Monday, July 23, 2018

Overview of the Routines-Based Model

It would be impossible for me to describe the Routines-Based Model (RBM) in detail in only a few paragraphs. This post is designed to show how all the practices fit together and to show the scope of the model. I thought I’d throw together a short, accessible blog post that turned into this monster. I’ve ended up describing what the model is, attending to the principles, followed by the three major categories of practices in the model (assessment and intervention planning, working with families and teachers, Engagement Classroom Model), and how we evaluate the Routines-Based Model.

What Is It?
The Routines-Based Model is a collection of practices that, together, provide a unified approach to working with young children with disabilities and their families (McWilliam, 2010). It emphasizes (a) children’s functioning in their everyday routines and (b) supporting families. Many early intervention (birth to 5 years) have or claim this focus, so what’s different about the RBM? First, the practices are well defined, have implementation checklists, and are supported by research. Second, they work together. Third, they adhere to the following set of principles.


  • ·       All the intervention occurs between visits (caregivers provide intervention; visits are for professionals to provide service or support)
  • ·       Early intervention sessions aren’t golf lessons (we don’t work directly with the child, using massed trials, expecting the child to generalize to nonsession time)
  • ·       Caregivers address children’s learning needs in everyday routines (rather than in separate lessons or sessions)
  • ·       We don’t abnormalize children and families (early intervention matches families, not vice versa)
  • ·       We promote evidence-based, functional strategies (not popular techniques that claim to get at underlying causes of dysfunction)
  • ·       Whose child is it anyway (families not professionals decide what’s right for children)?

My colleagues and I have followed these principles in developing the model, and implementers of the model have used them as mantras. One can think of the model in terms of four general areas: assessment and intervention planning, working with families and teachers, the Engagement Classroom Model, and evaluation.
the family has to have the capacity to help their child and other family members—as they define that capacity

Assessment and Intervention Planning

We follow the logic represented below, which is best viewed through backward mapping. Our distal outcomes are children’s learning and development and family quality of life (Garcia Grau, McWilliam, Martínez-Rico, & Grau Sevilla, 2016). For those to happen we believe children need to be able to function maximally in their daily routines, the family has to have the capacity to help their child and other family members—as they define that capacity—and family needs must be at least addressed and at most met. For those outcomes to be realized, professionals need to provide collaborative consultation, including family consultation (a consultative or “coaching” approach), using the Next-Steps Form to emphasize how much families do with their children and to give them control over the visits.



Many people consider the heart of the RBM to be the Routines-Based Interview, for good reason: Without a decent needs assessment, how should we help families and their children (Hughes-Scholes, Gavidia-Payne, Davis, & Mahar, 2017)? In the RBM, we provide professionals with professional development through an annual institute and state bootcamps (including hands-on practice with families), with a protocol, with an outline, and with a practice-based checklist.
Institute and Bootcamps
Almost every year, since 2008, we have conducted an RBI Certification Institute, in which professionals from around the world have received training in conducting these needs assessments. In addition to the U.S., Spain, Costa Rica, Portugal, and Australia have been represented. I run these week-long institutes with Cami Stevenson from Portland, OR, along with certified trainers who work as coaches. Participants get to practice with families in early intervention. About two thirds of participants make it through to certification.

We also help states organize state bootcamps—versions of the international certification institute. We have held these bootcamps in Australia, Colorado, Kentucky, Mississippi, Montana, Nebraska, New Zealand, and other places.
The RBI Protocol (McWilliam, 2009) is a step-by-step guide through the RBI, providing professionals with the wording, the structure, and the framework for the interview. It takes the guesswork out of this semi-structured interview, although, of course, the meat of the interview cannot be scripted. To conduct the RBI with fidelity, however, certain parts must be done according to well-tested rules. For example, the three “magic” questions at the end of the interview have to be asked a certain way, to avoid awkwardness:

·       Do you have enough time for yourself or yourself and another person?
·       When you lie awake at night worrying, what do you worry about?
·       If there’s anything you could change in your life, what would it be?

