Home-School Connection for Embedded Intervention with

Parent Implemented Routines

Juliann Woods, Ph.D. CCC-SLPAssociate Professor

Director of Clinical and Distance Education

Why talk about a home-school connection?

• Education agencies with active parent programs identify improved child outcomes, greater family satisfaction (and better real estate sales.)

• Family centered services are not consistently implemented despite widespread support (Guralnick, 2002).

• Transition is one of the most frequent OSEP compliance citations (USDOE) and identified by families as a major struggle.

• Changing demographics provide constraints to current policies and procedures (Vacca, 2000).

• Society (politics) espouses a more active parental role in education.

What’s embedded intervention?(and why should I care?)

• Easier to say than do… and despite rumors otherwise, it isn’t “just” done

• Child centered philosophy• Data supports use in both individual and group

settings and by professionals and parents• Benefits child by enhancing functionality,

opportunities for practice, and motivation• Decreases need for generalization training• Saves time and energy for caregivers

Why parent implemented 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 identifies 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

So what about routines?

• Routines, activities and events fill the days of children and families

• Routines are integral to home, center, and preschool programs…a context for collaboration

• Family-guided routines: – Match the child and family interests– Promote positive interactions– Embed functional targets into meaningful outcomes– Are flexible and adaptable– Change with the child and family

Components of a routine

• Beginning and ending

• Outcome oriented

• Meaningful

• Predictable

• Sequential and systematic

• Repetitious

Variables that impact family routines

• Family history, culture, and values• Personality or style• The number of people in a household• Environmental arrangements, such as

sharing a bathroom• Logistics, such as work or school

schedules• Physical and mental health• Abilities and disabilities

And how does this all go together?

• Kids spend their day in various routines and activities that are opportunities for learning

• Parents are successful co-interventionists in the teaching and learning process

• More learning opportunities are available through home-school collaborations

• Many routines are repeated in home and school environments

• Others could be to enhance learning for children and involvement for families

First steps in building routines

• Identify preferred activities and routines• Learn about child’s preferences and family

expectations for participation in routines• Discuss frequency, participants, comfort and utility of

routine• Observe careproviders in routine(s) with child• Identify outcomes appropriate for routine• Specify strategies and sequence• Gather feedback and monitor progress

Activities and routines include:

• Caregiving • Play (Indoor and outdoor)• Family recreation and relaxation• Family organizations (e.g. social, spiritual)• Community outings and errands• Housekeeping chores• Appointments (e.g. medical, financial)• Disability related activities• Literacy activities• Family rituals

Strengthening skills in identifying routines • Broaden your definition of routines• Practice thinking out of the IFSP/IEP boxes• Shop for ideas while completing the tasks of your

everyday life• Survey the family for special interests or activities

regularly and using varying formats• Complete an environmental scan of your own

routines and materials to use as suggestions• Complete an environmental scan during a home

visit and ask open-ended questions• Solicit ideas from families… you’ll never run out

of routines!

Beyond the list of typical routines types

• Parents, preferred playmates, caregivers, pets, places

• Physical space, materials, resources• Expectations, rules, rituals• Life style, roles, responsibilities• Language• Frequency of opportunities, events, activities

Making the Most of Every Opportunity

Routines

Getting the mail

Petting the cat

Waiting for snack

Getting a drink

Going down a slide

Playing ball

Turning on music

Outcomes

Washing hands

Using words

Walking stairs

Playing with toys

Following directions

Sitting without support

Reach, grasp, release

Observing Routines

• Observe the routine

• Observe the child

• Observe the careprovider

• Observe the dyad

Choosing Routines for Intervention

• Is it preferred by the child(ren)?• Is it relatively brief? • Does it occur frequently?• Is it predictable?• Does it include interesting materials?• Does it result in a positive outcome?• Does it offer opportunities for interaction?• Can varied skills be included?• How much wait time between turns?• Is there repetition within the routine?• Is caregiver comfortable?

