Monday, May 15, 2017

Mental Shift 10. It's about helping families feel confident in their competence with their children


Since September 2015, I've been addressing the following mental shifts required to take a family-capacity-building, routines-based approach to early intervention:
12 Mental Shifts
1.       All the intervention occurs between visits.
2.       Whose child is it anyway?
3.       Children are learning from their caregivers, whether you want them to or not.
4.       Anyone spending time with the child has the opportunity to teach the child.
5.       Passing judgment on parents or other caregivers is a self-fulfilling prophecy.
6.       Parent failings don’t exist; only professional ones.
7.       What matters is how children function in their everyday lives. Function = participation = engagement = learning.
8.       The rush to get ahead leads to failure in early intervention.
9.       It’s about getting children engaged, independent, and in social relationships.
10.   It’s about helping families feel confident in their competence with their children.
11.   Too many cooks spoil the broth.
12.   Teamwork can work through collaborative consultation.

Helping Families Feel Confident

Here are four things to do with families and one thing not to do. I then discuss specific practices in the Routines-Based Model that help families feel confident.

Some Level of Covertness

The indirect approach is sometimes the best way to appear sincere. Although we talk about the value of being positive in our interactions with families, it we’re too gushy about how great they are, they might question our sincerity. For example, if we say on every visit, “Oh, you’re awesome in teaching Nigel,” after a few visits Nigel’s mother is going to wonder if you’re just saying that to be nice. So it’s a good idea to change it up, such as, “I was just thinking on my way over here that I wish other mothers I work with could see how you teach Nigel.” You’ve inserted the compliment by reflecting on your own thoughts.
Home visit in Paraguay

Better Than You

To build others’ confidence, it’s helpful to be confident yourself—confident enough to acknowledge when they’re better than you in some way. For example, “Wow! I wish I had your patience.”

Appreciate Them

This can be overt, somewhat contradicting “some level of covertness.” It is about finding something the caregiver is responsible for—something said, something done, something in his or her environment—and letting the caregiver know you value it. It could be, “You’re really sensitive to his feelings,” or, “You make diaper change so fun,” or, “He’s so cute in that outfit.” Feeling appreciated is such a basic need.
Along with being responsive, oriented to the whole family, friendly, and sensitive, being positive—appreciating caregivers—is one of the characteristics we found of family-centered professionals working with families of young children with disabilities (McWilliam, Tocci, & Harbin, 1998).

Encourage Them in Their Chosen Role

If we’re living a life we chose, we like our choices to be validated. For example, if a person with a good job decides to stay home with her child, we should covertly make statements about how much time she spends with her child or how focused she is on helping her child be engaged.
Some people are not living a life they chose but they’ve talked themselves into believing it was their choice. This cognitive dissonance is a way for people to deal with competing values. What you get and have to take at face value is their saying they’re living a life they chose.
Other people are not living a life they chose and they feel it was their fault or someone else’s fault. If they talk to you about it, either putting themselves or others down, you have an opening to find out what in particular they would like to change and then using family consultation to help them find a solution. You have to start by asking them if they want to do something about the particular bother. They might say no—they just want to vent… and to have you listen.

Don’t Positively Reframe Their Negative Statements

The chirpy positive reframe, like, “No, you’re really good at that!” or “Oh, all parents go through that!” or “That’s no way to think! Everything will turn out fine!” is annoying at best and insulting at worst. It’s negating what the caregiver is saying. We listen and acknowledge. It can be difficult when much negativity is coming out.
In all these situations, the stronger the relationship you have with the caregiver, the more direct you can be in your helping them.

From the Routines-Based Model

In the Routines-Based Model, various practices build families’ confidence. Four such practices are as follows:
1.     The ecomap shows them (a) they can identify many people in their informal- and formal-support networks and (b) they’re not alone;
2.     The Routines-Based Interview (RBI) shows them they can report on details of child and family functioning and can choose 10-12 meaningful outcomes/goals;
3.     Family consultation shows them they are solution finders and interventionists;
4.     The Measure of Engagement, Independence, and Social Relationships (MEISR) shows them they can assess their child’s functioning in everyday routines

Families’ Competence

We’re helping families to feel confident about their competence in four roles.

