EI Talk: A Blog for Early
Childhood Professionals

“Isn’t more better?”- a question commonly asked by families and providers when first hearing about the Primary Service Provider (PSP) model.  Responses to these questions and more are answered below

Isn’t more better? 

Contrary to popular belief, more service is not always better.  In fact, one study found that multiple services provided at high frequencies actually related negatively to parent well-being and function (Dunst, Brookfield, & Epstein 1998).  However, more intervention is better.  Embedding strategies into daily routines increase the opportunities for practice and increases learning.  The TaCTICS website provides a detailed comparison of a traditional approach (ST and OT one time a week each) vs the PSP approach. http://tactics.fsu.edu/MIH/handouts/steps/step5/adultlearning/JamesJamaal.pdf.  It is our responsibility as providers to educate families about the way young children learn and the role they have

Is one time a week really enough? 

The PSP model does not stipulate that the primary provider can only see the family one time per week.  The frequency of the visits by the PSP model should be determined by the IFSP team during the IFSP meeting.  The decision should take into account the caregiver’s level of comfort in providing strategies and the family’s schedule.  Some professionals advocate for starting with a high frequency of service and tapering off as the caregiver’s confidence and competence increase.  Also remember that the IFSP can be changed at any time.  If the team recommends one time a week initially, but later feels an increase (or decrease) is necessary, the team can call an IFSP meeting to make the change.

Are you sure I only need one provider to meet all of my concerns?

The PSP model does not mean a family will only have one provider.  The intent of the model is not to say that families have to choose between physical therapy or speech therapy.  Remember that the primary provider has a team of professionals working with them to meet the child’s needs.  Consultation visits can occur in which the primary provider, the consultant, and the family all meet together to observe the routines and embed strategies.

How is an SLP supposed to do a PT’s job? 

The short answer is they aren’t.  The focus of early intervention services is on supporting families to increase caregiver confidence and competence.  Providers focus less on direct interaction with the child and more on educating the family about strategies to promote development.  An SLP has basic knowledge of development, including motor development, and is, therefore, capable of making basic recommendations.  Remember that a child does not work on developmental areas in isolation.  An SLP is “working on” on all areas of development all the time.  It is expected that the SLP would ask the PT to consult when questions or concerns arose that she was not comfortable answering or addressing.

For more information:

Shelden ML & Rush DD (2013). The Early Intervention Teaming Handbook The primary service provider approach. Baltimore, MD:  Brookes Publishing.

Dunst, CJ, Brookfield J, & Epstein J (1998). Family-centered early intervention and child, parent and family benefits:  Final report.  Asheville, NC:  Orelena Hawks Puckett Institute. 

– Jamie Holloway

Best practice recommendations for early intervention services include embedding developmental strategies into daily routines and activities that are already occurring in a child’s life.  Routines allow for increased opportunities for a child to practice and learn a skill within a familiar context.  This allows for optimal learning and carryover.  While all families have routines, it is not always easy for providers to gather information about these routines.  Included below are some tips that can be used to gain more information from families about their daily routines and activities:

• Provide background information about the purpose of your questions.  Families may be more willing to provide information when they know why they are being asked.
• Remember that a routine is not the same as a schedule.  Routines are activities that happen in a predictable sequence.  All families have routines, even though they may not have a set schedule of when certain routines occur each day.
• Expand your definition of a routine.  Getting the mail, washing hands, and helping to prepare meals are predictable, functional activities.  Each of these activities  contain multiple opportunities for learning.
• Use open-ended questions!  Ask the family what works well within the routine and what does not.
• Can you show me?  Observing the routine as it typically happens will provide an opportunity to ask follow-up questions and problem solve with the family for solutions.
• Use coaching strategies to guide questioning.  Ask questions to help the family come up with an answer that works for them.  Avoid suggesting alternatives without family input.
• Ask the family regularly about their interests.  For example, the routines in which a family participates over the summer time are likely very different than the routines of the family during the holiday season.  Jennifer Swanson and her colleagues at the Family, Infant, and Preschool Program have created a series of checklist that may help you help families identify interests of their children. The checklists can be downloaded from http://www.fipp.org/case/casetools.html Promoting Young Children’s Participation in Interest-Based Everyday Learning Activities Jennifer Swanson, A.B.D., Melinda Raab, Ph.D., Nicole Roper, Ed.D., & Carl J. Dunst, Ph.D. CASEtools, Vol. 2, Number 5
• Observe items and objects in the family’s home that may provide clues to the family’s routines.  For example, by observing a baseball hat and glove near the back door, you may learn, after questioning, that the family spends the entire weekend at the ball park watching a sibling play baseball.  Embedding strategies into the family’s ball park routine might be beneficial for this child.
• Be respectful.  Routines vary greatly from family to family.  It is important for providers to keep an open-mind when working with families.
• If a formal tool such as the Routines-Based Interview (RBI) has been used to complete the IFSP, consider using the information obtained from the RBI to guide follow-up questions with a family.
• Published instruments such as the AEPS Family Report and the HELP Family-Centered Interview can also be used for routines assessment.  In addition, simple questionnaires and handouts to guide conversations with families are available online.  Visit http://tactics.fsu.edu for more information.

