Running head: GUIDE TO EARLY INTERVENTION 1

Guide to Family-Focused, Culturally Responsive Early Intervention

Kelsie Burkhard

Virginia Commonwealth University

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Introduction

Early intervention is a program that provides supports and services to families of infants

and toddlers, ages birth to three, with or at risk for developmental delays or disabilities (Keilty,

2010). Early intervention supports and services in Virginia are provided through the Infant &

Toddler Connection of Virginia. These supports and services are available for all eligible

children and their families regardless of the family’s ability to pay. According to the Infant &

Toddler Connection of Virginia, “early intervention supports and services focus on increasing

the child’s participation in family and community activities that are important to the family”

(Infant & Toddler Connection of Virginia, 2014, home page). The purpose of this guide is to

describe family focused services in the process of early intervention. It will discuss the

importance of family-professional partnerships, awareness and responsiveness to a variety of

cultures, and provide online and community resources that align with each topic.

The sections of this guide include: family-focused assessment, family-focused goal

setting, family-focused learning, family-focused community supports, and family-focused

service coordination.

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Family-Focused Assessment

In order to determine a family’s priorities, strengths, and needs, both professionals and

families must collaborate in the process of assessment. Keeping assessment family focused is

key because “the child is a member of the family and the family has a significant impact on the

child’s development” (Keilty, 2010, p.38). In order to figure out how early intervention will best

support a family, the family-professional partnership first needs to identify what the child already

knows and what the family is already doing. This is done so through assessment, which includes

observations and conversations between both professionals and families. “Assessment begins by

identifying the child’s competencies in everyday life, and ends with interpreting what those

competencies mean so that interventions can be planned” (Keilty, 2010, p.38). Therefore,

assessment is continually asking what the child already knows how to do, how the child learns

best, and what strategies have already been tried. Reasons for assessments include determining

eligibility for early intervention, understanding the child’s learning characteristics, and

determining how well the intervention is working. Specific assessment can be done at certain

points, such as in determining eligibility, but assessment is an ongoing process during early

intervention.

Authentic assessments, through observation of the child in daily routines and play

comfortable to them, are most effective. One physical therapist describes authentic assessment as

observation that allows her to see skills she might otherwise not have seen (Colorado Department

of Education, 2014). While observing a regular dinner with a family, she was able to see the

child stack crackers and count, a skill she had not yet observed. Another key principle to note is

that the family-professional partnership works best when it works as an informal resource. For

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example, when “the early intervention professional interacts with the family in a casual and

friendly manner, and is viewed as an ally” (Keilty, 2010, p.49).

Because the assessment process is so focused on the family’s individual needs and

strengths, it is important to recognize the influence of culture. Family focused assessment will

look different for each culture. A family’s culture may have an effect on the family views of

child development, such as what types of extended family members are involved in child rearing.

For example, in families with American Indian roots, child rearing may fall into the hands of

other family members besides the parents, such as grandmother or aunt, who live in the home

with the immediate family (Lynch & Hanson, 2011). Because of a group focus, family members

work for the collective group, and communication might be directed to the entire group during

assessment to help respect this practice (Lynch & Hanson, 2011). From another perspective, self-

determination and self-reliance are highly regarded values in Anglo-American culture, as well as

the ability to overcome challenges with hard work and resources. (Lynch & Hanson, 2011).

When assessing the child’s development, you may want to collaborate with those involved with

the child in order to get an accurate picture of the child’s development in relation to the family’s

culture.

The entire goal of assessment is to encourage positive development for the child and to

support the family. As an aspiring early interventionist, I need to be honest and respectful of

varying cultures. One way to learn more about cultures is to have conversations with my co-

workers and community resources who have knowledge of that culture. It doesn’t seem like an

easy task, to be culturally aware, but I think that over time working with the family and building

rapport with one another, I will discover their preferences. I do this every day as I make new

friends and co-workers.

