1. Dr Carolyn Hughes-Scholes & Assoc Prof Susana Gavidia-Payne – RMIT University Nicole Mahar & Dr Kate Davis – Education Program for Infants and Children

2. Background Embedding learning opportunities in activities and routines occurring in family and community environments is beneficial. Many ECI programs in USA adopt a routines- based approach to intervention. A routines-based early intervention model has been recently developed (McWilliam, 2010).

3. Background Cont. Quality of goals/objectives on individual family support service plan increased after receiving training to conduct Routines-Based Interviews (Boavida, Aguiar, & McWilliam, 2014; McWilliam, Casey, & Sims, 2009). Routines-based model more effective than traditional home visiting in promoting children’s functional outcomes and attaining child goals (Hwang, Choa, & Liu, 2013). Only components of routines-based model implemented rather than whole model in prior studies. Little research exploring the implementation of a routines-based model in community settings.

4. Aim To evaluate the implementation of a Routines-Based Model of Early Childhood Intervention (RBECI) by an early childhood intervention service provider in Australia and its impact on the practices of ECI and ECEC professionals, and families. RBECI model consisted of four components: (a) routines-based interviews (RBI) (b) participation-based goals (c) home visits (d) community consultations

5. Method Research design mixed methods: questionnaires, rating scales, in-depth interviews Participants 5 Key Workers from the Education Program for Infants and Children Inc. (EPIC) 8 families new to EPIC in 2013

6. What did we want to know? 1) How well in terms of skills, knowledge, and confidence do ECI professionals implement RBECI as a model with families?

7. Measures Knowledge and Understanding Assessment measured KWs’ knowledge and understanding of the RBECI. Confidence Scale measured KWs’ confidence in implementing the RBECI in the home and community. Support-Based Home Visiting Scale (McWilliam, 2010) assessed home visiting skills. Coaching Practices Rating Scale (Rush & Sheldon, 2011) assessed community consultation skills. RBI Implementation Checklist (McWilliam, 2010) checked whether KW’s were including the essential steps for conducting an RBI. Goal Functionality Scale III (McWilliam, 2010) examined the goals on the individual family support service plan ( IFSSP).

8. Procedure KW’s completed assessment of their competencies before and 6 months after receiving training in RBECI model. KW’s conducted RBIs with families and completed IFSSPs. RBI Implementation Checklist and Goal Functionality Scale completed by two researchers. Group reflective practice sessions and individual feedback provided to KW’s. In-depth interviews with KW’s to find out their experiences with implementation of RBECI model at end of study.

9. What did we find? KW’s Knowledge, Understanding, and Confidence. Significant improvement from pre- to post-intervention in KW’s knowledge and understanding, t(4) -9.14, p =.001, and confidence in implementing the RBECI model during home, t(4) -12.34, p <.001, and community consultations, t(4) -6.63, p =.003. Home Visiting Skills. Significant improvement in all areas of KW’s home visiting skills from pre- to post-intervention, t(4) 7.76, p =.001. Community Consultation Skills. KW’s skills in implementing community consultations did not significantly improve from pre- to post-intervention, t(4) -1.32, p =.26.

10. What did we find? Cont. Routines-Based Interviews (RBI). Average total score KW’s attained on the RBI Implementation Checklist was 82%. This average score almost reached the recommended minimum of 85%. KW’s lost marks by not asking questions related to: (a) child’s social relationships (b) child’s functioning (c) what parents would like to see next, when there were no problems in the routines.

11. What did we find? Cont. Participation-Based Goals. Average score for each question on the Goal Functionality Scale III was 3 out of 4. Therefore, KW’s developed functional IFSSP’s. BUT … Majority of goals did not include a meaningful acquisition criterion or a generalisation criterion.

12. In-depth Interviews: Key Workers RBIs elicited a broader scope of information that may not have been acquired using previous methods (e.g., screening assessment). “... a lot more information than just talking about the different skills [of the child].” Functional participation-based goals were produced as a result of information acquired during the RBI. “Setting goals was pretty good because it kind of moved seamlessly from getting that list of goals at the end of the RBI into writing the IFSSP.”

