Coaching Frequently Asked Questions

There is a reason providers go to school and become experts in their field. If the parents are providing therapy, where do the hands on techniques that the therapists know come into play?
Practitioners go to school to learn how to be whatever it is they want to be (i.e., therapists, teachers, nurses). When using a coaching approach in a manner consistent with the characteristics of the practice as we describe, parents are not providing therapy. The literature indicates parents do not want to become therapists (Brotherson & Goldstein, 1992; Pollock & Stewart, 1998; Bruder & Dunst, 1999). We are not advocating for parents to be therapists. We are describing a model that research supports in terms of supporting caregivers in maximizing child participation in existing and desired activity settings. The following are two examples of therapy. Example 1 fits the model we described at the training. Example 2 does NOT fit the model we described in the training.

Example 1
The family (mother-Cindy, daughter-Ellie (age 4), daughter-Maggie (age 2), daughter-Wendy (4 months eligible for EI) lives in a trailer park in a suburb outside of a large metropolitan area. Wendy's physician referred her to early intervention because she has a diagnosis of lessencephaly and needs therapy). The team goes through the process with the family and identifies the following IFSP outcomes:
  1. Cindy will feel comfortable taking all three girls to the playground at the trailer park.
  2. Cindy will feel comfortable and know how to care for Wendy to keep her from becoming sick.
  3. Cindy will pursue her GED.
The team identifies Paula, PT as the primary coach for the family.

Frequency of service delivery:

  • Joanie, SC will visit the family home for 12, 1 hour visits between 4/1/05 and 10/1/05.
  • Paula will visit the family home for 10, 1 hour visits between 4/1/05 and 5/1/05.
  • Paula will visit the family home for 16, 1 hour visits between 5/1/05 and 7/1/05.
  • Paula will visit the family home for 12, 1 hour visits between 7/1/05 and 10/1/05.
  • Daniel, SLP will visit the family home (with Paula) for 3, 1 hour visits between 4/1/05 and 5/1/05.
  • Daniel will visit the family home (w/Paula) for 4, 1 hour visits between 5/1/05 and 7/1/05.
The focus of the visits will begin with Paula obtaining an understanding of Cindy's current capabilities/ understanding regarding the care of Wendy. Paula and Daniel will support Cindy in learning how to position Wendy, feed her, bathe her, watch for ear infections, etc. This will require assessing for and assisting in obtaining special equipment for Wendy. Paula and Daniel will also support Cindy in trips to the playground in the trailer park. They will go to the playground, observe Cindy's current approach to doing this and support her in developing new skills and more confidence. This would probably involve demonstration, ongoing assessment, equipment adaptation and LOTS of hands on by all of the adults as they discover together the best way for Cindy to be able to do this on her own.

Joanie and Paula would also work together in supporting Cindy in identify and obtaining resources needed for her to pursue her GED.

Example 2
The family (mother-Cindy, daughter-Ellie (age 4), daughter-Maggie (age 2), daughter-Wendy ( 4 months eligible for EI) lives in a trailer park in a suburb outside of a large metropolitan area. Wendy's physician referred her to early intervention because she has a diagnosis of lessencephaly and needs therapy). The following IFSP outcomes are identified by the SC, Cindy, PT, OT, and SLP.

  1. Wendy will roll from supine to prone and prone to supine in order to get to her toys.
  2. Wendy will eat strained baby foods.
  3. Wendy will hold a rattle without support.
  4. Cindy will pursue her GED.
Frequency of service delivery:

  • Joanie, SC will visit the family home for 12, 1 hour visits between 4/1/05 and 10/1/05.
  • Paula, PT will visit the family home twice weekly, for 1 hour visits between 4/1/05 and 10/1/05.
  • Daniel, SLP will visit the family home twice weekly, for 1 hour visits between 4/1/05 and 10/1/05.
  • Marti, OT will visit the family home once weekly, for 1 hour visits between 4/1/05 and 10/1/05.
  • Paula, PT will work with Wendy during her visits facilitating rolling, working on sitting balance, and teaching Cindy exercised to strengthen her muscles. Cindy will be given a home program to practice rolling, sitting and standing Wendy. Paula will also get needed assistive technology for Wendy.
  • Daniel, SLP will work on feeding with Wendy during her visits. When Wendy is ready, Daniel will teach Cindy techniques to help Wendy eat better and obtain any needed assistive technology.
  • Marti, OT will work with Wendy on playing with and reaching for toys. She will also work on activities practice Wendy's rolling and sitting. Marti will also give Cindy a home program for how to carry-out these activities between Marti's visits.
  • Joanie, SC will work with Cindy to identify and obtain the resources she needs to pursue her GED.


Please describe a "typical" OT, PT, SLP visit and what documentation of that visit would look like?
See example above. Paula, PT working with Cindy (mother) and daughter (Wendy) and siblings (Maggie and Ellie).

Let's say that Paula, PT is well into her visits with Cindy (i.e., month two or three) and Cindy is ready to take on a family trip to the playground in the trailer park. The plan for between visits was for Cindy to get together the items she would need to take to the playground and "talk up" the event with all three girls. Cindy was also writing down any questions, or what ifs she could think of about the event. Weather permitting, they would head to the playground during Paula's next visit.

