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Outcome and Objectives

VIEWS: 56 PAGES: 63

									                                   Early Childhood Tutorial
                               Developing & Implementing IFSPs
Session 3: Implementing the IFSP: Family/Child Supports & Services

         Outcome: Understand how to provide family/child supports and services to promote a
         child‟s participation in family and community life

         Objectives:

                 Contrast the role of early intervention providers in supporting family members to
                  ensure their child‟s participation in family and community settings with providing
                  direct service for a child

                 Illustrate with 2 examples how culture and past experience affect family/child
                  supports and services

                 Describe at least 3 concerns families and other caregivers may voice during the
                  implementation of family/child supports and services

                 Describe how the principles of adult learning influence provider-family
                  collaboration

                 Explain how to support families in achieving their child‟s IFSP outcomes

                 Illustrate with two examples how to ensure ongoing assessment of a child‟s
                  progress is part of early intervention supports/services

                 Explain how to modify early intervention supports and services to reflect child
                  and family progress

                 Describe the importance of collaborating with formal (e.g., physicians and private
                  therapists) and informal (e.g., child care providers, librarians, instructors at the
                  YMCA pool) resources and support networks in implementing a child/family‟s
                  IFSP

                 Identify at least 3 issues to consider when using interpreters to communicate
                  with families

                 Describe the key role of service coordination in implementing family supports
                  and services

                 Specify at least 3 issues influencing the effectiveness of providing early
                  intervention supports and services in child care and pre-school settings

                 Illustrate with 2 examples how to document family/child supports and services in
                  user-friendly formats
                                                                                         Page 1
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Session 3-Implementing the IFSP
Implementing Family/Child Supports and Services has four key activities for readers:
reading essential content, engaging in application activities to integrate the presented
information, reviewing recommended reading and completing a self assessment. The following
chart gives an overview of the session‟s activities with suggested time allotments.


                                          Summary of Activities

                                       Activities                             Time
                                                                           allotment
       Read Essential Content about implementing family/child          2 hours
       supports and services
       Application 3.1 Tracking how IFSPs are implemented with         1-2 hours
       families
       Application 3.2: Addressing concerns families may about         1 hour
       implementing an IFSP
       Application 3.3: Reflections on Adult Learning                  1 hour
       Application 3.4 Individualizing strategies for adult learners   1 hour
       Application 3.5: Early intervention supports and services for   1 hour
       Yvonne and Blake
       Application 3.6: Early intervention supports and services for   1 hour
       Nolan and his family
       Application 3.7: Early intervention supports and services for   1hour
       Jenni and her family
       Application 3.8 Early intervention supports and services for    1 hour
       Evan and his family
       Recommended Reading                                             2 hours
       Complete Self-Assessment                                        .5 hour



Guiding question for Implementing Family/Child Supports and Services:

    1. How will early intervention providers use their expertise to support family members and
       other adults in promoting a child‟s participation in family-desired settings and routines
       within natural environments?

    2. How will family members and early intervention providers collaborate to achieve desired
       child and family outcomes?

Why this topic was selected
Implementing Family/Child Supports and Services focuses on how to support family
members in helping their children participate in desired family and community life. A
critical outcome for early intervention is to assist families in finding ways to develop and
generalize the skills and behaviors of their children to ensure their participation in
                                                                                     Page 2
Developing and Implementing the IFSP
Session 3-Implementing the IFSP
naturally occurring activities and settings. By observing and honoring each family‟s
unique culture and child rearing routines, early intervention providers can help children
use an emerging skill and/or modify routines and tasks to take part in family life.

         TIP: Working in natural environments enables early intervention providers to transform
         “their hands-on time with a child and move to a different position alongside the parent as
         a coach rather than as lead player" (Hanft & Pilkington, 2000, p.2).

By sharing their expertise and collaborating with one another, early intervention
providers and family members can:
        facilitate a child‟s participation in meaningful family and community activities;

        follow a child‟s interests and build on the strengths he or she is most likely to demonstrate
         when interacting with familiar people in familiar routines and environments;

        ensure mastery of a child‟s emerging skills through practice in multiple activity
         settings/situations;

    Insert reflection box here: Consider the evidence for family support in natural
    environments. How do you incorporate this evidence in your work/care giving roles?
    (link to Mod 2 session 2 pg. 2)

Supporting families to help their children is the essence of early intervention. Early
intervention providers may ask whether they are providing “real intervention”, and
wonder if they have diluted their profession to meet the demands of policy makers who
really do not understand what they do. Consider this essential point:


         A child‟s daily actions and interactions provide opportunities for learning and participation in
         situations that matter for the child and family. Supporting caregivers in facilitating a child‟s
         optimal functioning within ordinary routines will greatly increase the likelihood that family
         members can prompt their children to practice and master essential skills within a
         meaningful context (Hanft & Pilkington, 2004).




Essential Content: What early intervention providers and families need to know
about implementing family/child supports and services


Implementing Family/Child Supports and Services, the third session in Module 2, is part of a
tutorial about the IFSP process developed by the Maryland State Department of Education for
early intervention providers, and interested readers. Other sessions available: (link to
outcomes/objectives for each session below)


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                 Module                                        Session

         Module 1:                     1: Legal Requirements
         Evaluation and
         Assessment                    2: Planning with Families for Evaluation & Assessment

                                       3: Comprehensive Evaluation and Assessment

         Module 2:                     1: Legal Requirements
         Developing and
         Implementing an               2: Developing an IFSP with Families
         IFSP
                                       3. Implementing family/child supports & services (this
                                       session)



The following topics are covered in Implementing Family/Child Supports and Services:

    a. Natural environments and early learning

    b. Informal and formal early intervention supports and services

    c. Concerns that families may have during IFSP implementation

    d. Role of early intervention providers in providing family support

    e. Being an expert vs. sharing expertise with families

    f.   Collaborating with adult learners

    g. Service Coordinator‟s responsibilities during implementation of an IFSP

    h. Assessing ongoing progress

    i.   Models of team interaction

    j.   Understanding cultural competence

    k. Becoming culturally competent early intervention providers

    l.   Issues to consider when working with interpreters

    m. Considerations for providing early intervention supports/ervices in group settings



a. Natural environments and early learning

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Natural environments and early learning

         Add Tip box below : Routine and spontaneous activities that take place in
         familiar places with familiar people provide the opportunities for a child‟s
         “learning and doing.”

Each child and family has many natural environments - not just one - where they spend
time with family, friends, and neighbors in specific activity settings. Early intervention
providers can help families explore how spontaneous and routine interactions and
actions within familiar places become the focal point for a child‟s “learning and doing.”
Such growth is most likely to occur when the setting for early intervention supports and
services is in a family‟s natural environment (Schmidt & Lee, 1999; McLean & Woods
Cripe, 1997).
The term “natural environment” describes the context in which a child and family
interact and act, and includes:
        Physical location (e.g., family home, community park, grandma‟s house);



        Activity settings within a location (e.g., eating a picnic in the backyard of a family home,
         feeding the sheep at a petting zoo in a community park, wading in a pool at grandma‟s
         house; and



        Natural learning opportunities within a specific activity setting (fitting lids on plastic
         containers while sitting on a blanket during a picnic, filling a cup with little pellets to feed
         the sheep, naming body parts while playing in a pool) .


Video vignette of Pumpkin Patch: An example of activity settings and natural learning
opportunities


This video clip shows children from a local infants and toddlers program in Maryland visiting a
pumpkin patch with family and friends. Look for the activity settings and natural learning
opportunities (NLO) that are available in this informal community resource.

Some examples to watch for:

        Activity setting: riding in a wagon NLO: sitting up independently next to friends

        Activity setting: singing a song          NLO: saying specific sounds/words

        Activity setting: sitting on a tractor NLO: holding head up to look around

        Activity setting: feeding a goat          NLO: opening hand to hold food for goat


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            Video Clip: Pumpkin Patch


Natural environments for young children
Infants and toddlers spend most of their time in three broad categories of natural
environments: family, community and early childhood programs (Dunst et al, 2001). As
illustrated in the pumpkin patch video vignette above, each physical location presents
numerous activity settings and natural learning opportunities for promoting a child‟s
current skills and learning new ones.

         Add reflection box below: As you review this chart, think of additional examples
         of activity settings and natural learning opportunities that you could help a
         specific family identify and use.

Examples of activity settings (AS) and natural learning opportunities (NLO, in italics
below) in natural environments common to young children and their families: family,
community and early childhood.



 Family                Community                 Early Childhood

 Family
 routines:                                       Preschool/child
 AS: Preparing Family excursions:                care:
 a meal                                          AS: Playing
               AS: Riding on a bus
 NLO: Stirring NLO: Looking for red cars         circle games
 with spoon                                      NLO:Recognizing
                                                 name


 Parenting                                       Family child
 routines:             Recreation:               care:
 AS: Brushing          AS: Wading in a pool      AS: Playing in
 teeth                 NLO: Sitting              sandbox
 NLO: Standing         independently             NLO: Filling
 on stool                                        containers

 Child
                                                 YMCA:
 routines:             Children’s attractions:
                                                 AS: Infant swim
 AS: Playing           AS: Petting animals at
                                                 class
 with pet              zoo
                                                 NLO: Relaxing in
 NLO:Following         NLO:Holding hand open
                                                 water
 movement

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 Family
                                               Mother’s
 rituals:              Place of worship
                                               morning out
 AS: Birthday          AS: Singing songs/hymns
                                               AS: Eating snack
 party                 NLO: Remembering
                                               NLO: Sucking on
 NLO: Blowing          words
                                               a straw
 candles out

 Interacting                                      Library
 with family                                      preliteracy
                       Family outings
 AS: Phoning                                      group As:
                       AS: Eating at a restaurant
 grandma                                          Listening to story
                       NLO: Drinking from cup
 NLO: Saying                                      NLO: Paying
 “hi”                                             attention

                                                  Informal play
 Play activities
                                                  groups
 AS: Playing     Play centers
                                                  AS: Splashing in
 with sister     AS:Sitting in baby swing
                                                  sprinkler
 NLO: Using      NLO: Enjoying movement
                                                  NLO: Interacting
 two hands
                                                  w/peers

 Entertainment                                 Community
 AS: Banging           Art/music/entertainment recreation
 drum                  AS: Attending puppet    AS: Finding
 NLO:                  show                    Easter eggs
 Repeating             NLO: Sitting with peers NLO: Finding
 rhythm                                        specific object

                                                  School drop-in
 Gardening
                                                  center
 AS: Planting          Outdoor
                                                  AS: Finger
 seeds in pots         AS: Picnicking at a park
                                                  painting
 NLO: Poking           NLO: Crawling on grass
                                                  NLO: Moving arm
 with finger
                                                  and hand




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The key is how, not where, EI services and supports are offered

Add a tip box to text below: “Children‟s activity settings are the architecture of their
everyday life and the context of their development.” (Gallimore and Goldenberg, 1993,
p. 315)

The mandate of natural environments is not only to identify where early intervention
takes place but more importantly, to consider what happens for children and families in
specific locations. How early intervention providers offer family/child supports and
services, not just where, is key to whether early intervention is truly family-centered or
merely replicates a clinical model within a child‟s home or child care setting. Daily
routines and activity settings are…
         “…important contexts for integrating various family/child supports and services.
         For families and other caregivers, this approach allows infants and toddlers to
         participate more successfully in daily living activities and reduces the need for
         families to add „treatment‟ sessions to already busy schedules ” (Rainforth &
         Roberts, 1996, p. 252).



Yvonne & Trudy: Comments about natural environments
These video clips from Just Being Kids illustrates how a mother, Yvonne, and her early
intervention provider, Trudy, figure out how Yvonne can "multitask" i.e., buy groceries and help her
son, Blake, enjoy shopping while prompting his communication and pre-literacy skills. Listen to
what they say about early intervention supports and services in natural environments




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         Video Clip:

         Parent’s perspective about how early intervention is helpful.
         How an occupational therapist views natural environments.
         Parent’s comments about early intervention in everyday routines.




b. Informal and formal early intervention services

         Add Tip box below: Informal community resources are rich sources of natural
         learning opportunities.

