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Coaching Families Module

1. Coaching Introduction

Introduction

Welcome to the Coaching Families training module. This module was created by the Texas Early Childhood Intervention State Office. It was developed to assist service providers in learning how to implement the coaching approach with families.

For more information contact: ECI_CEU@hhsc.state.tx.us

What's in it for you?

As you work through Coaching Families, you’ll acquire knowledge fundamental to your job and apply it in realistic scenarios through guided practice activities.

If you’re a new staff member, the module serves as an opportunity to observe best practice in service delivery and analyze how you can incorporate coaching into the services you provide.

If you’re a veteran staff member, Coaching Families is a resource to identify how to implement coaching as it was originally intended. You’ll be able to look up specific information or brush up on key skills.

Module Navigation

On the left side of the player, you have access to the main menu. This is a listing of topics and will serve as a guide to identify where you are in the module. There is also a Narration tab; select Narration to view a text version of the audio for the slide.

On the bottom right of the player are the “Next” and “Previous” buttons. Use these to navigate through the module. You can also use “Enter” on your keyboard to move to the next slide and the “Spacebar” to open objects within a slide.

The Seekbar at the bottom of the player provides you with controls to pause and play the slide, and a progress bar to track where you are within a given slide. There’s also a button for volume control.

At various times throughout the module, there will be an opportunity to do a quick knowledge check. Hover over the icon to view the question. Then click to reveal the information.

Therapist's Perspective

As you work through this module, you‘ll:

revisit key information fundamental to the coaching approach for service delivery;

observe the coaching approach through video demonstrations;

obtain a tip sheet and fidelity checklist; and

have the opportunity to apply your coaching skills in realistic scenarios through guided practice activities.

Select the image to learn this occupational therapist’s (OT) experience with implementing the coaching approach as it was intended. Listen for what Patty, the OT finds to be very rewarding. The link takes you to a video clip from the Family Guided Routines Based Intervention website.

Video link:

Seven Key Principles

As Patty stated, it’s a really rewarding thing to see when parents build capacity and have confidence working on things without the therapist’s input. In the field of early intervention, we know that The Mission and Key Principles for Providing Early Intervention Services in Natural Environments is the foundation for how all early intervention services should be provided. Principle three states that the primary role of a service provider in early intervention is to work with and support family members and caregivers in children’s lives. The coaching approach is an example of how to infuse this principle into service delivery.

Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice:

Part C Settings. (2008, March). Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved from

Coaching Approach

Coaching is an evidence-based practice that has been used in Texas Early Childhood Intervention for many years. It is a way for the service provider to help build the capacity of the caregiver through supporting caregiver learning and incorporating intervention strategies into regularly occurring daily activities. Coaching, rather than the direct provision of services to the child, allows caregivers to feel confident and competent by promoting their ability to:

• support the child in all areas of development,

• reflect on interactions with the child, and

• develop a plan for future interactions.

Research shows that there are five components necessary for effective coaching and all components must be implemented in each visit to be considered an evidence-based practice. Barbara Hanft, MA, OTR, FAOTA, Dathan Rush, MA, CCC-SLP, and M'Lisa Shelden, PT, PhD, therapists who are recognized as national experts in early intervention, describe the components as joint planning, observation, action or practice, feedback, and reflection. In service delivery, these components can be used in any order and repeated several times during each visit. The exception is joint planning, which must occur at the beginning and end of the visit. Coaching is not a technique only used during a portion of your visit. The approach is the foundation or template for how you provide early intervention services.

Coaching Main Menu

Starting with Joint Planning and going around the circle, select each component to learn more about the approach and view examples.

(when all steps completed)

Good job! Now that you've looked at each step of the coaching approach, you're ready to see what the coaching approach looks like when you're providing services to families.

2. Joint Planning

Joint Planning Main Menu

Select how you would like to proceed.

• Learn more about the process

• Access tip sheet

• Obtain fidelity tool

• View video demonstrations

Joint planning

Joint planning happens at the beginning and end of every visit. At the beginning of the visit, talk with the family about what has happened since the last visit. Here are some questions that can help guide the discussion:

(no audio)

• What techniques or activities have you used since my last visit?

• What has worked well? ... then ask the parent to describe successes.

• What didn’t work well? ... then ask the parent to describe any challenges

• Did you notice any changes in your child? How did she respond to the techniques and activities? Do you think your child has made progress?

• Is anything causing worry or concern?

• Let's talk about any changes related to the IFSP outcomes ...

Considerations

Based on the answers to these questions, help the family to decide what help you can provide in this visit. Do you need to:

• Teach some new activities or strategies?

• Adjust strategies that have been used?

• Identify different routines for intervention?

• Brainstorm different materials or toys in the home to use?

Closing Joint Plan

Joint planning also occurs at the end of the visit. Joint planning at the end of the visit helps the provider and parent organize and plan for the next visit. During joint planning, discuss the activities and techniques introduced during the visit and what the parent or caregiver will continue to work on until the next visit. Then discuss what the parent or caregiver would like to work on at the next visit. In addition to developmental skills, remember to plan for the routines or activity settings that will be used during the next visit.

Cultural Considerations

Let’s consider how a family’s culture can affect the coaching process, especially joint planning. Consider this scenario: A speech pathologist became frustrated with a parent who would not join in a turn-taking game of sorting laundry while sitting on the floor, even after being asked directly and indirectly several times. The SLP later learned from a co-worker that in some Central American cultures, parents do not typically sit on the floor and play; that is the role of other children in the family, such as older siblings or cousins. Once the speech pathologist took the family’s culture into consideration, she adapted her intervention strategies, using routines such as mealtime for the parents to practice turn-taking with their baby. She also showed the baby's older siblings games they could play with their brother.

Cultural Reflection

(No audio)

Take a few minutes now to think about ways you can better prepare yourself for or learn more about cultural diversity with the families you serve.

Did you consider:

Discussing questions with your supervisor?

Talking with co-workers from similar cultural communities?

Every family is unique and comprised of many cultural elements?

Reviewing information from the ECI Collection at the DSHS Audio Visual Library?

Joint Planning Video 1

Within the video demonstration section of this module, you have the opportunity to observe two videos that demonstrate joint planning. Have the coaching fidelity tool nearby to begin familiarizing yourself with the joint planning section of the tool.

Let’s take a look at this video of an occupational therapist from MHMR Tarrant County with a family discussing what the family has been working on and what will be worked on during this visit. Watch how the provider:

- actively engages the mom;

- plans for today’s session by addressing the parent’s priorities for services;

- has mom reflect on what has happened since the last visit; and

- responds to the information mom provides to make changes to the joint plan.

Video transcript:

OT: So last time we talked, you kind of filled me in on how things are going with Miss Mia since she’s been home from the hospital and you shared with me some of the things you were seeing that were positive things. Can we go over that again so I can get it on a note?

MOM: She is now sitting in her high chair and eating.

OT: Yay! That’s awesome!

MOM: Lots of different things that we have for dinner.

OT: Can you give me an example? Like, what did she have last night?

MOM: Last night she didn’t really eat (laughs), but the last time she did eat, she had mashed potatoes, and she’s had cheese-- she ate a cheese stick and chewed on it. Like, you can give her a whole one and she’ll eat it. She’s had some thin slices of pork chops, she’s had green beans, things like that.

OT: What I love about that is that it’s a lot of variety of textures and she has to chew because remember before she was gagging if it was textured and pretty much all refusals of foods.

MOM: Yeah. She’s eaten popsicles.

OT: Oh! So different temperatures, too! That’s so awesome. And how are you presenting it to her?

MOM: Sometimes I just hand stuff to her, like a cheese stick. But most of the time she’s sitting in her chair. She’ll use a spoon sometimes or I cut it up into finger food size where she can pick it up.

