280 -Infant Toddler Development Part 2
Counselor Toolbox

 
 
00:00 / 64:12
 
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ITDS Module 2
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs Counselor Education
Podcast Host: Counselor Toolbox, Addiction Counselor Exam Review and Happiness Isn’t Brain Surgery

Note
• This presentation is designed for counselors as well as early intervention specialists and family team members. Some information may be review for some people.
Objectives
• Define teams and teaming
• Describe the basic tenets of systems theory, as applied to early intervention teams
• Discuss the teaming process in all stages of early intervention, from first contacts to transition
• Understand the importance of ‘enablement'
• Discuss the five components of the early intervention model
• Understand how ecomaps can be used as relationship-building tools
• Appreciate the ‘The Goose Story' as a metaphor for teams and systems
• Discuss how preconceptions, attitudes and beliefs influence team behavior
• Discuss barriers to effective communication
• Describe the components of a successful team meeting
• Describe the stages of team development
• Identify qualities of effective teams/families

5 Components for Early Intervention
• Understanding family ecology using an ecomap
• Functional intervention planning using a routines-based interview
• Functional child outcomes are those that address participation or engagement needs, that address independence needs, and that address social-relationship needs
• Routines are naturally occurring activities happening with some regularity
• Integrated services with a primary service provider
• Effective, support-based home visits
• Collaborative consultation to child care
Principles
• All the intervention with the child occurs between specialists’ visits.
• Therapy and instruction are not golf lessons.
• Children cannot transfer skills well from one learning setting, especially a decontextualized one, to everyday life, where they need the skills.
• Caregivers need to own the goals, and are not likely to address target behaviors in which they have little investment
• Caregivers influence the child. Professionals influence the family.
• Children learn throughout the day
• When parents provide interventions in daily routines, they are more likely to feel empowered.
• It is maximal intervention the child needs, not maximal services.

Ecomap (Brofenbrenner)
5 Stages of Functional Intervention Planning
• Five stages were delineated:
• Family and staff preparation for the interview
• The routines-based interview itself
• Outcome selection by the family
• Writing of objectives and strategies by professionals with family input
• Review in subsequent months

6 Questions for the Routine-Based Interview
• What does everyone else do? For home routines, this means other family members; for classroom routines, it means other children.
• What does the child do?
• What is his or her engagement like how and how much does the child participate in the routine?
• What is his or her independence like? How much can the child do by him or herself?
• What are his or her social relationships like? How does the child communicate and get along with others?
• How satisfied is the caregiver with the routine?
During the Implementation Stage
• Use a child's strengths to enhance learning in the natural environment
• Remember that the relationship with the family is the context for intervention
• Offer appropriate anticipatory guidance with respect to social, emotional and behavioral issues
• Work cooperatively across disciplines. Be partners, not competitors

Questions for Visits
• Remember he 4 Es: Ears (listen), Elicit (ask), Empathize, Encourage
• Questions
• How have things been going?
• Do you have anything new you want to ask me about?
• How have things been going with each IFSP outcome, in priority order?
• Is there a time of day that’s not going well for you?
• How is [family member] doing?
• Have you had any appointments in the past week? Any coming up?
• Do you have enough or too much to do with [your child]?
• For each question, use the following follow-up prompts:
• Do you need any information to help with this?
• Should we try to solve this?
• Would you like me to show you

Empowering (Enabling) Caregivers
• The goal of enablement is to increase caregiver self-sufficiency
• Techniques
• Joining– “We” terms, ask for parent’s expert opinion
• Amplification: Notice resources, describe the event positively, initiate a conversation that has the caregiver take ownership of the event.
• Johnny seems much more engaged and focused today. What have you been doing that has brought this about?

