Using "Mom" Instead of Her Name

For years, I have exhorted early interventionists not to use "Mom" or "Dad" when referring to parents or, worse, when addressing them, as in, "Mom, do you have anything you'd like to add?" In today's New York Times, Heather Havrilesky writes about "Our ?Mommy? Problem" (click on title). She mentions this bad habit and a whole lot more about the expectations today's mothers face.

Just last night, I was at a social event (can you believe that?!) and a mother of a 5-month-old asked me what she should be doing with her baby. She was worried she wasn't doing the right things, she worried when her baby cried and she couldn't soothe her immediately, and her (this mother's) days were often boring. I asked, "Do you talk to her? Do you play with her? Do you read to her? Do you respond to her when she makes sounds, including crying? Do you do things YOU like to do in your day?" Answers: yes, yes, yes, yes, sometimes. I told her to work on the last one and she'll have this mother thing licked. Like many mothers, she thought that all day every day had to be about the baby--and she isn't even American!

I also realized how lucky our early intervention parents are, getting weekly visits from a friendly, knowledgeable, supportive person--our home- and community-based early interventionists. Some parents are surprisingly isolated in their roles as parents. And when the child has a disability, of course, that's exacerbated.

You'll notice I said "weekly." More infrequent visits are, as Dathan Rush says, checking in, not digging in.

Read the New York Times article!

Hugs and Kisses

In the New York Times on September 26, 2014, Henry Alford wrote a column about the bro hug, how it’s becoming pervasive, and how anything less is considered unfriendly. President Obama, who notoriously keeps a cool distance in personal relationships outside his immediate circle, is a persistent bro hugger. I count myself among the hug resistant.

BuzzFeedNews May 30, 2014

In the column, Aisha Tyler, whom I love on “Whose Line Is It Anyway?” says she hugs contextually inappropriately. “I’m very slutty. They should hire me to go to death row to hug inmates because I’ll hug anyone, regardless of what they’ve done.”

I love Aisha Tyler's comments (I generally love Aisha). Some years ago, I decided, when I go to early intervention conferences, to hug anyone I know. It seems to be the accepted thing, because the hand-shake seems too formal. That means I'm hugging people I see at most once a year and, sometimes, haven't seen in years. Then, the excuse, if needed, is exactly that. The whole thing makes me uncomfortable on the one hand (I hate hugging) but comfortable on the other (I have a default greeting so I don't have to overthink what to do). Similarly, in Portugal and Spain, every woman gets a double air kiss. I have to remember that the Latin Americans, on the other hand, do only a single air kiss; if I forget, there's a whole awkward thing where I'm bobbing around in the other person's facial space trying to get to the other cheek, when they think the ritual is over.

examiner.com July 30, 2013

This article doesn't get right down to the nitty gritty of the bro-hugs. With some guys, it's a hand shake with the right hand and a sort of hug with the left, with the unfortunate result of the clasped right hands being around private-parts level. With others it's a thumb grab, like we used to do in the 70s, with the right hand and a hug with the left. With others, it's a full-on two-handed hug, meaning no barrier between our torsos. OK, why would we want to be doing that?

Anyone remember when the handshake with the left-hand clasped over the hands was an accepted indication of bro-love? Maybe a grasp of the person's biceps? The latter had the added advantage of checking out how strong the other person was, which therefore made me uncomfortable but loved.

Preschool Service Locations

This post continues the discussion begun in the August 19 post on “Hours and Places.” Where are school districts putting their resources for preschoolers on IEPs?

Location and Placement

According to IDEA, special education services should be provided in the least restrictive environment, and the IEP should ensure that the child’s placement is as close as possible to his or her home. Many preschoolers are “placed” in a setting the IEP team considers to be appropriate to meet the child’s needs, even if that child is or would be attending another child care setting. Therefore, it’s not unusual for preschoolers to have three places where they spend time most week days: home, a designated placement for preschool services, and child care. In this post, I explore who should get the help from special educators and therapists, why this decision should be different for preschoolers compared to school-aged children, dual placement rules, and investment in itinerant services.

Who Should Get the Help?