Because some professionals find these questions difficult to ask, we have learned to script the questions. In fact, we are building a bank of scripts for introducing different parts of the model to families and professionals.
The RBI Outline provides the structure for the interview. The beginning and end of the interview are structured. Even the middle—the discussion of child and family functioning in routines—has a hidden structure. To keep interviewer and note takers on track, the one-page Outline is useful.
The backbone of the RBM is its performance checklists

The backbone of the RBM is its performance checklists (Boavida, Akers, McWilliam, & Jung, 2015). These define the practices, provide a platform for feedback, and constitute the fidelity measure. We have operationally defined each practice in the model to reduce ambiguity about what should be done and what should not be done. When training professionals, we observe them, check their performance on the checklist, and provide feedback. This, rather than workshops, is real training. By using checklists to observe the model in action, we obtain fidelity and implementation data: We can quantify the extent to which the practice is implemented as designed. In this case, we use the RBI With Ecomap Checklist to explain the practices (RBI, ecomap, functional outcome/goal writing), to train people, and to document fidelity to the model.


The ecomap is the method we use to determine the composition of the family’s ecology (Jung, 2010). We complete it early in our encounters with families—at intake or at the beginning of the RBI. As is true in all the practices in the model, the professional completing it usesan informal, respectful style with the family. To ascertain the level of support from informal supports (i.e., extended family, friends, neighbors), we ask about the frequency of contact, even though we understand the closeness you feel to someone goes beyond frequency of contact. To ascertain the level of support from formal supports (i.e., professionals, financial assistance, medical professionals), we ask how the family likes the support, because we don’t want to ask them to judge the quality of their professional practice. The ecomap shows supports and different thicknesses of lines to indicate level of support but the process of asking about these supports is more important than the product. We say in the model that we are not trying to capture the truth; we’re trying to capture what families want to tell us. Later, when providing support to the family, the professional refers to the ecomap, when they discuss a need, particularly a family-level need, to see if anyone in the family’s existing network can help. Here is an example.

Participation-Based Goals

The deliverable from the RBI is the list of family-chosen goals (known as outcomes in Part C of IDEA). Because the interview is about what happens in daily routines, families choose functional skills they want their child to do, such as use words or signs to indicate what they want for breakfast, look for toys that fall out of sight during hanging-out time, walk down the hallway at bedtime, pick up food at lunch time, say hi to Grandma when she walks in the door, or take off shoes when coming inside. These examples, by the way, cover all developmental domains, even though we use engagement, independence, and social relationships as our domains.

In writing goals, we emphasize that the reason for the goal is for the child to participate meaningfully in routines. Participation is widely considered a core concept of the functioning of people with disabilities. For example, it is one of the three parts of the International Classification of Functioning, Disability and Health (ICF), along with body structures/functions and activities. How “disabled” a child is can be thought of as how meaningfully the child can participate in routines of home, school, and community.

Therefore, we write goals in the RBM beginning with [child’s name] will participate in…, followed by the routines for the skill in question. For example, Mats will participate in breakfast, lunch, dinner, and snacks by using words or signs to indicate what he wants (Fleming, Sawyer, & Campbell, 2011). The social relationships (language) goal doesn’t hang out there on a goal, with no context. The reason for his using words or signs is to participate in meal times meaningfully. This doesn’t mean Mats won’t learn or use words in other routines, but these are the ones the family targeted as particularly important. 

How will we know he is using words or signs? To answer this, we establish criteria. First, we work with the family to answer how many words Mats might be able to learn in 6 months, considering where he’s starting from. This is an acquisition criterion. Second, we have a generalization criterion, when appropriate. In the RBM, it is almost always generalization across routines. In this example, we might target the use of words or signs in all four routines: breakfast, lunch, dinner, and one snack. Finally, to make sure the skill sticks, we establish a maintenance criterion, such as the number of consecutive days in which the skill is displayed. Therefore, the final participation-based goal might read Mats will participate in breakfast, lunch, dinner, and snacks by using words or signs to indicate what he wants. We will know he can do this when he uses five different words or signs at breakfast, lunch, dinner, and one snack on four consecutive days.

