Transcript Components of Triadic Support in FG-ABI

The Vision for Enhancing the Capacity of
Families in Natural Environments
http://tactics.fsu.edu
Why are we here today?
Genuine commitment to high quality EI
services
 Frustration with current level of
implementation
 Curiosity about what and how others are
doing
 Interest in continuous improvement
 Recognition of importance of administrative
and supervisory support
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Project EPIC
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Collaboration between KU and local EIP
Questions included:
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Level of implementation for high poverty families
Barriers and facilitators to success
Applicability of FGRBI in inner city
Results included:
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Fewer services were received consistently; cancellations by
providers equaled families
EI was provider directed and not routines based
Families liked the concept of RBI (but didn’t have many
opportunities)
Providers concern about family participation was #1 barrier;
Administrative support was #2 barrier
Objectives for This Morning
Describe and define various family centered
approaches used in natural environments
 Identify observable provider behaviors and
key program indicators to assist in program
development and staff supervision
 Review the barriers to full implementation and
share solutions
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Top 10 List:
Why is this so hard?
10. Intrinsic vs. Extrinsic Reinforcement
9. “Public” Practice – Visibility of Providers
8. Change
7. Knowing How and Believing it Should
6. Self Reflection and Evaluation
5. Collaboration
4. “Thinking” Creatively
3. Balance of Complex Interactions
2. Time
1. Diversity of Family Values and Expectations
Big Problem #1
 Knowing
what “it” is…
Family Centered Services, Natural Environments
 Believing
“it” is effective…
Evidence, Attitudes
What are Family Centered Services?
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Embraces the unique and lasting relationship between
family members
Recognizes the family and their life as the context for
assessment and intervention
Respects and adapts to the multiple and diverse
responsibilities and roles of families
Provides adequate information and support for the family
to make informed decisions and respect for their choices
Offers information and opportunities for participation in a
timely, sensitive and individualized format
Recognizes importance of relationships between family
and team as partners in the teaching and learning process
Why Talk About
Family Centered Services?
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EI with active parent programs identify improved child
outcomes, greater family satisfaction (Brooks-Gunn 2002).
Family centered services are not consistently
implemented despite support (Guralnick, 2002).
Day to day actualization of family centered practices is a
major OSEP compliance citation (USDOE) and identified
by program directors as a major struggle (Hughes, 2003).
Changing demographics provide constraints to current
policies and procedures (Vacca, 2000).
Society (politics) espouses a more active parental role in
education.
What is Early Intervention in
Natural Environments?
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More than moving to a new location and continuing
toy bag or clinic practices
Easier to say than do… and despite rumors
otherwise, it isn’t “just” done
Integrates child and family centered philosophies
Data supports use in both individual and group
settings and by parents and paid caregivers
Examples include: JARs, ABI, ELO, FG-RBI, NLO
Benefits child by enhancing functionality,
opportunities for practice, and motivation
Decreases need for generalization training
Saves time and energy for caregivers
Why Parent Mediated Interventions?
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Natural environments legislation increases emphasis
on parent participation.
Evidence supports success of parent implemented
interventions.
Parents learn multiple strategies for varying goals
with diverse children in a variety of cost-effective
models.
Outcomes identified for children are positively
impacted by parent implemented interventions.
Parents are satisfied with their participation.
More specifically…
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Multiple strategies
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Diverse children
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“Packages” of development and behavioral methods (EMT, Hanen)
ABA (prompts, cues, reinforcement)
Sequences of facilitative interactions
Communication and language delay
Down syndrome and other DD
Autism and “Challenging Behavior”
Cost-effective methods
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Group classes
Modeling and instruction
Video demonstrations and feedback
Home-based problem solving
Child outcomes included…
Increased understanding and use of gestures,
picture symbols, words and word combinations
 Decreased use of maladaptive behaviors and
increased use of communication replacement
behaviors
 Direction following
 Toilet training and other adaptive skills
 Self-feeding, increase in food intake
 Social interactions with siblings, peers
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How Do NE Models Differ?
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Context for instruction
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Activity type
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Everyday experiences, events and routines
Therapy or planned special instruction
Child preferred & directed
Adult planned & directed
Blended
Delivery of instruction
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Natural learning opportunities
Adult directed
Parent mediated
1
Level 1 = Location
2
Level 2 = Activity
3
Level 3 = Learning Opportunity
(Dunst, 1997)
1
Playground
2
Slide
3
•Steps
•Platform
•Turntaking
•Up/down, On/off
•Problem solving
•Sliding through
Inputs
Routines,
Activities,
Events, Settings,
Interactions
Child Characteristics
Personal Values, Preferences
Family Characteristics and
Structure
Geography, Community
Resources
Supports
Costs (Personal, Time, Money)
Interventions
Outputs
Child Choice, Participation
Child Competence
Child Quality of Life
Family Well-Being
Family Satisfaction
Family Quality of Life
Psychological Costs
(Adapted from Dunst, 1999)
Inputs
Routines,
Activities,
Events, Settings,
Interactions
Child Characteristics
Personal Values, Preferences
Family Characteristics and
Structure
Geography, Community
Resources
Supports
Costs (Personal, Time, Money)
(Adapted from Dunst, 1999)
Big Problem #2
 Knowing
what and how to do it….
 Working
with families
 Being a consultant
Dyad
Make or Break Practices for
Family Centered Services
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Gathering and Giving – Reciprocal Information and
Resource Sharing Process
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Observing and Modeling – Individualized Interactions
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Explain why information is meaningful in everyday life
Provide examples and developmental knowledge
Watch what, how, & when parent interacts
Show what strategies or behaviors are needed
Problem Solving and Decision Making - Supportive &
Respectful Relationships
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Present alternatives for caregiver participation
Integrate learning strategies for adults in process
Initial Contacts
 Establish
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Everyone is an expert…
and everyone is a learner
Initiate capability -vs- disability point of view
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partnership process
Communicative competence as basis for
intervention
Set the stage for proactive caregiver
participation
Prepare caregivers for process; seek input for plan