Finally, remember that routines assessment is an ongoing process.  The routines of a family will change over time just as intervention strategies will change as the child’s strengths and needs change.  By knowing how to gain information about a family’s routines, providers can offer meaningful strategies for a family and increase the child’s participation in activities.

Further Reading:

1.  Workgroup on Principles and Practices in Natural Environments (February, 2008) Seven Key Principles:  Looks like/doesn’t look like. OSEP TA Community of Practice-Part C Settings. http://www.nectact.org/topics/families/families.asp.
2. Woods, J. TACTICS. http://tactics.fsu.edu 

— Jamie Holloway

Young children learn best through experience.  They need many opportunities for practice or repetition of skills within a meaningful context.  For infants and toddlers, the meaningful context is the activities and routines they do every day.  Embedding strategies into daily routines will increase a child’s opportunities to practice the skill and provide that meaningful context for learning.  In addition, by focusing on the family’s routines as the basis for intervention, the child will increase participation within routines and activities as a result.  

For example, Joey’s parents are concerned about helping her learn to sit independently.  The traditional model of therapy would involve the therapist performing activities to work on sitting and then giving a few things for the family to work on between sessions.  With routines-based intervention, the therapist and family would look at daily routines that provide opportunities for sitting such as bath-time or mealtime.  The provider would observe the current routine and problem solve with the family to offer strategies to target sitting within those routines.  Because the provider is not a typical part of the family’s routine, the caregiver should be given ample opportunity to practice the strategies during the session so they will feel comfortable performing it when the provider is not there.  In between sessions, the family would continue to implement the strategies.  

Most providers agree that families need a “home program” to work on skills in between sessions.  Indeed, the “therapy” is actually what happens between sessions.  By providing strategies that occur during already-occurring daily routines, the need for “therapy homework” is eliminated.  An added benefit is that the family is more likely to try the strategies because they are part of what they already do, not an “extra” thing added to their already busy day.

Embedding strategies into daily routines and activities of families is an important step to helping children and families achieve IFSP outcomes.  It’s a model that applies what we know about how young children learn and maximizes the child’s learning opportunities.  The provider can work to increase the caregiver’s confidence and competence as they learn to work with their child within the familiar framework of their routines.  What routines have you observed with families?  How have you observed routines-based intervention “in action?”

— Jamie Holloway

For more information:

Family Guided Routines Based Intervention- http://fgrbi.fsu.edu/model.html

McWilliam, R.A. (2010). Routines-based early intervention: Supporting young children and their families. Baltimore:  Paul H. Brookes Publishing.

IDEA mandates that services are provided in a child’s natural environment, but natural environment services are about more than the location in which an intervention session takes place.  They are also about what happens during the session and what materials are used.  Best practice recommendations suggest that providers should use toys and materials already available in the child’s home or child care center or other environment that the child regularly attends.  Using the materials found in that environment increases the likelihood that they will be able to “practice” activities and increases carryover of skills.  Listed below are some tips for providers to decrease the use of toy bags during early intervention sessions.  What other suggestions have you tried?

• The essential factor that will help us learn to rely less on our toys and more on “found materials” is knowing the properties of the toys that we use and why we are using them.  During EI visits we should be using toys for a specific reason, rarely to entertain.  Part of our planning with families should take that into consideration.  If we plan out what we are doing and why we will increase the likelihood that “found objects” will emerge as just what we need.
• Pick one family you are working with who you feel comfortable with not using a toy bag.  Perhaps you’ve started to notice there’s one family you see that seems to have everything and you’ve already been using your toy bag less.
• Don’t be afraid to ask questions.  If you are looking for a particular property of a toy or object or material ask.  Many times families already have something that would work for the task you are trying to create.  The key is knowing the property.
• Bring an empty bag.  Have the child pick out toys from his own closet to fill the bag and use for the session.  You may just find out what really interests the child.
• When you find yourself reaching for a toy from the bag, make it a point to help the family problem solve what they have at home that can also be used for the activity after you leave.  This way the family won’t feel like they can’t work on things when you’re not around or like they have to go buy all the same toys you bring.
• Start with the next new family that is referred to you.  Old habits die hard and changing things in the middle of the game can be difficult.  However, if you never bring a toy bag in, there’s no need to decrease use of it!

—  Jamie Holloway

For more information and ideas, visit http://tactics.fsu.edu/pdf/HandoutPDFs/TaCTICSHandouts/Module2/10step.pdf.