Enhancing Services in Natural Environments

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Enhancing Services in Natural Environments
Common Themes Of National Trainers and
Researchers Based on excerpts from Larry
Edelmans Summary Call and an Overview by Hurth
And Pletcher, NECTAC
Part of a Web-based Conference Call Series
Sponsored by the OSEP Part C Settings Community
of Practice
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Complexity A Variety of Approaches to Thinking
about Services in Natural Environments

• Contextually Mediated Practices TM 1)
  Intervention 2) Therapy
• Family-Centered Home-Based Service Approach
• Family-guided routines based intervention
• Home-Based Integrated Services
• Natural Learning Opportunities
• Primary Coach Approach
• Primary Service Provider Model
• Routines-Based Interview
• Support-Based Home Visits
• Transdisciplinary Service Delivery
• Transformation Family Centered Transagency Team
  Model

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Complexity Terminology

• Activity Setting
• Asset-Based Context
• Capacity-Building Models
• Classroom-Based Integrated Services
• Coaching
• Collaborative Consultation
• Consultation
• Consultative Model Adapted for Diverse Adult
  Learners
• Context
• Deficit-based Models
• Development-Enhancing Learning Opportunities
• Dyadic Interaction/Triadic Exchange
• Ecomap
• Embedded Intervention
• Everyday Learning Opportunities
• Everyday Natural Learning Opportunities
• Expertise Models
• Family Centered
• Family/Child Supports Services

• Initial Planning Conversation
• Integrated Specialized Services
• Interventions
• Learning Opportunity
• Natural Environment
• Natural Learning Environment
• Outcome Functionality
• Peer Coaching
• Planning Conversation
• Primary Coach
• Primary Service Provider
• Professionally-Centered Models
• Promotion Models
• Rationale
• Resource-Based Models
• Routine
• Routine Based
• Routines-Based Assessment
• Routines-Based Interview

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• There are some significant differences among
  various approaches presented.
• There also seems to be some common themes and
  areas of clear agreement.

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The Dual Focus of Early Intervention

• Two important purposes of Part C of IDEA are
• To enhance the development of infant and toddlers
  with disabilities and minimize their potential
  for developmental delays
• AND
• To enhance the capacity of families to meet the
  special needs of their infants and toddlers with
  disabilities
• (20 U.S.C.section 1471 (a) )

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Natural Environments Its the Law Part C of
IDEA

• Section 303.12(b) To the maximum extent
  appropriate to the needs of the child, early
  intervention services must be provided in natural
  environments, including the home and community
  settings in which children without disabilities
  participate.
• 303.18 -Natural environments means settings that
  are natural or normal for the childs same- age
  peers who have no disabilities.
• 303.167 (1) and (2) Each state application for
  IDEA funds must have policies and procedures to
  ensure that- (1) To the maximum extent
  appropriate, early intervention services are
  provided in natural environments and (2) the
  provision of early intervention services for any
  infant or toddler occurs in a setting other than
  a natural environment only if early intervention
  can not be achieved satisfactorily for the infant
  or toddler in a natural environment.

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Natural Environments Its the Law Part C of
IDEA

•  The Content of the childs IFSP must include a
  statement of the major outcomes expected to be
  achieved for the child and family and include
  303.344(d)(ii) the natural environments as
  described in 303.12(b) and 303.18 in which early
  intervention services will be provided, and a
  justification of the extent, if any, to which the
  services will not be provided in a natural
  environment.

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A Natural Environment
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Areas of Agreement

• Family-centered supports and services
• Individualized approach
• Natural Learning Opportunities How children
  learn
• Participation in families everyday routines,
  activities, places, and relationships
• Integrated supports and services

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Family-centered supports services

• Being responsive to family directed priorities.
• Recognizing and supporting the familys role in
  making decisions in all aspects of the early
  intervention process.
• Building on the recognition that the family is
  the primary influence on the child and has the
  greatest impact on young childrens learning and
  developmental.
• Recognizing and supporting child and family
  strengths.
• Supporting the familys competence and confidence
  in enhancing the childs learning and
  development.
• Providing informational, emotional, and material
  support to families.
• Acknowledging and supporting the cultures,
  values, and traditions of families.

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• Positive, respectful and supportive relationships
  with families are essential in successfully
  promoting family competence and confidence.
• Positive relationships can be established by
• Listening to families
• Being responsive to family questions and concerns
• Respecting family values and culture
• Using conversations to gather information from
  families on their everyday activities and
  routines and what people, places, and things
  their child and family find important, enjoyable,
  and of interest
• (Hanft, Rush Sheldon, 2004)

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Individualized approach

• Assumption that supports and services need to be
  tailored to meet the unique needs and
  characteristics of every child and family.
• Thoughtful gathering of information from families
  about concerns, resources, strengths, priorities
  and
• everyday routines and activities.
• Thoughtful consideration for working with a wide
  diversity of families (culture, ethnicity,
  religion, socio-economic, linguistic).

