1. Corey Herd Cassidy, Ph.D., CCC-SLP Radford University Corey Herd Cassidy, Ph.D., CCC-SLP Radford University Coaching in Natural Environments: Beyond the Bag of Tricks

2. A Change in Thinking Early intervention that is most effective reaches far beyond the traditional “home visit.”

3. The Medical/Clinical Model versus A Supports and Services Approach What’s the Difference?

4. Medical/Clinical Approach Supports & Services Approach Work with child/family to address IFSP outcomes Provider uses knowledge to help child develop new skills Provider uses knowledge to help family apply strategies in daily life to enhance the child’s development Limited in time and scope of intervention Is flexible and explores activities & routines in “real time” May focus on isolated skill development Focuses on strategies family can use between visits

5. Natural Environments IDEA Part C (2004):  Settings that are typical for infants and toddlers without disabilities or delays

6. Most frequently identified natural environment location for families is in their homes (NEILS, 2007)

7. A New Meaning for “Home Visit” WHAT the visit looks like and WHERE it occurs depends on the IFSP outcome & activity being addressed. Examples: Informal play session at home Lunchtime at McDonalds Observation of bath time Shopping trip to the mall

8. It is not what the service provider does in the home that will make the difference in the child’s development; it is what the family, child care providers, etc. learn during the sessions and use during their activities and routines throughout the week that facilitates the child’s learning and development. McWilliam, 2000

9. “A child, on average, can be expected to find himself or herself in some 16 different home and some 25 community locations where learning takes place. These 40 or so different locations, on average, result in child participation in about 150 activity settings, which, in turn, give rise to more than 200 different kinds of learning opportunities promoting child development.” Dunst & Bruder, 1999

10. What are some of the routines that a child and his/her family engage in on an everyday basis? Which of those routines might serve as meaningful and functional opportunities for learning?

11. A Process…not a place

12. Consider this… Knowledge and skills are best developed under conditions that are authentic and reflect the reality and demands of daily living. (Brown, Collins, Duguid, 1989) Real activities and purposeful interactions help children become more effective communicators. (Bricker, 1986)

13. And this… A child needs repeated opportunities to experience a desired behavior within the context of an activity across different activities Ukrainetz (2006)

14. But what about our bags of toys?! Fact or Fiction? The toy bag/toys are used for direct instruction; the materials in the natural environment are for generalization of outcomes. Some homes have nothing-no materials or activities or everyday routines-with which to address outcomes. Parents WANT us to bring toy bags/toys into the home. The children LOVE our toys! The use of a toy bag is an addiction and we depend on those toys to do our jobs.

15. The toy bag carries our toys… and a message… “Your stuff isn’t good enough.” Intervention only occurs during the visit.

16. 10 Step Program to Decreasing Your Toy Bag Dependence! FACETS: http://facets.lsi.ku.edu/

17. 1. Conduct a functional assessment of the home/natural environment.

19. 2. Use social and daily routines that are already occurring to join the caregiver and child upon your arrival.

20. 3. Plan activities for your next visit before leaving.

21. 4. Plan a special activity with the caregiver.

22. 5.Organize a play date with other children and caregivers.

23. 6. Ask the child to show you/get toys or preferred objects from another room in the house. Follow the child’s lead and move into other rooms of the house.

24. If you are STILL feeling the need to carry a bag into the natural environment… 7. Fade your dependence by decreasing the size of the bag over time.

25. 8. Demonstrate the use of a toy that includes opportunities to practice a skill. Then look around the home for toys or other materials that might provide additional practice for the same skill.

26. 9. Use “hybrid approaches”: Forgetfulness is always an option! Provide a choice. Sabotage the bag.

27. 10. Leave the toy bag by the door and join the child’s activities. Use the toy bag only when and if needed.

28. So…FACT or FICTION??? The toy bag/toys are used for direct instruction; the materials in the natural environment are for generalization of outcomes. Some homes have nothing-no materials or activities or everyday routines-with which to address outcomes. Parents WANT us to bring toy bags/toys into the home. The children LOVE our toys! The use of a toy bag is an addiction and we depend on those toys to do our jobs.

29. Coaching the Caregivers 5 considerations for working with the ADULTS! (Knowles, 1995)

30. Agree on priorities and clarify roles.

31. Join in; try not to take over.

32. Encourage the caregivers to identify opportunities that they already enjoy! From there, build on the caregiver’s strengths within those routines and activities.

33. Provide specific and meaningful feedback.

34. THE RELATIONSHIP DOES MATTER!

35. Coaching Take Away Message What happens BETWEEN visits is far more important than what happens DURING visits!

36. Ask Yourself Have I provided this family with practical strategies to try in their daily life when I’m not here? Does the caregiver understand the strategies and feel competent to incorporate them into the family’s routine?

37. Life isn't a matter of milestones, but of moments. Rose Kennedy Share an “a-ha” moment with the person sitting next to you that you want to take away from this session.

38. YOU touch the lives of families every day! Help them make most the of every moment!

39. References Campbell, P.H., Milbourne, S., & Wilcox, M.J. (2008). Adaptation interventions to promote participation in natural settings. Infants & Young Children, 21(2), 94-106. Orientation to Part C online training module. (2007). Retrieved October 20, 2007, from http://www.infantva.org/pr- TrainingResourcesArchive.htm http://www.infantva.org/pr- TrainingResourcesArchive.htm Snow, K. (2009). People first language. Retrieved February 3, 2009, from http://www.disabilityisnatural.com/peoplefirs tlanguage.htm http://www.disabilityisnatural.com/peoplefirs tlanguage.htm

40. Contact Me! Corey Herd Cassidy, Ph.D., CCC-SLP Associate Professor/Speech-Language Pathologist Radford University (540) 831-7637 cherd@radford.edu