MacWilliam from the university of alabama i am going to talk to you today about teller intervention and the routines based model I have written a blog about this which you can find at natural environments dot blog spot.com these are interesting times for us but not so scary if you have been using the routines based model or a similar model the routines based model is primarily one that focuses on building families capacities and other caregivers capacity to enhance the child's meaningful participation in everyday life so much of the visit in face-to-face life has to do with working collaboratively with caregivers parents teachers and other caregivers of the child because this interaction is largely with adults when we have to move to a virtual home visit because families are staying at home the change is really not all that different in fact this situation which is not pleasant for anybody to be trapped in the home is actually demonstrating the power of working with families to enhance their children's engagement in everyday routines and it makes intervention much more relevant in fact since children spend most of their time with families anyway even when we do have face-to-face visits we can see that we have always believed that working with families to help them be able to get their children engaged independent and in social relationships in their everyday activities is the way to go so I'm going to discuss today how the principles of the routines based model match the demands of distance service delivery I do encourage you to go to a eieio let me just get my layers here at WWE ie I owe you a edu where you will find many resources the principles of the routines based model first all the intervention occurs between visits not during visits but between visits that's where it is that children are learning and if that's the case then what do we do during visits what we do during visits is we help the families have all the information and support that they need to be able to intervene or parent their child so visits build the family's capacity to meet child and family needs and so in the teller intervention visit were still going to be doing that that emphasis on building families capacity another principle of the routines based model is that the family sets the agenda the professional does not prepare for what they think we should talk about at the next visit you will see some more details about that as we go along the next steps form which I'll show you later is virtually completed and reviewed during visits that is we can ask the family what it is that they intend to do in the coming week and what they would like the focus of the next visit to be on and then at the beginning of the next virtual visit we review that family sets the agenda another principle is that parents are competent adults so understanding that that is true we then in a virtual world collaborate to determine interventions that parents will carry out we do not give families homework we work with them to help them decide what it is that they want to be able to do with their child and of course we give them ideas once we have enough context another principle of the RBM is that we that family consultation is how we work with families family consultation is collaborative consultation but with families so we asked many questions to help families arrive at solutions that they want to implement we asked many questions before we make a suggestion so that our suggestions are relevant for the family another principle of them of the model is the two bucket principle this principle says that a mother or father or other caregiver can only fill her child's bucket to the extent that her bucket is full that is to say that we need to ensure that caregivers of children have the information support resources that they need so that then they have the energy information and resources to be able to help their child so the visit the virtual visit includes discussion of family outcomes and goals and other family needs in this family centered approach the routines based model we are concerned about helping all members of the family understanding that a family is like a child's mobile that you tug on one element of the mobile and all the other elements move with it families are are a system that is interdependent on each other the last principle I want to mention is that we provide support based visits this has been true in a face-to-face world and is also true in a virtual world and so in our visits are designed to provide emotional support for families and ensure that they have emotional support from their own networks to provide material support to families that is information about how they can have access to the things that they need to be able to run their lives the way they want to and importantly that they have informational support so these three types of support emotional material and informational support are essential at every visit and we can provide those when we're using teller intervention I don't need to tell you about all the technological requirements for doing teller intervention because there are many many resources out there now in the past two to three weeks telling people what they need in terms of Wi-Fi enough bandwidth the right kind of technology etc so I'm more or less going to skip over that other than to tell you that the most commonly teller intervention visits will be via videoconferencing so with some kind of camera involved it can be by phone and this has become a very important issue because we understand that for reasons of equity we cannot have early intervention that can only go to people who have their own personal Wi-Fi because there are some families who do not have that so in this spirit there are organizations and states scrambling to provide Wi-Fi to all families such as by providing them with hot spots that they can use through their cellular connections and so forth so videoconferencing does have pros and cons for different families and in a