Transcript No Slide Title

Family-Centered Practices for
Young Children with Visual
Impairment
Deborah D. Hatton, Ph.D.
July 5, 2007
Toronto, Ontario
Best Start
Ontario Ministry of
Children and Youth
Services
The University of North Carolina at Chapel Hill
Early Intervention Training Center for Infants and Toddlers With Visual Impairments
FPG Child Development Institute
Produced in collaboration with R. A. McWilliam and P.J. Winton (2002)
Objectives
After completing this session, participants will
1. describe and implement strategies that can be
used to build reliable alliances with families and
other professionals and to implement familycentered practices.
2. describe and implement strategies to effectively
communicate and collaborate with families and
other professionals.
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).
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Objectives
After completing this session, participants will
4. identify three key child outcomes and five
key family outcomes that should be
considered when providing intervention to
young children with visual impairments and
their families.
5. complete an ecomap to identify key features
of the family ecology that might influence
intervention/education.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Objectives
After completing this session, participants will
6. complete a routines based assessment to
identify family concerns, priorities, and
resources that describe the strategies that
members of teams use to effectively
communicate and collaborate with families
and other professionals.
7. identify functional outcomes for intervention
that are tied to sensory assessments,
ecomaps, and routines based assessment.
8. describe and implement strategies for
successful home visits and consultative
visits to child care settings.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Family-Centered Support
• reflects a method of coordinating and
delivering assistance, support, and services
to the families of children with disabilities that
enhances their capacity to care for
their children.
• 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.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Central Values of
Family-Centered Approach
• Emphasizing families’ strengths rather
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than deficits
Promoting family choice and control
over desired resources
Developing collaborative relationships
between professionals and parents
Viewing family from a holistic
perspective
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
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
to make joint decisions.
Turnbull & Turnbull, 2001
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Eight Obligations Involved in
Establishing Reliable Alliances
Reliable alliances involve the following eight
obligations (Turnbull & Turnbull, 2001, p. 58):
1. Knowing yourself
2. Knowing families
3. Honoring diversity
4. Affirming and building on family strengths
5. Promoting family choices
6. Affirming appropriate choices
7. Communicating positively
8. Warranting trust and respect
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Responses to Grief
• Early models of the grieving process
•
included sequential stages of shock,
denial, anger, depression, and
acceptance.
Today a broader understanding of
responses to grief exists. Individuals
may sporadically, randomly, or
predictably experience sadness, guilt,
regret, longing, disbelief, fear, irritability,
hopelessness, and powerlessness.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Diversity
Diversity 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 beliefs.
• sexual orientation.
Family culture can affect
• treatment of medical issues.
• primary language spoken within the home.
• literacy activities.
• interactive play (social skills).
• daily routines.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Milian & Erin, 2001
Consider Variations
Within Cultures
Families vary in their adherence to cultural
norms based on
• primary language in home and community.
• educational level.
• religious affiliation.
• country of origin, length of time in U.S.,
degree of acculturation, or current
residence.
• income.
Santos & Reese, 1999
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Cultural Diversity and
Visual Impairment
Some cultures
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believe that caring for the child is more
important than teaching independence.
expect adults with blindness/VI to hold only
certain jobs or not work at all.
value oral communication over the written
word.
vary in their gender expectations.
ascribe special meaning to particular types of
visual impairment.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Erin, 2002
Religious Diversity and
Visual Impairment
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Some individuals may think that having a
visual impairment is retribution for sin.
For some families, a religious leader or
the head of the family may be the critical
decision maker.
Some families visit religious healers during
their child’s early years.
Erin, 2002
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Importance of Collaborating
with Families
• Almost all child-level intervention occurs
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between home visit sessions.
Almost all interventions can be
implemented in the context of family
routines and daily activities.
