Best Practice

IDENTIFYING AND RECOMMENDING FAMILY SUPPORTS

• Professionals have a more indirect influence on children who receive early intervention services than those in their natural environments. Because of this, a critical aspect of early intervention is understanding the supports that families already have in place to improve the health and well-being of the family and the child, and those that they still need. (1)
• Types of supports to look for include material supports (physical and financial resources the family needs to progress toward their goals), emotional supports (resources that enhance a family's feelings of self-confidence, self-worth, and sense of control), and informational supports (resources that fill a family's need to know or understand things such as their child's condition, services offered to families in their situation, etc.). (1)
• Informal supports such as friends, family, church groups, and recreational clubs should be the primary means for supporting families, however if a family has a need that those informal supports cannot fill, it is then the responsibility of professionals to recommend formal supports in their community that can fill that need. (1)
• When recommending material supports to enhance a child's development such as positioning equipment, service providers should strive to use materials already present in the home and limit recommendations for "abnormal" equipment. (1)
• A fun and personalized way to identify the supports that a family has is to draw an ecomap. An ecomap allows the family and the professional to see a visual representation of the supports already surrounding the family, which can then give the professionals insight in to which supports the family has and which they still need. (1)
• ALL professionals should be prepared to provide families with emotional, material, and informational supports such that the supports promote progress toward the IFSP outcomes. (1 & 2)
• Additional to providing families with information about external emotional supports, professionals should provide direct emotional support to families through positivity, responsiveness, orientation to the whole family, friendliness, and sensitivity. (1)

ASSESSMENT/EVALUATION

• Professionals should use multiple measures to assess a child and gather information from multiple sources. (2)
• Before assessing a child, professionals should become familiar with the child. (2)
• Professionals should explain limitations of evaluation tools in a way that is understandable to the family and give the families sufficient time to review the evaluation results. (2)
• Professionals should explain the early intervention rules and regulations regarding evaluation and assessments. (2)
• Professionals should primarily use norm-referenced (with children similar to the child being assessed), developed, field-validated, standardized measures, unless these assessments/evaluations are deemed inappropriate to the child and family. (2)

NATURAL ENVIRONMENTS

• Early intervention services are best provided in natural environments, such as home or community settings including daycare, friends and family members' houses where the child spends time, and neighborhood parks & libraries that the family visits. (1 & 2)
• Children do not need to be taken out of their everyday contexts to learn and develop - this is actually the environment in which the child learns best! The role of professionals is to teach the family how to enhance the child's learning and development during the everyday activities that they engage in with their child. (1)
• Professionals should assist families in structuring routines, including play routines, and transitions to promote interaction, communication, and learning through responsiveness to the child's behavior. (2)
• Professionals should focus on strengthening the capacity and confidence of the parents to provide their children with developmentally-enriching opportunities. The professionals should try to limit their direct interactions with the child to when it serves as a role model for the parents. (1)
• Focus on what the child is interested in (cars, superheroes, dolls, food, etc.). Activities involving a child's interests are more likely to promote positive social and non-social behaviors. (1)
• Encourage parents to engage with their child more frequently in everyday activities that the child can do and/or enjoys doing. (1)
• Try to limit the amount of toys you bring to the home visits - go bag-less! Bringing toys to use on home visits relays the message to families that change occurs as a result of home visits and the specific toys service providers bring to home visits and that the toys and materials in the families' home are not good enough to achieve address the child's needs. (1)
• Going bag-less additionally means that the service provider is entering the home without a preconceived notion of what the time will look like. This will allow the service providers to focus their intervention on what is most important to the family at the time of the home visit. (3)

TALKING TO FAMILIES

• In short, parents/caregivers are the experts of their child. Treat them as such. (1)
• With regard to families, it is integral that we as professionals promote trust, mutual respect, and a sense of equality. As such, we must invite parents to join us in each step of the early intervention process, making sure they understand what is happening and why with each intervention. This includes explaining to parents the research behind what you are doing, such as when using the primary service provider model, in a way that is easy for them to understand (EI Teaming Handbook).
• Chit-chat is important! Informal exchanges between the parents and the professionals builds trust and allows the professionals to gain understanding of what is influencing the family and the child in their environment. Parents must be invited into this type of informal exchange, as they may think that you are there solely to interact with the child. (1)
• Face-to-face conversations are much more effective than written or email communications. (1)
• Emphasize strengths of the family and the child. This builds parental self-confidence - affirmation that they are doing something right instead of only telling the parents things they could be doing better. Compliments about AND TO the child and the family should not be reserved for IFSP meetings, but should be given in each interaction. (1)
• When a parent or caregiver brings forth a question or concern to a professional, the professional should dialogue with the parents about what it is they want, what they have tried, how that has worked, and brainstorm WITH them a new solution to try. (1)
• When offering suggestions, be sure to ask how they think this would work with their family's routine and schedule. If a professional suggests doing an exercise with their child twice a day, they will likely say "okay, we can do that," so that they do not seem like they are going against a professional's opinion. However, when it comes to actually doing those exercises twice a day, the family quickly realizes they do not have the time or energy to devote to the exercises so they do not get done. This can be frustrating for both the parents and the professionals. Dialoging about the suggestion and how it will work with the family will allow everyone to have more realistic expectations of how the suggestion will go.(1)
• Trust is more likely to be built when professionals seek to understand the parents' perspectives. Take the time to listen to them and make sure your body language shows you have time to listen and desire to understand them. (1)
• Try to ask open-ended questions and don't be afraid of silence - give the parents time to think about their answers. (1)
• Do not negate families' negative emotions. Negative emotions are uncomfortable, but trying to cheer people up by saying things like, "don't worry, it'll get better," or "look at the bright side," can make them feel like they are wrong to have those feelings. Always validate feelings before offering solutions. (1)

