IFSP Tutorial: Developing and Implementing an IFSP (Module...

IFSP Tutorial: Developing & Implementing IFSPs (Module 2 Session 2)Session 2: Developing an IFSP with a Family

Outcome and Objectives

OutcomeUnderstand the purpose and scope of an IFSP as a vehicle for selecting family-desired supports and services in natural environments

Objectives

Discuss the evidence supporting community-based early intervention and the importance of providing family/child supports and services in natural environments

Explain the variety of ways that formal and informal family/child supports and services can be offered

Explain how the identification of a family’s priorities, concerns and resources provides the foundation for decision-making during the development of an IFSP

Explain the purpose for developing a flexible IFSP with families that reflects their desired outcomes

Identify the information which must be included on an IFSP, and how to facilitate discussion with families to ensure all IFSP components are addressed

Identify at least 4 concerns families may voice during the development of an IFSP for their child

Describe how to assist families to identify their desired outcomes

Identify the components of a functional outcome, measurable criteria and effective strategies and illustrate with 3 examples

Describe the factors to consider in determining the frequency and intensity of family/child supports and services

Describe at least 4 decisions to make with family members while developing a flexible IFSP

IFSP Process Tutorial – Pilot Version as of July 1, 2004 Page 1Developing and Implementing the IFSPSession 2 - Developing the IFSP

Developing an IFSP with Families has four key activities for readers: essential content, application activities, recommended reading and self assessment. The following chart gives an overview of the session with suggested time allotments:

Summary of ActivitiesActivities Time allotment

Read Essential Content about developing an IFSP with families 2 hours Application 2.1: Reviewing program practices re: IFSP outcomes, strategies, criteria and supports/services

2 hours

Application 2.2 Developing functional IFSP outcomes, criteria and strategies

2 hour

Application 2.3 Addressing Family Concerns about Developing IFSPs

2 hour

Application 2.4 Evidence-based practice: Developing IFSPs with Families

2 hours

Recommended Reading 1-2 hoursComplete Self-Assessment Inventory: Developing IFSPs with families

1 hour

Guiding questions:

1. What aspects of family/community life do family members want their child to participate in?

2. Which formal and informal early intervention supports and service can help family members achieve their desired outcomes for their child?

Why this topic was selected

Developing an IFSP with Families defines early intervention as the formal and informal supports and services that will help each family implement the strategies necessary to reach their desired outcomes. This session focuses on identifying, with families, the IFSP outcomes, criteria, strategies, and supports/services that enhance a child’s participation within meaningful contexts for each family. This is the heart of the natural environment mandate in the Individuals with Disabilities Education Act- to support families to ensure that their very young children participate in meaningful routines and activities, in and out of their home.

Developing an IFSP with Families draws on the planning discussion with families that guided a child’s initial evaluation and assessment for eligibility for a Local Infants and Toddler’s Program in Maryland. (link to mod 1 session 2 a purpose of planning) Information about a family’s priorities, concerns and resources, together with the data and observations collected during a child’s evaluation and assessment,


lays the foundation for a discussion between family members and early intervention providers about developing an Individualized Family Service Plan (IFSP).

Specifically, Developing an IFSP with Families focuses on including families in making decisions about four key components of an IFSP:

1. functional outcomes for a child and/or family members;

2. measurable criteria;

3. effective strategies; and

4. formal and informal family/child supports and services.

NOTE: Maryland’s IFSP document has specific instructions on the back of each page for completing each section. A blank copy is available through one of the 24 Local Infants and Toddlers Programs (link to http://www.cte.jhu.edu/dse_eis/directory1.cfm?DirID=2&location=2) or online. (TBD)

Functional outcomes are the cornerstone for providing early intervention supports and services to families and children in natural environments. Functional outcomes specify where each family “wants to go” and direct early intervention providers to focus their expertise on ensuring that a child participates in specific contexts within family and community life. Traditionally, IFSP outcomes have represented domain specific skills (e.g., Aman will push up on hands and knees, or Gina will use signs) that require formal services from a professional in a specific discipline. For example, a physical or occupational therapist might work with Aman to help him learn to crawl, and a speech-pathologist or special educator might help Gina learn to use signs to communicate.

Instead of measurable criteria that families can use as indicators of when functional outcomes have been achieved, criteria for traditional outcomes is often identified as “therapist/teacher checklist” or “6 month review.” Likewise, strategies for traditional outcomes generally indicate what early intervention providers will do rather than how family members will be supported to include their children in specific family and community activities and routines. Thus, for Aman, rolling over becomes the means for him to get around his family’s home to play with his older brothers. For Gina, signs are paired with initial sounds to help her express her desires for a drink of milk or more apple during mealtimes with her family.


Essential Content: What early intervention providers and families need to know about developing an IFSP

Developing an IFSP with Families, the second session in Module 2, is part of a tutorial about the IFSP process developed by the Maryland State Department of Education for early intervention providers, and any interested readers. Other sessions available: (link to outcomes/objectives in Mod 1 and 2 for each session below)

Module SessionModule 1: Evaluation and Assessment

1: Legal Requirements

2: Planning with Families for Evaluation & Assessment

3: Comprehensive Evaluation and AssessmentModule 2:Developing and Implementing an IFSP

1: Legal Requirements

2: Developing an IFSP with Families (this session)

3: Implementing Family/Child Supports and Services

The following topics are covered in Developing an IFSP with Families:

a. Evidence for providing family/child supports and services in natural environments

b. Overview of developing flexible IFSPs with families

c. Concerns families may have while developing an IFSP

d. Considerations for scheduling IFSP discussions with families: Who, where, when, how and who

e. Decisions to make with families about what to include on an IFSP

f. The role of service coordinators during development and implementation of an IFSP

g. Functional outcomes: The guide for early intervention supports and services

h. Assisting families to identify functional outcomes

i. Measurable criteria: How we know we have achieved outcomes achieved

j. Effective strategies identify how functional outcomes will be achieved

k. Identifying early intervention supports and services

a. Evidence for providing family/child supports and services in natural environments

Providing evidence-based practice is now an expected responsibility in multiple professions including


early intervention, medicine, occupational and physical therapy, speech-language pathology, nursing, education, and mental health. (link to Appendix A) Evidence-based practices help early intervention providers make sound decisions about what they can do to support families in achieving their desired outcomes for their children (Dunst, Trivette, & Cutspec, 2002).

The following points summarize why it is important to provide family/child supports and services in natural environments (references are listed in Appendix B): (link to Appendix B) Additional information is available on an excellent website highlighting evidence-based early childhood practices for parents, providers and researchers posted by The Research and Training Center on Early Childhood Development. (link to www.researchtopractice.info)

A child’s relationships with primary caregivers organizes all his or her early development.

“The idea is that we are born to form attachments, that our brains are physically wired to develop in tandem with another’s, through emotional communication, beginning before words are spoken.” (Schore, 2003, p.16)

Young children need a relationship with at least one emotionally invested, predictable caregiver who is available to the child and understands how to provide meaningful stimulation through daily experiences. A strong, secure attachment to a nurturing caregiver also has a protective biological function, helping a young child learn from, and withstand, the ordinary stresses of daily life. Repeated positive care-giving experiences make a decisive impact on a baby’s brain development across all areas of development. Extensive research in early child development and learning, reviewed in From neighborhoods to neurons: The science of early childhood development (link to www.nap.edu/execsumm/0309069882.html) emphasizes the:

1. importance of early life experiences, as well as the inseparable and highly interactive influences of genetics and environment, on the development of the brain and the unfolding of human behavior;

2. central role of early relationships as a source of either support and adaptation or risk and dysfunction;

3. powerful capabilities, complex emotions, and essential social skills that develop during the earliest years of life; and

4. capacity to increase the odds of favorable developmental outcomes through planned interventions. (National Research Council & Institute of Medicine, 2000, p. 1).

Children are active participants in their own development, based on their drive to explore and master their environment.

“Given the drive of young children to master their world, most developmentalists agree that the full range of early childhood competencies can be achieved in typical, everyday environments….All forms of early childhood intervention are most effective when they counteract obstacles to growth and promote the expression of a child’s natural drive toward mastery.” (National Research Council, 2000, p.27)


http://www.researchtopractice.info/

Infants are aware of the effects of their own behaviors, and prefer consequences that they can control directly versus those that are uncontrollable. A young child’s ability to create his or her own knowledge depends on having an environment which provides opportunities for growth and supports individual interests. Learning is enhanced when children’s interests engage them in interactions that provide opportunities to practice existing skills and explore their environment. Finally, when early intervention is provided in a family’s environment compared to unfamiliar settings such as clinics and intervention centers, the opportunities increase for parents to be more effective interacting with their children at home.

New motor and communication behaviors are learned and used when a child has repeated opportunities for practice in meaningful situations with generalization of skills across different settings.

Motor behaviors must be retained and used in different contexts in order to be considered “learned” to use spontaneously in response to specific demands in different environments. Even when a child is taught specific motor or communication skills during a traditional intervention session, he or she must then practice these skills over and over in real life settings in order to use the skill competently.

“A child who learns to walk between parallel bars, on a balance beam, or in a quiet therapy room, for example, must transfer or generalize to walking on a carpet at home or in a crowded hallway at school if walking is to be meaningful.” (McEwen & Shelden, 1995, p.35)

Fundamental motor learning principles include promoting age-appropriate functional tasks, embedding movement within a physical and sociocultural environment, and fostering active exploration of the environment. Meaningful input across multiple domains of development, not just in motor or language areas, is also critical and encourages a young child’s learning. Such learning occurs in the context of an ongoing care-giving relationship and dramatically improves a child’s memory of the action/event and provides a framework for updating it.

The knowledge and resources of early childhood specialists can be shared with a child’s key caregivers through adult-adult relationships that support caregivers in their daily roles and responsibilities caring for their children.

