Gathering and Giving Information With Families

Infants & Young ChildrenVol. 21, No. 4, pp. 272–284Copyright c© 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins

Gathering and GivingInformation With Families

Juliann J. Woods, PhD, CCC-SLP; David P. Lindeman, PhD

The exchange of information between family members and service providers is a central feature ofearly intervention services and is integral to the development of an individual family service plan.Early intervention professionals pressured by timelines and documentation requirements eithermay resort to a directive style of communication that is not matched to the interaction or learningstyle of the family members or may ask general interview questions that do not provide sufficientinformation for effective intervention planning. Neither approach offers the family members aclear depiction of their role on the team. A framework and 5 strategies that support a reciprocalprocess for providing and receiving information while promoting family members’ understandingof intervention in their everyday routines and activities are described. These strategies, developedand tested in the field within 5 federally funded research, demonstration, and outreach trainingprojects, offer tools for service providers to gather and give information cognizant of differentadult learning preferences. Key words: information gathering, reciprocal exchange, routines

AN ESSENTIAL PRACTICE for assessmentand intervention in natural environments

is the identification of the routines, activi-ties, and events that occur regularly for chil-dren and families at home and in the com-munity. Gathering information about wherefamilies go, what they do, when they doit, and how they engage in the tasks of ev-eryday life is pivotal to the identification ofauthentic outcomes and the initiation of in-tervention that has the likelihood of mak-ing a difference (Bernheimer & Keogh, 1995;Bernheimer & Weismer, 2007; McWilliam &Scott, 2001). However, service providers are

Author Affiliations: Department ofCommunication Disorders, Florida State University,Tallahassee (Dr Woods); and Life Span Institute/Parsons, University of Kansas, Parsons(Dr Lindeman).

Support for the initial work and development ofthe manuscript was received in part from grantsfrom the US Department of Education, Office ofSpecial Education and Rehabilitation Services(nos. H324C020091, H024D30033, H024B0015,H024070028, and H324R990079).

Corresponding Author: Juliann J. Woods, PhD,CCC-SLP, Department of Communication Disorders,Florida State University, Tallahassee, Fl 32306 ([email protected]).

challenged on multiple levels to gather thisinformation. First, they are seeking personalinformation about the intricate workings ofa family while developing rapport and build-ing a relationship. Second, this sensitive taskis amplified as information is sought from thefamily members while they are learning abouttheir child’s special needs, the early inter-vention (EI) services and supports available,and the professionals and systems that pro-vide them (Fialka, 2000). Furthermore, ser-vice providers have a legislated timeline to de-velop an individual family service plan (IFSP)with the family when the child qualifies forservices and the family is interested. The re-quirement of gathering information and com-pleting documentation within 45 days ex-erts pressure for teams to be efficient andmay limit giving information to the familyabout the principles and practices of EI. Fi-nally, different models of service deliverycreate different demands for communicationamong team members and families. For exam-ple, when evaluation and IFSP teams involvedifferent professionals than the interventionteam, sharing information in a thorough andtimely manner is difficult.

Many EI programs provide staff develop-ment activities on “why” better practices are

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Gathering and Giving 273

important and “what” the changes shouldbe, but often do not offer adequate infor-mation on “how” to accomplish the recom-mended changes in practice (Campbell &Halbert, 2002). The purpose of this arti-cle is to present a framework and describe5 strategies that are efficient and effectivemethods to engage the family members ini-tially and support their continued participa-tion throughout the intervention process. Thestrategies described have been field testedin multiple EI programs (Lindeman & WoodsCripe, 1997; McLean, Lindeman, & WoodsCripe, 1994; Woods, 2008; Woods Cripe &Lindeman, 2001, 2004) and promote a recip-rocal approach to assessment, IFSP develop-ment, and intervention planning. A recipro-cal approach gives families information (eg,the relevance of teaching and learning op-portunities within daily routines, their child’sabilities) while gathering information (eg, thefamily members’ concerns and priorities, thechild’s interests, and the places and activitiesof their daily life available for teaching andlearning).