Parents

Early intervention is a parenting program. We enhance families’ ability to address specific outcomes/goals for their children. In the Routines-Based Model, we also encourage their competence in talking to their children, reading with their children, playing with their children, and teaching their children.

Family Members

Watching home visit with GuaranĂ­-speaking professional
The mother we might visit regularly might not be only the mother of the child in early intervention. She might be a mother of other children too, a wife, a daughter, a daughter-in-law, and so on. The Routines-Based Model teaches professionals to be oriented to the whole family, helping caregivers be the kinds of family members they want to be.

Interventionists

In their role as parents, parents are teaching their children, both addressing outcomes/goals and the usual teaching parents do. Helping parents be effective teachers of their children is a huge part of what we do.

Collaborators

We help families feel confident in working with us, together, to find solutions to needs they identified. Some families are natural partners; others are not used to being in that role and require some hand-holding to get there. We are helping prepare them for the marathon of parenting, not just the sprint in early intervention. As they move to other systems of support, we want them to be confident in determining their own needs and in working with professionals.
Let’s end with a saying from Lao Tzu: 
“Kindness in words creates confidence. Kindness in thinking creates profoundness. Kindness in giving creates love.”

 

McWilliam, R. A., Tocci, L., & Harbin, G. L. (1998). Family-centered services: Service providers’ discourse and behavior. Topics in Early Childhood Special Education, 18, 206-221.

 

Saturday, April 29, 2017

Mental Shift 9: It’s About Getting Children Engaged, Independent, and in Social Relationships



Our field is so influenced by assessment and legal issues that we think of children’s functioning in developmental domains. In children’s tests, whether compendium instruments like the Hawaii Early Learning Profile or norm-referenced tests like the Battelle Developmental Inventory, child development is carved up into developmental domains. IDEA Part C followed suit, by requiring IFSPs to document present levels of development in five developmental domains. Numerous problems exist with this view of children, many of which are well known.

First, functioning usually requires more than one domain. For example, a child might need to be able to play outside, but he has gross motor problems. But to take advantage of the opportunities outside, such as the purpose of playground equipment, he also has to have the cognitive competence to understand the concept of climbing a ladder, sitting on a see-saw, and so on. One can almost always throw cognitive into the domain cocktail. Conversely, in young children, you can rarely isolate a cognitive skill, because children demonstrate cognitive abilities with communication, fine motor, gross motor, and so on.

Second, our service delivery system is aligned with domains, so some people (including uninformed federal and state monitors) assume that gross-motor outcomes/goals should be addressed by physical therapists (PTs), fine-motor skills should be addressed by occupational therapists (OTs), and speech or language outcomes/goals should be addressed y speech-language pathologists (SLPs)—the ostentatious American title for speech-language therapists.

Third, the preoccupation with domains means that skills children need for successful functioning in everyday routines might not fall neatly into a list of domain-referenced skills. For example, where does splashing the water at bath time fall? (This is functional because of the first three letters of functional.) Fine motor, cognitive, adaptive? What about choosing which pajamas to wear? Communication, cognitive, fine motor, self-help? If skills don’t appear in a list of domain-referenced skills, such as on an assessment, they might not be targeted for intervention, which is a whole problem in itself—choosing deficits from tests or curricula. On the other hand, if the child has these undocumented skills, they won’t show up as strengths if they’re not on the lists.

