Intervention in Natural Environments: Setting the Stage for a Lifetime of Learning Kat Stremel Pip Campbell Sheila Pearson

Challenges to Implementation Theoretical Frameworks Theoretical Frameworks Preservice Training Preservice Training Service Provider Knowledge Service Provider Knowledge Service Provider Experience & Skills Service Provider Experience & Skills

A Framework of Implementation Source: Core intervention practices Source: Core intervention practices Communication Link #1: Training, coaching, supporting interventionists and teachers Communication Link #1: Training, coaching, supporting interventionists and teachers Communication Link #2: Collaborating, coaching, supporting families as major providers Communication Link #2: Collaborating, coaching, supporting families as major providers Destination: Child/Youth and families within home, communities, daily routines and activities Destination: Child/Youth and families within home, communities, daily routines and activities (Based on Fixsen et al. 2005)

Core Components of Natural Environment Practice Relationships with families Relationships with families Assessment in the environment Assessment in the environment Identification and use of locations, settings, activities/routines Identification and use of locations, settings, activities/routines Outcomes-based Decisions Outcomes-based Decisions Environmental arrangements and adaptations Environmental arrangements and adaptations Child-individualized intervention strategies Child-individualized intervention strategies Evaluation Evaluation Generalization Generalization

Critical Qualities of Child Assessment Asset & interest based Asset & interest based Acceptable to families Acceptable to families Authentic: Observed in natural environment Authentic: Observed in natural environment Typical behavior across routines Typical behavior across routines Reflect different perspectives, including families Reflect different perspectives, including families (Based on Neisworth and Bagnato – 2005) Accommodate the child’s motor and sensory development Accommodate the child’s motor and sensory development Sensitive to show progress Sensitive to show progress Materials validated Materials validated

Identification and Use of Locations, Settings, Activities, and Routines Family routines Family routines Parenting routines Parenting routines Child routines Child routines Play Play Physical play Physical play Entertainment Entertainment Family rituals and celebrations Family rituals and celebrations Socialization activities Socialization activities (Dunst, Hamby, Trivette, Raab & Bruder, 2000)

Outcomes Based Decision-Making Increasing access to locations, settings, activities Increasing access to locations, settings, activities Increasing participation Increasing participation Increasing family enjoyment Increasing family enjoyment Building relationships or skills for development Building relationships or skills for development Decreasing behavior that interferes with learning Decreasing behavior that interferes with learning Promoting acquisition, maintenance, and generalization of learning skills Promoting acquisition, maintenance, and generalization of learning skills

Environmental Arrangements, Adaptations & Assistive Technology Children with physical and sensory disabilities Children with physical and sensory disabilities Common “Wait to Fail” strategies in EC Common “Wait to Fail” strategies in EC Resources for families Resources for families

Development of Child- Individualized Intervention Strategies Families best know the interests and characteristics of their children Families best know the interests and characteristics of their children Service providers should know which intervention techniques (evidence-based practice) works best for which child, for what purpose, under what circumstance. Service providers should know which intervention techniques (evidence-based practice) works best for which child, for what purpose, under what circumstance. Natural environment practice is only as effective as the intervention techniques that are individually designed for children Natural environment practice is only as effective as the intervention techniques that are individually designed for children

Meet Cass at 2 years of age OSEP-Funded Early Childhood Program OSEP-Funded Early Childhood Program Parent Participation…”this makes sense so I don’t rush through the activities Cass enjoys to “work” on her therapy, but aren’t you asking me to be her Speech Therapist, OP, PT, Early Interventionist and still give her a bath?” Parent Participation…”this makes sense so I don’t rush through the activities Cass enjoys to “work” on her therapy, but aren’t you asking me to be her Speech Therapist, OP, PT, Early Interventionist and still give her a bath?” Initially identified 32 skills to target during undressing, bathing, hair drying routine. Initially identified 32 skills to target during undressing, bathing, hair drying routine.

Early Skills Areas to Target Vision Vision Hearing Hearing Physical Physical Communication Communication Cognitive Cognitive Health Health

Cass: Bathing Routine Increase participation in continued movement Increase participation in continued movement Increase head control Increase head control Increase reach to grasp Increase reach to grasp Increase grasping objects Increase grasping objects Increase visual fixation Increase visual fixation Increase response to voice Increase response to voice Increase anticipation through touch and object cues (adaptations) Increase anticipation through touch and object cues (adaptations)

Promote Learning of Targeted Skill: Undressing, Bathing, Hair Drying Routine Targeted Skill AT/Adaptations Individualized Intervention Strategies Beginning - Undressing Grasping objects Anticipation Object/touch cues Toe splints Prelinguistic strategies Shaping/fading Middle - Bathing Head control Increase vocaliz Response to auditory Back brace Later: Bath sling Stool for Mom Imitation Fade support End – Drying off Head control Communication Hooded towel Mom’s positioning Start-stop-wait

Cass at 19 years of age Skill areas that remain critical Skill areas that remain critical

Teaching Strategies that remain relevant Partial or full participation Partial or full participation Responsiveness to self-determination & self- initiations Responsiveness to self-determination & self- initiations Opportunities for choice making Opportunities for choice making Opportunities for higher forms/functions of communication Opportunities for higher forms/functions of communication Consistent prompts, cues, waiting for responses Consistent prompts, cues, waiting for responses Reinforcement and feedback Reinforcement and feedback Utilization routines and activities for learning Utilization routines and activities for learning

Components for Implementation Selection of practitioners who are qualified to carry out child interventions Selection of practitioners who are qualified to carry out child interventions Provision of preservice or inservice training Provision of preservice or inservice training Use of ongoing consultant/coaching within the environments where interventions will be practiced Use of ongoing consultant/coaching within the environments where interventions will be practiced Assessments of practitioner performance Assessments of practitioner performance Evaluation of the Early Intervention Program (Campbell) Evaluation of the Early Intervention Program (Campbell) Provision of administrative support and leadership Provision of administrative support and leadership (Fixsen et al. 2005) (Fixsen et al. 2005)