1. Introduction to the Routines-Based Interview Method
Kellie Horn
Chris Miller
Introductions-roles, responsibilities, interest
Why we are here-background…

2. We agree that…
__________, with the necessary supports and resources, can enhance their children’s learning and development.
Early intervention service providers
A few families
All families
None of the above-It is not possible to provide enough support and resources for families to enhance their children’s learning and development.
Make sure we are all on the same page before we look at the agenda…..
The reason we are talking about routines is…… It is all about the family!

3. Agenda RBI in Real Life The purposes of the RBI Completing an RBI
RBI in the IFSP Process
Implementing the RBI

4. The RBI in Real Time

5. Observing the Demonstration
Look for:
Good, juicy questions
Missed Questions
Nonverbal Behaviors
Important Assessment Information
Likely Outcomes

6. “Routines are naturally occurring activities happening with some regularity. “ (R.A. McWilliam, 2009)
Watch video – what kind of information is Robin gathering?
What are the main concerns?
2. Go through the day & get information from each routine (“time of day”)
What everyone is doing at that time
What the child does (development & functioning)
Engagement
What is the child doing? How does the child participate?
Independence
What does the child do by himself? What does he need help with? How does the child ask for help? Respond when help is given?
Social relationships
How does the child communicate? Respond to communication from others? How does she express herself? How does the child get along with others during this routine? Cooperative? Initiate interactions with others?
Satisfaction with routine
priorities, concerns, potential outcomes
Star concerns-potential outcomes
4. Satisfaction ratings-potential outcomes
5. Worry & change questions-potential outcomes
When you lie awake at night, worrying, what is it you worry about?
If there’s anything you could change in your life, what would it be?
6. Family chooses outcomes (“what would you like to work on?”)
7. Priority order – potential outcomes

7. 3 Main Purposes of the RBI
Develop a list of functional IFSP outcomes
Assess child and family functioning
Establish a positive relationship with the family
RBI article

8. 6 Steps for Completing an Interview
Step #1: Introductions and main concerns
Explain the purpose and process
Clarify who lives in the home and other resources that may be relevant throughout the interview
ecomap
*Ask about main concerns for the child and family

9. 6 Steps for Completing an Interview
Step #2: Gather information from the family using the family’s routines as the agenda, take notes & star concerns
Six Items:
1. What everyone does at this time
Provides information about the task demands of the routine for everyone
2. What the child does
Assesses the interaction of the child’s interests or abilities with the demands of the routine
3. What the child’s engagement is like
The extent to which and quality with which the child participates in the routine
Notes pages

10. 6 Steps for Completing an Interview
Step #2: Gather information from the family using the family’s routines as the agenda, take notes & star concerns (continued)
Six Items (cont.):
4. What the child’s independence is like
Extent to which the child can perform the demands of the routine by himself or herself
5. What the child’s social relationships are like
Information about how the child communicates and gets along with others
6. How satisfied the family is with this routine
MEISR
SAFER

11. 6 Steps for Completing an Interview
Step #3: Ask families about their satisfaction with each routine
Helps them solidify how much they really want to change it
Provides some insight into the family’s quality of life
On a scale of 1 to 5, how well is this time of day working for you?
SAFER

12. 6 Steps for Completing an Interview
Step #4: Worry & change questions
When you lie awake at night, worrying, what is it you worry about?
If there’s anything you could change in your life, what would it be?
Step #5: Identify concerns and priorities
Parent selects outcomes and prioritizes
Step #6: Write outcomes
Informal outcome statements into formal ones using 7-step process

14. Quality Indicators of an Interview
Active listening
Repeats what the parent says vs. simply saying, “Okay”
In-depth follow-up questions
Helps the parent paint a picture of the routine and child’s functioning within routine
Continuing conversation
Not ask, listen, write, ask, listen, write

