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.

The post Take a Walk with Me appeared first on Early Intervention Strategies for Success.

In evidence-based early intervention, our primary aim is to coach, rather than to “do therapy” ourselves. We teach families how to help their children. The most challenging part of coaching can be finding effective ways to invite parents to participate and join in the interactions with their child.

Location, Location, Location

As therapists, it is natural for us to think about our relationship with the child in service. After all, we are teaching the child. That’s what we are trained to do. Right? Not exactly. We’re teaching the parent, so that the parent can teach the child. That changes the relationship. Our relationship with the parent, and the parent’s relationship with the child suddenly become much more important when we look at them through this lens. As coaches, we know that the interactions that the parent has with the child are primary and we work to keep those interactions at the forefront. I’ve learned to place myself behind a child rather than in front of him during an activity, or to create a triangle between myself, the mom, and the child. This breaks up the traditional child-therapist pair and gives the parent a space to join in. Locations other than the living room floor that can make this easier include the couch, a high chair, a table, or wherever the parent and child typically spend time together.

Start with Routines

Keep in mind that unless parents have been involved with coaching before, they’re probably expecting traditional therapy. All parents want to be involved and want to help their children, but they may not know how to step in and participate, especially during playtime. Coaching phrases like, “Do you want to try this?” or “Can I model that for you?” can feel awkward to deliver if you aren’t used to them. And we all know, if you feel awkward, it will be awkward.

Rather than starting with an activity that we initiate, we can set the stage for authentic parent involvement by observing the family’s natural routines first. I sometimes ask parents what they would be doing if I wasn’t there. Is it snack time? Does little Joey need a diaper change? This leads naturally into a mutual discussion about ways to increase interaction and language in everyday activities. If it is snack time and Joey heads for the refrigerator or brings us his cup, we have a perfect opportunity to introduce a word or sign for “eat” or “drink”, model and practice offering choices to build language, or encourage eye contact as a first way of requesting. Snack time, diaper changes, and dressing are activities that parents generally do so they are more likely to take the lead and give us a chance to support and encourage, rather than waiting for us to lead an activity.

When You Have to Play

If parents seem more inclined to hang back, say that their child normally plays by himself while they do other things, or are otherwise hesitant, we may have to fall back on some more traditional therapy or play activities. This is when we are most likely to lose parent interaction if we don’t keep it at the forefront. If we are looking at a book, rolling a ball, working on a puzzle, blowing bubbles, or doing any other traditional therapy activity, it is very easy to let the focus drift back to us and the child. I have to work to consciously keep the parent-child interaction at the forefront, rather than my interaction with Joey. If we are looking at a book and working on pointing out pictures, I stand or sit behind him and put the parent in front of us or next to Joey on the couch to ask those, “Where’s the…?” questions and help him point out the pictures. This tends to feel much more natural and I find it less intimidating for everyone. It also increases the chance that the next time Joey brings a book to his mom, she will point out a few pictures rather than reading complicated text because we’ve practiced this together.

If I’m rolling a ball or car back and forth, once Joey is into the game I roll or throw the ball to his mom and have her join the game that way. If Joey is having trouble getting into the game, I sit behind him and help him throw the ball to his mom, rather than encouraging him to throw the ball to me. I find that most parents want to participate with us, we just have to invite them in. The responsibility for not pushing parents out is with us, even when we are working with more traditional play activities.

Stepping Back in Trust

Once we have used location, positioning, routines, and a bit of creativity to get parents engaged and interacting with the child, this is when the magic happens. Once we have the parents involved, our job is to get out of the way. When I am in a visit, I feel this as a continual sense of stepping back from the parent-child dyad, maybe most during those times when I really want to get involved. If they are engaged in a social game or activity, the last thing I want to do is get in the way. I may give a suggestion of something to try, but I often stop myself from even doing that much.

Wait It Out

Instead, I tend to smile and nod encouragingly and wait. The last thing we want to do after the parent gets involved is to pull her back out of the activity again and put the attention on us rather than on Joey and the interaction. Generally, it lasts a few minutes and then the child is off to something else. This is my time to open a discussion, starting with, “Wow, he loved that game and he was really engaged with you.” From there we might reflect together and move to brainstorming strategies. If parents struggle with coming up with a strategy I might share some expertise with ideas like, “Next time you play that game with him, wait a little bit longer for him to look at you.” Having parents reflect first gives them an opportunity to think about how an activity went before I add to their thoughts. This encourages them to seek out and capitalize on opportunities for interaction during the time when I’m not in the home.

