Saturday, December 17, 2011

Systematic Incidental Teaching

We have not yet secured funding to study the effects of teaching parents to use systematic incidental teaching. So here’s where we stand on related research:

Amy Casey and I have shown that it is possible to train early childhood teachers to increase their rate of incidental teaching:
Casey, A. M., & McWilliam, R. A. (2008). Graphical feedback to increase teachers' use of incidental teaching. Journal of Early Intervention, 30, 251-268.
Ann Kaiser has shown that it’s possible to teach parents to use milieu language interventions, which include incidental teaching:
She has also shown that parent-implemented milieu teaching has a positive impact on children’s social communication:
These researchers have shown that it’s possible to train parent trainers in the use of milieu teaching:

…it goes on. You might ask Why aren’t you just teaching parents this “milieu teaching”? Because most of the training was done in a lab setting and the outcomes were communication ones only. We want to “train” parents in the home for all kinds of outcomes, across routines and domains. The essence of milieu teaching (teaching in context, following children’s interests, eliciting more sophisticated behavior) is also the essence of SIT.

Many states face the issue of therapists’ POLITICAL claims that the routines-based, family-centered approach is watering down services or even denying services to families . They might believe what they’re saying, but those beliefs are wrong and might be a consequence of cognitive dissonance: They have to believe what they believe, otherwise they lose money and professional face. Unfortunately, they don’t listen when we say that the routines-based approach actually increases the importance of therapists, because we need them to support the natural workforce (regular caregivers) and the paid workforce. It’s easy to do therapy with a child in a distraction-free environment; it’s hard as hell to figure out the right interventions to teach to lay people that fit into their lives. So weariness or laziness also must factor in to their claims.

The key about how to support families effectively lies more in the family consultation approach than in SIT, which is really content (i.e., a skill we teach families). The method for teaching families is family consultation. Although I have developed this model for early intervention specifically, the roots are found in existing research on parent-implemented early language intervention (again—sorry!, variables that influence collaborative relationships (, and vocational programming ( Again, we haven’t yet secured funding to study family consultation per se. It’s almost impossible to get the Institute of Education Sciences to fund studies with family behaviors as the outcomes.

Don't forget to look at additional information at

Monday, November 28, 2011

Toy Bags Again

Banishing toy bags from home visits is both symbolic and meaningful. I have written about this issue before: Here's a summary:

Working from a toy bag implies that the home visitor’s interaction with the child for 1 hour a week is intervention.
The hour is better spent working with the parents, because adults can benefit from 1-hour, weekly sessions.
The toy bag implies that what the family has is inadequate.
The home visit should be, in part, about reassuring families’ of their competence.
If the toys are so important, why are they removed at the end of the visit?
The home visit should prepare the family to intervene during all the many hours between home visits.
Toy bag ladies (and gentlemen) spend 80% of the home visit on something that consumes 5-15% of a child’s time: adult-child-toy play.
Home visits should provide consultation to families on interventions that can happen in all naturally occurring routines.
Toy bag play tends to be adult-directed.
Intervention is most effective when it follows a child’ interest.

How Cognitive is Engagement?

In the early days of engagement research, engagement was measured as happening or not happening in planned activities. Our research, first with Carl Dunst and then with Don Bailey, and much since both of them, has emphasized the fact that engagement is not dichotomous variable. It is instead one that ranges from nonengagement (same as the dichotomous way of looking at it) to sophisticated behavior--a pot into which we put encoded, constructive, persistent, and symbolic). We usually array these codes in a developmental sequence, acknowledging that there is a "cognitive" component to the construct. Our studies have shown that Battelle scores were somewhat correlated with engagement levels.

In a study currently under review, conducted by the brilliant young Portuguese researcher, Cecilia Aguiar, sophisticated-engagement levels in classrooms were associated with sophisticated-engagement levels in homes. Does this mean children are carrying around their engagement trait from one setting to another?

Aguiar found that sophisticated engagement was correlated with age: Older children have more of it. Because children obviously carry around their age from one setting to another, ipso facto, engagement will look like a trait.

Engagement and developmental age are not exactly correlated, however, so we recognize that there is something of a developmental or "cognitive" dimension to engagement. But don't discount the environment. Within children who spend quite a lot of time engaged in a sophisticated manner, those in interesting environments are more likely to spend time in sophisticated engagement. Even more important, perhaps, children who spend much time nonengaged are more likely to be nonengaged in uninteresting settings.