15. Quality Indicators of an Interview
Proactive questioning about child development
What the child is likely to do next
“Smart questions”
Reveal understanding about family functioning
Nonverbal messages
Convey acceptance and interest (e.g., smiling and nodding)
Social milieu of routines
Context of the child’s engagement

16. Quality Indicators of an Interview
Seeking evaluative and interpretive opinions
Ascertaining the family’s opinion about the child’s and family’s functioning
Managing the conversation
Control pace, deal with distractions, etc.
Empathizing
Convey understanding and emotional connection with both hardships and successes

17. Practice, Get a Feel for the RBI
Divide into groups of 2 to 3 people
Decide who will be the parent, who will be the interviewer(s), and the note taker
Mothers read vignette
Interviewers use the RBI protocol and note taking form to go through the interview
Debrief
Tell mothers not to exaggerate, to stay in character, to make up details!
Trainers wander, interrupting seldom.
Ask more details about child and family functioning in routines
Don’t fall into ask, listen, write…
After minutes-
Recap starred items and select outcomes

18. The IFSP Process happens in the “Context of the Family’s Everyday Life”
Identify priorities & concerns and resources within the context of the family’s daily life
Assess the child’s functioning (and development) in the context of the family’s daily life
Identify opportunities to help the family help their child make progress toward IFSP outcomes in context of the family’s daily life
Develop IFSP outcomes that can be addressed in the context of the family’s daily life
Plan strategies and activities that address outcomes with families and other caregivers in the context of the family’s daily life

19. Types of Information
Family concerns & priorities (IFSP Child Outcomes)
What is challenging right now?
What should the team address first?
Family resources & strengths (IFSP Child Outcomes)
What the family has to meet their child’s needs
Child/Family routines & activities (IFSP Child Outcomes & SFP)
Events and activities that occur with some regularity in the family’s everyday life
Child’s level of functional performance in the context of the family’s everyday life (IFSP Child Outcomes & SFP)
How the child uses developmental skills to function in the context of the family’s every day routines and activities
Child’s present levels of development and skills (IFSP Child Outcomes & SFP)
What the team knows about the child’s various abilities, strengths and needs

20. Questions to Consider
How do you gather information needed for the IFSP Process?
Family/Child Routines & Activities
Concerns & Priorities
Resources & Strengths
Child’s development and functioning in the 3 global child outcome areas

21. The Process Begins…
Susie, the Amazing FRC visits Jack’s house for the first time and…
explains the ESIT program to the family
shares brochures (A Family’s Guide to Early Intervention in Washington State, Family Outcomes brochure and ESIT Guiding Concepts, and DMS Family Brochure)
explains and provides parent rights and procedural safeguards, discusses reasons for referral
determines if the family wishes to participate in the Part C program
Challenges…Too much too soon, 45-day timeline, it is a complex process!

22. The Process Continues…
determines if the screening is needed to decide if an evaluation/assessment is appropriate
If screening is necessary:
provides Notice and Consent for screening to parents
explains parent rights
conducts screening
If it is determined that an evaluation is needed
provides Notice and Consent for Initial Evaluation,
obtains written parental consent to obtain information from other agencies and release ESIT information, explains how the information will be shared with other team members

23. 45, 44, 43, 42…

24. A Complex Process
Gathering information-What are ways we use (can use) to gather the types of information we need?
Activity – Big Post it for each group
SYNTHESIZE

25. *This information is used by the team to choose a COS rating in the DMS.

26. Gathering Information from Families is an Adaptive Process!
Team members need to know their role and responsibilities as a member of the team
Team members must have shared understanding of what is being assessed (i.e. define “routines & activities”)
Team members must have consensus on the process for each member to gather information about the family’s routines, priorities, concerns, resources, and child’s development and functioning in his everyday life
Who will gather what type of information and how? (Everyone on the team will gather information in all areas, but some team members will likely focus on one component of the assessment (e.g., FRC-Routines-based questions, Practitioner-developmental areas)
How will the information be tracked and synthesized?
Always having to adapt-every LLA is different, every family is different, every team is different, resources are different, etc.
Idea- everyone on the team gets the same form-very basic and simple!