The people who should get the help are those who care for the child for significant amounts of time—say 15 hours a week. This is often not the policy in preschool special education programs; they often send their ECSE teachers and therapists to the place where the child spends the least amount of time, which also might be where you find the highest qualified staff. Let’s look at one scenario:

Here we have a child placed in a setting—perhaps a public preschool program—for two mornings a week (8 hours, to give maximal benefit of the “morning”). If this child goes to child care during the rest of the week, perhaps while the parent is at work, he or she spends 52 hours a week there. That’s three mornings and five afternoons. This leaves 49 hours of awake time at home: 2 hours in the morning, 3 in the evening, during the week, and 12 hours on the weekends. This is a simplistic breakdown, I realize, because it doesn’t account for transitions, other places where the child might be, and so on. Nevertheless, if the paid setting (i.e., the place where the school district is paying for the child to go) is the placement on the IEP, this is often the only place where the ECSE teacher and therapists will go. That paid setting likely has a certified teacher, whereas the child care and home settings might not. Most important, however, is the number of learning opportunities in each setting. Those who have the most opportunities are clearly the child care providers and the family. Let’s look at another scenario:

It’s similar, but here the paid setting (i.e., the official placement) is a week-long, mornings-only program. Although this might seem like a full-time setting, in fact it’s still only a third of the time the child would be in child care, ignoring travel time between the two, if the locations are different. Again, should the ECSE teacher and therapists go to the 15-hour-a-week place or to the 45- and 49-hour-a-week places?

Why Should This Decision Be Different for Preschoolers?

If we were discussing school-aged children, this might be a different story. Older children, especially if they have cognitive strengths, can retain and transfer skills and knowledge from one place to the other. They also can learn with massed trials. Young children, however, learn better by having distributed “trials” implemented in the places and at the times where the skills are needed. In other words, we teach them skills as they need them for successful participation in whatever routine they’re in at the time.

Dual Placement

Dual placement, or providing services in two places, is allowed in some places and not in others. Legally, I think dual placement needs to be an option on the IEP, but in practice many school districts say they’ll provide services only in one setting—the primary or only placement. This is short sighted. To add to the possibilities and complexity, some children are served in specialized, self-contained settings (i.e., “special classes”). Here, the classroom teacher is an ECSE teacher. If the child is enrolled in such a classroom for significant amounts of time (e.g., > 15 hours a week), the teacher has a chance of having an impact on the child’s development and learning. If the child is enrolled in such a classroom for a couple of mornings a week, we’re back to the dosage issue: The child is receiving special ed for too little time to make much difference. If that teacher spends no time consulting with the child’s other caregivers, then, really, the impact is low. If the teacher spends afternoons consulting with children’s other caregivers, he or she might be doing some good. It depends on what he or she does, but I’ll leave the topic of quality itinerant work for another time. Right now, the issue is whether special ed and related services are going to the right people.

Invest in Itinerant Services

LEAs that rely much on itinerant ECSEs and therapists have the opportunity to make a difference. Whether the itinerant should be a primary service provider or one of a number of professionals going into the classroom (i.e., multidisciplinary) is another matter. If we want good inclusion and we want to maximize the effects of ECSE, we need to send qualified teachers and therapists into the settings where children spend the most amount of time, not the least amount of time.

Implementation Planning

When programs, states, or countries (i.e., entities) are seeking to improve early intervention/early childhood special education services, the EIEIO can help them with implementation planning. We have now helped many entities develop implementation plans. From implementation science, we know entities move through four stages: exploration, installation, initial implementation, and full implementation. By the time an entity has contacted us, they are usually well into exploration. In the jargon of implementation science—and there’s a lot of it, we are a purveyor—the developer of the model they are implementing or considering implementing.

Some entities have worked with us for a while, and we have agreed to formalize the implementation plan. What’s so important about an implementation plan?

1.      It forces stakeholders to think about what a true commitment to implementation really consists of, particularly how long it takes.

2.      It helps entities put its efforts into priority order—of importance but also of feasibility and timeliness.

3.      It announces to the entity, administrators, and policy makers what the plan is. Therefore it sends a message.

4.      It acknowledges that not everything can be done at once, that entities have to spread out expenditures over time.

The implementation-planning meeting has some distinct stages:

·        Explaining the model under consideration—in our case, the Routines-Based Model;

·        Listing components of the model that might be good to adopt;

·        Brainstorming areas of needed improvement, whether related to the model or not;

·        Matching improvement needs to components of the model;

·        Finalizing the list of components to adopt (i.e., implement);

·        Deciding on timelines for preparation, implementation (i.e., intensive training), and maintenance of each component;

·        Deciding on the definition of “full implementation” for each component chosen;

·        Planning who will write which action steps (one set of action steps per component) by when.

The final implementation plan, therefore, shows the timelines and what needs to be done, for each component, (a) to prepare for implementation, (b) to train people, and (c) how fidelity to the model will be maintained. Preparation for implementation can mean gathering materials, reviewing policies that might enhance or interfere with implementation, and finding or developing instruments for measuring implementation fidelity (e.g., checklists).

Stakeholders provide input. It is actually usually administrators who make the final decisions, because they have the funds and responsibility. One of the decisions that needs to be made is what “full implementation” means. Literally, it would be that all children and families are receiving a given practice or that all providers are using the practice. But if decision-makers decide they won’t or can’t make everyone do it, the goal for implementation might be that a given number or percentage of children and families or professionals are receiving or delivering, respectively, the practice. This option is especially popular in entities with much local control. For example, a state’s preschool special education program might want to implement components of the Engagement Classroom Model (part of the Routines-Based Model) in 20 local education agencies by the target date. They would not be targeting implementation in all LEAs, which might be considered unfeasible in their situation. 

