Introduction to the Routines-Based Interview Method Kellie Horn khorn@esd123.org Chris Miller chris.miller@esd112.org Introductions-roles, responsibilities, interest Why we are here-background…

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!

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

The RBI in Real Time

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

“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

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

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

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

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

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

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

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

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

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

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 20-30 minutes- Recap starred items and select outcomes

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

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

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

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!

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

45, 44, 43, 42…

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

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

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!

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? --

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

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.

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!!!

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

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)? _____

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

Child Assessment

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

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

IFSP Outcomes

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

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!

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”

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”

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.

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?

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

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.

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.

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.

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.

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

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

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.

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

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.

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…

Thank you!