Top Mistakes Robin Wcwilliam
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Transcript of Top Mistakes Robin Wcwilliam
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Top 10 Mistakes in Early
Intervention in NaturalEnvironmentsand the Solutions
Robin McWilliam
Siskin Childrens Institute
Chattanooga, TN
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Contact
Write for copy of PowerPoint www.siskinresearch.org
mailto:[email protected]:[email protected] -
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Center mission:Improving the quality of life for children and families
The Siskin Center for Child and Family Research improves the quality of lifefor children of all abilities by conducting high-quality and important appliedresearch, discovering effective and innovative methods of intervention with
children and families, and discovering significant information about theirdevelopment and functioning.
StrategiesConduct research within the Institute, in the community, and internationally
Present and disseminate locally, across the United States, and overseasConduct Routines-Based Certification InstitutesEstablish international partnershipsParticipate in statewide advocacy and initiatives in TennesseeStrengthen university collaborations
Participate in citywide or countywide early-childhood initiativesUse the Siskin Centers for Early Learning as applied-research settingsEstablish local services based on supporting research
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Areas of focusChallenging behaviorsClassroom interventionsEarly intervention in natural environments
EngagementFeedback to teachersHome visitingIFSP qualityIntegrated classroom servicesMeasurement of EISR in routinesParenting supportQuality of lifeRoutines-Based Interview
Teaching practicesVideo self-modeling
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Top 10 Mistakes (in order of when
they happen in practice)1. Doing all the talking at intake visits
2. Asking families about daily routines at every meeting leading upto the IFSP3. Basing goals just on what parents say they want4. Ignoring the participationpurpose of child-level goals and
skimping on measurability of goals5. Matching services to deficits6. Working directly with the child on home visits7. Modeling/demonstrating blindly
8. Using the same home visiting approach for all families9. Focusing exclusively on the childs well-being and quality of life10. Working just with children in classrooms
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Intake
Mistakes
1. Doing all the talking at intake visits Conditions parents to think they are passive
recipients of service
2. Asking families about daily routines atevery meeting leading up to the IFSP
Tedious! Solution Ecomap
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Krista has little time for friends, but doesnt know what to do with her
afternoons (the worst time of day)
Steven, Krista,Darcy
Ks parents
Tulsa friends
Ks brother
Ks sisters
RobynNeighbors
Ss sisters
Ss aunt &uncle
Ss parents
Hometownfriends
SLP (Liz)weekly at
home
Dr. Trainer(physiatrist)
Golf weekly
Work: Alcoa
SC (Donna)6
months min.
Ophthalmolog-istAmy (DMRS
teacher)weekly HVs
PT (Scott)
2x/wk at clinic
OT(Michelle)
2x/wk at clinic
Church (1st
Baptist)
Regularpediatrician
(Glover)
Aquatictherapy(weekly)
Harris(neurosurg-
eon)
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Assessment
Mistake
3. Basing goals just on what parentssay they want
Solution
Routines-Based Interview
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The Routines-Based Interview
Go through each routine (i.e., time of day or activity)
Get a sense of familys and childs functioning
Write down significant information Star concerns
Recap concerns with the family, showing them the starred items
Ask what the family would like to concentrate on Write down these outcomes
Ask them for the priority order
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Structure
Home Routines
Waking upChanging diaper/bathroom
Going to kitchenBreakfast
Parent getting dressedGoing outIn shopsLunch
Going to parkOther family members
coming home
Dinner preparationDinnerBathTV
Bedtime
Classroom RoutinesArrivalCircle
Free playSnack
Small toysCentersOutsideMusicStoryLunch
NapCenters
Departure
Within Each Routine1. What does everyone else do?2. What does this child do?
a) Engagement
b) Independencec) Social relationships
3. How satisfactory is this routine?
3. How well is this routineworking for the child(goodness of fit)
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The 3 Foundations of Learning
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Outcome Writing
Mistakes
3. Ignoring the participationpurpose of child-level goals
Purpose for everyday life needs to be clear
4. Skimping on measurability of goals
Measurement of progress and attainment
Sports psych finding! Solution 7 steps of functional outcome writing
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7 Steps of Functional Outcome Writing
1. Read the short-hand version of the outcome from a family-centered, functional needs assessment (e.g., RBI)
2. Find out what routines this affects3. Write Child will participate in [the routine(s) in question]
4. Write by _____ing, addressing the specific behaviors
5.
Add a criterion for demonstration the child has acquired theskill
6. Add another criterion for generalization, maintenance, orfluency, if appropriate
7. Over what amount of time?
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Play with toys during hanging-out times
Tyrell will participate in hanging-out times at
home by playing with toys. We will know he can do this when he plays
with a toy for 5 minutes, independently, 3
times in 1 week.