Supporting and increasing the knowledge of those who spend the most time with very young children-- parents, brothers and sisters, friends, extended family, child care providers-- enhances the impact of early intervention. Strategies implemented at home or child care by family members and other care-givers can lead to generalization of a child’s emerging skills in various family and community activities. Information embedded in an emotional context appears to stimulate neuronal circuitry more powerfully than information presented in isolation of a meaningful context. For very young children, relationships with key caregivers provide ongoing and numerous opportunities for learning within an emotional context. For example, a child who becomes interested in letters and words through daily reading with a parent and associates “the joy of being in her father’s lap, seeing beautiful pictures, and hearing a wonderful story” is more likely to understand the meaning of letters than a child who is taught to recite the letters of the alphabet by rote (National Research Council and Institute of Medicine, 2000, p.156).


b. Overview of developing IFSPs with families

Once a child’s eligibility for early intervention has been established by a Local Infants and Toddlers Program in Maryland, an individualized family service plan (IFSP) is developed. (link to mod 1` session 1 who is eligible?) The following overview gives a summary of the critical steps in developing an IFSP with a family.

1. Revisit a family’s priorities, concerns, and resources.2. Review data collected during a child’s evaluation/assessment.3. Identify functional outcomes with parents.4. Select measurable criteria to define when an outcome has been achieved.5. Describe strategies for achieving each outcome. 6. Discuss which formal and informal supports/services can assist families to

achieve desired outcomes. 7. Once an IFSP is implemented, assess progress towards achieving family/child

outcomes as well as overall family satisfaction with their participation in early intervention.

1. Revisit a family’s priorities, concerns, and resources. Parents’ comments about family and child interests, their resources, and their priorities for the activities and routines in which they want their child to participate guide the conversation for selecting IFSP outcomes and family/child supports and services. This discussion should begin with a planning conversation with families in preparation for a child’s evaluation/assessment. (link to mod 1 session 2 a purpose of planning) Family/community activities and routines are the context for natural learning opportunities in which young children develop social competence, master their environment, and acquire information and experience. In preparation for the IFSP, explore with families where a child and family spend their time, along with the activities they do in these places, would like to do, or improve upon (Rosenketter & Squires, 2000). A routines-based interview can guide this discussion (McWilliam, 1992; in press). (link to www.vanderbiltchildrens.com/uploads/documents/cci_rbi__form_rev.pdf )

2. Review data collected during a child’s evaluation/assessment with families. A comprehensive evaluation and assessment collects information from multiple sources about a child’s and family’s interests, strengths/resources and challenges/concerns. (link to essential content Mod 1 session 3) These sources include quantitative tests, as appropriate, and qualitative methods such as natural observation of a child with family members in familiar situations. This data is helpful when determining how to enhance a child’s participation in specific family and community activity settings.

3. Identify functional outcomes with parents. Outcomes are the changes that families would like to see for their children or themselves as a result of their participation in early intervention. Functional outcomes, written in language understandable to each family, identify the desirable knowledge, skills and/or behavior that a child or family members will acquire to ensure a young child’s successful


http://www.vanderbiltchildrens.com/uploads/documents/cci_rbi__form_rev.pdf

participation in daily life (Pretti-Frontczak & Bricker, 2000). (link to section g “functional outcomes” in this session) Functional outcomes promote a child’s (McWilliams, 2002):

Social competence, including:

understanding and expressing emotions forming friendships interacting with family members/peers becoming a member of a social group

Mastery over environment, including:

caring for one’s self navigating spaces and places using tools, toys and objects purposefully in specific activity settings

Engagement for learning, including

focusing on information from body/environment adapting to familiar and novel situations in specific activity settings

4. Select measurable criteria to define when an outcome has been achieved. Criteria enables all team members to know when an outcome is achieved to the satisfaction of parents. Criteria must be measurable, i.e., can be seen or heard in a specific context, and specifies how frequently a family hopes a certain action or behavior will occur. (link to section h “measurable criteria in this session)

5. Describe strategies for achieving each outcome. Strategies clarify how intended outcomes will be achieved; not which early intervention services will be provided. Effective strategies build on a child’s and family’s interests and surroundings and involve routines/activities, materials/toys/pets, interactions, hobbies/leisure and one’s environment. (link to section i in this session) They should identify how early intervention providers and other community resources will support family members to reach intended outcomes as well as specify the actions family members will take. Talking about strategies with families provides an opportunity to think about the places and spaces where a child can practice and generalize skills, and leads to discussing which formal and informal community resources can be used to reach desired outcomes.

6. Discuss the formal and informal supports/services which can help families achieve their desired outcomes. Before listing early intervention services on the IFSP, it is important to ask “Who has the expertise to support family members in achieving specified child and family outcomes?” rather than trying to decide whether a child needs therapy and/or special instruction (Hanft & Pilkington, 2001). Family members and early intervention providers should discuss the variety of formal and informal supports and services that can be helpful to families and children in reaching desired outcomes (Trivette, Dunst & Deal, 1997). (link to section j in this session)


7. Once an IFSP is implemented, assess progress towards achieving family/child outcomes as well as overall family satisfaction with their participation in early intervention. Progress and family satisfaction can be informally assessed on an ongoing basis by considering these questions with family members:

How much progress is a child/family making toward attaining desired outcomes? Are family members satisfied with this progress, and their participation in a Local Infants

and Toddlers Program? How will modifications, if needed, be made in services and supports?

A periodic IFSP review must be held every six months or sooner, if requested by a family (Link to mod 2, session 1d) to review progress and revise outcomes as necessary. In addition, an annual meeting must be held to evaluate the IFSP, and revise its provisions, as appropriate. (Link to mod 2, session 1d) and

c. Concerns families may have while developing an IFSP

It is---------------------------------- important to anticipate, and address as appropriate, concerns that family members may have during the development of their IFSP. Many questions related to a child’s rate of development and future independence cannot be answered completely during a child’s first few years. Keep in mind that some parents may not feel comfortable asking the following questions or talking about concerns that they are only beginning to think about, particularly with early intervention providers they have just met. When family concerns do arise, early intervention providers can:

1. Encourage family members to talk about what is on their minds;

2. Listen, before making suggestions, in order to understand and show respect for a family’s beliefs and values;

3. Provide information, as appropriate, to address specific concerns;

4. Review with families their informal support networks; and

5. Offer to link families to formal support networks, such as parent-parent programs through a local infants and toddlers program or other organizations.

Some examples of concerns that may arise as parents think about desired outcomes for themselves and their child:

About a child’s development….

Will my child ever be able to …..?

Why isn’t my child developing like other children?


I don’t know what my child can do.

I’m not sure about my child’s diagnosis, so why do all this now?

About participating in early intervention…

Will this help me/my family cope, learn what to do about……?

What if all this doesn’t help my child to ….?

I don’t know if I accept the results of my child’s evaluation/assessment.

What assurance is there that this approach will make a difference?

About schedules, services and supports…

I want more/less time/services for my child.

There are too many /not enough people coming to my home.

I/my partner work and aren’t home during the day.

d. Considerations for scheduling IFSP meetings with families: who, where, when, how and who

Who participates ? (link to Mod 2 session 1e)

A flexible, individualized IFSP for each child/family should be developed by the people who really know a child and/or have spent some time evaluating and assessing a child’s strengths and needs:

Participants Description

Family Parents/legal guardians

Other family members/friends, as requested by parents, if feasible

Early intervention providers

Service coordinator/interim service coordinator

Qualified personnel (at least one) directly involved in a child’s evaluation/assessment *

Providers who will provide EI supports/services, as appropriate


Community agencies/links, as appropriate

Advocate, as requested by parent

Representatives of community agencies and programs, as requested by parent.

* If the early intervention provider(s) directly involved in conducting a child’s evaluation and assessment are unable to attend the IFSP meeting, he or she can participate in one of three ways: by a telephone conference call, having a knowledgeable authorized representative attend, or making pertinent records available for discussion. (link to Mod 2, session 1e)

Where?

An IFSP meeting must be held in a setting that is convenient to the family. (link to mod 2 session 1--

When?

The first meeting to develop an initial IFSP for a child eligible for a Local Infants and Toddlers Program must be conducted within an initial 45-day time period which starts with the initial referral from a parent or other source. The time for the IFSP meeting must be convenient for the family. (link to mod 2 session 1d)

Arrangements for this and all other IFSP meetings, including the periodic and annual reviews, must be made with a family and other participants before the meeting to ensure that they will be able to attend.

How will notice be given?

Prior written notice must be provided to the parent(s) within a reasonable time, as determined or agreed to by the parent(s). The notice must use the native language of the family, or other mode of communication used by the family, unless clearly not feasible to do so. (link to mod 2 session n)

e. Decisions to make with families about what to include on an IFSP

The IFSP is intended to be a flexible document that identifies how early intervention providers and community resources will support a family in their efforts to help their child learn from and participate in everyday activities. It is a family’s guide for reaching their intended outcomes, rather than the providers’ treatment plan with specific outcomes for each discipline.

The IFSP includes family-selected outcomes for a child, and family members (if desired). Functional outcomes are the foundation for the entire IFSP, and describe a child’s and/or family’s actions/interaction within a specific context or activity setting. After functional outcomes are selected, criteria and strategies for achieving each outcome are discussed. Only then can the discussion turn to selecting the early intervention supports and services which can help a family achieve their outcomes. This includes but is


not limited to formal service providers such as educators, therapists, counselors, nurses and social workers.

Table 2.1poses critical decisions to make with families when developing an IFSP and identifies the components mandated by the Individuals with Disabilities Education Act which must be included on an IFSP: (link to mod 2 session 1c)

Table 2.1 IFSP Decisions to make with families

Decisions IFSP Components Why we are providing EI

Outcomes identify what will happen for a child/family

How we will know we have achieved outcomes

Criteria, procedure and timelines to measure progress towards achieving outcomes

What is needed to achieve IFSP outcomes

Methods (strategies) .

