Early social and emotional development includes the ability for young children to “form close and secure adult and peer relationships; experience, regulate, and express emotions in socially and culturally appropriate ways; and explore the environment and learn — all in the context of family, community, and culture” (Yates et al., 2008, p. 2). This describes the way infants and toddlers understand and communicate their emotions to build healthy relationships with those closest to them.

When you think about social and emotional development, all of the words above may come to mind. Each word is a critical component of social and emotional development. In early intervention, all practitioners play a key role in supporting the emotional well-being of every young child and their family.

Why and What You Can Do

“Social and emotional experiences with primary caregivers as well as interactions with other children and adults early in life set the stage for future academic and personal outcomes, and undergird other areas of development” (Darling-Churchill & Lippman, 2016, p. 2). You have a unique opportunity to nurture the connection between the caregiver and child and promote successful outcomes for each child you serve.

Here are eleven easy strategies you can implement to support social and emotional development:

1. Boost the parents’ confidence. This is a hard time for many parents. Parents may feel responsible for their child’s developmental delay. Building their confidence empowers them to feel competent. When someone feels good, it makes them happy. This helps promote positive parent-child interactions.

2. Support the child’s self-esteem. Children tend to avoid difficult tasks. After all, nobody likes failing. Boosting a child’s self-esteem gives him/her confidence to explore and try new things.

3. You can never give too much information. Explain what you are doing and why you are doing it. This helps parents understand the reasoning behind the intervention strategies you suggest or model.” Give parents plenty of opportunities to ask questions.

4. Focus on increasing positive parent-child interactions. Many children may resist demands placed on them. A positive parent-child interaction removes the feeling of a demand and makes the interaction playful and fun. It enhances the bond between the caregiver and child.

5. Read cues and intervene before a child is in his/her red zone. There are four stress responses a child may experience: Green zone, red zone, blue zone, or combo zone. Click here to read the checklist that identifies different behaviors associated with each zone. Positive emotions are associated with the green zone and negative emotions are associated with the other stress responses. Children are more likely to come back and stay in the green zone when parents are attuned to their moods and feelings. Becoming a detective for your child’s stress cues can be a great tool to improve attunement.

6. Model the behaviors you wish to see. We can help parents learn to model behaviors they want to see in their children as they grow into adults. Children learn how to manage big feelings in large part by watching their adults manage big feelings.

7. Explain the importance of comfort. Comfort is a big part of secure attachment. So often parents get mixed messages about comfort from society – sometimes it seems as if comfort is the same as creating a weak child. We can bust that myth by sharing the information we know about the role of comfort in early brain development.

8. Provide structure and routine. Routines are the safe walls around a child’s day. There is no RIGHT kind of routine but whatever it is, the more predictable for the child, the better. Routines that are repetitive for a child help them make sense of the world. They will always have another chance to practice the things they struggle with most.

9. Use positive behavior supports. A positive and proactive approach to supporting behaviors helps reduce parental stress and increase positive behaviors in children as they aim to please their parents. These strategies decrease reactivity and should be individualized for each child and situation.

10. Label emotions. Language is a major learning tool for children and during the young toddler and preschool years, we learn and use language as a way of making sense of the world. Putting words to feelings helps children learn that feelings are generally transient and aren’t a permanent state of being. This is something we should be regularly talking about with our parents.

11. Increase parent responsiveness. Parent responsiveness nurtures a safe, secure attachment allowing a child to explore and thrive in their environment as the child becomes more resilient and independent. Wonder with the parents about what their child may be feeling or thinking so they can respond in an intentional and positive way. 

What challenges or barriers do you face as an early interventionist supporting social and emotional development?

What other strategies would you add to support each child’s social and emotional development?

Additional Resources:

DEC Child Social-Emotional Competence Checklist

Supporting Social and Emotional Development: What ALL Early Interventionists Can Do Handout

References

Darling-Churchill, & Lippman, L. (2016). Early childhood social and emotional development: Advancing the field of measurement. Journal of Applied Developmental Psychology, 45, 1–7. https://doi.org/10.1016/j.appdev.2016.02.002 

Yates, T., Ostrosky, M., Cheatham, G., Fettig, A., Shaffer, L., & Santos, R. (2008). Research synthesis on screening and assessing social–emotional competence. Retrieved from Center on the Social Emotional Foundations for Early Learning http://csefel.vanderbilt.edu/documents/rs_screening_assessment.pdf

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Amanda and I met while working at a special education charter school as an Assistive Technology specialist and special education teacher. Somehow, several years later, we have both ended up working in EI. Amanda currently works as a Speech-Language Pathologist providing EI services and AAC evaluations in DC and I am a Developmental Therapist in Arlington County.

