IFSP Tutorial Developing and Implementing an IFSP _Module 2_ by pengxuebo

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									                                    Early Childhood Tutorial
                                Developing & Implementing IFSPs

                     Session 2: Developing an IFSP with a Family


Outcome and Objectives

Outcome
Understand the purpose and scope of an IFSP as a vehicle for selecting family-desired
supports and services in natural environments


Objectives

        Discuss the evidence supporting community-based early intervention and the
         importance of providing family/child supports and services in natural environments

        Explain the variety of ways that formal and informal family/child supports and services
         can be offered

        Explain how the identification of a family’s priorities, concerns and resources provides
         the foundation for decision-making during the development of an IFSP

        Explain the purpose for developing a flexible IFSP with families that reflects their desired
         outcomes

        Identify the information which must be included on an IFSP, and how to facilitate
         discussion with families to ensure all IFSP components are addressed

        Identify at least 4 concerns families may voice during the development of an IFSP for
         their child

        Describe how to assist families to identify their desired outcomes

        Identify the components of a functional outcome, measurable criteria and effective
         strategies and illustrate with 3 examples

        Describe the factors to consider in determining the frequency and intensity of
         family/child supports and services

        Describe at least 4 decisions to make with family members while developing a flexible
         IFSP


Developing an IFSP with Families has four key activities for readers: essential content,
application activities, recommended reading and self assessment. The following chart gives an
overview of the session with suggested time allotments:

1    Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                                         Summary of Activities

                                       Activities                             Time
                                                                           allotment
       Essential Content about developing an IFSP with families         2 hours

       Application 2.1: Reviewing program practices re: IFSP            2 hours
       outcomes, strategies, criteria and supports/services
       Application 2.2 Sandi: Developing functional IFSP outcomes,      2 hour
       criteria and strategies
       Application 2.3 Jacob: Developing functional IFSP outcomes,      1 hour
       criteria and strategies
       Application 2.4 Manny: Developing functional IFSP                1 hour
       outcomes, criteria and strategies
       Application 2.5 Lurindell: Developing functional IFSP            1 hour
       outcomes, criteria and strategies
       Application 2.6 Addressing Family Concerns about                 2 hour
       Developing IFSPs
       Application 2.7 Evidence-based practice: Early intervention      2 hours
       in natural environments
       Recommended Reading                                              1-2 hours

       Self-Assessment Inventory: Developing IFSPs with families        1 hour




Guiding questions:

         1. What are our goals? Which aspects of family/community life do family
            members want to help their child participate in?

         2. How will we accomplish our goals? Which formal and informal supports and
            services can help family members achieve their desired outcomes for their
            child?



Why this topic was selected

Developing an IFSP with Families focuses on identifying, with families, the IFSP outcomes,
criteria, strategies, and supports/services that enhance a child’s participation within meaningful
contexts for each family. The session describes early intervention as the formal and informal
supports and services that will help each family implement the strategies necessary to reach

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Session 2 - Developing an IFSP with a family
their desired outcomes. This is the heart of the natural environment mandate in the Individuals
with Disabilities Education Act: to support families so that their young children with disabilities
participate in meaningful routines and activities, in and out of their home. (link to mod 3 session
3, pg. 3 informal and formal EI services)


         Insert tip box below: Maryland’s IFSP document has specific instructions on the back of
         each page for completing each section. A blank copy is available through one of the 24
         Local Infants and Toddlers Programs (link to
         http://www.cte.jhu.edu/dse_eis/directory1.cfm?DirID=2&location=2) or online. (TBD)


Developing an IFSP with Families draws on the planning discussion with families that guided
a child’s initial evaluation and assessment for eligibility for a Local Infants and Toddler’s
Program in Maryland. (link to mod 1 session 2 a purpose of planning) Information about a
family’s priorities, concerns and resources, together with the data and observations collected
during a child’s evaluation and assessment, lays the foundation for a discussion between family
members and early intervention providers about developing an Individualized Family Service
Plan (IFSP).


Specifically, Developing an IFSP with Families focuses on including families in making
decisions about four key components of an IFSP:

         1. functional outcomes for a child and/or family members;

         2. measurable criteria;

         3. collaborative strategies; and

         4. formal and informal family/child supports and services.


Functional outcomes are the cornerstone for providing early intervention supports and
services to families and children in natural environments. Functional outcomes specify where
each family “wants to go” and direct early intervention providers to focus their expertise on
ensuring that a child participates in specific contexts within family and community life.
Traditionally, IFSP outcomes have represented domain specific skills (e.g., Aman will push up
on hands and knees to crawl, or Gina will improve expressive language that require formal
services from a professional in a specific discipline. For example, a physical or occupational
therapist would typically work with Aman to help him learn to crawl, and a speech-pathologist or
special educator would help Gina learn to use signs to communicate in formal therapy or play
“sessions.”

Measurable criteria are indicators for families and early intervention providers to help them
recognize when identified functional outcomes have been achieved. Likewise, collaborative
strategies clarify how early intervention providers and family members will work together to
include children in family and community life. Thus, for Aman, rolling over is the way he will get
around his family’s home to play with his older brothers. For Gina, signs will be paired with


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Session 2 - Developing an IFSP with a family
initial sounds to help her express her desires for a drink of milk or more apple during mealtimes
with her family.


Essential Content: What early intervention providers and families
need to know about developing an IFSP

Developing an IFSP with a Family is part of the Early Childhood Tutorial about the IFSP
process developed by the Maryland State Department of Education for early intervention
providers, and any interested readers.

Other sessions available: (link to outcomes/objectives in Mod 1 and 2 for each session below)

The following topics are covered in Developing an IFSP with a family:

    a. Evidence for providing family/child supports and services in natural environments
    b. Overview of developing flexible IFSPs with families
    c. Concerns families may have while developing an IFSP
    d. IFSP discussions with families: Who, where, when, how and who
    e. Decisions to make with families about what to include on an IFSP
    f.   The role of service coordinators during development and implementation of an IFSP
    g. Functional outcomes: Guiding early intervention supports/services
    h. Assisting families to identify functional outcomes
    i.   Measurable criteria: How we know we have achieved outcomes achieved
    j.   Family-specific strategies identify how functional outcomes will be achieved
    k. Identifying early intervention supports and services


a. Evidence for providing family/child supports and services in
natural environments


         Insert tip box below: Evidence-based early childhood practices for parents, providers
         and researchers is posted online by The Research and Training Center on Early
         Childhood Development. (link to www.researchtopractice.info)

Evidence-based practices help early intervention providers to make sound decisions about how
to support families in achieving their desired outcomes for their children (Dunst, Trivette, &
Cutspec, 2002). Providing evidence-based practice is an expected responsibility in multiple
professions including early intervention, medicine, occupational and physical therapy, speech-
language pathology, nursing, education, and mental health. (link to Appendix A)


The following points summarize why it is important to provide family/child supports and services
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Session 2 - Developing an IFSP with a family
in natural environments.


   A child’s relationships with primary caregivers organize all his or her early
    development.

         “The idea is that we are born to form attachments, that our brains are physically wired to
         develop in tandem with another’s, through emotional communication, beginning before
         words are spoken.” (Schore, 2003, p.16)


    Insert tip box below: Click here for supporting references.(link to corresponding section in
        Appendix B)


    Young children need a relationship with at least one emotionally invested, predictable
    caregiver who is available to each child and understands how to provide meaningful
    stimulation through daily experiences. A strong, secure attachment to a nurturing caregiver
    also has a protective biological function, helping a young child learn from, and withstand,
    the ordinary stresses of daily life. Repeated, positive care-giving experiences make a
    decisive impact on a baby’s brain development across all areas of development.

    Extensive research in early child development and learning, reviewed in From
    neighborhoods to neurons: The science of early childhood development (link to
    www.nap.edu/execsumm/0309069882.html) emphasizes the:


         1. importance of early life experiences, as well as the inseparable and highly
            interactive influences of genetics and environment, on the development of the brain
            and the unfolding of human behavior;

         2. central role of early relationships as a source of either support/adaptation or
            risk/dysfunction for a child;

         3. powerful capabilities, complex emotions, and essential social skills that
            develop during a child’s earliest years of life; and

         4. capacity to increase the odds of favorable developmental outcomes for children
            through planned interventions. (National Research Council & Institute of Medicine,
            2000, p. 1).


   Children are active participants in their own development, based on their drive to
    explore and master their environment.

         “Given the drive of young children to master their world, most developmentalists agree
         that the full range of early childhood competencies can be achieved in typical, everyday
         environments….All forms of early childhood intervention are most effective when they
         counteract obstacles to growth and promote the expression of a child’s natural drive
         toward mastery.” (National Research Council, 2000, p.27)

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Session 2 - Developing an IFSP with a family
    Insert tip box below: Click here for supporting references. (link to corresponding section in
        Appendix B)


    Infants are aware of the effects of their own behaviors, and prefer consequences that they
    can control directly versus those that are uncontrollable. A young child’s ability to create his
    or her own knowledge depends on having an environment which provides opportunities for
    growth and supports individual interests. Learning is enhanced when children’s interests
    engage them in interactions that provide opportunities to practice existing skills and explore
    their environment. Finally, when early intervention is provided in a family’s environment
    rather than unfamiliar settings (e.g., clinics and intervention centers), many more
    opportunities are created for parents to interact effectively with their children at home.


   New motor and communication behaviors are learned and used when a child has
    repeated opportunities for practice in meaningful situations with generalization of
    skills across different settings.


    Insert tip box below: Click here for supporting references. (link to corresponding section in
        Appendix B)


    Motor behaviors must be retained and practiced in different contexts to be considered
    “learned” and used spontaneously in response to specific environmental demands. Even
    when children are taught specific motor or communication skills during traditional
    intervention sessions, they must then practice these skills over and over in familiar settings
    in order to use the skill competently.

         “A child who learns to walk between parallel bars, on a balance beam, or in a quiet
         therapy room, for example, must transfer or generalize to walking on a carpet at home
         or in a crowded hallway at school if walking is to be meaningful.” (McEwen & Shelden,
         1995, p.35)

    Principles of motor learning include promoting age-appropriate functional tasks, embedding
    movement within a physical and sociocultural environment, and fostering active exploration
    of the environment. Meaningful input across multiple domains of development, not just in
    motor or language areas, is also critical and encourages a young child’s learning. This
    learning typically occurs in the context of an ongoing care-giving relationship and
    dramatically improves a child’s memory of the action/event and provides a framework for
    updating it.


   The knowledge and resources of early childhood specialists can be shared with a
    child’s key caregivers through adult-adult relationships that support caregivers in
    their daily roles and responsibilities caring for their children.



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Session 2 - Developing an IFSP with a family
    Supporting and enhancing the knowledge/experience of those who spend the most time
    with very young children--- parents, brothers and sisters, friends, extended family, early care
    and education providers--- dramatically increases the impact of early intervention.
    Strategies implemented at home or child care by family members and other care-givers can
    lead to generalization of a child’s emerging skills in various family and community activities.
    Information embedded in an emotional context appears to stimulate neuronal circuitry more
    powerfully than information presented in isolation of a meaningful context.


