Dynamic Impact Helps a Maryland County Implement the Routines-Based Interview

 Written with Jennifer Dale and Mary Hendricks

Implementation of the Routines-Based Interview across a program requires a commitment of all members of the team, from leadership to direct providers of services.  One small program in Maryland has made great gains by applying the practices of Dynamic Impact to the implementation of RBI across all Part C providers. 

St. Mary's County, MD (Google Maps)

In February 2019, St. Mary’s County in Leonardtown Maryland held a five-day RBI institute for the county’s 13 providers of early intervention and 2 child find evaluators. This institute, modeled on the International RBI Certification Institute, provided content, demonstration, practice and a plan for fidelity for all providers.  With three internationally certified RBI coaches already on staff in conjunction with a state RBI content coach, this program was set for positive results for use of the RBI with fidelity.  By June 2019, two additional providers had met fidelity criteria for the interview. 

Dynamic Impact was suggested as a means for sustainability and scalability. 

Dynamic Impact is a systematic approach designed to support teams to implement evidence-based practices using a customized training package.

  Data-informed and decision-making practices are highlighted as key elements to a team-based approach for focused continuous improvement.    A team of seven, including St. Mary’s leadership, and direct service providers as well as members from the Johns Hopkins University Center for Technology in Education developed a vision and mission statement and set goals for the year long work.  The goals included increasing the number of RBI interviewers, using the RBI during initial individualized family service plans (IFSPs) and annual reviews, and ensuring that IFSPs were of high quality, as measured by a rating scale. 

 

The final review of the implementation goals in St. Mary’s County showed dramatic changes, despite the COVID-19 crisis. A year following the RBI Institute, St. Mary’s increased their number of staff trained to RBI fidelity from 3 three to 10. Currently, one staff member from the original training, and two new providers are working towards fidelity.

 

Additional goals set forth in the Dynamic Impact process included a movement from 51% to 93% of all initial IFSPs using the RBI as the family assessment, and from 32% to 64% of all annual reviews included an RBI.

 

In a review of 15 IFSPs, all four reviewers rated the IFSPs as meeting the standard set for high quality IFSPs. In addition, inter-rater reliability was established for these IFSP ratings. The Dynamic Impact approach was the catalyst for change.

 “I've striven to help our program embrace the use of the RBI to facilitate development of the IFSP for many years.  The Dynamic Impact Process allowed our team to come together and set goals to move us forward.  We surpassed my wildest dreams - in less than a year we increased our rate of RBI use in the development of Initial IFSPs to over 90%!  I couldn't be more pleased with the work my team did throughout this process!”  Debbie Crosby, Coordinator of Special Education, St. Mary's County Public Schools

 
 

For more information on how Dynamic Impact might help your program implement   the Routines Based Model, contact Dr. Jennifer Dale at jdale6@jhu.edu.

Telepractice Checklists

For 5 months, implementers of the Routines-Based Model (RBM) have been noting how relatively easy the switch to virtual visits has been, especially for home visits. Because Routines-Based Home Visits have always been centered on collaboration with the caregiver, we simply switched from sitting in the living room together to talking via Zoom. The biggest difficulty has obviously been the small amount of time the home visitor might have been interacting directly with the child. I have always said there are three reasons to put your hands on a child:

• ·       Assessment (seeing what a child might do with a certain strategy)
• ·       Demonstration (showing the family what your strategy looks like)
• ·       To show you love the child.

In telepractice, we can’t do these in the same way, with literal hands on, but “home visitors” have devised creative ways to have caregivers show what the child does (assessment) and to be explicit about their ideas (the equivalent of demonstration).

The RBM has always used performance checklists to (a) describe practices in the model, (b) serve as a platform for feedback in coaching, and (c) measure the fidelity to the model of a professional’s practice (Dunst & Raab, 2010; Marturana & Woods, 2012). We have therefore created the Routines-Based Telepractice Visit Checklist and the Telepractice Collaborative Consultation to Children’s Classrooms (CC2CC) Checklist. You can find these at www.eieio.ua.edu/materials under Consultative Service Delivery.

Routines-Based Telepractice Visit Checklist

We were able to use the Routines-Based Home Visit Checklist as the basis for this telepractice version. The new one has a section on establishing a technology connection. It also recognizes that the pandemic, the lockdown, early intervention delivered through telepractice, working from home, and so on, demand extra sensitivity and empathy from the home visitor.

