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ECI: Making It Work - IFSP section

4. IFSP

Introduction4.1 Moving on to IFSP

Notes:

MIW SC:

The Individualized Family Services Plan, or IFSP, documents the childs strengths, needs, functional abilities, the familys priorities for services, and the type and amount of services the child will receive. The IFSP form is completed by the team during the IFSP meeting, but the form reflects all of the information gathered during pre-enrollment, the evaluation, needs assessment, and the IFSP meeting.

Keep in mind that the IFSP form is much more than an actual document. The completed IFSP form is the result of the IFSP process. In this section of the module, youll have the opportunity to talk through the IFSP process and practice the related documentation.

4.2 Objectives (TBD)

4.3 IFSP and the 7 key principles

Notes:

MIW SC:

Which of the 7 Key Principles relate to the IFSP? All of the 7 key principles are relevant, but the fifth principle is the one that speaks directly to the IFSP: IFSP outcomes must be functional and based on childrens and families needs and priorities.

By listening to a family's concerns and priorities, you learn about many aspects of the family, their activities, and interests. This information is essential to developing meaningful IFSP outcomes.

The fourth principle is also important here: The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the childs and family members preferences, learning styles and cultural beliefs.

Scores on standardized tests can provide important information about a child, but they should not drive intervention. You will need more than test scores to understand a childs functional abilities. As we saw in the previous section of the module, you collect a lot of information about the child and family throughout the evaluation & assessment process. Now, we bring all that information to the IFSP process, to ensure it is dynamic and individualized.

4.4 Activity: Does principle 4 look like this?

Principle 4:

The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the childs and family members preferences, learning styles and cultural beliefs.

Answer the following 2 questions: Does principle 4 look like this?

Question 1: Directing the IFSP process in a rote, professional-driven manner and presenting the family with prescribed outcomes and a list of available services.

A. Yes

B. No

The answer is B, No. It's important to listen to what the family wants for their child, share what you know as a professional, and then synthesize the discussion to develop an outcome meaningful to the family.

Question 2: Listening to families priorities & needs, preparing the family to participate in the IFSP meeting, and supporting them to develop the outcomes, strategies, activities, services and supports.

A. Yes

B. No

The correct answer is A, Yes. These behaviors demonstrate respect for the family, and support them as equal team members. This will also help strengthen your rapport and relationship with the family. Families engaged in the ECI process from the very beginning are more likely to be actively involved during service delivery.

4.5 IFSP in TAC & CFR

Notes:

MIW SC:

The rules and regulations related to the IFSP process are found in TAC, Title 40, Part 2, Chapter 108, Subchapter J: Individualized Family Service Plan and in the Code of Federal Regulations, Title 34, Part 303, Subchapter D, Sections 303.340 through 303.346.

Federal Regulations for IDEA Part C are listed here: http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=6b266fffdc7890f6646b0e34961691ca&rgn=div5&view=text&node=34:2.1.1.1.2&idno=34

Check your understanding: Can you find this in TAC?

Question: What section of Rule addresses who must attend the initial IFSP meeting?

TAC is listed here: http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=2&ch=108

Answer: TAC 108.1009.

In this section you'll also find who must attend the annual IFSP.

4.6 IFSP team

Notes:

MIW Coach:

The IFSP team consists of the parent and or caregiver, a service coordinator, and one additional professional with expertise in a different discipline than the service coordinator. In some instances, the service coordinator may have 2 roles: coordinating services for the family and providing services based on expertise in a specific discipline. One of the professionals on the IFSP team must be someone who was directly involved in the child's evaluation & assessment and in most cases there must be a Licensed Practitioner of the Healing Arts (LPHA) on the team.

If the family receives services from Early Head Start, Migrant Head Start, or other community agencies such as a Medicaid managed care program, staff from those agencies should be invited to participate to share additional information about the child and family. Parent consent is required before inviting providers from other agencies to the IFSP meeting.

Remember, the parents may want to invite other people to the IFSP meeting to provide additional information or to provide support.

The IFSP Form4.7 Required elements

Notes:

MIW Coach:

Now let's take a look at the IFSP form. ECI requires specific elements be included in each IFSP. The instructions for the IFSP form (titled Required Elements of the IFSP) provide detailed directions for completing the form. The form contains prompts and some minimal instructions, but the Required Elements describes in detail the necessary components of an IFSP and how to document them. You should review the Required Elements and be familiar with the instructions.

4.8 Required elements on the web

Notes:

MIW Coach:

The Required Elements can be found on the ECI Website (https://hhs.texas.gov/services/disability/early-childhood-intervention-services)

On the left hand side of the page, click For ECI Programs

Now click on, ECI Provider Forms

The Required Elements for the IFSP, the Periodic Review of the IFSP and the Annual Evaluation of the IFSP can also be found on this page.

Here is a sample Initial IFSP Form: https://admin.abcsignup.com/files/{07D0901F-86B6-4CD0-B7A2-908BF5F49EB0}_59/IFSP_form_initial.doc

Here is a sample IFSP annual review form: https://admin.abcsignup.com/files/{07D0901F-86B6-4CD0-B7A2-908BF5F49EB0}_59/IFSP_form_annual.docx

Here is a sample IFSP Outcomes Form: https://admin.abcsignup.com/files/{07D0901F-86B6-4CD0-B7A2-908BF5F49EB0}_59/IFSP_outcome_template.pdf

4.9 Get to know the IFSP form

Notes:

MIW Coach:

Take some time now to learn more about each section of the form. We will review what is documented in each section.

4.10 Physical development

Notes:

MIW Coach:

To develop outcomes and plan services, it is necessary for the IFSP team to describe a childs functional abilities in his daily routines and identify his developmental needs. That description is completed by interviewing the family, and recording it in the first section of the IFSP referred to as the Functional Abilities, Strengths and Needs Assessment.

The IFSP form guides the team through the process of assessing and identifying the developmental strengths and needs of the child. The first section records physical development and covers health, nutrition, hearing and vision. Some of this information may have been gathered using the ECI Needs Assessment, ID and Referral Form, and can be summarized here. Concerns are noted, but functional information about each area is also required. Information that should be recorded here includes important medical history, diagnostic testing the child has undergone, and current health status.

Examples of what to document here include: a childs medical diagnosis, history of frequent ear infections, surgeries, or use of medical equipment.

Also list all medications the child takes on a regular basis, including non-prescription medications. Some medications can cause side effects that can impact a childs development such as a seizure or allergy medication that can cause the child to feel sleepy and lethargic and it is important for the team to be aware of this information.

The date of the last well child check or physical is included in this section. If the child was premature, enter his gestational age as calculated at the time of eligibility determination.

Vision and hearing should be described in functional terms to reflect how the child uses his hearing or vision within the context of everyday activities. Here are two examples: Jamie gets excited when she hears the school bus at the stop out front, because she knows her big sister is home

Thomas can see his bottle on the table from across the room, and gets upset if someone does not get it for him quickly in the morning.

Even if there are no concerns about the childs vision or hearing status, it is still important to describe the childs status in functional terms. It is not sufficient to only write family has no concerns or passed hearing screening.

4.11 The routines section

Notes:

MIW Coach:

The next section of the IFSP describes the typical routines and activities of the child and family. Be sure to ask all the questions on the form, but dont limit yourself to those questions. Use them as a springboard to start a discussion.

It is important to connect the child's evaluation results to the IFSP. If a child shows a significant delay on the BDI-2, that delay will be reflected in the description of the child. For instance, the evaluation may indicate a child has a delay in fine motor skills. That delay may impact his functional ability to self-feed and to play with toys. We need to describe strengths and abilities, but a clear description of developmental needs is also necessary to establish the child's need for services. We listen to and record the familys concerns, but we also apply our professional expertise and experience to identify potential areas of need.

4.12 Discussing routines

Notes:

MIW Coach:

The Code of Federal Regulations requires that the description of the child cover all developmental domains to present a complete picture of the childs abilities and needs. The IFSP form provides prompts for each routine to help you describe all the developmental areas relevant to the routine. Each routine has an associated prompt, which is related to several developmental domains.

Functional skills are skills a child is using in a meaningful way. For example, some children on the autism spectrum may use words, but not to ask for things they want. Dont ask leading questions, such as, Katelyn can feed herself with her fingers, right? Instead ask, What is lunch time like with Katelyn? What kinds of things does she eat and how does she eat them? Ask open-ended questions to allow parents to give examples of how their child uses skills during daily routines.