    Insert tip box below: Click here for supporting references. (link to corresponding section in
        Appendix B)


    For very young children, relationships with key caregivers provide ongoing and numerous
    opportunities for learning within an emotional context. For example, a child who becomes
    interested in letters and words through daily reading with a parent and associates “the joy of
    being in her father’s lap, seeing beautiful pictures, and hearing a wonderful story” is more
    likely to understand the meaning of letters than a child who is taught to recite the letters of
    the alphabet by rote (National Research Council and Institute of Medicine, 2000, p.156).



b. Overview of developing IFSPs with families
Once a child’s eligibility for early intervention has been established by a Local Infants and
Toddlers Program in Maryland, an individualized family service plan (IFSP) is developed. (link to
mod 1` session 1 who is eligible?)

The following overview gives a summary of the critical steps in developing an IFSP with a
family.



                 1. Revisit a family’s priorities, concerns, and resources;

                 2. Review data collected during a child’s evaluation/assessment;

                 3. Identify functional outcomes with parents;

                 4. Select measurable criteria to define when an outcome has been
                    achieved;

                 5. Describe strategies for achieving each outcome;

                 6. Discuss which formal and informal supports/services can assist families
                    to achieve desired outcomes; and

                 7. Assess progress towards achieving family/child outcomes as well as
                    overall family satisfaction with their participation in early intervention,
                    once an IFSP is implemented.


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1. Revisit a family’s priorities, concerns, and resources. The conversation for selecting
    IFSP outcomes and family/child supports and services is guided by parents’ comments
    about family/child interests, resources, and priorities for the activities and routines in which
    they want their child to participate guide. This discussion should begin with a planning
    conversation with families in preparation for a child’s evaluation/assessment. (link to mod 1
    session 2 a purpose of planning)

         Insert resource box below: A routines-based interview can guide this discussion
         (McWilliam, 1992; in press). (link to
         www.vanderbiltchildrens.com/uploads/documents/cci_rbi__form_rev.pdf )


    Family/community activities and routines are the context for natural learning opportunities in
    which young children develop social competence, master their environment, and acquire
    information and experience. In preparation for developing an IFSP, families and early
    intervention providers discuss where a child and family spend their time, along with the
    activities they do in these settings, would like to do, or improve upon (Rosenketter &
    Squires, 2000).


2. Review data collected during a child’s evaluation/assessment with families. A
    comprehensive evaluation and assessment collects information from multiple sources about
    a child’s and family’s interests, strengths/resources and challenges/concerns. (link to
    essential content Mod 1 session 3) These sources include quantitative tests as appropriate,
    and qualitative methods such as natural observation of a child with family members in
    familiar situations. This data is helpful when determining how to enhance a child’s
    participation in specific family and community activity settings.


3. Identify functional outcomes with parents. Outcomes are the changes that families
    would like to see for their children or themselves as a result of their participation in early
    intervention. Functional outcomes, written in language understandable to each family,
    identify the desirable knowledge, skills and/or behavior that a child or family members will
    acquire to ensure a young child’s successful participation in daily life (Pretti-Frontczak &
    Bricker, 2000). (link to section g “functional outcomes” in this session)

    Functional outcomes promote three critical areas for a child’s participation in family and
    community life (McWilliams, 2002): social competence, mastery of the environment, and
    engagement for learning.

                                                               Examples

           Social                          understanding and expressing emotions
           competence                      forming friendships
                                           interacting with family members/peers
                                           becoming a member of a social group


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           Mastery of the                  caring for one’s self
           environment                     navigating spaces and places
                                           using tools, toys and objects purposefully in
                                            specific activity settings

           Engagement for                  focusing on information from one’s
           learning                         body/environment
                                           adapting to familiar and novel situations in
                                            specific activity settings




4. Select measurable criteria to define when an outcome has been achieved.
     Measurable criteria enable all team members to know when an outcome is achieved to the
     satisfaction of parents. Criteria that is measurable, i.e., can be seen or heard in a specific
     context, and specifies how frequently a family hopes a certain action or behavior will occur.
     (link to section h “measurable criteria in this session)


5. Describe collaborative strategies for achieving each outcome. Strategies clarify how
     intended outcomes will be achieved; not which early intervention services will be provided.
     Collaborative strategies build on a child’s and family’s interests and surroundings and
     involve routines/activities, materials/toys/pets, interactions, hobbies/leisure and one’s
     environment. (link to section i in this session) They identify how early intervention
     services/supports and other community resources will assist family members in reaching
     their intended outcomes. Talking about strategies with families provides an opportunity to
     think about the “places and spaces” where a child can practice and generalize skills. This
     conversation leads to the next step in developing an IFSP: identifying formal and informal
     services/supports.


         Insert tip box below: Family members and early intervention providers should discuss
         the variety of formal and informal supports and services that can be helpful to families
         and children in reaching desired outcomes (Trivette, Dunst & Deal, 1997). (link to Mod
         2 session 3 page 2 inf/formal services)


6. Discuss the formal and informal supports/services which can help families achieve
     their desired outcomes. Before identifying any formal early intervention services on the
     IFSP, it is critical to consider “Who has the expertise to support family members in
     achieving specified child and family outcomes?” Otherwise, the conversation is very likely
     to focus on how frequently therapy and special instruction should be provided (Hanft &
     Pilkington, 2001).


7.    Once an IFSP is implemented, periodically assess progress towards achieving
     family/child outcomes as well as overall family satisfaction with their participation in
     early intervention. Ongoing assessment of progress and family satisfaction can be
     initiated by prompting families to think about:
9    Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
         Insert tip box below: An annual meeting must be held to evaluate a family’s IFSP and a
         periodic IFSP review must be held every six months or sooner, if requested by a family.
         (Link to mod 2, session 1d)


            How much progress a child/family is making toward attaining their desired outcomes;

            Level of satisfaction with this progress, and their participation in a Local Infants and
             Toddlers Program; and

            Modifications, if any, to services and supports.



c. Concerns families may have while developing an IFSP

It is important to anticipate, and address as appropriate, concerns that family members may
have during the development of their IFSP. Many questions related to a child’s rate of
development and future independence cannot be answered completely during a child’s first few
years. 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.

When family concerns do arise, early intervention providers can:

     1. Encourage family members to talk about what is on their minds;

     2. Listen, before making suggestions, in order to understand and show respect for a
        family’s beliefs and values;

     3. Provide information, as appropriate, to address specific concerns;

     4. Review with families their informal support networks; and

     5. Offer to link families to support networks, such as parent-parent programs through a
        local infants and toddlers program or other organizations.


Some examples of concerns that may arise as parents think about desired outcomes for
themselves and their child:


About a child’s development….

         Will my child ever be able to …..?

         Why isn’t my child developing like other children?
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Session 2 - Developing an IFSP with a family
         I don’t know what my child can do.

         I’m not sure about my child’s diagnosis, so why do all this now?


About participating in early intervention…

         Will this help me/my family cope, learn what to do about……?

         What if all this doesn’t help my child to ….?

         I don’t know if I accept the results of my child’s evaluation/assessment.

         What assurance is there that this approach will make a difference?


About schedules, services and supports…

         I want more/less time/services for my child.

         There are too many /not enough people coming to my home.

         I/my partner work and aren’t home during the day.



d. Considerations for scheduling IFSP meetings with families: who,
   where, when, how and who

        Who participates in IFSP meetings? (link to Mod 2 session 1e)


     A flexible, individualized IFSP for each child/family should be developed by the people who
     really know a child and/or have spent some time evaluating and assessing a child’s
     strengths and needs.


                Participants                                       Description

              Family                  Parents/legal guardians (must attend)

                                      Other family members/friends, as requested by parents, if
                                      feasible

              Early                   Service coordinator/interim service coordinator must attend
              intervention
              providers               Qualified personnel (at least one) directly involved in a child’s
                                      evaluation/assessment (must attend) (link to note below)


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                                      Providers who will provide EI supports/services, as
                                      appropriate

              Community               Advocate, as requested by parent
              agencies/links,
              as appropriate          Representatives of community agencies and programs, as
                                      requested by parent.


         Note: If the early intervention provider(s) directly involved in conducting a child’s
         evaluation and assessment are unable to attend the IFSP meeting, he or she can
         participate in one of three ways: by a telephone conference call, having a
         knowledgeable authorized representative attend, or making pertinent records available
         for discussion. (link to Mod 2, session 1e)



    Where are IFSP meetings held?

     An IFSP meeting must be held in a setting that is convenient for the family. (link to mod 2
     session 1d, pg 8 how are meetings conducted). This includes a family’s home or another
     setting where they feel comfortable (e.g., relative’s home, meeting room at a public library
     or religious site).


    When are IFSP meetings held?

     The first meeting to develop an initial IFSP for a child eligible for a Local Infants and
     Toddlers Program must be conducted within an initial 45-day time period which starts with
     the initial referral from a parent or other source. The time of day for the IFSP meeting must
     be convenient for the family. (link to mod 2 session 1d)

     Arrangements for IFSP meetings, including the periodic and annual reviews, must be made
     with a family and other participants before the meeting to ensure that they will be able to
     attend.


    How will families be notified about IFSP meetings?

     Prior written notice must be provided to the parent(s) within a reasonable time, as
     determined or agreed to by the parent(s). The notice must be written in the native language
     of the family, or other mode of communication used by the family, unless clearly not feasible
     to do so. (link to mod 2 session n)




e. Decisions to make with families about what to include on an IFSP
The IFSP is intended to be a flexible document that identifies how early intervention providers
and community resources will support a family in their efforts to help their child learn from and

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participate in everyday activities. It is a family’s guide for reaching their intended outcomes,
rather than a lengthy treatment plan for early intervention providers with specific outcomes for
each discipline.

The IFSP includes family-selected outcomes for a child, and family members themselves, if
desired. Functional outcomes are the foundation for the entire IFSP, and describe a child’s
and/or family’s actions/interaction within a specific context or activity setting. After functional
outcomes are selected, criteria and strategies for achieving each outcome are discussed. Only
then can the discussion turn to selecting the formal and informal supports and services which
can help a family achieve their outcomes. This includes but is not limited to formal early
intervention services such as educators, therapists, counselors, nurses and social workers.
(link to Mod 3 session 3 pg 2)


The critical decisions to make with families when developing an IFSP are identified below.


  IFSP Decisions                              Mandatory Components of an IFSP
                                                 (link to mod 2 session 1c)

Why we are                   Outcomes identify what will happen for a child/family
providing EI

How we will know             Criteria, procedure and timelines to measure progress towards
we have achieved             achieving outcomes
outcomes

What is needed to            Methods/strategies
achieve IFSP                       .
outcomes

Who will provide             Formal services/supports from a Local Infants and Toddlers
family/child supports        Program, including service coordination and the name of the
and services                 service coordinator

                             Community linkages to related agencies providing formal
                             supports/services to children and families may be identified (e.g.,
                             health, transportation, housing and informal supports/services
                             such as child care, recreation events, and children’s programs)

Where family/child           Natural environment(s) where family/child supports and services
supports and                 will be provided (including a justification if any supports/services
services will be             cannot be provided in a natural environment)
provided

When, and for how            Frequency and intensity of family/child supports and services
long, family/child           (number of days or sessions, length of each session, group or
supports/services            individual basis) with initiation and projected duration dates
will be provided


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f. The role of service coordinators during development and
implementation of an IFSP

         Insert tip box below: Service coordinators and other early intervention providers must
         place families at the center of team decision making.

The intended outcome of effective service coordination is for families to understand the formal
and informal resources in their community so that they receive appropriate supports and
services to meet their child’s and family’s needs. Family members must also be supported in
their efforts to enhance their child’s health, development and participation in family and
community life. This includes successful transition to other community resources, as
appropriate, at age 3 years. (Research and Training Center on Service Coordination, 2002).