THE NEED FOR A RECIPROCAL PROCESS

Most families have little, if any, knowledgeof EI prior to the referral of their child.They have not experienced the principles offamily-based, natural environments, team de-cision making, or care provider–implementedapproaches (Sandall, Hemmeter, Smith, &McLean, 2005). If a family has any experi-ence with EI, it is likely to be with a medi-cal, a clinical, or an educational model, withexpectations for team members to diagnoseand prescribe a treatment, do therapy, teach,or give homework. It is fair to assume thatwithout the knowledge of what EI is, why andhow it is to be delivered, early intervention-ists should anticipate that families will needsupport at varying levels and types to partic-ipate fully (Bruder, 2000; McWilliam & Scott,2001). To put it simply, families need to havea clear description of what the program en-tails and what their roles are so that they canparticipate.

Unfortunately, because of time constraints,service providers frequently begin the eval-uation and the IFSP process with intake pa-perwork and eligibility determination, andthen proceed with assessment for interven-tion planning. They gather information aboutthe child’s health and development, familyconcerns, and resources and supports avail-able or needed. Often, families are expectedto describe their typical day, prioritize out-comes for the IFSP process, and identifycontexts to embed teaching opportunities in1 meeting. The individualization that is theframework of EI services is lost (a) whenmarathon meetings are conducted, (b) jargonsuch as “natural environments,” “transdisci-plinary teams,”“primary service providers,”or“family-centered services” is used frequently,and (c) documentation requiring signatures isamassed. Families may be participating with-out adequate knowledge of the purpose of EI,what their roles and responsibilities are, andwhat evidence supports the effectiveness ofan approach (Peterson, Luze, Eshbaugh, Jeon,& Kantz, 2007).

In a reciprocal process, family members be-come acquainted with the concept of “natu-ral environments”through examples providedand reflection on their own lives and inter-actions. They learn that it is not about theplaces where they spend time with their chil-dren, but, more importantly, the experiencesand learning opportunities that occur withtheir child through daily communications androutines. They learn that they are active par-ticipants in their child’s development. Familymembers generally do not reflect on all theconcepts their child is (or could be) learningwhile drinking from a bottle or riding a tricy-cle. Even if well informed, they may not rec-ognize how essential their parenting role is—and how simply they can increase opportuni-ties or complexity of responses of their childwithout interfering with their primary roleof being a nurturing parent (Dunst, Hamby,Trivette, Raab, & Bruder, 2000). Families ben-efit from information about how young chil-dren learn by doing and that the family mem-bers’ role in the process will be to “keep

274 INFANTS & YOUNG CHILDREN/OCTOBER–DECEMBER 2008

doing,” not doing more or changing radi-cally everything they have done (Jung, 2003).Families gain confidence and understandingwhen the information is shared with spe-cific examples that emphasize their accom-plishments, not the deficits. Throughout theprocess from assessment to intervention, theneed for the reciprocity exists and can besupported through the use of a reciprocalprocess.

Building a framework for a

reciprocal process

The ecological context of everyday rou-tines, activities, and settings (Bronfenbrenner,1979) serves as an anchor for the transactionalinterplay between caregivers and the childwhere learning occurs (Sameroff & Chandler,1975). Service providers benefit from infor-mation shared by families that describes theirvalued routines and interactions when de-veloping intervention plans (Bernheimer &Weismer, 2007). To share this information,families need to understand the value of theinformation to the service providers and theintervention process (Edelman, 2004; Woods& McCormick, 2002). Reciprocal and respect-ful communication strategies support the ef-fectiveness of the information sharing whilemaintaining efficiency by incorporating thefollowing principles:

Sharing information concurrent with gath-ering information: Sharing informationwith the family about what, how, andwhere children learn while gathering in-formation about the family’s specific dailyroutines, activities, and events providesa context to establish a reciprocal pro-cess that will facilitate family participa-tion throughout intervention. For exam-ple, dad is distracting his 15-month-olddaughter with a game of peek-a-boo whileanswering questions about the family’sschedule of typical activities. The earlyinterventionist takes notes for the IFSPabout morning routines, childcare, familywork schedules, and the child’s favoriteactivities. She notes Jessica prefers peo-

ple rather than her many toys. While dadcontinues the game, the interventionistcomments to dad that he is already help-ing his daughter develop communicationskills, the major concern expressed bythe family, while playing peek-a-boo. First,when he alters the tone of his voice orthe words he says just a little each timehis daughter pulls his face toward her, heis gaining her attention. When he pausesand gives her a chance to respond, heis helping her learn to take turns in gamesand conversations, and when he laughswith her, he is encouraging her to enjoysocial interaction with others. The inter-ventionist used a “teachable moment” toillustrate to dad the process of addressingthe priorities for his child in natural envi-ronments by moving from abstract wordsto more concrete and meaningful exam-ples of “how” it will be done.

Recognize each child and family is unique:To develop a truly family-centered pro-gram, information specific to the childand family’s natural environments, pref-erences, values, and priorities must beknown. The family must identify the rou-tines, activities, and settings for the in-tervention to ultimately be effective andvalued by the family. Although daily rou-tines appropriate for intervention mayseem obvious, they are individual to thefamily members on the basis of their in-terests, beliefs, and their unique char-acteristics. Family members and serviceproviders would likely agree that a com-mon daily routine for children and fam-ilies is meals and snacks. This activityappears to provide several opportunitiesdispersed throughout the day to engagein planned learning opportunities. Whatis identified as an excellent activity by theprovider may not be preferred by the fam-ily. The parents may value mealtime as atime for relaxing and sharing or find ittoo busy to focus on 1 child. Furthermore,the child may not be motivated by meal-time. Activities of interest to the child areimportant because they provide built-in


motivation for exploring and expandingon current skills (Dunst, 2001; Wolery,2005). Although providers may have pre-ferred and comfortable intervention rou-tines and activities, they should not au-tomatically become the contexts for thechild and the family. The family membersshould identify what they like to do andwhen and where they will be comfortableaddressing intervention. They are also theexperts on the activities and routines ofinterest to their child.

Develop an individualized plan for gath-ering and giving information: Familiesneed a context to share information abouttheir family. The service provider’s firstpriority must be to establish a relation-ship with the family that underscores therelevance of the family members’ per-spective regarding their child, their val-ues and beliefs, their concerns, and theoutcomes they hope to achieve. Histori-cally, service providers have initiated EIby focusing on an evaluation of the child’sstrengths and needs (Stremel & Campbell,2007; Woods & McCormick, 2002). Withthe shift in service delivery resulting fromthe revision of IDEA (Individuals with Dis-abilities Education Act) legislation aroundnatural environments, service providersare looking to the family for informationthat can guide the evaluation/assessmentprocess and establish the intervention pri-orities. Rather than choosing the most ap-propriate child assessment tools, serviceproviders are identifying the strategiesmost appropriate to establish the role ofthe family within the evaluation and IFSP.Service providers must prepare to involvethe family members in this process byconsidering many variables that may in-fluence their responses including familyhistory, culture, religious beliefs and val-ues, education level, primary language,and learning style of the caregivers. En-vironmental factors also impact families’responses such as work and school sched-ules, transportation options, and the num-ber of people living in the household.

The team must set the stage to include thefamily as partners in the evaluation and assess-ment, IFSP development, and, ultimately, theintervention process. Addressing the family’spreference for time and location, participants,and roles in each component of the EI processenhances the partnership process. Gatheringinformation about each family’s unique qual-ities helps the team prepare to both gatherand give information that will be meaning-ful and functional. Time spent upfront estab-lishing the reciprocal relationship is impor-tant for the team’s success in implementationthroughout the program.

FIVE STRATEGIES THAT FACILITATE A

RECIPROCAL APPROACH

Service providers can benefit from using avariety of strategies both for initial identifica-tion of family and child contexts and for on-going program development. In addition tosharing information about the child’s skills,families share their routines, activities, andsettings with service providers in many ways,both obvious and incidental. Strategies thatare discussed include inventories and ques-tionnaires, conversations, community map-ping, ecological or environmental scans, andinformal problem-solving discussions. No sin-gle proper procedure exists to gather andmonitor information about the child and fam-ily’s preferred settings and routines, and ser-vice providers need multiple methods to beable to choose an option that will support ini-tial and ongoing exchanges (Table 1).

