Thursday, October 11, 2007

Toy Bags

The following request for information came to me recently:

Hello I am emailing for advice and resources. I attended the seminar on routines based early intervention in XXXX.

I am a Director of an agency and we are discussing our roles as therapists and working towards shifting our thought process.

As we begin the shift of our staff "away" from bringing toys in - I was wondering if you had any resources or lists to help me with explaining the importance, and the role the therapy bag plays in the home? and the consequences? etc

any handouts? suggetions ? feedback?

example- parents WANT the providers who bring in the toy bags, not the ones who dont. "or" the therapists who "NEEDS" the items so they can have children learn skill or have they toys available

thank you for your help

Problems With the Toy Bag

There are two major problems with the toy bag. The first is that it sends a message to families that “your junk ain’t good enough.” Why else would we be bringing in other toys and materials. I recently conducted an RBI in which the mother told me that the home visitor brought toys that she already had in the home!

The second major problem, the really serious one, is that it implies that intervention occurs during the visit. If a home visitor gets down on the floor with the child and the toy bag an starts “working with” the child, it is not surprising that the parent would believe that the child is being taught. We have made the point in many places, including on this blog, that the purpose of weekly early intervention is not to teach children—that that is futile—but rather to provide caregivers with emotional, material, and informational support.

The persistent use of the toy bag thus leads to the attribution problem of parents’ attributing their children’s progress to weekly interactions with people outside the family instead of to ongoing interactions with regular caregivers. The consequences of parents’ making this erroneous attribution are obvious.

An indicator that the toy bag user him- or herself thinks that the intervention actually occurs during the visit is that they usually take the toys away at the end of the visit. If they believed that intervention is what happens between visits, they would leave the toys.

Another concern about the implication that intervention occurs during the visit is that so much of the visit is spent on triadic play among the home visitor, the child, and toys. Does anyone know of research that documents how much time families actually spend in such triadic play? I suspect it is a very small percentage of time.

So the staff in this program need to understand first how children learn (throughout days, not in lessons or sessions) and how services work (by supporting natural caregivers, not by working with the child weekly). Until they grasp those notions, they probably won’t understand what’s wrong with the toy bag.

Why do some parents want toy-bag-wielding home visitors? It’s because of the attribution problem. Once they are conditioned to believe that their child really needs direct, hands-on lessons with a teacher or sessions with a therapist, the empty-handed home visitor will look like a fisherman who forgot his pole, a carpenter without a saw, a plumber without a wrench—you get the idea. You probably also by now understand that early intervention is about teaching people to fish with their own poles, to make cabinets with their own saws, and to fix leaks with their own wrenches.

Some therapists say they need items. Hmmmm. What items are critical? Especially, what items are critical for supporting families to teach their children functional skills that the children need to participate in their routines? Surely nothing that comes out of a toy bag. After all, if the outcomes we’re working on are functional, that means we found out what the needs were in everyday contexts. We need to be working with the materials that are in those everyday contexts.

In addition to therapists or teachers saying they need items to do their home visiting job, other excuses for taking toy bags abound. One is that the toy bag items are for instruction; home stuff is for generalization. Another is that some homes have nothing (people in the U.S. actually say that with a straight face). Yet another is that parents want to see what their children might like. This is actually a reasonable reason to take toys—for children and families to try them out, but then leave them there for at least a week. Some fake interaction on a home visit doesn’t tell you whether the child will continue to be interested in the toy. These are mostly excuses that toy bag addicts make.

Yes, a number of experts in early intervention have identified the obsession with toy bags as an addiction! Some behaviors common to addicts will surface when toy bag addicts are told to stop taking them.

But program managers need to be prepared to ban toy bags, if they understand the points I’m making here. You can’t expect people to do something (or stop doing something) if you don’t tell them to do it (or stop doing it). The occasional bright home visitor will get it and abandon the toy bag as a result of training or reading or some other self-directed learning. But most addicts need to be told to stop.

The methadone treatment I suggest is a combination of the Routines-Based Interview and the Vanderbilt Home Visit Script. A future blog posting can address the VHVS, if there is interest. It was included in the training of the person who wrote me with this excellent question (at the beginning of this posting).

In conclusion then, (a) the staff need learn how children learn and how services work, (b) the program needs to ban toy bags (they are both symbolic and necessary for the propagation of atheoretical and nonempirical early intervention), and (d) the staff need to be trained to be support providers or consultants to the families. Only then will children get the amount and quality of early intervention they deserve, given the best available evidence.