deborah d. hatton, ph.d. fpg child development institute

Early Intervention Training Center forInfants and Toddlers With Visual ImpairmentsFPG Child Development InstituteUniversity of North Carolina at Chapel HillFebruary 2005

Deborah D. Hatton, Ph.D.FPG Child Development InstituteThe University of North Carolina at Chapel Hill

Family-Centered Practices:Multimedia Resources for Professional Development2005 OSEP National Early Childhood ConferenceFebruary 9, 2005Washington, D.C.


Purposes of Presentation

• Provide overview of Early Intervention Training Center for Infants and Toddlers With Visual Impairments

• Review modules and multimedia CDs being developed by the Center

• Review curriculum and content for preparing personnel to provide family-centered practices

• Secure feedback on resources from participants


Deborah D. Hatton, Ph.D.FPG Child Development InstituteThe University of North Carolina at Chapel Hill

Early Early InterventionIntervention Training Center for Training Center for Infants and Toddlers Infants and Toddlers With With Visual Visual ImpairmentsImpairments

OSEP Cooperative Agreement H325B000003


Early Intervention Training Center for Infants and Toddlers With Visual Impairments

Mission: To enhance the capacity of universities to prepare personnel to serve infants and toddlers with visual impairments and their families


Modules Developed by EITC

• Family-Centered Practices• Visual Conditions and Functional Vision: Early Intervention Issues• Developmentally-Appropriate Orientation

and Mobility • Communication and Emergent Literacy• Assessment • Recommended and Evidence-Based Intervention Practices


What is a module?A course (2 to 3 semester hours of graduate credit) consisting of five to seven sessions

Each session includes• Introduction and objectives• Knowledge synthesis (Major Points)• List of instructor resources• Suggested instructional sequence• PowerPoint summarizing Major Points• Quiz• Video clips and self-check on CDs for application

of knowledge to practice


Building a Module• Literature review• Professional standards• Recommended practices• Review of relevant products from other projects• University partner input• Practitioner input• Family/consumer input• Expert input

Visual impairmentEarly interventionAccessibilityTechnology


Developing and implementing

• Field review process• Module revision• Field test process• Module revision• Module publication• Dissemination


Field Test Locations:Family-Centered Practices• University of Alabama at Birmingham• University of Arizona• Drake University, Iowa• Florida State University• Kutztown University• North Carolina Central University

Building Reliable Alliances Session 1

Family-Centered Practices

Early Intervention Training Center for Infants and Toddlers With Visual ImpairmentsFPG Child Development Institute

Produced in collaboration with P.J. Winton (2003)

The University of North Carolina at Chapel Hill


Objectives

After completing this session, participants will

1. describe the legal basis for family-centered practices in the context of early intervention.

2. identify and implement the key features of family-centered practices: focusing on family strengths, promoting family choice, and collaborating with families and other professionals while respecting and honoring diversity within the context of families, communities, and cultures.

PowerPoint 1A


3. describe the rationale for using family-centered practices and demonstrate the ability to initiate and sustain a reliable alliance with families based on effective help-giving practices.

4. describe their overall philosophy for working with families including the basic assumptions and principles that guide their approach. Develop self-awareness of personal values, assumptions, and biases related to childrearing and interactions with families and understand how those affect relationships with families and children.

PowerPoint 1B

Objectives


History of Early Intervention Federal Legislation

• 1975 Public Law (PL) 94-142 The Education of the Handicapped Act guaranteed free appropriate public education to children with disabilities ages 5 to 21 years.

• 1986 PL 99-457 Extended PL 94-142 down to age 3 years due to an urgent and substantial need to • enhance development of infants/toddlers with disabilities,• reduce educational costs,• minimize institutionalization,• maximize independence, and• enhance capacity of families to meet children's needs.

PowerPoint 1C


IDEA Amendments of 1997 (PL 105-17)Individuals with Disabilities Education Act

Part C Provided the legislative support for family-

centered early intervention services for infants and toddlers (0-3) with disabilities and their families.

IDEA will probably be reauthorized in 2004. Final regulations will be issued following reauthorization. Be alert for changes in federal legislation that affect early intervention in 2005.

