Telepractice Checklists

For 5 months, implementers of the Routines-Based Model (RBM) have been noting how relatively easy the switch to virtual visits has been, especially for home visits. Because Routines-Based Home Visits have always been centered on collaboration with the caregiver, we simply switched from sitting in the living room together to talking via Zoom. The biggest difficulty has obviously been the small amount of time the home visitor might have been interacting directly with the child. I have always said there are three reasons to put your hands on a child:

• ·       Assessment (seeing what a child might do with a certain strategy)
• ·       Demonstration (showing the family what your strategy looks like)
• ·       To show you love the child.

In telepractice, we can’t do these in the same way, with literal hands on, but “home visitors” have devised creative ways to have caregivers show what the child does (assessment) and to be explicit about their ideas (the equivalent of demonstration).

The RBM has always used performance checklists to (a) describe practices in the model, (b) serve as a platform for feedback in coaching, and (c) measure the fidelity to the model of a professional’s practice (Dunst & Raab, 2010; Marturana & Woods, 2012). We have therefore created the Routines-Based Telepractice Visit Checklist and the Telepractice Collaborative Consultation to Children’s Classrooms (CC2CC) Checklist. You can find these at www.eieio.ua.edu/materials under Consultative Service Delivery.

Routines-Based Telepractice Visit Checklist

We were able to use the Routines-Based Home Visit Checklist as the basis for this telepractice version. The new one has a section on establishing a technology connection. It also recognizes that the pandemic, the lockdown, early intervention delivered through telepractice, working from home, and so on, demand extra sensitivity and empathy from the home visitor.

We still review child goals, if that’s what the family wants to talk about, going over existing strategies the family has been using or developing new strategies. One of the hallmarks of the RBM is the collaborative approach with caregivers, which, with families, we call family consultation. We do not simply listen to a family’s report or concern and immediately give them suggestions: That would be an expert model, not a collaborative model. In telepractice visits, it’s the same: We ask many questions before venturing an idea.

If demonstration by the home visitor would be helpful, telepractice challenges us. On the checklist, we have added describing the strategy in detail to demonstration (Item 25). Whereas on a live visit, the home visitor might describe the strategy in fairly general terms, followed by, “Would you like me to show you what I’m talking about?” the virtual visit cannot rely on showing the family what you’re talking about. For example, the home visitor might say, after asking many questions to get context, “Have you considered sitting behind him on the floor and applying gentle pressure on his hips to stabilize him?” After the parent’s quizzical look, the home visitor says, “Would you like me to show you?” Now, in a telepractice visit, the home visitor might still suggest the pressure on the hips and, instead of offering to demonstrate, say, “Would you like me to be more specific?” If the parent says yes, the home visitor continues, “You can sit behind him, with him sitting between your legs. He should have things to do in front of him—toys he likes, for example. To help him be stable, you can put your hands at the tops of his legs, with gentle pressure. That should stabilize him. Over time, you can release that pressure, to give him opportunities to stabilize himself, using his core.” This can be accompanied by demonstrating on yourself, about the placement of hands, for example. Some home visitors are using dolls as props for demonstration.

Just like in-person home visits, when you conduct a visit virtually, you should have the Next-Steps Form, the ecomap, and the matrix. These can all be found at www.eieio.ua.edu/materials. These are the three key documents a home visitor using Routines-Based Home Visits has at every visit. In the virtual world, we still use them.

Just like in-person visits, virtual visits take advantage of the opportunity to provide emotional, material, and informational support, as needed. They also take advantage of the opportunity to attend to parenting basics, which, in our model, are talking to children, reading to children, playing with children, and teaching children. We say in the RBM that early intervention is a parenting program, not a rehabilitation or special education program.

Telepractice CC2CC Checklist

Visiting teachers, virtually, is a tricky business. Some classrooms are open to accommodate the needs for child care of essential workers. Our useless federal leadership is telling us contradictory and scienceless noninformation about how to meet the needs of children in classroom programs. This situation has revealed much about the strengths and weaknesses of governors, even within the two major parties. In our field, we have to recognize that some infants, toddlers, and preschoolers with disabilities are going to classrooms, and we early interventionists (I include in this term early childhood special educators and therapists) need to support their teachers, without visiting the classrooms in person.

