What We Will Do Today - jeffline.tju.edujeffline.tju.edu/cfsrp/tlc/pdfs/supervisor_9-22-10.pdf ·...

9/23/2010

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Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp

What We Will Do Today

• Review Overall Program for 2010‐11

• Learn about the Competency Training for Providers

• See How We are Doing in Implementing A Quality Service Approach

• Supervisor Project


• Supervisor Project

• Questions ‐‐ Discussion

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Via A TransdisciplinaryA h f P idi


Approach for Providing Services

• Meaningful Outcomes• Teaching & Learning Interventions

– Directed to Child by Another PersonDirected to Child by Another Person– Directed to Environment via adaptations & AT

• Teaching Caregivers (to use interventions embedded within activities & ti )


& routines)• Progress Monitoring & Decision Making

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What is the difference between skill performance and participation ?


Skill performance means ‐‐‐

• Ability to do something wellsomething well

• Competence

• Excellence in execution


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Participation Means ‐‐the fact of taking part


Children are included when they are able to Children are included when they are able to participate in typical activities and routinesparticipate in typical activities and routines


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Inclusion occurs when people participate in activities & routinesparticipate in activities & routines

that take place in various settings likeHome

Community Child Care


Child Care

Name the routine that providers most frequently use with infants and toddlers?


10

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h h 2 fWhat are the 2 most frequent routines that caregivers do with infants and toddlers?


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Activities & Routines At Home

• Activities – things that families do together like outings, errands, chores, outdoor play, etc.

• Routines – things that occur regularly each day like morning and evening (bedtime) routines, mealtimes, indoor play/activity

• Some routines/activities go well,


some not.

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So – how do we ensure participation for each child?

Embed adaptation & Assistive Technology (AT)

interventions into Activities


interventions into Activities & Routines

First Step: Assess Activity & Routine Participation

• What environments or settings?g

• What activities & routines?

• Who are the “first hand” reporters?

• How do early intervention, special education related services personnel


education, related services personnel get information from the “first hand” people?

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Ask about Activities & Routines• Ask families or caregivers

• Ask child caregivers

• Observe• Observe

Find out about Adult Perceptions of Children’s Functional Skills

• Communication

• Socialization


• Socialization

• Getting Around

• Using arms and hands

Caregiver Assessment of Activities & Routines

DIRECTIONS FOR THE CAREGIVER ASSESSMENT AS AN INTERVIEW/CONVERSATION:

1. Ask the caregiver open ended questions about each activity/routine. For example, start by saying “tell me about bathtime and how your child participates during bathtime.” Follow‐up by asking additional questions so that you gain an understanding, a picture, of what the routine or activity looks like. Then ask the caregiver to rate the child’s participation in terms of the caregiver’s expectations (e.g., exceeds, meets, occasionally meets, does not meet). If you wish, you may ask the p p g p ( g , , , y , ) y , y ycaregiver about how satisfied they are with how the activity/routine is going. For some families, this helps them to decide the routine on which they may want to focus.

2. Ask the caregiver to rate their child’s use of functional skills (e.g., socializing, communicating) within activities and routines and their satisfaction with the child’s abilities. You are not trying to find out about the child’s deficit (e.g., speech) but rather the extent to which problems with speech interfere with a child’s participation.

3. Identify any routines which may not be going well (so that you can help families make them go better); Identify routines that are positive for families/children as these will provide a context in which to show families how to teach their children identified skills

EXPECTATIONS SATISFACTION

ROUTINE/ACTIVITY

Exceeds

Meets

Occasionally

Meets

Does not meet

COMMENTS

Very

Is OK

Somewhat

Not

Did Not Ask

BATHTIME


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BATHTIME

MORNING ROUTINE (getting up, getting dressed, etc.)

