Mental Shift 10. It's about helping families feel confident in their competence with their children

Since September 2015, I've been addressing the following mental shifts required to take a family-capacity-building, routines-based approach to early intervention:

12 Mental Shifts

1.       All the intervention occurs between visits.

2.       Whose child is it anyway?

3.       Children are learning from their caregivers, whether you want them to or not.

4.       Anyone spending time with the child has the opportunity to teach the child.

5.       Passing judgment on parents or other caregivers is a self-fulfilling prophecy.

6.       Parent failings don’t exist; only professional ones.

7.       What matters is how children function in their everyday lives. Function = participation = engagement = learning.

8.       The rush to get ahead leads to failure in early intervention.

9.       It’s about getting children engaged, independent, and in social relationships.

10.   It’s about helping families feel confident in their competence with their children.

11.   Too many cooks spoil the broth.

12.   Teamwork can work through collaborative consultation.

Helping Families Feel Confident

Here are four things to do with families and one thing not to do. I then discuss specific practices in the Routines-Based Model that help families feel confident.

Some Level of Covertness

The indirect approach is sometimes the best way to appear sincere. Although we talk about the value of being positive in our interactions with families, it we’re too gushy about how great they are, they might question our sincerity. For example, if we say on every visit, “Oh, you’re awesome in teaching Nigel,” after a few visits Nigel’s mother is going to wonder if you’re just saying that to be nice. So it’s a good idea to change it up, such as, “I was just thinking on my way over here that I wish other mothers I work with could see how you teach Nigel.” You’ve inserted the compliment by reflecting on your own thoughts.

Home visit in Paraguay

Better Than You

To build others’ confidence, it’s helpful to be confident yourself—confident enough to acknowledge when they’re better than you in some way. For example, “Wow! I wish I had your patience.”

Appreciate Them

This can be overt, somewhat contradicting “some level of covertness.” It is about finding something the caregiver is responsible for—something said, something done, something in his or her environment—and letting the caregiver know you value it. It could be, “You’re really sensitive to his feelings,” or, “You make diaper change so fun,” or, “He’s so cute in that outfit.” Feeling appreciated is such a basic need.

Along with being responsive, oriented to the whole family, friendly, and sensitive, being positive—appreciating caregivers—is one of the characteristics we found of family-centered professionals working with families of young children with disabilities (McWilliam, Tocci, & Harbin, 1998).

Encourage Them in Their Chosen Role

If we’re living a life we chose, we like our choices to be validated. For example, if a person with a good job decides to stay home with her child, we should covertly make statements about how much time she spends with her child or how focused she is on helping her child be engaged.

Some people are not living a life they chose but they’ve talked themselves into believing it was their choice. This cognitive dissonance is a way for people to deal with competing values. What you get and have to take at face value is their saying they’re living a life they chose.

Other people are not living a life they chose and they feel it was their fault or someone else’s fault. If they talk to you about it, either putting themselves or others down, you have an opening to find out what in particular they would like to change and then using family consultation to help them find a solution. You have to start by asking them if they want to do something about the particular bother. They might say no—they just want to vent… and to have you listen.

Don’t Positively Reframe Their Negative Statements

The chirpy positive reframe, like, “No, you’re really good at that!” or “Oh, all parents go through that!” or “That’s no way to think! Everything will turn out fine!” is annoying at best and insulting at worst. It’s negating what the caregiver is saying. We listen and acknowledge. It can be difficult when much negativity is coming out.

In all these situations, the stronger the relationship you have with the caregiver, the more direct you can be in your helping them.

From the Routines-Based Model

In the Routines-Based Model, various practices build families’ confidence. Four such practices are as follows:

1.     The ecomap shows them (a) they can identify many people in their informal- and formal-support networks and (b) they’re not alone;

2.     The Routines-Based Interview (RBI) shows them they can report on details of child and family functioning and can choose 10-12 meaningful outcomes/goals;

3.     Family consultation shows them they are solution finders and interventionists;

4.     The Measure of Engagement, Independence, and Social Relationships (MEISR) shows them they can assess their child’s functioning in everyday routines

Families’ Competence

We’re helping families to feel confident about their competence in four roles.

