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Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
What We Will Do Today
• Review Overall Program for 2010‐11
• Learn about the Competency Training for Providers
• See How We are Doing in Implementing A Quality Service Approach
• Supervisor Project
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
• Supervisor Project
• Questions ‐‐ Discussion
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Via A TransdisciplinaryA h f P idi
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Approach for Providing Services
• Meaningful Outcomes• Teaching & Learning Interventions
– Directed to Child by Another PersonDirected to Child by Another Person– Directed to Environment via adaptations & AT
• Teaching Caregivers (to use interventions embedded within activities & ti )
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& routines)• Progress Monitoring & Decision Making
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What is the difference between skill performance and participation ?
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Skill performance means ‐‐‐
• Ability to do something wellsomething well
• Competence
• Excellence in execution
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
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Participation Means ‐‐the fact of taking part
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Children are included when they are able to Children are included when they are able to participate in typical activities and routinesparticipate in typical activities and routines
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Inclusion occurs when people participate in activities & routinesparticipate in activities & routines
that take place in various settings likeHome
Community Child Care
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Child Care
Name the routine that providers most frequently use with infants and toddlers?
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h h 2 fWhat are the 2 most frequent routines that caregivers do with infants and toddlers?
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Activities & Routines At Home
• Activities – things that families do together like outings, errands, chores, outdoor play, etc.
• Routines – things that occur regularly each day like morning and evening (bedtime) routines, mealtimes, indoor play/activity
• Some routines/activities go well,
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
some not.
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So – how do we ensure participation for each child?
Embed adaptation & Assistive Technology (AT)
interventions into Activities
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
interventions into Activities & Routines
First Step: Assess Activity & Routine Participation
• What environments or settings?g
• What activities & routines?
• Who are the “first hand” reporters?
• How do early intervention, special education related services personnel
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education, related services personnel get information from the “first hand” people?
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Ask about Activities & Routines• Ask families or caregivers
• Ask child caregivers
• Observe• Observe
Find out about Adult Perceptions of Children’s Functional Skills
• Communication
• Socialization
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• Socialization
• Getting Around
• Using arms and hands
Caregiver Assessment of Activities & Routines
DIRECTIONS FOR THE CAREGIVER ASSESSMENT AS AN INTERVIEW/CONVERSATION:
1. Ask the caregiver open ended questions about each activity/routine. For example, start by saying “tell me about bathtime and how your child participates during bathtime.” Follow‐up by asking additional questions so that you gain an understanding, a picture, of what the routine or activity looks like. Then ask the caregiver to rate the child’s participation in terms of the caregiver’s expectations (e.g., exceeds, meets, occasionally meets, does not meet). If you wish, you may ask the p p g p ( g , , , y , ) y , y ycaregiver about how satisfied they are with how the activity/routine is going. For some families, this helps them to decide the routine on which they may want to focus.
2. Ask the caregiver to rate their child’s use of functional skills (e.g., socializing, communicating) within activities and routines and their satisfaction with the child’s abilities. You are not trying to find out about the child’s deficit (e.g., speech) but rather the extent to which problems with speech interfere with a child’s participation.
3. Identify any routines which may not be going well (so that you can help families make them go better); Identify routines that are positive for families/children as these will provide a context in which to show families how to teach their children identified skills
EXPECTATIONS SATISFACTION
ROUTINE/ACTIVITY
Exceeds
Meets
Occasionally
Meets
Does not meet
COMMENTS
Very
Is OK
Somewhat
Not
Did Not Ask
BATHTIME
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BATHTIME
MORNING ROUTINE (getting up, getting dressed, etc.)
NIGHT TIME (getting ready for bed, going to bed, sleeping)
D
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What can you learn?• Adults’ (e.g., caregivers, teachers, parents, etc.) perspectives
• What goes well (is pleasurable or functions ok) AND
• What does not go well
• What happens when something is
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
pleasurable? Or when something is not going well?
• What would the adult like to have happen?
