"Daily Routines" and Other Changes in EI

Great feedback - it is very reassuring to know I'm not the only therapist out there struggling with some of this issues. I find it so helpful to read your comments and hear the good (and not so good) of what is happening in EI beyond my little part of the world. Please keep sharing!

p.s. I can completely relate to allergy issues - I too work in homes where there is smoking and pets. I like dogs and cats, BUT I am allergic and that can be really difficult when trying to work! Most families put their dogs in another room when I'm there for therapy.

I also include the phrase "across all settings" to emphasize to team members that this is the optimal way to facilitate progress for the child.  "Daily routines" sounds like a similar way to say the same thing.  

At the initial IEP meeting, I provide a "Best Practices" file to all team members with clinical material to be used by all such as scripts, social stories, contingency maps, WH & yes/no questions, etc.  As new material is collaboratively developed, it is distributed to all team members.

This is a great blog! Thanks so much for doing this, Stephanie!  I have been an SLP in Birth to Three for close to 5 years. The program I work for has been working through all of these same issues.  In regards to goals and routines...I think the biggest shift in my understanding has been to view routines as the context in which parents work with their child not necessarily something that needs to be "fixed." Parents should be generating the goals and can prioritize the routines that they would like to use and/or improve. Our objectives can be specific to those routines chosen by the parent and what the child will be capable of learning, given their development and/or age. The more specific the goal is, the easier it will be to assess progress. Helping the parent help their child is the focus of our work. Strategies that are specific to routines help parents shape what they already do so their child can learn the skills they need to continue on their developmental path. In regards to the lack of communication within your program, your frustration is understandable. My program is finding out that the need for time to meet with other team members is crucial to this work.  There are resources out there to support this. Hope some of this helps!

I previously worked in center-based programs, and I am relatively new to the EI program (Chicago area).  My approach to therapy actually fits better into family-based intervention, but I do agree that the multitude of rules and procedures can be very confusing!  I have found that provider meetings, EI trainings, and a study group (where we discuss "bag free" therapy) to be very beneficial.  Networking with colleagues has been the best way to keep up to date.  I eventually figured out that the IFSP goal is a broad long term goal.  I write, and work on, my own short term goals and objectives that fit with the family's lifestyle.

I also face smokers and dogs, plus I am allergic to cats.  I finally booked houses with cats on the same day so I only have to take antihistamines once a week, and "cat day" is now laundry day!

In the state of South Carolina, the Dept. of Health is the lead agency. The Early Interventionist (who only has to have some type of education related college experience) has already written the speech goal which is very general; "Increase receptive and expressive language to age expected levels" or "Increase variety of vocalizations." There are no "objectives" like there were when I worked in Minnesota. Also, it's almost impossible to find an SLP that will do rural home visits. My biggest issues so far have been dealing with smokers and dogs. Talk about feeling isolated as an SLP moving from a big city up North to a very rural area where poverty rules! I do enjoy the variety, and have come to respect and even enjoy the dialectic differences. I love all the beautiful and amazing rural scenery of the South. There is no beauty like that of a string of laundry on a makeship wash line. I take my camera where ever I go and love all "my" babies!! Thank you for starting this blog. It's a Godsend.

I think you have brought up an important point that I feel has been going on for a long time. Often IEP procedures or language come to us through "urban myth" (a therapist is told by another therapist something she thought was said by someone downtown) or through a coordinator who doesn't really understand the IEP process. I was once told that in order to make sure that the IEP team & parents were crafting the IEP together, we were to bring no notes or rough drafts to the meeting, but only blank pieces of paper!

I now often check with the speech/language official at the state level (in my case the DPI SLP Consultant), to really understand s the offical line.

Ah yes - the old "We must change the wording" directive! When working for an urban school system I learned to expect that directive, over the 14 years there, at least every 2-3 years. The move afoot is to write both IFSPs and IEPs in language the parents can understand. With the move toward measurable outcomes and greater transparency in the public school arena, this is understandable. I myself use the phrase, "at home and in the community" in an IFSP goal. One can further refine the language if the parent specifies the meaning of 'in the community' to mean church, playground, etc.. The more things change the more they............

I greatly enjoy your blog, Stephanie!