Enhancing Services in Natural Environments

1. Enhancing Services in Natural Environments Common Themes from the Community of Practice on Part C Settings/Natural Environments conference call series on effective practices in early intervention. Presented byLarry Edelman, Univ. of Colorado Health Sciences CenterJoicey Hurth, NECTAC Lynda Pletcher, NECTAC Report on the Conference Call Series Sponsored by the OSEP Part C Settings Community of Practice

2. Goals of the Session • Review common themes and key practices that emerged from the Community of Practice on Part C Settings/Natural Environments series of eight conference calls on effective practices in early intervention.  • Explore the degree to which these common themes and key practices are reflected in early intervention programs.

3. Presenters in the Series • Mary Beth Bruder, University of Connecticut • Juliann Woods, Florida State University • Geneva Woodruff, Concord Family and Youth Services • M'Lisa Shelden, , Family, Infant and Preschool Program • Dathan Rush, Family, Infant and Preschool Program • Barbara Hanft, Consultant • Carl Dunst, Orlena Hawks Puckett Institute • Robin McWilliam, Vanderbilt University Medical Center • Larry Edelman, University of Colorado Health Sciences Center

4. Ordering Information Downloadable Handouts and PowerPoint presentations, and ordering information for tapes or CD’s of the audio portions of the calls in the series are available at: http://www.nectac.org/~calls/2004/partcsettings/partcsettings.asp

5. Complexity: A Variety of Approaches to Thinking about Services in Natural Environments • Contextually Mediated Practices TM • Family-Centered Home-Based Service Approach • Family-Guided Routines Based Intervention • Home-Based Integrated Services • Natural Learning Opportunities • Primary Coach Approach • Primary Service Provider Model • Routines-Based Interview • Support-Based Home Visits • Transdisciplinary Service Delivery • Transformation Family Centered Transagency Team Model

6. Approach Beliefs Characteristics Components Constructs Guiding Questions Key Elements Key Indicators Key Ingredients Key Practices Key Terms Misassumptions Model Paradigms Protocol Quality Indicators Roles Strategies Techniques Touch Points Complexity:Lots of Differently Labeled Lists of Ideas are Used to Describe Ways of Thinking

7. Complexity Don’t Forget… • IDEA Legislation • Federal Rules and Regulations • State Rules and Regulations • Program Policy

8. Activity Setting Asset-Based Context Capacity-Building Models Classroom-Based Integrated Services Coaching Collaborative Consultation Consultation Consultative Model Adapted for Diverse Adult Learners Context Deficit-based Models Development-Enhancing Learning Opportunities Dyadic Interaction/Triadic Exchange Ecomap Embedded Intervention Everyday Learning Opportunities Everyday Natural Learning Opportunities Expertise Models Family Centered Family/Child Supports & Services Family-Centered Home-based Service Approach Family-Centered Models Family-Guided Family-Guided Routine Based Intervention Focused Assessment Functional Evaluation/Assessment Functional Goals Functional Outcomes Home-Based Integrated Services Initial Planning Conversation Integrated Specialized Services Interventions Learning Opportunity Natural Environment Natural Learning Environment Outcome Functionality Peer Coaching Planning Conversation Primary Coach Primary Service Provider Professionally-Centered Models Promotion Models Rationale Resource-Based Models Routine Routine Based Routines-Based Assessment Routines-Based Interview Service-Based Models Services Strengths-Based Models Supports Support-Based Home Visits Transdisciplinary Treatment Models Triadic Support Hierarchy Typical Natural Learning Environment Settings Complexity: Terminology

9. There are some significant differences among various approaches presented. There also seems to be some common themes and areas of clear agreement.

10. Common Themes • Relationship-based approach • Individualized approach • How children learn • Family-centered supports and services • Participation in families’ everyday routines, activities, places, and relationships • Children’s learning in the context of families’ natural learning opportunities • Integrated supports and services

11. Tools for Change

12. Relationship-Based Approach • A child’s relationships with primary caregivers organizes all his or her early development (Hanft). • The knowledge and resources of early childhood specialists are shared with a child’s key caregivers through adult-adult relationships that support family members in their day-day responsibilities caring for their children (Hanft). • Effective collegial relationships are important for improving skills, trying new approaches and resolving challenges (Hanft).

