Early Intervention Program NYC DoHMH Families As Partners: Part 1 of 2.

Early Intervention ProgramNYC DoHMH

Families As Partners: Part 1 of 2

Early Intervention Program

EARLY INTERVENTION PROGRAM David Rosin, MD, Executive Deputy Commissioner

for Mental Hygiene Janice Chisholm, Acting Assistant Commissioner, EI Jeanne Clancy, Ph.D. Director, Families as Partners

Project Prashil Govind, M.D. Medical Director, EI Linda Stone, Ph.D., Director of EI Programs Judith Davison, Director of Training Barbara Burns, Ph.D. NYCEIP Consultant

Goals of Families as Partners Training

Educate Inform Inspire

Learning Objectives For Training the Trainer: Families as Partners (FAP)

1. Be able to explain to your staff the scientific basis for family involvement in Early Intervention

2. Understand new procedures and FAP forms 3. Learn tools, activities, references to train your

staff on FAP4. Learn about EI’s continued assessment of FAP

for quality improvement and better outcomes for children and families

EffectiveEarly

Intervention Child, Parent,

Interventionist

FAP Forms

Family Involvement

Assessment of Effectiveness

Train the Trainer in FAP

Part 1. Section 1: Why family involvement is critical to EI services Section 2: Families As Partners: Rationale, Principles, Forms Section 3: FAP: Co-Visits, Provider and Parent Progress

Notes

Part 2. Section 1: FAP Principles and natural routines of families Section 2: IFSP: Gateway to manageable family involvement Section 3: Coaching parents effectively Section 4: Evaluation of FAP and Effective Early Intervention

Why family involvement inEI services is critical

Part 1, Section 1

Brain development

Brain and early development

At birth, infants have about 100 billion brain cells and 50 trillion connections

By 3 months of age, the connections multiple to more than 1000 trillion

At 3 years, child has twice as many connections as adult

Connections not used disappear …

Understanding brain development

Advances in imaging technology have allowed new understanding of brain development

EEG (Electroencephalograph)

EEG--early way to measure electric signals produced by brain—can show how long it takes the brain to process certain information (though can’t tell where in the brain it is happening)

CAT scan (Computerized Axial Tomography)

Two-dimensional x-ray Can detect damage in brain and show changes in

flow of cerebral blood while person completes a task

PET scans (Positron Emission Tomography)

After injecting radioactive glucose the PET scan can show what is absorbed by brain cells. More active areas absorb more glucose. Allows assessment of structures deep in the brain.

MRI (Magnetic Resonance Imaging)

Using a gigantic magnet the protons (nuclei of hydrogen atoms) of an organism align with the magnet polarity.

Can image soft tissue (they contain more water)

MEG (Magnetoencephalography)

New technology which assesses magnetic fields due to brain activity. Magnetic detection coils in liquid helium are placed over a person’s head.

Highly accurate assessment of nerve cell activity

What do we know about early brain development?

Specific toxins (e.g., alcohol) negatively affect brain development

Prematurity is associated with differences in brain structures

Deprivation of stimulation impacts developing brain

Child abuse anddifferences in brain

Maltreated children have typically smaller brains than healthy children (biological reaction to intense stress)

Maltreated children often exhibit depression, learning problems, anxiety in childhood, and other problems…

Brain is sensitive to experience

“Experience can change the mature brain---but experience during the critical periods of early childhood organizes brain development” (Perry, et al., page 290)

Perry, B.D., et al., 1995 Childhood trauma, the neurobiology of adaptation and “use-dependent” development of the brain: How ‘states’ become ‘traits’. Infant Mental Health Journal, 16, 271-92.

Parent-child interactions impact brain functioning and development

Mothers with depression Typical behaviors: disengaged,

little interest in pleasure and/or

irritable and overintrusive P-C interactions: mother mirrors

infant’s negative emotions &

infant mirrors mom (Dawson, Frey, Self et al., 1999; Field, 1998)

Mom’s depression impacts infant’s neurological system

EEG patterns of 1 month old infants Reduced left frontal lobe activity compared to

right frontal lobe activity (left = joy, interest, anger and right = sadness, anxiety, distress)

By 32 months, reduced left frontal lobe activity in infants appears permanent

Even with animated, joyful caregiver!

Model of Parent-Child Interactions

Parent

ChildBirth

complications

Anxioushandling

Poor Self regulation

Disengage-ment

Poor lang, Soc. skills

(Sameroff, 2000)

Model of Parent-Child Interactions

Parent

ChildBetter lang, Soc. skills

Birthcomplications

Confidenthandling

Better Self regulation

High engage-ment

Developmental delays and stress

Children with developmental delays or children who are at risk for developmental delays (due to low birth weight, Down syndrome, etc.) often have multiple stressors (e.g., difficulties in sensory integration, frustration, delays in communication abilities, self regulation problems in temperament, feeding etc.)

Stressors may impact brain systems and brain circuitry (Porges, 1996)

Brain structures are malleable and affected by stress hormones

Hippocampus - brain structure important for learning and memory

Amygdala - mediates physiology and behavior and reaction to fear, emotions

Prefrontal cortex - important for learning, memory, executive function

Brain structures are malleable and impacted by stress hormones

Hippocampus - brain structure important for learning and memory

STRESS atrophy and memory impairments

Amygdala - mediates physiology and behavior, reaction to fear, very strong emotions

Prefrontal cortex - important for learning, memory,

executive function


Hippocampus - brain structure important for learning and memory STRESS atrophy and memory impairments


STRESS growth responses and anxiety/aggression



Hippocampus - brain structure important for learning and memory STRESS atrophy and memory impairments


STRESS growth responses and anxiety/aggression


STRESS atrophy and memory impairments

Stress impact brain systems and brain circuitry

Stress release of neurotransmitters (monoamines, amino acids, neuropeptides) and hormones (cortisol, ACTH)

Stress impacts connections between thalamus and amygdala and HPA axis and diminishes ability to calm down, focus, etc.