Sunday, November 13, 2011

Functionality in School-Aged Children

Question from Ireland: What in your opinion are the critical functional outcomes that apply generally to school-age children and their families?  

For children and youth with disabilities, I believe the core outcomes of engagement, independence, and social relationships (EISR) still apply—as well as quality of life for their families. My so-called expertise is limited to young children but I am the father of a person with disabilities, and other outcomes people mention for older children and adults (e.g., self-determination, feelings of belonging or membership, quality of life) in my experience are all tied to the big three. Of course, that might just be me, seeing everything through that lens.

For school-aged children, academic success is also important, but I see EISR as precursors to the ability to learn academic content. It’s just that we can’t stop at EISR. We have to ask what they will be useful for—self-fulfilment, becoming an interesting person and therefore having friends, getting a job, and so on.

I do think that self-determined satisfaction with one’s life is huge, within reason. You and I might share some common ideas about what should be a satisfactory life, based on our shared ability level and possibly some shared interests, but that doesn’t qualify us to determine what a satisfactory life is for someone else. On the other hand, we might have a responsibility to protect people. If a person likes sitting in front of a video game hour after hour, we might think this is a shallow, empty existence. The individual might think it’s a rich, interesting, exciting existence. If the person’s hours in front of the video game are during recreation time, that’s one thing. If the person doesn’t hold down a job, because of his or her obsession with video gaming, that’s another thing. We would presumably try to protect the person from penury by teaching him or her that that the decision to forego employment in favor of the video game is a bad one. A tricky issue. But the point I began with is that the variety of ways people with disabilities define their quality of life might be even bigger than the variety of definitions held by people without disabilities.

Tuesday, October 25, 2011

Relation versus relationship

Can you P-L-E-A-S-E tell me when it is appropriate to use them term "relation" versus "relationship?" ...I typically use the term "relation" with variables in stat/data analysis. I'd like to be right, but I'm more interested in being accurate. 

A couple of my relations, 6 years ago

A very good question, especially because certain people—behaviorists, mostly—have made up rules that defy good usage and elegance. First, the mistake they often make is to say that “relations” should be used for the connection between two variables. In behaviorism, of course, this is most commonly used in “functional relation.” These people can’t stand “functional relationship,” even though this is actually a better form and doesn’t clang to people who know their English. These behaviorists think “relationship” belongs to the affiliations between people (e.g., “the child had a good relationship with his brother”).

In fact, a relationship has two meanings: personal affiliations (friendships, romantic link, etc.), the way two things are connected (including variables—e.g., “the relationship between the predictor and the outcome” or “the correlational relationship between Variable X and Variable Y” or “the functional relationship between the independent and the dependent variables”). Relation also describes the link between people (e.g., relations between teachers and students should be nurtured). You can see that this could also be “relationships between teachers and students….” So when discussing links between people, groups, or countries and the way they behave towards each other (I’m quoting the BBC here), the two terms are interchangeable. But in certain contexts “relations” is always used: diplomatic relations, race relations. Relations can also be used interchangeably with relatives, although that’s not as common in the U.S. as in British-English countries.

So, I’m afraid you’re not right about variables taking “relation,” although, as I said, many behaviorists would agree with you—and probably statisticians too. But if I had to pick two groups of people who like to talk fancy and who consider themselves precise but who slaughter the language, it would be behaviorists and statisticians. Eighty percent of the time “relationship” will serve you well. Which one you choose depends on whose wincing you care most about!

