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Working With Families Not Too Much, Not Too Little
Robin McWilliam
Contact
[email protected] www.VanderbiltChildDevelopment.us Within 1 week, this PowerPoint will be
available on the website, under Presentations
What Does This Title Mean?
Working with families not too much, not too little Working with families too much
means usurping their role (Dunst, 1985)
Working with families too little means failing to attend to family-level needs (Turnbull)
The 2-Pronged Approach to Working With Families
What we attend to Do we attend inordinately to child-
level needs? How we work with families
Do we have a framework for family-friendly interactions?
Change Framework by Changing Practice
Assess child- and family-level needs by conducting a Routines-Based InterviewTM
Addressing family-level needs through the IFSP
5 evidence-based characteristics of working with families in a family-centered way
Usurping Families’ Role Their role: To raise their children,
which includes teaching them How we usurp it: By trying to teach
children during home visits or other weekly contacts What does this convey to families?
What we should do to avoid usurping it: Take a consultative role in working with families (Hobbs)
Failure to Attend to Family-Level Needs The field of [early intervention] has
focused primarily on implementing family-centered practices in regard to how families and professionals should interact, but it has not sufficiently addressed what supports and services should be offered to families in order to enhance the likelihood of positive outcomes for families, themselves, as well as for children with disabilities.
Turnbull et al. (2007). Family supports and services in early intervention: A bold vision. Journal of Early Intervention, 29, 187-206
Attending Inordinately to Child-Level Needs This study revealed that many IFSPs in the sample
included strategies implying that services were to be delivered by professionals during intervention sessions separate from the family’s daily routines. This finding suggests that practices on IFSPs collected in 2001 show little progression from research findings of several years ago, which found that intervention is frequently hands-on, child-focused, professionally-designed and devoid of active family involvement (e.g., Boone et al., 1998; Harbin et al., 1998; McBride & Peterson, 1997; McWilliam et al., 1998).
Jung, L. A., & McWilliam, R. A. (2005). Reliability and validity of scores on the IFSP Rating Scale. Journal of Early Intervention, 27, 125-136.
Attending to Family-Level Needs
Take a support-based approach to Understanding the family ecology Assessing the family’s, including the
child’s, needs Home visiting
Understanding the Family Ecology
Develop an ecomap
Krista has little time for friends, but doesn’t know what to do with her afternoons (the worst time of day)
Steven, Krista, Darcy
K’s parents
Tulsa friends
K’s brother
K’s sisters
RobynNeighbors
S’s sisters
S’s aunt & uncle
S’s parents
Hometown friends
SLP (Liz)—weekly at
home
Dr. Trainer (physiatrist)
Golf weekly
Work: Alcoa
SC (Donna)—6 months
min.
Ophthalmolog-istAmy (DMRS
teacher)—weekly HVs
PT (Scott)—2x/wk at
clinic
OT (Michelle)—2x/wk at
clinic
Church (1st Baptist)
Regular pediatrician
(Glover)
Aquatic therapy (weekly)
Harris (neurosurg-
eon)
Assessing the Family’s, Including the Child’s, Needs
Conduct a Routine-Based Interview
The Routines-Based Interview Go through each “routine” (i.e., time of day or
activity) Get a sense of family’s and child’s functioning Write down significant information Star () concerns Recap concerns with the family, showing them
the starred items Ask what the family would like to concentrate on Write down these outcomes Ask them for the priority order
StructureHome Routines
Waking upChanging diaper/bathroom
Going to kitchenBreakfast
Parent getting dressedGoing outIn shopsLunch
Going to parkOther family members
coming homeDinner preparation
DinnerBathTV
Bedtime
“Classroom” RoutinesArrivalCircle
Free playSnack
Small toysCentersOutsideMusicStoryLunchNap
CentersDeparture
Within Each Routine1. What does everyone else do?2. What does this child do?
a) Engagementb) Independencec) Social relationships
3. How satisfactory is this routine?
3. How well is this routine working for the child (“goodness of fit”)
Family-Level Outcomes on the IFSP
Informal goal Specific goal Criterion for accomplishment
Therapies more under Jo’s control
Jo will revise the schedule of [Child’s] therapies to suit her own needs
By [date]
Child care when Jo needs longer term care (e.g., during her medical treatments)
Jo will have child care lined up for when she needs longer term care
By [date]
Information on research, what other moms do, bedtime rituals
Julie will have information on research relevant to her child, on what other parents of similar children do, and on bedtime routines.