NIGHT TIME (getting ready for bed, going to bed, sleeping)

D

DP1 Will this look clearer?Diane Paul, 7/30/2009

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What can you learn?• Adults’ (e.g., caregivers, teachers, parents, etc.) perspectives

• What goes well (is pleasurable or functions ok) AND

• What does not go well

• What happens when something is


pleasurable? Or when something is not going well?

• What would the adult like to have happen?

Use the Caregiver Assessment of Activities/RoutinesEXPECTATIONS SATISFACTION

ROUTINE/ACTIVITY

Exce

eds

Mee

ts

Occ

asiona

lly

Mee

ts

Doe

s no

t mee

t

COMMENTS

Very

Is O

K

Somew

hat

Not

Did N

ot A

sk

BATHTIME X

Sitting in tub is problem; Slides under seat belt; does not hold him well enough. Enjoys play with tub toys.

X

MORNING ROUTINE (getting up, getting dressed, etc.)

X

I dress him in the morning –no time and he can help but it takes too long. He wakes up happy and ready to go.

X

BEDTIMES (getting ready for bed, going to bed, sleeping)

X

Watches video and then we read a book in his rocking chair; he enjoys both of these activities and falls

l il

X


asleep easily.

MEALTIMES (appetite, level of assistance)

X

Does not finger or spoon feed; can help a little with cup; chews ok but not big pieces; Eats with us and can stay in highchair until everyone is done.

X

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Decide What Should Happen

IFSP/IEP Outcomes

• Promote participation in activities and routines by:

“Fixing” those that are not going well by using adaptations and AT

Embedding specialized interventions and/or adaptations and AT in routines/activities that


p /are going well (meaning are enjoyable for caregiver/child; child is engaged, etc.)

• General Plan of Expectations

Based on your answers above, list the routines/activities that do not meet your expectations.

ROUTINE/ACTIVITY What would you like to see happening: What would the child be doing? What would you or other family members be doing? What

strategies have you tried?

1.

2.

3.

Based on your answers above, list the routines/activities that are enjoyable for you and your child.

ROUTINE/ACTIVITY

1.


2.

3.

Additional Comments:

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Eric will participate in transitions in his childcare program by riding his bike.


Robbie will participate at the playground by using his communication noodle to indicate choices (e.g., drink;

people to play with; equipment to play on)


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Transition has been improved by embedding the intervention of the battery‐operated bike

Playtime on the playground (and other situations) has been improved by embedding the intervention of use of a communication noodle.


Bike and noodle are examples of intervention strategies.

Two Categories of Child Interventions

Directed to the Child by Another person

Adaptations/AT Directed to the EnvironmentAnother person

(e.g., caregiver, another adult-provider, child, sibling)

to the Environment


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ICF Classification of Disability adopted by the World Health Organization (the figure is adapted from the ICF Beginners Guide available from:

http://www.who.int/classifications/icf/icfapptraining/en/index.html )


Directed to Child by Another Person

• Discipline‐Specific Strategies

– Education

– PT

– OT

– SLP

– Behavior Specialist


Behavior Specialist

– Mental Health Specialist

– ETC

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•Exposure & Opportunities

•Sensitive Adult Mediation

Directed to the Child By Another Person Least Intrusive

Adult‐Directed Strategies(Selected Examples)

•Opportunities for practice (within and across activities & routines)

•Reinforcement (e.g., praise; success)

•Modeling another child by watching & imitating

•Modeling an adult by watching and doing

•Contrived (Teacher/Therapist Designed) Activities

•Contrived Practice (e.g., Discreet Trial Training)

•Physical Guidance or Assistance

•Therapeutic Facilitation


•Verbal directions

•Cueing with natural or contrived cues

•PromptingMost Intrusive

CUSTOM Specialized, Individualized

Directed to the Child By Another Person

DIFFERENTIATED

Needed for Some but not all Children

UNIVERSAL


Used with ALL Infants

&Toddlers

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Adaptations as Interventions• Environments, activities & routines, have social and physical expectations for participation

• Adaptations, including assistive technology allow participation in typical family routines and activities

• Adaptations function as a mediator to make a bridge between the child’s abilities and the


“demands” or expectations of the environment

• By promoting participation, opportunities for learning are increased

What does Adaptation mean?

