1. The Routines Based Interview
Based on the work and publications of Robin A. McWilliam, PhD.

2. What to expect from today
Knowledge of how the EcoMap and RBI fits into the IFSP process
Why RI has chosen to implement RBI
How to complete an Ecomap
How to conduct a RBI
Critical interview skills
A little practice
How to be RI RBI Approved
What questions does group have?
What are routines?
Activities that occur with some regularity.
But we don’t really have any routines…we’re a pretty easy going family?

3. Some states will do the RBI while the eval is being scored
IFSP Eligibility Meeting
Communicate El Eligibility, Update Concerns if applicable, (This meeting marks 45 day timeline)
Multidisciplinary Assessment
YES
Multidisciplinary Evaluation/Assessment NO
Eligible?
IFSP Eligibility Meeting and Provide Community Resources
Single Established Condition?
Other occasions where RBI may be beneficial include: Annual IFSP review and outcomes development, uncertainty about what to work on next, and families who seem uninterested or unable to participate in EI strategies. Adapted from R.A. Mc William, Ph.D.
IFSP Team Meeting
Finalize outcomes if not completed at end of RBI Identify Strategies, Services, and Parent Signature
Intake with EcoMap
Plus Pages 2 & 3 of IFSP
Some states will do the RBI while the eval is being scored

4. RBI ties to Global Child Outcomes
RBI Focuses on:
Engagement
Independence
Social Relationships
Use of Appropriate Behaviors to
Meet Needs
Acquisition and Use of Knowledge and Skills
Positive Social Emotional Skills Including Social Relationships
Global Child Outcomes
Used in the New IFSP

5. Why do an RBI? Develop a list of functional outcomes
To assess child and family functioning
To establish a positive relationship with the family
Purpose: Gather information and plan interventions
BETTER OUTCOMES – MORE FUNCTIONAL
FAMILIES IN STUDY WERE MORE SATISFIED WITH IFSP DEVELOPMENT
GREATER NUMBER OF OUTCOMES

6. Why do an RBI? Research Based
RBI produces better outcomes than traditional approach to IFSP development.
Outcomes are more functional
Families are more satisfied with IFSP development
More meaningful interventions = more progress
RESEARCH
BETTER OUTCOMES – MORE FUNCTIONAL
FAMILIES IN STUDY WERE MORE SATISFIED WITH IFSP DEVELOPMENT than those w/0 RBI
GREATER NUMBER OF OUTCOMES
McWilliam, R. A., Casey, A. M., & Sims, J. (2009). The routines‐based interview: A method for assessing needs and developing IFSPs. Infants & Young Children, 22, 224‐233.

7. REVIEW CRITICAL INTERVIEW BEHAVIORS – COLLECT ON POST ITS

8. Starting at Intake… The Ecomap
Shows we’re interested in the family, not just the child
Establishes a friendly, interested relationship
Gives us an alternative to the checklist method of doing intakes
What are some of the things you do at intake?
Family Friendly activity
Useful in thinking about interventions later
Take out at IFSP review to update
File with intake paperwork, not IFSP
Tab 1

9. Ecomap Example Questions to understand each relationship:
How often do you talk with/see her?
For Non-Family
How do you get along with them?
Other types of questions
If something cool happened with one of your children, who would you call?
The important thing is to find out how supportive or stressful this person is
Do not ask about relationships within immediate family
WATCH ROBINS VIDEO DEMONSTRATION
THEN ACTIVITY
GROUPS OF 3 – ONE INTERVIEWER – PARENT- OBSERVER
USE CHECKLIST

10. Who lives in the home with the child?
EcoMap Template
Father’s Family/Parent 1
Mother’s Family/ Parent 2
Who lives in the home with the child?
Father’s Friends
Mother’s Friends
People at Work
People at Work
I have updated this to align with Robin’s structure
Be respectful and sensitive
PRACTICE
Community Supports
Community Supports
Professional Supports and Services