Chronic stress associated with learning problems and deficits in emotion regulation

Advances in molecular biology and understanding brain development

Path from fertilized egg to newborn to developing infant and toddler:

Not rigidly determined by genetic program

Dramatically influenced by experiences

Early experiences can change the neural connections in the developing brain.

Early experiences can alter how genes are expressed in the developing brain.

New York Academy of Sciences2006 Conference: Resilience in Children

Parenting behaviors impact sensory, perceptual and emotional systems in developing organism INDEPENDENT

from genes (Meaney et al., 2000, 2002)

Biology impacts parental behaviors Hormones involved (oxytocin, estrogen, prolactin) 9 genes isolated

Feb 26-28, 2006 Washington, DC

Parent-child interactions can buffer stress in infants/toddlers

Brain development and parent-child interactions

Parent-child interactions impact brain development

Parent-child interactions can impact how genes are expressed

Responsive parent-child interactions promote accelerated development of sensory, perceptual cognitive and emotional systems

Research has shown that: Parent-child interactions characterized by

responsivity are associated with higher levels of sensory, perceptual, cognitive, emotional development

Responsive parenting: Secure attachments Improved self-regulation

Advances in molecular biology have implications for early interventions for children with

developmental delays

Healthy brain development is supported by:

Interaction with caring people Touch Consistent responsive

relationships Positive affect Healthy environments

Sensory and social experiences are changed

Stress is reduced by parent education & support

Brain development is positively impacted by support of responsive parent-child interactions

Early intervention services are effective because:

Parent-child interactions are central to effective early intervention services

EI services can: Provide optimal stimulation Support healthy development of brain Wire the brain for learning Promote attachment processes

NYC EI Program aims to harness the power of family-child interactions

Traditional role of the interventionist (Guralnick,1997)

Traditional direct services One-on-one structured services in therapy

room Not in natural environment Parents not typically involved in session Time-limited and time-specific

Family participation in early intervention services improves child and family outcomes (Guralinick, 1997, 2005)

Consistent benefits of family involvement for early intervention:

“Without family involvement, intervention is likely to be unsuccessful, and what few effects are achieved are likely to disappear once the intervention is discontinues” (Bronfenbrenner, 1974)

Handbook of Effective Early Intervention (Guralinick, 1997)

“The most effective programs are those where parents are closely involved…” (Comptroller General, 1979)

“Interventions adapted to a particular child and family which include the family are most likely to benefit the child” (Landy, 2006)

“Parents act in synergy with many influences, most notably, the child’s biologically based characteristics but also… the family, preschool, child care center, school, neighborhood, community and larger culture.” (p. 247) Berger, 2001, Awakening Children’s Minds: How

Parents And Teachers Can Make A Difference, Oxford Univ. Press

Children are most influenced by factors that impact interactions in daily life

Family

Neighborhood

Child-parent interactions

Society, Culture

Bronfenbrenner, 1974

Developmental Systems Model(Guralnick, 2000; 2005)

CHILD CHARACTERISTICS & STRESSORS

FAMILY PATTERNS OF INTERACTION

CHILDDEVELOPMENT

OUTCOMES

Quality of Transactions

Child Experiences

Health and Safety

Individual Differences

of Child

Families AsPartners:

Message 1: The

human brain

changes

with experience.


Message 2: Parent-

child interactions

are a powerful

component

of early intervention.

EffectiveEarly


Interventionist FAP

Forms

Family Involvement


Families As Partners in EI

Part 1, Section 2

Families As Partners – the Early Intervention Program

Rationale and principles

Keys elements that support family involvement

Forms: IFSP, Session Notes, Calendar or other Communication Tool, Progress Note-Provider, Progress Note-Parent

NYC Department of Health and Mental Hygiene’s Early Intervention Program

Services provided to 35,000 children Queens, Brooklyn, Bronx, Manhattan,

Staten Island Approximately 130 providers > 400 million dollar/year budget Children referred by pediatricians, parents,

Early Head Start programs, etc.

Services in Early Intervention Program

special instruction speech pathology and audiology occupational therapy physical therapy psychological services nursing services nutrition services social work services vision services assistive technology devices family education and counseling, home visits, parent support groups family training service coordination

Families As Partners: Goals Increase family/caregiver involvement

in EI services Incorporate EI services into the

natural routines of the child and family

FAP is designed to ensure that families receive education and training to support their child’s development EI

Family

Child

Families As Partners

Goals of Families as Partners

Improve developmental outcomes for children

Increase family skill and confidence in supporting child development

Early Intervention is focused on the ‘child in the context of the family’

We now know that doing a session just with a child is simply not enough!!

Early Intervention is designed to include the family so they can continue practicing skills with the child between sessions

Families As Partners is a system designed to empower families – ALL families

Families As Partners: Principles

When families learn to use natural routines as learning opportunities, they can continue helping their child between sessions with the EI interventionist

When families use natural routines as learning opportunities, they can continue helping their child after families leave EI

Family characteristics at entry to Early Intervention services:

43% in poverty 16% in single parent household; 63%

with biological father; 20% with another child with special needs

7% foster care 38% have > 3 environmental risks

Based on NEILS (2004) representative sample

Family characteristics at entry to Early Intervention services:

43% in poverty 16% in single parent household; 63%

with biological father; 20% with another child with special needs

7% foster care 38% have > 3 environmental risks

Based on NEILS (2004) representative sample

These factors can provide challenges to healthy

family interactions!

