Working With Families Not Too Much, Not Too Little

Robin McWilliam

Contact

Robin.McWilliam@Vanderbilt.edu www.VanderbiltChildDevelopment.us Within 1 week, this PowerPoint will be

available on the website, under Presentations

What Does This Title Mean?

Working with families not too much, not too little Working with families too much

means usurping their role (Dunst, 1985)

Working with families too little means failing to attend to family-level needs (Turnbull)

The 2-Pronged Approach to Working With Families

What we attend to Do we attend inordinately to child-

level needs? How we work with families

Do we have a framework for family-friendly interactions?

Change Framework by Changing Practice

Assess child- and family-level needs by conducting a Routines-Based InterviewTM

Addressing family-level needs through the IFSP

5 evidence-based characteristics of working with families in a family-centered way

Usurping Families’ Role Their role: To raise their children,

which includes teaching them How we usurp it: By trying to teach

children during home visits or other weekly contacts What does this convey to families?

What we should do to avoid usurping it: Take a consultative role in working with families (Hobbs)

Failure to Attend to Family-Level Needs The field of [early intervention] has

focused primarily on implementing family-centered practices in regard to how families and professionals should interact, but it has not sufficiently addressed what supports and services should be offered to families in order to enhance the likelihood of positive outcomes for families, themselves, as well as for children with disabilities.

Turnbull et al. (2007). Family supports and services in early intervention: A bold vision. Journal of Early Intervention, 29, 187-206

Attending Inordinately to Child-Level Needs This study revealed that many IFSPs in the sample

included strategies implying that services were to be delivered by professionals during intervention sessions separate from the family’s daily routines. This finding suggests that practices on IFSPs collected in 2001 show little progression from research findings of several years ago, which found that intervention is frequently hands-on, child-focused, professionally-designed and devoid of active family involvement (e.g., Boone et al., 1998; Harbin et al., 1998; McBride & Peterson, 1997; McWilliam et al., 1998).

Jung, L. A., & McWilliam, R. A. (2005). Reliability and validity of scores on the IFSP Rating Scale. Journal of Early Intervention, 27, 125-136.

Attending to Family-Level Needs

Take a support-based approach to Understanding the family ecology Assessing the family’s, including the

child’s, needs Home visiting

Understanding the Family Ecology

Develop an ecomap

Krista has little time for friends, but doesn’t know what to do with her afternoons (the worst time of day)

Steven, Krista, Darcy

K’s parents

Tulsa friends

K’s brother

K’s sisters

RobynNeighbors

S’s sisters

S’s aunt & uncle

S’s parents

Hometown friends

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)

Regular pediatrician

(Glover)

Aquatic therapy (weekly)

Harris (neurosurg-

eon)

Assessing the Family’s, Including the Child’s, Needs

Conduct a Routine-Based Interview

The Routines-Based Interview Go through each “routine” (i.e., time of day or

activity) Get a sense of family’s and child’s 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

StructureHome Routines

Waking upChanging diaper/bathroom

Going to kitchenBreakfast

Parent getting dressedGoing outIn shopsLunch

Going to parkOther family members

coming homeDinner preparation

DinnerBathTV

Bedtime

“Classroom” RoutinesArrivalCircle

Free playSnack

Small toysCentersOutsideMusicStoryLunchNap

CentersDeparture

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

a) Engagementb) Independencec) Social relationships

3. How satisfactory is this routine?

3. How well is this routine working for the child (“goodness of fit”)

Family-Level Outcomes on the IFSP

Informal goal Specific goal Criterion for accomplishment

Therapies more under Jo’s control

Jo will revise the schedule of [Child’s] therapies to suit her own needs

By [date]

Child care when Jo needs longer term care (e.g., during her medical treatments)

Jo will have child care lined up for when she needs longer term care

By [date]

Information on research, what other moms do, bedtime rituals

Julie will have information on research relevant to her child, on what other parents of similar children do, and on bedtime routines.

By [date]

Informal goal Specific goal Criterion for accomplishment

Time for Chris and Julie together [a very common outcome in many families]

Chris and Julie will have 3 nights out.

