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EI Research to Practice Brief #4 – Participation-based Practices Result in More Engaged Children and Caregivers

Where are your practices on the traditional vs. participation-based continuum?

Wherever you are on the continuum, take some time to examine the6025324093_e153e84562_o similarities and differences between the two interventions, reflect on your own practices, and plan for how to evolve your work to a more evidence-based approach. This brief provides a summary of research by Campbell & Sawyer (2007), who examined videotaped intervention visits to determine differences between traditional and participation-based intervention. One significant finding: parents and children are more engaged in general, and with each other, when intervention focused on the child’s participation in daily routines, rather than targeting missing skills. When parents and children are engaged, intervention is more likely to be meaningful, useful, and successful. Read on to learn more about how you can use participation-based intervention practices in your work with families.

Source: Campbell, P. H., & Sawyer, L. B. (2007). Supporting learning opportunities in natural settings through participation-based services. Journal of Early Intervention, 29(4), 287-305.

Research: What Do We Know?

The authors of this study examined 50 videotapes of “typical” visits from early interventionists from a variety of disciplines. Videos were analyzed using the Natural Environments Rating Scale (NERS) and the Home Visiting Observation Form (HVOF) to determine differences between traditional and participation-based intervention. Traditional intervention included learning activities planned by the interventionist that targeted specific skills, with the interventionist working directly with the child. In contrast, participation-based intervention focused on helping the child participate in naturally occurring learning opportunities and teaching caregivers how to interact with their children using intervention strategies to support participation. Strategies were incorporated into family routines and activities because they provided the context for the child’s participation. A primary differences between the two types of intervention were what roles the interventionist and the caregiver played in the service. The authors provide a detailed table in the article comparing the two types of intervention (p. 290).

Based on the review of the videotaped visits, the authors concluded that more visits showed traditional practices (70%!) than participation-based practices, which is consistent with other EI literature. Despite what we know from the literature – that traditional practices are not most effective – they persist. When participation-based practices were used, children were more frequently rated as “very engaged” and the child or parent was more likely to be the leader of the activity. The interventionist acted more frequently as a facilitator with the parent-child-interventionist triad rather than providing more direct, child-focused intervention. Interventionists providing participation-based intervention engaged in more observation, used more modeling and verbal support, and focused more on the parent-child interaction. There was more caregiver involvement in general and more interaction with the child, with less time spent in a more passive role. In both types of intervention, materials in the home were used and play provided the context of triadic interactions between the parent, child, and provider. There was, however, a statistically significant difference between what occurred during traditional and participation-based intervention.

Practice: How Can You Use What You Know?

What practices can you start using to provide more participation-based intervention? Here are a few to get you started:

Videotape a few of visits – Use a similar method as was used in this study. Videotape a few visits (with parent permission) then compare your work with the table on pg 290 in the article. Reflect on whether your practices are more traditional or participation-based and why. This could be done individually, with a supervisor or mentor, or as a group staff development activity.

Step back and let them lead – Let go of your plan for the visit and let the parent and child lead. Try this with new families, or explain to a family you have a relationship with that you’d like to try something different. Keep the IFSP outcomes in mind and look for opportunities for learning and participation in whatever routine you find yourself in.

Spend more time actively observing – This was an important difference between the two approaches. Rather than “doing,” spend more time watching. Use what you learn from watching to provide guidance and support to help the parent adapt the routine so that the child can learn from it.

Focus on caregiver-child interactions – That’s where learning happens. Shift your focus from what you think YOU need to what the PARENT can learn to do.

Let go of assessment skills – What we learn at the assessment is important, but don’t let it be the guide for your intervention. Look at the bigger picture. How do children learn to use a pincer grasp in everyday life? Yes, the child isn’t standing in the middle of the floor for 5 seconds, so how can she learn this kind of balance while helping her dad rake leaves? Keep your eye on the prize – learning while participating in real life.

Where are you on the continuum? If your practices are more traditional, what’s your next step for becoming more participation-based? If you already focus on participation, what advice to you have for others?

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9 Comments to “EI Research to Practice Brief #4 – Participation-based Practices Result in More Engaged Children and Caregivers”

  1. From the numbers shared in this article, our team is not alone in struggling with this issue as well as capitalizing on daily routines.

