engaging families in natural environments tactics therapists as collaborative team members for...
TRANSCRIPT
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