A set of new referrals comes across your desk: two children in the same family. Twins! Wow, you think…twice the paperwork, twice the visits, twice the fun. The funny thing is that 
you probably wouldn’t have balked if you’d just gotten two referrals about children from different families. Why is it that multiples in the same family, whether they are twins, triplets, or siblings, seem like so much more work?
Supporting Families of Multiples – How Do You Do It?
You might be thinking: the intake could take twice as long, the assessment at least an extra hour, and then intervention visits – will there be a really long visit to address IFSP outcomes for both children, or separate visits for each child? When you look at EI this way, it can seem overwhelming. Or, maybe there’s another way to think about it? Let’s look at a few strategies for managing the EI process with families of multiples.
Offer choices – This goes for intake, assessments, IFSP meetings, and intervention visits. The family might want to focus on each child separately, or mimic real life and manage EI activities together. The benefit of one visit for both children to complete the intake, assessment or IFSP meeting could be that you only have to explain paperwork and processes once. The challenge might be with having to keep track of screening/assessment/intervention activities and completing paperwork for multiple children in one sitting.
Get organized and prepare BEFORE the visit – This is the secret to success with multiples. Clip each child’s paperwork together or keep it in separate working folders of different colors for your visit. Complete as much of the paperwork before the visit as you can by filling in dates, demographics, history, your signatures, etc. Make it easy to move through the paperwork with everything well-labeled and organized.
Take your time during service coordination visits – Avoid rushing the parent through duplicate paperwork. Ask if you need to explain something again. If it’s overwhelming for you, imagine how the parent might feel with learning a new system for more than one child.
Think about each child as an individual… – Develop unique IFSP outcomes for each child; you should not be able to substitute each child’s name in the same outcome (if you can, it’s not individualized). When determining services and frequency, focus on recommendations to address each child’s unique outcomes. It’s hard not to mesh the children together, but each has his or her own strengths and needs.
…And then think about the family as a unit – The reality is, with siblings or twins, their experiences are closely linked with each other. Families don’t function child by child; they function as a system where what any one member needs or does affects the others. Once you have the outcomes written for each child, and the team has discussed service options, think again about how to implement those services with the whole family in mind. This is where creativity can come in and when family input is so crucial.
Intervention Visits – How Often? How Long? On Whom Do You Focus?
Mapping out services is important for any child and family, but it can be a little more complicated for families of multiples. When the team collaborates and keeps the family at its center, intervention can go smoothly for everyone. Consider these key questions as you plan for EI services:
How Often? How Long? – If two (or more) children will receive services from the same discipline/provider, then maybe that provider could see both children during a single visit, if that works for the family. For example, if the visit is 90 min long, then each twin’s IFSP would list 45 min as the service intensity. As another example, if siblings receive different services 1x/week, then there could be more than one visit with the family each week, or providers could co-treat. Whatever frequency and intensity works, it’s important to be sure that each child’s outcomes are being addressed.
On Whom Do You Focus During the Visit? – Each child should receive his or her service at the frequency and intensity listed on the IFSP. However, this does not necessarily mean that the first half of the visit focuses on one child and the last half focuses on the other. It also does not mean that one twin’s visit must exclude the other to avoid confusion. Everyday routines and activities, which are the context of intervention, don’t work that way! The skillful service provider must be aware of each child’s outcomes and find ways to help the parent integrate and address them for both children during family activities. Sure, the provider and the parent might focus on one child for a little while, then switch to the other, but the provider must keep in mind that most likely, daily routines include both children much of the time. Whenever possible, observe both children with the parent in the routine or activity, help the parent think about how to address their development (e.g., prompting one child to ask for the ball while the other practices stooping to pick the ball up), and weave strategies into the routine that support them both. The focus of the visit really should be on helping the parent with both children!
Final tip: Write it down! – Especially with multiples, write the routine and strategies down to make it easier for the parent to remember the joint plan. Revisit the plan at the next visit and build from there!
If you can show the family how to support both children’s development in the context of what they naturally do everyday, then intervention will hopefully be easier and more meaningful for everyone.
Share an example of how you’ve collaborated with a family of multiples or siblings receiving EI. What did you do? How often did you visit the family? What worked well and where did you struggle?
