A Collaborative Inservice Training Model for Early Development

Providers

February 20, 2004

Mary Pat Moeller, Ph.D. Boys Town National Research Hospital

Presenting Issues

Geographically challenged state affecting access to services

Long-standing history of birth-3 services in public school programs

Limited availability of specialists to work with population of newly-identified D/HH infants

Advances in technology and concomitant need to update expertise

Practice shifts (primary service provider model; services coordination)

Collaborators:

Parent-Infant Team at Boys Town National Research Hospital

Parent-Infant Team at Omaha Hearing School

Part H Program (Co-leads: Dept of Education, Dept of Health & Human Services)

Nebraska Regional Programs for D/HH

Needs Assessment

Surveys and interviews revealed need for:

-update on new technologies-strategies for working with families-family support methods-teamwork within primary service provider model-assessment and IFSP development

Most felt “comfortable” with development and communication

Needs: Post Hoc

Specific auditory development stages and strategies

Shifting from child-focus to relationship-focus Process for determining priorities with

families in communication and audition Process for supporting/guiding families in

decision making Expectations for infants and families

Inservice Program Components

S u m m e r In ten s iveT ra in ing W orksh op

R e g ion a l W o rksh o ps M e nto ring P rog ram

S te erin g Co m m itteeN D E /N D H S S

R e g io na l P ro gra m s fo r D /H HB T N R H /O H S

Laying a Foundation

Why focus on relationships, not child skill development?

Techniques: Lecture & Discussion

Envision “The Potential“

Two hours/week = 2% of total waking hours for a toddler

Diapering, feeding, playing = each happen at least 2000 times before the first birthday

Just 20 everyday activities would equal 40,000 learning opportunities by age one (Dunst, 2001)

Review Research Findings

McBride & Peterson (1997) observed a child-focused dominance in 160 sessions

Too little focus on parent-child relationship Mahoney, et al., (1998) – Interventions

impact child development to the extent that parents are supported and encouraged to engage in responsive interactions with the child

Consider Outcomes Expectations

When identification is late, families have a “short stay” in the birth-3 program

Parents in this situation did not demonstrate independence or confidence in addressing goals

Implications: Parents benefit from “longer stay” in EI

Calderon, Bargones & Sidman, 1998

Consider Parental Expectations

Dromi & Ingber (1999) qualitative analysis of parental expectations for intervention (in Israel)

Independent Decision-makers (N = 7)Well Socialized (N = 13)

Full Collaborators (N=7)Relinquish Responsibility (N = 23)

How do our practices influence perceptions? Does one size fit all?

20 in Partnerships

Avoid Deficit Model

-Attachment patterns of H/HH are similar to H/H

- Deaf and hearing toddlers equally likely to perceive mothers as sensitive & emotionally responsive

-Parents make adaptive & intuitive adjustments

-We should not assume the need to focus on negative aspects of interaction

                                         

Lederberg & Prezbindowski, 2000

Core Values & Beliefs

We are in the home to support care providers in developing competence and confidence in helping the infant learn

Each family is unique & we work to honor this diversity

The family is the expert on the child and the constant in the infant’s life

Families are equal team members

ABC’s of Family-Centered Intervention

Monday: Audition, Babies and Coping with Technology

Tuesday: Assessing Babies A-ZWhat parents want from EI

Wednesday: Signature behaviors for communication and auditionIFSP development

Thursday: Learning and coaching through daily routines

Friday: Cultural competence, partnerships and support for decision making

Beyond Lecture: Skill Building Activities

Hands-on interactive experiences Expectations-shaping experiences Videotape analysis Provision of operating frameworks Prompted practice Group brainstorming application

Skill Building Activities (Cont)

Small groups: family case studies Dialogue with parents/families & strategies

for family support Identifying “tools of trade”

“Hands On“ Interactive Experiences

Small groups rotate to learning stations:

-identify problem with hearing aids/earmolds-identify parts of cochlear implant; -administer six sound test-listen to FM system-problem-oriented role play

Resource library – review unfamiliar curriculum and resources; share with group

Expectations Shaping

“Guess the audiogram” game

Simulations of hearing loss

Longitudinal observations of children

Experienced providers sharing challenges and rewards

Program observations

Videotape Analysis

Developmental examples to support learning of hierarchies and evaluation techniques

Longitudinal examples with discussion

Practice identifying target behaviors with “answer key” and “coach”

Early Communicative Functions (Intentions)

Behavioral RegulationUse communication to get others to do what I want or stop doing something-Request object/action-Protest object/action

Early Communicative Functions (Intentions)

Social Interaction-get adult to look at or notice me for affiliation purposes-request social routine-request comfort-call -greet-show off-request permission

Heehee..

let’s play more

Early Communicative Functions (Intentions)

Joint Attention- “Direct attention to share the focus”- Get the adult to look at or notice- Comment on object/action- Request information (wh? or rising intonation or facial expression)

Look..cool

Wow..check that

out

Provision of Operating Frameworks

Examples: providing a structure for typical progression of a home visit

Providing a model for exploring communication matches

Rubric for a Home Visit

Arlene Stredler-Brown, 2004

Family’s Evolving Goals & Needs

Parent to Parent Contact

Family Resources

Collaborative Problem Solving

Sounding Boards

Profession-al input; Role models

Program

Visits

Evaluation Findings

Community Resources

Content Sources

Family Values & Beliefs

Sources of Input for Decision Making

Prompted Practice

Guided practice with language sample analysis & criterion referenced checklists.

