Sunday, November 17, 2019

The Routines-Based Model Internationally Implemented: 1. The Model

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:

  1. Conducting the RBI to establish functional, routines-based goals;
  2. Incidental teaching to address all goals in all routines, by following the child’s lead and eliciting higher order functioning;
  3. Integrated therapy, meaning specialists work with teachers in the classroom and never pull the child out;
  4. Zone defense schedule to arrange the room in zones, to organize the adults, and to decrease nonengagement time during transitions between activities; and
  5. 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.