Throughout this tutorial, the phrase “family/child supports and services” or “early
intervention supports and services “ is used to encourage readers to think of early
intervention as more than formal services from therapists, educators, nurses, social
workers, and service coordinators.
Early intervention supports and services for families of young children include formal
and informal networks (Trivette, Dunst & Deal, 1997):

         Formal supports/services are provided by local Infants and Toddlers Programs,
         as well as other agencies, organizations or programs serving children and
         families. Examples include parent education classes in a public school or social
         service agency, health and specialized medical services for young children, and
         housing programs for homeless families.
         Informal supports/resources include child care centers, toddler reading programs
         in libraries, community service clubs, recreation and sports programs, and
         education programs in parks, nature centers and museums.



         Add Reflection box below: How have you helped children participate in key
         activity settings with their family members and peers?

An effective IFSP identifies a range of formal and informal services and resources to
assist families in achieving their functional outcomes for their children. Where
family/child supports and services are provided depends on the outcomes selected by
families. The essential question to discuss with families: How can we help a child
participate in key activity settings with family members and peers? Each family‟s
unique culture, including their daily activities and parenting routines, form the basis for
helping a child use emerging skills to participate in desired activity settings.



Examples of informal support networks
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Reflect on the questions posed after each vignette to consider how child and family
interests, routines and interactions as well as informal community settings provide
natural learning opportunities for each child.


    Sharon’s story: Using the library to encourage making choices



    Sharon‟s family wants her to “talk more” so that she can express her needs and
    wants instead of whining and crying. Sharon loves to sit on her grandmother‟s lap
    for stories but needs books with large print and pictures to accommodate her
    limited vision.
    Her early intervention provider joins Sharon, her mother and grandmother at their
    local library to look for appropriate books and talk about how to use the library
    setting to prompt Sharon‟s language and social interaction. The three adults talk
    about how to help Sharon use words to indicate where she wants to sit, which
    book she wants to look at, what she sees on each page, and how to ask for a
    drink of water. The early intervention provider also explores with Sharon‟s mother
    and grandmother how to accommodate Sharon‟s low vision (e.g., sitting Sharon
    right next to the librarian, making her the page turner, avoiding glare from the
    overhead lights on the pages) so she can enjoy the toddler pre-literacy group.
    Finally, they reflect on how to share these tips with the librarian and other adults in
    Sharon‟s life.




         Insert reflection box below: Click here for suggestions to these questions about
         using informal community settings to promote Sharon‟s IFSP outcomes. (link to
         answers at end of this section)

     Sharon’s Story: Points to ponder

         1. What outcome has Sharon‟s parents identified for her?

         2. What interests of Sharon‟s provide natural learning opportunities for her to
         practice emerging skills?

         3. What are the physical location and activity settings illustrated in Sharon‟s
         story?

         4. Which opportunities for natural learning are available in these activity
         settings?

         5. How does the early intervention provider use her expertise to support
         Sharon‟s family in reaching her outcomes?
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    Deep’s story: Playing at home and at a
    playground to promote social and
    motor skills


    Deep loves to play with his older brother,
    Rajiv. His early intervention provider,
    Jorges, schedules visits when Rajiv is
    home from school whenever possible
    because he motivates Deep to use his
    arms and legs to move around and play.
    Currently, Deep tends to sit or lie still in
    one spot in his living room or bedroom.
    Jorges accompanies the brothers and
    their mother to the playground in their
    apartment complex as well as at the local
    McDonalds restaurant. Together, they
    explore ways for Deep to play with his
    brother and use both his hands together
    (e.g., climb on and over the play
    equipment and throw balls to one
    another). Jorges shows the mother and
    Rajiv how to get Deep‟s attention, and
    position him so that he can use his arms
    most efficiently. They also talk about the
    toys and games in general that will help
    Deep use both hands together.




                                                   Page 11
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         Insert reflection box below: Click here for suggestions to these questions about
         using informal community settings to promote Deep‟s IFSP outcomes. (link to
         answers at the end of this section)

    Deep’s story: Points to Ponder



    1. What outcome has Deep‟s parents identified for him?


    2. What interests of Deep‟s provide natural learning opportunities for him?


    3. What are the physical location and activity settings illustrated in Deep‟s

         story?


    4. Which natural learning opportunities are available in this activity setting?


    5. How does the early intervention provider use his expertise to support Deep‟s
       family in reaching his outcomes?


    Donelle’s story: Talking walks in the neighborhood to increase
    verbalizations:


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    Donelle‟s mother would like him to start talking. His big interests are trucks and
    buses, and he gets really excited whenever he sees them. His early intervention
    provider accompanies the family and his babysitter on walks around the
    neighborhood so she can model sounds and gestures to help Donelle
    communicate his excitement when he sees trucks and buses, as well as practice
    using a specific sound for familiar people, pets and places he sees during their
    walk.




         Insert reflection box below: Click here for suggestions to these questions about
         using informal community settings to promote Donelle‟s IFSP outcomes. (link to
         answers at the end of this section)



Donelle’s story: Points to Ponder



         1. What outcome has Donelle‟s parents identified for him?

         2. What interests of Donelle‟s provide natural learning opportunities for him to
         practice emerging skills?

         3. What are the physical location and activity settings illustrated in Donelle‟s
         story?

         4. Which opportunities for natural learning are available in these activity
         settings?

         5. How does the early intervention provider use her expertise to support
         Donelle‟s mother and child care provider in reaching his outcomes?

Sharon’s Story: Points to ponder



1. What outcome has Sharon‟s parents identified for her?
         Sharon’s family wants her to “talk more to tell us what she wants.” Their desire
         can be included on her IFSP as:
                 Outcome (for the next six     Measurable criteria
                        months)

                 Sharon will use             Sharon will use at

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                 one/two words to         least 5 two word
                 express her needs and    combinations each
                 wants to her family.     day when verbally
                                          prompted.

2. What interests of Sharon‟s provide natural learning opportunities for her?
         Spending time with Grandma; looking at picture books



3. What are the physical location and activity settings illustrated in Sharon‟s story?
         Location: public library

         Activity settings: looking at books; listening to a story during toddler hour



4. Which opportunities for natural learning are available for Sharon in these activity
settings?
         Using words to select a book, naming objects etc. on a page, asking for a drink
         of water, listening to a story with peers, watching what other children do at the
         library.



5. How does the early intervention provider use her expertise to support Sharon‟s
family in reaching her outcomes?
         Asks family members what Sharon likes to do and then suggests a community
         resource (toddler hour at the library to take advantage of this interest;

         Explores with family how they can adapt the activity setting to ensure that
         Sharon can use her vision in functional e tasks (position Sharon so she can see
         the book, avoiding glare from overhead lights; choosing books with appropriate
         contrast, picture size);

         Talks with family members about prompting Sharon’s language so that she can
         participate in reading books and interacting with family members and peers.

Deep’s story: Points to Ponder



1. What outcome has Deep‟s parents identified for him?
         Deep’s mother wants her son to play and move around his home using his arms
         and legs better. Her desire can be included on his IFSP as:

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                           Outcome         Measurable criteria



                 Deep will pick up and    Deep will use both
                 throw balls and other    hands together
                 toys/objects with both   during play sessions
                 hands while playing      for 15 minutes per
                 with his brother and     day.
                 friends.




2. What are some of Deep‟s interests that form the basis for natural learning
opportunities for him?
         Being around his older brother motivates Deep to roll over move, climb and use
         his arms together.



3. What are the physical location and activity settings illustrated in Deep‟s story?
         Physical location: living room and bedrooms at home; playground at apartment
         complex; McDonald’s restaurant

         Activity settings: playing with brother in bedroom/living room, at playground and
         in the play area at McDonald’s



4. Which natural learning opportunities for Deep are promoted in these activity
settings?
         Using his arms and legs to move around and keep up with brother

         Socializing with family members

         Paying attention to what he wants, and figuring out how to get it



5. How does the early intervention provider use his expertise to support Deep‟s family
in helping them reach his outcomes?
         Analyzes the activity setting to look for ways to prompt Deep to use his arms and
         legs to move around, play and hold a ball

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         Show’s family members how to help Deep sit with support to use his arms during
         play in ways that are enjoyable and also challenge him to develop more complex
         movements.

Donelle’s story: Points to Ponder



1. What outcome has Donelle‟s parents identified for him?
         Donelle’s parents would like him to talk. Their desire for improving his
         communication could be included on his IFSP as:


                           Outcome          Measurable criteria



                 Donnelle will use        Donnelle will use
                 specific sounds for      identified sounds a
                 each family member,      minimum of twice per
                 and answer “Yes/no”      day
                 questions



2. What interests of Donelle‟s provide natural learning opportunities for him to practice
   emerging skills?
         Loves vehicles like cars and trucks

         Likes to walk in the neighborhood to see and hear real vehicles


3. What are the physical location and activity settings illustrated in Donelle‟s story?
         Physical location: family home, neighborhood

         Activity setting: taking walks with family and babysitter



4. Which opportunities for natural learning, related to Donelle‟s IFSP outcome, are
   promoted in this activity setting?
         Use specific sounds to recognize family members and gain their attention

         Recognize familiar people, places and things


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5. How does the early intervention provider use her expertise to support Donelle‟s
   family in reaching his outcomes?
         She models how and when to prompt Donelle to use his sounds.

         Helps family identify sounds Donelle can make.

         Welcomes the baby sitter to join in, with the mother’s consent.

         Visiting the pumpkin patch with friends and family

         TBA: Add text describing this visit to the pumpkin patch by families with early
         intervention providers from a Maryland Infants and Toddlers Program

         Review a video clip of children visiting a pumpkin patch in Maryland with family
         and friends. This informal community resource provides family recreation and
         multiple learning opportunities for children to promote social interaction (e.g.,
         sitting next to friends in a wagon), communication (e.g., listening to and/or
         singing a song), gross motor skills (e.g., sitting on a tractor seat), as well as fine
         motor skills and sensory input (e.g., holding food in open hand to feed goats).

                                         Video Clip: pumpkin patch


c. Concerns families may have during IFSP implementation
It is important to anticipate, and address as appropriate, concerns that family members
may have while participating in an early intervention program. Early intervention
providers can use four strategies to address a family‟s concerns:
    1. Encourage family members to talk about any concerns;

    2. Listen, in order to understand and show respect for a family‟s beliefs and traditions;

    3. Provide information, when available, to address concerns; and

    4. Offer to link families to parent-parent support networks, both in a Local Infants and Toddlers
       Program and through community support networks. (link to
       http://www.marylandpublicschools.org/MSDE/programs/specialed/infant_toddlers/directories/
       Family_support.htm)


Keep in mind that some parents may not feel comfortable asking the following
questions or talking about concerns that they are only beginning to think about,
particularly with early intervention providers they have just met. Some examples of
concerns that may arise for parents during implementation of their IFSP:

Communication:
        I can‟t communicate/don‟t get along with the early intervention providers coming to help me
         with my child.
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        Confidentiality– who will see this information about my child? Will it also be included in his
         or her school records?

        How are all these services and supports coordinated (especially for children with multiple
         challenges when different agencies are involved?)

        The doctors/private therapists told me I should be getting a different kind of therapy.


Changing early intervention supports and services:
        What if I change my mind about participating in the program? Can I withdraw?

        When and how often will the IFSP be reviewed?

        How easy is it to change early intervention outcomes and supports/services?



What comes next?
        My child is almost 3 years old- we‟re not ready to leave early intervention.

        What is the difference between an IEP and an IFSP?




d. Role of early intervention providers in providing family support
         Insert Reflection box below: How does family support differ from “hands-on”
         intervention from an early intervention provider? Listen to the comments of one
         family and their early intervention provider in Evan‟s video vignette below.

Providing family/child supports and services within natural environments requires a shift
in perspective for many early intervention provides who were prepared to provide
“hands-on” sessions with individual children. Too often, early intervention providers
focus on helping a child acquire discrete skills such as learning to say specific words,
handle puzzle pieces with a mature grip, or balance on a bolster, and assume parents
will help their child generalize these skills in daily activities.
By focusing solely on helping a child develop specific skills in a one-one session, early
intervention providers miss critical opportunities to support family members in finding
ways to ensure that their child participates in the everyday “places and spaces” where
these skills should be practiced and mastered. Provider directed “sessions”, whether at
home or in a center-based program, demonstrate what a child can do in a one-to-one
situation rather than how she or he participates in everyday actions and interactions
that are at the heart of family and community life (Hanft & Pilkington, 2000).

When early intervention providers offer family/child supports and services, they:


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    1. Prompt family members to identify and discuss their interests, routines, activities, and
       strengths. This provides a rich source of activity settings that support a child‟s learning and
       development.