By [date]

Sue get a new job Sue will have information about potential new jobs

By [date]

New beds for kids Sue will get new beds for the children

By [date]

Time for Gina to play with Maria and Emily (15-30 mins)

Gina will play with Maria and Emily, together, for 15-30 minutes a day.

4 days in 1 week.

Informal goal Specific goal Criterion for accomplishment

Down time before dinner for family

Gina will arrange for the family to have down time before dinner

3 nights a week for 3 weeks.

Find child care Gina will find acceptable child care for Emily.

By [date]

Maria (sister) cooperate

Maria will participate in play time, dressing, and meals by cooperating.

She does what she’s told within 5 seconds 5 times a day for 5 consecutive days.

(Alternative if sibling outcome is unacceptable in a system) Gina will get Maria to cooperate.

Gina will get Maria to do what she’s told within 5 seconds 5 times a day for 5 consecutive days.

Hobby for Andrew (not video, not car)

Andrew will acquire a new hobby.

He participates in the activity at least once a week for 8 weeks.

Jo’s Priorities1. Communicate his needs (drink, don’t feel well,

eat, more, play, TV, outside)2. Eating with combination of textures; vegetables,

fruits3. Handwashing—water rinsing4. Identifying objects (in a book, on body), to see

where he is cognitively5. Transitions (e.g., from park) when he has to stop

doing something fun6. Therapies more under Jo’s control7. Child care when Jo needs longer term care (e.g.,

during her medical treatments)

Julie’s Outcomes1. Making sounds (playing with Chris, diaper, reading,

play, feeding)2. Responding to Julie and Chris during reading, play,

meals3. Reach (playing on floor, bath, swim class, music,

feeding)4. Batting for toys and splashing (play, bath)5. Grasp things in front of him (music, bath, feeding)6. Rolling both ways, pushing up (play)7. Sitting unassisted (music, bath, feeding)8. Information on research, what other moms do,

bedtime rituals9. Time for Chris and Julie together (get parents here)

Sue’s Priorities1. Sue get a new job2. Samantha communicate, esp. “I love you” at

wake up and what to eat at meals3. Eat without stuffing4. Cup drinking5. Eat with utensils6. Potty training7. Dressing independently8. Play with toys appropriately at hanging-out

times9. New beds for kids

Gina’s Goals1. Emily will extend arms at dressing2. Play without head-banging (because of child care)3. Time for Gina to play with Maria and Emily (15-30

mins)4. Communicate Mama, no, up, cup, Dada, etc.5. Down time before dinner for family6. Sit in car seat without self-stimulating with middle

strap (for social reasons)7. Walk faster8. Find child care9. Maria cooperate

Home Visiting

Use Support-Based Home Visits and the Vanderbilt Home Visit Script

Discussed in concurrent session

The Framework for How We Support Families

Support-Based Home Visits Emotional Support

Positiveness Responsiveness Orientation to the

whole family Friendliness Sensitivity

Material Support Equipment and

materials Financial resources

Informational Support Child development Child’s disability Services and resources What to do with the

child

The 5-Component Model for Early Intervention in Natural Environments

CollaborativeConsultation

to ChildCare

Support-BasedHomeVisits

TransdisciplinaryServices

FunctionalFamily-Centered

NeedsAssessment

UnderstandingThe

FamilyEcology

EngagementIndependence

Social RelationshipsSatisfaction w/ Home Routines

ResponseTo

Support

FunctionalOutcomes

Principles All the intervention occurs

between specialists’ visits. Therapy and instruction are not

golf lessons. Regular caregivers (i.e., parents

and teachers) need to own the goals.

Professional Support

Child Outcomes

Caregiver Competence &

Confidence

Who Has How Much Influence on What?

How Children Learn

Through repeated interactions with the environment, dispersed over time.

Not in massed trials.

Between Visits

The Conceptual Framework

Desired Result of This Model

text

Maximal & Optimal Interventions Provided by

Natural Caregivers in Natural Routines

Engagement, Independence, & Social

Relationships

Other Desired Outcomes (e.g., Academics,

Friendships, Family Quality of Life)

Family Ecology

Rou

tines

-Bas

ed O

utco

mes

Transdisciplinary, Support-Based Home Visits