FAP principles support healthy child development and positive family-child relationships

Keys to the FamiliesAs Partners system

1. Clear messages to parents (and pediatricians) about family involvement and effective early intervention

2. Forms designed to support family involvement3. Individualized service plans for manageable family

involvement4. Ongoing training for EI staff and providers5. Continued quality improvement by monitoring

service fidelity and treatment effectiveness

Keys to Improving Services through Family Involvement


2. Forms designed to support family involvement3. Individualized service plans for manageable family

involvement 4. Extensive training for EI staff and NYC providers5. Monitoring and accountability of service fidelity and

treatment effectiveness

Message 1: Family involvement in EI can enhance child development

Message 2: In EI, families will be coached to learn

new ways to help their child’s development

Natural Routines: Interventionists will help the family use their everyday activities to help improve their child’s skills

Message 3: These activities are NOT home work but simply part of the every day experience that families have.

Message 4: Frequent and continued family involvement will enhance EI services for your child

Messages to families

Service coordinator Brochures Letter to families Outreach to pediatricians Outreach to child care programs including

Early Head Start



2. Forms designed to support family involvement3. Individualized plans for manageable family

involvement 4. Extensive training for EI staff and Providers5. Monitoring and accountability of service fidelity

and treatment effectiveness



2. Forms designed to support family involvement3. Individualized service plans for manageable

family involvement 4. Extensive training for EI staff and Providers5. Monitoring and accountability of service fidelity


Keys to Families As Partners

Forms are designed to support family involvement

At initial IFSP meeting During services with child and families Between services to child and families At 3 month intervals to assess progress

on outcomes


Forms are designed to support family involvement--OVERVIEW

At IFSP meeting IFSP paperwork has changed (see Part 2 of

training)

Individualized Family ServicePlan Meeting

TWO VERY IMPORTANT POINTS

(1) IFSP contract is for services with family involvement

(2) How family can be involved (time schedules, language issues,family limitations, etc.) must be identified at IFSP meeting

“planning for family involvement”



During services … SESSION NOTE

… FAP CALENDAR

FAP forms guide family involvement: SESSION NOTE

NEW AND IMPROVED—DESIGNED TO SUPPORT AND DOCUMENT FAMILY INVOLVEMENT

SESSION NOTEChild’s name _________________________________________________________________________________________________________Service provider ______________________________________________________________________________________________________

IFSP OUTCOME ADDRESSED

PROGRESS BY CHILD/FAMILY RELATED TO IFSP OUTCOMES:

O Worked with child o Worked with parent/caregiver and child together o Worked with parent/caregiver aloneActivity During Session:

Activity with parent/caregiver(check all that apply):O Reviewed Calendar with parent

0 Discussed session activity withy parent/caregiver 0 Parent/caregiver unavailableO Showed parent/caregiver activity0Paren/caregiver tried activity,therapist assisted 0 Therapist used alternate tool to work with parent (e.g., phone call, notebook)

List Family Plan/Calendar Activity for next week:

Just like now, interventionists must document what was done with child and how child responded.








WHAT IS NEW: The interventionist must document how the family was involved.







List FAP Calendar Activities:

WHAT IS NEW: The interventionist must also record what activities she/he taught the family to practice with the child.

Information about how the family was involved in the session

Documentation of specific activities taught to family members by the interventionist

Session Note requires:






0 Discussed session activity withy parent/caregiver 0 Parent/caregiver unavailableO Showed parent/caregiver activity0 Paren/caregiver tried activity,therapist assisted 0 Therapist used alternate tool to work with parent (e.g., phone call, notebook)


Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

“Take out your copy of the

SESSION NOTE!”








Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________




O Treated child o worked with parent/caregiver and child together o worked with parent/caregiver aloneActivity During Session:

Activity with parent/caregiver(check all that apply): O Discussed session activity with parent/caregiver O Showed parent/caregiver activity O Parent/caregiver tried activity, therapist assisted


Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

Write in IFSP Outcome HERE




O Treated child o Worked with parent/caregivener and child together o Worked with parent/caregiver aloneActivity During Session:

Activity with parent/caregiver(check all that apply) O Discussed session activity with parent/caregiver o Revuewed Calendar with parent O Showed parent/caregiver activity o Parent/caregiver unavaiklableO Parent/caregiver tried activity, therapist assisted o Therapist used alternate tool to work with parent/caregiver (e.g. phone call, notebook


Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

Write Child/Family progress HERE




O Treated child o Worked with parent/caregiver and child together o Worked with parent/caregiver aloneActivity During Session:


List Family Plan/Calendar Activity

Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

Write activities completed during session HERE







Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

Activities with parent/caregiver

Activities with parent/caregiver: Check off all that apply

Discussed session activity with parent/caregiver

Showed parent/caregiver activity

Parent/caregiver tried activity, therapist assisted

Activities with parent/caregiver (cont.)

Reviewed calendar with parent/caregiver

Parent/caregiver unavailable

Therapist used alternate tool to work with parent/caregiver (e.g., phone call, log, notebook)







Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

Write here what you and the parent decided would be a good activity that would fit in the family’s routines, and

That they could try until the next time the therapist comes. Answer ‘what is the

family to practice with the child?”







Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

what, and where OR when

IMPORTANT & REQUIRED







Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

what, where OR when

FOR THE SESSION NOTE TO BE COMPLETETHIS MUST BE ON THE SESSION NOTE!

What is required in a Session Note?

Notation of IFSP outcomes Documentation of activities that therapists

teach parents to practice Record of child’s responses to session Record of family involvement Record of specific calendar activities

(what, where, OR when)

The FAP Session Note is a tool to LINK interventionists and families



During services … SESSION NOTE

… FAP CALENDAR

During services: FAP CALENDARS*

* Or other communication tool

The FAP Calendar is a daily reminder of activities that families can practice with their child to enhance development

The FAP Calendar is designed to support parent-child learning activities that occur during the daily routines of the family

Posting the FAP Calendar on the fridge may be ideal for many families…

FAP Calendar

That looks like a FAP

Calendar!

…as the kitchen is often a central part of a family’s home and the calendar can be easily seen and shared with the EI team.