30. What are the strengths/resources in this family?
Example-Othello RBI
Asking “strengths-based” questions.
Not-Who is the child’s father? Ask-Who lives in the home?
Not-How do you get along with her? Ask- How often do you talk to her? --

31. FORMAL vs. INFORMAL Formal supports = 1 hour of a family’s daily life
Intermediate supports = planned or organized
Informal supports = a constant

32. Using Information about Resources in the IFSP Process
Establish a family-centered process/relationship (not child- centered)
Family’s early experiences in early intervention are often related to the child, such as evaluation and development of the IFSP outcomes
Build the foundation for the IFSP process with existing supports (not services)
Develop an effective overall plan based on strengths that the family has for supporting their child’s development.
Resources are not routines, don’t ask about routines when gathering information about resources.

33. Child/Family Information & Medical Info.
“How is Hope’s health?”
“Please tell me everything about Hope’s…birth history, medical conditions or diagnoses, illnesses, hospitalizations, vision and hearing screening and other developmental evaluations (right now)?”
“Has Hope had previous developmental evaluations/assessments, early intervention and/or therapy services?”
“Can I have all of the records (right now)?”
“So…who lives in your home?”
Too personal too quick!!!

34. One Method… The Ecomap
A graphic representation of the family supports (people and agencies) and the links to those supports

37. Scale for Assessment of Family Enjoyment within Routines (SAFER)
Waking up
1. Could you describe what wake up time is like?
2. Who usually wakes up first?
3. Where does your child sleep?
4. How does your child let you know she is awake?
5. Does she want to be picked up right away? If so, is she happy when picked up?
6. Or is she content by herself for a few minutes? What does she do?
7. What is the rest of the family doing at this time?
8. Is this a good time of day? If not, what would you like to be different?
How Satisfied (1-5)? _____

39. Discussion
How do you get information from families about their concerns, priorities, resources and routines?

40. Child Assessment

43. Measure of Engagement, Independence, and Social Relationships (MEISR) a Functional domain: E = engagement, I = independence, S = social relationships b Developmental domain: A = adaptive, CG = cognitive, CM = communication, M = motor, S = social c Outcomes: S = positive social relations, K = acquiring and using knowledge and skills, A = taking action to meet needs
SAFER
SHORE

44. Discussion
How do you get information from families about their child’s development, participation, and functioning in the 3 global child outcome areas?

45. IFSP Outcomes

46. In a RBI model IFSP outcomes are:
Derived from functional routines-based needs
Measurable
Logical criteria
Frequency displayed in 1 week
Behaviors MUST be necessary, meaning without it the child would not be able to function in everyday routines

47. Criteria for Functional Outcomes
Reflect the priorities of the family
Useful and meaningful
Reflect real-life situations
Free of jargon
Measurable
Keep IFSP outcome functional
Engagement, independence, and social relationships!

48. Tips for Writing Functional Outcomes
Write outcomes that can be addressed by multiple people, at multiple times of the day, during normal routines and activities
“Auguste will participate in outside play by stepping up and down on to and off different surfaces”
NOT “Auguste will step up and down on the stair equipment in the PT Center”

49. Tips for Writing Functional Outcomes
Ask yourself, “Why is the child working on this goal?”
Auguste is working on this goal so he can participate in outside play.
Be clear!
NOT “Auguste will maintain a four-point position for 30 seconds five times a day”

50. Why Write Participation-Based Outcomes?
Ensures that the context in which the skill is needed comes first, so everyone working on the outcome understands that the desired behavior (i.e., the target skill) is not meaningful in and of itself but how it helps the child participant in homes, school, and community (Wilson, Mott, & Batman, 2004).
Prompts adults to work on the skill at the times of the day when the skill is needed.

