I Know We Need to Improve 619 Services, But Where Do I Start?

1. I Know We Need to Improve 619 Services, But Where Do I Start? Robin McWilliam Siskin Children’s Institute Chattanooga, TN www.siskin.org

2. Outline • Ecological issue of inclusion • Proposed practices to improve • Implementation stages • Implementation planning • Drawbacks and benefits

3. Ecological Issue of Inclusion

4. Who are the child’s natural caregivers? How many hours a week make a difference? Ecological Issue

5. Ecological Issue • Short classroom times are extended clinic times! • Long classroom times are natural environments (sort of). • Short classroom times stress the family ecology (transitions to other child care, incl. home). • Long classroom times reduce transitions.

6. Good classrooms are good for kids. Bad classrooms are bad for kids.

7. Proposed Practices to Improve • Assessment: functional, needs-based, contextual—for individualized planning • Partnerships with families • Goal functionality (IEP quality) • Teamwork • With other professionals • Effective use of all adults in classroom • Inclusion • Teaching • Child engagement • Data collection • Teacher as PSP, addressing all areas of child functioning • Training and supervision

8. Keys to Successful Inclusion • Components of the Engagement Classroom Model • Promoting Children’s Engagement, Independence, and Social Relationships

9. Components of the Engagement Classroom Model

10. Robin McWilliam Unified Model of Early Intervention 0-5

11. 1. RBI and Functional Goals • Semi-structured, in-depth interview about child functioning at home and in classroom • Results in 10-12 family-chosen child and family goals • Child goals written as participation-based goals Emma will participate in meals, play, dinner preparation, and outside by using words or signs. We will know she can do this when she uses 3 different words or signs at two times of the day (meals, play, dinner preparation, outside) on 4 consecutive days.

12. 2. Organization by Routines • Context is everything • Home and classroom routines for needs assessment • Participation in routines for child goals • Interventions designed to be carried out in naturally occurring routines • Consultation around interventions carried out by caregivers in routines

13. 3. Behavior Management • Prevention through engagement in activities • Sit and watch for teaching appropriate participation (consequating undesired behavior) • Behavior plans using reinforcement theory for persistent challenging behavior

14. 4. Family/Collaborative Consultation For professional visitors to classroom • Collaborative not expert consultation • Hoosiers rule • Joint problem solving (solution finding) • Consultant-teacher relationship

15. 5. Data • Intervention fidelity data (process evaluation) • Checklists • Proximal outcomes • Goal functionality • Engagement • Goal attainment • Distal outcomes • Child progress • RBI Implementation • Incidental Teaching • Integrated Therapy • Receiving Consultation • Zone Defense Schedule • Goal Functionality Scale III • Engagement Check II • STARE • Goal Attainment Scale • Minnesota Individual Child Engagement (MICE)

16. 6. Checklist Training • Define expectations • Platform for feedback • Performance data • Diminishes feeling of being judged • Who’s available to observe?

17. 7. Integrated Therapy • …and itinerant special education • Individualized within routines • In the classroom • Join the child in whatever he or she is engaged with • Weave interventions into that engagement • Model for and observe teachers • Communicate with teachers

18. 8. Incidental Teaching Engage Prompt Longer Respond More sophisticated Next steps Elicit Specific goal Reinforce Developmentalhierarchy More differentiated Generalizable

19. 9. Inclusion • Reverse mainstreaming • Natural proportions • Engagement (participation) • Independence (including from prompts) • Social relationships (“socialization”)

20. 10. Zones • Room arrangement • Adult organization • Transitions

21. Implementation Stages

22. Implementation Planning

23. Ensure everyone knows general components of model to be discussed List practices group is interested in Discuss quality Ignoring model, what needs to improve across the state (or other entity) 15-20 needs Implementation Planning

24. See whether practices address quality improvement needs What needs won’t model address? Document that these will remain unaddressed Timelines for practices Implementation Planning

25. Action steps for implementation of each practice How will practitioners become aware of the practice? How will you show that the desired practice is different from what they’re currently doing? What materials are needed to describe the practice (e.g., checklists)? What materials are available as background on the practice (not that anyone ill read them)? Will you use pilot sites with replication statewide or statewide training and implementation from the beginning? vi. How will you show the practice? What do you have to do to ensure coaching/supervision is available? Implementation Planning

26. End of the day: List of practices Timelines for full implementation and PD periods Action steps List of improvements that will be addressed List of improvements still needing consideration Implementation Planning

27. Goal – Early intervention in Aotearoa will be engaged in these best practices by July 20185 Year Time-line R-BEI Best Practice Implementation Plan Check points along the way

28. Montana Statewide RBEI Implementation Timeline Goal – RBEI practices will be fully implemented in Montana by June 2016 (implementation by FSSs by December 2015)

29. Drawbacks and Benefits Drawbacks Benefits • Apparently superficial needs assessment • Limited by what’s in model under consideration • Draws on so-called wisdom of stakeholders • Model has usually been tested • Model means practices fit together • Purveyor is identified • Long-term plan • Allocate resources across plan • Systematic preparation • Systematic sustaining