FAP Calendar

Did he say FAP or YAP?

FAPFAPFAPFAPFAPFAP

During services: FAP CALENDARS*

* or other communication tool

“Take out your copy of

the FAPCALENDAR”

FAP CALENDAR: a communication tool for family involvement !

Families as Partners CALENDAR: a communication tool for family involvement !

NYC EARLY INTERVENTION PROGRAM FAMILIES AS PARTNERS (FAP) CALENDAR FOR MULTIPLE SERVICESChild’s Name:________________________________________ (Last) (First)EI #:_______________________ Dates: From ___/___/___ To ___/___/___

Family Plan

Month of _____(Filled out by Interventionists)

Questions about Family Plan: What worked well in the plan? What didn’t work? Comments, concerns and adjustments. (Filled out by Family/Caregiver or Interventionists)

Parent/Caregiver: Put “+” if the activity worked well and “-” if it didn’t work well. (Filled out by Family?Caregiver)

______________

________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

Name of Interventionist/ AuthorizedAgeny Service____________________________________________________________________________________________________________________________________________

Family member(s)/Caregiver(s) who completed calendar:_____________________________IMPORTANT!! SAVE!! KEEP THIS PAGE AND GIVE IT TO YOUR SERVICE COORDINATOR!!__


Family Plan




________________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Interventionist and parent/caregiver

review what to work on for the next week.


Family Plan




what, when, where

________________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Interventionist writes in activities

for family to try


Family Plan




________________________

Su

+

M

+

T

+

+

+

W

+

T

-

F

-

+

+

S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Family can keep track of when activities in the Family Plan are

practiced HERE + (plus) means it went well - (minus) means not so well


Family Plan




Family feedback here!

Therapist adjustments here!

________________________

_________________________

_________________________

_________________________

S+

+

m

-

-

T

+

-

W

-

+

+

T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Family gives feedback-- how the activities are working, questions and concerns.

Interventionist writes adjustments to plan HERE


Family Plan




______

_____________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S


Family member(s)/Caregiver(s) who completed calendar:___mom IMPORTANT!! SAVE!! KEEP THIS PAGE AND GIVE IT TO YOUR SERVICE COORDINATOR!!__

Family member(s) who complete the calendar puts their

name(s) here

FAP CALENDAR: Example

Consider treatments for communication delays: how might the family support child outcomes?

Show parent how to respond to child so more

conversation is generated

Show parent how to get conversations started with the child

Show parent how to deal with everyday communication issues in daily routines

Thinking in FAP : 3 questions

Interventionist thinking…

1) What activities can families complete between sessions to support progress?

2) What are the routines of this family and how can those activities be designed to fit within the routines of THIS family?

3) How can I communicate these activities to THIS family?

FAP thinking: IFSP to Calendar

Activities must be clearly

communicatedto THIS family

Use your

expertise to help parent adjust the

routine slightly

to work on child’s needs

Learn the

routines of this family


Family Plan




Practice sounds at meal times and at bath time

_______

________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Interventionist and parent design activities that support IFSP

outcome –Interventionist writes them here!


Family Plan





_______

________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Include what to do, where, and

when (Identify a family

routine!)


Family Plan





_______

________________________

Su

M

-

T

-

W T

+

+

+

F

S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Family makes a mark when he/she practices the activities and codes the baby’s response “ + ” means activity went well “ – ” means it did not go well

Family Plan





_______

________________________

Su

+

+

M

=

T

=

W

++

T

=

+

+

F S

-

+

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Before meals baby fussed At bath she enjoyed it

Family can provide feedback here– what worked, what

didn’t work?

What would it mean to design calendar activities with FAP thinking?

What, when and where included

Fits into daily routine of the family

Culturally sensitive and family-friendly language


Family Plan




EXAMPLE.“Child will imitate names of familiar body parts”

______________

________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Does this example illustrate the design of a calendar activity using FAP thinking???

What, when and where included?

Fits into daily routine of the family?

Family-friendly language?

“Child will imitate names of familiar body parts”

Does this example illustrate the design of a calendar activity using FAP thinking?

What, when and where included? NO

Fits into daily routine of the family? NO

Family-friendly language? NO


What would it mean to design a calendar activity with FAP thinking?

What, when and where included

Fits into daily routine of the family

Family-friendly language


Designed with FAP thinking:

“Practice pointing to body parts during dressing and bath time”


Family Plan




Mom will name body parts during dressing and bath time

______________

________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Let’s look at another example!


Family Plan




Do more lively activities with Siobhan –

before meals sing songs

at playtime use touching game we practiced today

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Therapist designs activities to address

IFSP outcomes and fit with family life


Family Plan






at playtime play touching game we practiced today

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



WhatWhere OR When


Family Plan






at playtime play touching game we practiced today

Baby screamed when we played touching game

________________

________________

________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Family can write in how the plan

worked


Family Plan






at playtime play

tapping game we played today

Play the game only on her hands not head

________________

________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Interventionist makes

adjustments to the Family Plan

FAP CALENDAR: Example for a child receiving two services


Family Plan




___________________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S




Family Plan




___________________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

Name of Interventionist/ AuthorizedAgeny ServiceNiki Gupta Speech Therapist ___________________________________Rachel Woo Occupational Therapist


Speech Therapist and Occupational

Therapist share a

calendar


Family Plan




1) During mealtime, position Max and use word play

2) In stroller, position Max so he can see clearly and hold a toy

___________________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

Name of Interventionist/ AuthorizedAgeny ServiceNiki Gupta Speech THERAPIST ___________________________________Rachel Woo Occupational Therapist


OT designs two activities based on

family priorities


Family Plan




1) During mealtime, position Max and use word play


3) Practice blowing bubbles with Max at playtime

________________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Speech Therapist adds a third activity


Family Plan




1) During mealtime, position Max and use word play like in our session


3) Practice blowing bubbles with Max at playtime

________________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



What, where and when to do activity!


