High Quality, Team-based Early Intervention Services for Infants
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Transcript High Quality, Team-based Early Intervention Services for Infants
High Quality, Team-based Early Intervention
Services for Infants and Toddlers
March 24, 2011
Council Bluffs, Iowa
Lynda Cook Pletcher
[email protected]
We are here today and over the next few months as
early intervention teams to…..
In our time together today and the next
few months we will explore:
Current trends and
approaches in use for
providing EI services
around the country
The roles and functions of
a team during the Early
intervention process
Practices of functional
Common underlying
themes to these
approaches
assessment
Writing functional
outcomes
Some of the agreed upon
practices (implementation)
of these approaches
Team responsibilities
providing on on-going
services
Quality teams have:
Common purpose
Agreed upon values and beliefs
Share common information
Share common tasks
Understand each others role and functions
Frequent and clear communication
QT
Value and respect each member
Willingness to help one another
Share and support each others learning and growth
Focus on personal and team growth
Children AND families are the focus of
Early Intervention services
“Services that are designed to meet
the developmental needs of each
child eligible…. AND THE NEEDS
OF THE FAMILY related to
enhancing the child’s development.
303.12(a) (1)
The team’s broad purpose:
to work with children and their families.
Early Intervention Services are:
Designed to meet the
developmental needs of
each eligible child
Designed to meet the needs
of the family related to
enhancing the child’s
development
Are selected in collaboration
with parents
Are provided under public
supervision by qualified
personnel
In conformity with the
individual family service plan
Meet the standards of the
state and federal regulations
To the maximum extent
appropriate to the needs of
the child, are provided in
“natural environments”
including the home and
community settings in which
child without disabilities
participate
At no cost unless federal or
state law provides for a
system of payments by
families including sliding fees
(sec. 303.12)
General role of All service providers
Consulting with parents,
other service providers and
representatives of
community agencies
Training parents and
others regarding the
provision of early
intervention services
Participating in the
multidisciplinary team
assessment of the child and
family and in the
development of integrated
goals and outcomes for the
IFSP
QT
Common
Functions
Scenario 1 and 2 activityHow are the two “visits” different?
What are the things in each you “like” or dislike”?
Which scenario seems more “like” us currently?
The statues and regulations tell us some
information about
What services are provided under the law
General purpose of early intervention
Who can provide the services
States responsibility of oversight and monitoring
How services are paid for
States can then choose their service delivery approach:
the program design to support their services and the
actual how and what those services look like in practice.
Changing landscape out there
What was described in the late 1980’s and ’90’s in each state’s
original grant application, which defined their system and the
services, has evolved and changed over the years.
Life has changed greatly in the same time period!
Federal & State surplus to state deficits
Infant health survival rates
Paper and pencil records to advanced technology
Changing insurance coverage
New research and better practices… just to name a few…..
Its not that providers aren’t doing a good job with
children and families…
Its more that we are impacted by the constantly
changing tides.
Some reasons states have given for now looking at
changing or refining their service delivery approach
according to their APR’s
Help with staff shortages
More effective services
Cost less?
More efficient processes
Research has caught up with practices
It’s the “right” thing to do
Matches our purpose and mission of Early
intervention in a better way……..
WHAT are your reasons?
The service delivery approach impacts:
State (regional) structures necessary to support the
approach
The way the EI services are organized at the program
or regional level
Teaming practices and team composition
What “it” looks and feels like/ doesn’t look like, to
families (and to the providers)
Providers knowledge or training
Beliefs, values and demonstrated competencies
Names states identified as endorsing or using
within their state (in 2010):
Transdisciplinary team-primary
service provider (8)
Primary Service Provider (PSP)
(7)
Coaching-Primary service
provider (5)
RBI-with primary service
provider (2)
Family Centered services (3)
Family centered/
Transdisciplinary teams (1)
Team based service delivery (1)
ERRAPP or ERAP (3)
Direct Therapy/consultation (1)
Consultative Team model (1)
Independent provider model
with a vendor system (1)
Individualization of services (1)
Multidisciplinary team (1)
More information about states
5 states reported using a combination of approaches
4 states reported a named approach in use now, but said they are
moving towards a primary service provider model and 1 other said
primary service provider/ coaching model
23 states did not name a specific approach but many used words
in their training or vision that are included in the various
approaches (RBI, functional outcomes, consultation, teaming,
coaching, natural learning environments.
