Routines-Based InterviewRobin McWilliam

Siskin Children’s Institute Inservice Workshop May 2010

RBI Certification Institute July 2010

Need for Routines-Based Assessment The assessment legislation and our field amazingly forgot:

needs! Functional outcomes/goals (target behaviors)

Address participation (engagement) needs Address independence needs Address social relationships needs

Family priorities reflected in the IFSP/IEP Outcomes/goals meaningful to the child’s caregivers To capitalize on learning opportunities, without embedding

nonfunctional outcomes/outcomes

What is the RBI Semi-structured interview Asking about child and family functioning

during everyday routines (home, classroom) Purposes

To establish positive relationship with family To get rich and thick description of child and

family functioning To produce a functional, family-centered set of

outcomes/goals

At Siskin Children’s Institute, Who Could Conduct the RBI? ELC administrative staff? Teachers? Beth?

Why Teaching Staff Need This Information They might be interviewers They will be interviewed They will receive IFSPs, IEPs derived from

the RBI They need to explain it and talk it up to

families

The RBI and Outcome Functionality The RBI does lead to more functional

outcomes, meaning They specify what the child or family will do The contextual need has been identified (i.e.,

what makes it functional) It’s important to the primary caregivers

RBI What is your experience with the RBI?

Each person Observed a trainer do one live? Seen a video? Conducted one?

What’s My Experience? RBIs have been used

for > 20 years In countless

states, districts, and programs, across the

U.S., they are Mandated, Recommended, or Encouraged

Most interviewers wouldn’t dream of doing IFSPs without an RBI

Training is very helpful/necessary

Tools are necessary at the beginning

Families love them

A Bad Interview …is possible …happens as a result of incorrect

implementation It’s almost impossible to have a correctly

implemented interview result in a bad interview Definition of bad interview

Family unhappy with process < 6 goals Interview lasted < 1hour

Review of RBI Steps Key components

“What are your main concerns?” Home routines

“How does your day start?” 6 pieces of information per routine (everyone, child—engagement,

social relationships, independence, rating of satisfaction) Classroom routines

5 pieces of information + goodness of fit rating 2 pivotal questions (lie away at night; if you could change anything) Recap of concerns Goal decisions Priority Order

RBI Checklist

Including Classroom Routines in the RBI

When Ideally, parent and teacher are together If not, teacher first, if possible Many options exist for adding classroom

routines Most involve adding outcomes to the IFSP

Interview Together Parent first, all the way through home

routines Teacher next Recap home and school routines Parent chooses outcomes pertaining to either

setting

Options Ask the worry and change question at the end

of home routines or after school routines Ask about home routines until “school” time,

then ask about classroom routines, followed by home afternoon and evening routines Don’t forget to ask about what other family

members do during the child’s school time

What “Teachers” Get Interviewed Those who have enough contact with a child

to have a meaningful impact on his or her learning I use a criterion of 15 hours a week

Can be any classroom caregiver who knows the child’s functioning in daily classroom routines (i.e., generally, not a therapist or itinerant teacher)

During Each Classroom Routine Same 6 questions (with a twist on the 6th one)

What does everyone else do? What does this child do?

Engagement? Independence? Social relationships?

How well does this time of day work for the child (1-5)?

Concluding the RBI

Outline The two summary questions The recap Choosing outcomes Priority order Next steps

The Two Summary Questions The worry question The change question

Getting There “Now that we’ve gone through the day, I’m

going to ask you two more questions before I summarize what I heard you say.”

The Worry Question “When you lie awake at night, worrying, what is it you worry

about?” Main purpose: To show the family you care enough to ask

For some professionals, this is too sentimental a reason Tough. It’s now part of the RBI It can produce a new concern that gets chosen as a high-priority

outcome It helps identify important concerns that don’t come up in

discussion of routines Acknowledge feelings, first, as always Just enough discussion to ensure you understand (active

listening); you are trying to conclude the interview

The Change Question “If there’s anything you could change in your life, what

would it be?” With both questions, ask exactly this way; these are standard

questions Main purpose: Gives the parent an opportunity to think about

an overall goal for his or her life—to think beyond “one day at a time”

Variation on the miracle question used in psychotherapy Acknowledge feelings, first, as always Just enough discussion to ensure you understand (active

listening); you are trying to conclude the interview

The Recap “I’m going to go through my notes and remind you of the main points

you made. Starting with waking up. You said this was a great time for you, but you would like Colin to snuggle with you when you pick him up and he always plays with the same thing, if he gets up before you wake him up.”

Should be done by whomever took notes Position yourself so the parent can see your notes as you’re going through

them Make extremely brief comment about overall routine and mention starred

items (concerns) Only check in with the parent for confirmation, if you really are unsure.