Use the Caregiver Assessment of Activities/RoutinesEXPECTATIONS SATISFACTION
ROUTINE/ACTIVITY
Exce
eds
Mee
ts
Occ
asiona
lly
Mee
ts
Doe
s no
t mee
t
COMMENTS
Very
Is O
K
Somew
hat
Not
Did N
ot A
sk
BATHTIME X
Sitting in tub is problem; Slides under seat belt; does not hold him well enough. Enjoys play with tub toys.
X
MORNING ROUTINE (getting up, getting dressed, etc.)
X
I dress him in the morning –no time and he can help but it takes too long. He wakes up happy and ready to go.
X
BEDTIMES (getting ready for bed, going to bed, sleeping)
X
Watches video and then we read a book in his rocking chair; he enjoys both of these activities and falls
l il
X
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
asleep easily.
MEALTIMES (appetite, level of assistance)
X
Does not finger or spoon feed; can help a little with cup; chews ok but not big pieces; Eats with us and can stay in highchair until everyone is done.
X
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Decide What Should Happen
IFSP/IEP Outcomes
• Promote participation in activities and routines by:
“Fixing” those that are not going well by using adaptations and AT
Embedding specialized interventions and/or adaptations and AT in routines/activities that
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
p /are going well (meaning are enjoyable for caregiver/child; child is engaged, etc.)
• General Plan of Expectations
Based on your answers above, list the routines/activities that do not meet your expectations.
ROUTINE/ACTIVITY What would you like to see happening: What would the child be doing? What would you or other family members be doing? What
strategies have you tried?
1.
2.
3.
Based on your answers above, list the routines/activities that are enjoyable for you and your child.
ROUTINE/ACTIVITY
1.
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
2.
3.
Additional Comments:
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Eric will participate in transitions in his childcare program by riding his bike.
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Robbie will participate at the playground by using his communication noodle to indicate choices (e.g., drink;
people to play with; equipment to play on)
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
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Transition has been improved by embedding the intervention of the battery‐operated bike
Playtime on the playground (and other situations) has been improved by embedding the intervention of use of a communication noodle.
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Bike and noodle are examples of intervention strategies.
Two Categories of Child Interventions
Directed to the Child by Another person
Adaptations/AT Directed to the EnvironmentAnother person
(e.g., caregiver, another adult-provider, child, sibling)
to the Environment
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
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Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
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ICF Classification of Disability adopted by the World Health Organization (the figure is adapted from the ICF Beginners Guide available from:
http://www.who.int/classifications/icf/icfapptraining/en/index.html )
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Directed to Child by Another Person
• Discipline‐Specific Strategies
– Education
– PT
– OT
– SLP
– Behavior Specialist
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Behavior Specialist
– Mental Health Specialist
– ETC
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•Exposure & Opportunities
•Sensitive Adult Mediation
Directed to the Child By Another Person Least Intrusive
Adult‐Directed Strategies(Selected Examples)
•Opportunities for practice (within and across activities & routines)
•Reinforcement (e.g., praise; success)
•Modeling another child by watching & imitating
•Modeling an adult by watching and doing
•Contrived (Teacher/Therapist Designed) Activities
•Contrived Practice (e.g., Discreet Trial Training)
•Physical Guidance or Assistance
•Therapeutic Facilitation
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
•Verbal directions
•Cueing with natural or contrived cues
•PromptingMost Intrusive
CUSTOM Specialized, Individualized
Directed to the Child By Another Person
DIFFERENTIATED
Needed for Some but not all Children
UNIVERSAL
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Used with ALL Infants
&Toddlers
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Adaptations as Interventions• Environments, activities & routines, have social and physical expectations for participation
• Adaptations, including assistive technology allow participation in typical family routines and activities
• Adaptations function as a mediator to make a bridge between the child’s abilities and the
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
“demands” or expectations of the environment
• By promoting participation, opportunities for learning are increased
What does Adaptation mean?