Saturday, September 10, 2011

New Part C Regulations: Much Ado About Nothing

The finally arrived new Part C regulations have some interesting features. I haven’t compared the old with the new; CEC is going to do that within the month. Some of the new regulations are noteworthy for practitioners of the model described in Routines-Based Early Intervention, published by Brookes. Direct quotations from the new-regs document are italicized.
The two disciplines. The definition of multidisciplinary in §303.24 has been revised with respect to the individualized family service plan (IFSP) Team composition to require the parent and two or more individuals from separate disciplines or professions with one of these individuals being the service coordinator.
An interesting interpretation of a discipline is the inclusion of service coordinator, which is actually a role or function. But this will alleviate the pressure on IFSP teams who have previously thought they had to find two people other than the service coordinator. The intent, originally, was to have different perspectives from the field. Now, when we’re lucky enough to have a service coordinator with content knowledge about child development, family functioning, and disability, we’ll be fine. In states where service coordinators are limited in their content knowledge, there will theoretically be a loss. I can’t say, however, that I’ve noticed much of a gain by having two additional professionals from different disciplines. Evaluations have to be rushed anyway, and they’re just for determining eligibility—not for diagnosis, so we might as well make the process as efficient as possible. A good change.
Scientifically based research. Scientifically based research has the meaning given the term in section 9101(37) of the Elementary and Secondary Education Act of 1965, as amended (ESEA). 
Well, thanks. That’s pretty useless. You can, however, read the definition at (thanks to Oklahoma higher ed). Could have been clearer.
Transition. New §303.209(b)(1)(iii) provides that if a child is referred to the lead agency fewer than 45 days before that toddler’s third birthday, the lead agency is not required to conduct the initial evaluation, assessment, or IFSP meeting, and if that child may be eligible for preschool services or other services under Part B of the Act, the lead agency, with the parental consent required under §303.414, must refer the toddler to the SEA and appropriate LEA.
If this was already the regulation, I didn’t know about it. I assume it’s new. This definitely provides relief to the Part C program and makes sense. We still can’t be sure, though, that a child with a third birthday on June 1, for example, referred at the end of May won’t be made to wait until August or September before anyone will provide help. A good change, nevertheless.
The 45 days. New §303.310 (proposed §303.320(e)(1)) requires that, within 45 days after the lead agency or early intervention service (EIS) provider receives a referral of a child, the screening (if applicable), initial evaluation, initial assessments (of the child and family), and the initial IFSP meeting for that child must be completed (45-day timeline).
When the clock stops has long been a contentious issue, with states receiving conflicting messages from OSEP. Note that the regulation says the clock ends when the initial IFSP meeting is completed. Although this could be interpreted as the IFSP meeting for the first (i.e., initial) IFSP, it could also be interpreted as the first meeting about the IFSP. In our model, I have argued that this could be the Routines-Based Interview, even if the signing of the IFSP happens later—that is, after the 45 days are over. The two problems with my argument are, first, that, unless the RBI date is documented somewhere, no accountability is possible about meeting the 45 days. Second, it could delay service delivery, which is the point of the 45-day requirement. I don’t buy this second argument, however, because many parents have told us that the RBI itself is very beneficial. A good regulation, as long as it doesn’t get misinterpreted by states or the feds.
Abbreviation. “EIS” is the long-standing, commonly accepted abbreviation used in the field of early intervention and we do not anticipate any confusion by the abbreviation’s continued use in programs administered under Part C of the Act.
It is?
Purposes of early intervention. Two commenters recommended that, when describing the purpose of early intervention services in general, we retain the language that these services must be designed to serve “the needs of the family related to enhancing the child’s development” that is in current §303.12(a)(1).  The commenter stated that meeting family needs is a key component of an early intervention system and should be addressed routinely in IFSP development, rather than only upon family request.
The originally proposed regs had included “as requested by the family, the needs of the family.” In the final version “as requested by the family” was omitted to ensure that family needs should always be addressed, unless the family doesn’t want this. We shouldn’t wait for them to ask for their needs to be met. A good change.
Definition of early intervention services. One commenter requested that we clarify in the definition of early intervention services that EIS providers who work with infants and toddlers with disabilities and their families should focus their services on ensuring that family members and children have the tools needed to continue developing the skills identified in the IFSP whenever a learning opportunity presents itself even when a teacher or therapist is not present. 
A great comment. It might even have been mine. If not, I’m claiming it anyway. The feds weren’t swayed for the following reason:
However, in addition to the reasons stated, adding language to §303.13 as requested is not necessary because the definition of EIS provider in §303.12(b)(3) specifies that such providers are responsible for consulting with and training parents and others concerning the provision of early intervention services described in the IFSP of the infant or toddler with a disability.  Additionally, this consultation and training will provide family members with the tools to facilitate a child’s development even when a teacher or therapist is not present.
They missed a golden opportunity to discuss preparation for what happens between visits.
Types of early intervention services—family training, counseling, and home visits. One commenter recommended deleting the reference to “home visits” in the title of this paragraph because the commenter considered home visits to be a method of providing a service rather than a service in and of itself… Section 632(4)(E)(i) of the Act expressly states that early intervention services include family training, counseling, and home visits.  Thus, removing the reference to home visits from §303.13(b)(3) would be inconsistent with the Act.  .
No change was made. The discussion, however, shows that OSEP still is unclear about how children learn and how services work. The paragraph following the above discussion is as follows:
The language in §303.13(b)(3) does not mean that family training must occur in the home or include counseling.  Section 303.13(b)(3) merely defines three separate early intervention services –- family training, counseling, and home visits -- that may be provided to assist the family of an infant or toddler with a disability in understanding the special needs of the child and enhancing the child’s development.
This suggests the other services, such as special instruction, OT, PT, and speech-language are not also services that may be provided to assist the family of an infant or toddler with a disability in understanding the special needs of the child and enhancing the child’s development. It implies that the some services are for direct application to the child and others are for helping the family. Not how I see it!
Furthermore, I always thought home-based was a setting but not a service. You can’t like home visits in the service section of an IFSP, can you? I hope someone can straighten me out in a comment following this post. Unclear.
Sign language and cued sign services. The phrase “as used with respect to infants and toddlers with disabilities who are hearing impaired” has not been included in the definition of sign language and cued language services in new §303.13(b)(12).
The discussion includes the point that it isn’t only children who are hearing impaired who might benefit from signing. Well done.
Speech-language pathology services. Several commenters recommended adding such services as auditory habilitation and rehabilitation, dysphagia, auditory-verbal therapy, oropharyngeal, or feeding and swallowing services to the definition of speech-language pathology services in new §303.13(b)(15) (proposed §303.13(b)(12)).
No change was made because the definition in this section is not intended to be exhaustive. Good! We already have too much overspecialization in early intervention, leading to fragmentation of services and professionals whose focus is too narrow. We also have certain subspecialty groups trying to capture the market for certain types of children. Good nonchange.
Other services. Another commenter requested that the Department revise the language in this paragraph to indicate that any other services identified in the IFSP of an infant or toddler with a disability be based on proven methods or evidence-based practices…. Discussion: Mirroring this standard, §303.344(d)(1) requires that each IFSP include a statement of the specific early intervention services based on peer-reviewed research (to the extent practicable) that are necessary to meet the unique needs for the child and the family to achieve the measurable results or outcomes identified in the IFSP.
This whole idea of services, either those identified as the regular ones in Part C or “other services,” being based on peer-reviewed research is laughable. As much as I’d like to advocate for this regulation, the services used in Part C and the way they are implemented do not have a sufficient research base anyway. But we’re not going to do away with them. So, to apply a higher standard to other services would be ridiculous. Furthermore, in the past 7 years or so, when the field started acting serious about evidence-based practices, we have become bogged down in debates about which studies are good enough to be included in analyses of EBPs and how many studies from how many research groups need to be conducted to determine a practice is evidence based. And then we have the issue of gradations of evidence-based, because we’re loath to say a practice is or isn’t evidence based. And this discussion in the regs is about services, not even practices, and everything is hugely more complicated when we have such a broad scope as a “specific early intervention service.” Correct nonchange but the regs still don’t help us get rid of bogus treatments.
Services neither required nor funded under Part C. Section 303.344(e) provides for the IFSP Team to identify in the IFSP medical and other services that the child or family needs or is receiving through other sources, but that are neither required nor funded under Part C of the Act. 
This discussion about a rather pointless comment serves as a good reminder that these other services can be listed in the IFSP and they don’t commit the Part C program to pay for them. Many states, especially where education is the lead agency, shy away from (i.e., tell service coordinators not to) list these services, in case the family thinks the program is going to pay for them, as would happen on an IEP. Good reminder.
Infant or toddler with a disability. :   We have revised §303.21(a)(2)(ii) to add  “severe attachment disorders” to the list of diagnosed conditions that have a high probability of resulting in developmental delay. 
