the vision for enhancing the capacity of families in natural environments
Post on 25-Dec-2015
215 Views
Preview:
TRANSCRIPT
The Vision for Enhancing the Capacity of Families in Natural Environments
http://tactics.fsu.edu
Why are we here today?
Genuine commitment to high quality EI services
Frustration with current level of implementation
Curiosity about what and how others are doing
Interest in continuous improvement Recognition of importance of
administrative and supervisory support
Project EPIC Collaboration between KU and local EIP Questions included:
Level of implementation for high poverty families Barriers and facilitators to success Applicability of FGRBI in inner city
Results included: Fewer services were received consistently;
cancellations by providers equaled families EI was provider directed and not routines based Families liked the concept of RBI (but didn’t have
many opportunities) Providers concern about family participation was #1
barrier; Administrative support was #2 barrier
Objectives for This Morning
Describe and define various family centered approaches used in natural environments
Identify observable provider behaviors and key program indicators to assist in program development and staff supervision
Review the barriers to full implementation and share solutions
Top 10 List: Why is this so hard?
10. Intrinsic vs. Extrinsic Reinforcement 9. “Public” Practice – Visibility of Providers 8. Change 7. Knowing How and Believing it Should 6. Self Reflection and Evaluation 5. Collaboration 4. “Thinking” Creatively 3. Balance of Complex Interactions 2. Time 1. Diversity of Family Values and Expectations
Big Problem #1
Knowing what “it” is… Family Centered Services, Natural
Environments
Believing “it” is effective…Evidence, Attitudes
What are Family Centered Services?
Embraces the unique and lasting relationship between family members
Recognizes the family and their life as the context for assessment and intervention
Respects and adapts to the multiple and diverse responsibilities and roles of families
Provides adequate information and support for the family to make informed decisions and respect for their choices
Offers information and opportunities for participation in a timely, sensitive and individualized format
Recognizes importance of relationships between family and team as partners in the teaching and learning process
Why Talk About Family Centered Services?
EI with active parent programs identify improved child outcomes, greater family satisfaction (Brooks-Gunn 2002).
Family centered services are not consistently implemented despite support (Guralnick, 2002).
Day to day actualization of family centered practices is a major OSEP compliance citation (USDOE) and identified by program directors as a major struggle (Hughes, 2003).
Changing demographics provide constraints to current policies and procedures (Vacca, 2000).
Society (politics) espouses a more active parental role in education.
What is Early Intervention in Natural Environments?
More than moving to a new location and continuing toy bag or clinic practices
Easier to say than do… and despite rumors otherwise, it isn’t “just” done
Integrates child and family centered philosophies
Data supports use in both individual and group settings and by parents and paid caregivers
Examples include: JARs, ABI, ELO, FG-RBI, NLO Benefits child by enhancing functionality,
opportunities for practice, and motivation Decreases need for generalization training Saves time and energy for caregivers
Why Parent Mediated Interventions?
Natural environments legislation increases emphasis on parent participation.
Evidence supports success of parent implemented interventions.
Parents learn multiple strategies for varying goals with diverse children in a variety of cost-effective models.
Outcomes identified for children are positively impacted by parent implemented interventions.
Parents are satisfied with their participation.
More specifically… Multiple strategies
“Packages” of development and behavioral methods (EMT, Hanen)
ABA (prompts, cues, reinforcement) Sequences of facilitative interactions
Diverse children Communication and language delay Down syndrome and other DD Autism and “Challenging Behavior”
Cost-effective methods Group classes Modeling and instruction Video demonstrations and feedback Home-based problem solving
Child outcomes included…
Increased understanding and use of gestures, picture symbols, words and word combinations
Decreased use of maladaptive behaviors and increased use of communication replacement behaviors
Direction following Toilet training and other adaptive skills Self-feeding, increase in food intake Social interactions with siblings, peers
How Do NE Models Differ?