Who will providefamily/child supports and services

Formal services/supports from a Local Infants and Toddlers Program, including service coordination and the name of the service coordinator Community linkages to related agencies providing formal supports/services to children and families may also be identified (e.g., health, transportation, housing and informal supports/services such as child care, recreation events, and children’s programs)

Where family/child supports and services will be provided

Natural environment where family/child supports and services will be provided (including a justification if any supports/services cannot be provided in a natural environment)

When, and for how long, family/child supports/services will be provided

Frequency and intensity of family/child supports and services (number of days or sessions, length of each session, group or individual basis) with initiation and projected duration dates

f. The role of service coordinators during development and implementation of an IFSP

The IFSP is a family’s plan for where they want to go and how to get there; it is not a treatment plan for early intervention providers. As identified in the Individuals with Disabilities Education Act, (link to Mod 2 session 1m) service coordinators can play a pivotal role in developing and implementing IFSPs with families by:

Assisting parents of eligible children in gaining access to the early intervention services and other services identified in the individualized family service plan;


Coordinating the provision of early intervention services and other services (such as medical services for other than diagnostic and evaluation purposes) that the child needs or is being provided;

Facilitating the timely delivery of available services; and

Continuously seeking the appropriate services and situations necessary to benefit the development of each child being served for the duration of the child's eligibility.

These responsibilities are delineated in the following service coordination activities:

First contacts

Visit family informally to gather information and develop rapport

Obtain releases of information to facilitate sharing of information and notify referral source that initial contact with the family has been made

Maintain communication with referral sources and other contacts that may be requested by the family

Plan with families for evaluation/assessment and assist families in identifying their priorities, resources and concerns.

Developing an IFSP

Facilitate and participate in the development of the an initial IFSP

Coordinate the completion and dissemination of the initial IFSP documents following confidentiality and time frame guidelines

Ongoing activities

Develop and maintain interagency contacts.

Coordinate and monitor the delivery of services.

Facilitate and participate in periodic review and annual evaluation of the IFSP.

Inform families of the availability of advocacy services.

Assist families to identify their priorities, resources, and concerns throughout the IFSP process.

Facilitate communication between the family, early intervention providers and other formal and informal services/supports.


Facilitate problem solving and collaboration among team members.

Maintain current information regarding services available in the community

Adapted from Nebraska Early Development Network, 2004 (link to http://www.answers4families.org/ifspweb/coordination.html)

While the IDEA requires that service coordination be provided as an active, ongoing process, it does not specify how it should be implemented. Two primary models for providing service coordination are used in Maryland:

1. Blended: the service coordinator provides early intervention services as well as the responsibilities and activities of service coordination, described above.

2. Dedicated: the service coordinator fulfills only the responsibilities and activities of service coordination, described above.

The intended outcome of effective service coordination is for families to understand the formal and informal resources in their community so that they receive appropriate supports and services to meet their individual needs. To accomplish this, service coordinators and other early intervention providers must place families at the center of team decision making. Family members must also be supported in their efforts to enhance their child’s health, development and participation in family and community life, including successful transition to other community resources, as appropriate, at age 3 years. (Research and Training Center on Service Coordination, 2002).

g. Functional outcomes: The guide for early intervention supports and services

Functional outcomes point to where a family “wants to go”. They provide direction for collaboration between family members and early intervention providers about how to reach a family’s desired outcomes. Too often, IFSPs focus only on child outcomes and do not address family supports from early intervention providers and other community resources (Jung & Baird, 2003; Boone et al, 1998; McWilliam et al, 1998). Identifying functional outcomes with families is the cornerstone for developing the IFSP document since the outcomes specify what should happen for families and children as a result of their participation in early intervention.

The following questions guide early intervention providers and family members in identifying functional outcomes that are meaningful, family-desired, specific and “do-able.” Measurable criteria for each outcome is included in a different section of the Maryland IFSP document.

1. Meaningful:

Do the outcomes promote a child’s competence in situations, activities and routines that are meaningful for each family/child?


Meaningful outcomes promote a child’s functioning in three key foundations of early development - social interaction, mastery over environment and engagement in learning- in ways specific to each family/child (McWilliam, 2002; National Research Council, 2000). Examples include:

Social interaction (e.g., understanding & expressing emotions, forming friendships, interacting with family members/peers);

Mastery over environment (e.g., caring for one’s self, navigating spaces and places, using tools, toys and objects purposefully in specific activity settings);

Engagement in learning (e.g., acquiring and using information from body/environment in play and relationships, adapting to familiar and novel people/objects in specific situations, figuring out cause and effect).

These three foundations of early development- social interaction, mastery over environment and engagement in learning- cover the domain-specific skills that have traditionally been identified as child outcomes on IFSPs. Traditional outcomes typically focus on isolated motor, language, social/emotional, cognition, and self-help skills, and often lose sight of the family/community context in which a specific behavior or skill will be used. Meaningful outcomes include a real life context i.e., how and/or where a child or parent will use an identified action or interaction (Rosenketter, & Squires, 2000).

Examples of functional and traditional child outcomes:

Functional outcomes(what child and/or family will do

in a specific context)

Traditional outcomes(focus on child’s skills within a

specific domain) Neena will eat and drink by mouth like other kids during family outings

(For a child who currently has a feeding tube which the parents would love to replace with Nina eating by mouth so the family can go out together)

Neena will improve eating skills

Tommy will tell mom what he wants to eat and play with so that both are happier with each other.

(For a child who does not talk very well and whines and cries when he wants something. His parents are very frustrated trying to understand what he says.)

Tommy will improve expressive language skills or Tommy will say 25 words

Jermaine will walk on his own with family during after dinner outings

(For a child who has increased tone in his legs which interferes with independent walking)

Jermaine will develop motor skills at the 12-14 month level

orJermaine will decrease muscle tone in his legs


Examples of functional outcomes for families:

Paula and Pete will find a wheelchair for Megan and feel comfortable using it during family outings (Megan gets around her home by rolling over and crawling, but has to be carried on family outings. Pete and Paula are interested in using a wheelchair so they can all go out together, and need help with paying for it)

Sylvia will take Paolo to the park and shopping, by herself (Sylvia has a significant visual impairment and wants to “shine” as a parent and take her son to the library, a park or the mall by herself)

2. Family-selected:

Are the outcomes, selected by each family, written in language understood by family members?

IFSP outcomes should be written in language that reflects a family's understanding about “where we are going.” The outcomes reflect how family/child knowledge, skills, actions will help a child participate successfully in family/community life. Early intervention providers can help families with IFSP outcomes by using words that a family might say, rather than the professional jargon understood by early intervention providers (Nebraska Department of Education, Early Development Network, 2004; Rosenkoetter & Squires, 2000).

This does not mean writing down word-for-word what a parent says without trying to understand what they really want to happen. For example, when parents identify a very broad outcome, e.g., they would like their child to “walk” and/or “talk better”, it is helpful to clarify what walking or talking would look like and how a child could participate to a greater extent in family/community life before making it an IFSP outcome.

The following vignette illustrates how Jana, a service coordinator, prompted a mother, Mayra, to think more specifically about the daily activities she hoped her son could participate in more fully during her initial IFSP meeting with the early intervention team.

Mayra, when we first met, you told us that you wanted to help Pedro understand language like other children his age,” summarizes Jana. “When we visited you at home to do his evaluation, we looked at how much Pedro understands and what he said. Then we all talked about what we observed. Now it’s time to think about how we can help you and your husband take care of Pedro.

Mayra responds, “I want him to understand what others say to him, just like his brothers did at his age.”

“That’s important, for sure,” agrees Jana. “Can you tell us a little more about the times you would really like Pedro to understand what people are saying to him?”

“Well, he really likes going to nursery school on Mondays and Wednesdays but has a hard time keeping up with what the teacher says,” explains Mayra. “She plays a song on the tape recorder for snack and Pedro thinks it’s time to go outside. Then when she says it’s time to go back inside after lunch, he runs over to the sandbox. He’s always doing things different than the other


kids.”

Jana (wondering if there are other times this happens) asks, “Do you notice this at home too?”

“Oh, yes! There are some things, like getting up in the morning, eating dinner, that we do the same way most of the time, so Pedro knows what’s happening. But when we change his schedule, or go somewhere only one or two times a week, like nursery school or my sister’s, then he has a hard time keeping up.”

Understanding that Mayra really would like Pedro to fit in with the flow of activities at nursery school, at home and his aunt’s home provides a context for a functional outcome that early intervention providers and family can address together. Without this information, it would be easy to misinterpret what Mayra really means by “understanding language like other children.” So far, she has told us what she thinks about an outcome being:

Meaningful (help Pedro “fit in” at his nursery school and at home)

Specific (Pedro will understand what to do/where to go when given a direction)

Regarding the guideline that a functional outcome be understandable to a family and reflect words that a family might use, an outcome could be worded to reflect Mayra’s desires for Pedro as:

Pedro will join activities with others at home and nursery school by understanding and following directions from his family and teacher.

3. Specific:

Does each outcome identify the positive knowledge, skills and/or actions for a child and/or family members?

Functional outcomes identify specific behavior and/or knowledge that support a child’s and family’s participation in family/community life. Non-specific outcomes are very broad and often use words such as improve, increase, change, decrease etc. (e.g., Mina will improve her fine motor skills; Sara will decrease aggressive behavior). Identifying positive and specific actions and skills is one of the key factors in writing family-centered IFSPs (McWilliam, Ferguson, Harbin, Porter, Munn & Vandiviere, 1998).

