Using Progress Monitoring to Support RTI Services for Infants and Toddlers

1. Using Progress Monitoring to Support RTI Services for Infants and Toddlers DEC October, 2008

2. Presenters • Charles Greenwood , Jay Buzhardt, & Dale Walker • Juniper Gardens Children’s Project, University of Kansas • Jerry Gruba, & Sheri Haupert • Heartland Area Education Association, Johnston, Iowa

3. Objective To examine the role of progress monitoring and decision making regarding children’s response to intervention (RtI) in tiered models of early intervention. To illustrate an RTI approach using Individual Growth and Development Indicators (IGDIs) home visiting by providing multiple levels of support for children learning early communication skills.

4. Presentation Topics • Introduction to Progress Monitoring– Charles Greenwood • Data-based decision making – Jay Buzhardt • Evidence-based language intervention practices – Dale Walker • Discussants • Jerry Gruba • Sheri Haupert • Q & A

5. Defining Progress Monitoring • A scientifically based practice that is used to assess children’s short-term progress toward outcomes and evaluate the effectiveness of instruction. • Designed to “help caregivers implement and modify curriculum and teaching practices to ensure that all children, including children with disabilities, are progressing toward identified goals” (DEC Promoting Positive Outcomes.., pg 14) • Brief, repeatable formative assessment sensitive to short-term child learning • Benchmarks help decide when a child is or is not progressing • Individual Growth and Development Indicators (IGDIs) www.igdi.ku.edu

6. Features of Progress Monitoring Measures Reflect progress toward a socially valid general outcome Strategic (a leading indicator) not comprehensive measurement Chart an individual’s progress Brief and quick to administer Repeatable (rate of growth, slope) Trend line compares expected vs. actual rates of learning

7. The most well known IGDIs are Pediatric Growth Charts Widely used by pediatricians and parents

8. Monitoring a Child’s Progress Acquiring Expressive Communication Proficiency 36 Mos Expectation Child’s Observed Trajectory Normative Trajectory

9. ECI Constructs and Key Skills

10. Administration Toy Form A: House Toy Form B: Barn • Administration Procedures • Toy-play setting with familiar adult as play partner • 6-minute testing sessions • Play partner’s role is to facilitate play and follow child’s lead • Set-up/clean-up/put away • Alternate Toy Forms • Observational Recording Procedures

12. Data-based Decision Making Framework Progress Monitoring Monitor Identify/ Validate Need For Intervention Exploring Solutions Generate Intervention Strategies Evaluate Intervention Effectiveness Implement Intervention Monitor ©2003 Juniper Gardens Children’s Project

13. Family Involvement Each family plays a role in the decision making process with respect to review of child progress data and decisions about need for intervention Caregivers are involved in the home-based assessment process and as implementers of intervention strategies

14. Diversity • Individual differences • RTI and IGDIs reflect the fact that children with and without disabilities develop and respond to early intervention differently • Children require different intervention intensities to learn. • Children vary in their rate of progress over time • IGDIs are sensitive to this diversity • Language differences • IGDIs may be administered by assessors skilled in the native language of the family and child as well as in English.

15. Key RtI Principles • A child’s RtI is a critical determinant of appropriate intervention services • Measures to make this determination must be sensitive to short-term progress and monitor progress over time (IGDIs) • Evidence-based practices are provided forchildren who are not responsive to Tier 1 intervention (Language Intervention Strategies)

16. Conceptualizing RTI in an EHS/Part C Home Visiting Context • Home Visiting is a predominant service delivery mode in early intervention, birth to 3 services. • Early Head Start Programs • Part C, IDEA Services • 80% of children received Part C services in the home (2005 Report to Congress) • Only 30% of home visits were rated as • family-centered, participation-based versus • traditionally provided services (e.g., Campbell & Sawyer, 2007; Peterson et al., 2007).

17. Multiple Levels of Support for Early Communication • Tier 1 – All Children • Home visitors provide general support and resources to parents to encourage use of strategies to promote communication • Tier 2 – For Children who are below benchmark and making less than expected communication growth • Individualize intervention decisions • Improve home language environment using participant-based strategies, more frequent progress monitoring, measures of intervention fidelity • Tier 3 – not making progress – may be Part C eligible • more intensive practice, modeling, additional strategies • add expert based services (e.g., SLP) to Tier 2

18. Using Evidence-based Practice Dale Walker

19. Using effective interventions to promote communication • Importance of using effective, evidence-based interventions to promote communication • Importance of exploring possible reasons for child not performing at expected levels • Importance of deciding what the possible resources are to effectively deliver intervention • Importance of monitoring intervention delivery to make sure that it is effective in promoting communication