study by Olson at all in 2012 we found that what they did was they had families rate the ease with which they were able to do I think it's seven practices and they were turning on the computer connecting the camera and microphone connecting to the internet connecting to the project website the platform that was used for connect for the visit logging on to the website starting the camera and locking the microphone to talk some of these sound a little dated to me but the point was that families by and large were fairly comfortable once they had good directions at the beginning and remained comfortable throughout the course of the study the as I said earlier I'm not going to go into the details of all of the issues I really want to talk about how the routines based model can be used successfully via teleconference the one the first elements of the routines based model is the routines based interview for assessing needs and cami Stevenson and I will be doing a webinar on this hosted by CEC and Dec in a couple of weeks so the RBI is essential and it includes ecomap development so that is drawing the picture of the families ecology including especially importantly there are informal supports and this can be done by just asking the family questions the professional will draw the eco map and then use technology to show the family the eco map such as by scanning it and sending a copy to the family scanning can be used with various types of software on telephones or can be simply a picture that is then sent to the family so obviously we have to have in addition to the teleconference connection we have to have some kind of connection with the family by our text or email or some other system like that Facebook Messenger or whatever that actually those other methods of connection are important for setting up the visit I do want to say that I have seen some guidances around teller visits that to me sound a much too prescriptive for working with families our visits should be a gentle intrusion into the family's life because they want us to be there because we're helpful to them it is not that the family has to bend over backwards to accommodate our visits through technology so ensure that the setup for the visits is gentle and kind and sensitive to the fact that families are stuck together in their homes and some families are feeling isolated and sometimes a feeling that too much intrusion in their lives so we need to be really sensitive not to make it that the families have to bend to us but that we accommodate the family's schedules so the ecomap is the first part of the RBI then we get into the interview itself about the child's engagement independence and social relationships in the different routines of the day this happens in face-to-face as a conversation so there's no reason it cannot happen through a computer and the procedures for doing an RBI basically are that we go through the families day at each time of the day or routine we find out what everyone else is doing what the child is doing the child's engagement child's in gate independence the child's social relationships and then how satisfied the family is with that time of the day and we proceed that way through the interview towards the end of the interview we do ask the family the time worried and change questions which are do you have enough time for yourself for yourself and another person when you lie awake at night worrying what do you worry about and if there's anything you could change in your life what would what would you change and those questions still get asked because just because we're doing it over a computer that doesn't really make any difference it's very important in my opinion to have the camera on the interventionist and the family so that you can just some extent read affect in both people and it's very important for the family to be able to see the effect in their interviewer then the interviewer recaps the conversation now the notes can be taken by hand or they can be taken on the computer usually in face to face computer taken notes don't work all that well because it's a lot to handle when you're to keep up with well-written notes and to keep the conversation going it's a little easier from a to do that so people have a choice of taking their notes either way in the recap they need to show their notes to the family so again we either have to use scanning or pictures for the family or we share our screen or some combination of the two because you can actually capture the image of your notes and share the screen from that image so the point is that the family needs to be able to see the notes during the recap because they're going to revisit the notes a little bit later on after the recap the family then chooses theirs the recap and they decide what their goals are going to be at this point at the beginning that we just asked them what the goals they want and the professional starts writing down what the family wants and maybe asking for a little bit of clarification to make sure that these informal goals have enough that we have enough information about these informal goals to know what the family really wants if the if the family has chosen fewer than 10 which is usually true we then hand over our notes to the family so in a virtual way this would be making sure that the family had could see the images of the handwritten notes or could see the the typed notes through shared screen or through a copy some other method of sending a copy such as saving a document of the notes and sending it to the family so they can look through it now the important thing here is that the family should be able to see these notes and add additional goals that they hadn't thought about goals or outcomes and then the professional and the family together should be able to look at at the notes each person can have his or her own copy or their with a shared screen they can both see these notes so that we end up with 10 to 12 functional child 10 to 12 outcomes or goals some of which are