Examples of specific outcomes:

Family outcome: Charlotte and Bruce will know how well Sonya hears people and sounds

Family outcome: Darla will be cared for competently in their church nursery while Denise and Denny attend services


Child outcome: Mina will play with small toys and feed herself little bites of finger food

Child outcome: Sara will play with other children her age on playground equipment at her local playground

Child outcome: Chantell will let her family know what she wants and answer simple questions, using words and short phrases

4. “Do-able”:

Can the outcomes reasonably be achieved within 4-6 months?

This guideline for a functional outcome considers whether or not an action, knowledge or skill is “do-able” by a child or family member within 4-6 months, given the child’s expected rate of progress, family routines and current responsibilities and commitments (Rosenkoetter & Squires, 2000). Parents, understandably, often think of things they want for their children that will be achieved in the distant future. It is important for early intervention providers to acknowledge that they accept a family’s long-range goal as guiding their supports and services over the next 4-6 months. (Remember that Jana in the vignette above agreed with Mayra that it was very important that Pedro understand language like his brothers did before asking her to describe it more specifically).

Sometimes a parent insists on an outcome that will probably be achieved in more than a year (e.g., Darla will walk by herself). In order to support a family’s desire for this future outcome, use the parent’s preferred wording in the outcome statement. Then, talk with the family about an intermediate step that is achievable in 4-6 months and record that in the criteria section of the IFSP (e.g., Darla will hold on to furniture or another’s hands and take at least 5 steps, 3x per day).

Table 2.1 provides additional examples of functional outcomes with guidelines for avoiding wording that is broad, negative and/or domain-specific outcomes (link to Table 2.1 Examples of functional outcomes).

h. Assisting families to select functional outcomes

Outcomes identify the aspects of family and community life that parents would like to see their child to participate more fully in. They are not indicators of developmental delays identified by early intervention providers. Outcomes are “owned” by a family and “adopted” by early intervention providers who will provide supports and services to help families achieve their outcomes. This does not mean, however, that all parents have their desired outcomes on the “tips of their tongue.” Asking parents what they want a child to do next, rather than where and how they want a child to participate in family and community life, overemphasizes domain-specific skills separate from a meaningful context defining where and how skills will be used. Evidence about early development emphasizes that a child’s active exploration within multiple contexts, supported by key caregivers, is critical to developing competency. (link to Appendix B


this session)

Assisting a family to identify functional outcomes begins with exploring a child’s and family’s positive interactions and interests (Dunst, Hamby, Trivette, Raab, & Bruder, 2000). Family interests and routines (e.g., gardening, cooking, raising pets/animals, playing musical instruments, visiting friends and family) provide a context for young children. Child and family interests also provide direction for selecting individualized IFSP strategies in support of family-desired outcomes. In the vignette about Pedro, for example, Pedro’s interest in playing with other children in his nursery school suggests key strategies for prompting his receptive language, as identified by his mother.

In addition to interests, prompt family members to talk about the kinds of actions, places and routines they would like to see their child be part of. A Routines-Based Interview (McWiliams, in press) helps focus on functional outcomes versus developmental delays or deficits. (link to www.vanderbiltchildrens.com/uploads/documents/cci_rbi__form_rev.pdf) Other prompts that invite families to think about their interactions and interests include:

Child’s interests Family’s interestsMy child likes it when…

My child gets excited about….

My child likes to do…

Ways my child shows me she/he is interested in something…

My child pays particular attention to…

My child’s favorite place...

My child’s favorite people….

Our family enjoys…

When we have time we like to…

Places we often go….

People we like to spend time with…

Things we do at home for fun…

Things we like to do in our community…

i. Measurable criteria: How we know we have achieved outcomes

Maryland’s IFSP document has a section for recording family-selected outcomes and another section for specifying the criteria for determining when an outcome has been achieved. Criteria should reflect what success in achieving an outcome would look like to family members, and use tracking procedures that family members are comfortable with. The following questions can help family members and early intervention providers discuss and select measurable criteria so that all team members will know when an outcome has been accomplished.

1. What:

Can specific actions and/or behaviors by a child/family be seen and/or heard?


http://www.vanderbiltchildrens.com/uploads/documents/cci_rbi__form_rev.pdf

Measurable criteria track an action or behavior that can be seen or heard reliably by others, and do not require interpretation or guessing to figure out if an outcome has been achieved.

Examples:

Outcome: Hang will communicate with family members by imitating sounds and words and speaking simple words spontaneously

CRITERIA: Hang will say m, p, t at the beginning/end of simple words, with family members in and out of her home

Outcome: Paula and Pete will find a wheelchair for Megan and feel comfortable using it during family outings

CRITERIA: Pete and Paula take Megan out in her wheelchair to the park or shopping at least 2x/week

Outcome: Neena will eat and drink by mouth like other kids during family outings

CRITERIA: Neena will drink a minimum of 4 oz of fluids from a cup and eat 3 spoonfuls of food during family outings

2. Where:

What is the context/activity setting in which the identified action/behavior will be seen or heard?

Criteria should specify where and when to observe a behavior/action, or set a date when an action will be completed. For example,

Outcome: Charlotte and Bruce will know how well Sonya hears people and sounds)

CRITERIA: Parents will have written results from an audiological screening for Sara by March 1, 2004

Outcome: Jermaine will walk on his own with his family on their after dinner walks CRITERIA: Jermaine will keep his hands open for 20 minutes when walking with his parents outside their home, 3 times per week.

Revisiting why this outcome was selected for Jermaine by his parents helps identify criteria that is measurable and simple to track. Jermaine has increased muscle tone which prevented him from walking independently with his family after dinner. His parents felt that one measure of relaxed muscles that would have great meaning for their family was if Jermaine could begin the family walk on his own, like his twin brother.


3. How often?

Is a realistic frequency identified for reviewing an action/behavior?

Specific criteria establishes a realistic reference point for parents, other caregivers and early intervention providers to easily see or hear that an outcome has been achieved. Tracking progress is difficult when criteria is broad, e.g., Jermaine will keep his hands open 75% of the time. Criteria stated in terms of “percentage of time” a child will demonstrate an action or participate can easily be misunderstood because it is not context-based. Will Jermaine keep his hands open 75% of the time he is awake, at rest, during play or while walking with his family? The frequency is easy to track when stated as:

Outcome: Jermaine will walk on his own with his family on their after dinner walks

CRITERIA: Jermaine will keep his hands open for 20 minutes when walking with his parents in and outside their home, 3 times per week

Table 2.2 provides examples of measurable criteria (link to Table 2.2 Measurable criteria ) with guidelines for avoiding wording that is unspecified or too broad.

j. Effective strategies identify how functional outcomes will be achieved

Strategies indicate how specific child and family outcomes desired by families can be achieved. It is particularly important to keep informed about evidence-based practices in early intervention when selecting both initial and continuing strategies for achieving family-selected outcomes. (link to Appendix B in this section )

The questions below guide family members and early intervention providers in choosing effective strategies when an IFSP is initially developed, and later, as ongoing progress is reviewed with a family. Each strategy recorded on an IFSP should address one or more of the following guidelines:

1. Individualization2. Context3. Mastery4. Collaboration

1. Individualization:

Do strategies build on child and family interests?

Children are active participants in their own development, based on their drive to explore and master their environment. Interest-based learning has positive benefits and is an important factor


contributing to a child’s learning and development (Dunst, Hamby, Trivette, Raab & Bruder, 2000; Bruder, Trivette, Raab & McLean, 2001; Nelson, 1999). Strategies should build on family/child interests and activities such as:

routines/special events (e.g., taking a bath, going to a family celebration)

objects/toys/pets (e.g. feeding a family pet,

interactions (e,g, visiting grandma, playing with brother, answering the phone)

hobbies/fun/leisure (e.g., playing/listening to music, squirting hose at one another)

environment (e.g. taking a walk, playing in back yard, planting flowers)

Examples of strategies that build on family/child interests:

Outcome and Criteria Strategies Family outcome:

Sylvia will take Paolo to the park and shopping, by herself

Sylvia will take one trip with Paola to either the library, mall or other community activity by herself within the next 4-6 months

Sylvia will review the mobility training she received at the MD School for the Blind

I/T provider (or linkage service) will accompany Sylvia and Paola to community activities such as the library

Sylvia will identify available transportation and ask family and other community supports to accompany her on a trial run

Child outcome:

Neena will eat and drink by mouth like other kids during family outings

Neena will drink a minimum of 4 oz of fluids from a cup and eat 3 spoonfuls of food during family outings

Family and I/T staff consult with GI doctor about realistic timetable and plan for Neena to drink and eat

I/T providers will share information about oral-motor development with parents and suggest enjoyable hand/mouth games to play with Neena

Family and I/T staff work together to introduce Neena to new foods and liquids and track her likes and dislikes

I/T staff will accompany family on outings to adapt eating suggestions

I/T staff will link family to other families who have a child with a feeding tube to see how they cope and get around in the community


2. Context:

Do strategies build on familiar places, people and routines?

Strategies build on familiar family/community situations and people a family typically interacts with. An effective strategy is part of a child’s and family’s existing (or intended) actions and interactions in every day life. Strategies that are used only during provider-directed therapy or lessons isolate a child and do not take advantage of the numerous opportunities for meaningful interactions with caregivers in environments that are most likely to promote mastery (Dunst, Trivette, Humphries, Raab & Roper, 2001). (link to section a this session)

Examples of strategies that focus on a familiar context:

While reading to Sabrina, her family will emphasize beginning and ending sounds of words (versus producing specific sounds “on command” from an early intervention provider)

I/T staff will show Tallie and her parents how to walk on different surfaces in and out of her home using her walker (versus practicing walking in a therapy session once per week)

3. Mastery:

Do strategies ensure generalization of a child’s actions/interactions in multiple settings and tasks?

Much evidence has accumulated about how very young children learn. (link to section a in this session). Children are active participants in their own development, due to on their drive to explore and master their environment. Even infants are aware of the effects of their own behaviors, and prefer consequences that they can control directly versus those that are uncontrollable. Expanding motor and communication behaviors depends on repetition and practice in meaningful situations with generalization across different settings.

