Refocusing our Perspective Based on the Available Evidence
(excerpted from Shelden, M. & Rush, D. (2005). Practitioner as coach: Our role in early intervention. American Association for Home-Based Early Interventionists, 9(3), 7-9, 11.)
Looking back on our careers as early interventionists, particularly as we moved from center-based services to supporting families in natural learning environments (circa 1990), we realized early on that kerplunking what we'd always done in the clinic into families' living rooms didn't make sense. We soon learned that being in a family's home provided us with a wealth of critical information and also heightened our sense of responsibility. We began to understand that using the family's/child's interests, routines, rituals, and priorities was the venue for promoting the child's existing abilities and learning new skills. By providing therapy to the child and giving homework for parents to perform in our absence or embedding activities and exercises into daily life, we were actually disrupting well-established, meaningful learning opportunities (Raab & Dunst, in press). We found that what we were doing or telling the parents to do was very often our priority not theirs. We also recognized that most of our therapy and recommendations did not take place within the context of naturally occurring activities. As we focused on the child as the direct recipient of our instruction/therapy we were sending the message that the child needed something that only we could do. Unfortunately, our efforts emphasized our importance and inadvertently diminished the significance of the fundamental role that families play in relation to child learning.
As we continued to clarify our ideas and look for research to support or refute our practices, we found the Dunst (2000) article, "Revisiting rethinking early intervention," particularly useful. This article defines the framework for reconceptualizing our role as practitioners working in early intervention and especially in supporting parents in natural learning environments. Based on considerable evidence about child learning and effective helpgiving as well as considerable effort in changing our mental models and practices, we learned to:
- Appreciate what children and families can do instead of dwelling on what they can't;
- Build on parent knowledge and skills instead of creating dependence on us as professionals;
- Help parents identify and access desired resources instead of assuming the need for and benefit of professional services;
- Recognize child and family strengths instead of emphasizing the problems; and
- Support family priorities and interests instead of dispensing professionally-driven recommendations.
As we share these reflections and research evidence with therapists, teachers, and service coordinators we often hear statements such as, "Well, I know what I'm doing with the child is working," or "I can see that the child is making progress," and "I'm the only person with the skills and knowledge who can do what I do for the child." We counter hese statements (and many more like them) by asking questions to promote reflection about evidence-based practices.
- What evidence do you have that the intervention you're using or recommending works?
- What evidence do you have to demonstrate that the child would not have made the same progress without the intervention(s)?
- How does what you're doing address the purpose of early intervention, which is to promote parent competence and confidence in helping the child learn and grow?
- How do you know if your interventions are consistent with child and family interests, priorities, and routines or if these interventions have a negative impact and actually impede a family's ability to participate in interest-based, real-life activities?
Our responsibility as practitioners and service coordinators working in early intervention is to use available evidence to refocus the lens through which we have traditionally viewed and interacted with children with disabilities and their families. In doing so, we stop telling and doing and start listening and building the capacity of family members to support their child's development. As suggested by disciplines across the field of early intervention (Campbell, 1997; Dinnebeil, McInerney, Roth, & Ramaswamy, 2001; Hanft & Pilkington, 2000; Rush, 2000; Rush, Shelden, & Hanft, 2003), our role clearly emerges as a coach to the adults in the child's life to maximize their confidence and abilities so that child learning and development of new skills occurs naturally as a part of everyday life (Dunst, Hamby, Trivette, Raab, & Bruder, 2000; Rush, Shelden, & Hanft, 2003).