PowerPoint 1D


IDEA Amendments of 2004 Individuals with Disabilities Education

Improvement Act

Part C• Provides the legislative support for family-

centered early intervention for infants and toddlers (0-3) with disabilities and their families.

• Requires that families direct assessment of their resources, priorities, and concerns.

PowerPoint 1D


Goals of Part C of IDEA• Enhance the development of infants and

toddlers with disabilities

• Reduce costs to society by minimizing need for special education

• Minimize likelihood of institutionalization and maximize independent living

• Enhance capacity of families to meet children's needs

PowerPoint 1E


Family-Centered Support

• Reflects a way of coordinating and delivering assistance, support, and services to families with children who have disabilities that enhances their capacity to care for their child

• Is based upon an understanding of the complexity that exists within families and that decisions and services will influence each member of the family and the unit as a whole

PowerPoint 1F


Family Systems Theory• Family systems theory provides a framework

for looking at families and their challenges.• Practitioners are most effective when they

view the context of each unique, individual family and craft solutions that fit the family, rather than making the family adapt to the solution.

• Practitioners who implement family systems theory explore options with a family based on their unique characteristics rather than imposing options on a family.

Foster & Phillips, 1992

PowerPoint 1J


Central Values of theFamily-Centered Approach

• Emphasizing families’ strengths rather than deficits

• Promoting family choice and control over desired resources

• Developing collaborative relationships between professionals and parents

• Viewing family from a holistic perspective

PowerPoint 1L


Shifting Assumptions

Child-centered Family-centeredStandardized IndividualizedDoing to families Doing with familiesSpecialized IntegratedFragmented CoordinatedMultidisciplinary Transdisciplinary

PowerPoint 1M


• Family is constant in child’s life

• Collaboration at all levels is essential

• Cultural, racial, ethnic, socioeconomic diversity are honored

• Family strengths are recognized and respected

• Unbiased information is shared continuously

• Networking and family-to-family support are promoted

Turnbull, Turbiville, & Turnbull, 2000PowerPoint 1N

Family-Centered Practices:Current Assumptions


• Expertise regarding developmental needs of child is shared

• Systems are accessible, flexible, culturally competent, responsive to strengths/concerns identified by family

• Comprehensive programs for financial and emotional support are available

Turnbull, Turbiville, & Turnbull, 2000

PowerPoint 1O

Family-Centered Practices:Current Assumptions


Establishing Reliable Alliances

The term reliable alliance has been used by Turnbull and Turnbull (2001) to describe a dynamic relationship between families and professionals in which they experience individual and collective empowerment by sharing their resources equally in order to make joint decisions.

Turnbull & Turnbull, 2001

PowerPoint 1P


Eight Obligations Involved in Establishing Reliable Alliances

Reliable alliances involve the following eight obligations.

1. Knowing yourself 5. Promoting family choices2. Knowing families 6. Affirming great 3. Honoring cultural expectations

diversity 7. Communicating 4. Affirming and positively

building on family 8. Warranting trust and strengths respect

Turnbull & Turnbull, 2001, p. 58PowerPoint 1Q


DiversityDiversity refers to differences in individuals and

families across a variety of dimensions including• culture, language, race, class, disability, age, and

gender.• personal affiliations to religious and political groups

or belief.• sexual orientation.Family culture can affect any of the following:• treatment of medical issues,• primary language spoken within the home,• literacy activities,• interactive play (social skills), and• daily routines.

Milian, 2000

PowerPoint 1V


Cultural Diversity and Visual Impairment

Some cultures

• believe that caring for the child is more important than teaching independence.

• expect adults with blindness/VI to hold only certain jobs or not to work at all.

• value oral communication over the written word.

• vary in their gender expectations.• believe that specific types of VI have

special meaning. Erin, 2002

PowerPoint 1X


Religious Diversity and Visual Impairment

• Many religions still think that visual impairments result from retribution for sin.

• For some families, religious leaders and heads of family may be the critical decision makers.

• Many families visit religious healers during their children’s early years.

Erin, 2002PowerPoint 1Y


Cultural Reciprocity According to Harry (as cited by Warger, 2001), families And professionals must engage in a two-way process to gain understanding and respect for each other’s values. This two-way process is the basis for cultural reciprocity and involves• identifying cultural values,• determining if you and the family are aware of each

others’ assumptions and how you differ,• identifying and respecting cultural differences—

explaining and discussing cultural basis of assumptions, and

• determining the best way to adjust recommendations to match values.