 Offer examples, opportunities, alternatives:
Assessment is a novel and frightening experience
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Identifying Routines and Activities for
Observation during Assessment
Discuss child and family preferred routines
and activities prior to assessment visit
 Suggest alternatives to the family to assist in
their choice making
 Survey the family for special interests or
activities that will enhance their comfort in
participation
 Identify routines and materials that enable
easy completion of assessment measure(s)
identified for use by the team
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Roles for the Family
More than a continuum of options for
participation (Crais et al)
 Multi-faceted and dynamic participation
throughout the relationship (Woods & McCormick)
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Guide
Team member
Decision maker
Contributor
Observer and validator
Problem solver
Teacher
Observing routines
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Routine
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Sequence
Repetition
Joint attention
Positive, motivating
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Child
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Anticipate
Attend
Initiate
Respond
Imitate
Independently participate
Careprovider
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Expect participation
Respond, expand
Use objects
Read child’s cues
Use intervention strategies
Encourage
Dyad
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Position, proximity
Mutual attention
Turn taking
Positive affect
Cues, repairs
Giving Information
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Remember the capability and proactive
participation planning
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Share strengths… “JP loves his snacks so that’s a great
opportunity for communication… using gestures and
vocalizations. You’re right…he doesn’t have words, but
there are many ways…”
Avoid all jargon
 Be concrete and give practical examples that
relate to family
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You told me you like to go to the playground…
Use a variety of adult learning strategies
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Visuals
Plan of Action
Family’s Priority: Communicate using words everybody
understands.
Specific Outcome: JP will use 5 new words (supported with
gestures where needed) to gain attention and answer questions.
STRATEGIES
At music, computer and play time,
encourage JP to imitate sounds,
noises, words, and motor actions.
While playing outside JP will be asked
to choose between bikes, ball, and
favorite sand toys.
WHO
WHERE
Ms. Mary
Mom & Kelly
will share
songs&
computer
time
Home and
Childcare
Dad, Ms.
Mary,
Friends,
Derek, Anne
Home and
Childcare
Plan of Action
Family’s Priority: Communicate using words everybody
understands.
Specific Outcome: JP will use 5 new words (supported with
gestures where needed) to gain attention and answer questions.
STRATEGIES
During activities in the community
such as Church, softball, or errands,
JP will name family, friends, and
common objects with models
During caretaking routines (bathtime,
meals, dressing, potty) JP will label
choices when asked
WHO
WHERE
Dad, Mom,
Kelly,
Jennifer,
Josh, Derek,
friends
Community
activities,
car, church
Mom
Home
Big Problem #3
 Embracing
the family’s perspective
Values, Lifestyle, Roles, Responsibilities,
 Believing
families want to and can…
Scaffolding for Careproviders
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Occurs within collaborative environment with acceptance
of and respect for each other’s values, skills, and
knowledge
Begins with skills/strategies the partner exhibits
Relationship provides support for new ideas and skills to
develop and security for risk taking to occur
Working within each other’s “zones of proximal
development” increases use of knowledge within practice
Use of adult learning strategies and systematic instruction
enhances learning success for caregiver and professional
Adult Learners
Comfortable
Environment
 Respect for Values
and Priorities
 Effective
Communication
 History and
Experiences
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Contributions and
Participation
 Collaboration and
Problem Solving
 Applicability to Life
and Functionality
 Competing
Commitments
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For Learning to Occur
Efficiently:
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Child must engage with the
environment
Child and caregiver must
interact contingently with
each other
Caregiver must mediate the
physical and social
environment for the child,
thus linking the child’s
engagement to the
environment
Components of Triadic Support
Hierarchy
PIWI Projects, Children’s Research Center, University of Illinois at Urbana-Campaign
Establish Supportive Environment
Enhance Caregiver Competence
Provide Information
Focus Attention
Model
Suggest
4 Steps for Problem Solving
Define
the problem
Generate ideas
Choose solutions
Develop the plan
Questions to Enhance Problem Solving in
Family Centered Services
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What is the problem?
Who is affected? How?
 What is the impact?
 What could happen if it is ignored?
 What could happen if it is addressed?
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What are the facts? What is believed?
 When, where, how and who should join in the
problem solving process?
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Problem Solving … continued
What has been tried? What worked? What
didn’t? Any ideas why?
 What other ideas should be considered?
 What should be tried first? What is an
alternate plan?
 Are resources available?
 Who will do what? When? How?
 How will we know if it works?
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Increasing caregiver competence
with strategies
Initial discussion with handouts
 Video of another parent using strategy in a
caregiving or play routine
 Discussion about pros and cons of the
strategy
 Practice together
 Video taping of caregiver using strategy with
opportunity to watch and critique
 Problem solving with data collected weekly
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Key learning strategies identified
by caregivers
 Problem
solving weekly with clinician
 Initial video of other parent using
strategy
 Discussion of pros and cons to make a
good match between strategy, outcome,
routine and child interest
 Time to talk about the data
What research says doesn’t work
for generalization
 Modeling
(McBride & Peterson)
 Handouts (Fox & Dunlap)
 Group training without feedback and
follow-up (Strain et al)
 Facility based service delivery (NAS
report)
Our Data
 Child
change occurs at rate greater than
anticipated from maturation
 Family satisfaction is very high
 Parents learn strategies within daily
routines and play
 Parents report improved confidence in
ability to parent child with special needs
So what’s special about the model?
Systematic instruction increased acquisition
rate of embedding by caregivers
 Family members generalized strategy use
across routine types and into community
settings
 Parents initiated identification of routines for
intervention through problem solving with
providers
 Data collection by families was integral
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Why is this so hard?
National Perspectives on Implementation of
Natural Environments
DEC International Conference
San Diego – 12/6/2002
Panel
Judy Carta – Juniper Gardens Children’s
Projects, KU- Kansas City
 David Lindeman – University Center of
Excellence, KU - Parsons
 Christine Salisbury- Child and Family
Development Center, University of IllinoisChicago
 Juliann Woods- Florida State University,
Tallahassee
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Inservice Personnel Preparation:
Problems and Solutions
Problem: Moving from knowledge to
consistent implementation
 Solutions:

Develop “FC-NE” culture across team members
and agencies supported by administrative policies
 Provide time and funding for collaboration and
coaching within team including FSC
 Develop friendly communication formats and
require it among team members including family
 Infuse “FC-NE” into every agenda and initiative

Preservice Personnel Preparation:
Problems and Solutions
Problem: Quality practicum opportunities in
NE with skilled EI
 Solutions:







Become a community provider on the matrix for families to choose
– authentic training including the policies and paperwork
Use a consistent model with guidelines, systematic instruction,
student expectations, video feedback, fidelity checklists
Establish relationships and help build programs through continuing
ed., grant opportunities and $$ incentives
Grow your own – hire them – expect them to develop program
further
Connect with the State agency
Establish Department policies on FC-NE placements
Examples of Solutions…
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Administrator identified NE as priority for hiring
personnel and subsequent evaluations
Regional team defined PSPM for their region through
stakeholder meetings… before the state did it for
them!!
Team of SLPs are defining process for decision
making on services for kids with ASD in NE using
logic syntax as a part of their district performance
standards
TA consultants infuse NE into every initiative, e.g.
early literacy in NE – not another new state
initiative… just expansion
Barriers Still Exist…
Payment disincentives for non-NE services
 Legislation aimed at accountability that
requires “time” in services- not quality
 Confusion between co-treatment, consulting,
coaching for re-imbursement
 Limited information and resources for families
on what NE is and isn’t and their roles….
 Limited involvement in DEC

Inservice Personnel Preparation:
Problems and Solutions
Problem: Moving from knowledge to
consistent implementation
 Solutions:

Develop “FC-NE” culture across team members
and agencies supported by administrative policies
 Provide time and funding for collaboration and
coaching within team including FSC
 Develop friendly communication formats and
require it among team members including family
 Infuse “FC-NE” into every agenda and initiative

Preservice Personnel Preparation:
Problems and Solutions
Problem: Quality practicum opportunities in
NE with skilled EI
 Solutions:







Become a community provider on the matrix for families to choose
– authentic training including the policies and paperwork
Use a consistent model with guidelines, systematic instruction,
student expectations, video feedback, fidelity checklists
Establish relationships and help build programs through continuing
ed., grant opportunities and $$ incentives
Grow your own – hire them – expect them to develop program
further
Connect with the State agency
Establish Department policies on FC-NE placements
Examples of Solutions…




Administrator identified NE as priority for hiring
personnel and subsequent evaluations
Regional team defined PSPM for their region through
stakeholder meetings… before the state did it for
them!!
Team of SLPs are defining process for decision
making on services for kids with ASD in NE using
logic syntax as a part of their district performance
standards
TA consultants infuse NE into every initiative, e.g.
early literacy in NE – not another new state
initiative… just expansion
Barriers Still Exist…
Payment disincentives for non-NE services
 Legislation aimed at accountability that
requires “time” in services- not quality
 Confusion between co-treatment, consulting,
coaching for re-imbursement
 Limited information and resources for families
on what NE is and isn’t and their roles….
 Limited involvement in DEC