In the RBM, we use these criteria and goal-attainment scaling for monitoring progress on goals, but some professionals choose different measurement systems. Some use a rating scale for the family’s satisfaction with the child’s performance, for example. In this system, the goal is attained when the family is happy with what the child is doing. For full fidelity to the RBM, however, we use the three criteria (acquisition, maintenance, generalization). 

Family Goals

Some goals the family chooses at the end of the RBI are goals for members of the family other than the child in early intervention. Family goals can be child related or family level. Child-related family goals are those things the family wants to happen, related to the child in early intervention. They might be about information, obtaining equipment, looking for resources (even services), learning a skill that will help the child (e.g., sign language), and so on. Family-level goals are not directly related to the child but specifically for other members of the family, such as meeting basic needs, getting a job, having recreation time, helping a sibling of the child, or—the most common one—having time for yourself or yourself and another person. To keep track of the family and child goals, home visitors use a matrix.


The matrix writes itself from the RBI, because it lists the informal outcomes/goals on the left-hand column and the routines on the top row. Outcomes are listed in the family’s order of importance priority. In the corresponding cells, you put an X for the routines in which the child will participate by performing the skill. It looks like this:

Before dinner
1.      Persist


2.      Follow 2-step directions



3.      Mother resume education

4.      Use 3 different pieces of playground equipment


5.      Use fork with little spilling


6.      Parents info about Fragile X syndrome

7.      Wait for others’ turns


8.      Put on shirt and pants


9.      Parents time for themselves

10.   Count to four when upset




11.   Express opinion without whining or crying



12.   Visit transition programs

13.   Stay in bed without protesting


We leave a couple of columns for other routines that the family wants addressed—perhaps those we didn’t have enough time to get to in the RBI.

Assessment and intervention planning according to the RBM, therefore, consist of the RBI, the ecomap, participation-based child goals, and family goals. All outcomes/goals are represented on the Outcomes x Routines matrix.

Working With Families and Teachers

In the RBM, working with families and teachers is essentially a consultative endeavor, similar to what others call coaching. We provide this collaborative consultation through support-based home visits, during which we provide family consultation, and collaborative consultation to children’s classrooms (CC2CC).

Support-Based Home Visits

Years ago, we defined home visits as support based (McWilliam & Scott, 2001). The three types of support are emotional, material, and informational. Home visitors should be aware of their obligation to provide all three, although not necessarily at every visit. Nevertheless, they should be alert to the needs for any of the supports and to the opportunities to provide these three types of support.
We have found five supportive behaviors seen in family-centered early intervention service providers:

  • ·       Saying positive things about both the child and the adults;
  • ·       Being responsive to families, reading between the lines yet not operating on too many assumptions;
  • ·       Being oriented to the whole family, not only the client child, especially to the child’s primary caregiver’s well-being;
  • ·       Being friendly, beyond rapport; and
  • ·       Being sensitive—walking in the family’s shoes.

Other emotionally supportive behaviors are important also, such as being encouraging and empowering. We found these five in some research we conducted on patterns of service use in early intervention 0-5 (McWilliam, Tocci, & Harbin, 1998).
In the RBM, we think about two kinds of material support: ensuring families have basic needs met and ensuring they have the necessary adaptive equipment for the child’s engagement in routines. Home visitors cannot ignore basic needs even if they aren’t service coordinators. They have to help the family find solutions if the family has problems with housing, safety, food, clothing, and so on. They should use the family’s ecology (i.e., whip out the ecomap), especially the informal network, but also the formal network, including the service coordinator, case manager, or whatever the person serving in that role is called.