Some people might consider it inadvisable to have the purveyor also do the implementation planning, but we have found it to work well. You want a facilitator who knows early childhood, and it’s a good idea to have someone from outside the system doing the implementation to facilitate. In our case, we have enough experience with facilitating these meetings that we know how to do so without pushing ideas the group doesn’t want.

 

As Thomas Alva Edison said, “The value of an idea lies in the using of it.” Therefore, entities should plan for implementation and should not be surprised at how long implementation takes.

Hours and Places

A common method of service delivery for preschoolers with disabilities is for them to attend a public preschool of some kind for a few hours a morning, for perhaps 4 days a week. Therefore, the dosage of this particular intervention is 10-12 hours, sometimes 15 hours, a week. This has become so common, so ingrained, that some administrators are unwilling to examine the flaws of this method. Unfortunately, they should look at the four significant problems with this method.

Dosage

We don’t know how much time you need to spend with a child to have a significant impact on his or her learning and development. It depends on what’s going on during that time and on a host of child characteristics. If the rate of teaching during the 10-15 hours of service is high, which our research has shown not to be the case, presumably the impact would be high. If the child has severe intellectual disabilities, presumably the impact of 10-15 hours would be less than if the child had mild intellectual disabilities. The cruel truth is that this dosage of intervention is probably too low for children who are learning throughout the day. If they were school-aged children, it would be another matter. The younger the child, the more learning happens in a spread-out fashion (i.e., distributed trials versus massed trials).

The dosage issue is put in stark relief when we see how children in these formal programs spend their time. The first of the following two pie charts show the hours in a day for a child who attends a formal preschool for 619 services, attends child care when the formal preschool is not in session, is at home awake, and is sleeping. The second pie chart shows the hours in a week, including weekends, for the same settings and events.

 

This time model shows that a child whose day looked like this would spend 8.93% of his or her week in the 619 service, 14.88% of the week in child care, 30.36% of the week awake at home, and 45.83% of the week sleeping. If we assume that learning potential is equal across environments, which is not necessarily true, we see that home provides twice as much opportunity for learning as child care, which provides 3/5 more opportunity than the 619 service. Therefore, the amount of time the child is in the 619 program might be insufficient to have a significant impact, at least compared to other settings.

Transitions

A second problem with part-time 619 services is the transitions children have to make. Some children have before-“school” care, sometimes in a different classroom from their preschool program. Then, at 12, for morning kids, they are transported to child care, usually by a family member. Then they make the transition to the home. Ironically, children with no particular problems in learning and behavior usually have to go to only one day-time setting (e.g., one child care program), but children with disabilities, who often are less able to make transitions smoothly, have to go to two. Transitions are difficult for some children, require the family to interrupt their day, and might not be used as learning time, thereby resulting in a decrease of engagement.

Failure to Support Other Environments

If the 619 program is providing its services through the preschool programs, it rarely also provides supports to the other environments. It uses up its resources on the 10-15 hours a week, rather than on the remaining 75% of the child’s waking day. The child care programs including children with disabilities often get insufficient support (i.e., no support) from an itinerant teacher. As for all that time in the home: It’s a disgrace that our federal policies and therefore more local ones are developmentally inappropriate. I’m talking about the use of the IEP, with no provision for (a) child-level goals related to functioning in the home, (b) family goals related to the child, or (c) family-level goals only indirectly related to the child. The part-time service delivery model leaves the child’s major supports unsupported by the early childhood special education establishment.

 

Inclusion

Wolf Wolfensberger

Why are children going to two classroom settings, a formal preschool and a community child care program? In full inclusion, they would be going to the places they would go if they didn’t have disabilities, which presumably would be the community child care program. It’s helpful to think about inclusion in terms of normalization—an old concept from Bengt Nirje and Wolf Wolfensberger. Twenty-four years ago, Don Bailey and I wrote an article called “Normalizing Early Intervention,” in which we argued that professionals could make (a) the physical environment, (b) teaching and therapeutic strategies, and (c) family-focused services as natural as possible, but that the twin values of normalization and effectiveness might sometimes be at odds with each other. Fortunately, in the last two decades we have studies and models that give us direction for effective inclusive practices (see my post of July 26, 2013).

In conclusion, preschool special education programs need to examine carefully the old familiar method of providing low-dosage classroom experiences, more daily transitions than typically developing children have, and lack of support to community child care and to families. Our field might have pulled off part-time, minimally consultative services for years, but it’s time to pay attention.