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.


Vicky said...

Hi. Absolutely no disrespect intended by this question, but I am curious as to whether you have personally provided direct, home-based EI services on a daily/weekly basis?

Anonymous said...

Being a minimalist and believer in RBI and ABI philosophies when it comes to providing home visiting services, I appreciate the researched based trend of providing services with using what's available in the home and bring in supplementary resources/handouts when need be. Although, there is a saying in early intervention offices that a specialist's "bag of tricks" is very worthwhile tool. It can be a good start to some good "play based therapy" And yes, sometimes, we go into home where those tools aren't readily available. I work with many talented specialists that bring along their bags of tricks. For, in home visiting, you never know what's behind that door or not behind that door, so it's good to always come prepared. This is a teacher's job . . . a specialist's job and a overall caregiver's job to provide those tangible tools, even if they come in a "bag of tricks". Those tangible tools are developmentally appropriate toys, and other eye catching materials that will capture a child's interest. This to me is common sense to provide our therapy with materials. A teacher doesn't plan her lesson without thinking of the materials she/he needs.

When I read Vicky's comment I started thinking that this article gives the impression that the professional use of "toy bags" is a "fad" that needs to go away like a pair of acid-washed jeans from the 80's rather than looking at them as a specialist's creative way to embed goals.
Thank you for this article, as I've been inspired to think about the use or the researched recommended "non-use" of toy bags in my profession and share your insights on my own blog. Sincerely, alik!

johnna said...

I am current providing home based EI services on a daily basis and do not use a toy bag and have not for about 5 years. I have 20 years working in EI. SO, I did suffer from toy bag withdrawal at first as I was trying to wrap my head around the RBI philosophy. (Julianna Woods has a great handout about how to deal with toy bad dependence) As I got more comfortable explaining RBI to parents and more comfortable with just joining in with whatever was happening in the family at THAT moment, even if the routine did was not identified by the family as a time of concern, I figured out what part of the problem with this transition was. As a clinician I was used to thinking that strategies had to emerge out of my materials (toys) or the materials that the parents had (toys) (thus the comment "well the family doesn't have anything". I realized that I had not understood RBI while I thought I did.

The WHOLE POINT of RBI is to be ROUTINES BASED, but as clinicians we are not taught to think about strategies from routines. We are taught to think about strategies.We also have to learn to think better on the fly as each family and each routine is different. Much more different than individualizing strategies for kids from OUR toys, which we have a lot of experience with. So, challenge yourself. Go in to your next visit and "forget" your toys in the car. Ask the family what the were just doing and join in. How many ideas (strategies) can you come up with during your visit to meet one of the goals?????? from washing dishes, folding laundry, taking the DVS's on and off the shelf, teasing the dog (I am sure you get the picture). THAT is RBI!!!!!


marla said...

Hey all, thanks for the insight into using a toy bag. I visit my homes bimonthly and do not use a toy bag. I try to join in on whatever my parents/families and child are doing at that time. I believe that early interventions need to be imbedded throughout the childs regular routine, not a separate thing. I understand that for some this might be a challenge, but you just need to be a bit creative. Some homes may lack materials, but how then must the parents and family continue the interventions? I would never want to offend (stuff not good enough) or lead them to think that the interventions only happen when I am there. I do not teach language for only 30 minutes 2x a week in my classroom, I teach it throughout the day, it is imbedded into every part of every routine. Just a thought and wanted to thank you all for your professional wisdom! P.S. My colleagues and I are going to get together and brainstorm ideas-things that have worked for them, things to use found in the homes, etc... (however, we must remember it is based on child's interest).

Gwen said...

Well said!!! As someone who has recently steered away from bringing a toy bag to the home; it’s quite refreshing. At first I thought or shall I say made it a challenge. The child or the siblings continue to look for the bag and look into my business bag looking for a book, toy, or puzzle. It amazes me how now that I think about it… they probably remembered me…as the lady that brought the toy bag. Its funny their interest in participating has shifted a bit, however I have figured out strategies to engage them and now I focus on routine-based activities and strategies in the everyday context of the individual family. I have been able to focus on identifying opportunities within the family’s natural environment. It is easier to involve other members of the family with gathering additional information on other routines/activities the family enjoys and engage those members in participating. I discuss with families what activities are working for them throughout different routines and which are not; this is an opening for them to show you the activity and then I am able to make suggestions for enhancing the interaction. Leaving the toy bag behind is an opportunity for modeling techniques or strategies using existing toys or activities within the home.

tyn said...

Great one! eye opener. Made me think outside the box.never really thought of it as an issue until now,but well said.

