Wednesday, September 2, 2015

Ecomap and Respite

Respite services are notoriously hard to come by, for families of children with disabilities. Respite means having a break and tends to be used instead of the more normalized babysitting. Indeed, some children require babysitters with special training and who probably prefer the fancier name of respite providers. Some families might feel more comfortable having specialized people, given society’s proclivity for specialization. 

Some respite opportunities involve families’ dropping their children off somewhere like a church, where volunteers watch the children for a few hours. For some families, these are no doubt a great resource. They do, however, involve having to transport the child to the babysitting place and leaving the child with people the family might not know. Furthermore, there might be a number of children being looked after. As beneficial as drop-off respite can be, for some families in-home respite is preferred. The advantages are (a) that the child doesn’t move, the babysitter does, which can be especially helpful if the child comes with much equipment, as in the case of some medically fragile children; (b) the child has only one caregiver; and (c) unless the child has siblings also being babysat, the caregiver has only one child to care for. Even harder to find is in-home, overnight babysitting, which might be especially valuable for some parents. 

In my Routines-Based Model, we ask parents if they have enough time for themselves as individuals or, if relevant, a couple. Many intervention plans therefore include this goal. I heard about one state that suffered through a monitoring review where the monitor questioned the “date night” goal—and this was for an individualized family service plan. A cursory understanding of family systems theory and of social-support theory should make it obvious that a date night goal can have an impact on the child. 

Karen's Ecomap
If a plan does have a goal for adults to have time for themselves, the ecomap should be the first tool the early interventionist should use when using family consultation to help the family meet the goal. Here you see an ecomap for Karen’s family and her intervention goals, as written at the end of the RBI. Later, they were written to be measurable. 

Karen’s Goals

3. Potty trained
9. No pacifier (nap, bedtime, car)
2. E cooperate and not be so confrontational (dressing, tooth brushing, home from school, dinner prep, evening time)
6. G dressing
5. K behavior management strategies (dinner)
4. G speak clearly (breakfast, car rides, play time)
8. Independently use whole sentences (outings, meals, play times)
1. E and G play independently (not breaking down; dinner prep)
7. Info about G being patient
8. Time for Karen

As is common, time for Karen was one of her lowest priority goals but it’s on the plan. Therefore, when Karen is ready to tackle this goal, the early interventionist might say, “Are you able to do this? Is there anything getting in the way?” 

Karen would presumably say, “Giada,” the babysitter.

“You said you like her OK when we drew this ecomap. Is that still true?”

“Yes, but she’s in school, so she’s not always available.”

“Is there anyone else who might be available?” the early interventionist might ask.

“I’ll have to think about that.”

“Let’s have a look at the ecomap.”

“I suppose we could ask the couple who live next door,” says Karen. “They have no children and get on really well with all three of ours.”

“Is that what you’d like to do then? Ask them to babysit one evening so you can have time for yourself?”

“Yes, I can ask them.”

“OK,” says the early interventionist. “Next week, I’ll ask you how it went. Asking them, I mean.”

One of the main purposes of the ecomap is to be able to whip it out when looking for resources to find a solution, which means address a goal.