Examples of strategies that encourage mastery of actions/interactions in different places and spaces:

Mom will show grandparents how to relax Hang before her bottle (for a premature infant who is cared for by her grandmother while her mother works)

I/T staff and Dad will look at backpacks with enough support for Dad to take Jamie (for a toddler who enjoys the outdoors and is just learning to sit up)

I/T staff will help parents adapt their bedtime routine so Luci can sleep in places other than her crib (so family can go visiting with Luci who is easily overstimulated in new situations)

LITP will help Veronique (childcare provider) find toys/activities that encourage Kata to play quietly beside other children (for a child who is both social and very distractable)


4. Collaboration:

Do strategies specify “who will do what”?

Shared implementation of strategies by family members, child care and early intervention providers reinforces the evidence-based practice of supporting key adults to promote child learning and development in family and community settings. (link to section A this session) Discussing “who will do what” provides another opportunity to talk with families about the early intervention model of supports and services in natural environments.

Examples of strategies that specify “who will do what”:

I/T staff will model rate of speech for family members when talking to Kyle

Mother will call Dr. – to ask about lactose intolerant formula

I/T staff and mother will explore community networks for child care close to mother’s job

Family and child care provider will hold Neena so she can see what is going on and who is talking

Table 2.3 provides examples of strategies that build on family/child interests and routines in familiar contexts across multiple settings to promote child mastery and parent competence. (link to Table 2.3 Examples of Effective Strategies)


k. Identifying early intervention supports and services

The IFSP is intended to briefly outline which early intervention services will be provided, how a service coordinator can initiate those services, and what actions will be taken by parents. (link to mod 2 session 1a (note 4 in sec. 303.344 content of IFSP) After family/child outcomes, criteria and strategies are selected, the IFSP team can then consider:

1. Who will provide family/child supports and services;

2. When, and for how long, family/child supports and services will be provided; and

3. Where family/child supports and services will be provided.

NOTE: Session 3, Implementing IFSPs with Families, focuses on providing formal and informal supports and services from Part C early intervention programs, related agencies and informal community resources. (link to essential content mod 2 session 3)

1. Who will provide family/child supports and services

There are a variety of professional services and community resources which can assist families and children in reaching their desired IFSP outcomes (Trivette, Dunst & Deal, 1997). Each IFSP team should consider a variety of formal and informal supports, services and resources such as:

Formal supports/services include early intervention services in a local Infants and Toddlers Program funded by the IDEA, as well as from other departments, organizations or programs serving children and families such as parent education classes in a public school or social service agency, health and specialized medical services, or housing options for homeless families.

Informal resources include child care centers, toddler programs in libraries, community service clubs, recreation and sports programs, education programs in parks, nature centers and museums.

When reviewing with families whether formal early intervention supports/services from a local Infants and Toddlers Program would be helpful, the primary consideration of an IFSP team is:

Who has the expertise to assist a family in reaching their desired child/family outcomes?

Expertise refers to the knowledge and experience that any team member, including family members, can contribute. The dialogue should focus on which early intervention provider(s) has the specific knowledge and experience to complement the knowledge and experience of family members so that desired child/family outcomes can be achieved.

It is critical to review all the outcomes and strategies identified by an IFSP team before selecting formal early intervention supports and services. The goal is not to assign a different discipline to each outcome, but to consider:


How are early development foundations of social interaction, mastery of the environment and engagement in learning addressed in child/family outcomes and strategies?

Are specialized skills needed to implement the strategies and supports to reach each outcome?

Who will be the most effective early intervention provider(s) in implementing these strategies supporting a child’s ability to participate in family and community life?

If formal supports/services from a local Infants and Toddlers Program are selected by an IFSP team, the IDEA requires that the specific early intervention services necessary to meet the unique needs of a child and family be identified on their IFSP. (link to mod 2 session 1c) Table 2.4 presents examples of formal and informal supports and services for achieving child and family outcomes. (link to table 2.4 this session)

2. When, and for how long, family/child supports and services will be provided.

The IDEA requires that the frequency, intensity and method of delivery for specific early intervention services be identified on an IFSP, with projected dates for initiation of services and their anticipated duration. (link to mod 2 session 1c)

In selecting the frequency, intensity and method of delivery of early intervention supports/services, the primary consideration for an IFSP team is:

How much support/service is needed to assist family members in reaching their desired outcomes?

To adequately address this question, the IFSP team should think about:

Prioritizing family/child outcomes, especially if a family feels that focusing on one or two outcomes more intensively for an agreed upon period of time would help them manage competing family, personal and work responsibilities. For example, some families may prefer to prioritize outcomes to focus on a child’s feeding, sleep or behavior issues since they often affect the daily rhythms of the entire family.

Flexibility in providing early intervention supports/services. In many instances, one primary service provider can support a family in implementing IFSP strategies with ongoing coaching/consultation from colleagues who have specialized knowledge, skills and experiences that will assist the primary provider and family in reaching desired outcomes.

Table 2.4 presents examples of formal and informal supports and services for achieving child and family outcomes. (link to table 2.4 this session)


3. Where family/child supports and services will be provided

The IDEA requires that the natural environments in which early intervention supports/services will be provided must be identified on an IFSP (link to mod 2 session 1k)

In selecting where early intervention supports/services will be provided, the primary consideration is:

What functional outcomes have been selected by a family, and in what context will they be demonstrated?

Functional outcomes identify the desirable knowledge, skills and/or behavior that a child or family members will acquire to ensure a young child’s successful participation in daily life. (link to section g functional outcomes in this module) The “context” specifies where this knowledge, skills or behavior will occur in selected routines, activity settings, spaces and places that a child and family spend their time, and/or would like to participate in.

These contexts, identified by families, are the natural environments for early intervention services and are the actual situations in which a child will use and master emerging skills. Obvious natural environments are a child’s home and/or child care setting; others include the neighborhood/community spaces and places where families with very young children spend their time participating in activities and interactions with friends, neighbors and other families. (mod 2 session 3a natural environments and activity settings)

Table 2.4 presents examples of formal and informal supports and services for achieving child and family outcomes. (link to table 2.4 this session)

The IDEA also requires that an IFSP include justification of the extent, if any, to which early intervention supports/services will not be provided in a natural environment. (link to mod 2 session 1c) Locations which are not considered natural environments for very young children include hospitals, clinics, private offices and settings/activities in which only children with disabilities attend. The intent of the natural environment mandate is to focus the efforts of early intervention providers on ensuring that young children master and use specific skills and interactions so that they and their family can participate in meaningful situations and activity settings that typically developing children/families engage in. If an IFSP team decides that early intervention services must be provided outside a child’s natural environments, very careful consideration should be given to how and when mastery of the child’s emerging skills in daily situations will be addressed.


Application 2.1 Reviewing program practices:IFSP outcomes, strategies, criteria and supports/services

Review how you and your colleagues developed IFSPs with two families recently. Use the Self-Assessment Inventory: Developing IFSPs with Families in this session to guide your reflection/discussion. (Link to inventory at end of this session) If you are not involved in IFSP discussions with a family, consider interviewing family members or early intervention providers who have participated in them.

After completing the Self-Assessment Inventory, reflect (preferably with colleagues and families) on the following:

1. How do I/we identify IFSP outcomes, criteria, strategies and family/child supports/services with families?

2. How do I/we use information from our initial planning conversation with families to select outcomes, criteria, strategies and supports/services? (link to Mod 1 session 2a) How do I/we use data (collected using multiple methods) from a child’s evaluation and assessment to select outcomes, criteria, strategies and supports/services? (link to Mod 1 session 3d key components/methods)

3. Do I/we describe and implement our process for developing IFSPs with families in similar ways? Is the same process used consistently throughout all regions of our Infants and Toddlers Program?

4. How do I/we help families understand the process for developing IFSPs that are meaningful for their family? How do I/we support families in making decisions related to where and how they want a child to participate in family and community life, and how to accomplish this?

5. Do key community partners and referral sources understand how I/we develop IFSPs with families?

6. Do I/we need continuing education about developing IFSPs with families? If so, what specifically would be helpful?


Application 2.2Developing functional outcomes, measurable criteria and individualized

strategies

Review the examples of traditional IFSP outcomes, criteria and strategies for Sandi, Manny, Jacob and Lurindell. Reword each example to reflect:

functional outcomes ; (link to section g this session)

measurable criteria ; (link to section i this session)

individualized strategies ; (link to section j this session)

Information about Sandi and her family: Sandi is 19 months old and is just starting to cruise around holding on to furniture and loves going outside in her stroller for walks. She is not very interested in playing with small toys or feeding herself but she does like to eat when someone feeds her. Sandi goes to family child care each day while her parents work.

Examples Outcomes Criteria Strategies

Traditional Sandi will improve her fine motor skills

Sandi will eat independently at least 80% of the time

Teacher will work with child/family to increase activities for carryover in the home

Family-generated

Compare your outcomes, criteria and strategies with suggestions provided in Table 2.5 (link to Sandi in Table 2.5 at end of this session)


Application 2.2 con’t

Developing functional outcomes, measurable criteria & individualized stategies

Information about Jacob and his family: Jacob is 22 months old and spends his day at home with his mother and 4 year old sister. He likes to play with toy trains and anything that his older sister is doing (much to her annoyance). Jacob’s family really like him to say what he wants rather than grunting and pointing.

IFSP Examples

Outcomes Criteria Strategies

Traditional Jacob will talk using simple words

Therapist checklist Language stimulation activities

Family-generated

Compare your outcomes, criteria and strategies with suggestions provided in Table 2.6 (link to Jacob in Table 2.6 at end of this session)




Information about Manny and his family: Manny is 12 months old and wants to be carried everywhere, even though he can stand up by hanging on to someone or furniture. Manny’s family lives by the Chesapeake Bay and spends as much time as possible fishing, swimming and boating. Manny has two older sisters who are in elementary school and are devoted to helping to take care of him.