11. Chapter 4 of Routines Based Early Intervention
Practice Activity

12. The Routines Based Interview

13. Getting Started “Set the stage” for RBI at intake
Encourage family to invite others
Try to arrange for quiet time
“This is an important conversation. We find that taking the time to talk in detail about your day helps us to help you and your child make quicker progress toward your goals.”
What do we need to think about?
CHILD DOES NOT HAVE TO BE THERE
MINIMIZE INTERUPTIONS
NO 2 PEOPLE WOULD CONDUCT THE INTERVIEW EXACTLY THE SAME WAY = KEEP IN MIND END GOAL

14. Getting Started 1 or 2 interviewers Sit at 45° angle to parent
Role of 2nd person is to help cover missed questions, take notes, handle interruptions and recap
Sit at 45° angle to parent
Keep paper flat on table
Be focused
What do we need to think about?
CHILD DOES NOT HAVE TO BE THERE
MINIMIZE INTERUPTIONS
NO 2 PEOPLE WOULD CONDUCT THE INTERVIEW EXACTLY THE SAME WAY = KEEP IN MIND END GOAL

15. SRF and Billing
SRF should indicate a RBI was completed but do not recap the conversation
Indicate date of RBI on IFSP
Remind data entry to check RBI box in Welligent (only for full initial RBI’s)
Service Coordination T1016 (one person)
Team Coordination T10TF (2 people)

16. How to talk about the RBI?
“Talking about your day to day activities will help us come up with an effective plan for helping you and your child”
“Talking in detail about your day helps us to work on the things that are most meaningful to your child and family”
“When we focus on the things you do every day, your child will be able to practice his new skills over and over again with little effort”
CHILD CARE AND PARENT – IF SEPARATE CHILDCARE PRIOR TO FAMILY

17. Beginning the RBI Tell me as much or as little…
Why is your child in Early Intervention?
What are your main concerns?
CHILD CARE AND PARENT – IF SEPARATE CHILDCARE PRIOR TO FAMILY
Now I’m going to ask you some questions about your day to day activities. Is that ok?

18. Traditional RBI questions within each routine
What is the child doing?
What is everyone else doing?
What is this child’s engagement like?
What is this child’s level of independence?
What are this child’s social relationships like?
How satisfied are you with this routine?
If appropriate: How would you like it to be different?
Starting the conversation…..Point out Army conversation starters
Helps gather information for COSF…Outcomes…

19. Within each routine….
Engagement: How and how much does the child participate in the routine? Independence: How much can the child do by him/herself? Social Relationship: How does the child communicate and get along with others?
VIDEO clip - 10:29 – 19:57
What did you see?
PARENTS BEGIN TO REALIZE NEW THINGS
BEGIN TO PROBLEM SOLVE

20. The RBI Outline Go through each daily activity one by one
Write BRIEF notes! (you will see why later)
Note concerns (mostly parents’ but can be yours) Put stars next to them
Use transitional phrases like “what happens next”
STAR THINGS THAT ARE NOT GOING WELL “EVERYTIME I OPEN THE DOOR, HE DARTS OUT ONTO THE SIDWALK”
THINGS THEY WOULD LIKE TO BE DIFFERENT “IM NOT SURE I HAVE ENOUGH OF THE RIGHT TOYS TO HELP HIM USE BOTH HANDS”
THINGS THEY THINK THE CHILD WILL DO NEXT “HE IS TAKING A FEW STEPS BY HIMSELF, I GUESS HE WILL BE ABLE TO WALK UP AND DOWN THE STAIRS HOLDING MY HAND SOON”
ALSO STAR YOUR CONCERNS – “WHEN HE CRIES AT NIGHT, I JUST YELL TO PIPE DOWN AND GO TO SLEEP”
THESE ARE NOT THE FAMILY OUTCOMES….YET…

21. Success hinges on follow‐up questions!!
What does ____ look like?
What happens when he sees you?
How does she get from the bedroom to the playroom?
How do you know he is happy?
What do you think that means?
How does that make you feel?
What do you do when that happens?
What happens next?
Lets watch some video demonstrations