The following 5 routines are listed in this order on the IFSP Form. Under each routine are sample questions on the form, along with the developmental domain(s) addressed with each question:

1. How Your Day Starts

a. How does your child let you know he/she is awake? (cognitive, communication and social-emotional)

b. How does your child get out of bed? (adaptive/ self-help and motor)

c. Is your child happy or sad when he/she wakes up? (social-emotional and communication)

2. Bathing, dressing, diapering and toileting

a. How does your child help with dressing? (communication, adaptive/ self-help and motor)

b. What does bath time look like for you and your child? Is bath time a fun or stressful time of day? (adaptive/ self-help, cognitive, communication, motor and social-emotional)

c. How does your child let you know that he/she needs a diaper change or to use the toilet? (adaptive/ self-help and communication)

3. Meal Times

a. What do meal times look like for your child? Is there anything difficult or special about meal times? (adaptive/ self-help, motor, social-emotional and communication)

b. How does your child let you know when he/she is hungry or thirsty, what he wants and when he is finished? (communication, adaptive/ self-help and cognitive)

c. What are your childs likes and dislikes? How do you know? (communication and nutrition)

4. Play time and other daily activities

a. How does your child play? What does he/she like to play with? Are there times that are easier or more frustrating than others? (cognitive, communication, motor and social-emotional)

b. Does your child have the opportunity to be around other children and adults? If yes, how and where does your child interact with them? (cognitive, social- emotional)

c. How does your child act when you take them out in public? How does your child respond to separations and transitions? (motor, social-emotional and communication)

d. How does your child follow directions? Respond to limits? (cognitive, communication and social-emotional)

e. Are there certain days that look different? If yes, how does your child respond to the changes? (social-emotional)

5. Bed time and nap time:

a. How do you prepare your child for bed time and map time? How does your child let you now he/she is sleepy? (adaptive/ self-help, cognitive, communication and social-emotional)

b. How does your child fall asleep? How long does he/she sleep? (adaptive/self-help and social-emotional)

4.13 Child outcome codes

Notes:

MIW Coach:

The IFSP has a space in each routine for assigning global child outcome codes. Global child outcomes are not the same as IFSP outcomes. There is a dedicated module on the global child outcomes that is highly recommended for you to complete in the coming weeks. For now, we will discuss briefly here the relationship of global outcome measurement to the IFSP.

Global child outcomes apply to every child in ECI. They are rated by the team at a childs entry to and exit from ECI. This information about individual children is then compiled and provides the state with data that is used to measure the effectiveness of ECI services.

The same three global child outcomes are measured for every child. Information about a childs functional abilities across developmental domains is used to assign an outcome rating for the childs:

social-emotional skills (including social relationships)

acquisition and use of knowledge and skills (including early language/communication); and

use of appropriate behaviors to meet their needs

The description of the child in the IFSP provides supporting evidence for a childs rating on the three global child outcomes. On the left side of the Routines section are columns that correspond to the three outcomes. An X in the box for a global early childhood outcome indicates information about the child's functional skills related to that routine can provide supporting evidence for that outcome. For example, in describing a child's functional abilities in his mealtime routines, you should record information about his social-emotional skills, his acquisition of skills, and his use of appropriate behaviors to meet his needs. The team will then make a determination about whether his functioning in that routine is

age-appropriate (A),

age-appropriate only occasionally or in some settings and situations (O),

just below the childs age level and might be considered as an emerging skill (I),

well below the childs age level, but are considered to be skills that could be built upon to help the child make progress in a particular area (N).

The ratings of A, O, I and N are then used to make decisions for the final Child Outcomes Ratings for that child, and are put in the code box

4.14 Strengths, needs, concerns, priorities

Notes:

MIW Coach:

The routines section also identifies strengths, needs, concerns, and family priorities. It is important that the team identify every routine affected by a developmental concern. For example, if a child is not walking, numerous routines will be affected. You can see this in the number of times motor is prompted as a developmental domain to be addressed when discussing a routine. The needs and concerns must be clearly identified in the IFSP. This provides documentation that services are needed, and will help the team develop appropriate outcomes later in the IFSP.

While interviewing the family, it is appropriate for the team to use their expertise to suggest to a family that a behavior seems like a concern or strength. There may be circumstances when a family considers a behavior to be both strength and a concern. In this case, both boxes may be checked, but the information written in the IFSP should make clear why this is so.

For each routine in which a need was identified, the team will help families decide if the routine is a priority. Remember, this is the familys plan for their child, not the ECI professionals plan. Sometimes, parents may identify a concern, but not wish to address it with an outcome. Place a priority number or a check next to every routine or behavior that is considered by the family to be a priority.

The team will then develop outcomes to address the needs and priorities, using the strengths of the child to build on when developing procedures and strategies.

4.15 Examples of routines

On your caseload, Elizabeth is one of your children. See example notes for Elizabeth for two routines: bathing and playtime. In each note, think about what might be strengths and what might be needs/ concerns.

4.16 Elizabeths routine: bathing

Example Note: Howard (Dad) baths Elizabeth in an infant tub. She does not have very steady head control, so she needs the extra support. Elizabeth does not really like being bathed and she usually cries. He has tried to distract her with brightly colored bath toys, but she still cries. She briefly looks at the toy when Howard shows it to her. Elizabeth moves her arms and kicks with her legs in the tub. She immediately quiets when Howard picks her up and wraps her in a towel. She seems to enjoy snuggling with Howard after her bath.

Question: Which of these are strengths and which are needs/ concerns?

Strengths: She briefly looks at the toy when Howard shows it to her. Elizabeth moves her arms and kicks with her legs in the tub. She immediately quiets when Howard picks her up and wraps her in a towel. She seems to enjoy snuggling with Howard after her bath.

Needs/concerns: She does not have very steady head control, so she needs the extra support. Elizabeth does not really like being bathed and she usually cries. He has tried to distract her with brightly colored bath toys, but she still cries.

4.17 Elizabeths routine: playtime

Example Note: Susie holds Elizabeth a lot and carries her in her sling. She enjoys sounds and looking at her mobile but needs help to turn her head completely to either side. Susie is concerned that Elizabeth might develop a flat spot on her head because she doesnt seem to have the strength to pick her head up and turn it. Elizabeth spends most of her time at home.

Susies sister has visited several times. Elizabeth does not smile when being held or talked to by her aunt, but she isnt fussy either. She has not had many opportunities to be around others.

She has only been to the doctors office once and Elizabeth remained asleep in her car for the entire car ride. Susie is not sure if Elizabeths car seat has enough support for her head. Elizabeth is a calm baby. She doesnt cry a lot. When she does cry, she calms easily when Susie picks her up and carries her. She doesnt seem to have any self-soothing techniques yet.

Question: Which of these are strengths and which are needs/ concerns?

Strengths: She enjoys sounds and looking at her mobile. She isnt fussy either. Elizabeth is a calm baby. She doesnt cry a lot. When she does cry, she calms easily when Susie picks her up and carries her.

Needs/ Concerns: She needs help to turn her head completely to either side. Susie is concerned that Elizabeth might develop a flat spot on her head because she doesnt seem to have the strength to pick her head up and turn it. Elizabeth does not smile when being held or talked to by her aunt. Susie is not sure if Elizabeths car seat has enough support for her head.

4.18 Family resources

Notes:

MIW Coach:

The final item at the bottom of the Routines section is a description of the parents resources available to meet the developmental concerns and priorities that have been identified. This may include extended family, preschools, childcare, neighbors, resources within the home (toys, books, etc.), and neighborhood resources. Example: If the parent is concerned about the childs social skills, a resource may be The child has an opportunity to be around other children his or her age at home and at daycare. Another example is: the child is delayed in walking. A resource for this family is the childs older sibling. The ECI child loves to follow his older sister around the house, so the older sibling can be used to encourage the child to walk. Another example could be a childs doctor or the childs medical specialist, especially if the child is medically fragile, or if he is seeing specialist for his diagnosis.

After a discussion of the resources available to assist the family with the childs developmental needs, the next step in the IFSP is to identify and document the child and familys case management needs, and resources that might help meet those needs.

4.19 Child & family resources and case management needs

Notes:

MIW Coach:

The minimum requirements for case management are to monitor the implementation of the IFSP and to follow up with the family to ensure that the child's needs are being adequately addressed. The team should explain the statement at the top of the Child and Family Resources and Case Management Needs section on the IFSP to the family to inform them of these minimum requirements.

