Transcript Applying Interdisciplinary Evidence Based Research to
Applying Interdisciplinary Evidence Based Research to Intervention Practices
Paediatric Update Symposium ELLEN POPE, MS, OT UNIVERSITY OF KANSAS MEDICAL CENTER February 28, 2011
Parental Perspectives of Therapy
“Concerns exist regarding whether extensive therapy can send a message that the child is unacceptable as they are and needs “fixing up” “The effect of much early intervention has been for me to focus on what Sean cannot do at the expense of celebrating and wondering at all that he has achieved.”
Traditional vs. New Paradigm
Treatment models Expertise models Deficit-based models Service-based models Professionally centered models (Dunst, 2000) Promotion models Capacity-building models Strengths-based models Resource-based models Family-centered models (Dunst, 2000)
But, why can’t I provide a traditional approach to therapy?
Laws and often times funders require that our practice is based on peer-reviewed research to the extent practicable.
This peer reviewed research supports changing our practice at least as often as we change our hairstyle……..:)
THIS HAIRSTYLE WAS A GOOD IDEA IN 1986 (Nicholson, 2009)
It is probably not a good idea now. If you haven’t changed your practice as often as you have changed your hairstyle, you are out of date!
Look at the interdisciplinary research
…
How do adults learn? (
what do you know about this??)
How do children learn? (
what do you know about this?)
Who are you working with in your therapy practice?
TRADITIONAL Treatment Models
Focus on remediation of a disorder, problem, or disease, or its consequences
NEW Promotion Models
Focus on promoting competence and positive functioning
Expertise Models
Depend on professional expertise to solve problems for people
Capacity Building Models
Provide opportunities for people to use existing abilities and develop new skills
Deficit-Based Models
Focus on correcting a person’s weaknesses or problems
Strengths-Based Models
Acknowledge the assets of people and help them use these assets to improve functioning
Service-Based Models
Describe practices primarily in terms of professional services
Resource-Based Models
Describe practices in terms of a wide variety of formal and informal supports within a community
Professionally-Centered Models
View professionals as experts who determine the needs of a person from their own as opposed to the other person’s perspective
Family-Centered Models
View professionals as agents of families and responsive to family desires and priorities
AGREED UPON MISSION AND KEY PRINCIPLES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS
Sponsored by the Office of Special Education Programs, US Department of Education OSEP TA Community of Practice – Part C Settings (Hurth & Pletcher, 2007)
7 KEY PRINCIPLES
(modified
)
2. All families, with the necessary supports and resources, can enhance their children’s learning and development.
1. Children learn best through everyday experiences and interactions with familiar people in familiar contexts.
3. The primary role of a service provider in early intervention is to work with and support family members and caregivers in children’s lives.
7 KEY PRINCIPLES
4. The process must be dynamic and individualized to reflect child and family preferences, learning styles and cultural beliefs.
5. Outcomes must be functional and based on children’s and families’ needs and family identified priorities 6. The family’s priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support.
7 KEY PRINCIPLES
7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations
#1 Children learn best through everyday experiences and interactions with familiar people in familiar contexts
Everyday experiences With familiar people In Familiar Contexts
Natural Learning
Opportunities
Children’s learning opportunities that are interest-based and provide contexts for asset expression are more likely to optimize learning and development (Dunst, Bruder, et al., 2001; Dunst et al, 2000; Gallimore & Goldenberg, 1993; Gelman et al., 1991; Guberman, 1999; Nelson, 1999; Riksen-Walraven, 1978; Shelden & Rush, 2001)
Consider this….
“It’s important to remember that the amount of service is not what’s important, because all the child’s
learning occurs between sessions.”
(McWilliam, 1996)
Frequency Issues
Two hours/week = 2% of total waking hours of a one year old child Diapering, feeding, playing=each happen at least 2000 times by the child is one year of age Just 20 everyday activities would equal 40,000 learning opportunities by age one.
(Dunst, 2001)
Looks Like/ Doesn’t Look
Using toys and materials found in the home or community setting
Like
Using toys, materials and other equipment the professional brings to the visit Identifying activities the child and family like to do which build on their strengths and interests Designing activities for a child that focus on skill deficits or are not functional or enjoyable
Principle #1 Looks Like: Using toys and materials found in the home or community setting
“But……..the family doesn’t have any toys in their house for Natalie to play with.” “But……I can get Joey to do things with my toys that nobody else can get him to do.” “But…..the family really likes it when I play with Ezra in the living room so they can prepare dinner in the kitchen.” “But…..the family doesn’t have any routines.” “But….all this family does is sit on the couch and watch tv”
#2 All families, with the necessary supports and resources, can enhance their children’s learning and development All
families With necessary supports & resources
Looks Like Does NOT
Assuming all families have strengths and competencies; appreciating unique learning preferences of each adult Basing expectations for families on characteristics such as race, ethnicity, education, or income
Looks Like Does NOT
Matching outcomes and intervention strategies to the families’ priorities, needs and interests, building on routines and activities they want and need to do Viewing families as apathetic or exiting them from services because they miss appointments or don’t carry through on prescribed interventions
#3 The primary role of the service provider in early intervention is to:
Work with and support the family members and caregivers in a child’s life
Looks Like Does NOT
Valuing and understanding the provider’s role as a collaborative coach; Focusing only on the child and assuming the family’s role is to be a passive observer of what the provider is doing “to” the child
Looks Like Does NOT
Pointing out children’s natural learning activities and discovering together the “incidental teaching” opportunities that families do naturally between the provider’s visits Giving families activity sheets or curriculum work pages to do between visits and checking to see these were done
One approach…coaching as a style of adult interaction
We are working more as partners; side by side Both partners have specific, valuable information Both partners have unique skills We are learning together Just as a coach helps his or her players tap into their talents, so does the home visitor with the families
Coaching is...
