Routines-based interventions are an effective approach to use in Early Intervention. In this blog post (part two of the guest blog post series from Rebecca at @Connect.Explore.Enrich), you’ll learn all about how to embed routines-based intervention into your parent-coaching sessions. Check out part-one of this mini-series here.
Tip 1- Be clear about how routines-based intervention sessions are set up from the start
According to Jennings, Hanline, and Woods, “Routines based intervention relies heavily on communication” and I could not agree more. I see many kiddos who have clinic-based sessions as well as home-based sessions with me. And so, when I arrive families think our sessions will be set up like the clinic sessions- but they’re not.
It is our job to have clear conversations with families on this, (I have written myself a script to literally read). It is crucial that we are on the same page from the beginning. If parents/caregivers are unclear about how sessions will be set up, then it may be more difficult to get them on board with the activities/strategies as sessions progress. This script from the Evidence-based International Early Intervention Office gives an example of answers to frequently asked questions about coaching and routines based intervention.
BTW- The Evidence-based International Early Intervention Office website has some great information for both professionals and caregivers about utilizing a routines based approach in every session. Be sure to check out the materials section for a range of free handouts, checklists, and tools.
Tip 2- Make sure all adults know their role when implementing routines-based intervention
Planning and implementing effective routines based intervention relies on all adults knowing what their role is. It also requires the parent/caregiver having a good rapport with the Early Interventionist, Speech and Language Therapist, Occupational Therapist, etc. This is important so they feel they are heard, and their concerns, culture, and lifestyle are respected. Learn more about building effective working relationships in Early Intervention sessions here.
Everyone knowing their roles and responsibilities centres on conversation and communication. In Early Intervention, communication is key. Often, the first 1-2 sessions are very heavily focused on adult discussion in order to gather/share all this information. It is useful to explain this to families before your session so they aren’t taken aback by all the questions. I make a point of verbally saying, “I may be the expert/professional on child development but you are the expert on your child and together we will make a great team”. These discussions are important, so I know the parents/caregivers are clear on their role, and mine, before sessions truly begin.
Tip 3- Use a matrix to help with choosing goals in routines-based intervention
Choosing goals in routines-based intervention can feel challenging at times. For some children, there are many skills to work on, so it can be hard to know where to start. I like to use a matrix to help guide me when goal setting with families in our coaching sessions.
The company I work for uses a grid, similar to the routines matrix from Evidence-based International Early Intervention Office, where we write down all the routines the family has during the day. I tend to start them off with ‘getting out of crib’ and they will go from there. We then pick 3 areas the family would like to see the child develop in. Typically, the family will give a broad answer; I get a lot of “I want them to talk”. So this leads us to discuss where the child is currently, and we pick an appropriate goal to get them towards this. This is the goal I put in the chart, not the end goal. I do this so the family know all the small steps we are doing to reach the big goal. Parent/caregiver education is key– so the family know that A will help achieve B.
We continue the discussion about which routines (listed down the side) they’d like to use to practise the goals (listed across the top). You can check out the example above- I have filled it in as I would with a family.
As you can see, I don’t complete all the boxes straight away as this is an ongoing grid. As mentioned constantly in this post, conversation and communication are key. Talking to families about their daily routine, and identifying times they can practice goals, and getting them to take ownership of this, is really important. I like to think- ‘What small thing can the family do that would make the biggest difference?‘ For some families it may just be waving in the morning and on walks. If this is going to be manageable, then this is what we put in the grid. But whatever is decided- it is vital that when embedding routines intervention the family makes the final decision.
Example daily routines and ideas for supporting skills/goals at home
Here are some common daily routines we often see in Early Intervention sessions with ideas for how you can encourage families to use them to work on goals:
|Greeting me at the door.||Practice waving (saying hi) at me (or whoever is on the other side of the door) when opening it.|
(Pre linguistic skill/social skills)
|Pointing to the door when the doorbell alerts or knocks.|
(Pre linguistic skill/fine motor)
|Turning the handle to open the door.|
|Adult to model “open” when she/ they open the door. (Receptive/expressive language)|
|Walking up the stairs to the main living area.||Is the child using one leg for all up steps?- Practice alternating.|
(Gross motor skills)
|Adult to model “up” on every step. Counting is fine, but ‘up’ is better for pre verbal/early communicators.||Songs, “Up the stairs, up the stairs, up we go, up we go, up up up, up up up” – repeat till the top.|
(Verbal routine to support language)
|Getting child in/out of highchair before/after snack.||Adult to raise hands and model “up” before picking child up and putting them into the chair.||Using a verbal routine like “snack time!” And watch child’s response to see if they understand the phrase. This also allows them to say it when they’re ready.||Having small amounts of snack for child to practice pincer grasp – I suggest an ice cube tray and snacks in each section for this. (Fine motor).||Small amounts of food also works for introducing the sign ‘more’. Give child a few pieces then adult models “more”- child might copy, wiggle, reach and they get more snack.|
(Receptive and expressive language)
|Preparing snack.||Adult narrates what they are doing using short phrases. (General strategy to support language)||Concept – in, child takes responsibility for putting food ‘in’ bowl and every time they do, adult models the word in.|
Supports turn taking also- adult then child, etc.
|Child can practice getting their mat/cutlery for their snack. (Personal responsibility/building independence and life skills)||Choices – another general language strategy giving the child some control over what they want to eat and also increasing the language they hear. Encourage families to accept gestures such as nodding, reaching, grunts for making choices before expecting imitation of words.|
|Looking out the window.||Follow the child’s lead, name what they’re looking at with a clear point. If they’re making sounds and not words yet, copy that sound and then point and name.||Imitation of actions, will the child copy you tapping on the window? Or waving to passers-by? Model, model, model.||If the child names what they see, adult can add a word to this, expanding their utterances. Child – “Plane”. Adult – pointing to the plane, “Yes, big plane”.||Holistic phrases – “I see a X” for children working on expanding their utterances.|
These are just a drop in the ocean of routines, big and small, that you may see during the hour you are with families. These routines offer so many opportunities for children to learn, progress, and thrive!! It can literally start as the family opens the door. It’s so rewarding to see the eyes of families light up when you mention this, and that they don’t have to find specific time to sit and work on activities. I have personally seen a lot of relief and more buy in when I have focused on these routines as well as play.
So, I STRONGLY encourage everyone reading this, parents and professionals, to think about your routines today. No matter how insignificant they may seem, and think about how they can be used to support children in their development. Remember, children don’t need to most expensive toys, or hours and hours of “sit and listen”, all they really need is YOU.
I hope you’ve found this two-part blog post series helpful. I’d love to connect with you on Instagram where I share more ideas for supporting learning and communication skills during daily routines.
Rebecca is an Early Intervention specialist, previously from the UK, though she has been living in Northern California for the past 4 years. Rebecca started her career journey as a teacher in the UK for almost 20 years, where supporting children with additional needs became her passion. Now in California, she supports families through parent coaching and family guided routines based intervention in their homes. She is the woman behind @connect.explore.enrich on Instagram where she aims to inspire and empower parents and professionals to find learning opportunities within all daily routines.
Woods, J., Kashinath, S., & Goldstein, H. (2004). Effects of Embedding Caregiver-Implemented Teaching Strategies in Daily Routines on Children’s Communication Outcomes. Journal of Early Intervention, 26(3), 175–193. https://doi.org/10.1177/105381510402600302