OT: Wow! That’s wonderful. I’m so happy to hear that. And then the other thing you told me she was basically sedated for 40 days in the hospital so she grew weak but she’s walking now, I see. That’s awesome. But what are the concerns in regards to her weakness?

MOM: She still needs to build up her leg strength. It took her about a week to start walking again without holding onto us, to gain her confidence back. Her arms are really weak. She can’t crawl around much still. Her arms kind of collapse, although she’s getting stronger. She’s holding the ball.

MIA: (handing ball to mom) Here you go.

MOM: Thank you!

OT: Is she getting up and down the stairs like she was before?

MOM: Yes, she has done that. She’s not real excited about it.

OT: It probably real hard.

MOM: Yeah, it’s her right now because of her arm strength I think.

OT: So today I can show you some exercises that will help her kind of rebuild some that strength that she lost. Some of them you probably know from before but we’ll just review it and then you can practice with her.

MOM: OK

OT: Didn’t you tell me she’s having trouble walking down the thresholds?

MOM: Yeah that’s been an ongoing concern even before the hospital. She gets really nervous about changes in-- I don’t know how to call it-the texture of the floor, from grass to sidewalk or from carpet. She’s just kind of hesitant. She’ll do it but she’s not real confident with it.

OT: Mia? I know that your sister got you dressed today but mommy and I had talked about practicing dressing skills. Are you going to help me get you undressed? Come and sit with mommy and show me how you’ve been practicing.

MOM: You want to change your clothes?

MIA: Yeah! (starts clapping)

OT: Yeah!

MOM: OK, come here. (calling to Mia) Come here.

MIA: YAAAAY!

(VIDEO ENDS)

Follow Up Video 1

The provider:

- actively engages the mom by asking her follow up questions when she explains what has happened since the last visit;

- plans for today’s session by acknowledging the mom’s emerging concerns and reminding her of what they had previously planned for today’s visit;

- has mom reflect on what has happened since the last visit; and

- modifies the plan to include mom’s emerging concern of weakness in arms and legs due to hospitalization.

Joint Planning Video 2

Take a look at this video of a physical therapist from MHMR Tarrant County with a family discussing what the family has been working on and what will be worked on during this visit. Again, watch how the provider:

- actively engages the mom;

- plans for today’s session by addressing the parent’s priorities for services; and

- has mom reflect on what has happened since the last visit; and

- responds to the information mom provides to make changes to the joint plan.

Video transcript:

PT: Did he get his new SMOs?

MOM: Yes, I got them yesterday. So I haven’t really used it yet. (unintelligible) We did them at Cook’s and she showed me everything but I’ve been so busy last week.

PT: Well, we can do that today. It’s going be the exact same as putting on his AFOs. They’re going to be just a little bit easier because they do go so high up. So it shouldn’t be trouble but I’ll watch you put those on him today so that we can just make sure they’re fitting good. What did Cook’s have to say about them?

MOM: They said they fit well. She actually said he might have had a little growth spurt between fittings but she said we could always go back and get them resized under the warranty with them. I don’t know. She said they would be fine. If it’s not sized right, they can redo it within so many months. It’s not a problem.

PT: Last week we concentrated on walking and using his walker and we knew he was going to get his SMOs this week, so the goal of those because they were shorter so maybe he could pull to stand a little bit easier than in his AFOs. So we’ll try that today and see if it makes a difference, if it makes it easier. We talked last week too about our plan for this week was to work on getting him to pull to stand in that walker and using his walker to get into the kitchen for breakfast. Have you tried any of the strategies that the speech therapist gave us that day?

MOM: Yes, with the straw mainly.

PT: Mainly with the straw? OK. How’s he doing with that?

MOM: He’s doing well.

PT: When I observed him that day, he was kind of putting the straw over to the side. So let’s look at his goals a little bit. Of course, we’re working on using words. She gave us the strategy about imitating him no matter what it is, even if he goes, “Aaah,” you’re going to say it back.

MOM: Yes, and I have something to say. So last night, it wasn’t even me it was daddy. He was in bed with daddy and I was cleaning and doing my thing. He kept saying to daddy, “Night night. Night night. Night night!” and he said, “night night!” And I walked in and he was, “ni-ni-ni-ni-ni-ni.” I know! I was so excited!

PT: That almost makes me cry a little bit.

MOM: I know! Me too! It was awesome.

PT: That’s great. So that’s really, the ‘n’ is really a new one.

MOM: That was great last night. And of course, when it was actually time for night night and I was walking out saying, “Night night to daddy! Night night!” And he didn’t do it. He just said, “bye.”

PT: (To Bryce) Say, “I did it once!”

(VIDEO ENDS)

Follow Up Video 2

The provider:

- actively engages the mom by asking her follow up questions when she explains what has happened since the last visit;

- plans for today’s session by pulling forward the plan they decided on from the week before;

- has mom reflect on what has happened since the last visit by asking open-ended questions and yes/no questions for clarity; and

- modifies the plan to include using his new supra malleolar orthosis (SMO) inserts while using his walker.

3. Observation

Observation Main Menu

Select how you would like to proceed.

• Learn more about the process

• Access tip sheet

• Obtain fidelity tool

• View video demonstrations

Observation

Observation often happens at the same time as joint planning. This step involves observing both the parent and the child, because ECI services target both. The third Key Principle from the Agreed upon mission and key principles for providing early intervention services in natural environments reminds us that the primary role of the service provider in early intervention is to work with and support family members and caregivers in children’s lives. Not only do we want the child to gain important developmental skills as a result of our services, we want the parent to feel increasingly confident and effective in his ability to develop and carry out strategies that will help his child. Click on the icons next to both the mother and the child to see a couple of ways you can use observation during the visit:

(no audio)

1. Ask the caregiver to demonstrate what they have been doing with the child. You can then offer ideas and feedback about the techniques.

2. Watch the child as you talk with the parent. Point out any new skills, or subtle progress you see, and relate the progress to the work the parent has done since your last visit.

Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. (2008, March). Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved from

Observation Video 1

Within the video demonstration section of this module, you have the opportunity to observe two videos that demonstrate observation. Have the coaching fidelity tool nearby to begin familiarizing yourself with the observation section of the tool. Take a look at this video of an occupational therapist from MHMR Tarrant County with a family observing what typically happens for the family prior to suggesting new or modified strategies. Watch how the provider observes the mom getting Mia undressed and dressed before suggesting new strategies for dressing.

Video transcript:

OT: (To Mia) Show me what you’re doing!

MOM: Well let’s stand up. Can you take your pants off?

MIA: Yeah!

MOM: Well, let’s do it. OK. Keep going. Just your pants, not your diaper. Pull them down. No, not your diaper. Your pants. Look, right here.

OT: There you go!

MOM: There we go. Can you sit down? Or you just going to step out? It’s kind of hard with shoes on, huh? OK.

OT: Good job!

MOM: You want to put some new shorts on?

MIA: Yeah! (clapping)

OT: Yay!

MOM: Are you excited?

MIA: Yeah!

OT: Well you’re a big girl being able to take your shorts off! Yay! Going to do a little dance too?

MOM: (laughing) This kid is quite entertaining. Alright, fix your legs. Can you help me? Mommy, I have my shoes on, first mommy. Try to do this by ourselves. Can you do it? You’ve got to practice. Here, pull it. I made it hard, huh? Oh, my goodness. Even mommy can’t do it. Now what? Can you pull your pants up? Good job! Here, hold them at the top.

OT: It’s hard to get over the diaper. It’s always the toughest.

(VIDEO ENDS)

Follow Up Video 1

The provider observes the mom and Mia complete a routine activity without suggesting new strategies for dressing. Mia and mom were so proud she was able to complete some of the activity with minimal assistance.

