The Art and Practice of Home Visiting

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The Art and Practice of Home Visiting

• Early Intervention for Special Needs Children and
  Families
• Shirley Sparks, CCC-SLP
• ASHA
• November 22, 2008
• s.sparks_at_comcast.net

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(No Transcript)
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Children Served (NEILS 2007)

• Speech/communication 41
• Prenatal/Perinatal 19
• Motor Delay or impairment 18
• Global Delay 12
• Congenital Disorders 9

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Families Served

• 10X more in foster care
• 15 live in single parent households
• 20 have another child with special needs
• 53 have 2 or more socio demographic risks

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Learning Outcomes

• Discuss core principles to home visiting
• Identify 7 Parts of a Home Visit
• Identify the tests of efficacy for current
  strategies in early intervention

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3 Parts to this Presentation

• 1. Core principles for personal philosophy
• 2. Service to the family. Family-centered home
  visit
• 3. Service to the child. Strategies and tests for
  efficacy

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Core PrinciplesResearch from Neurons to
Neighborhoods

• 1.Human development is shaped by a dynamic and
  continuous interaction between biology and
  experience
• Provide experiences to fire neurons

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• 2. Children are active participants in their own
  development
• Provide Developmental Guidance

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• 3. Childrens development is individual
• Reframe and normalize
• Similar to developmental guidance but
  differences are
  put into context for
• parents

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• 4. Nurturing and dependable human relationships
  are the building blocks of healthy development
• Preserve and nurture all relationships
  within the family

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• 5. Parent is the expert on her child
• All parents have strengths. Parenting
  is built on trial and error
• Individualized approach matches goals to
  specific needs and resources of the
• family

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• 6. Culture influences everything.
• Childrearing practices and beliefs
• No intervention will be effective if it can
  not fit into the daily routine of
  the family

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They wont care what we know til they know
that we care

• Necessary but not sufficient

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Personal Characteristics

• Be reliable
• Act like a guest in the home
• Explain jargon
• Observe yourself

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Service to the FamilyTasks of the Home Visitor
for the Family

• Provide information
• Provide resource supports
• Provide social supports

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Tasks of Home VisitorProvide Information

• Provide information they can trust and
  understand.
• www.healthfinder.gov
• www.hon.ch
• Teach how to do things with child
• Tell about childs disability
• Give developmental guidance

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Tasks of Home VisitorResource Supports

• Give access to needed materials
• Get equipment
• Access to financial resources they are entitled to

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Tasks of Home VisitorSocial Supports

• Support emotionally
• Be positive
• Be responsive
• Pay attention to the whole family
• Empower and expect change

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Service to the Child
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Structure of VisitsTiming and Focus

• Generalist
• 1 X per week to as needed
• Specialist SLP
• Less often. Work with generalist or parent.
• Focus is usually more on the child
• Contribute recommendations for Generalist

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First Visit

• Getting acquainted
• Hearing their story
• Typical Day. What child does well. Routines
• Prioritizing and Summarizing
• Building trust

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Format of a Regular Visit

• 1. Arrival and greeting
• 2. Whats new?
• 3. Todays activities
• Where to begin
• Toy bag?
• Modeling

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Modeling 8 Steps(McWilliam 2007)

• Talk about your suggestion
• Ask if want to be shown
• Tell parent what you will do
• Do it
• Tell what you did and point out consequences
• Ask if she would like to try it
• Yes, watch. Limited feedback
• No, leave it alone

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• 4. Reflect and plan for next visit
• 5. Whats coming up?
• 6. Anything else?
• 7. Good-bye

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Service to the Child Strategies for Intervention

• The soundness of the strategy
• Its acceptability to the recipients
• The quality of its implementation
• Functionality

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Strategies in Current Use

• Continuum of Naturalness
• Drill
• Drill Play
• Free Play
• Routine Based
• Family-Guided Activity Based
• www.parsons.Lsi.ku.edu/facets

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Tests of Efficacy for Strategies

• Soundness
• Acceptability
• 3. Quality of Implementation
• Functionality

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Soundness

• Drill gives more opportunities
• More natural is more likely used
• All are sound when used with appropriate
• child and family

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Acceptability

• Parents need to own the goals
• Parents as interventionists
• Requires parent education
• Hard work
• May be beyond them
• May opt out

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Advantages of Using Parents as Interventionists

• They maximize intervention as consistent,
  frequent, functional
• Increase intensity of intervention
• Caregivers feel more confident

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Quality of Implementation

• Learn by repeated interactions with environment
  between visits
• Generalist - Problem solving, Developmental
  Guidance, some modeling
• Specialist Customize interventions. SLP
• Exceptions

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Functionality

• Function Focus
• Interventions are appropriate for regular
  routines.
• Interventions can be carried out by regular
  caregivers
• They are delivered multiple times per day

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Conclusions from tests of Efficacy

• Best strategies from research are
• Naturalistic
• Spontaneous in Family Routines
• Accepted by Caregivers
• Well implemented
• Functional

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Ask Yourself

• Can I ask the family for solutions instead of
  suggesting my own first?
• Does my intervention have anything to do with the
  family?
• When I go home, what has really changed with the
  family?

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• What is going to happen between visits that is
  going to make a change?
• Was that intervention or did I just sit in the
  family room and go through some motions?
• Can I handle cultural and personal values that
  are different from my own?

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• Can I abandon my agenda?
• What can I do when I see things that I think are
  wrong?
• How much control do I need to exert over the
  intervention process?

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A Tall Order for Us

• Thats why we need a personal philosophy built on
  core principles
• Rely on Mentors
• Ask for help

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Take Home Messages

• Personal philosophy is built on core principles
  of the science of neurodevelopment and the
  science of intervention
• We consider the family in all we do
• Art is choosing efficacious strategies for
  individual family and child

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Up to the Home Visitor to Choose the Best
Intervention for this Family and ChildThat is
our task and our expertise

• Source Cook, R. and Sparks, S. (2008) The Art
  and Practice of Home Visiting Early intervention
  for children with special needs and families
  Brookes

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(No Transcript)
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• Source Cook, R. and Sparks, S. The Art and
  Practice of Home Visiting Early Intervention
  for Special Needs Children and Families.
• (2008) Paul H. Brookes

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Other Subjects

• Working with interpreters
• Safety
• Ethical Issues
• First Contact
• Nurturing the nurturer
• Guidelines for specific disorders
• Personal concerns of the home visitor
• Family Systems Parent/Child interaction

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• Special situations
• Parents teens, mental health, DD
• Foster-Adopt
• Expanding the team
• Working with physicians