You are committed to helping families practice using intervention strategies during your visits. You truly believe that’s an important part of the intervention process. You’re very aware of your own interactions during visits and try hard not to “hog” all of the child’s attention. You redirect the child’s attention from you back to the parent whenever you can, use intentional modeling, and encourage the parent to engage her child. You know how to do this…but you still feel like it’s a struggle sometimes to stay in your lane.

True Confessions

Okay, true confessions time. The “you” here is actually me. Recently, I’ve been working with some wonderful families and am trying hard to be sure that they have opportunities to practice using intervention strategies. It’s hard, though, when the children behave as if they prefer to play with the biggest new toy in the room – me. I’m pretty good at making kids laugh, keeping their attention, and prompting them for words or actions. Plus, it’s just fun. However, I know that my strengths are not the totality of what’s needed here. Sure, I’m visiting to help the child learn and achieve the outcomes on the IFSP, but that’s not the whole reason I’m there. I absolutely believe that my actions on the visit will make the biggest impact if I use them to help the parent learn strategies she can use when I’m not there. I know what to do…it’s just the implementation part that can be hard.

Here’s the Challenge…

Here’s the challenge – we take what we “know” and “believe” and then have to use it in different homes with different families who have different ways of interacting with one another. They also likely have different understandings of how EI works, different ideas about why their child has a delay, different ideas about what will help, and different expectations for visits. We have to adjust what we do and how we do it to adapt to these differences.

As our field has evolved, we’ve learned that the best way to impact the child’s development is through the parent. We have to find ways to share what we know so the parent can confidently use that information between visits, when we aren’t there. Sure, we can just play with the child while the parent watches and hope he/she “gets” it. Or, we can use the visit to really partner with the parent to develop and practice intervention strategies with the child that match how they learn and interact. We can spend our time together reflecting on what the parent and child do together. We can problem-solve, plan, and practice strategies during the visit to help them achieve their goals. This requires us to stay in our lane – meaning that we remember our roles as coaches, consultants, and supports to parents, not just play partners and “teachers” of children.

4 Strategies to Help You Stay in Your Lane

Here are a few strategies that might help you stay in your lane:

Explain how the practice component of EI works at your first visit – Set the tone for good early intervention by explaining how you will work together with the child. Share your goal of using the visit as a practice session for the parent and child to try out intervention strategies, with your support, so they can use them between visits, when most of the learning will occur. Prepare the parent and she’s more likely to feel comfortable jumping in.

Take time to learn together – Let parents (and children) have time to warm up. Find out what they like to do, what they want help with, how they like to learn, and what is motivating for them.  This doesn’t mean that coaching has to wait…but sometimes it might take a few visits before the family is comfortable enough to be coached. During this warm-up time, you both are learning how to work together and that’s okay.

Be intentional – Go into the home with the mindset that you are there to help the parent and the child – not just the child. Be intentional about asking open-ended questions about what’s going well and where the struggles to find out how to help. Look for and seize parent-child interaction opportunities when the parent can practice using an intervention strategy. Be intentional in facilitating interaction, reflecting on it, sharing feedback, problem-solving and planning together.

Stay in your lane – Be mindful of what you’re doing in the moment. Pay attention to where you place yourself, what you do, and how you do it. Use your knowledge and skills to help the parent engage her child. Yes, you will use modeling. Yes, you will playfully engage the child. When you veer out of your coaching lane and find yourself as the biggest toy in the room for too long, swerve back into your lane and refocus.

The truth is that, even with these strategies, every visit is different and some will be awesome, while others will leave you feeling glad you have a do-over next week. We have to be patient with ourselves and with families, remembering that we are partners who are growing and learning together. Walking in the door with the intention to stay in your lane and make room for parents to practice using strategies with their children is a great place to start.

When you’ve swerved out of your lane for too long, what do you do?

How do you keep your focus on facilitating parent-child engagement and practice during your visits?

The post 4 Strategies to Help You Stay in Your Lane During EI Visits 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.