As EI providers, we know that communication creates the opportunity to learn about and understand the world around us. Yet, often children wait until they receive school services before they have consistent access to robust AAC (Augmentative and Alternative Communication) systems. When working with toddlers who are not using verbal language to communicate functionally throughout their day, it is important to offer information and have conversations about the benefits of AAC with the family.

Figuring out your role in these conversations as an EI provider, as well as how to support a family with their AAC journey, can be challenging. Below, we have listed a few common myths and misconceptions about AAC as well as examples of toddlers we know who have started their journeys with AAC. We hope you can use this as a resource as you continue to expand your knowledge about AAC as a primary provider.   

Myth #1: Toddlers Are Too Young  

We are never too young for language exposure. Most AAC relies on a different language system than what we are exposed to from birth. If children are going to use AAC functionally, they need to hear everyone in their lives use the same system to talk to them. Waiting to provide children with the opportunity to use AAC until they are “old enough” can deprive them of months and years of language input that is necessary when learning to effectively communicate. The earlier a child has access to language, the faster he or she will learn to use it and be able to engage more with the world (American Speech and Hearing Association, n.d.). There are no prerequisites to begin using AAC. While there are considerations as to the mode of access and system used, these are determined as part of an evaluation.   

Amanda: Earlier this year, I had a conversation with the parents of a 15-month-old with limited vocalizations.  We had an honest discussion about his diagnosis and the likelihood that he may not verbally speak for a while.  Within the month, several low tech AAC systems (paper-based choice boards) and a GoTalk32 (recordable, fixed 32 cell device) were introduced.  Before he was two, he started using a high-tech dynamic display (digitized display changes based on user actions) device and by two he was using phrases to communicate.  By providing AAC from an early age, this child has the chance to continue his expressive language development at a rate similar to his typically developing peers.  

Myth #2: AAC is for Speech Language Pathologists (SLPs)  

While it is always challenging to talk about something that feels like it’s out of your area of expertise, the conversation about language development and ACC can come from any knowledgeable provider! SLPs are great resources about AAC, but remember that all providers can talk about communication. This is especially important when we think about babies and toddlers with complex bodies, who may also have complex communication needs. These children are much more likely to see a motor therapist as their primary service provider due to family priorities. Within their role, the PT or OT is also engaging in discussions and ongoing assessment in all areas of development with a family. This is the perfect opportunity to offer information about options for communication for a child who may not begin to develop verbal language in the same way as their peers.   

Lauren: A few years ago, I began as a secondary service provider for a family, when the PT working with them began this very discussion. Due to his diagnosis, this child was not likely to begin speaking within his toddler years. Although his parents were concerned about his future communication, they did not know that there were options for him to begin using words at the same time as his peers. This PT provided the family with information about an AAC clinic hosted by the local infant and toddler program. Through this process, insurance covered a high-tech device that allowed the child to communicate using eye-gaze.   

Myth #3: High-Tech Comes at High Cost  

This statement is both true and false. Dedicated, high-tech AAC devices (those with digitized displays that change based on user actions) can cost tens of thousands of dollars. It is false that these devices always come at a high out-of-pocket cost. In fact, public and private insurance will cover a variety of devices. It is important to have a knowledgeable specialist provide a thorough AAC evaluation and report.  This website from a device company provides some additional information about funding.

Amanda: I’ve been doing AAC evaluations for EI in Washington, DC for the past three years and have had many AAC devices covered by insurance including mid tech, high tech, eye gaze, and mounting accessories.  Though coverage varies by insurance plan (some private insurances require a copay or deductible, but Medicaid and Medicare typically cover AAC at 100%), there are also grants and programs available to help cover the cost of AAC. 