By [date]
Informal goal Specific goal Criterion for accomplishment
Time for Chris and Julie together [a very common outcome in many families]
Chris and Julie will have 3 nights out.
By [date]
Sue get a new job Sue will have information about potential new jobs
By [date]
New beds for kids Sue will get new beds for the children
By [date]
Time for Gina to play with Maria and Emily (15-30 mins)
Gina will play with Maria and Emily, together, for 15-30 minutes a day.
4 days in 1 week.
Informal goal Specific goal Criterion for accomplishment
Down time before dinner for family
Gina will arrange for the family to have down time before dinner
3 nights a week for 3 weeks.
Find child care Gina will find acceptable child care for Emily.
By [date]
Maria (sister) cooperate
Maria will participate in play time, dressing, and meals by cooperating.
She does what she’s told within 5 seconds 5 times a day for 5 consecutive days.
(Alternative if sibling outcome is unacceptable in a system) Gina will get Maria to cooperate.
Gina will get Maria to do what she’s told within 5 seconds 5 times a day for 5 consecutive days.
Hobby for Andrew (not video, not car)
Andrew will acquire a new hobby.
He participates in the activity at least once a week for 8 weeks.
Jo’s Priorities1. Communicate his needs (drink, don’t feel well,
eat, more, play, TV, outside)2. Eating with combination of textures; vegetables,
fruits3. Handwashing—water rinsing4. Identifying objects (in a book, on body), to see
where he is cognitively5. Transitions (e.g., from park) when he has to stop
doing something fun6. Therapies more under Jo’s control7. Child care when Jo needs longer term care (e.g.,
during her medical treatments)
Julie’s Outcomes1. Making sounds (playing with Chris, diaper, reading,
play, feeding)2. Responding to Julie and Chris during reading, play,
meals3. Reach (playing on floor, bath, swim class, music,
feeding)4. Batting for toys and splashing (play, bath)5. Grasp things in front of him (music, bath, feeding)6. Rolling both ways, pushing up (play)7. Sitting unassisted (music, bath, feeding)8. Information on research, what other moms do,
bedtime rituals9. Time for Chris and Julie together (get parents here)
Sue’s Priorities1. Sue get a new job2. Samantha communicate, esp. “I love you” at
wake up and what to eat at meals3. Eat without stuffing4. Cup drinking5. Eat with utensils6. Potty training7. Dressing independently8. Play with toys appropriately at hanging-out
times9. New beds for kids
Gina’s Goals1. Emily will extend arms at dressing2. Play without head-banging (because of child care)3. Time for Gina to play with Maria and Emily (15-30
mins)4. Communicate Mama, no, up, cup, Dada, etc.5. Down time before dinner for family6. Sit in car seat without self-stimulating with middle
strap (for social reasons)7. Walk faster8. Find child care9. Maria cooperate
Home Visiting
Use Support-Based Home Visits and the Vanderbilt Home Visit Script
Discussed in concurrent session
The Framework for How We Support Families
Support-Based Home Visits Emotional Support
Positiveness Responsiveness Orientation to the
whole family Friendliness Sensitivity
Material Support Equipment and
materials Financial resources
Informational Support Child development Child’s disability Services and resources What to do with the
child
The 5-Component Model for Early Intervention in Natural Environments
CollaborativeConsultation
to ChildCare
Support-BasedHomeVisits
TransdisciplinaryServices
FunctionalFamily-Centered
NeedsAssessment
UnderstandingThe
FamilyEcology
EngagementIndependence
Social RelationshipsSatisfaction w/ Home Routines
ResponseTo
Support
FunctionalOutcomes
Principles All the intervention occurs
between specialists’ visits. Therapy and instruction are not
golf lessons. Regular caregivers (i.e., parents
and teachers) need to own the goals.
Professional Support
Child Outcomes
Caregiver Competence &
Confidence
Who Has How Much Influence on What?
How Children Learn
Through repeated interactions with the environment, dispersed over time.
Not in massed trials.
Between Visits
The Conceptual Framework
Desired Result of This Model
text
Maximal & Optimal Interventions Provided by
Natural Caregivers in Natural Routines
Engagement, Independence, & Social
Relationships
Other Desired Outcomes (e.g., Academics,
Friendships, Family Quality of Life)
Family Ecology
Rou
tines
-Bas
ed O
utco
mes
Transdisciplinary, Support-Based Home Visits