Teachers of the Deaf in Early Intervention

Recommendations for Successful Home Visits by Teachers of the Deaf 

In general, I believe it’s best to have a similar role to what we call a secondary service provider, assuming the family has a general early interventionist (sometimes called a developmental specialist or therapist). It could also be possible, theoretically, for you to be the primary service provider, but we wouldn’t want two people trying to function as primaries. That takes away many of the advantages of a primary-service-provider approach. As secondary, you would make joint home visits with the primary (usually a general early interventionist). 

The focus of those meetings would be on your consultation with the family. The primary is there to ask additional questions, make sure the family understands your ideas, prompt the family to assess the feasibility of your suggestions and to ask for alternatives if necessary, and pay attention to your suggestions, because he or she will be supporting the family in carrying them out. 

As you know only too well, a second and hugely important role is to encourage the family to become proficient in the communication mode they’ve chosen. Ask them to think about what it would be like for a hearing infant or toddler to have parents who could say only more, sit, and cookie. If the early interventionists is any good, he or she knows a number of signs. But nowadays parents can learn to sign in a variety of ways. I would expect that, in addition to teaching them some signs, you also counsel them on ways they can learn without you (e.g., Internet sites, community college classes). Also, you can tell them about the order of signs very young children learn, which is different from the first spoken words hearing children learn. So your expertise is vital, but not weekly—if there’s a general early interventionist—and not just as a signing teacher.

Photo from Special Education Department, Illinois State University

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Attention and Engagement

How are attention and engagement related to each other?

Attention is a component of engagement, so figuring out the relationship between the two is tricky. Some early studies (Dunst, McWilliam, & Holbert, 1986) separated attentional from active engagement but didn’t really look at attention as a stand-alone construct. In the early days of figuring out engagement, I read quite a bit of Michael Lewis’s work.

Within engagement, my colleagues and I pay attention to casual attention, as an indicator of indifferentiated engagement, and focused attention. The former appears to have less value—at least, we put it lower on the developmental hierarchy than we do focused attention.

Can a child spend much time attending yet not be engaged? If it were casual attention (looking around), we’d consider it low engagement. But if it were focused attention, we’d consider it good engagement. Because we work with young children, however, we know that too much focused attention without accompanying manipulative (i.e., active) engagement could be a bad thing. Children with cerebral palsy have shown us that attentional engagement can go only so far; it’s better for a child to have actual control over his or her environment. Attention even more than engagement, therefore, seems necessary but not sufficient. Can a child spend much time engaged yet not be attending? At first, we might think so: The child who is very appropriately active appears not to spend much time just looking. But we do use eye gaze (i.e., looking) to help judge what a child is interested in. So, even in active engagement, attention plays a role.

People who like to categorize children (and don’t we all, in some ways?) might think of some children as watchers and others as doers. We know better than to consider these “learning styles,” yet they might describe how children make sense of their environment. Some might attend first and then experiment; others might jump in first—and then probably never spend a lot of time attending.

Another place where attention has an interesting role is in mastery pleasure, when a child looks at what he or she has accomplished, indicating to us adults that the child finds the accomplishment reinforcing. Compare this to the child who does something and shows no affective response. We don’t know whether that kid found the activity reinforcing or not, unless he or she returns to it, which after all is the definition of reinforcement.

Attention and engagement, therefore, are intertwined but it research is needed to find out more about the connection between the two.

Who Chooses Outcomes/Goals?

Remember that, in both the Routines-Based Early Intervention and the Engagement Classroom models, the family chooses outcomes/goals. Professionals don't.

This has come up recently in a situation where the child's classroom teachers were interviewed with a Routines-Based Interview after an IFSP was in place. Such a situation occurs when, for some reason, the original IFSP occurs with only the family, or the child doesn't start in a classroom-based program until he or she has been in early intervention for a while. Teachers were interviewed and they chose the goals. Someone then presented those goals to the family to see if they agreed with them. Wrong.

First, the family should have been invited to the interview with the teachers, so they could have heard first-hand what the teachers said. Second, If the family didn't go to the interview, the professional (probably the interviewer) should have taken the information back to the family and asked the family if they wanted to amend the IFSP. If the family had picked only about six home-related and family outcomes, originally, and they they chose about six new, school-related outcomes, they can just add them to the plan. If, however, they had had an RBI and had picked 10-12 outcomes to start with, you wouldn’t want to add six more. The family would reconsider all their outcomes/goals or pick the top 10-12 out of the whole list.

It's tempting to think that teachers who see the child's functioning in school routines and who will be responsible for teaching the child in those routines should select the outcomes/goals, but the IFSP and the IEP are the family's plan. I know they're supposed to be the team's plan, but we're trying to make this a family-centered endeavor. Whose child is it? Teachers provide information about the child's engagement, independence, and social relationships during school routines, so families can make decisions about what they want the child to do during those routines. If teachers feel the child really could benefit from acquiring or bettering certain skills during certain routines, this will come out in the interview. Furthermore, teachers are not limited to working on outcomes/goals during the classroom day, so they can still work on skills the family didn't choose. They just can't ignore any skills the family did choose.

Remember, families--not professionals--choose outcomes/goals.

Family-Level Needs of Families of Preschoolers

From Kansas, comes an important question about how to promote family engagement and support to the family of preschoolers with special needs, even though there are no requirements or data collected for Part B of the Individuals with Disabilities Education Improvement Act--the part pertaining to children 3 years old and up. 
 

