Working With Families Not Too Much, Not Too Little

1. Working With Families Not Too Much, Not Too Little Robin McWilliam

2. Contact • Robin.McWilliam@Vanderbilt.edu • www.VanderbiltChildDevelopment.us • Within 1 week, this PowerPoint will be available on the website, under Presentations

3. What Does This Title Mean? • Working with families not too much, not too little • Working with families too much means usurping their role (Dunst, 1985) • Working with families too little means failing to attend to family-level needs (Turnbull)

4. The 2-Pronged Approach to Working With Families • What we attend to • Do we attend inordinately to child-level needs? • How we work with families • Do we have a framework for family-friendly interactions?

5. Change Framework by Changing Practice • Assess child- and family-level needs by conducting a Routines-Based InterviewTM • Addressing family-level needs through the IFSP • 5 evidence-based characteristics of working with families in a family-centered way

6. Usurping Families’ Role • Their role: To raise their children, which includes teaching them • How we usurp it: By trying to teach children during home visits or other weekly contacts • What does this convey to families? • What we should do to avoid usurping it: Take a consultative role in working with families (Hobbs)

7. Failure to Attend to Family-Level Needs • The field of [early intervention] has focused primarily on implementing family-centered practices in regard to how families and professionals should interact, but it has not sufficiently addressed what supports and services should be offered to families in order to enhance the likelihood of positive outcomes for families, themselves, as well as for children with disabilities. • Turnbull et al. (2007). Family supports and services in early intervention: A bold vision. Journal of Early Intervention, 29, 187-206

8. Attending Inordinately to Child-Level Needs • This study revealed that many IFSPs in the sample included strategies implying that services were to be delivered by professionals during intervention sessions separate from the family’s daily routines. This finding suggests that practices on IFSPs collected in 2001 show little progression from research findings of several years ago, which found that intervention is frequently hands-on, child-focused, professionally-designed and devoid of active family involvement (e.g., Boone et al., 1998; Harbin et al., 1998; McBride & Peterson, 1997; McWilliam et al., 1998). • Jung, L. A., & McWilliam, R. A. (2005). Reliability and validity of scores on the IFSP Rating Scale. Journal of Early Intervention, 27, 125-136.

9. Attending to Family-Level Needs • Take a support-based approach to • Understanding the family ecology • Assessing the family’s, including the child’s, needs • Home visiting

10. Understanding the Family Ecology • Develop an ecomap

11. Krista has little time for friends, but doesn’t know what to do with her afternoons (the worst time of day) Robyn Neighbors Tulsa friends S’s aunt & uncle S’s parents K’s parents Hometown friends K’s sisters S’s sisters K’s brother Work: Alcoa Church (1st Baptist) Golf weekly Steven, Krista, Darcy Aquatic therapy (weekly) Dr. Trainer (physiatrist) SLP (Liz)—weekly at home Harris (neurosurg-eon) OT (Michelle)—2x/wk at clinic Ophthalmolog-ist Regular pediatrician (Glover) PT (Scott)—2x/wk at clinic Amy (DMRS teacher)—weekly HVs SC (Donna)—6 months min.

12. Assessing the Family’s, Including the Child’s, Needs • Conduct a Routine-Based Interview

13. Go through each “routine” (i.e., time of day or activity) Get a sense of family’s and child’s functioning Write down significant information Star () concerns Recap concerns with the family, showing them the starred items Ask what the family would like to concentrate on Write down these outcomes Ask them for the priority order The Routines-Based Interview

14. Structure • Within Each Routine • What does everyone else do? • What does this child do? • Engagement • Independence • Social relationships • How satisfactory is this routine? Home Routines Waking up Changing diaper/bathroom Going to kitchen Breakfast Parent getting dressed Going out In shops Lunch Going to park Other family members coming home Dinner preparation Dinner Bath TV Bedtime “Classroom” Routines Arrival Circle Free play Snack Small toys Centers Outside Music Story Lunch Nap Centers Departure 3. How well is this routine working for the child (“goodness of fit”)

15. Family-Level Outcomes on the IFSP

18. Jo’s Priorities • Communicate his needs (drink, don’t feel well, eat, more, play, TV, outside) • Eating with combination of textures; vegetables, fruits • Handwashing—water rinsing • Identifying objects (in a book, on body), to see where he is cognitively • Transitions (e.g., from park) when he has to stop doing something fun • Therapies more under Jo’s control • Child care when Jo needs longer term care (e.g., during her medical treatments)

19. Julie’s Outcomes • Making sounds (playing with Chris, diaper, reading, play, feeding) • Responding to Julie and Chris during reading, play, meals • Reach (playing on floor, bath, swim class, music, feeding) • Batting for toys and splashing (play, bath) • Grasp things in front of him (music, bath, feeding) • Rolling both ways, pushing up (play) • Sitting unassisted (music, bath, feeding) • Information on research, what other moms do, bedtime rituals • Time for Chris and Julie together (get parents here)

20. Sue’s Priorities • Sue get a new job • Samantha communicate, esp. “I love you” at wake up and what to eat at meals • Eat without stuffing • Cup drinking • Eat with utensils • Potty training • Dressing independently • Play with toys appropriately at hanging-out times • New beds for kids

21. Gina’s Goals • Emily will extend arms at dressing • Play without head-banging (because of child care) • Time for Gina to play with Maria and Emily (15-30 mins) • Communicate Mama, no, up, cup, Dada, etc. • Down time before dinner for family • Sit in car seat without self-stimulating with middle strap (for social reasons) • Walk faster • Find child care • Maria cooperate

22. Home Visiting • Use Support-Based Home Visits and the Vanderbilt Home Visit Script • Discussed in concurrent session

23. The Framework for How We Support Families

24. Emotional Support Positiveness Responsiveness Orientation to the whole family Friendliness Sensitivity Material Support Equipment and materials Financial resources Informational Support Child development Child’s disability Services and resources What to do with the child Support-Based Home Visits

25. The 5-Component Model for Early Intervention in Natural Environments Functional Outcomes Response To Support

26. Principles • All the intervention occurs between specialists’ visits. • Therapy and instruction are not golf lessons. • Regular caregivers (i.e., parents and teachers) need to own the goals.

27. Caregiver Competence & Confidence Professional Support Child Outcomes Who Has How Much Influence on What?

28. How Children Learn The Environment The Child Through repeated interactions with the environment, dispersed over time. Not in massed trials.

29. Home Visit Home Visit Family-Child Interactions & Other Learning Opportunities Family Family Between Visits Child Learning

30. Family Competence & Confidence Child Progress Home Transdisciplinary HVs Classroom Embedded Interventions Professional Support Integrated Therapy The Conceptual Framework

31. Desired Result of This Model