Adaptive equipment can include alternative and augmentative communication devices, adaptive furnishings (e.g., corner chairs, adapted strollers), and adaptive technology (e.g., switch toys, augmented reality). We don’t like to abnormalize families with excessive adaptations but neither do we want children to go for long without the necessary equipment to function in routines.

As mentioned earlier, a principle of the model is not to abnormalize families, which means not create situations when an intervention disrupts the family’s natural routines. For example, we wouldn’t recommend that a family sit down to “work on goals.” First, the goals should be for functions that occur in regular routines—not lessons or sessions. Second, the intervention should be a strategy that the family can use while parenting, playing, or otherwise going about their everyday lives with their child. The no-abnormalization principle can be more positively stated: Early intervention should help families lead as normal a life as possible.
Families always want information. The four kinds of support they typically want are about

  1. ·       Child development: What other children my child’s age do or what comes next;
  2. ·       Resources, including services;
  3. ·       The child’s disability; and
  4. ·       Interventions: what to do with the child. This last one takes up about 80% of the support professionals provide.

The core of early intervention visits, whether to the home or elsewhere, is support. Think of support in terms of emotional, material, and informational support.

Family Consultation

Encounters with the family, according to strong U.S. commitments (e.g., federal law), occur in natural environments. In other countries implementing the model, however, such as Spain, Paraguay, and Taiwan, early interventionists have not found a way to rip themselves from their centers. Recognizing that the quality of a visit doesn’t rest entirely on the location, we have developed procedures for family-centered, functional visits occurring in centers, clinics, or offices. We have seen that home visits can be clinical, nonfunctional, and noncollaborative. We have also experienced functional, capacity-building encounters in offices. One of the key practices in the RBM for making visits effective, regardless of location, is the use of family consultation.
Solution Finding
We have coined the term family consultation to describe a carefully selected series of steps for Reports-Based Home Visits (McWilliam, 2010). When the family chooses to discuss child functioning, the professional first asks what time of day (routine) the family has in mind, for discussing the child skill. Child functioning is never discussed outside the context of routines. Even if the parent says, “All the time,” as they might for language learning, we ask them to identify routines when it would be especially helpful for the child to communicate. Once the professional understands the skill the parent wants, the professional asks many questions in the quest for the best potential solution (i.e., strategy).
Hoosiers Rule
I have borrowed from one of the best sports movies made the Hoosier’s Rule, which says that a home visitor cannot make a suggestion until he or she has asked four questions. From the movie, the rule was you can’t shoot until you’ve passed the ball four times. The four-question rule (a) increases the likelihood of understanding the child’s current level of performance, (b) provides you with enough context to make a reasonable suggestion, (c) conveys to the family you’re really interested in working with them; and (d) helps the family see they’re part of the solution finding (i.e., developing strategies).
Feasibility Questions
Once we’ve hit on a strategy and perhaps shown the family how to do it, or they’ve practiced while we coached, we ask two important questions: 

  • Do you think this strategy will work?
  • With everything you have going on at this time of the day, do you think you’ll be able to carry out this strategy?
If our relationship with the family is good, they’ll tell us honestly if the answer to either question is no. That allows us to pull another arrow out of our quiver, after probably some more questions.
Key Tools
The support-based home visit includes three tools—pieces of paper.
The Next-Steps Form (NSF) has three essential pieces of information:

  • What we did today
  • What we will do until the next visit
  • What we will concentrate on during the next visit
What we did today helps the early interventionist reflect on what happened during the visit. The activities of some visits are clear. Those of other visits, such as listening to the parent talk about something bothering him or her, aren’t as clear. Each visit should serve a purpose. Knowing you’re going to have to complete this first box helps the early interventionist focus on what happened today.

Documenting what the family said they want to try doing with their child is another box for closure and it serves as a reminder to the parent. It also reminds the early interventionist before the next visit.