functional child goals and some of which are family goals now then we get into visits and in my blog I have my blog post I have described the difference between synchronous versus asynchronous visits and I will say that most people are talking about only synchronous visits that is real-time visits which are ideal but it is also possible to have asynchronous visits which is basically the professional providing some ideas and feedback perhaps on on material that the family has sent such as video or questions by email or what have you and so I don't want us to lose track of the possibility that sometimes asynchronous visits might also be an option I have also already mentioned that the agenda for the visits and I'm now talking about synchronous visits should be set by the family and with the family's priorities in mind the focus of of the visit is determined as part of the next steps forum which I'll show you in a minute and then we review interventions that the family said that they were going to carry out this review of the interventions that they were going to do the ways to help the child be engaged can involve some action such as they could show you over the with the camera what the child is doing they could also show you what they have been doing to help the child often we have to remind the family that the positioning of their camera should be often capturing both child and caregiver not just the child the development of strategies with families has always involved a of talking questions by the professional and that once the professional has enough context understands what the family wants understands what the child has been doing what the caregiver has been doing etc then they stick the landing as cami Stephenson always calls it and so that is actually comes up with a specific suggestion for the family and then they talk about whether that's going to be feasible whether the family likes that idea and if not they move on to another one so that still can all happen through telecommunication and then the visit needs to conclude with a plan for the next visit because we are working with 10 to 12 outcomes or goals we use the matrix to remind the family of the goals that they have chosen so in case they want to focus on certain ones that maybe we haven't talked about in a while this is a an example of the matrix and you can see that we have the goals or outcomes down the left-hand side routines across the right if the X's are the routines in which the functional child goal will is targeted for so in this one which is acknowledging people when they greet Jamal the family had and the early interventionists had thought that this would be important at waking up time hanging out time and outside time for example so you can see how each of the goals has the routines that is that it is targeted for some of these goals don't have any routines here and because they are the family goals which are not routine bound so this is Shamika will get information about inclusive preschool options that is her outcome number 7 by the way at the end of the RBI once families have chosen their goals they put them into the order of importance and then we always keep that up that order when we list out the goals so their most important one was for Jamal to acknowledge people when they greet him and you can see that their goals go all the way down to Shamika exploring going back to work and again that has no no routines because it's a family level goal and here is the next steps form this is a very important form for us other models have similar forms this for us what we have on the left-hand panel is what we did today and progress on any goals discussed in the right-hand panel what we will do from now until the next visit we being the caregiver but it could also be the early interventionist and the plan for the next visit is down at the bottom and what we often do is show the family the matrix to remind them of all of the goals that they have chosen for their child and family when they are thinking about what the plan for the next position be so the next steps form is used for documentation of the visit it is a reminder of the commitment that the adults involved have made about what's going to happen between visits remember all the intervention occurs between visits and it is the agenda for the next visit the agenda for the next visit will be the plan for the next visit on the bottom panel but it will also be a review of what we did in the past week or since the previous visit again I want to ask the question who sets the agenda it is the family that sets the agenda in our model so to revisit the principles then all the intervention occurs between visits family sets the agenda parents are competent adults and so we work with them as partners in this process they are not children we use Adult Learning Theory we do not use pedagogy family consultation is how we work with families and so that is a collaborative consultation approach not an expert consultation approach we don't go in there giving parents suggestions and expecting them to follow through we go in there working with them to figure out what it is that's going to work for them and what they consider to be likely to succeed and feasible in their busy lives we followed the two-bucket principle which is to ensure that families are getting the resources and supports that they need to build themselves up as individuals which then makes them more rested prepared and confident as parents of their children and we provide support based visits focusing on emotional support material support and informational support so I encourage you please to visit WWIII OUA edu where we have many materials and other information and please do write to us at eiu o @ üa edu and you can write to us in Spanish or English and we will reply quickly so thank you for letting me talk to you today about how tella intervention and the routines based model are natural partners and I wish you luck in supporting families thank you very much