PowerPoint 1Z


Building Positive Relationships With Families

• Respect the uniqueness of families

• Develop personalized, trustful relationships

• Consider cultural issues that influence communication

• Recruit staff who value diversity

• Develop relationships with leaders of cultural groups who serve as guides

• Evaluate outcomes and processes Bruns & Corso, 2001

PowerPoint 1AA


Consider Variations Within Cultures

Families vary in their adherence to culturalnorms based on

• Primary language in home and community

• Educational levels

• Religious affiliations

• Country of origin, length of time in U.S., degree of acculturation, current residence

• Income Santos & Reese, 1999

PowerPoint 1BB


Families Within Cultures VaryFCM 1-07

PowerPoint 1BB


• Examine personal biases, values, and past experiences and how they may impact interactions with families.

• Be sensitive to families’ reactions to disability within the context of the family, community, and culture.

• Get to know and appreciate families and their perspectives, strengths, needs, and concerns.

Honoring Diversity

Teams and Service Coordination Session 2



Produced in collaboration with P.J. Winton and R.A. McWilliam (2002)



ObjectivesAfter completing this session, participants will

1. identify, observe, and describe factors that contribute to effectively functioning teams.

2. contrast three team models and cite the advantages and disadvantages of each.

3. recognize families as key members of teams and describe factors that contribute to family participation on early intervention teams.



4. identify, observe, and describe the possible collaborative roles of TVIs on early intervention teams. Identify their own strengths and areas of potential growth regarding teamwork and collaboration.

5. describe the potential roles of the official service coordinator and the required elements of service coordination.


Effective Early Intervention Teams

• Members understand and accept the mission, purpose, and goals.

• Members have appropriate training, skills, and experience.

• Members practice open communication.

• Organizational support is available.

• Leadership is identified.

• Effective problem-solving strategies are utilized.

• Members have high standards and evaluation methods.

• Trust and support are evident.

• Sufficient time and resources are available.

Briggs, 1993


Ecology of a Team

TEAM

Organizational Resources

Organizational Structures

Individual Characteristics Relationships

Organizational Culture

Political & Community Factors


Effective Communication Strategies

• Start with general questions and statements.

• Offer support; follow through on commitments; listen empathetically.

• Restate key components; listen actively.

• Seek clarification.

• Practice nonverbal communication and passive listening.

• Summarize information.

• Model effective communication.


Parents may feel estranged from the team when they are• not involved in planning stages,

• not given meaningful roles,

• not prepared for meetings, or

• not supported in their involvement.

Factors that make it difficult for parents to feel a part of a team:


Factors that make it difficult for parents to feel a part of a team:

Parents may feel estranged from the team when professionals• discount parent perspectives or priorities,

• see the child from single discipline’s perspective, or

• are not sensitive to the fact that they can be intimidating.


Increasing Family Involvement in IFSP Development

When parents• participated in a developmental

assessment, • recorded their family profile, and• met with a school or community liaison,

the meeting that followed resulted in the parents• presenting their goals and concerns first,• suggesting more goals, and• making more decisions. Brinckerhoff & Vincent, 1987


Effective team members

• approach early intervention from a transdisciplinary perspective in partnership with service agencies and families,

• know how to find information, and

• are critical thinkers and life-long learners who seek innovative solutions.


Involving Families in TeamsFCM 2-06


Collaborative Team MeetingsFCM 2-02


• Service coordinators support families of infants and toddlers with disabilities who are eligible for services.

• They do so by assisting and enabling the child and family to receive the rightful services, including procedural safeguards, authorized by the state’s early intervention program.

• While supporting families when needed, service coordinators also encourage families to become self-directed and empowered so they acquire the skills required for life-long advocacy for their child.

Service Coordination as Defined by IDEA

Support-Based Early Intervention and Developing Ecomaps

Session 3



Produced in collaboration with R.A. McWilliam (2002)




1. describe why all high-quality early intervention practices are considered support; contrast support and services; and describe the three types of support that should be provided to families by early interventionists.

2. discuss the importance of focusing on family strengths.



