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Module Two: Lesson Two

Routines Information

In the following video segment, Dr. McWilliam further discusses the dimensions of the Routines-Based Interview.

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OK, so here are the dimensions of the routines based interview. One is that you begin with general concerns questions, or the question about general concerns. "What are your general concerns about your child?" Second, you go through the family's routines, starting off with "How does your day begin?" and that's when, if you're interviewing the father, for example, that would be the beginning of the father's day, not the child's day.

Admittedly, most of the routines based interviews end up being interviews of the mother. You go through the family's routines, and then for each routine, you ask about three very important areas of child functioning, that I hope I have time to come back and discuss a bit further. You ask within that routine, let's say it's breakfast time, for example, about the child's engagement. So, when I use the word engagement, for those of you in this room here, what do you think engagement means? It makes you think about what? What's another word for engagement? Just shout it out; I'll repeat it for her.

Participation. Involvement. Interaction. Attention.

Yes, all of those are true. It's being busy, participating in the activity. That's engagement. So, we ask about the engagement of the child in that routine. We ask about independence, because in the United States usually we want children to be independent, or to learn to develop independence in the routine.

And social relationships, that's the third domain that we ask about. We don't ask using these words, because those are kind of jargonny for a lot of families, but we ask social relationships is mostly about how does a child communicate and get along with the people around. And this applies to a newborn.

Let's say you're talk about breakfastm might be nursing as the routine, and so, are there any social relationships in a nursing newborn? Oh, yeah. And, you know there are disruptions to those. The social relationships have to do with how easy is it to hold the child, eye contact, even the latching on is in a sense a form of social relationships. So you ask the mother whether it makes any difference to her whether the kid can latch on, or not, and she'll say "Yeah," it's a highly social event. So all, whether you're talking about a nursing newborn all the way up to a verbal two and a half year old, that still, social relationships are really important.

So, in fact, all three are: engagement, independence, and social relationships. And then, perhaps the most important question of all is, "How happy are you with the way breakfast time goes?" or "Is breakfast time working for you?" "Is this the way you want breakfast time to go?" That's the key, because after the family has described what goes on in that routine and have described the child's engagement, independence and social relationships, they might say, and it might sound good to you, but they might say "No, I really want it to be different. I want it to go faster." or "I wanted to enjoy my time more at this time." and so on. So getting that evaluation of the routine is critical and I will make the case that this is what is really hitting at what should be our primary goal in early intervention, which is the family's quality of life.

One way of measuring quality of life is measuring our satisfaction with our daily routines. If you're satisfied with the way your daily life goes, you know, time by time as you go through the day, then you're pretty much going to be satisfied with your life. With families, when they're having a lot of difficulty in their routines, sometimes because of their child with a disability, sometimes for other reasons, that's when their quality of life sucks, another technical term.

 

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