Routines-Based Interview

1. Routines-Based Interview Siskin Children’s Institute Inservice Workshop May 2010 RBI Certification Institute July 2010 Robin McWilliam

2. Need for Routines-Based Assessment The assessment legislation and our field amazingly forgot: needs! Functional outcomes/goals (target behaviors) Address participation (engagement) needs Address independence needs Address social relationships needs Family priorities reflected in the IFSP/IEP Outcomes/goals meaningful to the child’s caregivers To capitalize on learning opportunities, without embedding nonfunctional outcomes/outcomes

3. What is the RBI • Semi-structured interview • Asking about child and family functioning during everyday routines (home, classroom) • Purposes • To establish positive relationship with family • To get rich and thick description of child and family functioning • To produce a functional, family-centered set of outcomes/goals

4. At Siskin Children’s Institute, Who Could Conduct the RBI? • ELC administrative staff? • Teachers? • Beth?

5. Why Teaching Staff Need This Information • They might be interviewers • They will be interviewed • They will receive IFSPs, IEPs derived from the RBI • They need to explain it and talk it up to families

6. The RBI and Outcome Functionality The RBI does lead to more functional outcomes, meaning They specify what the child or family will do The contextual need has been identified (i.e., what makes it functional) It’s important to the primary caregivers

7. RBI • What is your experience with the RBI? • Each person • Observed a trainer do one live? • Seen a video? • Conducted one?

8. RBIs have been used for > 20 years In countless states, districts, and programs, across the U.S., they are Mandated, Recommended, or Encouraged Most interviewers wouldn’t dream of doing IFSPs without an RBI Training is very helpful/necessary Tools are necessary at the beginning Families love them What’s My Experience?

9. A Bad Interview • …is possible • …happens as a result of incorrect implementation • It’s almost impossible to have a correctly implemented interview result in a bad interview • Definition of bad interview • Family unhappy with process • < 6 goals • Interview lasted < 1hour

10. Review of RBI Steps • Key components • “What are your main concerns?” • Home routines • “How does your day start?” • 6 pieces of information per routine (everyone, child—engagement, social relationships, independence, rating of satisfaction) • Classroom routines • 5 pieces of information + goodness of fit rating • 2 pivotal questions (lie away at night; if you could change anything) • Recap of concerns • Goal decisions • Priority Order • RBI Checklist

11. Including Classroom Routines in the RBI

12. When • Ideally, parent and teacher are together • If not, teacher first, if possible • Many options exist for adding classroom routines • Most involve adding outcomes to the IFSP

13. Interview Together • Parent first, all the way through home routines • Teacher next • Recap home and school routines • Parent chooses outcomes pertaining to either setting

14. Options • Ask the worry and change question at the end of home routines or after school routines • Ask about home routines until “school” time, then ask about classroom routines, followed by home afternoon and evening routines • Don’t forget to ask about what other family members do during the child’s school time

15. What “Teachers” Get Interviewed • Those who have enough contact with a child to have a meaningful impact on his or her learning • I use a criterion of 15 hours a week • Can be any classroom caregiver who knows the child’s functioning in daily classroom routines (i.e., generally, not a therapist or itinerant teacher)

16. During Each Classroom Routine • Same 6 questions (with a twist on the 6th one) • What does everyone else do? • What does this child do? • Engagement? • Independence? • Social relationships? • How well does this time of day work for the child (1-5)?

17. Concluding the RBI

18. Outline • The two summary questions • The recap • Choosing outcomes • Priority order • Next steps

19. The Two Summary Questions • The worry question • The change question

20. Getting There • “Now that we’ve gone through the day, I’m going to ask you two more questions before I summarize what I heard you say.”

21. The Worry Question • “When you lie awake at night, worrying, what is it you worry about?” • Main purpose: To show the family you care enough to ask • For some professionals, this is too sentimental a reason • Tough. It’s now part of the RBI • It can produce a new concern that gets chosen as a high-priority outcome • It helps identify important concerns that don’t come up in discussion of routines • Acknowledge feelings, first, as always • Just enough discussion to ensure you understand (active listening); you are trying to conclude the interview

22. The Change Question • “If there’s anything you could change in your life, what would it be?” • With both questions, ask exactly this way; these are standard questions • Main purpose: Gives the parent an opportunity to think about an overall goal for his or her life—to think beyond “one day at a time” • Variation on the miracle question used in psychotherapy • Acknowledge feelings, first, as always • Just enough discussion to ensure you understand (active listening); you are trying to conclude the interview

23. The Recap • “I’m going to go through my notes and remind you of the main points you made. Starting with waking up. You said this was a great time for you, but you would like Colin to snuggle with you when you pick him up and he always plays with the same thing, if he gets up before you wake him up.” • Should be done by whomever took notes • Position yourself so the parent can see your notes as you’re going through them • Make extremely brief comment about overall routine and mention starred items (concerns) • Only check in with the parent for confirmation, if you really are unsure. This is not interaction time. • But do respond to parent’s interruptions • Minimal conversation; you are not going to rehash issues

