1. March 24, 2011 Council Bluffs, Iowa
High Quality, Team-based Early Intervention Services for Infants and Toddlers
March 24, 2011
Council Bluffs, Iowa
Lynda Cook Pletcher

2. We are here today and over the next few months as early intervention teams to…..

3. In our time together today and the next few months we will explore:
Current trends and approaches in use for providing EI services around the country
Common underlying themes to these approaches
Some of the agreed upon practices (implementation) of these approaches
The roles and functions of a team during the Early intervention process
Practices of functional assessment
Writing functional outcomes
Team responsibilities providing on on-going services

4. QT Quality teams have: Common purpose Agreed upon values and beliefs
Share common information
Share common tasks
Understand each others role and functions
Frequent and clear communication
Value and respect each member
Willingness to help one another
Share and support each others learning and growth
Focus on personal and team growth QT

5. Children AND families are the focus of Early Intervention services
“Services that are designed to meet the developmental needs of each child eligible…. AND THE NEEDS OF THE FAMILY related to enhancing the child’s development (a) (1)
The team’s broad purpose:
to work with children and their families.

6. Early Intervention Services are:
Designed to meet the developmental needs of each eligible child
Designed to meet the needs of the family related to enhancing the child’s development
Are selected in collaboration with parents
Are provided under public supervision by qualified personnel
In conformity with the individual family service plan
Meet the standards of the state and federal regulations
To the maximum extent appropriate to the needs of the child, are provided in “natural environments” including the home and community settings in which child without disabilities participate
At no cost unless federal or state law provides for a system of payments by families including sliding fees
(sec )

7. General role of All service providers
Consulting with parents, other service providers and representatives of community agencies
Training parents and others regarding the provision of early intervention services
Participating in the multidisciplinary team assessment of the child and family and in the development of integrated goals and outcomes for the IFSP QT
Common
Functions

8. Scenario 1 and 2 activity-
How are the two “visits” different? What are the things in each you “like” or dislike”? Which scenario seems more “like” us currently?

9. The statues and regulations tell us some information about
What services are provided under the law
General purpose of early intervention
Who can provide the services
States responsibility of oversight and monitoring
How services are paid for
States can then choose their service delivery approach: the program design to support their services and the actual how and what those services look like in practice.

10. Changing landscape out there
What was described in the late 1980’s and ’90’s in each state’s original grant application, which defined their system and the services, has evolved and changed over the years.
Life has changed greatly in the same time period!
Federal & State surplus to state deficits
Infant health survival rates
Paper and pencil records to advanced technology
Changing insurance coverage
New research and better practices… just to name a few…..

11. Its not that providers aren’t doing a good job with
children and families…
Its more that we are impacted by the constantly changing tides.

12. Help with staff shortages More effective services Cost less?
Some reasons states have given for now looking at changing or refining their service delivery approach according to their APR’s
Help with staff shortages
More effective services
Cost less?
More efficient processes
Research has caught up with practices
It’s the “right” thing to do
Matches our purpose and mission of Early intervention in a better way……..
WHAT are your reasons?

13. The service delivery approach impacts:
State (regional) structures necessary to support the approach
The way the EI services are organized at the program or regional level
Teaming practices and team composition
What “it” looks and feels like/ doesn’t look like, to families (and to the providers)
Providers knowledge or training
Beliefs, values and demonstrated competencies

14. Names states identified as endorsing or using within their state (in 2010):
Transdisciplinary team-primary service provider (8)
Primary Service Provider (PSP) (7)
Coaching-Primary service provider (5)
RBI-with primary service provider (2)
Family Centered services (3)
Family centered/ Transdisciplinary teams (1)
Team based service delivery (1)
ERRAPP or ERAP (3)
Direct Therapy/consultation (1)
Consultative Team model (1)
Independent provider model with a vendor system (1)
Individualization of services (1)
Multidisciplinary team (1)

