Early Intervention Services: Key Principles and Practices
In 2008, the OSEP TA Community of Practice on Part C Settings: Services in Natural Environments convened a national workgroup that produced several consensus documents on principles and practices validated through research, model demonstration and outreach projects. This page summarizes the output of that work.
See also: Literature Supporting Key Principles, Discipline-Specific Support
Seven Key Principles and Practices for Providing Early Intervention Services in Natural Environments
Mission: Part C early intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children's learning and development through everyday learning opportunities.
Each principle includes descriptive statements of what the principle "looks like" in practice. There are also descriptions of what it "doesn't look like"—too often, these practices are still used.
PRINCIPLE 1. Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts.
Key Concepts
- Learning activities and opportunities must be functional, based on child and family interest and enjoyment.
- Learning is relationship-based.
- Learning should provide opportunities to practice and build upon previously mastered skills.
- Learning occurs through participation in a variety of enjoyable activities.
Looks Like
- Using toys and materials found in the home or community setting
- Helping the family understand how their toys and materials can be used or adapted
- Identifying activities the child and family like to do which build on their strengths and interests
- Observing the child in multiple natural settings, using family input on child's behavior in various routines, using formal and informal developmental measures to understand the child's strengths and developmental functioning
- Helping caregivers engage the child in enjoyable learning opportunities that allow for frequent practice and mastery of emerging skills in natural settings
- Focusing intervention on caregivers' ability to promote the child's participation in naturally occurring, developmentally appropriate activities with peers and family members
- Assuming principles of child learning, development, and family functioning apply to all children regardless of disability label
Doesn't Look Like
- Using toys, materials and other equipment the professional brings to the visit
- mplying that the professional's toys, materials or equipment are the "magic" necessary for child progress
- Designing activities for a child that focus on skill deficits or are not functional or enjoyable
- Using only standardized measurements to understand the child's strengths, needs and developmental levels
- Teaching specific skills in a specific order in a specific way through "massed trials and repetition" in a contrived setting
- Conducting sessions or activities that isolate the child from his/her peers, family members or naturally occurring activities
- Assuming that certain children, such as those with autism, cannot learn from their families through naturally occurring learning opportunities
PRINCIPLE 2. All families, with the necessary supports and resources, can enhance their children's learning and development.
Key Concepts
- All means ALL (income levels, racial and cultural backgrounds, educational levels, skill levels, living with varied levels of stress and resources).
- The consistent adults in a child's life have the greatest influence on learning and development-not EI providers.
- All families have strengths and capabilities that can be used to help their child.
- All families are resourceful, but all families do not have equal access to resources.
- Supports (informal and formal) need to build on strengths and reduce stressors so families are able to engage with their children in mutually enjoyable interactions and activities.
Looks Like
- Assuming all families have strengths and competences; appreciating the unique learning preferences of each adult and matching teaching, coaching, and problem solving styles accordingly
- Suspending judgment, building rapport, gathering information from the family about their needs and interests
- Building on family supports and resources; supporting them to marshal both informal and formal supports that match their needs and reducing stressors
- Identifying with families how all significant people support the child's learning and development in care routines and activities meaningful and preferable to them
- Matching outcomes and intervention strategies to the families' priorities, needs and interests, building on routines and activities they want and need to do; collaboratively determining the supports, resources and services they want to receive
- Matching the kind of help or assistance with what the family desires; building on family strengths, skills and interests to address their needs
Doesn't Look Like
- Basing expectations for families on characteristics, such as race, ethnicity, education, income or categorizing families as those who are likely to work with early intervention and those who won't
- Making assumptions about family needs, interests, and ability to support their child because of life circumstances
- Assuming certain families need certain kinds of services, based on their life circumstances or their child's disability
- Expecting all families to have the same care routines, child rearing practices and play preferences
- Viewing families as apathetic or exiting them from services because they miss appointments or don't carry through on prescribed interventions, rather than refocusing interventions on family priorities
- Taking over and doing "everything" for the family or, conversely, telling the family what to do and doing nothing to assist them
PRINCIPLE 3. The primary role of a service provider in early intervention is to work with and support family members and caregivers in children's lives.
Key Concepts
- EI providers engage with the adults to enhance confidence and competence in their inherent role as the people who teach and foster the child's development.
- Families are equal partners in the relationship with service providers.
- Mutual trust, respect, honesty and open communication characterize the family-provider relationship.
Looks Like
- Using professional behaviors that build trust and rapport and establish a working "partnership" with families
- Valuing and understanding the provider's role as a collaborative coach working to support family members as they help their child; incorporating principles of adult learning styles
- Providing information, materials and emotional support to enhance families' natural role as the people who foster their child's learning and development
- Pointing out children's natural learning activities and discovering together the "incidental teaching" opportunities that families do naturally between the providers visits
- Involving families in discussions about what they want to do and enjoy doing; identifying the family routines and activities that will support the desired outcomes; continually acknowledging the many things the family is doing to support their child
- Allowing the family to determine success based on how they feel about the learning opportunities and activities the child/family has chosen
- Celebrating family competence and success; supporting families only as much as they need and want
Doesn't Look Like
- Being "nice" to families and becoming their friends
- Focusing only on the child and assuming the family's role is to be a passive observer of what the provider is doing "to" the child
- Training families to be "mini" therapists or interventionists
- Giving families activity sheets or curriculum work pages to do between visits and checking to see these were done
- Showing strategies or activities to families that the provider has planned and then asking families to fit these into their routines
- Basing success on the child's ability to perform the professionally determined activities and parent's compliance with prescribed services and activities
- Taking over or overwhelming family confidence and competence by stressing "expert" services
PRINCIPLE 4. The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child's and family members' preferences, learning styles.
Key Concepts
- Families are active participants in all aspects of services.
- Families are the ultimate decision makers in the amount, type of assistance and the support they receive.
- Child and family needs, interests, and skills change; the IFSP must be fluid, and revised accordingly.
- The adults in a child's life each have their own preferred learning styles; interactions must be sensitive and responsive to individuals.
- Each family's culture, spiritual beliefs and activities, values and traditions will be different from the service provider's (even if from a seemingly similar culture); service providers should seek to understand, not judge.
- Family "ways" are more important than provider comfort and beliefs (short of abuse/neglect).
Looks Like
- Evaluation/assessments address each family's initial priorities, and accommodate reasonable preferences for time, place and the role the family will play
- Preparing the family to participate in the IFSP meeting, reinforcing their role as a team member who participates in choosing and developing the outcomes, strategies, activities and services and supports
- Collaboratively tailoring services to fit each family; providing services and supports in flexible ways that are responsive to each family's cultural, ethnic, racial, language, socioeconomic characteristics and preferences
- Collaboratively deciding and adjusting the frequency and intensity of services and supports that will best meet the needs of the child and family
- Treating each family member as a unique adult learner with valuable insights, interests, and skills
- Acknowledging that the IFSP can be changed as often as needed to reflect the changing needs, priorities and lifestyle of the child and family
- Recognizing one's own culturally and professionally driven childrearing values, beliefs, and practices; seeking to understand, rather than judge, families with differing values and practices
- Learning about and valuing the many expectations, commitments, recreational activities and pressures in a family's life; using IFSP practices that enhance the families' abilities to do what they need to do and want to do for all family members
Doesn't Look Like
- Providing the same "one size fits all" evaluation and assessment process for each family/child regardless of the initial concerns
- Directing the IFSP process in a rote professional- driven manner and presenting the family with prescribed outcomes and a list of available services
- Expecting families to "fit" the services; giving families a list of available services to choose from and providing these services and supports in the same manner for every family
- Providing all the services, frequency and activities the family says they want on the IFSP
- Treating the family as having one learning style that does not change
- Expecting the IFSP document outcomes, strategies and services not to change for a year
- Acting solely on one's personally held childrearing beliefs and values and not fully acknowledging the importance of families' cultural perspectives
- Assuming that the eligible child and receiving all possible services is and should be the major focus of a family's life
PRINCIPLE 5. IFSP outcomes must be functional and based on children's and families' needs and family-identified priorities.
