Tuesday, August 27, 2019

How to Conduct an RBI With a Parent Who Has Two Children in Early Intervention


two babies lying on teal textile
unsplash.com
When you conduct a Routines-Based Interview with a family having two children in early intervention, you conduct one interview but end up with two plans. Here, I talk about the implications of having two children in the program for conducting the ecomap; asking about routines; the time, worry, and change questions; the recap; and goal decision making.

Ecomap

Who lives in the home, informal supports, and intermediate supports are largely unaffected by the number of children in early intervention in the family. Some formal supports might, however, pertain to one child only, in which case that should be indicated on the relevant box. One strategy is to put the initial of the child in question somewhere in the box. For example, maybe only one child receives speech-language services (by which we mean, the family and the primary service provider receive consultation from an SLP!). You create a box for that service and, perhaps, the therapist’s name and write in the child’s initial.

Routines

When we interview the family about children’s functioning in routines, we constantly check in with what each child’s engagement, independence, and social relationships are like. If the parent reports “they” do something, you might double-check that they both do it the same way. Not every time. If the parent has already established that they do a number of things the same way, you can often assume “they” really means both of them.

Notes

When the parent reports that one of them does not do something the other does do, use a clearly visible initial and draw the star. By this time, we’re really hoping they have different initials! Not Joshua and Jason! But you can go to the first and second letters, if you’re that unlucky. The clearly visible initial will become important for the recap and goal decision making. Generally, I would not draw a line down the paper, with one column for one child and one for the other child. The flow of the recap will go better if you intermingle the children. If you are interviewing and taking notes, it becomes burdensome to make two sets of notes. Ultimately, however, it is your decision. Ensure you keep the conversation on the routine and what the children and other family members are doing.

TWC Questions

The time question is rarely about the children, although, occasionally, a parent will say he or she wants more time with a child—one of the siblings in early intervention or perhaps another sibling altogether. The worry and change questions might be about one child only, in which case that would be treated the same as in the notes for the routines conversation, with an initial.

Recap

We still want the recap to fall in the 5- to 7-minute window. Much beyond that, and it’s hard to keep paying attention. The recap mentions what the children are not yet doing or what one or the other is not yet doing. This is why the designation of which child is related to a star/concern in the notes needs to be clear, so the recap can proceed smoothly.

Goal Decision Making

You need two sheets of paper or two columns for the informal goals the family decides upon. Some child goals will be shared, so they will go on both pieces of paper. For example, if the parent says, “I want them to use a cup with a spout,” you would write use a cup with a spout on both pieces of paper. Later, when it is time to decide on criteria for progress monitoring and attainment, those criteria might be different. One child might have more delays than the other, for example. Some child goals will be idiosyncratic, so they will go on only the piece of paper pertaining to that child. Family goals will go on both pieces of paper. For example, if the parent says I want time for myself—two hours once a week in the evening—that would go on both pieces of paper.

What about the ideal of having 10-12 goals? We count up all the shared goals (each shared goal counting as one goal) and add the idiosyncratic goals, aiming for a total of 10-12. After all, it’s one family addressing these goals, and the strategies for shared goals might be different for the two children.

Families love the fact that the Routines-Based Model, including the RBI, recognizes that parents of more than one child have multiple responsibilities. This sensitivity begins with the RBI, where we combine questions, until we have to separate plans. Each child has to have an individual plan, but the procedures described here integrate the needs assessment and intervention planning as much as possible.

Sunday, July 21, 2019

What Happens After the RBI?


The Routines-Based Interview (RBI) is arguably the best known component of the Routines-Based Model (RBM). It is the method we use for assessing child and family needs and the structure for helping families decide on goals. It is, however, only one part of the RBM. In addition to the functional and family goals produced by the RBI, we need to follow this up with effective practices so those goals are actually addressed.

In this post, I’ll describe how the RBI sets the stage for meaningful visits to caregivers, such as parents, teachers, and others caring for the child for substantial amounts of time. The RBI was never designed to be a stand-alone “family assessment.” It was always designed to be the beginning of an approach to working with families, children, and teachers (McWilliam, 1992).

