Why should we do a Routines-Based Interview for children
whose only need is related to a speech or language delay? After all, the RBI is
lengthy and addresses much more than the presenting problem. More efficient
methods exist for identifying speech or language goals.
Four reasons explain why the RBI is a good practice to use
with “speech-only” children. (This colloquial label violates the person-first
rule and is used to acknowledge my familiarity with early-intervention team
vernacular!)
1. Early intervention is supposed to be more than a rehabilitation or
remediation service. The purposes of early intervention are to support
the family and other natural caregivers in promoting the child’s development
just to provide a service to tackle those things that have gone wrong. It is
supposed to address all areas of child development and family functioning,
including and especially parenting.
Speech-only children are developing in other areas beyond
those identified as deficient or delayed. They are learning to play, to solve
problems, to move, to handle increasingly small and complicated objects, to get
along with others, and so on. The ticket into early intervention is admittedly
an established condition or a delay, but, once in, the program has an
obligation not to put on blinders and address only the deficits.
Whether the early intervention system should pay for
services addressing typically developing areas of development is a matter of
public policy. From child development and family systems perspectives, addressing
nondeficit areas is appropriate even for single-deficit children. In child development,
to promote children’s language, we know it is helpful to promote their overall
engagement. In family systems, we know that family members have many
opportunities to work on children’s speech and language throughout every day.
Therefore, it is not inappropriate for public funds to be used for promoting
skills other than the deficient ones.
Another developmental reason for taking a broader view to
needs assessment (i.e., conducting an RBI) is that children with speech or
language delays might have behavior problems. Research has documented these areas
are associated with each other more often than would be expected by chance.
Therefore, we should conduct needs assessments for speech-only children that
assess engagement (i.e., appropriate behavior) across the day.
The last issue related to the purposes of early intervention
is that speech-only children have parents and other family members who might
need support. An effective way of finding out what kind of support they might
need is to conduct an RBI. This procedure helps identify whether they need
emotional support, material support, or informational support, whereas traditional
speech or language assessments do not identify support needs adequately.
2. What’s the best way of addressing a child’s speech-language goals?
The most effective and efficient method for providing interventions to young children
is to embed interventions into everyday interactions, activities, and routines.
To do this, the team of people designing the interventions (i.e., the family
and professionals) need to know what happens currently in routines and what the
desired behaviors are (even if they are primarily about speech or language).
Understanding the concept of goodness of fit, when children have speech or
language deficits that means that the demands for communication and social
interaction in different routines and the abilities or interests of the child
do not match well. In other words, meaningful participation in a routine might
require the child to speak clearly and, if the child doesn’t yet have the
ability to speak clearly, a functional problem ensues. Now we have three
options: (a) change (i.e., teach) the child, (b) change the routine, or (c)
change your expectations. This goodness-of-fit approach requires us to assess
routines in a way best accomplished by the RBI.
3. Do we really want to discriminate against speech-only children and
their families? The RBI is heartily endorsed by families, has been
shown to be effective, and is valued by many early intervention programs around
the world. To deny families with children with speech or language delays the
opportunity to participate in an RBI is discriminating against them, therefore,
on the basis of the child’s specific disability.
4. The RBI helps determine the functional needs that arise because of the
child’s speech-language deficits. Often the existence of a delay is
determined, appropriately, by a norm-referenced measure, so that a person can
say with some confidence that the child’s reported or observed speech or
language is behind what would be expected for a child of that age. What it does
not tell us is how this impairment affects functioning. If it did not affect
functioning—if the child lived on a desert island, being raised by friendly
animals who did not have conventionalized communication (so we might have to
rule out chimpanzees), the deficits might not be important. Who cares?
So-called normal communication isn’t needed. But usually there is some
functional impact of a speech or language impairment. In fact, often the
functional impact is what precipitates a referral to early intervention. To
obtain an environmental scan of the current and potential impact of the
impairment, an RBI is ideal. It addresses the everyday contexts of the child’s
life, which are more varied and challenging than life on a desert island.
Without everyday context, the documented deficits could
become “speech” goals that have no relevance to specific times, people, places,
or activities. Therefore, children can be working on their final-th sound (e.g.,
both, bath, Beth, cloth) completely devoid of a reason to be using this sound.
Although decontextualized instruction can be used with older children, it is
usually very difficult to use effectively with young children. But many
therapists and teachers try.
The final issue about functionality is that speech goals, as
distinct from language goals, are actually about speaking so as to be
understood. People familiar with my model will recognize these as the controversial
“artic” goals—where we wonder why so much attention goes into articulation
therapy when articulation is not resolved until children are in elementary
school. But of course I do recognize that families want to be able to
understand children and that children want to be understood when they speak.
All children go through artic training by their natural caregivers, but some
children still have great difficulty making themselves understood. So
understandability goals are very relevant. The RBI can help figure out who
needs to understand the child, when, where, and about what. Further assessment,
usually by a speech-language pathologist, can help identify what specific
problems the child might have, such as a structural or tone problem, which might
guide what the intervention options are.
So, when you wonder why you’re going to all the trouble of
doing an RBI with the family of a speech-only child, remember it’s because
early intervention is supposed to address the whole child, it’s the best way of
identifying speech-language goals, it’s discriminatory to deny an RBI to any
specific group of families, and it helps determine functional needs.
