A Routines-Based Approach to Partnering With FamiliesRobin McWilliam, Ph.D.Vanderbilt University6/7/2007 McWilliam 2GettingȱtoȱKnowȱtheȱFamilyJointȱAssessmentȱofFamilyȱNeedsServiceȱDecisionsȱtoȱEnhanceFamilyȱQualityȱofȱLifeSupportȬBasedȱHomeȱVisits6/7/2007 McWilliam 3Contact• [email protected]• www.VanderbiltChildrens.com/earlyintervention/• www.earlyintervention.blogsource.comSkip intro6/7/2007 McWilliam 4ProfessionalSupportChildOutcomesCaregiverCompetence & ConfidenceWho Has How Much Influence on What?6/7/2007 McWilliam 5How Children LearnThrough repeated interactions with the environment, dispersed over time.Not in massed trials.6/7/2007 McWilliam 6The Model6/7/2007 McWilliam 7Getting to Know the Family6/7/2007 McWilliam 8Family Ecology• We need a method to show we’re interested in the family, not just the child– Children live in families• We need something to establish a friendly, interested relationship• We need an alternative to the checklist method of doing intakes6/7/2007 McWilliam 9Kevin SarahMichelle (24 mo.)MaternalGrandparentsSarah’s work colleaguesBrad & Fam. (Kevin’s bro.)Nicole(Sarah’s sister)Johnsons(neighbors)PaternalGrandparentsSLP (Consult)PT (Consult)ChurchHome VisitorKevin’s work colleaguesPediatricianSarah’ssoftball teamA Quick Look at an Ecomap6/7/2007 McWilliam 10Krista has little time for friends, but doesn’t know what to do with her afternoons (the worst time of day)Steven, Krista, DarcyK’s parentsTulsa friendsK’s brotherK’s sistersRobynNeighborsS’s sistersS’s aunt & uncleS’s parentsHometown friendsSLP (Liz)—weekly at homeDr. Trainer (physiatrist)Golf weeklyWork: AlcoaSC (Donna)—6 months min.Ophthalmolog-istAmy (DMRS teacher)—weekly HVsPT (Scott)—2x/wk at clinicOT(Michelle)—2x/wk at clinicChurch (1stBaptist)Regular pediatrician (Glover)Aquatictherapy(weekly)Harris (neurosurg-eon)6/7/2007 McWilliam 11Joint Assessment of Family Needs6/7/2007 McWilliam 12Need for Routines-Based Assessment• Functional goals (target behaviors)– Address participation needs in routines– Address independence needs in routines– Address social relationships needs in routines• Family priorities reflected in the IFSP• Outcomes broad enough yet specific enough• Investment by caregivers other than the family in the IFSP• Family-level outcomes6/7/2007 McWilliam 13The 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 order6/7/2007 McWilliam 14StructureHome RoutinesWaking upChanging diaper/bathroomGoing to kitchenBreakfastParent getting dressedGoing outIn shopsLunchGoing to parkOther family members coming homeDinner preparationDinnerBathTVBedtime“Classroom” RoutinesArrivalCircleFree playSnackSmall toysCentersOutsideMusicStoryLunchNapCentersDepartureWithin Each Routine1. What does everyone else do?2. What does this child do?a) Engagementb) Independencec) Social relationships3. How satisfactory is this routine?3. How well is this routine working for the child (“goodness of fit”)6/7/2007 McWilliam 15Beatrice’s Priorities1. What to do with Miracle during downtimes2. Beatrice’s health3. Move around to get toys4. Play with toys5. Sit up at play time6. Miracle communicate with others in the family at play time7. Eat meals by mouth to be able to eat with the rest of the family; increase variety of foods8. Time for Beatrice for herself9. Beatrice continue her nursing education6/7/2007 McWilliam 16Jo’s Priorities1. Communicate his needs (drink, don’t feel well, eat, more, play, TV, outside)2. Eating with combination of textures; vegetables, fruits3. Handwashing—water rinsing4. Identifying objects (in a book, on body), to see where he is cognitively5. Transitions (e.g., from park) when he has to stop doing something fun6. Therapies more under Jo’s control7. Child care when Jo needs longer term care (e.g., during her medical treatments)6/7/2007 McWilliam 17Service Decisions to Enhance Family Quality of Life6/7/2007 McWilliam 18Rachel’s Priorities1. Adam—independent at dressing2. Independent eating (using utensils, initiating clearing table)3. Play with toys and people at the same time4. Participate in conversations (vs. just getting needs met)5. Meals without “attacking” Paige (sister)6. Do more things with Paige and Hailey (sisters)7. More varied foods8. Rachel—info re: sleep and autism spectrum disorder9. Jeff do things with Adam10. Adam play with toys more11. Potty training6/7/2007 McWilliam 19Outcomes TraditionalIncrementalexperienced (real)IncrementalinexperiencedDressingOT ECSE ECSEUsing utensilsOT ECSE ECSEPlay w/toys and peopleECSE ECSEECSE + SLPConversationsSLP ECSEECSE + SLPMeals w/o attacking sisterECSE ECSEECSE + SLPR do more things with Adam’s sisters?ECSEECSE + SLPVaried foodsOTECSE + NutECSE + SLP + NutInfo about sleep disordersSC?ECSE + NutECSE + SLP + NutJeff with Adam?ECSE + NutECSE + SLP + NutToy playECSEECSE + NutECSE + SLP + NutPotty trainingECSEECSE + NutECSE + SLP + Nut + Ȍ6/7/2007 McWilliam 20Service Intensity• In PSP approach, assume weekly for 1 hour by PSP•Others– As needed– One consultation– Quarterly– Monthly6/7/2007 McWilliam 21Definition of PSP Approach• One professional provides weekly supportto the family, backed up by a team of otherprofessionals who provide services to the child and family through joint home visitswith the primary service provider. The intensity of joint home visits depends on child, family, and primary-service-provider needs.6/7/2007 McWilliam 22Problems With the Multidisciplinary Model• Imply that interventions for the child occur during the home visits• Imply that the family needs massive doses of demonstration• Separates child functioning into domains• Requires much family time• Allocates scarce resources inappropriately6/7/2007 McWilliam 23Benefits of PSP Model• Family receives strong support from one person, not having to get to know multiple people• Program for child and family is coordinated, not fragmented• Weekly, family has to host only one visit in the home, not multiple visits• Service providers, especially therapists, can serve more families• Cost to