An important and ongoing part of a service coordinator’s job is gathering information from families about their child and how that child fits into the daily routines of their life. This information ebbs and flows, changing as children and parents develop together over time. By gaining insight into these routines service coordinators can facilitate an IFSP rich with meaningful outcomes and goals and can aim to provide services that best meet the needs of the child and family. Come walk a mile with me as we step through a day in the life of a family. Simple though it may seem, let’s start in the very beginning…

It’s time to wake up.

There’s so much information that can be gained by simple, open-ended questions about how a child moves through his/her day. Does a child wake up like a ray of sun or a storm cloud? Does the 7-day forecast call for sunshine or partly cloudy skies? Ask questions about what constitutes a child’s daily routines. Also ask how that child is participating in their day within those routines. If a child starts their day in tears, does it continue to pour or are there rainbows?

Little Sammy wakes up with the sun with tears in his eyes. He calls out “mommy” while sitting in his toddler bed. After a few minutes of snuggles he’s ready to start the day. When his mom asks what he wants to wear today he pulls open the dresser drawer and says “Paw Patrol” while pulling out his shirt. He lays down on the bed in anticipation of having his diaper changed. He grabs it and says “peepee.” As soon as he is dressed and dry he runs out the door calling out for “daddy” and tells him he’s ready for “a snack” (aka breakfast). He pulls over the kitchen stool to the pantry. He gives a “bar” to dad for help opening the package.

This small part of Sammy’s morning routine alone contains a wealth of information. He has a healthy attachment to his parents. He is growing in independence. Sammy recognizes the routines in his day and participates in dressing. He is showing early signs of readiness for toilet training. Sammy calls out to his family by name. He is using words to tell others what he needs and to identify when he needs help. He is using nice problem solving to figure out how to get something himself. What other things can we ascertain about Sammy from the first 15 minutes of his day?

The days are long, but the years are short.

Most of us are probably familiar with this little adage but unless you are still in those days, then it can be all too easy to forget just how long the days can be. As the family talks about the ins and outs of their daily routines, ask follow-up questions about the child’s likes and dislikes, what do they love to play with and how do they play with it, and what happens when it’s time to stop doing that activity. Are there times of the day the family dreads? The family’s answers can provide a valuable insight into what direction to take with the providers as you plan for the assessment and segues smoothly into the conversation about the family’s concerns and priorities. It can also help you identify challenges within the day the family might not recognize as a challenge.

Service Coordinator: Does your son take a nap?

Mom: Yes, after lunch.

Service Coordinator: How long are his naps?

Mom: Usually about an hour and a half.

In this interaction we’ve established that Sammy takes a nap but a few follow-up questions might reveal that Sammy can easily take up to an hour (or more) to fall asleep and will only stay asleep with his mom next to him. It’s a challenge and frustration for his mom because she doesn’t have that time free to get a few things done around the house. Meanwhile, at daycare he’s the only child in the room that doesn’t nap. His teachers have given up rubbing his back and he now spends the 2 hours lying still in his cot not allowed to talk or move. He has come to associate daycare with being forced to lie still for 2 hours and now drop-off has become a challenge, filled with tears and begging not to go. Take a moment to reflect on how you frame questions to families about their child’s routines. Challenge yourself to think more reflectively and capture the quality of the routines.

Pulling it all together.

The benefits of delving more deeply into daily routines and activities during the development of the IFSP are numerous. Those benefits include a broader knowledge of the child’s natural environments and possible locations for services to take place in the future, capturing challenging moments in the day that might not have been reported at the initial referral, and identifying naturally-occurring routines that can be used to develop richer, more meaningful outcomes and goals for the child and family, only to name a few. Empathy and open-mindedness are useful tools that will enable you to meet a family where they are. Using those tools to gather information from families about their child and how their child fits into the daily routines of their life lends itself naturally to capturing a true picture of a child’s development and functioning that enables us to move beyond our assessment tools. Early intervention supports and services are bound to be more successful when they’re meaningful to the family and embedded naturally into the child’s daily activities and routines.

While we walk alongside a family in the direction of their rainbow, what questions can you ask to better understand how to walk a mile in their shoes?

Share your ideas in the comments below.

Kimberly Morse, MS, CFCS-HDFS, EIP, lives and works in Chesapeake, VA. She holds a BA in Psychology and MS in Child Development and Family Relations. She began working in Early Intervention for the State of North Carolina in December of 2008. She relocated with her family to Virginia in 2015 and resumed working in Early Intervention first through the Infant and Toddler Connection of Norfolk and currently through the Infant and Toddler Connection of Chesapeake. Kimberly and her husband Matthew have 2 little boys, ages 2 and 6. Days spent as their mother are filled with loving memories, a few tears, and a healthy dose of humility and perspective. Kimberly can be reached at kimberly.morse@chesapeakeibh.net.