Family Plan




1) During mealtime, position Max and use word play 2) In stroller, position Max so he can see outside world and hold a toy 3) Practice blowing bubbles with Max at playtime

____________________________

Su

+

M

+

T

+

+

+

W

+

T

-

F

-

+

+

S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Family members can make a mark on the calendar when they

practice the activities and code their baby’s

response

“+” means it went well“ - ” means it didn’t go

well


Family Plan




1) During mealtime, position Max and use word play 2) In stroller, position Max so he can see outside world and hold a toy 3) Practice blowing bubbles with Max at playtime

Max can’t sit up straight in high chair or stroller. HELP!

___________________

___________________

___________________

___________________

Su

+

M

+

T

+

+

+

W

+

T

-

F

-

+

+

S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Any family member can write

in comments, questions etc.

Need to ask family at each

session “how is it going?”


Family Plan




1) During mealtime, position Max and use word playrachel

2) In stroller, position Max so he can see outside world and hold a toy rachel

3) Practice blowing bubbles with Max at playtime niki

Max can’t sit up straight in high chair or stroller. Help!

OT- I will show parent how to use towel to help provide support for Max, BB 6/3/06

___________________

___________________

___________________

Su

+

M

+

T

+

+

+

W

2+

T

1-

F

1-

+

+

S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



At each session, the

interventionist reviews

calendar with family, makes

modifications to activities.

.

Session Notes and Calendars work together to increase family involvement

Sessions in EI consist of: Discussion of calendar activities and parent

feedback Explicit modeling by interventionist and skill

building of parent Supportive coaching for family involvement

FAP emphasizesfamily involvement:

Families receive coaching during EI sessions Interventionists discuss with family how to

implement activities that support child’s development

If parents are not present for a session, they should receive a phone call or notes, pictures, e- mails, examples, etc. from the interventionist

Recommended reading:

Coaching Families and Colleagues in Early Childhood by Barbara E.Hanft, Dathan D. Rush and M’Lisa L. Shelden ( 2004) Baltimore: Brookes.

Practical guidebook on ways to coach families in natural settings to support

their child’s development

…the family loses

the calendar?

…or...

Great idea! Love the FAP Calendar! Great tool for

behavior change but what if…

…the dog eats the calendar!

…the babies hide the calendar!

…the toddler uses the FAP calendar for her own family plan!

FAP Calendars are easy to replace!

Interventionists need to carry copies of calendars with them to each session and replace as needed

Interventionists have their own record of family plan activities (on session notes)

Other communication tools that can be documented are also acceptable

All interventionists are required to discuss the

calendar or other tool with the parent. BUT…

PARENTS MAY CHOOSE TO NOT use a calendar at all Use one calendar for all therapists Use one calendar for each therapist working

with child Use one calendar at their home and one at

Grandma’s or the daycare or babysitter’s

Replacing a calendar may happen frequently for some families!

Interventionists must make continued efforts to involve each family in EI services

Authentic involvement

Manageable involvement

Calendars, behavior change and powerful early intervention…

Monitoring tools (e.g., calendars) are used in many fields of psychology, counseling, health maintenance, medication adherence, etc.

Calendars can support the practice of learning activities as part of daily routines

Consistent family interaction is powerful early intervention

…the family has difficulty with the calendar or needs extensive instruction?

Great idea! Love the FAP Calendar! Great tool for

behavior change but what if…

Family Training (FT) and manageable family involvement

Family Training (FT) is an established EI service that may be offered at IFSP meeting to further support family involvement in EI

FT allows one-on-one sessions for family to receive additional assistance in learning how to support their child’s development (family must be present)

DON’T MISUNDERSTAND THIS!!! Families are expected to be involved in all sessions.

EVERY SESSION whether billed as SP, OT, PT, SI, FT is expected to:

Involve the family Include review of the calendar, or other

communication tool Include efforts by interventionist to

communicate with family to receive feedback

Family Training: Who provides it?

Family training (FT) may be assigned to any of the interventionists approved to provide EI services

FT may also be used by the interventionist and family to train a babysitter, nanny or other family member on the best ways to interact with the child

Family Training (FT) may be authorized at IFSP for a specific number of sessions to be used as needed during the IFSP period

As with all EI services, FT is optional and individualized for each family

Family Training in FAP


Message 3: In FAP,

family involvement

is expected at each

session.

Message 4: The FAP forms guide service

delivery.


Message 5: The FAPCalendar is the

presumptive

communication

tool between

interventionists

and families.

Video Example: Jenni

Video Example of FAP Principles: Jenni

2 ½ year old girl in mono-lingual Spanish speaking family of 5

Diplegic cerebral palsy and delays in walking and expressive language

Video shows how therapists work with family to build intervention activities into family routines

8 minutes

Questions about the video

How does the video captures principles of FAP?

In the video a second provider who spoke fluent Spanish was brought in for consultation. What other strategies could be used? What other strategies have you used?

Jenni and FAP Forms

Jenni and FAP forms

Take out the one page handout marked Jenni (left side of folder). Collaborate with your video-watching partner.

Look at session note (top half of HANDOUT) and imagine that you were one of the interventionists for Jenni. Fill out a session note.

Look at FAP calendar (bottom half of HANDOUT). Write one activity for Jenni’s family to practice between sessions in space marked Family Plan. (WHAT< WHERE< WHEN)

SESSION NOTE (Jenni)Child’s name _________________________________________________________________________________________________________Service provider ______________________________________________________________________________________________________







Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

SESSION NOTE (Jenni)Child’s name _________________________________________________________________________________________________________Service provider ______________________________________________________________________________________________________







Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

NYC EARLY INTERVENTION PROGRAM FAMILIES AS PARTNERS (FAP) CALENDAR FOR MULTIPLE SERVICESChild’s Name:__ ________________________JENNY________ (Last) (First)EI #:_______________________ Dates: From ___/___/___ To ___/___/___

Family Plan




______________

________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Examples of family plan activities for Jenni

What Where When

Discuss family plan activities developed by

participants. Evaluate for FAP thinking…

…the family is not literate?

