Tuesday, October 12, 2010

Behavioral Consultation on Home Visits

Home visits in this model are strong supports to families to help them make the most of the learning opportunities, as Dunst and Bruder would call them, that occur throughout the day. The Vanderbilt Home Visit Script is a beginning, but the real meat of the home visit is in the "behavioral consultation" that the home visitor provides.

My definition for this term, which has existed in school psychology and other professions using consultation, is specific to working with caregivers in early intervention: Collaborative problem solving and solution finding related to families' concerns for their child or other family members, including parents.

Behavioral consultation on child-level issues occurs in when discussing, on a home visit, progress on a child-level outcome or goal. Answers are expected to fall into three categories:

  1. The child has not improved in performing the skill;

  2. The child has improved; or

  3. The child has mastered the skill.

Each of these leads the home visitor down a path of questions that include

  • Getting detailed descriptions from the family;

  • Asking for demonstration of child functioning, if necessary; and

  • Asking how previously discussed interventions are going.

Common consultative strategies in this approach are using

  • Ask-to-suggest (i.e., "Have you tried this? Have you tried that?");

  • Offering to demonstrate with the child;

  • Refining the skill the child is working on;

  • Tweaking implementation of the intervention;

  • Suggesting a change in how the routine is carried out;

  • Encouraging the family to persist with an intervention;

  • Upping the ante (i.e., changing the criterion when the child has mastered a skill); and

  • Constructing an Outcome x Routine matrix.

These home visits are usually highly focused and aimed directly at ensuring families have interventions they can use all the time between home visits, when child learning really happens. Sometimes families choose to talk about issues other than child skills, and sometimes the home visitor is using behavioral consultation on family-level issues.

When home visitors use behavioral consultation, they don't work with the child directly (although they might demonstrate interventions with the child), they don't take activities into the home (unless previously the family had requested them), and they don't spend all their time engaged in toy play with the child. The visit is structured around the IFSP outcomes or other topics the family wants to discuss. By the end of the visit, the family should have

  • interventions they have had a part in developing,

  • information, and

  • encouragement.

Behavioral consultation is described in Routines-Based Early Intervention, a book I wrote, published by Paul H. Brookes Publishing Co. (http://www.brookespublishing.com/).