Other terms mentioned were ECO mapping, relationship based
activities, TACTICS and FACETS and floor time
Are we all speaking the same language???
QT
Common
language
Adoption or Adaption
HUGE variation in the words states choose
States at various stages of exploring to implementing
Only a few states have tried to go “statewide”
States are doing multiple approaches
A few states have tied themselves to a one particular “developer”
who does the training and support during implementation of pilot
sites.
Some states are using the developer’s materials and doing their
own thing- providing their own training and adapting various
pieces with their own state name
Other states are using the “agreed upon principles and practices”
and focusing on the commonalities.
States are working through issues first that appear to be in the
way of adoption of an approach
“Unpack” some of the most frequently mentioned
approaches or terms
Primary Coach Approach to
Teaming (PSP with coaching
FACINATE
TaCITS, FACETS & FGRBI
Everyday Routines and
Activities, CMP
Agreed upon Principles and
Practices
People associated with the most frequently
mentioned approaches
Family Centered Practices- Dunst,Trivette and Deal
Using Everyday Routines and Activities-Carl Dunst/ Mary Beth Bruder
Primary Coach Approach to teaming, PSP with Coaching- Rush, Shelden and
Hanft
Routine Based Early Intervention and Family Centered Intervention in Natural
Environments (FACINATE)-Robin McWilliam
Therapists as Collaborative Team Members and Family Guided Routine Based
Interventions- Julianne Woods- (FACETS/TaCTICS and FGRIB))
CoP work approach neutral, Principles and Practices (Pletcher, Hurth, Lucas,
Younggren et all)
Other names sharing information; Naomi Younggren, Bonnie Keilty,
Pip Campbell, Lee Anne Jung
QT
Common
Information
Primary Coach Approach to Teaming , PSP with Coaching
Dathan Rush, M’Lisa Shelden and Barbara Hanft
Geographically located team
One person primary coach to family
Receives support (coaching) from other team members
Provides direct support to parents/ other caregivers using
coaching techniques
Natural learning environment practices
Strengthens parents competence and confidence while
promoting children’s learning and development
Use of developmental enhancing strategies used throughout the
families daily activities
Respecting parents and other care provider as adult learners
For more information
http://www.coachinginearlychildhood.org/index.php
Hanft, B.E. &Rush, D.D.& Shelden, M.L. (2004) Coaching families and
colleagues in early childhood. Baltimore:Brookes
Shelden, M.L.& Rush, D.D. (2010) “A primary coach approach to teaming and
supporting families in early childhood intervention. In; Working with families of
young children with special needs. R.A.McWilliam (ed) Guilford Press, NY.
Family Centered Intervention in NATural Environments
(FACINATE)- Robin McWilliam
Understanding the family ecology (ECO mapping)
Functional Intervention Planning (RBI Routines based interview)
Integrated services- a primary service provider works with family,
with backing from a team of professionals to address the IFSP
outcomes with family
Consultation and joint home visits with the PSP when needed
Support based home visits with the Vanderbilt home visiting script
to provide informational, emotional and material support
Collaborative child care Consultation
Functional child outcomes to increase engagement, independence
and social relationships throughout everyday routines
For more information
http://www.siskin.org/www/docs/112.180
R.A.McWilliam (2010) Routines-Based Early Intervention:
Supporting Young Children and their Families. Brookes, MD.
R.A.McWilliam (2010) volume Ed. Working with Families of Young
Children with Special Needs. Guilford Press, N.Y.
Family Guided Routines Based Intervention
(FGRBI)- Julianne Woods
Introduction of natural environments and welcoming the family
Routine based assessment in natural environments (RBA)
Linking assessment to intervention- Contextually relevant
outcomes tied to family routines and activities; embedding
outcomes into natural occurring routines
Involving care givers in teaching and learning
Monitoring progress
Collaborative teams working together with families
Family guided, family focused
For more information and resources:
http://fgrbi.fsu.edu/
http://tactics.fsu.edu
Using Everyday Routines and Activities
(Carl Dunst and Mary Beth Bruder)
Uses everyday family and community opportunities, experiences
and events as the source of children’s learning
Locations yield activity settings, the settings are rich in multiple
learning opportunities
Child engagement in enjoyable activities- interest based learning
opportunities
Contextually Mediated Practices (CMP)-child interest, everyday
activity settings, increased learning opportunities and parent
mediate child learning)
Home visits assist families to identify and engage in these
meaningful activities and meet their needs
Family centered practices and effective helping practices used
by professionals
More information:
http://www.everydaylearning.info/index.php
http://www.puckett.org/
Dunst, C.J.,Raab, M., Trivette, C.M. & Swanson, J. (2010)
“Community-based everyday child learning opportunities” in R.A.