OK, but I think states still have the right to determine for themselves who’s on their special list for diagnosed conditions. Severe attachment disorders was the only addition, among a number suggested. The list is of examples only, however, so I don’t think it really matters.
Multidisciplinary. Multidisciplinary was defined in proposed §303.24, with respect to evaluation and assessment of a child, an IFSP Team, and IFSP development under subpart D of this part, as the involvement of two or more individuals from separate disciplines or professions or one individual who is qualified in more than one discipline or profession.
Back to this issue, but now focusing on how many people should be there. Apparently, the transdisciplinary-approach haters rallied to comment on the regs, because a number of comments wanted to ensure the regs didn’t allow just one person who might be qualified in two areas (service coordination and special instruction, for example?) to replace a group, which the commenter says is explicitly defined in Part B. Commenters requested that the definition be modified to ensure that multiple perspectives are included on each IFSP Team and adequate representation is not hampered or constrained on any given IFSP Team by an individual who is qualified in more than one discipline or profession. It’s a toss-up whether representation is more hampered in this situation or in one where two people have blinkers on, with respect to attending only to areas of their narrow training.
The discussion about evaluation and assessment includes the following: With respect to IFSP Team meetings, we believe it is important for the parent to be able to meet not only with the service coordinator (who may have conducted the evaluation and assessments), but also with another individual (whether that person is the service provider or another evaluator) to obtain input from two or more individuals representing at least two disciplines and have revised §303.24 accordingly.
They want two people there. For those states using medical as one of the professions, this is not the intent of this regulation, unless the child has a chronic illness or something similar. This regulation doesn’t address how a provider could meet with the family on an initial IFSP, before services have been determined. I suppose the feds would say that then an evaluator would serve as the second person. In our model, I want states and teams to consider a most likely primary service provider (MLPSP).
Some commenters, including possibly me, wanted a reference to transdisciplinary or interdisciplinary, but OSEP said, referencing specific team models in the regulatory definition of multidisciplinary is not necessary.
Natural environments. Two other commenters recommended the definition indicate that a clinical setting could be the natural environment, particularly when the service requires the use of specialized equipment that cannot be transported to the child’s home.  One commenter expressed concern that mandating services to be provided in settings where non-disabled children are present may suggest that the alternative is less than acceptable.  Another commenter recommended that the definition of natural environments require that services be provided within family routines and activities and opposed identifying specific settings.
We expected clinic-based professionals to challenge the natural-environments provision. Fortunately, the OSEP response was We do not believe that a clinic, hospital or service provider’s office is a natural environment for an infant or toddler without a disability; therefore, such a setting would not be natural for an infant or toddler with a disability. Good nonchange.
Section 632(4)(G) of the Act provides that natural environments may include home and community settings.  However, the reference to community settings was not included in the proposed regulations.  “Community settings” was added back in. Good change.
Qualified personnel. Additionally, §303.344(g), which provides that an IFSP contain information about the service coordinator, requires that the service coordinator be selected from the profession most immediately relevant to the child’s or family’s needs or be a person who is otherwise qualified to carry out all applicable responsibilities under Part C of the Act.  
I don’t know that this is a change, but most service coordinators in dedicated-service-coordination states are not from the profession most immediately relevant to the child’s or family’s needs, so let’s hope they’re otherwise qualified to carry out all applicable responsibilities…. The feds might have been thinking about service coordinators who are also providers to the family (the blended model). But the second half of the definition of the qualification is a complete cop-out, just when we probably needed to raise the qualifications. That responsibility is probably correctly with the states, but that means we’ll have to be vigilant about which states actually make it possible for families to have properly qualified (not as defined in the regs) service coordinators. Confusion and cop-out.
Paraprofessionals. The feds continue to allow paraprofessionals to “assist in the provision of early intervention services to infants and toddlers with disabilities.” They mention certification and supervision. It’s unclear to me whether a state could allow paraprofessionals to be the primary service providers or weekly home visitors to a family. I have serious reservations about the suitability of paraprofessionals serving in that role. Missed opportunity.
I have been through all 932 pages of the regs, and the items above were the only ones worthy of mention. I might have missed other notables, so I hope readers will post comments below if they have other changes to point out. Until someone points out something different to me, the most notable change I notice is counting the service coordinator as one of the two professionals.