    2. Identify, adapt, craft, and figure out, with family members, how natural learning
       opportunities can promote a child’s new or emerging skills in multiple areas of
       development so that a child can participate in, and enjoy, family and community life. (link to
       mod 2 session 2 page 2)



    3. Read, reflect, and use evidence-based practices within each provider‟s profession, as
       well as in child development, early learning, and family-centered care so that family support
       is individualized, flexible, and helpful. (link to mod 2 session 2 evidence for providing
       family/child supports and services pg 2)




Review a video clip from Just Being Kids about early intervention supports/services for Evan.
The video illustrates how a mother and father, Michelle and Bob, and their early intervention
provider, Renee, a speech-language pathologist, view family/child supports and services for
Evan. (link to Just Being kids in recommended reading this session)

         Parents‟ perspectives about early intervention supports/services (link to Evan A)

         Comments from a speech-language pathologist about her early intervention role (link to
         Evan C)


NOTE: Application activity 3.8 provides an opportunity for an early intervention team to consider
how they could provide supports/services to Evan in his child care setting.




e. Being an “Expert” vs. sharing expertise with families

         Insert Tip box below: Each and every suggestion shared with families and other
         care givers should be followed by: ” How will this work for you?”

Collaborating with families requires rethinking traditional lines of authority and decision
making. Who is the privileged party i.e., who "owns" the IFSP? There is a vast
difference between presenting oneself as an early intervention provider with special
expertise versus as an “Expert” whose recommendations must be followed as
specified. When early intervention providers share their expertise, they promote an
information exchange, and learn about a family‟s perspectives and approach to caring
for their children. Providers look for opportunities to ask, “How can we work together to

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help your child ……” rather than make recommendations that are unconnected to a
family‟s daily life.


When parents are unsure about early intervention supports and services, an
opportunity is presented to consider whether IFSP outcomes are on target and/or
providers‟ suggestions are “do-able”. Perhaps an outcome needs to be refined, or
different strategies tried. Early intervention providers can prompt discussion with family
members by asking: “What happened when you tried to help Sasha use her words?” or
“What would you like Adam to do when he visits his grandma?”



Sharing expertise to fit a family’s story

         Add Reflection box: Review Nolan‟s story and observe how an early intervention
         provider prompts, and listens to, his parents talk about their family “story”. (link
         to video below)

An important part of sharing expertise is understanding how to translate (not transfer)
professional knowledge and skills to fit another person‟s role and interests. This applies
to working with colleagues or family members (Hanft & Pilkington,2000). Early
intervention providers “transfer” their knowledge and skills to others when they expect
them to carry out specific activities without ongoing support. These activities are often
what the provider would do with a child during a play or therapy session. Transferring
expertise leads to expectations that family members and colleagues should, and can,
function just like a therapist, special educator or nurse.
When early intervention providers translate their expertise, they listen to family
members (or colleagues) talk about their “story”. Family “stories” describe a child‟s and
family‟s context and interactions as well as the events, celebrations, actions and
routines they share. Colleague‟s “stories” highlights their professional background, their
role in early intervention and how they hope to support a child and his or her family.
These stories guide an early intervention provider in selecting relevant information and
strategies from his or her knowledge and experience to help other people achieve their
outcomes.



         Insert resource box below: Click here for a discussion about special education
         and related service personnel sharing their expertise with early childhood
         providers in community settings. (link to Mod 3 session 3, essentials of a
         collaborative role)

A second skill in translating expertise is to figure out how to assist another‟s learning.
Every person has individual knowledge, values and experience that provides a
foundation for refining and/or adding new information and skills. Translating expertise
includes considering the other person‟s experiences, learning preferences, role and

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desire for follow-up support, before making any suggestions about how to promote a
child‟s participation in community and family life. As one mother stated simply, “I want
to be Zak‟s mother, not his therapist (Lyon, 1989)”. This mother‟s story focused on her
hopes to play with, and enjoy, her son without turning every interaction into goal-
directed therapy. Their early intervention provider, in order to translate her expertise
effectively, must understand the mother‟s role expectations about parenting as well as
her hopes for her son before offering strategies to help the mother reach her outcomes
for her child.
Nolans’ story: Understanding me and my family



Review this video clip from Just Being Kids illustrating early intervention supports and services
for Nolan and his family. This clip focuses on how parents Kim and Ron were prompted by their
early intervention provider, Lisa, a physical therapist, to talk about their family hopes and
challenges. Lisa asked about the “good times” in their family as well as how she could help
them improve their child care routines so that Nolan could enjoy and benefit from natural
learning opportunities presented during bath time (link to Just Being kids in recommended
reading this session)

            Physical therapist‟s comments about sharing expertise and listening to a family‟s
             story (link to Nolan A)


            Mother‟s comments about how she benefits from therapist‟s expertise (link to Nolan
             B)


NOTE: Application activity 3.6 provides an opportunity for an early intervention team to consider
how they could provide supports/services to Nolan and his family.




f. Collaborating with adult learners
Adult learners (family members and early intervention providers) are self-directed
problem solvers who learn best when they can relate new information to past
experience (Donovan, Brandsford, & Pellegrino, 1999; Knowles, 1996; Brookfield,
1993). Such transfer of learning occurs when adults gather new information, formally
through instruction or reading, or informally, through experience. The new information
is then integrated with prior knowledge. This same process unfolds when early
intervention providers “translate” their expertise to support family members and
colleagues in acquiring and using specific knowledge and skills to promote a child‟s
participation in natural environments. (link to previous section being and expert…)

Principles of Adult Learning



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         Insert reflection box below: Reflections on adult learning, helps link personal and
         professional learning with six variables critical to acquiring and refining
         knowledge and skills. (link to application activity 3.3 at end of this session, adult
         learners)

Partnerships among early intervention providers and family members are influenced by
six core principles of adult learning. These principles are the same whether early
intervention providers partner with family members, child care providers or colleagues
(Hanft, Rush & Shelden, 2004). When early intervention providers translate their
expertise to support other adults in refining their knowledge and skills, they must
consider their partners‟:
             1. Motivation;


             2. Respectful learning environment;


             3. Experience (past and current);


             4. Achieving self-direction and active involvement;


             5. Critical, reflective thinking; and


             6. Learning styles and coping strategies.


1. Motivation: adult learners must feel comfortable and desire to engage in (or be
coached to think about) a relationship with another person that is focused on helping a
child/family participate in desired activities. Motivation is highly individualized and
depends on each adult‟s situation and what he or she is interested in learning/doing.


         Samantha’s story: Connecting with a young mother

         Carly, a teenage mom, was struggling to care for her son, Nick, and keep up with her high
         school friends. She resented taking the time to talk with Samantha, their early intervention
         provider, until “Sam” brought two cans of soda to for them to drink. Sam began each visit by
         asking Carly about what she did during the week for herself; then guided the conversation to
         her parenting issues like helping Nick talk more.


         Put Reflection symbol here: How did Sam‟s strategy of drinking cokes motivate Carly to talk
         with her about taking care of Nick?




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2. Respectful learning environment: the physical and emotional climate for learning
provides powerful supports (and challenges) for adults to establish collaborative
relationships and share their ideas and skills.


         Scott’s Story: Creating a positive learning environment

         Scott, an early childhood special educator, noticed that Mybinh was much more at ease
         talking with him about her daughter, Lin, when her mother was also present.
         Recognizing that Mybinh was uncomfortable talking to an unrelated man in her home,
         Scott asked if there was any other place they could meet when her mother returned to
         Vietnam for a month. Mybinh gratefully suggested her sister‟s house, and over the next
         month, she and Scott focused on how to prompt Lin‟s communication during play with
         her cousins, aunt and uncle. Mybinh, with Scott‟s support, also took the opportunity to
         show other members of her family how to use signs to facilitate Lin‟s speech.


         Insert reflection symbol: What did Scott do to create a positive learning environment for
         MyBinh?



3. Past and current experience: adult learners‟ base of experiences and knowledge
provides the critical foundation for merging new information and experience. Early
intervention providers must work within each adult‟s context and relate specific
information to what family members and colleagues already know.



         Sasha’s Story: What does my partner already know?

         Sasha realized that using professional jargon when talking to parents and child care
         providers was not helpful for getting everyone “on the same page.” She made sure to
         use simple terms when she visited Kelley, a child care provider who took care of the
         twins Sasha was following. However, it was several months before Sasha realized that
         Kelley, who was trained as a medical technologist, had looked up all the medical terms
         about the twins‟ genetic diagnosis and symptoms. Kelley had felt Sasha disregarded her
         knowledge when Sasha used simple terms during their discussions, and did not enjoy
         talking with her.


         Insert reflection symbol here: Sasha could have invited Kelley to share her perspective
         on how the twins were doing when they first met. She would have then learned some
         important information about Kelley‟s “story” ie, her medical experience and broad
         knowledge of medical terminology.



4. Achieving self-direction and engagement : adult learners have unique perspectives

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regarding what they want to learn and how fast they can integrate new information and
practices to change their current behavior and thinking.



         Tamara’s story:

         Tamara, a speech-language pathologist, felt like she was not connecting with Mrs.
         Jacobs about how to encourage Cory to express his needs. Mrs. Jacobs, Cory‟s family
         child care provider, hardly ever asked questions, and seemed content to sit on the sofa
         and watch her play with Cory. However, their service coordinator called Tamara with
         great excitement about Cory‟s progress, and made a special point of saying that Mrs.
         Jacob told her all about trying Tamara‟s “hints and tricks” in between her visits. Tamara
         realized that Mrs. Jacob‟s engagement in their visits was expressed through her
         observation and physical presence during her visits. Tamara also realized that she
         needed to spend more time talking with Mrs. Jacob‟s about prompting Cory to “use his
         words” during the week than focusing on getting him to talk during her visit to Mrs.
         Jacobs.


         Insert Reflection symbol here: How did Tamara‟s expectation for “active” involvement
         lead her to misread Mrs. Jacob‟s engagement in their partnership? What are other
         signs of engagement have you have observed in adult learners?




5. Critical, reflective thinking: adult learners must be given an opportunity to think about their
efforts to change their actions and interactions as they refine their information and try new
stratetgies. Early intervention providers can prompt reflection by asking what, when, where,
who and how questions. Then, listen and observe to understand another person‟s perspective
before offering feedback or more suggestions (Kinlaw, 1999; Hanft, Rush & Shelden, 2004)


         Janelle’s story:

         Lorenza wanted Macario to sit quietly in a shopping cart during their frequent trips to the
         grocery store to buy food for their big family. Janelle, an occupational therapist, listened
         to Lorenza describe her hectic shopping trips with Macario and offered to join them at
         the grocery story so she could observe Macario‟s disruptive behavior. She and Lorenza
         talked about how they could help Marcaio sit up in the shopping cart and look for
         specific items on his mother‟s shopping list. Janelle modeled each of her suggestions,
         asked Lorenza, “How would this work for you…?” and then listened to what Lorenza had
         to say.


         Insert reflection symbol here: To prompt reflection, ask objective questions about what,
         when, where, how, or who. Be careful about asking “why?” since this type of question
         can make a person feel judged.


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6. Learning styles/coping strategies: adult learners have individualized strategies for
processing information, meeting challenges and accomplishing a task. The table, “Multi-
sensory options for adult learning,” identifies visual, auditory and kinesthetic strategies
for assisting another adult to acquire and use new information and experiences (Hanft,
Rush & Shelden, 2004).

         Insert reflection box below: What learning strategies did Mybinh use in Scott‟s
         story? (link to story above) Click here to compare your response. (Link to
         another page for this comment: Mybinh used a kinesthetic strategy to reinforce
         her learning by demonstrating to other family members how to use signs to
         facilitate her daughter‟s speech. )

Typically, adult learners combine strategies, preferring some for orienting to new
information, and others to reinforce their learning. In two stories described in this
section, for example, Mrs. Jacob and Lorenza first observed their early intervention
providers (visual learning), and then reinforced their learning by “practicing” the
modeled strategies (kinesthetic learning) with their children during their daily activities.
Multi-sensory options for adult learning

Visual learning:
                                       Auditory learning: Hearing Kinesthetic learning: Doing
Seeing

Caregiver* observes                    Caregiver summarizes         Caregiver keeps journal of
EI provider                            feedback from EI provider    actions and reflections

                                       Caregiver narrates actions   Caregiver practices new
Caregiver observes others
                                       watching a video             actions/approach

                                       Caregiver listens to         Caregiver demonstrates
Caregiver watches video
                                       audiotape                    actions to others

Caregiver reads an article; looks      Caregiver talks with peer    Caregiver joins support
at a photo or illustration             about his/her experiences    group or visits peer


    Note: In this chart, the term “caregiver” refers to all adult learners- family members, child
    care providers and early intervention providers.