Service Coordinators must contact families on a regular basis to determine if services are being provided in accordance with their child's IFSP and determine whether the child's goals or outcomes are being met and if there have been changes in the child's needs.

Every child in ECI receives case management services, but some families may not understand the benefit of the service. Case management isnt only for families with obvious social service needs. The team should talk to the family about how case management can help them access material, informational and support services and can help to ensure that their ECI services are meeting their family's needs.

The Child and Family Resources and Case Management Needs section is broken down into four areas, Medical, Educational, Social and Other. The team will review the information they have learned about the family and indicate if an item listed on the form is one of the following: a need for which an outcome will be developed; a need for which the family declines to develop an outcome; not identified as a need; or, a resource.

If the family has expressed a need that is not listed on the form, the team should check the Other box and document the need.

Completing this section of the IFSP is part of the initial needs assessment for case management.

There is also a space on the form that allows team members to document additional information about an identified need or resource. Service Coordinators - if you are documenting needs on this form after the initial IFSP, the notes section should be used to indicate the date when the new need was identified. The notes section can also be used to record any other important details about the resource or need.

At this point in the IFSP, the needs assessment has been completed. You have gathered relevant information from numerous sources, and compiled it in to a document that will now guide the team in developing outcomes and planning services to meet the needs of the child and family.

4.20 The outcomes section of the IFSP

Notes:

MIW Coach:

In the discussion of routines in the previous section of the IFSP, you learned about identifying developmental strengths and needs of the child, concerns of the team, and priorities of the family. The team will develop outcomes based on those needs and concerns.

4.21 What is an outcome

Notes:

MIW Coach:

An IFSP outcome describes an expected change -- a change that is a result or consequence of ECI services. It is a specific description of what a child will be able to do in a specified amount of time. IFSP outcomes are specific to each child and family. IFSP outcomes differ from the global child outcomes.

Outcomes should be designed to enhance a childs ability to participate in family and community activities, and should directly address the familys concerns and priorities for their child. Based on your professional knowledge, identify areas you think should be addressed and share your ideas with the team, always remembering the final decisions about outcomes rest with the family.

Caregivers have much more influence on a child's development than professionals. The professional's greatest impact comes from helping caregivers develop the skills and knowledge they need to help their child develop in the context of everyday activities. The brain of a young child is strengthened by positive early experiences, especially stable relationships with caring and responsive adults in safe and supportive learning environments. For this reason, we help parents look at their routines and then develop outcomes to support development within these routines.

4.22 Activity: IFSP outcomes and 7 key principles

Notes:

MIW Coach:

Principle 5 specifically addresses IFSP outcomes. It states: IFSP outcomes must be functional and based on childrens and families needs and priorities.

The following are 8 characteristics of what this principle looks like and doesn't look like in practice. Determine if you think each of these statements looks like or doesnt look like Principle 5.

1. Writing IFSP outcomes based on test results.

a. Look like

b. Doesnt look like

The correct answer is B. This does not look like Principle #5.

2. Changing outcomes to meet the evolving needs of the family.

a. Look like

b. Doesnt look like

The correct answer is A; this does look like Principle #5.

3. Listing the services to be provided as an outcome.

a. Look like

b. Doesnt look like

The correct answer is B. This does not look like Principle #5.

4. Writing targeted outcomes to fix problems.

a. Look like

b. Doesnt look like

The correct answer is B; this does not look like Principle #5.

5. Reinterpreting what families say to better match the service providers ideas.

a. Look like

b. Doesnt look like

The correct answer is B. This does not look like Principle #5.

6. Basing outcomes on the priorities of the family.

a. Look like

b. Doesnt look like

The correct answer is A; this does look like Principle #5.

7. Writing outcomes that address the whole child.

a. Look like

b. Doesnt look like

The correct answer is A; this does look like Principle #5.

8. Writing outcomes that are focused on family routines.

a. Look like

b. Doesnt look like

The correct answer is A; this does look like Principle #5.

Routines

4.23 Take a closer look at the routines section

Notes:

MIW Coach:

Good job! Youve taken a first look at each section of the form.

Now lets go back to the routines section and take a closer look at how to describe routines and how to conduct the routines-based interview.

4.24: RBI video, part 1

Notes:

MIW Coach:

As you just saw, in the routines section of the IFSP form, you record information about the typical routines and activities of the child and family. An effective way of learning about those routines is to use a Routines-Based Interview or RBI. The RBI is a clinical, semi-structured interview used to assess the childs engagement, independence, and social relationships within everyday routines. The interview also gauges the familys satisfaction with home routines.

Note that the RBI does not result in a developmental score. It does result in a list of outcomes/goals chosen by the interviewee.

Now its time to learn about the typical routines and activities of the child and family. You will want to identify the familys desired outcomes and goals.

The following video clips are from a routines-based interview. Take note of some strategies the interviewer uses to obtain additional information from the family. You'll notice that in this example, only one person is conducting the RBI, but keep in mind it is required to be conducted by an interdisciplinary team. After watching the video, you will answer a question.

4.25 RBI video part 1, self-check

This video takes place in the home with EIS, mother and father sitting at the kitchen table and toddler in the background.

Transcript of Video RBI-1:

EIS: Well I would like to thank you all very much for participating in this interview process with us today. The purpose of doing the interview like this is to access familys needs so that we can help them develop a plan thats going to be appropriate for you and its going to fit into your lifestyle so that we can set priorities about what to work on first.

Mom: Thank you

EIS: and what to work on second. Um Im going to do this by asking a series of questions. Im just going to ask you about what your daily life is like well go through your daily schedule.

EIS: Um, lets talk a little bit about what happens when you go in the car. You know when I called you the first time you were on your way to El Paso I think.

Mom and Dad both answered: we were on our way to actually on our way to San Diego.

EIS: oh you were in El Paso then.

Toddler begins making noises

Mom: shh

EIS: So apparently they do fairly well in car trips?

Mom: Yes, well theyve been traveling since they were just a couple weeks old each of them so on long road trips so there used to it.

EIS: Okay, so when you tell them we are going to I believe Walmart, Home Depot those are our favorite places to go to.

Mom: yea then its like okay shoes.. shoes.. wheres shoes?

EIS: So everybodys good to go with that. Does he help you to put on his shoes when youre going to go somewhere? Hell go get them?

Mom: yea, hell go get them and I will put them on otherwise hell sit there and try to put them on.

EIS: But generally he is always ready to go. When you want to go somewhere he is good with that? But he wants his own car seat?

Mom: own car seat, and be the first one to be put in.

EIS: And if we rate going somewhere in the car how would we rate it?

Mom: Its probably like a 5.huh sarge?

Mom and Dad both answered: It just depends generally its 9 times out of 10 its a five but there just these days. One day out of 30 you know he will be like he just wants to stay home, he will just throw a fit to get in the car and then throw a fit in the car and throw a fit where we are going, but its rare but still it happens.

Mom: Hell just want rather stay home. Throw a fit wherever we are going.

EIS: Ok um, is that something that you see as typical child behavior or something that you see as unusual kind of thing for a child to do?

Mom: I think its unusual. Just because Ive been around so many kids I never have seen it happen. But you know who am I to say its typical every child is different.

EIS: Alright, So sometimes when he does have those days where he doesnt want to go and he has his behavior. What does he do?

Mom: Do you want to tell her?

Dad: Hell let his body go limp when were trying to get him up. He wont get up on his own like he normally does. We have to get him up then we have to get his shoes on him hell calm down for a few minutes and then hell start raising stink you know once we put him in the car then hell just scream the whole way until we get somewhere he wants to be.

EIS: Ok so when he just goes limp like that then do you just bodily pick him up and put him in the car and go ahead and do what you want to do?

Mom: mm hum.

EIS: OK then uh when we get to Walmart, Home Depot those places that we go what does he do? Does he ride in the cart? Does he walk?

Mom: Its a mixture of both. Hell walk you know if its both of us or he will ride in the cart if its just me hell sit in the back if I have to pick up you know one or two things. But when its with both of us unless hes having one of his fit days hell walk. If hes having a fit day then hell be in the cart.

EIS: Okay, so he can go either way when you go shopping?

Mom: kind of depends on how he is doing that day.

EIS: Okay if hes walking does he go and take things off the shelves?

Mom: Hell do what we ask him to we have a little back pack with a little tail on it looks like a monkey it has big ones and then little people on it.

