Monday, July 7, 2014

Self-Regulation in Working With Families



Home-based early interventionists need self-regulation too. In this post I discuss what relationship we have with families, who the hero of the visit is, and the Hoosiers Rule.

As we develop our relationship with families, do we present ourselves as the people with answers? To some extent, we do, to build the family’s confidence in us and to show them they’re not wasting their time hosting us. But if we always have the answers, what are we doing to families? We might be enhancing their dependence on us rather than their self-confidence as parents, problem solvers, and “case managers” for their child. As Anne Isabella Thackeray Ritchie wrote in her 1885 novel, Mrs. Dymond, “If you give a man a fish he is hungry again in an hour. If you teach him to catch a fish you do him a good turn.”

We need to be careful not to try to be the hero of the visit, which can happen if we have all the answers—the strategies, the ideas, the suggestions, the information…. Getting into the car at the end of the visit, when we have given the family the gift of our creativity, wisdom, and knowledge, we feel self-satisfied. We feel useful. We are immediately gratified. This feeling is addictive. Many home visitors are absolutely convinced their role is to give families everything they can, right away. They are convinced because families love them and they themselves have that feeling of self-satisfaction at the end of home visits. 

It is much harder to take the long view by taking the slower road. When a father asks me, “What should I do? It takes us one to two hours to get her to sleep,” I can immediately start talking about what the medical people ridiculously call “sleep hygiene” (bedtime environment and ritual) and I can tell the father how to condition the child to decreasing attention time (fading). In the course of doing so, I would undoubtedly mention things they have tried, things they wouldn’t like to try, things they wouldn’t believe would work, and also some great ideas. It would be quite easy for me to feel like the hero of the visit.

Instead, however, I want the father to be the hero of the visit. At the end of the visit, I want him to think, “I came up with a plan, with Robin’s help. I’ve already done a number of things right and I provided useful information for us to arrive at the new plan.” Furthermore, the act of coming up with that plan should have helped the father with problem-solving skills. Almost everyone can solve problems, of course, but sometimes families benefit from learning how we arrive at solutions—the factors we consider when trying to find the right strategy. I will save strategy selection factors for another post.

In not trying to be the hero, we have to practice self-regulation: Hold off on that brilliant idea and work with the family.


  • ·        Tell me more about the problem.
  • ·        What time of the day does this happen, how often, for how long?
  • ·        What would you like to see happen instead?
  • ·        What have you already tried and what happened?
  • ·        Have you ever tried _____?

To each of these questions, there could be many follow-up questions, so the discussion is often detailed and of some length. The last question, which I have dubbed, in Routines-Based Early Intervention, “ask-to-suggest,” is actually a suggestion. It might not be the strategy the family implements, because they might not think it’s feasible, but “Have you tried _____?” should not be considered a lead-up question: It’s really a suggestion in the form of a question.

These questions follow the Hoosiers Rule, which we invoke in this method of coaching with families, called family consultation. The Hoosiers Rule comes from the eponymous movie, where the coach asks the kids, “How many times we gonna pass the ball before we shoot?” And the answer is four. We train people to ask four questions before they mention a potential solution (i.e., a suggestion). This helps slow down the home-based early interventionist. It helps with his or her self-regulation.

This approach to working with families, which we call family consultation, builds families' skills in arriving at solutions, makes them feel like a partner not a client, and might even make them feel like the hero of the visit.

3 comments:

M Raven said...

The idea behind self regulation in working with families is a place to start, specifically with the Hoosiers rule. However I think it's not just the number of questions, but the kinds of reflective questions we ask. Most professionals, especially therapists, have little to no graduate training on reflective questioning/coaching as they are learning about PT, OT, etc. I've found Rush, Shelden, and Raab's article, "A Framework for Reflective Questioning When Using a Coaching Interaction Style" to be very helpful to examine the question type and question content needed in a situation based on where a family is.

Mary said...

Hooray, you are back! Great post!

Chelsie Guilford-MONTANA said...

I think it is really hard to hold back on giving the answer. This is something I struggle with at every home visit so it was really great to read this blog. I always want to "fix the problem" and provide all the answers. But, it is not about me. It's about the family and how I can help encourage/coach them to come up with the answers themselves. Very encouraging blog!