If you are reading this blog post, you are very likely familiar with early intervention or birth to three programming. I have been a speech-language pathologist since 1980, and the last 25 years of my career I spent working with young children and coaching parents. During those 25 years, the model of providing service changed considerably.
I always felt very connected to parents and encouraged them to always be present during our speech and language therapy sessions. Encouraging parents to directly participate in therapy sessions and engage with their child was always important to me. I would have to say, though, that, during those earlier years, I primarily worked directly with the child, teaching the parent along the way. My approach and style to intervention had a positive effect on children and parents. I still feel that way, but oh how things have changed. With all the changes, though, I still believe this – Routines-Based Intervention and Parent Coaching include Direct Teaching.
I have had extensive training in the area of routines-based intervention, routines-based interviewing, and the parent coaching model of service. This model helped me see beyond just playing with a child in therapy. I am so grateful for the training I received.
After about 10 years, my service model changed dramatically. I started focusing more on parent coaching and family guided routines-based intervention as opposed to directly teaching the child. This model of service is something I fully embraced and continue to support. I became more effective on guiding parents, listening to them, and determining exactly what they can do to help their child every moment of their day. Let me explain, though, a factor that I encourage all early intervention providers to consider.
Are we providing an effective service for our clients?
There are many components to routines-based intervention. For an effective program, I encourage you to embrace all of them and be willing to adapt the components according to the needs of the child and parent. I have noticed a pattern that some service providers have adopted, and it goes against one of the components of routines-based intervention and parent coaching. I am concerned that with our change to parent coaching, we are sometimes creating confusion, frustration, and alienation for parents. Let me discuss what I feel has been avoided to a fault.
Direct Teaching has been avoided and inappropriately so.
Many providers have developed a very hands-off model, never working with the child or developing a rapport with him/her. The providers say that they never want a parent to feel inadequate by watching us work so easily with their child. I don’t disagree that this could happen, but I also know that the way we approach direct teaching is crucial to a parent’s comfort level. By avoiding direct teaching, I feel that we have perhaps created the exact opposite atmosphere of what we want to create. Remember that Routines-Based Intervention and Parent Coaching include Direct Teaching.
Are parents and/or caregivers getting what they need from the service we provide?
We have gotten so far away from working with the child directly and, because of that, have left some parents questioning the value of the services we provide. I have heard from too many parents that they were cancelling early intervention services. I also have heard parents who were so uncomfortable with “being observed.” I have heard from parents that providers didn’t consider a parent’s past experience with educators, culture, and comfort level. Parent coaching was created to empower parents, and I have found that we often follow a cookie-cutter approach that every parent has to conform to. I caution and encourage all of us to truly evaluate whether we are giving parents and kids what they need.
Why should we continue to incorporate some Direct Teaching?
Yes, routines based early intervention includes direct teaching. Don’t under-estimate the effect you have on parents and your clients. They listen to you and watch what you do. Parents want to know that you care about their child and that you are there to support them. They want to see first-hand that you think their child is awesome. They also want to know that you are good at what you do. Because of that and many other reasons, don’t under-estimate the power of direct teaching.
If you are an early intervention provider, I’m sure you are focused on routines-based intervention. At least, I hope you are. If not, please get some training in that model of service. Even if you work in a clinic versus a child’s home, you can and should embrace routines-based intervention and parent coaching.
What are the components to home visiting?
The components of routines-based intervention focus on caregivers interacting with their child. It also includes how you coach and guide caregivers and how you establish a relationship with the caregivers and child. Coaching involves listening, observing, determining the parents’ desires for their child, practical goal setting, guided practice, reflection, direct teaching, and much more. I fear, though, that we may forget that directly interacting with and teaching a child is also an important component to early intervention.
Don’t forget about Direct Teaching.
Direct teaching should not be forgotten, and there are many reasons why I believe this is essential to being an effective EI provider. I mentioned a few of them earlier in this article, but I will expound on this topic a bit. Hear me out as I explain some of my reasoning.
1. Exploring techniques that will work and doing that in the most efficient way –
Direct teaching allows you as a provider to explore techniques that you think may work with a child. Others can say that you should teach the parent to explore those techniques instead. That is certainly ideal, but at times, I need to explore certain ideas myself. I want to determine how effective they will be for a child and how easy they will be for a parent to incorporate into their day. I can accomplish this more rapidly if I explore the technique first.
Let’s face it. Our time with families is limited, so I always think about the most effective and efficient way to create the biggest change in the shortest amount of time. Direct teaching sometimes saves me valuable time, but it should NEVER be used as our only approach.
2. Direct teaching is valuable for those providers who are less experienced.
Direct teaching is also valuable for those of you who are newer to the field of early intervention and in working with young children. If you do not explore techniques directly with a child, you are missing your own personal growth that will make you a better parent coach. The manner in which you provide early intervention services will change depending on the parent’s experiences and needs, the child’s experiences and needs, but also the provider’s experiences. I did not become a parent coach until I had many years of experience working directly with children who exhibited a variety of speech and language delays and disorders. Those years of experience had a huge effect on my ability to coach parents.
3. Examining a parent’s comfort level –
Over the many years working with kids and their families, I have worked with an incredibly diverse group of parents. Every parent brings a different perspective, history, culture, expectation, and knowledge to the table, but, most of the time, one thing is always true. Parents care about their kids. We may not always agree with how they interact with their children, but we need to go in with an understanding and belief that parents are doing the best they can.
That belief also should change your approach and expectation of what a parent may be comfortable doing during a home visit. Get to know the parent, but approach it carefully. Perhaps ask them about where they grew up and how they as children typically played and participated in life. What interaction did their parents have with them when they were young?
