Home visits have been suspended during the Covid-19
pandemic, but early interventionists can still provide supports to families. I
discuss here how the principles of the Routines-Based Model match the demands
of distance service delivery, the definition of tele-intervention, the research
behind telepractice, how to use telepractice for the Routines-Based Interview,
and how to use tele-intervention for home visits.
How the Principles of the Routines-Based Model Match the Demands of Distance Service Delivery
The Routines-Based Model of Early Intervention (Birth to
Five Years) is a method of providing supports to children with disabilities and
their families that focuses on functioning in children and on meeting families’
needs. Numerous countries, states, and programs are implementing this evidence
based model (see www.eieio.ua.edu and http://robinmcwilliam3.wixsite.com/ram-group).
The following table shows important principles in the Routines-Based Model
(RBM) and the demands of distance service delivery. The table shows that the
RBM can be used to deliver useful tele-intervention and that tele-intervention
can be used to apply the RBM.
Principles of the Routines-Based
Model
|
Tele-Intervention
Application
|
All the intervention
occurs between visits
|
“Visits” build the family’s capacity
to meet child and family needs
|
Family sets the agenda
|
The Next-Steps Form is virtually
completed and reviewed during visits
|
Parents are competent
adults
|
We collaborate to determine
interventions parents will carry out
|
Family consultation is
how we work with families
|
We ask many questions to help
families arrive at solutions they want to implement
|
The two-bucket principle
|
The visit includes discussion of
family outcomes/goals and other family needs
|
We provide support-based
visits (McWilliam
& Scott, 2001)
|
We provide emotional, material, and
informational support
|
Definition
Early intervention has been delivered via tele-intervention
for many years, especially in remote, rural areas (Davis, Hopkins, & Abrahams, 2012). We define tele-intervention
as the provision of support to families via videoconferencing technology.
Providers can use Zoom, Skype, FaceTime, or other methods of connecting with
families via both video and audio. These platforms allow for both the
interventionist and the family to be on camera. Zoom, Skype, and other
platforms also allow for screen sharing, which might be helpful as early
interventionists provide families with information.
Tele-intervention requires families to have Internet
connection and a device for communicating via videoconference, such as a smart
phone, a tablet, or a laptop. By definition, these devices have embedded
cameras.
Research
Much of the research on telepractice has been conducted in
providing early intervention to children who are deaf or hard of hearing. In a
study of 48 children who were deaf or hard of hearing and their families, one
group received telepractice and one group received traditional in-person home
visits (Behl et al., 2017). Children in the telepractice group scored
higher than children in the in-person group on some language scores, and the
groups were equal in other language scores. Family measures did not differ. In
the telepractice group, providers were more responsive, and families were more
engaged.
In an evaluation of tele-intervention, parents rated their
comfort with seven steps required to use the videoconferencing platforms:
“(1) turning on the computer,
(2) connecting the camera and microphone,
(3) connecting to the Internet,
(4) connecting to the VHV Project website,
(5) logging on to the website,
(6) starting the camera, and
(7) locking the microphone to talk.”
Parents' initial comfort with these technical skills was
high and remained so. Conclusions from this study were that “virtual home
visits” had pros and cons for different families and providers but that they
“can be useful in accomplishing the mission of early intervention.” (Olsen, Fiechtl, & Rule, 2012).
In addition to tele-intervention with families, telecoaching
can be successfully used to train early interventionists (Neely, Rispoli, Gerow, & Hong, 2016; Tomeny, 2020)
Routines-Based Interview
Service coordinators can conduct an RBI via a teleconferencing
platform. The following table shows the main steps of the RBI and how they are
accomplished via tele-intervention.
Major Steps of the RBI
|
How Tele-Intervention Applies
|
Ecomap development
|
Ask families the usual questions and
draw the ecomap.
Once concluded, take a picture of
it.
Save the picture.
Either share it with the family
through Messenger, email, or another method or share your screen and show the
family the saved ecomap.
Ask them about any changes, what
they think of the ecomap, what will be done with it, and how it will be used.
|
RBI
|
Looking at parents, proceed from
main concerns, through routines, all the way to the time, worry, and change
questions. Take notes. If you take notes by hand, copy them and save them. If
you take notes electronically, save them. If you type notes, highlight, bold,
or in some other way indicate starred items.
|
Recap
|
Share the screen to show either your
picture of your notes or your typed notes.
Recap the starred items
|
Goal decision making
|
Looking at parents, ask for the
things they want to work on.
When they need it, share your
screen, showing your notes.
Ask the family when you should move
ahead.
After they have added some
outcomes/goals, you, still sharing your screen, go through the notes until
you have at least 10 outcomes/goals.
|
Routines-Based Home Visits
Providers can similarly use tele-intervention for visits. I
concentrate on home visits, because during the Covid-19 season, children’s
classroom programs have been suspended. After discussing synchronous versus
asynchronous visits, I address the essential stages of Routines-Based Home
Visits: the agenda, reviewing progress, reviewing interventions, developing
strategies, and planning for the next visit.
