Routines Based Early Intervention

1. Routines Based Early Intervention Principles for TVI’s DeEtte Snyder State Coordinator, Birth to 3 Vision Services Washington State School for the Blind

2. Goals for Presentation Questions we will answer: • What is Routines Based Early Intervention (RBEI)? • Why is this important for children with B/VI and their families? • How can TVIs, who provide EI services, implement these principles and strategies as they support families and children with B/VI?

3. Mission of Part C-Early Intervention Services Part C early intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children’s learning and development through everyday learning opportunities. Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. (2008). Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved from http://ectacenter.org/~pdfs/topics/families/Finalmissionandprinciples3_11_08.pdf

4. For further exploration… The Early Childhood Technical Assistance Center www.ectacenter.org • Mission and 7 Key Principles • Agreed Upon Practices • Seven Key Principles: Looks Like/Doesn’t Look Like

5. What is Routine Based Early Intervention? Interventions that are focused in naturally occurring activities in the family and child’s daily life. Meaningful and repeated experiences are the critical foundation of learning. Focus of intervention support should be placed on those that interact with child on regular basis…the parents not the professional. Participation is engagement. Engagement is the foundation for routine based intervention!

6. Otherwise known as… • Family Guided Early Intervention • Participation Based EI • Activity Based EI • Individually responsive coaching • Responsive teaching • Incidental teaching • Embedded instruction

7. 4 Principles of RBEI • Family Centered Practice • Family Systems and Ecology • Trans-disciplinary Service Delivery • Complexity of Home Visits (McWilliam, 2010)

8. Why RBEI is important for young children with B/VI? Berthold Lowenfeld’s 3 Basic Limitation of a Visual Disability • Range and variety of experiences • The ability to get about • Interaction with the environment These limitations are best intervened through the use of repeated, meaningful, hands on experiences through daily activities with family members.

9. What is a “routine”? • Beginning and ending • Outcome oriented • Meaningful • Predictable • Sequential or systematic • Repetitious (FGRBI, Florida State University, 2014)

10. Poll #1 What defines a Routine?

11. Answer to Poll #1 Bath time Trip to zoo Breakfast A visit from Grandma who lives out of state Trip to grocery store Weekly visit from EI service provider Yes No Yes No Yes no, but how can it be made a routine?

12. Video #1“Ready to Change” As you watch Joel and his mother in their diaper routine, try to answer the following: • What is the beginning and the ending? • What is the outcome? • What is meaningful? • What is predictive? • What is the sequence? • What is repetitious?

13. Paradigm Shift • Parent priority and concerns not child deficit • Activity based not skill based • Coaching for parents not direct instruction to child • Most learning occurs in between the specialist’s visits • Caregivers and parents “own” the goal not the professional. (McWilliam, 2010)

14. Role of the TVI in EIGeneralist or Specialist? • Informational, instructional, and emotional support regarding everything about vision or lack of vision and its impact on learning. • Ongoing Functional Vision Assessment • Child’s specific vision condition (including interpreting medical records) • All sensory learning modalities • Appropriate environmental adaptations • Consult multi-disciplinary team on how vision affects learning in all development areas • Address issues specific to visual impairments (Expanded Core Curriculum) • Social interaction and attachment • Incidental learning for concept development • Differences in adaptive behaviors • Use of other senses to explore world (Chen, 2014; Hatton, McWilliam, & Winton, 2002)

15. ECC: The Expanded Core • Disability-specific skills or vision related skills • Complements core curriculum • Necessary for complete accessibility to learning environment (both home and school) • Taught by TVI and COMS • Begins in early intervention • Important to introduce to parents at an early age • They are child’s first teacher • Advocacy www.familyconnect.org

16. 9 ECC Areas Compensatory Orientation and Mobility Social Interaction Independent Living Recreation and Leisure Sensory efficiency Technology Career Education Self Determination

17. Developing Outcomes • Priorities and Preferences • Functionality • Generality • Ease of Integration • Developmental Appropriateness (Chen, 2014)

18. Video #2“Bedtime” Let’s watch Christopher and his mother in their bedtime routinepay attention to the following through the lens of a TVI to prepare for writing an outcome: • Priorities and Preferences • Functionality • Generality • Ease of Integration • Developmental Appropriateness

19. Poll #2 Which one of these goals is an appropriate IFSP outcome to help expand Christopher and his mother’s bedtime routine?

20. Answers to Poll #2 • Christopher will reach towards preferred objects in other activities. Yes. Generalizing and ease of integrating the skill of reaching (visual motor) to other activities. • Christopher will reach 10 times. No…not meaningful or functional. • Christopher will repeat “night night” or give kisses in response to his mother at bed time. Yes. Expands his use of language and social engagement, which is developmentally appropriate. • Christopher will say “night night”. No…not meaningful or functional, and actually limited.

21. Strategies from TVI to Support Goal • Attention to sensory information vision, hearing, tactile, smell • Environmental adaptions example: lighting • Material adaptions example: high contrast • Instructional adaptions (“teaching” from parent) example: hand under hand

22. Sensory Experiences in Bath Time • Vision • red washcloth, bubbles, yellow shampoo bottle • Auditory • Splashing and running water, squeaky toy • Tactile • Temperature of the water, soft washcloth, shampoo in hair • Smell • Shampoo, soap

23. ViSioN Program:Vision Skills in the Natural Environment Includes: 4 “scenarios” of child disability level • No vision • Low vision • Vision loss and mild/moderate additional disability • Vision loss and severe additional disability 4 developmental areas • Sensory • Literacy and Readiness • Visual Motor • Independence (Neilsen & Petersen, 2005)

24. ViSioN Program:Vision Skills in the Natural Environment Routines • Child (bathtime, bedtime, dressing) • Family (cooking, mealtime, games) • Play Activities (outdoor, indoor) • Literacy (Storytime, trips to library) • Outings (riding in the car, shopping, pets/nature, eating out) • Holiday/Seasonal (birthday, seasonal awareness) Parent Lessons • Skills/behaviors for each developmental area and how to embed into routine • Description in the child’s voice with clear instructions for ideas to individualize (Neilsen & Petersen, 2005)

25. Conclusion… Questions?Ideas during other routines? Discussion?

26. Contacts DeEtte Snyder State Coordinator of Birth to 3 Vision Services Washington State School for the Blind DeEtte.Snyder@wssb.wa.gov (360) 696-6321 x172

27. References Chen, D. (Ed.). (2014). Essential Elements in Early Intervention: Visual Impairment and Multiple Disabilities. New York, NY: AFB Press. Family Connect. (nd). The Expanded Core Curriculum. Retrieved from www.familyconnect.org/info/education/expanded-core-curriculum/13 Hatton, D. , McWilliam, R., & Winton, P. (2002). Infants and toddlers with visual impairments: Suggestions for early interventionists. Eric Digest, ED473829. McWilliam, R. A. (2010). Routines-Based Early Intervention: Supporting Young Children and Their Families. Baltimore, MD: Paul H. Brooks Publishing Co. Petersen, B. & Nielsen, J. (2005). Vision Program: Vision Skills in the Natural Environment. Utah Schools for the Deaf and the Blind. Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved from http://ectacenter.org/~pdfs/topics/families/Finalmissionandprinciples3_11_08.pdf ViSioN Program available through Hope Inc. at www.hopepubl.com