As identified in the Individuals with Disabilities Education Act, (link to Mod 2 session 1m) service
coordinators play a pivotal role in developing and implementing IFSPs with families by:

        Assisting parents of eligible children to gain access to the early intervention services
         and other services identified in their individualized family service plan;
        Coordinating early intervention and other services (such as medical services for other
         than diagnostic and evaluation purposes) that a child needs or receives;

        Facilitating the timely delivery of available services; and

        Continuously seeking the appropriate services and situations necessary to benefit
         the development of children participating in a Local Infants and Toddlers Program.



Responsibilities of service coordination



A service coordinator’s responsibilities include the following activities during first contacts,
developing an IFSP, and coordinating ongoing activities with families:



                                 First contacts with families

        Visit family informally to gather information and develop rapport.

        Obtain release of information to facilitate sharing of information and
         notify referral source that initial contact with the family has been made.

        Maintain communication with referral sources and other contacts,
         as requested by a family.


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Session 2 - Developing an IFSP with a family
        Plan with families for evaluation/assessment of their children.

         Assist families in identifying their priorities, resources and concerns.
         (Resource: Routines-based assessment planning checklist for service
         coordinators) (link to www.vanderbilt
         childrens.com/uploads/documents/ccd_rba.pdf)

                                      Developing an IFSP

        Facilitate and participate in the development of an initial IFSP.

        Coordinate the completion and dissemination of the initial IFSP
         document, following confidentiality and time frame guidelines.



                                        Ongoing activities

        Develop and maintain interagency contacts.

        Coordinate and monitor the delivery of services.

        Facilitate and participate in periodic review and annual evaluation of
         the IFSP.

        Inform families of the availability of advocacy services.

        Assist families to identify their priorities, resources, and concerns
         throughout the IFSP process.

        Facilitate communication between the family, early intervention
         providers and other formal and informal services/supports.

        Promote collaboration and problem solving among all team
         members.

        Maintain current information regarding services available in the
         community



         Adapted from the Nebraska Early Development Network, 2004. (link to
         http://www.answers4families.org/ifspweb/coordination.html)



Providing service coordination

While the IDEA requires that service coordination be provided as an active, ongoing process, it
does not specify how it should be implemented. Two primary models for providing service
coordination are used in Maryland:



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Session 2 - Developing an IFSP with a family
             1. Blended model of service coordination: the service coordinator is also a
                direct service provider for a family, and manages the responsibilities and
                activities as well as early intervention services.

             2. Dedicated model of service coordination: the service coordinator fulfills only
                the responsibilities and activities described above.




g. Functional outcomes: Guiding early intervention supports/services

         Insert tip box below: Functional outcomes should be meaningful, family-desired,
         specific and “do-able.”


Functional outcomes point to where a family “wants to go”. They provide direction for
collaboration between family members and early intervention providers about how to reach a
family’s desired outcomes. Identifying functional outcomes with families is the cornerstone for
developing the IFSP document since the outcomes specify what should happen for families and
children as a result of their participation in early intervention. Too often, IFSPs focus only on
child outcomes and do not address family supports from early intervention providers and other
community resources (Jung & Baird, 2003; Boone et al, 1998; McWilliam et al, 1998).

The following guidelines assist early intervention providers and family members during the
development of a family’s IFSP. Functional outcomes should be:


         1. meaningful:

         2. family-desired:

         3. specific; and

         4. do-able. (link to each section below)



1. Functional outcomes should be meaningful to families.

                  Insert reflection box here: Do outcomes promote a child’s participation in
                  situations, activities and routines meaningful to each family?


     Outcomes that are meaningful promote a child’s functioning in three key foundations of
     early development - social interaction, mastery of the environment and engagement in
     learning- in ways specific to each family/child (McWilliam, 2002; National Research Council,
     2000).



16   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
              Social interaction includes understanding & expressing emotions,
              forming friendships, interacting with family members/peers;

              Mastery over environment includes caring for one’s self, navigating
              spaces and places, using tools, toys and objects purposefully in
              specific activity settings;

              Engagement in learning includes acquiring and using information
              from body/environment in play and relationships, adapting to familiar
              and novel people/objects in specific situations, figuring out cause and
              effect.



     Examples of functional child outcomes

         Insert tip box below: Click here for examples of functional outcomes with guidelines for
         avoiding wording that is broad, negative and/or domain-specific. (link to Examples of
         functional outcomes at end of this session).


     The three foundations of early development- social interaction, mastery over environment
     and engagement in learning- cover the domain specific skills that have traditionally been
     identified as child outcomes on IFSPs. Traditional child outcomes typically focus on isolated
     motor, language, social/emotional, cognition, and self-help skills, and often lose sight of the
     family/community context in which a specific behavior or skill will be used. Functional
     outcomes that are meaningful to families include a real life context i.e., how and/or where
     a child or parent will use an identified action or interaction (Rosenketter, & Squires, 2000).



                          Functional outcomes                        Traditional outcomes
               (what child and/or family will do in a specific       (domain specific skills)
                                 context)

            Neena will eat and drink by mouth during               Neena will improve her
            family outings.                                        eating skills.
                   (For a child whose feeding tube keeps
                   the family from going out to eat
                   together)

            Tommy will tell Mom what he wants to eat               Tommy will improve his
            and play with so that both are more relaxed            expressive language skills;
            with each other.                                       or Tommy will say 25
                                                                   words.
                      (For a child who whines and cries,
                      creating much stress for his mother)

            Jermaine will walk on his own during after             Jermaine will develop motor
            dinner walks with his family.                          skills at the 12-14 month

17   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                                                                   level; or Jermaine will
                      (For a child who has increased muscle        decrease muscle tone in his
                      tone which interferes with taking family     legs.
                      walks)



     Examples of functional outcomes for families


           Paula and Pete will find an appropriate wheelchair for Megan and feel
            comfortable using it during family outings.

                  Megan gets around her home by rolling over and crawling, but has to be carried
                  on family outings. Pete and Paula are interested in using a wheelchair so they
                  can all go out together.

           Sylvia will take Paolo to the park and shopping, by herself.

                  Sylvia has a significant visual impairment and wants to “shine” as a parent and
                  take her son to the library, a park or the mall by herself.



2. Functional outcomes are desired by a family.

         Insert reflection box below: Are outcomes, identified by each family, written in language
         understood by family members?

      IFSP outcomes should be identified by a family, and written in language that reflects a
     family's understanding about “where we are going.” Functional outcomes reflect how
     family/child knowledge, skills, actions will help a child participate successfully in
     family/community life. After prompting family members to talk about how they would like
     their child to participate in daily activities, early intervention providers can assist families to
     “wordsmith” their desires as IFSP outcomes. Use words that a family might say, rather than
     the professional jargon understood by early intervention providers (Nebraska Department of
     Education, Early Development Network, 2004; Rosenkoetter & Squires, 2000).


         Insert reflection box here: Mayra’s story illustrates how Jana, a service coordinator,
         prompts a mother to think about what she wants for her son. (link to Mayra’s story at
         end of session 2)

     Using words that a family understands, and uses themselves, is not the same as writing
     down word-for-word what a parent says as an IFSP outcome without first trying to
     understand what parents want for their child. For example, parents often identify a very
     broad outcome for their child, e.g., to “walk” and/or “talk.” It is helpful to clarify what walking
     or talking would look like in the next four to six months, and how this could help a child
     participate to a greater extent in family/community life before crafting an IFSP outcome.


18   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
3. Functional outcomes are specific.

         Insert reflection box here: Do outcomes identify specific knowledge, skills and/or
         actions for a child and/or family members that will promote meaningful participation in
         daily life?


     Functional outcomes identify specific behavior and/or knowledge that support a child’s and
     family’s participation in family/community life. Non-specific outcomes are very broad and
     often use words such as improve, increase, change, decrease etc. (e.g., Mina will improve
     her fine motor skills; Sara will decrease aggressive behavior). Identifying positive and
     specific actions and skills is one of the key factors in writing family-centered IFSPs
     (McWilliam, Ferguson, Harbin, Porter, Munn & Vandiviere, 1998).


     Examples of specific family outcomes:


                 Charlotte and Bruce will know how well Sonya hears people and sounds.

                 Darla will be cared for competently in their church nursery while Denise attends
                  services.

     Examples of specific child outcomes:

                 Mina will play with small toys and feed herself little bites of finger food.

                 Sara will play with other children on equipment at her local playground.

                 Chantell will let her family know what she wants and answer simple questions,
                  using words and short phrases.



4. “Do-able”:

         Insert reflection box here: Can each outcome reasonably be achieved within 4-6
         months?

     The “do-able” guideline for a functional outcome considers whether or not an action,
     knowledge or skill can happen within 4-6 months, given the child’s expected rate of
     progress, family routines and current responsibilities and commitments (Rosenkoetter &
     Squires, 2000). Parents, understandably, often think of things they want for their children
     that will be achieved in the distant future. It is important for early intervention providers to
     acknowledge that they accept a family’s long-range goal as a guide for their supports and
     services over the next 4-6 months. For example, in Mayra’s story, the service coordinator
     with Mayra that it was very important for her son to understand language like his brothers

19   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
     did before prompting the mother to be more specific. Link to Mayra’s story at the end of
     this session

     Sometimes a parent insists on an outcome that will probably be achieved in more than a
     year (e.g., Darla will walk by herself). In order to demonstrate support for the family’s
     desire, use the parent’s preferred wording in the outcome statement. Then, talk with the
     family about an intermediate step that is achievable in 4-6 months, and record that in the
     criteria section of the IFSP (e.g., Darla will hold on to furniture or another person to take at
     least 5 steps, 3x per day).




h. Assisting families to select functional outcomes

Outcomes identify the aspects of family and community life that parents would like to see their
child participate in. Outcomes are “owned” by a family and “adopted” by early intervention
providers who will provide supports and services to help families achieve their outcomes. This
does not mean, however, that parents have their desired outcomes on the “tips of their tongue.”

Ask parents where and how they want a child to participate in family and community life, rather
than what they want their child to do, or learn next. This helps define a meaningful context for
prompting a child’s desired behavior and interactions. Active exploration within multiple contexts,
supported by key caregivers, is critical to a child’s early development. (link to Appendix B this
session)

         Insert tip box below: A Routines-Based Interview (McWilliams) helps focus on functional
         outcomes versus developmental delays or deficits. (link to recommended reading)

Exploring a child’s and family’s positive interactions and interests also helps parents think about
outcomes that will be meaningful to them (McWilliams, 2005; Dunst, Hamby, Trivette, Raab, &
Bruder, 2000). Family interests and routines (e.g., gardening, cooking, raising pets/animals,
playing musical instruments, visiting friends and family) provide a context for young children.
Child and family interests also provide direction for selecting individualized IFSP strategies in
support of family-desired outcomes. In Mayra’s story, for example, Pedro’s interest in playing with
other children in his nursery school suggests key strategies for prompting his receptive language,
as identified by his mother, Mayra. (link to Mayra’s story at end of this session)

In addition to exploring family/child interests, prompt family members to talk about the actions,
places and routines they would like to see their child be part of. Prompts that invite families to
think about their interactions and interests include:


                   Child’s interests                               Family’s interests

      My child likes it when…                           Our family enjoys…

      My child gets excited about….                     When we have time we like to…

20   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
      My child likes to do…                             Places we often go….

