Quality Physical Therapy in NYC EI

Family Centered Practices.

Embedded Coaching is composed of two main elements

  • Embedded Interventions : Interventionists collaborate with families to find ways to support their children’s functioning in routine activities, respecting the family’s style and culture. This is achieved by using information:
    • From ongoing observations of routines and conversations with the family;
    • About the child’s and family’s capacities, interests and strengths; and
    • About the family’s goals, concerns, priorities, resources and routine activities.
  • Collaborative Coaching : Interventionists observe, coach, and provide feedback to families to:
    • Support them in learning new ways to support their children’s development throughout the day during family routines; and
    • Enhance family competence and confidence in helping their children learn.

On-going communication and collaboration among EI team members and the family is essential in providing families with cohesive clinical support whether children receive services at home, a center-based program, a facility, or day care.

Why routine activities?

  • IDEA Part C is the federal law that requires EI services to be provided in natural environments and routine activities.
  • The family’s routine activities provide many natural opportunities for children to practice new skills in different contexts. By using routines, children’s learning is enhanced between sessions.
  • Children need to be engaged and actively participate in their learning activities. Children learn skills better in the situations where they are going to use them.
  • Families do not have to set aside a special time to practice since routine activities occur naturally throughout the day and week.

Families do not replace therapists. When families incorporate these strategies into their routines, they expand their ability to support their child’s development. At the same time, they enhance and expand the work of the interventionists. One of the eight federal outcomes for the Early Intervention Program is to enhance families’ capacity to support their children’s learning and development.

Embedded Interventions and Collaborative Coaching Approaches

  • Support not supplant what families already do and expect to do as parents •
  • Take advantage of already existing community opportunities •
  • Children are continually a part of their family and community, and learning •
  • Prepare families for community settings and life after early intervention

Families  Should Know

  • Identified “natural environments” as more than location, but learning opportunities.
  • Agreed professionals’ role is to provide specific strategies to family •
  • Chose coaching model as more beneficial •
  • Almost exclusively identified learning opportunities in home and community •
  • Identified benefits of family participation, capacity building, easy to fit into “real life” (Campbell, Sawyer, & Muhlenhaupt, 2009; Dunst & Raab, 2004; Sayers, Cowden, & Sherrill, 2002; Scales, McEwen, & Murray, 2007)

Embedded Interventions

Interventions occur during home and community routines and other times of the child’s day that are identified by family members as activities within which they would like support.

  • Embedded interventions occur when, where, and how the routine activities usually occur, as well as with the people who usually take part in the routines.
  • Interventionists partner with families to identify developmental strategies that the family can try with their child between visits.
  • Interventionists collaborate with families to adapt learning opportunities and strategies that promote their child’s participation in activities across family and community settings.

What’s the Difference? Comparing Traditional Approaches vs. Embedded Coaching Practices

Embedded Interventions: Reflect on your practices….

How close are you to applying embedded intervention approaches in your work? Consider each practice carefully to see the difference between traditional approaches and embedded intervention approaches.

Traditional Approaches Embedded Intervention Approaches
Rely solely on assessment information gathered from tabletop testing and/or general developmental tasks that are known not to generalize well to a child’s functioning in everyday life Understand each family’s routines and activities, and how the child currently functions during those times, to individualize intervention approaches to the child and his/her family
Identify generic intervention approaches common for all children or children with a specific disability label or developmental characteristic Identify intervention approaches that fit the individual child’s learning characteristics (e.g., interests, temperament, strengths, needs) and each family’s culture and values
Schedule intervention visits based on professional availability Schedule intervention visits at the time when the routine activities (identified by the family) usually occur, or when the family would like support.
Bring materials into the home for the intervention visit, and then leave with those materials Use materials the family already has available, or bring materials the family can use and keep
Change the way the routine activity usually occurs, including the participants (e.g., ask the parent or siblings to leave the room) and arrangement (e.g., move the activity to another room) Work within the routine activities as they usually occur, including participants and location

Routine Activities and Authentic Assessments

What are Routine Activities?

  • Routine activities are what the child and family normally do during the day.
  • Each family has its own routines.
  • Each family decides whether a certain routine activity is an opportunity for their child to learn, and therefore a time for intervention. These routines are identified in the functional outcomes of their Individualized Family Service Plan (IFSP).

What are Authentic Assessments?

  • Authentic assessments are when interventionists observe the child in his/her routine activities, and interview family members and other important adults, to determine how each family engages in a routine activity.
  • Authentic assessments enable interventionists to gather information about children’s strengths, needs, and interests, as well as the impact of their social and physical environments on their everyday routines.
  • By gathering this information, interventionists can collaborate with the family to create activities/strategies that respect the family’s culture, style and characteristics.

Routine activities include:

Home Child care Community
Playing with toys Playing with peers Going for a walk
Eating Eating Playing in the park
Taking a bath Playing outside Shopping
Reading stories Putting on/taking off coat or jacket Listening to a story at the library
Feeding a pet Engaging in messy play Riding the bus/subway
Getting dressed Changing diapers Swimming at the JCC
Playing with other children in the building Saying goodbye/hello at drop off/pick up Hanging out at the barber shop/beauty salon

Collaborative Coaching Approaches

Specific approaches used to ensure that important adults in the child’s life (e.g., child care providers) are confident and competent in using agreed-upon strategies between intervention visits to promote the child’s learning and development.

  • The interventionist explains, models, and supports family members as they practice the strategies with their child during routines.
  • Interventionists and family members share feedback on the experience and success of the strategies.
  • Successful collaborative coaching results in:
    • intervention strategies that fit the individual family context, and
    • family members and/or caregivers who feel comfortable using effective developmental strategies between visits.

What is Collaborative Coaching and Who Is Involved?

Collaborative coaching ensures that the important adults in a child’s life can and will effectively use developmental approaches between visits.

  • The person(s) the interventionist is coaching are those who are responsible for ensuring the child’s learning and participation within the specific routine activity.
  • At home, those individuals might be parents, siblings, extended family members, or live-in caregivers.
  • In child care, they might be the teacher, assistant(s), child care provider, or volunteers.
  • In the community, it might be a family member or caregiver who accompanies the child during that activity, and/or the facilitator of a child-directed, formal activity, such as library story hour. Other community members may participate to varying degrees as appropriate.

Collaborative Coaching: Reflect on your practices….

How close are you to applying collaborative coaching approaches in your work? Consider each practice carefully to see the difference between traditional approaches and collaborative coaching approaches.

Traditional Approaches Collaborative Coaching Approaches
Focus on professional priorities for child development Focus on family priorities for child development, integrating professional opinion with the family’s priorities
Give the family specific strategies to promote child development Develop and test approaches and strategies in collaboration with the family
Create strategies that require the interventionist, or another person not usually a part of the activity, to help the family member successfully apply the strategy Create strategies that the family member can easily use when the interventionist is not present
Give the family a way to apply the strategies when the family already has a way to do so (e.g., suggest a turn-taking game) Ask the family for ideas on how best to apply the strategies (e.g., ask the family for any interactive activities they like to play)
Work directly with the child while the parent either watches or “assists” by engaging the child in the activity Interact with the child for the explicit purpose of demonstrating to the family how to use a strategy, and the child’s response (or asking the family to identify the child’s response)
Leave without knowing if the family understands, is comfortable with, and can effectively use the approaches Have the family practice the strategies during the visit and share feedback so that both family and professional know the family can and will use them in between visits.