Lauren: Just this month, one of the toddlers I see received a device through insurance just in time to use it on his family trip to Disney World! 

What Next?   

You do not need to know everything about AAC to begin the conversation. Before you talk with families, though, make sure you have some knowledge of AAC. If you are interested in learning more general information about AAC, there is a fantastic Talks on Tuesday as well as a free AAC 101 Course to get you started.  We have only covered a few of the myths and misconceptions about AAC here. You can find more information and the supporting research through the American Speech-Language-Hearing Association.  Another great step is becoming knowledgeable about the resources for ACC evaluation in your area. Begin by reaching out to local children’s hospitals, rehab centers, and speech therapy clinics in your area to find out if they offer AAC evaluations. Where are they? How can a family contact them? What public or private insurances do they accept?  With this information, you’ll be better prepared to help families begin to explore AAC options and boost communication. 

What are some of the strategies or resources you have used in your professional journey with AAC?  

Share your strategies in the comments below!

References:

American Speech-Language-Hearing Association. (n.d.) Key Issues, AAC Myths and Realities.

Lauren Lamore-Chen has worked in EI in the Northern Virginia area since 2016 and currently works as a Developmental Therapist with the Arlington Parent-Infant Education Program. She has a master’s degree in special education and worked as an instructional coach and special education teacher where she developed her passion for all things AAC. You can reach Lauren at llamore-chen@arlingtonva.us

Amanda Soper specializes in working with individuals with complex communication needs who use AAC systems. She works at a special education school and for the early intervention program in DC. Amanda is an adjunct professor at Gallaudet University and has a private practice, providing therapy services for children using AAC. You can reach Amanda at AmandaSoperSLP@gmail.com

The post AAC in EI: Debunking Common Myths and Misconceptions appeared first on Early Intervention Strategies for Success.

Ever been in a home visit with a parent who is simultaneously using his/her phone while discussing the child with you? There are lots of ways that phones and screen time show up during visits. For instance, parents hand their child a phone to keep him quiet or distract other children in the home. Parents may pull out their phones to take down notes about interventions or the next appointment. They show us videos and pictures of exciting progress in milestones, or to ask a question about something going on with their child.

Cell phones and all other forms of screens are such a huge part of life today, including children’s lives starting as early as infancy and toddlerhood. As service coordinators and providers, we can choose to resist or ignore these changes, and feel frustrated with how they impact early intervention outcomes. OR, we can step up to the challenge of employing phones and technology as tools in our interventions and interactions with families.

AAP Screen Time Recommendations

The American Academy of Pediatrics has made a formal statement of recommendations for use of technology for children of all ages in their Media and Young Minds Policy (2016). Some specific advice for ages 0-3 includes:

• For children younger than 18 months, discourage the use of screen media other than video-chatting.
• For parents of children 18 to 24 months of age who want to introduce digital media, advise that they choose high-quality programming/apps and use them together with children, because this is how toddlers learn best. Letting children use media by themselves should be avoided.
• In children older than 2 years, limit media to 1 hour or less per day of high-quality programming. Recommend shared use between parent and child to promote enhanced learning, greater interaction, and limit setting.
• Recommend no screens during meals and for 1 hour before bedtime.

Parents often express guilt to providers over undesirable screen time issues with their child, and look to us for support. Advice from author, Lisa Guernsey, recommends that families and early childhood professionals consider the “Three C’s” when determining when and how to use various technologies: content, context and the individual child. Together with families, we can consider the following questions to begin supporting them in implementing the AAP’s recommendations, while keeping technology as a tool on our side.

• We can ask how does the content help children learn, engage, express, imagine, or explore?
• What kinds of social interactions are happening before, during, and after the use of the technology? Does it complement, and not interrupt, children’s learning experiences and natural play patterns?
• Does this technology match with this child’s needs, abilities, interests, and development stage? (Guiding Principles for Use of Technology with Early Learners, 2016)

7 Ways to Support Families and Outcomes Using Technology

Once we’ve evaluated the values of technology per each child’s situation, we can consider employing some of the following strategies for intervention and improvement.