We still review child goals, if that’s what the family wants to talk about, going over existing strategies the family has been using or developing new strategies. One of the hallmarks of the RBM is the collaborative approach with caregivers, which, with families, we call family consultation. We do not simply listen to a family’s report or concern and immediately give them suggestions: That would be an expert model, not a collaborative model. In telepractice visits, it’s the same: We ask many questions before venturing an idea.

If demonstration by the home visitor would be helpful, telepractice challenges us. On the checklist, we have added describing the strategy in detail to demonstration (Item 25). Whereas on a live visit, the home visitor might describe the strategy in fairly general terms, followed by, “Would you like me to show you what I’m talking about?” the virtual visit cannot rely on showing the family what you’re talking about. For example, the home visitor might say, after asking many questions to get context, “Have you considered sitting behind him on the floor and applying gentle pressure on his hips to stabilize him?” After the parent’s quizzical look, the home visitor says, “Would you like me to show you?” Now, in a telepractice visit, the home visitor might still suggest the pressure on the hips and, instead of offering to demonstrate, say, “Would you like me to be more specific?” If the parent says yes, the home visitor continues, “You can sit behind him, with him sitting between your legs. He should have things to do in front of him—toys he likes, for example. To help him be stable, you can put your hands at the tops of his legs, with gentle pressure. That should stabilize him. Over time, you can release that pressure, to give him opportunities to stabilize himself, using his core.” This can be accompanied by demonstrating on yourself, about the placement of hands, for example. Some home visitors are using dolls as props for demonstration.

Just like in-person home visits, when you conduct a visit virtually, you should have the Next-Steps Form, the ecomap, and the matrix. These can all be found at www.eieio.ua.edu/materials. These are the three key documents a home visitor using Routines-Based Home Visits has at every visit. In the virtual world, we still use them.

Just like in-person visits, virtual visits take advantage of the opportunity to provide emotional, material, and informational support, as needed. They also take advantage of the opportunity to attend to parenting basics, which, in our model, are talking to children, reading to children, playing with children, and teaching children. We say in the RBM that early intervention is a parenting program, not a rehabilitation or special education program.

Telepractice CC2CC Checklist

Visiting teachers, virtually, is a tricky business. Some classrooms are open to accommodate the needs for child care of essential workers. Our useless federal leadership is telling us contradictory and scienceless noninformation about how to meet the needs of children in classroom programs. This situation has revealed much about the strengths and weaknesses of governors, even within the two major parties. In our field, we have to recognize that some infants, toddlers, and preschoolers with disabilities are going to classrooms, and we early interventionists (I include in this term early childhood special educators and therapists) need to support their teachers, without visiting the classrooms in person.

Hence, we have developed the Telepractice CC2CC Checklist as a guide. I hope, in some programs, coaches are joining the visits to classrooms, and providing feedback, using the checklist. If not, visitors (i.e., “home visitors” going to child care, itinerant ECSEs) can check themselves.

Again, we did not have to make many changes to our CC2CC Checklist. The same issues discussed in virtual home visits are pertinent in classroom visits, so I won’t repeat them here. In in-person visits as well as in telepractice visits with teachers, we do want to include classroom-wide issues, such as the zone defense schedule, using incidental teaching, and using ideas from Reggio Emilia (see Item 31).

With both Routines-Based Telepractice Visits and Telepractice CC2CC, we should keep the following in mind.

1.   Visits might be shorter because of distractions, interruptions, and videoconference fatigue.
2.     Visits might seem disjointed and disorganize; give yourself a break—you have less control over the situation.
3. Families might be distracted, uninterested in your visit, or inconsistent in their reports; give them a break—we don’t know everything they’re dealing with, although you should try to find out and understand.
4. Some families might be thriving in this environment. They love being home with their kids and don’t want to be out with other people.
5.   Teachers in classrooms are true front-line workers. I hope people put up signs saying “Heroes work here,” like they do at hospitals. These teachers are under more stress than usual. Maybe your work is to reassure them, give them a laugh, and maybe help them with some difficult situations.

I hope the checklists help. Thanks to Cami Stevenson for working on these checklists with me.

 

Dunst, C. J., & Raab, M. (2010). Practitioners’ self-evaluations of contrasting types of professional development. Journal of Early Intervention, 32, 239-254.