    Source: Hanft, B.E., Rush, D.D., & Shelden, M.L. (2004). Coaching families and colleagues
    in early childhood (p. 176). Baltimore: Paul H. Brookes Publishing Co.; adapted by
    permission.




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g. Service coordinator’s responsibilities during implementation of an
IFSP

    Insert resource box below: Developing IFSPs with Families describes a service
    coordinator‟s responsibilities during the development of a family‟s IFSP. Link to mod
    2 session 2 pg 7

During implementation of a family‟s IFSP, service coordinators for local Infants and
Toddlers Programs have key responsibilities to:
         1. Coordinate and monitor delivery of services as described in the IFSP;


         2. Schedule and facilitate periodic and annual IFSP reviews; and


         3. Facilitate communication among family members, early intervention staff and
            other community agencies.



1. Coordinate and monitor delivery of services as described in the IFSP.

            A service coordinator ensures that formal and informal supports and services
             identified on a child and family‟s IFSP are implemented within 30 calendar
             days of the date of parent signature.

            Once an IFSP is implemented, a service coordinator monitors early
             intervention supports and services by facilitating ongoing assessment of
             progress towards achieving family/child outcomes. This ongoing assessment
             includes the periodic and annual IFSP reviews mandated by federal/state law
             as well as discussions by early intervention providers and family members.
             (Link to this session, assessing progress, pg 9)

            A service coordinator also assists families to update their priorities, resources
             and concerns throughout the implementation of their IFSP.



2. Schedule and facilitate periodic and annual IFSP reviews.
    The service coordinator has primary responsibility for scheduling and facilitating
    periodic and annual IFSP reviews.


                          Periodic review              Annual IFSP review

                    (link to Mod 2, session 1d)   (link to Mod 2, session 1d)

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                 Timeline: every 6 months, or     Timeline: Every 12 months
                 more frequently if needed        after the initial evaluation



                 Purpose: consider a child‟s      Purpose: update the IFSP and
                 progress toward achieving        review a child‟s current
                 IFSP outcomes and any            strengths, and need for
                 modification or revision of      services and family supports.
                 outcomes or family/child         Results of any current
                 supports and services. The       evaluations and other
                 periodic review may be           information from ongoing
                 conducted as a meeting or by     assessment with the family are
                 another means acceptable to      also considered.
                 the parent(s) and other
                 participants




         Who's Involved in periodic and annual reviews

                  Insert tip box below: Prior written notice must be provided to the parent(s)
                  and other participants within a reasonable time, as determined or agreed
                  to by the parent(s).

             For both the periodic and annual reviews, a service coordinator discusses
             with parents how they would like to participate in the meetings and who
             should attend. (link to mod 2 session 1, pg. 7) The IDEA mandates that
             parent(s) and their service coordinator attend, and that service providers and
             person(s) directly involved in conducting any additional evaluations or
             assessments be included, if appropriate. The parents can also request that
             other family members and an advocate, or other individual, outside the family
             be included in the meetings.



         Team actions facilitated by a service coordinator during periodic/annual
         reviews:

                • Review outcomes, strategies, activities, criteria, timelines
                and services;
                • Review family‟s resources, concerns, and priorities;

                • Review and discuss natural environments;

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                 • Revise outcomes, strategies, activities, and/or services, if
                 necessary; and

                 • Discuss transition, if appropriate.



         Documenting the periodic and annual reviews
                 For a periodic review, a service coordinator records revisions and obtains
                  parental signatures on appropriate parts of the Maryland IFSP Document &
                  Program Data Add/Change Form.

                 For the annual review, a service coordinator records revisions on a new Part I
                  of the Maryland IFSP document and obtains all required signatures.

                 For both, a service coordinator gives parents a copy of the IFSP, files a
                  copy in the child‟s early intervention record and submits a copy to data
                  entry.



3. Facilitate communication among family members, early intervention staff and
other community agencies.
         Service coordinators have primary responsibility for facilitating communication
         among all participants throughout their participation in local infants and toddlers
         program, not only at periodic and annual reviews. Service coordinators must
         also ensure that IFSP meetings: (link to mod 2 session 1 pg. 8)

                 Are scheduled early enough with written notice provided to the family and
                  other participants to ensure that they will be able to attend;

                 Take place in settings and at times that are convenient to families;

                 Use a family‟s native language, or other mode of communication, unless it
                  is clearly not feasible to do so; and


h. Ongoing assessment of progress

         Add Tip box below: Review “what happened” between visits each time you see
         a family and child. Listen to what family members say about reaching their IFSP
         outcomes.

Ongoing assessment starts soon after implementation of the early intervention supports
and services identified on a family‟s IFSP. Providing these services/supports, and
assessing their impact, are intertwined processes, each influencing the other (Meisels &
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Fenichel, 1996). Experienced early intervention providers listen to what families say,
watch for signs of progress, and adjust their suggestions accordingly. This gives
families and other caregivers an opportunity to share their perspectives, and participate
in decision making about “staying on course”, or changing some aspect of their IFSP.



         Add resource box below: Comprehensive Evaluation and Assessment notes that
         ongoing assessment must include natural observation of a child in his or her
         familiar context, and identifies what to look for. (link to mod 1 session 3 pg. 12
         ongoing assessment)

Ongoing assessment includes the formal mileposts mandated in the IDEA for periodic
review and annual evaluation of a child‟s and family‟s IFSP; it also includes an informal
time for family members and early intervention providers to talk about if they are
“heading in the right direction.” (link to Mod 2 session 1, pg 6 what type of IFSP
meetings must be held) The following questions can prompt all team members to think
about the progress they are making towards achieving family/child outcomes:

         1. What are the functional outcomes the family has selected? Do they still
         represent where the family “wants to go” in relation to helping their child
         participate in family and community life?

         2. How close are we to meeting measurable criteria for each outcome?

         3. What are we learning about child and family interests, routines and
         resources? How are we using this information to individualize strategies and
         interactions with families and children?

         4. Do our strategies need adjusting, and/or would others be helpful?

         5. Would other informal and formal family/child supports and services be
         helpful in assisting this family to reach their desired outcomes?



i. Team models for providing family/child supports and services

Collaborative consultation

         Insert Tip box below: Consultation is one approach to sharing expertise among
         team members, and is a powerful tool for collaborative problem solving and
         change.

Consultation in early childhood is an indirect service model that involves three partners:
a consultant, consultee and client. The consultant, an early intervention provider,
addresses a client‟s area of concern by working with a third party, a family member or
colleague, instead of providing direct service to the client (Buysse & Wesley, 2005). In
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a consultation model, a client can be a child, group of children or program. Team
members can use consultation to assist families and colleagues to work together to
help children with special needs participate in family and community life.
         Insert Resource box below: The vignette of Evan shows a speech-language pathologist
         providing collaborative consultation to a child care teacher. (link to pg. 16, group settings
         this session)
There are many styles of consultation, ranging from an expert model that places the
consultant in the role of the decision maker to a collaborative model with shared
responsibility for problem analysis and solution generation. Collaborative consultation,
described as “Let‟s meet as equals on this” is often preferred by educators and families
over expert consultation, experienced as “You tell me what to do” (Dettmer, Dyck &
Thurston, 1999).
Collaborative consultation is a process that facilitates partnerships between families
and early intervention providers because it is: voluntary, initiated by either a family
member or early intervention provider;
                 interactive, with team members coordinating their expertise to work
                  together towards a common goal; and

                 dynamic, emphasizing systematic problem solving and coping (Hanft &
                  Place, 1996)
Collaborative consultation enables teams of people with diverse expertise to identify
and analyze issues and generate creative solutions to mutually defined concerns.
When families, other caregivers and early intervention providers share their unique
perspectives via collaborative consultation, they come up with strategies and options
that are generally more comprehensive from those that an individual team member
could produce independently (Idol, Paolucci-Whitcomb & Nevin, 1987).



                   Jenni’s story: Consultation between colleagues
                            This video clip about Jenni from Just Being Kids
                            shows a team consultation between Jenni‟s primary
                            service provider, a physical therapist, and a
                            speech-language pathologist. The SPL suggests
                            how the PT and Jenni‟s family can prompt Jenni‟s
                            communication during play with her siblings and
                            friends.
                                         Video Clip: Jenni

         Note how the speech-language pathologist shows the physical therapist and
         older siblings how to use Jenni‟s interest in refrigerator magnets, clapping games
         and the hokey pokey to prompt her speech. The speech-language pathologist
         translates her knowledge about language development and communication to
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         suggest intervention that is: (link to Mod 3 session 3 pg 6 building an adults
         skills/knowledge)

              1.   fun for Jenni and her siblings, and


              2. appropriately facilitated by a physical therapist as the primary service
                 provider.

Janice and Mindy’s Story: Effective teaming using reflective practices

         Insert reflection box below: When early intervention providers use coaching or
         consulting to support the key adults in a child‟s life, they must always consider:

         Are my suggestions and supports appropriate for the experience, knowledge and role of
         the adult(s) I am interacting with?

The following vignette illustrates how an early intervention provider in an Infants and Toddlers
Program in Maryland provided collaborative consultation to a colleague and mother using
reflective dialogue, a critical component of coaching. Note how Janice individualized her
suggestions and interactions to support her colleague, Mindy, and the family Mindy was working
with.


         Who’s who in this consultation:

                   Consultant: Janice, a speech-language pathologist

                   Colleague: Mindy, an early childhood special educator

                   Clients:    Bintu, and her 19 month old daughter, Imani


         Why colleague consultation was requested

         Mindy invited her colleague, Janice, to join her on one of her bimonthly visits to Bintu
         and Imani in their home. Bintu was extremely concerned because Imani rarely made
         any sounds; Bintu also expressed frustration about trying to follow the communication
         recommendations made by a university prematurity clinic. Since Janice‟s expertise was
         in language development, Mindy wanted some ideas about how to help Bintu encourage
         her daughter‟s communication.


         How Janice and Mindy prepared for their joint visit with Bintu and Imani

         Janice asked Mindy to describe a typical visit with Imani and Bintu.
         (Mindy usually conducts a play session with Imani while Bintu watches and dozes on the
         coach since she works at night.) Janice wanted to help Mindy learn to support Bintu‟s
         interactions with Imani, rather than do a play session with Imani while her mother

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         watched.

         Janice explained the evidence-based practice of using natural learning opportunities to
         promote Imani‟s language development. (link to Mod 2 session 2 NE and early learning,
         pg. 2) She explained how important it was to support the key caregivers in Imani‟s life
         to promote her communication in everyday situations, rather than rely on Mindy to
         conduct a play therapy session every other week with Imani. (link to Mod 2 session 2 pg.
         2 evidence for…)


                  Insert reflection box below: How will this conversation help Mindy provide
                  meaningful support to Bintu?

         In preparation for their consultation, Janice suggested that Mindy talk with Bintu about
         Imani‟s interests, and current abilities, especially:

                  • which family activities Bintu wants Imani to be part of, and how Bintu would like
                  her daughter to participate in theses activities;

                  • times when Imani makes the most sounds;

                  • ways the family can get Imani to smile and look at them; and

                  • situations when Bintu thinks Imani is trying to communicate.


         What happened during the consultation:

         Following is Janice‟s description of her actual consultation with Mindy and Bintu.

         “We arrived at Imani‟s home early in the morning and Mindy introduced me to Bintu.
         Because of their discussion beforehand about Imani‟s interests and abilities, Bintu was
         ready for our visit and had actually prepared a list of questions and situations she
         wanted to talk about.”

         “Bintu immediately expressed her concern regarding Imani‟s negative reactions to the
         oral motor activities recommended by the NICU clinic, especially using an electric
         toothbrush. Imani would begin crying and wouldn‟t let her mother use it. I was hesitant to
         start our conversation with a negative situation, but thought we could try to help Bintu
         figure out how to make oral-motor games into a play time with Imani. She was
         obviously very upset about how to follow the clinic‟s recommendations.”

         “I sat back and invited Bintu to talk about Imani instead of trying things out with her
         myself. I asked Bintu for ideas about how to introduce the electric toothbrush so that
         Imani could see it and touch it herself. We decided to teach her just how to turn it on
         and off. She liked this and was aware of the action, so I suggested that Bintu say “on”
         and wait for Imani to make a sound before turning it on for her.”

