Introduction to the Routines-Based Interview Method

1. Introduction to the Routines-Based Interview Method Kellie Horn khorn@esd123.org Chris Miller chris.miller@esd112.org

2. We agree that… __________, with the necessary supports and resources, can enhance their children’s learning and development. • Early intervention service providers • A few families • All families • None of the above-It is not possible to provide enough support and resources for families to enhance their children’s learning and development.

3. Agenda • RBI in Real Life • The purposes of the RBI • Completing an RBI • RBI in the IFSP Process • Implementing the RBI

4. The RBI in Real Time

5. Observing the Demonstration • Look for: • Good, juicy questions • Missed Questions • Nonverbal Behaviors • Important Assessment Information • Likely Outcomes

6. “Routines are naturally occurring activities happening with some regularity. “ (R.A. McWilliam, 2009)

7. 3 Main Purposes of the RBI • Develop a list of functional IFSP outcomes • Assess child and family functioning • Establish a positive relationship with the family

8. 6 Steps for Completing an Interview • Step #1: Introductions and main concerns • Explain the purpose and process • Clarify who lives in the home and other resources that may be relevant throughout the interview • ecomap • *Ask about main concerns for the child and family

9. 6 Steps for Completing an Interview • Step #2: Gather information from the family using the family’s routines as the agenda, take notes & star concerns Six Items: 1. What everyone does at this time • Provides information about the task demands of the routine for everyone 2. What the child does • Assesses the interaction of the child’s interests or abilities with the demands of the routine 3. What the child’s engagement is like • The extent to which and quality with which the child participates in the routine

10. 6 Steps for Completing an Interview • Step #2: Gather information from the family using the family’s routines as the agenda, take notes & star concerns (continued) Six Items (cont.): 4. What the child’s independence is like • Extent to which the child can perform the demands of the routine by himself or herself 5. What the child’s social relationships are like • Information about how the child communicates and gets along with others 6. How satisfied the family is with this routine

11. 6 Steps for Completing an Interview • Step #3: Ask families about their satisfaction with each routine • Helps them solidify how much they really want to change it • Provides some insight into the family’s quality of life • On a scale of 1 to 5, how well is this time of day working for you?

12. 6 Steps for Completing an Interview • Step #4: Worry & change questions • When you lie awake at night, worrying, what is it you worry about? • If there’s anything you could change in your life, what would it be? • Step #5: Identify concerns and priorities • Parent selects outcomes and prioritizes • Step #6: Write outcomes • Informal outcome statements into formal ones using 7-step process

14. Quality Indicators of an Interview • Active listening • Repeats what the parent says vs. simply saying, “Okay” • In-depth follow-up questions • Helps the parent paint a picture of the routine and child’s functioning within routine • Continuing conversation • Not ask, listen, write, ask, listen, write

15. Quality Indicators of an Interview • Proactive questioning about child development • What the child is likely to do next • “Smart questions” • Reveal understanding about family functioning • Nonverbal messages • Convey acceptance and interest (e.g., smiling and nodding) • Social milieu of routines • Context of the child’s engagement

16. Quality Indicators of an Interview • Seeking evaluative and interpretive opinions • Ascertaining the family’s opinion about the child’s and family’s functioning • Managing the conversation • Control pace, deal with distractions, etc. • Empathizing • Convey understanding and emotional connection with both hardships and successes

17. Practice, Get a Feel for the RBI • Divide into groups of 2 to 3 people • Decide who will be the parent, who will be the interviewer(s), and the note taker • Mothers read vignette • Interviewers use the RBI protocol and note taking form to go through the interview • Debrief

18. The IFSP Process happens in the “Context of the Family’s Everyday Life” • Identify priorities & concernsand resources within the context of the family’s daily life • Assess the child’s functioning (and development) in the context of the family’s daily life • Identify opportunities to help the family help their child make progress toward IFSP outcomes in context of the family’s daily life • Develop IFSP outcomes that can be addressed in the context of the family’s daily life • Plan strategies and activities that address outcomes with families and other caregivers in the context of the family’s daily life

19. Types of Information • Family concerns & priorities (IFSP Child Outcomes) • What is challenging right now? • What should the team address first? • Family resources & strengths (IFSP Child Outcomes) • What the family has to meet their child’s needs • Child/Family routines & activities (IFSP Child Outcomes & SFP) • Events and activities that occur with some regularity in the family’s everyday life • Child’s level of functional performance in the context of the family’s everyday life (IFSP Child Outcomes & SFP) • How the child uses developmental skills to function in the context of the family’s every day routines and activities • Child’s present levels of development and skills (IFSP Child Outcomes & SFP) • What the team knows about the child’s various abilities, strengths and needs