1. Parents can use video chats as a new and exciting way for children to use their language and imitation skills with a variety of people.
2. Show parents how they can engage in an app or screen time activity together with their child to promote quality interactions.
3. At the end of a visit, encourage parents to set a reminder alert in their phone to practice certain strategies or focus on a specific interaction with their child.
4. Recommend apps that educate and support parents in understanding child development, such as: CDC’s Milestone Tracker, VROOM, and HelloJoey.
5. Educate parents about how to evaluate apps/programs for developmental appropriateness.
6. Coach parents in setting boundaries with screen time and managing challenging behaviors that may arise from this. Help them determine specific “screen free” routines throughout the day.
7. Remind parents that no “educational” technology or program is better for their child’s development than regularly engaging in interaction, exploration, and play everyday!

Share your thoughts and experiences below by leaving a comment:

How have you seen screens and technology impacting Early Intervention visits?

Have families ever asked for advice about apps or programs to help their child? How do you or would you respond?

Please share any great technology resources that you have found in the comments too!

References

Guiding Principles for Use of Technology with Early Learners. (2016). Retrieved from https://tech.ed.gov/earlylearning/principles/.

Radesky, J., and Christakis, D. (2016). Media and young minds. Journal of the Academy of Pediatrics, 138(5), doi:10.1542/peds.2016-2591.

Rachel Todd lives in Northern Utah and has worked as a Service Coordinator for the Up to 3 Early Intervention Program since 2017. She has a Bachelor’s degree in Family, Consumer, and Human Development emphasizing in child development and worked with families in Early Head Start programs before joining EI. She is also a graduate student in the Instructional Technology & Learning Sciences program at Utah State University and loves professional development of all forms. Rachel and her husband have a one-year-old son and a spoiled fur baby and love to get outside in the mountains together every chance they get! You can reach Rachel at
rachel.todd@usu.edu

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You may have seen that awesome clip in the news recently of the father having an animated conversation with his 18-month old son. (If not, click the link and it will make your day!) Not only is it completely adorable, but it’s also a perfect example of a concept called “conversational turn-taking.”

Turn-taking is one of those early, essential skills that develops in the context of caregiving relationships. We early interventionists are always watching to see if a child can engage with another person in turn-taking. We know that turn-taking is important for early cognitive, communication, and social-emotional development and that it starts with imitation. Imitation and (eventually) turn-taking happen naturally in the context of silly games, making animal sounds while looking at books, playing with toys, eating a meal, learning how to get dressed, watching TV together, etc. When it happens in the context of early conversation between a very young child and a caregiver, turn-taking can a critical building block for communication.

How critical? Let’s find out.

Source: Gilkerson, J. Richards, J. A., Warren, S. F., Oller, D. K., Russo, R., & Vohr, B. (2018). Language experience in the second year of life and language outcomes in late childhood. Pediatrics, 142(4). Retrieved from https://pediatrics.aappublications.org/content/pediatrics/142/4/e20174276.full.pdf (PDF, New Window)

Research: What Do We Know?

In this study, Gilkerson and her colleagues examined the relationship between conversational turn-taking in 146 infants and toddlers and parents and the children’s later IQ, receptive, and expressive communication. In Phase I of the study, data was initially collected when these children were mostly between the ages of 2- to 36-months of age using a recording system that captured communication in the infant’s or toddler’s environment. This system then automatically counted conversational turns (between the parent and child), adult word count (both overheard and words directed to the child), and child vocabulary. Children were evaluated to determine their expressive and receptive language abilities, and parents completed an inventory to estimate the child’s vocabulary size. In Phase II, families in the first phase were invited to have their children (ages 9-13 years old) participate in follow-up cognitive and language assessments.

Data from Phases I and II were statistically analyzed to look for correlations. The strongest relationship was found between conversational turn-taking and adult word count occurring when children were between 18-24 months old; both were predictive of child outcomes 10 years later. However, when controlling for socio-economic status, the relationship between adult word count and child outcomes was much weaker.

Here’s the big take-away: Overall, conversational turn-taking that occurred with toddlers between 18-24 months of age and their parents showed the strongest relationship to later child outcomes, specifically related to IQ, vocabulary, and language skills at ages 9-13 years old. These findings suggest that how parents engage their 18-24 month old toddlers in turn-taking may be related to the child’s cognitive and communication development 10 years down the road. Wow.

