Early Intervention in Natural Environments

Early Intervention in Natural Environments

Wednesday, November 13, 2013

When Do You Demonstrate Something on a Home Visit?

It has always been my understanding that modeling for the parent is an appropriate first step, followed by giving the reins to the parent- am I missing something?
Modeling for the family is an appropriate SECOND step. First, we talk, then we offer to demonstrate. If, instead of modeling, we can talk the parent through the intervention, that's even better. But sometimes demonstration is called for.

One of parents' biggest complaints across the board continues to be too much “talk” and not enough modeling.

When parents say there's too much talk and not enough action, this could be because they expect us to have our hands on the child (i.e., they have wrong expectations about what home visiting should be--not their fault) or because indeed the home visitor is too passive and doesn't get down to brass tacks. Many home visitors implementing the RBEI (or "Unified") model let the pendulum swing too far to the consultative end, because their natural tendency is to be the expert. If the pendulum has swung to an extreme, they simply are not being helpful enough. There are, in this world, some home visitors who simply can't, along with the parents, come up with some strategies for addressing a problem. Either they were so used to doing dumb activities (e.g., from the toy bag, from some curriculum) that, without that crutch, they don't know what to do or they just don't have ideas.

Most parents seem to learn best from a visual demonstration by the service provider, followed by the coaching piece as the parent works with his/ her child.

Most parents have probably not received top-notch family consultation, which would be the home visitor's talking the family through the intervention, with the family doing the intervention. It's like my fly-fishing guide. He did indeed show me how to cast, on land, with no fly on the end of the line, so I'd see the correct movement. But very quickly he put the rod in my hand and gave me feedback on my attempts. Once we were in the water, he NEVER cast the line, because he was afraid of catching a fish. If he'd caught a fish, he believed he would have made me feel bad. Not true, but that's the way fishing guides in New Zealand are conditioned. You can see the parallel with home visitors: We don't want kids doing well with us. So the majority of the support is giving feedback and telling the learner how to make corrections.

I'd put outright demonstration as something we resort to, not something we begin with. Also, don't assume that what families tell you is the best way to go. Under the principle of the uninformed consumer (from marketing), if a person hasn't tried X but has tried Y, she will say Y is better. Hence, we need to make sure families experience good family consultation.

Practice Requirements

A requirement for fulfilling this contract is that practitioners will follow evidence-based family-centered practices, as outlined in the Agreed-Upon Mission and Key Principles for Providing Early Intervention Services in Natural Environments (Workgroup…; and as described by the practitioners’ professional organizations for pediatric practices for this age group. These practices are described here in terms of location, approach, teamwork, and compliance with the law.

Location

1.Under this contract, practitioners will provide services in the natural environments, which are described in the law and regulations as the places where the child would be if he or she did not have a disability. These places are most commonly the family’s home or the child’s child care program.

Approach

Consultation With/Coaching Caregivers

2.Practitioners will focus their work on using a consultative approach, also known as coaching, with the child’s caregivers to enhance those caregivers’ ability to provide interventions to the child between therapy sessions. This focus means practitioners

2.1.Spend the whole session communicating with caregivers;

2.2.Use collaborative not expert approaches in finding solutions (i.e., deciding on interventions); and

2.3.Demonstrate strategies as necessary.

Focus on Functioning in Routines

3.Practitioners will address outcomes on the individualized family service plan (IFSP), which will have target skills aimed at promoting functioning in routines. This means practitioners will promote

3.1.Child engagement, including meaningful participation, in home, school, and community activities;

3.2.Child independence, at the level the family wants, in routines; and

3.3.Child social relationships, including communication and social-emotional skills, in routines.

Teamwork

4.Practitioners will support the primary service provider (PSP) by

4.1.Making joint home visits with the PSP (if the practitioner does not practice in natural environments—seeLocationabove, welcoming the PSP on a visit to the clinic with the family);

4.2.Expressing to the family confidence in the PSP’s ability to support them in carrying out the practitioner’s suggestions; and

4.3.Providing information to the PSP.

Compliance With IDEA

5.Practitioners will adhere to Part C of the Individuals with Disabilities Education Improvement Act, because this is the law under which early intervention services are funded. Even if a third party is paying for the practitioner’s service, if the practitioner is serving the child as part of early intervention (i.e., because the agency or practitioner is listed as a Part C service on the individual child’s IFSP), legally they must follow IDEA. The law stipulates that

5.1.The IFSP team (not a doctor or another individual person) decides on what services are to be provided and at what frequency and intensity (i.e., prescriptions or practitioners’ recommendations on these matters do not dictate services);

5.2.Services are provided to meet the needs identified in the IFSP outcomes (i.e., not based only on diagnosis or evaluation results for eligibility); and

5.3.Changes in services, frequency, or intensity must be coordinated with the service coordinator and decided upon by the IFSP team (i.e., individual practitioners should not tell families how often they should see the child; they should discuss a potential change with the service coordinator first).

Failure to follow any one of these five practice guidelines can result in immediate termination of the contract. Practitioners can obtain more information from the contracting agency about this current approach to early intervention service delivery.

Posted byRobin McWilliamat7:16 PM1 comment: