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his post continues the 12 mental shifts I described in
September—the mental shifts that have to occur to move from a clinical approach
to a family-centered, functional approach. This time, the shift involves asking
the question, Whose child is it anyway?
The question most often crops up when professionals and the
family disagree. At least, it should crop up. The two disagreements are when
families want to address something you don’t care about and when they don’t want
to address something you do care about.
Families want to address something you don’t care about
Javier insisted his son, Carlos, should say please and thank you. Carlos could barely say mama and dada. The early
interventionist thought there were much more functional words he should be
learning next, such as more, yes, finished,
eat, drink, and so on. She explained to Javier that these words could be
useful in different routines and were generally easy for children to learn. She
noticed, however, that Javier himself didn’t use them in playing or feeding
Carlos but did model thank you and please. Then she remembered Whose child is it anyway? Not only is
this a true and obvious statement but because Javier had this as a priority, he
was motivated to work on it, so Carlos received the intervention frequently. Signing
please and thank you do no harm and actually help Carlos learn about
imitation, communication, and rituals—all important for learning and family
routines.
What if Javier had wanted Carlos to use the toilet at 18
months? The early interventionist would have had an ethical obligation to
provide Javier with information, which is another mantra of the Routines-BasedModel. We have an ethical obligation to
provide families with information.
Families don’t want to address something you care about
Philomena is a physical therapist and is working with Rose
and her family. Rose gets into a four-point position, on her hands and knees.
She often then sits back on her ankles, but there’s no movement—no “creeping”
on hands and knees, with the tummy off the floor. Philomena thinks this is
important: It would help Rose learn about reciprocal movement and weight
shifting, not to mention that it would be a more efficient way of moving than
the commando crawl Rose did use. But Rose’s parents were politely lukewarm
about creeping. They’d heard that many babies simply skip over creeping before
learning to stand and eventually walk. Also, they didn’t like making Rose do
things she didn’t want to do, and Rose had no interest in creeping, even with a
towel slung under her belly and held up by an adult. Philomena incorrectly
thought creeping was a prerequisite to walking; after all, it was next on the
mobility developmental checklist.
Then she remembered Whose
child is it anyway? She’d given the parents information about weight shift
and reciprocal movement, so she’d done her ethical duty. If the parents didn’t
work on creeping, it wasn’t going to harm Rose. Even if Rose learned to move
independently later than she would if she crept, so what? Early intervention doesn’t
mean we have to push all skills to be learned as early as possible. If children
or their caregivers aren’t interested, it’s futile to perseverate on the topic.
A few weeks went by, when Rose’s mother said she wanted her
to play more independently and for longer, so she could get dinner ready (the
dreaded dinner preparation routine). Philomena worked with the mother to come
up with solutions, and, on one visit, the mother said, “If it didn’t take her
so long to get to her toys, she wouldn’t get fussy so quickly.”
Philomena said, “How can we get her to be quicker? Or should
we put the toys closer?”
“We need to get her moving better than that crawling she
does.”
“We can certainly work on that, but that would require a
grown-up with her, and you’re busy preparing dinner.”
“Maybe I can work on it when we’re just hanging out, playing
in the living room,” said Rose’s mother.
“Is that a useful time for her to be able to move better?”
asked Philomena.
“Yes, it’s the same issue. She can be more independent in
her play.”
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| Asunción, Paraguay, where I recently spoke at the ORITEL Conference |
This is an example of how, even when we acknowledge whose
child it is, the skill might be addressed. It was only when Rose’s mother saw a
functional need, for Rose to be engaged during dinner preparation, that the
skill became a priority. After this conversation, perhaps even at another visit
focused on play time, Philomena would have used family consultation (Mental Shift 12) to develop, with the mother,
the specific intervention strategies.