Key Concepts
- Functional outcomes improve participation in meaningful activities.
- Functional outcomes build on natural motivations to learn and do; fit what's important to families; strengthen naturally occurring routines; enhance natural learning opportunities.
- The family understands that strategies are worth working on because they lead to practical improvements in child and family life.
- Functional outcomes keep the team focused on what's meaningful to the family in their day to day activities.
Looks Like
- Writing IFSP outcomes based on the families' concerns, resources, and priorities
- Listening to families and believing (in) what they say regarding their priorities/needs
- Writing functional outcomes that result in functional support and intervention aimed at advancing children's engagement, independence, and social relationships
- Writing integrated outcomes that focus on the child participating in community and family activities
- Having outcomes that build on a child's natural motivations to learn and do; match family priorities; strengthen naturally occurring routines; enhance learning opportunities and enjoyment
- Describing what the child or family will be able to do in the context of their typical routines and activities
- Writing outcomes and using measures that make sense to families; using supportive documentation to meet funder requirements
- Identifying how families will know a functional outcome is achieved by writing measurable criteria that anyone could use to review progress
Doesn't Look Like
- Writing IFSP outcomes based on test results
- Reinterpreting what families say in order to better match the service provider's (providers') ideas
- Writing IFSP outcomes focused on remediating developmental deficits
- Writing discipline specific outcomes without full consideration of the whole child within the context of the family
- Having outcomes that focus on deficits and problems to be fixed
- Listing the services to be provided as an outcome (Johnny will get PT in order to walk)
- Writing outcomes to match funding source requirements, using medical language and measures (percentages, trials) that are difficult for families to understand and measure
- Measuring a child's progress by "therapist checklist/observation" or re-administration of initial evaluation measures
PRINCIPLE 6. The family's priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support.
Key Concepts
- The team can include friends, relatives, and community support people, as well as specialized service providers.
- Good teaming practices are used.
- One consistent person needs to understand and keep abreast of the changing circumstances, needs, interests, strengths, and demands in a family's life.
- The primary provider brings in other services and supports as needed, assuring outcomes, activities and advice are compatible with family life and won't overwhelm or confuse family members.
Looks Like
- Talking to the family about how children learn through play and practice in all their normally occurring activities
- Keeping abreast of changing circumstances, priorities and needs, and bringing in both formal and informal services and supports as necessary
- Planning and recording consultation and periodic visits with other team members; understanding when to ask for additional support and consultation from team members
- Having a primary provider, with necessary support from the team, maintain a focus on what is necessary to achieve functional outcomes
- Coaching or supporting the family to carry out the strategies and activities developed with the team members with the appropriate expertise; directly engaging team members when needed
- Developing a team based on the child and family outcomes and priorities, which can include people important to the family, and people from community supports and services, as well as early intervention providers from different disciplines
- Working as a team, sharing information from first contacts through the IFSP meeting when a primary service provider is assigned; all team members understanding each others on-going roles
- Making time for team members to communicate formally and informally, and recognizing that outcomes are a shared responsibility
Doesn't Look Like
- Giving the family the message that the more service providers that are involved, the more gains their child will make
- Limiting the services and supports that a child and family receive
- Providing all the services and supports through only one provider who operates in isolation from other team members
- Having separate providers seeing the family at separate times and addressing narrowly defined, separate outcomes or issues
- Providing services outside one's scope of expertise or beyond one's license or certification
- Defining the team from only the professional disciplines that match the child's deficits
- Having a disjointed IFSP process, with different people in early contacts, different evaluators, and different service providers who do not meet and work together with the family as a team
- Working in isolation from other team members with no regular scheduled time to discuss how things are going
PRINCIPLE 7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.
Key Concepts
- Practices must be based on and consistent with explicit principles
- Providers should be able to provide a rationale for practice decisions
- Research is on-going and informs evolving practices
- Practice decisions must be data-based and ongoing evaluation is essential
- Practices must fit with relevant laws and regulations
- As research and practice evolve, laws and regulations must be amended accordingly
Looks Like
- Updating knowledge, skills and strategies by keeping abreast of research
- Refining practices based on introspection to continually clarify principles and values
- Basing practice decisions for each child and family on continuous assessment data and validating program practice through continual evaluation
- Keeping abreast of relevant regulations and laws and using evidence-based practice to amend regulations and laws
Doesn't Look Like
- Thinking that the same skills and strategies one has always used will always be effective
- Using practices without considering the values and beliefs they reflect
- Using practices that "feel good" or "sound good" or are promoted as the latest "cure-all"
- Using practices that are contrary to relevant policies, regulations or laws
Agreed Upon Practices for Providing Early Intervention Services in Natural Environments
Key Concepts
- Learning activities and opportunities must be functional, based on child and family interest and enjoyment.
- Learning is relationship-based.
- Learning should provide opportunities to practice and build upon previously mastered skills.
- Learning occurs through participation in a variety of enjoyable activities.
Looks Like
- Using toys and materials found in the home or community setting
- Helping the family understand how their toys and materials can be used or adapted
- Identifying activities the child and family like to do which build on their strengths and interests
- Observing the child in multiple natural settings, using family input on child's behavior in various routines, using formal and informal developmental measures to understand the child's strengths and developmental functioning
- Helping caregivers engage the child in enjoyable learning opportunities that allow for frequent practice and mastery of emerging skills in natural settings
- Focusing intervention on caregivers' ability to promote the child's participation in naturally occurring, developmentally appropriate activities with peers and family members
- Assuming principles of child learning, development, and family functioning apply to all children regardless of disability label
Doesn't Look Like
- Using toys, materials and other equipment the professional brings to the visit
- mplying that the professional's toys, materials or equipment are the "magic" necessary for child progress
- Designing activities for a child that focus on skill deficits or are not functional or enjoyable
- Using only standardized measurements to understand the child's strengths, needs and developmental levels
- Teaching specific skills in a specific order in a specific way through "massed trials and repetition" in a contrived setting
- Conducting sessions or activities that isolate the child from his/her peers, family members or naturally occurring activities
- Assuming that certain children, such as those with autism, cannot learn from their families through naturally occurring learning opportunities
Key Concepts
- All means ALL (income levels, racial and cultural backgrounds, educational levels, skill levels, living with varied levels of stress and resources).
- The consistent adults in a child's life have the greatest influence on learning and development-not EI providers.
- All families have strengths and capabilities that can be used to help their child.
- All families are resourceful, but all families do not have equal access to resources.
- Supports (informal and formal) need to build on strengths and reduce stressors so families are able to engage with their children in mutually enjoyable interactions and activities.