Practice: How Can You Use What You Know

So what does this really mean? The quality of how a caregiver talks with (not to) a toddler in the 18-24 month age range may have a significant impact on that child’s later IQ, his ability to comprehend language, and his overall expressive and receptive language skills. This is probably not that surprising for us in EI, but when you think about it, this impact is amazing. Not only is the amount of words a child hears important, but the opportunities for the child to engage, back-and-forth, with an adult in a conversational manner are essential, especially while toddlers are developing their early abilities to talk.

Here are a few strategies to help you use what you now know:

Build parent responsiveness

Help parents recognize communication cues from infants and older toddlers who are still learning to talk. Point out the child’s attempts to communicate, whether by eye gaze, gesture, body movement, or sound. Model for parents how to respond and provide positive, specific feedback when the parent responds to the child’s communication (e.g., “Wow, when Taylor said “ka” you knew exactly what she wanted! When you said “cup” back to her, you gave her a great example of how the word sounds!”)

Build turn-taking skills with actions and sounds

Encourage parents to always pair sounds/words with actions when playing turn-taking games with their children. Rolling a ball back and forth or blowing soap bubbles could be paired with fun sounds or repetitive words like “ready, set, go!” or “your turn!” and “my turn!”

Encourage parents to have conversations with their infants and toddlers – often!

Model how this sounds and praise it when you see it happening between the parent and child. Assure them that even if they feel silly talking to a child who can’t “talk” yet, they are teaching their child about how words sound, what words mean, and how to use sounds and words to communicate with others. Conversational turn-taking also teaches the child what may be the most important lesson of all – that the child is valued and loved. Use video examples like the fantastic clip mentioned above to see these conversations in action!

My biggest take away from this article (and that amazing dad) is that it’s not always about the number of words a young child hears. What may be even more important is the quality of the interaction. Conversations matter – even and maybe especially with toddlers!

What are your favorite strategies to encourage conversational turn-taking between parents and their babies?

Share your ideas in the chat below!

The post EI Research to Practice Brief #7 – Conversational Turn-Taking between 18-24 Months Really Matters 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

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Wyatt is a happy 19-month old child who was recently released from the hospital, where he lived for the first 17 months of his life. Wyatt was born very prematurely and has been diagnosed with a visual impairment and cerebral palsy. You want to conduct an assessment to learn about Wyatt’s strengths and needs, especially related to communication, which is a priority for his family. When you look at the assessment tools, you worry that Wyatt is likely to score much lower than his chronological age. You wonder – Is this is good test to use? How do I get meaningful information that will help our team write good goals?

Thinking Beyond the Test Scores

From experience, we know that young children with multiple disabilities often perform much lower than their chronological or adjusted age on our developmental assessments. We walk into an assessment bracing ourselves for how to tell a family that their 19-month old son has the skills of a 4-7 month old infant. We struggle because we don’t want to hurt a parent’s heart with this difficult news. We also struggle because I think, on a deeper level, we realize that this information really isn’t all that meaningful. While we can quantify that Wyatt can or cannot do certain tasks on the test, we also know that qualitatively, Wyatt has had more experiences than a 4 or 7 month old infant. Wyatt may be just starting to roll over, hold a toy, and make babbling noises but he is not an infant.

Establishing a developmental age is something we have to do when children enter EI and annually to help us track progress. We can’t avoid it, and shouldn’t, because it is helpful when considering what will come next developmentally for Wyatt. Perhaps our more important task, then, is to think about how to gather meaningful information about Wyatt’s functional abilities, including how he communicates and engages others, acquires and uses knowledge, and takes actions to meet his needs.

Tips for Assessing Young Children Who Have Multiple Disabilities

I recently came across a great resource that prompted me to think more deeply about how we assess very young children with multiple disabilities: Assessing Communication and Learning in Young Children Who are Deafblind or Who Have Multiple Disabilities (Rowland, 2009) (PDF, New Window). This document includes some great tips that we could use if we really were conducting Wyatt’s assessment, such as:

Plan for extra time – It takes time to get to know the child and learn how to read his cues, how to position him, how to offer assessment materials, etc. Assessing Wyatt would involve more than observation and conversation with his caregivers; it would also be a process of experimentation to figure out what he can do and how to support him in doing it. Wyatt may also need extra time to complete activities and/or extra rest time between them.

