The Routines-Based Interview

1. Greater Nashville LICC TrainingNashville, TNAugust 7, 2006 The Routines-Based Interview Robin McWilliam, Ph.D. Vanderbilt University Medical Center Mass. Early Intervention Consortium Conference Marlborough, MA May 12, 2005 EDIS Conference 2005 Garmisch, Germany August 22, 2005 NIPIP Training Denver, CO September 14, 2005 TEIS Knoxville, TN September 19, 2005 Inclusion Institute Chapel Hill, NC July 2005 & 2006

2. Contact • Robin.McWilliam@Vanderbilt.edu • www.VanderbiltChildrens.com/earlyintervention/ E-mail me for a copy of this presentation

3. Need for Routines-Based Assessment • Functional outcomes (target behaviors) • Address participation/engagement needs • Address independence needs • Address social relationships needs • Family priorities reflected in the IFSP • Outcomes broad enough yet specific enough • Strategies that aim directly at function problem (i.e., teach first) • Investment by caregivers other than the family in the IFSP

4. RBI Study • Funded by the Family Research Program of the Vanderbilt Kennedy Center • Randomized control design: RBI vs. traditional IFSP development • Findings • RBI group more satisfied with IFSP process than contrast group • No difference in satisfaction with routines for either group, in 3 months • More outcomes on RBI-produced IFSPs • More functional IFSP outcomes for RBI group than contrast group

5. Conclusions • For implementation with fidelity, more extensive training is needed • The range of knowledge and skills of potential interviewers is huge • Dedicated service coordinators often have large caseloads and little intervention experience • Some interviewers might need support with the “elements” of functioning in routines to ask about • Further research can and should be done with these and other measures

6. What Are Routines? • In this model, they are not activities the professional sets up with the family. Instead, they are • Naturally occurring activities happening with some regularity • Caregiving events • Hanging out times

7. Routines-Based Assessment Described in Family-Centered Intervention Planning: A Routines-Based Approach (McWilliam, 1992) www.IndividualizingInclusion.us Click on Materials • Preparation of families and staff • Routines-based interview • Goal selection • Goal writing • Strategies and review

8. Routines-Based Interview • Families report on their routines first. • If present, child care providers report on their routines second. • If they cannot attend, they get interviewed earlier, and someone reports on child care routines • Other team members ask questions and provide information during discussions of routines. • Professionals withhold giving advice.

9. 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

10. Routines Information • What does everyone else do? • Home: Other family members • Classroom: Other children • What does the child do?

11. More Routines Information • Engagement • How and how much does the child participate in the routine? • Independence • How much can the child do by him- or herself? • Social Relationships • How does the child communicate and get along with others?

12. Key Routine Question • Home: How satisfied is the caregiver? • Classroom: How good is the fit between the child and the routine • Instrument: RBI Form

13. Preparation for the Observation • Note good, juicy questions • Note questions I didn’t ask (i. e., missed follow-up questions) • Note the interviewer’s nonverbal behaviors • Note potential outcomes

14. What did you observe? • Good, juicy questions • Missed questions • Nonverbal behaviors • Outcomes you thought would be selected • Outcomes you were surprised to see

15. Be natural and as informal as is appropriate; Put the parent at ease with this naturalness and informality; Look the parent in the eye when he or she is talking; Avoid the use of jargon; if the parent uses jargon, ask what he or she means; Nod and in other ways affirm what the parent is saying; From time to time, express admiration for what the parent does with his or her family; Express understanding about how the parent might feel (e.g., “I bet you feel really good about that,” or “I bet that’s really frustrating”); more safely, ask the parent how he or she feels; Place papers being written on flat, so the parent can see what is being written—distance notwithstanding; Find a point of personal contact and very briefly use “self-disclosure” or “therapeutic use of self”; If the parent cries, offer to stop the conversation; Critical Interview Behaviors

16. If the parent becomes emotional, either move on to another topic or ask if something else should be talked about; As much as possible, refrain from engaging in judgmental talk about the other parent, if only interviewing one parent; Ask about later, specific routines to move the interview along, if it is taking a long time; the goal is to end in 90 minutes; Ask detailed questions at the beginning of the interview to show the parent the level of detail required; and Keep the structure of the six questions per routine: What’s everyone doing? What’s this child doing? What’s this child’s engagement like? What’s this child’s independence like? What are this child’s social relationships like? How satisfactory is this time of day (home) or how good as fit are this routine and the child (classroom)? More Interview Behaviors

17. Outcome Selection • Interviewer reads aloud notes about potential problem areas. • The family selects 6-10 outcomes • The family put outcomes into priority order

18. RBI Report Form • State the routine • Prompts the new domains • Engagement • Independence • Social Relationships • Score satisfaction or goodness of fit • What Part C domains are addressed • Is this a concern?

19. Activity • Get into groups • Select one “mother” to be Lynn, Ophelia, or Ruth • Select another person to be the father, grandmother, or some other adult family member • Families, go off and read your story • During the interview, fill in details as necessary • Group, select a primary interviewer and a second person to help interview, take notes, etc. • Others, observe and take notes about the interviewers’ behaviors; you will be giving feedback

20. Activity (cont.) • Begin the RBI • At some point, jump ahead to later in the day • Cover at least six routines • On my signal, interviewers review with the family what you know so far • Interviewers have families select outcomes • To summarize • Interview • Review needs • Get family’s choice of 6 things to work on

21. Key Statements and Questions • “You don’t have to answer any questions you don’t want to.” • “Who is in your family?” • “Briefly describe your child.” • “What are your main concerns?” • “How does your day begin?” • Get the 6 pieces of information • “What happens after that?” • Get descriptions of 2 morning routines, then skip to 2 evening routines • “Let me remind you of the concerns you mentioned.” • “What would you like the team to work on?” • If necessary, remind the parent of issues that arose during the interview • “Which is the most important of these? And then?”

22. Activity (cont.) • Hints • Keep the flow going; do not ask and write, ask and write, ask and write…. • Get a good picture of the child’s functioning in the routine; do not gloss over each routine

23. Activity Review • Small group • Observers give feedback • Large group • Family members’ impressions • Interviewers’ impressions • Observers’ impressions

24. Implementation • Local decision: When should this be done? • Intake? • Evaluation? • Between evaluation and IFSP? • IFSP?

25. Adaptation • Increasingly, communities/programs are scoring instruments from information provided during the RBI! • What % of children tested for delay are ineligible? • If > 10%, • Do evaluations first or • Screen children at intake

26. Who’s There? • Family decides who they want from the family • Child does not have to be there • Minimize interruptions • Ideal to have 2 professionals • 1 is manageable

27. Roles of 2nd Person • Help with questions • Take notes • Handle interruptions • Score developmental test?

28. Implementation Decisions Groups of about 8 • As a group, answer the following questions, but everyone writes down the group’s answers • What 3 things did you like about the RBI? • Where can we fit in the RBI? • What are 3 challenges to implementing the RBI? • What is at least 1 solution for each of the 3 barriers?

29. 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)

30. Finito