Breaking, and building, routines

I am admittedly a fairly methodical person and rely on established routines and patterns in order to remain organized and productive.  At home this consists of lot’s of lists and scheduling chores, errands and down time.  At work that usually entailed repetition and a detailed schedule.  However, I recently quit my “real” job and jumped off the cliff into building a private practice.  Suddenly all of my routines, schedules and predictability had vanished and as a result I am feeling a bit unsettled.  Time to build some new routines!

This notion of routine and predictability is an important consideration for our EI families.  Children crave structure (no matter what they tell you!).  I have met numerous families who claim to have no routine in their day so how can I embed my brilliant ideas?  The answer is simple – even the least organized families still have some form of routine to their day.  Start with the necessities – eating and sleeping.  Everyone (hopefully) does those two things.  I bet they also take a bath and maybe play outdoors.  Bingo – now we are up to four routines. With a little investigation you can help parents see that there is structure in their family life and rich opportunities for embedding strategies.

So now it is your turn – have you tried recently to step outside the family room and venture into other routines or areas of the home?  Was it comfortable for you? the mom? the child? Do you have questions about how to actually weave intervention throughout the day?  Let’s get a conversation started – reply to this blog post!

What does ACC football and EI have in common?

The answer to the riddle is simple – great coaches! With football season in full swing consider the following analogy. In athletics the coaches roles is to guide the quarterback in using their      skills and talents across any number of play configurations. However, at game time, that same coach is not going to suddenly run onto the field to catch the football himself.Rather he is going to      analyze plays after the game and help the team plan on how to do a better job next time. In the case of early intervention, you as a provider of care serves a similar role of coach.You help parents identify and analyze challenges, internalize solutions, apply evidence-based strategies across multiple situations or routines, and reflect together on what did and did not work. Versus taking charge and allowing the parent to play a passive role it becomes a team approach.

Traditionally early intervention consisted of hands-on, child focused sessions usually on the living room floor.Parents were only occasionally invited to observe or participate in the session.Research now tells us that best practice is to shift to a family focused approach which includes demonstrating skills and strategies to the caregiver, watching them model the skill back and then embedding those strategies throughout the families routines and activities.Suddenly the early interventionist is working more as a coach, partnering with the parent as they work towards targeted family outcomes.  Since the intervention is embedded throughout the day the opportunity for learning and development is expanded from that one hour session in the living room to innumerable learning opportunities.

The coaching process can be divided into five basic steps or characteristics:
#1:Joint planning: Start your time together with a review of what has happened the previous week.  Were there things that went really well or completely flopped?  Have concerns or priorities changed since the last visit? Confirm that you are all still on the same page.  Finally, end your time together by developing a plan for the coming week.
#2: Observation: This is a two way exchange of information.  As the coach you can quietly observe the parent and child interact.  Take a moment to model a specific technique, strategy or skill to the parent while they observe you work directly with their child.
#3: Action/Practice: As you demonstrate to the parent a strategy always tie it to a valued family routine or activity.  Then, ask them to model it back to you.  This is a great way to get that reluctant mommy off the sofa and down on the floor, engaged in the session and their child.
4: Reflection: Use reflective questions to help the parent analyze or critique what you practiced or discussed.  Discuss what the next steps should be. 
#5: Feedback: Affirm what the parent says or does and offer positive feedback. 

Give coaching a try and share your clinical experiences with your peers!

It’s (not) in the bag

Hello. My name is Beth and I am a recovering toy bag addict.  I used to pack individual bags of toys for each of the children on my case load and cram them into the trunk of my car daily.  The bags were well organized and full of what I considered to be fun ways to build skills during my hour      long sessions.  Even after research started showing that children learned best using their own materials in their natural settings, I continued to sneak my bag of tricks in the door of unsuspecting families. I hit my bottom one day when a mommy said to her daughter “maybe Beth will have something interesting today”.  I did not.

Sound familiar?  Maybe a bit on the dramatic side but we are all probably guilty of similar habits.  Walking into a family’s home or a daycare setting empty handed feels foreign and uncomfortable to us.  However, we all know that the magic is not inside our carefully packed bag of tricks.  The real magic is in your knowledge and skill base, clinical experiences, creativity, and passion for helping families and young children.

Research shows that children and families demonstrate better outcomes when they are encouraged to use materials commonly found in their homes and natural settings.  With a little coaching and encouragement from us (the ‘experts’) they can then practice those same skills and strategies throughout the day versus during that brief one hour weekly session with us.

So here are some handy tricks to help wean yourself from your bag of tricks.  Pick one or two and give it a shot next week as you visit with families. Take a moment to share with others how it went and good luck!

  • Fill your toy bag with things you know the family has on hand already
  • Take an inventory and gradually decrease the number few items in your bag until you are down to only a  couple that you can easily loan to the family until your next visit.
  • Walk in with an empty toy bag and have the child and parent join you in filling it with different toys and materials already in their home.  Coach the parent on how to use those materials differently across routines.
  • Gradually desensitize yourself by leaving the toy bag at the door, outside the front door and eventually in the trunk of your car.
  • Pretend that you forgot the toy bag and quickly get busy including yourself in whatever the family was doing when you arrived.

Changing clinical habits is not for sissies!

 As a “seasoned” therapist with over 30 years experience working with families and young children you would think that I had it down to a science.  Sadly, I tended to go about the business of practicing early intervention the same way every day – pack a bag of toys, drive to the child’s home, sit down in the middle of the living room and start playing.  Sometimes I would invite a parent to watch or even (rarely) join in.  I typically ended the session giving the parent some ‘homework’ for the following week.  Did I get results using that approach?  I believe so.  Were they the optimal results for that child and family? Probably not.

We now know that using a family centered approach to early intervention results in optimal outcomes for both the child and parents.  While this is not a new approach by a long stretch many of us have found changing our clinical habits less than intuitive.  Barriers to shifting our care from the child to the family unit as a whole has many barriers including: ethics (“it is not in my scope of practice”); natural environment (“the home is dirty and there are bugs”, “there are too many distractions like the TV or siblings”); parental expectations (“mom wants me to fix their child”, “parents have unrealistic expectations”); materials (“there are no toys in the home”, “they expect me to bring in toys”); and parent involvement (“mom refuses to join my session”, “there is no follow through after I leave”).

What are some solutions?  We can each attend continuing education offerings and workshops geared towards informing us on best practices, but I believe that is not enough. As a professional community we have to support each other, look to a mentor for guidance, and remain current with best practices.  It is my hope that by actively participating in this blog site, receiving reminders via social media, and participating in 1:1 mentoring with a seasoned EI provider we will each find moments of success when a new approach to how we do our job goes well.  In return clinical habits will gradually shift towards an approach which best serves families and young children.