Engaging Families, Intervention Visits, Practical Strategies, Professional Development

Don’t Let the “What Ifs…” Keep You From Using Routines-Based Practices!

shutterstock_52706353We’re really good, in early intervention, at the “what ifs…” – especially when it comes to adopting new practices. When a practice feels unfamiliar or even contrary to how we were trained, it’s so easy to jump to the “what ifs” and feel like there are many reasons not to use the new information. Often, though, with a little creative problem-solving and an open mind, the “what ifs…” can be managed and our practices can grow!

Here are two common “what ifs…” that I’ve heard when interventionists are trying to think about using routines-based practices with families:

What if I can’t be there when the routine naturally happens?

Maybe the target routine occurs when the child attends the church nursery on Sundays or during bath time at 7:30pm. Whenever you can, joining the child and family during the actual routine is the best way to provide support, but when you can’t be there, it doesn’t mean that you can’t support that routine. Here are 4 strategies to try when this happens:

  1. Ask the parent to describe the routine, focusing on what happens before, during and after the routine.
  2. Find out about what the parent does, what the child does, what others do during this routine.
  3. Ask more thought-provoking questions about what the parent has tried and why, what she thinks & feels about the routine, why she thinks the child does what he does, what she thinks she’d like to change and why.
  4. Go back over the routine together and develop a step-by-step plan for how to embed strategies into the routine to achieve the parent’s goal. Write the plan down.

Here’s a real example:

Micah disliked bath time. I’d been giving his grandmother general “have you tried this…” kinds of strategies for weeks that were just not working. I wasn’t able to join bath time because it happened before bedtime each evening. Finally I recognized that I really didn’t know much about how bath time worked for this specific family, so I asked the grandmother to describe it to me, starting from what happened leading up to Micah’s bath, how he was bathed, and what happened afterwards. We talked it through and came to the joint conclusion that he loved being in the water. Because he had very limited language but strong cognition, he knew he eventually had to get out of the water, which usually lead to a struggle, so he had started resisting bath time before even getting in the tub. Micah couldn’t communicate that he wanted to stay in the water so he cried instead.

After lots of joint-problem solving, his grandmother decided to give him several verbal warnings about bath time ending soon, instead of just snatching him up out of the water, then pull the plug on the water after the last warning. They also worked on simple words and signs like “all done.” She tried these relatively simple strategies and Micah got out of the tub without crying for the first time. Without the water, the tub wasn’t as fun anymore and, in fact, was kind of chilly so he was ready for his towel. The problem of this routine was solved, even though I couldn’t be there. Once bath time was enjoyable, it became a great place for learning opportunities too. Win-win all around!

What if the family doesn’t have any routines?

Yikes. This question is really a judgment on the part of the interventionist and indicates the need to step back and reflect on what we think about families. Routines are things families do during the day that take many different forms. Some families have lots of routines and activities, like going to child care, running errands, swimming, or reading books together. Other families have fewer routines that they recognize and may struggle to answer questions about them. Still others may be just beginning to set new routines after the birth of a new baby or a recent move.

By getting to know families and finding out about what they like to do or would like to do, we can discover their routines with them. It is not their responsibility to have “routines” that look the way we want them to look. Routines belong to families, not to us. Maybe the family’s main routine is watching TV during the day. If that’s what they do, then that’s where you start. Be careful not to assume that families don’t have routines just because their routines don’t look like yours.

The “what ifs” are everywhere.

Think about them, run them by your colleagues, find solutions…but don’t let them stop you. Use the “what ifs” as stepping stones to help you get better at what you do.

What other “what ifs…” can you think of? How would you answer this one: “What if the parent is used to me working with the child and doesn’t want to use strategies during other routines?

Share your thoughts and your answer to this one in the comments below!

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11 Comments to “Don’t Let the “What Ifs…” Keep You From Using Routines-Based Practices!”

  1. I’m glad you mentioned joint problem solving, which I think Robin McWilliam first attached to what he calls family consultation–making sure the interventions are arrived at by the family and the early interventionist together. Robin sometimes calls this “joint solution finding.”

    • I love that – joint solution finding! The longer I am in EI, the more I think that it is this joint solution finding that is the real key to making EI work. I’ve read that parents have reported that that is the most important activity of the visit. It’s really the key to meaningful, useful intervention!

  2. Another “what if” we have experienced is “what if I am the only team member who is trying to implement change in practice”? Some early interventionists are participating in professional development activities and are then incorporating strategies into their home visits – like using the child and family’s “stuff” rather than bringing the big old toy bag…Not only is this challenging for the home visitor trying out new ideas, but it can be confusing for families who are trying to understand very different approaches to intervention! Any suggestions to share would be most appreciated!

    • This is a popular one, Amy. I’m glad you brought it up! It’s one of the challenges to working as a team. Here are a few ideas:

      I’d start by talking with the family about the new practice (before using it) and why it could be useful in helping them help their child. I’d also go ahead and talk about why it might be different from what others are doing. Explain about how best practice is always evolving, about how this is a new practice for the whole team, or about why you think it will be useful and if it is, you’d like to share it with the rest of the team.

      Sometimes a more gradual change in practice is easier for families and colleagues too. Providers might want to try out new practices with new families, rather than completely changing practices with families who are used to an intervention approach.

      If this struggle is confusing families, then maybe it’s time to talk to the supervisor about how to help everyone on the team use best practices. This could be a sign of a training need for the whole team/program.