While it can be challenging to encourage parents to join in on the interactions during visits, paying attention to our words and actions can help us to create space for parents to actively participate rather than watching us play.

What strategies have you found for encouraging parents to join in during intervention visits?

Share your strategies in the comments below!

Stacy Zogheib has been a Developmental Specialist in Arizona since 2006. She has a Bachelor’s degree in Elementary and Special Education from Wittenberg University, and a Master’s degree in Early Childhood Education from Northern Arizona University. Stacy has a passion for supporting and empowering families with young children who have delays or disabilities. You can reach her at: stacypro@yahoo.com

The post Coaching from the Outside 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.

How much do I value families’ everyday routines in being able to positively influence children’s development? So very much. Yet… how often do I find myself on a home visit either: 1) only talking with a family about their routines, or 2) engaging with the family in only the routine of play? Too often!

Values versus Actions

What we know about early interventionists is that they tend to have values that align with current recommended practices about the importance of providing services that focus on families’ everyday routines. However, we also know that even with those values, our services tend to focus heavily on having discussions with families, or when we do participate in routines with them and their children, that routine tends to be play-based.

As the saying goes: ‘It’s easier to talk the talk, than walk the walk.’

Neither of these things, discussions or a focus on play, are problematic. Yet we know that our services have much greater potential to be useful to families and supportive of their children when they focus on the typical, everyday parts of their lives.

Therefore, if we want to be most supportive of families and their children, our actions during home visits need to align with our beliefs about the importance of all types of family routines!

Get Back to Walking the Walk

Many of us may be stuck in the ‘talk the talk’ portion of this – we know and value families’ routines. We may talk and brainstorm with families about many routines each time we see them. But how often are these routines themselves the focus of our visits?

Now may be the time to say to ourselves: “It’s time to get back to walking the walk!” That may mean doing some active observation of a particular family routine and providing strength-based feedback, or it may mean being part of the routine with the family (such as going on a walk to the park together). If we want to get back to ‘walking the walk’ of routines based services, one way to do this is to take a moment to evaluate your visits with families. Pause. Reflect. Be generous with yourself and notice your strengths. Be willing to notice the routines you struggle to be part of with families. Take the time to think about the barriers that either you or the family may face.

You are likely very knowledgeable about recommended practices in early intervention. Therefore, one of the most powerful ways to shape who you are as a continually developing professional is to simply reflect on what you do. Self-reflection can be a great step in the right direction for us as professionals by using it to first identify where we are now, and then set goals about where we’d like to be heading.

A Resource for Self-Reflection

This resource, Self-Reflection Worksheet on Home Visiting, can help you to do some self-reflection. Open up the link and take a moment to yourself, or discuss the questions with a trusted colleague. What do you notice when you reflect on the services you provide? For example:

• How do you spend time with families and their children during your visits?
• What routines could you incorporate into your visits with families in order to move past discussion?
• What are the barriers that you or the families you work with are facing that may make this challenging?
• What are your greatest strengths based on these questions, and what are the areas you hope to improve upon?

Share something you learn from this self-reflection by leaving a comment below!

Kalli is an Assistant Professor of Early Childhood Education & Child Services at Montana State University where her research focuses on early intervention services. Kalli also works part time as a Family Support Specialist through Family Outreach, a nonprofit agency in Bozeman, Montana. As a Family Support Specialist Kalli provides early intervention through home visiting services for infants and toddlers with delays or disabilities and their families.

The post “Walk the Walk” of Routines Based Services through Self-Reflection 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.

“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.

Joey is 25 months old.  He was referred to his local early intervention intake coordinator by his parents secondary to their concerns about his intelligibility and inability to effectively communicate his needs or wants.  They reported that he uses approximately 15 words but “talks in such a garbled manner” that both parents and Joey’s older siblings become frustrated when they don’t know what he is saying or requesting. When asked to describe Joey’s speech, his father noted that it sounds like: “babble-babble-babble-mama-babble-babble-babble, as if he knows he should be talking in longer sentences but he doesn’t have the vocabulary yet to form the actual sentence”.  His mother added that he sometimes sounds like he is humming around his words: “mmmmmmm-ball-mmmmm”.  Joey loves playing with balls.  His family often takes an extra ball with them to Joey’s brother’s soccer practice.  While his brother practices, Joey and his Dad kick the ball. According to Joey’s parents, they find his speech particularly frustrating before meal times; they noted that he loves to help them choose and prepare food for snacktime every day, but that they often don’t understand which foods and/or drinks he is requesting or suggesting.