EIS: Laughs and then says oh thats cute.

Mom: yeah so we have that and we uh and so Ill say you know go get the stuff off the shelf go put that in the cart you know and hell go and put the stuff it in the cart.

EIS: Okay so he helps then.

Mom: Yes if he is sitting in the cart hell help unload the cart at the end.

End of Transcript

Question: Which of the following statements is true about the video you just watched?

A. The interviewer only asked questions of the mother and did not attempt to include the father in the conversation.

B. The interviewer made the conversation feel as natural as possible by asking leading questions and then probing for more information to get a better description of the childs functional abilities.

C. The interviewer does not use active listening techniques.

The correct answer is B. The interviewer made the conversation feel as natural as possible by asking leading questions and then probing for more information to get a better description of the childs functional abilities. This was more of a conversation and not a person reading questions off of a list. The answer was not choice A, because the interviewer looked back and forth between the parents and would ask follow up questions from both parents. The answer was not choice C because the interviewer used active listening by making eye contact with the family, smiling, nodding her head and asking follow up questions.

4.26 RBI video part 2

Notes:

MIW Coach:

In this next clip, observe the father and how his demeanor and body language change from being disengaged in the previous clip to becoming more involved in the conversation.

Transcript, Part 2:

Dad: I just like, I would like to find out if were doing something wrong, honestly Id like to find out if theres any activities that were doing wrong I mean with the change in our lives.

Mom: I mean obviously we need to be sitting down and having meals with our kids and stuff like that and you know doing that kind of stuff.

Dad: But I mean Id like to find out if there is something within ourselves you know that we are kind of caring over to the kids that our worries are being carried over to the kids.

Mom and Dad: without us even knowing it.

EIS: so something in your parenting maybe that you?

Dad: Id like to find out if I am the driver of his behavior. Because I feel like that sometimes

Mom: trying to cut off the EIS: that maybe he is feeling our worries.

EIS: So you have a concern that maybe he if there is something that you do the kids are picking up. And they are responding to that in some way.

Dad: And just because I yell it just a challenge I was raised I was yelled at pretty bad so, unfortunately sometimes you learn by osmosis its just there.

EIS: Most people learn to parent by the way that they were parented.

Mom: Well I mean honestly in all fairness Kase has been through a lot. Surge, with my coping with my pregnancy being so bad and I was in the hospital almost all the time that kind of worry that you he went through.

Dad: Yea but I know that sometimes when he acts out I probably dont respond to that the best way I generally tend to yell a little bit you know try to make him.

Mom: Try to grasp his attention by yelling

Dad: Unfortunately I was raised the way I got response from other stuff was to either yell at it or you know get it done myself. Im at the point now where its like not working this yelling anymore maybe Im just you know blowing higher at this point I just want to find out if I am at all a driver in this situation

Mom: It feels like a therapeutic session.

Mom and EIS laugh

EIS: Well actually the interview process I wouldnt necessarily call it therapeutic

Mom: continues to laugh

EIS continues: but I think it is helpful for folks to step back for a minute and take a look at what their daily life is like you guys both have a very full very busy live and sometimes you dont realize how much youre doing until you look at it.

Mom: Laughs and says until you sit down and realize it.

EIS: Thats right.

End of transcript.

Now that you have watched the clip, the interviewer does a great job building rapport by calmly listening, not offering advice, supporting what the parents are expressing, and showing interest in the familys strengths, needs, and priorities. By the end Dad feels very comfortable with the interviewer and Mom states It feels like a therapeutic session.

4.27 Modifying the questions

Notes:

MIW Coach:

Sometimes it is necessary to modify the questions in the routines section of the IFSP to conduct an appropriate and complete assessment.

Because Elizabeth is an infant, some of the questions are not applicable to her. You'd need to modify the questions to best suit her circumstances. For example, in the section about how the day starts, you could combine the questions and have a general discussion about the wake up routine in the morning.

You can ask these questions: How many hours does the baby sleep? How do you know when she is awake? Can you leave her in her bed for a few minutes after she wakes?

Instead of these questions: How does your child let you know he/she is awake? How does your child get out of bed? Is your child happy or sad when he/she wakes up?

Here's another example: In the bathing, dressing, diapering and toileting section, you might ask "How does Elizabeth respond to being dressed and undressed? Is there anything difficult about dressing and undressing? instead of How does your child help with dressing?

4.28 Activity: Modifying questions for Elizabeth

Notes:

MIW Coach:

Now you try ... How would you modify the mealtime questions for Elizabeth? Think about these before looking at some possibilities.

Here are the mealtime questions on the IFSP form:

1. What do meal times look like for your child? Is there anything difficult or special about meal times?

2. How does your child let you know when he/she is hungry or thirsty, what he wants and when he is finished?

3. What are your childs likes and dislikes? How do you know?

Now that you have prepared some answers, here are some possible modifications:

How are you feeding Elizabeth?

Who feeds her?

Where do you feed her?

Is there anything difficult or special about feeding?

How many times a day do you feed her and how much does she take each time?

How long does a feeding session usually take?

If bottle fed, does she take the same amount of formula at each feeding?

Does Elizabeth fall asleep while being fed? If yes, does this happen occasionally or on a regular basis?

4.29 Activity: Elizabeth's bathtime routine

Notes:

MIW Coach:

Here's some of the information Elizabeths team gathered about her bath time. Notice that even though Elizabeth is a young baby, it's possible to write up thorough descriptions of routines. You are going to use the bath time description to see how each of the domains was assessed: Motor, Vision, Social-Emotional, and Communication.

Description of bath time routine:

Howard (Dad) bathes Elizabeth in an infant tub. She does not have very steady head control, so she needs the extra support. Howard feels more comfortable bathing her in a smaller space than in the regular tub. Elizabeth does not really like being bathed. She usually cries during her bath. Howard tries to bathe her as quickly as possible. He has tried to distract her with brightly colored bath toys, but she still cries. She does briefly look at the toy when Howard shows it to her. Elizabeth randomly moves her arms and kicks with her legs in the tub. She immediately quiets and stops crying when Howard picks her up and wraps her in a towel. She seems to enjoy snuggling with Howard after her bath.

Take a moment to think about how you would assess each of the domains, then read the following to see how each domain was assessed...

Motor: She does not have very steady head control, and Elizabeth randomly moves her arms and kicks with her legs in the tub.

Vision: She does briefly look at the toy when Howard shows it to her.

Social-Emotional: Elizabeth does not really like being bathed. She usually cries during her bath, she still cries, She immediately quiets and stops crying when Howard picks her up, and she seems to enjoy snuggling with Howard after her bath.

Communication: She usually cries during her bath, but she still cries, and She immediately quiets and stops crying when Howard picks her up and wraps her in a towel.

4.30 Activity: Elizabeth's playtime routines

Notes:

MIW Coach:

Elizabeths team also gathered the information about her play skills. Notice again, we have a good thorough description of her routine. You are going to use the play time description to see how each of the domains was assessed: Motor, Vision, Hearing, Social-Emotional, and Communication.

Description of playtime routine:

Susie holds Elizabeth a lot and carries her in her sling. Susie reports that Elizabeth enjoys sounds and looking at her mobile. Elizabeth needs help to turn her head completely in order to look at her mobile or to look at Susie when she sings or speaks to her. Susie is concerned that Elizabeth might develop a flat spot on her head because she doesnt seem to have the strength to pick her head up and turn it.

Elizabeth has spent most of her time at home. Susie reports she has only taken Elizabeth to the doctors office one time and Elizabeth remained asleep in her car seat for the entire car ride. Susie is not sure if Elizabeths car seat has enough support for her head.

Elizabeth is a calm baby. She doesnt cry a lot. When she does cry, she calms easily when Susie picks her up and carries her. She doesnt seem to have any self-soothing techniques yet.

Susies sister has visited several times. Elizabeth does not smile when being held or talked to by her aunt, but she isnt fussy either.

Take a moment to think about how you would assess each of the domains, then read the following to see how each domain was assessed...

Motor: Elizabeth needs help to turn her head completely, Susie is concerned that Elizabeth might develop a flat spot on her head because she doesnt seem to have the strength to pick her head up and turn it, Susie is not sure if Elizabeths car seat has enough support for her head.

Vision: She enjoyslooking at her mobile.

Hearing: Elizabeth enjoys sounds.

