in the classroom and are told to walk right out? Asking you to pull the child out into another room could indicate several things about what the child care provider may be thinking. Here are some strategies for dealing with the possibilities:

Possibility #1 – She doesn’t understand the purpose of your visit. 

The child care provider may think that you are there to provide therapy to Mason. She may not want to get in the way or have the other children distract you or him. Take the time to reiterate your roll as a support to her. Tell her that you are there to work together with her and her assistant to find ways to encourage Mason’s development during the activities that they do everyday. Let her know that you’d like to explore what they’ve already tried and what they’d like to do with Mason. Explain that if you pull Mason out of the classroom for therapy for one hour a week, then he’s not really getting much intervention. However, if you work with her and she’s able to implement intervention strategies throughout the week, he’ll get much more intervention, which is ultimately the goal of your visit. Don’t forget to ask how this sounds to her, if it is “doable.” What she thinks really matters.

Possibility #2 – She doesn’t know what to do with you.

This is just as likely in a child care center as it is in a home. Caregivers often don’t know their role in the collaborative partnership. Describe how you can work together. Ask her if she is okay with the first few visits focusing on getting to know her classroom and how Mason behaves there. Let her know that you will spend a lot of time talking with her and helping her and her assistant try out strategies with Mason during the activities in the classroom. You’ll help her come up with ideas, try them out, then reflect on them and problem-solve so she feels confident using them when you’re not there.

Possibility #3 – She doesn’t think there is any real reason for you to be there.

Sometimes, child care providers disagree with families about the child’s development. Maybe she thinks Mason will talk when he’s ready. Maybe he talks more at school than he does at home. Before you jump into strategies, find out her thoughts on his development. Tap into her expertise. If she doesn’t think he needs intervention, then ask how his communication (or motor development, or social skills, etc.) compares to other children in the room. Ask about what goes well for Mason and what challenges him – and what challenges her during the day with Mason. Maybe she doesn’t think Mason needs to talk yet, but the fact that he drops into a tantrum ten times a day is a big challenge. Find out about her day and determine how you can help – same as you would with a parent. After that, if you still don’t have her “buy in,” talk to the service coordinator and the parent about what to do next.

Possibility #4 – This is just not a good time for your visit.

It could be as simple as art time is usually chaos with eight toddlers so is not a great time for a visitor. Ask the question. Maybe another time of day would be better. Outside play time is often a great time to see the child move about, interact with others, and still be able to snag the teacher’s attention. If she needs you to come at a certain time of day and you don’t have that available in your schedule, you may need to contact the service coordinator to discuss changing providers. Working in child care requires a great deal of flexibility – even being flexible enough to realize that you may not be the best match for the situation, and that’s okay too.

Hopefully, after you’ve explored the possibilities with the teacher and helped her understand why you are there, you’ll all be on the same page and ready to work together. The collaboration between you and the child care staff is what will keep you IN the classroom!

What are your best strategies for dealing with these possibilities?

What have you done when asked to pull the child out of the child care classroom?

Share your experiences and ideas in the comments below!

The post The Teacher Wants You to Pull Mason Out of the Classroom…What Do You Do? appeared first on Early Intervention Strategies for Success.

Finally…some sunshine and warm weather! This time of year is a perfect time to break your floor play habit and get up and move around. Taking early intervention outdoors does not have to mean that you just move your bottom from the living room floor to a blanket of toys out in the grass, which is what we often do. What you do outdoors really depends on what the child and family already do out there. It’s your job to find out what learning opportunities are available that could be used to address the IFSP outcomes. If you break down your journey between the floor to the great outdoors, you’ll find there are tons of opportunities out there!

Outdoor Natural Learning Opportunities

Here are some specific opportunities that might be hiding in plain site:

Transitioning from in to out – Observe what the family typically does to get ready to go outside. Listen for the words they use. Look for opportunities for the child to participate in putting on his socks and shoes, asking to go out, and then following the direction to open the door. Watch to see how he moves down the stairs, steps from the sidewalk to the grass, and waits (or doesn’t) for his parent to come along.

Following their lead – Invite the parent to show you what they normally do outside or to show you things she’d like for her child to be able to do. Dig in the garden, make a mud pie, rake some leaves, go get the mail, chase a squirrel, kick a ball back and forth, or coach the mother in how to seize all of the opportunities that happen on a simple swingset. If she wants her child to do one of these things, then that’s where you focus – on how to help her make it happen.

Walking on different surfaces & feeling different textures – Find out how the child moves from the grass to the mulch under the swingset. Notice how he manages the different textures of grass, bark, and dirt on his feet, legs, and hands. Can he shift his balance to take a step down on his own? Does he raise his hands up and widen his gait when on uneven surfaces? Talk about it and problem-solve ways to help him maneuver.

Weaving in playful communication – Listen to see how the parent and child interact when outdoors – is it different from what you’ve noted inside? Does the child check in with his mom when he moves across the yard? Use the objects in the yard and follow the child’s lead to find his interests, keeping in mind the IFSP outcomes that you are there to support. Model how to use playful communication to narrate the child’s experience and engage him as he explores. Seize the opportunities when the child needs help or wants something to coach the parent in how to apply what she’s learned indoors to communication outside.

Transitioning back inside – There is always a time when the child must go back inside, so watch to see how that goes. If it’s a struggle, explore the possible reasons why and problem-solve with the parent about how to improve it. Does she give him cues that the transition is coming? Coach her as she tries a new transition strategy, such as racing the toddler to the door, taking his hands and jumping him inside like a bunny, or giving him something to carry. Once inside, let the child participate in the activities that get him settled back in, such as following a direction to take off his shoes and put them away, washing and drying his hands, and asking for more to drink or a snack.