      I also think we need to be able to explain HOW and WHY what we are doing is evidence-based to help families know what EB practices are. We don’t want to make our colleagues “look bad” and would certainly handle this professionally but we also don’t want to hold ourselves back from implementing best practice because of this. It can be a tricky situation, for sure.

      I’d love to hear other ideas for this “what if”!

      Also, here’s a great resource for the toy bag conundrum that an interventionist could share with the team: 10 Steps to Decrease Toy Bag Dependence http://tactics.fsu.edu/pdf/HandoutPDFs/TaCTICSHandouts/Module3/10step.pdf

      • It seems there are two audiences here….the family and the EI colleagues. If a relationship is nurtured with the family (trust), the presentation is logical, and it is clear that the best interest of the child is at the heart of this practice, most families will go along with it. There is ample evidence of successes with this approach. I think it’s critical to celebrate the first “win” in a big way, giving a toe-hold for the next win.

        With colleagues, there is a natural resistance to change. Only babies embrace change (diapers). Old practices will be given up when there is evidence that the “new way” can be rehearsed in a non-threatening environment, is evidence-based, is logical, and is proven to yield better results than the “old way”. Think how hard it would have been for Mary Poppins to give up her toy bag and teach the Von Trapp parents how to perform the “magic” many times throughout the entire day! She would have resisted the notion. After all, what would the have been called….certainly not “Mary Poppins”. Something like “Von Trapp Family Miracles”. We are reluctant to give up our starring roles in the old EI movie. There is glamour and self-satisfaction in being a Mary Poppins.

        If you are the ONLY one making a change it will be lonely for a while. Once there are two of you ….and then then three you’ll be poised for a friendly takeover! I have found that peer pressure (with support from the supervisor) works wonders, once there are a few early-adopters who stay true to the process and are enthusiastic about the positive outcomes.

        From personal experience traveling this road….it takes guts but the view at the end is gorgeous!

        • SO well said, David! I just love how you write that it’s hard to give up our starring role – that is so true. Many of us went into this field because we were fascinated by early development and love to interact with babies and help them grow. It’s what we knew, so switching gears to work alongside parents rather than in front of them is hard…but so worth it!

          What suggestions do you have for supervisors who are trying to help their staff make this change? As I’m sure you know, it can be really challenging to support staff who are at different places along this continuum…

          • Dana, I love your blog and we use one of your featured writings each month at our staff meeting….with discussion and open dialogue. Not all staff members agree with all points but it gives an opportunity to discuss the philosophy and practical application openly.

            It is an interesting question you pose, how supervisors can help their staff with this change. What follows is simply my opinion as a supervisor who has walked this bumpy road the past 2 years.

            Just as our families are all at different spots with their buy-in and commitment to EI, so are all EI staff members. A wise supervisor first and foremost needs to understand and absorb the philosophy of Routines-Based Early Intervention. Then there must be an undying commitment to see it through. Dr Winnie Dunn challenged me with this statement a couple years ago: “This requires courageous leadership. Are you up for it? I hope so.” A supervisor needs to be willing/able to commit to riding the horse and carrying the banner. If the supervisor IS willing to charge forward then my suggestions would be:
            * Bring in a quality and knowledgeable national-level trainer with the intent to inspire and motivate all staff.
            * Capture the enthusiasm and move with it quickly.
            * Work intensively with the “early adopters” and support them in every way possible.
            * Support and encourage most of the EI staff….those who will be hesitant and cautious. They need to watch their early-adopter colleagues, experience a “win” themselves, and see the positive impacts of this evidence-based model.
            * Ignore the resisters (assuming this is a small percentage of the staff).
            * Discuss it at EVERY staff meeting and at all one-on-one meetings/encounters with staff.
            * Be relentless in keeping any momentum moving forward…once the ship is moving don’t allow it to set back down in the water.
            * Coach – coach – coach each individual staff member. Just as we are expecting EI staff to coach families (which is both a science and an art) supervisors need to be adept at demonstrating strong coaching skills with staff. I love Rush and Shelden’s work in coaching (The Early Childhood Coaching Handbook) and a supervisor can easily take their concepts into coaching staff.

            To quote Dr Winnie Dunn once again, “Be courageous!”

          • This are fantastic strategies! You’re absolutely right, it does take a certain amount of courage and a lot of persistence to help your staff pave a new way. I love the ideas about keeping up the momentum and talking about the new practice at every staff meeting. I think the strategy that could be most challenging is ignoring the resisters – they can have such an impact on a group’s morale. I’ve found that resistance is usually a response to fear – fear of change, of the unknown, of learning something new. Helping them get over their fear and, like you said, see the successes, is key. Thanks so much for sharing your thoughts!

            I also LOVE it that our blog is stimulating discussion among your staff! I’d love to hear more about how you all use the articles for discussions. Let me know if you all come up with any great ideas for topics too! I’m always open to ideas and feedback!

  3. “Families do not have routines” is something I have heard even from my own staff. Of course we had the conversation that all families have routines. It was not until my daughter had her first baby and was talking about the difference between a routine and a schedule that I figured out an easy way to answer ” not all families have schedules “.
    “All families have routines, not all families have schedules”.

    People can grasp that idea.

    • What a great suggestion, Barbara! This subtle difference is how you address this is very powerful. It does make it more clear. Thanks for sharing!

      I’m wondering what other suggestions you might have for other supervisors who are trying to help their staff get beyond this. Like what questions would you recommend a provider ask to get beyond the family schedule and learn about routines? I really think that, even with the quietest families, it’s all about how we ask the questions and gather the information.

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