Written by Julie Higginbotham, Senior Case Coordinator, Mecklenburg County CDSA
When we met for last month’s event, we talked about coaching as an interaction style, so we followed up this month with a discussion about joint planning. We had Wendy Teal, Speech-Language Pathologist and owner of Pediatric Theraplay, Inc., and Amanda Forbis, Service Coordinator with the CDSA, to get us going and facilitate the conversation. The group discussed what joint planning should look like and why it is important in our practices – while this used to be a bit more informal in our practices, it has evolved into a more purposeful event that should be occurring in each visit with families, often more than once. There were some key ideas that came up during our conversation – take a look at what peaked our interest….
- Get started on the right foot. We’ve talked before about how our setup to supports is so important because families don’t know what to expect when it comes to early intervention. When they think of “therapy,” they may be thinking of a more clinical model, and it’s our job to help paint the picture of early intervention for families. This starts with the first conversations that service coordinators have, and it moves into the first visit for providers with families. Here in Mecklenburg County, service coordinators attend those first visits so we can help introduce providers to families and have specific conversations about what visits should look like on a regular basis. This is the perfect time to be modeling joint planning – service coordinators can open the conversation to get updated information since the outcomes were written and see where the family wants to get started, and providers can plan with the families for their next visit on their own. Patience is key here – think about how long we’ve been talking about this and implementing new practices. Families need time, too, as they start to think about us in a different (and hopefully brighter) light.
- Families don’t need to practice everything you talk about during your visits. Have you ever been in what you felt was an amazing visit? The family shared their concerns, you gave them stellar activities to work on, but you return the next week to find that they haven’t tried anything out yet. What went wrong there? One person discussed having had OT as an adult and being given a long sheet of activities – she knew how to do all of them, but she maybe actually did 2 of them. If we just discuss things that we know can be good ideas without considering the family’s routines, priorities, and time, we’re not being terribly helpful. “Da Plan” isn’t for families to get homework and carry over everything we talk about. We can discuss things that could fit into routines that they already have, but then there needs to be some joint planning around a few specifics that the family would like to try. They’ll be the ones to tell you what’s going to be meaningful and helpful to address their priorities.
- Be comfortable in the quiet. A lot of the time, we’re doing a lot of talking. If we’re there for specialized support, that’s what we’re supposed to be doing, right? Not so much if you’re engaging in more joint planning with the family. As a professional, it’s easy to worry about whether or not we’ve done “enough,” but what does that really mean? As opposed to sharing information and asking what the family thinks about it, we should be asking more questions and waiting for the family to provide their input. Rather than hearing a concern and giving the family a list of routines that they can use to help the child make more progress, we need to hold off and ask the family what routines would be good starting points to address the concerns they’ve shared. Waiting for the parent to put in their two cents helps them become more vested in the process and more likely to incorporate activities into their daily routines. Here’s some food for thought – when you are asking questions, be thinking about A Framework for Reflective Questioning When Using a Coaching Interaction Style. If you’re asking questions in a way that tells the family what you want them to try, you’re not really getting their input, right? You don’t have to quiz them or put them on the spot – the finesse of a conversation is a good thing to perfect, and you shouldn’t be able to hear the “Jeopardy” soundtrack in the background.
- Plan time to plan. This is a biggie – we’re usually in visits with families for about an hour, and as professionals, it can feel as though we need to make the most of that time since we’re not there all week. The issue with this is that we don’t leave enough time to be engaging with the family, checking in, and letting them talk about what’s most important to them. We may know a lot about development, but we have to learn about each family we meet. If we jump right in with the child when we get there, we don’t know how the week went or if there are specific things they want to focus on during that time. If we go straight through to the end without being deliberate in “da plan” for the week and the next visit, we leave families with the impression that everything we did that worked out great for us should happen during the week for them as well. How many times do we walk in and the family wants to talk about a routine that we might not get to see while we’re there, or they have some event coming up and want to talk about how their child will handle it? We don’t want to gloss over their priorities because we sat right on the floor and started working with their child. As you’re walking up the driveway for your visit, be thinking about how you want to start the conversation when you get inside, and keep an eye on your time so you have enough at the end to discuss specifics, plan for the week, and plan your next visit.
- Be specific when giving feedback. This one has come up before. When we’re talking with families, we need to be sure to keep the details in the conversation if we’re going to be helpful. When families are practicing something during a visit, or when you see something great that they are doing naturally, be sure that you tell them directly what they’re doing well and why it’s working. We want parents to feel confident in their skills as parents, and that’s what’s going to help them want to do more of it when you’re not there. One person described observing a visit during which a mother was so proud of what her child did during the week – fantastic moment, by the way – but the provider focused on what the parent had done to make it happen. Our job isn’t just to talk about the milestones that the kids hit or the way the child participates more in routines, it’s also about pointing out why the child was successful. Kids don’t learn in a vacuum, and parents need to be recognized for their efforts, too.
- What about other caregivers who aren’t there for visits? We tend to meet with one caregiver or another on a regular basis, but what about everyone else that’s involved with that child’s daily routines? This may be a parent who’s home in the evenings after work, or a grandparent who babysits on the weekends so the parents can go shopping. We talk often about the fact that different people have different learning styles and different relationships with children, and if we’re going to address routines as a whole, we need to be looking at ways to support everyone involved. This pertains particularly to children who spend time in childcare settings – kids will often do different things in different environments, and that’s important to know and address as well.
- OK, how about addressing routines with children that have more significant delays? One person talked about a scenario in which a family would like their child to be able to sit at the table and eat with his siblings at mealtime, but the child isn’t yet sitting or eating. These situations call for more sensitivity, and sometimes creativity, because we have to talk about the steps that we need to get there and celebrate each one as it passes, no matter how small. We don’t want to take away a parent’s ideal picture for a routine, but we do want to be sure that we don’t set them up to expect a quickly-acheived outcome for something that might take some time.
- And probably the biggest question – Is the family ready to work on the outcome yet? Think about it – families have wonderful pictures in their minds of what things could look like during the day, but some of them can be pretty daunting. Take sleeping for example – if a family is cosleeping with their child, but they want for the child to eventually sleep in her own bed in her own room, there are a few things in between that the family has to be ready to do. Does that mean that they need to jump right in? Not necessarily – we’re there to meet the family where they are, and through joint planning, we can learn more about what a parent is willing and able to do at that time. It may be that their priority stays on our radar so we can revisit it later, but the family just isn’t quite in a place to work on it more specifically. We have to be OK with that – maybe there are other routines that are challenging for similar reasons, and getting those things worked out can carry over into their sleeping routines.
Whew – that was really a lot of great discussion in an hour’s time! It was so great to hear about how people are trying to incorporate more and more joint planning into their visits, as well as talk about things folks find to be more challenging. Where do you fall in that arena? Take a look at our Intervention Tools to see how you’re doing – these are great, not only for looking at how we do our work, but also to help build rapport and have meaningful conversations with families.
If you’re part of the Mecklenburg County CDSA or provider network, come see us on January 15, 2014 to discuss DSS: Who Are They, and What Do We Do with Them? Our facilitators will be Lennie Latham, Easter Seals/UCP, and Amy Gleason, LMHC with the Mecklenburg County CDSA, and this is sure to be an interesting conversation!