Infants and toddlers cannot generalize
skills that early interventionists model
from one visit to the next.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
R.A. McWilliam August 2004
Components of Collaboration
• Empowering caregivers to meet children’s
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needs
Treating caregivers with respect and as full
members of the team
Conferring with specialists and other service
providers to develop and implement an
integrated and comprehensive intervention
plan that can be used across settings in daily
routines and activities
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Coordinating Services for Young
Children with Visual Impairment
1. Coordinating performance of
evaluations and assessments
2. Facilitating and participating in
development, review, and evaluation of
intervention plans
3. Assisting families in identifying
available service providers
4. Coordinating and monitoring delivery of
available services
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Coordinating Services for Young
Children with Visual Impairment
5. Informing families of availability of
advocacy services
6. Coordinating with medical and health
providers
7. Facilitating development of a transition
plan to other programs, if appropriate
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Four Collaborative
Roles for TVIs
1. Supportive - demonstrating concern and
caring for others during new and difficult
situations
2. Facilitative - assisting the professional
development of other team members
3. Informative - providing information and
support to other team members
4. Prescriptive - suggesting strategies or
resources in response to a request for
assistance
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Topor, Holbrook, & Koenig, 2000
Support-Based Intervention
An overarching feature of early intervention is
the provision of supports, rather than the
provision of services.
McWilliam and Scott (2001) identified three
primary types of support provided by early
interventionists:
• Emotional support
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Informational support
Material support
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Emotional Support
Emotionally supportive, family-centered
practitioners have the following
characteristics:
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Positiveness
Responsiveness
Orientation to the whole family
Friendliness
Sensitivity
Competence with and about children
Competence with and about communities
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
McWilliam, Tocci, & Harbin, 1998
Material Support
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Families cannot carry out interventions if their
needs for food, shelter, and security are not
met.
Children with VI may require specialized
materials, such as low-vision devices, to
enhance participation in daily routines.
Examples of Material Support
 Equipment and supplies
 Information about resources,
including financial resources
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Informational Support
Families with children with visual impairments
may report concerns about the future and
express a need for information about
• child development,
• the child’s visual condition,
• services and resources, and
• specific strategies and skills.
Leyser & Heinze, 2001
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Child and Family Outcomes
http://www.fpg.unc.edu/~ECO/
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Child Outcomes
Overall goal is to enable children to be active
and successful participants in their early
childhood years and in the future.
Three outcomes that reflect achievement of this
goal are:
1. Children have positive social relationships.
2. Children acquire and use knowledge and
skills.
3. Children take appropriate action to meet
their needs.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
ECO Center, 2005
Family Outcomes
1. Families understand their children’s
strengths, abilities, and special needs.
2. Families know their rights and advocate
effectively.
3. Families help their children develop and
learn.
4. Families have support systems.
5. Families access desired services, programs,
and activities in their communities.
ECO Center, 2005
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Responsibilities of Professionals
who Provide Specialized Services
for Young Children with VI
• Functional sensory assessments
• Adaptations/accommodations to assure
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accessibility
Functional and meaningful intervention
that is tied to assessment results, family
priorities, and standards and that can be
continuously monitored
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Collaboration Between
Professionals and Families
• Families provide essential information about
the assessment of their children.
• Families who are involved in assessment are
more likely to understand the process and
the results.
• Respect for family values, cultures, and
priorities is essential in planning and
implementing assessments and intervention.
Smith & Levack, 1996
Hatton, McWilliam, & Winton, 2004
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
PowerPoint 7
Family Ecology
Family ecology refers to the system of informal
supports available to the family that are
depicted graphically by an ecomap.
An ecomap is used to
• identify existing supports, how duplication of
efforts might be avoided, and possible gaps
that need to be addressed, and
• assist in identifying resources that will be
required to achieve functional outcomes.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Routines-Based Assessment
The RBA is a process whereby families
• share their concerns.
• identify priorities for early intervention
within the context of everyday activities
and routines, thereby assuring that
early intervention occurs within natural
environments.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Benefits of the RBA
The routines-based assessment
• emphasizes that intervention is familycentered.
• provides a structure for families to have a
meaningful role in planning.
• generates a list of functional intervention
outcomes.
