Enhancing Services in Natural Environments

1. Enhancing Services in Natural Environments Common Themes Of National Trainers and Researchers Based on excerpts from Larry Edelman’s 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

2. 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

3. 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 Family-Centered Home-based Service Approach Family-Centered Models Family-Guided Family-Guided Routine Based Intervention Focused Assessment Functional Evaluation/Assessment Functional Goals Functional Outcomes Home-Based Integrated 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 Service-Based Models Services Strengths-Based Models Supports Support-Based Home Visits Transdisciplinary Treatment Models Triadic Support Hierarchy Typical Natural Learning Environment Settings Complexity: Terminology

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

5. 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) )

6. Natural Environments – It’s the LawPart 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 child’s 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.”

7. Natural Environments – It’s the LawPart C of IDEA  The Content of the child’s 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.”

8. A Natural Environment

9. 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

10. Family-centered supports & services • Being responsive to family directed priorities. • Recognizing and supporting the family’s 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 children’s learning and developmental. • Recognizing and supporting child and family strengths. • Supporting the family’s competence and confidence in enhancing the child’s learning and development. • Providing informational, emotional, and material support to families. • Acknowledging and supporting the cultures, values, and traditions of families.

11. 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)

12. 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).

13. 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)

14. 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 child’s 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.

15. 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)

16. Promoting the child’s ability to “be and do” by facilitating the family’s or care provider’s ability to enhance the child’s 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)

17. 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 child’s participation, independence, and learning.

18. 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 )

19. 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 child’s home or community setting “We need an alternative to dumping clinic-based models on the living room floor” (Mc William, 2004)

20. Please, No Clinic-based services for me!

21. 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.

22. 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 child’s 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)

23. 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)

24. 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 child’s development • Enhance/increase child’s participation in family and community activities • Promote mutual enjoyment of family activities

25. 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 child’s 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 *Thanks, LeeAnn Jung, 2003