…or only speaks a language that the interventionist is not able to speak?”

“Great idea! Love the FAP Calendar! Great

tool for behavior change but what if…

Communication, calendars and challenges

How could the calendar be used for families in which the parents are not literate or family does not speak English?

What other challenges do you envision?

Discussion– translate some activities for calendar, at IFSP make sure key folks are identified to assist in translating information, photographs, other ideas?

…the child attends a center?”

but what if…

FAP CALENDAR and Center-Based Services

The FAP CALENDAR is the presumptive tool for EI sessions in Center-Based services

An alternate tool which can be documented is acceptable.

Interventionists in EI Center-Based Services currently use many ways to connect with families

Notebooks Notes Send home pictures Weekly updates written in notebook Phone calls E-mails

Using FAP Calendars as part of Center-based Services

FAP Calendar or other tool should become part of ongoing communication (stapled into notebook)

Communication tool should travel from program to home and back with the child

Interventionists should review feedback from calendar or other communication tool at EVERY session

Communication between the family and interventionists is critical for children receiving EI services in centers

Efforts to increase family participation must be documented on Session notes

If a family is not returning the communication tool, efforts are needed to increase family participation

Session Notes and Center-based services

Currently, interventionists use a variety of methods to document the services for children in center-based services

In FAP, the goal is to document the services and document the ways in which the family is involved in EI services

Communication with family should be documented on the session notes

FAP: New expectations for EI Interventionists

Learn about the child/family’s routines Design simple activities that can easily be

made a part of the usual routines Be a coach, a problem solver, a model of how

parent can help build the skills of their child Educate family that their involvement will

enhance their children’s development

EffectiveEarly


Interventionist FAP

Forms

Family Involvement


Video: Evan

Video Example of FAP Principlesin multiple settings: Evan

Evan is an 18 month old boy who has Down syndrome. A majority of his time is at a child care center.

Vignette shows sessions in which child and family goals are to achieve spoon feeding and more effective and active communication.

10 minutes

Watch Video for these specific points

Activities are incorporated into both household and child care settings.

Interventionist models activities for family and teacher (separately).

Interventions and family activities to practice are designed to work on multiple aspects of development.

Video illustrates a FAP session! (Pull out handout marked Evan)

Talk to your video partner --imagine you are Evan’s interventionist…

Sketch out a session note for the home visit shown on the video. Check off boxes!

Write in an activity taught to the family on both the calendar and the session note.

what, where and when






0 Discussed session activity withy parent/caregiver 0 Parent/caregiver unavailableO Showed parent/caregiver activity 0Paren/caregiver tried activity,therapist assisted 0 Therapist used alternate tool to work with parent (e.g., phone call, notebook)


Date________________________________________________________________________________________________________________________________________________________________________________________Signatures_______________________________________________________

All 3 activities were illustrated in video example of

Evan’s spoon feeding!

NYC EARLY INTERVENTION PROGRAM FAMILIES AS PARTNERS (FAP) CALENDAR FOR MULTIPLE SERVICESChild’s Name:__ ________________________JENNY________ (Last) (First)EI #:_______________________ Dates: From ___/___/___ To ___/___/___

Family Plan




What activity did the interventionist design for Evan’s parents to practice?

______________

________________________

Su M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S

S M T W T F S



Evan, multiple settings and FAP Interventionist addressed family priorities

and incorporated learning activities into the home AND center/child care settings

MODELING: Interventionist coached Evan’s family and teacher on spoon feeding

PRACTICE: Evan’s family and teacher practiced learning activities and got feedback during a session

EffectiveEarly


Interventionist FAP

Forms

Family Involvement


Families As Partners : Co-Visits, Provider and Parent Progress Notes

Part 1, Section 3

Families as PartnersInvolvement must be manageable

Children who receive more than one service need to receive integrated and coordinated family plan activities

Each interventionist can see what the others are working on through the FAP calendar

Co-Visit Session is another way to support coordination and integration of services

Review the letter from the STATE OF NEW YORK about Co-Visits

Letter Barbara McTague, Acting Director, Early Intervention Program, Division of Family Health, State of New York Department of Health

(electronic version attached)

Co-Visit Session: What is it?

Single session with 2 or more interventionists AND parent and child

Single session with 2 or more interventionists AND parent

Co-Visit Session:

Offered for families of children with multiple and severe delays

Not authorized routinely (weekly or biweekly) Can take place at family home or provider site

as specified on IFSP Not a separate service

Co-treat child Assess child’s progress Solve problems related to treatment Determine priorities for ongoing treatment Develop plan to integrate multiple services Provide instruction/training for parent Integrate services

Co-Visits: Purpose must be one of the following

Co-Visit Session: When appropriate?

Two or more interventionists are providing services

Multiple delays are severe Advantageous for treatment plan Advantageous to increase family

involvementNOT routine

Co-visits support the rationale and practice of

FAP. The Co-visit Session Note has been designed to guide integration of services

Co-Visit Session Note

Co-Visit SESSION NOTEChild’s Name______________________________________ DOB:_________ EI#_____________ List Co-Visit participants. Include name and role (discipline of interventionist):

Date: __/__/__ Date Session Note written: __/__/__Time: From____ To____ Location of Co-Visit (check one): o Home 0 Center

______________________________________________________________________________________________________________________________

IFSP OUTCOMES ADDRESSED:

PROGRESS OF CHILD?FAMILY RELATED TO ISFSP OUTCOMES:_____________________________________________________________________________________________________________DISCUSSION AT CO-VISIT If Appropriate: ACTIVITY AT CO-VISIT WITH

PARENT/CAREGIVER (check all that apply):o Discussion session activity with parent/caregiver

oParent/caregiver tried activity, interventionist assistedo Showed parent/caregiver activityo Reviewed Calendar with parento Interventionist used alternate tool to work w/ parentoOther (describe)

___________________________________________________________________________________________________________________________________________________________________

FAMILY PLAN FOR NEXT MONTH FOLLOW-UP BY TEAM OF INTERVENTIONISTS (listplans and strategies to (1) support next month’s Family Plan and (2) integrate services):

Co-Visit

What is required in the Co-Visit Session Note?