Parents

Early intervention is a parenting program. We enhance families’ ability to address specific outcomes/goals for their children. In the Routines-Based Model, we also encourage their competence in talking to their children, reading with their children, playing with their children, and teaching their children.

Family Members

Watching home visit with Guaraní-speaking professional

The mother we might visit regularly might not be only the mother of the child in early intervention. She might be a mother of other children too, a wife, a daughter, a daughter-in-law, and so on. The Routines-Based Model teaches professionals to be oriented to the whole family, helping caregivers be the kinds of family members they want to be.

Interventionists

In their role as parents, parents are teaching their children, both addressing outcomes/goals and the usual teaching parents do. Helping parents be effective teachers of their children is a huge part of what we do.

Collaborators

We help families feel confident in working with us, together, to find solutions to needs they identified. Some families are natural partners; others are not used to being in that role and require some hand-holding to get there. We are helping prepare them for the marathon of parenting, not just the sprint in early intervention. As they move to other systems of support, we want them to be confident in determining their own needs and in working with professionals.

Let’s end with a saying from Lao Tzu: 

“Kindness in words creates confidence. Kindness in thinking creates profoundness. Kindness in giving creates love.”

 

McWilliam, R. A., Tocci, L., & Harbin, G. L. (1998). Family-centered services: Service providers’ discourse and behavior. Topics in Early Childhood Special Education, 18, 206-221.

 

MENTAL SHIFT 7: What matters is how children function in their everyday lives.

Function = participation = engagement = learning

Yes, children should learn about the world, learn to move, learn to speak, learn to manipulate objects, learn to solve problems, learn to get along with others, and learn to take care of themselves. The curriculum of early childhood is clear. It shows up in state early-childhood standards, in tests, in curricula, and in parents' expectations. The question is What's the best way for children to learn this material? Or perhaps the philosophical question is whether this curriculum is what we aim for, or is it the natural outgrowth of normal development? Maybe we just made it the curriculum, because it's what we saw happening in early childhood. The outcome.

This question has bigger implications than you might think. If it's what children "should" learn, then adults will move heaven and earth to teach children these skills. It also becomes the framework for assessment and individualized program planning, usually based on the child's deficits. If a child is behind in one or more of these areas, those become targets for intervention. This can lead to making the child do what he or she is no good at.

If the areas of learning I outlined above are the outcome rather than curriculum, then we know children learn the content at different paces and in different ways and sometimes not at all. We call that developmental disability. Interesting.

Now let's turn our attention to how children learn best. If we take a curricular approach to functioning, as I mentioned above, we might be tempted to take an academic approach; I use that term to refer to the "academy"--the school, with lessons and a fair amount of adult direction. If we take an outcome approach, we let learning happen, supposedly naturally, which sounds almost as frightening. The classic constructivist philosophy endorses this approach. If the child is a curious, active, intelligent being with a good environment, naturally occurring learning will be fine. But if the child has inherent difficulties in learning or a poor environment, we need to pay attention.

So what do we change? We can't cure the biophysical condition, including what's going on in the brain--at least not efficiently. Brain science does claim we can restructure brains, but--and here's the kicker: We do it by changing the environment. The environment is comprised of social, nonsocial, and temporal conditions around the child. Included in the social environment are the interactions the child has with adults or even other children--interactions that can enhance or impede learning. The nonsocial environment includes safe or unsafe spaces, things to play with (they don't have to be toys), places to move around in or on, and so on. The temporal environment has to do with the sequence of routines, which in some families is predictable and in others is not.

The quality of the child's environment for enhancing learning is what Bruder and Dunst have discussed in their work on learning opportunities.