When Paula, PT arrived, Cindy was packed and ready to go. Wendy was in her stroller with jacket, hat, and mittens on. Maggie and Ellie were also in the process of zipping up their coats as well. Cindy had packed a back pack with a small blanket and snacks for the girls. Cindy was obviously excited about the event and commented that the weather was perfect. Cindy had written down only one question about the trip. She was worried about what to do in case Wendy wets her diaper. She knew that it wasn't good for Wendy to be out in a wet diaper, but also felt it might be worse to change her. We talked this through and Cindy decided she would check on Wendy frequently and if and when she did wet her diaper, we would just head back home.

Cindy reminded Maggie and Ellie of the rules for walking outside and the girls immediately clasped hands and headed out the front door. We problem-solved through several options, but decided that having Ellie hold the front door was the best option for assisting Cindy to maneuver the stroller out the front door. Once out the door, Cindy could carry the stroller down the four steps from the trailer. As we walked to the playground, Cindy was able to maneuver the stroller and keep track of the girls. Paula, PT commented on Cindy's ability to keep the girls engaged by the questions she asked the girls while also keeping them focused on being safe. Once at the playground Ellie ran toward the swings. Maggie also wanted to swing, so we followed to that area. Ellie climbed into the swing and Cindy gave her a push to get her going. Maggie cried out to get in a swing. The playground swing set did not have an infant/toddler swing available. Cindy looked at Paula, PT and asked what to do. Cindy could figure out ho w to swing Ellie and Maggie safely, but then Wendy would just be sitting in the stroller. Paula, PT talked with Cindy about her vision of a successful fun time for all of the girls. They discussed multiple possibilities. After Maggie and Ellie were tired of swinging they moved toward the small slide. Maggie and Ellie were able to go up and down the slide on their own, so Cindy saw this as a great opportunity to get Wendy out of her stroller. Cindy asked several questions and tried several ways of holding Wendy on the slide, but wasn't pleased with the results. Paula offered some suggestions and demonstrated some alternatives for Cindy to try. Cindy was able to successfully hold Wendy while being able to see her face and talk to her as she helped her slide down the few bottom feet of the slide. By this time, Wendy did have a wet diaper so the group headed back home.

After settling in from the trip to the playground, Paula, PT and Cindy discussed the event regarding what Cindy felt went well and what additional supports/ideas she would like to pursue. The joint plan that follows is a result of that conversation:

  1. Cindy will talk with trailer park manager about infant/toddler swings for the playground.
  2. Cindy will place a flyer in the trailer park office to see if other mothers of young children are interested in meeting at the playground.
  3. Paula will bring some catalogs of playground equipment (infant/toddler swings) to the next visit.
  4. Cindy is not ready to go to the playground alone with the girls, but would like to go again on Paula's next visit.
  5. Paula will visit again on Friday (in two days).
Documentation for visit (i.e., daily contact note)
5/17/05
Wendy S.
11:00 am-12:00 pm

Outcome #1 & #2:
  1. Cindy will feel comfortable taking all three girls to the playground at the trailer park.
  2. Cindy will feel comfortable and know how to care for Wendy to keep her from becoming sick.
Plan from last visit: Cindy was planning on getting together the items she would need to take to the playground and "talk up" the event with all three girls. Cindy was also writing down any questions, or what ifs she could think of about the event. Weather permitting, we would head to the playground during the next visit.

Current visit:I accompanied Cindy (parent) and three daughters ( Wendy, Maggie, and Ellie) on a trip to the playground in their trailer park. Prior to our walk to the playground, we discussed the parent's worries around Wendy having wet diaper at the playground and possible health ramifications. Cindy decided she would check the child's diaper frequently and if Wendy was wet, we would cut short the visit. When the weather is warmer, we plan to work on a safe, discreet way to change Wendy at the park. The walk to the playground was uneventful. Cindy was comfortable and competent in safely watching Maggie and Ellie and managing the stroller without any problems. The focus of the visit was how to have all three girls active and happy at the playground. The swings were a primary interest of Maggie and Ellie. The playground, however, had no infant/toddler swings available. Cindy was eager to talk with trailer park manager about obtaining appropriate equipment for younger children and plans t o do so prior to my next visit. She also thought of the idea of starting a play group time at the park for parents with young children. She was obviously excited about the idea. At the slide we discussed and I demonstrated safe ways to hold/support Wendy while playing on the slide. Cindy was able to choose the strategy most comfortable for her to support Wendy while maintaining eye contact to ensure Wendy's comfort.

Plan:

  1. Cindy will talk with trailer park manager about infant/toddler swings for the playground.
  2. Cindy will place a flyer in the trailer park office to see if other mothers of young children are interested in meeting at the playground.
  3. Paula will bring some catalogs of playground equipment (infant/toddler swings) to the next visit.
  4. Cindy is not ready to go to the playground alone with the girls, but would like to go again on Paula's next visit.
  5. Paula will visit again on Friday (in two days).


Signature ______________________

Date __________________________


Why have any specialists (PT, OT, SLP) if specific interventions are not needed?
Specific interventions are needed and so are the specialists if they are using evidence-based practices. The context of the interventions, the timing of the interventions, and the evidence to support the interventions are crucial elements.

Does this (coaching service delivery model) cause problems with parent choice?
Coaching is not a service delivery model, it is an evidence-based, capacity-building approach for supporting parents in promoting their child's development and learning. The question is whether parents have a choice when a program uses a primary coach approach to teaming, which requires that each family is assigned a full team of disciplines whose role it is to support the primary coach and family. Parents are active members of the IFSP team, which determines who will be the primary coach. If parents are not satisfied with their primary coach, service coordinator, or any other member, parents have the right to request someone else. IDEA, Part C says that parents need to have a say so, but not that they can choose any provider they want. How parent choice is interpreted varies widely across states.