    Our therapists say they don’t know how to do participation-based intervention and so continue with the traditional therapy with which they are comfortable. I have researched, and found a great deal of information for communication, but not for OT/PT.

    I am also not sure how EI policy dictates therapists to intervene for NICU grads with medical needs such as aspiration, trachs, enteral nutrition, and craniofacial anomalies such as cleft palates (my caseload – haha). Some sources claim that EI is ONLY developmental, but I see many medically fragile NICU grads. The nearest pediatric facilities are hours away, requiring parents risk job loss for time off.

    Are there readers who can provide links or comments about how OT/PT is intervening for babies and toddlers with impairments using participation-based practices?

    I am heading over to “Build the Blog” to make some suggestions….

    • Great question, Janet! You might want to head over to another post, the EI Research to Practice Brief #1, because we have a PT who just posted about this and I’ve asked her for her advice. Hopefully she’ll share some insights that you can pass along. You might want to look up more of Phillipa Campbell’s work in participation-based practices. She is an OT and she talks alot about collaborating with families around adaptations. M’Lisa Shelden, one of the gurus of coaching in EI, is at the Family Infant Preschool Program in NC and is also a PT so you might check with her for ideas too. Her work, and Pip Campbell’s, both offer great ideas. Folks in our staff are finding Rush and Shelden’s book, The Early Childhood Coaching Handbook, to be of great use and are doing book studies with it following training with the authors. If you need help finding articles, just shoot me an email and I’ll see what I can do (dcchildress@vcu.edu).

  2. Hello Dana:
    Thank you for bringing this study forward. I am a big fan of Dr. Campbell, having study under her back in 1995 when she was teaching “programming within activities and routines.” My commentary is to suggest that instead of letting go of assessment skills, we need to determine what is the most valuable information that should be gathering during the initial (and subsequent) assessment phase(s). Relevant information should carry directly over into program planning and help to identify the unique learning opportunities available within each family structure. This will set the stage beautifully for embedding strategies into routines. I believe this may actually help practitioners shift more easily from traditional to participation-based intervention. A good assessment makes a good plan. Your thoughts?

    • Great point, Pam! I so appreciate your insight. When I was thinking of letting go of assessment skills, I was thinking that we shouldn’t be “teaching to the test.” I absolutely agree with you that what we really need is to know what is important and how to use that relevant info during intervention. Assessment is important and does support a good plan when we translate what we learn from it into functional terms. Thanks for taking this point a little deeper! Hope your doc study is going well! 🙂

  3. I had the opportunity to observe a traditional therapy session in a rehab facility yesterday and was overwhelmed with how far we have evolved in Early Intervention. Yesterday, as I observed a very skilled therapist work with a child (whom I follow through EI), with the parent sitting off to the side and not participating, I found myself mentally calculating the number of natural occurring opportunities in which the family was already incorporating what the therapist was doing during her session during their routines and activities. There was quite an imbalance with natural opportunities far exceeding what was achieved in the hour of therapy. I trained and worked in a traditional medical model and my transition to participatory-based intervention was not without a little resistance and a few bumps in the road, but I’m happy to say that I’m a true convert now!

    • This is a fantastic reflection, Nancy. What a great opportunity to think about the differences between traditional therapy and early intervention using natural learning environment practices. I love it that you saw the natural learning opportunities that happened even in the clinic. What advice do you have for providers trained in a traditional medical model who are making the same transition to participation-based practices? Is there one nugget of advice you would share?

  4. Something I’ve been trying to work on lately is letting go of what I think I might be working on with the family that day. (I actually had to go back and delete what I originally wrote, working with the child!). I’ve been trying to shift my focus on asking how things have been going, if they have concerns right now, or if there’s something the parent would like to work on, whether it’s a skill or a routine. Sometimes letting go just means following whatever the parent and child are doing when I’m there. For this reason, I keep the child’s IFSP outcomes with me at each visit to review before going into each visit, so I can help the parent brainstorm how to meet these goals, or point out things they are already doing to meet those goals.
    I agree with Pamela Lang that a good assessment will make a good plan. I think it’s important to include information regarding the family’s priorities/routines/child interests within that assessment in order to make it a well rounded assessment. That is helpful when first going into the family’s home for home visits.

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