1. I Know We Need to Improve 619 Services, But Where Do I Start?
Robin McWilliam
Siskin Children’s Institute
Chattanooga, TN

2. Outline Ecological issue of inclusion Proposed practices to improve
Implementation stages
Implementation planning
Drawbacks and benefits

3. Ecological Issue of Inclusion
Interaction
Approach
Activities
Environment
Structure

4. Ecological Issue Natural Caregivers Children Specialists
Who are the child’s natural caregivers?
How many hours a week make a difference?
Ecological Issue
Natural Caregivers
Children
Specialists

5. Ecological Issue Short classroom times are extended clinic times!
Long classroom times are natural environments (sort of).
Short classroom times stress the family ecology (transitions to other child care, incl. home).
Long classroom times reduce transitions.

6. Good classrooms are good for kids. Bad classrooms are bad for kids.

7. Proposed Practices to Improve
Assessment: functional, needs-based, contextual—for individualized planning
Partnerships with families
Goal functionality (IEP quality)
Teamwork
With other professionals
Effective use of all adults in classroom
Inclusion
Teaching
Child engagement
Data collection
Teacher as PSP, addressing all areas of child functioning
Training and supervision

8. Keys to Successful Inclusion
Components of the Engagement Classroom Model
Promoting Children’s Engagement, Independence, and Social Relationships

9. Components of the Engagement Classroom Model

10. Unified Model of Early Intervention 0-5
Robin McWilliam
11/12/2018
Routines-Based Early Intervention
Both
Engagement Classroom Model
Ecomaps, Informal Supports
RBI, Functional Goals
Integrated Therapy
Support-Based Home Visits
Engagement, Independence, Social Relationships
Incidental Teaching
Primary Service Provider
Organization by Routines
Inclusion
Behavior Management
Zones
Family/Collaborative Consultation
Data
Checklist Training

11. 1. RBI and Functional Goals
Semi-structured, in-depth interview about child functioning at home and in classroom
Results in family-chosen child and family goals
Child goals written as participation-based goals
Emma will participate in meals, play, dinner preparation, and outside by using words or signs. We will know she can do this when she uses 3 different words or signs at two times of the day (meals, play, dinner preparation, outside) on 4 consecutive days.

12. 2. Organization by Routines
Context is everything
Home and classroom routines for needs assessment
Participation in routines for child goals
Interventions designed to be carried out in naturally occurring routines
Consultation around interventions carried out by caregivers in routines

13. 3. Behavior Management Prevention through engagement in activities
Sit and watch for teaching appropriate participation (consequating undesired behavior)
Behavior plans using reinforcement theory for persistent challenging behavior

14. 4. Family/Collaborative Consultation
For professional visitors to classroom
Collaborative not expert consultation
Hoosiers rule
Joint problem solving (solution finding)
Consultant-teacher relationship

15. 5. Data Intervention fidelity data (process evaluation)
Checklists
Proximal outcomes
Goal functionality
Engagement
Goal attainment
Distal outcomes
Child progress
RBI Implementation
Incidental Teaching
Integrated Therapy
Receiving Consultation
Zone Defense Schedule
Goal Functionality Scale III
Engagement Check II
STARE
Goal Attainment Scale
Minnesota Individual Child Engagement (MICE)

16. 6. Checklist Training Define expectations Platform for feedback
Performance data
Diminishes feeling of being judged
Who’s available to observe?

17. 7. Integrated Therapy …and itinerant special education
Individualized within routines
In the classroom
Join the child in whatever he or she is engaged with
Weave interventions into that engagement
Model for and observe teachers
Communicate with teachers

18. Developmental hierarchy
8. Incidental Teaching
Engage
Prompt
Longer
Respond
More sophisticated
Next steps
Elicit
Specific goal
Reinforce
Developmental hierarchy
More differentiated
Generalizable

19. 9. Inclusion Reverse mainstreaming Natural proportions
Engagement (participation)
Independence (including from prompts)
Social relationships (“socialization”)

20. 10. Zones
Room arrangement
Adult organization
Transitions

21. Implementation Stages
Exploration
Form implementation team
Communicate to stakeholders
Analyze need data
Select target audience
Review programs/practices to implement
Assess buy-in
Make final selections
Installation
Functional, structural changes
Changes to initiate new prog, practice, framework
Protocols for 1st practitioners
Select 1st practitioners
ID training resources
Train 1st cohort
Develop coaching
Analyze sustainability of training
Initial Implementation
Inform stakeholders of launch dates
Communication protocols
Support plan
Coaching system in place
Data systems functioning to measure outcomes
…to measure fidelity
Produce doc reviewing initial implementation
Recommend revisions
Plan for next cohort
Full Implementation
Monitor each implementation driver:
Recruitment, training, coaching processes, fidelity measures, outcome data, local policies, systems intervention, leadership support strategies
Feedback process from practitioners to local admins
…from locals to state
Data used to make decisions
…to improve processes

22. Implementation Planning

23. Implementation Planning
Ensure everyone knows general components of model to be discussed
List practices group is interested in
Discuss quality
Ignoring model, what needs to improve across the state (or other entity)
15-20 needs

24. Implementation Planning
See whether practices address quality improvement needs
What needs won’t model address?
Document that these will remain unaddressed
Timelines for practices

25. Implementation Planning
Action steps for implementation of each practice
How will practitioners become aware of the practice?
How will you show that the desired practice is different from what they’re currently doing?
What materials are needed to describe the practice (e.g., checklists)?
What materials are available as background on the practice (not that anyone ill read them)?
Will you use pilot sites with replication statewide or statewide training and implementation from the beginning?
vi. How will you show the practice?
What do you have to do to ensure coaching/supervision is available?

26. Implementation Planning
End of the day:
List of practices
Timelines for full implementation and PD periods
Action steps
List of improvements that will be addressed
List of improvements still needing consideration

27. R-BEI Best Practice Implementation Plan
Goal – Early intervention in Aotearoa will be engaged in these best practices by July Year Time-line
Implementation
Now
July
2014
2015
2016
2017
2018
Ecomap &
Cultural profile
RBI
Functional participation based goal writing
Keyworker (PSP)
Piloting model
Model developed
Support based home visits
Collaborative consultation & ECE engagement model/coaching
Incidental teaching (responsive teaching)
Natural environments
Evaluation
FINESSEII (adapted)
Case Studies
STARE data
Check points along the way

28. Montana Statewide RBEI Implementation Timeline
August 2013
June 2014
June 2015
June 2016
All families 0-8 will receive RBI & participation –based outcomes
Family Consultation in Home Visits
Collaborative Consultation to Child Care
Incremental Service Decision Making & Primary Service Provider
Billings ECI complete by
Therapists’ using consultative approach
Goal – RBEI practices will be fully implemented in Montana by June (implementation by FSSs by December 2015)

29. Drawbacks and Benefits
Apparently superficial needs assessment
Limited by what’s in model under consideration
Draws on so-called wisdom of stakeholders
Model has usually been tested
Model means practices fit together
Purveyor is identified
Long-term plan
Allocate resources across plan
Systematic preparation
Systematic sustaining