Linking developmental observations to ISFP goals.

Using family assessment tools with a partner: checking for “feel” of the tool.

Being a sounding board…parent expresses “X,” we answer “Y.”

Language Sample

5 Is it the same baby?

Yeah.

6 Yeah. What XX that? XX?

7 What are you doing?

I XX XX XX out baby.

8 Oh, you gonna take the baby out? Ow….hurt

9 What hurt?

Hurt XX baby!

Language Sample

10 Hurt the baby…the baby hurt you? (nods)

11 Are you all right?

Yes.

12

Is that a phone?

Oh! A telephone

Yes!

13 Is that like your phone? Yeah It Laryssa my

phone.

14 Now what? Baby hungry.

Ways to Analyze Samples:

What strengths did you observe? What objective measures can we make?

Complexity (mean length of utterance)39/18 = 2.16

% intelligible 11/17 = 64% Mom’s response types

meaning conveyedturn taking

Language functions Language means

Goals Related to Improving Speech

L will discriminate and say the differences between words that differ in vowel perception and consonant perception

Parents and professionals will monitor L’s discrimination errors and address as needed

L. will increase speech intelligibility (through strengthening of auditory skills)

Parents will provide a variety of forms of feedback to L (parallel talk, expansions, etc.)

Group Brainstorming Application

Karen Rossi “Signature Behaviors” Small groups assigned everyday task like

diapering the baby Determine how each signature behavior

could be targeted in this natural context Both communication and auditory behaviors

targeted

Small Group Case Studies

Teams from same geographic area work together

Experienced providers join each team Each group member brings case study to

workshop, including areas of challenge Workshop content applied to case studies;

Periods of discussion

Dialogue with Families

Parent panel with diverse representation Articles and web sites from parent

perspectives explored

Small group discussion of resources for family support

Brainstorming additional resources

Avoiding Info Overload!

IFSP, EHDI. MDT, dB, LRE, ENT, DSL, AV, BTE, CI, ASL, CS, MCE???…but I’m just a

BABY

Tools of the Trade

Identifying key strategies Taping examples Observe and label Discuss application in own setting

Specialized Knowledge & Skills

Child development Values & culture Potential impact of

hearing loss Communication &

language development

Communication approaches & fluency

Amplification and Listening Devices

Assistive technology Expectations

Stredler-Brown, Gallegos, Moeller & Pittman, 2004

What is Coaching?

Coaching is a mindset for providing intervention and supports

It shifts the service delivery model from expert-driven to learner-focused

Focuses on supporting the people involved with the child across natural environments

Dynamic exchange of information based on learner’s skills and needs

Reciprocal process –series of conversations focused on mutually agreed outcomes

Coaching

Use an interactive process of observation and reflection in which the coach promotes the learner’s ability to support the child in being and doing…

Learner gains confidence and competence to implement strategies to increase the child’s learning opportunities and participation in daily life

Learner knows when the strategies are successful, can modify & can generalize to new situations and needs

Caregivers and interventionists are the “learners”

Coaching Techniques

Active, supporting listening News commentator role – provision of

objective, descriptive feedback

-identifies what both parties are seeing-clarifies what is working-models how observation guides us-helps to pinpoint areas of strength & need

Coaching Techniques

Guided experiments – “I wonder what will happen if we….”

-a process of using discovery to figure out what works…what strategies are a “good fit”-partners “try it out” and evaluate

Coaching Techniques

Model or demonstrate a skill, and test it out together

Jointly discover what is typical (can you show me?…How does that work for you?…You don’t typically…)

Recruit and accept parental interpretations, predictions and advice (you don’t think so…?)

Coaching Techniques

Caregiver in the driver’s seat…may take negotiation about roles

Use of synthesizing statements (summarizing, notetaking, commenting on what we are finding out that is important)

Acting as a sounding board

Regional Workshops

Structured as follow up to summer workshop Based on regional needs assessment Workshop + case management issues Offered in regional sites throughout the state Practical, interactive:

-birth to 5 auditory learning -evaluation techniques-IFSP development

Enhanced understanding of learner needs Ongoing training opportunities essential

Mentoring Program

Planned: Link newer providers

with experienced providers

On-site visits with demonstration & technical support

Video, email and phone contacts throughout the year

Actual: More experienced

providers most willing Brainstorming helpful Email resource helpful Limited access to home

visits Confidentiality issues Requirement?

Outcomes

Successes: All parties gained

insights that strengthened the system

Increased access and capacity in state

System of contacts to support service provision

Improved training strategies

Limitations: Turnover in trained staff

(reassignments) Need for creative

models for implementing mentoring

“Ivory tower” perceptions

Modality-related issues

Summary

Learners profited from:

-Content responsive to needs assessment-Experiential practice -Practical illustration of methods-Clear steps in processes-Learning experiences that shift paradigms & expectations-Follow up tailored to specific needs