McWilliam (Ed.)Working with families of young children with
special needs. Guilford Press, NY.
Agreed upon Principles& Practices for Providing
Early Intervention Services in Natural Environments
This is NOT an approach
A document the reflects consensus practices validated through
several research, model demonstration and outreach projects
funded over the past decade
Practices are written to be approach neutral
Suggests a flow of activities that need to occur during the EI
process
Not intended as a sequential or all inclusive checklist
Practices can be used by any team member including the
Service coordinator and family
Three documents in the set
http://www.nectac.org/~pdfs/topics/families/Finalmissionandprinciples3_
11_08.pdf
Mission and Key Principles
http://www.nectac.org/~pdfs/topics/families/Principles_LooksLike_Doesn
tLookLike3_11_08.pdf
Looks like/doesn’t look like
http://www.nectac.org/~pdfs/topics/families/AgreedUponPractices_Final
Draft2_01_08.pdf
Agreed upon Practices
Members of the original workgroup: Susan Addison, Betsy Ayankoya,
Mary Beth Bruder, Carl Dunst, Larry Edelman, Andy Gomm, Barbara
Hanft, Cori Hill, Joicey Hurth, Grace Kelley, Anne Lucas, Robin Mc
William, Stephanie Moss, Lynda Pletcher, Dathan Rush, M’Lisa
Shelden, Judy Swett, Nora Thompson, Julianne Woods and Naomi
Younggren.
All these “approaches” have common
Foundational themes
Family Centered
Authentic/Functional
Practices
Assessment
Relationship Based
Functional Outcomes
activities
Adult learning
Natural Environments
principles
Natural learning
Team based service
opportunities,
delivery
activities
These common themes impact
our practices in many ways
How we interact with
families and other team
members
How we help child and
adults learn
The way we provide
help and support
How we do assessment
What we even write on
the IFSP
How we provide ongoing services
The elephant in the team room:
individual values and beliefs about…
How children learn best
Viewing disabilities
Role as a provider
Different types of families
Where “services” should
be provided
How to do
assessments/evaluation
Working with other
professionals
Your values and beliefs will impact:
What you actually do and even say to families.
Your participation on your team.
How comfortable (or not) you are with any of the
approaches?
How willing you may be to try specific practices?
QT
Shared
values
and
beliefs
Activity: Mission and Key PrinciplesWhat do you and your team believe and value?
Take 5 minutes and read over the “mission “ and 7 key
principles.
Use the pink or blue marker to highlight words that resonate with
you
Use the yellow or green marker to highlight words you feel more
Cautious about
Discuss as a team which words match what you believe and
know about…. And which words you feel more uncomfortable
about. Why?
Activity: Mission and Key PrinciplesWhat do you and your team believe and value?
Take 10 minutes to read 1 of the key principles/ looks like doesn’t
look like. Read all the descriptions of looks like doesn’t carefully!
Use the same color marking strategy as you just used
Discuss as a team does the principle feel any more comfortable
now that you can see more description of practices?
Are there areas you can see for personal or team improvement?
Team Based Service Delivery
Component
Multidisciplinary
Interdisciplinary
Transdisciplinary
Philosophy of
Team
Interaction
Team members
recognize the
importance of
contribution from
several disciplines
Team members are
willing and able to
share responsibility
for services among
disciplines
Team members
commit to teach, learn
and work across
disciplinary
boundaries to plan
and provide
integrated services
Family role
Generally families
meet with team
members separately
by discipline
The family might be
consider a team
member. Families
may work with whole
team or team
representative
Families are always
members of the team
and determine their
own team role
QT
Roles
and
tasks
Component
Multidisciplinary Interdisciplinary Transdisciplinary
Lines of
Communication
Typically informal.