20. Selecting Intervention from ECI Dropdown Menu • When ready to begin an intervention • Select intervention description from menu on Child Data Entry Form • Select menu under Condition Change • Select intervention that best describes the intervention

22. Child before and after intervention Intervention or condition Line Child’s Scores Child’s Trajectories Child Trajectories Slightly Below Benchmark Benchmark Trajectory Below Benchmark

23. Evaluating and monitoring intervention effectiveness • Continue administering ECI monthly or quarterly • Look at Key Skill Elements and Total Communication rates to check that they are moving toward benchmark • Look at the slope of communication progress to determine if the slope is increasing • Is there evidence that intervention has increased communication? • If progress is not at expected rate, examine intervention and make necessary changes

24. Key Skill Elements: Gestures Graph

25. Key Skill Elements: Vocalizations Graph

26. Resources for Intervention Decision- Making • Programs and interventionists able to select interventions of their choice and use ECI to monitor progress • IGDI website provides resources for intervention for programs/interventionists who would like intervention resources • Found that some programs and interventionists could benefit from more support for intervention decision making and generating intervention ideas that are individualized • Developed and are in the process of testing an online decision making model to support individualization • Indexed intervention recommendations from two sources to the ECI benchmarks to assist with individualization

27. ECI Key Skills Fitted Trajectories 3V /1.5G min 1 W/ min

28. Evidence-based Early Communication Interventions • Incidental, Milieu, and Responsive Teaching Language Intervention research • Evidence-based practices for home visitors • Language Intervention Tool Kit (Crowe, 2002) • Promoting Communication Strategies (Walker, Small, Bigelow, Kirk & Webb, 2004) • Early Communication Indicator (ECI), the communication IGDI

29. Making Strategy Determination Data-based • Helping gestures and vocalizations become words • Child is communicating mostly with gestures and vocalizations • When single word fluency is less than 1 per minute and gestures (1 to 1.5) and vocalizations (3.5 ) • Helping the child learn new words (expand vocabulary) as they are becoming word users • When single word fluency is less than 2.5 per minute • Helping the child combine words into sentences • When multiple word fluency is less than 5.0 per minute • Expanding and encouraging more multiple words as child moves into fluency at 5 multiple words per minute

30. Practice Recommendations • In the Language Intervention Tool Kit, these strategies are identified as Preverbal and are described on pages 13 – 21 • Feeding (p. 13 -14) • Diapering (p. 13, 15) • Bathing (pp 13, 16 & 19) • Reading (p. 13, 20) • Drawing/Writing (p. 13, 21)

31. Practice Recommendations In the Promoting Communication Manual, strategies for children communicating mostly through gestures and vocalizations include: • Following Child’s Lead (pp. 16 -17) • Commenting and Labeling (pp. 22 - 23) • Imitating and Expanding (pp. 28 - 29) • Using Questions (pp. 34 - 35) • Providing Positive Attention (pp. 46 - 47) • Providing Choices (pp. 52 – 53)

32. Helping Gestures and Vocalizations Become Words Responding to child’s communication so the child learns that they can get needs fulfilled and attention when they communicate Talking more and often to a child so that they hear words and labels for people, toys and activities of interest to them. Showing an interest in what the child is playing with, looking at, or exploring and commenting or labeling the toy or activity Expanding on the child’s vocalizations by repeating them back in words so child hears the words that are related to objects or activities of interest

33. Helping the Child Expand Vocabulary as they are Learning to Use Words • These strategies give adults ideas on how to expand children’s vocabulary as they begin to use words. The types of strategies used to promote communication at this level include: • Labeling words children may use as they engage in a variety of indoor and outdoor routines and activities • Commenting about what a child is doing or what the adult is doing so the child hears words paired with actions • Expanding on the child’s use of a vocalization or word by repeating the word correctly and adding another word to the sentence • Pausing before giving a child the label for something so that the child has the opportunity to say it on their own • Reading books with children in a manner that allows the child to point to and label pictures and to see words

34. Practice Recommendations • In the Language Intervention Tool kit, available strategies for helping promote multiple word sentences are identified as Expanding Verbal. Strategies are available for increasing Talk during: • Dressing (pp. 37, 38) • Eating (pp. 37, 39) • Inside Play (pp. 37, 40) • Reading (pp. 37, 41) • Writing (pp. 37, 42) • Math (pp. 37, 43) • Outdoor Play (pp. 37, 44)

35. Data-based Decision Making for Infants and Toddlers Jay Buzhardt

36. Discussion Highlights • Making Online Decisions (MOD) – A model for data-based decision making • What is it? • How is it used? • Pilot implementation with Early Head Start • Challenges and future directions