You probably won’t go outdoors for every visit this spring and summer, but when you do, look for each and every natural learning opportunity that present itself. Consider your role in helping the parent learn to recognize and seize each of them to encourage the child’s development. This is often easier when the parent expresses a concern that gets us up off the floor and out the door (like a concern with getting in the stroller). Keep in mind that moving outdoors can be a wonderful way to re-energize early intervention, even when going out is just for pure fun!

A Challenge for You

As you make this transition, challenge yourself – see how long you can go without planting yourself in the grass. When you think about it, how long do many toddlers really sit down anyway, especially when they are out in the fresh air? Join the parent and child in the sandbox or on the swings. Dig in the dirt, hide behind a tree, take a walk, watch the ants – enjoy the change of scenery!

What’s your favorite story about moving early intervention outdoors?

Share your success story in the chat below!

The post Time to Take Early Intervention Outside! appeared first on Early Intervention Strategies for Success.

Are you Service Provider A or Service Provider B?

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

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

Which Provider are You?

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

A Team Challenge

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

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

Strategies for Making It Easier

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

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

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

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

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

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

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

Which provider did you identify with?

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

Share you thoughts in the comments below.

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

This will come as no surprise to you as an early interventionist…findings from a new study in the online journal JAMA Pediatrics suggest that electronic toys are not so good for toddler communication development. Shocked? I knew you wouldn’t be.

Electronic Toys & Play Interactions

I often found this to be a big challenge on intervention visits – the plethora of electronic toys and books. I would try to join the family as they played with their toys, and found it hard to coach the parent in different ways to engage the child with these toys. The child would often delight in pressing the buttons (sometimes over and over again) to make the lights, sounds, or voices play, but that was about as creative as the play got. The parent would try to talk about pushing the button, ask the child to find a particular button, imitate the sound that played, or maybe praise the child after he found the button. That was often the extent of the language displayed, not because the parent wasn’t trying, but because the repertoire of activities that can be done with many electronic toys is just so limited. You might think, wait a minute, an iPad or the latest Fisher Price toy can do a ton of things…that may be true, but consider this…how can the parent interact with the child while the toy is doing all the work?

Too Many Buttons, Too Few Words

In the new study, parent-child communication was measured when the each dyad was playing with three kinds of toys: electronic toys, traditional toys (like blocks), and books. Children in the study were between 10-16 months of age. When parents and their toddlers played with electronic toys, both said fewer words. There were fewer conversational turns between them, the parent responded to the child’s utterances less often, and the parents used fewer content-specific words. This really matches what I’ve seen on visits and actually, what I’ve experienced when playing with toddlers with these toys myself. It’s just harder to communicate around electronic toys and books. I don’t necessarily thing that electronic toys are “bad” for children – in moderation. Electronic toys grab a toddler’s attention, and I think they are really well-marketed to grab ours (as adults). In moderation, a few lights and sounds toys can be fun. Too many, though, can hijack a child’s attention and make it harder for the parent and child to interact, which is so important for communication and social development. Like most things, it’s probably about balance. A few noisy, flashy toys with more traditional toys, like blocks, cars, baby dolls, rattles and (lots of!) books can go a long way, especially when there is a responsive adult playing along with the child.

A Few Suggestions

So, with this said, what’s an early interventionist to do in a home full of electronic toys? Here are a few suggestions:

Observe parent-child play – You might find that the pair are having a blast and interacting fantastically with whatever toy they have. Or, you might find that they are struggling to interact with toys that trap the child’s attention away from the parent. If a toy interferes with communication, talk to the parent about it, not in a “you bought the wrong toys” sort of way. Ask the parent what she notices about her child’s communication when he plays with his lights and sounds toy, and I bet she’ll say that he doesn’t talk much. That gives you a great lead-in to explore this topic with the parent.

Remove the batteries – I’m not suggesting that you remove them when the parent’s back is turned. Rather, if the child loves his animal farm that makes all of the animal sounds for him, ask the parent what she thinks would happen if the batteries were removed. Sure, the child might not be very happy at first, but when he figures out that interacting with his mom while she makes the silly sounds is much more fun, the parent might see how her interaction with her child, rather than the toy, can make a big difference.

Don’t play with toys – Wha? Yes, how about you suggest to the parent that on the next visit, that you do something else. Ask her what they like to do, what’s fun for them. Ask what they would be doing if you weren’t coming and plan to do that. Early intervention can be immensely successful without toys. Try it and you’ll be amazed. Don’t go in and automatically plop on the floor near the toy box. Afterall, parents really don’t spend most of their day playing with toys of any kind with their toddlers. Instead, they are running errands, fixing meals, doing laundry, cleaning the house, taking walks, getting the mail, etc. Join those activities on your next visit and help the parent seize the natural learning opportunities as they happen.

This is a fascinating subject to me. I love toy play, but I think this study reminds us that there are so many other fun and effective ways to interact with children that have nothing to do with batteries or lights and sounds. Sometimes parents need that reminder, and sometimes early interventionists do too.

Okay, now I am officially stepping down off of my soapbox, dismounting from my high horse. 🙂

What are your thoughts about electronic toys and infant/toddler development?

What do you do in a home full of electronic toys?

Share your thoughts and ideas in the comments below!

Reference

Sosa, A. V. (2016). Association of the type of toy used during play with the quantity and quality of parent-infant communication. JAMA Pediatrics, 170(2), 132-137.

The post The Challenge of Electronic Toys on Visits appeared first on Early Intervention Strategies for Success.