Looks Like
- Assuming all families have strengths and competences; appreciating the unique learning preferences of each adult and matching teaching, coaching, and problem solving styles accordingly
- Suspending judgment, building rapport, gathering information from the family about their needs and interests
- Building on family supports and resources; supporting them to marshal both informal and formal supports that match their needs and reducing stressors
- Identifying with families how all significant people support the child's learning and development in care routines and activities meaningful and preferable to them
- Matching outcomes and intervention strategies to the families' priorities, needs and interests, building on routines and activities they want and need to do; collaboratively determining the supports, resources and services they want to receive
- Matching the kind of help or assistance with what the family desires; building on family strengths, skills and interests to address their needs
Doesn't Look Like
- Basing expectations for families on characteristics, such as race, ethnicity, education, income or categorizing families as those who are likely to work with early intervention and those who won't
- Making assumptions about family needs, interests, and ability to support their child because of life circumstances
- Assuming certain families need certain kinds of services, based on their life circumstances or their child's disability
- Expecting all families to have the same care routines, child rearing practices and play preferences
- Viewing families as apathetic or exiting them from services because they miss appointments or don't carry through on prescribed interventions, rather than refocusing interventions on family priorities
- Taking over and doing "everything" for the family or, conversely, telling the family what to do and doing nothing to assist them
PRINCIPLE 3. The primary role of a service provider in early intervention is to work with and support family members and caregivers in children's lives.
Key Concepts
- EI providers engage with the adults to enhance confidence and competence in their inherent role as the people who teach and foster the child's development.
- Families are equal partners in the relationship with service providers.
- Mutual trust, respect, honesty and open communication characterize the family-provider relationship.
Looks Like
- Using professional behaviors that build trust and rapport and establish a working "partnership" with families
- Valuing and understanding the provider's role as a collaborative coach working to support family members as they help their child; incorporating principles of adult learning styles
- Providing information, materials and emotional support to enhance families' natural role as the people who foster their child's learning and development
- Pointing out children's natural learning activities and discovering together the "incidental teaching" opportunities that families do naturally between the providers visits
- Involving families in discussions about what they want to do and enjoy doing; identifying the family routines and activities that will support the desired outcomes; continually acknowledging the many things the family is doing to support their child
- Allowing the family to determine success based on how they feel about the learning opportunities and activities the child/family has chosen
- Celebrating family competence and success; supporting families only as much as they need and want
Doesn't Look Like
- Being "nice" to families and becoming their friends
- Focusing only on the child and assuming the family's role is to be a passive observer of what the provider is doing "to" the child
- Training families to be "mini" therapists or interventionists
- Giving families activity sheets or curriculum work pages to do between visits and checking to see these were done
- Showing strategies or activities to families that the provider has planned and then asking families to fit these into their routines
- Basing success on the child's ability to perform the professionally determined activities and parent's compliance with prescribed services and activities
- Taking over or overwhelming family confidence and competence by stressing "expert" services
PRINCIPLE 4. The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child's and family members' preferences, learning styles.
Key Concepts
- Families are active participants in all aspects of services.
- Families are the ultimate decision makers in the amount, type of assistance and the support they receive.
- Child and family needs, interests, and skills change; the IFSP must be fluid, and revised accordingly.
- The adults in a child's life each have their own preferred learning styles; interactions must be sensitive and responsive to individuals.
- Each family's culture, spiritual beliefs and activities, values and traditions will be different from the service provider's (even if from a seemingly similar culture); service providers should seek to understand, not judge.
- Family "ways" are more important than provider comfort and beliefs (short of abuse/neglect).
Looks Like
- Evaluation/assessments address each family's initial priorities, and accommodate reasonable preferences for time, place and the role the family will play
- Preparing the family to participate in the IFSP meeting, reinforcing their role as a team member who participates in choosing and developing the outcomes, strategies, activities and services and supports
- Collaboratively tailoring services to fit each family; providing services and supports in flexible ways that are responsive to each family's cultural, ethnic, racial, language, socioeconomic characteristics and preferences
- Collaboratively deciding and adjusting the frequency and intensity of services and supports that will best meet the needs of the child and family
- Treating each family member as a unique adult learner with valuable insights, interests, and skills
- Acknowledging that the IFSP can be changed as often as needed to reflect the changing needs, priorities and lifestyle of the child and family
- Recognizing one's own culturally and professionally driven childrearing values, beliefs, and practices; seeking to understand, rather than judge, families with differing values and practices
- Learning about and valuing the many expectations, commitments, recreational activities and pressures in a family's life; using IFSP practices that enhance the families' abilities to do what they need to do and want to do for all family members
Doesn't Look Like
- Providing the same "one size fits all" evaluation and assessment process for each family/child regardless of the initial concerns
- Directing the IFSP process in a rote professional- driven manner and presenting the family with prescribed outcomes and a list of available services
- Expecting families to "fit" the services; giving families a list of available services to choose from and providing these services and supports in the same manner for every family
- Providing all the services, frequency and activities the family says they want on the IFSP
- Treating the family as having one learning style that does not change
- Expecting the IFSP document outcomes, strategies and services not to change for a year
- Acting solely on one's personally held childrearing beliefs and values and not fully acknowledging the importance of families' cultural perspectives
- Assuming that the eligible child and receiving all possible services is and should be the major focus of a family's life
PRINCIPLE 5. IFSP outcomes must be functional and based on children's and families' needs and family-identified priorities.
Key Concepts
- Functional outcomes improve participation in meaningful activities.
- Functional outcomes build on natural motivations to learn and do; fit what's important to families; strengthen naturally occurring routines; enhance natural learning opportunities.
- The family understands that strategies are worth working on because they lead to practical improvements in child and family life.
- Functional outcomes keep the team focused on what's meaningful to the family in their day to day activities.
Looks Like
- Writing IFSP outcomes based on the families' concerns, resources, and priorities
- Listening to families and believing (in) what they say regarding their priorities/needs
- Writing functional outcomes that result in functional support and intervention aimed at advancing children's engagement, independence, and social relationships
- Writing integrated outcomes that focus on the child participating in community and family activities
- Having outcomes that build on a child's natural motivations to learn and do; match family priorities; strengthen naturally occurring routines; enhance learning opportunities and enjoyment
- Describing what the child or family will be able to do in the context of their typical routines and activities
- Writing outcomes and using measures that make sense to families; using supportive documentation to meet funder requirements
- Identifying how families will know a functional outcome is achieved by writing measurable criteria that anyone could use to review progress
Doesn't Look Like
- Writing IFSP outcomes based on test results
- Reinterpreting what families say in order to better match the service provider's (providers') ideas
- Writing IFSP outcomes focused on remediating developmental deficits
- Writing discipline specific outcomes without full consideration of the whole child within the context of the family
- Having outcomes that focus on deficits and problems to be fixed
- Listing the services to be provided as an outcome (Johnny will get PT in order to walk)
- Writing outcomes to match funding source requirements, using medical language and measures (percentages, trials) that are difficult for families to understand and measure
- Measuring a child's progress by "therapist checklist/observation" or re-administration of initial evaluation measures
PRINCIPLE 6. The family's priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support.
Key Concepts
- The team can include friends, relatives, and community support people, as well as specialized service providers.
- Good teaming practices are used.