22. Satisfaction Questions
After each routines ask parents how they feel about each routine
On a scale of 1-5
How is this time of day for you?
If the rating is 3 or less (this is flexible) ask:
How would you like this to be different?
1 is not enjoyable or tough 5 is pleasant and enjoyable
ASSESSSING GOODNESS OF FIT – As we transition through certain parts of your day, I am going to pause and ask you to rate how that time of day is for you. 1 is difficult or stressful and 5 is enjoyable or easy. You can pick whatever number you think best describes that time of day
STOP AND SHOW VIDEO

23. Let’s try it… Take out a RBI Interview Notes Page
You are the second interviewer
Take notes on what you hear

24. Worry, Change and Activity Questions
“Now let me ask you a couple of general questions…
When you lie awake at night, what do you worry about?
If there is anything you’d like to change about your life, what would it be?”
Is there anything you used to do that you would like to be able to do again?
SLIDE then VIDEO
ROBIN 1:34:07
Let it run thru recap

25. Recap
This should be done by person taking notes (2nd interviewer)
Be Brief!! (no more than 5 minutes)
There will likely be 10‐20 things you have starred!
If you have written a lot, it will be hard to pick out the highlights
No questions, no discussion, no ideas
BOOM, BOOM, BOOM
Continue on to the recap
This is where people get hung up!!
SANDRA RECAP 1:46:30 AND THEN ONTO GOALS 1:49:12 THEN PRIORITIES 1:55:17
ROBIN RECAP 6:25
RECAP – NOT TIME TO ELABORATE
NEW PIECE OF PAPER
DO WHEN ROUTINES ARE DONE OR AT 1 ½ HOURS
CHILD RELATED – CHILD FAMILY – FAMILY

26. List and Prioritize
“Let’s make a list of what would you like to work on?”
Let parent start, you can use notes to remind parent of what they said
Share notes with parent
“Lets put these goals into priority order. If you could only choose one thing to work on, what would it be?
Proceed until all goals are numbered
Slide then show part of video
SANDRA RECAP 1:46:30 AND THEN ONTO GOALS 1:49:12 THEN PRIORITIES 1:55:17
ROBIN RECAP 6:25
RECAP – NOT TIME TO ELABORATE
NEW PIECE OF PAPER
DO WHEN ROUTINES ARE DONE OR AT 1 ½ HOURS
CHILD RELATED – CHILD FAMILY – FAMILY

27. Managing the Interview
Make use of a “parking lot”
Families often begin to solve own troubles just by saying them out loud
Don’t forget to acknowledge ideas, and
Don’t forget to come back to them at another time
Manage time and distractions effectively

28. When you have a concern the parent does not choose
What if you have a concern, detect a delay or some other problem?
Check your own beliefs and biases…Is this a FUNCTIONAL concern?
Use natural learning opportunities
Obligation to give families information
Consider timing of when to address concern

29. A Successful Interview…
Lasts approx 1 to 1 ½ hours
Gives you a detailed picture of the child and family’s daily activities
Produces a minimum
of 6 – 10 outcomes
Getting into care seat
Getting dressed without fussing
Hard to control in store
Dinner time – crying
Bathtime – hard to wash safely
Crys a lot when put in crib
When we have asked parents how long they think we’ve been talking then always underestimate.

30. “Are we there yet?!!!”

31. Interview Skills Active listening In depth follow up questions
Proactive questioning about child development
Continuing the conversation
Smart questions
McWilliam,R.A, Casey, A.M, Sims, J. The routines based interview: a method for gathering information and assessing needs. Infants and Young Children. 22, 3,
When a parent of a 16 month old talks about their son independently getting himself to the toy box across the room…tell me how he gets there
Parent repsonds that he scoots on his behind...I am going to ask more questions as we go along to understand how independant this child is in each routine.
Sam is 10 months old...tell me how he gets snacks on his tray into his mouth.
No pause when writing – Should feel like a conversation despite its name
Smart questions reveal understanding about family functioning. That the interviewer really “gets” the family= family feels more confident.
“when she reaches up for you it must make you feel happy to be her mom”
“when your husband comes home is it a relief or like you have another child on your hands?
“so when do you have time to shower?”
These questions feel instrusive when the interviewer is not authentic and conversational

