Infant Toddler Development Training
Module 5, Lesson 5
Everyday Routines, Activities, and Places (ERAP)
Functional outcomes should be achieved with strategies used in the natural environment or the everyday routines, activities, and places in which the child and family live. Young children learn informally throughout the course of their day, wherever they are and whatever they are doing. Everyday experiences, events, and situations provide children with many learning opportunities that promote and enhance their development. These everyday experiences are naturally occurring learning opportunities. For example, having a child reach for and grasp a cup or a toy with both hands is something that most children would attempt without prompting, if the materials were within sight and reach.
Services provided in ERAP using the Early Steps Primary Service Provider model will require close collaboration between professionals to assure that the family member or caregiver will be given complimentary guidance on a procedure. In other words, the ITDS won't tell the caregiver to do one procedure while the physical therapist recommends another. This is illustrated in the Early Steps Service Delivery Policy and Guidance document (2005).
Therapists in early intervention programs must consider a variety of options and strategies to address therapeutic goals within the context of a family's desired outcomes for their child and the family. As functional outcomes change, frequent communication between team members will assist in this exchange of information (p. 21).
All members of the team should understand the caregiver activities so they can select appropriate activities to be embedded into daily routines. This should be done in a manner that is supportive, complimentary, or at least not at cross purposes to other developmentally beneficial activities (e.g., if increased vocalization during diapering is a functional outcome related to communication, the physical therapist can incorporate the technique of waiting for a verbal response as she assists the caregiver in also embedding techniques to address movement issues during the parent-child diapering interactions).
Linking Outcomes to Assessment and Developmental Skills
The type of system now in place in Early Steps uses a "linked systems approach". This approach uses information gathered from families and professionals during assessments to develop the functional outcomes. These outcomes, in turn, determine interventions and strategies. The child's development and progress based on the use of these interventions and strategies is a means of evaluating the outcomes. "Using a linked systems approach, an early intervention specialist implements a very fluid and dynamic assessment-intervention model to meet the needs of rapidly developing infants and toddlers and their families in early intervention settings" (Rugg, 2000,p.2).
Strategies for functional outcomes should help promote generalization of those outcomes in many different environments - at home, at the store, at the beach, at child care, etc. Interventions can target several outcomes in one activity. For example, when a child is eating, several developmental skills can be addressed - fine motor, verbal, and social skills, etc. Effective activities will be child directed and support their interest. These strategies should help the child become more independent.
Evaluating Functional Outcomes
Developmental gains are one indicator that functional outcomes have been met. If the functional outcomes and the strategies to reach them are well written, we will be able to evaluate them by answering these questions:
- "How will you know when you have accomplished the outcome?"
- "What will be different for the child (and/or the family) as a result of these strategies?"
- "What is the child doing differently?"
The use of criterion-referenced measures lends itself well to this approach (Cohen & Spenciner, 1994; Cook, 2003).
Facilitating a Smooth Process
It will fall to the team leader to ensure that good functional outcomes are developed through the best possible communication among the team members. Team leaders should possess good communication skills and know how to listen. Take a minute to review the list of communication skills in Lesson 2 in the section on "Communicating with Families". Four of the most important communication skills are:
- Listening skills - focusing on what the person is saying.
- Reflection skills - Accurately and sensitively reflecting back a person's feelings.
- Restating - Ability to briefly restate what was said.
- Questioning skills - Ability to ask clarifying questions in an accepting manner.
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