- One consistent person needs to understand and keep abreast of the changing circumstances, needs, interests, strengths, and demands in a family's life.
- The primary provider brings in other services and supports as needed, assuring outcomes, activities and advice are compatible with family life and won't overwhelm or confuse family members.
Looks Like
- Talking to the family about how children learn through play and practice in all their normally occurring activities
- Keeping abreast of changing circumstances, priorities and needs, and bringing in both formal and informal services and supports as necessary
- Planning and recording consultation and periodic visits with other team members; understanding when to ask for additional support and consultation from team members
- Having a primary provider, with necessary support from the team, maintain a focus on what is necessary to achieve functional outcomes
- Coaching or supporting the family to carry out the strategies and activities developed with the team members with the appropriate expertise; directly engaging team members when needed
- Developing a team based on the child and family outcomes and priorities, which can include people important to the family, and people from community supports and services, as well as early intervention providers from different disciplines
- Working as a team, sharing information from first contacts through the IFSP meeting when a primary service provider is assigned; all team members understanding each others on-going roles
- Making time for team members to communicate formally and informally, and recognizing that outcomes are a shared responsibility
Doesn't Look Like
- Giving the family the message that the more service providers that are involved, the more gains their child will make
- Limiting the services and supports that a child and family receive
- Providing all the services and supports through only one provider who operates in isolation from other team members
- Having separate providers seeing the family at separate times and addressing narrowly defined, separate outcomes or issues
- Providing services outside one's scope of expertise or beyond one's license or certification
- Defining the team from only the professional disciplines that match the child's deficits
- Having a disjointed IFSP process, with different people in early contacts, different evaluators, and different service providers who do not meet and work together with the family as a team
- Working in isolation from other team members with no regular scheduled time to discuss how things are going
PRINCIPLE 7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.
Key Concepts
- Practices must be based on and consistent with explicit principles
- Providers should be able to provide a rationale for practice decisions
- Research is on-going and informs evolving practices
- Practice decisions must be data-based and ongoing evaluation is essential
- Practices must fit with relevant laws and regulations
- As research and practice evolve, laws and regulations must be amended accordingly
Looks Like
- Updating knowledge, skills and strategies by keeping abreast of research
- Refining practices based on introspection to continually clarify principles and values
- Basing practice decisions for each child and family on continuous assessment data and validating program practice through continual evaluation
- Keeping abreast of relevant regulations and laws and using evidence-based practice to amend regulations and laws
Doesn't Look Like
- Thinking that the same skills and strategies one has always used will always be effective
- Using practices without considering the values and beliefs they reflect
- Using practices that "feel good" or "sound good" or are promoted as the latest "cure-all"
- Using practices that are contrary to relevant policies, regulations or laws
Agreed Upon Practices for Providing Early Intervention Services in Natural Environments
Key Concepts
- EI providers engage with the adults to enhance confidence and competence in their inherent role as the people who teach and foster the child's development.
- Families are equal partners in the relationship with service providers.
- Mutual trust, respect, honesty and open communication characterize the family-provider relationship.
Looks Like
- Using professional behaviors that build trust and rapport and establish a working "partnership" with families
- Valuing and understanding the provider's role as a collaborative coach working to support family members as they help their child; incorporating principles of adult learning styles
- Providing information, materials and emotional support to enhance families' natural role as the people who foster their child's learning and development
- Pointing out children's natural learning activities and discovering together the "incidental teaching" opportunities that families do naturally between the providers visits
- Involving families in discussions about what they want to do and enjoy doing; identifying the family routines and activities that will support the desired outcomes; continually acknowledging the many things the family is doing to support their child
- Allowing the family to determine success based on how they feel about the learning opportunities and activities the child/family has chosen
- Celebrating family competence and success; supporting families only as much as they need and want
Doesn't Look Like
- Being "nice" to families and becoming their friends
- Focusing only on the child and assuming the family's role is to be a passive observer of what the provider is doing "to" the child
- Training families to be "mini" therapists or interventionists
- Giving families activity sheets or curriculum work pages to do between visits and checking to see these were done
- Showing strategies or activities to families that the provider has planned and then asking families to fit these into their routines
- Basing success on the child's ability to perform the professionally determined activities and parent's compliance with prescribed services and activities
- Taking over or overwhelming family confidence and competence by stressing "expert" services
Key Concepts
- Families are active participants in all aspects of services.
- Families are the ultimate decision makers in the amount, type of assistance and the support they receive.
- Child and family needs, interests, and skills change; the IFSP must be fluid, and revised accordingly.
- The adults in a child's life each have their own preferred learning styles; interactions must be sensitive and responsive to individuals.
- Each family's culture, spiritual beliefs and activities, values and traditions will be different from the service provider's (even if from a seemingly similar culture); service providers should seek to understand, not judge.
- Family "ways" are more important than provider comfort and beliefs (short of abuse/neglect).
Looks Like
- Evaluation/assessments address each family's initial priorities, and accommodate reasonable preferences for time, place and the role the family will play
- Preparing the family to participate in the IFSP meeting, reinforcing their role as a team member who participates in choosing and developing the outcomes, strategies, activities and services and supports
- Collaboratively tailoring services to fit each family; providing services and supports in flexible ways that are responsive to each family's cultural, ethnic, racial, language, socioeconomic characteristics and preferences
- Collaboratively deciding and adjusting the frequency and intensity of services and supports that will best meet the needs of the child and family
- Treating each family member as a unique adult learner with valuable insights, interests, and skills
- Acknowledging that the IFSP can be changed as often as needed to reflect the changing needs, priorities and lifestyle of the child and family
- Recognizing one's own culturally and professionally driven childrearing values, beliefs, and practices; seeking to understand, rather than judge, families with differing values and practices
- Learning about and valuing the many expectations, commitments, recreational activities and pressures in a family's life; using IFSP practices that enhance the families' abilities to do what they need to do and want to do for all family members
Doesn't Look Like
- Providing the same "one size fits all" evaluation and assessment process for each family/child regardless of the initial concerns
- Directing the IFSP process in a rote professional- driven manner and presenting the family with prescribed outcomes and a list of available services
- Expecting families to "fit" the services; giving families a list of available services to choose from and providing these services and supports in the same manner for every family
- Providing all the services, frequency and activities the family says they want on the IFSP
- Treating the family as having one learning style that does not change
- Expecting the IFSP document outcomes, strategies and services not to change for a year
- Acting solely on one's personally held childrearing beliefs and values and not fully acknowledging the importance of families' cultural perspectives
- Assuming that the eligible child and receiving all possible services is and should be the major focus of a family's life
PRINCIPLE 5. IFSP outcomes must be functional and based on children's and families' needs and family-identified priorities.
Key Concepts
- Functional outcomes improve participation in meaningful activities.
- Functional outcomes build on natural motivations to learn and do; fit what's important to families; strengthen naturally occurring routines; enhance natural learning opportunities.
- The family understands that strategies are worth working on because they lead to practical improvements in child and family life.
- Functional outcomes keep the team focused on what's meaningful to the family in their day to day activities.