Select appropriate assessment tools – Look for tools that include info about how to adapt assessment items for children with sensory or motor disabilities. The Carolina Curriculum for Infants and Toddlers and the Assessment, Evaluation, and Programming System for Infants and Children (AEPS) are two examples.

Gather information about Wyatt’s everyday life – Prepare a list of specific questions you want to ask, such as:

• How does Wyatt react when you talk to him?
• What cues do you notice that tell you what Wyatt wants/needs?
• What does Wyatt like to do/not like to do?
• How does he use his vision?
• What would you like for Wyatt to be able to do?
• What would make things easier for you/for Wyatt? 

Ask the caregiver to “show” you how she plays with Wyatt, positions him, and engages him. Find out about Wyatt’s interests, preferences, what motivates and alerts him, and what tires him out.

Do a “head to toe inventory” when assessing communication – Look for the child’s movements, reactions, and sounds and consider which appear to be voluntary and which have communicative intent. If you aren’t sure, keep observing throughout the assessment to see if you notice the behavior or sound again. Watch for patterns and take careful notes.

Always assess sensory and motor skills too – The presence of hearing, visual, and motor disabilities will affect how Wyatt communicates. He could have cognitive skills closer to his adjusted age, but his difficulties with movement and vision could make it really hard for him to show you what he knows.

Rather than approaching Wyatt’s assessment with the worry that he’ll score low, the author of the resource encourages us to approach it as a “process of discovery.” You will use all of your tools – the test results, specific observations, conversation with the family, insights from other team members – to try to discover what Wyatt can do now and what comes next for him. Helping Wyatt be an active participant in his daily life is our goal, regardless of whether his skills are at the 4-7 or 19-month levels.

What strategies do you keep in mind when assessing an infant or toddler with multiple disabilities?

How do you share assessment info with families?

Add your comments below!

Want more information? Visit our VEIPD topic pages on Motor Delays & Disabilities, Multiple Disabilities, and Visual Disabilities.

The post Assessing Children with Multiple Disabilities – Tips and a Great Resource! appeared first on Early Intervention Strategies for Success.

When we whittle early intervention down to its core, I think it’s all about interactions. Interactions between the child and caregiver, first and foremost…interactions between the child and the environment (toys, sofa cushions, spoons and cups, buttons on the TV remote, the family dog)…interactions between the EI practitioner and caregiver that facilitate positive interactions with the child in the natural environment. See where I’m going here? It’s all related to positive, reciprocal, contingent interactions.

Translating our Super Powers

The Division for Early Childhood (DEC) Recommended Practices provide our field with a list of five interaction practices that we can use to “promote specific child outcomes” (p 14) when working with families. As early interventionists, we often have super powers related at using these practices – we know how to use our voices and language to engage children, how to observe behavior and encourage reciprocal communication, and how to help children sustain interactions and respond to the environment. Our use of our super powers won’t ever be enough, though. We have to use what we know to help others interact with the child in ways that boost development and learning. When caregivers use recommended practices for interaction, the child has more opportunities to develop social skills, communication, cognition, and independence throughout the day. Those daily interactions are what really matter.

Helping Caregivers Use the DEC Interaction Practices

Let’s consider the first three practices, which focus on promoting social and communicative interactions.

INT1. Practitioners promote the child’s social-emotional development by observing, interpreting, and responding contingently to the range of the child’s emotional expressions.

Early interventionists are great resources for caregivers in helping them observe and interpret their child’s behavior. This is especially helpful with children who communicate in ways that are harder to understand, such as children who may have autism or those with multiple disabilities. The interventionist can help the caregiver notice the child’s attempts to engage and communicate. Then, they can figure out how the caregiver can respond in ways that help the child learn the benefits of engaging others.

Example: An educator sees a child’s tendency to stroke his mother’s hair as an attempt to engage the mother and feel close to her. The mother originally found the “hair pulling” slightly annoying, but when she sees the possibility that it represents affection from her child, she can respond to the child with a warm smile and voice, encouraging rather than discouraging the interaction.

INT2. Practitioners promote the child’s social development by encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support.

