Routines-Based Practices to Replace Center-Based Services

In the next 12 posts, I shall describe shifts in thinking that have to occur to bring about family-centered, functional services—essentially the Routines-Based Model (RBM). Shifts in thinking are nothing without shifts in practice, so I will also mention practices that can either follow or precede thinking. The fact that the order is unimportant should be heeded. We know from Tom Guskey’s early work on attitudes towards mainstreaming that you can’t wait around for buy-in to occur. Sometimes, you have to employ the Nike principle to achieve buy-in.

 

In the U.S., we have come to take some practices for granted, such as the value of home visits. Yet, home- and community-based early intervention is not global. Even in the U.S., in some states, therapies are still provided in clinics, whereas “developmental therapy” (a term applied to either special instruction or family training) is almost always provided in the home or the child’s group-care facility.

Center-based services is a term I usually try to avoid, because “center” can apply to a classroom or an office. Here, I am using it to refer to an office; it’s what I usually call “clinic-based services.”

Administrators and advocates bemoaning practitioners’ use of passé methods as a failure to secure buy-in might be missing the boat. If you want people to do something, tell them to do it. It probably is true that to use the Routines-Based Model well, your heart has to be in it—you have to believe in this way of doing business. But the way to get there might not be to pump up the buy-in activities like communities of practice, publications, or posts. It might be to provide a structure for the practices you want.

Why do people practice early intervention the way they do? Most early interventionists didn’t pick up a book and follow the directions there. (If they wanted to, they could do worse than looking at Routines-Based Early Intervention, Engagement of Every Child in the Preschool Classroom, or Working With Families of Young Children With Special Needs.) Most people in the trenches are doing what their bosses or their colleagues told them was the way we do things around here.

In my 12 posts, I aim to highlight some assumptions undergirding “clinical” or professional-centered practices and to present some new assumptions. The overall paradigm shift (a term unfortunately overused), when all 12 aspects are attended to, is the adoption of a procedure for providing early intervention for children 0-6 and their families. This procedure involves treating families with informal respect, providing families with opportunities for meaningful decision making (e.g., the goals on the intervention plan), and meeting families’ needs even if indirectly related to the child; in other words, the procedure means being family centered. The 12 mental shifts required include rethinking professional roles with each other and with the family, rethinking authentic assessment and progress monitoring, rethinking goal selection, and rethinking the outcomes of early intervention. 

The paradigm shift throws a spotlight on quality of supports. For too long, early intervention and, in the U.S., early childhood special education have focused on how children get in (eligibility), what services they get, and, in the past 10 years, how they are rated in three broad outcomes relative to their peers. Family outcomes have also been required. But attention to what exactly was going on in home visits, in visits to child care programs, and in preschool special ed has been lacking. 

The first mental shift, coming in the next post, is All the intervention occurs between visits.