The Office of Special Education Programs’ three child outcomes did break away from the domain approach, to produce

  1. Positive social-emotional skills (including social relationships);
  2. Acquisition and use of knowledge and skills (including early language/communication [and early literacy]); and
  3. Use of appropriate behaviors to meet their needs.
Self-disclosure: I was on the Early Childhood Outcomes advisory board. For two glorious weeks, the three federal outcomes were to be engagement, independence, and social relationships. Then committees got to work. One can still see the conceptual links, as shown in the figure below:

Engagement

Engagement was originally defined by Todd Risley and his group as participation in planned learning activities. Risley broadened his concept somewhat to include people’s being busy even in unplanned activities, and he conceptualized engagement as a human right of people in the care of others. Disadvantaged children in child care, nursing home residents, and residents in institutions of various kinds were studied. 

In the early 1960s, John Carroll paid attention to how people spent time, especially the amount of time students spent in foreign-language labs: Those who spent more time there became more proficient. A little later, the proliferation of teacher effectiveness studies looked at how students spent time in the classroom, and terms like allotted or allocated time, academic learning time, and engaged time were used. An important point of these studies was that the amount of time students were actually engaged was often a relatively small fraction of the time they were at the school. This was also important for us in early childhood, where “learning time” isn’t confined conceptually by lessons. In fact, we understand that all the child’s awake time is potential engagement time.

When I began my engagement research with Carl Dunst in the 1980s, we were among only a handful of people looking at this construct. Others were Charlie Greenwood and Sam Odom and I’m sure some others. Our first study looked at engagement the way Risley, Cataldo, and those researchers had—as a dichotomous variable: engaged or not engaged. Furthermore, they used a scanning system to count the percentage of children engaged, so they were actually measuring the engagement value of the activities, not individual-child engagement.

My work, with Dunst, Bailey, Raspa, de Kruiff, Casey, and others, moved to measurement of engagement in individual children and—a significant leap—to the sophistication of children’s engagement. At the beginning we examined only active versus passive engagement. We went through various iterations, finally ending up with a nine-level observational-coding system that could be reduced to five categories, across three types of engagement, as shown below.

Engagement With Adults
Engagement With Peers
Engagement With Objects
Persistence
Symbolic behavior
Encoded behavior
Constructive behavior
Focused attention
Differentiated behavior
Casual attention
Undifferentiated behavior
Nonengaged

The five categorized as (a) sophisticated, (b) focused attention, (c) differentiated, (d) unsophisticated, and (e) nonengaged. Engagement is an exhaustive construct, meaning that all behavior can fit into it somewhere. The goal in early intervention birth-5, therefore, is to increase both the amount of time a child is engaged (remember that it’s about how children spend time!) and the sophistication of his or her functioning.

Put simply, in routines, engaged children are participating meaningfully, possibly with adults, other children, or objects; their participation is developmentally and contextually appropriate; which means their level of competence will depend on their developmental level and on the demands of the routine. A child can be nonengaged or underengaged through no fault of his or her own. For example, a child made to sit and wait for adults to get their acts together might be nonengaged, if he was given nothing to do. Not his fault, but he’s still nonengaged. Therefore, engagement is suitable for assessing goodness of fit, an appropriate way to look at kids’ functioning:

If the demands of the routine match the abilities and interests of the child, the child’s functioning will be successful. If they don’t match, it won’t be successful. For example, if lunch time at home doesn’t require the child to communicate, and the child has communication problems, it might go well. If, however, he is fed soup, and his ability to eat liquid with a spoon is low, lunch time won’t go so well. With every engagement problem, from a goodness-of-fit perspective, we have three options:

  • ·       Teach skills to the child
  • ·       Change something in the routine
  • ·       Change our expectations for the child.

Traditionally, we viewed the problem as the child’s, which blames the victim. In a routines-based approach, we take the goodness-of-fit perspective.

Way back in 1985, we wrote that, for a child to learn, he or she had to be engaged. Not much more needs to be said.

Independence

One might think that focusing on children’s learning to do things on their own would be universal, but cultural differences exist in the importance of independence. Not surprisingly, the U.S. emphasizes children’s autonomy, but families from other cultures might have more of an interdependent streak. Their conception of being a “good mother,” for example, might include the mother’s doing things for her child. 