Moving the interview to a conversation

Having conversations with caregivers is acommonly recommended strategy for gath-ering information (McWilliam, 2005; Wilson,Mott, & Batman, 2004). However, it is alsoan important strategy for giving information,especially during initial contacts when thepressure is on to gather information. Forsome families, engaging in 2-way conversa-tions or asking and answering questions arecomfortable and effective. They are willing toshare details, appreciate their importance, are


Table 1. Tools for gathering information

Strategy When to use What to share

Conversations Initial contacts

Updates throughout

intervention

Benefits of learning in everyday opportunities,

child development knowledge, impact of

disability, importance of parent-child

interaction

Questionnaires Initial contacts

Periodic updates

Role of family on team, typical development,

information supports progress

Mapping Intervention planning

Transitions

Community activities and resources, skill

generalization, family activities

Problem solving Throughout Options for intervention strategies,

adaptations, identification of learning

opportunities, affirmation of caregiver

strengths

Environmental scan Initial

Regularly

Potential routines, activities, environmental

arrangement strategies, examples of

outcome integration into family interests

anxious for intervention services to begin,are not concerned about approval fromthe provider, or respond to a providerskilled in facilitating nonintrusive discussions(McWilliam & Scott, 2001). Other parentsare less comfortable talking with unfamiliarpeople, engaging in face-to-face discussions,or responding to a list of questions theyconsider intimidating or intrusive (Vacca &Feinberg, 2000). Adding difficulty to the sit-uation may be a provider new to the processwho asks broad or leading questions such as“What would you list as your natural environ-ments?” or “What would you like Jasmine towork on?”Questions such as these often resultin nonanswers, such as “I don’t know,” or an-swers that are vague, lack detail, or appear de-fensive. The family member’s cultural and edu-cational background, view of professionals aspartners, and current status of emotional orphysical health are factors that can impact re-sponsiveness to questions or comments froma service provider.

The information gathered in an interviewor a conversation will not only vary by themethod employed but also be related to thevariability of the family’s lives (Bernheimer &Keogh, 1995; Bernheimer & Weismer, 2007).

When asked about their typical day, some fam-ilies easily identify a list of activities and eventsthat occur such as spending time with the tod-dler during snacks, diapering, playtimes, after-school sport events for siblings, dinner withthe family, and bedtime. Others focus only onspecific activities related to the care of theirchild such as doctor’s or therapy appoint-ments, physical exercises, or medical proce-dures such as breathing treatments. Still otherfamilies laugh and respond that a typical daydoes not exist. They just go with the flow.

Closed-ended questions such as those onthe intake or cover pages of the IFSP are of-ten asked when family responses are vague orthe service provider is in a hurry. However,they do not set the stage for a reciprocal part-nership. Instead, they appear to be a test forparents to find answers that will assist themin receiving services and supports. It is impor-tant that caregivers understand “why”you areasking questions about their day. Explainingwhy knowledge of routines and activities isimportant is a priority for “giving”informationand a logical initial step. Closed or checklist-formatted questions do not share informationabout the context to help the caregiver seethe value of sharing information. Identifying


activities and routines with families could be-gin with conversation starters such as thesethat share important context (Fig 1) or de-scriptions such as:

1. We would like to learn more about yourchild’s favorite activities and your fam-ily’s daily routines because these aretimes when children learn and parentsteach naturally such as playing peek-a-boo games or while driving to grandma’shouse. By sharing information about atypical day, you are identifying oppor-tunities when interactions that occurcould be used to support your child’slearning. Let us begin with you sharingthe times during the day when you andyour child are together. As the caregiveridentifies various activities or routines,the interventionist expands on the infor-mation by describing the skills the childcould be learning in each.

2. When a caregiver appears to be reluctantto respond to open-ended questions, of-fer friendly but more specific questionsthat focus the parent on child- or family-preferred activities, “I noticed you werein the yard with Kayla pulling the wagonwhen I drove up, does she enjoy wagonrides? What other play or outside activ-ities do you both enjoy?” After gettingsome additional routines and activitiesthat the child enjoys, the intervention-ist might share information about thevalue of building on the child’s intereststo enhance motivation and participation(Dunst, 2001).