3. describe why a TVI in early intervention is interested in family members, friends, and other natural supports.

4. demonstrate the completion of an ecomap and describe its advantages.

5. describe how teachers of children with visual impairments (TVIs) work in collaboration with other professionals in the early intervention system to provide support to families.


Early intervention is best described as a system of supports that enhances the capacity of families to meet the special needs of their children with disabilities.


Services Versus Support

• Services: specific, discrete activities intended to meet specific, discrete needs

• Support: providing or coordinating resources to meet a family’s needs


Early intervention is the process of providing support, not just services.

Describing early intervention simply as the provision of services is limiting and inaccurate.

• It suggests first that the professional’s activities, rather than the family’s own actions, account for progress and positive change within a family and the child.

• It leads to the notion that every need requires a service.

• It leads to the belief that more is better in terms of number of services and frequency of contacts.


Support-Based Intervention

McWilliam and Scott (2001) identified three primary types of support provided by early interventionists:

• emotional support,

• material support, and

• informational support.


Emotional SupportEmotionally supportive, family-centered practitioners have the following characteristics:

• positiveness,• responsiveness,• orientation to the whole family, • friendliness,• sensitivity,• competence with and about children, and• competence with and about communities.

McWilliam et al., 1998


Material SupportFamilies cannot carry out interventions if their needs for food, shelter, and security are not met. Sometimes children with VI require specialized materials and environmental modifications such as task lighting, optical aids, or brightly colored objects to enhance participation in daily routines.Examples• Equipment and supplies• Information about resources, including financial resources


Informational Support

Families whose child has a visual impairmentreport concerns about the future and a need for information about

•child development,•child’s visual condition,•services and resources, and•specific strategies and skills.

Leyser & Heinze, 2001


Families are the key to effective early intervention.• Family members are the child’s primary

sources of nurturance, lifelong advocates, and key decision makers.

• Family members know the child better than anyone else.

• Family members are the ones who will be most effective at implementing suggestions.

• In order to implement family-centered support effectively, professionals must look for strengths in families.


Focusing on Family and Child Strengths

• When emphasis is on strengths rather than deficits, the family is empowered.

• Fewer professional services may be required when a strengths-based approach is used.

• Collaboration between family and service providers is enhanced when professionals recognize and value existing strengths.

• The knowledge, skills, and talents of both the child and family should be considered in intervention planning and implementation.


Support-Based Early Intervention

and the Family Ecology• In addition to support from professionals, families obtain

support from relatives and friends, neighbors, coworkers, and groups with which they are associated.

• The system of supports that families have is part of the family ecology.

• By knowing about the family ecology, the TVI can make suggestions that ensure that family priorities are met with existing resources whenever feasible.


What’s the best time to ask about the family ecology?• If family members are interested, the initial

intake visit is the preferred time to learn about the family ecology.

• This can be postponed, however, if the family seems uncomfortable sharing

this personal information so early in the relationship, or

the intake procedures preclude learning about the family ecology.


Purposes of the Intake Visit• Establish rapport with the family.• Convey information about the program.• Determine family’s primary concerns.• Inform family of their rights.• Secure permission to conduct assessments.• Learn about the family ecology.


Methods of Learning About the Family Ecology

• Interviews and questionnaires

• Observation

• Community resource mapping

• Ecomaps


What is an ecomap?

• A visual depiction of the family’s informal, formal, and intermediate system of supports

• Completed during informal dialogue between family and early interventionist or TVI—may take about 15 minutes

• Preferably completed during intake visit, but can be completed whenever family seems comfortable with sharing the information


Developing an EcomapFCM 3-09

Eligibility and Routines-Based Assessment

Session 4


Developed in Collaboration with R.A. McWilliam, 2002





1. describe the eligibility criteria (established condition, developmental delay, atypical development, or being at risk for developmental delay) for children entering Part C of IDEA.

2. describe what IDEA says about multidisciplinary assessment and assessment of the child’s current level of functioning.



3. describe the difference between evaluation for eligibility and assessment for intervention planning.

4. describe what IDEA says about the assessment of families’ priorities and concerns as related to their capacity to meet the developmental needs of the child. Describe the difference between assessment of families’ needs and priorities and assessment of families.



5. contrast the benefits and drawbacks of questionnaires and interviews to assess families' priorities.