Notation of IFSP Outcomes Documentation of discussion at co-visit If appropriate, documentation of direct service

activities at co-visit Record of collaborative Family Plan for month

(must be duplicated on Calendar) Record of follow-up plans by EI team to (1) support Family Plan and (2) integrate

services



______________________________________________________________________________________________________________________________





___________________________________________________________________________________________________________________________________________________________________


Co-Visit

Write here the IFSP Outcome addressed



______________________________________________________________________________________________________________________________





___________________________________________________________________________________________________________________________________________________________________


Co-Visit

Write progress of child and family related to outcomes



______________________________________________________________________________________________________________________________





___________________________________________________________________________________________________________________________________________________________________


Co-Visit

Confirm and record thesessions for month and next co-visit session. Identify and record any new concerns ofparent/caregiver andInterventionists.

Co-Visit SESSION NOTE

Child’s Name______________________________________ DOB:_________ EI#_____________Interventionist’s Name:______________________________ Discipline:_______________________Interventionist’s Name:______________________________ Discipline:_______________________Interventionist’s Name:______________________________ Discipline:_______________________Date: __/__/__ Time: From____ To____ Location of Co-Visit (check one): o Home o Center_______________________________________________________________________________________________________________

______IFSP OUTCOMES ADDRESSED:______________________________________________________________________________________________

_DISCUSSION AT CO-VISIT ACTIVITY AT Co-VISIT:

Indicate only one: Worked with caregiver and childWorked with caregiver aloneWorked with child alone Check all that apply:o Discussed session activity with parent/caregivero Parent/caregiver tried activity, interventionist assistedo Showed parent/caregiver activityo Reviewed Calendar with parento Interventionist used alternate tool to work w/ parentoOther (describe)

Co-Visit Check off the boxes that apply and write in additionalinformation as appropriate

Co-Visit SESSION NOTEChild’s Name______________________________________ DOB:_________ EI#_____________Interventionist’s Name:______________________________ Discipline:_______________________Interventionist’s Name:______________________________ Discipline:_______________________Interventionist’s Name:______________________________ Discipline:_______________________Date: __/__/__ Time: From____ To____ Location of Co-Visit (check one): o Home o Center_____________________________________________________________________________________________________________________IFSP OUTCOMES ADDRESSED:________________________________________________________________________________________________DISCUSSION AT CO-VISIT If Appropriate: ACTIVITY AT CO-VISIT WITH

PARENT/CAREGIVER (check all that apply):X Discussion session activity with parent/caregiver

X Parent/caregiver tried activity, interventionist assisted

X Showed parent/caregiver activity

X Reviewed Calendar with parento Interventionist used alternate tool to work w/ parentoOther (describe)

PT and ST worked on positioning in high chair to improve

breath control to enhance speech production. Showed

parent

____________________________________________________________________________________________________________________________________________________

Co-Visit Write in what activities done with multiple interventionists, parent/caregiver, and child

Co-Visit SESSION NOTEChild’s Name______________________________________ DOB:_________ EI#_____________

Interventionist’s Name:______________________________ Discipline:_______________________


Interventionist’s Name:______________________________ Discipline:_______________________Date: __/__/__ Time: From____ To____ Location of Co-Visit (check one): o Home o Center

_____________________________________________________________________________________________________________________


________________________________________________________________________________________________

DISCUSSION AT CO-VISIT If Appropriate: ACTIVITY AT CO-VISIT WITH


oParent/caregiver tried activity, interventionist assisted

o Showed parent/caregiver activity

o Reviewed Calendar with parent

o Interventionist used alternate tool to work w/ parent

oOther (describe)

____________________________________________________________________________________________________________________________________________________

FAMILY PLAN FOR NEXT MONTH FOLLOW-UP BY TEAM OF INTERVENTIONISTS (list

plans and strategies to (1) support next month’s Family Plan and (2) integrate services):

Co-Visit

Write here specific activities for family to practice between now and next session Specific activities should be designed by the team of interventionists

Specific activities must be designed

using FAP thinking (family involvement should be connected to family routines)


______________________________________________________________________________________________







oOther (describe)

__________________________________________________________________________________________________________________________________________________

FAMILY PLAN FOR NEXT MONTH FOLLOW-UP BY TEAM OF INTERVENTIONI

plans and strategies to (1) support next month’s Plan and (2) integrate services):

Co-Visit

1. During mealtime, position Max and use word play

2. In stroller, position Max so he can see clearly and hold a toy

3. Practice blowing bubbles with Max at afternoon playtimes




Interventionist’s Name:______________________________ Discipline:_______________________Date: __/__/__ Time: From____ To____ Location of Co-Visit (check one): o Home o Center

_____________________________________________________________________________________________________________________


________________________________________________________________________________________________







oOther (describe)

____________________________________________________________________________________________________________________________________________________

FAMILY PLAN FOR NEXT MONTH FOLLOW-UP BY TEAM OF INTERVENTIONISTS (list

plans and strategies to (1) support next month’s Family Plan and (2) integrate services):

Co-Visit

Write in specific thingsthat interventionists will do to support planand other directives tobetter integrate services

Co-Visit SESSION NOTE

FOLLOW-UP BY TEAM OF INTERVENTIONISTS (list plans and strategies to (1) support next month’s Family Plan and (2) integrate services:

Co-Visit

1) PT will show parent how to adjust high chair and use household items to provide support

2) PT will show positioning to babysitter 3) PT will teach positioning outside of home4) Speech T-make sure child is positioned properly during

feeding sessions5) PT and Speech T- Use repetitive simple labeling during

sessions

FAP Calendars and Co-Visit Session Notes

Together the FAP Calendar and Co-Visit Session Note guide session activities for therapists and family members.