3. Ask about specific routines that havea high probability of occurring suchas dressing, watching TV, car travel,preparing/eating meals, householdchores, bath, nap/bedtime stories, or“just hanging out” as a method forencouraging a more reserved caregiverto join into the process. Questions onthe ease or the difficulty of specificroutines will yield information bene-ficial to establishing initial priorities.Giving information about how teachingin the common chores of everyday life

increases the functionality and mean-ingfulness of the skills being practicedand builds the caregiver’s knowledge ofhow “intervention” occurs throughoutthe day without scheduling extra timeand using special materials.

Explaining why information is important re-duces the caregiver’s concern and sets thestage for his or her participation. It is notenough to ask the right questions; they mustbe asked in a manner that encourages, ratherthan discourages, the family. Equally impor-tant is the ecology of the response. Is the care-giver responding with child-focused informa-tion or does it include all the family members?Do the activities illustrate the roles of infor-mal supports and community? Does the re-sponse appear to be a daily schedule with asequence of activities accompanied by timesof the day (eg, We get up at 7:30 AM) or is itloosely defined to match the moment? It is im-portant for service providers to remind them-selves frequently that routines should not beequated with schedules. Routines occur for allchildren, but the schedule of when they oc-cur will vary greatly. Knowledge of this dif-ferentiation between routines and schedulesis instrumental for successfully gathering in-formation from caregivers without appearingjudgmental or biased. This can be even morevaluable when explained to the caregiver whodescribed a tightly scheduled day.

The child and family’s day extends be-yond the activities that occur at home(Bronfenbrenner, 1979). To gain a more com-plete picture of the family that will supportthe family’s participation in the broader com-munity, service providers could discuss:

1. activities or appointments (eg, doctor’sappointments, workout) that occur on aregular basis (eg, once a week, every fewdays);

2. regular evening activities (eg, Wednes-day night church, sibling involved in GirlScouts);

3. recreational, seasonal, or spontaneousevents (eg, sports, movies, camping);

4. family or friend socialization or celebra-tions (eg, family dinners, birthdays); and


Family-guided Approaches to Collaborative Early intervention Training and Services

Identifying Family Activities and RoutinesConversation Starters

Consider using some of these comments or questions to open a dialogue about the child’s and family’s

activities, environments, and routines.

∗ We’d like to learn about some of your child’s daily routines and activities for teaching and learning. By

sharing your daily activities and routines, you are identifying potential times and places for your child’s

intervention.∗ Tell me about your day. What are the routines/activities or places that you go that most often occur for

you and your child?∗ What types of things happen on most:

Mornings? Afternoons? Nights? Weekends?

∗ Life with children usually makes us be pretty flexible. Can you give me some ideas about what usually

happens before or after ? (Use some event the care provider mentions— “One Life to Live.”

Systematically identify events, and then proceed.)∗ If the careprovider is having difficulty identifying activities or routines, ask some specific questions

about some of the following: dressing, breakfast, watching TV, car travel, preparing meals, household

chores, nap, lunch and evening meals, yard work, bath, bedtime stories, or hanging out.

Possible follow-up questions to consider:∗ Are there any activities or places that you go (eg, shopping, doctor’s appointments) that occur on a less

than regular basis (eg, once a week, every few days)?∗ Are there other events that occur fairly regularly or during the weekend (eg, sport events for siblings)?∗ Who are the important people who participate in your child’s life? Who are helpful in your child’s care,

and who may also have activities and routines for teaching and learning (eg, grandparents, big brother,

neighbor, friend)?∗ What routines/activities does (child’s name) enjoy doing?

• What makes this routine(s) enjoyable to ?

• What does usually do during the routine/activity?

• What do you (or the other care providers) do during the routine/activity?

• How long does it take?∗ Are there opportunities for your child to interact with other children?

• How many other children participate in this routine/activity?∗ What routine/activity(s) does not like?

• What makes this routine/activity difficult or uncomfortable for ?

• What does usually do during the routine/activity?∗ What are your (family’s) expectations of the children during the routine/activity?