• aids in developing a positive relationship
with the family.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Role of the Professional Providing
Specialized Services for Children
with Visual Impairment
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Organize an RBA and conduct the
interview, if this hasn't already been
done
Participate but not be the primary
interviewer
Train other team members to do RBAs
Receive the information after the fact
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Components of Individual Child and
Family Service Plans
1. Statement of current levels of functioning
2. Statement of the family’s resources,
priorities, and concerns
3. Statement of the long term and short term
goals, criteria, procedures, and timelines
4. Statement of early intervention services,
including the frequency, intensity, and
method of delivering services
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Components of Individual Child and
Family Service Plans
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 plan for transition to
preschool services
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Key Components of
Intervention Plans
• Family’s strengths, concerns, and
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priorities as derived from the RBA
Child’s current level of functioning, as
determined by sensory assessments,
routines based assessment, and
transdisciplinary assessment of child
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Linking Assessment to
Outcomes and Services
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Services on the intervention plan should be
related to needs identified during child and family
assessment.
The team should decide on services based upon
outcomes—not upon the diagnosis.
Children may have the same diagnosis, but their
unique strengths and needs may prompt different
outcomes, based on priorities of the family and
team.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Developing Intervention Plans
Should be a Team Effort
• Families are integral members of all teams.
• The team agrees upon functional outcomes
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and the strategies needed to achieve them.
The team identifies the services and service
providers that can provide the support needed
to achieve the functional outcomes and to
implement strategies.
The team determines the timelines for
achieving the outcomes.
The team identifies the primary home visitor
(and possibly the service coordinator).
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Functional Outcomes
For very young children,
functionality means
• having meaningful social
relationships
• acquiring and using knowledge and
skills (engagement),
• taking appropriate action to meet their
needs (independence)
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Social Relationships
Social relationships provide motivation and serve
as the foundation for learning and competence.
Social development involves
• forming relationships
(attachment),
• communicating,
• interacting appropriately,
• adapting to new situations,
• social interactions (parallel,
associative, cooperative play), and
• forming friendships.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Engagement
Engagement refers
to the child’s
developmentally and
contextually appropriate
interactions with the
environment.
To maintain
appropriate engagement,
children must
continuously acquire and
use knowledge and skills.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Independence
Independence refers to children’s ability to function
with as little assistance from others as possible and
requires children to take appropriate actions to meet
their needs.
Independence in
• communicating
• moving
• solving problems
• routines
• playing
• getting along with others
• looking after oneself
Independence promotes confidence and self-esteem.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Natural Environments and
Children with Visual Impairment
Although provision of services within a child’s natural
environments is the goal, children with visual
impairment and their families may also benefit from
specialized environments because
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children with visual impairment have unique
developmental needs (AER & AFB, 2003).
the presence of visual impairment can prevent an
infant or toddler from accessing the same visual
information available to sighted peers; therefore the
environment may need to be adapted in order to
meet specific needs (Chen, 1999).
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Support for Transitions
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Identify the possible future settings
Identify the skills of all people involved in the
transition
Provide the primary interventionist in the new
setting with information about the child
Key personnel who worked with the child
before the transition should maintain contact
with the new professionals
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Major Goal of Home Visits
Provide support that promotes
functional outcomes for family and child.
Support can be
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informational,
material, or
emotional.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Recommended Practice
for Home Visits
• Collaborate with families and with other
specialists and service providers.
• Use routines-based intervention to
achieve functional outcomes.
• Assure that a team approach with close
collaboration is used to support families
and children.
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
Role of Specialists in VI
Primary Home Visitor
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Responsible for regular
weekly home visits
Responsible for securing
information from
specialists and
incorporating into
integrated strategies for
functional outcomes
Responsible for
intervention plan
development,
implementation,
monitoring
Responsible for transition
planning
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill
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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
Additional Resources
For hundreds of resources on family-centered
practices for young children with visual
impairment, go to
http://www.fpg.unc.edu/~edin/Resources/mod
ules/index.cfm
or see Resources section of the website for the
Early Intervention Training Center for Infants
and Toddlers with Visual Impairments at
www.fpg.unc.edu/~edin
Early Intervention Training Center for
Infants and Toddlers With Visual Impairments
FPG Child Development Institute
University of North Carolina at Chapel Hill