20. Questions to Consider • How do you gather information needed for the IFSP Process? • Family/Child Routines & Activities • Concerns & Priorities • Resources & Strengths • Child’s development and functioning in the 3 global child outcome areas

21. The Process Begins… Susie, the Amazing FRC visits Jack’s house for the first time and… • explains the ESIT program to the family • shares brochures (A Family’s Guide to Early Intervention in Washington State, Family Outcomes brochure and ESIT Guiding Concepts, and DMS Family Brochure) • explains and provides parent rights and procedural safeguards, discusses reasons for referral • determines if the family wishes to participate in the Part C program

22. The Process Continues… • determines if the screening is needed to decide if an evaluation/assessment is appropriate • If screening is necessary: • provides Notice and Consent for screening to parents • explains parent rights • conducts screening • If it is determined that an evaluation is needed • provides Notice and Consent for Initial Evaluation, • obtains written parental consent to obtain information from other agencies and release ESIT information, explains how the information will be shared with other team members

23. 45, 44, 43, 42…

24. A Complex Process

25. *This information is used by the team to choose a COS rating in the DMS.

26. Gathering Information from Families is an Adaptive Process! • Team members need to know their role and responsibilities as a member of the team • Team members must have shared understanding of what is being assessed (i.e. define “routines & activities”) • Team members must have consensus on the process for each member to gather information about the family’s routines, priorities, concerns, resources, and child’s development and functioning in his everyday life

31. FORMAL vs. INFORMAL • Formal supports = 1 hour of a family’s daily life • Intermediate supports = planned or organized • Informal supports = a constant

32. Using Information about Resources in the IFSP Process • Establish a family-centered process/relationship (not child-centered) • Family’s early experiences in early intervention are often related to the child, such as evaluation and development of the IFSP outcomes • Build the foundation for the IFSP process with existing supports (not services) • Develop an effective overall plan based on strengths that the family has for supporting their child’s development.

33. Child/Family Information & Medical Info. • “How is Hope’s health?” • “Please tell me everything about Hope’s…birth history, medical conditions or diagnoses, illnesses, hospitalizations, vision and hearing screening and other developmental evaluations (right now)?” • “Has Hope had previous developmental evaluations/assessments, early intervention and/or therapy services?” • “Can I have all of the records (right now)?” • “So…who lives in your home?”

34. One Method… The Ecomap A graphic representation of the family supports (people and agencies) and the links to those supports

37. Scale for Assessment of Family Enjoyment within Routines (SAFER) Waking up 1. Could you describe what wake up time is like? 2. Who usually wakes up first? 3. Where does your child sleep? 4. How does your child let you know she is awake? 5. Does she want to be picked up right away? If so, is she happy when picked up? 6. Or is she content by herself for a few minutes? What does she do? 7. What is the rest of the family doing at this time? 8. Is this a good time of day? If not, what would you like to be different? How Satisfied (1-5)? _____

39. Discussion • How do you get information from families about their concerns, priorities, resources and routines?

40. Child Assessment

43. Measure of Engagement, Independence, and Social Relationships (MEISR)a Functional domain: E = engagement, I = independence, S = social relationshipsb Developmental domain: A = adaptive, CG = cognitive, CM = communication, M = motor, S = socialc Outcomes: S = positive social relations, K = acquiring and using knowledge and skills, A = taking action to meet needs

44. Discussion • How do you get information from families about their child’s development, participation, and functioning in the 3 global child outcome areas?

45. IFSP Outcomes

46. In a RBI model IFSP outcomes are: • Derived from functional routines-based needs • Measurable • Logical criteria • Frequency displayed in 1 week • Behaviors MUST be necessary, meaning without it the child would not be able to function in everyday routines

47. Criteria for Functional Outcomes • Reflect the priorities of the family • Useful and meaningful • Reflect real-life situations • Free of jargon • Measurable • Keep IFSP outcome functional • Engagement, independence, and social relationships!

48. Tips for Writing Functional Outcomes • Write outcomes that can be addressed by multiple people, at multiple times of the day, during normal routines and activities • “Auguste will participate in outside play by stepping up and down on to and off different surfaces” • NOT “Auguste will step up and down on the stair equipment in the PT Center”

49. Tips for Writing Functional Outcomes • Ask yourself, “Why is the child working on this goal?” • Auguste is working on this goal so he can participate in outside play. • Be clear! • NOT “Auguste will maintain a four-point position for 30 seconds five times a day”

50. Why Write Participation-Based Outcomes? • Ensures that the context in which the skill is needed comes first, so everyone working on the outcome understands that the desired behavior (i.e., the target skill) is not meaningful in and of itself but how it helps the child participant in homes, school, and community (Wilson, Mott, & Batman, 2004). • Prompts adults to work on the skill at the times of the day when the skill is needed.