NYC Dept of Health & Mental Hygiene EARLY INTERVENTION PROGRAM

NYC Dept of Health & Mental HygieneEARLY INTERVENTION PROGRAM Part 2 of 2 Train the Trainer Curriculum Families As Partners

Early Intervention ProgramNYC DoHMHFamilies As Partners: Part 2 of 2

EI: Families As Partners Program • EARLY INTERVENTION PROGRAM • David Rosin, MD, Executive Deputy Commissioner for Mental Hygiene • Janice Chisholm, Acting Assistant Commissioner, EI • Jeanne Clancy, Ph.D. Director, Families as Partners Project • Prashil Govind, M.D. Medical Director, EI • Linda Stone, Ph.D., Director of EI Programs • Judith Davison, Director of Training • Barbara Burns, Ph.D. NYCEIP Consultant

Family Involvement Effective Early Intervention Child, Parent, Interventionist FAP Forms Assessment of Effectiveness

Train the Trainer in FAP Part 1. • Section 1: Why family involvement is critical to EI services • Section 2: Families As Partners: Rational, Principles, Forms • Section 3: FAP: Co-Visits, Provider and Parent Progress Notes Part 2. • Section 1: FAP Principles and natural routines of families • Section 2: IFSP: Gateway to manageable family involvement • Section 3: Coaching parents effectively • Section 4: Evaluation of FAP and Effective Early Intervention

FAPPrinciples and natural routines of families Part 2, Section 1

FAP Principle # 1 FAP recognizes that the FAMILY is the CONSTANT in the child’s life • Family is the source for strength and nurturance for the child SERVICE PLANS ARE DESIGNED TO SUPPORT THE FAMILY TO HELP THEIR CHILD

FAP Principle # 2 FAP recognizes and accepts differences across families • Differences may include structure of family unit, family values, resources and support team, daily routines SERVICE PLANS ARE FIT TO INDIVIDUAL FAMILES

FAP Principle # 3 FAP acknowledges that every family has strengths • May not always be easy to immediately identify • Skills and strengths often not apparent due to societal or personal factors, etc. SERVICE PLANS BUILD ON STRENGTHS OF FAMILY

FAP Principle # 4 FAP emphasizes that evidence-based practices must be tailored to individual family situations • The special circumstances of every family and child must be considered when designing course of treatment and service plans SERVICE PLANS ARE DESIGNED FOR OPTIMAL PROGRESS FOR INDIVIDUAL CHILDREN AND FAMILIES

“Family-focused” services mean the focus is on theCHILD-IN-THE-FAMILY • Cultural diversity highly valued • Focus on family strengths • Service plans designed with consideration of family’s ability to enhance child’s development FAP supports manageable family involvement FAMILY culture, strengths..

Family-focused early intervention • Focus is NOT just on therapist doing “hands on” intervention with the child • “Hands on” intervention used for: • assessment (e.g., see upcoming video– OT shows how Jacob rides at playground) • modeling techniques to family (e.g., previous video- Evan’s parents and teacher shown feeding techniques)

Core FAP Principles: Video and Discussion of Jacob Meaningful and family-focused services

Video Example: Jacob’s Story • Jacob is a 2 ½ yr old boy who has spastic quadriplegic cerebral palsy • Vignette shows Heidi, a physical therapist, working with Jacob and his mom to have FUN at the playground 5 minutes

Watch Video for these points • Session activities are incorporated into family activities • Consulting with family is interactive (not ‘just talk’) • Parent practices activities during the session and receives feedback from interventionist • Interventionist’s goal is to have family be able to apply activities to other settings between sessions

Video Discussion • How did the video illustrate family-focused interventions? • What did the interventionist do that supports a family focused approach?

Changing roles of EI providers • Previously many EI services were child-focused • Interventionists treated the developmental delay • In FAP the focus is on the child in the family Child in family

The role of the family in EI services “In the past, the EI experience was different in terms of delivery of services for each family. Some therapists worked with the child in a separate room or corner. Whatever lesson was provided for that ½ hour ended when the session was over. Some parents used to peek in to see how the session was going. Some parents would do chores or meet their own needs when their child was in a session. I tell parents that they are not intruding by being present at a session, we want them to be present to learn new skills and share concerns regarding their child’s development” EIOD, 5/2/06

Using the daily routines of the family to incorporate activities that help the child’sdevelopment is powerful early intervention

The natural environment includes the school, center, and the home. The natural environment is where the child’s peers who have no disabilities spend their time.

Scientific research has guided changes in federal legislation: IDEA Part C

It’s the law! • Individual with Disabilities Act (IDEA) Part C (Program for Infants and Toddlers) specifies that early intervention services should be provided in NATURAL ENVIRONMENTS whenever possible.

FAP supports the design of therapeutic activities in natural learning environments • Intervention activities need to become a part of the daily life activities of the child and family • Families need to be coached to recognize the learning opportunities that exist every day • Intervention activities should NOT be viewed as something that happens only when the interventionist arrives

When is it time for the family to practice learning activities ? Learning opportunities for children can occur many many many times across every day.

When is it time for the family to practice learning activities? Learning opportunities for children can occur many many many times across every day. NOT JUST DURING EARLY INTERVENTIONSESSIONS!

Learning activities and family involvement in EI • Family-child interactions are powerful, positive ways of enhancing development • Families can learn to help themselves and reinforce skills learned in EI sessions to practice during everyday activities Family involvement in EI: • Manageable • Authentic

Learning opportunities occur during daily routines of the family In FAP the interventionist helps the family see how they can use those opportunities to help their child.