13. Relationship-Based Approach • We need to capitalize on families’ forming close relationships with a primary service provider (McWilliam). • Reciprocal coaching and learning occur between the primary coach and care providers and between the primary coach and other program staff or contractors (Shelden and Rush). • Key practices include establishing supportive and respectful relationships among practitioners and parents for problem solving and decision making (Woods).

14. Relationship-Based Approach • “… those adults who are most consistently available and committed to the child’s well-being play a special role in promoting competence and adaptation that cannot be replaced by individuals who are present less consistently or whose emotional commitment is not unconditional.”National Research Council and Institute of Medicine (2000) From neurons to neighborhoods, p. 389 • Every relationship has the potential and power to enhance other associated relationships.

15. Individualized approach • Every step of the IFSP process from first contacts through implementing supports and services should be tailored to meet the unique needs, priorities, interests, and preferences of each child, family member, and caregiver. • Individualizing necessitates thoughtful, sensitive gathering of information from families during every contact. • Frequency and intensity of services can be considered in a different way: how often do the adult caregivers need service providers to support them in enhancing their child’s development, learning, and participation in every day activities? • Too much service may reduce a family’s confidence (Dunst). • Working with a wide diversity of families (culture, ethnicity, religion, socio-economic, linguistic) requires thoughtful consideration.

16. How Children Learn • Through repeated interactions with their environment, usually dispersed over time; Not in massed trials (McWilliam, 2004) • When interested and engaged in an activity, which in turn strengthens and promotes competency and mastery of skills (Dunst, Bruder, Trivette, Raab & McLean, Exceptional Children, Vol 4, No 3; Sheldon & Rush, 2001; McCollum & Yates, 1994)

17. How Children Learn (continued) • Mastery of functional skills occur through high-frequency, naturally occurring activities in a variety of settings that are consistent with family and community life.(Sheldon & Rush, 2001; Dunst & Bruder, 1999-2000)

18. An early interventionist is only “there” a tiny bit of the week: Two 30 minute sessions = 60 minutes of intervention a week. The family, and other care givers, are always there 10 minutes of intervention during ~10 waking hours = 100 minutes a day or 700 minutes a week. Learning Occurs between “Sessions” McWilliam

19. Twice a week hourly intervention or therapy provided in the absence of parent participation equals about 2% of the total waking hours of a one-year old. Each routine (e.g. putting a child asleep for a nap) that infants experience regularly accounts for more than 2,000 episodes of everyday learning opportunities by the time a child is one year old. Do the Math Again Dunst, Ferrier

20. Family-centered supports & services means: • Being responsive to family directed priorities • Recognizing and supporting the family’s role in making decisions in all aspects of the early intervention process • Building on the recognition that the family is the primary influence on the child and has the greatest impact on young children’s learning and developmental • Recognizing and supporting child and family strengths • Supporting the family’s competence and confidence in enhancing the child’s learning and development • Providing informational, emotional, and material support to families • Acknowledging and supporting the cultures, values, and traditions of families

21. Participation in families’ everyday routines, activities, places, and relationships means: • Providing supports and services within the context of families’ lives • Supporting child and family participation in everyday life • Creating functional rather than developmental outcomes • Supporting that which happens between visits • Being guided by the context of a child and family's everyday life and the families’ goals for their child’s participation, independence, and learning

22. Natural learning opportunities means: Basing strategies on how all children learn Having a sound understanding of typical infant and toddler development Recognizing that young children learn throughout the course of everyday life, at home and in the community Focusing on naturally occurring learning opportunities, rather than contrived, specialized instruction Supporting primary caregivers to provide children with learning experiences and opportunities that strengthen and promote a child’s competence and development Supporting learning that occurs in context of the things that have high levels of interest and engagement for children and their families