      Ways my child shows me she/he is                  People we like to spend time with…
      interested in something…
                                                        Things we do at home for fun…
      My child pays particular attention to…
                                                        Things we like to do in our
      My child’s favorite place...                      community…

      My child’s favorite people….



i. Measurable criteria: How we know we have achieved outcomes

Maryland’s IFSP document has a section for recording family-selected outcomes and another
section for specifying the criteria for determining when an outcome has been achieved. Criteria
should clearly state expectations for achieving an outcome, using family-friendly language.
Family members should be able to track progress comfortably.

(Insert reflection symbol here) The following guidelines can help family members and early
intervention providers select measurable criteria so that all team members will know when an
outcome has been accomplished:


     WHAT: Can specific actions and/or interactions by a child/family be seen and/or heard by
     any team member?

     WHERE: What is the context/activity setting in which the identified action/interaction will be
     seen or heard?

     HOW OFTEN: Is a realistic frequency identified for reviewing an action/interaction?




1. Measurable criteria answers WHAT to look for

     Measurable criteria track an action or behavior that can be seen or heard reliably by others.
     No interpretation (or guessing) is needed to figure out if an outcome has been achieved.


                               Outcomes                            Examples of criteria that can be
                                                                          seen or heard

                Hang will communicate with                   Hang will say “m,” “p,” and “t” at the
                family members by imitating                  beginning/end of simple words, with
                sounds and words and speaking                family members in and out of her
                simple words spontaneously.                  home, at least 3x/day.

21   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                Paula and Pete will find an                  Pete and Paula will take Megan out in
                appropriate wheelchair for Megan             her wheelchair to the park or
                and feel comfortable using it                shopping, at least 2x/week.
                during family outings.

                Neena will eat and drink by                  Neena will drink a minimum of 4 oz
                mouth during family outings.                 of fluids from a cup and eat 3
                                                             spoonfuls of food during family
                                                             outings, a minimum of 2x/week...




2. Measurable criteria identify a context for WHERE an action/interaction will take place


     Criteria should specify where and when to observe a behavior/action, or set a date when an
     action will be completed. For example,

                               Outcomes                       Examples of criteria that identify a
                                                                  context for an outcome

                Charlotte and Bruce will know                Parents will have written results from
                how well Sonya hears people and              an audiological screening for Sara by
                sounds.                                      March 1, 2004

                Jermaine will walk on his own                Jermaine will keep his hands open for
                with his family on their after               20 minutes when walking with his
                dinner walks.                                parents outside their home, 3 times
                                                             per week.



             Considering why a family selects an outcome can point the way to identifying criteria
             that is measurable and simple to track. For example, Jermaine has increased
             muscle tone which makes it difficult for him to walk independently with his family on
             their daily after dinner walks. His parents felt that one measure of relaxed muscles
             that would have great meaning for their family was if Jermaine could begin the family
             walk on his own, like his twin brother. If after, 20 minutes, he grew tired, he could
             then sit on his father’s shoulders, or in a stroller.



3. Measurable criteria identify HOW OFTEN an action/interaction will occur




22   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
         Insert resource box here: Click her for examples of measurable criteria (link to
         Measurable criteria at end of this session) with guidelines for avoiding wording that is
         unspecified or too broad.


     Criteria for functional outcomes should always help parents, other caregivers and early
     intervention providers easily see or hear that an outcome has been achieved. Tracking
     progress is difficult when criteria are broad, e.g., Jermaine will keep his hands open 75% of
     the time. Criteria stated in terms of “percentage of time” a child will demonstrate an
     action/interaction is open to misinterpretation because it is not context-based. Will
     Jermaine keep his hands open 75% of the time he is awake, at rest, during play or while
     walking with his family?

     Measurable criteria should be specific and simple so that family members always know what
     to look for. Specific criteria to accompany Jermaine’s outcome to walk on his own with his
     family could be written as:

                  Jermaine will keep his hands open for 20 minutes when walking with his parents
                  in and outside their home, 3 times per week.




j. Effective strategies identify how functional outcomes will be
achieved

         Insert tip box below: Keep informed about evidence-based practices in early intervention
         when selecting both initial and continuing strategies for achieving family-selected
         outcomes. (link to Appendix B in this section )


Strategies indicate how specific child and family outcomes desired by families can be achieved.
The guidelines below can assist family members and early intervention providers in choosing
effective strategies when an IFSP is initially developed, and later, as ongoing progress is
reviewed with a family. Each strategy recorded on an IFSP should address one or more of
the following guidelines:

                  1. Individualization, based on family/child interests;

                  2. Context, building on familiar people, places and routines;

                  3. Mastery, of actions/interactions across settings; and

                  4. Collaboration, between families, early intervention and community providers.


1. Effective strategies are individualized for each family.


23   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
         Insert reflection box below: Do IFSP strategies build on child and family interests?

     Children are active participants in their own development, based on their drive to explore
     and master their environment. Interest-based learning has positive benefits and is an
     important factor contributing to a child’s learning and development (Dunst, Hamby, Trivette,
     Raab & Bruder, 2000; Bruder, Trivette, Raab & McLean, 2001; Nelson, 1999). Strategies
     should build on family/child interests and activities such as:

            routines/special events (e.g., taking a bath, going to a family celebration)

            objects/toys/pets (e.g. feeding a family pet,

            interactions (e.g., visiting grandma, playing with brother, answering the phone)

            hobbies/fun/leisure (e.g., playing/listening to music, squirting hose at one another)

            environment (e.g. taking a walk, playing in back yard, planting flowers)


     Examples of strategies that build on family/child interests:


      Outcome and Criteria                 Strategies that are individualized for a family

      Sylvia will take Paolo to           Sylvia will review the mobility training she received at
      the park and shopping,               the MD School for the Blind
      by herself.
                                          I/T provider (or linkage service) will accompany Sylvia
      Criteria:                            and Paola to community activities such as the library
      Sylvia will take one trip
      with Paola to either the            Sylvia will identify available transportation and ask
      library, mall or other               family and other community supports to accompany
      community activity by                her on a trial run
      herself within the next 4
      months

      Neena will eat and drink            Family and I/T staff will consult with GI doctor about
      by mouth during family               realistic timetable and plan for Neena to drink and eat
      outings.
                                          I/T providers will share information about oral-motor
      Criteria:                            development with parents and suggest enjoyable
      Neena will drink a                   hand/mouth games to play with Neena
      minimum of 4 oz of
      fluids from a cup and               Family and I/T staff work together to introduce Neena
      eat 3 spoonfuls of food              to new foods and liquids and track her likes and
      during family outings,               dislikes
      2x/week
                                          I/T staff will accompany family on outings to adapt
                                           eating suggestions


24   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                                          I/T staff will link family to other families who have a
                                           child with a feeding tube to see how they cope and
                                           get around in the community


2. Effective strategies build on familiar contexts.

         Insert reflection box here: Do IFSP strategies build on familiar places, people and
         routines?

     Strategies build on familiar situations and people for each family. An effective strategy
     should become part of a child’s and family’s every day life. Strategies that are used only
     during provider-directed sessions isolate a child and miss the numerous opportunities for
     meaningful interactions with caregivers in environments that are most likely to promote
     mastery (Dunst, Trivette, Humphries, Raab & Roper, 2001). (link to section a this session)


     Examples of strategies that focus on a familiar context:

                 While reading to Sabrina after her bath, emphasize beginning and ending
                  sounds of words (versus producing specific sounds “on command” from an early
                  intervention provider).

                 I/T staff will show Tallie and her parents how to walk on different surfaces in
                  and out of her home using her walker (versus practicing walking in a therapy
                  session once per week).



3. Effective strategies emphasize mastery of actions/interactions across settings.


         Insert reflection box here: Do IFSP strategies ensure generalization of a child’s
         actions/interactions across settings and tasks?


     Much evidence has accumulated about how very young children learn. (link to section a in
     this session). Children are active participants in their own development, due to their drive to
     explore and master their environment. Even infants are aware of the effects of their own
     behaviors, and prefer consequences that they can control directly versus those that are
     uncontrollable. Expanding motor and communication behaviors depends on repetition and
     practice in meaningful situations with generalization across different settings.


     Examples of strategies that encourage mastery of actions/interactions:


            Mom will show grandparents how to relax Hang before her bottle (for a premature
             infant who is cared for by her grandmother while her mother works).

25   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
            I/T staff and Dad will look at backpacks with enough support for Dad to take Jamie
             on family hikes (for a toddler who enjoys the outdoors and is just learning to sit up).

            I/T staff will help parents adapt their bedtime/nap routine so Luci can sleep in
             places other than her crib (so family can go visiting with Luci who is easily
             overstimulated in new situations)

            LITP will help Veronique (childcare provider) find toys/activities that encourage Kata
             to play quietly beside other children (for a child who is both social and very
             distractible).



4. Effective strategies promote collaboration among families and providers

     Insert reflection box here: Do IFSP strategies specify “who will do what”? Click here for
     examples of effective strategies. (link to Examples of Effective Strategies, end of this
     session)

     Shared implementation of strategies by family members, child care and early intervention
     providers reinforces the evidence-based practice of supporting key adults to promote child
     learning and development in family and community settings. (link to section A this session)
     Discussing “who will do what” provides another opportunity to talk with families about the
     early intervention model of supports and services in natural environments.


     Examples of strategies that specify “who will do what”:


         I/T staff will model rate of speech for family members when talking to Kyle.

         Mother will call Dr. – to ask about lactose intolerant formula

         I/T staff and mother will explore community networks for child care close to mother’s
         job

         Family and child care provider will hold Nooni so she can see what is going on and
         who is talking.




k. Identifying early intervention supports and services

         Insert resource box here: Click here for examples of early intervention supports/services
         for achieving child and family outcomes. (link to “examples of formal and informal
         supports/services”, at end of this session)


26   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
The IFSP is intended to briefly outline which early intervention services will be provided, how a
service coordinator can initiate those services, and what actions will be taken by parents. (link
to mod 2 session 1a (note 4 in sec. 303.344 content of IFSP) After family/child outcomes,
criteria and strategies are identified, the IFSP team can then consider:

             1. Who will provide family/child supports and services;

             2. When, and for how long, family/child supports and services will be provided; and

             3. Where family/child supports and services will be provided.



1. WHO will provide family/child supports and services?


         Insert resource box below: Implementing an IFSP with a family focuses on the issues to
         consider when providing formal and informal supports/services (link to essential content
         mod 2 session 3)

There are a variety of professional services and community resources that can assist families
and children in reaching their desired IFSP outcomes (Trivette, Dunst & Deal, 1997):

         Formal supports/services include early intervention services in a local Infants and
         Toddlers Program funded by the IDEA, as well as from other departments, organizations
         or programs serving children and families such as parent education classes in a public
         school or social service agency, health and specialized medical services, or housing
         options for homeless families.

         Informal supports/resources include child care centers, toddler programs in libraries,
         community service clubs, recreation and sports programs, education programs in parks,
         nature centers and museums.


If formal supports/services from a local Infants and Toddlers Program are identified by an IFSP
team, the IDEA requires that the specific early intervention services necessary to meet the
unique needs of the child and family be identified on their IFSP. (link to mod 2 session 1c)
The next consideration is for the IFSP team to decide:

         Who has the expertise to support a family to reach their desired child/family
         outcomes?

         “Expertise” refers to the knowledge and experience that any team member, including
         family members, can contribute. The IFSP team discusses which early intervention
         provider(s) has the specific knowledge and experience to complement the knowledge
         and experience of family members so that desired child/family outcomes can be
         achieved.