         “Imani could imitate her mother‟s sound by producing “ah” and was delighted when the
         toothbrush turned on. Bintu was happy to see her daughter smile and anticipate the

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         action. Their interaction with the toothbrush changed dramatically, and Imani increased
         her eye contact with her mother rather than turning away and closing her eyes. They
         even played with it in Imani‟s mouth. Bintu, Mindy and I explored other ways to
         encourage Imani to laugh and use a few other words during daily routines and family
         interactions.”

         Follow-up between Mindy and Janice

         After their home visit, Janice and Mindy stopped for a cup of coffee to talk about their
         observations. First, Janice invited Mindy to reflect on her observations before offering
         her own feedback. This was an important part of supporting Mindy as an active learner.

         Mindy observed these positive interactions:

              Because Mindy had talked with Bintu about what she really wanted to know to
               help Imani before Janice‟s visit, Bintu became an active player in the
               consultation rather than an observer of what someone else did with her
               daughter.

              Janice invited Bintu to show her what she was doing and what was/was not
               working before Janice made any suggestions. As a result, Bintu was invested in
               their discussion and did not appear tired, even after working all night.

              Janice keyed in on what works from Bintu‟s point of view and asked “How about
               if we try this, too?” rather than tell or show Bintu what was the “right” way to
               interact with Imani.

              Imani actually changed her interactions during the visit and became more
               animated playing with her mother. There were immediate changes in her
               vocalizations as well which delighted Bintu.


             Insert reflection box below: Janice is convinced that really listening and validating a
             parent‟s ideas and actions is more effective than doing a “session” with a child,
             hoping that a parent or colleague will “catch on” and repeat it. What is your
             experience?


         Janice expanded Mindy‟s perspectives by presenting positive alternatives to direct
         intervention by:

                          suggesting topics to discuss with Bintu before the consultation;

                          modeling how to engage a parent in reflective conversation and validate
                           their ideas and strategies; and

                          debriefing with Mindy after their home visit, and inviting her to reflect on
                           her observations before giving any feedback.

         Since their consultation, Mindy has shared with Janice that Bintu is continuing to use the
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         suggestions they discussed, and also tried them to introduce Imani to new things.




j. Understanding culturally competence

         Insert reflection box below: Becoming culturally competent is a process of
         learning “to craft respectful, reciprocal and responsive interactions across
         diverse cultural and linguistic parameters” (Barrera, Corso & Mcpherson, 2003).

Cultural competence is the ability to see beyond the boundaries of one‟s own cultural
perspective to interpret and understand, without judgment or bias, the behaviors and
intentions of people who come from different cultural groups (Walker, 1991). Sarah, an
early intervention provider, must look beyond her first interpretation of a mother‟s
behavior in order to provide culturally competent supports and services to the family.




Sarah’s story: Becoming culturally competent




         On two out of four of Sarah‟s first visits to
         Xee Dao and her family, no one was home
         at the agreed upon time. Sarah would like
         to communicate to Mrs. Dao the
         importance of keeping appointments so
         Sarah can support Mrs. Dao in caring for
         Xee. She wonders how invested Mrs. Dao
         is in helping her daughter.

         Mrs. Dao wanted to keep her appointment
         with Sarah, but she was helping her aunt
         and uncle. It would be improper for her to

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         say it was time for her and Xee to leave
         their home to meet someone else.

         Insert reflection box here: Culture is broadly defined as a system of learned and
         shared standards for perceiving, interpreting and behaving in interactions with
         others and with the environment (Jezewski, 1990).

If Sarah is to react to this situation as a culturally competent provider, she must first
understand how her own “culture” influences her behavior and perceptions, as well as
the families she works with in her local Infants and Toddlers Program. An individual‟s
culture comes from his or her race, ethnicity, age, education, socio-economic status,
gender, religion, and sexual orientation. Early intervention providers must be aware of
their own familial and professional cultures, and be willing to explore their biases and
values as the starting point for understanding people from other cultures (Wells &
Black, 2000).


Sarah’s story: Becoming culturally competent

         Sarah‟s upbringing and professional culture value keeping appointments and
         doing what is agreed upon. She views Mrs. Dao‟s missed appointments as
         “dropping the ball” for Xee.
         Mrs. Dao, on the other hand, feels pulled between two conflicting responsibilities-
         to her daughter, and to her aunt and uncle. Mrs. Dao has been taught to always
         honor the requests of senior family members. Her uncle is ill, and her aunt called
         unexpectedly to ask Mrs. Dao to drive them to medical appointments.

Sarah‟s must first acknowledge that her interpretation of Mrs. Dao‟s behavior is based
on her expectation that appointments should always be kept. Then she can begin to
explore how Mrs. Dao‟s culture may provide an alternative explanation for her behavior
in this situation. Diversity i.e., differences in behavior, values and perception between
two or more people/groups, does not exist outside of a specific context. One person
does not simply assign another person as being culturally “diverse”; it is the interaction
between two or more individuals that creates the opportunity for diverse perceptions
and expectations to arise.
Sarah‟s and Mrs. Dao‟s expectations about keeping appointments and meeting
responsibilities have a great influence on their interaction. As a culturally competent
provider, Sarah cannot view Mrs. Dao as “culturally diverse” without also recognizing
that from Mrs. Dao‟s viewpoint, Sarah is equally “diverse”.




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Sarah’s story: Becoming culturally competent




    n. Sarah incorrectly assumes that Mrs. Dao is

         not very interested in helping Xee because

         she does not keep her appointments. An

         opportunity is presented for Sarah to

         initiate “skilled dialogue” with Mrs. Dao to

         listen to her viewpoints and understand the

         multiple family responsibilities Mrs. Dao is

         trying to meet each day. This discussion

         can lead to an exploration of options for

         rescheduling early intervention visits,

         including sometimes seeing Mrs. Dao and

         Xee at the home of her aunt and uncle,

         and/or scheduling around their medical

         appointments. (link to next section in this

         session Becoming culturally competent

         early intervention providers)



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Culturally competent early intervention providers understand that “culture” influences all
partners in an interaction, and sets the stage for how each person perceives and
interprets the other persons‟ behavior. For further discussion about the influence of
culture on early intervention supports and services in this tutorial please review:
         Influences on a family‟s decision to talk about priorities, concerns and resources; (link
         to Module 1, Session 2e)”

         Appreciating cultural beliefs and practices; (link to Mod 1 session 2 Application 2.2)

         Planning with families: Lee Family; (link to Mod 1 session 2 Application 2.6)

         Recommended Reading: Developing cross-cultural competence and The spirit catches
         you and you fall down. (link to mod 1 session 2)


k. Becoming culturally competent early intervention providers

Five key principles promote culturally competent practices in early intervention.
Culturally competent early intervention providers (Barrera, Corso & Macpherson, 2003):
         1. Expect and appreciate, differences in parenting and child development
         practices between culturally diverse families;
         2. Recognize the potential for barriers when they interact with people from
         cultures different than their own;
         3. Look for and find ways to support the meaning an individual gives to specific
         behaviors;
         4. Craft respectful, reciprocal and responsive relationships with people from
         cultures different from their own; and
         5. Use the skills of anchored understanding and 3rd space dialogue to develop a
         concrete and empathetic understanding of a family‟s cultural context



1. Expect, and appreciate, that parenting and child development practices
between culturally diverse families will often be different.
         One mother may nurse her child until 30 months of age and another weans her
         baby at age 6 months. One father places his child‟s hands around a football
         during play and another considers play with infants something that only mothers
         do. One grandmother sees her role as “spoiling” the first born son of her own son
         and another takes great pleasure in teaching her grandson to feed himself at an
         early age.
         A culturally competent early intervention provider understands that each of these
         examples is “right on”- for that particular parent and family. There is not one
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         standard for judging a father‟s play, how long a mother may nurse, or how a
         grandmother should prompt a grandson‟s independence.



2. Look for and find ways to support the meaning an individual gives to specific
behaviors (Landrine, 1995).
         The mother who nursed her child for several years followed the examples of her
         mother, aunts and cousins, and would consider it a great disruption in raising her
         child if she could not do so. The second mother feels remorse in giving up
         breast feeding as she returns to work, but also is pleased that she could do so
         for 6 months since neither her mother or her grandmother nursed their babies.
         The nursing behavior of both mothers is rooted in their own culturally derived
         belief systems. If each child was not adequately nourished by nursing, alternative
         recommendations for feeding their children could be judged very differently by
         each parent.
         A culturally competent early intervention provider would explore multiple options,
         and their meanings and consequences, with each parent in order to help her
         select and embrace another way to feel good about feeding her child. Such a
         provider would recognize that suggestions that require big changes in behavior,
         or that do not complement each mother‟s values, will require more support and
         exploration before they are accepted, if at all.



3. Recognize the potential for barriers when they interact with people from
cultures different than their own because of the various meanings and values
connected to family life and parenting.
    The discomfort and/or conflict which can arise among people from different
    backgrounds has been called a “cultural bump” (Archer, 1986). Cultural bumps
    signal the unfamiliar, and may result in minor discomfort (e.g., do I take my shoes
    off before entering this family‟s home?) or major discomfort (e.g., do I accept family
    members‟ “folk” remedies rather than giving a child physician prescribed
    medication?). Cultural bumps result from differences in how individuals view their:
        Sense of self: learning who you are and how to act. For example:

                  How to address elders;

                  Acceptance of special physical or mental conditions;

                  Which personal characteristics are valued by family and community;



        Funds of knowledge: access to information to guide important life events. For example:

                  Who to go to for advice about relationships or money;
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                  How to find good medical care or the right herbs to treat specific symptoms;

                  What to teach a child about family beliefs and values.



        Perceptions of power: behavior and skills associated with status and privilege. For
         example:

                  Speaking English versus another language;

                  Talking in public;

                  Contradicting authority figures.




4. Craft respectful, reciprocal and responsive relationships with people from
cultures different from their own.

         Insert resource box below: Click here for further discussion about the three
         qualities- respect, reciprocity and responsiveness- underlying skilled dialogue
         across cultures. (link to http://www.brookespublishing.com/store/books/barrera-
         6377/excerpt.htm)

    Being willing to create respectful, reciprocal and responsive relationships is just as
    important in becoming culturally competent as learning about the beliefs and mores
    of various cultures. Skilled dialogue among people from diverse cultures promotes
    relationships between families and early intervention providers (and among
    colleagues) that are:


        Respectful. Respect is demonstrated by acknowledging and accepting the boundaries
         that naturally exist between people. These boundaries both connect and distinguish people
         from one another. Physical boundaries specify how to relate to other people using body
         language (e.g., how close to stand to another person, always making eye contact with
         elders). Emotional boundaries define the content and tone of the interaction (e.g., making
         small talk before discussing serious issues; whether to bring up family matters before
         strangers).

                  Danielle’s Story: Respecting physical boundaries

                  Understanding that many Cambodian families believe a person’s head is
                  the most important part of the body because one’s spirit rests there,
                  Danielle was sure to ask Sooyen’s parents if she could touch Sooyen’s
                  mouth and cheeks before beginning his feeding assessment.




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        Reciprocal. Identifying, and valuing, the contribution of each person restores the balance
         between family members and early intervention providers, and among colleagues. All
         people are equally valued and one person is not viewed (or acts as) an expert authority
         who has the “right” answers.

                  Sam’s story: Recognizing a partner’s contribution

                  During his home visit with Leathia’s family, Sam recognized that he was
                  slipping into a nonproductive judgment about Leathia’s mother: “She is
                  more interested in watching TV than talking with me.” Sam consciously
                  made an effort to switch his thinking to: “Here’s someone from whom I
                  can learn what Sam likes to do, and who may like to learn what I know
                  about playing with toddlers.”



        Responsive to family values and beliefs. Responding to another person‟s values and
         beliefs is not the same as assuming them for yourself. Before suggesting strategies,
         culturally competent early intervention providers consider a family‟s life style and offer
         choices that may still need some “tinkering” to make the right fit. They avoid making
         assumptions and instead, draft “lightly held hypotheses” about what others know and
         believe (Barrera & Corso, 2003, p.47).

