Real Alignment

Real Alignment: Routines-Based Model and DEC Recommended Practices

Practices in the Routines-Based Model are directly aligned with just over half (53%) of the 2014 DEC Recommended Practices. They are indirectly aligned with a further quarter (26%) of the Recommended Practices. This model, therefore, is a useful vehicle for implementing most of the Recommended Practices.

The Routines-Based Model (RBM) is a way of providing early intervention and early childhood special education, focusing on naturally occurring routines, on family strengths, and on children’s engagement. Some of its well-known components are the Routines-Based Interview (RBI), the ecomap, the primary service provider, support-based home visits, collaborative consultation or integrated therapy, incidental teaching, and the zone defense schedule. The model provides guidance on both home- and classroom-based service delivery, serving children birth to 6 years of age and their families.

The DEC Recommended Practices (Division for Early Childhood, 2014) were developed to provide guidance to practitioners and families about the most effective ways to improve the learning outcomes and promote the development of young children, birth through five years of age, who have or are at-risk (sic) for developmental delays or disabilities. (p. 2)

My colleagues and I have been developing and refining the RBM since the 1980s, so some practices, such as the RBI, predate DEC Recommended Practices—even the original ones in 1991. All RBM components predate the current (i.e., 2014) Recommended Practices (McWilliam, 2010; McWilliam & Casey, 2008). 

To determine the real alignment, not to be confused with wheel alignment, of the RBM with the Recommended Practices, I determined whether each of the latter was directly addressed by an RBM component, indirectly addressed by the RBM, or not addressed by the RBM. The Recommended Practices, which can be downloaded from http://www.dec-sped.org/recommendedpractices, are organized in eight topic areas.

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 Leadership

Most of the recommended practices in this area are not linked to the RBM, which tends to emphasize practitioner-level practices. But our use of implementation science and our methods for program evaluation are linked to the practice related to collaboration with stakeholders on the collection and use of data (L12). Also, our use of the primary service provider (PSP) is directly linked to promoting the efficient and coordinated service delivery from multiple disciplines (L13). The model is indirectly linked with L3, L6, and L9.

Assessment

The RBM addresses needs assessment for program planning, monitoring child progress, and measuring child outcomes, so it is aligned with all but two of the assessment recommended practices (A1, A8). The major assessment tools in the RBM are the RBI (McWilliam, 2012); the Measure of Engagement, Independence, and Social Relationships (MEISR) (McWilliam & Younggren, in press); the Classroom MEISR (ClaMEISR) (McWilliam, 2014); the Children’s Engagement Questionnaire (McWilliam, 1991); and the STARE (Casey & McWilliam, 2007). All of these are directly linked to working as a team with the family (A2) but less so with other professionals. They are also directly linked to conducting assessments that include all areas of development (A4). The RBI and STARE are directly linked to using a variety of methods including observation and interviews (A6). The RBI, MEISR, and ClaMEISR are directly linked to obtaining information about the child’s skills in daily routines (A7), systematic ongoing assessment (A9), and assessment tools with enough sensitivity to detect child progress (A10). The model is indirectly linked to a further three recommended practices (A3, A5, A11).

Environment

The RBM is linked, mostly indirectly (E2, E4, E5, E6), to all the environment recommended practices. The Engagement Classroom Model, which in a previous form was known as the individualizing inclusion model (Wolery, 1997), along with support-based home visits and participation-based goals, directly addresses services and supports in natural and inclusive environments (E1). Family consultation addresses working with the family and other adults to promote children’s participation (E3).

Family

The RBM is linked to all but one family recommended practice (F8). The RBI and family consultation directly address building trusting and respectful partnerships with the family (F1). Support-based home visits are directly linked to four recommended practices. Along with our mantra that we have an ethical obligation to provide families with evidence-based information, they are directly linked to the practice that says almost exactly that (F2). Through family consultation, support-based home visits are directly linked to supporting family functioning and promoting family confidence and competence (F5). By incorporating the five parenting skills in our model, these home visits are directly linked to engaging the family in opportunities that support parent knowledge and skills (F6). The emotional-support component of the home visits is directly linked to being responsive to the family’s concerns, priorities, and resources (F3). The RBI is directly linked to creating outcomes and goals that address the family’s priorities (F4). The RBM is indirectly linked to two family recommended practices (F9, F10).