Context for instruction Everyday experiences, events and routines Therapy or planned special instruction
Activity type Child preferred & directed Adult planned & directed Blended
Delivery of instruction Natural learning opportunities Adult directed Parent mediated
Child CharacteristicsPersonal Values, PreferencesFamily Characteristics and
StructureGeography, CommunityResourcesSupportsCosts (Personal, Time, Money)
InputsRoutines, Activities, Events,
Settings, Interactions
Outputs
Child Choice, Participation
Child CompetenceChild Quality of LifeFamily Well-BeingFamily SatisfactionFamily Quality of LifePsychological Costs
Interventions(Adapted from Dunst, 1999)
Child CharacteristicsPersonal Values, PreferencesFamily Characteristics and
StructureGeography, CommunityResourcesSupportsCosts (Personal, Time, Money)
(Adapted from Dunst, 1999)
InputsRoutines, Activities, Events,
Settings, Interactions
Make or Break Practices for Family Centered Services
Gathering and Giving – Reciprocal Information and Resource Sharing Process Explain why information is meaningful in everyday life Provide examples and developmental knowledge
Observing and Modeling – Individualized Interactions Watch what, how, & when parent interacts Show what strategies or behaviors are needed
Problem Solving and Decision Making - Supportive & Respectful Relationships Present alternatives for caregiver participation Integrate learning strategies for adults in process
Initial Contacts Establish partnership process
Everyone is an expert… and everyone is a learner
Initiate capability -vs- disability point of view Communicative competence as basis for
intervention Set the stage for proactive caregiver
participation Prepare caregivers for process; seek input for
plan Offer examples, opportunities, alternatives:
Assessment is a novel and frightening experience
Identifying Routines and Activities for Observation during Assessment
Discuss child and family preferred routines and activities prior to assessment visit
Suggest alternatives to the family to assist in their choice making
Survey the family for special interests or activities that will enhance their comfort in participation
Identify routines and materials that enable easy completion of assessment measure(s) identified for use by the team
Roles for the Family
More than a continuum of options for participation (Crais et al)
Multi-faceted and dynamic participation throughout the relationship (Woods & McCormick) Guide Team member Decision maker Contributor Observer and validator Problem solver Teacher
Observing routines Routine
Sequence Repetition Joint attention Positive, motivating
Child Anticipate Attend Initiate Respond Imitate Independently
participate
Careprovider Expect participation Respond, expand Use objects Read child’s cues Use intervention
strategies Encourage
Dyad Position, proximity Mutual attention Turn taking Positive affect Cues, repairs
Giving Information Remember the capability and proactive
participation planning Share strengths… “JP loves his snacks so that’s a great
opportunity for communication… using gestures and vocalizations. You’re right…he doesn’t have words, but there are many ways…”
Avoid all jargon Be concrete and give practical examples
that relate to family You told me you like to go to the playground…
Use a variety of adult learning strategies Visuals
Plan of ActionFamily’s Priority: Communicate using words everybody understands.
Specific Outcome: JP will use 5 new words (supported with gestures where needed) to gain attention and answer questions.
STRATEGIES WHO WHERE At music, computer and play time, encourage JP to imitate sounds, noises, words, and motor actions.
Ms. MaryMom & Kelly will share songs& computer time
Home and Childcare
While playing outside JP will be asked to choose between bikes, ball, and favorite sand toys.
Dad, Ms. Mary, Friends, Derek, Anne
Home and Childcare
Plan of ActionFamily’s Priority: Communicate using words everybody understands.
Specific Outcome: JP will use 5 new words (supported with gestures where needed) to gain attention and answer questions.
STRATEGIES WHO WHERE During activities in the community such as Church, softball, or errands, JP will name family, friends, and common objects with models
Dad, Mom, Kelly, Jennifer, Josh, Derek, friends
Community
activities, car, church
During caretaking routines (bathtime, meals, dressing, potty) JP will label choices when asked
Mom Home
Big Problem #3
Embracing the family’s perspectiveValues, Lifestyle, Roles, Responsibilities,
Believing families want to and can…
Scaffolding for Careproviders
Occurs within collaborative environment with acceptance of and respect for each other’s values, skills, and knowledge
Begins with skills/strategies the partner exhibits Relationship provides support for new ideas and skills
to develop and security for risk taking to occur Working within each other’s “zones of proximal
development” increases use of knowledge within practice
Use of adult learning strategies and systematic instruction enhances learning success for caregiver and professional
Adult Learners
Comfortable Environment
Respect for Values and Priorities
Effective Communication
History and Experiences
Contributions and Participation
Collaboration and Problem Solving
Applicability to Life and Functionality
Competing Commitments
For Learning to Occur For Learning to Occur EfficientlyEfficiently::
Child must engage with the environment
Child and caregiver must interact contingently with each other
Caregiver must mediate the physical and social environment for the child, thus linking the child’s engagement to the environment
Components of Triadic Support Hierarchy
PIWI Projects, Children’s Research Center, University of Illinois at Urbana-Campaign
Establish Supportive Environment
Enhance Caregiver Competence
Provide InformationFocus Attention
Model
Suggest
Questions to Enhance Problem Solving in Family Centered Services
What is the problem? Who is affected? How? What is the impact? What could happen if it is ignored? What could happen if it is addressed?
What are the facts? What is believed? When, where, how and who should join
in the problem solving process?
Problem Solving … continued
What has been tried? What worked? What didn’t? Any ideas why?