• Change in behavior of an individual or group i dj t t t difi din adjustment to new or modified surroundings is an adaptation.
• Something that is changed or changes so as to become suitable to a new or special use or
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
become suitable to a new or special use or individual situation is an adaptation.
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CUSTOM Specialized,
Adaptations/AT Directed to the Environment
DIFFERENTIATED
Needed for Some but not all Children
UNIVERSAL
pIndividualized
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
UNIVERSAL Used with ALL
Infants &Toddlers
– Things that we might all use with infants and toddlers
• Placing toys outside reach of child to promote t
Tier 1: Universal Adaptations/AT
movement
• Safety plugs in outlets
• Bath seat
• Toys with large grips or safe to chew
• Rewards (i.e., preferred activity) after doing something that is difficult
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
• Break apart multi‐step directions into single step (e.g., Go to the kitchen and get the napkin” becomes 2 separate directions.)
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Tier 2: Differentiated Adaptations/AT
Interventions we might use to enable children to do something that they are unable to do and may not something that they are unable to do and may notbe able to do for a while
– Bath seat for 18 month old– Velcro on bottom of bowl so a 24 month old child can learn to scoop
– Push play toy (e.g., baby stroller, shopping cart)– Providing a more active child with a toy to manipulate
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
g y pduring circle time
– Schedule picture board
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Tier 3: Customized Adaptations/AT
Child Specific/Custom Interventions allow a child to do something they cannot otherwise do
– Communication board for social interaction with siblings and cousins
– Specialized positioning equipment so that a child may sit up at a table to play, sit on the floor for circle time, sit and swing, stand at the sink M i d bili d i d f l
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
– Motorized mobility device to get around from place to place
– Switch to activate something that is part of an activity/routine
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Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Does the child havea disability or a i ifi t d l i
The 3 YES Conditions of AT
Is significant delay in
the area of development ?
YES
Is this a device or adapted material? Can
Can the child perform the skill only with the
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
p
YES
Canydevice or adapted material?
YES
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AT AAC
A word about Assistive Technology (AT) and Augmentative & Alternative Communication
(AAC)
AT
Socialization
Communication
Getting Around
Use of Arms & Hands
AAC
Sign
Picture Exchange
Picture Board
Single Switch Voice
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Use of Arms & Hands Single Switch Voice Output
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Low Tech ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐High TechGeneral; Readily Available Targeted; Specialized
General market Small market
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Adaptation/AT An Intervention to promote participation
This child is participating at her preschool by giving information about a school project to the TV interviewer by using a voice output device
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voice output device.
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Environmental AccommodationsAdapt Room Set‐UpAdapt/Select Child Equipment
Facilitating Children’s Participation and Learning
Adapt/Select Child EquipmentEquipment/Adaptations for Positioning
Adapt ScheduleSelect or Adapt ActivityAdapt MaterialsAdapt Requirements or InstructionsHave Another Child Help ‐‐
Peer Assistance/Tutoring
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Cooperative LearningHave an Individual Child Do Something DifferentHave an Adult Help a Child Do the ActivityHave an Individual Child Do Something Outside
of the Room (with an Adult)
Continuum:
Adaptations to the Environment
• Adaptations to the environment change the setting. F lFor example:
• Rearrange the furniture in the room so that a child in a wheelchair can move about freely.
• Adapt or add equipment (e.g.,use a slant board to help a child participate in coloring
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
activities, use wedge to provide supportive seating during circle activities).
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Continuum:
Adaptations to Activities and RoutinesAn activity or routine may be adapted to accommodate special
needs. For example:
• Add periodic movement activities to a story time activity to help children who have difficulty paying attention.
• Do the initial pieces of a routine for a child & let them do the end parts – e.g., dress a child up to the point of pulling up long pants
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
• Start dinner earlier for a child who needs longer to eat than the rest of the family.