15. More information about states
5 states reported using a combination of approaches
4 states reported a named approach in use now, but said they are moving towards a primary service provider model and 1 other said primary service provider/ coaching model
23 states did not name a specific approach but many used words in their training or vision that are included in the various approaches (RBI, functional outcomes, consultation, teaming, coaching, natural learning environments.
Other terms mentioned were ECO mapping, relationship based activities, TACTICS and FACETS and floor time

16. Are we all speaking the same language???QT
Common language

17. Adoption or Adaption HUGE variation in the words states choose
States at various stages of exploring to implementing
Only a few states have tried to go “statewide”
States are doing multiple approaches
A few states have tied themselves to a one particular “developer” who does the training and support during implementation of pilot sites.
Some states are using the developer’s materials and doing their own thing- providing their own training and adapting various pieces with their own state name
Other states are using the “agreed upon principles and practices” and focusing on the commonalities.
States are working through issues first that appear to be in the way of adoption of an approach

18. “Unpack” some of the most frequently mentioned approaches or terms
Primary Coach Approach to Teaming (PSP with coaching
FACINATE
TaCITS, FACETS & FGRBI
Everyday Routines and Activities, CMP
Agreed upon Principles and Practices

19. People associated with the most frequently mentioned approaches
Family Centered Practices- Dunst,Trivette and Deal
Using Everyday Routines and Activities-Carl Dunst/ Mary Beth Bruder
Primary Coach Approach to teaming, PSP with Coaching- Rush, Shelden and Hanft
Routine Based Early Intervention and Family Centered Intervention in Natural Environments (FACINATE)-Robin McWilliam
Therapists as Collaborative Team Members and Family Guided Routine Based Interventions- Julianne Woods- (FACETS/TaCTICS and FGRIB))
CoP work approach neutral, Principles and Practices (Pletcher, Hurth, Lucas, Younggren et all)
Other names sharing information; Naomi Younggren, Bonnie Keilty, Pip Campbell, Lee Anne Jung QT
Common Information

20. Primary Coach Approach to Teaming , PSP with Coaching Dathan Rush, M’Lisa Shelden and Barbara Hanft
Geographically located team
One person primary coach to family
Receives support (coaching) from other team members
Provides direct support to parents/ other caregivers using coaching techniques
Natural learning environment practices
Strengthens parents competence and confidence while promoting children’s learning and development
Use of developmental enhancing strategies used throughout the families daily activities
Respecting parents and other care provider as adult learners

21. For more information http://www.coachinginearlychildhood.org/index.php
Hanft, B.E. &Rush, D.D.& Shelden, M.L. (2004) Coaching families and colleagues in early childhood. Baltimore:Brookes
Shelden, M.L.& Rush, D.D. (2010) “A primary coach approach to teaming and supporting families in early childhood intervention. In; Working with families of young children with special needs. R.A.McWilliam (ed) Guilford Press, NY.

22. Understanding the family ecology (ECO mapping)
Family Centered Intervention in NATural Environments (FACINATE)- Robin McWilliam
Understanding the family ecology (ECO mapping)
Functional Intervention Planning (RBI Routines based interview)
Integrated services- a primary service provider works with family, with backing from a team of professionals to address the IFSP outcomes with family
Consultation and joint home visits with the PSP when needed
Support based home visits with the Vanderbilt home visiting script to provide informational, emotional and material support
Collaborative child care Consultation
Functional child outcomes to increase engagement, independence and social relationships throughout everyday routines

23. For more information http://www.siskin.org/www/docs/112.180
R.A.McWilliam (2010) Routines-Based Early Intervention: Supporting Young Children and their Families. Brookes, MD.
R.A.McWilliam (2010) volume Ed. Working with Families of Young Children with Special Needs. Guilford Press, N.Y.

