The Routines Based Interview Based on the work

The Routines Based Interview Based on the work and publications of Robin A. Mc. William, Ph. D.

What to expect from today • Knowledge of how the Eco. Map and RBI fits into the IFSP process • Why RI has chosen to implement RBI • How to complete an Ecomap • How to conduct a RBI • Critical interview skills • A little practice • How to be RI RBI Approved

IFSP Eligibility Meeting and Provide Community Resources Intake with Eco. Map Plus Pages 2 & 3 of IFSP Single Established Condition? NO YES NO Multidisciplinary Evaluation/Assessment Multidisciplinary Assessment IFSP Team Meeting Finalize outcomes if not completed at end of RBI Identify Strategies, Services, and Parent Signature RBI Eligible? YES IFSP Eligibility Meeting Communicate El Eligibility, Update Concerns if applicable, (This meeting marks 45 day timeline) Other occasions where RBI may be beneficial include: Annual IFSP review and outcomes development, uncertainty about what to work on next, and families who seem uninterested or unable to participate in EI strategies. Adapted from R. A. Mc William, Ph. D.

RBI ties to Global Child Outcomes RBI Focuses on: Engagement Use of Appropriate Behaviors to Meet Needs Independence Social Relationships Acquisition and Use of Knowledge and Skills Positive Social Emotional Skills Including Social Relationships ew Global Child Outcomes he N t n i d Use IFSP

Why do an RBI? • Develop a list of functional outcomes • To assess child and family functioning • To establish a positive relationship with the family

Why do an RBI? Research Based • RBI produces better outcomes than traditional approach to IFSP development. • Outcomes are more functional • Families are more satisfied with IFSP development • More meaningful interventions = more progress

Starting at Intake… The Ecomap • Shows we’re interested in the family, not just the child • Establishes a friendly, interested relationship • Gives us an alternative to the checklist method of doing intakes Tab 1

Ecomap Example Questions to understand each relationship: • How often do you talk with/see her? For Non-Family • How do you get along with them? Other types of questions • If something cool happened with one of your children, who would you call? The important thing is to find out how supportive or stressful this person is

Eco. Map Template Father’s Family/Parent 1 Mother’s Family/ Parent 2 Who lives in the home with the child? Father’s Friends People at Work Community Supports Mother’s Friends People at Work Community Supports Professional Supports and Services

The Routines Based Interview

Getting Started • “Set the stage” for RBI at intake • Encourage family to invite others • Try to arrange for quiet time “This is an important conversation. We find that taking the time to talk in detail about your day helps us to help you and your child make quicker progress toward your goals. ”

Getting Started • 1 or 2 interviewers • Role of 2 nd person is to help cover missed questions, take notes, handle interruptions and recap • Sit at 45° angle to parent • Keep paper flat on table • Be focused

SRF and Billing • SRF should indicate a RBI was completed but do not recap the conversation • Indicate date of RBI on IFSP • Remind data entry to check RBI box in Welligent (only for full initial RBI’s) • Service Coordination T 1016 (one person) • Team Coordination T 10 TF (2 people)

How to talk about the RBI? “Talking about your day to day activities will help us come up with an effective plan for helping you and your child” “Talking in detail about your day helps us to work on the things that are most meaningful to your child and family” “When we focus on the things you do every day, your child will be able to practice his new skills over and over again with little effort”

Beginning the RBI Tell me as much or as little… Why is your child in Early Intervention? What are your main concerns? Now I’m going to ask you some questions about your day to day activities. Is that ok?

Traditional RBI questions within each routine 1. What is the child doing? 2. What is everyone else doing? 3. What is this child’s engagement like? 4. What is this child’s level of independence? 5. What are this child’s social relationships like? 6. How satisfied are you with this routine? 7. If appropriate: How would you like it to be different?

Within each routine…. Engagement: How and how much does the child participate in the routine? Independence: How much can the child do by him/herself? Social Relationship: How does the child communicate and get along with others?

The RBI Outline Go through each daily activity one by one Write BRIEF notes! (you will see why later) Note concerns (mostly parents’ but can be yours) Put stars next to them Use transitional phrases like “what happens next”

Success hinges on follow‐up questions!! • What does ____ look like? • What happens when he sees you? • How does she get from the bedroom to the playroom? • How do you know he is happy? • What do you think that means? • How does that make you feel? • What do you do when that happens? • What happens next?

Satisfaction Questions After each routines ask parents how they feel about each routine • On a scale of 1 -5 • How is this time of day for you? If the rating is 3 or less (this is flexible) ask: • How would you like this to be different?

Let’s try it… Take out a RBI Interview Notes Page You are the second interviewer Take notes on what you hear https: //vimeo. com/154905455 https: //vimeo. com/154905504

Worry, Change and Activity Questions “Now let me ask you a couple of general questions… • When you lie awake at night, what do you worry about? • If there is anything you’d like to change about your life, what would it be? ” • Is there anything you used to do that you would like to be able to do again?

