Sunday, November 3, 2019

What Happens After the RBI?


I  am reposting this blog entry, from July 21, 2019, because formatting of the example matrix was all messed up.

The Routines-Based Interview (RBI) is arguably the best known component of the Routines-Based Model (RBM). It is the method we use for assessing child and family needs and the structure for helping families decide on goals. It is, however, only one part of the RBM. In addition to the functional and family goals produced by the RBI, we need to follow this up with effective practices so those goals are actually addressed.

In this post, I’ll describe how the RBI sets the stage for meaningful visits to caregivers, such as parents, teachers, and others caring for the child for substantial amounts of time. The RBI was never designed to be a stand-alone “family assessment.” It was always designed to be the beginning of an approach to working with families, children, and teachers (McWilliam, 1992).

Before the actual RBI begins, the interviewer develops the family’s ecomap by asking the family who lives in the home, about their informal, intermediate, and formal supports. The RBI itself is a semi-structured interview with one or more of the child’s primary caregivers. The interviewer asks the caregiver detailed questions about the child’s engagement, independence, and social relationships and the doings of everyone in the home. During these discussions of everyday life in the family, families often talk about matters other than the child’s functioning, such as about their own lives. We ask families also about whether they have enough time for themselves, about their main worries, and about anything they would like to change. At the end of the interview, families consider the whole conversation and choose 10-12 goals for their child and other family members, including the adults.

The hinge between this family-centered process to obtain goals and what happens after the RBI is the Routines-Goals Matrix. The matrix, shown below, can be completed whenever the RBI is done because, during goal decision making (at the end of the interview), the interviewer ascertains for what routines each skill the family chooses is needed. I developed this matrix from the list of informal goals developed during goal decision making. They are listed in the order of importance to the family (i.e., “prioritizing”).

 

Family goals don’t have routines assigned to them—hence the rows with no Xs. On the first visit after the RBI, the person providing support (i.e., services) to Shamika would ask a couple of questions to see what she might want to talk about. If she had no pressing matters, the professional would show Shamika the matrix and ask her to look at the goals/outcomes. The professional would ask her what she would like to discuss on this visit. If Shamika chose the first priority, acknowledge people when they greet Jamal, the professional and she would begin the solution-finding process. 

This practice is covered in our Routines-Based Home Visit Checklist. When Shamika chooses a child goal/outcome like this, the professional would ask at what time of the day. The matrix shows this goal was needed for waking up, hanging out, and outside. If Shamika said it was important at hanging out time, she and the professional would start on strategy development, which is the same as solution finding, for teaching Jamaal to acknowledge people when they greet him during hanging out time. 
The matrix therefore (a) shows the caregiver the list of goals/outcomes they chose and (b) reminds the partners of the contexts for the skill—why it’s needed.

Let’s say Shamika and her home visitor discuss a strategy (AKA solution or intervention) for her to use to address Jamaal’s acknowledging people when they greet him during hanging out time, and she decides the strategy is likely to work and is feasible for her to carry out. So, it’s time to move on to another topic. The home visitor can ask the horizontal question (look at the matrix!), “Would you like to talk about Jamaal’s acknowledging other people at other times of the day, such as waking up time or outside time or would you like to talk about other skills you’d like to see during hanging ou timet, such as Jamaal’s using one word or sign, playing with toy for 5 minutes, walking without assistance, playing without throwing toys, or pointing to pictures?” This question allows for a smooth transition to another goal or routine the family has identified as a priority.

Here, I have used a home visit as an example, but you can see how a similar approach would work with a child care provider or preschool teacher. The routines would be classroom routines, and the early interventionist would ask the teacher what skill he or she wanted to work on and proceed accordingly.

The RBI (a) arrives at truly meaningful functioning the parent wants for their child, (b) identifies the contexts (i.e., routines) for that functioning, and (c) reveals family needs that directly or indirectly have an impact on child functioning. The matrix captures all that information, which helps the early interventionist and the caregiver focus on skills and contexts.

We’ve always known the RBI is only the beginning. Now, I hope you’ll see how it leads to meaningful supports to caregivers… and improved functioning in children.

McWilliam, R. A. (1992). Family-centered intervention planning: A routines-based approach. Tucson, AZ: Communication Skill Builders.