24. Family Guided Routines Based Intervention (FGRBI)- Julianne Woods
Introduction of natural environments and welcoming the family
Routine based assessment in natural environments (RBA)
Linking assessment to intervention- Contextually relevant outcomes tied to family routines and activities; embedding outcomes into natural occurring routines
Involving care givers in teaching and learning
Monitoring progress
Collaborative teams working together with families
Family guided, family focused

25. For more information and resources:

26. Using Everyday Routines and Activities (Carl Dunst and Mary Beth Bruder)
Uses everyday family and community opportunities, experiences and events as the source of children’s learning
Locations yield activity settings, the settings are rich in multiple learning opportunities
Child engagement in enjoyable activities- interest based learning opportunities
Contextually Mediated Practices (CMP)-child interest, everyday activity settings, increased learning opportunities and parent mediate child learning)
Home visits assist families to identify and engage in these meaningful activities and meet their needs
Family centered practices and effective helping practices used by professionals

27. More information: http://www.everydaylearning.info/index.php
Dunst, C.J.,Raab, M., Trivette, C.M. & Swanson, J. (2010) “Community-based everyday child learning opportunities” in R.A. McWilliam (Ed.)Working with families of young children with special needs. Guilford Press, NY.

28. Agreed upon Principles& Practices for Providing Early Intervention Services in Natural Environments
This is NOT an approach
A document the reflects consensus practices validated through several research, model demonstration and outreach projects funded over the past decade
Practices are written to be approach neutral
Suggests a flow of activities that need to occur during the EI process
Not intended as a sequential or all inclusive checklist
Practices can be used by any team member including the Service coordinator and family

29. Three documents in the set
11_08.pdf Mission and Key Principles
tLookLike3_11_08.pdf Looks like/doesn’t look like
Draft2_01_08.pdf Agreed upon Practices
Members of the original workgroup: Susan Addison, Betsy Ayankoya, Mary Beth Bruder, Carl Dunst, Larry Edelman, Andy Gomm, Barbara Hanft, Cori Hill, Joicey Hurth, Grace Kelley, Anne Lucas, Robin Mc William, Stephanie Moss, Lynda Pletcher, Dathan Rush, M’Lisa Shelden, Judy Swett, Nora Thompson, Julianne Woods and Naomi Younggren.

30. All these “approaches” have common Foundational themes
Family Centered Practices
Relationship Based activities
Natural Environments
Natural learning opportunities, activities
Authentic/Functional Assessment
Functional Outcomes
Adult learning principles
Team based service delivery

31. These common themes impact our practices in many ways
How we interact with families and other team members
How we help child and adults learn
The way we provide help and support
How we do assessment
What we even write on the IFSP
How we provide on- going services

32. The elephant in the team room: individual values and beliefs about…
How children learn best
Viewing disabilities
Role as a provider
Different types of families
Where “services” should be provided
How to do assessments/evaluation
Working with other professionals

33. Your values and beliefs will impact:
What you actually do and even say to families.
Your participation on your team.
How comfortable (or not) you are with any of the approaches?
How willing you may be to try specific practices? QT
Shared values and beliefs

34. Activity: Mission and Key Principles- What do you and your team believe and value?
Take 5 minutes and read over the “mission “ and 7 key principles.
Use the pink or blue marker to highlight words that resonate with you
Use the yellow or green marker to highlight words you feel more Cautious about
Discuss as a team which words match what you believe and know about…. And which words you feel more uncomfortable about. Why?

35. Activity: Mission and Key Principles- What do you and your team believe and value?
Take 10 minutes to read 1 of the key principles/ looks like doesn’t look like. Read all the descriptions of looks like doesn’t carefully!
Use the same color marking strategy as you just used
Discuss as a team does the principle feel any more comfortable now that you can see more description of practices?
Are there areas you can see for personal or team improvement?

36. Team Based Service Delivery

37. Component Multidisciplinary Interdisciplinary Transdisciplinary QT
Philosophy of Team Interaction
Team members recognize the importance of contribution from several disciplines
Team members are willing and able to share responsibility for services among disciplines
Team members commit to teach, learn and work across disciplinary boundaries to plan and provide integrated services
Family role
Generally families meet with team members separately by discipline
The family might be consider a team member. Families may work with whole team or team representative
Families are always members of the team and determine their own team role QT
Roles and
tasks