Early interventionists can help caregivers seek out opportunities for the child to interact by observing typical routines, especially those that the caregiver and child enjoy together. By asking the caregiver open-ended questions (“What makes your child laugh? What do you like to do together? When do you do to spend time together? What would you like to do together?), the interventionist can identify activities to target for intervention.

Example: An occupational therapist (OT) observes the morning dressing routine, during which a mother plays peek-a-boo and tickle games with her infant. The OT coaches the mother to use an expectant look and extra wait time to facilitate her child’s engagement and teach her child how to take turns, make sounds, and perhaps pull the blanket from the mother’s face to keep the game going.

INT3. Practitioners promote the child’s communication development by observing, interpreting, responding contingently, and providing natural consequences for the child’s verbal and non-verbal communication and by using language to label and expand on the child’s requests, needs, preferences, or interests.

Rather than being the communication partner for the child for most of the visit, the interventionist can coach the caregiver in how to respond contingently, use words that are just above the child’s language level, and expand on what the child says. This works well during play and other routines.

Example: A speech-language pathologist coaches a father in how to expand a child’s gestural request for his cup to be filled with water. The child hands his cup to his father and walks away. Through modeling and practicing simple prompts, the father can learn to label the child’s request (“More water?”), hold the cup up near his own mouth to draw the child’s attention to the word being said, and wait before meeting the need so that the child has a chance to imitate the model. The father and child can then practice this interaction whenever this request is made, which is likely to be often – more often than if the therapist used this strategy 2-3 times on a single visit.

These are just a few examples of how we can implement the Interaction Recommended Practices through the caregiver-child interaction.  Our knowledge of how to facilitate interactions can translate into the strategies we share and practice with families. Using those parent-interventionist interactions to facilitate parent-child interactions in natural environments – that’s what it’s all about!

Next week, we’ll continue this discussion by looking at the next two practices, which focus on facilitating cognitive skills. In the meantime:

Why is it important that early interventionists translate these practices for use with families?

How have you use these practices on visits? With child care providers?

Share your thoughts and examples of implementing these practices by leaving a comment below!

To read more about how to implement other DEC Recommended Practices, be sure to check out the rest of this series by searching for “DEC Recommended Practices” using the search feature at the top of the page.

The post DEC Recommended Practices – Interaction (Part 1) appeared first on Early Intervention Strategies for Success.

Oliver’s mother calls you and tells you, with a shaky voice, that he’s been “kicked out” of his third child care center. The center director told her that his behavior has become “more than we can handle” and “a safety concern for the other children.” You’ve been working with this family for several months now on IFSP outcomes related to reducing Oliver’s acting out behavior and increasing his ability to communicate using words. You’ve been struggling because whenever you’ve tried to discuss positive discipline techniques and share other information about social emotional health, Oliver’s mother tells you that she doesn’t believe in disciplining her children. She wants them to grow up with freedom to become who they are and she feels that they will have their whole lives to have boundaries. At the same time, she needs for Oliver to attend child care while she works part-time.

What do you do?

How Can You Support Oliver’s Mom?

What do you do when there’s a difference between what you believe you know about child development and a parent’s beliefs and style of guiding his/her child’s social-emotional development? In Oliver’s scenario, it can feel like you are bumping up against a wall. You might think the “wall” is this difference between your beliefs and the parent’s beliefs, but really, the wall is probably your own approach to the situation. It can be very tempting to judge Oliver’s mother’s beliefs and think that she should be parenting differently, but we have to remember that it is not our role to judge her. We are there to provide support and share what we know about development in a way that supports her and Oliver. This usually requires lots of active listening, observation, collaborative problem-solving, and maybe most importantly, keeping an open mind. Instead of trying to change how Oliver’s mom thinks or “make” her see things our way, it can be helpful to step back and revisit our coaching skills to think about how we can provide the right kind of support.

Here are a few strategies to consider when preparing to support Oliver’s family:

Pause and Reflect – This is always the place to begin, especially when there is a disconnect between what you think and what the parent believes. It’s easy to imagine feeling frustrated and judgmental. Keep in mind that it’s your job to learn about Oliver’s family and how he behaves at home and at child care so that you can figure out how to support him and his caregivers in both environments. Sometimes, putting your feelings aside can help clear the way for progress.

