Engaging Families in Natural Environments

TaCTICSTherapists as Collaborative Team members for

Infant/Toddler Community Services

http://tactics.fsu.edu

Objectives

Identify routines and play activities that promote positive interactions for embedded intervention

Identify basic problem solving strategies to promote family participation in the intervention process

Reflect on practices that “join” rather than “train” the families

Agenda 1:15 Getting to family centered services… in spite of

ourselvesJP in Natural Environments

1:45 Make it or break it practices for joining in… not taking overShanka

2:15 Observing routines for embedding interventionShoes

2:45 Break 3:00 Problem solving strategies 3:30 Triadic intervention strategies for facilitating

servicesTirara

Family Centered Approach

Embraces the unique and lasting relationship between family members

Recognizes the family as the context for assessment and intervention

Respects and adapts to the multiple and diverse responsibilities and roles of families

Provides adequate information and support for the family to make informed decisions

Offers information and opportunities for participation in a timely, sensitive and individualized format.

Why talk about family centered services?

Programs with active parent programs identify improved child outcomes, greater family satisfaction.

Family centered services are not consistently implemented despite widespread support (Guralnick, 2002).

Transition is one of the most frequent OSEP compliance citations (USDOE) and identified by families as a major struggle.

Changing demographics provide constraints to current policies and procedures (Vacca, 2000).

Society (politics) espouses a more active parental role in education.

What Families Want in Assessment

adapted from Zero to Three Newsletter, Washington, DC

Opportunity to work together to learn about the child

A “real” picture that reflects the child in familiar and functional settings using multiple methods to share information

Participation in meaningful activities Information to support informed

decision making

Roles for the Family

More than a continuum of options for participation (Crais et al)

Multi-faceted and dynamic participation throughout the relationship (Woods & McCormick) Guide Team member Decision maker Contributor Observer and validator Problem solver Teacher

Make or Break Practices for Family Participation

Gathering and Giving Explain why information is important Provide examples and developmental knowledge

Observing and Modeling Watch what, how, & when parent interacts Show what strategies or behaviors are needed

Problem Solving and Decision Making Present alternatives for caregiver participation Integrate learning strategies for adults in process

8 Strategies to Support ALL Adult Learners

Comfortable Environment

Respect for Values and Priorities

Effective Communication

History and Experiences

Contributions and Participation

Collaboration and Problem Solving

Applicability to Life and Functionality

Competing Commitments

Adult Learning Styles

Active Experimenters Give it to me! Just do it; try, practice Parent completed

measures e.g. Screening Conceptualizers

Tell me about it! Think, analyze, question Handouts, brochures;

e.g. Day in the Life, or Letter to … from Lorna

Observers Show me! Watch and reflect Videos of other parents

or role play assessments

Experiencers Share with me! Feel, listen, project Questionnaires or

structured interviews, e.g. Getting to Know Your Child or Community Map

Initial Contacts Establish partnership process

Everyone is an expert… and everyone is a learner

Initiate capability -vs- disability point of view Communicative competence as basis for

intervention Set the stage for proactive caregiver

participation Prepare caregivers for process; seek input for

plan Offer examples, opportunities, alternatives:

Assessment is a novel and frightening experience

Child

Family

Priorities

Concerns

Current Status Pertinent History Progress Typical and Preferred

Routines, Events and Activities Problems with

Participation, Interaction Expectations

Talk! Listen! Watch!

Information Gathering

Gathering Information Conversations/Interviews

With family members With caregiver in other environments

Observation Natural Systematic or structured

Direct Tests and checklists Instruments

All About MeWho are the Important people in my life?

What activities do I like to do at home and in the community?

How do I play with children, adults, and toys?

What does my family want me to be able to do?

Conversation Startersfor Family and Caregiver

Routines Typical day Nights, weekends Regularly or frequently scheduled

appointments/events Sibling activities Family activities/events Preferences Expectations

“Tell me about your day…”

What happens?When?With who?Where?What works?What doesn’t?What activities are preferred?

Powerful Questions What’s working well for you now? What worry wakes you up at night? If you had an assistant for a day, what

would you be doing? What would your assistant be doing?

What has been an accomplishment for you and your child that makes you happy?

What community activities do you feel you are missing where you would like to participate?

What makes a day challenging?

Talk! Listen! Watch!

Information Giving

Development

Impact of Impairment or Disability

Resources, Supports

Confidence

Competence

Connections

Giving Information Remember the capability and proactive

participation planning Share strengths… “JP loves his snacks so that’s a great

opportunity for communication… using gestures and vocalizations. You’re right…he doesn’t have words, but there are many ways…”

Avoid all jargon Be concrete and give practical examples

that relate to family You told me you like to go to the playground…

Use a variety of adult learning strategies Visuals

Playground

Slide

•Steps •Platform•Turntaking •Up/down, On/off•Problem solving•Sliding through

1

2

3

Strengthening Skills inIdentifying Routines

Practice thinking out of the IFSP boxes Shop for ideas while completing the

tasks of your everyday life Survey the family for special interests or

activities Complete an environmental scan of

your own routines and materials Complete an environmental scan during

a home visit

Beyond the List of Routines and Activities

Parents, preferred playmates, caregivers, pets, places

Physical space, materials, resourcesExpectations, rules, ritualsLife style, roles, responsibilitiesLanguageFrequency of opportunities, events,

activities

Why Go “Beyond” the List?

Gives the family “more” voice in the process

Provides meaningful information for the family and team members

Increases ease of putting information into functional family words on the IFSP

Individualizes routine for the identified outcomes for the child and family

Supports actual implementation through adequate and accurate information

Dyad

How to: Establish Supportive Environment

Shift body position to increase caregiver capacity Identify routines, materials, and positions that enhance

interaction Interpret child’s signals in response to caregiver Explain or clarify caregiver role in interaction Provide gestural and verbal cues to caregiver during

routine or play Identify and explain strategies caregiver uses to support

child Comment on child’s enjoyment and engagement Connect child’s and caregiver’s actions

How to: Enhance Caregiver Competence

Point out child competence Comment positively on caregiver action- child response Acknowledge caregiver’s feelings, frustrations Ask caregiver’s opinions, ideas, feedback Answer questions Listen and expand caregiver’s idea or action Problem-solve with caregiver Plan ahead collaboratively for future activities, routines

How to: Provide Information Give direct development information Describe developmental skill while child demonstrates Explain impact of disability on child’s skill development Interpret child’s adaptation and efforts to learn Explain connections between past, present, and future

skills Interpret child’s feelings within developmental context Reinforce caregivers actions by explaining how it

enhances child learning Describe child progress within context of play, routine,

or activity

How to: Focus Attention Comment positively on aspect of action or response Provide material or activity to demonstrate child’s

competence Ask caregiver for information or interpretation of child’s

activity Talk for caregiver to child and child to caregiver on skill

or action as it occurs Connect child action to previous level of development Comment through the child in response to caregiver Parallel talk regarding child or caregiver

action/feeling/emotion Interpret child’s cues or signals for caregiver

How to: Model

Use developmentally appropriate actions or materials Verbally model caregiver role Illustrate facilitation strategies:

Environmental arrangements

Responsive interventions Focused stimulation Milieu teaching Response prompting

Describe strategy, purpose, value Illustrate strategy within a different context

How to: Suggest

Invite caregiver to join interaction Observe caregiver use of strategy and offer

enhancements or adaptations Suggest action or strategy directly, indirectly, or by

talking through the child Identify and explain features of the suggestion or

strategy Directly demonstrate action for caregiver Repeat demonstrations as needed Solicit caregiver input on suggestion or strategy Problem solve best use of suggestion or strategy