IFSP Examples


Traditional Parent would like Manny to do more pull to stand w/weight bearing and cruise on furniture

Manny will pull to stand using a ½ kneel position, 2x daily

PT once per week

Family-generated

Compare your outcomes, criteria and strategies with suggestions provided in Table 2.7 (link to Manny in Table 2.7 at end of this session)




Information about Lurindell and her family: Lurindell is 2 1/2 years old and has been attending a child care center sponsored by her parent’s employer. Lurindell enjoys the activities at the child care center, especially the outside play area and the water table. Her parents have been informed that unless Lurindell can interact with other children appropriately, they will have to make other child care arrangements. Lurindell has a seizure disorder which is fairly well controlled by her medication.

IFSP Examples


Traditional Lurindell will stop kicking and biting

Parent/therapist observation

Behavior management program

Family-generated

Compare your outcomes, criteria and strategies with suggestions provided in Table 2.8 (link to Lurindell in Table 2.8 at end of this session)


Application 2.3Addressing concerns families may have about developing IFSPs

Reflect on the following concerns (often unspoken) families may have and consider responses that families would find helpful. Review any information sheets or “Frequently Asked Questions” for families that may be available in your Infants and Toddlers program. It is recommended that family members, early intervention providers and administrators work together to draft responses that are family-friendly and reflect Maryland Infants and Toddlers Program policies. Use this opportunity to ask family members, advocates, and family support coordinators about other concerns families may have, and draft responses to these questions also.

About a child’s development….

Will my child ever be able to …..?

Why isn’t my child developing like other children?

I don’t know what my child can do.

I’m not sure about my child’s diagnosis, so why do all this now?

About participating in early intervention…

Will this help me/my family cope, learn what to do about……?

What if all this doesn’t help my child to ….?

I don’t know if I accept the results of my child’s evaluation/assessment.

What assurance is there that this approach will make a difference?

About schedules, services and supports…

I want more/less time/services for my child.

There are too many /not enough people coming to my home.

I/my partner work and aren’t home during the day.


Application 2. 4Evidence-based practices: EI in Natural environments

Review the evidence for providing early intervention supports and services in natural environments and consider: (link to section a –“Why provide family/child support this section)

How do you apply evidence-based practices to guide your discussion with families about IFSP outcomes, criteria, strategies and supports/services?

Evidence-based practice Prompt Example


Who are a child’s primary caregivers, and how do they spend their time together?

How do I support caregivers to make IFSP decisions, in ways meaningful to each person?


How do I solicit and build on child and family interests for selecting strategies?

New motor and communication behaviors are learned with repeated opportunities for practice in meaningful situations across different settings.

How do I vary settings, strategies, people and places, so a child really “owns” his or her actions and interactions, and uses them to participate in family/community life?

Knowledge/resources are shared with a child’s key caregivers through supportive adult-adult relationships

How do I help caregivers build their competency rather than direct children in “hands-on” sessions by myself?


Recommended Reading: Developing IFSPs with Families

Law, M. (2000). Strategies for implementing evidence-based practice in early intervention. Infants and Young Children, 12(2), 32-40.

This article focuses on specific strategies that can be used to support an evidence-based early intervention practice. Methods are described about gathering information from the literature, to review research studies critically, and to summarize research information for practice.

McWilliam, R., Ferguson, A., Harbin, G., Porter, P., Munn, D., & Vandiviere, P. (1998). The family-centeredness of Individualized family service plans. Topics in Early Childhood Special Education, 18(2), 69-82.

This study assess the validity of a rating scale of how family-centered an IFSP is and includes a detailed Appendix with characteristics such as writing style, active voice, positiveness, judgment, specificity, and context-appropriateness. Examples of family-centered and non-family centered IFSPs are also provided in the Appendix.

National Research Council and Institute of Medicine (2000). From neurons to neighborhoods: The science of early childhood development. Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah Phillips, eds. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. D.C.: National Academy Press. (see www.nap.edu/execsumm/0309069882.html for an executive summary) (link to this website)

This extraordinary report regarding research and evidence-based practices supporting early learning and development was produced by a committee of 17 researchers and clinicians with backgrounds in neuroscience, psychology, child development, economics, education, pediatrics, psychiatry and public policy. Their charge was to review all research about the nature of early development and the influence of early experiences on children’s health and well-being, to separate established knowledge from erroneous popular beliefs, and to examine the implications of the science base for policy, practice, professional development, and research.

Rosenkoetter, S. & Squires, S. (2000). Writing outcomes that make a difference for children and families. Young Exceptional Children, 4(1), 2-8.

This early intervention provider/parent team offers guidelines for developing the “heart of the IFSP”, the outcome statements which map the path the team members will take together. The authors pose six questions for evaluating outcomes:

1. Do we know why we’re writing this?2. Does this outcome mesh with activities that the family chooses to do?3. Have we explored informal, natural and community-based supports to determine

whether they might accomplish developmental aims, rather than automatically listing more restrictive options?


4. Who will pay or provide?5. Is the outcome written in language the family might use, rather than professional jargon?6. Does this outcome really matter to this child and family?

Especially for families:

Nebraska Department of Education, Early Development Network. www.answers4families.org/ifspweb/outcomes.html .

Nebraska’s online discussion of the IFSP provides a clear summary of information for families about developing an IFSP for their children as well as other topics of interest to families.

Squires, S. (2000). Our family’s experience: An important outcome achieved. Young Exceptional Children, 4(1), 9-11.

This article was written by a parent of four children (one of whom has cerebral palsy). Squires illustrates how the IFSP process was used to develop outcomes and strategies to educate the nursery caregivers in the family’s church to integrate her twin girls in the nursery group during church services. One of the girls enjoyed a new social opportunity, her twin was freed from translating her sister’s needs, and the rest of the family participated in church services knowing that both girls were safe and happy.


http://www.answers4families.org/ifspweb/outcomes.html

Self-Assessment Inventory: Developing IFSPs with families

Review your competency in developing functional outcomes, effective strategies, measurable criteria and informal/formal supports and services with families by checking

the appropriate column for each category.

Where are we going with families?

Functional outcomes are:

I need moresupport

I have basic skills

I do this very well

Specific: Identifies knowledge, skills or actions to be demonstrated by child or family

Meaningful: address a child’s participation in particular family/community activities/routines

Family-selected: identified by parents and written in language understood by family

Do-able: Can reasonably be accomplishedwithin 4-6 months

How will a family know they are “there”?

Measurable criteria specify:

I need moresupport

I have basic skills

I do this very well

What: Actions/behavior of a child can be seen or heard

Where: Specifies a context for observing actions/behavior

How often: States realistic frequency for demonstrating action/behavior


Self-Assessment Inventory: Developing IFSPs with families (con’t)

How can we help a family get “there”?

Effective strategies address:

I need moresupport

I have basic skills

I do this very well

Individualization: Builds on interests and learning style of child and family

Context: Focuses on familiar people, activity settings and routines

Mastery: generalizes a child’s actions & interactions across family/community settings Collaboration: Identifies what EI providers, family, community linkages will do

What resources can a family use & where?

EI supports/services include:

I need moresupport

I have basic skills

I do this very well

Formal supports/services: PART C (therapy, counseling, service coordination, special instruction, nursing etc) and related agencies (social service, medical/health, mental health etc)

Informal resources within family/community networks (child care, libraries, religious events, Kiwanis, nature centers, YMCA etc.)


Appendix A. About evidence-based practice

Early intervention providers must critically evaluate the effectiveness of the assessment procedures and interventions they use in their daily practice with children and families. Evidence-based practice is guided by research results and,

“in no way advocates throwing the clinical experience of established practitioners out the window…Evidence-based practice’s central message here is one of flexibility and of being able to blend the old ways with the fruits of research and new knowledge.” (Law, 2002, p.5).

References: Evidence-based practice across disciplines

Dunst, C., Trivette, C. & Curspec, P. (2002). An evidence-based approach to documenting the characteristics and consequences of early intervention practices. Centerscope, 1(2), 1-6. (www.researchtopractice.org)

Gambrill, E. (1999). Evidence-based practice: An alternative to authority based practice. Families in society: the Journal of Contemporary Human Services, 80, 341-350.

Geddes, J., Reynolds, S., Streiner, D., & Szatmari, P. (1997). Evidence based practice in mental health. British Medical Journal, 315, 1483-1484.

Greenhalgh, T.(1997). How to read a paper: The basics of evidence-based medicine. London: BMJ Press.

Law, M. (2000). Strategies for implementing evidence-based practice in early intervention. Infants and Young Children, 12(2), 32-40.

Law, M. (2002).(Ed). Evidence-based rehabilitation. Thorofare, NJ: Slack Inc.

Melnyk, b., Fineout-Overholt, E., Stone, P., & Ackerman, P. (200). Evidence based practice: The past, the present, and recommendations for the millennium. Pediatric Nursing, 26, 77-80.

Occupational therapy: www.fhs.mcmaster.ca/rehab

Physical therapy: http://ptwww.cchs.usyd.edu.au/pedro

Reilly, S., Perry, A., Douglas, J., & Oates, J. (2001). Evidence based practice in speech pathology. London: Whurr.

Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence-based medicine: What it is & is not. British Medical Journal, 312, 71-2.


http://ptwww.cchs.usyd.edu.au/pedro

http://www.fhs.mcmaster.ca/rehab

http://www.research/

Appendix B Evidence-based practices supporting early intervention in natural environments

Evidence from interdisciplinary sources (early childhood, neuroscience, occupational and physical therapy, speech-language pathology, social sciences, medicine and nursing) provides critical support for early intervention in natural environments, as follows:


Atkins-Burnett, S. & Allen-Meares, P. (2000). Infants and toddlers with disabilities: Relationship-based approaches. Social Work, 45(4), 371-377.