An adult learning strategy in which the coach promotes the learner’s ability to reflect on his or her actions as a means to determine the effectiveness of an action or practice and develop a plan for refinement and use of the action in immediate and future situations.
(Rush & Sheldon, 2004)
Uses of Coaching
Coaching is used to provide support and encouragement, refine existing practices, develop new skills, and promote continuous self-assessment and learning.
Coaching Principles
Assist the person in feeling successful by taking one small step at a time Support the person in demonstrating new learning Create an environment in which it is ok to fail as part of the process and to ask for help
Coaching Principles
Remind yourself.... You are not the person with the answers. You have astute observations, questions and reassuring support to offer that will help the family member feel able to propose new ideas and options.
Characteristics of Coaching
Joint Planning Observation Action/Practice Reflection Feedback
Functional Outcomes Probe Question Examples
“What does your family want to see happen or changed as a result of intervention?
“ What are the activities that your family would like to do that are difficult?
“What kinds of things would you like “Joey” to do that would make life easier for you or more FUN for him?”
Example of a functional outcome
“Kyle will help feed and water the dogs every morning and every evening”
#6 The family’s priorities needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support
Primary Provider Represents and receives team and community support
“children don’t come in pieces”
Marion Wright Edelman
The more (decontextualized, skill-based) services the child and family received, the less satisfied they were with early intervention
96% of parents having one provider rated him/her as helpful 77% of parents having two providers rated them as helpful 69% of parents having three or more providers rated them helpful Dunst et. al 1998
Looks Like Does NOT
Having a primary provider, with necessary support from the team, maintain a focus on what is necessary to achieve functional outcomes Having separate providers seeing the family at separate times and addressing narrowly defined, separate outcomes or issues
Looks Like Does NOT
Coaching or supporting the family to carry out the strategies and activities developed with the team members with the appropriate expertise Providing services outside one’s scope of expertise or beyond one’s license or certification
Primary Coach Approach
All team members attend regular team meetings for the purpose of colleague-to colleague coaching. The team is comprised of all key disciplines (OT, PT, ST, ECSE)
How do you decide who will be the primary provider/coach?
What are the family’s and child’s outcomes?
Who has the knowledge and availability?
Who has rapport or a relationship with the family?
What do I do differently on
Monday morning?
Find the “Bright Spots” (Heath & Heath, 2010) What is already working? Where is it working well?
Explore the websites Think reflectively: What is most important to the family? What are the participation issues? Are we writing functional , participation based outcomes? Am I using the activities and routines of the family? Do I know the child’s interests? Do I use them In intervention? What are the child’s strengths?
Questions???
Thank you for your interest and participation!
Resources
http://www.coachinginearlychildhood.org
http://www.disabilityisnatural.com
http://www.fippcase.org
http://www.poweroftheordinary.org
http://www.researchtopractice.info
Bibliography
Bridle, L. & Mann, G. Mixed Feelings –
A Parental Perspective on Early Intervention.
Supporting Not Controlling: Strategies for the New Millennium: Proceedings of the Early Childhood Intervention Australia National Conference
, July 1-3, 2000, pp. 59-72 Campbell, P.H. (2004) Participation Based Services: Promoting children’s participation in natural settings. Young Exceptional Children, 8 (1) 20-29.
Dunst, C. J. (1995).
Key characteristics and features of community-based family support programs
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Topics in Early Child- hood Special Education, 19
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Dunst, C. J. (2000). Revisiting “Rethinking early intervention”.
Topics in Early Childhood Special Education, 20,
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Dunst, C. J., & Trivette, C. M. (1996). Empowerment, Trivette, C. M., Dunst, C. J., & Hamby, D. W. (1996). Factors associated with perceived control appraisals in a family-centered early intervention program.
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Bibliography
Dunst, C. J., Trivette, C. M., & Deal, A. G. (Eds.). (1994).
Supporting and strengthening families: Methods, strategies and practices
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Jung, L.A. (2003). More is better: Maximizing natural learning opportunities. Young Exceptional Children, 6(3), 21-26.
Law, M. (2000). Strategies for implementing evidence-based practice in early intervention.
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Bibliography
Trivette, C. M., Dunst, C. J., & Hamby, D. W. (1996). Factors associated with perceived control appraisals in a family-centered early intervention program.
Journal of Early Intervention, 20,
165-178. Workgroup on Principles and Practices in Natural Environments (November, 2007
) Mission and principles for providing services in natural environments.
OSEP TA Community of Practice Part C Settings. http://www.nectac.org/topics/families/families.asp