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Web Resources for Professionals and Families on Assessment:

http://www.zerotothree.org/child-development/mental-health-screening-assessment/tips-

for-surviving-child-developmental-assessment.html: ZERO TO THREE: Parent to

Parent tips in preparing for child assessment.

http://ectacenter.org/~pdfs/topics/families/questions_familiy_interests.pdf: Early

Childhood Technical Assistance Center: Questions for eliciting family interests,

priorities, concerns, and everyday routines and activities.

https://www.childwelfare.gov/famcentered/: U.S. Department of Health & Human

Services: Practices in Family-Centered Practice.

http://nccc.georgetown.edu/documents/ChecklistCSHN.pdf: Georgetown

University: Self-assessment checklist for personnel providing services and supports

to children with disabilities & special health needs and their families.

http://www.parentcenterhub.org/topics/family-supports/: Center for Parent Information

and Resources: List of family support resources.

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Family-Focused Goal Setting

Family focused goal setting describes how early intervention supports are planned and

will be implemented. When a family first enters early intervention, their initial plan is created.

This plan is called the Individualized Family Service Plan or IFSP, and contains the outcomes

related to the child’s development. Outcomes are described as the expected accomplishments for

the child based on the family’s priorities, or what the child may be able to do after intervention

support (Keilty, 2010). In early intervention, goals for the family are usually described as the

short term steps that lead up to the family or child outcomes. “The guiding principle of an IFSP

is that the family is the child’s greatest resource” (Center for Parent Information and Resources,

2014, para.2). This tells us that we must base any outcomes on the child’s development around

their family’s structure and routines. Every family priority is represented in the outcomes listed

on the IFSP (Keilty, 2010).

The team included in the family goal setting process can include any and all family

members involved in the child’s routines and a variety of early intervention professionals

including the family’s service coordinator, occupational therapists, physical therapists, speech

therapists, developmental specialists, teachers, or medical experts (Keilty, 2010). Although there

are a variety of disciplines between these professionals, the best way to blend the knowledge and

minimize the number of professionals coming into the child’s home is to follow a

transdisciplinary model. The transdisciplinary model allows for professionals to consult other

disciplines and share their expertise with each other, so that the professional who provides the

direct supports to the family can work on all aspects of the situation (Keilty, 2010).

The IFSP is a realistic plan with measurable goals that can be modified at any time, and

should be modified as the child progresses. Goals should be functional, measurable, and

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developmentally appropriate. In order to create the goals for the family, the team should consider

the child’s current level of functioning and the family’s priorities, concerns, and resources

(Center for Parent Information and Resources, 2014). Best practices tells us that IFSP goals are

individualized to address the needs of different family members (Sandall, Hemmeter, Smith, &

McLean, 2005). There may be many family members who want to be involved and the goals

must address everyone. For example, a family of African American culture may value the shared

responsibility of child rearing with the immediate family and extended family, as well as

consulting the older adults for expertise due to their wisdom as an elder (Lynch & Hanson,

2011). African American cultures may also value fictive kinship and the obligation to family and

community through sharing of resources (Lynch & Hanson, 2011). It will be important to

consider the roles of these family members in the child’s life during the goal setting process.

Sandall et al. (2005) also tells us that “practices, supports, and resources build on existing

parenting competence and confidence” (pg. 118). Goals and outcomes addressed in the IFSP

should build on the family’s strengths and use their existing resources. If I can help families

achieve goals, I can help them to feel more confident in their daily routines. By demonstrating

cultural sensitivity and recognizing what each family needs, I can encourage families to come up

with their own priorities and ideas. By gathering information through assessments and

conversations with families, I will involve families in the goal setting process.

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Web Resources for Professionals and Families on Goal Setting:

http://www.ifspweb.org/resources.html: Answers4Families: Examples of building on

family strengths and resources

http://veipd.org/earlyintervention/3-rules-to-live-by-when-writing-ifsp-outcomes-goals/:

Childress, D.: Blog post on 3 “Rules to live by” when writing IFSP outcomes & goals.

http://www.cpeip.fsu.edu/earlysteps/testtoolkit/test/devel-ifsp-outcomes.html: University

of Florida: Tools for early steps teams: Developing functional IFSP outcomes.

http://ectacenter.org/topics/ifsp/ifspprocess.asp: The Early Childhood Technical

Assistance Center: Planning and implementing family-centered services in natural

environments.