Synchronous Versus Asynchronous Visits
Visits can be in real time, in which the family turns on the
device, and the early interventionist communicates with the family in real
time. This method is most like a live home visit. A family can also record what
goes on in one or more routines and share them, electronically, with their
early interventionist, who then gives feedback. In the following sections, I
assume synchronous (i.e., live) electronic visits, but, remember, you can
communicate not IRL (in real life).
Agenda
Once connected, the early interventionist proceeds the same
way she[1]
would as if she were there in person. She gives the family an opportunity to
talk about anything they want to talk about.
Focus of Visit
If the family has nothing in particular they want to talk
about, the early interventionist refers to the bottom panel of the Next-Steps
Form: what the focus of the next visit should be. This might be a child
outcome/goal, so the early interventionist might say, “You said you wanted to
talk today about Vinny’s standing independently. How’s that going?” The answers
to this question could be “not much improvement,” “child is improving,” or
“child can do it.” Each of these answers leads to questions the early
interventionist can ask: See the family consultation flow chart at http://eieio.ua.edu/uploads/1/1/0/1/110192129/family_consultation_english.pdf.
Review Interventions
In this flow chart, we see “How’s intervention going?” This
important question can lead to a number of adjustments: refine the skill to be
tackled, tweak the implementation change the intervention or the routine,
decide whether to change or persist, or try the matrix. Offering to demonstrate
again is virtually (to coin a term) impossible via technology. Reviewing
interventions include the other two actions: child demonstration and caregiver
demonstration.
Child demonstration via technology occurs when the
early interventionist observes what the child typically does. The caregiver
might say, “I want you to see what he usually does.” This could be something
good (i.e., an accomplishment) or something bad (i.e., something the child
cannot do or does badly). It can be initiated by the caregiver, as in “I want
you to see what he does.” Or it can be initiate by the early interventionist,
as in “Would you mind showing me what he does?”
Caregiver demonstration via technology occurs when
the early interventionist observes what the caregiver does to help the child.
Again, this could be initiated by the caregiver, as in “I want you to see what
I do.” Or it can be initiated by the early interventionist, as in “Would you
mind showing me what you do?”
Develop Strategies
Strategy development with families via technology, using the
RBM, is little different from doing so live. Early interventionists should
follow the steps in the Routines-Based Home Visit Checklist and the Family
Consultation flow chart. In case it hasn’t been obvious, life conversations,
such as through Zoom, Skype, and WhatsApp are better than email or chats.
Follow-up summaries by email, however, are extremely valuable (Barton, Kinder, Casey, & Artman, 2011; Tomeny, 2020).
Plan for Next Visit
As with a regular home visit, the tele-intervention visit
should include what the caregiver will work on from now until the next visit
and what the focus of the next visit should be: the right-hand and bottom
panels of the Next-Steps Form. The early interventionist should scan, screen
shot, or save the NSF and send it to the caregiver.
Principles Revisited
Supporting families without visiting them seems anathema to
early intervention in the U.S. Nevertheless, we realize that, in the RBM, it’s
about providing emotional, material, and informational support to families.
This support does not require us to be natural environments. We learned
that in working with international implementation sites that could not see
their way out of their clinics and rehab centers. It’s not where you support
families: it’s how you support them. Therefore, get families online and support
them by attending to the following principles:
Principles
of the Routines-Based Model
|
All the
intervention occurs between visits
|
Family sets
the agenda
|
Parents are
competent adults
|
Family
consultation is how we work with families
|
The
two-bucket principle
|
We provide
support-based visits (McWilliam
& Scott, 2001)
|
References
Barton, E. E., Kinder, K., Casey, A. M.,
& Artman, K. M. (2011). Finding your feedback fit: Strategies for designing
and delivering performance feedback systems. Young Exceptional Children, 14, 29-46.
Behl, D. D.,
Blaiser, K., Cook, G., Barrett, T., Callow-Heusser, C., Brooks, B. M., . . .
White, K. R. (2017). A multisite study evaluating the benefits of early
intervention via telepractice. Infants
& Young Children, 30, 147-161.
Davis, A.,
Hopkins, T., & Abrahams, Y. (2012). Maximizing the impact of telepractice
through a multifaceted service delivery model at the Shepherd Centre, Australia.
The volta review, 112, 383.
McWilliam, R. A.,
& Scott, S. (2001). A support approach to early intervention: A three-part
framework. Infants & Young Children,
13, 55-66.
Neely, L.,
Rispoli, M., Gerow, S., & Hong, E. R. (2016). Preparing interventionists
via telepractice in incidental teaching for children with autism. Journal of Behavioral Education, 25,
393-416.
Olsen, S.,
Fiechtl, B., & Rule, S. (2012). An evaluation of virtual home visits in
early intervention: Feasibility of "virtual intervention". The volta review, 112, 267-281.
Tomeny,
K. R. (2020). Telecoaching in early
intervention: Supporting professionals and families of toddlers with or at risk
for autism spectrum disorder. The University of Alabama, Tuscaloosa,
AL.
3/23/2020
[1]
The feminine pronoun is used for convenience, recognizing early
interventionists, like me, can be men.