Social-Emotional: Susie holds Elizabeth a lot and carries her in her sling, Elizabeth is a calm baby, She doesnt seem to have any self-soothing techniques yet, Elizabeth does not smile when being held or talked to by her aunt, but she isnt fussy either.

Communication: She doesnt cry a lot. When she does cry, she calms easily when Susie picks her up and carries her.

4.31 Activity: Connecting behaviors to routines

Notes:

MIW Coach:

Riley has delays in the areas of cognitive, communication, adaptive, and social emotional development, and it is important that the description of the child in the IFSP reflects concerns for his development as well as his strengths. Adelia, Rileys mother, reported certain behaviors. Read the following description of his behaviors documented in the IFSP to learn more. Which routines are affected by the behavior? :

Beginning of Rileys IFSP (from Handout):

How Your Day Starts:

Question: How does your child let you know he/she is awake?

Description: Riley usually walks downstairs by himself, but sometimes he will call out by saying mama. He will also say up to be picked up, but he does not put words together, and doesnt use more than a few words. He likes for Mom to be the one to come in and get him if he is still in bed and is grumpy if Dad is the one to wake him up.

Question: How does your child get out of bed?

Description: He will crawl out of his toddler bed on his own by sliding down on his stomach with feet down first. His door is closed and he can turn the door handle to open it. If he hears us downstairs, he will come down by himself, holding on to the rail and alternating feet.

Question: Is your child happy or sad when he/she wakes up?

Description: Hes very sweet when he wakes up. He smiles when he finds us. Weve taught him to blow a kiss when he sees us. He is surprisingly alert when he first wakes up, like he is ready for the day. If we have to wake him up, it takes him a little longer to wake up and he is a little grumpy.

Bathing, Dressing, Diapering and Toileting:

Question: How does your child help with dressing?

Description: Sometimes he doesnt want to get dressed and fights me. I have tried offering him choices of clothing items by holding out one shirt at a time, but it just seems to make him angry. Other times he will help get dressed by pushing his arms through the sleeves and pulling his pants up once I get his feet through.

Question: What does bath time look like for you and your child? Is bath time a fun or stressful time of day?

Description: It is hard to get him in to the tub he doesnt want to leave the rest of the family, and will cry and sometimes try to bite. He is able to climb into and out of the tub on his own. He will take the washcloth from Mom and clean ledge. He babbles to himself in the tub, but we dont understand any of what he says.

Question: How does your child let you know that he/she needs a diaper change or needs to use the toilet?

Description: Hes not toilet trained, but he doesnt like to have a dirty diaper. He will come to us and tug on the front of his pants when he wants a fresh diaper. If I try to get a diaper, he sometimes gets a diaper and brings it back. He helps during diaper changes by lifting his legs while we change him.

Meal Time:

Question: What do meal times look like for your child? Is there anything difficult or special about meal times?

Description: Riley primarily finger feeds himself, but is able to use a spoon or fork. When he finishes what is on his plate, I show him different foods until he reaches out for the food he wants. If I dont offer a choice he wants or if he is finished, he will scream and throw his plate. He does not name any food items or use any signs during meal time.

Question: How does your child let you know when he/she is hungry or thirsty, what he wants and when he is finished?

Description: He will come in to the kitchen and say eat, but this is the only word he uses. He gets frustrated when he cant tell us what he wants to eat. If he is thirsty, he will point at his favorite sippy cup. Sometimes he will drink from our cup if it is within his reach. If he is finished eating, he will push his food away or climb out of his booster.

Question: What are your childs likes or dislikes? How do you know?

Description: He likes to eat: chicken nuggets, cheeseburgers, hot dogs, peanut butter and jelly sandwiches, macaroni&cheese, French fries, grapes, strawberries, corn, baked beans, whole grain rice, and drinks milk and juice.

He does not like: steak, grilled chicken, broccoli, lettuce, tomatoes, mashed potatoes, peaches, or most soft textures. He will sometimes drink water but it is not his favorite.

Playtime and other daily activities:

Question: How does your child play? What does he/she like to play with? Are there times that are easier or more frustrating than others?

Description: He loves to run and play with the older boys at daycare he follows them up and down the stairs on the playscape, and chases them around. While inside the daycare, he will put all of the toy cars in a row and is more interested in spinning the car wheels than driving the cars around the room. He lines up most toys at home as well instead of using the toy for the intended purpose.

Question: Does your child have the opportunity to be around other children and adults? If yes, how and where does your child interact with them?

Description: He loves being around the other children at daycare, and other kids in the neighborhood. He likes to try to imitate them, especially movements, and uses gestures and facial expressions to communicate, but no words. He is good at throwing balls toward his teacher and laughs when she pretends it hits her.

Question: How does your child act when you take them out in public? How does your child respond to separations and transitions?

Description: Taking him to the grocery store is difficult he wont stay with me and runs away, and when I try to put him in the cart, he screams and will have a tantrum. He wants to climb into and out of the car seat on his own. When dropped off at daycare, he walks in without a problem. Picking him up can be difficult if he is doing an activity he enjoys, but we can tell him there are animal crackers in the car, and he gets excited and runs to the car.

Question: How does your child follow directions? Respond to limits?

Description: When the kids are all playing out in the front yard it is hard for Riley. He cant go in the street, but he tries to do that a lot. When we bring him back to the yard he will throw a tantrum. He doesnt seem to understand directions at all.

Question: Are there certain days that look different? If yes, how does your child respond to the changes?

Description: Most days look the same for us. It may not be the exact same activity at home or daycare, but we try to keep him on a similar schedule as the daycare. We have already learned that he likes consistency, so we prepare with having his favorite snack or treat readily available for moving from one activity to another.

Bed Time and Nap Time:

Question: How do you prepare your child for bed time and nap time? How does your child let you know he/she is sleepy?

Description: He doesnt like to go to bed. When he sees we are starting the bedtime routine he becomes upset and will try to bite. He has also done this at daycare naptime, and it is presenting a problem for them. We have tried separating him from the other children for nap so he does not wake them up and he wants to walk back to be near them.

Question: How does your child fall asleep? How long does he/she sleep?

Description: We try a few different approaches to get him to sleep like pat his back, rub his back, sing to him and tickle his arms. None of these approaches works consistently. When we finally get him down to sleep, he will sleep 10 hours through the night in his own bed.

End of Rileys IFSP.

Quiz:

The following are some behaviors that Rileys mother, Adelia, has reported, or that were identified during evaluation, written on the IFSP. Connect each general description of Riley's behavior to the routine(s) that demonstrate the behavior. Which routines are affected by this behavior?

Behavior #1: Riley runs, jumps and can go up and down stairs.

A. How the Day Starts

B. Bathing, Dressing, Diapering, Toileting

C. Meal Times

D. Play Time and other daily activities

E. Bed time and nap time

The correct answers are A and D. This behavior affects How the day starts since Riley walks downstairs to find his parents after he wakes up. It also affects Playtime and other daily activities because Riley loves to run and play with the older boys at daycare and goes up and down stairs on the playscape.

Behavior #2: When its time to make a transition to a different activity, he becomes frustrated and will scream, try to bite, etc.

A. How the Day Starts

B. Bathing, Dressing, Diapering, Toileting

C. Meal Times

D. Play Time and other daily activities

E. Bed time and nap time

The correct answers are B and E. This behavior affects Bathing, dressing, diapering, toileting because it is hard to get Riley in to the tub. He doesnt want to leave the rest of the family, and will cry and sometimes try to bite. It also affects Bed time and nap time since Riley doesnt like to go to bed. When he sees his parents are starting the bedtime routine, he gets upset and tries to bite, which he does at daycare nap time, too.

Behavior #3: We offer him choices, but he often becomes frustrated and cries.

A. How the Day Starts

B. Bathing, Dressing, Diapering, Toileting

C. Meal Times

D. Play Time and other daily activities

E. Bed time and nap time

The correct answers are B and C. This behavior affects Meal times because Mom shows Riley different foods until he reaches out for the food he wants. If she doesnt offer a choice he wants or if he is finished, he will scream and throw his plate. It also affects Bathing, dressing, diapering, toileting since Mom offers Riley choices of clothing items by holding out one shirt at a time, but this only makes him angry.

Behavior #4: Riley uses a few words to communicate.

