Written by Julie Higginbotham, Senior Case Coordinator, Mecklenburg County CDSA
We took a little breather around the end of the year, and we came into January ready to tackle a new subject for our Table Talk Wednesday event – what happens when we get the feeling that a family doesn’t want to participate in early intervention services? We had two great facilitators to help us navigate this discussion: Patti Archer, Speech-Language Pathologist and Owner of Speech Techniques, and Cassandra Cumberbatch, Service Coordinator with the CDSA. We started off discussing the most important thing that parents need to know when they are referred for early intervention services – we are there to help them. A pediatrician may have referred them to us because there was a concern that came up during a well-baby visit, or social services may have told the family that they need to enroll in the program, but the bottom line is that we’re there to be as helpful as possible by focusing on the things that are most important to that family. So what happens when the family doesn’t see it that way? Here were some interesting perspectives and strategies that came from around the table…
- Families might feel that needing early intervention services is a negative thing. On the front end, parents may not realize that being involved in early intervention is a wonderful thing – we’re there to be helpful, see the great things that they’re already doing, and celebrate in their child’s accomplishments. What could be better than that? Oh, wait – they were referred because there was a concern or an established condition that makes their child automatically eligible. One attendee talked about her perspective as a parent and how it can feel when someone says that you need help with your child – not the greatest feeling, is it? That’s why we have to go in and tell parents that we’re there to be a positive support and that we’re working off of the premise that they are the experts on their children, not us. We want to catch them doing fantastic things with their kids and boost their confidence as parents, and we have to be genuine when we do it. Parents don’t plan on needing our help when they were growing their families, and some families may need a little more time to really invest in it, but if we start on the front end and give them a great view of early intervention, that can make the difference in whether or not they want to participate in the program.
- Why on earth would a parent want to add more “work” to their day? This one really caught me off guard – how often do we say things like, “What do you want to work on today?” or “Here are some things you can work on between now and my next visit.” I’m really sensitive to the way we say things to families, but I use the w-word all the time! Parents have enough to do, day in and day out, whether they work outside the home or get to stay home with their children. That could even explain no-shows – a parent might not want to work on something with you, or maybe they didn’t do their homework since the last time they saw you (Ugh – work to homework wasn’t really an improvement, was it?). So, what do we do to fix this? Everyone has to come up with a natural way to talk about activities for families to try without making it sound like adding something laborious to the day…..feel free to comment below and share your wisdom and semantics with the rest of us! I do know that this is where starting with the family’s routines and activities setting is so important. If you’re talking about something the family is already doing, it takes some of the weight off of the work and puts more emphasis on making those activities easier. Remember that Playfulness vs. Play concept? That might be a good place to start.
- Parents might not like to be told they need us. This was another interesting moment for me. We talk about families’ rights when they’re enrolled in the Infant-Toddler Program, we don’t do anything without their consent, and we make sure they can make informed decisions about supports and services. But what about the first part, you know, when someone told them that they were being referred to us? We had a great discussion about the fact that our program is voluntary, and folks talked about the initial phone calls we make to start the process. There are lots of ways to take a step back and very clearly give that decision to the parents – maybe you have described the program beautifully, but the parent isn’t ready to move forward. You can ask permission to send them some information, and then the ball is in their court to call you back. There’s something to be said for picking up the phone to access a support like early intervention, rather than waiting for people to call you to move forward. That bit of power and responsibility on the front end could be the turning point for some parents.
- Some parents are texting, talking on the phone, or taking care of household chores during visits. Have you ever been in a visit with a family, and the parent is on the phone the whole time? What about the parent who is relieved to see you because it means that she gets to put in a load of laundry or go to the bathroom by herself for once? There are important moments when explaining our philosophy is crucial – at the start of the referral, when writing the IFSP and discussing supports and services, and at the first visit for a provider and service coordinator, just to name a few. If you talk about coaching with families and joint planning, then you follow through and do it, you’re more likely to get more engagement from families because you’ve set up that expectation on the front end. If you are interacting more with the child while the parent is watching (or not), the family won’t see the value in their participation during visits. You can turn it around, though, by changing your interaction style with the family. One person said that, if you go in and ask a parent a question about how an outcome is coming along or how you can help them today, it would be a little awkward for them to ignore you and pick up the phone instead, or walk out of the room to do dishes, right? Another person joked that you can send them a text to bring them back to you! You might need to get a little creative and maybe think about how your style fits in with best practices in early intervention, but it’s worth it to put the parent back in control of our visits. Keep in mind that we need to practice what we preach – if we’re on our phones during a visit, what does that say to the parent?
- “Time to make the donuts…..again….” This was a really clever group, can you tell? 🙂 We often get started with a family, and things are going just swimmingly. Then, after visits every Thursday morning at 10:00, maybe we run out of ways to work on specific outcomes, or there are conversations around how well the child does when the parent isn’t in the room. Wait….doesn’t that mean that we’re doing “therapy” with the child if there’s no one there for us to talk to? Hmm…sounds like a great opportunity to go back to the IFSP and other team members to see how things are going. You also might want check back in with the family to talk more about things like joint planning and ways to put them back in the driver’s seat during visits. One person talked about a 3-month “honeymoon” when things are fresh and new, so are there opportunities to plan for some teaming moments to check in around this time (or any other, for that matter), to keep things on that more productive tract? Maybe so – what do you think about it?
- Can we see the family’s bigger picture? It’s easy as professionals to be focusing on how a child is doing developmentally and forget that there’s much more to that family than a child’s diagnosis or delays that are impacting their routines. Unfortunately, we sometimes work with families who are in crisis a lot of the time, so their focus is on whether or not they can get the next meal on the table, keep their lights on for the day, or stay on top of multiple doctor appointments. Taking that a step further, families who are involved with DSS typically have a separate plan that keeps them busy with those social workers and supports, and let me tell you, those things aren’t exactly optional. How are we supporting families when we walk into these homes? Are we focusing on the things most important to the family, or are we focusing on our priorities? Have we talked about coordinating resources the family already has available naturally or through other agencies? We want to be helpful without adding more stress for them, and the more we talk about natural learning opportunities that are already happening, the less we are adding to the family’s plate.
- The family has the right to say “no.” This one can be a tough pill to swallow, right? We know that we can do so much to be helpful to families, and we want to help families understand our purpose. We can talk until we’re blue in the face, but this is a voluntary program, and parents have the right to decline. They may come back to us later, they may never come back at all. We just have to keep doing the good things that we are doing with as many families that will invite us in the front door.
In case you didn’t see it, there is a theme of building rapport in every one of these points. When we get started with families, we need to be talking about why we’re there and what we can do to be supportive. Taking that a step further, we need to be setting the stage for natural, routines-based supports that use more coaching interactions than clinical interventions. Yep, that’s a mouthful, so we have to find ways to say it so that parents really understand how ongoing services are delivered. More often than not, we’re able to get in and provide the supports we all want to provide, and the families we feel like we “lost” will always stand out in our minds. When have you felt like a family didn’t want to be involved in early intervention, and what did you do to try to change it? (Remember, confidentiality…)
Join us when we meet next month for our great Table Talk Wednesday event on February 18,2015, where we’ll be talking about Making Something Out of Nothing when it comes to assistive technology. How creative are you when a child needs a little extra support? Join us and share your ideas!