38. Component Multidisciplinary Interdisciplinary Transdisciplinary QT
Lines of Communication
Typically informal. Members may not think they are part of a team
Team meets regularly for case review, consultation etc.
Meets regularly to share information and to teach and learn across disciplines; consultation and team building
Staff Development
Happens independently and within individual disciplines
Frequently shared and held across disciplines
Frequently occurs and is across disciplines. Viewed as critical to team development and role transitions. QT
Roles and
tasks

39. Component Multidisciplinary Interdisciplinary Transdisciplinary
Assessment Process
Members conduct separate assessments by disciplines.
Members conduct assessments by disciplines and share results with one another
Team participates in an “arena” assessment, observing and recording across disciplines
IFSP Development
Members develop separate plans for intervention with in their own disciplines
Goals are developed by disciplines and shared with rest of team to form a single service plan
Staff and family develop plan together based functional assessments information from the family and the child
IFSP Implementation
Implemented separately by disciplines and separate visits by discipline
Still discipline specific but some times-co-visits when working on several outcomes/goals
One person is the major implementer with the family and other members consult or teach the primary member

40. Activity: Team types
Look over the team descriptions silently. When done look up to signal you are finished reading.
In a round robin- each member share honestly what they feel is best description of the current team .
Once each person has had a chance to comment talk about discuss openly some of the following.
Is that adequate to what we are hoping to provide to children and families; are their things we need to learn more about, things in our way; are their any conflicting values and beliefs?

41. No disguising it- it’s still a cat…

42. Teaming in 1200 AD: Leaning a New Technology

43. Support one another to learn
Video Demonstrates
Coaching What did you see? Functional (Authentic) Assessment Contextually mediated practice QT
Support one another to learn

44. Other methods for teams to become more Transdisciplinary Adopted from: McGonigel &Woodruff (1994) The Transdisciplinary team: A model for family-centered early intervention. In L. Johnson (Eds) Meeting Early intervention challenges: Issues from birth to three (pp ). MD: Paul H. Brookes
Role Extension
Role Enrichment
Role Expansion
Role Exchange
Role Release
Role Support

45. The Early Intervention Journey: Large Steps in the Team Process
Intake
Initial visit(s)
Evaluation and assessment
IFSP Initial meeting
Development of IFSP goals and functional outcomes
On-going services
Ongoing assessment and review of IFSP
Exit -transition

46. Intake/acting on the referral
First opportunity to help families know more than just the name of your program
First opportunity for the team to get information from the family
Even this very first encounter should demonstrate your value and beliefs and purpose.
Who on the team does what?
What do you share with families?
How do you communicate information to other team members?

47. Some possible team tasks at intake
Contacting the family
Introducing yourself and the EI program
Listening to their concerns or reasons for referral
Verifying information
Answering questions
Setting up initial visit(s)
Sharing or mailing more information

48. Resources for this step
CO Brochure which clearly describes their Transdisciplinary team
Woods- Welcoming the family
McWilliam book Chapter 3 (Checklist)
CoP Practices 1-4
Others you have….

49. Initial Visit: Some team tasks
Becoming acquainted and establish rapport
Clarifying family concerns, or reason for contacting EI
Getting to know the family and the child
Explaining the program
Listening
Collecting useful information- child and family
Going over necessary paper work
Discussing parental rights.

50. Initial visit(s) Explaining and screening of the child (if needed)
Gathering information about family’s every day routines and activities
Gathering information about family supports and resources
Explaining and sharing information (again)-Answer questions
Explaining and coordinating the evaluation and assessment
Exploring involvement/roles of the family in the child’s evaluation and assessment and IFSP

51. Resources for initial visits
Robin’s text chapter 4/5
Practices document pages 2-5
TACTICS handouts- Identifying Family activities… What families want to know about assessment, Getting to know your child
Handout- Questions for eliciting Family routines, interest and priorities
ECO mapping
Routine Based interview
Other methods things you have found and like

52. Evaluation
Evaluation and assessment are considered processes that have different purposes under Part C. (34 CFR )
“Evaluation is defined as the procedures used by "appropriate qualified personnel to determine a child's initial and continuing eligibility", consistent with the state definition of infants and toddlers with disabilities' and includes determining the status of the child in each of the developmental areas (cognitive development, physical development, including vision and hearing, communication development, social or emotional development and adaptive development”.
Usually view as “tests, scores and percentage to establish delays in one or more areas of development.”

