Greater Nashville LICC Training Nashville TN August 7

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Greater Nashville LICC Training Nashville, TN August 7, 2006 The Routines-Based Interview Robin Mc.

Greater Nashville LICC Training Nashville, TN August 7, 2006 The Routines-Based Interview Robin Mc. William, Ph. D. Vanderbilt University Medical Center Mass. Early Intervention Consortium Conference Marlborough, MA May 12, 2005 EDIS Conference 2005 NIPIP Training TEIS Inclusion Institute Garmisch, Germany Denver, CO Knoxville, TN Chapel Hill, NC August 22, 2005 September 14, 2005 September 19, 2005 July 2005 & 2006

Contact • Robin. Mc. William@Vanderbilt. edu • www. Vanderbilt. Childrens. com/earlyintervention/

Contact • Robin. Mc. William@Vanderbilt. edu • www. Vanderbilt. Childrens. com/earlyintervention/

Need for Routines-Based Assessment • Functional outcomes (target behaviors) – Address participation/engagement needs –

Need for Routines-Based Assessment • Functional outcomes (target behaviors) – Address participation/engagement needs – Address independence needs – Address social relationships needs • Family priorities reflected in the IFSP • Outcomes broad enough yet specific enough • Strategies that aim directly at function problem (i. e. , teach first) • Investment by caregivers other than the family in the IFSP

RBI Study • Funded by the Family Research Program of the Vanderbilt Kennedy Center

RBI Study • Funded by the Family Research Program of the Vanderbilt Kennedy Center • Randomized control design: RBI vs. traditional IFSP development • Findings – RBI group more satisfied with IFSP process than contrast group – No difference in satisfaction with routines for either group, in 3 months – More outcomes on RBI-produced IFSPs – More functional IFSP outcomes for RBI group than contrast group

Conclusions • For implementation with fidelity, more extensive training is needed • The range

Conclusions • For implementation with fidelity, more extensive training is needed • The range of knowledge and skills of potential interviewers is huge – Dedicated service coordinators often have large caseloads and little intervention experience • Some interviewers might need support with the “elements” of functioning in routines to ask about • Further research can and should be done with these and other measures

What Are Routines? • In this model, they are not activities the professional sets

What Are Routines? • In this model, they are not activities the professional sets up with the family. Instead, they are • Naturally occurring activities happening with some regularity – Caregiving events – Hanging out times

Routines-Based Assessment • Preparation of families and staff • Routines-based interview • Goal selection

Routines-Based Assessment • Preparation of families and staff • Routines-based interview • Goal selection • Goal writing • Strategies and review Described in Family. Centered Intervention Planning: A Routines-Based Approach (Mc. William, 1992) www. Individualizing Inclusion. us Click on Materials

Routines-Based Interview • Families report on their routines first. • If present, child care

Routines-Based Interview • Families report on their routines first. • If present, child care providers report on their routines second. – If they cannot attend, they get interviewed earlier, and someone reports on child care routines • Other team members ask questions and provide information during discussions of routines. • Professionals withhold giving advice.

The Routines-Based Interview • • • Go through each “routine” (i. e. , time

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

Routines Information • What does everyone else do? – Home: Other family members –

Routines Information • What does everyone else do? – Home: Other family members – Classroom: Other children • What does the child do?

More Routines Information • Engagement – How and how much does the child participate

More Routines Information • Engagement – How and how much does the child participate in the routine? • Independence – How much can the child do by him- or herself? • Social Relationships – How does the child communicate and get along with others?

Key Routine Question • Home: How satisfied is the caregiver? • Classroom: How good

Key Routine Question • Home: How satisfied is the caregiver? • Classroom: How good is the fit between the child and the routine • Instrument: RBI Form

Preparation for the Observation • Note good, juicy questions • Note questions I didn’t

Preparation for the Observation • Note good, juicy questions • Note questions I didn’t ask (i. e. , missed follow-up questions) • Note the interviewer’s nonverbal behaviors • Note potential outcomes

What did you observe? • • • Good, juicy questions Missed questions Nonverbal behaviors

What did you observe? • • • Good, juicy questions Missed questions Nonverbal behaviors Outcomes you thought would be selected Outcomes you were surprised to see

Critical Interview Behaviors • • • Be natural and as informal as is appropriate;

Critical Interview Behaviors • • • Be natural and as informal as is appropriate; Put the parent at ease with this naturalness and informality; Look the parent in the eye when he or she is talking; Avoid the use of jargon; if the parent uses jargon, ask what he or she means; Nod and in other ways affirm what the parent is saying; • • • From time to time, express admiration for what the parent does with his or her family; Express understanding about how the parent might feel (e. g. , “I bet you feel really good about that, ” or “I bet that’s really frustrating”); more safely, ask the parent how he or she feels; Place papers being written on flat, so the parent can see what is being written—distance notwithstanding; Find a point of personal contact and very briefly use “self-disclosure” or “therapeutic use of self”; If the parent cries, offer to stop the conversation;

