Writing and Implementing IFSPs for Young Children with Autism

1. Writing and Implementing IFSPs for Young Children with Autism Phil Strain & Ted Bovey Positive Early Learning Experiences Center

2. Agenda Functional assessment of strengths and needs Writing functional goals and objectives Implementing your intervention with fidelity Monitoring outcomes and making data-based decisions.

3. The IFSP is a process that includes a written plan that: • Is family directed and: • Identifies the strengths of a child and family. • Prioritizes the family’s concerns for their child and family as related to the child’s development. • Documents current levels of development within the daily routines of the family. • Develops a plan of action that: • Identifies functional learning objectives for the child and family. • Documents outcomes expected to be achieved by the child and family based on the family’s priorities. • Specifies the details of the recommended early intervention services needed to implement the strategies necessary to meet the outcomes on the IFSP.

4. IFSP Checklist It is recommended that IFSP teams ask themselves these questions to guide the IFSP planning process in order to support the delivery of services that are individualized, evidence-based and comprehensive.

5. Gathering Family Information • Resources, concerns and priorities of the family related to their child’s development through: • conversational interviews, • family report, and • assessment.

6. Recommended by Connecticut Birth to Three System Family Needs Scale (Dunst et al., 1988) Family Resource Needs, A Screening Tool (Adapted from Project Dakota) Family Intake and Interest Survey (Adapted from Children’s Therapy Services Routines Based Interview (McWilliam, 2008) AEPS Family Interest Survey (Cripe & Bricker)

7. Recommend in the Service Guidelines: Two Tools To Help Parents Identify Current Level of Functioning Around Common Everyday Experiences • Routines Based Interview (RBI) (McWilliam, 1992, 2005, 2008) • Functional interview planning process to help determine what skills or behaviors a child must learn to be successful in daily routines • The purpose is to go through all of a family’s day-to-day activities to find out what they really want and need for their child • About Our Child Assessment Tool (Strain, 2002) • Aids parents or other caregivers in identifying skills their child currently demonstrates in common everyday activities and routines • Helps parents to identify skills they would like their child to learn

8. RBI (McWilliam 2008): • Supports parents in sharing information regarding their day-to-day activities and routines. • Helps gather information in the following areas: • About the child • About the child and family’s routines • About the child and family’s activities • About the child and family’s supports • Discussion helps families in clarifying their concerns • Helps link child’s skills to the development of Functional Objectives.

9. RBI - Information To Be Gathered About Each Routine • What does everyone do at this time? • What does the child do? • How does the child do by him/herself? • How does the child communicate or get along with others? • How satisfied is the caregiver with the routine: • rate from 1 (not satisfied) to 5 (very satisfied)

10. RBI Outline Getting Started: 1 Who lives in the home with you and the child? 2 Why is the child in special services? 3 What are your main concerns? Home Routines • How does your day begin? (Start marking concerns with stars) In each routine… • What is everyone else doing? • What does the child do? • Engagement (How well does the child participate in the activity? Stay involved?) • Independence • Social Relationships (communication, getting along with others) Rating 1-5 how happy you are with this time of day Transition to next routine: What happens next?

11. About Our Child • Asks parents/caregivers to list what the child can do and what they would like to see their child doing in these areas: • Play (e.g., toy play, sharing, taking turns, playing independently, and playing with other children) • Language (e.g., communicating wants and needs, following directions, listening skills, understanding concepts) • Adaptive (e.g., dressing, hand washing and toileting) • Meal Time (e.g., eating with utensils, eating a variety of foods, using a cup and sitting at the table)

12. About Our Child cont. Bath time (e.g., sitting in the tub, washing, brushing teeth and combining hair. Cognitive (e.g., understanding simple stories, identifying pictures, identifying letters, numbers, shapes, and colors, matching and sorting) Motor (e.g., gross and fine motor skills) Community Activities (e.g., sitting in a grocery cart, riding in the car, eating out) Behavior (e.g., behaviors that interfere with learning, that parents would like the child to do less often, are aggressive, self injurious or deal with sensory sensitivities)

13. ABOUT OUR CHILD Child's Name: Date:

15. Activity – About Our Child • Small groups of 3-6 • Task: • Using information from the case study narrative & sample RBI complete the following sections for four domains on the About Our Child form (From the Parent’s Perspective) • “What our child knows or already does in this area” • “Skills we would like our child to learn in this area” and, • “Priority Level” • Groups will briefly report back to the large group.

16. Present Levels of Development Information taken from the About Our Child and the RBI are summarized in Section II Summary of Family’s Concerns, Priorities, and Resources

17. Large Group Activity Together as a group we will list families’Family Outcomes for Oscar:

18. Identifying IFSP Outcomes • Review the family information, health information, present levels of development, and Family Outcomes • Identify family priorities • Specify the desired behavior • Specify details that describe what the behavior should look like (how often, how long, etc.) • Specify the routine or activity in which the child will demonstrate the behavior • Specify how a family will know when the goal has been meet

19. Components of Functional Outcomes • Does the outcome result in: • Increased child engagement/play skills • Improved social relationships • Improved communication skills • Increased independence in family and community routines and activities • Reductions in challenging behaviors achieved by increases in appropriate behaviors

20. Activity – Functional or Not? Requests desired objects? Sorts pictures by category? Eats with utensils? Letter recognition? Will bounce on a ball? Will string beads? Plays quietly alone? Greets friends?

21. Activity – Section V. Outcomes • Group Size: Small groups (3-6) • Task: Refer to Section V. Outcome of the IFSP and fill out the following sections: • What we want is: • What is happening now: • What are the next steps (Objectives) • This information should relate directly to the Family Outcomes identified in Section II.