This is not interaction time. But do respond to parent’s interruptions Minimal conversation; you are not going to rehash issues

Concerns Are Not Outcomes No one at any time should make a list of concerns Recapping is just going over notes A list of concerns will get treated by someone as a

list of outcomes The family was not picking outcomes when they

discussed their concerns In RBI-speak, understand the difference between

concerns (starred items on notes) and outcomes (deliberately chosen goals to go on the IFSP)

Choosing Outcomes “That was the reminder of what you talked about. Now, what would you

like the team to work on with you. Include things for anyone in the family, including yourself.”

Have a blank sheet of paper Let the parents come up with as many outcomes as they can Write down the routines in which the concern presented itself When the parents seem not to be able to think of any more, show them

the notes with stars Ask about specific concerns that seemed important during the discussion Focus on stars, not ratings Do not stop prompting until at least 6 outcomes have been chosen. Try

not to exceed 12.

Priority Order “Now, can you please put these into order of

importance. It’s not true, but if we could only work on one of these outcomes, which would it be? Next? Next?”

Show the parents the list while they’re doing this

Ensure there’s a number next to each outcome

Next Steps “Excellent. This is a great list of things for us

to work on. If we can do these, it will be really good for [your child] and the whole family.”

Explain how the next two steps will be completed Outcomes need to be written in IFSP format Services and settings need to be decided

Effects of Conducting RBIs Meatier intervention program (goals) More function- and participation-based child-

level goals Fewer irrelevant, “clinical,” or vague goals

More family goals A point of discomfiture for traditional early

intervention “teachers” and therapists Supported by theory, legislative history, expert

knowledge, and research

“What if a parent wants something like more time to herself, and we don’t have the resources to meet that need? Am I expected to go babysit her kids?”

Interventionists’ Concerns

What if a professional has detected a delay or other problem? Ask yourself if it’s a FUNCTIONAL concern? Ask deficit-related questions during RBI? Fit intervention into existing outcome

Might not be able to justify a specialized service!

Obligation to give families information But make sure it is evidence based

Who’s There?

Family decides who from the family they want Child does not have to be there Minimize interruptions

Ideal to have 2 professionals 1 is manageable

Roles of 2nd Person

Help with questions Do not simply observe the first interviewer

floundering! Take notes

Brief notes, capturing main points Handle interruptions Score developmental test?

RBI Any additional thoughts about how an RBI differs

from traditional assessment? How can you use RBI information?

Concerns, priorities, and resources Connecting with other developmental assessment

information (TEIDS-Plus RBI Summary Form) Goals Action steps

Strengths and needs

Biggest Mistakes in Interviewing

Ask-listen-write, ask-listen-write…. Giving too much information during recap Confusing recapped concerns with selected

outcomes

7 Steps of Functional Goal Writing

1. Read the short-hand version of the goal from the RBI.2. Identify routines affected by the goal.3. Write “Child (or family member) will participate in [the

routine(s) in question]”4. Write “by _____ing,” addressing the specific behaviors5. Add a criterion for demonstrating the child or family

member has acquired the skill6. Add another criterion for generalization, maintenance, or

fluency, if appropriate (e.g., during school and home meals).7. Write the timeframe in which the criterion will be displayed

or achieved (e.g., for one week; by June).

Example Goal: Can you identify all the components?

Hector will participate in play dates by using the same toys as another child and talking with the child about their play. He will play for 10 minutes during two play dates per week for 3 consecutive weeks.

Hector will participate in play dates by using the same toys as another child and talking during that play. We will know he can do this when he plays with similar toys, near another child, using at least three words (can be the same word or different words) for 10 minutes during two play dates per week [kids have this many?!] for 3 consecutive weeks.

Family-Level Outcomes

Preserve as much of the wording as is appropriate

Add at least 1 measurable criterion

In school and finish and decide what to do

Dulcie will stay in school for 1 year

Brande’s Outcomes

1. Brande feel OK about Brandon’s lung development and his O2 status

2. Brandon gain weight steadily to 5th %ile3. Communicate mama, dada, more, done4. Move independently, shifting weight5. Fingerfeeding6. Be more vocal7. Throw things8. Swallow liquid from cup9. Clap by himself10. Megan and Hayley get along11. Hayley not scream at dinner prep time

Ana’s and Andrew’s Outcomes

1. Jenevae will move independently (like crawling)2. Time for Ana and Andrew3. Learn to play with more complicated toys4. Hobby for Andrew (not video, not car)5. Andrew to college6. Info re: financial help7. Say words8. Pulling to stand9. Come to sitting10. Lower Ana’s stress11. Time for Ana for herself (trustworthy child care)12. Info on child care

Jackie’s Goals1. Engagement with other children (join other kids)2. Engagement with adults (home, school)3. Initiate with people about what he wants4. Play with toys without “stimming”5. Have “conversations”6. Imitate others7. Eat more foods (less picky, more nutritious)8. Play on outside equipment (hang, climb ladder)9. Jackie will have information about Owen’s

developmental progress and engagement at school