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Focused evaluations conducted in a variety of
settings assist families and providers to jointly
identify child strengths and challenges related
to developmental skills and their functional
participation in everyday activities and
routines(Hanft, 2004) Service providers must
join family and caregivers in a partnership
providing resources, supports, information,
modeling, joint planning and problem solving
appropriate to learning styles and preferences of
each caregiver and family members.(Woods- 2004)
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Natural learning opportunities How children learn

• Basing strategies on how all children learn.
• Recognizing that young children learn throughout
  the course of everyday life, at home and in the
  community.
• Focusing on naturally occurring learning
  opportunities, rather than contrived, specialized
  instruction.
• Supporting primary caregivers to provide children
  with learning experiences and opportunities that
  strengthen and promote a childs competence and
  development.
• Supporting learning that occurs in context of the
  things that have high levels of interest and
  engagement for children and their families.

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Children Learn

• Through repeated interactions with their
  environment, usually dispersed over time. Not in
  massed trials.
• (McWilliam, 2004)
• When interested and engaged in an activity, which
  in turn strengthens and promotes competency and
  mastery of skills
• (Dunst, 2004)
• Mastery of functional skills through
  high-frequency, naturally occurring activities in
  a variety of settings that are consistent with
  family and community life
• (Sheldon Rush, 2001 Dunst, 2004 Bruder,
  2004)

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• Promoting the childs ability to be and do by
  facilitating the familys or care providers
  ability to enhance the childs development using
  what they consider important.
• (Rush, Shelden, Hanft, 2003)
•  For the child, this means being with the
  partners in life who the child wants and needs to
  be with and doing what he wants and needs to do.
• (Shelden Rush, 2001)

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Participation in families everyday routines,
activities, places, and relationships

• Providing supports and services within the
  context of families lives.
• Supporting child and family participation in
  everyday life.
• Creating functional rather than developmental
  outcomes.
• Supporting that which happens between visits.
• Being guided by the context of a child and
  family's everyday life and the families goals
  for their childs participation, independence,
  and learning.

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Parents prefer interventions that are easy to do,
fit into their daily lives, and support their
child in learning skills that help them be a part
of family and community life(Bruder, 2004
Dunst, 2004)Learning opportunities facilitated
within the context of family and community life
have greater impact on child progress than
intervention sessions (Hanft, Rush Sheldon,
2004 )
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• How early intervention is provided, not just
  where, is key to whether services are
  family-centered or whether the interventionist
  replicates a clinical model in the childs home
  or community setting
• We need an alternative to dumping clinic-based
  models on the living room floor
• (Mc William, 2004)

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Please, No Clinic-based services for me!
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Integrated supports and services

• Basing intervention on functional, integrated
  goals.
• Avoiding a discipline-specific or domain-specific
  focus.
• Team-based approaches (e.g. transdisciplinary,
  primary service provider).
• Collaborative efforts.

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Collaborating with the family and caregiver(s) is
the most influential factor in providing
effective intervention in the context of everyday
routines and activities of children and families.
(Hanft and Pilkington, 2001) Early
interventionists/therapists roles have shifted
from the practitioner as the expert to the
practitioner as sharing his/her knowledge and
resources with a childs key caregivers through
adult-to-adult relationships in which family
members are supported in their day-to-day
responsibilities of caring for their child.
(Hanft, 2004) Learning in a natural environment
requires that the resources of the setting (i.e.
the physical environment, daily routines,
interactions with people and pets etc.) are used
to provide the child experiences and
opportunities that lead to his increased
understanding of his world, increased functional
skills and greater independence. (Woodruff, 2004)
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• IFSP outcomes and strategies are determined
  before services and supports are identified
• Overall, deciding what will be necessary to
  achieve each functional IFSP outcome is the basis
  for decisions about services and supports that
  the child and family need
• (Bruder, 2004)
• Frequency and intensity of services need to be
  based on the amount of support the family needs
  in using natural learning opportunities
  throughout everyday routines and activities of
  family and community life
• Visits provided too frequently can be
  dissempowering or send the message that the
  parent is not competent
• (Dunst, 2004)

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Agreement on Important Outcomes of Early
Intervention

• Although speakers would probably differ in
  emphasis and priorities and each speaker might
  add more outcomes, all support these outcomes
• Support family confidence and competence in
  enhancing their childs development
• Enhance/increase childs participation in family
  and community activities
• Promote mutual enjoyment of family activities

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A Final Agreement

• More is better
• BUT this means more learning opportunities,
• NOT more services
• Learning is what happens between visits of the
  professionals
• Throughout the childs day
• In everyday routines and activities
• Through multiple repetitions and lots of practice
  
• The way all young children learn and participate
  with families and friends in their communities