Sonia Pina said...

I'm currently doing my student teaching and I have found that bags are fun for children. The EI usually takes a bag for children and leaves it for at least a month. I work with some families that don't have many resources to buy toys or need assistance in finding adequate toys. I think that this is a good use of toy bags.

Valerie said...

I wonder if bringing a toy bag into the home environment is actually disregarding the whole movement of "natural environments"? If we are bringing these toys into the home for services intended to take place in the child's natural environment, what happens when we leave? These toys are not "natural" to the child and will not be available to them when our visit ends. I think that some parents also think that if the child is interacting with the toys we're bringing, their child is actually learning something or that we are teaching them something. How are we going to justify taking the toys away if they served the purpose of teaching skills? And if these children don't have these toys to "learn from" on a daily basis, what is the point of the intervention? I think that the toys (or lack thereof) that each family has determine a child's natural environment and this should be taken into consideration when we on our home visits.

Jiyun said...

Thanks for sharing! It was a eye opener for me since most of my experiences were in center-based settings. And I haven't really thought about the toy bag as a problem until I read this blog. I think it is important to really focus on the family's concerns and to support them by providing strategies and ideas to help the child participate in the family's daily routines.

ashley said...

Thanks for the information. I think the families get more out of the intervention when there is not a toy bag. The children expect the toy bag when the interventionist arrives and that is what they focus on. When the interventionist leaves, how much information did the parents get out of it and what could the parents use during the week or until the next visit? I think if the interventionist focused more on what support families need during their daily routines, the children and the families would benefit more from the home visit.

Steven said...

Wow, someone really has strong feelings abot NOT BRINGING TOYS to a home visit. I agree with some of what was said. However, in the beginning I do not see anything wrong with bringing a few toys to help break the ice with the child you are seeing in the house. In addition, I would think that you could use the toys to help provide service to the child and to model for the family on how they can play and teach the child. Then, you can slowly fade the toys away.

Lisa Henggeler said...

Maybe we could meet in the middle!!! Although my experience is in a center based program, is it possible to to expose the child to both teacher provided toys and home toys and let the child decide? Don't we take our lead from the child? If the child's preference is the teachers, perhaps the teacher could leave it at the home for a short period of time.

Sarah said...

I see do see the points you are making however I feel most of us cannot go from bringing toy bags to not having them at all. It is a little discouraging to read the blog, maybe we as professionals need some more ideas on how transition to no bags or have a happy medium. I feel there needs to be more discussion on the in between areas. I feel there is room for bags and no bags.

Lisa-Marie said...

The "great toy bag debate" is new to me. To be honest, at first I didn't really see the big deal in not bringing a toy bag. However as I have learned more I have begun to understand that at least for myself I can see where by bringing a bag into the home it changes the focus away from the child and their environment to the the child and my environment. I can also see that by using items from the child's own surroundings the therapy becomes much more natural and the parents can be empowered to continue the activities when you are not present.

alotstuff said...

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Neil said...

I feel that within this article we have an almost evangelical lurch towards a position that appears based only on papers and not practical experience with a wide range of familes.
It certainly does not seem to be based on empirical evidence or feedback on a personal or professional level.
The 'toy bag' (which I assume is a bag of resources with which a professional initiates rapport and interaction) is nothing more than a tool. It's use and effectiveness is solely up to the skills and judgement of the professional weilding it. Now what we seem faced with is a moralistic drive theoretical judgement which does not seem based on sound research. It is also one that seeks to eliminate a tool without researching the good vs poor use of the said tool. Surely it would be wise to conduct SOME research into perceptions of the use and effectiveness of the tool by professionals, but also some real research into parental perceptions. I find the sound bite simplification of the parental perceptions to be virtually deceptive, in that it implies that all parents feel this way, which I am sure they do not.

However putting this aside, let us look at it from another perspective: all organisations and services have an inertia. To change the direction of any body takes energy and in the case of service provision it also takes money. Now we have a suggestion to change pratice, which will have a cost that will be both immediate and longer term. I envisage that the 'new' model by it's very nature will entail a greater time element for a given client group. Both in it's implementation with the child but also in garnering acceptance and traction within the family and community. Now later in this blog do we find out that there appears to be no empirical evidence to support a suggestion of increased efficacy.
Sadly this suggestion to do away with the tool (toy bag) would appear more a case of management by decree along the lines of 'thoust shall do what I decree because I knowest best!'
By the way this is the second time such a methodology has come around in my 17 years of early paed work, yet another cycle of theory!