In child development, we understand that children become more independent as they mature, so independence clearly increases with maturity. This independence is part of engagement. Children are more engaged as they depend less on adults. Or their engagement shifts from being recipients of adult stimulation to being initiators of interactions with people or objects. 

Perhaps nowhere is independence more noticeable in early childhood than in motor development. But motor development for its own sake is shallow. What is the functional usefulness of children’s motor independence—their ability to move across space independently, their ability to position themselves to do things, their ability to negotiate their bodies in the presence of other people and of objects? As children develop motor independence, they become more competent participants in their routines They can be engaged in those routines. Thereby, we see how independence is a component of engagement.

Social Relationships

The book From Neurons to Neighborhoods, which purportedly had an impact on policy in the U.S., reviewed the literature on early childhood development and concluded that children’s social and emotional development were precursors to their learning. The scientists represented in this book said that, for children to learn, they had to be comfortable in their environment, they had to know how to interact appropriately with others, and they had to have effective communication skills. The interaction between communication and appropriate behavior is well documented. In this mind shift, we recognize the link between the two. 

No one cares what a child can do in a speech therapy room with a speech therapist. That’s not life. What matters is how a child understands what others are communicating and what he or she communicates to others in daily routines. Furthermore, helping a child communicate effectively is going to be more successful if the adults in the child’s environment have strategies to use with the child. Someone “working with” the child in a strange environment (e.g., a clinic or center) once a week is going to have virtually no impact on the child, especially if not caregiving adult is learning the strategies.

I could have used any area of development or discipline to make this point. In early intervention, communication is the most common single reason for receiving services. 

An explosion in behavior problems in young children has occurred in early childhood. These problems interfere with social relationships. Sometimes, children’s problem behaviors are related to his or her difficulties in communicating: Because the child cannot communicate with words, he lashes out with inappropriate behavior. Sometimes, however, children have perfectly good language skills but they still have behavior problems—perhaps because they have self-regulation problems or emotional problems. Even then, in this model, we view them as having problems with social relationships because their behavior interferes with interactions with others.

Putting This All Together

Whether we’re helping families or teachers or rearing children ourselves, it’s helpful to keep the big picture in mind. This big picture is that, for children to be functioning and happy members of society, they need to be as independent as possible, to have social relationships, and to be able to participate in their home, school, and community. The manageable chunks of home, school, and community are the routines within them—the activities and events comprising these environments. When children can enjoy these routines, meet the demands of the routines, do so with less adult assistance, understand other people and convey to others, and do all this in a happy and appropriate manner, we can say the outcomes are positive.

An index of these outcomes is the Measure of Engagement, Independence, and Social Relationships (MEISR). This tool is being published this year by Brookes Publishing Company. It has almost 400 items of functional skills children 0-3 commonly demonstrate in 13 home routines. Families complete the MEISR, because they’re the only people who know what a child does in home routines. Professionals can use the MEISR (a) to monitor child progress, (b) to help rate children’s federal outcomes (items are cross-walked with the ECO outcomes), and (c) to report children’s present levels of functioning on IFSPs (items are also cross-walked with the five developmental domains required for reporting on IFSPs). The MEISR has been translated into Spanish, Portuguese, Chinese, and probably other languages (see www.ramgroup.info).
 
In 2016, UNICEF developed a module on child functioning, divided into age bands (https://data.unicef.org/resources/module-child-functioning/). The section for children ages 2-4 gives parents the chance to answer questions about vision, hearing, walking, picking up small objects, understanding parents, parents understanding the child, the child’s learning things, playing, and behavior problems. We tried to capture the major areas of development or milestones in the National Early Intervention Longitudinal Study, some years ago. This UNICEF survey might be a useful profile that can be used across cultures. If only it were organized by routines….