6. describe the rationale for routines-based assessment (RBA) and identify and demonstrate sensitive and appropriate interactions with families in the process of RBA. Review major concerns and help parents select their priorities.

Objectives



7. identify and demonstrate the six questions to ask caregivers in the context of each routine.

8. describe the role of the TVI in determining eligibility and conducting an RBA.

Objectives


Evaluation for Eligibility

Does the child qualify for early intervention based on the eligibility criteria?

Or more simply,

Is the child in or out of early intervention?


Eligibility Criteria

• Established disability or “condition”

• Developmental delay

• Atypical development

• At risk for developmental delay due to biological and/or environmental factors


Multidisciplinary Assessment• Once eligibility is established, IDEA requires that

the child’s current level of functioning be determined by a multidisciplinary assessment. Two or more professionals from at least two disciplines must participate in the multidisciplinary assessment to determine current level of functioning.

• A functional vision assessment may be performed as part of the multidisciplinary assessment.

• The purpose of the multidisciplinary assessment is to identify the unique strengths and needs of the child.


Current Level of Functioning

• Current level of functioning describes cognitive, communication, motor, social-emotional, and adaptive/self-help skills.

• Some states accept a descriptive narrative of current level of functioning.

• Current level of functioning is a required component of the IFSP.


Routines-Based AssessmentA process whereby families

• share their concerns and

• identify priorities for early intervention within the context of everyday activities and routines, thereby assuring that early intervention occurs within natural environments.

This process is more comprehensive thaneither questionnaires or interviews.


What are routines?

• Routines are the everyday or frequently occurring events needed to maintain family life.

• Routines occur in the family’s natural environments.

• Routines reflect cultural and personal values, vary from day to day, appear chaotic or rigid, may be organized or disorganized, and may reflect a family’s goals.

Bernheimer & Keogh, 1995


Benefits of the RBA

The routines-based assessment

• emphasizes that intervention is family-centered,

• provides a structure for families to have a meaningful role in planning,

• generates a list of functional intervention outcomes, and

• aids in developing a positive relationship with families.


Components of an RBA• Routines-based interview

An early interventionist interviews the family about daily routines and how the child and family interact during those routines.

• Identification of concernsFrom the interview, family members generate a list of concerns they would like to address.

• Prioritization of concernsFamily members prioritize the list of concerns so that their most immediate concerns become outcomes for intervention planning.


Steps to Ensure an Effective Routines-Based Assessment

1. Prepare: Think about routines and logistics; devote full attention to planning.

2. Listen: Conduct the routines-based interview; learn about daily routines; highlight the family’s concerns.

3. Summarize: Identify major concerns; ask family members what they would like to work on; assist family in prioritizing these potential outcomes.


Interviewing Skills

• Be friendly: Make an effort to put the family at ease.

• Relax: Don’t go through a checklist of questions.

• Show real interest: Your goal is to learn about and support this family.

• Empathize: Don’t be poker-faced.

• Accept: Don’t judge.


The Routines-Based Assessment: Getting Ready

• Before the interview, encourage the family to think about their daily routines.

• When appropriate, arrange to have childcare providers from outside the family report on routines.

• Keep eligibility evaluations separate from intervention planning assessments.


RBI Overview

• Families report on their routines first.

• Staff from childcare settings report on routines.

• Specialists ask questions.

• Specialists and staff withhold giving advice.


Routines-Based Assessment1. Go through each routine.2. Get a sense of family’s and child’s functioning

using the six questions that will follow.3. Write down significant information.4. Highlight concerns.5. Recap concerns with the family, showing

them the highlighted items.6. Ask what the family would like to concentrate

on.7. Write down these potential outcomes.8. Help family determine priority order.


Introducing RBAFM 4-03


Six Questions About Each Routine

1. What does everyone else do?Home: other family members?Classroom: other children?

2. What does the child do?

3. Engagement How and how much does the child participate in the routine?


Six Questions About Each Routine

4. Independence What does the childdo without assistance?

5. Social relationships How does the child communicate and get along with others?

6. How satisfied is the caregiver with theroutines?

Developing Functional Outcomes and the IFSP Process

Session 5


Developed in Collaboration with R.A. McWilliam (2003)




ObjectivesAfter completing this session, participants will1. identify and describe the benefits and

required components of an individualized family service plan (IFSP).