Because we have many outcomes/goals in the RBM, we ask the family to look at the entire list of outcomes to tell us what they’d like to concentrate on during the next visit. This is helpful if some outcome/goal hasn’t been discussed in a while. Families can also mention other topics that aren’t outcomes/goals, such as an upcoming doctor’s visit, a concern about a sibling, or another issue with the target child.
The second key tool for family consultation is the matrix which was described in the Assessment and Intervention Planning section above.
The ecomap is the third tool the home visitor has available on Routines-Based home visits. It also was described in the Assessment and Intervention Planning section.


In addition to making support-based home visits and using family consultation during visits, the model includes collaborative consultation to children’s classrooms (CC2CC) and, within those visits, integrated therapy (McWilliam & Bailey, 1994; Woods, Wilcox, Friedman, & Murch, 2011).
Collaborative Consultation
“I’m here to help you because you have a child with disabilities in your room.”

Using CC2CC is best done by establishing a role with classroom teachers that probably is new for most itinerant ECSEs and therapists. This role is that of classroom consultant, rather than that of a professional ostensibly assigned to work directly with or about a single child in the classroom. The environment of the classroom program (administration, philosophy, layout, materials, etc.) make a difference to the functioning of children, including the one with disabilities (McWilliam, deKruif, & Zulli, 2002). We like to introduce ourselves to teachers with the statement, “I’m here to help you because you have a child with disabilities in your room,” rather than “I’m here to help you with the child with disabilities” or, worse, “I’m here to work with the child with disabilities.”

Once the teacher and visitor begin working together, the visitor uses a collaborative not expert consultation approach. Early interventionists will notice the similarities of CC2CC with the popular coaching, which had been defined and redefined by numerous experts. I don’t use that term to talk about working with families or teachers because I respect the tight definitions experts have applied to coaching practices, and my methods don’t fit those tight definitions, and I reserve coaching for training professionals. For example, in our RBI institutes, the trainers are coaches. Years ago, Sue Sheridan’s (Sheridan, Kratochwill, & Bergen, 1996) work on Conjoint Behavioral Consultation influenced me to think about three stages of consultation and the difference between an expert and a collaborative approach, as follows:

Consultation Stages[1]
Expert Consultation
Collaborative Consultation
Problem identification (why can’t the child do this?)
Specialist informs teacher
Specialist and teacher decide together why the child can’t do this
Solution identification (what strategy should be used?)
Specialist makes recommendation to teacher.
Specialist and teacher decide on strategy together
Evaluation (did it work?)
Specialist determines success of intervention
Specialist and teacher decide together whether strategy was feasible and successful

When specialists and teachers have the luxury of actual meeting time, the RBM has no specific format… yet. Rush and Shelden (2011) provide good ideas for meetings. To be consistent with the model, I recommend a problem-focused (also known as solution-focused) approach:
  1. What’s the problem?
  2.  In what routine does the problem occur or let’s pick a representative routine?
  3. What are the demands of the routine (i.e., how are children supposed to be engaged—to participate)?
  4. Is our child able to meet those demands or does he have a disability-related reason for not being able to?
  5. Is our child interested in this routine and its activities?
  6. How can we change the routine (e.g., environment, materials, activities) to better match the child’s abilities and interests?
  7.  Instead or in addition, skills should we teach the child to increase his or her engagement?
  8. Should we change our expectations and no longer consider this a problem (i.e., pick our battles)?
Although nowadays I concentrate on CC2CC, with an emphasis on specialists’ collaborating with teachers, our work in this area began with integrated therapy. We were first interested in the relative merits of pulling kids out for therapy and instruction versus having specialists go into the classroom. We soon realized it was a more nuanced question, especially what the specialist does in the classroom, from one-on-one in classroom, separate from the ongoing activity (i.e., pull-aside, push-aside) through group activity to individualized within routines.

Integrated therapy we now know is best done through individualized within routines. This entails the specialist going into the classroom, talking to the teachers, joining the child in what the child is already engaged with, and weaving intervention into the ongoing activity—to show teachers how the intervention can be embedded in their activities. The consultation occurs in the classroom, with specialists and teachers talking during the classroom activity. This consultation makes it in vivo.