Helping Parents (and Teams) with Communication
• Good communication involves
• Approaching interactions positively, with an open mind
• Listening attentively to your fellow team members
• Maintaining awareness of your internal state and body language
• Accurately interpreting the non-verbal communications of others
• Using the proper tone of voice
• Choosing the right words
• Delivering your message at the appropriate time

Barriers to Effective Communication
• Moralizing: Telling youth what they ‘should' or ‘ought' to do
• Offering advice prematurely: Work with your child to generate a number of possible solutions
• Judging, criticizing, blaming: Own your own stuff (You don’t try. You are better than this. Your Dad taught you this…)
• Humor: Avoid ridiculing, teasing
• Dominating: Avoid talking too much, interrupting others, asking rapid-fire questions, giving ‘expert' advice
• Reassurances and diminishing responses: Avoid statements such as “cheer up,” “it's not that bad,” and “everything is going to be fine”
Barriers to Effective Communication
• Ego
• Differences in degree of knowledge
• Differing purposes for communicating
• The use of jargon and technical language
• One-way communication
• Emotional distance
• Assuming you know what the other person is going to say, or is feeling
• Feeling defensive
• Letting your mind wander
• Being in a hurry. The pressure of time.
Communication Styles
• Direct – To the point. Need to get to the bottom line quickly.
• Indirect – “Global” thinker. Looks at the big picture. May take more time to come to a decision.
• Dominating – In charge. May not always absorb input from another. Has a plan and wants to move it forward.
• Cooperative – Non-judgmental. Can serve in peacemaker role and bring others to consensus. May shy away from confrontation.
• Non-verbal – Does not actively engage in discussions, but silence may be the way they express themselves. Watch for body language.

Child Care Consultation
• The specialist can provide early intervention in six ways:
• One on one pull out
• Small-group pull out
• One on one in classroom
• Group activity (practice bouncing balls, talking about feelings, coloring)
• Individualized within routines (nap time, going to lunch, recess)
• Pure consultation

Characteristics of Systems
• Holistic: Systems are wholes. You have probably heard the expression ‘the whole is greater than the sum of the parts.’
• Interdependent: Since systems operate as wholes, an individual component of a system cannot be understood in isolation.
• Dynamic: Systems are dynamic and changing. Yet, within all systems, there is a strong tendency to maintain balance or homeostasis. This is why systems such as families and work teams tend to resist change.
• Complex and Non-linear: Systems are often described as complex and non-linear. The interactions and patterns of behavior among system components cannot be described in simple terms. Linear, cause and effect explanations are not sufficient to describe system events. In order to discuss systems, we must instead examine complex cycles and patterns of behavior over time
The Early Intervention Team as a System
• First Contacts
• Family and Service Coordinator
• Evaluation is to determine eligibility for early intervention services.
• Assessment is to obtain detailed information about a child's unique strengths and needs which is used for intervention planning.

The Early Intervention Team as a System
• Transdisciplinary Teams
• Foundation of the transdisciplinary team is collaboration
• One assessment is performed by the team and one integrated report is written by the team. This minimizes the inconvenience to families.
• Arena-style assessments: A single primary facilitator interacts with the child while parents and other team members observe and assist
• Family involvement is key

Guidelines for Transdisciplinary Teams
• The team should adopt a “strengths over deficits” approach
• Assessments should be conducted over time, in natural environments
• Emphasis should be placed on building and maintaining positive relationships with families
• Transdisciplinary assessments culminate in a single integrated report which incorporates information from
• The family's stated concerns, priorities and resources
• Observations of the child's behavior during the assessment
• The family's statements about what the child is able to do
• The results of the assessment instrument that is utilized
• Professional opinions and recommendations.

Transdisciplinary Team Meetings
• Be straightforward. Do not be evasive. The caregiver should not be put in the position of having to guess what you mean.
• Recognize the limitations of your own knowledge. It is acceptable to say “I don't know.”
• Avoid the use of professional jargon.
• Allow sufficient time for caregivers to ask questions and discuss their concerns
• Many early intervention meetings involve discussing and developing an action plan.
• Action plans specify goals, strategies for achieving those goals, the roles of particular team members, a timeframe for achieving each goal, and a method of reviewing progress.

