E Embedded Coachingt o Embedded Coaching Sunny Choi, MA. ED, BCBA.

EEmbedded Coachingto Embedded Coaching

Sunny Choi, MA. ED, BCBA

WHY Embedded Coaching?

• Embodies 'the critical role that families play in child learning and development'

• Programs focused on family strategy use were more effective than other family participation methods (Shonkoff & Hauser-Cram, 1987)

• Family involvement results in significantly greater intervention effects (Shonkoff & Hauser-Cram,1987; Ketelaar, Vermeer, Helders, & Hart, 1998)

• 23 other states also utilize this approach

I Have GREAT Ideas! Why Aren't Parents Following Through With Them??!?

Interventions fail to be implemented and sustained when they do not fit the daily routine of the family…when the intervention cannot be incorporated into the daily routine, or when the intervention is not compatible with the goals, values,beliefs of the parents(Bernheimer & Keogh, 1995, p. 424)

Defining Embedded Coaching (EC)

• Parent mediated interventions• Interventions are designed and occur within the

individual, everyday family and community routine activities of the child (Embedded Interventions)

• Support is provided to family members and other important adults to use strategies in-between professional intervention visits (Collaborative Coaching)

** Focus is on the in- between session times

Direct Service Model VS. EC Model

Direct Service • Participants

- child and therapist• Learning

opportunities - typically 1 hour/week during sessions only

EC• Participants

- child, therapist, and parent

• Learning opportunities - more than 10 hours/week, ongoing throughout the day

Misperception!

Parents are not expected to be therapists!

When families use the strategies in meaningful contexts such as natural routine activities and fit into their way of doing, learning opportunities will naturally multiply.

Same Objective, Different Approaches

**** Discriminate 'DOG' ****Direct Service Model : • Using flash cards, the teacher dictates "Point to the

DOG!" • While reading a book side by side, the teacher asks

"Show me the DOG!" and to every opportunity there is a picture of a dog

EC Model: • Mom and child take a stroll in the park. Mom asks,

"What's that?" • While reading a book in mom's arms, mom asks "Point to

the DOG!" and to intermittent opportunities of a picture of a dog

How is teaching occurring?

Two Video Sessions of Speech Therapy <http://jeffline.jefferson.edu/videos/cfsrp/player_001.html>

Focus on the,1) Routine activity2) Physical positioning of the therapist 3) Therapist's feedback

What is an Authentic Assessment?

• What is it? (Please see Appendix 2)a. The first step of embedded coaching. b. An assessment of how the child functions in everyday life.

• What does it reflect?a. What the child knows how to dob. How well the child knows how to do itc. How the child learnsd. The child's overall strengths, needs, interestse. The parents' overall strengths and needsf. How well interventions are working

Facts about the Authentic Assessment Process

Authentic:• Real life• Actual happenings• Uninterrupted• Culturally relevant• Directly related to

IFSP outcome

Assessment: • Gathering

information• Interpreting data• Making decisions

Nolan's Story

This video clip shares how an Occupational Therapist conducted a brief authentic assessment and introduced familiar tools and doable strategies for the family.

<http://www.cde.state.co.us/resultsmatter/RMVideoSeries_JustBeingKids.htm>

What is a Routine Activity?

•• Examples include, playing, eating, traveling,

getting dressed (Please refer to Appendix 3)• Not based on a set time or a specific manner,

but rather the familiarity of the act• Family specific - based on the culture and

values of the family (each family has their own way of 'doing')

Defined as 'Activities that children and their family do during their day'

Contextual Characteristics of Assessment within Routine Activities

What ?

Who ?

Where ?

When ?

How ?

Where to begin?!

Review the IFSP functional outcomes as they should outline

-> specific activities (routine)-> "so that" (priority)

• Henry will stop an activity, look up and maintain eye contact for 2-3 seconds when his name is called so that he can follow directions.

• Evan will sit and eat his meal using a spoon by himself with minimal spillage so that he can participate in meal times with her family.

Principles of EC Intervention Visits

• Focus on priorities• Choose everyday routine activities

individualized to the family (family's 'way of doing')

• Promote child participation and engagement in these routines

• Ensure family is actively participating to understand and appreciate recommended strategies

• Ensure family is confident and competent using strategies in-between visits

When Collaborating With Parents

• Ask questions - Which strategies have you used before? Did they work/Did they not work? Why did you choose those strategies specifically?

• Listen with sensitivity and without judgement

• Brainstorm together

• Model the strategy

• Reinforce their progress!

EC Strategies VS. Homework

EC Strategies• Family determines

what they want to work on

• Individualized to family's needs, culture, way of life

• Fit in with everyday routines

Homework• Therapist alone

determines what activity is assigned

• Based on outside curriculum and goals, not the learner's needs

• Separate from usual daily routines

Strategies should...

Make Sense and be Doable for the Family. •Include materials that belong to the family, fit into the way the routine occurs, or materials are left for the family as a permanent product to be used during the routine. •Easily fits into the routine and feels natural•Should promote repeated opportunities to practice•Make sure that the child actively participates vs. on the sideline•Employ the 'Just Enough Challenge'

• Agreed upon between the family and therapist

• Explained, modeled, and practiced with feedback 'live' and followed up by questions/reservations

*** These tips ensure the use of strategies between visits! ***

Tisha's Intervention Visits (Appendix 1)

What is different between the two therapy sessions? Please underline the answers for each example.

1. When are the PT sessions scheduled?2. Whose toys are being used? 3. How involved is the PT? 4. How involved is Tisha's father? 5. Does the PT provide feedback? If so, how does it

occur? 6. How are expectations for in-between visits and for

next therapy sessions discussed?

Determining Success

What? • What strategies fit the family the best?• What is different about how the child is participating

in the activities?When?• When were the strategies used in between sessions?• How often are they being used?How?• Were strategies used in the same way they were

during the coaching session?• How is the family tracking the child's progress?

In Summary,

EC is an approach to intervention that begins with Authentic, Routine-based Assessment

in order to Create and Implement Embedded

Interventionsusing

Collaborative Coaching so families can effectively apply developmental

strategies in-between visits.