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

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

Was What I Did Wrong?

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

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

Developing the Partnership that Facilitates the Practice

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

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

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

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

The post Oops…Guess What I Forgot? appeared first on Early Intervention Strategies for Success.

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.

Are you Service Provider A or Service Provider B?

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

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

Which Provider are You?

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

A Team Challenge

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

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

Strategies for Making It Easier

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

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

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

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

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

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

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

Which provider did you identify with?

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

Share you thoughts in the comments below.

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

“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’s so easy, almost reflexive, to provide suggestions to a parent who tells us about a struggle with a child. Most of us have tons of ideas packed in our brains and are eager to share them, hoping we’ll have the magic solution to make life easier for the family. We spew suggestions without even thinking about it – it’s the “have you tried…?” habit. A parent says “Bath time is such a struggle because he can’t sit up in the tub!” so you say “Have you tried a bath chair?” or “Have you tried taking a bath with him to hold him up?” The “have you tried…?” routine could go on and on. The problem with “have you tried…?” is that we assume (as does the parent) that we have the answer. It builds a reliance on us to solve problems, which is not the intention of early intervention. It also wastes time because we are essentially guessing based on our own experiences, not the parent’s.

Families Value Problem-Solving

Families have reported in the EI literature that problem-solving is one of the most helpful activities that occurs on an EI visit. It offers a non-threatening chance to talk to someone about a struggle and brainstorm together about possible solutions. Problem-solving together also offers a wonderful learning opportunity for the parent because he/she gets to practice thinking about solving the problem, with someone else’s support. As the source of that support, we can either teach the parent that she needs us to do the thinking for her, or we can facilitate her problem-solving so that she is better prepared to tackle a similar struggle when it happens in the future. Which would you rather do?

Breaking the Habit

So how do you break the habit and really facilitate problem-solving?

Step #1: Pause – This seems easy but it’s usually not! Remembering to pause before you automatically move into “have you tried…?” mode is the first step. Take a deep breath, count to 5, sit on your hands, whatever it takes to stop spewing suggestions after you hear about a challenging situation.

Step #2: Listen – I mean, really listen. Slow down and listen because there are likely to be clues in the description of the problem that will help solve it. Take the time to get all of the info before exploring solutions.

Step #3: Ask good reflective questions – Substitute “have you tried…?” with “what have you already tried?” Very similar questions but with very different purposes. Asking what the parent has already tried accesses their prior experience and builds on their knowledge, which is important for adult learning. It also eliminates the majority of the guessing. Follow this open-ended question up with asking the parent to describe what she’s tried, how it worked, what she thinks could be changed, etc. It can also be so easy to slip back into “have you tried…?” after asking an open-ended question so be careful to remember that you are facilitating the parent’s problem-solving and it’s a reciprocal, ongoing process.

Step #4: Listen for clues – As the parent describes her past efforts, listen closely for important clues. Point them out and ask for more info. Exploring different paths, what each person does or doesn’t do, what’s happening in the environment, and what the parent would like for the situation to look like if it worked better, are all important to listen for.

Step #5: Identify the possibilities and let the parent choose – If you and the parent come up with some good options, ask the parent which she would like to try. Rather than prescribing an solution, let her decide. Adults are self-directed learners, meaning we like to choose what we want to do so take advantage of that and you’ll likely see families feeling more successful with using strategies between visits.

Step #6: Purposefully and specifically plan for what to do – Once the best option is chosen, work together to plan for how the parent will implement it between visits. If possible, practice it during the visit so that you and the parent can work out the kinks and problem-solve a Plan B if the initial idea doesn’t work. Always have a Plan B so that the parent has something else to try if Plan A doesn’t work. This way she doesn’t have to wait all the way until your next visit for support. The plans should be brief, detailed, individualized, and jointly agreed upon. I’ll talk more about joint planning in a future post, because when done well, it can make an incredible difference in the success of the support you provide.

Step #7: Follow-up – Don’t leave the family hanging. Check in on your next visit to see if the problem is solved or if the solution needs tweaking. Problem-solving is an ongoing, flowing activity that is woven throughout each visit.

