On February
19, 2019, I vowed to write my next seven posts about the Routines-Based
Model internationally implemented. Well, I got distracted by other pressing
issues but now I’m back on track. Please click on the link for that post to see
colleagues from The RAM Group who have contributed this information.
The Routines-Based
Model Internationally Implemented
In
Minga Guazú, in the hot eastern side of Paraguay, where many of the families in
early intervention (birth-6 years of age), are indigenous Guaraní, a young
occupational therapist (OT) welcomes a family to the early intervention center.
The center is for children with physical disabilities. This OT has been trained
in the Routines-Based Model (RBM) and, today, she will talk to the family about
2 or 3 of the 12 goals on the child’s and family’s intervention plan.
Meanwhile,
in Lisbon, a physical therapist (PT) is going on a home visit. The family has
10 goals, and this PT will talk to the family about, perhaps, 3 of these goals.
In one of them, she will ask the family if they would like to show her what
they’ve been doing, and she will guide them through some strategies that,
together, they have decided might help the child participate meaningfully in
breakfast time.
In
Cieszyn, Poland, workers are still hammering nails, as a dorm on a university
campus is being remodeled to become a preschool (“kindergarten” in Polish
parlance) following the Engagement Classroom Model. This model demonstration
site will show how you can run a classroom to promote child engagement.
In
this series of posts, we discuss the Routines-Based Model; how it became of interest,
internationally; what practices implementers adopted; what challenges they
faced; what successes they had; and our conclusions about what has to happen to
improve early intervention around the world.
The Model
My colleagues and I developed the Routines-Based Model over many years (McWilliam,
2016b; McWilliam, Trivette, & Dunst, 1985). The model has three main
components: needs assessment and intervention planning, a consultative
approach, and a method for running classrooms.
Needs Assessment and Intervention Plan
Development
In
the RBM, nothing good can happen unless we have a list of goals meaningful to
the family and other caregivers spending time with the child. To develop
an intervention plan, which
goes by different names in different countries, we conduct an ecomap and a
Routines-Based Interview, from which the family chooses functional goals and
family goals.
Ecomap. The ecomap is a picture of
the family’s ecology (Jung, 2010). Most
important, it identifies the family’s informal supports. In most early intervention
services, they don’t find out the extended family, friends, and neighbors the
family might be able to count on for support, before resorting to formal
supports.
Routines-Based
Interview.
The Routines-Based Interview (RBI) is the best known component of the RBM, but
it is only one of 17 components (McWilliam, 2016a).
A professional interviews the family about the details of child and family
functioning in daily routines, and the family chooses goals/outcomes. In New
Zealand, they try to avoid “interview,” because some people thought it was a
formal 2-hour bombardment of the family with questions (Woods & Lindeman, 2008).
From an implementation and branding perspective, however, we encourage
implementers to keep using “Routines-Based Interview,” because of its name
recognition.
Functional
goals. Goals for child functioning
are written to emphasize the child’s participation in routines, such as, “Jared
will participate in breakfast time, hanging out time, and outside time by using
single words” (Fleming, Sawyer, & Campbell, 2011).
Furthermore, we write the goals with criteria for acquisition, generalization,
and maintenance, such as, “We will know he can do this when he uses five
different single words, in two of these three times of day in one day, over four
consecutive days.”
Family goals. As a result of the RBI, the
family chooses goals for other members of the family. The most common goal is
time for oneself, such as, “Diane will have two hours for herself every two
weeks, for 10 consecutive weeks.”
Consultative Approach to Early
Intervention
A
principle of the RBM is that all the intervention occurs between visits, so the
point of visits with caregivers is to build their capacity to meet child and
family needs when the professional is gone (i.e., during all the other hours of
the week).
Family
consultation. Family consultation involves
the professional, usually a home visitor, working with the family to identify
(a) why a child isn’t doing something, (b) what might be a viable solution, and
(c) whether the strategy worked. This involves the professional’s asking many
questions to find out what’s being going on so far before making a suggestion (Boyer & Thompson, 2014; Dougherty, 2013; Horne & Mathews, 2004). He or she also asks the family whether they would like to try it out during the session
and whether they think it is feasible.
Collaborative
consultation to children’s classrooms (CC2CC). Similarly, when
professionals see “a child” in child care or preschool, they actually go to
visit the teaching staff. Again, they jointly decide why a child isn’t doing
something, what the strategy might be, and whether it has worked. This practice
is based on seven years of research on “integrated therapy” (McWilliam, 1995).
Engagement Classroom Model
The
RBM includes procedures for running classrooms to promote child engagement,
which we have dubbed the Engagement Classroom Model (McWilliam & Casey, 2008).
Implementers focus on five components:
- Conducting the RBI to establish functional, routines-based goals;
- Incidental teaching to address all goals in all routines, by following the child’s lead and eliciting higher order functioning;
- Integrated therapy, meaning specialists work with teachers in the classroom and never pull the child out;
- Zone defense schedule to arrange the room in zones, to
organize the adults, and to decrease nonengagement time during transitions
between activities; and
- Incorporating Reggio Emilia concepts to promote children’s exploration, to encourage creativity in art, and to make the environment “provocative” and beautiful.
Here, I have described the model, focusing on needs
assessment and intervention plan development, our consultative approach to
early intervention, and the Engagement Classroom Model. Next time, I address how
the model became of interest, internationally.
Boyer, V. E., & Thompson, S. D. (2014).
Transdisciplinary model and early intervention: Building collaborative
relationships. Young Exceptional
Children, 17, 19-32.
Dougherty, A. M.
(2013). Psychological consultation and
collaboration in school and community settings. Belmont, CA: Cengage
Learning.
Fleming, J. L.,
Sawyer, L. B., & Campbell, P. H. (2011). Early intervention providers’
perspectives about implementing participation-based practices. Topics in Early Childhood Special Education,
30, 233-244.
Horne, S. G.,
& Mathews, S. S. (2004). Collaborative consultation: International
applications of a multicultural feminist approach. Journal of Multicultural Counseling and Development, 32, 366-378.
McWilliam, R. A.
(1995). Integration of therapy and consultative special education: A continuum
in early intervention. Infants &
Young Children, 7, 29-38.
McWilliam, R. A.
(2016a). Metanoia in early intervention: Transformation to a family-centered
approach. Revista Latinoamericana de
Educación Inclusiva, 10, 155-173.
McWilliam, R. A.
(2016b). The Routines-Based Model for supporting speech and langauge. Logopedia, Foniatría y Audiología, 36,
178-184.
McWilliam, R. A.,
& Casey, A. M. (2008). Engagement of
every child in the preschool classroom. Baltimore, MD: Paul H. Brookes Co.
McWilliam, R. A.,
Trivette, C. M., & Dunst, C. J. (1985). Behavior engagement as a measure of
the efficacy of early intervention. Analysis
and Intervention in Developmental Disabilities, 5, 59-71.
Woods,
J., & Lindeman, D. P. (2008). Gathering and giving information with
families. Infants & Young Children,
21, 272-284.