Before the actual RBI begins, the interviewer develops the family’s ecomap by asking the family who lives in the home, about their informal, intermediate, and formal supports. The RBI itself is a semi-structured interview with one or more of the child’s primary caregivers. The interviewer asks the caregiver detailed questions about the child’s engagement, independence, and social relationships and the doings of everyone in the home. During these discussions of everyday life in the family, families often talk about matters other than the child’s functioning, such as about their own lives. We ask families also about whether they have enough time for themselves, about their main worries, and about anything they would like to change. At the end of the interview, families consider the whole conversation and choose 10-12 goals for their child and other family members, including the adults.

The hinge between this family-centered process to obtain goals and what happens after the RBI is the Routines-Goals Matrix. The matrix, shown below, can be completed whenever the RBI is done because, during goal decision making (at the end of the interview), the interviewer ascertains for what routines each skill the family chooses is needed. I developed this matrix from the list of informal goals developed during goal decision making. They are listed in the order of importance to the family (i.e., “prioritizing”).




Routines
Goals/Outcomes
Waking Up
Meals
Hanging Out
Outings
Outside
Dinner Prep
Bath Time
Bedtime
1.      Acknowledge people when they greet Jamal
X

X

X



2.      Spoon feed himself with little spilling

X






3.      Use one word or sign

X
X




X
4.      Play with  toy for 5 minutes


X


X


5.      Indicate what he wants.

X

X
X



6.      Walk without assistance


X
X
X



7.      Shamika get information about inclusive preschool options








8.      Shamika have 2 hours a week to spend with her BFF








9.      Jamal play without throwing toys


X


X

X
10.    Play in bath tub without excessive splashing






X

11.    Point to pictures named by an adult


X




X
12.    Shamika explore going back to work








 

Family goals don’t have routines assigned to them—hence the rows with no Xs. On the first visit after the RBI, the person providing support (i.e., services) to Shamika would ask a couple of questions to see what she might want to talk about. If she had no pressing matters, the professional would show Shamika the matrix and ask her to look at the goals/outcomes. The professional would ask her what she would like to discuss on this visit. If Shamika chose the first priority, acknowledge people when they greet Jamal, the professional and she would begin the solution-finding process. This practice is covered in our Routines-Based Home Visit Checklist. When Shamika chooses a child goal/outcome like this, the professional would ask at what time of the day. The matrix shows this goal was needed for waking up, hanging out, and outside. If Shamika said it was important at hanging out time, she and the professional would start on strategy development, which is the same as solution finding, for teaching Jamaal to acknowledge people when they greet him during hanging out time. The matrix therefore (a) shows the caregiver the list of goals/outcomes they chose and (b) reminds the partners of the contexts for the skill—why it’s needed.

Let’s say Shamika and her home visitor discuss a strategy (AKA solution or intervention) for her to use to address Jamaal’s acknowledging people when they greet him during hanging out time, and she decides the strategy is likely to work and is feasible for her to carry out. So, it’s time to move on to another topic. The home visitor can ask the horizontal question (look at the matrix!), “Would you like to talk about Jamaal’s acknowledging other people at other times of the day, such as waking up time or outside time or would you like to talk about other skills you’d like to see during hanging ou timet, such as Jamaal’s using one word or sign, playing with toy for 5 minutes, walking without assistance, playing without throwing toys, or pointing to pictures?” This question allows for a smooth transition to another goal or routine the family has identified as a priority.

Here, I have used a home visit as an example, but you can see how a similar approach would workwith a child care provider or preschool teacher. The routines would be classroom routines, and the early interventionist would ask the teacher what skill he or she wanted to work on and proceed accordingly.

The RBI (a) arrives at truly meaningful functioning the parent wants for their child, (b) identifies the contexts (i.e., routines) for that functioning, and (c) reveals family needs that directly or indirectly have an impact on child functioning. The matrix captures all that information, which helps the early interventionist and the caregiver focus on skills and contexts.

We’ve always known the RBI is only the beginning. Now, I hope you’ll see how it leads to meaningful supports to caregivers… and improved functioning in children.

McWilliam, R. A. (1992). Family-centered intervention planning: A routines-based approach. Tucson, AZ: Communication Skill Builders.