Instruction

The RBM is linked, mostly directly, to all the instruction recommended practices. All the assessment tools mentions earlier are directly linked to identifying each child’s strengths, preferences, and interests (INS1). The RBI is directly linked to identifying skills to target for instruction with the family (INS2), and, with incidental teaching, planning for and providing the level of support the child needs to participate in routines (INS4). Incidental teaching is also directly linked to embedding intervention within and across routines (INS5), using systematic instructional strategies to promote child engagement (INS6), and using explicit feedback and consequences (INS7). The STARE and goal attainment scaling are directly linked to gathering and using data to inform decisions (INS3). The focused RBI and our behavior-management strategies are directly linked to using functional assessment and related strategies for challenging behaviors (INS9). Participation-based goals are directly linked to implementing the frequency, intensity, and duration of instruction (INS10). Finally, family consultation is directly linked to using coaching or consultation strategies with primary caregivers (INS13). The RBM is indirectly linked to three instruction recommended practices (INS8, INS11, INS12).

Interaction

The RBM is directly linked, because it includes incidental teaching, to all the interaction recommended practices. With our focus on engagement, it is directly linked to promoting the child’s social development (INT2). Our focus on social relationships, along with incidental teaching, is directly linked to promoting the child’s communication development (INT3).

Teaming and Collaboration

The model is linked also to all the teaming and collaboration recommended practices, although not all directly. The PSP and associated joint home visits are directly linked to representing multiple disciplines (TC1) and working with families as a team to exchange information (TC2). The PSP is also directly linked to identifying one practitioner from the team who serves as the primary liaison (TC5). The RBM is indirectly linked to two other recommended practices (TC3, TC4).

Transition

The RBM is not linked to either of the transition recommended practices.

If the DEC Recommended Practices can be considered the most effective ways to help young children with disabilities and their families (I wish they included families in the outcomes of the practices, not just in the implementation of the practices), this real alignment validates the model. The model has other components that aren’t directly aligned with the recommended practices, and one fifth of the recommended practices aren’t addressed by the model. Nevertheless, the alignment is good enough to say that the RBM can keep early intervention 0-6 on the road and not in the ditch.

References

Casey, A. M., & McWilliam, R. A. (2007). The STARE: Data collection without the scare. Young Exceptional Children, 11, 2-15.

Division for Early Childhood. (2014). DEC recommended practices in early intervention/early childhood special education.   Retrieved February 25, 2015, from http://www.dec-sped.org/recommendedpractices

McWilliam, R. A. (1991). Children's Engagement Questionnaire. University of North Carolina. Chapel Hill, NC.

McWilliam, R. A. (2010). Routines-based early intervention. Baltimore, MD: Brookes Publishing Co.

McWilliam, R. A. (2012). Implementing and preparing for home visits. Topics in Early Childhood Special Education, 31, 224-231. doi: 10.1177/0271121411426488

McWilliam, R. A. (2014). Classroom Measure of Engagement, Independence, and Social Relationships (ClaMEISR). The RAM Group. Nashville, TN.

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

McWilliam, R. A., & Younggren, N. (in press). Measure of Engagement, Independence, and Social Relationships. Baltimore, MD: Paul H. Brookes.

Wolery, M. (1997). Individualizing inclusion of young children with disabilities in child care: A model demonstration project. Chapel Hill, NC: U.S. Department of Education.

Incorporating Parenting Into Ongoing Family Consultation

Sonny McWilliam with her daughter, Tinsley, at the Outer Banks

Early intervention is, at its core, a parenting program. I mean it is designed to help parents rear their children in ways they want to, with added information about what’s good for their child, considering his or her disabilities, delays, or risk status. The child’s situation is the key unlocking the door for the family and us to get together, but, once we’re in the same room, parenting is what we’re talking about—at least when implementing the Routines-Based Model.

I don’t mean to imply that parents are deficient in their parenting. Rather, as we engage in joint solution finding around the individualized goals, we have the opportunity to encourage five evidence-based parenting strategies.

