Robin McWilliam, Ph.D.
Vanderbilt University

Contact
•	Robin.McWilliam@Vanderbilt.edu
•	www.VanderbiltChildrens.com/earlyintervention/
•	http://naturalenvironments.blogspot.com/ 

Getting to Know the Family
Family Ecology
•	We need a method to show we’re interested in the family, not just the child
–	Children live in families
•	We need something to establish a friendly, interested relationship
•	We need an alternative to the checklist method of doing intakes
Ecomap

Need for Routines-Based Assessment
•	Functional goals (target behaviors)
–	Address participation needs in routines
–	Address independence needs in routines
–	Address social relationships needs in routines
•	Family priorities reflected in the IFSP
•	Outcomes broad enough yet specific enough
•	Investment by caregivers other than the family in the IFSP
•	Family-level outcomes
The Routines-Based Interview
•	Go through each “routine” (i.e., time of day or activity)
•	Get a sense of family’s and child’s functioning
•	Write down significant information
•	Star concerns
•	Recap concerns with the family, showing them the starred items
•	Ask what the family would like to concentrate on
•	Write down these outcomes
•	Ask them for the priority order

Beatrice’s Priorities
•	What to do with Miracle during downtimes
•	Beatrice’s health
•	Move around to get toys
•	Play with toys
•	Sit up at play time
•	Miracle communicate with others in the family at play time
•	Eat meals by mouth to be able to eat with the rest of the family; increase variety of foods
•	Time for Beatrice for herself
•	Beatrice continue her nursing education
Jo’s Priorities
•	Communicate his needs (drink, don’t feel well, eat, more, play, TV, outside)
•	Eating with combination of textures; vegetables, fruits
•	Handwashing—water rinsing
•	Identifying objects (in a book, on body), to see where he is cognitively
•	Transitions (e.g., from park) when he has to stop doing something fun
•	Therapies more under Jo’s control
•	Child care when Jo needs longer term care (e.g., during her medical treatments)

The Incremental Process for Deciding on Services
•	Who is the Primary Service Provider for [the mother]?
•	Can this PSP address Outcome 1?
–	Does she need help?
–	From whom?
–	How often?
•	(“Address”: Support the family in interventions to address Outcome 1)
–	Support = emotional, material, informational (incl. what to do with the child)
•	If anyone is added to the team, then the next question is…
•	Can the PSP, with the help of the team member already helping her, address Outcome 2?

Primary Service Provider Model
Definition
•	One professional provides weekly support to the family, backed up by a team of other professionals who provide services to the child and family through joint home visits with the primary service provider. The intensity of joint home visits depends on child, family, and primary-service-provider needs.
Problems With the Multidisciplinary Model
Multidisciplinary Time Allotment
The Numbers
•	20 visits
•	20 children
Transdisciplinary Time Allotment
The Numbers
•	20 visits (same $!)
•	5 children as PSP
•	15 children consulting
In 1 month…
•	Multidisciplinary = 20 children
•	Transdisciplinary = 5 as PSP
15 as consultant X 4 weeks = 60 children
= 65 children
•	Same $!

Support-Based Home Visits
•	Emotional Support
•	Material Support
•	Informational Support

VHVS: The Questions
•	How have things been going?
•	Do you have anything new you want to ask me about?
•	Outcomes in priority order
•	Is there a time of day that’s not going well for you?
•	How is [family member] doing?
•	Have you had any appointments in the past week? Any coming up?
•	Do you have enough or too much to do with [your child]?

The 8 Steps of Modeling: Avoiding the Model-&-Pray Approach
•	Talk to the parent about your suggestion
•	If the parent appears not to understand, ask if he or she would like to be shown
•	Tell the parent what you’re going to do
•	Do it
•	Tell the parent what you did and point out the consequence
•	Ask the parent if he or she would like to try it
•	If the answer’s yes, watch the parent trying it; if the answer’s no, leave it alone
•	If yes, praise the parent and give a limited amount of corrective feedback