Help her Reflect on her Goals – Check in with Oliver’s mother to find out how you can help and what she would like to see happen. Don’t take it for granted that you know these answers. Ask her what she thinks is contributing to Oliver’s struggles and what she thinks she can do at home to help him be more successful in child care. Find out about her goals and encourage her to voice them.

Ask about What She Knows about Discipline – Find out how she defines “discipline” and “boundaries.” Be sure that you both are speaking the same language. You could find out that “discipline” means spanking to her, and she is unwilling to spank. Get specific so that you both understand.

Provide Information Linked to her Goals – Share information about social emotional health and discipline techniques as they link to what’s important to Oliver’s mother. If she says she doesn’t agree or doesn’t want to use those techniques, ask if she’s open to trying something new. Her answer will inform you about whether or not this is an issue about which you can actually help her.

Consider this: you may not have all the information you need you figure out what to do next…

First, what questions arise for you? What else do you need to know??

Once you have all the info, consider:

Option 1: What would you do if Oliver’s mother says that she is not open to a new strategy?

Option 2: What would be your next move be if she replied that she did want to try something new?

How do you support a parent when his/her parenting style is different from what you know/believe about social emotional development? 

Share your experiences in the comments below.

The post You and Oliver’s Mom have Different Beliefs about Discipline…What Do You Do? appeared first on Early Intervention Strategies for Success.

I have a confession…I don’t actually think we should spend so much time talking with families about their concerns. I think we should ask once, so that we have it for Section II of the IFSP, then leave it alone. Instead, I think we should focus much more on the family’s priority for their child’s development. Concerns and priorities are not the same thing, and the difference matters.

Concerns and Priorities – What’s the Difference?

Concerns are often similar from family to family. Think about the many, many toddlers who are referred to early intervention who are not talking. In fact, most of the children we see are not talking as an age-appropriate level. When you ask their parents what they are concerned about, they are likely to say something like, “He’s not talking like other kids his age.” This is a very common, very real concern. Same with children who are late walkers. These concerns are very important because they are what drive a parent to EI, and they are what keep a parent up at night, worrying about her child. We must acknowledge these concerns, and record them on the IFSP, then dig deeper to find out about priorities.

Turning to priorities reframes the discussion to become more individualized, more positive, and more functional. Priorities are the answers to questions like “What would it look like to you if she was able to talk more?” or “How would your day or your child’s day be easier if she could say more words?” Priorities are descriptions of what life would be like for a child and family if things got better. Priorities reflect the family’s vision for the child’s development. Priorities are the foundation for individualized, functional IFSP outcomes.

Why It Matters

It’s really, really hard to write a good IFSP outcome based on concerns alone. When we focus on concerns, we get outcomes that are “cookie-cutter.” You can substitute any child’s name in the body of an outcome like this: Noah will use words to express his wants and needs. All toddlers need to be able to do that – it’s not an individualized outcome. If you focus on priorities for Noah and his family, you’ll find out that life would be grand if Noah could say words to label toys and activities he likes to do when he plays with his siblings after school. Noah loves to play with his blue ball in the back yard, play in the toy kitchen with his sisters, and look at books with his dad. By digging into priorities for Noah and hus family, we learn about how the family works and what’s important to them. This rich information is where you glean what you need to know to write a good outcome. Here’s an example:

Noah will use 50 words to label his favorite toys (ball, cup, book, doggie) and activities (play, outside, kitchen, dinner, books) when playing with his siblings each afternoon after school for two weeks.

This outcome is individualized to what Noah likes to say and do, includes a context that happens frequently in his home, and includes a measurable criteria that the family can keep track of. If the professionals on Noah’s IFSP team had only focused on his family’s concerns, then they would have missed out on what they really needed to know to ensure that the IFSP was meaningful to Noah’s family. This is important because the IFSP outcomes guide service delivery, and meaningful services are based on what’s important to the family – their priorities for their child.

What do your teams typically focus on – concerns or priorities?

What challenges do you face with finding out about family priorities?

How do you guide the conversation to dig deeper into what’s important to families when writing IFSP outcomes?

Share your comments below!

The post A Priority or a Concern – What’s the Difference and Why it Matters 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.