37. Making Online Decisions (MOD) The MOD is a web-based tool informed by the ECI that supports data-based decision making and a general RtI model for infants and toddlers

38. How Does the MOD Help Service Providers Make Data-based Decisions? • Quickly identifies children who are performing below benchmark on the ECI • Prompts problem solving to determine why a child might be low on the ECI • Recommends evidence-based, caregiver-delivered language strategies based on child’s ECI performance • Provides tools for monitoring implementation fidelity • Reports whether or not the strategies are working; and recommends what to do next

39. Case Example of the MOD You conduct an ECI with child and enter it into the online data system

40. Is There A Problem? The system shows that this score is “Below Benchmark” Popeye’s EHS Oyle, Olive Oyle, Olive

41. The MOD asks if the assessment was ‘valid’ If invalid, do another ECI within two weeks If valid, “Why Is It Happening” stage of the MOD is initiated Is There A Problem? Was the assessment valid?

42. Why Is It Happening? Answer three brief questions to help determine why this child’s language may be falling below benchmark Medical issues, major family changes, or changes in her daycare environment are considered If recent change or medical condition is identified… Child moves to monthly ECIs If the cause of the problem is unknown… Child moves to monthly ECIs “What Should Be Done” is initiated Language Strategies are recommended immediately

43. What Should Be Done? MOD recommends strategies and routines for the caregiver(s) to try based on the child’s ECI key skill elements Recommended strategies are indexed to Language Intervention Tool Kit Promoting Communications Strategies Manual Home visitor chooses routines he/she believes would be most appropriate for the caregiver.

44. Is It Being Done? On each subsequent home visit, home visitor completes an implementation fidelity checklist How much are they using the strategies? Which ones do they like the most? Are they having trouble using them? Are they noticing any language improvement? Enters checklist into the MOD

45. Is It Working? Three ECI’s after the caregiver(s) receive the recommendations… MOD analyzes ECI performance ECI before and after the recommendations were provided ECI slope Expected ECI performance six months from now

46. Is It Working? After 3 more ECIs, MOD compares communication before and after, makes recommendations The “What Should Be Done” recommendations will adapt to reflect changes in performance on the Key Skill Elements. Manhattan, Mike Manhattan, Mike

47. MOD Preliminary Implementation Three Early Head Start programs throughout KS Home visitors with a case load ≥ 2 in each program randomly assigned to MOD (N=18) No MOD (N=17) Monthly Monitoring Indicator

48. Future Directions More graphing options, permit users to include/exclude benchmark performance Phasing in more programs around Kansas into the MOD Allow for the use of other interventions in the MOD IGDI assessments and MOD delivered via handheld computers Allow for more immediate “point-of-care” recommendations

49. References Campbell, P. H., & Sawyer, L. B. (2007). Supporting learning opportunities in natural settings through participation-based services. Journal of Early Intervention, 29, 287-305. Carta, J. J., Greenwood, C. R., Walker, D., Kaminski, R., Good, R., McConnell, S. R., et al. (2002). Individual growth and development indicators (IGDIs): Assessment that guides intervention for young children. Young Exceptional Children Monograph Series, 4(15-28). Crowe, L. (2002). The Language Intervention Toolkit. Topeka, KS: Kansas Department of Social and Rehabilitative Services. Greenwood, C. R., Carta, J. J., Baggett, K., Buzhardt, J., Walker, D, Terry, B. (2007). Best Practices in Integrating Progress Monitoring and Response-to-Intervention Concepts Into Early Childhood Systems. In Best practices in School Psychology, V (A. Thomas & J. Grimes Eds.), pp. 535 – 548. National Association of School Psychologists: Bethesda, MD. Greenwood, C. R., Carta, J. J., Walker, D., & Hughes, K. (2006). Preliminary investigations of the application of the Early Communication Indicator (ECI) for infants and toddlers. Journal of Early Intervention, 28(3), 178-196. Peterson, C. A., Luze, G. J., Eshbaugh, E. M., Jeon, H., & Kantz, K. R. (2007). Enhancing parent-child interactions through home visiting: Promising practice or unfulfilled promise? Journal of Early Intervention, 29, 119-140. Walker, D., Carta, J. J., Greenwood, C., & Buzhardt, J. (2008). Individual Growth and Development Indicators: Their use in progress monitoring and intervention decision making in early education. Exceptionality, 16, 33-47. Walker, D., Small, C., Bigelow, K., Kirk, S., & Harjusola-Webb, S. (2004). Strategies for Promoting Communication and Language of Infants and Toddlers Manual. Juniper Gardens Children's Project, Schiefelbusch Institute for Life Span Studies, University of Kansas.