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.

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

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

5 Strategies for Responding to Discomfort

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

Here are 5 responsive strategies to help you manage discomfort:

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

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

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

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

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

How Much Discomfort is Okay?

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

What do you do when a parent seems uncomfortable? 

Share your experiences and strategies in the comments below!

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

It’s Thursday afternoon and I’m banging my head on the steering wheel after my home visit. Why? Because I’ve spent the last hour coaching this family to stop giving their two year old a bottle when she can drink from a sippy cup, straw, and an open cup. It’s not like we haven’t worked on this IFSP goal every week for the last 4 months. It is such a struggle for me–what is the point of me going if they aren’t going to follow through?

WAIT! The struggle isn’t about me.

I recently came across this video about leadership and coaching that used a butterfly emerging from a cocoon as an illustration. The man watching saw the butterfly struggling and finally decided to help. Unfortunately, the struggling is important for the butterfly’s wings and body to correctly form. By helping, the man caused more harm than good.

This made me ask myself: Am I helping this family by sharing my experience and knowledge with child development or am I harming them by not coaching them to solve the problem themselves?

The following coaching strategies recommended in this video shaped the next few visits I had with this family.

Ask Questions – I asked more questions about the bottle. I learned that the issue isn’t the little girl drinking from a bottle, but being consoled in the middle of the night when she cries too loud and wakes up other family members.

Explore the Situation – I was able explore the family’s bedtime routine and brainstorm with the family possible replacement behaviors for the bottle to soothe the little girl.

Have Patience – It has been two more months since I began viewing this struggle differently. The little girl is still taking the bottle, but the family is trying some of the strategies we come up with during visits. More importantly, they have shared other challenges and ways they have tried to work through them (they don’t wait for me).

The struggle is still real, but I now realize how important it is for the family and I can see the beautiful results emerging!

What are some of the problems your families have struggled with?

Are you coaching to solve their problem for them or coaching them to solve problems themselves?

Laura Harrell is an Early Interventionist and Early Intervention Resource Agency Manager with Prospect. She has provided developmental therapy to families just east of Nashville for the last three years. Laura previously worked for ten years in Alabama with Early Intervention, Childcare Enhancement with a Purpose, and Assistive Technology. She can be reached at: Lharrell@prospectinc.com

The post The Struggle is Real…Important 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.

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.

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.

Pop Quiz: What is the activity that families report in the literature as the most helpful thing that happens on EI visits?

Answer: Problem-solving

Are you surprised? It makes so much sense when you think about how much you talk with families about their challenges – teaching the 18 month old to sit in the grocery chart, understanding a toddler who uses elaborate jargon and no true words, helping an infant feed without aspiration, etc. Being a resource for families is an important part of what we do. However, being a resource does NOT mean that we have all of the answers. Giving answers isn’t the same thing as problem-solving.

Consider this Scenario

Jason asks Camilla (the occupational therapist) how to help his daughter, Breanna, eat a wider variety of foods. Right now, all she will eat is macaroni and cheese and Pringles chips. Camilla suggests that Jason start offering an unfamiliar food along with Branna’s favorites at each meal to expose her to different foods and maybe offer a cheesy dipping sauce since she likes mac and cheese. She also says that she will bring a great handout with some ideas to her next visit. Then, they return to working on Camilla’s ability to use a spoon to feed herself.

Clearly, Camilla did not do any problem-solving here. She spouted a few general suggestions and promised a handout without any idea of what Jason has already tried, why this was important to him, or how he envisioned success. Problem-solving with Jason would require much more effort and attention to what is unique about Jason’s and Breanna’s situation. It requires flexibility to allow the activity of an intervention visit to veer away from what was planned, to go where the family needs it to go. It also requires that Camilla step out of her standard answers and dig deeper into what the parent needs. These are not always easy for service providers (or service coordinators, who often find themselves in similar situations when asked for resources or to help out in a crisis).

Tips for Collaborative Problem-Solving

Collaborative problem-solving is a reciprocal process that focuses on a real situation for a child and family. Whenever possible, it works best when it happens in the moment, rather than by discussing a hypothetical situation. For instance, the service provider observes a challenging situation with the parent and child, then the parent and provider problem-solve together about how to improve it. Here are a few strategies for problem-solving with families:

Ask for the parent’s perspective first – Ask the parent “What did you think about that?” or “How did that feel to you?” Another good idea would be to ask the parent what he has already tried. This reinforces the importance of the parent’s perspective on solving the problem and gives you valuable information.

Find out the parent’s goal – A great next question would be “If this situation was better, what would that look like to you?” Again, find out what the parent’s goal is for improving the situation because it may be different from yours. Then, ask “What could be done differently here to get closer to that goal?” Let the parent think a bit before offering suggestions.

Offer suggestions if needed – Many of us skip straight to this step because we have so many child development strategies floating around in our heads. Collaborative problem-solving involves helping the parent solve his own problem, with your support. If you just give general suggestions, I guarantee that most of them will bounce right off the parent because they won’t be obvious to him how he can use them. Taking the first three steps first will help you link the right solution to the actual goal. Just be careful to avoid the “have you tried…?” trap.