27   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
It is critical to review all the outcomes and strategies identified by an IFSP team before talking
about if, and how, formal early intervention supports/services are needed. The goal is not to
assign a different discipline to each outcome, but to consider:


                 What skills/experience are needed to implement the strategies and supports to
                  reach each outcome; and

                 Which family members, early intervention provider(s) and/or community
                  resources will be most effective implementing these supports and strategies to
                  promote a child’s participation in family and community life?




2. WHEN, and HOW LONG, family/child supports and services will be provided.

     Insert tip box below: The IDEA requires that the frequency, intensity and method of delivery
     for specific early intervention services be identified on an IFSP, with projected dates for
     initiation of services and their anticipated duration. (link to mod 2 session 1c)


In selecting the frequency, intensity and method of delivery of early intervention
supports/services, the primary consideration for an IFSP team is:

         How much support/service is needed to assist family members in reaching their
         desired outcomes?

         To answer this question, the IFSP team should think about:

                 Prioritizing family/child outcomes, especially if a family feels that focusing on
                  one or two outcomes more intensively for an agreed upon period of time would
                  help them manage competing family, personal and work responsibilities. For
                  example, some families may prefer to prioritize outcomes to focus on a child’s
                  feeding, sleep or behavior issues since they often affect the daily rhythms of the
                  entire family.

                 the team approach they use for providing early intervention
                  supports/services. Three approaches to teaming- coaching, transdisciplinary
                  and collaborative consultation- emphasize collaboration among team members
                  to achieve a family’s IFSP outcomes. For example, one primary service provider
                  can often support a family in implementing IFSP strategies with ongoing
                  coaching/consultation from colleagues. Back-up support should come from the
                  colleague(s) who have specialized knowledge, skills and experiences that will
                  assist the primary provider and family in reaching desired outcomes. (link to
                  mod 2 session 3 pg.10 team models)




28   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
3. WHERE family/child supports and services will be provided



         Insert tip box below: The IDEA requires that the natural environments in which early
         intervention supports/services will be provided must be identified on an IFSP (link to
         mod 2 session 1k)


In deciding where early intervention supports/services will be provided, the primary
consideration is:

         What functional outcomes have been selected by a family, and in what context
         will they be demonstrated?

         Functional outcomes identify the desirable knowledge, skills and/or behavior that a child
         or family members will acquire to participate successfully in daily life. (link to section g
         functional outcomes in this module) The “context” specifies where the knowledge, skills
         or behavior will occur e.g., in selected routines, activity settings, spaces and places that
         a child and family spend their time, and/or would like to participate in.

         These contexts, identified by families, are the natural environments where early
         intervention supports and services enable a child to use and master emerging skills.
         Obvious natural environments are a child’s home and/or child care setting; others
         include the neighborhood/community spaces and places where families with very young
         children spend their time participating in activities and interactions with friends,
         neighbors and other families. (mod 2 session 3a natural environments and activity
         settings)


         Insert tip box below: If an IFSP team decides that early intervention services can only be
         provided outside a child’s natural environments, very careful consideration should be
         given to how and when mastery of the child’s emerging skills in familiar situations will be
         prompted.


The IDEA also requires that an IFSP include justification of the extent, if any, to which early
intervention supports/services will not be provided in a natural environment. (link to mod 2
session 1c) The intent of the natural environment mandate is to focus the efforts of early
intervention providers on ensuring that young children master and use specific skills and
interactions so that they and their family can participate in meaningful situations and activity
settings that typically developing children/families engage in. Locations which are not
considered natural environments for very young children include hospitals, clinics, private
offices and settings/activities in which only children with disabilities attend.




29   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                Application 2.1 Reviewing program practices:
          IFSP outcomes, strategies, criteria and supports/services


Review how you and your colleagues developed IFSPs with two families recently. Use the Self-
Assessment Inventory: Developing IFSPs with Families in this session to guide your
reflection/discussion. (Link to inventory at end of this session) If you are not involved in IFSP
discussions with a family, consider interviewing family members or early intervention providers
who have participated in them.


After completing the Self-Assessment Inventory, reflect (preferably with colleagues and
families) on the following:


     1. How do I/we identify IFSP outcomes, criteria, strategies and family/child
        supports/services with families?


     2. How do I/we use information from our initial planning conversation with families (link to
        Mod 1 session 2a) and data from a child’s evaluation and assessment (collected using
        multiple methods link to Mod 1 session 3d key components/methods) ) to select
        outcomes, criteria, strategies and supports/services?


     3. Do I/we describe and implement our process for developing IFSPs with families
        consistently throughout all regions of our Infants and Toddlers Program?


     4. How do I/we help families engage in developing IFSPs that are meaningful for their
        family? How do I/we support families in making decisions related to where and how
        they want a child to participate in family and community life, and how to accomplish this?


     5. Do key community partners and referral sources understand how I/we develop IFSPs
        with families?


     6. Do I/we need continuing education about developing IFSPs with families? If so, what
        topics would be helpful to focus on?




30   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                              Application 2.2
      Sandi: Developing functional outcomes, measurable criteria and
                         family-specific strategies


         Insert reflection box below: Compare your ideas for functional outcomes, measurable
         criteria and family-specific strategies with suggestions for Sandi and her family. (link to
         examples of … for Sandi and her family on next page)


Discuss this vignette with colleagues and family advocates. Review the examples of traditional
IFSP outcomes, criteria and strategies for Sandi and her family. Consider how your team could
collaborate with Sandi’s family to identify:


                 functional outcomes; (link to section g this session)

                 measurable criteria; (link to section i this session)

                 family-specific strategies; (link to section j this session)



     Information about Sandi and her family: Sandi is 19 months old and is just starting to
     cruise around holding on to furniture and loves going outside in her stroller for walks. She
     is not very interested in playing with small toys or feeding herself but she does like to eat
     when someone feeds her. Sandi goes to family child care each day while her parents work.
     Her parents would like her to feed herself.


     Example              Outcomes                      Criteria                 Strategies

Traditional         Sandi will improve          Sandi will eat       Teacher will work with
IFSP                her fine motor skills       independently at     child/family to suggest
                                                least 80% of the     activities for carryover in
                                                time                 the home


Suggestions
for functional
outcome,
measurable
criteria and
family-specific
strategies




31   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
        Examples of functional outcomes, measurable criteria and family-specific
                           strategies for Sandi and her family



     Information about Sandi and her family: Sandi is 19 months old and is just starting to
     cruise around holding on to furniture and loves going outside in her stroller for walks. She
     is not very interested in playing with small toys or feeding herself but she does like to eat
     when someone feeds her. Sandi goes to family child care each day while her parents work .
     Her parents would like her to feed herself.




         IFSP                 Outcomes                     Criteria             Strategies
       Examples

     Traditional         Sandi will improve         Sandi will eat       Teacher will work with
     IFSP                her fine motor             independently at     child/family to suggest
                         skills                     least 80% of the     activities for carryover
                                                    time                 in the home

     Collaborative       Sandi will feed            Sandi will feed      Mom and EI Provider
     IFSP                herself, using her         herself at least 6   will review Sandi’s
                         hands to finger            mouthfuls at each    favorite foods,
                         feed and hold a            meal                 various baby utensils
                         spoon                                           and how to make
                                                                         eating enjoyable for
                                                                         Sandi

                                                                         Mom and EI Provider
                                                                         will explore with child
                                                                         care provider how to
                                                                         help Sandi feed
                                                                         herself




         Insert resource box here: Examples of formal and informal supports and services to
         guide families in achieving their outcomes are discussed in Implementing an IFSP with a
         family (link to essential content of session 3)




32   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                             Application 2.3
     Jacob: Developing functional outcomes, measurable criteria and
                        family-specific strategies


         Insert reflection box below: Compare your ideas for functional outcomes, measurable
         criteria and family-specific strategies with suggestions for Jacob and his family. (link to
         examples of … for Jacob and his family on next page)


Discuss this vignette with colleagues and family advocates. Review the examples of traditional
IFSP outcomes, criteria and strategies for Jacob and his family. Consider how your team could
collaborate with Jacob’s family to identify:


                  functional outcomes; (link to section g this session)

                  measurable criteria; (link to section i this session)

                  family-specific strategies; (link to section j this session)



       Information about Jacob and his family: Jacob is 22 months old and spends his day at
       home with his mother and 4 year old sister. He likes to play with toy trains and anything
       that his older sister is doing (much to her annoyance). Jacob wears a hearing aide and
       has global delays due to his prematurity. His family really would like him to say what he
       wants rather than grunting and pointing.


     IFSP Examples             Outcomes                    Criteria               Strategies

     Traditional          Jacob will talk           Therapist checklist   Language stimulation
                          using simple                                    activities
                          words

     Suggestions for
     functional
     outcome,
     measurable
     criteria and
     family-specific
     strategies




33   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
        Examples of functional outcomes, measurable criteria and family-specific
                           strategies for Jacob and his family


      Information about Jacob and his family: Jacob is 22 months old and spends his
      day at home with his mother and 4 year old sister. He likes to play with toy trains and
      anything that his older sister is doing (much to her annoyance). Jacob wears a hearing
      aide and has global delays due to his prematurity. His family really would like him to say
      what he wants rather than grunting and pointing.



          IFSP                 Outcomes                   Criteria             Strategies
        Examples

     Traditional           Jacob will use           Therapist          Language stimulation
                           fluent speech            checklist          activities


     Collaborative         Jacob will               Jacob will make    Family will serve and play
     IFSP                  speak clearly to         choices using at   with Jacob’s favorite
                           tell parents             least 8 words      foods and toys
                           what he wants            clearly during
                           during meals             meals, snacks      EI provider will model how
                           and while                and play each      to say words slowly and
                           playing                  day                clearly when talking to
                                                                       Jacob

                                                                       Mom and EI provider will
                                                                       identify a list of simple
                                                                       words for Jacob to say
                                                                       during meals/snack/play

                                                                       Mom and EI provider will
                                                                       explore play activities with
                                                                       Jacob and his sister using
                                                                       food (cooking, loading
                                                                       food on toy trains etc)



         Insert resource box here: Examples of formal and informal supports and services to
         guide families in achieving their outcomes are discussed in Implementing an IFSP with a
         family (link to essential content of session 3)




34   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                            Application 2.4
     Manny: Developing functional outcomes, measurable criteria and
                       family-specific strategies


         Insert reflection box below: Compare your ideas for functional outcomes, measurable
         criteria and family-specific strategies with suggestions for Manny and his family. (link to
         examples of … for Manny and his family on next page)


Discuss this vignette with colleagues and family advocates. Review the examples of traditional
IFSP outcomes, criteria and strategies for Jacob and his family. Consider how your team could
collaborate with Manny’s family to identify:

                  functional outcomes; (link to section g this session)

                  measurable criteria; (link to section i this session)

                  family-specific strategies; (link to section j this session)



        Information about Manny and his family: Manny is 12 months old and wants to be
        carried everywhere, even though he can stand up by holding on to someone or the
        furniture. Manny’s family lives by the Chesapeake Bay and his dad owns his own shrimp
        boat. Manny has two older sisters who are devoted to helping to take care of him. His
        family looks forward to the time he can stand up and walk by himself.