Key Intervention Targets

• Family priorities and concerns

• Disability related priorities

• Environment priorities– placement retention

– future setting

– social

Functional Skills

• Does the child need or use this skill in everyday life? • Does the child need this skill both now and in the

future?• Does someone else currently have to help him

perform this skill?• Will learning this skill enable the child to be more like

“typical” peers?• Will learning this skill enable the child to participate in

the community?

General Goals for PDS-FSU Collaboration

• Pre-service: 4-8 graduate students in SLP will complete a 15 hours per week semester long practicum at Oak Ridge.

• Professional Development: 6 weeks of in-service training will be held for PreK staff; weekly collaborative planning between SLPs and PreK staff, PDS staff present in select courses.

• Action Research: Does collaborative in-classroom consultation increase children’s understanding and use of concepts?

• Performance Measures: Increase students scores on standardized measures and classroom usage; increase caregiver (teacher and parent) use of facilitative strategies.

Vision

Language and communication are key components of educational, social and vocational success. The earlier language skills are enhanced, the greater is the ability to avoid poor educational and social outcomes for students in the Southside community. A team, including educators, family members and speech pathologists, participating in typical everyday activities provides the best context for developing communication and language skills.

Meaningful Differences

Children enter school with “meaningful differences” in vocabulary knowledge (Hart & Risley, 1995).

What doesn’t matter: What does matter:

race/ethnicity, relative economic advantagegender, birth order

© 2000 by Edward J. Kame’enui and Deborah C. Simmons

Emergence of the Problem

Actual differences in Quantity of Words HeardIn a typical hour, the average child would hear:

Welfare: 616 words

Working Class: 1,251 words

Professional: 2,153 words

Actual differences in Quantity of Words HeardIn a typical hour, the average child would hear:Professional: 32 affirmations; 5 prohibitionsWorking Class: 12 affirmations; 7 prohibitionsWelfare: 5 affirmations; 11 prohibitions

Hart., B. & Risley, T.R (1995). Meaningful Differences in the Everyday Experience of Young American Children. Baltimore: Paul H. Brooks.

© 2000 by Edward J. Kame’enui and Deborah C. Simmons

The Vocabulary Gap

• Children who enter with limited vocabulary knowledge grow more discrepant over time from their peers who have rich vocabulary knowledge(Baker, Simmons, & Kame’enu, 1997)

• The number of words students learn varies greatly

© 2000 by Edward J. Kame’enui and Deborah C. Simmons

2 vs. 8 words per day

750 vs. 3000 words per year

Cumulative ExperienceWords heard Words heard Words heard 4 years

per hour in a 100-hour in a 5,200-

week hour week

Welfare 616 62,000 3 million 13 million

Working 1,251 125,000 6 million 26 million

Class

Professional 2,153 215,000 11 million 45 million

© 2000 by Edward J. Kame’enui and Deborah C. Simmons

Hart & Risley, 1995

Language is very difficult to put into words.-Voltaire (1694-1778)

1. Printed school English, as represented by materials in grades 3 to 9, contains 88,533 distinct word families (Nagy & Anderson, 1984).

2. 88,533 word families result in total volume of nearly 500,000 graphically distinct word types, including all proper names. Roughly half of 500,000 words occur once or less in a billion words of text (Nagy & Anderson, 1984).

3. An average student in grades 3 through 12 is likely to learn approximately 3,000 new vocabulary words each year, assuming he or she reads between 500,000 and a million running words of text a school year (Nagy & Anderson, 1984).

© 2000 by Edward J. Kame’enui and Deborah C. Simmons

Family Activities

• Concept calendars

• Digital photos demonstrations

• Newletter and notes

• Message phones

• Inventive incentives

• Morning messages

• Concept stories

“Hard work to break old habits and learn a new skill.”

“The kids loved the marbles in the jar!”

“Point to the tallest teacher.”

“Point to the shortest teacher.”

“Who is on Mrs. Weekly’s right?”

“Who is on Mrs. Weekly’s left?”

“Topic of concepts were appropriate. We needed ya’ll to help us zoom in on concepts.”

“I now have a vision. There are specific concept words I need to target.”

“The kids loved the concepts!”

Staff Comments

“Find the box of colors that is empty.”

“Find the box of colors that has some.”