• Change in behavior of an individual or group i dj t t t difi din adjustment to new or modified surroundings is an adaptation.

• Something that is changed or changes so as to become suitable to a new or special use or


become suitable to a new or special use or individual situation is an adaptation.

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CUSTOM Specialized,

Adaptations/AT Directed to the Environment

DIFFERENTIATED

Needed for Some but not all Children

UNIVERSAL

pIndividualized


UNIVERSAL Used with ALL

Infants &Toddlers

– Things that we might all use with infants and toddlers

• Placing toys outside reach of child to promote t

Tier 1: Universal Adaptations/AT

movement

• Safety plugs in outlets

• Bath seat

• Toys with large grips or safe to chew

• Rewards (i.e., preferred activity) after doing something that is difficult


• Break apart multi‐step directions into single step (e.g., Go to the kitchen and get the napkin” becomes 2 separate directions.)

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Tier 2: Differentiated Adaptations/AT

Interventions we might use to enable children to do something that they are unable to do and may not something that they are unable to do and may notbe able to do for a while

– Bath seat for 18 month old– Velcro on bottom of bowl so a 24 month old child can learn to scoop

– Push play toy (e.g., baby stroller, shopping cart)– Providing a more active child with a toy to manipulate


g y pduring circle time

– Schedule picture board

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Tier 3: Customized Adaptations/AT

Child Specific/Custom Interventions allow a child to do something they cannot otherwise do

– Communication board for social interaction with siblings and cousins

– Specialized positioning equipment so that a child may sit up at a table to play, sit on the floor for circle time, sit and swing, stand at the sink M i d bili d i d f l


– Motorized mobility device to get around from place to place

– Switch to activate something that is part of an activity/routine

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Does the child havea disability or a i ifi t d l i

The 3 YES Conditions of AT

Is significant delay in

the area of development ?

YES

Is this a device or adapted material? Can

Can the child perform the skill only with the


p

YES

Canydevice or adapted material?

YES

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AT AAC

A word about Assistive Technology (AT) and Augmentative & Alternative Communication

(AAC)

AT

Socialization

Communication

Getting Around

Use of Arms & Hands

AAC

Sign

Picture Exchange

Picture Board

Single Switch Voice


Use of Arms & Hands Single Switch Voice Output


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Low Tech ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐High TechGeneral; Readily Available Targeted; Specialized

General market Small market


Adaptation/AT An Intervention to promote participation

This child is participating at her preschool by giving information about a school project to the TV interviewer by using a voice output device


voice output device.

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Environmental AccommodationsAdapt Room Set‐UpAdapt/Select Child Equipment

Facilitating Children’s Participation and Learning

Adapt/Select Child EquipmentEquipment/Adaptations for Positioning

Adapt ScheduleSelect or Adapt ActivityAdapt MaterialsAdapt Requirements or InstructionsHave Another Child Help ‐‐

Peer Assistance/Tutoring


Cooperative LearningHave an Individual Child Do Something DifferentHave an Adult Help a Child Do the ActivityHave an Individual Child Do Something Outside

of the Room (with an Adult)

Continuum:

Adaptations to the Environment

• Adaptations to the environment change the setting. F lFor example:

• Rearrange the furniture in the room so that a child in a wheelchair can move about freely.

• Adapt or add equipment (e.g.,use a slant board to help a child participate in coloring


activities, use wedge to provide supportive seating during circle activities).

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Continuum:

Adaptations to Activities and RoutinesAn activity or routine may be adapted to accommodate special

needs. For example:

• Add periodic movement activities to a story time activity to help children who have difficulty paying attention.