What to Do? What to Do?!

We see this quite often, don’t we?!  Parents will often come to us with concerns about their child’s intelligibility and “speech skills” because they have difficulty understanding the messages that their children are trying their hardest to convey.  As a speech-language pathologist (SLP), my first goal with this child would be to conduct a comprehensive communication assessment by collecting a speech and language sample.

Within this play-based sample, I would listen for those three speech-related red flags that I presented in the March Talks on Tuesdays webinar and in my previous blog post: 1) initial sound deletions; 2) distortion or consistent difficulty with vowels; and 3) deletion of LOTS of sounds—the child uses only one or two consonant sounds. Ultimately, however, above and beyond my observations regarding Joey’s speech productions, I would assess whether he is using the language skills that are developmentally expected for his age.

Typical Language Development vs. Expressive Language Delay or Disorder

Keep in mind that we expect children to have a vocabulary of at least 15-20 words by 18 months, although typically developing children often have more than 50 words and are beginning to string simple, repetitive 2 word phrases together (e.g. more drink, my juice) by this age.  By 24 months, we expect a children who are typically developing to use AT LEAST 50 words and to combine lots of different phrases. Between 18-24 months, children may still use some jargon to expand their sentence length and to attempt to provide “more information” in their messages.  If you have a child who is 20-24 months and using a lot of jargon and not a lot of words, however, you are probably looking at a child who has an expressive language disorder.

Is It a Language Disorder or a Speech-Related Disorder?

Toddlers who are extremely difficult to understand are often still using a lot of jargon when they speak because they lack vocabulary…or have difficulty with grammatical markers… or struggle to put words together into phrases.  All of these are skills that are expected by two years of age.  We typically expect that jargon (which can be defined as “babbling with intent”) will begin to fade at about 18 months and completely dissipate by 24 months.  If a toddler has an expressive language delay or disorder, his intelligibility will be affected as he will often continue to use a lot of jargon in lieu of words.  Instead of recognizing that the jargon is a substitute for real words or grammar that SHOULD have developed, we often misinterpret the jargon to be speech sound production errors.

In this scenario, Joey’s desire to communicate is there…his speech is continuing to develop…his language skills are not. Therefore, most toddlers, including Joey, who are difficult to understand will be diagnosed with a language disorder—not a speech-related disorder!  It is the language (or lack thereof) that is most likely having the greatest impact on this child’s intelligibility.  Unless Joey presents with any of the speech-related red flags, his speech will most likely continue to develop as his language skills are addressed in early intervention!

Why Not Provide Traditional Articulation Therapy Anyway?

Early speech and language skills are acquired and used primarily for communicating during every day, natural social interactions. Traditional articulation therapy focuses on the repetition and drilling of target sounds…there is nothing natural about this process. Early intervention is intended to be embedded into families’ every day, natural activities and routines to ensure that children are processing the information that they are learning in order to utilize these new skills within their own environment—this is known as authentic learning.  Targeting articulation directly and drilling toddlers to produce speech sounds is the furthest thing from “natural” that there is!

Optimal early communication intervention services are provided in natural environments, which offer realistic and authentic learning experiences for the child and promote successful communication with the caregivers. Authentic learning can maximize children’s acquisition of functional communication skills and promote generalization of newly mastered behaviors to natural, everyday contexts. 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 the child to imitate specific sounds in isolation (e.g. “say /ba/”), is not going to work.  Infants and toddlers truly do not learn speech or language through artificial methods.  For most children, when functional language and communication needs are addressed within the natural environment, speech will develop as well (ASHA, 2008)!

What Would This Look Like for Joey and his Family?

My first suggestion for Joey’s parents is to support and encourage him to continue to produce the sounds and words that he IS producing within the routines that he most enjoys.  If he makes ANY sounds, imitate those. If he uses any word approximations or words, repeat them back to him! Continue to imitate his sounds and words…and then expand on them a bit.  If Joey says “babble-babble -nana-babble-babble-juice” while choosing foods for his snack, repeat his word approximations and words back to him:  “Banana!  Juice!”  Then, I would coach his parents to expand on his verbalizations: “You want bananas and juice for snack today! Let’s have bananas and juice!”  Let him know that what he is attempting to say has been heard and IS important.  I would encourage his parents to provide him with articulate models of his words and to provide a model of a complete sentence in order to facilitate Joey’s expansion of his message.

What other authentic learning opportunities might you use to facilitate Joey’s expressive language development during snack time and ball play during his brother’s soccer practice?