Hence, we have developed the Telepractice CC2CC Checklist as a guide. I hope, in some programs, coaches are joining the visits to classrooms, and providing feedback, using the checklist. If not, visitors (i.e., “home visitors” going to child care, itinerant ECSEs) can check themselves.

Again, we did not have to make many changes to our CC2CC Checklist. The same issues discussed in virtual home visits are pertinent in classroom visits, so I won’t repeat them here. In in-person visits as well as in telepractice visits with teachers, we do want to include classroom-wide issues, such as the zone defense schedule, using incidental teaching, and using ideas from Reggio Emilia (see Item 31).

With both Routines-Based Telepractice Visits and Telepractice CC2CC, we should keep the following in mind.

1.   Visits might be shorter because of distractions, interruptions, and videoconference fatigue.
2.     Visits might seem disjointed and disorganize; give yourself a break—you have less control over the situation.
3. Families might be distracted, uninterested in your visit, or inconsistent in their reports; give them a break—we don’t know everything they’re dealing with, although you should try to find out and understand.
4. Some families might be thriving in this environment. They love being home with their kids and don’t want to be out with other people.
5.   Teachers in classrooms are true front-line workers. I hope people put up signs saying “Heroes work here,” like they do at hospitals. These teachers are under more stress than usual. Maybe your work is to reassure them, give them a laugh, and maybe help them with some difficult situations.

I hope the checklists help. Thanks to Cami Stevenson for working on these checklists with me.

 

Dunst, C. J., & Raab, M. (2010). Practitioners’ self-evaluations of contrasting types of professional development. Journal of Early Intervention, 32, 239-254.

Marturana, E. R., & Woods, J. J. (2012). Technology-supported performance-based feedback for early intervention home visiting. Topics in Early Childhood Special Education, 32, 14-23.

 

The Routines-Based Model Internationally Implemented: 1. The Model

On February 19, 2019, I vowed to write my next seven posts about the Routines-Based Model internationally implemented. Well, I got distracted by other pressing issues but now I’m back on track. Please click on the link for that post to see colleagues from The RAM Group who have contributed this information.

The Routines-Based Model Internationally Implemented

In Minga Guazú, in the hot eastern side of Paraguay, where many of the families in early intervention (birth-6 years of age), are indigenous Guaraní, a young occupational therapist (OT) welcomes a family to the early intervention center. The center is for children with physical disabilities. This OT has been trained in the Routines-Based Model (RBM) and, today, she will talk to the family about 2 or 3 of the 12 goals on the child’s and family’s intervention plan. 

Meanwhile, in Lisbon, a physical therapist (PT) is going on a home visit. The family has 10 goals, and this PT will talk to the family about, perhaps, 3 of these goals. In one of them, she will ask the family if they would like to show her what they’ve been doing, and she will guide them through some strategies that, together, they have decided might help the child participate meaningfully in breakfast time.

In Cieszyn, Poland, workers are still hammering nails, as a dorm on a university campus is being remodeled to become a preschool (“kindergarten” in Polish parlance) following the Engagement Classroom Model. This model demonstration site will show how you can run a classroom to promote child engagement.

In this series of posts, we discuss the Routines-Based Model; how it became of interest, internationally; what practices implementers adopted; what challenges they faced; what successes they had; and our conclusions about what has to happen to improve early intervention around the world.

The Model

My colleagues and I developed the Routines-Based Model over many years (McWilliam, 2016b; McWilliam, Trivette, & Dunst, 1985). The model has three main components: needs assessment and intervention planning, a consultative approach, and a method for running classrooms.

Needs Assessment and Intervention Plan Development

In the RBM, nothing good can happen unless we have a list of goals meaningful to the family and other caregivers spending time with the child. To develop an intervention plan, which goes by different names in different countries, we conduct an ecomap and a Routines-Based Interview, from which the family chooses functional goals and family goals.

Ecomap. The ecomap is a picture of the family’s ecology (Jung, 2010). Most important, it identifies the family’s informal supports. In most early intervention services, they don’t find out the extended family, friends, and neighbors the family might be able to count on for support, before resorting to formal supports.

Routines-Based Interview. The Routines-Based Interview (RBI) is the best known component of the RBM, but it is only one of 17 components (McWilliam, 2016a). A professional interviews the family about the details of child and family functioning in daily routines, and the family chooses goals/outcomes. In New Zealand, they try to avoid “interview,” because some people thought it was a formal 2-hour bombardment of the family with questions (Woods & Lindeman, 2008). From an implementation and branding perspective, however, we encourage implementers to keep using “Routines-Based Interview,” because of its name recognition. 