Marturana, E. R., & Woods, J. J. (2012). Technology-supported performance-based feedback for early intervention home visiting. Topics in Early Childhood Special Education, 32, 14-23.

 

Black Lives Matter and the Routines-Based Model

Implementers of the Routines-BasedModel (RBM) around the world and members of The RAM Group stand with our brothers and sisters of color in decrying police brutality, discrimination, and both overt and implicit racism. We want to describe how the RBM is already designed to empower all families and how implementers of the model need to redouble our efforts to identify and combat injustice.

Black lives matter and so do other lives too easily marginalized. Here, we include all people who are treated with judgment and bias, including people who speak differently, look different, understand differently, act differently, and so on. 

To acknowledge the diversity of families, the first thing we do with families is construct an ecomap depicting their informal supports as well as their intermediate and formal supports. Each ecomap begins with a blank sheet of paper because every family is different. Families tell us who is in their lives and how frequently they communicate with them.

To develop a plan of support for children and families, we find out how families lead their lives and what they would like to be different. To assess needs, we don’t hold child and family functioning up to some given standard that might not conform to this family’s priorities or resources. We listen to what families do and want, without judgment. This procedure is the Routines-Based Interview (RBI).

The RBI ends with the family’s deciding on their goals for the child and family. Even for children in child care or preschool. Not only does the family decide on 10-12 goals; they put them in priority order of importance.

In providing supports to families, ideally in the home but also in other settings, the family sets the agenda for the visit, the family helps come up with the strategy, and the family decides what they will do with the child or for the family. In this model, professionals do not assume an authoritarian or “colonial” approach. We provide emotional support, material support, and informational support. But families make the decisions, helped by our information. These are Routines-Based Visits.

In the RBM, when professionals go to children’s classrooms, they really visit the teachers—to help them meet children’s needs throughout the week. Just like home visits. This Collaborative Consultation to Children’s Classrooms (CC2CC) includes rules about respecting whose turf you’re on. Classrooms often reflect the culture of the children and staff, and RBM implementers seek to understand this ecology. As with families, teachers tell early intervention (0-5) professionals what they need.

We have highlighted some of the ways the RBM respects each family’s and teacher’s culture, way of life, decisions, and priorities. The model supports families as they are; it does not try to change them—unless they want to change. Science, ethics, and common sense endorse this approach.

Now, we need to take new action. We need to do the following:

1. Listen to ourselves as we speak to families and teachers—for signs of implicit racism;
2. Listen to ourselves and our colleagues when we discuss children, families, and teachers, and put a stop to judgmental language;
3. Listen for families’ or teachers’ reports about being treated unfairly and follow up to find out more, however uncomfortable that might be for us; and
4. Speak up to perpetrators of racism, bias, and injustice or report them to their superiors.

Signed by[1]

Robin McWilliam, Nashville, Tennessee, and Tuscaloosa, Alabama, USA

Cami Stevenson, Portland, Oregon, USA

Sue Bainter, Lincoln, Nebraska, USA

Lisa Spurlock, Chattanooga, Tennessee, USA

David Munson, Billings, Montana, USA

Margarita Cañadas Perez, Valencia, Spain

Marisú Pedernera, Asunción, Paraguay

Pau García Grau, Valencia, Spain

Catalina Morales Murillo, Valencia, Spain

Denise Luscombe, Perth, Australia

Brooke Serpell, Melbourne, Australia

Ai-Wen Hwang, Taipei, Taiwan

Lily (Hua-Fang) Liao, Taipei, Taiwan

Rosa Fernández Valero, Spain

Lin-Ju Kang, Taoyuan, Taiwan

Valecia Davis, Jackson, Mississippi, USA

Cecília Aguiar, Lisbon, Portugal
Brandi Brown, Montgomery, Alabama, USA
Naomi Younggren, USA and Germany
Charity Yang, Taiwan
Sylwia Wrona, Cieszyn, Poland
Hong Hway Lim, Singapore
Stephen Carberry, Canberra, Australia
Becky Hoo, Singapore

Claudia Escorcia, Valencia, Spain

Hui-Ching (Jane) Su, Beitun, Taichung, Taiwan

Stacy Callender, Jackson, Mississippi, USA

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[1] Signatures do not reflect endorsement by our employers