Looks Like
- Writing IFSP outcomes based on the families' concerns, resources, and priorities
- Listening to families and believing (in) what they say regarding their priorities/needs
- Writing functional outcomes that result in functional support and intervention aimed at advancing children's engagement, independence, and social relationships
- Writing integrated outcomes that focus on the child participating in community and family activities
- Having outcomes that build on a child's natural motivations to learn and do; match family priorities; strengthen naturally occurring routines; enhance learning opportunities and enjoyment
- Describing what the child or family will be able to do in the context of their typical routines and activities
- Writing outcomes and using measures that make sense to families; using supportive documentation to meet funder requirements
- Identifying how families will know a functional outcome is achieved by writing measurable criteria that anyone could use to review progress
Doesn't Look Like
- Writing IFSP outcomes based on test results
- Reinterpreting what families say in order to better match the service provider's (providers') ideas
- Writing IFSP outcomes focused on remediating developmental deficits
- Writing discipline specific outcomes without full consideration of the whole child within the context of the family
- Having outcomes that focus on deficits and problems to be fixed
- Listing the services to be provided as an outcome (Johnny will get PT in order to walk)
- Writing outcomes to match funding source requirements, using medical language and measures (percentages, trials) that are difficult for families to understand and measure
- Measuring a child's progress by "therapist checklist/observation" or re-administration of initial evaluation measures
PRINCIPLE 6. The family's priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support.
Key Concepts
- The team can include friends, relatives, and community support people, as well as specialized service providers.
- Good teaming practices are used.
- One consistent person needs to understand and keep abreast of the changing circumstances, needs, interests, strengths, and demands in a family's life.
- The primary provider brings in other services and supports as needed, assuring outcomes, activities and advice are compatible with family life and won't overwhelm or confuse family members.
Looks Like
- Talking to the family about how children learn through play and practice in all their normally occurring activities
- Keeping abreast of changing circumstances, priorities and needs, and bringing in both formal and informal services and supports as necessary
- Planning and recording consultation and periodic visits with other team members; understanding when to ask for additional support and consultation from team members
- Having a primary provider, with necessary support from the team, maintain a focus on what is necessary to achieve functional outcomes
- Coaching or supporting the family to carry out the strategies and activities developed with the team members with the appropriate expertise; directly engaging team members when needed
- Developing a team based on the child and family outcomes and priorities, which can include people important to the family, and people from community supports and services, as well as early intervention providers from different disciplines
- Working as a team, sharing information from first contacts through the IFSP meeting when a primary service provider is assigned; all team members understanding each others on-going roles
- Making time for team members to communicate formally and informally, and recognizing that outcomes are a shared responsibility
Doesn't Look Like
- Giving the family the message that the more service providers that are involved, the more gains their child will make
- Limiting the services and supports that a child and family receive
- Providing all the services and supports through only one provider who operates in isolation from other team members
- Having separate providers seeing the family at separate times and addressing narrowly defined, separate outcomes or issues
- Providing services outside one's scope of expertise or beyond one's license or certification
- Defining the team from only the professional disciplines that match the child's deficits
- Having a disjointed IFSP process, with different people in early contacts, different evaluators, and different service providers who do not meet and work together with the family as a team
- Working in isolation from other team members with no regular scheduled time to discuss how things are going
PRINCIPLE 7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.
Key Concepts
- Practices must be based on and consistent with explicit principles
- Providers should be able to provide a rationale for practice decisions
- Research is on-going and informs evolving practices
- Practice decisions must be data-based and ongoing evaluation is essential
- Practices must fit with relevant laws and regulations
- As research and practice evolve, laws and regulations must be amended accordingly
Looks Like
- Updating knowledge, skills and strategies by keeping abreast of research
- Refining practices based on introspection to continually clarify principles and values
- Basing practice decisions for each child and family on continuous assessment data and validating program practice through continual evaluation
- Keeping abreast of relevant regulations and laws and using evidence-based practice to amend regulations and laws
Doesn't Look Like
- Thinking that the same skills and strategies one has always used will always be effective
- Using practices without considering the values and beliefs they reflect
- Using practices that "feel good" or "sound good" or are promoted as the latest "cure-all"
- Using practices that are contrary to relevant policies, regulations or laws
Agreed Upon Practices for Providing Early Intervention Services in Natural Environments
Key Concepts
- Functional outcomes improve participation in meaningful activities.
- Functional outcomes build on natural motivations to learn and do; fit what's important to families; strengthen naturally occurring routines; enhance natural learning opportunities.
- The family understands that strategies are worth working on because they lead to practical improvements in child and family life.
- Functional outcomes keep the team focused on what's meaningful to the family in their day to day activities.
Looks Like
- Writing IFSP outcomes based on the families' concerns, resources, and priorities
- Listening to families and believing (in) what they say regarding their priorities/needs
- Writing functional outcomes that result in functional support and intervention aimed at advancing children's engagement, independence, and social relationships
- Writing integrated outcomes that focus on the child participating in community and family activities
- Having outcomes that build on a child's natural motivations to learn and do; match family priorities; strengthen naturally occurring routines; enhance learning opportunities and enjoyment
- Describing what the child or family will be able to do in the context of their typical routines and activities
- Writing outcomes and using measures that make sense to families; using supportive documentation to meet funder requirements
- Identifying how families will know a functional outcome is achieved by writing measurable criteria that anyone could use to review progress
Doesn't Look Like
- Writing IFSP outcomes based on test results
- Reinterpreting what families say in order to better match the service provider's (providers') ideas
- Writing IFSP outcomes focused on remediating developmental deficits
- Writing discipline specific outcomes without full consideration of the whole child within the context of the family
- Having outcomes that focus on deficits and problems to be fixed
- Listing the services to be provided as an outcome (Johnny will get PT in order to walk)
- Writing outcomes to match funding source requirements, using medical language and measures (percentages, trials) that are difficult for families to understand and measure
- Measuring a child's progress by "therapist checklist/observation" or re-administration of initial evaluation measures
Key Concepts
- The team can include friends, relatives, and community support people, as well as specialized service providers.
- Good teaming practices are used.
- One consistent person needs to understand and keep abreast of the changing circumstances, needs, interests, strengths, and demands in a family's life.
- The primary provider brings in other services and supports as needed, assuring outcomes, activities and advice are compatible with family life and won't overwhelm or confuse family members.
Looks Like
- Talking to the family about how children learn through play and practice in all their normally occurring activities
- Keeping abreast of changing circumstances, priorities and needs, and bringing in both formal and informal services and supports as necessary
- Planning and recording consultation and periodic visits with other team members; understanding when to ask for additional support and consultation from team members
- Having a primary provider, with necessary support from the team, maintain a focus on what is necessary to achieve functional outcomes
- Coaching or supporting the family to carry out the strategies and activities developed with the team members with the appropriate expertise; directly engaging team members when needed
- Developing a team based on the child and family outcomes and priorities, which can include people important to the family, and people from community supports and services, as well as early intervention providers from different disciplines
- Working as a team, sharing information from first contacts through the IFSP meeting when a primary service provider is assigned; all team members understanding each others on-going roles
- Making time for team members to communicate formally and informally, and recognizing that outcomes are a shared responsibility
Doesn't Look Like
- Giving the family the message that the more service providers that are involved, the more gains their child will make
- Limiting the services and supports that a child and family receive
- Providing all the services and supports through only one provider who operates in isolation from other team members
- Having separate providers seeing the family at separate times and addressing narrowly defined, separate outcomes or issues
- Providing services outside one's scope of expertise or beyond one's license or certification
- Defining the team from only the professional disciplines that match the child's deficits
- Having a disjointed IFSP process, with different people in early contacts, different evaluators, and different service providers who do not meet and work together with the family as a team
- Working in isolation from other team members with no regular scheduled time to discuss how things are going
PRINCIPLE 7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.