First, if IEP teams did Routines-Based Interviews, they would (a) identify family-level needs, (b) get “authentic” and functional child-level needs, and (c) give the family a good basis on which to decide what their top priorities are for IEP goals. This puts the IEP team in the awkward but wonderful position of knowing about family-level needs but not being able to do anything about them, in the traditional sense, which is to write a goal to address them. 

Second, the IEP team then has a moral and intellectual (because of our knowledge of child and family development) obligation to help the family. The problem is they don’t have a legal obligation to do so, and many school-system personnel don’t  consider anything other than what’s required by law. So the two decisions to be made at this point are where to document these needs and how to address them. 

Third, I recommend that each school district or program within a district have a policy for where family-level needs are documented, so supervisors can check whether needs have been addressed. This document should list the needs as well as all efforts to meet those needs. 

Fourth, I recommend that each district or program decide whether the child’s special ed teacher, a Section 619 local administrator (e.g., director of preschool special ed), or another person be designated as the person to help meet family-level needs. 

Fifth, school personnel need good professional development on how to meet family-level needs within the constraints of their resources, which is often almost 0 time or money! The focus of that PD is on providing information to families and following up with them. If a family determines that a need exists for the mother to spend more time with an older sibling, for example, the school people should be trained to ask about informal supports for babysitting and, failing that, to give the family information about babysitting or respite resources. 

Sixth, school personnel need to ensure that someone in the school system has a good handle on community resources for families and that the designated family people know who that person is.

No magical tools apart from the RBI exist. The rest requires a culture change, but I firmly believe the way to change beliefs is to provide structures or procedures that lead people to do the right thing. You can’t just preach at them. So, in my experience in working through this difficult issue—difficult because the law does not provide for meeting family-level needs, these six structures need to be put in place if schools want to overcome the gap in the law.

Making Teams out of Individuals

Early intervention for infants and toddlers in some communities is almost devoid of teamwork, even though multiple people might be in the on-paper team for a child and family. The on-paper "team" is simply the list of people providing services. If those people come from different agencies or are sole providers and they each do their own thing, they aren't a true team.

In my book Routines-Based Early Intervention, I discuss virtual teams, which are very much like what M'Lisa Shelden and Dathan Rush call geographically based teams. See their books on the primary service provider and on coaching.

This is how it works: Professionals from different disciplines, often education/child development, OT, PT, and SLP, and different agencies agree to form a team that will use evidence-based practices and the primary-service-provider (PSP) approach. Any member of the team can serve as the PSP for a child and family. All members of the team agree to support each other. In Shelden and Rush's model, they actually attend meetings together. They sometimes go on joint home visits with the PSP. The secondary service providers don't make separate visits: That defeats the purposes of the PSP approach.

Azusa, Laurie, and Tania

Each team member bills back to his or her respective agency, insurance company, Medicaid, and so on for their services. They have an agreement with the service coordinators to have the referral go to the team, so the team, not the service coordinator, decides who the PSP will be.

The thorny question becomes who decides on the individual services, with frequency and intensity: the service coordinator or the team? Ideally, the team does, with the family, and they inform the service coordinator. In this ideal world, the service coordinator trusts the team because they're using a transdisciplinary model and therefore not piling on services. Technically, however, the service coordinator is responsible for completing the IFSP, so this arrangement can become a power issue.

The different agencies involved in the virtual team (perhaps as many as four) need to approve this approach, whereby their people are sometimes the primary and sometimes the secondary. It shouldn't be an issue, because they bill for every visit, regardless of role. In some places, though, you can't bill for each person's hour of service on joint home visits ("co-treats"--dreadful term; "co-visits"). Some people know how to be flexible with this approach, essentially ignoring the other person at billing time, whereas others are sticklers and have to agree to payment for half the time.

The virtual or geographically based team is a great way to restore teamwork to early intervention, but it requires individual professionals to take the initiative and get it done. It also requires service coordinators to cooperate and help.

The Real Spanish-Translation Confusion in the RBI

My last post was about translating “worry” and “change”: A bit of a nonissue, really. It turns out that wasn’t’ really the issue. The real issue was indeed a thorny one—the difference between “concerns” and “worry.” In Spanish, preocupación would typically be the word for both. You will see in a minute why the same word for both could be a problem.

When conducting the RBI with fidelity, the interviewer keeps track of concerns, usually by starring them (i.e., drawing a star or asterisk in the margin). We train interviewers to notice concerns, indicate them, and then refer to them during the recap. The recap is the quick reminder of the main points—or “concerns”—that came up during the interview. Therefore, the interviewer or note taker goes through the starred items (i.e., concerns) to help the family remember them when they decide on outcomes/goals. We don’t actually use the word “concerns” with families, which might be part of the answer to the question about translation. But first, let’s review when “worry” crops up in the RBI.

Immediately preceding the recap, in fact right after discussion of the last routine of the day, the interviewer asks the “worry and change” questions. The worry question is, “When you lie awake at night, what do you worry about?” You can see that, if the interviewer has just asked the parent what she worried about (¿Qué te preocupa?) and then the interviewer or note taker says he or she is going to review her preocupaciónes, the parent might well think, “I just told you what it was.” If the interviewers use the same word for worry and concern, it could be confusing for the parent.

The answer is don’t use preocupación to refer to the starred items. Even in English, as I mentioned earlier, it’s best not to use “concerns”: It sounds too heavy. In English, it’s better to say, “Now I’m going to go through the things that came up at each time of the day.” (Notice the avoidance of both “concerns” and “routines,” another potentially confusing word.) Therefore, in Spanish, it would be something like, “Ahora voy a enumerar las cosas que usted mencionó en cada momento del día.”