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Okay, when you read that title, maybe you were curious, wondering if you were going to learn about three new discoveries that will make your job easier. Or, maybe you did a quick eyeroll, thinking “Here we go, the next big ‘thing’ that I need to do.” Either way, I’m glad you’re here. While I’m not sure that these three interventions will make your job easier, I do think they can make your work more effective. No, these interventions aren’t new or the next big “thing,” but they are based on the evidence we have about what early interventionists do that has a positive impact on child and family outcomes – meaning child development is enhanced, children learn and participate in everyday activities, families understand how to help their children, and quality of life is improved. One of the key aspects of these three interventions is YOU – how you interact with families and what you do to support parent-child interaction. You are a key, so read on and learn what you can do on your next visit to have that positive impact.

Here we go. Interventions that:

1. Emphasize caregivers’ awareness and interpretation of their own actions,
2. Help caregivers identify and use everyday learning opportunities to enhance child development, and
3. Support caregivers’ responsiveness to their children

have been found to be most effective in positively impacting child outcomes (Dunst & Trivette, 2009; Mahoney, 2009; Swanson, Raab, & Dunst, 2011). That’s big stuff. In this post, I’ll tackle what the first intervention looks like in practice. I’ll discuss the other two interventions in Parts 2 and 3.

Emphasize Caregivers’ Awareness and Interpretation of their own Actions

When you implement this intervention, you go deeper than just modeling or teaching caregivers intervention strategies. You approach intervention from the perspective of expanding how the caregiver thinks about her (or his) capabilities, her impact on her child’s development, and the positive effects of her everyday interactions with her child. Some caregivers come to EI already embracing their influence as the parent, but many are in the vulnerable position of being a new parent or a parent of a child with strengths and needs that are different from what they expected or previously experienced with other children. Early intervention can be a new window through which to see a child’s potentialities, and we can open that window with how we approach the support we provide.

I truly believe that it’s not enough to tell families that “you are the expert on your child.” Those can be empty words if we don’t back them up with support that builds on what caregivers already know and do. We need to convey, through practice and intentional interactions, that the parent is just the right person to help her child grow and learn, she is enough, and what she does really matters. She may not have entered the program knowing how to stretch her child, how to prompt her child to increase vocabulary, how to teach her child to sign, or how to regulate herself so that her child learns to manage his emotions – and that’s all okay. We are there to teach, guide, and help the caregiver become aware of, embrace, and learn to interpret the link between her actions and her child’s behaviors, interactions, and learning. That’s a deeper level of engaging families, a level at the core of who a parent is. Full disclosure – I don’t think this is easy (often it’s not), but I completely believe that if we walk in the door of every visit with the perspective that we are there to look for opportunities to build the caregiver’s awareness of her own actions and help her learn to interpret that impact, what we do and how we do it changes – for the better.

What Does This LOOK LIKE in Practice?

Here are some strategies I’ve learned from EI practitioners in recent conference sessions where we talked about this intervention:

Use open-ended questions to help the caregiver reflect and think about what she (or he) is doing and why. Ex: What did you notice…? What did you see Jack do when you…? Why do you think that happened? 
What did you do differently that time? What could you do differently next time to help Jack learn to…?

Look for moments to build awareness and interpretation. Keep your eyes and ears open for opportunities to point out those moments when the caregiver interacts with the child in ways that enhances development. Adult learners typically want to know if they are doing something “right” so reinforcing positive interactions helps caregivers know they are on the right track.

Provide specific feedback that points out what the caregiver did, what the child did, and the relationship between the two actions. Help the caregiver make the connection, then ask what she thinks about it. Ex: When you waited before helping Emma stand up, she reached up for the pack ‘n play bar to try to stand herself up. What did you think about that?

Use video recordings to build awareness and interpretation. Record the caregiver using a strategy with her child using her cell phone. Then, watch the video together and process it using reflection and feedback. Share what you notice and ask the caregiver about her observations and feelings. Problem-solve if the strategy or interaction can be tweaked to help the caregiver get closer to her goal for the child. You can also encourage the caregiver to record short videos between visits to watch together during the next visit. These videos can become joint plans and records of progress too, so their value (and the learning opportunity) expands beyond the reflection point that happens during your visit.

Now it’s your turn:

What strategies have you used to build caregivers’ awareness and ability to interpret their own actions? What did this look like on your last visit?

Share your ideas and examples in the comments below!

In Part 2, I’ll dig into the second intervention to explore how to help caregivers identify and use every day learning opportunities…and what to do when this is hard. In the meantime, pay attention to how you build awareness on your next visit. Use this series to help you celebrate when it goes well and problem-solve when you need help. Let’s learn together!

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.

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