More Interview Behaviors • • If the parent becomes emotional, either move on to

More Interview Behaviors • • If the parent becomes emotional, either move on to another topic or ask if something else should be talked about; As much as possible, refrain from engaging in judgmental talk about the other parent, if only interviewing one parent; Ask about later, specific routines to move the interview along, if it is taking a long time; the goal is to end in 90 minutes; Ask detailed questions at the beginning of the interview to show the parent the level of detail required; and • Keep the structure of the six questions per routine: – What’s everyone doing? – What’s this child’s engagement like? – What’s this child’s independence like? – What are this child’s social relationships like? – How satisfactory is this time of day (home) or how good as fit are this routine and the child (classroom)?

Outcome Selection • Interviewer reads aloud notes about potential problem areas. • The family

Outcome Selection • Interviewer reads aloud notes about potential problem areas. • The family selects 6 -10 outcomes • The family put outcomes into priority order

RBI Report Form • State the routine • Prompts the new domains – Engagement

RBI Report Form • State the routine • Prompts the new domains – Engagement – Independence – Social Relationships • Score satisfaction or goodness of fit • What Part C domains are addressed • Is this a concern?

Activity • Get into groups • Select one “mother” to be Lynn, Ophelia, or

Activity • Get into groups • Select one “mother” to be Lynn, Ophelia, or Ruth • Select another person to be the father, grandmother, or some other adult family member – Families, go off and read your story – During the interview, fill in details as necessary • Group, select a primary interviewer and a second person to help interview, take notes, etc. • Others, observe and take notes about the interviewers’ behaviors; you will be giving feedback

Activity (cont. ) • • Begin the RBI At some point, jump ahead to

Activity (cont. ) • • Begin the RBI At some point, jump ahead to later in the day – • Cover at least six routines On my signal, interviewers review with the family what you know so far • Interviewers have families select outcomes • To summarize 1. Interview 2. Review needs 3. Get family’s choice of 6 things to work on

Key Statements and Questions 1. 2. 3. 4. 5. “You don’t have to answer

Key Statements and Questions 1. 2. 3. 4. 5. “You don’t have to answer any questions you don’t want to. ” “Who is in your family? ” “Briefly describe your child. ” “What are your main concerns? ” “How does your day begin? ” • 6. “What happens after that? ” • 7. 8. Get descriptions of 2 morning routines, then skip to 2 evening routines “Let me remind you of the concerns you mentioned. ” “What would you like the team to work on? ” • • Get the 6 pieces of information If necessary, remind the parent of issues that arose during the interview “Which is the most important of these? And then? ”

Activity (cont. ) • Hints – Keep the flow going; do not ask and

Activity (cont. ) • Hints – Keep the flow going; do not ask and write, ask and write…. – Get a good picture of the child’s functioning in the routine; do not gloss over each routine

Activity Review • Small group – Observers give feedback • Large group – Family

Activity Review • Small group – Observers give feedback • Large group – Family members’ impressions – Interviewers’ impressions – Observers’ impressions

Implementation • Local decision: When should this be done? – Intake? – Evaluation? –

Implementation • Local decision: When should this be done? – Intake? – Evaluation? – Between evaluation and IFSP? – IFSP?

Adaptation • Increasingly, communities/programs are scoring instruments from information provided during the RBI! –

Adaptation • Increasingly, communities/programs are scoring instruments from information provided during the RBI! – What % of children tested for delay are ineligible? • If > 10%, • Do evaluations first or • Screen children at intake

Who’s There? • Family decides who they want from the family – Child does

Who’s There? • Family decides who they want from the family – Child does not have to be there – Minimize interruptions • Ideal to have 2 professionals – 1 is manageable

Roles of 2 nd Person • • Help with questions Take notes Handle interruptions

Roles of 2 nd Person • • Help with questions Take notes Handle interruptions Score developmental test?

Implementation Decisions Groups of about 8 • As a group, answer the following questions,

Implementation Decisions Groups of about 8 • As a group, answer the following questions, but everyone writes down the group’s answers – What 3 things did you like about the RBI? – Where can we fit in the RBI? – What are 3 challenges to implementing the RBI? – What is at least 1 solution for each of the 3 barriers?

Jo’s Priorities 1. 2. 3. 4. 5. 6. 7. Communicate his needs (drink, don’t

Jo’s Priorities 1. 2. 3. 4. 5. 6. 7. Communicate his needs (drink, don’t feel well, eat, more, play, TV, outside) Eating with combination of textures; vegetables, fruits Handwashing—water rinsing Identifying objects (in a book, on body), to see where he is cognitively Transitions (e. g. , from park) when he has to stop doing something fun Therapies more under Jo’s control Child care when Jo needs longer term care (e. g. , during her medical treatments)

Finito

Finito