24. Concerns Are Not Outcomes • No one at any time should make a list of concerns • Recapping is just going over notes • A list of concerns will get treated by someone as a list of outcomes • The family was not picking outcomes when they discussed their concerns • In RBI-speak, understand the difference between concerns (starred items on notes) and outcomes (deliberately chosen goals to go on the IFSP)

25. Choosing Outcomes • “That was the reminder of what you talked about. Now, what would you like the team to work on with you. Include things for anyone in the family, including yourself.” • Have a blank sheet of paper • Let the parents come up with as many outcomes as they can • Write down the routines in which the concern presented itself • When the parents seem not to be able to think of any more, show them the notes with stars • Ask about specific concerns that seemed important during the discussion • Focus on stars, not ratings • Do not stop prompting until at least 6 outcomes have been chosen. Try not to exceed 12.

26. Priority Order • “Now, can you please put these into order of importance. It’s not true, but if we could only work on one of these outcomes, which would it be? Next? Next?” • Show the parents the list while they’re doing this • Ensure there’s a number next to each outcome

27. Next Steps • “Excellent. This is a great list of things for us to work on. If we can do these, it will be really good for [your child] and the whole family.” • Explain how the next two steps will be completed • Outcomes need to be written in IFSP format • Services and settings need to be decided

28. Effects of Conducting RBIs • Meatier intervention program (goals) • More function- and participation-based child-level goals • Fewer irrelevant, “clinical,” or vague goals • More family goals • A point of discomfiture for traditional early intervention “teachers” and therapists • Supported by theory, legislative history, expert knowledge, and research

29. “What if a parent wants something like more time to herself, and we don’t have the resources to meet that need? Am I expected to go babysit her kids?”

30. Interventionists’ Concerns What if a professional has detected a delay or other problem? Ask yourself if it’s a FUNCTIONAL concern? Ask deficit-related questions during RBI? Fit intervention into existing outcome Might not be able to justify a specialized service! Obligation to give families information But make sure it is evidence based

31. Who’s There? Family decides who from the family they want Child does not have to be there Minimize interruptions Ideal to have 2 professionals 1 is manageable

32. Roles of 2nd Person Help with questions Do not simply observe the first interviewer floundering! Take notes Brief notes, capturing main points Handle interruptions Score developmental test?

33. RBI • Any additional thoughts about how an RBI differs from traditional assessment? • How can you use RBI information? • Concerns, priorities, and resources • Connecting with other developmental assessment information (TEIDS-Plus RBI Summary Form) • Goals • Action steps • Strengths and needs

34. Biggest Mistakes in Interviewing Ask-listen-write, ask-listen-write…. Giving too much information during recap Confusing recapped concerns with selected outcomes

35. 7 Steps of Functional Goal Writing • Read the short-hand version of the goal from the RBI. • Identify routines affected by the goal. • Write “Child (or family member) will participate in [the routine(s) in question]” • Write “by _____ing,” addressing the specific behaviors • Add a criterion for demonstrating the child or family member has acquired the skill • Add another criterion for generalization, maintenance, or fluency, if appropriate (e.g., during school and home meals). • Write the timeframe in which the criterion will be displayed or achieved (e.g., for one week; by June).

36. Example Goal: Can you identify all the components? Hector will participate in play dates by using the same toys as another child and talking with the child about their play. He will play for 10 minutes during two play dates per week for 3 consecutive weeks. Hector will participate in play dates by using the same toys as another child and talking during that play. We will know he can do this when he plays with similar toys, near another child, using at least three words (can be the same word or different words) for 10 minutes during two play dates per week [kids have this many?!] for 3 consecutive weeks.

37. Family-Level Outcomes Preserve as much of the wording as is appropriate Add at least 1 measurable criterion

38. Brande’s Outcomes Brande feel OK about Brandon’s lung development and his O2 status Brandon gain weight steadily to 5th %ile Communicate mama, dada, more, done Move independently, shifting weight Fingerfeeding Be more vocal Throw things Swallow liquid from cup Clap by himself Megan and Hayley get along Hayley not scream at dinner prep time

39. Ana’s and Andrew’s Outcomes Jenevae will move independently (like crawling) Time for Ana and Andrew Learn to play with more complicated toys Hobby for Andrew (not video, not car) Andrew to college Info re: financial help Say words Pulling to stand Come to sitting Lower Ana’s stress Time for Ana for herself (trustworthy child care) Info on child care

40. Jackie’s Goals • Engagement with other children (join other kids) • Engagement with adults (home, school) • Initiate with people about what he wants • Play with toys without “stimming” • Have “conversations” • Imitate others • Eat more foods (less picky, more nutritious) • Play on outside equipment (hang, climb ladder) • Jackie will have information about Owen’s developmental progress and engagement at school