Key Concepts
- Practices must be based on and consistent with explicit principles
- Providers should be able to provide a rationale for practice decisions
- Research is on-going and informs evolving practices
- Practice decisions must be data-based and ongoing evaluation is essential
- Practices must fit with relevant laws and regulations
- As research and practice evolve, laws and regulations must be amended accordingly
Looks Like
- Updating knowledge, skills and strategies by keeping abreast of research
- Refining practices based on introspection to continually clarify principles and values
- Basing practice decisions for each child and family on continuous assessment data and validating program practice through continual evaluation
- Keeping abreast of relevant regulations and laws and using evidence-based practice to amend regulations and laws
Doesn't Look Like
- Thinking that the same skills and strategies one has always used will always be effective
- Using practices without considering the values and beliefs they reflect
- Using practices that "feel good" or "sound good" or are promoted as the latest "cure-all"
- Using practices that are contrary to relevant policies, regulations or laws
Agreed Upon Practices for Providing Early Intervention Services in Natural Environments
Key Concepts
- Practices must be based on and consistent with explicit principles
- Providers should be able to provide a rationale for practice decisions
- Research is on-going and informs evolving practices
- Practice decisions must be data-based and ongoing evaluation is essential
- Practices must fit with relevant laws and regulations
- As research and practice evolve, laws and regulations must be amended accordingly
Looks Like
- Updating knowledge, skills and strategies by keeping abreast of research
- Refining practices based on introspection to continually clarify principles and values
- Basing practice decisions for each child and family on continuous assessment data and validating program practice through continual evaluation
- Keeping abreast of relevant regulations and laws and using evidence-based practice to amend regulations and laws
Doesn't Look Like
- Thinking that the same skills and strategies one has always used will always be effective
- Using practices without considering the values and beliefs they reflect
- Using practices that "feel good" or "sound good" or are promoted as the latest "cure-all"
- Using practices that are contrary to relevant policies, regulations or laws
These practices have been validated through research, model demonstration and outreach projects. They are model neutral, and don't endorsing a specific model or approach. The practices suggest a flow of activities that need to occur during the IFSP process—from first contacts through transition. They are not a sequential "checklist", and variation of implementation due to state and local procedures is inevitable.
A. First Contacts with Families from Referral to the IFSP Meeting
A-1. Become acquainted and establish rapport.
- Use communication styles and social behaviors that are warm and welcoming and respectful of family culture and circumstances.
- Ask what language the family usually speaks (mode of communication) and if any family members may want an interpreter. Explore their level of comfort with written documents.
- Balance the time listening to the family with sharing information.
- Let the family know that you are interested in exploring the family's concerns and working with them to find solutions.
A-2. Engage in a conversation to find out why the family is contacting early intervention and to identify the next appropriate step in the referral process.
- Use open-ended questions and/or comments such as "Why did you contact early intervention?" "What are your questions or concerns about Michael's health and development?" "If someone suggested that you call us, what were his/her concerns?" "What kind of information would be most useful to you?"
- If the child has a diagnosis, ask questions such as: "What has your doctor/nurse told you about Michael's diagnosis?" "What questions do you have about the diagnosis? "What questions or concerns do you have about how it might affect your child and family?"
- Listen for developmental "red flags" indicating an appropriate referral or a diagnosis that would make a child automatically eligible.
- Consider whether a child's development sounds typical enough that a screening may be a good idea before the full evaluation and assessment.
- Explain the general purpose of the early intervention program and how children and families are eligible. Provide public awareness materials.
- If a decision is made that early intervention is not appropriate at this time, explain that the family can contact the early intervention program any time up until the child turns three years old.
- Share with the family other appropriate community resources or services.
A-3. Describe early intervention as a system of supports and services for families to assist them in helping their children develop and learn.
- Discover family members' personal preferences for sharing and receiving information.
- Offer information in multiple formats.
- Explain how children learn best through everyday experiences and interactions with familiar people in familiar contexts. Explain how services work to support caregivers in making the most of the many learning opportunities.
- Explain how family members are "experts" in understanding their child and family circumstances and interests.
- Use the family's interests and concerns to offer concrete examples of how a service provider might work with the child and family.
- Explain that the early intervention program has rules and procedures that providers must follow.
- Show the family the location of the procedural safeguards written in the program materials and tell them that you'll review these at different points in the process.
- Describe the kinds of information that will be important in the assessment process. Explain confidentiality. Make sure that the family knows that they should only share information they are comfortable sharing.
A-4. As applicable, conduct a developmental screening.
- Follow state and local procedures about providing written prior notice and obtaining consent for screening. Always explain the meaning and intent of pertinent procedural safeguards.
- Ask engaging questions that invite the family to share their thoughts and concerns about their child's development.
- Explain that there is an age range when children learn certain skills and abilities and that screening is a quick way to determine how a child is doing.
- When implementing a screening protocol clearly describe the process with the family.
- Talk with families about what the screening is showing and ask for their observations of their child's behavior or other information they want to share.
- Come to agreement on the results of the screening and what the next steps should be.
- If the screening shows no concerns and the family does not want their child to be evaluated, describe other available community resources, as appropriate.
- Explain that the family can contact the early intervention program any time up until the child turns three years old.
- Leave the family with necessary information, such as how to contact the early intervention program, resources on developmental milestones, and information about other community resources.
- Follow state and local protocols about notifying the referral source about action taken on referral.
A-5. For children proceeding to evaluation/ assessment, explain the purpose and process, including the importance of gathering information about family concerns, priorities, and resources.
- Plan with the family how to address relevant individual, cultural, and linguistic characteristics that may influence assessment.
- Explain how family information can be used to know who to involve and how to conduct an appropriate evaluation/assessment.
A-6. Begin gathering information about the family's everyday routines and activities and the child's behavior and interactions with others in those contexts.
- Ask open-ended questions such as: "What activities do you and your child do throughout the day or a typical week?" "Describe how your child participates in those activities."
- Ask strengths- and interest-based questions such as "What activities go very well?" "What do you like to do together?" "What do you wish you could do together?"
- Ask questions about activities the family might find challenging such as "What's a tough time of the day or activity for you? "How does your child behave and interact with others in these challenging activities?"
- Use prompts and observations to encourage the family to describe their child's engagement/participation, independence, and social interaction in various routines and activities.
A-7. Discuss with the family the formal and informal supports they use or would like to use.
- Ask open ended questions such as: "Who's important to your child and other members of your family?" "Who do you call on for help?" "Who do you see regularly? Consider friends, relatives, members of your faith community or other community activities that you engage in."
- Ask the family members if they would like to be put in contact with other families in early intervention or family organizations that offer support.
- Inquire about formal services and other community programs the family uses or may wish to use (for example, medical, social services, Medicaid, recreation, place of worship).
A-8. Explore and identify the roles that the family may want to play in their child's evaluation and assessment process.
- Describe and discuss the evaluation and assessment process.
- Discuss who the family would like to include in the evaluation and assessment process.
- Use screening and family information to identify the team members and assessment styles to fit the needs and interests of the child and family.
- Schedule times and locations that are convenient to the family.