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Family-Focused Learning

Family focused learning follows a coaching model in which the “coach helps the

individual or team meet the goals they’ve identified for themselves” (Keilty, 2010, p. 90). As the

professionals, we are the coach, whose job is to support families in promoting their child’s

learning. In family focused learning, the professional watches the parent and child interacting

together during the family routine. The parent and professional should discuss what is going

right and identify what could make the situation better, making use of the family materials

(Keilty, 2010).

Keilty (2010) states that the three building blocks to effective communication are

identifying a common purpose, using family-professional strengths, and being flexible. It is

important for families to know that early intervention professionals are there for support rather

than substitution of family member interaction. Each family brings their cultural traditions,

materials, and routines, while the professional brings knowledge of child development,

disabilities, and resources (Keilty, 2010). By combining the family member’s routines and

materials with the professional’s knowledge, more effective strategies to support the child’s

development can be used. It is also important to be flexible, as early intervention is meant to fit

easily into the family’s life. Even though there are goals outlined on the IFSP, developmental

concerns may have emerged or the family may decide to focus on something else (Keilty, 2010).

Additionally, families have many other things to focus on and visits may have to be rescheduled.

While families are already promoting their child’s development, in order to expand on

their skills, they need the opportunities to practice and understand new ideas with professional

support (Keilty, 2010). An example given by Keilty (2010) compares this type of learning

to watching cooking or sports shows on television. Even though you are watching the person

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perform the actions, you may not be able to competently perform those skills yourself. This

shows that early intervention will work best when families perform the new strategies

themselves, and have the time to ask professionals questions and receive feedback. This allows

the family to successfully perform the interventions when the professional is not there.

Key principles tell us that open communication and feedback are key to having

successful interventions. This is especially true when understanding the family’s culture and how

it relates to learning. For example, Asian American families may not have a rigid schedule for a

young child and condition their children to respond to multiple caregivers in order to teach them

to see the world as a network of relationships (Lynch & Hanson, 2011). Child rearing may also

include close monitoring and Asian American families may feel that praise and credit are not

needed for behaviors that are expected (Lynch & Hanson, 2011). Filipino families may give

constant indulgence to the child without many demands and milestones may occur at a later age.

For example, the emphasis on dependency might be shown in longer periods of breastfeeding,

possibly until 36 months of age (Lynch & Hanson, 2011). In working with these families, it is

important to ask what the family would like for the child to be doing. One speech therapist talks

about how important it is to meet the family where they are and build upon the family priorities

(Virginia Early Intervention Professional Development, 2013).

When working with families it is important to have family members actively engaged. As

a professional, I hope to be able to learn more about how to build rapport and engage families

who may not be as verbal in communicating their needs. Additionally, I think that getting

feedback from families is the best way to figure out if everyone is on the same page and if their

cultural values are being addressed. I would like to find out more about effective ways to get

feedback from families, especially from those of a non-English speaking family.

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Web Resources for Professionals and Families on Learning:

http://www.youtube.com/watch?v=sL_WOCu3Ptg: Virginia Early Intervention

Professional Development: What intervention can-and-should look like.

http://www.asha.org/Publications/leader/2008/080325/f080325b.htm: American Speech-

Language-Hearing Association: Article on providing early intervention services in

natural environments.

http://fgrbi.fsu.edu/model.html: Florida State University: A model for family guided

routines based intervention.

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Family-Focused Community Supports

Natural learning environments are not just within the child’s home, but also in their

surrounding community. Communities include those places that the child may interact, such as

neighborhoods, towns, grandparent’s house, playgrounds, day care facilities, or the grocery store.

Community routine activities are “what the families and children do as part of their everyday

lives” (Keilty, 2010, p. 109). There are several different types of community activities. Formal

activities are planned on purpose to be a learning activity, such as child care or swimming

lessons (Keilty, 2010). Casual activities are those that are not structured such as playgrounds or

libraries (Keilty, 2010). Practical activities are those which are a part of the family’s day to get

their needs met, such as walking the dog (Keilty, 2010). Impromptu activities are those that the

family may have stumbled upon without meaning to, such as driving by a construction site

(Keilty, 2010). To help families identify these activities, a community map may be useful.