Core FAPPrinciples: Video and Discussion of Blake

Video Example: Blake’s Story • Blake is a very bright 2 ½ yr old boy who has spastic diplegia. His mom Yvonne wants to be able to carry out routine grocery shopping with Blake. Currently it is a frustrating experience as Blake’s cognitive development exceeds his motor abilities and he gets bored and disrupts the activity. • Vignette shows Trudy, an occupational therapist, working with Blake and his mom at the grocery store to engage Blake in learning at the store and supporting his skilled use of both hands. 7 minutes

Watch Video for these FAP points • Activities are designed according to family priorities • Interventionist designs activities from everyday routines that address multiple child outcomes • Interventionist provides feedback

Video Discussion • How does Blake’s story illustrate the major components of EI-FAP? • Will all parents be as “coach-able” as Blake’s mom? If not, what strategies would you suggest to address challenges to successful coaching?

Interventionist may need to evaluate whether Service Coordinator should identify additional services which support EI Other factors that may limit family involvement • Parental mental state (depression, anxiety) • Social (work hours, daycare, problem relationships) • Lack of confidence in their ability to help their child • Other factors?

What can interventionists do to encourage involvement? • Listen • Encourage • Listen • Design manageable therapeutic activities • Listen • Modify activities based on family feedback • Listen

FAPsystem: If the activities fit what the family is already doing it can make them more MANAGEABLE

Family Involvement Effective Early Intervention Child, Parent, Therapist FAP Forms Assessment of Effectiveness

IFSP: Gateway to manageable family involvement Part 2, Section 2

IFSP meetings • Individualized • Family • Service • Plan

At entry to the system: Individualized Family Service Plan TWO VERY IMPORTANT POINTS: First, contract is for services with family involvement Second, how family can be involved (time schedules, language issues, family limitations, etc. etc.) will be discussed at IFSP “planning for family involvement”

IFSP Forms: Page 3 & 4 • Page 3 Focus on Family activities, routines, sites for EI activities, strengths of families • Page 4 Focus on the IFSP outcomes and the plan for achieving those outcomes, family assistance and settings for services Please take out your IFSP and turn to page 3

IFSP Forms: Page 3 & 4 • Page 3 Focus on Family activities, routines, sites for EI activities, strengths of families • Page 4 Focus on the IFSP outcomes and the plan for achieving those outcomes, family assistance and settings for services

IFSP (pg. 4) outcomes and the plan for achieving outcomes Outcomes: What you want to see happen or change for your child and family as a result of early intervention services. 1 2 3 4 5 Please take out your IFSP and turn to page 4

IFSP (pg. 4) outcomes and the plan for achieving outcomes Outcomes: What you want to see happen or change for your child and family as a result of early intervention services? 1 2 3 4 5

IFSP (pg. 4) outcomes and the plan for achieving outcomes PLAN: PLAN Interventionists will work toward the above outcomes by: Providing appropriate treatment for the child and teaching caregivers to use what is readily in order to bring services into the child’s daily life. The interventionist must show that the services they provide fall under FAP (Families as Partners) principles by using an ongoing record of what is taught and how it is taught. The interventionists should use theFAP Calendar (or other tool), and theSession Notes to record these activities. This is then summarized in theProgress Note. The Family’s full participation, including working with the child on activities suggested by the therapist/educator will result in the best outcome for the child. List ideas/activities and things Families and therapists will do to achieve the above outcomes. Who will assist the family in achieving these outcomes?

The IFSP plan for achieving outcomes (pg. 4): PLAN: Interventionists will work toward the above outcomes by: Providing appropriate treatment for the child and teaching caregivers to use what is readily in order to bring services into the child’s daily life. The interventionist must show that the services they provide fall under FAP (Families as Partners) principles by using an ongoing record of what is taught and how it is taught. The interventionists should use the FAP Calendar (or other tool), and the Session Notes to record these activities. This is then summarized in Progress Note. The Family’s full participation, including working with the child on activities suggested by the therapist/educator will result in the best outcome for the child. List ideas/activities and things Families and therapists will do to achieve the above outcomes. Who will assist the family in achieving these outcomes?

What is new about IFSP outcomesin the FAP System? Interventionists need to: • Write IFSP Outcome(s) addressed on each Session Note • Estimate progress on each IFSP Outcome on Provider Progress Note

IFSP outcomes and the Session Note Child’s name _________________________________________________________________________________________________________ Service provider ______________________________________________________________________________________________________ OUTCOME(S) ADDRESSED: child communicates effectively O Worked with child o Worked with parent/caregiver and child together o Worked with parent/caregiver alone Activity During Session: Child response to session: List Family Plan/Calendar Activity for next week: O Session is within week span from previous calendar activity Date_________________________________________________________________________________________________________________________ _______________________________________________________________Signatures_______________________________________________________

IFSP outcomes • On every Session note: Write IFSP outcome(s) you addressed • On the Progress Notes: Assess progress on each child and family outcome addressed

IFSP meetings and EI services • INITIAL EI SERVICES WILL CONTINUE TO BE: • Connected clearly to evaluation and outcomes • Evidenced-based • Tailored to families • Culturally sensitive • Closely monitored by EI, families, providers

FAP Guidelines • Plan of services • fits family needs • 2) Manageable family involvement in EI • 3) Services are • integrated

Before an IFSP meeting: • Age • Delays • Severity • Recommendations • Available parent information

NYC Dept of Health & Mental Hygiene EARLY INTERVENTION PROGRAM