Recap M O O B , M • This should be done by person taking notes (2 nd interviewer) • Be Brief!! (no more than 5 minutes) • There will likely be 10‐ 20 things you have starred! • If you have written a lot, it will be hard to pick out the highlights • No questions, no discussion, no ideas M O O B ,

List and Prioritize “Let’s make a list of what would you like to work on? ” • Let parent start, you can use notes to remind parent of what they said • Share notes with parent “Lets put these goals into priority order. If you could only choose one thing to work on, what would it be? • Proceed until all goals are numbered

Managing the Interview • Make use of a “parking lot” • Families often begin to solve own troubles just by saying them out loud • Don’t forget to acknowledge ideas, and • Don’t forget to come back to them at another time • Manage time and distractions effectively

When you have a concern the parent does not choose What if you have a concern, detect a delay or some other problem? • Check your own beliefs and biases…Is this a FUNCTIONAL concern? • Use natural learning opportunities • Obligation to give families information • Consider timing of when to address concern

A Successful Interview… • • • Lasts approx 1 to 1 ½ hours Gives you a detailed picture of the child and family’s daily activities Produces a minimum Gett ing in s to ca e at of 6 – 10 outcomes re G ettin with g dresse o d Hard ut fussin g t store o contro l in Dinn e Bath r time – c t wash ime – ha rying rd to Crys safely a lot whe in cr ib n pu t

“Are we there yet? !!!”

Interview Skills • Active listening • In depth follow up questions • Proactive questioning about child development • Continuing the conversation • Smart questions Mc. William, R. A, Casey, A. M, Sims, J. The routines based interview: a method for gathering information and assessing needs. Infants and Young Children. 22, 3, 224 -233.

Interview Skills • Non verbal communication to convey acceptance and interest • Social environment of routines • Seeking evaluative and interpretive opinions • Managing the conversation • Empathizing Mc. William, R. A, Casey, A. M, Sims, J. The routines based interview: a method for gathering information and assessing needs. Infants and Young Children. 22, 3, 224 -233.

Other Tips • Ask open ended questions • Do NOT answer your own questions • Do NOT make the RBI conversation into a multiple choice quiz • Use “why” with caution • Practice with co-workers and friends

Practice Interviews Divide into groups of 3 Mother Interview er Observer

Preparation for Interview: 5 Minutes Mothers – Receive assigned role – Read the vignette – Prepare to make up details Interviewers – Read RBI Implementation Checklist Observers – Read RBI Implementation Checklist

Flow of Activity • Begin interview as though you had 90 minutes ahead of you—in depth information • After 20 mins, I will tell you when you should move on to evening routines • After another 10 mins, you should be recapping and selecting outcomes • You are done when outcomes are selected

7 Steps for Writing Functional Outcomes You can’t just take a nonfunctional outcome and turn it into a functional outcome… That will merely produce a well‐written nonfunctional outcome

7 Steps to Writing Functional, Measureable, Family Owned • Read the informal functional outcome • Determine the routines involved • Write “[The child] will participate in [those routines]” • Write “…by _____ing, ” inserting the desired behavior • Consider We will know this when he or she _____ and add a measurable acquisition criterion • Add a generalization criterion • Add the criterion specifying the amount of time

Smith Family Goals -Get Samantha to chew her food -Move to get to places (rolling, crawling, walking) -In and out of sitting -Stand up -Play with toys the way they’re designed… more toys -Communication (reaching, sounds) -Cup drinking -Jacque’s relationship with Gabriel and Andrea

Developing Child Outcomes Step 1 Take what the family listed as a goal in the RBI We want Sam to chew her food

Developing Child Outcomes Step 2 Find out what routines this affects Lunch and dinner

Developing Child Outcomes Step 3 Write “Child will participate in [the routine(s) in question]” Samatha will participate in lunch and dinner

Developing Child Outcomes Step 4 Write “by _____ing, ” addressing the specific behaviors By chewing her food and moving food from side to side with her tongue before swallowing

Developing Child Outcomes Step 5 Add a criterion for demonstration the child has acquired the skill We will know she can do this when she eats 1/2 cup of food in this manner

Developing Child Outcomes Step 6 Add another criterion for generalization, maintenance, or fluency, if appropriate (across routines, people, materials, places, over time) One time at lunch, one time at dinner

Developing Child Outcomes Step 7 What amount of time will it take until we presume mastery? Samantha will participate in lunch and dinner by chewing her food and moving food from side to side with her tongue before swallowing. We will know she can do this when she eats ½ cup of food in this manner, one time at lunch, one time at dinner for 1 week.

Developing Child Outcomes Play with toys in the way they are intended Samantha will participate in play time by playing with toys the way they’re intended. We will know she can do this when she plays appropriately with 2 toys a day for three consecutive weeks.

Video Resources RBI Interview https: //www. youtube. com/watch? v=IVKc. T-Owu. UE Difference is in the Details: The value of asking good questions https: //vimeo. com/154905455 https: //vimeo. com/154905504