“Find the box of colors that is full.”

“Who is in the middle?”

Boehm Test of Basic Concepts

• A change of 7.5% from pre- to post-test represents a mean gain of 4 items (52 possible).

• A paired t-test revealed a highly significant difference (t (53) = 7.0, p < .001).

Number of Students Mastering Boehm Concepts

Pre- & Post-Measures on the Learning Accomplishment Profile

Other Home-School Collaborations

• E-pals for 3rd & 4th graders

• Computer assisted homework

• Community pot-luck play groups

• Storybooks and newsletters

• Breakfast book buddies

Triadic Intervention

• Triadic intervention strategies are employed by team members during caregiver-child interactions to promote positive teaching and learning opportunities for the dyad

• Triadic intervention is used to enhance the caregiver’s competence and confidence in parent implemented approach. Caregiver’s embed the child’s IFSP/IEP outcomes during preferred daily routines, activities, and play as they occur throughout the day.

Dyad

Components of Triadic Support HierarchyPIWI Projects, Children’s Research Center, University of Illinois at Urbana-Campaign

Establish Supportive Environment

Enhance Caregiver Competence

Provide InformationFocus Attention

Model

Suggest

Establish Supportive Environment

• Shift body position to increase caregiver capacity • Identify routines, materials, and positions that

enhance interaction• Interpret child’s signals in response to caregiver• Explain or clarify caregiver role in interaction• Provide gestural and verbal cues to caregiver during

routine or play• Identify and explain strategies caregiver uses to

support child• Comment on child’s enjoyment and engagement• Connect child’s and caregiver’s actions

Enhance Caregiver Competence

• Point out child competence• Comment positively on caregiver action- child response• Acknowledge caregiver’s feelings, frustrations• Ask caregiver’s opinions, ideas, feedback• Answer questions• Listen and expand caregiver’s idea or action• Problem-solve with caregiver• Plan ahead collaboratively for future activities,

routines

Provide Information

• Give direct development information• Describe developmental skill while child

demonstrates• Explain impact of disability on child’s skill

development• Interpret child’s adaptation and efforts to learn• Explain connections between past, present, and

future skills• Interpret child’s feelings within developmental context• Reinforce caregivers actions by explaining how it

enhances child learning• Describe child progress within context of play,

routine, or activity

Focus Attention

• Comment positively on aspect of action or response• Provide material or activity to demonstrate child’s

competence• Ask caregiver for information or interpretation of

child’s activity• Talk for caregiver to child and child to caregiver on

skill or action as it occurs• Connect child action to previous level of development• Comment through the child in response to caregiver• Parallel talk regarding child or caregiver

action/feeling/emotion• Interpret child’s cues or signals for caregiver

Model

• Use developmentally appropriate actions or materials• Verbally model caregiver role • Illustrate facilitation strategies:

– Environmental arrangements

– Responsive interventions

– Focused stimulation– Milieu teaching– Response prompting

• Describe strategy, purpose, value• Illustrate strategy within a different context

Suggest

• Invite caregiver to join interaction• Observe caregiver use of strategy and offer

enhancements or adaptations• Suggest action or strategy directly, indirectly, or by

talking through the child• Identify and explain features of the suggestion or

strategy• Directly demonstrate action for caregiver• Repeat demonstrations as needed• Solicit caregiver input on suggestion or strategy• Problem solve best use of suggestion or strategy

Increasing caregiver competence in parent implemented interventions

• Initial discussion with handouts• Video of another parent using strategy in a

caregiving or play routine with discussion• 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

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)

Systemizing caregiver interventions

• Identify opportunities to practice each outcome clearly… “more” isn’t better

• Carefully plan who will be involved, when, and where it will occur

• Provide caregivers time to practice and problem solve “what might happen if…”

• Use natural cues with the routine• Establish system for monitoring

progress

ARCS Model

•A Attention

•R Relevance

•C Confidence

•S Satisfaction

John Keller, Ph.D. Florida State University, Instructional Design Dept.

Why ARCS?

