Who Chooses Outcomes/Goals?

Remember that, in both the Routines-Based Early Intervention and the Engagement Classroom models, the family chooses outcomes/goals. Professionals don't.

This has come up recently in a situation where the child's classroom teachers were interviewed with a Routines-Based Interview after an IFSP was in place. Such a situation occurs when, for some reason, the original IFSP occurs with only the family, or the child doesn't start in a classroom-based program until he or she has been in early intervention for a while. Teachers were interviewed and they chose the goals. Someone then presented those goals to the family to see if they agreed with them. Wrong.

First, the family should have been invited to the interview with the teachers, so they could have heard first-hand what the teachers said. Second, If the family didn't go to the interview, the professional (probably the interviewer) should have taken the information back to the family and asked the family if they wanted to amend the IFSP. If the family had picked only about six home-related and family outcomes, originally, and they they chose about six new, school-related outcomes, they can just add them to the plan. If, however, they had had an RBI and had picked 10-12 outcomes to start with, you wouldn’t want to add six more. The family would reconsider all their outcomes/goals or pick the top 10-12 out of the whole list.

It's tempting to think that teachers who see the child's functioning in school routines and who will be responsible for teaching the child in those routines should select the outcomes/goals, but the IFSP and the IEP are the family's plan. I know they're supposed to be the team's plan, but we're trying to make this a family-centered endeavor. Whose child is it? Teachers provide information about the child's engagement, independence, and social relationships during school routines, so families can make decisions about what they want the child to do during those routines. If teachers feel the child really could benefit from acquiring or bettering certain skills during certain routines, this will come out in the interview. Furthermore, teachers are not limited to working on outcomes/goals during the classroom day, so they can still work on skills the family didn't choose. They just can't ignore any skills the family did choose.

Remember, families--not professionals--choose outcomes/goals.

Writing Outcomes or Writing Goals

Are there times you write goals for a child that are not tied to specific routines? If so, can you give me an example?

Toileting for children who need to toilet at any time. They wouldn’t have actual toileting routines. People need to understand the vital importance of participation or engagement, in order for this question not to come up. Here’s the abstract to a good article by Jeanne Wilcox and Juliann Woods about the importance of participation for writing outcomes: http://lshss.asha.org/cgi/content/abstract/42/3/365. They focus on language, but the same argument can be applied to all areas of development.

We are still working from a mind set that we need to be writing goals based on provider concerns - even if the parent is not concerned or invested in the goal. We are basically saying that we should be telling the parents what they should be concerned about. I am not sure how to get past that.

Shouldn’t be allowed because it’s not family centered, as I explain below.

The basic issues are these:

1. How do we decide on an appropriate measurement if we do not break down the goal into smaller steps?

Would coming up with a breakdown of short-term objectives serve the same purpose as writing a measurement with the three criteria or should the list of short-term objectives be something in addition to the functional goal with measurement included?

The question is related to the seven steps for writing participation-based outcomes/goals, as described in the book Routines-Based Early Intervention. An example is below.

This question assumes that all skills are going to be taught in the steps in a task analysis, so the measurement becomes the accomplishment of step after step. This is an acceptable measurement method to supplement the criteria for outcome accomplishment. You see, the difference is between progress monitoring and the criteria for the END of the instruction—what answers the question How will we know when we got there—when to reassess, when to stop? The three criteria ask the questions, When is this overall skill (i.e., all the steps or a subset of the steps) needed (i.e., what routines), what level of performance is required (e.g., how many steps in the chain, what level of prompt, what frequency, what duration—whatever makes sense for the skill in context), and over what amount of time (which should be specified in any measurement system, even a task analysis one)? So it’s a false question to say it’s chaining versus our three criteria.

I am worried that those who don’t want to specify routines (a) don’t think of the necessity factor in outcomes (is it necessary?); they think more in terms of deficit—what can the child not do, regardless of context; and (b) think that professionals have to teach the child during routines, which would be difficult to do (instead of thinking that we need to be consulting with families so they can teach the child during routines).

2. How do we include professional opinion in goal-writing?

First, the rewording of the goal into a participation-based goal with three criteria is professional behavior. Second, professional opinion can go into the process of functional assessment, by the questions we ask families, the stars we highlight if we do an RBI, and the reminders of concerns we provide while the family is choosing outcomes/goals. But this requires a strong commitment to ethics, to ensure professionals are not talking parents into choosing outcomes they actually are not interested in or that are not actually functional. Third, professional input really comes into the strategies for intervention. It is a paradigm shift (sorry about the cliché) to let families make decisions about goals. Understanding whose child it is and that families need to be reinforced for the decisions they make about their children’s goals is the hallmark of a family-centered professional. Others are nice to families but don’t really trust them or care about the families’ priorities and long-term growth as parents; they are not truly family centered, even though they sometimes think they are God’s gift to families.

3. Does having a list of short-term objectives with the final objective being the end goal supercede the need to write the measurement piece?

This is partially addressed in my first answer. No, it doesn’t. If you want short-term objectives, here’s how it can work:

Joshua will participate in hanging out time and bath time by playing with a variety of toys. We will know he can do this when he plays with three toys in two hanging-out times and one bath time in a day for five consecutive days. [This is an example of a participation-based outcome with multiple criteria.]

Short-term objectives:

1. Joshua will play with two toys during one hanging-out time by October 1.

2. Joshua will play with two toys during one bath time by December 1.

3. Joshua will play with three toys during two hanging-out times by February 1.

4. Joshua will play with three toys during one bath time by April 1.

5. Joshua will play with three toys in two hanging-out times and one bath time in a day for five consecutive days by June 1.

If you have any pearls of wisdom that might help me find a way to navigate this I would really appreciate it. I fear I am just causing myself more confusion the more we go around on the subject.

Reread Chapter 7 in the RBEI book and look at the Goal Functionality Scale III.

Implementation I: Writing Outcomes for Family-Level Needs

The next few blog entries will be about implementation issues that have arisen in one state I've been helping.

Question: Instead of writing 10 IFSP outcomes, some teachers [home visitors] are using [the daily contact log] to document concerns such as needing help finding day care, putting plastic on the windows, looking for a toddler bed, etc. The need/concern is documented, and the teacher follows up with the concern on the next visit.

Answer: These kinds of concerns are family needs, which are supposed to be part of early intervention and on the IFSP. What makes the askers of this question think that these needs shouldn't be outcomes? Do the have some child needs they also don't write outcomes for? Our accountability is at the level of outcomes, so we need important activities to be listed as outcomes, not hidden away in the child's record for which there is no accountability.

If the need came up during the Routines-Based Interview and the family selected it as an outcome, obviously it is written as an outcome. If a need comes up in the course of home visiting, it does not necessarily need to be added as an outcome. If much time and energy is going to be put on resolving the issue or if it becomes a big deal for the family, it should be added as an outcome, if the family chooses. Professionals should encourage not discourage this. Home visitors should be working on outcomes, so if something is not an outcome and they're spending much time on it, they are not doing what they should be doing. Similarly, if it's important to the family, we need to see that there is truly a goal to be accomplished, so an outcome gets written.