32. Interview Skills
Non verbal communication to convey acceptance and interest
Social environment of routines
Seeking evaluative and interpretive opinions
Managing the conversation
Empathizing
McWilliam,R.A, Casey, A.M, Sims, J. The routines based interview: a method for gathering information and assessing needs. Infants and Young Children. 22, 3,
Social environment….activities and events change when different people are present
We need to know the families opinion about the child and family functioning. Not just the facts…Why do you think he does that? How do you feel about that?
You are in charge of the pace and content of the conversation....sometimes speed it up, sometimes you dont know enough and need to ask about more settings, people, weekends, events, etc OR skip routines that are repetitive
While we are professionally neutral – we are human and must show empathy when it is authentic and appropriate – hardships or sucessess

33. Other Tips Ask open ended questions Do NOT answer your own questions
Do NOT make the RBI conversation into a multiple choice quiz
Use “why” with caution
Practice with co-workers and friends

34. Practice Interviews Mother Interviewer Observer
Divide into groups of 3
Mother
Interviewer
Observer
IF Groups of 4: mother, primary interviewer, secondary interviewer, observer
IF Groups of 5: mother, other family member, 2
interviewers, observer

35. Preparation for Interview: 5 Minutes
Mothers
– Receive assigned role
– Read the vignette
– Prepare to make up details
Interviewers
– Read RBI Implementation Checklist
Observers

36. Flow of Activity
Begin interview as though you had 90 minutes ahead of you—in depth information
After 20 mins, I will tell you when you should move on to evening routines
After another 10 mins, you should be recapping and selecting outcomes
You are done when outcomes are selected

38. 7 Steps for Writing Functional Outcomes
You can’t just take a nonfunctional outcome and turn it into a functional outcome…
That will merely produce a well‐written nonfunctional outcome

39. 7 Steps to Writing Functional, Measureable, Family Owned
Read the informal functional outcome
Determine the routines involved
Write “[The child] will participate in [those routines]”
Write “…by _____ing,” inserting the desired behavior
Consider We will know this when he or she _____ and add a measurable acquisition criterion
Add a generalization criterion
Add the criterion specifying the amount of time over which the behavior needs to be displayed (e.g., “in one week”)

40. Smith Family Goals -Get Samantha to chew her food
-Move to get to places (rolling, crawling, walking)
-In and out of sitting
-Stand up
-Play with toys the way they’re designed… more toys
-Communication (reaching, sounds)
-Cup drinking
-Jacque’s relationship with Gabriel and Andrea

41. Developing Child Outcomes
Step 1
Take what the family listed as a goal in the RBI
We want Sam to chew her food

42. Developing Child Outcomes
Step 2
Find out what routines this affects
Lunch and dinner

43. Developing Child Outcomes
Step 3
Write “Child will participate in [the routine(s) in question]”
Samatha will participate in lunch and dinner

44. Developing Child Outcomes
Step 4
Write “by _____ing,” addressing the specific behaviors
By chewing her food and moving food from side to side with her tongue before swallowing

45. Developing Child Outcomes
Step 5
Add a criterion for demonstration the child has acquired the skill
We will know she can do this when she eats 1/2 cup of food in this manner

46. Developing Child Outcomes
Step 6
Add another criterion for generalization, maintenance, or fluency, if appropriate
(across routines, people, materials, places, over time)
One time at lunch, one time at dinner

47. Developing Child Outcomes
Step 7
What amount of time will it take until we presume mastery?
Samantha will participate in lunch and dinner by chewing her food and moving food from side to side with her tongue before swallowing.
We will know she can do this when she eats ½ cup of food in this manner, one time at lunch, one time at dinner for 1 week.

48. Developing Child Outcomes
Play with toys in the way they are intended
Samantha will participate in play time by playing with toys the way they’re intended.
We will know she can do this when she plays appropriately with 2 toys a day for three consecutive weeks.
Now you try one

50. Video Resources RBI Interview
Difference is in the Details: The value of asking good questions