Be specific, especially when the parent lacks the experience to offer a solution – Parents are great problem-solvers, but when they ask for your help, they often really need it. This doesn’t mean you have to spout answers, though. Offer information, maybe a choice of possible strategies, then let the parent decide what to try.

Let the parent decide – Let him choose how to solve the problem, then let him try out his choice with your support nearby. Coach him through using the strategy if needed, then reflect on the success of the strategy together.

Loop back to the original goal – This is an easy step to forget. Once the parent has a plan, wrap back around to the original challenge by asking if the parent feels that this plan will address his goal for the situation. If not, work through it some more. If yes, write it down with the parent so he has a record of the steps to solve the problem. This will help him remember what to do between visits when you aren’t there.

Follow-up on your next visit – Always.

Instead of telling Jason what to do, Camille may have been more helpful had she taken the time to explore Jason’s question more fully. Then, she would have learned that he had already tried offering other foods but Breanna seems to choke on anything chunky like meats. He’s also noticed that she gags really easily and seems to have a hard time moving food around in her mouth. The solutions to this problem are unlikely to be found by simply offering more foods or dipping sauce or reading a handout.

When a challenge surfaces, seize the opportunity to collaboratively problem-solve with the parent. It’s in this problem-solving that we can make such a big difference in the quality of life for a child and family.

If you were Camille, what would you do next?

What challenges do you face with trying to help families problem-solve?

What’s your biggest problem-solving success story?

Share your ideas and experiences in the comments below!

Reference

Woods, J. J., & Lindeman, D. P. (2008). Gathering and giving information with families. Infants & Young Children, 21(4), 272-284. (PDF, New Window)

The post The Value of Collaborative Problem-Solving 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.

“Emma runs away every chance she gets. Open a door and she bolts. Try to walk with her into a store and she screams until she wiggles free. We can’t take her anywhere!”

This is how Emma’s mother describes one of the family’s main concerns. Emma’s behavior is difficult for them to manage, and one of the routines that is especially problematic is taking her on errands. Emma seems to crave movement and dislikes being contained; she doesn’t like having her hand held, being in the shopping cart or riding in a stroller. Because of this, her family is unable to go out together, as one parent must stay at home with her. This is disruptive for the family and limits Emma’s learning opportunities too. If you were Emma’s EI service provider, how could you help?

Typical Toddler Behavior or Something More Challenging?

This is a rather common scenario for many toddlers. At one point or another, they grow out of wanting to be contained, or even slowed down. Most will move through this phase without too much strife. For some children, though, this time can be very disruptive for the whole family. It can also be complicated by a child’s limited expressive and receptive language skills, lack of attention to safety, or sensory processing differences. Improving a frequent routine like running errands can be equally, if not more important, than teaching a child a specific skill, like asking for juice or waiting her turn.

Baby Steps to Successful Behavior

Here are a few ideas for addressing this challenging behavior in the context of Emma’s family’s errand-running routine:

Find out what everyone does before, during, and after running errands – Look and listen for clues about what motivates Emma to continue running. Is there something that happens before the errand that preps her for an uncomfortable experience – like being snatched up to get in the car without warning? Is Emma somehow rewarded for the behavior (ex: she gets her mom’s phone to play on as a distraction after she tries to run – big reward!).

Ask the parent what she would like to have happen instead – Be sure to ask and not assume. What the routine looks like when it’s successful may be unique to that family, and may be different from what you envision.

Break the routine down in to its small steps… – Especially when it’s a big challenge that has been going on for a while, back up with the parent and talk or walk through the smaller steps, like getting Emma ready to get in the car, buckling her in, riding in the car, getting her out of the car seat, walking across the parking lot, putting her in the shopping cart or stroller, etc. The solution probably lies in one of these steps.

…Then break the strategies down further into baby steps – Rather than tackling the entire routine at once, start at the very beginning and inch toward a solution. For example, if Emma runs as soon as she’s out of the car, start there. Help Emma’s mother teach Emma to hold her hand in the parking lot. Coach her through taking Emma’s hand, taking a step, and stopping if Emma pulls or tries to drop to the ground. Coach her through stopping each time Emma fusses, waiting for Emma to settle down before taking another step, then praising Emma as soon as they are able to walk again. Help Emma’s mother teach her daughter what the expectations are for going out on errands. Prepare her for the time, consistency, and practice needed to teach Emma a new way of being during outings. Look at it as if you are addressing a routine within a routine; the baby steps make up the big journey – especially when improving a challenging behavior.

Be there when the parent practices – Stand beside the parent as she tries out these strategies in the parking lot. Reflect with her on what works and what doesn’t. Model if needed, but more importantly, coach her in the moment and share feedback to help her learn how to teach her child. Overcoming a challenging behavior like this can be such a confidence booster for a parent. Having someone there beside her, someone who won’t judge her and who is there to as a problem-solving partner, can not only help her help her child, but also improve the family’s quality of life and that’s a powerful thing.