Not only can the family participate in community learning activities, but interventions

can take place outside of the home as well. The family-professional partnership can decide if the

professional should go along with the family into the community. If they do, they will also want

to decide how to explain the intervention to others, how coaching is going to take place, and

identify strategies “to focus on membership and avoid stigma” (Keilty, 2010, p. 113). We want

to determine if the family wants to explain the interventionist to others in the community, or

keep intervention confidential and introduce the interventionist as a friend. Families may not feel

comfortable using certain strategies in the community, if they feel that those strategies stigmatize

their child. Everyone wants to feel included as a member of their community, and as

professionals we will have to discuss with the family what makes them feel the most

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comfortable. We are there to support families to ensure that community activities are of high

quality, for children with and without disabilities (Keilty, 2010).

In the town of Cape Charles Virginia, there is great playground that was actually

designed by the community for the community. It has a fenced in area with a climbing structure,

rock wall, slide, and swings. These structures are common at playgrounds and may offer

challenges for families of children with disabilities. However, it also accommodates children

with disabilities as there is a swing in which the child can recline in, with a strap, and still be

pushed. This swing could be great for a child with physical disabilities who may not be able to

use the other structures. I have also seen this same swing on the playgrounds of several state

parks. This playground is also great because it has a sandbox, good for feeling textures, and

musical bells placed at a very low level for sound play. Families can also interact with other

families at playgrounds.

In addition to playgrounds, the YMCA is a great place for families. The YMCA here in

Richmond Virginia often has educational programs just for children with disabilities, including

sports games for older children. They also offer child care and parent/child swimming lessons for

children up to 3 years old. Families could really benefit from support at the YMCA, as they are

often the hub of community resources and children/families can make friends in their

community. However at the YMCA, participation in these activities is not always free, and could

be a barrier for families.

As an aspiring early interventionist, it is important to help families identify the resources

and supports within their community. It is also essential to align community supports with a

family’s culture by communicating with the family about activities they most benefit from. I

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believe that making schedules and community maps may be the most useful way to help families

by uniquely illustrating their community resources.

Web Resources for Professionals and Families on Community Supports:

http://www.ymcarichmond.org/downtown/programs-registration/youth-

development/swim-sports-play/youth-swim-lessons/: YMCA of Richmond, List of youth

activities.

http://www.completelykidsrichmond.com/resources/. List of community resources for

parents and caregivers by topic/disability

http://www.specialneedskidsinfo.com/virginialocalresources4.html: Community groups

and resources in the state of Virginia.

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Family-Focused Service Coordination

During the process of early intervention, families may have a lot to keep track of. There

may be many different visits, appointments, and professionals involved. Service coordination is

support to help organize the process, programs, and professionals involved with families in early

intervention (Keilty, 2010). It is provided at no cost to families under Part C of the IDEA. The

service coordinator serves as the single point of contact and helps keep track of all supports,

making sure that they fit together and are not overwhelming for the family.

The service coordinator acts as the team facilitator (Keilty, 2010). They will coordinate

early intervention processes such as following laws, completing forms, and reviewing family

rights and procedural safeguards (Keilty, 2010). They also understand funding and sources of

funds for supports/services families may need, such as assistive technology. Service coordinators

focus on making sure that families are participating equally in the early intervention process and

have a good understanding of the process as it continues.

One service coordinator describes her role as a resource specialist who provides support

to families (VA Early Intervention Professional Development, 2013). This support is in finding

and obtaining any resources that help families meet their priorities inside and outside early

intervention (Keilty, 2010). Additionally, the service coordinator might be involved in helping

families achieve family outcomes, due to their knowledge of resources. Types of resources

families may access include health community resources (primary care doctor, health insurance,

specialists), developmental community resources (playgroups, child care programs, Head Start,

preschool), and family support community resources (family centers, financial, social services,

disability specific opportunities, charities) (Keilty, 2010).