Members may not
think they are part of
a team
Team meets
regularly for case
review, consultation
etc.
Meets regularly to
share information and
to teach and learn
across disciplines;
consultation and team
building
Staff
Development
Happens
independently and
within individual
disciplines
Frequently shared
and held across
disciplines
Frequently occurs and
is across disciplines.
Viewed as critical to
team development and
role transitions.
QT
Roles
and
tasks
Component
Multidisciplinary Interdisciplinary
Transdisciplinary
Assessment
Process
Members conduct
separate
assessments by
disciplines.
Members conduct
assessments by
disciplines and share
results with one
another
Team participates in
an “arena”
assessment,
observing and
recording across
disciplines
IFSP
Development
Members develop
separate plans for
intervention with in
their own disciplines
Goals are developed
by disciplines and
shared with rest of
team to form a single
service plan
Staff and family
develop plan together
based functional
assessments
information from the
family and the child
IFSP
Implementation
Implemented
separately by
disciplines and
separate visits by
discipline
Still discipline
specific but some
times-co-visits when
working on several
outcomes/goals
One person is the
major implementer
with the family and
other members
consult or teach the
primary member
Activity: Team types
Look over the team descriptions silently. When done look
up to signal you are finished reading.
2. In a round robin- each member share honestly what they
feel is best description of the current team .
3. Once each person has had a chance to comment talk
about discuss openly some of the following.
4. Is that adequate to what we are hoping to provide to
children and families; are their things we need to learn more
about, things in our way; are their any conflicting values and
beliefs?
1.
No disguising it- it’s still a cat…
Teaming in 1200 AD: Leaning a New Technology
http://www.youtube.com/watch?v=0Cd7Bsp3dDo
Video Demonstrates
Coaching
What did you see?
Functional (Authentic) Assessment
What did you see?
Contextually mediated practice
What did you see?
QT
Support
one
another to
learn
Other methods for teams to become more
Transdisciplinary
Adopted from: McGonigel &Woodruff (1994) The Transdisciplinary team: A model for family-centered early
intervention. In L. Johnson (Eds) Meeting Early intervention challenges: Issues from birth to three (pp. 95-131).
MD: Paul H. Brookes
Role Extension
Role Enrichment
Role Expansion
Role Exchange
Role Release
Role Support
The Early Intervention Journey:
Large Steps in the Team Process
Intake
Initial visit(s)
Evaluation and assessment
IFSP Initial meeting
Development of IFSP goals and functional outcomes
On-going services
Ongoing assessment and review of IFSP
Exit -transition
Intake/acting on the referral
First opportunity to help families know more than
just the name of your program
First opportunity for the team to get information
from the family
Even this very first encounter should
demonstrate your value and beliefs and purpose.
Who on the team does what?
What do you share with families?
How do you communicate information to other
team members?
Some possible team tasks at intake
Contacting the family
Introducing yourself and the EI program
Listening to their concerns or reasons for referral
Verifying information
Answering questions
Setting up initial visit(s)
Sharing or mailing more information
Resources for this step
CO Brochure which clearly describes their
Transdisciplinary team
Woods- Welcoming the family
McWilliam book Chapter 3 (Checklist)
CoP Practices 1-4
Others you have….
Initial Visit: Some team tasks
Becoming acquainted and establish rapport
Clarifying family concerns, or reason for
contacting EI
Getting to know the family and the child
Explaining the program
Listening
Collecting useful information- child and family
Going over necessary paper work
Discussing parental rights.
Initial visit(s)
Explaining and screening of the child (if needed)
Gathering information about family’s every day
routines and activities
Gathering information about family supports and
resources
Explaining and sharing information (again)-Answer
questions
Explaining and coordinating the evaluation and
assessment
Exploring involvement/roles of the family in the child’s
evaluation and assessment and IFSP
Resources for initial visits
Robin’s text chapter 4/5
Practices document pages 2-5
TACTICS handouts- Identifying Family activities…
What families want to know about assessment,
Getting to know your child
Handout- Questions for eliciting Family routines,
interest and priorities
ECO mapping
Routine Based interview
Other methods things you have found and like
Evaluation
Evaluation and assessment are considered processes that have different
purposes under Part C. (34 CFR 303.322)
“Evaluation is defined as the procedures used by "appropriate qualified
personnel to determine a child's initial and continuing eligibility",
consistent with the state definition of infants and toddlers with
disabilities' and includes determining the status of the child in each of
the developmental areas (cognitive development, physical development,
including vision and hearing, communication development, social or
emotional development and adaptive development”.