2. describe the importance of functional outcomes and strategies for children and families. Describe functionality for very young children—engagement, independence, and social relationships within daily activities and routines.

3. describe the importance of assessing current level of functioning in developing functional outcomes.



4. describe the role of the team in developing the IFSP according to IDEA(2004).

5. describe the process by which the IFSP is monitored and reviewed.

6. use ecomaps and routines-based assessment (RBA) to identify functional outcomes and strategies and the natural environments in which they are most likely to be implemented.

Objectives



7. develop a successful IFSP that includes functional outcomes; strategies for achieving the outcomes; specification of any necessary early intervention services and supports; and requirements for coordination and accountability.

8. describe the transition process from Part C (infant and toddler) to Part B (preschool) services.

Objectives



9. describe the structure of effective and efficient IFSP meetings, including preparing families.

10. describe differences between an IFSP and an individualized education program (IEP).

Objectives


Benefits of the IFSP• Family-centered: focuses on the family’s

concerns and priorities—a dynamic process and document that guides early intervention

• Contains procedural safeguards• Provides a holistic plan to assure that

outcomes are achieved in a timely manner• Requires service coordination• Requires that two or more professionals from

at least two disciplines are involved in assessment and in development of the IFSP

• Requires that meetings are accessible and convenient for families


IFSP: Eight Required Components

1. Statement of current levels of functioning

2. Statement of the family’s resources, priorities, and concerns

3. Statement of the major outcomes, criteria, procedures, and timelines

4. Statement of early intervention services including the frequency, intensity, and method of delivering services


IFSP: Eight Required Components

5. Statement of the natural environments in which services will be provided

6. Statement of the projected dates for the initiation and duration of services

7. Identification of the service coordinator

8. Description of the transition plan for the transition to preschool services


Natural Environments• According to IDEA (2004), early intervention services should be provided in natural environments.• Natural environments are defined as settings and activities that are typical for the child’s peers of the same age who do not have delays or disabilities.• Natural environments include childcare centers, playgroups in public facilities, parks and recreation centers, festivals, retail establishments, and other community settings.


Family Resources, Priorities, and Concerns

Use the ecomap (Session 3) and routines-based interview (Session 4)

• to identify familyresources,priorities, andconcerns.

• to identify the natural environments in which intervention will occur.


Meaningful descriptions of the child’scurrent level of functioning promote development of functional outcomes.• Describe the child’s current level of

functioning in terms of the child's engagement (participation), independence, and social relationships in everyday activities.

• Typically, the current level of functioning contains information from the multidisciplinary assessment.


Meaningful descriptions of the child’scurrent level of functioning promote development of functional outcomes.

• Information from the RBA is incorporated into the current level of functioning.

• The TVI may use information from the FVA, orientation and mobility assessments, and the RBA to help develop descriptions of current levels of functioning.


Functional Outcomes

For a very young child, functionality means

• engagement,

• independence, and

• social relationships.McWilliam, 2005


Engagement

Engagement means developmentally and contextually appropriate interactions with the environment, including adults, peers, and materials.


Social Relationships

Social development involves

• forming relationships (attachment),

• communicating,• developing trust,• adapting to new situations,• interacting with peers (parallel,

associative, cooperative play), and • forming friendships.

Social relationships provide motivation and serve as the foundation for learning and competence.


IFSP development is a team effort.

• The IFSP team agrees on functional outcomes and the strategies needed to achieve them.

• The IFSP team determines who will provide support and services.

• The IFSP team determines the timelines for achieving the outcomes.

• If the team plans to provide transdisciplinary services, the primary home visitor (and possibly the service coordinator) can be identified during the IFSP meeting.


Multidisciplinary Versus Transdisciplinary

• Part C regulations of IDEA (2004) specify that in order to assure that more than one discipline is involved, a multidisciplinary team must complete assessments and collaborate with families to develop the IFSP.

• Transdisciplinary models can also be used to fulfill the mandate.

• Increasingly, the transdisciplinary model is recommended for providing early intervention support and services.


The IFSP is a living document.

• Most programs require that the IFSP be reviewed every 6 months, as required by law.