Functional goals. Goals for child functioning are written to emphasize the child’s participation in routines, such as, “Jared will participate in breakfast time, hanging out time, and outside time by using single words” (Fleming, Sawyer, & Campbell, 2011). Furthermore, we write the goals with criteria for acquisition, generalization, and maintenance, such as, “We will know he can do this when he uses five different single words, in two of these three times of day in one day, over four consecutive days.”

Family goals. As a result of the RBI, the family chooses goals for other members of the family. The most common goal is time for oneself, such as, “Diane will have two hours for herself every two weeks, for 10 consecutive weeks.”

Consultative Approach to Early Intervention

A principle of the RBM is that all the intervention occurs between visits, so the point of visits with caregivers is to build their capacity to meet child and family needs when the professional is gone (i.e., during all the other hours of the week). 

Family consultation. Family consultation involves the professional, usually a home visitor, working with the family to identify (a) why a child isn’t doing something, (b) what might be a viable solution, and (c) whether the strategy worked. This involves the professional’s asking many questions to find out what’s being going on so far before making a suggestion (Boyer & Thompson, 2014; Dougherty, 2013; Horne & Mathews, 2004). He or she also asks the family whether they would like to try it out during the session and whether they think it is feasible.

Collaborative consultation to children’s classrooms (CC2CC). Similarly, when professionals see “a child” in child care or preschool, they actually go to visit the teaching staff. Again, they jointly decide why a child isn’t doing something, what the strategy might be, and whether it has worked. This practice is based on seven years of research on “integrated therapy” (McWilliam, 1995).

Engagement Classroom Model

The RBM includes procedures for running classrooms to promote child engagement, which we have dubbed the Engagement Classroom Model (McWilliam & Casey, 2008). Implementers focus on five components:

1. Conducting the RBI to establish functional, routines-based goals;
2. Incidental teaching to address all goals in all routines, by following the child’s lead and eliciting higher order functioning;
3. Integrated therapy, meaning specialists work with teachers in the classroom and never pull the child out;
4. Zone defense schedule to arrange the room in zones, to organize the adults, and to decrease nonengagement time during transitions between activities; and
   
5. Incorporating Reggio Emilia concepts to promote children’s exploration, to encourage creativity in art, and to make the environment “provocative” and beautiful.

Here, I have described the model, focusing on needs assessment and intervention plan development, our consultative approach to early intervention, and the Engagement Classroom Model. Next time, I address how the model became of interest, internationally.

Boyer, V. E., & Thompson, S. D. (2014). Transdisciplinary model and early intervention: Building collaborative relationships. Young Exceptional Children, 17, 19-32.

Dougherty, A. M. (2013). Psychological consultation and collaboration in school and community settings. Belmont, CA: Cengage Learning.

Fleming, J. L., Sawyer, L. B., & Campbell, P. H. (2011). Early intervention providers’ perspectives about implementing participation-based practices. Topics in Early Childhood Special Education, 30, 233-244.

Horne, S. G., & Mathews, S. S. (2004). Collaborative consultation: International applications of a multicultural feminist approach. Journal of Multicultural Counseling and Development, 32, 366-378.

McWilliam, R. A. (1995). Integration of therapy and consultative special education: A continuum in early intervention. Infants & Young Children, 7, 29-38.

McWilliam, R. A. (2016a). Metanoia in early intervention: Transformation to a family-centered approach. Revista Latinoamericana de Educación Inclusiva, 10, 155-173.

McWilliam, R. A. (2016b). The Routines-Based Model for supporting speech and langauge. Logopedia, Foniatría y Audiología, 36, 178-184.

McWilliam, R. A., & Casey, A. M. (2008). Engagement of every child in the preschool classroom. Baltimore, MD: Paul H. Brookes Co.

McWilliam, R. A., Trivette, C. M., & Dunst, C. J. (1985). Behavior engagement as a measure of the efficacy of early intervention. Analysis and Intervention in Developmental Disabilities, 5, 59-71.

Woods, J., & Lindeman, D. P. (2008). Gathering and giving information with families. Infants & Young Children, 21, 272-284.