Commission on Children at Risk. (2003). Hardwired to connect: The new scientific case for authoritative communities. New York, NY: Institute for American Values.

Gunnar, M, Brodersen, L., Krueger, K., & Rigatuso, R. (1996). Dampening of behavioral and adrenocortical reactivity during early infancy: Normative changes and individual differences. Child Development, 67: 877:889.

Meisels, S. Dichtelmiller, M. & Liaw, F. (1993). A multidimensional analysis of early childhood intervention programs. In Handbook of Infant Mental Health. New York, NY: Guildford Press.

Schore, A. (2003). Quoted in Hardwired to Connect: The new scientific case for authoritative communities (p. 16). New York, NY: Institute for American Values.

Shore, R. (1997). Rethinking the brain. NY: Families and Work Institute.

Thompson, R. (1999). Early attachment & later development. In Cassidy & Shaver (Eds), Handbook of Attachment: Theory, Research & Clinical Applications (pp. 265-286). NY: Guilford Press.

Weston, D. Ivins, B. Heffron, M. & Sweet, N. (1997). Formulating the centrality of relationships in early intervention: An organizational perspective. Infants and Young Children, (9)3, 1-12.


Chandler, B. (Ed.) (1997). The essence of play: A child's occupation. Bethesda, MD: The American Occupational therapy Association, Inc.

Dalgeish, T. & Power, M. (1999) (Eds.) Handbook of cognition and emotion. New York: NY: John Wiley and Sons.

Dunst, C. J., Bruder, M. B., Trivette, C. M., Raab, M., & McLean, M. (2001). Natural learning opportunities for infants, toddlers, and preschoolers. Young Exceptional Children, 4(3), 18-25.


Hamilton, V., Bower, G., & Fridja, N. (!988). (Eds.) Cognitive perspective on motivation and emotion. NATO Asi Series, Series D, Behavioral and Social Sciences Vol. 44. New York,, NY: Kluwer Academic Publications.

Mandler, J. (2000). Perceptual and cognitive processes in infancy. Journal of Cognition and Development, 1, 3-36.

National Research Council and Institute of Medicine (2000). From neurons to neighborhoods: The science of early childhood development. Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah Phillips, eds. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. D.C.: National Academy Press. (see www.nap.edu/execsumm/0309069882.html for an executive summary)

Parritz, R., Mangelsdork, S., & Gunnar, M. (1992). Control, social referencing and the infant’s appraisal of threat. In S. Feinman (Ed). Social referencing and the social construction of reality in infants (pp. 209-228).

New motor and communication behaviors are learned and used when a child has repeated opportunities for practice in meaningful situations with generalization of skills across different settings.

Dunn, W., Brown, C., McGuigan, A. (1994). The ecology of human performance: A framework for considering the effect of context. American Journal of Occupational Therapy, 48, 595-607.

Eiserman, W., McCoun, M. & Escobar, C. (1990). A cost-effective analysis of two alternative program models for serving speech-disordered preschoolers. Journal of Early Intervention, 14(4), 297-317.

Greenough, W. (1987). Experience and brain development. Child Development, 58, 539-59.

Heriza, C,. & Sweeney, J. (1994). Pediatric physical therapy: Part I. Practice scope, scientific basis and theoretical foundation. Infants and Young Children, 7(2), 20-32.

Lewthwaite, R. (1990). Motivational considerations in physical activity involvement. Physical Therapy, 70, 808-819.

MacLean, P. (1990). The triune brain in education. New York, NY: Plenum Press.

McEwen, I. & Shelden, M. (1995). Pediatric therapy in the 1990s: The demise of the educational vs. medical dichotomy. Physical & Occupational Therapy in Pediatrics, 15(2), 33-45.

McLean, L. & Woods Cripe, J. (1997). The effectiveness of early intervention for children with communication disorders. In M. Guralnick (Ed), The effectiveness of early intervention (pp 349-428). Baltimore: Paul H. Brookes.

Schmidt, R. & Lee, T. (1999). Motor control and learning: A behavioral emphasis (3rd edition).


Champaign, IL: Human Kinetics.

The knowledge and resources of early childhood specialists are shared with a child’s key caregivers through adult-adult relationships that support family members in their day-day responsibilities caring for their children.

Bricker, D, Pretti-Frontczak, K, & McComas, N.(1998). An activity-based approach to early intervention (2nd edition). Baltimore: Brookes Publishing Co.

Dunst, C. J. (2001). Participation of young children with disabilities in community learning activities. In M. Guralnick (Ed.), Early childhood inclusion: Focus on change (pp. 307-333). Baltimore: Brookes

Dunst, C. J., Hamby, D., Trivette, C. M., Raab, M., & Bruder, M. B. (2000). Everyday family and community life and children’s naturally occurring learning opportunities. Journal of Early Intervention, 23, 151-164.

Hanft, B., Rush, D., & Shelden, M (2004). Coaching families and colleagues in early childhood. Baltimore, MD: Brookes Publishing.

Mahoney et al (1999). Parent education in early intervention. Topics in Early Childhood Special Education, 19(3), 131-140.

Marvel, M. Epstein, R., Flowers, K., Beckman H. (1999). Soliciting the patient’s agenda: Have we improved? JAMA, 281, 283-287.

National Research Council and Institute of Medicine (2000). From neurons to neighborhoods: The science of early childhood development. Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah Phillips, eds. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. D.C.: National Academy Press. (see www.nap.edu/execsumm/0309069882.html for an executive summary)

Odom, S. Favazza, Brown & Horn, E. (2000). Approaches in understanding the ecology of early childhood environments for children with disabilities. In Behavioral observation: Technology and application in developmental disabilities (pp. 193-214). Baltimore: Brookes.


References for essential content

Boone, H., McBride, S., Swann, D, Moore, S. & Drew, B. (1998). IFSP practices in two states: Implications for practice. Infants and Young Children, 10(4), 36-45.

Bruder, M. (2000). The Individual Family Service Plan. ERIC Early Childhood Digest # E605. Arlington, VA: ERIC Clearinghouse on Disabilities and Gifted Education.

Dunst, C., Trivette, C., & Deal, A. (1997). Resource-based approach to early intervention. In S. Thurman, J. Cornwell & S. Gottwald (eds), Contexts of early intervention: Systems and settings (pp.73-92). Baltimore, MD: Paul H. Brookes.

Dunst, C. J., Hamby, D., Trivette, C. M., Raab, M., & Bruder, M. B. (2000). Everyday family and community life and children’s naturally occurring learning opportunities. Journal of Early Intervention, 23, 151-164.

Dunst, C., Trivette, C., Humphries, T., Raab, M. & Roper, N. (2001). Contrasting approaches to natural learning environment interventions. Infants and Young Children, 14(2), 48-63.

Grisham-Brown, J. Hammeter, M.L. (1998). Writing IEP goals and objectives: Reflecting an activity-based approach to instruction for children with disabilities. Young Exceptional Children, 1(3), 2-10.

Jung, L. & Baird, S. (2003). Effects of service coordinator variables on individualized family service plans. Journal of Early Intervention, 25(3), 206-218.

McWilliam, R., Ferguson, A., Harbin, G., Porter, P.,Munn, D., & Vandiviere, P. (1998). The family-centeredness of Individualized family service plans. Topics in Early Childhood Special Education, 18(2), 69-82.

McWilliam, R. Routines-based therapy: Integration of ancillary services and instruction for early childhood. Presentation at NECTAS Early Childhood Conference, Washington D.,C. October 23, 2002.

McWilliam, R. A. (in press). Assessing the resource needs of families in the context of early intervention. In M. J. Guralnick (Ed.), A Developmental systems approach to early intervention: National and international perspectives. Baltimore, MD: Paul H. Brookes Publishing Co.

National Research Council and Institute of Medicine (2000). From neurons to neighborhoods: The science of early childhood development. Committee on Integrating the Science of Early Childhood Development. Jack P. Shonkoff and Deborah Phillips, eds. Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences and Education. D.C.: National Academy Press.

Nebraska Department of Education, Early Development Network. Downloaded from www.answers4families.org/ifspweb/outcomes.html March, 15, 2004.

Pretti-Frontczak, K., & Bricker, D. (2000). Enhancing the quality of individualized education plan (IEP) goals and objectives. Journal of Early Intervention, 23(2), 92-105.

Pretti-Frontczak, K, (2003). Developing team-based meaningful IFSPs/IEPs. Presentation at Great Beginnings, October 24-25, 2003, Marlboro, Massachusetts.


http://www.answers4families.org/ifspweb/outcomes.html

Rosenkoetter, S. & Squires, S. (2000). Writing outcomes that make a difference for children and families. Young Exceptional Children, 4(1), 2-8.


