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How Do They Come Up with These Outcomes? – A Table Talk Wednesday Recap

Written by Julie Higginbotham, Senior Case Coordinator, Mecklenburg County CDSA

Well, we survived Snowmaggedon here in Mecklenburg County just in time for our latest Table Talk Wednesday event.  While we had a smaller group this time around, we had some new faces, both from the CDSA and from our provider network – yay!  This month, our focus was on how outcomes get onto the IFSP, and Michelle Robertson, PT and owner of Team Therapy Group, started us off with the great thought that the outcomes are the who, what, when, where, why, and how of what we do when we are working with families.  We know that the Individualized Family Service Plan, or IFSP, is meant to be a fluid document that maps out supports and services as a whole, but the outcomes really give us direction so we know more specifically what we’re helping the family accomplish during their routines. She and Lisa Cloninger, Unit Supervisor with the CDSA, helped guide us along this great conversation, starting with a question:  What are the most important elements of a good outcome?  Folks felt that a good outcome is….

*  Meaningful to the family and makes sense in their world;

*  Individualized and specific to each family;

*  Something that is part of the family’s natural, daily routine to make it more memorable;

*  Worded in a family-friendly way that makes sense to them;

*  Addressing the family’s priorities, not ours; and

*  Measurable – you’ll know when you get there and the outcome has been met.

Great thoughts, right?  These are all important pieces to keep in mind, but what about the way that we write them on the IFSP to reflect the intent of focusing on routines, not on skills?  One person mentioned the “old way” of writing outcomes, like saying that a child will do a specific thing that the family might not actually work on regularly.  It’s easy to fall into the general mindset of “I want my child to walk,” but how do we frame it up so we end up with a more routines-based outcome?  Some helpful hints from the group included…..

Start in the routines.  It can be easy to start with the concerns around developmental milestones, but once you start there, you could end up staying there.  Since we want to be addressing the child’s skills within their routines, using that context can help you get to the ultimate priorities and outcomes.  As you talk with families, reflect on those routines to see how they feel about the way things are going.  There doesn’t have to be a “concern” in order for a given routine to make a great outcome for the family.

Frame up the next six months.  We’ve all been in situations where the family might want their child to be doing something that might not come along in the next six months, and one person gave the example of walking for a child who isn’t yet able to sit up.  Does that mean that we don’t want to work on it?  Not necessarily – while we want to address family priorities, the intent of the outcomes is to look at what can be accomplished over the next six months.  Families need to understand why we’re asking questions the way that we are, and you can talk about the smaller steps to get to the bigger ones by narrowing down the function of those skills in the family’s daily routines.  Here’s a visual for you – one person said, “Don’t eat the whole elephant, just take a bite.”  Clever, huh?

Try not to ask, “When do you want him to talk/walk/etc.?”  When we do that, we set the family up to say, “all the time,” and then we are trying to fit a skill into a routine, rather than make a routine more functional by building up skills.  You can, however, ask about routines that happen on weekends, at night, or any other time that you might not necessarily be there to find out if some of the skills the parent doesn’t see are needed at those times.  Actively listening during the conversation can lead you to fantastic routines to use as learning opportunities.  Other, more helpful, questions may include, “If your child could _____, what part of your family’s day together would be more enjoyable?” or “How could your child be more involved in this family’s activity?”  Another favorite was, “What do you want to do, or have you stopped doing, but that you would like to if your child could participate more?”  See – there are lots of ways to get to great outcomes without having to look for routines that will fit in needed skills, and this can increase the likelihood that the parents will carry over activities if it’s important to them.

Don’t feel like you have to have an outcome for every concern the parent mentions, or that you need to write one for every need you hear that might not be a priority for the family.  As professionals, we sometimes fall on the side of hearing that there are so many priorities for the family, so we must need to address every single one via an outcome.  You may actually find that one outcome addresses several of those priorities in a way that makes the outcome more functional, rather than picking apart different parts of their day.  On the flip side of that, we sometimes see so many more opportunities for outcomes that the family just doesn’t want to address.  We have to remember that we need to meet families where they are and that this is their plan, not ours.  As we build the relationship with the family and they see how we want to support them, more outcomes may come down the line.  We have to remember, though, that it’s OK if they don’t.

Look for opportunities to combine activities that the family can continue doing with ones that they might be able to add into their routines.  This is a big one, and a newer concept for writing outcomes.  We can’t forget that we are there to build the competence and confidence in parents and caregivers, and what better way than to purposefully point out the great things that are already helping meet their own goals?  Parents may forget, or not even realize, the wonderful things they do regularly to support their children, and we want to recognize that as much, if not more, than we want to bring in our expertise and new ideas.  As you progress over time and a parent shares that something went well, ask them what they did to make that happen so you take advantage of the opportunity to give them a pat on the back.

Take yourself out of the equation.  This has to do with meeting the family where they are and addressing their day, not their day as we feel it should be happening.  We need to be looking at family priorities as they see them – even if we don’t think that something is attainable, or if we wouldn’t do things that same way with our own children, we don’t want our “stuff” to get in the way of supporting the family and helping them meet their goals.

With established IFSPs, have conversations to help plan for the next review.  Once you have your IFSP and ongoing services in place, you know you’ll have a review coming up at least every 6 months to update the plan, discuss progress, and plan out the next 6 months.  Why not take the opportunity in those last visits before the review to help the family in thinking about their routines now that you’ve been there and learning more about the family?  You can help set up the context of the outcomes, whether you’re a provider who’s been engaging in more joint planning so the family can guide you through supporting them, or if you’re a service coordinator planning and scheduling the next review.  Again, starting off on the right foot is always the way to more functional outcomes for the family.

Can you believe that this isn’t all of the conversation with this great group of early interventionists?  The bottom line in all of this is that outcomes need to address priorities that are settled in routines to be most functional for the family – if we can’t make their day run more smoothly or help get them out and doing something together as a family, how helpful have we really been?  A last quote from one of our attendees was that “It’s a team thing” – everyone should be on the same page and see the significance of the outcomes for each family we serve.  Have you found some questions that tend to lead towards functional outcomes, or have you had trouble finding a way to address certain needs and how they fit into routines?  Leave us a comment and add your two cents to the discussion!

Do you want to know the rest of the details that were discussed in this wonderful group?  Then you need to come along and attend the next Table Talk Wednesday event, where we’ll be sharing what we might do when I’m a Rock Start at the Daycare, but Where Are the Teacher and Parent?



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