• It may be desirable to review the IFSP on a quarterly basis—particularly since young children may change quickly.

• The schedule for review will determine the projected dates for initiation and duration of services.


Services on the IFSP must be related to needs identified in the multidisciplinary assessment.

The team should decide on services basedon the outcomes—not on the diagnosis.• Just because the child has a deficit in a given

area, it doesn't mean that it’s a priority for the family.

• Just because a family chooses an outcome, it doesn't necessarily mean that a service is needed for that outcome to be met.


Suggestions for WritingMeaningful Descriptions of the

Child’s Current Level of Functioning

• Balance positive statements about the child's functioning with straightforward statements about the child's needs.

• Focus on functional needs in daily routines rather than on test performance.

• Use language that a layperson would understand; avoid professional jargon.


Outcome Selection

• The concerns identified by the family during the RBA are reviewed.

• The family selects 6 to 10 outcomes (goals).

• Team members, including the family, suggest outcomes based upon the multidisciplinary assessment and integrate them into the family outcomes.

• The family and other team members put outcomes into priority order.


The most important point about outcome writing is

that outcomes should be worded directly, simply, and measurably.

• It should be clear what the child is learning to do.

• It should be understood by everyone involved.

• It should be clear how to determine when the outcome has been achieved.

Writing Functional Outcomes


Identifying Strategies andSpecifying Supports and Services

• Strategies are actions that will be taken to achieve the functional outcomes specified in the IFSP.

• Strategies should fit into the family’s daily routines and meet family priorities.

• After outcomes and strategies have been identified, the team specifies the supports and services needed to achieve the outcomes, including the frequency, intensity, and method of delivering services.


Identifying Natural Environments and Initiation

and Duration of Services• The IFSP must identify the natural environments in

which support will be provided or a rationale for why support was not provided in a natural environment.

• The IFSP must specify the projected dates for initiation and duration of services.


Support for Transitions from Part C to Part B Services• When the child is between 24 and 30 months of

age, professionals should begin preparing the family for the transition from infant/toddler services (Part C) to preschool services (Part B).

• The family should be offered options for resources to meet their goals for their child.

• The family may want to visit as many options as they can.

• The family may need to be prepared for the shift from a focus on the family to a focus on the child.


Planning Effective IFSP Meetings

• Prepare families for the meeting.

• Set the time and location based on the family’s preferences.

• Promote communication among all from intake onward.

• Treat all with warmth and respect.

• Promote participation by all in the meeting.

• Encourage everyone to provide input.

• Remember that the IFSP meeting is a team process.


• Begin with introductions.• Review family concerns and priorities. • Review child and family strengths. • Describe child’s current level of functioning.• Review and prioritize family members’

concerns. • Use concerns as a basis for developing functional

outcomes that can be incorporated into the context of daily routines across natural environments.

• Write outcomes in measurable, easy-to-understand terms.

Implementing Effective IFSP Meetings


Effective Home VisitsSession 6



Developed in Collaboration with R.A. McWilliam, 2003




1. identify the major goals of home visits: providing informational, material, and emotional support that promotes functional outcomes based on family priorities within the context of daily routines.

2. describe the importance of developing an awareness of cultural diversity and cultural reciprocity.



3. describe the rationale for a transdisciplinary, collaborative, routines-based approach to home visits; the difference between regular home visits and consultative home visits within the transdisciplinary approach; and the role of the TVI in each.

4. use modeling appropriately to facilitate the acquisition of functional outcomes.


Objectives


5. structure home visits around family priorities in order to promote the acquisition of functional outcomes for the child and family within the context of daily routines and activity settings.

6. identify situations in which outside assistance must be sought.


Major Goal of Home Visits Providing support to

families is the foundation for effective home visits.

Three types of support early interventionists can provide include:

• emotional,• material, and• informational.


Communication Barriers

Family

• Lack of resources (e.g., time and money)

• Current emotional response (e.g., grieving)

Professional

• Lack of experience working with families

• Negative attitude toward family

Berry & Hardman, 1998


Cultural Awareness

• To be effective early interventionists and to accomplish the goals of the home visit, TVIs must develop cultural awareness and respect for diversity.

