Based on the work and publications of Robin A. - PowerPoint Presentation

Based on the work and publications of Robin A. McWilliam, PhD. The Routines Based Interview

Knowledge of how the EcoMap and RBI fits into the IFSP processWhy RI has chosen to implement RBIHow to complete an EcomapHow to conduct a RBICritical interview skills A little practiceHow to be RI RBI Approved What to expect from today

RBI IFSP Eligibility Meeting Communicate El Eligibility, Update Concerns if applicable, (This meeting marks 45 day timeline) Multidisciplinary Assessment YES YES Multidisciplinary Evaluation/Assessment NO Eligible ? IFSP Eligibility Meeting and Provide Community Resources NO Single Established Condition? Other occasions where RBI may be beneficial include: Annual IFSP review and outcomes development, uncertainty about what to work on next, and families who seem uninterested or unable to participate in EI strategies. Adapted from R.A. Mc William, Ph.D. IFSP Team Meeting Finalize outcomes if not completed at end of RBI Identify Strategies, Services, and Parent Signature Intake with EcoMap Plus Pages 2 & 3 of IFSP  

RBI Focuses on: Engagement Independence Social Relationships Use of Appropriate Behaviors to Meet Needs Acquisition and Use of Knowledge and Skills Positive Social Emotional Skills Including Social Relationships Global Child Outcomes RBI ties to Global Child Outcomes Used in the New IFSP

Why do an RBI?Develop a list of functional outcomesTo assess child and family functioning To establish a positive relationship with the family

Why do an RBI?Research BasedRBI produces better outcomes than traditional approach to IFSP development. Outcomes are more functionalFamilies are more satisfied with IFSP development More meaningful interventions = more progress

Starting at Intake … The Ecomap Shows we’re interested in the family, not just the child Establishes a friendly, interested relationship Gives us an alternative to the checklist method of doing intakes Tab 1

Example Questions to understand each relationship:How often do you talk with/see her? For Non-FamilyHow do you get along with them? Other types of questions If something cool happened with one of your children, who would you call? The important thing is to find out how supportive or stressful this person is Ecomap

Who lives in the home with the child? Father’s Family/Parent 1 Mother’s Family/ Parent 2 Father’s Friends Community Supports Professional Supports and Services Mother’s Friends People at Work People at Work Community Supports EcoMap Template

The Routines Based Interview

“Set the stage” for RBI at intake Encourage family to invite others Try to arrange for quiet time Getting Started “ This is an important conversation. We find that taking the time to talk in detail about your day helps us to help you and your child make quicker progress toward your goals.”

1 or 2 interviewers Role of 2nd person is to help cover missed questions, take notes, handle interruptions and recap Sit at 45° angle to parent Keep paper flat on table Be focused Getting Started

SRF should indicate a RBI was completed but do not recap the conversationIndicate date of RBI on IFSP Remind data entry to check RBI box in Welligent (only for full initial RBI’s) Service Coordination T1016 (one person) Team Coordination T10TF (2 people) SRF and Billing

How to talk about the RBI? “Talking about your day to day activities will help us come up with an effective plan for helping you and your child” “Talking in detail about your day helps us to work on the things that are most meaningful to your child and family” “When we focus on the things you do every day, your child will be able to practice his new skills over and over again with little effort”

Tell me as much or as little…Why is your child in Early Intervention? What are your main concerns ? Beginning the RBI Now I’m going to ask you some questions about your day to day activities. Is that ok?

Traditional RBI questions within each routine What is the child doing? What is everyone else doing? What is this child’s engagement like? What is this child’s level of independence? What are this child’s social relationships like? How satisfied are you with this routine? If appropriate: How would you like it to be different ?

Engagement: How and how much does the child participate in the routine?Independence: How much can the child do by him/herself?Social Relationship: How does the child communicate and get along with others ? Within each routine….

The RBI OutlineGo through each daily activity one by one Write BRIEF notes! (you will see why later) Note concerns (mostly parents’ but can be yours) Put stars next to them Use transitional phrases like “what happens next”

What does ____ look like?What happens when he sees you?How does she get from the bedroom to the playroom? How do you know he is happy? What do you think that means?How does that make you feel? What do you do when that happens? What happens next? Success hinges on follow‐up questions!!