I may also ask a parent their experience and comfort with educators. For example, my experience with parents who are immigrants has been that educators are held in high esteem. Having a provider like us in their home may cause a great deal of anxiety. Our expectation for them to be the primary teacher for their child is a delicate issue and one that should be approached with respect and with complete comfort for the parent.
Some parents are able to jump right into being observed, coached, and reflective about their interaction with their child. That immediate expectation can be very uncomfortable for other families. I have observed many situations over the years that I felt made the parent very uncomfortable. Meet the parent where they are. Establishing rapport is essential. Don’t jump in too fast.
If you are losing families to cancellations, no-shows, or discontinuing intervention completely, always analyze what you could have done differently. Perhaps your approach was too invasive, too uncomfortable for families who come from a very different perspective. Never walk away thinking it was because of a “difficult parent.” Yes, we will lose some families for a variety of reasons, but we have to always learn from those situations and know how to approach a parent differently the next time.
4. Showing the parent that you love their child.
There is something very special about showing a parent that you think their child is the coolest kid around. Kids who struggle often don’t get those positive interactions with others. Using direct teaching and direct interaction with a child shows the parent that you truly care about their little one. I have had countless parents tell me that the love I showed their child was a huge factor in them believing that their child will improve. They also felt that I was their biggest cheerleader in that journey.
5.Giving the parents the confidence that you are competent in your work and that you bring a knowledge to the table that parents need.
As I mentioned earlier, I have heard countless times that you never want to look more skilled than a parent in working with their child. The reason was that this will make the parent feel that they can’t possibly be an effective teacher for their child. The assumption is that the parent will feel defeated.
This belief has resulted in early intervention providers resorting to a “hands off” approach to home visits. I simply do not believe in this philosophy. Parents are welcoming you into their home, and they want to see that you are skilled and can offer knowledge that they do not have. If you approach your knowledge base with humility and compassion, you should not hesitate showing a parent that you can effectively work with their child. I always approach my own skills by first telling parents what skills THEY bring to the table that I don’t have. Show parents that you are a TEAM with them. This gives them the understanding that you will count on them for their expertise just as much as they will count on you.
Direct teaching can show parents so many things. Direct teaching can provide parents with ideas that they would not see any other way. Direct teaching can show a parent that YOU are on their team and that they are not alone.
Having said all of this, direct teaching should be used with caution.
Do not hesitate to utilize DIRECT TEACHING in your work with young children. But equally important, do NOT allow direct teaching to be the primary method or only method of your therapy.A child’s skills improved more rapicly when the parent was the primary partner in therapy sessions. I also knew that I was setting the stage for the parent to be his child’s valuable teacher throughout his life.
The dreaded therapy bag – Is it as bad as people say it is?
I rarely bring my own materials to a person’s home. The therapy bag filled with toys is seldom necessary and should not be the routine way of providing services in a child’s home. There are too many other daily routines that can be the focus of your sessions.
Eliminating a therapy bag is especially true in the initial visits with the family. I prefer to use what is available in a child’s home and what is related to a child’s daily routines. As therapy sessions continue, there are some exceptions to this rule.
I have brought items into a child’s home, but I only did so for very specific reasons. At times, I would bring some of the products I created to a child’s home if I felt that the child would improve more rapidly by using them. I would also bring them if I felt the parent would benefit from seeing a different way of helping their child. I would also bring novel toys at times for children who were on the autism spectrum and who could not engage with a person unless something novel was used.
You may have your favorite toys or materials that you use. Here are a few examples of items I would occasionally bring into the home. But please remember that these were used carefully and for very good reasons.
Animal Face Posters –
When a child doesn’t yet imitate verbally or take visual or verbal turns, I love using my animal face posters with a song to get that ball rolling. Go here to view a video teaching this song. Sometimes children need a visual cue to take a verbal turn. I found that these animal face posters were very effective in giving children the cue they needed to take a turn. I would always give parents loaner copies of these faces to practice throughout their week.
Talk It Rock It Songs and Visuals –
I also used my songs by giving parents loaner sets for speech and language practice. I rarely had time to use my songs during home visits. There were just too many other things to emphasize during a one-hour visit, but I knew which songs would be great to practice. As a result, I would give parents ideas on how to practice my songs depending on a child’s skills and needs. Never hesitate using my songs with a variety of different speech and language needs. I wrote them for kids with special needs. And my songs come with printable visuals, so you can create little books for your clients that they can keep. Songs WORK! Use coupon code, Songs50, to receive 50% off any song set.
Blast Off Board –
If you have students who need to practice imitating and saying sounds, sound sequences, words, and phrases in a fun way, the Blast Off Board is for you! If you have students who do not understand the skill of pointing or pointing to pictures upon request, the Blast Off Board is for you! Go here to see all of the benefits and features of this amazing set. I often used movement activities or the Blast Off Board for kids who needed drill and practice but would get bored with more standard approaches.
We all know that kids need books to be successful readers. Getting books into the hands of young children and their parents is essential. How we do that is often tricky, especially with families who have no books in their home, do not know the value of reading to their child, have never been trained on dialogic reading, or cannot read themselves. The book, Talk with Me, is such an incredible resource for SLPs and other educators to teach parents the value of looking at books with their child. I have other books available on my website as well, but the most important thing is to find ways to empower parents to commit to reading. Tell them why it is important and teach them how to use a book to help their child.
Thank you for reading this article on a topic very dear to my heart. I hope you find it valuable to your work with young children.