Pronouns Indicating Teamwork and Humility

Occasional Posts on Language

I once worked with a graphics designer who had a couple of co-workers she routinely referred to as "my staff." Indeed, she was the team leader, but this use of the first person seemed self-aggrandizing. And I have subsequently found it in other middle managers in our field.

In early intervention and other human-service organizations, when we have at least three layers (e.g., boss, middle manager, workers), for the middle manager to talk about "my team" and "working for me" reveals (a) insensitivity to the fact that these people are also the boss's, (b) self-importance, and (c) unawareness of the organization or team. Better language is "our team" and "working for us."

In my experience, this problem is most commonly found in people who haven't supervised others before or very much.

Behavioral Consultation on Home Visits

Home visits in this model are strong supports to families to help them make the most of the learning opportunities, as Dunst and Bruder would call them, that occur throughout the day. The Vanderbilt Home Visit Script is a beginning, but the real meat of the home visit is in the "behavioral consultation" that the home visitor provides.






My definition for this term, which has existed in school psychology and other professions using consultation, is specific to working with caregivers in early intervention: Collaborative problem solving and solution finding related to families' concerns for their child or other family members, including parents.


Behavioral consultation on child-level issues occurs in when discussing, on a home visit, progress on a child-level outcome or goal. Answers are expected to fall into three categories:

1. The child has not improved in performing the skill;


2. The child has improved; or


3. The child has mastered the skill.

Each of these leads the home visitor down a path of questions that include

• Getting detailed descriptions from the family;


• Asking for demonstration of child functioning, if necessary; and


• Asking how previously discussed interventions are going.

Common consultative strategies in this approach are using

• Ask-to-suggest (i.e., "Have you tried this? Have you tried that?");


• Offering to demonstrate with the child;


• Refining the skill the child is working on;


• Tweaking implementation of the intervention;


• Suggesting a change in how the routine is carried out;


• Encouraging the family to persist with an intervention;


• Upping the ante (i.e., changing the criterion when the child has mastered a skill); and


• Constructing an Outcome x Routine matrix.

These home visits are usually highly focused and aimed directly at ensuring families have interventions they can use all the time between home visits, when child learning really happens. Sometimes families choose to talk about issues other than child skills, and sometimes the home visitor is using behavioral consultation on family-level issues.

When home visitors use behavioral consultation, they don't work with the child directly (although they might demonstrate interventions with the child), they don't take activities into the home (unless previously the family had requested them), and they don't spend all their time engaged in toy play with the child. The visit is structured around the IFSP outcomes or other topics the family wants to discuss. By the end of the visit, the family should have

• interventions they have had a part in developing,


• information, and


• encouragement.

Behavioral consultation is described in Routines-Based Early Intervention, a book I wrote, published by Paul H. Brookes Publishing Co. (http://www.brookespublishing.com/).

Curriculum for Home Visiting

Q: I would like to know what you would suggest as a good curriculum for us to use as providers. Many curriculums are on the market, but we need something that can be useful for sharing when doing activities and providing carry over suggestions to parents.

A: A curriculum is supposed to be what is taught to the learner. In early intervention, (a) home visiting is not just about "teaching" parents and (b) when they do want to be taught something, the content should come from (i) their individualized needs, not a curriculum; and (ii) the IFSP, if those needs are already reflected on there. In some cases, needs not on the IFSP should be put on there, if the family desires.

Many people confuse a curriculum with intervention suggestions. So your question might actually be about the intervention suggestions we make to parents. In our model, these come not from a book (e.g., curriculum) but from a process called Home-Based Behavioral Consultation. This is a collaborative, problem-solving process that marries the family's needs and resources (e.g., which routines they want help with and what they think is feasible) with the home visitor's expertise (i.e., strategies that address the specific need identified). This requires the home visitor to have knowledge about child development, family functioning, and behavioral interventions. It would be a great resource to take typical problems in everyday home routines and list various commonly suggested strategies, but I know of no such resource. So we are still left with relying on the training, experience, and collaboration of home visitors with families. Home visiting isn't an entry level position; it is sophisticated.

Having said all this, we do use the Measure of Engagement, Independence, and Social Relationships to monitor children's functioning in routines. This should not be used as a curriculum: It does not dictate what we do with families, but it helps those home visitors who don't think about the various components of child functioning within routines.

Perhaps the closest thing to a "curriculum" we use is the Routines-Based Interview, which is actually a process, not a product. But it is the tool for helping families decide what they want on the IFSP, which, as I mentioned earlier, is the list of things to work on--the definition of a curriculum.