3.5 Observation Video 2

Take a look at this video of a physical therapist from MHMR Tarrant County with a family observing what typically happens for the family prior to suggesting new or modified strategies. Watch how the provider explains to the mom that she is going to observe how Bryce typically gets into the walker.

Video transcript:

PT: (To Bryce) Are you ready for breakfast? Yes?

MOM: Eat? Eat?

PT: Now whenever you’re signing to him like that, are you ever doing hand over hand back?

MOM: Sometimes, yeah. He’s always just doing the pointing all the time.

PT: Alright, we’re going to get in your walker so we can walk… (Bryce leans over to kiss her) Oh, you’re just so lovey this morning!

MOM: So do you want me to…

PT: Actually, I want him to crawl over and then I want to observe how you normally help him get in there.

MOM: Come on! Come on! Let’s go walk. Let’s go walk. (Bryce starts fussing) I know. I know you don’t like it. Up! Up!

PT: So have you had any luck at all getting him to pull to stand in the walker instead of you putting him in there?

MOM: No, not really. Like, he wants to try.

PT: Well let’s just get him started a little bit maybe we can…

MOM: It’s okay. Let’s go eat. Go eat? Look! Look! Come on. Look. Come on. Come on. Let’s go eat. Come on. Go eat! Could you move the table a little?

PT: Yes, ma’am I sure will do that.

MOM: Good job!

PT: How do you think his stepping looks with his SMOs on?

MOM: I think it looks great. I really…yes. I really like it.

PT: I think it looks so much better.

MOM: I’m really excited about those. OK. This is the tricky part. This is the tricky part! (Bryce goes over door threshold) Up. There you go! Good job! There you go.

PT: Good job, Bryce!

MOM: Good job! Up! Up! There you go!

PT: OK. Do you care if we stop right here and have him get down since now he knows since he’s going to have breakfast. Then I’d like to see him try to pull to stand in here. (To Bryce) Can you get down?

MOM: There you go!

PT: Nice job, Bryce! OK. One more. Look. Do you want to come eat? Let’s get in your walker. (To mom) Is it okay if I demonstrate a little bit? If you want to hold. (To Bryce) Let’s go! Let’s go eat.

MOM: Up! Up! Up we go!

PT: (To mom)And so same thing. We’re going to put a foot up and have him stand up. (Bryce gets in walker)

MOM: There you go! Good job! YAY!

PT: (To Bryce) Good job! Now turn around so we can go eat breakfast . (To mom) And then if you want to try to guide him just a little bit by moving his hands.

MOM: There you go. There you go! Step back! This leg. There you go.

PT: (To mom) That was great hand placement when you moved his hands around like that. (To Bryce) OK. Look! Here it is! Let’s go! Oh, go slow! Good job! Can you walk forward and put your hands there? Can you transition for me? Let’s go! Yes! You’ve got it.

MOM: Come on! You’ve got it. It’s okay. It’s not going to slide. I promise. I’ve got it.

PT: Go get in it! Go get in it. You have to get in it. C’mon.

MOM: He says, “I’m not sure.”

PT: Good job, darling!

(VIDEO ENDS)

Follow Up Video 2

The provider observes how the mom typically supports Bryce in getting into his walker, and then provides suggestions and feedback. If the provider went immediately into putting Bryce into the walker herself and then moved on to walking, she would have missed the opportunity to build on what the mom is already doing with Bryce. This will help build the mom’s confidence and competence in supporting her son.

4. Action/Practice

Action Practice Main Menu

Select how you would like to proceed.

• Learn more about the process

• Access tip sheet

• Obtain fidelity tool

• View video demonstrations

Action/Practice

After planning and observing, you and the parent should be ready to try out some new ideas. This is when you will teach or adjust activities or strategies, help the parent practice, and try out different materials or toys. This action and practice step will probably be the longest part of your service delivery visit. If you find you are completing the same activities with the family session after session, it’s probable that the intervention is not having the desired effect. Return to joint planning to decide how you can modify your strategies, and consider asking other team members to provide input.

Modeling in Action/Practice

Modeling is one of the most common techniques used by service providers in the action and practice step. Effective modeling is more than showing a caregiver an activity. If you find yourself spending most of your time in a session working directly with the child, you probably aren’t using effective modeling.

Steps for Modeling

Here are 8 steps for modeling, based on an approach suggested by Robin McWilliam, Ph.D:

1. Talk to the parent about a technique, and explain how it will help achieve the outcome.

2. Ask if he or she would like a demonstration. If the parent says yes, then ...

3. Tell the parent what you’re going to do.

4. Do it.

5. Tell the parent what you did and point out the benefits.

6. Encourage the parent to try it. The parent’s attempt is what we call “return demonstration”. This step is critical to the success of intervention and learning.

7. Watch the parent trying it.

8. Encourage the parent by finding some positives to point out. Give suggestions about how to modify, and provide corrective feedback as needed, in a supportive manner.

Other Techniques

Modeling is not the only strategy used to teach parents new intervention techniques. Thoroughly explaining a technique, “talking through” a technique while a parent tries it out and even having the parent watch another parent demonstrate a technique on a video are also effective strategies.

Activity: Action/Practice

What would you do?

What if the process stops at return demonstration because a parent is reluctant to try while you're there? (Select all that apply.)

(Multiple Response, 10 points, 1 attempt permitted)

|Correct |Choice |

|X |Emphasize that intervention in ECI happens between our visits. |

|X |Suggest that the parent can videotape the techniques and the service provider can view it with the parent at the|

| |next visit. |

|X |Help the caregiver understand how a young child learns. |

|X |Gradually move toward more parent participation in every session. |

| |Show the parent the activity many times, and show how much the child enjoys it. |

| |Continue to model, and hope the parent can do the activity when you leave. |

Correct

Great job! Those four strategies are good for encouraging parents to show you that they can implement activities when you aren’t there.

Incorrect

Not quite… Any of the first four strategies could be used, but continuing to only model for the parent might lead them to feel they can’t effectively help their child and does not provide an opportunity for you to give praise or constructive feedback.

Action/Practice Video 1

Within the video demonstration section of this module, you have the opportunity to observe two videos that demonstrate action/practice. Have the coaching fidelity tool nearby to begin familiarizing yourself with the action/practice section of the tool. Take a look at this video of an occupational therapist from MHMR Tarrant County with a family as the therapist moves from observation into action/practice. Watch how the provider:

- works on an activity within a typically occurring routine;

- uses materials within the home to practice skills;

- talks/guides the mom through an activity; and

- allows for the mom to practice the strategy.

Video transcript:

OT: (To Mia) Are you going to feed yourself with a spoon? Uh huh. Her bites are so tiny. Did you notice that? You’re doing a good job biting it, though.

MIA: Nanana

OT: A banana, yes it is.

MOM: Yes, it will take her quite some time to eat a banana.

OT: It’s all in the front of her mouth, too.

MOM: Is it?

OT: You see how she’s using such beautiful manners and chewing with her lips closed. You’re not really supposed to do that at this age because we really can’t what’s happening inside and I think it’s because it’s all being chewed up in the front, which-you’re not taking super big bites so you can manage it that way.

MOM: Well, I was going to say we didn’t teach her that.

OT: Oh, no, I know you didn’t teach her. So when you and I would take a bite of a banana, what do you think we do with it in our mouth? Why don’t you take a bite of a banana and you’ll see what I’m talking about.

MOM: You’re putting me on the spot. Let’s see. (To Mia) Can mommy have some banana?

OT: Hopefully mommy likes bananas.

MOM: Yes, I do. Everybody likes bananas. Hmm…I move it to the back of my mouth.

OT: You sure do. You move it to the side and the back and chew it with your molars. And so she’s doing it with the front.

MOM: Well, that’s where her teeth are.