         IFSP                   Outcomes                       Criteria           Strategies
       Examples

     Traditional          Parent would like            Manny will pull to   PT once per week
                          Manny to do more             stand using a ½
                          pull to stand with           kneel position, 2x
                          weight bearing and           daily
                          cruise on furniture

     Suggestions
     for functional
     outcome,
     measurable
     criteria and
     family-specific
     strategies




35   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
        Examples of functional outcomes, measurable criteria and family-specific
                          strategies for Manny and his family


        Information about Manny and his family: Manny is 12 months old and wants to be
        carried everywhere, even though he can stand up by hanging on to someone or the
        furniture. Manny’s family lives by the Chesapeake Bay and his dad owns his own shrimp
        boat. Manny has two older sisters who are devoted to helping to take care of him. His
        family looks forward to the time he can stand up and walk by himself.


             IFSP                 Outcomes                  Criteria                Strategies
           Examples

        Traditional           Parent would            Manny will pull to   PT once per week
                              like Manny to do        stand using a ½
                              more pull to            kneel position, 2x
                              stand with              daily
                              weight bearing
                              and cruise on
                              furniture

        Collaborative         Manny will play         Manny will use       Family will put favorite toys
        IFSP                  with his                environmental        on sofa/chairs/shelf for
                              favorite toys           supports as          Manny to reach for and
                              while standing          needed to stand
                              and moving              and move             Manny will dance & sway to
                              around his              around to play       music holding his sisters’
                              home and                at home & one        hands
                              community               community
                                                      setting within       EI Provider will model
                                                      (give date           physical prompts & supports
                                                      within 4-6           to encourage Manny to
                                                      months)              move and explore his
                                                                           surroundings

                                                                           Mom and EI provider will
                                                                           visit community settings
                                                                           (e.g., park, beach, fishing
                                                                           pier, family boat) with Manny
                                                                           to identify ways to motivate
                                                                           him to stand up safely and
                                                                           move around


         Insert resource box here: Examples of formal and informal supports and services to
         guide families in achieving their outcomes are discussed in Implementing an IFSP with a
         family (link to essential content of session 3)


36   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                            Application 2.5
  Lurindell: Developing functional outcomes, measurable criteria and
                       family-specific strategies


         Insert reflection box below: Compare your ideas for functional outcomes, measurable
         criteria and family-specific strategies with suggestions for Lurindell and his family. (link
         to examples of … for Lurindell and her family on next page)


Discuss this vignette with colleagues and family advocates. Review the examples of traditional
IFSP outcomes, criteria and strategies for Lurindell and her family. Consider how your team
could collaborate with Lurindell’s family to identify:

                 functional outcomes; (link to section g this session)

                 measurable criteria; (link to section i this session)

                 family-specific strategies; (link to section j this session


Information about Lurindell and her family: Lurindell is 2 /12 years old and has been
attending a child care center sponsored by her parent’s employer. Lurindell enjoys the activities
at the child care center, especially the outside play area and the water table. Her parents have
been informed that unless Lurindell can interact with other children appropriately, they will have
to make other child care arrangements. She has a seizure disorder which is fairly well controlled
by her medication. When tired or frustrated, Lurindell resorts to kicking, hitting and biting to get
what she wants.


  IFSP Examples              Outcomes                       Criteria            Strategies

  Traditional           Lurindell will stop         Parent/therapist      Behavior
                        kicking and biting          observation           management program


  Suggestions for
  functional
  outcome,
  measurable
  criteria and
  family-specific
  strategies




37   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
         Examples of functional outcomes, measurable criteria and family-specific
                         strategies for Lurindell and her family



Information about Lurindell and her family: Lurindell is 2 /12 years old and has been
attending a child care center sponsored by her parent’s employer. Lurindell enjoys the activities
at the child care center, especially the outside play area and the water table. Her parents have
been informed that unless Lurindell can interact with other children appropriately, they will have
to make other child care arrangements. She has a seizure disorder which is fairly well controlled
by her medication. When tired or frustrated, Lurindell resorts to kicking, hitting and biting to get
what she wants.



       IFSP              Outcomes                 Criteria                    Strategies
     Examples

   Traditional       Lurindell will          Parent/therapist      Behavior management program
                     stop kicking and        observation
                     biting

   Collaborative Lurindell will              Lurindell will        Parents will talk to pediatrician
   IFSP          play with other             participate in        about reviewing Lurindell’s
                 children at her             her child care        current medication
                 child care                  program for 2
                 center without              hours/day, 3          EI provider and Mom will
                 hitting, biting             days a week           explore what Lurindell
                 or pushing                                        understands and responds to

                                                                   EI Provider, child care teacher
                                                                   and Mom will identify and
                                                                   address the “triggers” for
                                                                   Lurindell’s undesirable
                                                                   behavior at home and child care

                                                                   EI provider will demonstrate
                                                                   strategies to refocus Lurindell’s
                                                                   behavior in a positive way when
                                                                   tired or upset




38   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                           Application 2.6
     Addressing concerns families may have about developing IFSPs

         Insert tip box below: Family members, early intervention providers and administrators
         should work together to draft responses that are family-friendly and reflect the policies of
         local Infants and Toddlers Programs.


Reflect on the following concerns (often unspoken) families may have and consider 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. 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.



About a child’s development….

         Will my child ever be able to …..?

         Why isn’t my child developing like other children?

         I don’t know what my child can do.

         I’m not sure about my child’s diagnosis, so why do all this now?


About participating in early intervention…

         Will this help me/my family cope, learn what to do about……?

         What if all this doesn’t help my child to ….?

         I don’t know if I accept the results of my child’s evaluation/assessment.

         What assurance is there that this approach will make a difference?


About schedules, services and supports…

         I want more/less time/services for my child.

         There are too many /not enough people coming to my home.

         I/my partner work and aren’t home during the day.




39   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                               Application 2. 7
              Evidence-based practices: EI in Natural environments

Review the discussion about providing early intervention supports and services in natural
environments and consider: (link to section a –“Why provide family/child support.. this section)

              How do I/we apply evidence-based practices to guide my/our
                           IFSP discussions with families?

     Evidence-based                                    Prompt                 Example from my
         practice                                                                 practice

1. A child’s relationships            Who are a child’s primary
   with primary                        caregivers, and how do they spend
   caregivers organize                 their time together?
   all his or her early
   development.                       How do I/we support caregivers to
                                       make IFSP decisions, in ways
                                       meaningful to each family?

2. Children are active                How do I/we solicit and build on
   participants in their               child and family interests for
   own development,                    selecting strategies?
   based on their drive
   to explore and master              How do I/we ensure that children use
   their environment.                  emerging skills across settings?


3. New motor and                      How do I vary settings, strategies,
   communication                       people and places, so a child really
   behaviors are learned               “owns” his or her actions and
   with repeated                       interactions, and uses them to
   opportunities for                   participate in family/community
   practice in                         life?
   meaningful situations
   across different
   settings.

4. Knowledge/resources                How do I support caregivers to
   are shared with a                   feel competent, rather than direct
   child’s key caregivers              children in “hands-on” sessions by
   through supportive                  myself?
   adult-adult
   relationships




40   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
Recommended Reading: Developing IFSPs with Families

Law, M. (2000). Strategies for implementing evidence-based practice in early intervention.
Infants and Young Children, 12(2), 32-40.

         This article focuses on specific strategies that can be used to support an evidence-
         based early intervention practice. Methods are described to gather information from the
         literature, review research studies critically, and summarize research information for
         practice.



McWilliam, R. Routines-based interview. Center for Child Development at Vanderbilt Children's
Hospital, Vanderbilt University, Nashville, TN.

         A routine-based interview is a semi-structured interview by one or more professionals
         with a child’s primary caregivers, including parents and teachers as appropriate. The
         interview focuses on everyday activities and events from a family’s perspective. The
         interview elicits a family’s priorities regarding the child’s and family’s well-being,
         establishes a positive relationship, and helps identify functional IFSP outcomes. A
         Routines-Based Interview Form and 45 minute video are available from the Center for
         Child Development. http://www.vanderbiltchildrens.com/interior.php?mid=2261)



National Research Council and Institute of Medicine (2000). From neurons to neighborhoods: The
science of early childhood development. Committee on Integrating the Science of Early
Childhood Development. Jack P. Shonkoff and Deborah Phillips, eds. Board on Children, Youth,
and Families, Commission on Behavioral and Social Sciences and Education. D.C.: National
Academy Press. (see www.nap.edu/execsumm/0309069882.html for an executive summary)
(link to this website)

         This extraordinary report regarding research and evidence-based practices supporting
         early learning and development was produced by a committee of 17 researchers and
         clinicians with backgrounds in neuroscience, psychology, child development, economics,
         education, pediatrics, psychiatry and public policy. Their charge was to review all research
         about the nature of early development and the influence of early experiences on children’s
         health and well-being, to separate established knowledge from erroneous popular beliefs,
         and to examine the implications of the science base for policy, practice, professional
         development, and research.



Rosenkoetter, S. & Squires, S. (2000). Writing outcomes that make a difference for children
and families. Young Exceptional Children, 4(1), 2-8.

         This early intervention provider/parent team offers guidelines for developing the “heart of
         the IFSP”; the outcome statements which map the path the team members will take
         together. The authors pose six questions for evaluating outcomes:

41   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
             1. Do we know why we’re writing this?

             2. Does this outcome mesh with activities that the family chooses to do?

             3. Have we explored informal, natural and community-based supports to
                determine whether they might accomplish developmental aims, rather than
                automatically listing more restrictive options?

             4. Who will pay or provide?

             5. Is the outcome written in language the family might use, rather than professional
                jargon?

             6. Does this outcome really matter to this child and family?



Especially for families:

Nebraska Department of Education, Early Development Network.
www.answers4families.org/ifspweb/outcomes.html .

         Nebraska’s online discussion of the IFSP provides a clear summary of information for
         families about developing an IFSP for their children as well as other topics of interest to
         families.


Squires, S. (2000). Our family’s experience: An important outcome achieved. Young
Exceptional Children, 4(1), 9-11.

         This article was written by a parent of four children (one of whom has cerebral palsy).
         Squires illustrates how the IFSP process was used to develop outcomes and strategies
         to educate the nursery caregivers in the family’s church to integrate her twin girls in the
         nursery group during church services. One of the girls enjoyed a new social
         opportunity, her twin was freed from translating her sister’s needs, and the rest of the
         family participated in church services knowing that both girls were safe and happy.




42   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                                   Self-Assessment Inventory:
                                  Developing IFSPs with families


                  Review your competency in developing functional outcomes, measurable criteria,
                  family-specific strategies, and informal/formal supports and services with families
                               by checking the appropriate column for each guideline...



               Where are we going with families?                   I need more   I have basic   I do this
                                                                   support       skills         very well

                  Functional outcomes are:

          Meaningful: address a child’s participation in
          particular family/community activities/routines


          Specific: Identifies knowledge, skills or actions
          to be demonstrated by child or family


          Family-identified: identified by parents and
          written in language understood by family


          Do-able: Can reasonably be accomplished
          within 4-6 months


          How will a family know they are “there”? I need more I have basic I do this
                                                                   support       skills         very well

                Measurable criteria specify:

          What: Actions/behavior of a child can be seen
          or heard


          Where: Specifies a context for observing
          actions/behavior


          How often: States realistic frequency for
          demonstrating action/behavior




43   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                Self-Assessment Inventory: Developing IFSPs with families (con’t)



             How can we help a family get “there”?                 I need more   I have   I do this
                                                                   support       basic    very well
                                                                                 skills
           Family-specific strategies address:

          Individualization: Builds on interests and
          learning style of child and family


          Context: Focuses on familiar people, activity
          settings and routines


          Mastery: generalizes a child’s actions &
          interactions across family/community settings


          Collaboration: Identifies what EI providers,
          family, community linkages will do


              What services/resources will help a                  I need more   I have   I do this
                family reach their outcomes?                       support       basic    very well
                                                                                 skills

                EI supports/services include:

          Formal supports/services: PART C (therapy,
          counseling, service coordination, special
          instruction, nursing etc) and related agencies
          (social service, medical/health, mental health
          etc)

          Informal resources within family/community
          networks (child care, libraries, religious events,
          Kiwanis, nature centers, YMCA etc.)