• What do you do during the routine/activity?

• How do you let the child know what is expected in this routine/activity?∗ Are there better times for you during the day or locations that are more comfortable for intervention

routines?

SUMMARY INFORMATION

Potential outcomes Care provider & child routines Good times & places

What to do Who Which Routine When Where

Figure 1. Conversation starters. FACETS is a joint project of Kansas University Affiliated Program and

Florida State University.


5. opportunities for the child to interactwith peers (eg, church nursery, child-care, library story hours, play groups).Explaining how other family, friends,and activities enhance the child’slearning logically follows identificationof routines and activities within thecommunity.

Questionnaires and checklists:

Making paper talk

Another familiar strategy is the use of aquestionnaire or a checklist that requests thefamily members to self-identify or describetheir child’s strengths, routines, activities,and settings. While certainly time- and cost-efficient, it can also be educational by offeringpossible categories of opportunities to fami-lies unfamiliar with the process. Ideas listedabout family recreation, household chores,children’s school activities, or errands serveas examples. These written documents maybe commercially available (eg, Ages and StagesQuestionnaire, parent-completed child moni-toring system; Bricker & Squires, 1999), de-veloped by the service provider (eg, Gettingto Know Your Child; Fig 2), or a compo-nent of the actual IFSP document (eg, spe-cific sections or pages to document fam-ily members’ information about their naturalenvironments).

There are certain advantages to this strat-egy. Documents are frequently completed inthe home or at the childcare center, the child’snatural environments, making the setting con-ducive to accurate and thoughtful responses.The written format allows multiple caregiversto provide input and identify routines and ac-tivities. Family members can reflect on theirresponses for a few days and not feel theneed for a quick response. The family mayalso choose to complete the form with a ser-vice provider, using the document as a guideto a conversation. There are also disadvan-tages to the use of questionnaires and check-lists. They can be ignored, lost, or completedwithout attention to detail. Paper-and-penciltasks may limit the depth or the breadth of thefamily response to the options or the spaceprovided on the form. They are not interac-

tive. Opportunities for follow-up or clarifica-tion may not be available or, at best, may bedelayed until the service provider reviews theinformation. It is often difficult to establishthe significance or the emotionality of the re-sponse from the written answer (Sexton, Sny-der, Rheams, Barron-Sharp, & Perez, 1991).Literacy levels must be considered. The ser-vice provider must carefully reflect on theappropriateness of paper-and-pencil tasks foreach family. For the family to “get”informationfrom the checklist, the interventionist shouldengage in a follow-up conversation with theparent that emphasizes the family members’role on the team as their child’s expert andhow the family information is used to supportthe other team members’ practice (Woods &McCormick, 2002).

Community mapping: Pictures tell

1000 words

Another format for gathering informationabout the child and the family, while shar-ing information about the purpose and pro-cess of EI, is a “mapping” strategy. Toolsdemonstrated in the work of Falvey, For-est, Pearpoint, and Rosenberg (1997) thatcan be used to help families identify theirdreams and goals for their child in a long-rangelife plan are useful for the development ofperspective and a plan for the immediateday-to-day program. An innovative use of thistechnique for EI is community mapping, aprocess in which a family identifies the nat-ural learning opportunities that are occurringand offers information about inclusion oppor-tunities available within their neighborhood(Dunst, Herter, Shields, & Bennis, 2001). Thisstrategy is very useful to introduce commu-nity activities or expand opportunities for thechild and the family to engage in meaning-ful teaching and learning opportunities. Thismapping provides concrete information anddisplay of the current environments and illus-trates possible options for the family. Givingfamilies ideas for community resources withintheir defined community builds their inde-pendence. The strategy is especially usefulwhen discussing potential locations/activitieswithin the community to provide additional


Figure 2. Getting to Know Your Child. Adapted from Noonan and McCormick (1993). Created

for TaCTICS (Therapists for Collaborative Team Members for Infant/Toddler Community Services) at

http://tactics.fsu.edu.

teaching and learning opportunities for iden-tified outcomes.