                  Silvia’s story: Linking strategies to a family’s lifestyle

                  Listening to Mrs. Pena talk about how she wanted Mayra to sit at the
                  table and eat “all by herself” during the family dinner each day, Silvia
                  wondered how independent Mrs.Pena hoped Mayra would be in 6
                  months. Silvia realized she needed to first understand what dinner time
                  at the Penas was like, and how this family viewed independence. Then
                  she could help Mrs. Pena come up with strategies that would be aligned
                  with family beliefs about independent feeding for young children with
                  motor delays.


5. Culturally competent early intervention providers use the skills of anchored
understanding and 3rd space dialogue to develop a concrete and empathetic
understanding of a family’s cultural context (Barrera, Corso and Macpherson, 2003).


         When differences inevitably arise among people from diverse cultural groups, providers
         commit to developing creative and inclusive choices with families and colleagues that
         honor all individuals involved by using two strategies:

                 anchored understanding of diversity; and
                  3rd space dialogue.


                  Insert tip box here: You do not have to admire the behavior of culturally diverse

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                  family members and colleagues as long as you believe that their behavior makes
                  sense from the other person‟s cultural perspective.


         Anchored understanding of diversity is the “experiential knowing” that accumulates
         when interacting with a family(s) from a specific cultural group. It takes some effort to
         recognize that other people are unique, yet also part of a larger cultural framework,
         without rejecting either component. For example:


                  Bettina understood from talking to Klaus that he believed his son would learn to
                  roll over and crawl on his own time table, just like his other children. His “typical”
                  children developed age appropriate motor skills at various times, and so would
                  this fourth child. Bettina accepted that Klaus viewed her suggestions as
                  “assignments”, which his son did not need. Klaus wanted to play with this child
                  like he had done with his other children, and her suggestions had to fit this belief.



         Using strategies for developing anchored understanding of diversity, culturally
         competent early intervention providers can begin to answer:

                 Does my perspective of a child complement that of family members?

                 Do I describe a child using words that family members can embrace?

                 Do I understand a family‟s hopes and dreams for a child?

                 Can I accurately describe what family and participation in family life mean to
                  each family I interact with?

                 Do I recognize when a family‟s “story” is not congruent with my “story” about their
                  child, and actually sets up barriers between us?




         A second skill, 3rd space dialogue, can ease the tension generated by contradictions
         between different people‟s behaviors and perceptions. If diverse perspectives can be
         viewed as complementary, new options/actions/viewpoints can then be generated.
         Barrero, Corso & Macpherson (2003) use the following vignette to illustrate the concept
         of “3rd space dialogue”:


                  Betsy and Karen’s story: Working out a relationship

                  Betsy, an early childhood provider, visits Mayra, and her mother, Karen, a single
                  mother who recently moved from Puerto Rico. Betsy is frustrated because
                  Karen views her as an “Expert”, and often leaves the room so Betsy can work
                  with Maya by herself. Betsy wonders how she can be a culturally responsive
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                  provider when she goes into the homes of families from cultures that make sharp
                  distinctions between parents and “experts.”


         Using an analogy of connecting rooms is a helpful way to understand 3rd space
         dialogue. When Betsy is in a “room” all by herself (called singular space) with no input
         from others, only her own opinions and perspectives matter. She is by herself and
         doesn‟t have to relate to Karen, or think about her perspectives.

         If Betsy realizes that she and Karen each have their own perspectives, she now has a
         dualistic perspective about her relationship with Karen. They coexist in their own
         spaces, but hold on to their own opinions and values. Betsey may realize that Karen‟s
         beliefs are as valid as her own. Yet Betsy‟s behavior is limited by her polarized thinking
         (i.e., either Karen‟s view or mine is the “correct” perspective). There is no room for
         other possibilities in dual space dialogues since each person remains in their own
         “room,” certain of her own view.

         A 3rd space perspective embraces the possibility that both Betsy‟s and Karen‟s
         perspectives could co-exist, without either one labeled as “wrong.” Betsy could ask
         herself, “In Maya‟s best interests, how can I adapt my beliefs and values with Karen‟s,
         emphasizing our collective strengths?” Betsy and Karen are now freed from the barrier
         of viewing early intervention as an either-or situation (i.e., I‟m right and she is wrong)
         regarding how Karen and Betsy interact during home visits.


                  Betsy and Karen’s story (con’t) : Exploring possibilities

                  A discussion between Betsy and Karen can now explore the following
                  possibilities:

                     Betsy could reframe her view of Karen’s “noninvolvement” in a number
                      of ways:

                      - as an opportunity for Maya to develop problem solving skills apart from her
                      mother for a portion of each visit which Betsy and Karen can then talk about;

                      - understanding that Karen is engaged in helping her daughter and has her
                      own ideas about how to help Maya. Labeling Karen‟s participation in early
                      intervention as “noninvolvement” is really an inaccurate view of Karen‟s
                      behavior because she periodically listens and watches from the doorway.
                      The real issue is that Karen does not want to interfere with Betsy‟s “work”.
                      Betsy has an opportunity to ask Karen for her opinions and reactions, and
                      craft a way for them to “work” together to help Maya;

                      -as respectful of Karen‟s style of parenting as supportive rather than
                      directive. Betsy‟s suggestions for play and caring for Maya are far out of
                      Karen‟s comfort zone and should be reframed to fit her parenting style.




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                     Betsy and Maya could accompany Karen on “field trips” to other parts
                      of the house or places in the community, giving Betsy the opportunity to
                      see first-hand what Karen‟s day is like. Betsy then would have a much
                      clearer idea of how to use natural learning opportunities to help Karen and
                      Maya achieve specific outcomes for Maya‟s participation in family life.


l. Issues to consider when working with interpreters
Effective interpreters enable early intervention providers to communicate with families in their native
language so that family members understand how to help their children participate in meaningful
situations and experiences that acknowledge family beliefs and values.



In this video clip from Just Being Kids, Gloria, a mother of three children, reinforces how
important it is to communicate with her early intervention providers in order to help her
daughter, Jenni, learn to talk and walk on her own.

                                          Video clip: Gloria



Qualities of an ideal interpreter (Lynch & Hanson, 2004):


      Appreciates the cultural background of all parties and uses sensitivity in conveying their
       messages to one another. A culturally competent interpreter can guide an early intervention
       provider respectfully with regards to pacing, responding to a family members cues and
       nonverbal responses. They must watch carefully for reluctance or signs of discomfort
       which can arise when family members are invited to discuss personal issues with
       unfamiliar people. Such reluctance to talk to unfamiliar people extends to an interpreter
       as well as early intervention providers.



      Proficiency in speaking the language of a family as well as the early
       intervention provider(s). An effective interpreter recognizes differences in
       dialects, and translates all messages accurately without adding his or her own
       interpretation, advice or opinion. One example of inaccurate translation: after a
       health questionnaire was translated from English to Spanish, one item, “How
       often do you kiss your child?” was consistently scored very low by Latino
       families. When the translation was double checked, it actually asked: “How
       often do you kiss your puppy?” (Yu & Liu, 1994)


      Training and experience the process of interpreting and cross-cultural
       communication. An effective interpreter can translate without omitting, adding,
       paraphrasing or changing the intent or substance of the speaker. An interpreter treats all
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       interactions as confidential, and understands his or her job is to remain neutral while
       facilitating communication between two or more people who have important messages for
       one another.



      Understands early intervention terms and its basic mission. An effective interpreter
       understands the purpose for the interaction between early intervention provider(s) and a
       family whether it is to evaluate a child‟s eligibility for a local infants/toddlers program, share
       evaluation information, or support parents during a home visit. If specific English terms do
       not have a suitable equivalent in a family‟s language, an experienced interpreter knows how
       to convey the intent of the message accurately.



Using family members as interpreters

When close family members or friends serve as interpreters, discomfort can arise due
to gender or age differences, or just talking about personal information. Family
members acting as interpreters may also wish to censor answers and keep certain
information confidential in order to minimize anticipated public stigma.
For all these reasons, it is not recommended to use siblings as interpreters for any
significant discussions. “The role reversals, mutual resentments, and complex family
dynamics that can emerge from this process should discourage interventionists from
using children, regardless of how mature they seem to be (Lynch & Hanson, 1992,
p.54). Siblings, however, should always participate with early intervention providers in
play and other family activities/routines, in their usual manner.


Responsibilities of early intervention providers when working with interpreters
(you could split



         Insert tip box below: Notices of IFSP meetings, parental permission for a child‟s
         evaluation and assessment of family concerns, priorities and resources as well
         as participation in early intervention must be presented in writing, in a family‟s
         language, as mandated by the Individuals with Disabilities Education Act.

In preparation for talking with a family through an interpreter, early intervention
providers should brief the interpreter about the:

Purpose of the meeting (e.g., initial planning conversation, evaluation and assessment,
developing/reviewing an IFSP, progress review, family support visit);



             Key points to communicate (e.g., what provider would like to share with
              family, how family members can participate, family views, next steps);

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             Information that may be sensitive (e.g., test scores, a child‟s
              performance/progress, parent concerns, financial information);



             Specific medical or early childhood terms that must be used. Carefully
              review terms referring to programs and services (e.g., Part B, Part C;
              transition, physical therapy, audiologist), eligibility (e.g., 25% delay in one or
              more developmental areas; pre-existing condition; test names) and child
              performance (e.g., cognitive skills, expressive language, muscle tone).



             Documents that will be shown or referred to. Reconsider using
              documents/brochures if they are not available in the family‟s language;
              testing protocols and an IFSP form are important to share and describe.


Strategies that early intervention providers can use when working with an interpreter to
facilitate communication and the translation process includes (Randall-David, 1989;
Hanson & Lynch, 2004; Roney, 2001):

                             Strategies for facilitating communication

         Introduce yourself, your interpreter and describe your roles. Clarify mutual
         expectations about the purpose of the interaction/visit.
         Understand cultural norms regarding paying attention, respect for elders and
         members of opposite sex, talking with unfamiliar people;
         Learn a few greetings and social phrases in a family‟s primary language, the
         names they wish to be called, and know how to pronounce them;
         Use a positive tone, and speak in a calm, unhurried voice, conveying respect
         for each family member;
         Periodically ask family members to summarize what they have heard. Avoid
         asking, “Do you understand?” Rather, ask the family if they have any
         questions or if they would like to hear about a topic again.



                                 Strategies to facilitate translation

         Address all remarks to the family, not the interpreter. Look at family members
         when they speak and observe their nonverbal communication.

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         Speak clearly, and a little slowly, and be sure not to increase your volume.
         Pause after several sentences so the interpreter will not have to translate too
         much information at one time. Avoid jargon, slang, idioms, and colloquialisms.
         Expect that it will take additional time to convey your message when using an
         interpreter.
         Give instructions in a clear, logical sequence, emphasizing key words. Use
         gestures and pictures, and when possible, give a demonstration.
         Focus on the key questions to ask, or information to share. Avoid
         oversimplifying and condensing important explanations.
         Try, respectfully, to determine a family‟s literacy level before using too many
         written materials. Remember that even families who speak English may not
         read it as well.




m. Considerations for providing early intervention supports and
services in group settings

         Insert tip box here: Community settings for a group of very young children can
         range from a neighborhood play group of 3 toddlers to a preschool program for 2
         year olds in a religious institution to a swim program for 6 month old babies at a
         community pool.

Early childhood settings are important resources for informal support networks for
families because they provide multiple natural learning opportunities in activity settings
that families feel comfortable in participating. The critical factor for very young children
with special needs is that these learning opportunities occur with similar age peers
without disabilities (Wolery & Odom, 2000). When staff in community group settings are
properly supported to include children with disabilities, all children demonstrate positive
effects (Bruder & Brand, 1995; Odom, 2000). (link to this session section a natural
environments)

One of the essential supports in inclusive settings is helping staff to promote social
interaction and participation between children with and without disabilities. Early
intervention providers who serve children in group settings should carefully review how
much time they spend pulling children into spaces and activities that are separate from
the ongoing routines and interactions of other children.


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Key issues to consider when serving young children in community-based group
settings:


1.   Understand and respect the philosophy, curriculum and beliefs of community program
     personnel so that early intervention suggestions for a child complement the program‟s intent
     and day-to-day routines.

         Leonard’s story: Using classroom routines to promote fine-motor skills
         (put in story format for staff)
         Leonard, with the approval of Sharmane‟s parents, contacted the director of the
         inclusive child care program that Sharmane attended to set up a bi-monthly visit
         with Sharmane‟s group leader, Jantelle. While talking with Jantelle, Leonard
         learned that she was a former practical nurse and felt very strongly about
         teaching the children to wash their hands before eating. Since he was looking
         for ways to increase Sharmane‟s hand skills in daily activities, he asked
         Jantelle if she could incorporate various wrist and hand motions into hand
         washing and water play for all the children. Together, they thought about how
         Sharmane and the other children could play at the water table and sink
         everyday.