22. Strategies • Methods for working on this outcome during your child’s and family’s daily activities and routines. • Helpful to use language that provides real examples of a strategy. • Recommended strategies (EBPs) should be indicated. • Obtaining AAC devices should be included as a strategy.

23. Nine Recommended Strategies • Antecedent Package • Prompting • Behavioral Intervention Package • Discrete Trial Training (DTT) • Positive Behavior Interventions and Supports (PBIS) • Joint Attention • Modeling • Naturalistic Teaching Strategies • Peer Training Package • Pivotal Response Treatments • Schedules (Use of Pictures) • Augmentative and Alternative Communication (AAC)

24. Activity – Identifying Recommended Practices Description Strategy • Encourage to watch other children by pointing out what they are doing. • Guide to take items from peers when offered. • Follow routine directions independently. Make sure to guide him to follow it if necessary. • Utilize PECS to support requesting. • Hold up items that he wants & wait for him to request the item • Augmentative and Alternative Communication • Naturalistic Teaching • Peer-Mediated Strategies • Joint Attention Intervention • Antecedent Package (Prompting least to most assistance)

25. Putting the IFSP into Practice • Using the About Our Child, RBI and Section V you developed for the IFSP, develop an Intervention Table that provides the following information: • Outcome • Objective (Objectives under your Outcome) • Setting and Participants • Methodologies and Strategies • Helps address issues of consistency and fidelity across providers.

26. Example – Established Intervention Table

28. Activity – Developing an Established Intervention Table • Group size: 3-6 • Task 1: • Using all of the material developed thus far complete the Strategies box of Section V. • Task 2: • Fill out the table entitled Established Interventions based on your case study. Write a priority (Outcome), an outcome (Objective), the settings and participants and the methodologies and strategies related to the outcome.

29. Monitoring Progress Making data-based decisions

30. The Link Between Achieving Good Outcomes and Ongoing Data Collection is Undeniable • Every Established Intervention outlined has been used in conjunction with an ongoing, dynamic data system. • No practice is universally effective. • Behaviors elicit strong emotional responses necessitating the need for objective measurement. • Existing data must be used to make timely, individualized modifications and accommodations.

31. The Challenge: • To select measurement methods that yield meaningful data on socially relevant behaviors. • Collecting data on the right dimensions of behaviors. • Designing a system that is efficient and effective (easy to use and easy to monitor).

32. Behavior Rating Scales • Simple system that, in recent years, has been used effectively with parents and professionals. • Useful for tracking a wide range of behaviors including: • General cognitive goals • Adaptive skills • Self help skills • Direction following • Receptive language goals • Based on measuring the level of assistance (prompting) needed to complete a task.

33. Prompting Hierarchy Adult Gives an Initial Direction and: Rating • Child completes skill Independently. • Adult Points/Gestures/Models in conjunction with repeated verbal direction. • Adult provides Partial Physical Assistance to complete the skill but the child does some on their own. • Adult provides 100% Physical Assistance to complete the skill. • Child Refuses, skill is not completed. • 4 • 3 • 2 • 1 • 0

35. Recording Data • Data point represents adult’s most frequently used level of prompt to ensure the child’s successful response. • Representative of trials across multiplelearning opportunities throughout the day. • Multiple interventionists • Multiple stimuli • Multiple settings

36. Setting Levels and Criteria • Initial performance is set based on your first 5-10 data points. • Level is your Target Level or the next step. • If initial performance is at Level 2 your Target Level = 3 • Criteria is how many data points at your target level before you move to the next level. Criteria will be set based on the frequency of your data points. • If data is taken daily you could use 6 out of 8 or 8 out of 10. • If data is taken less frequently 3 out of 4 or 4 out of 5.

37. Charting Your Data – Example 1 3

38. Adjusting Your Key to Specific Behaviors Expressive Language Behaviors with which you want to track changes in intensity, frequency, duration over time

39. Expressive Language - Prompting Hierarchy Adult provides a environmental cue or general prompt, “What do you want”: Rating • Child spontaneously uses target word(s). • Adult Models first sound or first word of targeted response. • Adult provides Full model of the targeted response. • Adult Backs up to an easier response (from targeting a sentence to accepting a 1-word response. • Child Refuses, looses interest, teaching episode is discontinued. • 4 • 3 • 2 • 1 • 0

40. Expressive Language – Example 2 3 2

41. Behavior Ratings Tracking changes on a specific dimensions of behavior over time. Scored on a 1 to 5 scale. Anchors are determined for each level of the scale moving from 1 (undesired behavior) to 5 (desired behavior)

42. Behavior Ratings – Example 3 Screams Screaming to protest (loud, inappropriate voice): 5 = 16 or more times 4 = 9-15 times 3 = 5-8 times 2 = 2-4 times 1 = 0-2 times

43. Making Smart Decisions About Data Systems • With what frequency/intensity should data be collected? • For target behaviors considered crucial to safety and well-being maximize data collection. • When and how do we make decisions regarding changes to our intervention approaches? • After 2 weeks (or 10 successive data points/days) of no progress or regression. • Varying data across interventionists

44. Activity - Developing a Data Sheet • Group size: 3-6 • Task: • Develop a data sheet based on your case study. • Pick one Outcome from your Established Interventions Table. • Using the appropriate data sheet fill out the objective, and based upon all your information determine the level and criteria you would start at. • If you choose a challenging behavior, set appropriate anchors for your Behavior Rating Scale.

45. Issues Regarding Fidelity?

46. Questions?