Problem-solving discussions: Working

together

While information important for the IFSPmay be readily provided through previouslyidentified strategies for most families, results

may be superficial or lacking with others.Problem-solving simulations or discussionsabout “What do you do when?”can be used toidentify intervention contexts and supports.The interventionist suggests a situation thatcould potentially occur for any family and asksthe caregiver to describe what he or she mightdo (eg, your child has a doctor’s appointment


and your car is broken down or Joey is crankyand none of the usual toys or activities seemto be working). Problems such as these canbe organized to identify informal or formalsupports such as neighbors, family members,or agencies the family accesses during spe-cific situations. Other situations might focuson more common day-to-day needs such as“What do you do when your baby won’t takehis bottle or has been crying or fussing forseveral hours?” Describing solutions to com-mon problems provides information aboutthe strategies the family uses, the resourcesand supports available, and other possiblepartners in the intervention process. Thisstrategy also provides an opportunity for thefamily members and the service providers toinitiate activities where joint problem solvingis a comfortable process for working together.

Seeking information on what is not happen-ing, where the family is not going, or how anactivity is not working is another opportunityfor problem solving with the family. The ini-tial discussion may be in response to a directquestion, “What routines or activities are dif-ficult for you and your family?”or a statementshared in frustration to a team member, “We’dgo to the park more often if the car ride wasn’tsuch a horror.”It may be an observation madeincidentally during a home visit such as whendad struggles mightily to keep his toddler outof the dog food while the dog eats. Whilewatching the interaction, the “light bulb”goesoff for the service provider that problem solv-ing some other environmental arrangementsfor the dog, its meals, and the toddler wouldbe useful. Joint problem solving requires theservice provider to listen to and observe thecaregivers as they discuss and demonstrateconcerns and problems they are having.Problem-solving simulations during the ini-tial contacts set the stage for the ongoinguse of the technique within the interventionprocess.

Environmental scans: Making the most

of life

Service providers are trained to be goodobservers of child behaviors. Observations

can enhance the identification of routinesand activities by observing the environmentwhere the child lives, learns, and plays. Ser-vice providers should look for familiar andpreferred materials, as well as some uncom-mon or novel things that are present. Noticingpotential activities and routines can becomesecond nature after some practice. If music isplaying, the interventionist could suggest it asan opportunity to the caregiver and problemsolve with him or her on how to incorporateintervention such as a singing or a dancingroutine between the child and the caregiver.Cardboard boxes in the kitchen may signifya new purchase for the family and result in acouple of great containers to use as pretendcars in the family room or the backyard. Scrap-booking materials on the dining room tablecould be the stimulus for the development of aphoto book specific to the child’s communica-tion targets, thereby resulting in the develop-ment of 2 new routines—scrapbooking withthe toddler and storytelling with the resultantscrapbook. Looking around the environmentshould not be mistaken for “being nosey.”Theability to see the possibilities for interventionwithin everyday activities and settings neces-sitates familiarity with the child and family op-portunities. Scans often identify new ideas todiscuss with the family for expanding oppor-tunities for teaching and learning.

Service providers can engage the caregiverin a scan of the child and family environment,looking for opportunities by discussing what“could be” and waiting for the family to de-cide what is preferred or is realistic. As theprovider is greeted upon arrival, a “greeting”routine could be illustrated. A mirror by thefront door could provide an opportunity fora game of peek-a-boo to extend the greeting.As the service provider and the caregiver de-termine what to do during a visit, discussioncan focus on different locations and activi-ties where the child could practice specificintervention outcomes. Furniture in the fam-ily room may be conducive to supported sit-ting because the corner of the couch is se-cure or the pillows from the chair providea soft cushion if tipping over occurs. The


family photos in the hallway could be a fre-quent opportunity for labeling familiar nameswithout the added step of finding the photobook in the toy box. The location and theheight of the garbage could make it a perfectdiscovery for practicing release of objects indefined spaces. Chasing the family cat couldbe a reason to crawl on hands and knees.Systematically scanning the environment withthe intention of maximizing opportunities forpractice that already exist for the child andthe family decreases the amount of disruptionto the family’s life, and, more importantly, al-lows the family members to see all the naturallearning opportunities that exist for them—without adding more to their lives. Promot-ing the caregivers’ active participation in thescanning process and problem solving withthem about possibilities for embedding inter-vention increases their competence at initiat-ing novel activities or adapting familiar ones.