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Service Decisions
Mistake
5. Matching services to deficits Pile-on of services, especially dangerous
in vendor (non)systems Solutions
Incremental service decision making Integrated services
Primary service provider
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Incremental Decision Making
1. Start with a primary provider (primary service provider, generalisthome visitor or consultant to child care)
2. Remember the child is getting intervention from regularcaregivers (parents, teachers)
3. Only add services needed to address outcomes the primaryprovider and the regular caregivers need help with
Example: Child is delayed in talking, but primary provider andparent know how to teach him to talk, there is no need to add anongoing service
4. When you do add a service, you plan for the intensity needed toensure the regular caregivders and the primary provider haveinformation necessary
Its not about working directly with the child
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Integrated Services
Focused support to
families Teamwork ensured by
having one professional
through whom teammembers work
Regular home visitor
Classroom teacher Classroom consultant
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The Other Approach
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Definition of Primary-Service-
Provider Model One professional provides weekly support to
the family, backed up by a team of otherprofessionals who provide services to the
child and family throughjoint home visitswith the primary service provider. The
intensity of joint home visits depends on
child, family, and primary-service-providerneeds.
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Home Visits
Mistakes6. Working directly with the child on home visits
Child deserves more intervention7. Modeling/demonstrating blindly
This is the model-and-pray approach
8. Using the same home visiting approach for all families Different child responsiveness Different family preferences
9. Focusing exclusively on the childs well-being and quality oflife
Family-centered, especially primary caregiver Solutions
Support-based home visits 3-tiered, response-to-support approach
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Collaborative Assessment.of Effectiveness
Collaborative Assessment.
of Effectiveness
Routines-based
suggestions
Written instructionalguidelines
Parenttraining
Intensity
Childprogress &
familydesire
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VHVS: The Questions
1. How have things been going?
2. Do you have anything new you want to ask meabout?
3. Outcomes in priority order
4. Is there a time of day thats not going well for you?
5. How is [family member] doing?6. Have you had any appointments in the past week?
Any coming up?
7. Do you have enough or too much to do with [yourchild]?
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Behavioral Consultation in the Context of
Support-Based Home VisitsHows it goingw/Outcome 1? Child still
not doing it
Getting better
Fine
GetdetaileddescriptionAsk for demo of
child func., ifnec.
Ask-to-SuggestHows interventiongoing?
Implementing
Description
Demo by parent?
Refineskill Tweakimpl.
Not implementing
Hard to fit in Child not
responding
Forgot
Changeinterv orroutine Change
orpersist
Trymatrix
Offer to demo
(8 modelingsteps)
Get det. descrip
Need help?
Yes
No
Up theante
End interv.?
Yes
No
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Logic Model for Support-Based Home
Visits
Family qualityof life
Improvedchilddevelopment
Maximal quality
of interventionfor the child
Maximal amountof intervention
for the child
Emotional,material, &informational
support
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Home-Based Programs
Do
Use accessiblematerials
Engage in kitchen talk
Find out what familieswant to be shown
Talk about everyday
routines
Dont
Take a toy bag Work just with the child
Model unnecessarily
Imply that lessons areimportant
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Wanna Be in a Study of the Response-to- Support Approach? Recruit 3 families Participate in an information conference call with me
Receive a manual on how to implement the approach Data:
Family-completed questionnaires Home-visitor-completed questionnaires
Child assessment (MEISR + a norm-referenced childdevelopment tool)
Benefit to you: Efficient training in cutting-edge home-basedservice delivery
Benefit to families: Excellent home-based service delivery
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Classroom Visits
Mistake
10. Working just with children inclassrooms
Children deserve more intervention
Solutions
Individualized within routines
Group activities
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Integrated Specialized Services
DEFINITION
When therapy and specialized instruction occur inthe classroom with other children usually present,and in the context of ongoing routines andactivitieswhen the teaching staff can learn fromthe consultant and vice versa
Specific approaches: individualized within routinesand group activity
Purpose: To ensure the teaching team has the
knowledge and skills to be able to maximize thechilds meaningful participation in everydayroutines
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The 5-Component Model for Early
Intervention in Natural Environments
CollaborativeConsultation
to Child
Care
Support-BasedHomeVisits
TransdisciplinaryServices
FunctionalFamily-Centered
Needs
Assessment
UnderstandingThe
FamilyEcology
EngagementIndependence
Social RelationshipsSatisfaction w/ Home Routines Functional,
measurableoutcomes