53. Assessment
"Assessment means the ongoing procedures used by appropriate qualified personnel throughout the period of a child's eligibility under this part to identify - (i) the child's unique strengths and needs and the services appropriate to meet those needs; and (ii) the resources, priorities, and concerns of the family and the supports and services necessary to enhance the family's capacity to meet the developmental needs of their infant or toddler with a disability.
Assessment methods can include tests, but also includes observation, open or close ended questions, interviews with parents and other caregivers.

54. Functional or Authentic Assessment in EI
Methods and activities to really learn about the child (and family)
What the child can do, likes, is interested in, and how well he/she does it
What in the daily routines or activities is challenging to the child and family
Generate ideas to try and discover what support is necessary
MUST be done where the child is, and in the situations that parents want to address
Focus is on the child’s participation in family and community activities and routines

55. Can’t have functional Outcomes without functional assessment
“A functional outcome must by definition come from a functional assessment. One cannot take a non- functional goal and turn it into a functional one by writing it differently.” McWilliam (2010)

56. Resources on Functional Assessments
ECO Mapping - Chapter 4
Needs Assessment chapter- 5/6Facilitating a
Problem solving approach for Families- TaCTICS
Handout with family questions

57. The Early Intervention Journey: Large Team Steps in the Process
Intake
Initial visit(s)
Evaluation and assessment
IFSP Initial meeting
Development of IFSP goals & functional outcomes
On-going services
Ongoing assessment and review of IFSP
Exit from EI- transition
For June:

58. In the next month your team should:
Choose an individual action and/ or whole team action/task.
That you want to improve your confidence competence (and enjoyment too) in becoming a quality team or team player.
Look back at first three steps in the team journey and the resources, or other ideas you may have from today.
Commit to trying something out with the team and with family. We will be discussing “progress” concerns, questions on our April call.

59. Some possible ideas?
Team develop a talking point script to tell families about the purpose of EI and how the team (which includes the family) works together
Choose one of the resources (i.e. eco mapping , questions to elicit family concerns, routines) and try with a family
Practice the RBI with a team member and receive coaching from them

60. Team work is like white water rafting!
Have a clear sense of where you are headed
Plot your course together
Check for rapids or rough spots before entering the water when possible
Good communication strategies and clear methods to communicate before you start
Define the roles
Use individual strengths

61. White water rafting is a lot like our teamwork
All wear life jackets
Choose paddles that fit
Get in the boat together
Balance one another
All paddle equally
When one tires- out, provide extra support
Be mentally prepared for things not going as planned
In a tough spot follow the directions of the boat leader quickly
Rescue person overboard immediately
The thrill is in the successful journey of the entire boat (team) so endurance is an absolute

62. Functional Outcomes
First appeared in Rehabilitation field (Activities for daily living)
Improve child’s ability to participate in activities that are relevant to the child and family
Use natural motivators (interests and enjoyment)
Require an understanding of family’s routines and or activities
Are not development domain specific
IFSP functional outcomes look very different from traditional service-driven outcomes

63. Coaching
A methodology defined as “an interactive process of observation, reflection, and action in a which a coach promotes directly or indirectly a learner’s ability to support a child’s participation in family and community contexts.” Hanft, Rush and Shelden 2004
In this approach the methodology of coaching is equally applied to the team members
One team member becomes the primary coach who works closest with the family and can be a team members of any discipline

64. Contextually Mediated Practices (CMP) Dunst et all
Is an intervention approach involving:
Identification of the interest of the child and everyday community and family activities
Selection of the activities that provide the best opportunities for interest-based learning
Increasing child participation in the interest-based everyday learning opportunities
The use of different interactional techniques for supporting and encouraging child competency, exploration and mastery
Evaluation of the effectiveness of parent-mediated activities