WORKING WITH FAMILIES FROM DIVERSE BACKGROUNDS

• Diversity can come in the form of educational level, ethnicity, socioeconomic status, family structure, and so much more. (1)
• Determining which cultural components are important to the families and how those components are expressed allows professionals to effectively match interventions with the the families' beliefs and values. This increases the likelihood of the intervention's success.(1)
• Professionals should exercise caution in terms of the style of the early intervention meetings, following the family's cultural preferences.(1)
• Do not make assumptions about family members' roles. (1)
• Different cultures view child-rearing, acceptable child behavior, developmental norms, and caregiver/parent roles differently. It is important to understand what these views are and respect the family's values and desires for their child's development and family involvement, so as to maintain a trusting parent-professional relationship. (1)
• If available, a cultural mediator can ease tensions between a family and a professional and increase the professional's understanding of the family. (1)
• In evaluating children's abilities to participate in certain activities, it may be necessary to consider a child's cultural and sociocultural experience. For example, clinical expertise must be used when evaluating a child using an instrument that asks about the child's ability to use a fork, when their family only eats with chopsticks and has never given the child a fork to use.(1)
• Families may be more comfortable with professionals in their home if the number of professionals is limited and the family is encouraged to bring friends, family members, or cultural mediators to the meetings. (1)
• Make sure that the goals and outcomes listed in the IFSP are those listed as most important to the family. (1)
• Ensure that your references to community supports respect their cultural preferences. (2)

COACHING MODEL

• The coaching model occurs when an early intervention professional helps the family understand and feel comfortable implementing interventions that can be incorporated into their daily lives to promote the child's development.
• Key coaching characteristics that lead to intended outcomes include:
  • Joint planning - both the family and the professional plan what is going to be addressed during intervention
  • Observation - professional observes the family and vice versa
  • Action/Practice - opportunities for the family to implement a strategy when a professional is or is not present
  • Reflection - during the visit, the professional guides the family in reflecting about what did or did not work during an observation or action, and what are possible alternatives to this action so that the family's skills and knowledge can continue to grow and improve
  • Feedback - the professional offers feedback after reflection and is either an affirmation of the family's reflection or adds additional information to the reflection, such as current evidence-based practices, past professional experiences, discipline-specific knowledge and training, and input from other professionals. (4)
• Modelling is an important aspect of the coaching model when making suggestions to families. Here are the steps to take when modelling an intervention for parents and caregivers:
  1. Talk to the parent about your suggestion
  2. If the parent appears not to understand, ask if he or she would like to be shown
  3. Tell the parent what you’re going to do
  4. Do it
  5. Tell the parent what you did and point out the consequence
  6. Ask the parent if he or she would like to try it
     • If the answer is “yes,” watch the parent try it, praise the parent, and give a limited amount of corrective feedback
     • If the answer is “no,” leave it alone (1)

PRIMARY SERVICE PROVIDER MODEL

• When using the Primary Service Provider (PSP) model, ONE member of a multidisciplinary team of professionals serves as the family liaison, or primary service provider, and the rest of the team works to support the team liaison. (4)
• The PSP model has been shown to produce positive outcomes for children and families receiving early intervention services, discipline-specific organizations, and the early intervention field in general. (1)
• The PSP model simplifies the communication between the family and the early intervention team and allows deeper trust and respect to form. This model also means that family members do not have to keep track of who does what and remember to which provider they should mention a concern they have about their child. This model decreases gaps and overlaps in services and uses early intervention resources more efficiently. (4)
• The team must include a variety of members to ensure that the needs of the child will be met through the knowledge and expertise brought by those members. (4)
• After evaluation, a primary service provider is identified based on desired family outcomes, the relationship between the primary service provider and the family, and the family's and service provider's knowledge. (1)
• All members of the service providing team need to be present at team meetings for colleague-to-colleague coaching. (Teaming Handbook)
• Team members must be willing to release their role to other professionals by teaching them their skills and knowledge, and must be willing to accept the roles of other professionals by learning about their skills and knowledge. (2)
• Using a PSP model does not mean that other team members cannot accompany the primary service provider to a home visit. Joint visits can build trust and respect between team members, increase the primary service provider's competency in addressing the joint visitor's areas of expertise, and allows the family to meet the more behind-the-scenes team members involved in their child's care. (Teaming Handbook)
• The primary service provider should change as infrequently as possible to maintain a trusting relationship with the family. (Teaming Handbook)

GENERAL PRACTICE

• IFSP goals/outcomes should be jointly decided upon by family and professionals. (2)
• Professionals should use normalized and the least intrusive interventions possible in order to achieve the outcomes listed in the IFSP. (2)
• Professionals should use the least intrusive and least intensive adaptive equipment possible while maximizing effect on progress toward IFSP outcomes, keeping in mind the comfort level of the family with the equipment. (2)
• Professionals should be educated about relevant local, state, and federal policies and regulations that affect early intervention practice. Additionally, they should advocate for policies to reflect recommended practice. (2)