Lori said...

I was a home visitor for many years, making weekly visits to a wide range of families. I took a toy bag with me for most of those years. It got smaller and smaller as I got clearer about my primary goal--to support the parent as the person providing the main source of developmental support for the child--and smarter about strategies that worked--finding something the parent and child already enjoyed doing together and helping the parent recognize and support learning opportunities while doing those things. Since then, I have spent many years doing research on effective home visiting strategies, observing home visits, and talking with home visitors from a variety of programs. Based on all of this experience, data, and discussion, I have come to believe that getting rid of the toy bag is the easiest and most efficient way for a home visiting practitioner to become more effective with families. The blog was spot-on about the implicit message of the toy bag to the parent: your child needs me and my stuff, not you and your stuff. Of course, a cool toy or the clever use of some everyday object may be a good icebreaker, but that's all it should be. The central "stuff" of a home visit should be the parent and child doing something together that they will be doing together again many times in the future.

Sally said...
This comment has been removed by the author.
Kim said...

This toy bag issue appears to have some polarizing views. As with many issues that may spark emotion or strong opinions, I’m just wondering if both sides could be right to some degree. I understand that working with families in their home using what is available in real functional situations demonstrates learning opportuninities for families that will no doubt continue long after the intervention visit. I also agree with the idea that teachers and therapist should be using strategies more often. I’m also wondering if there could also be valid opportunities for learning where tools such as toys brought to the home to meet individual needs or concerns of a family also might be an opportunity for family growth and learning. I am an ECSE teacher. At this point I don’t directly work in home with families on a regular basis, but I do know that individual needs should always be considered.

soblessed said...

Like with any other therapy technique, therapy bags have the potential to enrich your therapy and the potential to be used in place of other, equally or even more appropriate therapeutic practices.

As a therapist, I have the skill to go into a home and assess not only how the client is (or isn't) communicating, but also to assess how Mom communicates with the child and if it encourages langauge growth. Some moms want to be involved in every session. Some moms will request a new therapist if you so much as hint that a little more direct interaction with their child may be helpful.

IME, it's unrealistic to think that all chldren are going to be intrinsically motivated to interact with you without something to interest them. In fact, *I* don't interact much with people who aren't interesting to me. :) For me, it's all about the engagement (with the client AND with the parent). Sometimes what engages my clients is toys. Sometimes what engages them is books. Sometimes what engages them is playing with siblings with my and/or their toys. Sometimes it's playing with my purse. Sometimes it's looking out the window. Sometimes it's taking a walk. Sometimes it's cleaning (yeah, I don't get it, either:). My job is to let the parent know that language is everywhere all the time and not just during 1:1 time, not just with a therapist and not just with a toy bag. I really don't think simply bringing in a toy bag is going to keep the parent from understanding that. I provide examples either IRL or through discussion or in written form....whatever makes` the Mom feel most comfortable so she'll be the most receptive.

My job with the client is to elicit and expand langauge. I start with what is immediately available and I build it, layer by layer, visit by visit until, at dismissal or transition to another program, the client is further along in their receptive/ expressive language then when they began. My job is ALSO to build and expand on Mom's understanding of how language works. If I don't start where she is, I will be at best ineffective and at worst I will lose her completely. And then where are we? The client has to wait for a new therapist, the mom hasn't changed her language approach with the child one bit AND she's feeling defensive and I'm out of a contract, losing money while I' waiting for another contract to bid on. Lose-lose.

Alternatively, I can work with the client with my toy bag as one PART of what I do. I can start with Mom where she is and begin introducing the concept of how to use language naturalistically so that by the time the client is discharged or transitioned to another program, she is supporting language much more directly than she was when I started. Win-win.

Anonymous said...

Does anyone teach children with autism that have 20 hours of ABA services a week? ABA is based on rewarding behavior with motivation. These kids motivation are toys. Yes the goal is to fade the toys out to social praise, but some use of a toy bag is needed. Even the parents have used this technique with their own toys.

Anonymous said...

This has been a very thought provoking thread indeed; two things. I was trained very recently that DARS does not allow therapists to bring extra toys (beyond specifica therepuetic equipment) into the home for state affiliated ECI programs. My reframing of a 'philosophical' difference of opinion is that I need to work within the framework I have been provided if for no other reason than to make sure that service provision is consistent. I can't tell you how hard it is when you take over a case from another therapist and the first thing caregivers and dependants look for is toys! Switching providers is hard enough but in a system that is supposed to promot continuity of care, it's important for therapists to agree to be on the same page procedurally even if there are some technical differences.

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