OT: But with a banana, you really don’t have to have teeth. You could gum a banana pretty good. So can you think of some ways we can work on her chewing more on the sides versus in the front? And to be really honest with you, I’m super excited to see this, period, because before she wouldn’t have even put a banana in her mouth. However, since she’s doing it, we want to teach her the right skill so she can progress because harder foods to chew are really going to be hard in the front of her mouth.

MOM: Right. Um, no, what do we do about that?

OT: Oh come on, Sarah, you can do this with me. Let’s put mommy on the spot again!

MOM: Sorry. Um, I really don’t know.

OT: OK, I’ll guide you. So, how does Mia learn most things?

MOM: Watching me?

OT: Yes, watching you. So what could you do to show her so she can try to imitate you?

MOM: I guess I’m going to need to eat a banana with my mouth wider.

OT: That’s right! Because if our mouths are closed, it’s like a magical occurrence is happening and so we don’t know what’s going on in there.

MOM: The mystery of the closed mouth?

OT: So, manners go out the window right now because we don’t really care about that right now. We just care about chewing. So if you show her how you chew and see if she will imitate and I would probably use small bites just because that’s all she could do, too. And over-exaggerate it to make it fun.

MOM: (To Mia) Can I take a bite? Are you going to take a bite, too? OK, look. (Mom takes a bite and both Mia and mom start laughing) Look! That’s some good banana!

OT: Good job!

MOM: Look! I’m chewing it.

OT: Is mommy using her big strong teeth?

MOM: What do you think?

OT: Can you even take a piece…(watching Mia) Oh, look at you, you moved it more to the side. Good job! You did it like mommy! (Mia and mommy high-five) You could even take a small piece and put it on the side so she sees where you’re chewing.

(VIDEO ENDS)

Follow Up Video 1

The provider uses the typically occurring routine of meal time and the activity is having Mia chew and swallow foods. This is a priority for the family because Mia was previously fed through a gastrostomy-button (G-button), but is now using her mouth to eat. They use materials from the home to complete the activity. The provider has a conversation with the mom on how to get Mia to move the food to the back and side of her mouth when chewing. Then the mom completes return demonstration by practicing what was discussed, chewing the banana with her mouth open for Mia. The provider points out the benefits of Mia seeing how mom chews as Mia begins moving her food to the side of her mouth after watching mom. During the visit, the provider and mom do identify ways to expand the strategy into other areas, but it is not shown in this clip.

Action/Practice Video 2

Take a look at this video of a physical therapist from MHMR Tarrant County with a family as the therapist moves into action/practice. Watch how the provider:

- works on an activity within a typically occurring routine;

- uses materials within the home to practice skills;

- models the activity; and

- allows for the mom to practice the strategy.

Video transcript:

PT: (To mom) He still pulled to stand over here, which is great, because he pulled to stand with them on. But we wanted to see if he could stand from that half-kneeling position with them on. So is it okay if I model that for you and then you try. OK. (To Bryce) Let’s do this. Come here. Look. (Setting building blocks) I’m going to build it tall, tall, tall.

MOM: We knocked them over!

PT: So, come watch this. Let me model this for you. Remember, what we want…(Bryce puts one foot down to stand) There you go! See, that’s going to allow him to get that foot all the way up. OK? Very important that when you’re doing that, not always putting the same foot forward, so do one left foot forward sometimes and the right foot. (To Bryce) I’m going to put you down, okay? (To mom) Do you feel comfortable practicing? (To Bryce) I know. I know I’m so mean, aren’t I? (Mom and PT switch places)

MOM: Go up. Up! (Bryce stands up with mom’s help)

PT: That was okay. That was perfectly fine. What we want is him to do as much that as possible by himself. Just like he kind of started with the right a while ago, but I just needed to finish. And so let him do as much of that as he can by himself before you fix it. If he’s trying to pull up of course with his legs together, which is what he’s used to, then you’re going to need to intervene a little bit quicker. Because we really want him to start separating those legs out.

MOM: OK.

PT: (To Bryce) Let mommy try. Go! You’ve got it! Look! Here’s your monster truck! It’s on top! Oh! Come on! (Bryce stands up) Beautiful. Good job! Good job, Bryce!

MOM: That was so good.

(VIDEO ENDS)

Follow Up Video 2

The provider uses the typically occurring activity of Bryce pulling up at the coffee table. They are getting ready to get into his walker to walk to the kitchen, but needed to make sure he was able to stand up while wearing his SMOs. This is a priority for the family because Bryce transitions out of ECI soon and primarily crawls to get to places. The provider does not bring in toys and they use materials from the home to complete the activity. The provider:

- explains they want to see him stand from the half-kneel position;

- asks mom if she can model the strategy for her;

- explains what is happening while she models the strategy; and

- explains what happened as a result.

After the provider models the strategy, she asks the mom if she feels comfortable trying the strategy. Mom practices the strategy and demonstrates understanding of what the provider modeled.

5. Feedback

Feedback Main Menu

Select how you would like to proceed.

• Learn more about the process

• Access tip sheet

• Obtain fidelity tool

• View video demonstrations

Feedback

Feedback is integrated throughout the session. You provide feedback about the caregiver’s ideas during joint planning, about your observations of the child, and about the caregiver’s actions and practice.

Feedback can be used to provide information, affirmation, acknowledgement, encouragement, and suggestions. Here are some varieties of feedback. Select each to reveal an example:

• Positive feedback paired with suggestions for tweaks: “That was great. I liked the way you supported her neck when you pulled her up to sitting. You might want to do it a tiny bit more slowly to help her work her muscles even more. Try it a few more times, and then let’s talk about the times of the day you can remember to practice.”

• Feedback to point out positive things you see in the parent-child relationship: “He really responds to your voice. Look how quiet he gets when you talk to him.”

• Feedback to identify new routines: “That is a really nice way to hold him for feeding -- he's more upright and his legs are bent. You could also hold him that way when you show him a toy.”

• Feedback to point out incremental skills the parent may not have picked up on: “That was great! When he moved his hands together like that, he looked like he was starting to sign ‘book.’”

• Feedback to explain why something was good: “You supported her arm just enough so she was able to grasp the blocks and put them away.”

Types of Feedback

Let’s take a look at some of the ways the various types of feedback are used in visits. Select each type of feedback to learn more.

Encouraging, Affirmative, or Positive Feedback:

- After the caregiver provides information about progress.

- After the caregiver practices a skill. Example: “The way you positioned her body was so good. That is exactly what we want to see.”

Informative Feedback:

- Explaining or educating the parent on why a strategy will help.

- Providing clarity. Example: After modeling for the caregiver, she asks how working on the child’s core strength will help with walking. You use your clinical knowledge to explain development.

Suggestive Feedback:

- When offering an alternative solution or idea. Example: The caregiver describes other ways she will incorporate the strategy into other activities. You state how the activity could be modified to use in other routines.

Videotaping

Consider videotaping the parent or caregiver practicing a skill while you coach. In today’s world, most everyone has a cell phone, and many of those phones have the capacity to record short video clips. The parent will not only have a visual reminder of the practice, but an audio reminder of your hints and instructions.

Benefits of Video

Short videos can be a powerful teaching tool and can help caregivers who can’t attend your visit learn new strategies to use during times they spend with the child. Additionally, a parent who may be reluctant to practice during your session may be willing to make videos during the week for you to discuss in your next session.

Activity: Using Video

There are lots of ways you can use video to make your intervention more effective. This video clip illustrates one way a service provider could use video during a service delivery visit. While watching, think of at least three other ways video might support your work with the family.

The link takes you to a video clip from the Colorado Department of Education Results Matter Video Library.

Link to video:

Activity: Using Video Part 2

Using this worksheet, record at least three other ways video might support your work with the family. When finished, select the icon to compare your ideas.