- Help the family decide how they want to participate in their child's evaluation and assessment, for example, assistant, facilitator, observer, assessor. Give concrete descriptions of the various ways they might participate using other families' scenarios as examples.
- Make a list with the family of specific questions they would like to have answered.
A-9. Provide written prior notice along with all the procedural safeguards, and ask the family to sign consent for evaluation and assessment and release of medical or other records.
- Explain that, just as the early intervention program cannot share information about the family without permission, it also needs the family's permission to ask other programs for information about their child and the family.
- Explain prior notice and review all the rights and procedural safeguards with the family, asking if they have any questions such as, "Is this clear and understandable?" "Do you have any questions about why we need to do it this way?"
A-10. Evaluate and assess the functional needs and strengths of the child.
- Use assessment procedures that ensure collaboration among the family and providers, including supporting the family to participate in the way they choose.
- Identify the child's skills that seem to be emerging.
- Observe the child's authentic behaviors in typical routines and activities.
- Use assessments that capture information about the child's interests, engagement, social relationships, and independence.
- Give equal weight to the family's observations and reports about their child's behaviors, learning, and development.
- Throughout the assessment process, reflect with the family about observations of the child's behaviors, summarize results, clarify and confirm that the family understands the process and results, and record the findings.
A-11. Throughout the assessment process, observe and ask the family about their teaching and learning strategies with their child.
- Observe and discuss with the family how they help their child learn.
- Offer compliments about how the family uses specific strategies that support the child's learning. Use concrete examples of how the family supported the child's skills during assessments.
A-12. Determine if the child is eligible and explain and provide written prior notice.
- Describe and discuss eligibility for the program.
- In order to make the eligibility decision, review and summarize findings, sharing perspectives among the team, which includes the family. If the team determines that the child is eligible, provide written prior notice, for both the eligibility decision and the IFSP meeting.
- If the child is not eligible, explain the team decision, provide written notice for the eligibility decision, including procedural safeguards and explain the process for filing a complaint if they disagree with the decision.
- If the child is not eligible, discuss and give information about available community resources, developmental milestones, and contacting the early intervention program in the future.
A-13. Describe the purpose and process, of the initial IFSP meeting, including a thorough explanation of the IFSP document.
- Explain that the family is an equal member of the early intervention team.
- Explain the various roles that the family might play in the meeting and explore how the family chooses to participate (for example, facilitator).
- Ask the family who they would like to invite to the meeting.
- Schedule times and locations that are convenient to the family.
- Describe the IFSP document as a dynamic plan, developed by the team that guides the provision of family-centered early intervention supports and services based upon the changing needs of the child and family.
B. The IFSP Meeting
B-1. Establish a welcoming and respectful climate for family members and caregivers as equal members of the IFSP team.
- Introduce all present as equal team members with essential input to share throughout the meeting.
- Clarify roles, for example service coordinator, facilitator, and note-taker.
- Encourage all team members to learn together, share observations, raise questions, and develop a functional plan.
- Avoid the use of jargon or explain what it means, so that everyone at the meeting understands terms that are used.
- Tailor interactions to the unique learning preferences and modes of communication of each adult.
B-2. Review the purpose and process (agenda) of the IFSP meeting. Review the IFSP document as a dynamic plan that will guide the provision of supports and services.
- Explain the meeting process thoroughly.
- Emphasize the family's role as an equal team member in developing the IFSP and in implementing, evaluating, and revising it over time.
- Explain the pertinent rights and procedural safeguards, and explain that the team will revisit these rights and safeguards throughout the IFSP process.
B-3. Collaboratively review information collected during early contacts regarding family concerns, priorities, and resources.
- Review and update family concerns, priorities, and resources in the context of the families' day-to-day life.
- Allow time for all of the team members to understand concerns from the family's perspective.
- Determine if there are any additional family needs or interests that the IFSP should address.
B-4. Collaboratively review information gathered previously about the child's health, development, and learning.
- Review and update health information pertinent to the child and the provision of early intervention support and services.
- Assure that the synthesis (report) of present levels of the child's development across all domains is functional and focused on skills, strengths, and behaviors rather than a rote recap of test scores.
- Review the child's unique abilities, emerging skills, and engagement or participation in various routines and activities.
B-5. Consider pre-literacy and language skills that are developmentally appropriate for the child.
- Talk with the family about the many ways they support language (pre-literacy) development through their daily activities.
- Consider outcomes or strategies to further support pre-literacy interests.
B-6. Collaboratively identify and write functional outcomes to be achieved for the child and the family.
- Discuss the outcomes the family wants to work on to enhance the child's development, engagement, social relationships, and independence in family and community routines and activities.
- Discuss the family outcomes that they want to include,
- Prioritize potential outcomes and choose which to work on first.
- Discuss what can be reasonably achieved in an agreed upon time frame.
- Write outcomes using active language that describe a desired and measurable end result, including what the routine/activity/behavior should look like and where/when/with whom it should occur. For example: "Abby will crawl to get toys out of her reach when playing on the floor, so she can play more independently."
B-7. Collaboratively plan and write strategies/activities, services, and supports to address outcomes and enhance participation and learning in natural environments.
- When developing strategies, activities and methods reinforce the positive, emphasize how caregivers and providers will work together, and indicate who will do what.
- What is the family already doing?
- What are the child's and family's interests?
- What family and community routines and activities could provide learning opportunities?
- What are the activities the family would like to participate in or try?
- What informal supports and services are needed to enhance participation and eliminate barriers or difficulties the family is experiencing or anticipating?
- Identify strategies/activities that enhance the child's natural learning opportunities; use toys, materials, interactions, and locations that are familiar and of interest to the child and family.
- Incorporate family strengths into strategies and activities that the family is comfortable implementing or put in place plans how to build those skills.
- Discuss and identify the informal supports and community services which can be used to address each outcome.
- Identify the primary service provider.
- Determinate the involvement of other team members in addressing each outcome.
- Consider the need for assistive technology or other adaptations to enhance the child's participation in targeted daily routines and activities.
- Finalize and list the formal early intervention services that the team decided upon, specifying frequency, intensity, and funding sources.
- List other formal services (beyond early intervention services) needed to meet outcomes.
- Review the balance of services and activities to determine if, as a whole, they support the family's everyday life or overwhelm the family.
- Remind the family and other team members that the family can accept or reject any service at any time and still participate in other early intervention services.
B-8. Identify the criteria, procedures, and timelines used to determine progress toward achieving each outcome.
- Ensure inclusion of measurable, functional criteria that any team member could use to review progress toward achieving each outcome.
- Use family-friendly language and verify the family understands in a supportive manner.
- Emphasis the critical role that families and caregivers play in sharing information with other team members about the status of progress made in achieving outcomes.
B-9. Provide justification of the extent, if any, to which services will not be provided in a natural environment.
- If the team decides that a specific child outcome cannot be met in a natural environment, write a sufficient justification.
- Make sure the justification includes a plan for how to move the child from the non-natural environment back into other settings at home or in the community once the specific outcome that could not be met in the natural environment is achieved.
- If services are provided in an exclusive/restricted environment, discuss plans for moving services to a natural environment.
B-10. Identify transitions that the child and family may be facing and identify useful supports.
- Assure that the family understands the timeframe for transition from early intervention and when transition planning should occur.
- If transition is eminent, develop an outcome and the strategies, services, and supports as appropriate (transition plan).
