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    Top 10 Mistakes in Early

    Intervention in NaturalEnvironmentsand the Solutions

    Robin McWilliam

    Siskin Childrens Institute

    Chattanooga, TN

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    [email protected]

    Contact

    [email protected]

    Write for copy of PowerPoint www.siskinresearch.org

    mailto:[email protected]:[email protected]
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    [email protected]

    Center mission:Improving the quality of life for children and families

    The Siskin Center for Child and Family Research improves the quality of lifefor children of all abilities by conducting high-quality and important appliedresearch, discovering effective and innovative methods of intervention with

    children and families, and discovering significant information about theirdevelopment and functioning.

    StrategiesConduct research within the Institute, in the community, and internationally

    Present and disseminate locally, across the United States, and overseasConduct Routines-Based Certification InstitutesEstablish international partnershipsParticipate in statewide advocacy and initiatives in TennesseeStrengthen university collaborations

    Participate in citywide or countywide early-childhood initiativesUse the Siskin Centers for Early Learning as applied-research settingsEstablish local services based on supporting research

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    [email protected]

    Areas of focusChallenging behaviorsClassroom interventionsEarly intervention in natural environments

    EngagementFeedback to teachersHome visitingIFSP qualityIntegrated classroom servicesMeasurement of EISR in routinesParenting supportQuality of lifeRoutines-Based Interview

    Teaching practicesVideo self-modeling

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    [email protected]

    Top 10 Mistakes (in order of when

    they happen in practice)1. Doing all the talking at intake visits

    2. Asking families about daily routines at every meeting leading upto the IFSP3. Basing goals just on what parents say they want4. Ignoring the participationpurpose of child-level goals and

    skimping on measurability of goals5. Matching services to deficits6. Working directly with the child on home visits7. Modeling/demonstrating blindly

    8. Using the same home visiting approach for all families9. Focusing exclusively on the childs well-being and quality of life10. Working just with children in classrooms

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    [email protected]

    Intake

    Mistakes

    1. Doing all the talking at intake visits Conditions parents to think they are passive

    recipients of service

    2. Asking families about daily routines atevery meeting leading up to the IFSP

    Tedious! Solution Ecomap

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    [email protected]

    Krista has little time for friends, but doesnt know what to do with her

    afternoons (the worst time of day)

    Steven, Krista,Darcy

    Ks parents

    Tulsa friends

    Ks brother

    Ks sisters

    RobynNeighbors

    Ss sisters

    Ss aunt &uncle

    Ss parents

    Hometownfriends

    SLP (Liz)weekly at

    home

    Dr. Trainer(physiatrist)

    Golf weekly

    Work: Alcoa

    SC (Donna)6

    months min.

    Ophthalmolog-istAmy (DMRS

    teacher)weekly HVs

    PT (Scott)

    2x/wk at clinic

    OT(Michelle)

    2x/wk at clinic

    Church (1st

    Baptist)

    Regularpediatrician

    (Glover)

    Aquatictherapy(weekly)

    Harris(neurosurg-

    eon)

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    [email protected]

    Assessment

    Mistake

    3. Basing goals just on what parentssay they want

    Solution

    Routines-Based Interview

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    [email protected]

    The Routines-Based Interview

    Go through each routine (i.e., time of day or activity)

    Get a sense of familys and childs functioning

    Write down significant information Star concerns

    Recap concerns with the family, showing them the starred items

    Ask what the family would like to concentrate on Write down these outcomes

    Ask them for the priority order

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    [email protected]

    Structure

    Home Routines

    Waking upChanging diaper/bathroom

    Going to kitchenBreakfast

    Parent getting dressedGoing outIn shopsLunch

    Going to parkOther family members

    coming home

    Dinner preparationDinnerBathTV

    Bedtime

    Classroom RoutinesArrivalCircle

    Free playSnack

    Small toysCentersOutsideMusicStoryLunch

    NapCenters

    Departure

    Within Each Routine1. What does everyone else do?2. What does this child do?

    a) Engagement

    b) Independencec) Social relationships

    3. How satisfactory is this routine?

    3. How well is this routineworking for the child(goodness of fit)

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    [email protected]

    The 3 Foundations of Learning

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    [email protected]

    Outcome Writing

    Mistakes

    3. Ignoring the participationpurpose of child-level goals

    Purpose for everyday life needs to be clear

    4. Skimping on measurability of goals

    Measurement of progress and attainment

    Sports psych finding! Solution 7 steps of functional outcome writing

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    [email protected]

    7 Steps of Functional Outcome Writing

    1. Read the short-hand version of the outcome from a family-centered, functional needs assessment (e.g., RBI)

    2. Find out what routines this affects3. Write Child will participate in [the routine(s) in question]

    4. Write by _____ing, addressing the specific behaviors

    5.

    Add a criterion for demonstration the child has acquired theskill

    6. Add another criterion for generalization, maintenance, orfluency, if appropriate

    7. Over what amount of time?

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    [email protected]

    Play with toys during hanging-out times

    Tyrell will participate in hanging-out times at

    home by playing with toys. We will know he can do this when he plays

    with a toy for 5 minutes, independently, 3

    times in 1 week.

