Shortcuts With the RBI

Sorry, but no effective shortcuts for the Routines-Based Interview (RBI) have been found. It's interesting that one of the most effective practices we have--one that families like--is one where professionals balk at the 2 hours it takes. Do we live in such a rushed professional society that every encounter has to be short? This medical-model mentality simply doesn't fit a family-centered, intellectually valid approach to our work. The problem is compounded by a well-meaning legislated mandate in Part C of IDEA--to have the IFSP completed within 45 days of the referral. The policy is intended to prevent delays in serving children, but it makes fitting in a longish interview seem difficult.

The RBI has three main purposes: to establish a positive relationship with the family, to get a rich and thick description of the child and family functioning, and to obtain a family-chosen list of functional outcomes/goals. So splitting it up, which is one frequently mentioned idea, wouldn’t work. Many good minds have applied themselves to the problem of the long RBI, but no good shortcuts have been found. So I always suggest people consider what’s using up all the time in the 45 days and it usually boils down to something to do with the evaluation: scheduling evaluators, the evaluation taking a really long time and therefore needing its own meeting, and so on. Many places successfully fit in four visits: intake, eligibility evaluation, RBI, finalize the IFSP. Places that don’t or that are afraid of going over the 45 days, bunch up two of these meetings into one meeting, usually either evaluation and RBI or RBI and finalize the IFSP. If the former, I urge them to examine their evaluation practices to choose the most efficient tool and not to turn the in-or-out event into a quasi-diagnostic encounter.

Almost all RBIs require some time management, and I train people to keep up the detail of information discussed within routines, but, if necessary, skip routines to be finished within 2 hours. Actually, the interview needs to be over after 1.5 hours, because the recap, goal selection, prioritizing, and criteria discussion (something new we’ve added) will take half an hour. Experienced interviewers know not to skip dinner preparation, bath time, and bed time. 

The RBI doesn’t claim to get everything—just enough--to come up with 10-12 goals, including family ones. So, if we skipped routines but we got enough goals, we don’t have to “continue the RBI.” We never split the RBI up over two days. There’s something about the arc of a complete interview, in terms of the relationship building, that is disrupted if we break it off in mid-stream and then, later, try to continue it.

Plan for the 2 hours and enjoy it. Families will.

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End of the RBI

Where do most people have difficulty following the protocol of the Routines-Based Interview? The end. The biggest mistake is interviewers confusing the starred items, which were concerns or things the family would like to see happen in the next 6 months, with outcomes. Confused interviewers read the starred items and ask parents which ones they want to put down as outcomes. No! A good interview ends up with many more stars than outcomes. Furthermore, stars are often repeated. For example, if the child doesn't communicate during breakfast, the interviewer or note taker marks a star next to his or her note about this. If the same issue comes up at lunch, another star. So stars or so-called concerns aren't outcomes.

After reading the concerns, which we train people to do in boom-boom-boom fashion, meaning quickly and without elaboration, we set the notes aside, take out a blank piece of paper or the blank form from the Protocol, and ask the parents what they want us all to work on. The parents' answers are the outcomes. We make sure we get the routines where they'd said they wanted to see that skill, but we don't, at that point, get much more. We're trying to finish up the interview, and this outcome selection takes about 20 minutes.

To help remember how the interview ends, here are three very short, very lame silent cartoons.

Beginning of the End

End of End Part 1

End of End Part 2