23. Integrated supports and services means: • Basing intervention on functional, integrated goals • Avoiding a discipline-specific or domain-specific focus • Using Team-based approaches (e.g. transdisciplinary, primary service provider) • Collaborating

24. Agreement on Important Outcomes of Early Intervention Although our speakers would probably differ in emphasis and priorities, and each speaker might add more outcomes, all support these outcomes: • Support family confidence and competence in enhancing their child’s development • Enhance/increase child’s participation in everyday relationships, routines, and activities • Promote mutual enjoyment of family activities

25. A Final Agreement- More is Better*… • But this means more learning opportunities, NOT more services • Learning opportunities happen BETWEEN practitioners’ visits: • Throughout the child’s day • In the context of everyday relationships, routines, and activities • Through multiple repetitions and practice *Thanks to LeeAnn Jung, 2003

26. So…..

27. Public Awareness: Key Questions to Address To what extent: • Do we provide adequate public awareness to alert families and potential referral sources of our services and supports? • Do our public awareness materials and activities clearly articulate our vision for EI supports and services?

28. Services provided to the child or Supports and services provided to the family as they enhance their child’s participation, learning, and development or Specific clinical services Integrated EI supports and services or Family involvement Practitioners not being able to do this work without parents and other caregivers Is the focus of Public Awareness on:

29. or Formal services Supports and services that incorporate how natural supports can help achieve IFSP outcomes or “The answer” EI supports and services as a way to help families achieve their outcomes Is the focus of Public Awareness on: Reference: TA Document: Natural Environments, NM Infant Toddler Program (2002)

30. Change Strategies

31. Using Change Models • Facilitating change in complex systems is challenging. • Models might be useful as analytical or diagnostic tools to help understand local conditions and to plan what can be done about them. • Models might be used: • At the inception of a change effort • During planning • During monitoring • After adoption

32. Change Strategies • Conditions of Change • Implementation Concerns • Concerns-Based Adoption Model (CBAM) • Diffusion of Innovations • The Innovation-Decision Process • The Attributes of Innovations

33. Conditions of Change: Conditions That Facilitate the Implementation of Innovations Donald P. Ely, Professor of Instructional Design and Development,Syracuse University Director of the ERIC Clearinghouse on Information Resources Facilitating Change, page 3

34. Conditions that Facilitate the Implementation of Innovations (Ely) 1. Dissatisfaction with the Status Quo 2. Knowledge and Skills Exist 3. Resources are Available 4. Time is Available 5. Rewards or Incentives Exist for Participants 6. Participation is Expected and Encouraged 7. Commitment by Those Who are Involved 8. Leadership is Evident

35. Conditions of Change (Ely) 1. Dissatisfaction with the Status Quo One of the first steps to initiate change is that dissatisfaction exists with things as they are. 2. Knowledge and Skills ExistThe people who will ultimately implement any innovation must possess sufficient knowledge and skills (competence) to do the job.

36. Conditions of Change (Ely) 3. Resources are AvailableThe material things that are needed to make the innovation work should be easily accessible. 4. Time is AvailableImplementers must have (paid) time to learn, adapt, integrate, reflect, pilot, practice, and evaluate new approaches.

37. Conditions of Change (Ely) 5. Rewards or Incentives Exist for ParticipantsWhy should anyone change? If current practice is going reasonably well, why risk it? Incentives vary for individuals, but intrinsic or extrinsic, can play an important role. 6. Participation is Expected and EncouragedUnless individuals who are expected to implement the change have a part in deciding what to do, it is unlikely that the innovation will be implemented with fidelity and enthusiasm.

38. Conditions of Change (Ely) 7. Commitment by Those who are InvolvedCommitment communicates support, and any individual who is about to try something new wants to know that there is continuing support for implementation. 8. Leadership is EvidentBoth program leadership and project managers need to: provide encouragement to consider new ideas; insure that training is offered; that necessary materials are accessible; and be available for when discouragement or failure occur.

39. Conditions of Change