A. How the Day Starts

B. Bathing, Dressing, Diapering, Toileting

C. Meal Times

D. Play Time and other daily activities

E. Bed time and nap time

The correct answers are A and C. This behavior affects How the day starts because Riley lets Mom and Dad know he is awake by calling out mama. Then he will say up to be picked up, but he does not put words together or use more than a few words. This behavior is also affects Meal times, as Riley lets his parents know he is hungry or thirsty by saying eat, but he gets frustrated when he cant tell them what he wants.

Outcomes

4.32 Outcomes and needs

Notes:

MIW SC:

You've done a great job with learning more about routines and how important they are to the IFSP process. Let's take a look now at outcomes.

Every outcome must relate to one or more identified needs. If an outcome is written, the need that corresponds should be clearly identified in the IFSP. But be aware that there is not a one-to-one correspondence between needs and outcomes; sometimes two or more related needs can be addressed by a single outcome. Similarly, every IFSP outcome does not need to have a corresponding service or be discipline-specific but all outcomes must be addressed through intervention.

4.33 Measurable outcomes

Notes:

MIW SC:

What makes an outcome measureable? The functional outcomes you develop must be measurable. That means the outcome:

Describes a specific action or behavior that can be seen or heard. It does not require interpretation or guessing to figure out if it has been achieved.

Describes the context or activity in which the action or behavior will be seen or heard.

Describes how many times, or what distance or amount, or how often the action or behavior will occur. It has a reference point for the parent to easily see or hear when the outcome is achieved

Indicates a realistic timeline identified for reviewing the action or behavior.

You'll have a chance to identify and write measurable outcomes in a little bit ...

4.34 Activity: Is the outcome measurable?

Recognizing measure outcomes activity: Measurable outcomes must meet all of these criteria: specific action by child; context (when/where); quantity and/or frequency; and timeline or target date. For each of the following six outcomes, which criteria does each outcome meet? Select all that apply.

Outcome #1: Mikal will be able to transition from his belly to sitting up and vice versa during the course of his daily routines.

A. Specific action by child

B. Context (when/where)

C. Quantity and/or frequency

D. Timeline or target date

E. None of these

The correct answer is A. As written, only the specific action is described by this outcome. Specific action by child is indicated: "be able to transition from his belly to sitting up and vice versa." Context (when/where) is not indicated. Although some context is given (daily routines) it should be more specific as to the type of routine. Also, no location is indicated (At home? In child care?). Quantity and/or frequency is not indicated. Timeline is not indicated (In 3 months? In six months?)

Now revise the outcome so it meets all the criteria. (Pause)

Rewritten measurable outcome: Mikal will be able to transition from his belly to sitting up and vice versa during floor time while mom cooks dinner. He will do this five times in one week (target date on outcome page).

Outcome #2: Sam will speak words clearly and label items in books and his environment and name family members daily for one month.

A. Specific action by child

B. Context (when/where)

C. Quantity and/or frequency

D. Timeline or target date

E. None of these

The correct answers are C and D. As written, the outcome gives a sense of the action to be performed but does not define it clearly. Context (when/where) is not indicated. Quantity and/or frequency: Daily, for one month. This outcome could be improved by specifying how many items or people the child will name. Timeline: Target date is written on outcome page.

Now revise the outcome so it meets all the criteria. (Pause)

Rewritten measurable outcome: Sam will use words his parents can understand to name pictures in books or photos of family members when his parents read to him at bedtime, daily for one month (target date on outcome page).

Outcome #3: Norah will be able to express her wants and needs in short three word phrases, like Mom, I hungry.

A. Specific action by child

B. Context (when/where)

C. Quantity and/or frequency

D. Timeline or target date

E. None of these

The correct answer is A. Specific action by child is indicated: express her wants and needs in short three word phrases. Context (when/where) is not indicated. Quantity and/or frequency: The outcome does not specify how often Norah will be able to express her wants and needs (e.g., twice a day for two weeks). Timeline is not indicated.

Now revise the outcome so it meets all the criteria. (Pause)

Rewritten measurable outcome: Norah will be able to express her wants and needs during meals and snacks using three word phrases two times a day, for a week, before she starts preschool in the fall.

Outcome #4: William will follow simple directions that are part of his daily routine, such as come here and stop at least 5 times a day.

A. Specific action by child

B. Context (when/where)

C. Quantity and/or frequency

D. Timeline or target date

E. None of these

The correct answers are A and C. Specific action is indicated by child: Following simple directions such as come here and stop. Context (when/where): This outcome vaguely addresses the when (during daily routines) but not the where. Quantity and/or frequency is indicated: at least five times a day Timeline is not indicated. When will you know William has met this goal? Its not indicated as written.

Now revise the outcome so it meets all the criteria. (Pause)

Rewritten measurable outcome: William will obey his parents when they say stop or come here at least five times a day while playing, four days in a week, before visiting grandma at Christmas.

Outcome #5: Janelle will call her mom and dad and make simple requests using words or signs.

A. Specific action by child

B. Context (when/where)

C. Quantity and/or frequency

D. Timeline or target date

E. None of these

The correct answer is E, none of the criteria are met with this outcome. More specificity is needed. No context is provided in the outcome as written. Quantity and/or frequency and timeline are not indicated.

Now revise the outcome so it meets all the criteria. (Pause)

Rewritten measurable outcome: Janelle will use a sign or a single word to ask for a toy when playing in the living room three days a week for a month (target date on form).

Outcome #6: Jack will eat two bites of his birthday cake using his hands.

A. Specific action by child

B. Context (when/where)

C. Quantity and/or frequency

D. Timeline or target date

E. None of these

The correct answers are A and C. Some specificity is provided in this outcome, but remember the more specific you are, the easier it will be for you and the parents/caregivers to report whether or not the outcome has been met. Context (when/where): Though you probably assume this would take place on Jacks birthday, it is not actually written in the outcome. Quantity and/or frequency is indicated: two bites. Regarding timeline, the outcome does not specify when he must eat the two bites of birthday cake. What if it took Jack eight hours? Would that be a realistic outcome?

Now revise the outcome so it meets all the criteria. (Pause)

Rewritten measurable outcome: Jack will eat and swallow two pieces of his birthday cake on his birthday, within 15 to 20 minutes using his hands.

4.35: Activity, Developing a measurable outcome

Notes:

Families often describe very general goals or ideas of what they want their child to be able to do. A conversation is usually required to identify needs and develop a measurable outcome.

Read the following exchanges between a parent and a service provider, then write an outcome that is individualized and measurable for each scenario.

Beginning of Excerpt, Scenario 1:

Parent: I just want my child to walk.

SP: Where would you like for him to walk?

Parent: I would like for him to walk when we go to the mall.

SP: How far would he need to walk? How often would you like for him to walk? (A parent might respond that she wants the child to walk everywhere." Closer questioning can reveal more specific information -- something like Is there an activity that would be easier if he was walking?)

Parent: We go to the mall once a week to play in the indoor play area. There is an elevator not far from the door that opens near the play area on the second floor.

SP: How much help would he need when hes walking?

Parent: I would like for him to walk by himself, at least a short distance.

SP: How will things be easier for you when he can walk?

Parent: I have a new baby who I must push in a stroller when we go to the mall. If Mark Anthony could walk, it would be much easier than pushing a stroller and having a two-year old on my hip.

End of Excerpt, Scenario 1.

Now, write an outcome based on that scenario.

Beginning of Excerpt, Scenario 2:

Parent: I just want my child to eat.

SP: When we talked about his routines, you mentioned he only eats mashed potatoes or baby food. What else would you like him to eat?

Parent: I would like him to eat little pieces of Chicken Nuggets and vegetables.

SP: How would you like for him to eat?

Parent: I dont mind feeding him the food; I just want him to be able to chew it.

SP: How much would you like him to eat?

Parent: I would like him to chew and swallow at least half of the food I give him.

SP: Where would you like him to eat?

Parent: I want him to be able to eat his food with the family at home and at the restaurant.

SP: When would you like him to eat?

Parent: He eats breakfast just fine, because I give him cereal and there is no chewing involved. I would like for him to be able to chew meat and other foods at lunchtime, dinnertime, and when we go to restaurants.

SP: How will things be easier for you when he can eat?

Parent: I still have to buy jars of baby food, which has grown to be pretty expensive. If he chews his food, he can eat what the family is eating. I dont mind cutting the food into small pieces, but I would like to give him what we eat.

End of Excerpt, Scenario 2.

Now, write an outcome based on that scenario.

Beginning of Excerpt, Scenario 3:

Parent: I just want my child to talk.

SP: What kinds of things would you like for her to say? (e.g. specific words, phrases, etc.)

