Quality Physical Therapy in NYC EI

Effective Practices in Early Intervention for Families and Their Infants and Toddlers

  • Historical Context Evidence Base • Family involvement results in significantly greater intervention effects (Shonkoff & Hauser-Cram, 1987; Ketelaar, Vermeer, Helders, & Hart, 1998) •
  • Programs focused on family strategy use were more effective than other family participation methods (Shonkoff & Hauser-Cram, 1987) •
  • Intervention effects dependent upon supporting families in using effective interaction strategies (Mahoney, Boyce, Fewell, Spiker, Wheeden, 1998)

Programs that combine child-focused [developmental]…activities with explicit attention to parent-child interaction patterns and relationshipbuilding appear to have the greatest impacts (National Research Council, 2000, p. 343)

Historical Context IDEA Legislation

  • Focus on the family •
  • Resource-based support •
  • Natural environments

The time has come to stop talking about parent involvement and to commit to learning how such involvement can be accomplished across a range of family constellations, circumstances, and values (Mahoney, Robinson, & Perales, 2004)

Current Evidence Base Natural Learning Opportunities

  • Family and community routine activities •
  • Multiple •
  • Individualized •
  • Development: 1. enhancing 2. Interest 3. Opportunity to practice (Bruder, 2001; Dunst, Bruder, Trivette, Hamby, Raab, & McLean, 2001; Dunst, Hamby, Trivette, Raab, & Bruder, 2000)

Current Evidence Base Effective Family Strategy Use •

  • Contextualized – Where strategies are used – Fit family’s priorities, values and everyday life •
  • Level of support – To learn and continue effective strategy use (Hinojosa, 1990; Hinojosa & Anderson, 1991; Von Wendt, Ekenburg, Dagis, & Janlert, 1984; Woods & Kashinath, 2007; Woods, Kashinath, & Goldstein, 2004)

Interventions fail to be implemented and sustained when they do not fit the daily routine of the family…when the intervention cannot be incorporated into the daily routine, or when the intervention is not compatible with the goals, values, beliefs of the parents (Bernheimer & Keogh, 1995, p. 424)

Current Evidence Base How Supports Are Provided •

  • Family capacity building – Building off family’s strengths & resources – Builds family sense of competence •
  • Family engagement – Professional coaching, listening, asking for information (Peterson, Luze, Eshbaugh, Jeon, & Ross Kantz, 2007; Trivette, Dunst, & Hamby, 2010)

Translating Research to Effective Practices: Embedded Interventions •

  • Individualized approaches – Child’s unique learning characteristics – Family’s culture, values, and ways of being – Routine activity structure and flow •
  • Assess child during routine activities •
  • Identify approaches that fit routine activities •
  • Blend into routine activities – Avoid redesigning or adding to routine activities (Selected: Bernheimer & Keogh, 1995; Bernheimer, & Weisner, 2007; Campbell, 2004; Dunst, Bruder, Trivette, Raab, & McLean, 2001; Dunst, Trivette, Humphries, Raab, & Roper, 2001; Gallimore, Weisner, Kaufman, & Bernheimer, 1989; Guralnick, 2001; Hanft, Rush, & Shelden, 2004; Jung, 2003; Kashinath, Woods, & Goldstein, 2006; McWilliam, 2000; McWilliam & Scott, 2001; Pilkington, & Malinowski, 2002; Roggman, Boyce, & Innocenti, 2008; Woods, Kashinath, & Goldstein, 2004)

Translating Research to Effective Practices: Collaborative Coaching

  • Family-professional collaboration – Design intervention approaches – Try out (family) – Make sure “doable” and comfortable for family •
  • Result – Family confident and competent in using approaches in between intervention sessions – Contextualized – Development-enhancing – Integrated-functional development
  • Adult learning principles – Provide rationale – Interact with child for explicit purpose of assessment and demonstration • Explain steps to approaches • Identify child response – Family practices approaches (majority of visit) • Family and professional provide feedback • Refine as needed