Table 2.1 Examples of functional outcomes

Functional outcomes avoid: How to modify: Examples of functional outcomes

Broad developmental goals such as:

Brian’s behavior will improve Katya will develop age appropriate gross motor skills

Specify a parent/child action, skill, or knowledge and how it will enhance a child’s participation in family/community life

Brian will sit quietly and look at a book during bedtime stories

Katya will watch her brother’s soccer games by standing up and holding on to bleachers and/or people

Separate goals for each developmental domain:

Babacar will: roll over (motor domain)

use sounds to express himself (language domain)

make choices when presented with two items (cognitive domain)

play with brothers (social- emotional domain)

Select outcomes that address family selected routines & activities that promote social interaction, mastery of the environment, and engagement in learning

Babacar will:

Play next to his sister by rolling across the room to reach her

Choose what he wants to do/eat/wear by using specific sounds for “yes” and “no”

Listing skills only:

Shawna will hold her head up 90° and maintain her position for awhile

Dante will walk up and down stairs

Show how action/interaction will help a child participate in family/community life

Shawna will watch videos and play with her sister by holding her head up

Dante will go outside to play or get in the car by walking up and down the stairs

Negative outcomes:

Lars will stop throwing toys and other items on the floor

Lily will decrease her sensitivity to light touch

Emphasize the positive actions/skills a family wants to replace the negative ones with

Lars will help clean up after play by picking up his toys/objects

Lily will enjoy washing her hands, hair and face


Table 2.2 Examples of measurable criteria

Measurable criteria avoid: How to modify: Examples of measurable criteria

Unspecified action/behavior

Jacob will make sounds

Jacob will respond to sounds in environment

Actions/behavior of a child can be seen and/or heard within a given context

Jacob will use the same sound to name each family member, 2 days in a row

Jacob will smile and turn when called by name by family members during play periods, 2 days in a row

Broad criteria


Family and therapist observation; therapist checklist

Specify a context for observing a skill/behavior

State frequency for demonstrating action/behavior within a specific time period

Sandi will use a spoon to feed herself for at least 10 minutes during each evening meal

Sandi will use a spoon to feed herself for at least 10 minutes during each evening meal


Table 2.3 Examples of collaborative strategies

Functional outcome for the examples of strategies in Table 2.7:

Babacar will choose what he wants to do by using specific sounds for “yes” and “no”

Collaborative strategies avoid:

How to modify: Examples of collaborative strategies

Vague/broad suggestions about what to do

Language stimulation

Family and service provider will continue to work on strategies and activities to increase skills in the home

Think about what is needed to help:

a child generalize actions/interactions across settings;

caregivers build competency, appropriate to their role.

Family will pair sounds with words “yes/no” when talking to Babacar and one another

EI provider will explore with parents/childcare provier what prompts, activities and interactions help Babacar use his sounds

Mom will show grandparents/babysitter how to prompt sounds from Babacar when feeding him

Formal EI services (in the strategy section of the IFSP)

Enroll in speech-language therapy

Physical therapy 1x/week

Strategies are not formal services, but could include family supports by EI providers

Strategies indicate how the entire IFSP team will work on achieving outcomes.

EI provider will go to the store with mom and Babacar to show how to help him use his sounds

See above examples about how parents, siblings, grandparents and EI providers can collaborate on goals

Unclear who will do what

Teacher will work with child/family to increase skills and provide activities for carryover in the home

Ideas for encouraging language at home activities

Completing the IFSP “Strategy” section is another opportunity to talk about the benefits of formal and informal services/supports to help a child participate in family & community life (the intent of EI in natural environments)

See examples above and:

EI provider will share info about parent-parent support networks

Dad/brothers will play with Babacar at the pool and in bathtub (child loves water)


Table 2. 4 Possible formal and informal supports/services for a family outcome and a child outcome

Family Outcome and Criteria

Strategies Options for early intervention supports/services

Outcome: Sylvia will take Paolo to the park and shopping, by herself

Criteria: Sylvia will take one trip with Paola to either the library, mall or other community activity by herself within the next 4-6 months

Sylvia will review the mobility training she received at the MD School for the Blind

I/T provider will accompany Sylvia and Paola to community activities such as the library

Sylvia will identify available transportation options and ask family and other community supports to accompany her on a trial run

Depending on their knowledge/experience any one of the following EI providers could support Sylvia in achieving this outcome:

Family support coordinatorOccupational therapist Social worker Special educator Physical therapist Other formal and informal services to support outcomes:

MD School for the BlindExtended family/friendsLibrary program for children

NOTE: In selecting services to help implement this family’s IFSP, all outcomes and strategies on Paolo’s IFSP should be reviewed.

The frequency and intensity of services should be chosen after discussion with Sylvia about how much support she desires to navigate the transportation system and reach her destination while attending to her son’s needs. Will Paolo need a stroller? Is he walking on his own? How far and how long? How easy will it be to address his toileting and eating needs while Sylvia and Paola are outside their home?

The natural environments in which supports/services would be provided to meet this outcome are the public library or shopping mall and the selected transportation method identified by Sylvia (bus, taxi, walking).

Child Outcome and Criteria

Strategies Options for early intervention supports/services

Outcome: Neena will eat and drink by mouth like other kids during family outings

Family and I/T staff consult with GI doctor about realistic timetable and plan for Neena to drink and eat

I/T providers will share information about oral-motor development with parents and

Depending on their knowledge/experience any one of the following EI providers could support Neena’s family in achieving this outcome:

Occupational therapist


Criteria: Neena will drink a minimum of 4 oz of fluids from a cup and eat 3 spoonfuls of food during family outings

suggest enjoyable hand/mouth games to play with Neena

Family and I/T staff work together to introduce Neena to new foods and liquids and track her likes and dislikes

I/T staff will accompany family on outings to adapt eating suggestions

I/T staff will link family to other families who have a child with a feeding tube to see how they cope and get around in the community

NurseSpecial educatorSpeech-lang pathologist

Other formal and informal services to support outcomes:

PediatricianGastroenterologistParent-parent support

NOTE: In selecting services to help implement this family’s IFSP, all outcomes and strategies on Neena’s IFSP should be reviewed at the same time.

The frequency and intensity of services should be chosen after discussion with Neena’s parents about how much support/services would be needed to implement the strategies identified above. It may be that the early intervention provider suggested above with the most experience/knowledge in helping children learn to eat by mouth could work with Neena and her parents in a flexible schedule (e.g.,2x/week for 6 weeks, and then visit once per week for another 8 weeks) until the parents are ready to try a family outing.

The natural environments in which supports/services would be provided to meet this outcome are the family home (to begin weaning Neena off tube feedings) and the community destinations chosen by Nina’s family, when they are ready to go out with her.


Table 2.5 Examples of traditional and family-centered IFSP outcomes, criteria and strategies

Information about Sandi and her family: Sandi is 19 months old and is just starting to cruise around holding on to furniture and loves going outside in her stroller for walks. She is not very interested in playing with small toys or feeding herself but she does like to eat when someone feeds her. Sandi goes to family child care each day while her parents work.

IFSP Examples


Traditional

Sandi will improve her fine motor skills


Teacher will work with child/family to increase activities for carryover in the home

Family-generated

Sandi will feed herself using her hands to finger feed and hold a spoon

Sandi will feed herself at least 6 mouthfuls at each meal using her fingers and a spoon

Mom and EI Provider will review Sandi’s favorite foods, various baby utensils and how to make eating enjoyable for Sandi

Mom and EI Provider will explore with child care provider how to help Sandi feed herself

NOTE:

Examples of formal and informal supports and services to guide Sandi’s family in achieving this outcome are discussed in Session 3. (Link to Mod 2 session 3--)



Information about Jacob and his family: Jacob is 22 months old and spends his day at home with his mother and 4 year old sister. He likes to play with toy trains and anything that his older sister is doing (much to her annoyance). Jacob’s family would most like him to express his needs with words rather than grunts and pointing.

IFSP Examples


Traditional Jacob will use fluent speech

Therapist checklist Language stimulation activities

Family-generated

Jacob will speak clearly to tell parents what he wants to eat during meals

Jacob will make choices speaking at least 8 words clearly during meals/snacks

Mom will serve Jacob’s favorite foods

EI provider will model how to say words slowly and clearly when talking to Jacob

Mom and EI provider will identify a list of simple → harder to say words for Jacob to say during meals/snack/play

Mom and EI provider will explore play activities with Jacob and his sister using food (cooking, loading food on toy trains etc)

NOTE:

Examples of formal and informal supports and services to guide Jacob’s family in achieving this outcome are discussed in Session 3. (Link to Mod 2 session 3--)



Information about Manny and his family: Manny is 12 months old and wants to be carried everywhere, even though he can stand up by hanging on to someone or furniture. Manny’s family lives by the Chesapeake Bay and his dad owns his own shrimp boat. Manny has two older sisters who are in elementary school and are devoted to helping to take care of him.

IFSP Examples


Traditional Parent would like Manny to do more pull to stand w/weight bearing and cruise on furniture

Manny will pull to stand using a ½ kneel position, 2x daily

PT once per week

Family-generated

Manny will play with his favorite toys while standing and moving around his home and community

Manny will use environmental supports as needed to stand and move around to play at home & one community setting within (give date within 4-6 months)

Family will put toys on sofa/chairs/shelf for Manny to reach for his toys/books/objects

Manny will dance and sway to music holding his sisters’ hands

EI Provider will model physical prompts & supports to encourage Manny to move and explore his surroundings

Mom and EI provider will visit community settings (e.g., park, beach, fishing pier, family boat) with Manny to identify ways to motivate him to move

NOTE: Examples of formal and informal supports and services to guide Manny’s family in achieving this outcome are discussed in Session 3. (Link to Mod 2 session 3--)



Information about Lurindell and her family: Lurindell is 2 /12 years old and has been attending a child care center sponsored by her parent’s employer. Lurindell enjoys the activities at the child care center, especially the outside play area and the water table. Her parents have been informed that unless Lurindell can interact with other children appropriately, they will have to make other child care arrangements. She has a seizure disorder which is fairly well controlled by her medication.

IFSP Examples


Traditional Lurindell will stop kicking and biting

Parent/therapist observation

Behavior management program

Family-generated

Lurindell will play with her own toys when near another child

For at least 10 minutes, without hitting, biting or pushing

EI Provider, child care teacher and Mom will identify and address “triggers” for Lurindell’s undesired behavior at home and child care

EI provider, Mom and child care teacher will explore what Lurindell understands and can respond to Parents will talk to pediatrician about reviewing Lurindell’s current medication

NOTE:

Examples of formal and informal supports and services to guide Lurindell’s family in achieving this outcome are discussed in Session 3. (Link to Mod 2 session 3--)


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