Enhancing Services in Natural Environments

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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
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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.

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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

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Ordering Information

• Downloadable Handouts and PowerPoint
  presentations, and ordering information for tapes
  or CDs of the audio portions of the calls in the
  series are available at
• http//www.nectac.org/calls/2004/partcsettings/pa
  rtcsettings.asp

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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

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ComplexityLots of Differently Labeled Lists of
Ideas are Used to Describe Ways of Thinking

• 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

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Complexity

• Dont Forget
• IDEA Legislation
• Federal Rules and Regulations
• State Rules and Regulations
• Program Policy

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Complexity Terminology

• 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

• 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

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

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Common Themes

• Relationship-based approach
• Individualized approach
• How children learn
• Family-centered supports and services
• Participation in families everyday routines,
  activities, places, and relationships
• Childrens learning in the context of families
  natural learning opportunities
• Integrated supports and services

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Tools for Change
Phase of the IFSP Process Key Practices Key Practices Key Practices Key Practices Key Practices Key Practices
Phase of the IFSP Process Relationship-Based Approach Individualized, Culturally Competent Family-Centered Supports Services Participation in Everyday Relationships, Routines, Activities, Places Natural Learning Opportunities Integrated Supports Services
Public Awareness
Identification
Referral
First Contacts
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Relationship-Based Approach

• A childs relationships with primary caregivers
  organizes all his or her early development
  (Hanft).
• The knowledge and resources of early childhood
  specialists are shared with a childs 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).

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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).

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Relationship-Based Approach

• those adults who are most consistently
  available and committed to the childs 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.Nation
  al 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.

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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 childs
  development, learning, and participation in every
  day activities?
• Too much service may reduce a familys confidence
  (Dunst).
• Working with a wide diversity of families
  (culture, ethnicity, religion, socio-economic,
  linguistic) requires thoughtful consideration.

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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)

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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)

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Learning Occurs between Sessions

• 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.

McWilliam
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Do the Math Again

• 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.

Dunst, Ferrier
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Family-centered supports services means

• Being responsive to family directed priorities
• Recognizing and supporting the familys 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 childrens learning and
  developmental
• Recognizing and supporting child and family
  strengths
• Supporting the familys competence and confidence
  in enhancing the childs learning and development
• Providing informational, emotional, and material
  support to families
• Acknowledging and supporting the cultures,
  values, and traditions of families

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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 childs participation, independence,
  and learning

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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 childs 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

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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

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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 childs development
• Enhance/increase childs participation in
  everyday relationships, routines, and activities
• Promote mutual enjoyment of family activities

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A Final Agreement- More is Better

• But this means more learning opportunities, NOT
  more services
• Learning opportunities happen BETWEEN
  practitioners visits
• Throughout the childs day
• In the context of everyday relationships,
  routines, and activities
• Through multiple repetitions and practice

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So..
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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?

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Is the focus of Public Awareness on
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Is the focus of Public Awareness on
Reference TA Document Natural Environments, NM
Infant Toddler Program (2002)
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Change Strategies
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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

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Change Strategies

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

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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

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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

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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.

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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.

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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.

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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.

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Conditions of Change
Condition of Change To what extent do these conditions currently exist? Which Need Improvement?
Dissatisfaction with the Status Quo
Knowledge and Skills Exist
Resources are Available
Time is Available
Rewards or Incentives Exist for Participants
Participation is Expected and Encourage
Commitment by Those Who are Involved
Leadership is Evident