B-11. Identify the team member who will provide ongoing service coordination.
- Assign the service coordinator, based on state and local model of service coordination.
- Assure that the family has appropriate contact information and a good understanding of service coordination
- Explain how the family may ask for a change in service coordinator, if state policy and procedures address this issue.
B-12. Ensure the family understands relevant procedural safeguards and next steps.
- Review procedural safeguards related to providing consent for services and obtain written consent for IFSP services.
- Discuss the "timely" initiation of services.
- Make sure the family understands that changes can be made to the IFSP as needed.
- Give the family reports, records, and copies of the IFSP.
- Discuss confidentiality and family access to educational records.
- Agree upon next steps for all team members to begin services in a timely manner.
C. Ongoing Intervention Practices
C-1. Build on or establish trust and rapport.
- Before each visit, reflect on your own beliefs and values and how they might influence your suggestions and strategies with this particular family or caregiver.
- Use communication styles and social behaviors that are warm and welcoming and respectful of family culture and circumstances.
- Conduct yourself as a guest in the family's home or caregiver's setting.
- Respectfully provide complete and unbiased information in response to requests or questions.
- Be credible and follow through on plans you made with the family.
- If you don't know the answer to a question, tell the family you do not know but will find out for them. Tell them when you will get back to them with the information.
C-2. During the first visit, review the IFSP and plan together how the time can be spent.
- Describe the practical aspects of a visit and what the family or caregiver can expect. For example, the length of the typical visit, that other people are always welcome at the family's invitation, the variety of places in which visits can occur, or the program's cancellation policy.
- Describe examples of visits in various home and community settings where the family participates. You might want to offer to share clips from commercial or videos produced by your program.
- Invite the family to reflect on their experience with the IFSP process to date and share any concerns or questions.
- Review the IFSP document and assessment information.
- Consider each agreed upon outcome—is it what the family is still interested in? Prioritize again if necessary, where to begin. Change wording if needed. Provide any explanations to help family understand purpose.
- Discuss how outcomes, activities, and strategies can be a starting place for each home visit.
- Clarify who will work on each outcome—family, friends, other caregivers, service providers.
- Talk about community activities and events that can be used to support practice and mastery for the specific outcomes.
- If not previously done, ask the family to sign the IFSP, consent forms, and any other necessary documentation.
- Provide information about family-to-family support and parent groups that are available.
C-3. For on-going visits, use the IFSP as a guide to plan how to spend the time together.
- Begin each visit by asking-open ended questions to identify any significant family events or activities and how well the planned routines and activities have been going.
- Ask if there are any new issues and concerns the family wants to talk about. Explore if these concerns need to be addressed as new outcomes; if so, plan an IFSP review.
- Decide which outcomes and activities to focus on during the visit.
C-4. Participate with the family or other caregivers and the child in the activity and/or routine as the context for promoting new skills and behaviors.
- Offer a variety of options to families for receiving new information or refining their routines and activities, for example, face-to-face demonstrations, video, conversations, written information, audios, CDs, or diaries.
- Gather any needed toys and materials and begin the selected activity or routine.
- Listen, observe, model, teach, coach, and/or join the ongoing interactions of the family and child.
- Encourage the family to observe and assess the child's skills, behaviors, and interests (a continual part of on-going functional assessment). For example, ask the family if behaviors are typical, if they've seen new behaviors (suggesting emerging skills), or how much the child seems to enjoy the activity.
- Use a variety of consulting or coaching strategies throughout the activity, for example, observing, listening, attending, acknowledging, expanding, responding, probing, summarizing.
- Reflect with the family on what went well, what they want to continue doing, and what they would like to do differently at the next visit.
C-5. Jointly revise, expand, or create strategies, activities or routines to continue progress toward achieving outcomes and address any new family concerns or interests.
- Having listened throughout the visit, reflect on what you have heard that may suggest new outcomes or activities; explore with the family if this is something they want to address soon.
- Support and encourage family decisions.
- Focus recommendations on promoting the child's participation in everyday family and community life.
- Explain the "why" behind recommendations that you make so the family understands what to look for and do.
- Together, plan next steps and/or revise activities and strategies to build on the child and family's interests, culture, enjoyment, strengths.
- Consider any adaptations and augmentations to toys, materials, or environments that are necessary for success.
- Try out new strategies or activities to be sure family members or caregivers can do them on their own.
- Determine if and what type of support from other team members is needed for the next steps (for example, consultation, information, or co-visit.)
C-6. Modify services and supports to reflect the changing strategies, activities, or routines.
- Identify community activities and informal supports that will assist the outcomes and activities to be achieved.
- Facilitate referrals and provide any needed assistance, adaptations, or support for the family and the child to participate in desired community activities.
- Plan what early intervention and other services and supports are needed to help the child succeed and make progress.
- Add to or modify the IFSP as appropriate. If changes are significant (adding outcomes, or changing services, frequency, or intensity), a team review of the IFSP is necessary.
C-7. Prepare and assist with formal reviews and revisions of the IFSP.
- Minimally, at 6 months and annually, and any other time the family/provider team wants to make significant changes to the IFSP, plan the review meeting with the family.
- Review with the family questions, recommendations, or suggestions they wish to discuss with other service providers.
- Decide with the family the agenda for the meeting and their preferred role(s), including who should facilitate.
- Determine together who should be included in the "formal review meeting", when and where the meeting should occur.
- Explain and provide written prior notice for the review meeting.
- Conduct the review meeting and evaluate progress toward outcomes. Ensure all outcomes, services, and supports are still needed, current, and accurate. Make additions and revisions as needed.
C-8. Prepare families for transition out of Part C services.
- Early in the relationship with the family have conversations about what they want for their child's future after the early intervention program ends.
- At formal 6 month/annual IFSP reviews share written information about the "transition process" and options (no services, community services, and Part B services) and describe that early intervention services end at age three.
- By no later than the child's second birthday, have conversations about the types of programs, places, and activities the family would like their child to participate in at age three.
- Discuss and share information about ALL options available to children and families at age three.
- Provide written information about these options or assist the family as needed to explore and visit these options.
- Jointly review the IFSP and revise/add outcomes and strategies based upon the above discussions.
- Develop a transition plan which includes the outcomes and activities to prepare the child and family for success after early intervention.
C-9. Explain and follow the regulations, timelines, and procedures for transition plans, planning conferences, and data collection.
- Help the family prepare for any formal evaluations the child may need.
- Assist in arranging the formal (transition?) meeting with the program staff who may be working with the child after age three.
- Assist the family to find on-going family support if needed.
- Acknowledge feelings about ending the relationship with this family and help to focus on a positive future as the child and family move on.
- Celebrate with the family or caregiver the accomplishments and joys they have experienced with their child.
Developed by the Workgroup on Principles and Practices in Natural Environments
- Susan Addision
- Betsy Ayankoya
- Mary Beth Bruder
- Carl Dunst
- Larry Edelman
- Andy Gomm
- Barbara Hanft
- Cori Hill
- Joicey Hurth
- Grace Kelley
- Anne Lucas
- Robin McWilliam
- Stephanie Moss
- Lynda Pletcher
- Dathan Rush
- M'Lisa Shelden
- Mary Steenberg
- Judy Swett
- Nora Thompson
- Julianne Woods
- Naomi Younggren