Thinking about behavior in terms of the routine in which it occurs can help the service provider frame intervention strategies in a real world context. It’s only so helpful to talk about general strategies a parent might use…the “have you tried…?” way of addressing a family concern. Just talking is not very likely to help the parent change the child’s behavior or the situation. Jumping in and joining the troublesome routine is always the best way to go, but this can be unnerving for the parent who is probably afraid of what will happen with you watching. Taking a routines-based approach to challenging behavior and addressing the challenge in baby steps can be a very effective, non-threatening way to support families and make the intervention strategies you develop together much more manageable and meaningful.

What strategies have you used with families to help them address challenging behaviors like Emma’s?

Share an example from your experience!

The post Using Baby Steps to Address Challenging Behaviors during Real Routines appeared first on Early Intervention Strategies for Success.

It is hard to believe but it is almost May!  The final Talk of the two-part series, entitled “Ditch the Animal Sounds: Writing Appropriate Outcomes that Lead to Effective Implementation,” will be presented live on May 5^th!  In anticipation of the upcoming webinar, I am excited to share with you just a few of the key points that I will be presenting in the session

In my first two blog posts on articulation and addressing language development, I talked specifically about how important it is to remember that functional services should be based on the appropriate diagnoses of the young children with whom we work.  These kids DO need services—but when we are diagnosing appropriately and accurately, our services for infants and toddlers will typically be based on a diagnosis of a language disorder versus a speech sound disorder. With that in mind, we should, therefore, be providing services that focus on language development rather than on speech sound development…or better yet, we should be using best practices by coaching families to facilitate speech sound development within (rather than separate from) activities that target functional communication by and with the child!

Sounds easy enough to do, right?!

Outcomes – Focusing on What’s FUNCTIONAL

When we are working with a child who is really struggling to get his basic needs or wants met because he does not have the LANGUAGE, focusing specifically on and teaching a child to produce a bunch of animal sounds is really not a FUNCTIONAL choice.  So a child learns to ‘moo’ or ‘meow.’  Does that really help him get a drink of milk or call his mom when he needs her?!  Those sounds can be fun…and for most children, they really do grab their attention and make them smile…if not even eventually imitate.  But what about those children for whom language is a challenge?  When writing outcomes, animal sounds, environmental sounds, and silly sounds are just not functional.

…Think about this for just a minute…

Is the family’s goal for this child really to produce animal sounds or to imitate the sound of an airplane or a car engine?!

When we work with young children who are struggling with language development, we recognize that they need to be able to produce sounds in order to produce words.  Those sounds, however, need to be addressed within functional, natural contexts.  Addressing a child’s ability to obtain needs and wants by learning how to label desired objects or to make a verbal request…THESE are functional outcomes.  In order to request a drink, or to ask for more, or to label the boots that a little boy wants to wear to play in the snow, he needs to be able to produce an approximation of the words “milk”…and “more”…and “boots”.  While the outcome itself is not to produce the /m/ or the /b/ sounds specifically, the production of these sounds can and should certainly be EMBEDDED into the intervention itself.

What should these outcomes look like?  Need examples of functional outcomes for a toddler who presents with an expressive language delay or disorder?  How can or should we select target words to include within a child’s outcomes? Join me for the May 5^th Talk on Tuesday to answer these and other questions you may have about writing outcomes!

Intervention: What Does It Look Like?!

When I work with families, I always keep a few key considerations in mind…and these considerations—or TIPS—tend to form the foundation by which I coach the parents and the caregivers on ways that they can embed speech sound development into their everyday activities and routines.  Each of these tips is intended to help families embed speech sounds into play-based or routines-based, language rich activities while they are engaged with their children. By now, we are all aware of the fact that children need to be able to make sense of stimuli in order to learn from it.  In order for a child to process information, it needs to be presented within a normal, naturally occurring event or opportunity in his or her own environment.  Using flashcards to teach sounds or words, or creating superficial teaching opportunities like pushing a child to imitate sounds, is not going to work.  Infants and toddlers truly do NOT learn, and ultimately develop, speech or language through artificial methods.

Instead, their verbalizations—their LANGUAGE–should be based on models that we have provided within the natural routines and activities—these are the opportunities that will have meaning, and positively impact learning, for, a child. Young children will naturally imitate the speech sounds that are embedded within the language that they can, and want, and need to use within their everyday lives–even those who are struggling with their language.  They do NOT, however, tend to imitate sounds that do not have a place within naturally occurring, everyday activities and routines—and those are the opportunities in which we can encourage and coach families to embed sounds in language.

So…anyone want to know what these fancy tips are?  Again, be sure to tune in to the May 5^th Talk on Tuesday to learn more about how to work with families and coach caregivers to embed speech sound development into everyday routines and activities. 

Do you have some tried-and-true strategies that you use to embed speech sounds into natural learning opportunities with the families with whom you work? 

Share your ideas here!

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

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

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

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

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

Address the Language: The Speech Will Follow!

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

The post Ditch the Animal Sounds! – Who’s Ready for the Next Talks on Tuesday?! appeared first on Early Intervention Strategies for Success.