Session 2

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Outline

•Review homework•Finish what an RBHV is•RBI That Service Coordinators Did•Functional vs. Nonfunctional Outcomes/Goals•Adjusting if IFSP Isn’t Functional

• Functional skills vs. toy bags

Anonymous Entry Poll

•RBM CoSeE• I have completed it• I have not completed it

Emerging Understandings About RBHVs

1. About building caregivers’ capacity

2. Extending “intervention” to the whole day and whole week and, in Alabama, whole month

3. Professionals need to work together

4. Children’s functioning is not logically divided by domains or disciplines

Functioning

• A different way of looking at children

• Meaningful participation• Engagement• Independence• Social relationships• You will hear A LOT

about EISR!

What Does It Take to Build Caregivers’ Capacity?

RBHVs With Fidelity

•Strong relationship with one weekly professional

•Weekly collaborative (family) consultation

Where Are We Now

•Multiple professionals•Monthly or twice monthly

•Child-centered visits

Alabama: CSP

Special Instructor

Whole Child and Family

SLP

Whole Child and Family

Alabama: CSP

OT

Whole Child and Family

PT

Whole Child and Family

Alabama: Multiple Providers

Whole Child & Family?

SI

SC

SLP

PTWhole Child & Family?

SI (CSP)

SC

SLP

PT

Alabama, One Day: PSP

PSP (SLP)

SIPT OT

• Still more than enough work to go around, if different disciplines can function as PSPs (20 slots a week)

• RBHVs address all child and family outcomes and other needs

• Therefore, you are being trained to be CSPs

Whole Child & Family

Hot to Get From Here to There

•Train everyone to be a PSP/CSP• Role acceptance

•Have service coordinators identify the CSP for each family• Role release

Homework

• See last slide of "Unused in Session 2"

Midpoint Poll

What % of the time during a home visit should be spent working with the child?

•75-100%•50-74%•25-49%•0-24%

Routines-Based Interview (RBI)

How come I’m getting these weird goals?

• RBI that service coordinators did (we hope)

• Semi-structured interview

• Going through the family’s day

• Digging deep into EISR

• Keeping an ear out for family needs

• Time, worry, and change questions

• Recap• Goal decisions• Priority order

Functional v. Nonfunctional Child Goals

•Skills necessary for meaningful participation

•Feasible for caregiver•Chosen by caregiver

7-Point Test of Functionality

1. Is the skill needed for successful participation in a normal routine?

2. If not needed, will it help?3. Can it be taught in a manner that respects the child’s

interests and abilities?4. Can it be taught in a manner that respects the family’s day-

to-day life?5. Can it be taught by the child’s natural caregivers?6. Do the caregivers care about this skill?7. Is the skill developmentally appropriate?

Types of Nonfunctional Goals

Makes /k/ sound Why is this skill neededRolls ball back and forth Why should the child learn this 1

particular skill?Holds head up for 7 seconds What would motivate him to do this?Use flash cards When? Why? Massed trials—really?Stretching with PT during PT session Is the PT going to adopt the child?Track a light 180 degrees Why?Point to letters said by adult Why now?

2Parent chooses child outcomes

4Specialized assessment, if needed: Why does

child function like this?

6Home visitor supports caregivers in

implementing strategies

1Child functioning by caregiver report

3Home visitor develops strategies with caregivers

5 Specialist provides strategies

“Role Assistance”

2 Perspectives

From provider: What if goals aren’t functional?

From service coordinator: What if provider ignores families’ priorities?

Where are RBHVs with PSP/CSP being implemented?• Maine (statewide)• Illinois• Tennessee• Missouri• Portland, OR (2,500

families a year; 200 professionals)

• Tuscaloosa, AL!• Who knows where else?!

• Internationally,• New Zealand• Victoria and Western

Australia, Australia• Singapore• Taiwan• Portugal• Spain• Paraguay• Alberta and Ontario,

Canada

Breakout

•Come up with 3 outcomes related to different areas of functioning• They can’t all be language

•Analyze each with the 7-Point Test of Functionality

•Choose a reporter•Report back after 15 minutes

Routines-Based Conversation With Family to Get Functional Needs

RBC StagesStage Virtual ImplicationsMain concerns No changeEISR in routines Move box with parent to under your camera. Look at

camera. If typing notes, move notes to under camera.

Notes Type or hand-write. If typed, try to limit notes to concerns (starred) or use bold, italics, or all caps to indicate concerns. If you hand-write notes, use stars.

Time, worry, & change questions

No change

Recap Preferably, share screen or send notes.Goal decision making Professional writes goals down. Family sees goals they

decided upon, through shared screen or attachment, to order the priority.

Assessing Needs

• Engagement• Independence• Social Relationships

Midpoint Poll

1. Average number of outcomes2. Functionality of child outcomes

Video and Discussion

• Routines-Based Intervention (VA Early Intervention Professional Development Center)

Exit Poll: Developmental Appropriateness

• If the outcome is something the child is nowhere close to being able to do but might reach in 6 months, right now we should (CHOOSE ONE)

• Hold off working on this outcome• Explain to the caregiver (and service coordinator) this outcome is

inappropriate• Work with the caregiver on the first step towards this outcome

Homework, Questions, Wrap Up

• Review the RBHV checklist (www. eieio.ua.edu/materials)

• Check yourself on it after 3 visits• Read “How to use the NSF”• Come with a home visit to discuss