EI Talk: A Blog for Early
Childhood Professionals


In the Family’s Words

Early Childhood Interventions January 30, 2014

Families who receive early intervention services participate in the development of the Individualized Family Support Plan (IFSP).  The IFSP is the document that describes the family’s resources, priorities, and concerns and identifies the support plan for the family.  The outcomes on the IFSP determine the focus of the support plan as well as services that will help meet the needs of the family and child.  Similar to other benchmarks, the outcomes on the IFSP need to be objective and measurable and time specific.  They also must describe how the child’s participation in activities and routines will be enhanced.  Outcomes are more than skill development goals.  Outcomes must clearly indicate what the child is expected to do or would like to do.

Let’s set up two examples of outcome writing.

Johnny is a two-and-a-half year old boy who is having difficulty communicating his wants and needs.  His family would really like him to talk more.  Sometimes his parents have to go through a whole litany of foods to find out what he would like to eat.  Johnny’s parents told the IFSP team that it would make meal time more fun if he could only tell us what he wants!

To help the family with their concern the IFSP team developed a variety of outcomes that they thought would be appropriate.

  1. In 3 months, Johnny will use a gesture or word to make a choice between two food items during breakfast and lunch each day.
  2. In 3 months, Johnny will label 10 pictures of food correctly for 7/10 trials.
  3. In 6 months, Johnny will increase his vocabulary by saying 15 new words.
  4. In 6 months, Johnny will use a single word to request his cup throughout the day when he is thirsty.

Which of these outcomes do you think best meets the needs of the family?  Why?

Let’s look at these outcomes closely to see which ones are examples of outcomes to include on the IFSP.

  1. This outcome gives a time frame (3 months) for when the outcome is expected to be met and clearly states who the outcome is about (Johnny).  This outcome is measurable in that Johnny will need to perform this skill consistently during 2 meals each day. When Johnny meets this outcome, it will be helpful for his family because they will know what he wants to eat.
  2. This outcome is time specific, child-focused, and measurable.  Let’s look closer at the “measurability” piece of this outcome.  Labeling 10 pictures of foods correctly for 7/10 trials is certainly an objective measure, but how likely is it that Johnny’s parents only want him to use words 70% of the time?  When we examine the helpfulness of this outcome, we see that it is lacking here as well.  Naming 10 pictures of foods is unlikely to be helpful to the family because it lacks context.  It does not address Johnny’s ability to communicate that he wants a certain food, only to name a picture of a food
  3. This outcome also gives a time frame (6 months) and clearly states that Johnny is the person the outcome is about.  This outcome is measureable–We know Johnny will have met this outcome when he has 15 new words.  However, this outcome may or may not be helpful for the family.  Johnny’s new words could be anything from animals to names of family member’s.  Also, Johnny could achieve this outcome without ever learning to use his words to communicate his wants and needs.  While this outcome is measurable and gives a specific time frame, it is not very helpful for the family and would not help Johnny increase participation in routines.
  4. Like outcome #1, this outcome meets our criteria for a good outcome.  It is measurable (Johnny will use a single word to request his cup when he is thirsty.  This would be helpful for the family because they would no longer have to guess if Johnny is thirsty or hungry or neither.  We know that we expect Johnny to meet this outcome in the next 6 months.  This outcome reflects Johnny learning in a natural context.

Writing IFSP outcomes can be challenging.  Teams want to write them in family friendly language and in plain terms, so everyone will know what the outcome is and why it is important to the family and when it should be reached.  Writing good outcomes takes practice.  There are a few hints that you may find helpful when your team creates outcomes with families:

  • Who (usually the child, may be the family or caregiver, NEVER the interventionist)
  • Will do what (the desired behavior)
  • How measured (objective criteria)
  • Under what conditions (are modifications, adaptations, accommodations needed)
  • In what routines/activities
  • When (time frame)

Click this link to the ECTA Center for more resources on writing outcomes.

http://ectacenter.org/topics/families/famresources.asp

 

Jamie Holloway, PT, DPT, PCS

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Isn’t More Better?