Remember that you aren’t there to solve problems for the family; you’re there to solve problems with the family. On your visits this week, pay attention to how tempted you are to say “have you tried…?” Parents are often looking for answers. By pausing, listening, and facilitating problem-solving during the visit, you will be helping the parent learn how to find those answers for herself.

Do you need to break the habit?

Which of these strategies have you used and how did they work for you and the parent?

What challenges have you faced with problem-solving with families?

The post Breaking the “Have You Tried…?” Habit appeared first on Early Intervention Strategies for Success.

The outcomes have been written, so now it’s time to determine services. The team sorts through possibilities for Arnold, a two year old with global developmental delays, and his family. Multiple team members recommend multiple services, then Winnie, the service coordinator, suggests they consider a primary service provider (PSP). The team decides that Patrick, the physical therapist, is the most appropriate choice for the PSP. The speech-language pathologist will provide monthly support to both Patrick and Arnold’s family. Other professional team members will also be available for support if needed in the future. The IFSP is signed and everyone goes on their way.

In the car, Patrick wonders what being the primary service provider really means…is he supposed to be the speech therapist, educator, and occupational therapist all rolled into one? Isn’t that expecting more of him than what he can do under his license?

What It Means To Be a Primary Service Provider

Understanding just what it means to be a primary service provider is important for all early interventionists. Let’s think about what being a PSP IS and what it ISN’T:

The PSP is the team member who will be the family’s primary contact for EI services. This means that, while there may be more than one service listed on the IFSP, the PSP is the person who will see the family most often.

The PSP is a collaborative partner who keeps in touch with other providers on the team. The PSP stays in regular contact with all team members, including the service coordinator, to keep everyone updated on progress and family questions.

The PSP is the team member who helps the family address the child’s development from a holistic perspective. One of the hallmarks, and great benefits, of using this approach is that the PSP takes a holistic view of development. The child is not viewed from a discipline-specific or domain-specific perspective – meaning that we don’t compartmentalize the child into developmental pieces. For example, we don’t only address motor skills during a physical therapy visit or communication skills during speech therapy. Instead, Patrick will help the family find ways to address Arnold’s communication and movement during daily activities. He might join the family while they prepare for lunch, helping Arnold’s mother prompt him to use words to request a food choice, then coaching her on how to help Arnold carry his plate to the sink. The PSP helps the family and all team members consider how all aspects of development intersect during the child’s everyday life.

The PSP is not a lone wolf. The PSP practices with the support of other team members. The PSP is not expected to intervene on developmental concerns that he or she is not comfortable addressing. For example, if a developmental services (DS) provider is asked to be the PSP with a child who has global delays and feeding concerns, but the provider has no training in feeding, then using the PSP approach may not be appropriate. OR, that DS provider isn’t the right choice to be the PSP for that child. However, if the DS provider is comfortable monitoring feeding with the support of an OT who joins visits on a regular basis, then it could work well.

The PSP is not the lone decision maker. Just because Patrick is the PSP, this does not give him liberty to make service decisions by himself. He is still part of a team that includes Arnold’s family, Winnie (SC), and the SLP. Decisions regarding the frequency, intensity, type, or end of services are made by the team, with Patrick as an important participant.

With the support of his team, Patrick settles into his role. He realizes that he is an early interventionist first – and an early interventionist is someone who sees the child as a whole and the family as providing the context for the child’s learning. He is an early interventionist with specialized training and expertise in physical therapy. He is an asset to his team, bringing his knowledge and experience and sharing his expertise in a way that builds the family’s capacity to encourage Arnold’s development. As the PSP, he also shares his expertise with other team members so that the team works as a unit to support the family. His role is rich, holistic, and responsive and he is ready.

How do you describe what a primary service provider IS and ISN’T?

When do you use a PSP approach and how do you know when it’s working well?

Share your experiences in the comments below!

The post Primary Service Provider…What Does That Mean? 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.