First Family-Centered Practicum Experience
Pre-Visit Thoughts and Lit Review (ha)
October 3, 2018
There is a collection of research that supports the process and benefits of home-based early intervention (EI) for children who are deaf or hard of hearing. At Fontbonne, we emphasize the notion that early intervention = family-centered intervention – to the point that I sometimes forget other service models have existed (and are still implemented). But there’s been a shift in the professional culture in which we engage in this partnership with families that’s relational and participatory: EI providers have the attitudes necessary to provide unbiased support and they are responsive to caregiver needs. We’re coaches. Per Rush and Shelden (2011), coaches are Competent, Open, Adaptable, Caring, and Honest (p. 78). They have the requisite knowledge and skills (Thank you, master’s degree and hello, continuing education!) necessary to facilitate the listening and spoken language development of young children. But being a good coach doesn’t begin and end with academia; instead, there is a multitude of dispositions necessary to be effective. Coaches are open, not just to new ideas, but to the family themselves. They make themselves available for questions, for guidance, and for support. Adaptability is crucial to EI. Let’s set the scene: You walk into a home with a lovely planned lesson about joint storybook reading, but you are ushered into the foyer by a frazzled mother who has a three-year-old crying at her feet and your 6-month-old client in her arms without her hearing aids. The client has not kept her hearing aids in for more than two hours a day for the past 2 weeks. Do you push through that reading lesson? NO. You are flexible, you are adaptable, you are ready and willing to meet families where they are to address their concerns. So don’t forget the toupee tape! Additionally, coaches are caring – beyond the standard rapport-building that we often hear of. Practitioners must develop a partnership with families, which occurs when you’re empathetic, personable, and human. One of my favorite quotes from Rush and Shelden proclaims, “At the core of the provision of family-centered care lies the premise that practitioners believe that all families are capable and competent” (p. 25). Scribbled next to this quote is my note that we’ve got to at least leave our biases at the door (better yet: let’s acknowledge them, unpack them, and confront them through discourse and learning) to show families we care. Finally, coaches are honest. We provide helpgiving strategies to encourage confidence and promote competence, but in such a way that meets parents and children where they are. We are truthful about levels of functioning, progress, realistic goals, and other areas so that coachees can truly be successful.
These thoughts, amongst other short and sweet reminders like “Be a sponge – absorb it all!” “REMEMBER THE FIVE COACHING PRACTICES” “Family-Coach dynamics” are what I’ll be dreaming about tonight and pondering tomorrow morning as I prepare for my first-ever home visit. This home visit is part of a family-centered practicum experience that is a requirement of our Interprofessional Early Intervention (IPEI) grant program – just one of the many unique opportunities that members of my cohort and I have to build our competencies as future professionals.
Post-Visit Reflection
October 4, 2018
After a long day of home-visiting and class, I’m taking the time to fully reflect upon today’s experience. McWilliam (2010) would be so proud. Today was unlike any clinical practica I have been a part of thus far; in short it was (spoiler alert) amazing. Not that the other placements have been uninteresting, or nonessential to shaping skills necessary to be a speech-language pathologist (SLP). It’s that I’m feeling extra grateful to be part of an early intervention practicum considering very few of us in the SLP program get the opportunity. So forgive me for sounding hokey, but I am buzzing with excitement. It’s just now hitting me that I graduate in approximately 7 months and I can actually see myself as an early interventionist – as a coach – to families and their young children.*
The schedule of an EI provider is conducive to critical thinking and regrouping. Some may say an EI provider’s schedule is My supervisor has quite a trek to this family’s home, but that’s a perfect time to perhaps work through scripts of what you’d say to a family throughout the coaching session or during one particular moment. Need to test out news ways to incorporate reflective questions? Well, that’s awesome because you can role play those interactions in the comfort and privacy of your car. If you have a graduate student working with you (hi), commutes become debriefings in which the session is both reviewed on the way there and reflected upon on the way. I’m lucky in that my cooperating practitioner allows me to ride with her – only downfall is fighting off motion sickness. (Sorry, Natalie!) What’s awesome is having the time immediately following a coaching session to discuss what worked, what can change next time, what skills the child with hearing loss is gaining, how the family is carrying over listening and spoken language strategies… the list goes on. I’m a learner who benefits from discussion; as a result, I’m currently looking forward to more of these discussions, which I know will only enrich this experience of learning from a teacher of the deaf. And, let’s talk about that for a moment: how cool (and very interprofessional. I see you, Dr. Voss) that I, and 2 other SLP grad students, are learning firsthand coaching practices from TODs – not SLPs. Say what?! I’m interested to know how many other universities can say they have similar programs/practica. Part actual question/part humble brag about the IPEI program and our department.
Now for the actual session. Rush and Shelden (geniuses) have also created a framework for coaching sessions that includes 5 key activities: Observing families engage with the child during a point in the daily routine, or allowing families to observe the coach using a given LSL strategy, etc.; practicing the given technique/strategy (practice and observation are reciprocal in nature: either the coach is observing while families practice, or vice versa depending on the needs of the caregivers.); reflecting upon the use of that strategy by asking a variety of questions to bring awareness to issues, analyze outcomes of a strategy, propose alternatives to current options, and form a plan of action for next time; providing feedback on the caregivers’ use of a strategy, based on the self-reflection they have already done; and joint planning to formulate a family-led action plan that will be executed until the next session and what issues will be addressed the following visit. That’s a lot to pack into a 60-minute session, right? It was incredible to see the TOD so effortlessly incorporate all 5 of these activities into the session. She said that she started this job 12 years ago because she loves kids, but she’s grown a deep appreciation for working with adult learners. From all the coursework I have completed and clinical experiences I’ve had, I can empathize with that. The development of children, especially those who are DHH, fascinates and thrills me. But what’s greater still is to take these developmental foundations (the science), match them with appropriate evidence-based interventions plus engaging routines-based activities (the art), and provide this knowledge to families to build on their strengths and further increase their confidence in interacting with their kiddos. Man, I’m jazzed right now.
And I didn’t even mention collaboration or co-treating! More on that later.
For more about coaching, see Dathan Rush’s article in the most recent ASHA Leader
*Ask me if I still feel this way after leading a session.
McWilliam, R. A. (2010). Working with Families of Young Children with Special Needs. The Guilford Press.
Rush, D. D., & Shelden, M. L. (2011). The Early Childhood Coaching Handbook. Brookes Publishing Company.