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    [email protected]

    Service Decisions

    Mistake

    5. Matching services to deficits Pile-on of services, especially dangerous

    in vendor (non)systems Solutions

    Incremental service decision making Integrated services

    Primary service provider

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    [email protected]

    Incremental Decision Making

    1. Start with a primary provider (primary service provider, generalisthome visitor or consultant to child care)

    2. Remember the child is getting intervention from regularcaregivers (parents, teachers)

    3. Only add services needed to address outcomes the primaryprovider and the regular caregivers need help with

    Example: Child is delayed in talking, but primary provider andparent know how to teach him to talk, there is no need to add anongoing service

    4. When you do add a service, you plan for the intensity needed toensure the regular caregivders and the primary provider haveinformation necessary

    Its not about working directly with the child

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    [email protected]

    Integrated Services

    Focused support to

    families Teamwork ensured by

    having one professional

    through whom teammembers work

    Regular home visitor

    Classroom teacher Classroom consultant

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    [email protected]

    The Other Approach

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    [email protected]

    Definition of Primary-Service-

    Provider Model One professional provides weekly support to

    the family, backed up by a team of otherprofessionals who provide services to the

    child and family throughjoint home visitswith the primary service provider. The

    intensity of joint home visits depends on

    child, family, and primary-service-providerneeds.

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    [email protected]

    Home Visits

    Mistakes6. Working directly with the child on home visits

    Child deserves more intervention7. Modeling/demonstrating blindly

    This is the model-and-pray approach

    8. Using the same home visiting approach for all families Different child responsiveness Different family preferences

    9. Focusing exclusively on the childs well-being and quality oflife

    Family-centered, especially primary caregiver Solutions

    Support-based home visits 3-tiered, response-to-support approach

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    [email protected]

    Collaborative Assessment.of Effectiveness

    Collaborative Assessment.

    of Effectiveness

    Routines-based

    suggestions

    Written instructionalguidelines

    Parenttraining

    Intensity

    Childprogress &

    familydesire

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    [email protected]

    VHVS: The Questions

    1. How have things been going?

    2. Do you have anything new you want to ask meabout?

    3. Outcomes in priority order

    4. Is there a time of day thats not going well for you?

    5. How is [family member] doing?6. Have you had any appointments in the past week?

    Any coming up?

    7. Do you have enough or too much to do with [yourchild]?

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    [email protected]

    Behavioral Consultation in the Context of

    Support-Based Home VisitsHows it goingw/Outcome 1? Child still

    not doing it

    Getting better

    Fine

    GetdetaileddescriptionAsk for demo of

    child func., ifnec.

    Ask-to-SuggestHows interventiongoing?

    Implementing

    Description

    Demo by parent?

    Refineskill Tweakimpl.

    Not implementing

    Hard to fit in Child not

    responding

    Forgot

    Changeinterv orroutine Change

    orpersist

    Trymatrix

    Offer to demo

    (8 modelingsteps)

    Get det. descrip

    Need help?

    Yes

    No

    Up theante

    End interv.?

    Yes

    No

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    [email protected]

    Logic Model for Support-Based Home

    Visits

    Family qualityof life

    Improvedchilddevelopment

    Maximal quality

    of interventionfor the child

    Maximal amountof intervention

    for the child

    Emotional,material, &informational

    support

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    [email protected]

    Home-Based Programs

    Do

    Use accessiblematerials

    Engage in kitchen talk

    Find out what familieswant to be shown

    Talk about everyday

    routines

    Dont

    Take a toy bag Work just with the child

    Model unnecessarily

    Imply that lessons areimportant

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    [email protected]

    Wanna Be in a Study of the Response-to- Support Approach? Recruit 3 families Participate in an information conference call with me

    Receive a manual on how to implement the approach Data:

    Family-completed questionnaires Home-visitor-completed questionnaires

    Child assessment (MEISR + a norm-referenced childdevelopment tool)

    Benefit to you: Efficient training in cutting-edge home-basedservice delivery

    Benefit to families: Excellent home-based service delivery

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    [email protected]

    Classroom Visits

    Mistake

    10. Working just with children inclassrooms

    Children deserve more intervention

    Solutions

    Individualized within routines

    Group activities

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    [email protected]

    Integrated Specialized Services

    DEFINITION

    When therapy and specialized instruction occur inthe classroom with other children usually present,and in the context of ongoing routines andactivitieswhen the teaching staff can learn fromthe consultant and vice versa

    Specific approaches: individualized within routinesand group activity

    Purpose: To ensure the teaching team has the

    knowledge and skills to be able to maximize thechilds meaningful participation in everydayroutines

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    [email protected]

    The 5-Component Model for Early

    Intervention in Natural Environments

    CollaborativeConsultation

    to Child

    Care

    Support-BasedHomeVisits

    TransdisciplinaryServices

    FunctionalFamily-Centered

    Needs

    Assessment

    UnderstandingThe

    FamilyEcology

    EngagementIndependence

    Social RelationshipsSatisfaction w/ Home Routines Functional,

    measurableoutcomes