What are some other ways in which you can help Joey’s family incorporate naturally occurring opportunities to embed speech sound development into these experiences along the way?

Reference

American Speech-Language-Hearing Association. (2008). Roles and responsibilities of speech-language pathologists in early intervention: guidelines [Guidelines]. Available from www.asha.org/policy.

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?!

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

Ditch the Animal Sounds! – Who’s Ready for the Next Talks on Tuesday?!

The post Address the Language: The Speech will Follow! appeared first on Early Intervention Strategies for Success.

Lynn meets Devon and his mother, Janae, at the grocery store for their visit this week. When she arrives, she finds them trying to walk into the store. They are struggling because Devon is having a tantrum and Janae is trying to carry him while he kicks and screams. Lynn goes up to them and asks if she can help. Janae puts Devon down and says she doesn’t know what to do. She reminds Lynn that this is why they decided to meet at the store, so that Lynn could help with this problem. Lynn asks if she can try something, and Janae agrees. Lynn takes Devon’s hand and plays a game with him, pretending to be tigers, rabbits, and birds trying to get across the parking lot. Janae follows them and says “I wish you could come to the store with us every week because he won’t do that for me.”

Is the Problem Solved?

Lynn has had the awesome opportunity to observe a natural routine for Devon and his mother. Rather than just hearing about the struggles walking in to the grocery store, she has wisely scheduled to join the family during their weekly trip. Rather than sitting back at the family’s home and spouting out tons of “have you tried…?” ideas, she is able to problem-solve with Janae in the moment. Lynn is able to get Devon into the store without a tantrum, so…is the problem solved?

No, not by a long shot.

Lynn demonstrated a technique that involved playfully distracting Devon during an activity that he doesn’t like or typically cooperate in. She was successful at dodging the typical tantrum, but it really doesn’t matter because she won’t be there the next time the family goes to the store. She is probably assuming that Janae watched her and would pick up how to play the games she played with Devon. From Janae’s comment, though, you can get a sense that she watched, but she doesn’t think she can do it. If that’s what Janae feels, then Lynn’s modeling did not accomplish the real goal, which was to help Janae learn ways to get Devon into the store without a tantrum.

If we just rely on modeling or demonstration for families, we are not very likely to truly build the parent’s capacity to manage similar real-life situations in the future. In fact, it could have a detrimental effect because the parent could see someone else being successful when she herself cannot. Without a more intentional approach to supporting the Janae’s learning, Lynn could do more harm than good.

Three Ways to Use Modeling to Support Parent Learning

Let’s consider how Lynn could wrap the following three steps around her modeling to better support Janae’s learning. Here’s the same situation, but with Lynn more actively helping Janae participate in her son’s success:

Model with Intention – Before trying her strategies with Devon, Lynn asks Janae to watch for what she (Lynn) does to distract Devon and make the trip into the store fun for him. She also asks Janae to watch Devon’s reaction.

Model with Narrative – While playing the pretending game with Devon, Lynn narrates what she is doing for Janae. She says she’s trying to make the walk more enjoyable as a way to help Devon learn that the trip into the store can be fun.

Model with Reflection – After they get about half way to the store, Lynn asks Janae what she observed so far. They talk about Devon’s different reaction and why he didn’t tantrum. They reflect on the specific activities Lynn used and which of those Janae wants to try.

After modeling, it’s ALWAYS good to remember to hand the reins over the parent. Giving the parent the opportunity to try what she has just observed and make that strategy her own is really when the learning happens!

Here’s what happened next for Lynn and Janae:

After establishing a few specific strategies that might work for Janae, Lynn steps back and Janae takes Devon’s hand. He starts to squirm and fuss but Janae says “Let’s jump like a kangaroo into the store!” and takes Devon’s hands to help him jump. When they reach the entrance, they stop and reflect about how that went. Devon made it into the store with his mom without incident. Success!

Consider, though, who is responsible for Devon’s success? At this point, both Lynn and Janae are, but Janae feels more capable because she has experienced her own ability to use the strategy. She is more likely to own this new strategy now. When the strategy becomes hers, and she’s able to use it when Lynn isn’t there for support – that’s when they’ll know that intervention worked!

How have you used modeling to support caregiver learning? 

For those of you who are using coaching interactions with families, what could Lynn have done differently before and after her modeling to make this activity even more successful?

Share your insights about how we can improve this interaction in the comments below!

The post Watch Me! – Using Modeling as a Caregiver Teaching Tool appeared first on Early Intervention Strategies for Success.