44   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
Appendix A. About evidence-based practice

Early intervention providers must critically evaluate the effectiveness of the assessment
procedures and interventions they use in their daily practice with children and families.
Evidence-based practice is guided by research results and,

         “in no way advocates throwing the clinical experience of established practitioners out the
         window…Evidence-based practice’s central message here is one of flexibility and of
         being able to blend the old ways with the fruits of research and new knowledge.” (Law,
         2002, p.5).


References: Evidence-based practice across disciplines

         Dunst, C., Trivette, C. & Curspec, P. (2002). An evidence-based approach to
         documenting the characteristics and consequences of early intervention practices.
         Centerscope, 1(2), 1-6. (www.researchtopractice.org)

         Gambrill, E. (1999). Evidence-based practice: An alternative to authority based practice.
         Families in society: the Journal of Contemporary Human Services, 80, 341-350.

         Geddes, J., Reynolds, S., Streiner, D., & Szatmari, P. (1997). Evidence based practice
         in mental health. British Medical Journal, 315, 1483-1484.

         Greenhalgh, T.(1997). How to read a paper: The basics of evidence-based medicine.
         London: BMJ Press.

         Law, M. (2000). Strategies for implementing evidence-based practice in early
         intervention. Infants and Young Children, 12(2), 32-40.

         Law, M. (2002).(Ed). Evidence-based rehabilitation. Thorofare, NJ: Slack Inc.

         Melnyk, b., Fineout-Overholt, E., Stone, P., & Ackerman, P. (200). Evidence based
         practice: The past, the present, and recommendations for the millennium. Pediatric
         Nursing, 26, 77-80.

         Occupational therapy: www.fhs.mcmaster.ca/rehab

         Physical therapy: http://ptwww.cchs.usyd.edu.au/pedro

         Reilly, S., Perry, A., Douglas, J., & Oates, J. (2001). Evidence based practice in speech
         pathology. London: Whurr.

         Sackett, D., Rosenberg, W., Gray, J., Haynes, R., & Richardson, W. (1996). Evidence-
         based medicine: What it is & is not. British Medical Journal, 312, 71-2.




45   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
Appendix B Evidence-based practices supporting early intervention
in natural environments

Evidence from interdisciplinary sources (early childhood, neuroscience, occupational and
physical therapy, speech-language pathology, social sciences, medicine and nursing) provides
critical support for early intervention in natural environments, as follows:


    A child’s relationships with primary caregivers organize all his or her early
     development.

         Atkins-Burnett, S. & Allen-Meares, P. (2000). Infants and toddlers with disabilities:
         Relationship-based approaches. Social Work, 45(4), 371-377.

         Commission on Children at Risk. (2003). Hardwired to connect: The new scientific case
         for authoritative communities. New York, NY: Institute for American Values.

         Gunnar, M, Brodersen, L., Krueger, K., & Rigatuso, R. (1996). Dampening of behavioral
         and adrenocortical reactivity during early infancy: Normative changes and individual
         differences. Child Development, 67: 877:889.

         Meisels, S. Dichtelmiller, M. & Liaw, F. (1993). A multidimensional analysis of early
         childhood intervention programs. In Handbook of Infant Mental Health. New York, NY:
         Guildford Press.

         Schore, A. (2003). Quoted in Hardwired to Connect: The new scientific case for
         authoritative communities (p. 16). New York, NY: Institute for American Values.

         Shore, R. (1997). Rethinking the brain. NY: Families and Work Institute.

         Thompson, R. (1999). Early attachment & later development. In Cassidy & Shaver (Eds),
         Handbook of Attachment: Theory, Research & Clinical Applications (pp. 265-286). NY:
         Guilford Press.

         Weston, D. Ivins, B. Heffron, M. & Sweet, N. (1997). Formulating the centrality of
         relationships in early intervention: An organizational perspective. Infants and Young
         Children, (9)3, 1-12.


    Children are active participants in their own development, based on their drive
     to explore and master their environment.


         Chandler, B. (Ed.) (1997). The essence of play: A child's occupation. Bethesda, MD:
         The American Occupational therapy Association, Inc.

         Dalgeish, T. & Power, M. (1999) (Eds.) Handbook of cognition and emotion. New York:
         NY: John Wiley and Sons.

46   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
         Dunst, C. J., Bruder, M. B., Trivette, C. M., Raab, M., & McLean, M. (2001). Natural
         learning opportunities for infants, toddlers, and preschoolers. Young Exceptional
         Children, 4(3), 18-25.

         Hamilton, V., Bower, G., & Fridja, N. (!988). (Eds.) Cognitive perspective on motivation
         and emotion. NATO Asi Series, Series D, Behavioral and Social Sciences Vol. 44. New
         York,, NY: Kluwer Academic Publications.

         Mandler, J. (2000). Perceptual and cognitive processes in infancy. Journal of Cognition
         and Development, 1, 3-36.

         National Research Council and Institute of Medicine (2000). From neurons to
         neighborhoods: The science of early childhood development. Committee on Integrating
         the Science of Early Childhood Development. Jack P. Shonkoff and Deborah Phillips, eds.
         Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences
         and Education. D.C.: National Academy Press. (see
         www.nap.edu/execsumm/0309069882.html for an executive summary)

         Parritz, R., Mangelsdork, S., & Gunnar, M. (1992). Control, social referencing and the
         infant’s appraisal of threat. In S. Feinman (Ed). Social referencing and the social
         construction of reality in infants (pp. 209-228).



    New motor and communication behaviors are learned and used when a child
     has repeated opportunities for practice in meaningful situations with
     generalization of skills across different settings.


         Dunn, W., Brown, C., McGuigan, A. (1994). The ecology of human performance: A
         framework for considering the effect of context. American Journal of Occupational
         Therapy, 48, 595-607.

         Eiserman, W., McCoun, M. & Escobar, C. (1990). A cost-effective analysis of two
         alternative program models for serving speech-disordered preschoolers. Journal of
         Early Intervention, 14(4), 297-317.

         Greenough, W. (1987). Experience and brain development. Child Development, 58, 539-
         59.

         Heriza, C,. & Sweeney, J. (1994). Pediatric physical therapy: Part I. Practice scope,
         scientific basis and theoretical foundation. Infants and Young Children, 7(2), 20-32.

         Lewthwaite, R. (1990). Motivational considerations in physical activity involvement.
         Physical Therapy, 70, 808-819.

         MacLean, P. (1990). The triune brain in education. New York, NY: Plenum Press.

         McEwen, I. & Shelden, M. (1995). Pediatric therapy in the 1990s: The demise of the
         educational vs. medical dichotomy. Physical & Occupational Therapy in Pediatrics, 15(2),

47   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
         33-45.

         McLean, L. & Woods Cripe, J. (1997). The effectiveness of early intervention for children
         with communication disorders. In M. Guralnick (Ed), The effectiveness of early
         intervention (pp 349-428). Baltimore: Paul H. Brookes.

         Schmidt, R. & Lee, T. (1999). Motor control and learning: A behavioral emphasis (3rd
         edition). Champaign, IL: Human Kinetics.


    The knowledge and resources of early childhood specialists are shared with a
     child’s key caregivers through adult-adult relationships that support family
     members in their day-day responsibilities caring for their children.


         Bricker, D, Pretti-Frontczak, K, & McComas, N.(1998). An activity-based approach to
         early intervention (2nd edition). Baltimore: Brookes Publishing Co.

         Dunst, C. J. (2001). Participation of young children with disabilities in community
         learning activities. In M. Guralnick (Ed.), Early childhood inclusion: Focus on change
         (pp. 307-333). Baltimore: Brookes

         Dunst, C. J., Hamby, D., Trivette, C. M., Raab, M., & Bruder, M. B. (2000). Everyday
         family and community life and children’s naturally occurring learning opportunities.
         Journal of Early Intervention, 23, 151-164.

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

         Mahoney et al (1999). Parent education in early intervention. Topics in Early Childhood
         Special Education, 19(3), 131-140.

         Marvel, M. Epstein, R., Flowers, K., Beckman H. (1999). Soliciting the patient’s agenda:
         Have we improved? JAMA, 281, 283-287.

         National Research Council and Institute of Medicine (2000). From neurons to
         neighborhoods: The science of early childhood development. Committee on Integrating
         the Science of Early Childhood Development. Jack P. Shonkoff and Deborah Phillips, eds.
         Board on Children, Youth, and Families, Commission on Behavioral and Social Sciences
         and Education. D.C.: National Academy Press. (see
         www.nap.edu/execsumm/0309069882.html for an executive summary)

         Odom, S. Favazza, Brown & Horn, E. (2000). Approaches in understanding the ecology
         of early childhood environments for children with disabilities. In Behavioral observation:
         Technology and application in developmental disabilities (pp. 193-214). Baltimore:
         Brookes.




48   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
References for essential content

Boone, H., McBride, S., Swann, D, Moore, S. & Drew, B. (1998). IFSP practices in two states:
Implications for practice. Infants and Young Children, 10(4), 36-45.

Bruder, M. (2000). The Individual Family Service Plan. ERIC Early Childhood Digest # E605.
Arlington, VA: ERIC Clearinghouse on Disabilities and Gifted Education.

Dunst, C., Trivette, C., & Deal, A. (1997). Resource-based approach to early intervention. In S.
Thurman, J. Cornwell & S. Gottwald (eds), Contexts of early intervention: Systems and settings
(pp.73-92). Baltimore, MD: Paul H. Brookes.

Dunst, C. J., Hamby, D., Trivette, C. M., Raab, M., & Bruder, M. B. (2000). Everyday family and
community life and children’s naturally occurring learning opportunities. Journal of Early
Intervention, 23, 151-164.

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.

Grisham-Brown, J. Hammeter, M.L. (1998). Writing IEP goals and objectives: Reflecting an
activity-based approach to instruction for children with disabilities. Young Exceptional Children,
1(3), 2-10.

Jung, L. & Baird, S. (2003). Effects of service coordinator variables on individualized family
service plans. Journal of Early Intervention, 25(3), 206-218.

McWilliam, R., Ferguson, A., Harbin, G., Porter, P.,Munn, D., & Vandiviere, P. (1998). The
family-centeredness of Individualized family service plans. Topics in Early Childhood Special
Education, 18(2), 69-82.

McWilliam, R. Routines-based therapy: Integration of ancillary services and instruction for early
childhood. Presentation at NECTAS Early Childhood Conference, Washington D.,C. October 23,
2002.

McWilliam, R. A. (2005). Assessing the resource needs of families in the context of early
intervention. In M. J. Guralnick (Ed.), A Developmental systems approach to early intervention:
National and international perspectives (pp.215-233). Baltimore, MD: Paul H. Brookes
Publishing Co.

