I am reposting this blog entry, from July 21, 2019, because formatting of the example matrix was all messed up.
The Routines-Based Interview (RBI) is
arguably the best known component of the Routines-Based Model (RBM). It is the
method we use for assessing child and family needs and the structure for
helping families decide on goals. It is, however, only one part of the RBM. In
addition to the functional and family goals produced by the RBI, we need to
follow this up with effective practices so those goals are actually addressed.
In this post, I’ll describe how the RBI
sets the stage for meaningful visits to caregivers, such as parents, teachers,
and others caring for the child for substantial amounts of time. The RBI was
never designed to be a stand-alone “family assessment.” It was always designed
to be the beginning of an approach to
working with families, children, and teachers (McWilliam, 1992).
Before the actual RBI begins, the
interviewer develops the family’s ecomap by asking the family who lives in the
home, about their informal, intermediate, and formal supports. The RBI itself is
a semi-structured interview with one or more of the child’s primary caregivers.
The interviewer asks the caregiver detailed questions about the child’s
engagement, independence, and social relationships and the doings of everyone
in the home. During these discussions of everyday life in the family, families
often talk about matters other than the child’s functioning, such as about their
own lives. We ask families also about whether they have enough time for
themselves, about their main worries, and about anything they would like to
change. At the end of the interview, families consider the whole conversation
and choose 10-12 goals for their child and other family members, including the
adults.
The hinge between this family-centered
process to obtain goals and what happens after the RBI is the Routines-Goals
Matrix. The matrix, shown below, can be completed whenever the RBI is done
because, during goal decision making (at the end of the interview), the
interviewer ascertains for what routines each skill the family chooses is
needed. I developed this matrix from the list of informal goals developed
during goal decision making. They are listed in the order of importance to the
family (i.e., “prioritizing”).
Family goals don’t have routines assigned
to them—hence the rows with no Xs. On the first visit after the RBI, the person
providing support (i.e., services) to Shamika would ask a couple of questions
to see what she might want to talk about. If she had no pressing matters, the
professional would show Shamika the matrix and ask her to look at the
goals/outcomes. The professional would ask her what she would like to discuss
on this visit. If Shamika chose the first priority, acknowledge people when they greet Jamal, the professional and she
would begin the solution-finding process.
This practice is covered in our
Routines-Based Home Visit Checklist. When Shamika chooses a child goal/outcome like
this, the professional would ask at what time of the day. The matrix shows this
goal was needed for waking up, hanging out, and outside. If Shamika said it was
important at hanging out time, she and the professional would start on strategy
development, which is the same as solution finding, for teaching Jamaal to acknowledge
people when they greet him during hanging out time.
The matrix therefore (a)
shows the caregiver the list of goals/outcomes they chose and (b) reminds the
partners of the contexts for the skill—why it’s needed.
Let’s say Shamika and her home visitor
discuss a strategy (AKA solution or intervention) for her to use to address
Jamaal’s acknowledging people when they greet him during hanging out time, and
she decides the strategy is likely to work and is feasible for her to carry
out. So, it’s time to move on to another topic. The home visitor can ask the
horizontal question (look at the matrix!), “Would you like to talk about
Jamaal’s acknowledging other people at
other times of the day, such as waking up
time or outside time or would you
like to talk about other skills you’d like to see during hanging ou timet, such as Jamaal’s using one word or sign, playing with toy for 5 minutes, walking without
assistance, playing without throwing toys, or pointing to pictures?” This question allows for a smooth
transition to another goal or routine the family
has identified as a priority.
Here, I have used a home visit as an
example, but you can see how a similar approach would work with a child care
provider or preschool teacher. The routines would be classroom routines, and
the early interventionist would ask the teacher what skill he or she wanted to
work on and proceed accordingly.
The RBI (a) arrives at truly meaningful
functioning the parent wants for their child, (b) identifies the contexts
(i.e., routines) for that functioning, and (c) reveals family needs that
directly or indirectly have an impact on child functioning. The matrix captures
all that information, which helps the early interventionist and the caregiver
focus on skills and contexts.
We’ve always known the RBI is only the
beginning. Now, I hope you’ll see how it leads to meaningful supports to
caregivers… and improved functioning in children.
McWilliam, R. A. (1992). Family-centered intervention planning: A
routines-based approach. Tucson, AZ: Communication Skill Builders.