2. Identifying when to visit and how to collaborate with the personnel who direct and carry
   out a program‟s activities for children. It is important to secure the support of a director of a
   preschool or child care center before making plans with group leaders for visits.



         Collaborating with personnel in group settings

           Find out when other adults have the most flexibility to talk with you (e.g., before and
           after the program, during nap or snack) and interact with the children.

           Ask about visitor‟s protocols, especially how children will address you (first name,
           Mrs./Mr., etc) and how to respond to children‟s requests for help or to play.

           Use email, voicemail, visit notes, communication books to reinforce key messages
           and share observations.

           Pitch in during all prep time and talk while getting ready for children and families to
           attend.

           Offer to lead an activity as a way to demonstrate suggestions and understand the
           context and staff roles in the program.

           Share responsibility for ensuring that all children are safe and engaged in program

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           activities.

           Instead of scheduling individual sessions with two or more children in a preschool or
           child care center, schedule a block of time to cover a portion of the schedule which
           presents the most learning opportunities for working on IFSP outcomes.




3. Maintain family and child confidentiality while interacting in community settings. Before
   visiting community programs and setting, early intervention providers should ask parents how
   they would like to handle possible situations which could arise (e.g., how to introduce an early
   intervention provider who accompanies family members to community locations frequented by
   others, or how to demonstrate or talk about suggestions for a child when other people are
   nearby).

         Debra’s story: Working her role out with a mother and teacher
         Debra accompanied Ian and his mom, Caryn, to their Gymboree class to see
         how she could offer suggestions so that Ian could spend more time
         participating in activities than watching them. Debra asked Caryn if she could
         talk with the gymboree teacher beforehand, and find out how she could be
         helpful to the teacher. Debra also asked how active a role Caryn wanted her to
         take during her visit. Caryn replied that friends and family frequently attended
         Gymboree, and that Debra should “jump in” and help Ian enjoy himself as much
         as possible.


4. Promote the inclusion and socialization of all children involved in the program.
   Encourage family members to talk about how to handle specific situations in preparation for a
   child joining a community group, or as situations arise afterwards.

    The following strategies can support all children in group settings (Hanft, Shelden &
    Rush, 2004).
         Support Strategies                 Examples


         Model strategies about             Sit with children on floor and demonstrate
         including other children in all    how long to wait (count softly to 5) for a
         suggestions you make for a         response from a child who uses gestures
         particular child.
                                            to communicate.


        Invite other children to join       “Stevie, come on over and build this tower
        you and the child you are           with us!” Then, as soon as possible, sit
        visiting.                           back and facilitate child-child interaction.
                                            Resist becoming the center of the
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                                               children‟s attention.



        Answer questions and                    When Tuyet asks about Sonya‟s wheelchair,
        comments from children                  answer “Sonya uses her wheelchair to get
        directly and honestly.                  around, just like you use your legs.” Discuss
                                                these interactions with program staff and
                                                family members to ensure they understand
                                                and approve your responses.



        Involve family members,                After responding to Tuyet about Sonya‟s
        when present, and a child              wheelchair, ask Sonya to demonstrate how she
        with special needs in any              moves her chair, or show the children how
                                               Sonya can give a ride to a doll as she is
        discussion or questions that
                                               pushed herself.
        arise from other children.


        Assist children and staff in           “LaQuan, remember that Sonya likes
        learning about the special             gentle hugs from her friends.” or “Danny, if
        interests, likes and dislikes,         you stand closer, Sonya can hear/see you
        and communication style of a           better.”
        particular child.



        Encourage children to ask              “Amy, this machine helps Leila get some
        questions; if they don‟t,              air to breathe easier so she can come to
        supply simple information              school.”
        pertinent to the task at hand.




Comments from a dad and teacher about working with an early intervention provider in a group
setting

This video clip from Just Being Kids illustrates early intervention supports and services for Evan and his
family. This clip focuses on how a father and a child care teacher view collaborative consultation from
Renee, a speech-language pathologist, to support Evan‟s functional outcomes of communicating with
family/peers and using a spoon independently during meals and snack.

                                              Video Clip: Evan




Application activity 3.1 Tracking IFSP implementation with families

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Review how you and your team provided early intervention supports and services for 2-3
families over a month period of time. Use the self-assessment survey for Session 3 to guide
your observations (to be developed). (link to self-assessment survey session 3) If you are not
involved in implementing an IFSP as a provider, service coordinator or family member, consider
interviewing the members of a specific family‟s team.


After your observations/interviews, reflect (preferably with colleagues and family members) on
the following:




    1. Do I/we describe and implement our supports/services with families in similar ways? Is
       the same process used consistently throughout all regions of our Infants and Toddlers
       Program?


    2. How do I/we help families understand how we provide early intervention supports and
       services that are meaningful for their family?


    3. Do key community partners and referral sources understand how I/we provide early
       intervention supports and services?



    4. Do we need to schedule professional development activities about providing formal and
       informal supports and services in natural environments? If so, what would be helpful?




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Application 3.2 Addressing concerns families may about
implementing an IFSP


Reflect on the following concerns (often unspoken) families may have and draft
possible responses that families would find helpful. Review any information sheets or
Frequently Asked Questions for families that may be available in your Infants and
Toddlers program. It is recommended that family members, early intervention
providers and administrators work together to draft responses that are family-
friendly and reflect program policies. Use this opportunity to ask family members,
advocates, and family support coordinators about other concerns families may have,
and draft responses to these questions also.


Concerns families may have:

Communication:

        I can‟t communicate/don‟t get along with the early intervention providers coming to help
         me with my child.

        Confidentiality– who will see this information about my child? Will it also be included in
         his or her school records?

        How are all these services and supports coordinated (especially for children with
         multiple challenges when different agencies are involved?)

        The doctors/private therapists told me I should be getting a different kind of therapy.


Changing early intervention supports and services:

        What if I change my mind about participating in the program? Can I withdraw?

        When and how often will the IFSP be reviewed?

        How easy is it to change early intervention outcomes and supports/services?



What comes next?

        My child is almost 3 years old- we‟re not ready to leave early intervention.

        What is the difference between an IEP and an IFSP?



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Application 3.3 Reflections on Adult Learning

Reflect on these questions regarding the principles of adult learning in relation to:


     1. Key adults in a family with whom you currently work.

     2. A colleague with whom you have consulted or shared information to enhance his/her
        professional skills.


     Adult learning depends on:                   Application for collaboration
                                                  with families and colleagues
1. Motivation: desire to work              What motivates me to learn new information
   together to accomplish                   and/or try new routines or activities?
   common outcomes
                                           What influences family members/colleagues to
                                            work together to acquire and apply new
                                            knowledge and skills?
2. Respectful learning                     What physical and emotional factors contribute
   environment: physical and                to a positive learning environment for me?
   emotional climate promotes
   learning and self-reflection            How do I apply these factors to working with
                                            families/colleagues in natural environments?
3. Past and current experience:            Do I understand my partner‟s “story” about
   new learning depends on                  supporting a child in natural settings? Finding
   merging knowledge and                    and adapting community resources?
   experience
                                           How do I build on these experiences to prompt
                                            new learning and actions for a
                                            family/colleague?
4.   Achieving self-direction and          What prompted my learning a new
     active involvement:                    skill/information? How did I pace myself?
     understanding what an adult
     learner uniquely needs                How do I assist families/colleagues to feel that
                                            they are in charge of their learning?
6.   Learning styles/coping                What are my learning styles and coping
     strategies: different ways to          strategies?
     process information, meet
     challenges and accomplish a           How do I assess and support different styles of
     task                                   learning and coping strategies in others?
7.   Critical, reflective thinking:        How do I identify strategies for keeping family
     partners contribute/revise their       members/colleagues involved in achieving early
     own perspectives                       intervention outcomes?
                                           When and how do I reflect with each
                                            family/colleague about our interactions and
                                            progress?


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Adapted from Hanft, Rush and Shelden, 2004




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Application 3.4 Individualizing strategies for adult learners


Adult learners (family members and colleagues) have preferences for processing new
information and learning a new skill. Table 3.1 identifies three categories of learning strategies
for visual, auditory and kinesthetic learners.

Review Table 3.1 and consider:

         1. Which strategies have you tried with family members? Colleagues?

         2. Do you have one or two strategies that you use most frequently? Why? What are
            the outcomes?

         3. Are there other strategies you use to help family members and colleagues acquire
            new information and skills?



Table 3.1 Visual, auditory and kinesthetic learning strategies for adult learners



      Visual learning                  Auditory learning           Kinesthetic learning

        Caregiver observes EI             Caregiver summarizes         Caregiver keeps journal
     provider                          feedback from EI provider   of actions and reflections


        Caregiver observes                 Caregiver narrates          Caregiver practices
     peers                             actions watching a video    actions


        Caregiver watches                 Caregiver listens to         Caregiver demonstrates
     video                             audiotape                   actions to others


          Caregiver reads an              Caregiver calls             Caregiver joins support
     article and/or looks at           another caregiver           group or visits another
     illustration                                                  caregiver


         Adapted from Hanft, Rush and Shelden, 2004




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Application 3.5 Early intervention supports and services for Yvonne
and Blake

Review the entire video clip about Yvonne and Blake from Just Being Kids (each Local Infants
and Toddlers Program in Maryland has a copy of the video and facilitators manual). Blake is a
very bright 2 ½ year old boy who likes “hot wheels” cars, computer games, cooking (play and
real), and imaginative play. Blake can walk slowly and unsteadily with a walker, but does not
like to use it. His fine motor skills have been one of his strengths, and he still needs help with
age appropriate activities that require the skilled us of both hands. Blake routinely became very
frustrated with the typical grocery shopping routine, due partly to the fact that his cognitive
development exceeds his motor abilities.

After watching Blake‟s entire vignette, discuss how your Infants and Toddlers Program could
assist this family. In “real life, Trudee, an occupational therapist, served as the primary service
provider for Blake and his parents to make shopping trips easier by supporting Yvonne to
improve Blake‟s behavior in the store, and actively engage him in learning opportunities found
in the grocery store.

Consider the following questions with colleagues and family representatives (e.g. your family
network coordinator and family members from your program).

    1. What functional outcomes has Yvonne selected to work on with Blake? ((link to mod 2
       session 2f functional outcomes)

    2. How will the early intervention team know that they have achieved this outcome?
       (Suggest measurable criteria this team might use to review Blake‟s progress) (link to
       mod 2 session 2h measurable criteria)

    3. What informal and formal family/child supports and services would be helpful in
       assisting this mother to reach her outcome for Blake?

    4. If formal early intervention supports/services from your Infants and Toddlers program
       are desirable, who has the expertise to address these outcomes?

    5. How does Trudy use her expertise to support all family members? What are her
       suggestions for promoting Blake‟s ability to participate positively in grocery shopping?
       What other strategies/suggestions might you suggest?

    6. How are key early development foundations (i.e., social interaction, mastery of the
       environment and engagement in learning) addressed in these outcomes as well as
       suggested strategies?

    7. How frequently, and for how long will formal early intervention family/child supports and
       services be provided?


    8. Where will family/child supports and services will be provided?


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Application 3.6 Early intervention supports and services for Nolan
and his family


Review the entire video clip about Nolan and his family from Just Being Kids (each Local Infants
and Toddlers Program in Maryland has a copy of the video and facilitators manual). Nolan is
almost three years old and likes to read with his sister, play on the computer, and “drive” his
remote-controlled car. He has cerebral palsy with significant motor delays. His parents, Ron
and Kim, describe good times the family has and also identify bath time as a routine they would
like to make more enjoyable for the entire family time.

After watching Nolan‟s entire vignette, discuss how your Infants and Toddlers Program could
assist this family. In “real” life, Lisa, a physical therapist, serves as a primary service provider
for Nolan and his family. Consider the following questions with colleagues and family
representatives (e.g. your family network coordinator and invited family members from your
program).



    1. What functional outcome has Ron and Kim selected to work on with Nolan? ((link to
       mod 2 session 2f functional outcomes)

    2. How will the early intervention team know that they have achieved this outcome?
       (Suggest measurable criteria this team might use to review Nolan‟s progress) (link to
       mod 2 session 2h measurable criteria)

    3. What informal and formal family/child supports and services would be helpful in
       assisting this family to reaching their outcome for Nolan?