Mental Shift 7 is about understanding that learning does happen in everyday routines. If a child is functioning in a routine, it means he or she is participating meaningfully, whether cuddling with the mother at wake-up time, eating independently at breakfast time, helping to get dressed at dressing time, putting on shoes at going-out time, pointing at trucks in the car ride, playing independently during dinner preparation, using words or signs at dinner time, playing with a parent during hanging-out time, putting a washcloth to the face at bath time, or turning pages in a book at bedtime. And I listed only one of a score of skills a child could display in each routine--and there are more routines than these. A child's day is full of learning opportunities--of opportunities to participate meaningfully. When a child is so participating, we say the child is engaged. And if the child is engaged, the child can learn. As Dunst, Trivette, and I wrote (on papyrus, I think) back in 1985, a child cannot learn if a child is not engaged.

We do want children to learn and we do want them to function in their environments. Fortunately, these two things go together, joined by participation and engagement.

MENTAL SHIFT 4: ANYONE SPENDING TIME WITH THE CHILD HAS THE OPPORTUNITYTO TEACH THE CHILD

Children learn from those around them, but there must be a threshold amount of time. Or perhaps the time spent is correlated with the impact one can have on the child. The mental shift in this post is from thinking that intervention comes from people who spend short amounts of time and not from those who spend long amounts of time.

The work of Mary Beth Bruder, Carl Dunst, and Carol Trivette on "learning opportunities" has documented that ordinary routines in a child's life are where learning naturally happens. And the work of Tom Weisner and Cindy Bernheimer has shown that everyday routines are the chunks of time that families construct to make their lives work, and that these ecocultural niches are the context of child and family development.    

The discussion here is about substantial time. I've used 15 hours a week as an informal, unscientific criterion for deciding whether a caregiver should be included in a Routines-Based Interview (RBI). If the relationship between time spent and influence on child functioning is linear, those spending fewer than 15 hours a week can't be said to have no influence. The issue becomes one of efficiency. If the amount of influence is small, then it's not worth their time or ours to be interviewed. Families, however, can always have anyone they like at the RBI.

Who spends substantial time with the child? Almost always the custodial adults, such as parents. Custodial adults, therefore, are the parent figures in the child's life, so, from now on, I'll just call them "parents." Adults who are responsible for care of the child, perhaps while the parent is working, also spend substantial time with the child; these are child care providers or preschool teachers, for example. 

What about influential people who don't spend the requisite amount of time, such as grandparents. They can give children enjoyable times, new opportunities, special moments, and so on--all of which can create memories, if the child is old enough. But early intervention should focus on those adults who are around during the everyday routines: They have enough teaching opportunities distributed through the day that can make a difference. Furthermore, they're teaching when, where, and with whom the child needs the skills. By teaching in the moment, the child is learning to respond to the naturally occurring "discriminative stimuli." When someone walks in the room, the child learns to say hi. That's a lot better than repeating hi in multiple trials in an early intervention session with a professional. Children can learn context-specific behaviors that reinforce the adults in charge of those contexts, and here I'm talking about the short-time caregivers, such as visiting grandparents or early intervention professionals. The child can learn not to touch the ornaments at Grandma's house or to take his seat in the therapy room. The issue now is one of functionality. How do these help with the child's functioning in everyday routines? If they generalize, fine, but young children, especially if they have developmental disabilities, do not transfer well. If the adult also "transfers," then you get a bit more bang for your buck. For example, if an early intervention visit focuses on the parent interacting with the child, perhaps practicing how to teach the child something during a routine, the parent can then use the same task directions and prompts during regular life. Therefore, because the adult generalized his or her strategies from the short-time session to the long-time real life, the child has a chance of learning the skill.

In the Routines-Based Model, early intervention supports (i.e., services) are aimed at the long-time adults, usually parents and teachers. In future MENTAL SHIFT posts I'll discuss how we provide those supports.