Usually view as “tests, scores and percentage to establish delays in one
or more areas of development.”
Assessment
"Assessment means the ongoing procedures used by appropriate
qualified personnel throughout the period of a child's eligibility under
this part to identify - (i) the child's unique strengths and needs and the
services appropriate to meet those needs; and (ii) the resources,
priorities, and concerns of the family and the supports and services
necessary to enhance the family's capacity to meet the developmental
needs of their infant or toddler with a disability.
Assessment methods can include tests, but also includes observation,
open or close ended questions, interviews with parents and other
caregivers.
Functional or Authentic Assessment in EI
Methods and activities to really learn about the child
(and family)
What the child can do, likes, is interested in, and how
well he/she does it
What in the daily routines or activities is challenging to
the child and family
Generate ideas to try and discover what support is
necessary
MUST be done where the child is, and in the
situations that parents want to address
Focus is on the child’s participation in family and
community activities and routines
Can’t have functional Outcomes
without functional assessment
“A functional outcome must by definition come from
a functional assessment. One cannot take a nonfunctional goal and turn it into a functional one by
writing it differently.” McWilliam (2010)
Resources on Functional Assessments
ECO Mapping - Chapter 4
Needs Assessment chapter- 5/6Facilitating a
Problem solving approach for Families- TaCTICS
Handout with family questions
The Early Intervention Journey:
Large Team Steps in the Process
Intake
Initial visit(s)
Evaluation and assessment
IFSP Initial meeting
Development of IFSP goals & functional outcomes
On-going services
For June:
Ongoing assessment and review of IFSP
Exit from EI- transition
In the next month your team should:
Choose an individual action and/ or whole team
action/task.
That you want to improve your confidence
competence (and enjoyment too) in becoming a
quality team or team player.
Look back at first three steps in the team
journey and the resources, or other ideas you
may have from today.
Commit to trying something out with the team and
with family. We will be discussing “progress”
concerns, questions on our April call.
Some possible ideas?
Team develop a talking point script to tell families
about the purpose of EI and how the team (which
includes the family) works together
Choose one of the resources (i.e. eco mapping ,
questions to elicit family concerns, routines) and try
with a family
Practice the RBI with a team member and receive
coaching from them
Team work is like white water rafting!
Have a clear sense of where
you are headed
Plot your course together
Check for rapids or rough spots
before entering the water when
possible
Good communication strategies
and clear methods to
communicate before you start
Define the roles
Use individual strengths
http://www.youtube.com/embed/EmlFZkGPHS8
White water rafting is a lot like our teamwork
All wear life jackets
Choose paddles that fit
Get in the boat together
Balance one another
All paddle equally
When one tires- out, provide extra support
Be mentally prepared for things not going as planned
In a tough spot follow the directions of the boat
leader quickly
Rescue person overboard immediately
The thrill is in the successful journey of the entire
boat (team) so endurance is an absolute
Functional Outcomes
First appeared in Rehabilitation field (Activities
for daily living)
Improve child’s ability to participate in activities
that are relevant to the child and family
Use natural motivators (interests and enjoyment)
Require an understanding of family’s routines and
or activities
Are not development domain specific
IFSP functional outcomes look very different from
traditional service-driven outcomes
Coaching
A methodology defined as “an interactive process of
observation, reflection, and action in a which a coach
promotes directly or indirectly a learner’s ability to
support a child’s participation in family and community
contexts.” Hanft, Rush and Shelden 2004
In this approach the methodology of coaching is
equally applied to the team members
One team member becomes the primary coach who
works closest with the family and can be a team
members of any discipline
Contextually Mediated Practices (CMP)
Dunst et all
Is an intervention approach involving:
Identification of the interest of the child and everyday
community and family activities
Selection of the activities that provide the best
opportunities for interest-based learning
Increasing child participation in the interest-based
everyday learning opportunities
The use of different interactional techniques for
supporting and encouraging child competency,
exploration and mastery
Evaluation of the effectiveness of parent-mediated
activities