For Caregivers• Motivation occurs with

optional amounts of attention, relevance, confidence and satisfaction

• Too much or too little of any component affects team relationships and intervention outcomes

For Team Members• Enhances

understanding of the caregiver’s role in the dyad

• Helps plan “scaffolds” for the caregiver

• Provides framework for team interactions and use of adult learning

Using the ARCS Model

• Establish a Strong Human Connection– Connections create confidence, more attention,

and trust that the intervention will be relevant– Connections help you identify routines and

activities that increase relevance and satisfaction– Connections enhance ability to assure cultural,

economic, religious sensitivity, learning style– Increases opportunities to share information and

problem solve that promotes confidence

ARCS continued

• Create a Safe Environment– Safety engenders confidence by lowering

fears of failure, embarrassment– It encourages “risk taking” and attention;

e.g. “upping the ante” within a safety net– Home visit routines provides predictability

with planned novelty– Providing specific, honest, liberal feedback

in context encourages confidence, relevance

ARCS continued

• Develop Metacognitive Awareness– Provide information and focus attention to make

connections for adult between child, environment, and outcomes

– “Scaffold” for adults to understand and be able to explain “why”

– Model, provide repetition, provide more repetition with variation

– Increase independent problem solving– Check in, clarify, monitor progress, plan next steps

Kathy24, bright, married, enthusiastic A- Sometimes too alert- need to slow her down, believes more is betterR- A little too relevant. She starts too many things and expects too muchC- Optimal. She believes in herself and her son’s abilityS- A little too low. She wants to be where she’s going faster

R

CA

S

GloriaFoster parent. Kind-hearted, slower to learnA- A little low - Usually tiredR- A little low. EI takes a little time for her to understand outcomesC- Low. She is frustrated in her abilityS- Low. She’d like him to be learning faster

R

C

A

S

SamanthaAge 31, two children under 3, part time job, single parentA-Tiredness lowers attention, although she wants to learnR-OptimalC-Low, especially in ability to play with sonS-low. She is discouraged because she wants son to walk and doesn’t see it soon

R

S

AC

What is a Primary Service Provider Model (PSPM) of Service Delivery?

• A team approach• Recognizes the unique needs of rapidly

developing infants-toddlers and their family• Establishes the identification of a primary

provider – Based on the priority outcomes for the child and family– Serves as the team leader with the family, service

coordinator, and other identified providers– Delivers services to meet priority outcomes with the child

and family– Consults with other providers on the IFSP to assure

continuity and consistency of services

Primary Service Provider Model

We need answers for the questions to implement for each child and family:– Who? (Identifying the primary and care providers)– Will do what? (Establishing priority outcomes) – When? (Identifying routines, sequence,

frequency)– Where? (Choosing contexts and locations)– How? (Delineating procedures and plans for

teaching, learning and problem solving)– Until what outcome is achieved? (Evaluating

progress, need for revisions, changes in provider)

PSPM is not TD dejevu

• TD– plan for the team with 1

provider translates and implements the family

– Established team meetings for updates

– May be child-directed & hands-on or consultative

– Primarily single agency personnel

• PNP– 1 primary provider with

options for others concurrently and/or sequentially

– Fluid communication between service & care providers

– Consultation-coaching model

– Accommodates multiple agency involvement

PSP can:

• Welcome the family to the program and process of early intervention

• Enhance relationships between provider and family

• Increase confidence and competence for care providers

• Provide the discipline expertise at the right time for the child and family

• Assure continuity and consistency in instruction and service delivery

PSP does not:

• Save program time or money• Eliminate the need for disciplines• Break the federal law• Eliminate family choice• Jeopardize licensure for therapists• Turn family members into therapists

PSP: Problems and Solutions

• Funding for collaboration and coaching• Co-treatment policies• Communication formats and frequency• Keeping up with necessary paperwork• Development of “team” culture across

individuals and agencies

Strategies for Ongoing Communication among Providers

• Engage the family as liaison • Develop common formats and share progress

notes at center or family• Use Email, voice mail, fastfax• Schedule periodic co-treatment or

assessment updates• Review video tapes or use videoconferencing• Attend joint training, coaching, consulting• Require communication in provider contracts