• Do the initial pieces of a routine for a child & let them do the end parts – e.g., dress a child up to the point of pulling up long pants


• Start dinner earlier for a child who needs longer to eat than the rest of the family.

• Allow a child to “walk” to mealtimes by being a duck so that the child is on task


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Continuum:

Adaptations to MaterialsMaterials used in an activity or routine, when adapted, may

help a child participate. For example:

• Make the pencil thicker by putting a foam curler around it or by wrapping the pencil with play dough or silly putty to help a child who has problems gripping pencils/crayons.

• Use assistive technology—as in the case of using a simple switch interface


pto help a child with motor difficulties activate a toy.


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Ideas to Share


Look Up By ‐‐• Functional Skill

C i ti

• Activity or Routine

• Errands

Ch– Communication

– Socialization

– Mobility

• Chores

• Outings

• Mealtimes

• Indoor Play

• Bathtime


– Arms and Hands • Morning

• Evening

• Outdoor Play (Physical)

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tion

mmun

icat


Com

eBa

thti

me


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Literacy – Book Reading

Continuum:

Requirements and InstructionChanging the requirements of an activity or a routine, or the way

you provide instruction for them can enable a child toyou provide instruction for them, can enable a child to participate. For example:

• Use photographs to show each step rather than simply speaking the instructions.

• Reduce the number of steps a child is expected


steps a child is expected to perform to change requirements.

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http://www.challengingbehavior.org/do/resources/teaching_tools/ttyc.htm

Hand Washing Sequence


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Beginning view of Turn over picture as Hand the child the picture of

Circle Time Sequence

Beginning view ofcircle mini schedule

Turn over picture as activities are completed

Hand the child the picture of the next place to go


Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children with Challenging Behavior. Tampa, Florida: University of South Florida, Early Intervention Positive Behavior Support.

http://www.challengingbehavior.org/do/resources/teaching_tools/ttyc.htm

It is hard to remember ‐‐‐but ADAPTATIONS & AT are NOT about

the “STUFF”


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ADAPTATIONS & AT ARE ‐‐‐‐

• INTERVENTIONS

• To help children participate in activities and routines to the maximal extent possible

• To increase opportunities for incidental (or unplanned) learning opportunities

• To increase functional skill performance across


• To increase functional skill performance across activities/routines for children with significant disabilities

Adaptations/AT Planning & Brainstorming

Environmental Modifications (Room, Child Equipment)

Equipment for Positioning

Adapt/Modify Schedule

What’s happening now?

What would you like to see happen?

Adapt ActivityAdapt Materials

Adapt RequirementsExpected Outcome


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ADAPTATIONS & AT ARE ‐‐‐‐Strategies /Interventions/Methods used by professionals and family members for the

purpose of influencing


Child Participation & Learning

In a Restaurant


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At Preschool/Child Care


In the Neighborhood


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How are we doing?

Phila n = 154 after feedback tapes


National n = 85 initial (6 states)

Overall Score

80

20

30

40

50

60

70

National

Phila1

Phila2


0

10

Traditional Participation

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Role of Caregiver

100

102030405060708090

National

Phila


010

Directly Observer NotPresent

Role of Provider

60

10

20

30

40

50

National

Phila


0

Teach CG JIC TeachChild

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Caregiver TeachingAverage # 30‐second intervals

total possible = 60

35

40

10

15

20

25

30

35

National

Phila--2

Phila - Pre


0

5

CPF DN C POR Mean

Use of Activities/Routines

100

102030405060708090

National

Phila


010

Play outdoor mealtimes

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Caregiver – Does Not Meet Expectations

70

0102030405060

lity

ion

ion ds

Phila


mobili

ty

com

mun

icat

io

soci

alizat

io

arm

s/han

d

Activities/Routines identified by caregivers as a problem or as

enjoyable30

0

5

10

15

20

25


0

bath

morning

bedtime

mealtim

es

play

story

chores

outings

outdoor

not meet meet

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What should be emphasized?


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