After each routines ask parents how they feel about each routineOn a scale of 1-5 How is this time of day for you?If the rating is 3 or less (this is flexible) ask: How would you like this to be different? Satisfaction Questions

Let’s try it… https ://vimeo.com/154905455 https :// vimeo.com/154905504 Take out a RBI Interview Notes Page You are the second interviewer Take notes on what you hear

“Now let me ask you a couple of general questions…When you lie awake at night, what do you worry about? If there is anything you’d like to change about your life, what would it be?” Is there anything you used to do that you would like to be able to do again? Worry, Change and Activity Questions

This should be done by person taking notes (2nd interviewer) Be Brief!! (no more than 5 minutes) There will likely be 10‐20 things you have starred!If you have written a lot, it will be hard to pick out the highlights No questions, no discussion, no ideas Recap BOOM, BOOM, BOOM

“Let’s make a list of what would you like to work on?”Let parent start, you can use notes to remind parent of what they said Share notes with parent “Lets put these goals into priority order. I f you could only choose one thing to work on, what would it be? Proceed until all goals are numbered List and Prioritize

Managing the InterviewMake use of a “parking lot” Families often begin to solve own troubles just by saying them out loudDon’ t forget to acknowledge ideas, andDon’ t forget to come back to them at another time Manage time and distractions effectively

What if you have a concern, detect a delay or some other problem? Check your own beliefs and biases…Is this a FUNCTIONAL concern? Use natural learning opportunities Obligation to give families information Consider timing of when to address concern When you have a concern the parent does not choose

Lasts approx 1 to 1 ½ hours Gives you a detailed picture of the child and family’s daily activities Produces a minimum of 6 – 10 outcomes Getting into care seat Getting dressed without fussing Hard to control in store Dinner time – crying Bathtime – hard to wash safely Crys a lot when put in crib A Successful Interview…

“Are we there yet?!!!”

Interview Skills Active listening In depth follow up questions Proactive questioning about child development Continuing the conversation Smart questions McWilliam,R.A, Casey, A.M, Sims, J. The routines based interview: a method for gathering information and assessing needs. Infants and Young Children. 22, 3, 224-233.

Interview Skills Non verbal communication to convey acceptance and interest Social environment of routines Seeking evaluative and interpretive opinions Managing the conversation Empathizing McWilliam,R.A , Casey, A.M, Sims, J. The routines based interview: a method for gathering information and assessing needs. Infants and Young Children. 22, 3, 224-233.

Other Tips Ask open ended questions Do NOT answer your own questions Do NOT make the RBI conversation into a multiple choice quiz Use “why” with caution Practice with co-workers and friends

Divide into groups of 3Practice Interviews M other Interviewer Observer

Mothers– Receive assigned role– Read the vignette– Prepare to make up detailsInterviewers– Read RBI Implementation Checklist Observers– Read RBI Implementation Checklist Preparation for Interview: 5 Minutes

Begin interview as though you had 90 minutes ahead of you—in depth informationAfter 20 mins, I will tell you when you should move on to evening routinesAfter another 10 mins, you should be recapping and selecting outcomesYou are done when outcomes are selected Flow of Activity

7 Steps for Writing Functional OutcomesYou can’t just take a nonfunctional outcome and turn it into a functional outcome…That will merely produce a well‐written nonfunctional outcome

Read the informal functional outcomeDetermine the routines involvedWrite “[The child] will participate in [those routines]” Write “…by _____ ing,” inserting the desired behavior Consider We will know this when he or she _____ and add a measurable acquisition criterion Add a generalization criterion Add the criterion specifying the amount of time over which the behavior needs to be displayed (e.g., “in one week”) 7 Steps to Writing Functional, Measureable, Family Owned

Smith Family Goals -Get Samantha to chew her food -Move to get to places (rolling, crawling, walking) -In and out of sitting -Stand up -Play with toys the way they’re designed… more toys -Communication (reaching, sounds) -Cup drinking-Jacque’s relationship with Gabriel and Andrea

Step 1Take what the family listed as a goal in the RBI Developing Child Outcomes We want Sam to chew her food

Step 2Find out what routines this affects Developing Child Outcomes Lunch and dinner

Step 3Write “Child will participate in [the routine(s) in question]” Developing Child Outcomes Samatha will participate in lunch and dinner

Step 4Write “by _____ing,” addressing the specific behaviors Developing Child Outcomes By chewing her food and moving food from side to side with her tongue before swallowing

Step 5Add a criterion for demonstration the child has acquired the skill Developing Child Outcomes We will know she can do this when she eats 1/2 cup of food in this manner

Step 6Add another criterion for generalization, maintenance, or fluency, if appropriate(across routines, people, materials, places, over time) Developing Child Outcomes One time at lunch, one time at dinner

Step 7What amount of time will it take until we presume mastery? Developing Child Outcomes Samantha will participate in lunch and dinner by chewing her food and moving food from side to side with her tongue before swallowing. We will know she can do this when she eats ½ cup of food in this manner, one time at lunch, one time at dinner for 1 week.

Play with toys in the way they are intendedSamantha will participate in play time by playing with toys the way they’re intended.We will know she can do this when she plays appropriately with 2 toys a day for three consecutive weeks. Developing Child Outcomes

Video Resources RBI Interview https:// www.youtube.com/watch?v=IVKcT-OwuUE Difference is in the Details: The value of asking good questions https:// vimeo.com/154905455 https:// vimeo.com/154905504