What other ideas should be considered? What should be tried first? What is an
alternate plan? Are resources available? Who will do what? When? How? How will we know if it works?
Increasing caregiver competence with strategies
Initial discussion with handouts Video of another parent using strategy in
a caregiving or play routine Discussion about pros and cons of the
strategy Practice together Video taping of caregiver using strategy
with opportunity to watch and critique Problem solving with data collected
weekly
Key learning strategies identified by caregivers
Problem solving weekly with clinician Initial video of other parent using
strategyDiscussion of pros and cons to make a
good match between strategy, outcome, routine and child interest
Time to talk about the data
What research says doesn’t work for generalization
Modeling (McBride & Peterson)Handouts (Fox & Dunlap)Group training without feedback
and follow-up (Strain et al)Facility based service delivery
(NAS report)
Our Data
Child change occurs at rate greater than anticipated from maturation
Family satisfaction is very highParents learn strategies within daily
routines and playParents report improved confidence
in ability to parent child with special needs
So what’s special about the model?
Systematic instruction increased acquisition rate of embedding by caregivers
Family members generalized strategy use across routine types and into community settings
Parents initiated identification of routines for intervention through problem solving with providers
Data collection by families was integral
Why is this so hard?National Perspectives on
Implementation of Natural Environments
DEC International ConferenceSan Diego – 12/6/2002
Panel
Judy Carta – Juniper Gardens Children’s Projects, KU- Kansas City
David Lindeman – University Center of Excellence, KU - Parsons
Christine Salisbury- Child and Family Development Center, University of Illinois-Chicago
Juliann Woods- Florida State University, Tallahassee
Inservice Personnel Preparation:
Problems and Solutions Problem: Moving from knowledge to
consistent implementation Solutions:
Develop “FC-NE” culture across team members and agencies supported by administrative policies
Provide time and funding for collaboration and coaching within team including FSC
Develop friendly communication formats and require it among team members including family
Infuse “FC-NE” into every agenda and initiative
Preservice Personnel Preparation:
Problems and Solutions Problem: Quality practicum opportunities
in NE with skilled EI Solutions:
Become a community provider on the matrix for families to choose – authentic training including the policies and paperwork
Use a consistent model with guidelines, systematic instruction, student expectations, video feedback, fidelity checklists
Establish relationships and help build programs through continuing ed., grant opportunities and $$ incentives
Grow your own – hire them – expect them to develop program further
Connect with the State agency Establish Department policies on FC-NE placements
Examples of Solutions…
Administrator identified NE as priority for hiring personnel and subsequent evaluations
Regional team defined PSPM for their region through stakeholder meetings… before the state did it for them!!
Team of SLPs are defining process for decision making on services for kids with ASD in NE using logic syntax as a part of their district performance standards
TA consultants infuse NE into every initiative, e.g. early literacy in NE – not another new state initiative… just expansion
Barriers Still Exist…
Payment disincentives for non-NE services Legislation aimed at accountability that
requires “time” in services- not quality Confusion between co-treatment,
consulting, coaching for re-imbursement Limited information and resources for
families on what NE is and isn’t and their roles….
Limited involvement in DEC
Inservice Personnel Preparation:
Problems and Solutions Problem: Moving from knowledge to
consistent implementation Solutions:
Develop “FC-NE” culture across team members and agencies supported by administrative policies
Provide time and funding for collaboration and coaching within team including FSC
Develop friendly communication formats and require it among team members including family
Infuse “FC-NE” into every agenda and initiative
Preservice Personnel Preparation:
Problems and Solutions Problem: Quality practicum opportunities
in NE with skilled EI Solutions:
Become a community provider on the matrix for families to choose – authentic training including the policies and paperwork
Use a consistent model with guidelines, systematic instruction, student expectations, video feedback, fidelity checklists
Establish relationships and help build programs through continuing ed., grant opportunities and $$ incentives
Grow your own – hire them – expect them to develop program further
Connect with the State agency Establish Department policies on FC-NE placements
Examples of Solutions…
Administrator identified NE as priority for hiring personnel and subsequent evaluations
Regional team defined PSPM for their region through stakeholder meetings… before the state did it for them!!
Team of SLPs are defining process for decision making on services for kids with ASD in NE using logic syntax as a part of their district performance standards
TA consultants infuse NE into every initiative, e.g. early literacy in NE – not another new state initiative… just expansion
Barriers Still Exist…
Payment disincentives for non-NE services Legislation aimed at accountability that
requires “time” in services- not quality Confusion between co-treatment,
consulting, coaching for re-imbursement Limited information and resources for
families on what NE is and isn’t and their roles….
Limited involvement in DEC
top related