Icon displays:

1) Sharing with other parent or family members so everyone is on the same page.

2) Showing the parent what it looks like as they are doing it.

3) Using video to celebrate progress.

4) Highlighting family strengths and child progress.

5) Explaining the process of what intervention services look like.

Feedback Video 1

Within the video demonstration section of this module, you have the opportunity to observe two videos that demonstrate feedback. Have the coaching fidelity tool nearby to begin familiarizing yourself with the feedback section of the tool. Take a look at this video of an occupational therapist from MHMR Tarrant County with a family as the therapist provides feedback to the mom. Watch how the provider uses a variety of feedback that is specific to the activity occurring.

Video transcript:

MOM: At some point, not real soon, but at some point, we’re going to have to teach her to take her meds orally again. She used to before her transplant but she didn’t have nearly as many.

OT: Do they taste bad?

MOM: I don’t think so. I think they’re all flavored or I think they can be flavored. I don’t bother with it right now.

OT: Because of her G-button.

MOM: But it’s a lot of volume is the problem. And you know toddlers, spit things back. Before they take that G-button out I’m going to make sure we can get her meds in without it. But we’re not there yet. But she used to be really good at taking medicine. (To Mia, administering medicine) You want to do it? Oh, we practice this, too. She’s strong.

OT: Good! Good job!

MOM: You want to do it again?

OT: P-U-U-U-S-SH! That’s smart, mom. That’s a great way for her to work on her arm strength again.

MOM: We count them, we sort them. We do all kinds of things with meds when it’s such a big part of the day. Good job!

OT: That’s such a great way to incorporate some teaching opportunities in something that she does every day.

MOM: Good job. What color was that?

MIA: Pink.

OT: That’s right.

MOM: You’re so smart.

(VIDEO ENDS)

Follow Up Video 1

The provider uses affirmative feedback by stating “that’s smart mom,” in response to seeing how mom is incorporating Mia into the medicine routine. She then provides instructional feedback by letting mom know how involving Mia in this process is also helping Mia develop her motor skills.

Feedback Video 2

Take a look at this video of a physical therapist from MHMR Tarrant County with a family as the therapist provides feedback to the mom. What how the provider uses specific positive, informative, and suggestive feedback.

Video transcript:

MOM: Go up. Up! (Bryce stands up with mom’s help)

PT: That was okay. That was perfectly fine. What we want is for him to do as much that as possible by himself. Just like he kind of started with the right a while ago, but I just needed to finish. And so let him do as much of that by himself before you fix it. If he’s trying to pull up of course with his legs together, which is what he’s used to, then you’re going to need to intervene a little bit quicker. Because we really want him to start separating those legs out.

MOM: OK.

PT: (To Bryce) Let mommy try. Go! You’ve got it! Look! Here’s your monster truck! It’s on top! Oh! Come on! (Bryce stands up) Beautiful. Good job! Good job, Bryce!

MOM: That was so good.

PT: I don’t think I’ve ever really seen him be able to separate that well, that fast. OK. That was great hand placement when you moved his hands around like that.

(VIDEO ENDS)

Follow Up Video 2

The provider uses affirmative feedback to encourage the mom, informative feedback to explain why the activity should be done in a specific way, and suggestive feedback to give ideas on how to do this activity in different situations. The feedback moved from general by stating “it was okay,” to specific feedback.

6. Reflection

Reflection Main Menu

Select how you would like to proceed.

• Learn more about the process

• Access tip sheet

• Obtain fidelity tool

• View video demonstrations

Reflection

This is the emotional component of feedback. Ask the parent how the activity felt for her and the child. Parents will not work on activities they don’t enjoy and won’t implement anything that causes them fear or worry so it is critical to have this discussion. If the parent does not feel comfortable, encourage him to practice a little more, or help him come up with some other strategies that might feel more comfortable. Ask the parent how he feels about the session you just completed, and then review the things you’ve covered that the family will work on before your next visit.

Reflection is also an opportunity for you, as a service provider, to think about your own work after a visit. Watch this short video clip about how a service provider uses video as a tool for the self-reflection process. Your self-reflection, combined with the family’s reflection about their child’s services is an important component of ongoing assessment and should inform planning for future visits.

The link takes you to a video clip from the Colorado Department of Education Results Matter Video Library.

Video links to

Examples of Reflective Questions

Select each post-it note to reveal examples of the different types of reflective questions.

• Awareness: What do you know? What have you tried? How do you…?

• Alternatives: What ideas do you have? What do you need to know? What do you need to find out? What can/will you do differently?

• Action: What is your plan/decision? What do you plan to do? What is your first step?

• Analysis: How well did/does that work? How did you know to do that? How does that compare to what you want to happen? What are your thoughts about what I shared?

Rush, D.D. & Sheldon, M.L. (2011) The early childhood coaching handbook. Balti ore, MD: Paul H. Brookes Publishing Co.

What If?

What would you do if when you ask a reflective question, the parent says, “I don’t know.” What if the parent says, “Just tell me.”

(Once I don’t know is selected)

Rephrase the question to make sure the parent understands what you are asking.

Provide informative feedback and then ask an analysis reflection question “How did that work?” or “What are your thoughts?”

(Once Just tell me is selected)

Stress that you do have ideas to share, but you want to hear the parent’s ideas because he/she is the expert about the child.

Provide informative feedback and then ask an analysis reflection question “How did that work?” “What are your thoughts?”

Rush, D.D. & Sheldon, M.L. 92011) The early childhood coaching handbook. Balti ore, MD: Paul H. Brookes Publishing Co.

Tips for Reflection

Here are some tips for including reflection in the visit.

Reflection questions should be open-ended and specific to the joint plan or intervention technique. Instead of asking an overarching question like, “how are things going?”, focus on a specific aspect of the joint plan or the use of an intervention technique in a specific activity. For example, “How did it work when you tried sitting Luke in the laundry basket during bath time?” “Do you have any other ideas for positioning him in the bathtub?”

Use a variety of reflective questions, but only ask one reflective question at a time. The various reflective questions are addressed on the next slide.

Be patient and allow the parent time to process the question and really reflect on his/her answer. Silence is ok.

When you are providing a suggestion or information, ask the parent an “analysis” reflective question. For example, “how do you think that will work” or, “What are your thoughts about that idea?”

Rush, D.D. & Sheldon, M.L. (2011) The early childhood coaching handbook. Balti ore, MD: Paul H. Brookes Publishing Co.

Reflection Video 1

Within the video demonstration section of this module, you have the opportunity to observe two videos that demonstrate reflection. Have the coaching fidelity tool nearby to begin familiarizing yourself with the reflection section of the tool. Take a look at this video of an occupational therapist from MHMR Tarrant County with a family as the therapist uses reflection to help build caregiver competence. Watch how the therapist uses open-ended questions and has the mom reflect on suggestions.

Video transcript:

(Mia offers banana to OT)

OT: No, it’s your turn. Are you just going to take bites? (To mom) OK, so she’s like, “I like what you’re doing but I want to do it my way because she likes holding it, I think. She has a little more control. But we can still work with that. What can we do?

MOM: I think she’s nervous about big bites, too. For sure. I think part of it’s going to be time.

OT: Absolutely. Can you think of other foods you guys typically eat that are soft like this that you could practice?

MOM: Well, the cheese sticks that she eats. I could probably cut them down.

OT: Yep, that’s a good one.

MOM: Because it’s a little firmer. That banana’s pretty mushy. We’d have to get firmer bananas to cut them down. I don’t know if she would eat cucumber or something like that without skin. I’m not sure.

OT: Yeah, that’s probably a little crunchy.