Parent: Honestly, to start, I just want her to say mama.

SP: At what times would you like her to talk?

Parent: I would really like for her to say mama to let me know she is awake and to let me know she wants a snack.

SP: Who would you like her to talk to?

Parent: She spends most of her time with me, so I would really like for her to call my name to get my attention.

SP: How will things be easier when she can talk?

Parent: I work from home and sometimes I am in my office downstairs. I dont know when Giana wakes up because she isnt able to say my name. If she could say mama, I could come get her without making her wait in her crib.

End of Excerpt, Scenario 3.

Now, write an outcome for scenario 3.

4.36 Activity, Try writing an outcome

Notes:

MIW SC:

Let's try writing an outcome for one of the MIW children. Use the RBI info for Elizabeth's playtime to write an outcome for her. Remember that there is not necessarily a one-to-one correspondence between needs and outcomes; sometimes two or more needs can be addressed by a single outcome, but every outcome must relate to one or more identified need.

Beginning of Excerpt, Elizabeths playtime routines:

Susie holds Elizabeth a lot and carries her in her sling. Susie reports that Elizabeth enjoys sounds and looking at her mobile. Elizabeth needs help to turn her head completely in order to look at her mobile or to look at Susie when she sings or speaks to her. Susie is concerned that Elizabeth might develop a flat spot on her head because she doesnt seem to have the strength to pick her head up and turn it.

Elizabeth has spent most of her time at home. Susie reports she has only taken Elizabeth to the doctors office one time and Elizabeth remained asleep in her car seat for the entire car ride. Susie is not sure if Elizabeths car seat has enough support for her head.

Elizabeth is a calm baby. She doesnt cry a lot. When she does cry, she calms easily when Susie picks her up and carries her. She doesnt seem to have any self-soothing techniques yet.

Susies sister has visited several times. Elizabeth does not smile when being held or talked to by her aunt, but she isnt fussy either.

End of Excerpt, Elizabeths playtime routines.

Try writing a measureable outcome. (Pause)

(When finished), is your outcome like one of these?

1. Elizabeth will hold her head up and turn to look at her caregivers, and at her mobile or other toys without assistance, at least 3 times a day at home and 3 times a day when she is at daycare every day for 2 weeks.

2. Elizabeth will smile and make eye contact when being held and talked to, at least twice a day at home and twice a day when she is at day care every day for 2 weeks.

4.37 Activity, Outcomes for Riley

Notes:

MIW SC:

You will first be reading an excerpt from Rileys RBI information. Based on the RBI info you will read for Riley, write two functional, measurable outcomes that can be worked on across routines: one to address speech and one to address behavior.

Beginning of Rileys RBI Info (from handout):

How Your Day Starts:

Question: How does your child let you know he/she is awake?

Description: Riley usually walks downstairs by himself, but sometimes he will call out by saying mama. He will also say up to be picked up, but he does not put words together, and doesnt use more than a few words. He likes for Mom to be the one to come in and get him if he is still in bed and is grumpy if Dad is the one to wake him up.

Question: How does your child get out of bed?

Description: He will crawl out of his toddler bed on his own by sliding down on his stomach with feet down first. His door is closed and he can turn the door handle to open it. If he hears us downstairs, he will come down by himself, holding on to the rail and alternating feet.

Question: Is your child happy or sad when he/she wakes up?

Description: Hes very sweet when he wakes up. He smiles when he finds us. Weve taught him to blow a kiss when he sees us. He is surprisingly alert when he first wakes up, like he is ready for the day. If we have to wake him up, it takes him a little longer to wake up and he is a little grumpy.

Bathing, Dressing, Diapering and Toileting:

Question: How does your child help with dressing?

Description: Sometimes he doesnt want to get dressed and fights me. I have tried offering him choices of clothing items by holding out one shirt at a time, but it just seems to make him angry. Other times he will help get dressed by pushing his arms through the sleeves and pulling his pants up once I get his feet through.

Question: What does bath time look like for you and your child? Is bath time a fun or stressful time of day?

Description: It is hard to get him in to the tub he doesnt want to leave the rest of the family, and will cry and sometimes try to bite. He is able to climb into and out of the tub on his own. He will take the washcloth from Mom and clean ledge. He babbles to himself in the tub, but we dont understand any of what he says.

Question: How does your child let you know that he/she needs a diaper change or needs to use the toilet?

Description: Hes not toilet trained, but he doesnt like to have a dirty diaper. He will come to us and tug on the front of his pants when he wants a fresh diaper. If I try to get a diaper, he sometimes gets a diaper and brings it back. He helps during diaper changes by lifting his legs while we change him.

Meal Time:

Question: What do meal times look like for your child? Is there anything difficult or special about meal times?

Description: Riley primarily finger feeds himself, but is able to use a spoon or fork. When he finishes what is on his plate, I show him different foods until he reaches out for the food he wants. If I dont offer a choice he wants or if he is finished, he will scream and throw his plate. He does not name any food items or use any signs during meal time.

Question: How does your child let you know when he/she is hungry or thirsty, what he wants and when he is finished?

Description: He will come in to the kitchen and say eat, but this is the only word he uses. He gets frustrated when he cant tell us what he wants to eat. If he is thirsty, he will point at his favorite sippy cup. Sometimes he will drink from our cup if it is within his reach. If he is finished eating, he will push his food away or climb out of his booster.

Question: What are your childs likes or dislikes? How do you know?

Description: He likes to eat: chicken nuggets, cheeseburgers, hot dogs, peanut butter and jelly sandwiches, macaroni&cheese, French fries, grapes, strawberries, corn, baked beans, whole grain rice, and drinks milk and juice.

He does not like: steak, grilled chicken, broccoli, lettuce, tomatoes, mashed potatoes, peaches, or most soft textures. He will sometimes drink water but it is not his favorite.

Playtime and other daily activities:

Question: How does your child play? What does he/she like to play with? Are there times that are easier or more frustrating than others?

Description: He loves to run and play with the older boys at daycare he follows them up and down the stairs on the playscape, and chases them around. While inside the daycare, he will put all of the toy cars in a row and is more interested in spinning the car wheels than driving the cars around the room. He lines up most toys at home as well instead of using the toy for the intended purpose.

Question: Does your child have the opportunity to be around other children and adults? If yes, how and where does your child interact with them?

Description: He loves being around the other children at daycare, and other kids in the neighborhood. He likes to try to imitate them, especially movements, and uses gestures and facial expressions to communicate, but no words. He is good at throwing balls toward his teacher and laughs when she pretends it hits her.

Question: How does your child act when you take them out in public? How does your child respond to separations and transitions?

Description: Taking him to the grocery store is difficult he wont stay with me and runs away, and when I try to put him in the cart, he screams and will have a tantrum. He wants to climb into and out of the car seat on his own. When dropped off at daycare, he walks in without a problem. Picking him up can be difficult if he is doing an activity he enjoys, but we can tell him there are animal crackers in the car, and he gets excited and runs to the car.

Question: How does your child follow directions? Respond to limits?

Description: When the kids are all playing out in the front yard it is hard for Riley. He cant go in the street, but he tries to do that a lot. When we bring him back to the yard he will throw a tantrum. He doesnt seem to understand directions at all.

Question: Are there certain days that look different? If yes, how does your child respond to the changes?

Description: Most days look the same for us. It may not be the exact same activity at home or daycare, but we try to keep him on a similar schedule as the daycare. We have already learned that he likes consistency, so we prepare with having his favorite snack or treat readily available for moving from one activity to another.

Bed Time and Nap Time:

Question: How do you prepare your child for bed time and nap time? How does your child let you know he/she is sleepy?

Description: He doesnt like to go to bed. When he sees we are starting the bedtime routine he becomes upset and will try to bite. He has also done this at daycare naptime, and it is presenting a problem for them. We have tried separating him from the other children for nap so he does not wake them up and he wants to walk back to be near them.

Question: How does your child fall asleep? How long does he/she sleep?

Description: We try a few different approaches to get him to sleep like pat his back, rub his back, sing to him and tickle his arms. None of these approaches works consistently. When we finally get him down to sleep, he will sleep 10 hours through the night in his own bed.

End of Rileys RBI info.

Now, pause now to write the two functional outcomes.

When you're done, take a look at the sample outcomes for Riley. Are yours similar to any of these?

Outcome #1: Riley will get into bed without biting his mother or screaming 5 nights a week for 4 weeks.