51. Participation-Based Outcomes Step 1
Assess functionality.
Begin with functional assessment!
What does the child need to be engaged, independent, and social in everyday activities?

52. Participation-Based Outcomes Step 2
2. Identify the informal statements that represent the family’s choice of what to work on. (child-level outcomes in italics)
More time as a family
Boys in own bedrooms
More help for Helen (mother)
Lance eating independently
Lance saying words (meals, playtime, hanging out)
Lance drinking from a cup

53. Participation-Based Outcomes Steps 3 & 4
Decide which routines are involved
4. Write “[The child] will participate in [those routines].
Lance will participate in breakfast, lunch, and dinner.
Lance will participate in meals, playtime, and hanging out time.

54. Participation-Based Outcomes Step 5
5. Write “…by ________ ing” inserting the desired behavior.
…by feeding himself independently.
…by saying words.
…by drinking from a cup independently.

55. Participation-Based Outcomes Step 6
Write “We will know he can do this when he or she______” and add a measurable criterion.
The criterion helps to determine the purpose of the goal. Goals have 4 main purposes:
To acquire a skill
To generalize a skill
To maintain a skill
To execute fluently.

56. Participation-Based Outcomes Step 6 (cont.)
We will know he can do this when use uses his hands, with or without a spoon, to put 10 bites into his mouth.
We will know he can do this when he says three different words
We will know he can do this when he drinks a whole cupful, holding the sippy cup independently.

57. Participation-Based Outcomes Step 7
Add a generalization criterion
Ask yourself, “If she did it only one time, would that be okay?”
If not, ask yourself, “How often, in how many routines, with how many people, or in how many places would she have to do this to convince me that the shad the skill?”
…at breakfast, lunch, and dinner…
…during each of the four times of day…
-all 3 meals, not or; therefore, we mean a total of 30 bites a day (10 at each)
-he can use the same three words at each routine, but he can’t use just 2 words in a routine, however many times he repeats them, for this criterion to be met
-saa

58. Participation-Based Outcomes Step 8
Add the criterion specifying the amount of time over which the behavior needs to be displayed.
…in 1 week
…in 2 weeks

59. Final IFSP Child Outcome
Lance will participate in breakfast, lunch, and dinner by feeding himself independently. We will know he can do this when he uses his hands with or without a spoon, to put 10 bites into his mouth at breakfast, lunch, and dinner in 1 week.
Lance will participate in meals, playtime, and hanging out by saying words. We will know he can do this when he says three different words during each of the four times of day in 2 weeks.
Lance will participate in breakfast, lunch, and dinner by drinking from a cup independently. We will know he can do this when he drinks a whole cupful, holding the sippy cup independently at breakfast, lunch, and dinner in 1 week.

62. Goal Functionality Scale III
Designed to rate seven dimensions on each IFSP Child Outcome:
Participation
Specificity
Necessity
Acquisition criterion
Generalization criterion
Meaningfulness
Time frame criterion

64. Functional IFSP Child Outcome?
What would your family like to see happen for your child/family?
Alex will eat a meal while sitting at the table at a restaurant.
How will we know we’ve made progress or if revisions are needed to outcomes or services?
Alex doesn’t go under the table at the restaurant as soon as the family sits back down from getting food.
Alex starts eating within 5 minutes of when the family returns to the table from the buffet.
Alex eats his meal when there are mild distractions nearby such as sounds or bright lights.
Help the team with the IFSP outcome – using 7 steps and assessment information. FIX IT!
Then let them practice using an outcome from their vignette.

66. Fitting the RBI into your work with children and families
What are your initial thoughts about implementing the RBI?
How would the RBI fit with other methods you currently use to gather information from families?
At what point in the IFSP process would you consider doing the RBI?
How would the RBI fit in your EI program procedures (e.g., intake and referral)?
# 1 Challenge to implementing the RBI
Possible solutions…

67. Thank you!