(VIDEO ENDS)

Follow Up Video 1

The provider uses open-ended questions to encourage reflection and build the mom’s capacity to work with her child. The provider pointed out to the mom that the strategy did not seem to be working and then stated, “We can still work with this. What can we do?” She then follows up to help the mom expand the idea to include other types of foods by asking, “Can you think of other foods you guys typically eat?”

Reflection Video 2

Take a look at this video of a physical therapist from MHMR Tarrant County with a family as the therapist uses reflection within the visit.

Video transcript:

MOM: Let’s go eat. Come on. Go eat! (To PT) Could you move the table a little?

PT: Yes, ma’am I sure will do that.

MOM: Good job!

PT: How do you think his stepping looks with his SMOs on?

MOM: I think it looks great. I really…yes. I really like it.

PT: I think it looks so much better.

MOM: I’m really excited about those. OK. This is the tricky part.

(VIDEO ENDS)

Follow Up Video 2

The provider uses an open-ended question to encourage reflection about a new strategy by asking, “How do you think his stepping looks with the SMOs on?”

7. Practice Activities

Activities with Fidelity Tool Main Menu

Select how you would like to proceed.

Observe Henley’s visit

Observe Lennox’s visit

Lennox

In this section, you will view videos of Lennox’s home visit. Mark your observations on the Coaching checklist. After the videos, you will have an opportunity to compare your observations and reflect on ways to implement these practices into your service delivery.

Before getting started, look over the information on Lennox’s outcome.

Outcome: Lennox will request toys he wants to play with by name and color when playing with his sister without hitting or biting at least one time daily for one week by his third birthday.

Lennox's Home Visit 1

Using the fidelity tool, determine if all of the components of coaching are implemented true to the original model during the following five video clips. Between each clip, take time to look over the tool, rate the provider, and determine how you could incorporate strategies you observed or how you would improve the session. After all five videos have been reviewed, you will have the opportunity to view the answers.

Video Transcript:

Rachel: So at our last visit we talked about what we wanted to work on at today’s visit which was naming colors and working on turn-taking. Is that still something that you guys want to work on today?

Mom: Yeah, I think so. Yeah, I think so. With Henley he likes to have his turn all the time. And colors, he still kinda struggles with.

R: So how have things been going with his speech since the last visit? Is he saying any new words or using words in different ways?

M: He actually has said some new words. He said like action words that we haven’t talked about before so that was kinda neat. He’s saying a few things more clearly and then there’s other words that he still kinda struggles through, like he can’t really say “Liam” very well.

R: And, Chas, have you noticed anything about his speech? Things that he’s still struggling with or things that he seemed to be doing new things with his speech?

Dad: Really, just pronunciation. He’s trying to get it out but “Liam” is “ye-ya-la”so that’s really the only thing I’ve noticed.

R: Yeah.

M: But he’s getting better, too. Like his “Yesses” are more clear and he’s not saying the “th” anymore. He’s actually saying “yes.”

R: And I’ve noticed that he seems to be using speech to protest. He’s saying “mine” instead of hitting or scratching.

M: Yeah, we’re trying to do that a lot more because of Henley we don’t want him to if she is playing with something, we don’t want him to reach out and hit her because she is so young.

R: Right, right. So what are some of the strategies you were using from last week to work on his speech?

M: You know, just letting him watch us really enunciate the words, repetition, things like that, we’ve been trying to do a lot more with him.

R: OK. Well, why don’t we try that out?

M: OK.

Lennox's Home Visit 2

Video Transcript:

(Playing on the floor with kids)

Rachel: So is this what you would be doing typically if I wasn’t here?

DAD: Um, I would be doing this. I don’t know Taryn usually doesn’t sit around.

Mom: I have laundry. I have dishes that kind of stuff that I really’d like to do but it’s hard usually if it’s not just Lennox out here with us it’s kinda hard to get that stuff out because it just makes a bigger mess sometimes.

R: Right, right. Well why don’t we try that. We can work on laundry or work on dishes just so we can include them into the activity.

M: OK I have laundry, do you want me to go get it out?

R: Great, that’d be great.

Lennox's Home Visit 3

Video Transcript:

Rachel: So one of the things you can work on is turn-taking. That’s one of the things that we were focusing on with taking turns and sharing. So you could take a turn, Liam could take a turn, Ava could take a turn and then move on from there. And when we’re taking the turns, working on pronouns saying “My turn, your turn, Liam’s turn,” so that we’re embedding the pronouns in too.

Mom: (To children) Is it Lennox’s turn? Can Liam have a turn? What about Ava? Can Ava have a turn?

Lennox: Yes.

Dad: Whose turn is it?

L: Lennox!

D: Good job!

M: Who’s this? (pointing to Liam)

L: Liam turn!

M: Good! OK, Liam, do you want one? You can take it. Can Mom have a turn?

L: Yeah.

M: Ok! Alright!

D: Whose turn is it now?

L: Momma turn!

D: Good job. Can Dad have a turn?

L: Yeah!

D: Whose turn?

L: Um, Liam. Ava!

R: Ava’s turn?

M: Thank you, Ava. You can take another one and help.

R: Another thing that you can work on is naming colors or even naming the type of clothes, like saying, “Here’s Lennox’s shirt,” or “Here’s Henley’s blanket.”

M: Hey, Lennox, can you come here? Whose shirt is this?

L: Lennox!

M: Do you know what color it is? What color is this? Did you say orange? You want to try again? What color?

L: Orange!

M: No, what color?

LIAM: Geen!

M: No, it’s blue! Can you say “Blue”?

L: Brue!

M: Good! (Laughing) We’ll work on it.

R: OK, just so you can start naming colors. You don’t have to use flash cards or anything, it’s just using everyday objects like cups or the clothes, the furniture, just anything, pictures in books, so anything like that.

M: OK. Lennox, can you tell me what color this is? What color is this? Liam, what color is this? (Holds up green washrag)

LIAM: Geen.

M: Good job, Liam. Lennox, what color is this?

LENNOX: Geen!

M: Good job!

Lennox's Home Visit 4

Video Transcript:

Rachel: So Taryn how do you think it went?

Mom: (Laughs) Kind of chaotic. If Lennox can sit and is calm enough, I think it could work but I think he’s a little distracted.

Dad: We might have to re-wash the laundry (Laughs).

R: Right. But if it’s not going to work and create more work for you guys, you definitely don’t want to say “keep doing it! Keep doing it!” It’s double the work now. So you can try it again maybe with just Lennox or say “we’ll just try something else.” Another thing that he may like working on the same things is getting the laundry from the washer into the dryer so you can work on there work on the “My turn, your turn” thing too and then putting things in and out with his fine motor pushing the buttons if you have a button on your washer or dryer to start it.

M: OK, I think he would like that. Yeah, he likes pushing buttons.

R: Yeah.

Lennox's Home Visit 5

Video Transcript:

Rachel: We worked on turn-taking, and worked on naming colors. We tried the laundry strategy. Maybe it doesn’t quite work that well but we can keep on looking at other different routines that are happening throughout the day. So you don’t have to try to carve time out of your day to say, “Oh, I need to work on speech right now.” Like what are things we can do that you’re already doing so we can embed those speech strategies in your routines. So next week, what do you want to focus on at that visit?

Mom: I still think speech is a very big one. And then just continuing to grow his vocabulary really. I think that’s important. He’s really good about asking “Mom what is it?” So just getting ahead of that kind of, things that just seems mindful of teaching new words.

R: OK. Chas do you have anything else you wanted to focus on?

Dad: Nope, I think speech is the big thing. We talked about it. Speech is what we’ve been focusing on.

M: Including colors and animal names and those sort of things.

R: Right, so anytime you can it doesn’t have to be anything special so just naming colors anytime throughout the day, even when you’re driving pointing out signs or when you’re taking walks or just around the house naming colors so he’ll hear it over and over and over again and that’s how he’s going to pick it up.