Outcome #2: Riley will pretend to drive a toy car on his racetrack at home and during center time at child care, instead of just spinning the cars wheels at least once a day for three weeks.

Outcome #3: Riley will use words to request things (toy, activity, food, drink) instead of only pointing, reaching or grabbing for the item at least six times during the day for two weeks. (Notice this outcome crosses domains to include speech and behavior with full consideration of the whole child. Multiple disciplines could assist in meeting this goal and it is not discipline specific.)

4.38 Procedures and Quiz

Notes:

MIW SC:

Good job! You've learned a lot about writing measurable outcomes.

Once you have written an outcome, you will develop procedures to provide the family a general idea of what services will look like, in other words, how to achieve the outcome. How do you achieve outcomes with procedures? Let's see what you already know about procedures ...

Question: Which of the following statements are true about procedures? (select all that apply)

A. Address meaningful family activities and routines

B. Are detailed instructions about how to achieve the outcome

C. Address the uniqueness of each child and family

D. Describe how change and progress will continually be assessed

E. Describe how the family and staff will work together to achieve the outcome

F. Describe methods for coaching and teaching

The correct answer is A, C, D, E, F (all but B). Procedures address the uniqueness of each child and family; address meaningful family activities and routines that reinforce to the family; describe methods for coaching and teaching; describe how the family and staff will work together to achieve the outcome; and describe how change and progress will be continually assessed.

4.39 Example of procedures

Notes:

MIW SC:

Here is an example of an outcome taken from an IFSP:

I want Robert to be able to sit up by himself, in his highchair and in the cart at the grocery store, for up to 30 minutes, before the end of the school year (June, 2015)

Here are examples of the anticipated procedures to achieve the outcome:

An ECI team member will meet you at the grocery store and will come to your home during lunch to try out different ideas.

We will show you ways to place him in different seats, and will show you exercises you can do when you change his diaper that can help make him stronger.

Your ECI team will ask you often how the ideas are working for you and about other activities you want to work on that involve Robert sitting up, and they will ask you how you feel about his progress.

Planning Services4.40 Expert recommendations

Notes:

National experts provided guidance to Texas ECI on factors teams should consider in planning services. The following are what experts recommend.

1.The professionals role is to provide support and strengthen families. In ECI, services are intended to teach, coach, and instruct the parent or caregiver as they help their child meet developmental outcomes. In planning, we consider how much help and support the caregiver will need, not how much hands on service the child will need.

2.A reasonable starting point for service planning discussions is one hour of service once a week. Meeting with a family once a week allows you to develop your relationship with the family and to help the parent adjust their routines as the child grows and changes. One hour a week should be a starting point in thinking about services; some families will need other frequencies of services depending on a variety of factors.

3.Consider creative variations in service patterns, such as providing more intense or frequent service early in a familys early intervention experience, or co-visits when the family would benefit from having two providers present at the same time.

4.41 Planning services

Notes:

MIW Coach:

Planning Services is the final step in developing the IFSP. The team has completed the description of the child, assessment of developmental needs, identification of family priorities, and development of outcomes, which all lead to planning services to meet the identified needs. Every IFSP outcome does not need to have a corresponding service but all outcomes must be addressed through intervention.

IFSP outcomes are the basis for planning intervention. If an outcome is written, the need that corresponds should be clearly identified in the IFSP. For example, if the team identifies three outcomes for the child, this does not mean three different services must be provided, but all three outcomes must be addressed by the staff providing intervention visits.

The following will discuss where services will be provided, with whom, how frequently and what services are provided.

4.42 Services in the natural environment (Where are services planned)

Notes:

Where are services provided? Services must be provided in a childs natural environment, that is, where children play, grow, and learn. Locations that are only for children with disabilities are not considered natural environments. The intent of providing services in the natural environment is to focus the intervention on supporting caregivers to enhance the development of children in their care. For most children, the natural environment will be their home or childcare, or other places in the community where typically developing children may be found. You can share with families the value of services in the natural environment by showing them how to maximize natural learning opportunities using everyday activities, and embedding intervention in daily routines.

4.43 Routine caregivers (With whom?)

Notes:

With whom are services provided?

MIW Coach:

ECI service providers may deliver services with a routine caregiver in place of the parent. This often means that the service will be delivered in a childcare setting, either in a center or a home. When services are planned to occur with a routine caregiver there are three planning requirements that must be met.

A written justification in the IFSP of how the child will benefit from delivering the specified services with the routine caregiver.

The parent provides a written authorization for ECI to provide services with the routine caregiver. The parent must also give written consent for the team to share information about the child's services with the routine caregiver.

The name of the routine caregiver is documented in the child's record.

A member of the IFSP team must contact the child's parent at least once a month either face to face or by telephone to discuss the child's progress and services. Recommended practice is that any ECI professional who is delivering services with a caregiver maintain close communication with the family about the childs progress.

4.44 Co-Visiting

Notes:

MIW Coach:

Co-visits occur when two or more service providers deliver different services to the child at the same time. Co-visiting is a creative variation in service planning, but can only occur when the family would benefit from having two providers present at the same time. Each service must be planned on the IFSP services page, and the team must write a justification in the designated space of how the child and family will receive greater clinical benefit from the services being provided at the same time. Some important things to remember about co-visits:

They should NOT occur at every visit to a family

Justification must be individualized to the child and family

Justification must show benefit to parent and child

Family convenience or the need for two providers to coordinate their services are not acceptable justifications.

An example of a justification for a co-visit:

The family will benefit from having SST and OT delivered at the same time once every two months. The providers will brainstorm with the parents ways to combine the positioning and sensory strategies with the SST learning activities into their daily routines. The team feels co-visits will help the family integrate all of the recommended strategies into a variety of routines, which will allow the child to make faster progress.

4.45 Factors determining frequency and intensity (how frequent?)

Notes:

MIW Coach:

As discussed previously, one hour per week of a service for a family should be considered as a starting point in planning. The frequency of supports and services provided by ECI will often change over time for an individual child and family, sometimes increasing, and sometimes decreasing, as needs change. Lets look closer at the factors that the national experts described.

1.Child needs. Consider higher service levels for a family caring for a child with complex physical, developmental or medical needs.

2.Complexity of outcomes. When an outcome is complicated, crosses developmental domains, or will require skilled, technical coaching of a parent, the team should consider a service to be planned at more frequent intervals.

3.The confidence of the family in their ability to help their child learn. A parent who has limited or no experience interacting with young children may not feel confident implementing strategies to address outcomes.

4.Family needs, including their support network. In a family that has multiple needs and concerns beyond the development of their child, the parent might need more frequent service and support.

5.Anticipated intervention strategies. This is related to complexity of outcomes. If there are lots of details to remember about the strategies that will be implemented, or if its anticipated that the child will make rapid progress, a parent might need more support.

Other considerations beyond those pointed out by the national experts include family risk factors (such as parents cognitive limitations) or family stressors. The childs age should be considered, and higher frequency of service is often indicated for very young children. Finally, the team should consider the number of different settings the child spends time in, and the providers skill level related to the needs of the child.

4.46 Self-check

Multiple choice question: Which of these are factors in determining frequency and intensity of services? (select all that apply)

A. Child's age

B. Family risk factors

C. Size of providers case load

D. Provider skill level

E. Providers availability to spend time with a particular family

F. Stressors

G. Complexity of outcomes

H. Number of settings child is in

I. Nature and complexity of child needs

The correct answer is A, B, D, F, G, H, and I. All are factors except for size of providers case load and providers availability to spend time with a particular family.

4.47 Frontloading

Notes:

MIW Coach:

A good starting point for services is one hour per week. But as you know, each childs service needs are individual and may require an increase in frequency or intensity.

Sometimes providing more frequent services early on, or front-loading services, may be needed. Here are some examples:

A parent needs to quickly acquire a specific skill that will be needed for a long time, such as how to lift, carry, bathe, and provide interaction opportunities for a child whose mobility is severely limited.

The child is at a particular point in development, when emerging skills are about to take off.

A very young child, when intervention can prevent or decrease later problems.

For a child who may only be enrolled for a short time. For example a child who is eligible due to a qualitative delay, or a child who enrolls close to the third birthday.

When a child has challenging behaviors and the family has to quickly learn how to manage challenging behaviors, so the child can benefit from daily learning opportunities.

When there is an urgent need for a modification of the environment to help a family achieve an outcome, for example, help with positioning the child at meal time.

4.