• Service providers may consider following a four-step process that will help them develop cultural reciprocity (Harry, as cited by Warger, 2001). Cultural reciprocity refers to a two-way process by which people from different cultures find mutual ground through sharing information about values and culture, to communicate effectively.


Cultural Reciprocity According to Harry (as cited by Warger, 2001),

professionals and families must engage in a two-way process to gain understanding and respect for each others’ values. This process is the basis for cultural reciprocity and involves

• identifying cultural values, • determining if you and the family are aware of

each others’ assumptions, and of how you differ,• identifying and respecting cultural differences—

explaining and discussing the cultural basis of assumptions, and

• determining the best way to adjust recommendations to match the family’s values.


Models of Service DeliveryMultidisciplinary Each specialist works

independently from assessment to intervention.Interdisciplinary Specialists share findings of

their assessments and plan outcomes together with the family but implement their own intervention programs.

Transdisciplinary One primary specialist or generalist is responsible for outcomes and collaborates with specialists to provide intervention.


Advantages of Transdisciplinary Approach

• Almost all child-level intervention occurs between visits.

• Almost all interventions can be implemented in

the context of family routines and daily activities.

• Infants and toddlers cannot generalize skills that early interventionists introduce.

• Not every need requires a service.• More is not necessarily better.


Components of Collaboration

• Empower regular caregivers to meet the child’s individual needs.

• Treat regular caregivers with respect and as full members of the team.

• Confer with specialists and other service providers to develop and implement an integrated and comprehensive intervention plan.


Outcomes of Effective Collaboration• Routines-based, family-centered assessment

and intervention planning Family discusses its routines and needs Staff members discuss classroom routines

(if appropriate) Family identifies priorities

• Functional outcomes tied to routines, family priorities, and needs

• Primary service provider/home visitor model (Transdisciplinary approach)


Roles of Home Visitors Primary Home Visitor• Responsible for regular

weekly home visits • Responsible for securing

formation from specialists and incorporating it into integrated strategies for functional outcomes

• Responsible for IFSP development, implementation, monitoring

• Responsible for transition planning

Consultant• Identifies priorities from

primary home visitor while formulating recommendations related to visual impairment

• Makes joint visits with primary home visitor

• Provides technical assistance to primary home visitor and direct service to child and family through joint home visits


Structuring the Home Visit

• General well-being How have things been going? • New questions or Do you have anything new you concerns

want to ask me about?• Review of outcomes How have things been going

in priority order with [priority #1]?• Problematic Is there a time of day that is routines not going well?• Other family How is [family member]

members doing?• Appointments Have you had any

appointments? • Workload Do you have enough or too much intervention

to do with [your child]?


Recommended Practicesfor Home Visits

• Collaborate with families and with other specialists and service providers.

• Use routines-based intervention to achieve functional outcomes.

• Use a transdisciplinary model with a primary home visitor.

• Ensure the primary home visitor collaborates with other specialists and service providers.


Collaborative ApproachFM 6-02


Promoting functional outcomes involves• empowering regular caregivers to make

their own decisions to achieve their priorities and meet the child’s individual needs.

• fostering important functional domains of child development: engagement, independence, and social relationships.

VI-Specific IssuesSession 7



Produced in collaboration with R. A. McWilliam and P.J. Winton (2002)




1. describe issues and strategies that will assist TVIs as they build reliable alliances and implement family-centered practices.

2. describe the strategies that TVIs use as members of teams to effectively communicate and collaborate with families and other professionals, identify the benefits of the transdisciplinary method of service delivery, and describe the responsibilities of the service coordinator.



3. describe the three types of support that are important for families of young children with visual impairments and explain the advantages of developing an ecomap (a graphic representation of a family’s existing supports).

4. describe the criteria for eligibility for Part C services under IDEA (2004) and the rationale for family-centered, routines-based assessment and identification of the family’s priorities, strengths, and concerns.



5. identify the eight required components of individualized family service plans (IFSPs) and strategies for developing functional IFSP outcomes and assuring smooth transitions from Part C to Part B services.

6. contrast the roles of TVIs who serve as primary home visitors to those of TVIs who serve as consultants to primary home visitors and families.

deborah d. hatton, ph.d. fpg child development institute

Documents

family strengths

family choice

context of early intervention

key features of family

visual impairmentsmission

context of families

families i

multimedia resources