Talk

Most people in early intervention are aware of the landmark study by Hart and Risley (1995) showing the relationship of the number of words a child hears to the child’s language development and the relationship of socioeconomic status to the number of words heard (poorer = fewer words). Hart and Risley also saw that the poorer children heard a greater proportion of negative words (stopping child engagement, redirecting unnecessarily, harsh words) than less poor and richer children heard. Other researchers have also stressed the importance of the quality of language used with and around children (Konishi, Kanero, Freeman, Golinkoff, & Hirsh-Pasek, 2014).

Read

Reading to the child can start even before birth. Reading is a good way for families that find talking to nonverbal children strange to provide them with words. On the other hand, “reading” isn’t as important as shared book time, when the adult talks to child about the pictures or about the story (Whitehurst & Lonigan, 2001). Reading with children is probably a good way to teach children to appreciate books.

Play

You’d think play comes naturally to parents, but not necessarily. I’m not talking about playing with a toy, necessarily. More about being playful. The key is really getting in tune with the child and keeping him or her engaged. Knowing when to expand on the play “schema” and when to stick with the existing one. It involves loosening up adult inhibitions. In addition to social play with adults, children do benefit from learning to play with objects independently.

Teach

Children learn from their parent, whether you want them to or not! But what is it parents do? They use reinforcement principles, for one. We point out to parents how there need to be good consequences when children are doing what the parents want him or her to do. And there should be a dearth of attention when they do what the parents don’t want him or her to do. We sometimes help parents with the timing of their interactions with the child, to promote their effectiveness at making those interactions teaching moments. Cultural anthropologists have said that, in many societies, children learn their cultural norms by observing adults who are not necessarily actively teaching them (Lancy, 2014).

Behavior Management

Behavior management of very young children is still about teaching them. Some parents have an easy time of it, either because they’re masters at behavior management or they’re blessed with children who don’t give them much trouble. Other parents might face challenges in this area, so early intervention is very much about helping families feel in control without getting into power struggles.

In the Routines-Based Model

In this model, the topic of conversation with families, especially in early intervention for children under 3, is often a child’s engagement, independence, or social relationships (EISR)—things addressed through goals, if a good Routines-Based Interview was conducted. If you focus on EISR, you still get to traditional developmental domains.

Even when we’re talking about outcomes/goals, however, we’re doing so in the context of routines. Routines as we define them (naturally occurring activities and rituals) are when parenting occurs; they provide the context both for goal-related interventions and for parenting strategies.

If we think of early intervention as a parenting program, we normalize the experience. The five parenting strategies listed above aren’t for parents of children with disabilities; they’re for all parents. Most parents are already doing at least some of these things, so our attention to parenting allows us to build on adult strengths and sometimes to point out things they could do more.

Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children: Paul H Brookes Publishing.

Konishi, H., Kanero, J., Freeman, M. R., Golinkoff, R. M., & Hirsh-Pasek, K. (2014). Six principles of language development: Implications for second language learners. Developmental Neuropsychology, 39, 404-420.

Lancy, D. F. (2014). The anthropology of childhood: Cherubs, chattel, changelings: Cambridge University Press.

Whitehurst, G. J., & Lonigan, C. J. (2001). Emergent literacy: Development from prereaders to readers. Handbook of early literacy research, 1, 11-29.

Unconditional love

In a thought-provoking column, David Brooks posits a straw-man argument, between conditional love, which he equates to a meritocracy, and unconditional love, which he equates to... love without concern for merit. Parents use behavioral principles of reinforcement to teach their children, some more effectively than others.

Whether "love" should be the reinforcer is a question--and anyway what is "love"? Attention, smiles, encouraging verbal behavior... Brooks and others need to define it in observable and measurable terms (not easy for "love"), if they claim it's the conditioning stimulus (i.e., reinforcer).

So what about unconditional love? It teaches a child that whatever he or she does is OK--or does it?

http://www.theandrewmeyer.com/?p=342

Back to the definition of love: A parent can convey the message I love you no matter what, but that doesn't mean I'm not going to consequate your behavior differentially. For example, you wanted to spend the night with your friend, but you're not going to now, because of what you did (or didn't do) today, but I still love you. In fact, I'm doing it because I love you.