The ability to gather information from par-ents and give it back within a context that il-lustrates recommended practices in EI neces-sitates a breadth of skills in communicatingand processing information with adults thatmany EI service providers have not had theopportunity to learn and refine. Furthermore,it may be perceived as inefficient because itrequires more time spent with parents dur-ing initial interactions. Intervention servicesare initiated when the paperwork is com-pleted rather than when the family membersfeel competent and confident in their partic-ipation. With practice, service providers canaccomplish both the paperwork and familyparticipation outcomes. Positive outcomes ofintervention will be related to the serviceprovider’s ability to simultaneously share in-formation with the family on why daily rou-tines and play are important for young chil-dren while gathering the required informationfor the development of the IFSP.

APPLICATION OF THE STRATEGIES

Development and refinement of the recip-rocal processes described in this article haveoccurred in multiple settings. The 5 strategies

are viewed as tools for the service providerto use separately or in combination, individ-ualized for each family, and are interwovenrather than linear. For example, in the South-east Kansas Regional Birth to Three Program,a welcome letter and the Getting to KnowYour Child questionnaire (Fig 2) were mailedto each family after the referral phone calland prior to the first home visit. At the firstmeeting, it was used to support conversa-tions about the child’s interests, activities, androutines, emphasizing the importance of theparent’s expertise and contributions. Specificquestions, such as those listed in the conversa-tion starters (Fig 1), were inserted to gain ad-ditional information or clarify content that theparent shared and that could be transferredto the intake and IFSP forms later. As in mostservice delivery programs, some families com-pleted the document prior to the visit and oth-ers did not. Either way, families and serviceproviders rated it as an effective tool for gath-ering and giving information in the program’sannual evaluation. Having the form and thedescription of how it would be used prior tothe initial visit, enhanced many families’ feel-ings of competence during the 3-year demon-stration project (Woods, 2008).

The use of problem-solving strategies dur-ing assessment and intervention was identi-fied in focus group interviews and individ-ual questionnaires as the families’ preferredmethods for learning about their child andhow they could be involved in the teachingand learning processes (Kashinath, Woods, &Goldstein, 2006; Woods, Kashinath, & Gold-stein, 2004). Using a team planning process,the unique learning styles of families were hy-pothesized and a sequence of assessment ac-tivities was developed with the families. Fam-ilies shared information about their child androutines using a questionnaire (Fig 2), as wellas conversations with the primary interven-tionist. Families actively participated in thecurriculum-based assessment by interactingwith their child in the routines they identifiedas interesting to the child and comfortable forthe parent (Woods & McCormick, 2002). Al-though the process was systematic, it was not


always accomplished in a sequence. Serviceproviders found that they used many of thestrategies, interchanged them as appropriatein the assessment phase, and continued touse them throughout intervention. This em-phasized the importance of flexible and em-powering communication strategies to gatherand give information to families as new prior-ities and interests developed, contrary to themore traditional step-by-step process utilizedin IFSP development.

Problem solving as a strategy for assess-ment and intervention was incorporated into2 studies and ranked highly by parents as ef-fective for learning new intervention strate-gies and increasing confidence in using mi-lieu teaching within daily routines (Kashinathet al., 2006; Woods et al., 2004). Problem solv-ing enhances reciprocity and shared perspec-

tives among participants in the gathering andgiving information processes, resulting in bet-ter understanding of the context, an impor-tant step in the development of a trustingcollaborative relationship and an effective in-tervention plan (Buysee & Wesley, 2004).

Service providers with multiple strategiesfor gathering and giving information with fam-ilies are better prepared to address the di-verse learning styles and interests of familiesand caregivers. Following a strict protocol ordocumentation process may result in comple-tion of the assessment process and compli-ance in specified timelines, but it may alsolimit the opportunities to gather important in-formation and offer informational supports tothe family. Efficiency without effectiveness isnot a benefit to the program, providers, familymembers, or the child.

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