13. In-depth interviews Cont. There was a positive impact of embedding intervention within routines on home visits and community consultations. “This is where I think it’s been amazing, because you’re not asking the family to do it [intervention] all day. You’re only focusing on this one routine and they see the success. It flows through to the rest of the day.” “We have such a focus now that you don’t just duck out to a preschool and do an observation for an hour for the sake of it... You might be observing to see where in the routine you could get this goal happening.”

14. In-depth interviews Cont. Parents were concerned with the length of time taken to commence intervention. “We got to a point where she [the mum] just felt like all we were doing was talking and we weren’t actually doing anything for the family. You could see she was like, ‘What are you here for? You’re not actually helping’.”

15. What did we want to know? 2) What is the impact of RBECI practices on the extent to which children participate in their daily routines?

16. Measures Adapted Vanderbilt Ecological Congruence of Teaching Opportunities in Routines (VECTOR) (Home) (Casey, Freund, & McWilliam, 2004) measures opportunities families provide in the home and extent to which children take advantage of opportunities. Adapted VECTOR (Community) (Casey, Freund, & McWilliam, 2004) measures opportunities ECEC professionals provide in the community setting and extent to which children take advantage of opportunities.

17. Procedure Prior to RBECI implementation and 6 months later children’s behaviour was observed for 10 mins in: − Home during a routine that the family had prioritised e.g., mealtime, getting dressed. − Childcare/kinder during ‘free play’. Child’s behaviour was rated using the Adapted VECTOR.

18. What did we find? No significant improvement in opportunities provided within home or childcare/kinder pre- to post- intervention. Significant improvement in extent to which children were taking advantage of opportunities in home and childcare/kinder pre- to post- intervention.

19. What did we find? Cont. Specifically: improvement in children using physical environment and available materials to be consistently engaged in home and childcare/kinder. improvement in children completing home and classroom routines independently. improvement in parent-child interaction over time. But … no improvement in peer interaction.

20. What did we want to know? 3) What is the impact of RBECI practices on the extent to which families’ incorporate intervention practices into their daily routines?

21. Measures Family Accommodations Questionnaire (Tainsh & Gavidia-Payne, 2006) measures adaptations made by families due to having a child with a developmental concern. Family Satisfaction Questionnaire (Kashinath, Woods, & Goldstein, 2006) measures families’ level of satisfaction with intervention strategies, level of information provided, and effects on child outcomes/goals. In-depth interviews with families to obtain their perceptions regarding the implementation of the RBECI model.

22. Procedure Prior to RBECI implementation and 6 months later, families completed Family Accommodations Questionnaire. Families completed Family Satisfaction Questionnaire at the end of the study. In-depth interviews conducted with 4 of 8 families regarding implementation of RBECI model at the end of the study.

23. What did we find? Families’ daily accommodations did not change from pre- to post-intervention. However … Families were satisfied with the intervention practices suggested to them by KW’s. Families found it useful to schedule intervention within daily routines. Intervention strategies were useful in meeting their child’s goals.

24. In-depth interviews: Families Families found the routines-based interview and developing child and family goals to be a useful exercise. “Really, really helpful because you know it gave us something to work towards within our routines, our lifestyle.” “A lot of those goals were so easy to achieve, once we got them on paper. It was a real success.” Families were able to incorporate the intervention practices into their daily routines with relative ease. “And I really thought it’s going to be really hard to put him to sleep on his own but it was actually quite easy.”

25. In-depth interviews Cont. Families found home visits and community consultations to be very valuable. “She would observe the way he was, his interaction with us, … she would sit with us, ask us specific questions regarding how we're feeling, how we’re finding good/bad progress, and then she would give us tasks and advice…She would say, ‘well try this’ and they’ve made a huge difference to our lifestyle.” “She could feedback her experiences with [child] and how [child] was doing… It was positive that she could explain to me strategies that she put in place in the kinder and what the staff were doing.”

26. Conclusions Support for RBECI model to be implemented on a larger scale (i.e., across EPIC, other ECI service providers). KW’s need further training and supervision to improve their implementation of RBECI model, especially community consultation skills. RBECI practices improved children’s participation in their daily routines at home and childcare/kinder. Families perceived the implementation of RBECI model favourably and were able to incorporate intervention practices into their daily routines. Researching the implementation of a new ECI model in ‘real settings’ is not easy!

27. Acknowledgements EPIC Families EPIC Key Workers ECEC professionals Dr Robin McWilliam