Friday, August 12, 2011

Writing Outcomes or Writing Goals

Are there times you write goals for a child that are not tied to specific routines? If so, can you give me an example?

Toileting for children who need to toilet at any time. They wouldn’t have actual toileting routines. People need to understand the vital importance of participation or engagement, in order for this question not to come up. Here’s the abstract to a good article by Jeanne Wilcox and Juliann Woods about the importance of participation for writing outcomes: They focus on language, but the same argument can be applied to all areas of development.

We are still working from a mind set that we need to be writing goals based on provider concerns - even if the parent is not concerned or invested in the goal. We are basically saying that we should be telling the parents what they should be concerned about. I am not sure how to get past that.

Shouldn’t be allowed because it’s not family centered, as I explain below.

The basic issues are these:

1. How do we decide on an appropriate measurement if we do not break down the goal into smaller steps?

Would coming up with a breakdown of short-term objectives serve the same purpose as writing a measurement with the three criteria or should the list of short-term objectives be something in addition to the functional goal with measurement included?

The question is related to the seven steps for writing participation-based outcomes/goals, as described in the book Routines-Based Early Intervention. An example is below.

This question assumes that all skills are going to be taught in the steps in a task analysis, so the measurement becomes the accomplishment of step after step. This is an acceptable measurement method to supplement the criteria for outcome accomplishment. You see, the difference is between progress monitoring and the criteria for the END of the instruction—what answers the question How will we know when we got there—when to reassess, when to stop? The three criteria ask the questions, When is this overall skill (i.e., all the steps or a subset of the steps) needed (i.e., what routines), what level of performance is required (e.g., how many steps in the chain, what level of prompt, what frequency, what duration—whatever makes sense for the skill in context), and over what amount of time (which should be specified in any measurement system, even a task analysis one)? So it’s a false question to say it’s chaining versus our three criteria.

I am worried that those who don’t want to specify routines (a) don’t think of the necessity factor in outcomes (is it necessary?); they think more in terms of deficit—what can the child not do, regardless of context; and (b) think that professionals have to teach the child during routines, which would be difficult to do (instead of thinking that we need to be consulting with families so they can teach the child during routines).

2. How do we include professional opinion in goal-writing?

First, the rewording of the goal into a participation-based goal with three criteria is professional behavior. Second, professional opinion can go into the process of functional assessment, by the questions we ask families, the stars we highlight if we do an RBI, and the reminders of concerns we provide while the family is choosing outcomes/goals. But this requires a strong commitment to ethics, to ensure professionals are not talking parents into choosing outcomes they actually are not interested in or that are not actually functional. Third, professional input really comes into the strategies for intervention. It is a paradigm shift (sorry about the cliché) to let families make decisions about goals. Understanding whose child it is and that families need to be reinforced for the decisions they make about their children’s goals is the hallmark of a family-centered professional. Others are nice to families but don’t really trust them or care about the families’ priorities and long-term growth as parents; they are not truly family centered, even though they sometimes think they are God’s gift to families.

3. Does having a list of short-term objectives with the final objective being the end goal supercede the need to write the measurement piece?

This is partially addressed in my first answer. No, it doesn’t. If you want short-term objectives, here’s how it can work:

Joshua will participate in hanging out time and bath time by playing with a variety of toys. We will know he can do this when he plays with three toys in two hanging-out times and one bath time in a day for five consecutive days. [This is an example of a participation-based outcome with multiple criteria.]

Short-term objectives:

1. Joshua will play with two toys during one hanging-out time by October 1.

2. Joshua will play with two toys during one bath time by December 1.

3. Joshua will play with three toys during two hanging-out times by February 1.

4. Joshua will play with three toys during one bath time by April 1.

5. Joshua will play with three toys in two hanging-out times and one bath time in a day for five consecutive days by June 1.

If you have any pearls of wisdom that might help me find a way to navigate this I would really appreciate it. I fear I am just causing myself more confusion the more we go around on the subject.

Reread Chapter 7 in the RBEI book and look at the Goal Functionality Scale III.

Friday, February 4, 2011

New Discovery: Home Visits

Home-visiting or "home visitation" programs have been discovered by the early childhood community and they're the new hot thing. Obama has called for support of such programs and they are proliferating and generally gaining a lot of national attention.

On February 16 and 17, the National Summit on Quality in Home Visiting Programs: Connecting Research to Policy and Practice will be held in Washington, DC ( Where is Part C? Nowhere to be found among the confirmed speakers.

This has been true over the past 2 years, as these programs have been created and debated. Despite the fact that over 70% of the Part C children are receiving their most important service in the home, we are by and large not at the table with these Johnny Come Latelies.

To give credit where it's due, David Olds and his nurse home visiting model have been around for a long time, but they do not operate at nearly the scale of Part C home visits. Should we be at the table with these other programs or are we so fundamentally different that we're relieved to be excluded?

This is an important question the early intervention field needs to contend with. Amazingly, when the evidence base about home visiting programs is discussed, the conclusion is that it is ineffective. These findings primarily came out of the old Abecedarian Project and the Infant Health and Development Program, where these disadvantaged-family home visits were largely discredited, compared to intensive classroom-based programing.

But think of the different nature of those home visits from Part C home visits. Whereas disadvantaged-family homes visits often involve quite didactic interactions between trainers and parents, early intervention home visits, when done well, are designed to provide emotional, material, and informational support to families. The support is aimed in part at addressing specific, measurable family-chosen goals. I'm not trying to make Part C home visits sound better. Both types are designed to help with parenting.

So do we want early intervention to be associated with these increasingly popular home visitation initiatives? It seems peculiar for these programs not to learn from the history of over 25 years of early intervention home visits. But we also don't want the association to be so strong that we shy away from our special obligation to work on IFSP outcomes/goals.

It just seems peculiar to have a national summit on home visiting with no representation of Part C in it.