Implementation II: Show Me the Research

Question: We have a supervisor who wants to see the research that better outcomes are occurring for children with using this method of service delivery (referring to my routines-based early intervention in natural environments).

Answer: I would like to see the research that better outcomes are occurring for children who get the current method of service delivery.

One might argue that the change model should produce the evidence. That the onus isn't on the homeostatic model but on the one requiring effort and psychological unrest. Another way of looking at this we learned a long time ago with respect to the research basis for inclusion. The model with the backing of theory, rational thought, and moral certainty does not have the onus of proof. The atheoretical, irrational, and morally questionable (i.e., not empowering families and other caregivers adequately) model has the onus of proof.

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.

Preschool Services Need Attention

It has become fashionable at early intervention/early childhood special education conferences to decry the supposed sorry state of affairs in Part C. In some places, criticism is warranted; in others, it's not. Many communities--the State of Missouri being one--are making significant strides towards excellent service delivery models.

 

 

Preschool services (Section 619 of Part B of IDE[I]A) have always been in a strange position. On the one hand, they receive much attention; on the other, they receive scant attention. They receive much attention in training in university programs for young children with disabilities, where much of the training is directed at preschool-aged children. In part, this emphasis is because of location: Students can be placed in classrooms for internships and student teaching, whereas placing students in home-based programs is much more problematic. Attention to preschool services is supposedly also revealed in conference presentations, where organizers and attendees alike are concerned about whether enough of the program is devoted to infants and toddlers and their families.

 

 

The scant attention I have noticed is in service delivery models.

 

• Just how are preschool services organized?
• What is the rationale?
• How much are administrators paying to dosage issues?
• Who are the targets of services?
• What philosophies underpin services?
• How much focus is on the influences of children's learning--children's learning opportunities?

 

These questions are related, and I will attempt to answer some of them. Others are for decision makers, practitioners, and families to consider, because my experience is that they often fail to consider them.

First, we can assume that, owing to what we now know about young brains and have long known about successful parenting, young children learn throughout the day better than they do in "lessons." This is related to the power of natural discriminative stimuli and to the difficulty young children, particularly those with developmental delays, have with generalization or "transfer."

Second, we can assume that what they are learning is far more than preschool behaviors (sitting, playing with play dough, negotiating with peers, etc.): They are still learning language, what their growing bodies can and cannot do, and how the world works, which is why learning opportunities exist throughout the day. This concept of alocated learning time is critical for understanding the difference between early childhood education and later education. The older children get, the more their learning can be concentrated into "school" (or Sunday school or piano lesson) time. In the preschool years, caregivers have the opportunity to teach throughout the day. This should make early childhood special educators think about their roles and opportunities.

Third, family systems theory, helpgiving theory, social support theory, and behavioral-ecological theory do not come to a grinding halt when the child turns three years of age. In Part C, there is some understanding that the whole of a child's waking hours is potential intervention time and that the environments in which the child finds him- or herself influence learning. Unfortunately, even though this understanding exist in theory, even in Part C it does not always translate into action. The situation is even worse in preschool, however, where service coordination is no longer a mandated service and where the (special) education mentality is pervasive.

• If family systems theory were acknowledged, preschool services would be organized to provide emotional, material, and informational support to families, including the systematic assessment of their needs and accountability on the IEP (if that document must continue to be the driving document) for developing family-level goals and providing supports to meet those goals.
• If helpgiving theory were acknowledged, preschool services would have an expanded view of family-centered practice, so they would attempt to meet families' needs for emotional, material, and informational support, rather than thinking that "parent participation" in school activities was most important.
• If social support theory were acknowledged, preschool services would see the link between child learning and family well-being and family well-being (quality of life) and their social support, especially informal support. Early childhood special education would therefore spend at least a little time getting to know families' ecologies and helping families preserve and, if they desire, expand their informal-support networks.
• If behavioral-ecological theory were acknowledged, preschool services would assess children's functioning throughout their typical day, through a family interview, and develop intervention plans that followed our knowledge of how young children learn. These plans would use children's interests and natural learning opportunities to teach them skills so they can participate successfully (i.e., be engaged) in their home, community, and school routines (activities).