M: OK.

D: Lennox, where’s green? (Lennox picks up orange ball)

M: Almost. Can you try again? (Lennox picks up green ball)

ALL: Woo hoo! Good job!

M: What color is it? (Holding green ball)

R: So part of it is you guys naming the colors, too.

M: OK.

Congratulations

Congratulations! You have completed the section on Lennox’s visit. Take time now to compare your fidelity tool to the answer key provided.

Henley

In this section, you will view video clips of Henley’s home visit. Mark your observations on the coaching checklist. After the clips, you will have an opportunity to compare your observations and reflect on ways to implement these practices into your service delivery.

Before getting started, look over the information on Henley’s outcome.

Outcome: Henley will sleep in her bed at least 5-6 hours every night for one week by the time Mom goes back to work.

Strategies include:

- Increasing calorie intake

- Using a tighter swaddle

- Incorporating a sound machine

Henley Joint Planning Clip

Using the fidelity tool, determine if all of the components of joint planning are implemented during this portion of the visit.

Video Transcript:

Rachel: So last time when I came out, we talked about at this visit you wanted to start working on spoon feeding and also working on some strategies to help her go to sleep and then sleep for a longer time through the night. Is that still something that you wanted to work on?

Mom: Yes. For sure on the sleep. And she’s been showing interest while we eat so I think she’s probably ready for the spoon feedings.

R: And there’s nothing from your pediatrician that would prevent her from starting some spoon feeding?

M: No, she actually said we could start the spoon feeding whenever at her last visit.

R: Great, great. What we can do, if this works with your schedule, we can work on the spoon feeding and then I think it’s probably close to her bedtime so we can work on some strategies for bedtime, too. If that still works for you.

M: Yeah, that sounds fine.

R: OK, great.

Joint Plan Question

Which component is missing from Joint Planning?

|Correct |Choice |

| |Actively engages the parent in planning for today’s session |

| |Plan addresses the child’s IFSP outcome |

| |Plan addresses parents’ priorities for service |

|X |Parents were asked to reflect on what has happened since last visit |

Incorrect

Rethink your answer. The provider is engaging the family by discussing the plan for today’s session which addresses the family’s priorities for services and the IFSP outcome. The provider did not ask the parents to reflect on what has happened related to the joint plan since the last visit including successes and challenges.

Consider the following: How would you ask the parent to reflect on what successes and challenges he/she has encountered since the last visit?

Remember to ask open-ended questions:

- “What techniques or activities have you used since my last visit?”

- “What worked well?”

- “What didn’t work well?”

- “Did you notice any changes in your child?”

- “How did she respond to the techniques and activities?”

- “What kind of progress has your child made?”

Correct

The provider did not ask the parents to reflect on what has happened related to the joint plan since the last visit including successes and challenges.

Henley Action/Practice Clip

Using the fidelity tool, determine which components of coaching are being implemented during this portion of the visit.

Video Transcript:

MOM: (Feeding Henley with a spoon) Alright. Are you ready honey?

RACHEL: Oh, she’s definitely interested.

M: You want to eat? You want to take a bite? Yeah? Okay. (To boys) OK, boys, sit down. (To baby, feeding) Oh, ok.

AVA: Why doesn’t she like it?

R: Oh, I think she does like it. See, she’s opening her mouth and she’s ready for the spoon then she closes her mouth on the spoon?

M: You like it, honey? Should I just put it in and…

R: Yep. So, you’re waiting for her to open her mouth (Laughs). And she’s definitely ready. And she will close her mouth around the spoon. I think she’s been doing that.

M: OK. Yeah, kinda. Trying to chew it. OK Should I go faster maybe?

R: Oh no, this is perfect.

M: OK. (Laughs) She chews on the spoon. You like it? You’re doing good. Yeah, I think she likes it.

R: Definitely. Definitely. So before you started with the spoon feeding, did you notice that she was really interested in what y’all were eating?

M: Absolutely. She started watching whenever we would take bites. She would follow our hands to our mouth.

R: Oh, wow. Because it looks like she’s really interested in food. Opening her mouth. Yeah. Definitely developmentally ready for that.

M: Good! I’m so glad! See, she’s eager! You OK? There you go.

R: So, I see that she’s moving around a lot and sometimes she’s leaning over to the side. Do you have a blanket or a towel that we could put around her to help position her?

M: Yeah, I think so. Can you hand me the blanket, Chas?

R: Great, great, great. So if you just want to roll it up and kind of get a fat roll.

M: Do I need to fold it?

R: Yes that’s great. And then we’ll put it along on her side over here to provide that extra support so her core is a little more stabilized.

M: OK.

R: OK, that looks great.

M: We’ll try this. Yeah. That seems to help. Not so wobbly! Good job.

R: Great. I think the rate that you’re feeding her is perfect. You’re definitely waiting until her mouth is open. If she starts to turn her head or really starting to fuss, that means she’s done. But she’s definitely showing that right now so she’s definitely really interested.

Henley Action/Practice Question

Which component(s) of coaching can be observed in the video clip?

|Correct |Choice |

| |Joint Planning |

|X |Observation |

|X |Action/Practice |

|X |Feedback |

| |Reflection |

Correct

Joint planning didn’t occur since that happens at the beginning and end of a visit. Reflection did not occur after trying the strategy. The provider could have asked “what are other places you could try using a blanket to help with stability,” or, “how did that work for you?”

Incorrect

Rethink your answer. The provider observed the mother implementing strategies, she provided the mother feedback, and the mother practiced feeding Henley with a blanket on her side to help with stability. Joint planning didn’t occur since that happens at the beginning and end of a visit. Reflection did not occur after trying the strategy. The provider could have asked “what are other places you could try using a blanket to help with stability,” or, “how did that work for you?”

Henley Reflection Clip

Using the fidelity tool, observe this video clip that focuses on reflection. Watch for if the provider uses yes/no questions, open-ended questions, specific questions related to the activity, or general questions like “what’s been going on?”

Video Transcript:

Rachel: So this is the first time you’ve spoon fed her?

Mom: Yeah.

R: So how do you think she’s doing with the spoon feeding?

M: I think she’s ready for it.

R: I definitely think so, too.

M: I try to make it a little bit more runny so she can take it well and I think she’s okay with it. She seems to like it, so, I think it’s going pretty good.

R: Are there any other times where she’s sitting in a seat like this where she might need a little more positioning?

M: Maybe so. She’s still small for some of the gear we have, so I think the blanket near her makes a lot of sense and we have a little bouncer that she kinda tilts in. So maybe we could roll a blanket and put it next to her there, too.

R: If she’s still really leaning over to one side, you can use a smaller towel and put a towel on both sides. That would probably work best--have one on each side.

M: Kinda even it out a little bit.

R: Yeah. But she seems to be doing great with that just one side. (To baby) Are you getting a tooth?

M: She likes to chew her hands, for sure.

Reflection Question

Which type(s) of question(s) did Rachel ask while Taryn reflected on the practice activity?

|Correct |Choice |

|X |Open-ended questions |

|X |Yes/no questions |

| |General questions |

|X |Specific questions related to activity |

Incorrect

Rethink your answer. Rachel opens with a yes/no question for clarity, then moves to two open-ended questions that are specific and related to that particular activity.

Consider the following: What has the mother gained through reflection?

The mother is able to think through using the blanket technique in various settings. She also gains insight into why or how a strategy works. This helps to build her competence in supporting her child

Correct

Correct. Rachel opens with a yes/no question for clarity, then moves to two open-ended questions that are specific and related to that particular activity.

Henley Bedtime Clip

Using the fidelity tool, observe this video clip. Watch how the provider observes the routine before discussing modifications.