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As with the other early intervention supports, service coordination works best when they

help the family as desired and do not replace families in parenting their child (Keilty, 2010).

Effective service coordination happens when families are provided with information and

education to address their individual needs, when families communicate the needs of their child,

when families make informed decisions about services for their child, when agencies and

professionals are coordinated, and families receive quality services (Keilty, 2010).

The service coordinator can also use coaching methods during their role in early

intervention by using resource based coaching practices (Childress, 2014). Instead of doing

everything for a family, the service coordinator can help strengthen the family’s capacity to

identify their own priorities and resources available, access those resources, and evaluate the

effectiveness of those resources (Rush & Shelden, 2011). Asking families what they know is

available and how to access that before sharing knowledge of resources gives families a chance

to explore their own knowledge and solve the problem themselves (Childress, 2014).

Web Resources for Professionals and Families on Service Coordination:

http://ectacenter.org/topics/scoord/scoord.asp: Early Childhood Technical Assistance

Center: Legal descriptions of service coordination under IDEA.

http://www.nectac.org/~pdfs/pubs/nnotes8.pdf: NECTAC: Descriptions of different parts

of service coordination.

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Conclusion

I believe that as professionals, we need to have an open mind and respect for others.

Lynch and Hanson (2011) say that respect for differences, an eagerness to learn, and willingness

to accept that there are many ways of viewing the world are some of the practices that make

professionals successful when working with cultures different than their own. In addition to

conversation with families, I can build my competence by taking time to understand each family.

I can reach out to community groups of different cultures to ask about resources that might be

helpful and to gain a better understanding of how the family fits into their community. I will also

develop my knowledge as I continue through the ECSE program here at VCU and talk with

current professionals to share in their experiences. I also need to continue to explore my own

culture and be aware of my personal knowledge and actions towards others. I will become more

comfortable as I work with a variety of different cultures and begin to see those types of

beliefs/values talked about in our readings. Finally, compiling resources that I discover along the

way will be great in sharing with families of many needs.

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References

Center for Parent Information and Resources. (2014). Writing the IFSP for your child. Retrieved

from http://www.parentcenterhub.org/repository/ifsp/.

Childress, D. (2014, July 31). Can service coordinators use coaching? [Blog post]. Retrieved

from http://veipd.org/earlyintervention/can-service-coordinators-use-coaching/

Colorado Department of Education. (2014). Authentic assessment in early intervention. [Video

file]. Retrieved

from http://www2.cde.state.co.us/media/ResultsMatter/RMSeries/AuthenticAssessInEI_S

A.asp.

Colorado Department of Education. (2001). Nolan’s story. [Video file]. Retrieved

from http://www2.cde.state.co.us/media/ResultsMatter/RMSeries/NolansStory.asp.

Colorado Department of Education. (2009). Reflections during the final home visit. [Video file].

Retrieved

from http://www2.cde.state.co.us/media/ResultsMatter/RMSeries/FinalVisit_SA.asp.

Infant & Toddler Connection of Virginia. 2014. Infant & Toddler Connection of Virginia.

Retrieved from http://infantva.org/.

Keilty, B. (2010). The early intervention guidebook for families and professionals. New York,

NY: Teachers College Press.

Lynch, E. W., & Hanson, M. J. (2011). Developing cross-cultural competence: A guide for

working with children and their families (4th ed.). Baltimore, MD: Paul H. Brookes

Publishing Co.

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Rush, D. D., & Shelden, M. L. (2011). The early childhood coaching handbook. Baltimore, MD:

Paul H. Brookes Publishing Co.

Sandall, S., Hemmeter, M. L., Smith, B. J., & McLean, M. E. (2005). DEC recommended

practices: A comprehensive guide for practical application in early intervention/early

childhood special education. Missoula, MT: Division for Early Childhood.

Virginia Early Intervention Professional Development. (2013, August 26). Early intervention: A

routines-based approach-part 2: What intervention can-and-should look like. [Video

file]. Retrieved from http://www.youtube.com/watch?v=sL_WOCu3Ptg.