Qualities of Effective Teams (and Families)
• Clear mission, goals and objectives
• Strong, supportive leadership
• Commitment
• Ownership and responsibility is shared
• Members are competent
• Communication is effective
• Atmosphere of trust and respect
• Self-awareness

Conflict Resolution
• The Competing person forces his own point without much consideration of the views of others. When tension escalates, the person pushes harder and harder.
• Why, what problems does it cause and how can we address it?
• The Accommodating person also sees conflict as a ‘win or lose' situation, but instead of intending to win, this person is resigned to losing.
• Why, what problems does it cause and how can we address it?
• The Avoiding type of person tends to sweep conflict ‘under the rug' and pretend that it does not exist.
• Why, what problems does it cause and how can we address it?
• The Compromising person prefers to meet the other party halfway.
• The Collaborating style looks for ‘win-win' solutions
Conflict Resolution
• Disagreements viewed as opportunities to learn
• Clarify the conflict/Seek to understand
• Develop awareness of personal motives
• Find positive points of agreement
• Generate alternative solutions
• Build a reciprocal bank account
• Commit to action/implement
• Monitor/Evaluate

Stages of Team Development
• Forming: A new group forms. Members are anxious and unsure of themselves. An atmosphere of uncertainty prevails.
• Storming: The team experiences conflict and tension as team members discard the superficial roles that characterized the Forming stage. Members struggle to define their roles in the group. Control issues are central.
• Norming: The team settles into a normative pattern. Ground rules and procedures have been established. The team is now much better able to focus on accomplishing specific tasks
• Performing: The team has become self-regulating and productive. There is pride in membership. The team is collaborating and meeting its goals.

Goose Teams
• When you see geese flying along in “V” formation, you might consider what science has discovered as to why they fly that way:
• As each bird flaps its wings, it creates an uplift for the bird immediately following. By flying in “V” formation, the whole flock adds at least 71 percent greater flying range than if each bird flew on its own.
• People who share a common direction and sense of community can get where they are going more quickly and easily because they are traveling on the thrust of one another.
• We will stay in formation with those people who are headed the same way we are.
• When the lead goose gets tired, it rotates back and another goose flies point.
• It is sensible to take turns doing demanding jobs.
• Geese honk from behind to encourage those up front to keep up their speed.
• Encourage eachother
Cultural Awareness
• Reflect on how the following factors have shaped your attitudes, beliefs, values and behavior:
• Your upbringing
• Your education (formal and informal)
• Your religious beliefs
• Your political beliefs
• Your culture and your ethnicity
• Your close relationships
• Your most powerful personal experiences (positive and negative)

Cultural Awareness
• Think about how the above factors have influenced your views about – child development
• Typical vs. Atypical child behavior
• Healthy vs. Dysfunctional families
• Appropriate methods of disciplining children
• Appropriate teaching methods
• Appropriate boundaries between children and adults
• The expression of emotion
• The expression of physical affection
• The importance (or lack of importance) of extended family
• The relative importance of educational pursuits, creative pursuits, social networks, personal development

Cultural Considerations
• Importance of saving face in some cultures
• Importance of preserving harmony – not being confrontational
• Emphasis on indirectness and subtlety

Summary
• First encounters, such as the intake visit, need to emphasize the family
• Interventions should address real-life, day-to-day needs
• We should maximize interventions or learning opportunities, which are not the same as “services”, for children
• Home visits need to be focused on emotional, material, and informational support
• Consultation to child care needs to ensure that teachers embed interventions.
• There are different types of conflict and different conflict management styles.
• Problems should be viewed as opportunities for team building and approached with the goal of arriving at a win-win solution.
• The overall mission or purpose of the team or family should always be considered when solving problems and making decisions.

Other Videos
• Using Adult Learning Theory to Improve Treatment Delivery and Planning (YouTube Video)
• Cultural Considerations (YouTube Video Series)
• Communication Skills Review (YouTube Video)