Working with families and teachers in the RBM includes support-based home visits, family consultation during visits, and collaborative consultation to children’s classrooms. As always, the focus is on promoting children’s functioning and on family well-being. 

Engagement Classroom Model

The RBM receives much attention for its impact on home- and community-based supports, but it has strong roots in classroom management. My first work, in fact, was in the co-ops of Project SUNRISE, with Carl Dunst. Over time, the SUNRISE model became the Individualizing Inclusion model and now the Engagement Classroom Model (McWilliam & Casey, 2008; McWilliam, Wolery, & Odom, 2001; Wolery, Sigalove Brashers, & Neitzel, 2002).

The model has five components. First, the RBI is the method for determining children’s and family’s goals. Both the family and the teacher are interviewed, because both home and classroom routines are important for assessing children’s functioning and for promoting it. Second, incidental teaching is the main method of intervention, with teachers (a) ensuring child engagement, (b) following the child’s lead, (c) eliciting higher forms of engagement, and (d) ensuring the interaction was reinforcing. Incidental teaching can be used across routines for all kinds of goals. Third, therapy is integrated into ongoing classroom routines. Therapists and itinerant special instructors/ECSEs work with teachers to build their capacity to intervene with the child throughout every day. Fourth, the zone defense approach is used to ensure, wherever a child is in the classroom, an adult is responsible for ensuring that child’s engagement and using incidental teaching with him or her. The zone defense schedule uses the teaching staff efficiently, with each teacher having his or her own column on the schedule. Fifth, we have drawn inspiration from Reggio Emilia to make classrooms beautiful for children and adults alike, to use natural colors and materials, and to organize the environment to promote engagement, social interaction, and creativity.


To determine the efficacy of the RBM, we are interested in both formative and summative evaluation. In formative evaluation, we measure professional practice and fidelity to the model. We assess professional practice by having professionals complete the FINESSE II (McWilliam, 2000) and having families complete the Family FINESSE (McWilliam, 2015). These two measures are used to rate typical and ideal practice, in the case of the FINESSE II, and typical practice and importance, in the case of the Family FINESSE. We measure fidelity to the model with performance checklists, such as the RBI With Ecomap Checklist, the Routines-Based Home Visit Checklist, and the Collaborative Consultation to Children’s Classrooms Checklist.

In summative evaluation, we measure goal attainment, child progress, family confidence, and family quality of life. We measure goal attainment with a version of goal attainment scaling. Child progress we measure with the Measure of Engagement, Independence, and Social Relationships (MEISR) (McWilliam & Younggren, in press) and the Classroom MEISR (ClaMEISR) (McWilliam, 2014). Family confidence we measure with the Fam-Con (McWilliam & Garcia Grau, 2017). And family quality of life we measure with the Families in Early Intervention Quality of Life Scale (FEIQoL) (McWilliam & García Grau, 2017).

 What began as an overview of the Routines-Based Model has turned into a dissertation. It can serve as an update to Routines-Based Early Intervention (McWilliam, 2010), which was published 8 years ago.
The concept is simple: Focus on children being engaged and on families being able to teach their children when we’re not there.

The model doesn’t solve all the problems or have all the answers, but it does pave a way for early intervention to address children’s functioning, to build families’ capacity, and to make our professional practice common-sensical, fun, and valid. This pavement can help professionals with concrete practices, moving us beyond well-meaning theoretical pronouncements. Our approach to needs assessment, intervention planning, service delivery models, home visits, and classroom visits works with most situations in serving infants, toddlers, and preschoolers. And it works with families from diverse cultures and in foreign lands. The concept is simple: Focus on children being engaged and on families being able to teach their children when we’re not there. Look at the practices in the RBM for the tools to make this simple concept work.

Visit us at

Thanks to Cami Stevenson for edits and suggestions.


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[1] Adapted from (Sheridan et al., 1996)