Now let's discuss the number of hours that preschool services are provided to a child. If the child can go to school five mornings a week (e.g., 20 hours, allowing for a full 4 hours a morning instead of the measly 2.5 hours some preschool programs offer) or three full days a week (e.g., 15 hours, allowing for a full 8 hours), the school environment becomes a true learning environment. The child spends enough time there for learning opportunities to be distributed across time, and the child's "caregivers" during that time (i.e., teaching staff) spend enough time with the child that they become direct instructional or intervention agents themselves. This can be labeled the classroom model.

If these classrooms are self-contained (i.e., having only children with disabilities), they represent a dated approach that potentially violates moral and legal positions. If they are inclusive (i.e., at least half the children in each classroom have no disabilities), these classrooms are defensible and potentially excellent. This article is not about inclusion; it is about attention to children's learning opportunities and to their families.

Many preschool services are offered on a much leaner schedule, such as one to four 2.5-hour mornings a week, with the number of mornings being related to either the severity of the child's disability or the number of services the child has on the IEP. When a child is "at school" for such a small percentage of his or her waking time, we have to ask what the point of this service time should be. The child is transported in, sometimes by school bus, which is another whole discussion, sometimes by parents. Usually, the child is left "at school" for these short bursts of early childhood special education and related services. Family communication is limited to (a) notebooks, (b) intermittent home visits, or (c) discussions at arrival and departure, sometimes, with those families who do drop off and pick up their children. Often, that communication is about what the school people are working on, what the child did, and what the family can do to support the school's efforts. Sometimes, these short sessions at school are thought of as the times the child comes in for his or her therapies and special ed. Short times at school (i.e., fewer than 15 hours a week) can be thought of as the playgroup/clinic model.

Some preschool services are offered through itinerant services, which have the potential to acknowledge the theoretical bases I earlier described. Itinerant teachers can consult with a child's regular caregivers/teachers in  child care or other classroom-based settings, such as Head Start. If the consultation is done well, using an individualized-within-routines approach and not a pull-out approach, this model of service delivery has the potential to expand intervention throughout the child's classroom day every day. Unfortunately, sometimes itinerant services are restricted to special education, with the therapies still happening in clinical types of settings at a school. If therapists can also travel to children's regular-early-childhood classroom settings and adopt a "consultative approach to direct services" (which is not as contradictory as it sounds), we really have the potential to provide meaningful intervention. There's still the family piece though.... This approach is labeled the itinerant model.

School districts fear that the itinerant model is too expensive, compared to keeping all the personnel in centralized locations and shipping the children in, in groups. For the reasons given above, this solution has to be considered pragmatic but atheoretical, if the playgroup/clinic model is adopted. Beginning steps for preschool administrators can include the following.

1. Become familiar with the literature on the theory and research related to the concepts described in this article, so decisions are made on intellectually and empirically defensible grounds.
2. Work towards converting the playgroup/clinic sessions into family support sessions. After all, because they consist of such short bursts, many families are presumably available to transport the children or to care for them when they're not "at school." Do not call this "school" time, because that has the connotation of teachers working directly with children, and these family support sessions will be much more than that.
3. Take all the FTEs currently devoted to preschool special ed and related services, acknowledging that some therapists might work also with older children, and divide that number into the number of children with IEPs. Consider this then to be potential caseloads, with one professional serving as the primary interventionist with that child and family in whatever location seems appropriate. This is a radical but highly commonsensical approach to resource distribution--and defensible on child-learning and service delivery grounds.
4. Expand itinerant services, once caseloads are reallocated to a primary service provider. Ensure this is done with both therapies and special education, not just the latter.

What to Study

A colleague of mine was pondering what research question to ask next, which got me thinking about what I believe really needs to to be tackled.

If I were my colleague, I’d be curious about the actual amount of intervention children get—what we sometimes call the dosage question. Usually, this is measured in terms of the amount of time a child attends a program, but I’m interested in (a) how much intervention, typical or compensatory, does a child get from his natural caregivers and (b) how much program time is actually what Fisher, Berliner, et al. called “academic learning time” or true instruction. Part of my question is a political one: I simply don’t believe that only professional time counts. And I believe that a lot of professional time is incomplete teaching.

So what? First, if we could measure what children get from natural caregivers, we could count this as a buffer or asset that the child has. Second, if we could show that complete incidental teaching (setting up an engaging environment, following the child’s lead, eliciting elaboration, and ensuring there’s a consequence) is better than incomplete incidental teaching, which is better than nonelaborative responses, which is better than nonresponsive directives, we’d know more about the whole package of interventions children get and need.