• Allow a child to “walk” to mealtimes by being a duck so that the child is on task
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Continuum:
Adaptations to MaterialsMaterials used in an activity or routine, when adapted, may
help a child participate. For example:
• Make the pencil thicker by putting a foam curler around it or by wrapping the pencil with play dough or silly putty to help a child who has problems gripping pencils/crayons.
• Use assistive technology—as in the case of using a simple switch interface
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
pto help a child with motor difficulties activate a toy.
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
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Ideas to Share
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Look Up By ‐‐• Functional Skill
C i ti
• Activity or Routine
• Errands
Ch– Communication
– Socialization
– Mobility
• Chores
• Outings
• Mealtimes
• Indoor Play
• Bathtime
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
– Arms and Hands • Morning
• Evening
• Outdoor Play (Physical)
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tion
mmun
icat
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Com
eBa
thti
me
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Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Literacy – Book Reading
Continuum:
Requirements and InstructionChanging the requirements of an activity or a routine, or the way
you provide instruction for them can enable a child toyou provide instruction for them, can enable a child to participate. For example:
• Use photographs to show each step rather than simply speaking the instructions.
• Reduce the number of steps a child is expected
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
steps a child is expected to perform to change requirements.
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Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
http://www.challengingbehavior.org/do/resources/teaching_tools/ttyc.htm
Hand Washing Sequence
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Beginning view of Turn over picture as Hand the child the picture of
Circle Time Sequence
Beginning view ofcircle mini schedule
Turn over picture as activities are completed
Hand the child the picture of the next place to go
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
Lentini, R., Vaughn, B. J., & Fox, L. (2005). Teaching Tools for Young Children with Challenging Behavior. Tampa, Florida: University of South Florida, Early Intervention Positive Behavior Support.
http://www.challengingbehavior.org/do/resources/teaching_tools/ttyc.htm
It is hard to remember ‐‐‐but ADAPTATIONS & AT are NOT about
the “STUFF”
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ADAPTATIONS & AT ARE ‐‐‐‐
• INTERVENTIONS
• To help children participate in activities and routines to the maximal extent possible
• To increase opportunities for incidental (or unplanned) learning opportunities
• To increase functional skill performance across
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
• To increase functional skill performance across activities/routines for children with significant disabilities
Adaptations/AT Planning & Brainstorming
Environmental Modifications (Room, Child Equipment)
Equipment for Positioning
Adapt/Modify Schedule
What’s happening now?
What would you like to see happen?
Adapt ActivityAdapt Materials
Adapt RequirementsExpected Outcome
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ADAPTATIONS & AT ARE ‐‐‐‐Strategies /Interventions/Methods used by professionals and family members for the
purpose of influencing
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Child Participation & Learning
In a Restaurant
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At Preschool/Child Care
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In the Neighborhood
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How are we doing?
Phila n = 154 after feedback tapes
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
National n = 85 initial (6 states)
Overall Score
80
20
30
40
50
60
70
National
Phila1
Phila2
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0
10
Traditional Participation
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Role of Caregiver
100
102030405060708090
National
Phila
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010
Directly Observer NotPresent
Role of Provider
60
10
20
30
40
50
National
Phila
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
0
Teach CG JIC TeachChild
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Caregiver TeachingAverage # 30‐second intervals
total possible = 60
35
40
10
15
20
25
30
35
National
Phila--2
Phila - Pre
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0
5
CPF DN C POR Mean
Use of Activities/Routines
100
102030405060708090
National
Phila
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010
Play outdoor mealtimes
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Caregiver – Does Not Meet Expectations
70
0102030405060
lity
ion
ion ds
Phila
Philadelphia Supervisors’ Meeting 9‐23‐2010 Pip Campbell http://tnt.asu.edu http://jeffline.jefferson.edu/cfsrp
mobili
ty
com
mun
icat
io
soci
alizat
io
arm
s/han
d
Activities/Routines identified by caregivers as a problem or as
enjoyable30
0
5
10
15
20
25
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0
bath
morning
bedtime
mealtim
es
play
story
chores
outings
outdoor
not meet meet