    4. If formal early intervention supports/services from your Infants and Toddlers program
       are desirable, who on the team has the expertise to address this outcome?

    5. How does Lisa use her expertise to support Ron and Kim? What are her suggestions
       for making bath time a more pleasurable experience for Nolan and his family? What
       other strategies/suggestions might you suggest?

    6. How are key early development foundations (i.e., social interaction, mastery of the
       environment and engagement in learning) addressed in this outcome as well as
       suggested strategies?

    7. How frequently, and for how long will formal early intervention family/child supports and
       services be provided?

    8. Where will family/child supports and services will be provided?




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Application 3.7 Early intervention supports and services for Jenni
and her family

Review the entire video clip about Jenni and her family from Just Being Kids (each Local Infants
and Toddlers Program in Maryland has a copy of the video and facilitators manual). Jenni, an
engaging 2 ½ year old girl, lives with her parents, Gloria and Fermin, her two brothers and
another family of five. She loves playing, reading, singing and being with the older children.
Jenni has delays in her ability to walk unassisted and in her expressive language due to diplegic
cerebral palsy. Since she also had a baby to care for, Gloria‟s primary goal was for Jenni to
walk independently in and out of their home.

After watching Jenni‟s entire vignette, discuss how your Infants and Toddlers Program could
assist this family. In “real” life, Jeannemarie, a physical therapist, served as the the primary
service provider for Jenni; ---- consulted with Jeannemarie and Gloria about prompting Jenni‟s
communication with her family.

Consider the following questions with colleagues and family representatives (e.g. your family
network coordinator and invited family members from your program).

    1. What functional outcomes have Gloria and Fermin selected to work on with Jenni? ((link
       to mod 2 session 2f functional outcomes)

    2. How will the early intervention team know that they have achieved this outcome?
       (Suggest measurable criteria this team might use to review Jenni‟s progress) (link to
       mod 2 session 2h measurable criteria)

    3. What informal and formal family/child supports and services would be helpful in
       assisting this family to reaching their outcome for Jenni?

    4. If formal early intervention supports/services from your Infants and Toddlers program
       are desirable, who on the team has the expertise to address these outcomes?

    5. How do Jeannemarie and --- use their expertise to support all family members? What
       are their suggestions for promoting Jenni‟s ability to walk independently and
       communicate with her family? What other strategies/suggestions might you suggest?

    6. How are key early development foundations (i.e., social interaction, mastery of the
       environment and engagement in learning) addressed in these outcomes as well as
       suggested strategies?

    7. How frequently, and for how long will formal early intervention family/child supports and
       services be provided?

    8. Where will family/child supports and services will be provided?




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Application 3.8 Early intervention supports and services for Evan and
his family

Review the entire video clip about Evan and his family from Just Being Kids (each Local Infants
and Toddlers Program in Maryland has a copy of the video and facilitators manual). Evan is a
social 18 month old boy who likes music, playing peek-a-boo, being with other children and
reading books. Both of Evan‟s parents work, and he attends a child care center. Michelle and
Bob would like Evan to use a spoon independently to feed himself during meals and snack at
home and child care, and communicate actively with family and peers.

After watching Evan‟s entire vignette, discuss how your Infants and Toddlers Program could
assist this family. In “real” life, Renee, a speech-language pathologist, serves as a primary
service provider for Evan and his family, and consults with Evan‟s child care teacher to share
outcomes and strategies so all caregivers can work together to achieve his outcomes.


Consider the following questions with colleagues and family representatives (e.g. your family
network coordinator and invited family members from your program).

    1. What functional outcome have Bob and Michelle selected to work on with Evan ((link to
       mod 2 session 2f functional outcomes)

    2. How will the early intervention team know that they have achieved this outcome?
       (Suggest measurable criteria this team might use to review Evan‟s progress) (link to
       mod 2 session 2h measurable criteria)

    3. What informal and formal family/child supports and services would be helpful in
       assisting this family to reaching their outcome for Evan?

    4. If formal early intervention supports/services from your Infants and Toddlers program
       are desirable, who on the team has the expertise to address these outcomes?

    5. How does Renee use her expertise to support Evan‟s teacher at child care? What are
       her suggestions for including him in the daily activities and achieve his outcomes? What
       other strategies/suggestions might you suggest?

    6. How are key early development foundations (i.e., social interaction, mastery of the
       environment and engagement in learning) addressed in this outcome as well as
       suggested strategies?

    7. How frequently, and for how long will formal early intervention family/child supports and
       services be provided?

    9. Where will family/child supports and services will be provided?




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Recommended Reading


Barrera, I., Corso, R., & Macpherson, D. (2003). Skilled dialogue: Strategies for
responding to cultural diversity in early childhood (pp.241-244). Baltimore, MD: Paul H.
Brookes Publishing Co. (link to http://www.brookespublishing.com/store/books/barrera-
6377/index.htm)
         Focused on cross-cultural interactions in early childhood, this book identifies
         specific questions and strategies that early intervention providers can ask to
         clarify common situations encountered in early childhood programs.
         Consideration of these questions can lead to respectful interactions with family
         members and colleagues from diverse cultures by increasing early intervention
         providers‟ awareness of another person‟s boundaries and by identifying
         information to help smooth out “cultural bumps.” The text includes numerous
         examples and strategies to use when interacting with families and/or colleagues,
         and discusses strategies for anchoring understanding of diversity and creating
         3rd space dialogue.


Dunst, C., Trivette, C., Humphries, T., Raab, M. & Roper, N. (2001). Contrasting
approaches to natural learning environment interventions. Infants and Young Children,
14(2), 48-63.
         A three dimensional model of natural environment interventions compares early
         childhood practices that are contextually vs. noncontextually based, adult or child
         directed, and early intervention provider vs. non early intervention provider
         implemented.


Hanft, B., Rush, D., & Shelden, M. (2004). Coaching families and colleagues in early
childhood. Baltimore, MD: Paul H. Brookes Publishing Co. (link to
http://www.brookespublishing.com/store/books/hanft-7225/index.htm)
         This is a practical guide that illustrates how coaching can help early intervention
         providers support families and share knowledge and experience with colleagues
         in partnerships which emphasize reflection and interpersonal communication.
         Five steps to coaching- initiation, observation, action, reflection, and evaluation-
         are discussed and illustrated with family/provider vignettes and reproducible
         forms.


Parlakian, R. (2001). The power of questions: Building quality relationships with
families. Washington, DC: Zero to Three.


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         This concise guide discusses how to use the three core principles of reflective
         supervision- reflection, collaboration and regularity- as the building blocks of
         strong parent/provider relationships. Ten specific guidelines are offered to build
         reflective relationships with parents and other caregivers while reinforcing their
         interactions with their children.


Edelman, L. (2000). Just being kids. Denver, CO: University of Colorado Health
Sciences Center. (video, distributed by Western Media Products, 800-232-8902) (link to
www.media-products.com)

         This video and facilitators guide highlights how early intervention was provided
         within natural environments (i.e., bathing, sliding and swinging at the playground,
         shopping at the grocery store, playing in the kitchen and living room of the family
         home) for six different children and their families. The facilitator‟s guide offers a
         wealth of questions to prompt small group discussion, as well as handouts and
         an extensive bibliography.


Orelena Hawks Puckett Institute in North Carolina. www.researchtopractices.org
         This website was established to create a bridge between research evidence and
         early childhood intervention practices. Information is posted specifically for
         parents, therapists, early childhood educators, and early interventionists, and
         includes:
         Bridges are practice-centered research syntheses of topics related to early
         childhood development.
         Bottomlines are one- to two-page summaries of the practice-based research
         syntheses. The summaries, written in simple language in a newspaper article
         format, are designed for practitioners and parents.
         Solutions Practice Guides offer downloadable brochures and information briefs
         for families that suggest activities to achieve the outcomes described in the
         Bridges research synthesis. Other formats include video and PowerPoint
         presentations in which the relationship between characteristics of the practice
         and the results that can be expected is carefully explained.




References

Barrera, I, & Corso, R. (2003). Skilled dialogue: Strategies for responding to cultural
diversity in early childhood. Baltimore, MD: Paul H. Brookes Publishing Co.

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Bellenca, J. (1995). Designing professional development for change. Arlington Heights,
Ill: Skylight Press.

Brookfield, S. (1993). Developing critical thinkers: Challenging adults to explore
alternative ways of thinking and acting. San Francisco: Jossey-Bass.

Bruder, M. & Brand, M. (1995). A comparison of two types of early intervention
environments serving toddler-age children with disabilities. Infant-Toddler Intervention,
5(3), 207-218.

Campbell, S. (1997). Therapy programs that last a lifetime. Physical and Occupational
Therapy in Pediatrics, 7(1), 1-15.

Dinnebeil, L., McInerney, W., Roth, J. & Ramaswamy, V. (2001). Itinerant early
childhood special education services: Service delivery in one state. Journal of Early
Intervention, 24(1), 35-44.

Donovan, S., Bransford, J., & Pellegrino, J. (Eds). (1999). How people learn: Bridging
research and practice. Washington, DC: National Academy Press, Committee on
Learning Research and Educational Practice.

Dunst, C., Bruder, M., Trivette, C., & McLean, M. (2001). Natural learning opportunities
for infants, toddlers and preschoolers. Young Exceptional Children, 4(3), 18-27.

Edelman, L. (2000). Just being kids. Denver, CO: University of Colorado Health
Sciences Center.(video).

Gallacher, K. (1996). Supervision, mentoring and coaching. In P. Winton, J. McCollum
and C. Catlett (Eds.), Reforming personnel preparation in early intervention (pp.191-
214). Baltimore, MD: Paul H. Brookes Publishing Co.

Haley, S., Baryza, M. (1990). A hierarchy of motor outcome assessment: Self-initiated
movements through adaptive motor function. Infants and Young Children, 3(2),1-14.

Hanft, B., & Feinberg, E. (1997). Toward a new paradigm for determining the frequency
and intensity of services in early intervention. Infants and Young Children, 10(1), 27-37.

Hanft, B., & Pilkington, K. (2000). Therapy in natural environments: The means or end
goal for early intervention? Infants and Young Children, 12(4), 1-13.

Hanft, B., Rush, D., & Shelden, M. (2004). Coaching families and colleagues in early
childhood. Baltimore, MD: Paul H. Brookes Publishing Co.

Haring, N., & Innocenti, M. (1989). Managing Learning Time: Structured learning during
unstructured times. In C. Tingey (Ed) Implementing Early Intervention. Baltimore; Paul
H. Brookes Publishing Co.

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Jezewski, M. & Sotnik, P. (2001). Culture brokering: Providing culturally competent
rehabilitation services to foreign-born persons. Retrieved from the World Wide Web 2-
25-04 at http://www.cirrie.buffalo.edu/cbrokering.html

Knowles, M. (1996). Adult learning. In Craig (Ed), Training and development: A guide to
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Lynch, E. & Hanson, M. (1992). Developing cross cultural competence. Baltimore, MD:
Paul H. Brookes Publishing Co.

McLean, L. & Woods Cripe, J. (1997). The effectiveness of early intervention for children
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intervention (pp 349-428). Baltimore: Paul H. Brookes.

McWilliam RA, Tocci L, Harbin G. (1995). Services are child-oriented and families like it
that way- but why? Chapel Hill, North Carolina: Early childhood Research Institute:
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Moore, J.R. (1988). Guidelines concerning adult learning. Journal of Staff Development,
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Odom, S. (2000). Preschool inclusion: What we know and where we go from here.
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Rainforth, B. & Roberts, P. (1996). Physical therapy. In R. McWilliams (Ed), Rethinking
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effective cross-border communication. Retrieved from the World Wide Web 2-24-04 at
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Schmidt, R. & Lee, T. (1999). Motor control and learning: A behavioral emphasis (3rd
edition). Champaign, IL: Human Kinetics.

Trivette, C., Dunst, C., & Deal, A. (1997). Resource-based approach to early
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Walker, M. (1991). Rehabilitation service delivery to individuals with disabilities…a
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Wells, S. & Black, R. (2000). Cultural competency for health professionals. Bethesda,
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Wolfe, B. & Snyder, P. (1997). Follow- up strategies: Ensuring that instruction makes a
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Wolery, M. & Odom, S. (2000). An administrator’s guide to preschool inclusion. Chapel
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