High Quality, Team-based Early Intervention Services for Infants

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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
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