Feedback and discussion of integrated services for child

Coordinated skill building for family members Integration of activities for family members Supportive and sensitive coaching for family

involvement

This sounds better and better! Are there other

FAP forms to support

family involvement?

Keys to Families As Partners system


Provider Progress Note - EVERY 3 MONTHS

FAP Provider ProgressNote: What is required?

Information about progress towards each IFSP outcome

Details about family involvement Specific instruments for assessment noted Information about challenges to family

partnership Information about how family feedback was

used to address barriers

Provider Progress Note- Page 1IFSP Outcome (s)___ Rate Progress in This Time Period__________________ No Little Moderate Great deal Outcome

__________________ Progress Progress Progress of Progress Achieved__________________________ O O O O O

How did you work with the family to help the child to reach this outcome?_____________________________________________________________________________________________________________________________________________________________________________________________________________________________

IFSP Outcome (s)___ Rate Progress in This Time Period__________________ No Little Moderate Great deal Outcome






Provider Progress Note- Page 1IFSP Outcome (s)___ Rate Progress in This Time Period__________________ No Little Moderate Great deal Outcome









Please look in your packet and pull out a

Provider Progress Note!

Provider Progress note- Page 1

IFSP Outcome (s)___ Rate Progress in This Time Period__________________ No Little Moderate Great deal

Outcome

__________________ Progress Progress Progress of Progress Achieved

_______________________ O O O O O

How did you work with the family to help the child to reach this outcome?__________________

_____________________________________________________________________________

_____________________________________________________________________________

Write an IFSP Outcome Here


IFSP Outcome (s)___ Rate Progress in This Time PeriodChild communicates___ No Little Moderate Great deal

Outcome

_effectively_________ Progress Progress Progress of Progress Achieved

_______________________ O O O O O


_____________________________________________________________________________

_____________________________________________________________________________

Write the IFSP Outcome Here



Outcome


_______________________ O O O O O


_____________________________________________________________________________

_____________________________________________________________________________

Estimate the child’s progress in previous 3 month-period



Outcome


_______________________ O O O O O


_____________________________________________________________________________

_____________________________________________________________________________

Report on how you achieved this(sum up session notes)


IFSP Outcome (s)___ Rating of Progress of IFSP Outcomes

Communicateseffectively No Little Moderate Great deal Outcome

Progress Progress Progress of Progress Achieved

O O x O O


Worked with family members to practice words with child across the day (meals, baths, visits to grandma, grocery shop.) Met parent during shopping trips to demonstrate how to generate language during grocery shopping expedition. Met with grandma to do same.

Report on your services(summary of session notes)

Provider Progress Note – Page 2

1. For the 3 and 9 month report, provide a description of child’s progress and current level of functioning. For the 6 and 12 month report, provide the description of progress; in addition, please estimate the percentage of delay at the end of the 6 and 12 month period and state how that was determined; e.g., criterion referenced instrument, developmental checklist, or clinical opinion (Standard deviation scores or formal evaluations are not required).

2. List factors that limit the collaboration between parent and interventionist. How have you addressed these factors? Be specific.

3. How have you used feedback from the family to modify how you work with the family? Be specific and provide examples.

4. Recommendations (include here any new IFSP outcomes, or changes in strategies and activities):

Identified challenges to family involvement can be addressed quickly

Keys to Families As Partners system


Parent Progress Note - EVERY 3 MONTHS

The Parent Progress Note has two main goals

Parent progress note makes clear that:

family feedback is important and needed

the family partnership with EI is a priority

FAP Parent Progress Note

Parent completes PPN with Service Coordinator

every 3 months

The FAP Parent Progress Notes support

our partnership with families

FAP Parent Progress Note1. Have you seen positive changes in your child as a result of EI

services? 2. Have you been taught skills or given ways to help support your

child’s growth? 3. Do you and the therapists/teachers review which activities are

working well and which are not working well? 4. For home based: Were the therapists or teachers flexible about

scheduling services for you and your child (days, nights, weekends)?For center based: Did the teacher or therapist keep in touch with you?

5. What are your current concerns about your child? Are there new skills you would like to learn?

In Families as Partners, there are clear expectations for families:

Communicate frequently with the EI interventionist

Learn activities from the EI interventionist to practice with your child during daily routines

Give feedback to the EI interventionist(s) as to how the learning activities are working in your family’s daily life

In Families as Partners,

there are clear expectations for interventionists:

Design activities to address priorities of families and design activities to fit into family routines

Coach families to learn and practice activities between sessions (home & center)

Support families to become more confident and flexible such that families can enhance children’s learning and development

FAP: A System for More Effective Early Intervention

Family involvement is expected during EI sessions and between EI sessions

Major focus in EI is on partnership of the interventionist and the family

The FAP system supports this partnership through documentation, assessments

Team EI

Keys to the FamiliesAs Partners system


2. Forms designed to support family involvement3. Individualized plans for manageable family

involvement 4. Extensive training for EI staff and Providers5. Monitoring and accountability of service fidelity



Message 6: The FAPSession note, Co-Visit

Session note, Provider

Progress Note, and

Parent Progress Note

guide the

implementation of

service delivery.

EffectiveEarly


Interventionist FAP

Forms

Family Involvement


End of FAP TRAINING Part 1 of 2

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Early Intervention Program NYC DoHMH Families As Partners: Part 1 of 2.

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