National Research Council and Institute of Medicine (2000). From neurons to neighborhoods: The
science of early childhood development. Committee on Integrating the Science of Early Childhood
Development. Jack P. Shonkoff and Deborah Phillips, eds. Board on Children, Youth, and
Families, Commission on Behavioral and Social Sciences and Education. D.C.: National Academy
Press.

Nebraska Department of Education, Early Development Network. Downloaded from
www.answers4families.org/ifspweb/outcomes.html March, 15, 2004.

Pretti-Frontczak, K., & Bricker, D. (2000). Enhancing the quality of individualized education
plan (IEP) goals and objectives. Journal of Early Intervention, 23(2), 92-105.
49   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
Pretti-Frontczak, K, (2003). Developing team-based meaningful IFSPs/IEPs. Presentation at
Great Beginnings, October 24-25, 2003, Marlboro, Massachusetts.

Rosenkoetter, S. & Squires, S. (2000). Writing outcomes that make a difference for children
and families. Young Exceptional Children, 4(1), 2-8.




50   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
     Mayra’s story: Identifying functional outcomes for Pedro


     This vignette illustrates how Jana, a service coordinator, prompted a mother, Mayra, to think
     about the daily activities she hoped her son, Pedro, could participate in more fully. Their
     conversation takes place during Mayra’s initial IFSP meeting with an early intervention team
     form a Local Infants and Toddlers Program.


                 Jana begins by summarizing, “When we first met, Mayra, you told me that you
         wanted to help Pedro talk more and understand you better. When we visited you last
         time for his evaluation, we talked about how much Pedro understands and listened to
         what he said while you and his brothers played with him. Now it’s time to think more
         specifically about what you want for Pedro and how we can help you do this.”

                Mayra responds, “I want Pedro to understand what others say to him, just like his
         brothers did.”

                “That’s important, for sure,” agrees Jana. “Can you tell us some more about
         when it’s really important for Pedro to understand what people are saying to him?”

                 “Well, he really likes going to a play group on Mondays and Wednesdays but has
         a hard time doing what the teacher says,” explains Mayra. “She plays a song on the
         tape recorder for snack and Pedro thinks it’s time to go outside. Then when they do go
         out and she says it’s time to come back inside, he runs over to the sandbox. He’s
         always doing things different from the other kids.”

               Jana (wondering if there are other times this happens) asks, “Does this happen
         at home, too?”

                 “Oh, yes!” Mayra replies emphatically. “ There are some things, like getting
         dressed in the morning, or eating dinner, that we do the same way most of the time, so
         Pedro knows what’s happening. But when we make a change, or go somewhere only
         one or two times a week, like nursery school or my sister’s, then he has a hard time
         keeping up.”

     Understanding that Mayra really would like Pedro to fit in with the flow of activities at his play
     group, at home and at his aunt’s house provides a context for a functional outcome that
     early intervention providers and family can address together. Without this information, it
     would be easy to misinterpret what Mayra means by “helping Pedro talk more and
     understand better.”

     Mayra has told us what she thinks about an outcome being:

                  Meaningful: Pedro will fit in with other children at his play group and with family
                  at home.

                 Family- desired: Mayra said that she wants her son to talk and understand
                  better to help him fit in with what others are doing.

                 Specific: Pedro will understand what to do/where to go when given a direction.
51   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
     While discussing this outcome, the team decides that they can expect Pedro to take part in
     more of the routines and activities that occur at home and nursery school. A functional
     IFSP outcome, reflecting Mayra’s desires, can be identified that is “do-able” in 4-6 months:

         Functional outcome: Pedro will understand and follow directions so that he can
         play with friends and family at home and in his play group.




52   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                               Examples of functional outcomes


   Functional outcomes                     How to modify:             Examples of functional
          avoid:                                                           outcomes
Broad developmental
goals such as:
                                       Specify a parent/child      Brian will sit quietly and look at
Brian’s behavior will improve          action, skill, or           a book during bedtime stories
                                       knowledge and how it
Katya will develop age                 will enhance a child’s      Katya will watch her brother’s
appropriate gross motor                participation in            soccer games by standing up
skills                                 family/community life       and holding on to bleachers
                                                                   and/or people
Separate goals for each
developmental domain:

Babacar will:                          Select outcomes that        Babacar will:
 roll over (motor domain)              address family
                                       selected routines &         Play next to his sister by rolling
 use sounds to express                 activities that promote     across the room to reach her
 himself (language domain)             social interaction,
                                       mastery of the              Choose what he wants to
 make choices when                     environment, and            do/eat/wear by using specific
 presented with two items              engagement in               sounds for “yes” and “no”
 (cognitive domain)                    learning

 play with brothers (social-
 emotional domain)
Listing skills only:

Shawna will hold her head              Show how                    Shawna will watch videos and
up 90° and maintain her                action/interaction will     play with her sister by holding
position for awhile                    help a child participate    her head up
                                       in family/community life
Dante will walk up and down                                        Dante will go outside to play or
stairs                                                             get in the car by walking up
                                                                   and down the stairs
Negative outcomes:

Lars will stop throwing toys           Emphasize the positive      Lars will help clean up after
and other items on the floor           actions/skills a family     play by picking up his
                                       wants to replace the        toys/objects
                                       negative ones with
Lily will decrease her                                             Lily will enjoy washing her
sensitivity to light touch                                         hands, hair and face




53   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                                Examples of measurable criteria



 Measurable criteria avoid:                How to modify:            Examples of measurable
                                                                            criteria
Unspecified
action/behavior
                                                                   Jacob will use the same
Jacob will make sounds                 Actions/behavior of a       sound to name each family
                                       child can be seen           member, 2 days in a row
                                       and/or heard within a
Jacob will respond to sounds           given context               Jacob will smile and turn when
in environment                                                     called by name by family
                                                                   members during play periods,
                                                                   2 days in a row
Broad criteria

Sandi will eat independently           Specify a context for       Sandi will use a spoon to feed
at least 80% of the time               observing a                 herself for at least 10 minutes
                                       skill/behavior              during each evening meal


Family and therapist                   State frequency for         Sandi will use a spoon to feed
observation; therapist                 demonstrating               herself for at least 10 minutes
checklist                              action/behavior within a    during each evening meal
                                       specific time period




54   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                           Examples of family-specific strategies

                                    Functional outcome:
       Babacar will choose what he wants to do by using specific sounds for “yes” and “no”


      Family-specific                     How to modify:            Examples of family-specific
     strategies avoid:                                                     strategies

Vague/broad
suggestions about what                                             Family will pair sounds with
to do:                             Identify how to help:           words “yes/no” when talking to
                                                                   Babacar and one another.
Language stimulation               a) a child generalize
                                   actions/interactions            EI provider will explore with
                                   across settings; and            parents/childcare provider
Family and service                                                 what prompts, activities and
provider will continue to          b) caregivers build             interactions help Babacar use
work on strategies and             competency, appropriate         his sounds.
activities to increase skills      to their role.
in the home                                                        Mom will show
                                                                   grandparents/babysitter how to
                                                                   prompt sounds from Babacar
                                                                   when feeding him.
Listing formal EI
services as strategies:
                                   Strategies are not formal       EI provider will go to the store
Enroll in speech-language          services- but could             with mom and Babacar to
therapy                            identify how an EI              show how to help him
                                   provider will support a         use his sounds.
Physical therapy 1x/week           family.

                                   Strategies indicate how         Examples above illustrate how
                                   the entire IFSP team will       parents, siblings, grandparents
                                   work on achieving               and EI providers can
                                   outcomes.                       collaborate on goals.

Unclear who will do
what:                              Completing the IFSP             See examples above, and:
                                   “Strategy” section is
Teacher will work with             another opportunity to talk     EI provider will share info
child/family to increase           about the benefits of           about parent-parent support
skills and provide                 formal and informal             networks
activities for 9the home           services/supports that can
                                   help a child participate in     Dad/brothers will play with
Ideas for encouraging              family & community life         Babacar at the pool and in
language at home                   (the intent of the natural      bathtub (child loves water)
activities                         environment mandate)



55   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
                Examples of formal and informal supports/services

For achieving a family outcome:

         Outcome and             Family-Specific Strategies                Examples of
           Criteria                                                      supports/services

                                      Sylvia will review the      Formal EI services:
     Outcome: Sylvia                   mobility training she       Depending on their
     will take Paolo to                received at the MD          knowledge/experience any of
     the park and                      School for the Blind        the following EI providers could
     shopping, by                                                  support Sylvia in achieving this
     herself                          I/T provider will           outcome:
                                       accompany Sylvia and
                                       Paola to community             Family support coordinator
     Criteria: Sylvia will             activities such as the         Occupational therapist
     take one trip with                library                        Social worker
     Paola to either the                                              Special educator
     library, mall or                 Sylvia will identify           Physical therapist
     other community                   available
     activity by herself               transportation options      Other formal service:
     within the next 4-6               and ask family and          MD School for the Blind
     months                            other community
                                       supports to                 Informal networks/resources:
                                       accompany her on a          Extended family/friends
                                       trial run                   Library program for children


         The frequency and intensity of services should be chosen after discussion with Sylvia
         about how much support she desires to navigate the transportation system and reach
         her destination while attending to her son’s needs. Will Paolo need a stroller? Is he
         walking on his own? How far and how long? How easy will it be to address his toileting
         and eating needs while Sylvia and Paola are outside their home?

         The natural environments in which supports/services would be provided to meet this
         outcome are the public library or shopping mall and the selected transportation method
         identified by Sylvia (bus, taxi, walking).




56   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family
For achieving a child outcome:

       Child Outcome                       Strategies                     Examples of
        and Criteria                                                    supports/services

                                 Family and I/T staff consult     Formal EI service:
                                  with GI doctor about             Depending on their
     Outcome:                     realistic timetable and plan     knowledge/experience any
     Neena will eat               for Neena to drink and eat       one of the following EI
     and drink by                                                  providers could support
     mouth like other            I/T providers will share         Neena’s family in achieving
     kids during                  information about oral-          this outcome:
     family outings               motor development with
                                  parents and suggest                     OTR
                                  enjoyable hand/mouth                    Nurse
     Criteria: Neena              games to play with Neena                Special educator
     will drink a                                                         SPL
     minimum of 4 oz             Family and I/T staff work
     of fluids from a             together to introduce Neena
     cup and eat 3                to new foods and liquids         Other formal services:
     spoonfuls of                 and track her likes and
     food during                  dislikes                                Pediatrician
     family outings                                                       Gastroenterologist
                                 I/T staff will accompany
                                  family on outings to adapt       Informal resource:
                                  eating suggestions
                                                                          Parent-parent support
                                 I/T staff will link family to
                                  other families who have a
                                  child with a feeding tube to
                                  see how they cope and get
                                  around in the community



         The frequency and intensity of services should be chosen after discussion with
         Neena’s parents about how much support/services would be needed to implement the
         strategies identified above. It may be that the early intervention provider (suggested
         above with the most experience/knowledge in helping children learn to eat by mouth)
         could work out a flexible schedule for Neena and her parents (e.g., 2x/week for 6 weeks,
         and then visit once per week for another 8 weeks) until the parents are ready to try a
         family outing.

         The natural environments in which supports/services would be provided to meet this
         outcome are the family home (to begin weaning Neena off tube feedings) and the
         community destinations chosen by Nina’s family, when they are ready to go out with her.




57   Early Childhood Tutorial- Developing and Implementing IFSPs
Session 2 - Developing an IFSP with a family

								
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