Right! thinks the child. It doesn't matter what the child thinks in the moment. That's the part a lot of modern American parents don't get. They see only the short view (am I popular with my child? Does my child love me?), not the long view (Is my child turning out independent, knowing right from wrong, interested in the world, and able to get along with others?).

And there you have my opinion of the four worthwhile goals parents have for their kids.

Shortcuts With the RBI

Sorry, but no effective shortcuts for the Routines-Based Interview (RBI) have been found. It's interesting that one of the most effective practices we have--one that families like--is one where professionals balk at the 2 hours it takes. Do we live in such a rushed professional society that every encounter has to be short? This medical-model mentality simply doesn't fit a family-centered, intellectually valid approach to our work. The problem is compounded by a well-meaning legislated mandate in Part C of IDEA--to have the IFSP completed within 45 days of the referral. The policy is intended to prevent delays in serving children, but it makes fitting in a longish interview seem difficult.

The RBI has three main purposes: to establish a positive relationship with the family, to get a rich and thick description of the child and family functioning, and to obtain a family-chosen list of functional outcomes/goals. So splitting it up, which is one frequently mentioned idea, wouldn’t work. Many good minds have applied themselves to the problem of the long RBI, but no good shortcuts have been found. So I always suggest people consider what’s using up all the time in the 45 days and it usually boils down to something to do with the evaluation: scheduling evaluators, the evaluation taking a really long time and therefore needing its own meeting, and so on. Many places successfully fit in four visits: intake, eligibility evaluation, RBI, finalize the IFSP. Places that don’t or that are afraid of going over the 45 days, bunch up two of these meetings into one meeting, usually either evaluation and RBI or RBI and finalize the IFSP. If the former, I urge them to examine their evaluation practices to choose the most efficient tool and not to turn the in-or-out event into a quasi-diagnostic encounter.

Almost all RBIs require some time management, and I train people to keep up the detail of information discussed within routines, but, if necessary, skip routines to be finished within 2 hours. Actually, the interview needs to be over after 1.5 hours, because the recap, goal selection, prioritizing, and criteria discussion (something new we’ve added) will take half an hour. Experienced interviewers know not to skip dinner preparation, bath time, and bed time. 

The RBI doesn’t claim to get everything—just enough--to come up with 10-12 goals, including family ones. So, if we skipped routines but we got enough goals, we don’t have to “continue the RBI.” We never split the RBI up over two days. There’s something about the arc of a complete interview, in terms of the relationship building, that is disrupted if we break it off in mid-stream and then, later, try to continue it.

Plan for the 2 hours and enjoy it. Families will.

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Sensory Integration Therapy and Decreasing Stereotypy

One of the disorders sensory integration (SI) therapy is said to help with is the decrease of behavioral excesses in children with autism. In a new single-subject experimental design to evaluate the efficacy of various SI techniques on reduction of stereotypic behaviors, a net swing, “deep pressure,” and a sensory diet consisting of “deep compression” via a therapy ball, “deep pressure” via heavy work activities, “meatball squeeze,” and joint compression were examined with three preschoolers with autism. 

Single-subject studies are truly experimental; the other truly experimental type of research is randomized control trials. Single-subject studies involve a small number of participants but many data on the dependent variable are collected over time. What you give up in the number of participants, you gain in the number of observations per participant. Furthermore, the controls on the independent variable (i.e., the treatment) are very tight. Finally, you can see the exact results of the difference between conditions—between baseline and treatment, for example.

The study is by Sniezyk and Zane and was published in March in Focus on Autism and Other DevelopmentalDisabilities, Volume 30, Number 1. The occupational therapists conducting the treatments had the freedom to determine what specific behaviors to target and what exact treatments to use. The study used rigorous inter-observer agreement procedures, to ensure the reliability of the data, and they measured the fidelity of the procedures to ensure the children really were receiving the SIT described by their therapists. Quoting the abstract, “The results showed that there was no causal relationship between the sensory procedures and improvements in the targeted dependent variables. Thus, SIT remains an unproven treatment for autism.”

The purpose of this post isn't simply to bash SIT, which is too easy, but rather to encourage the evidence-based treatments for reducing stereotypies. The National Professional Development Center on ASD has an excellent review of evidence-based practices.