Video Transcript:

Rachel: So we talked about some routines you want to try with her to go to sleep so what are the steps you wanted to try.

Mom: Usually, we rock and we make sure it’s dark and all that stuff. So we just kinda try to get a routine down. We give her a bath and stuff and then try to do the bedtime routine. So, we rock her. We rock her a little while and then make sure it’s dark and stuff.

R: OK. Then I think we talked that you wanted to try the noise machine since there’s a lot going on outside.

M: Yes. Since her brother is so loud, we do have a sound machine.

R: OK, well why don’t you show me how you put her down, if there’s any special routine that you have when you’re putting her in the crib.

M: OK. OK. She kinda likes to sleep on her side. So if I lay her on her side. I lay her down and I put the roll behind her so she doesn’t roll backwards and then I’ll give her a pacifier.

R: So do you still swaddle her when she’s sleeping or has she grown out of that now?

M: A little bit of both, depending on her mood. So sometimes we swaddle her. She likes to flail when she sleeps and that wakes her up, so I loosely swaddle her so she can break out if she wants. Her arms are always free when I come back.

R: I see she’s rolled onto her back. Does she prefer to be on her back to sleep? Or I think you said she prefers to be on her side?

M: Yeah, she usually does. Like I said, I loosely swaddle her and I kind of lay her tilted back that way. She usually likes that a lot. And if she wants to break out, then she can. The swaddle kind of depends on her mood.

R: Is she still doing that startle reflex when her arms flail?

M: Yeah, I don’t know if it’s a startle but she flails all the time. If she wakes up at all, her arms immediately drift up and it wakes her up so that’s why we like to swaddle her.

R: So that could be swaddling her a little tighter would prevent her arms from coming up so that may help with her waking up during the night.

M: OK. I can show you how I do it. (Demonstrating for Rachel) So, one arm tucked down and I’ll make sure it’s tight

R: (to baby) Your arm’s in there tight.

M: And then the bottom. So is that tight enough?

R: Definitely. That’s going to keep her arms from flailing.

M: OK.

Bed Time Question

What are the benefits to the service provider observing the activity as it happens normally?

List out three benefits to observing the activity.

Bed Time Considerations

Did you consider:

• The provider can see what is happening with the child and family before making suggestions.

• It provides information for the provider to include in the current and future joint plans.

• It reinforces the principle that the purpose of the intervention visit is to support the parent as he/she supports the child’s development.

Henley Reflection/Feedback Clip

Using the fidelity tool, observe this video clip. Begin thinking about why reflection is beneficial for the parent and the provider.

Video Transcript:

Rachel: So how do you feel about her being swaddled a little tighter?

Mom: I think she seems to like it. As long as she’s happy and that will help her sleep through the night a little bit more instead of her waking herself up, I’m all for it.

R: So were there any other recommendations you saw on the Internet or that people have told you that you want to try or that you’ve tried before and haven’t worked?

M: For sleeping? I heard that she’s been congested so we’re tilting her mattress a little bit would help, so a little pillow on one end. We’ve been having some allergy problems here so I read about humidifiers helping so we just recently put a humidifier near her bed. We’ve tried a lot of the swaddle sacks and things but I like the blanket a lot better in case she does break out. It’s really loose and she can still breathe through the blanket. Things like that but we’ve tried a lot to get her to sleep.

R: Right, I mean getting to sleep, staying asleep-everyone seems to have an opinion about what you need to try and not try and sometimes people really have strong opinions about it, so I think it’s definitely whatever you feel comfortable with, that works for you and your family is what’s going to work best for her.

M: Yeah, we’ve gone through a lot of different routines to try to get her to sleep through the night.

Reflection/Feedback Question

What information do you gain from reflecting on an activity with the parent after trying the strategy?

|Correct |Choice |

|X |The parent’s comfort level with the activity or strategy. |

|X |The parent’s perspective about the success of the activity or strategy. |

|X |The parent’s response can help you determine if an activity or strategy will occur when you are not there. |

| |How well the parent likes you as a provider |

Incorrect

Rethink your answer. Reflection does not indicate a parent’s like or dislike for a provider. Reflection helps the provider to understand the parent’s perspective, if the parent is comfortable with an activity or strategy, and if the parent will continue to use the activity or strategy between visits.

Correct

Correct. Reflection helps the provider to understand the parent’s perspective, if the parent is comfortable with an activity or strategy, and if the parent will continue to use the activity or strategy between visits.

Henley Final Clip

Using the fidelity tool, observe this video clip to see how the provider and mom reflect on the visit and begin planning for the next visit.

Video Transcript:

Rachel: So the routines seemed to work today because she’s asleep. We’ll see how long that lasts but how do you think that went?

Mom: She seemed very comfortable so pretty good. I’m hoping that by swaddling her a little tighter that she will stay asleep for longer and not wake up or wake herself up.

R: And do you think you’ll keep trying having the oatmeal before you start with the bedtime routine?

M: I think so. Hopefully she’ll be more full maybe so that’s one of the reasons maybe she was waking up frequently because she’s hungry so maybe that’ll help tie her over until morning.

R: OK, OK. So next time I come, what would you like to focus on then? I definitely want to hear how things are going with the spoon feeding and how the sleep routine’s going but what other things would you like to work on? What other challenges is she having?

M: I mean, she’s doing pretty good. Maybe by the time you come back, maybe we can actually try more than just the oatmeal; that would be interesting to try the puree baby food, that would be interesting and then maybe seeing her core control. Maybe we can work on some of that because she was kind of falling over.

R: Right, right, right. And then also you’re doing a great job with waiting until she opened her mouth and let’s see if she will close her mouth more around the spoon and then you just pull it.

M: Yeah. OK, yeah. We’ll try that too because I was kind of helping her get the food off. I see. OK.

R: Right, right. But this is her first time and you’re getting it so definitely, you’re doing a fantastic job, following her lead and she is really showing you that this is something she’s interested in and she really enjoys it.

M: Good. OK, thank you!

R: You’re welcome!

Final Question

How do you plan for the next visit with families?

Does your plan include:

• Addressing the caregiver’s priorities for services?

• Scheduling your next visit during a meaningful activity setting or routine?

• Discussing additional settings the caregiver could practice the strategy with the child?

Congratulations

Congratulations! You have completed the section on Henley’s visit. Take time now to compare your fidelity tool to the answer key provided.

8. Resources

Select a resource to learn more.

CASEcollections are groupings of web-based journal articles, tools, how-to guides, and bibliographies on a specific topic or theme related to early childhood and family-centered practices. This CASEcollection focuses on coaching in early childhood intervention.

Virginia Early Intervention Professional Development Center hosts a webpage with multiple resources about coaching in Part C intervention to include a facilitation guide, videos, webinars, articles, and handouts.

Early Intervention, IDEA Part C Services, and the Medical Home: Collaboration for Best Practice and Best Outcomes: This article may be a helpful resource for talking to medical referral sources about Part C early intervention and the coaching approach.

Family Guided Routines Based Intervention Overview Module: An early intervention approach in which caregivers use their everyday routines and activities as the context for helping their child.

9. Conclusion

You’ve learned about the five components of coaching and applied your knowledge using the checklist in the video scenarios. While the components do not always have to be implemented in a linear order, all components must occur at each visit to be considered coaching. As you implement coaching with fidelity, continue utilizing the Texas Coaching Checklist to ensure all aspects of the components are being met.

We would like to continue supporting you in the quality services being provided to families. One way we will support you is by following up with you in three months, six months, nine months, and one year. We will ask you to evaluate your ongoing development as a service provider, how you have applied the information you learned in this module, analyze the results of application, and provide you with additional resources and tools along the way. Until the next time, don’t forget about the resources in this module which provide additional information on the coaching approach. Select the survey link to provide your feedback or select next if you would like to return to the main menu.

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