Early Childhood Interventions January 15, 2014

“Isn’t more better?”- a question commonly asked by families and providers when first hearing about the Primary Service Provider (PSP) model.  Responses to these questions and more are answered below

Isn’t more better? 

Contrary to popular belief, more service is not always better.  In fact, one study found that multiple services provided at high frequencies actually related negatively to parent well-being and function (Dunst, Brookfield, & Epstein 1998).  However, more intervention is better.  Embedding strategies into daily routines increase the opportunities for practice and increases learning.  The TaCTICS website provides a detailed comparison of a traditional approach (ST and OT one time a week each) vs the PSP approach. http://tactics.fsu.edu/MIH/handouts/steps/step5/adultlearning/JamesJamaal.pdf.  It is our responsibility as providers to educate families about the way young children learn and the role they have

Is one time a week really enough? 

The PSP model does not stipulate that the primary provider can only see the family one time per week.  The frequency of the visits by the PSP model should be determined by the IFSP team during the IFSP meeting.  The decision should take into account the caregiver’s level of comfort in providing strategies and the family’s schedule.  Some professionals advocate for starting with a high frequency of service and tapering off as the caregiver’s confidence and competence increase.  Also remember that the IFSP can be changed at any time.  If the team recommends one time a week initially, but later feels an increase (or decrease) is necessary, the team can call an IFSP meeting to make the change.

Are you sure I only need one provider to meet all of my concerns?

The PSP model does not mean a family will only have one provider.  The intent of the model is not to say that families have to choose between physical therapy or speech therapy.  Remember that the primary provider has a team of professionals working with them to meet the child’s needs.  Consultation visits can occur in which the primary provider, the consultant, and the family all meet together to observe the routines and embed strategies.

How is an SLP supposed to do a PT’s job? 

The short answer is they aren’t.  The focus of early intervention services is on supporting families to increase caregiver confidence and competence.  Providers focus less on direct interaction with the child and more on educating the family about strategies to promote development.  An SLP has basic knowledge of development, including motor development, and is, therefore, capable of making basic recommendations.  Remember that a child does not work on developmental areas in isolation.  An SLP is “working on” on all areas of development all the time.  It is expected that the SLP would ask the PT to consult when questions or concerns arose that she was not comfortable answering or addressing.

For more information:

Shelden ML & Rush DD (2013). The Early Intervention Teaming Handbook The primary service provider approach. Baltimore, MD:  Brookes Publishing.

Dunst, CJ, Brookfield J, & Epstein J (1998). Family-centered early intervention and child, parent and family benefits:  Final report.  Asheville, NC:  Orelena Hawks Puckett Institute. 

– Jamie Holloway

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Tips for EI Practice: Talking to Families about Routines

Early Childhood Interventions December 02, 2013

Best practice recommendations for early intervention services include embedding developmental strategies into daily routines and activities that are already occurring in a child’s life.  Routines allow for increased opportunities for a child to practice and learn a skill within a familiar context.  This allows for optimal learning and carryover.  While all families have routines, it is not always easy for providers to gather information about these routines.  Included below are some tips that can be used to gain more information from families about their daily routines and activities:

  • Provide background information about the purpose of your questions.  Families may be more willing to provide information when they know why they are being asked.
  • Remember that a routine is not the same as a schedule.  Routines are activities that happen in a predictable sequence.  All families have routines, even though they may not have a set schedule of when certain routines occur each day.
  • Expand your definition of a routine.  Getting the mail, washing hands, and helping to prepare meals are predictable, functional activities.  Each of these activities  contain multiple opportunities for learning.
  • Use open-ended questions!  Ask the family what works well within the routine and what does not.
  • Can you show me?  Observing the routine as it typically happens will provide an opportunity to ask follow-up questions and problem solve with the family for solutions.
  • Use coaching strategies to guide questioning.  Ask questions to help the family come up with an answer that works for them.  Avoid suggesting alternatives without family input.
  • Ask the family regularly about their interests.  For example, the routines in which a family participates over the summer time are likely very different than the routines of the family during the holiday season.  Jennifer Swanson and her colleagues at the Family, Infant, and Preschool Program have created a series of checklist that may help you help families identify interests of their children. The checklists can be downloaded from http://www.fipp.org/case/casetools.html Promoting Young Children’s Participation in Interest-Based Everyday Learning Activities Jennifer Swanson, A.B.D., Melinda Raab, Ph.D., Nicole Roper, Ed.D., & Carl J. Dunst, Ph.D. CASEtools, Vol. 2, Number 5
  • Observe items and objects in the family’s home that may provide clues to the family’s routines.  For example, by observing a baseball hat and glove near the back door, you may learn, after questioning, that the family spends the entire weekend at the ball park watching a sibling play baseball.  Embedding strategies into the family’s ball park routine might be beneficial for this child.
  • Be respectful.  Routines vary greatly from family to family.  It is important for providers to keep an open-mind when working with families.
  • If a formal tool such as the Routines-Based Interview (RBI) has been used to complete the IFSP, consider using the information obtained from the RBI to guide follow-up questions with a family.
  • Published instruments such as the AEPS Family Report and the HELP Family-Centered Interview can also be used for routines assessment.  In addition, simple questionnaires and handouts to guide conversations with families are available online.  Visit http://tactics.fsu.edu for more information.

Finally, remember that routines assessment is an ongoing process.  The routines of a family will change over time just as intervention strategies will change as the child’s strengths and needs change.  By knowing how to gain information about a family’s routines, providers can offer meaningful strategies for a family and increase the child’s participation in activities.

Further Reading:

  1.  Workgroup on Principles and Practices in Natural Environments (February, 2008) Seven Key Principles:  Looks like/doesn’t look like. OSEP TA Community of Practice-Part C Settings. http://www.nectact.org/topics/families/families.asp.
  2. Woods, J. TACTICS. http://tactics.fsu.edu 

— Jamie Holloway

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Embedding Strategies into Daily Routines

Early Childhood Interventions November 11, 2013

Young children learn best through experience.  They need many opportunities for practice or repetition of skills within a meaningful context.  For infants and toddlers, the meaningful context is the activities and routines they do every day.  Embedding strategies into daily routines will increase a child’s opportunities to practice the skill and provide that meaningful context for learning.  In addition, by focusing on the family’s routines as the basis for intervention, the child will increase participation within routines and activities as a result.  

For example, Joey’s parents are concerned about helping her learn to sit independently.  The traditional model of therapy would involve the therapist performing activities to work on sitting and then giving a few things for the family to work on between sessions.  With routines-based intervention, the therapist and family would look at daily routines that provide opportunities for sitting such as bath-time or mealtime.  The provider would observe the current routine and problem solve with the family to offer strategies to target sitting within those routines.  Because the provider is not a typical part of the family’s routine, the caregiver should be given ample opportunity to practice the strategies during the session so they will feel comfortable performing it when the provider is not there.  In between sessions, the family would continue to implement the strategies.  

Most providers agree that families need a “home program” to work on skills in between sessions.  Indeed, the “therapy” is actually what happens between sessions.  By providing strategies that occur during already-occurring daily routines, the need for “therapy homework” is eliminated.  An added benefit is that the family is more likely to try the strategies because they are part of what they already do, not an “extra” thing added to their already busy day.

Embedding strategies into daily routines and activities of families is an important step to helping children and families achieve IFSP outcomes.  It’s a model that applies what we know about how young children learn and maximizes the child’s learning opportunities.  The provider can work to increase the caregiver’s confidence and competence as they learn to work with their child within the familiar framework of their routines.  What routines have you observed with families?  How have you observed routines-based intervention “in action?”

— Jamie Holloway

For more information:

Family Guided Routines Based Intervention- http://fgrbi.fsu.edu/model.html

McWilliam, R.A. (2010). Routines-based early intervention: Supporting young children and their families. Baltimore:  Paul H. Brookes Publishing.

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