Meeting the needs of our youngest and most vulnerable
Since Iowa switched its approach on working with infants through age 3 who are displaying developmental delays, education officials say they are seeing a vast improvement in progress.
The approach puts parents’ in the driver’s seat in working with their young children.
Through Iowa’s Early ACCESS system, parents at home are taught Family Guided Routines-Based Interventions, or better known by its acronym, FGRBI.
Iowa’s Early ACCESS services are available to infants and toddlers from birth to age 3 who have a health or physical condition that affects growth and development, such as delays in the ability to play, think, hear, see, eat, talk or move.
All children enrolled in Early ACCESS have a developmental delay in at least one area, or they have a diagnosed health or physical condition that is highly associated with causing delays. For example, a baby born with Down Syndrome is likely on track with milestones initially, but as the infant’s first birthday approaches, developmental delays become evident.
Providers of Early ACCESS may include a variety of disciplines such as special instruction, speech language pathology, physical therapy, occupational therapy or audiology. Iowa’s Area Education Agencies (AEAs) are primarily responsible for administering Early ACCESS throughout the state, along with providers from Child Health Specialty Clinics (CHSC), who also provide service coordination and nutrition services to children and their families.
Previously, most Early ACCESS providers were executing a medical model of care which meant they were coming into the home and working with the child for 45 minutes, maybe once a month. It wasn’t enough.
“Providers were more child focused,” said Melissa Schnurr, early childhood consultant with the Iowa Department of Education. “They would bring in their own equipment and maybe a toy bag. They weren’t using anything the family already had in the home, and weren’t necessarily working with the parent so that the parent could do interventions in between provider visits.
“Research now says providers need to be working with families so they can embed interventions into everyday routines because families are with the child many more waking hours than a provider is once or twice a month.”
In 2013, the Iowa Department of Education, in partnership with Florida State University, adopted the Distance Mentoring Model (DMM), which is a professional development approach to facilitate coordinated and consistent high-quality early intervention services and supports.
DMM incorporates evidence-based practices with technology strategies and supports, while also utilizing peer mentoring and coaching practices. Utilizing DMM, Florida State has worked with Iowa Early ACCESS providers and AEAs to scale up implementation of the evidence-based practice of FGRBI.
FGRBI works to integrate evidence-based early intervention, family-centered practices, adult learning, coaching and feedback, utilizing naturally occurring child and family routines and activities to intentionally provide developmental intervention and support. By involving parents/caregivers in the assessment and intervention process, caregivers collaborate on identifying priorities, plans, routines and activities for their child and help determine the schedule and frequency for embedding intervention strategies.
“Our early intervention providers are working with families who have an infant or toddler who is in Early ACCESS, and coaching the family to embed interventions in their everyday routines,” Schnurr said.
For example, if a child is behind in developing a vocabulary, an intervention may involve focusing on mealtime and repeating the names of foods and objects used during mealtime such as bowl, spoon, banana, apple, etc. During diapering or bath time, a caregiver might sing a song which engages the child and helps with early literacy and speech. Whether doing things like laundry, going to the grocery store, dropping off an older child at school, going for a walk or playing outside, interventions aimed at helping the child learn and grow are woven into everyday routines.
Jenny Seuntjens, Early ACCESS liaison and early childhood specialist with Green Hills AEA, says FGRBI has been a game changer for early intervention providers by providing a framework which focuses on family routines and strengths, and places the caregivers in the lead to practice, problem-solve and determine which strategies work best.
“Using FGRBI, parents learn why their actions are important and how they can impact their child's development,” Seuntjens said. “Parents and caregivers are more excited and engaged as they share updates, make plans and show us how it's going. Building parent competence and confidence will benefit the family and child now as well as in future years when they are no longer participating in our Early ACCESS program.”
And the survey says…
During the first three years of the DMM professional development model, the focus was on teaching providers FGRBI and how to use it. Multiple cohorts of Iowa Early ACCESS providers, representing every AEA in the state, received expert training from staff at Florida State.
Training included two-day, face-to-face workshops in the fall and spring, as well as coaching sessions via Zoom each month. Providers would record home visits with the families, and FSU experts would use those videos to offer providers feedback and coaching to learn FGRBI interventions.
Gradually, with the introduction of coaches, providers were more likely to be using the FGRBI 12 key indicators which help measure the use of FGRBI, and parent survey scores reflected that families felt increased competence and confidence in supporting their child.
“Parents are feeling more competent and confident to support their child because that is what the focus is now on the home visit,” Schnurr said. “It’s not ‘let’s go in and work with the child,’ it’s ‘let’s go in and build the capacity of the families to support their child.’”
And when you teach a person to fish…
By year four, Iowa had enough providers who were trained in FGRBI so the focus could shift to sustainability and building the capacity of local coaches to take the place of Florida State. Trainee coaches have a set of competencies and requirements to meet in order to move up to Provider level coach, and the top tier is Master coach.
“It’s very important that those coaches are still seeing families and practicing FGRBI with fidelity so they can teach their peers and colleagues to use the practice with fidelity,” Schnurr said. “The goal was for each AEA to have at least three coaches, and to have at least five Master coaches statewide.”
Now in its eighth year, the training focus is on supporting coaches. Instead of Florida State coming to Iowa and conducting face-to-face training on FGRBI, there are now online modules. The content of FGRBI is now the AEAs responsibility, and Florida State works with coaches and supports them with supporting the providers on the ground in Iowa.
“In the next couple of years, we are really focused on sustainability,” Schnurr said. “We are working more with higher education institutions to make sure future educators are exposed to this approach and content before they graduate and get a job in Early ACCESS. We want them to have exposure to FGRBI.
“We are also focused on getting those Master coaches, who are essentially taking the place of Florida State. The Master coaches are going to be the experts here in Iowa and they can train up additional coaches. By 2023, we will have a solid infrastructure built here so that FGRBI will continue on. It won’t be so much about scale up, it will just be about sustaining a philosophy that this is how we do the work.”
-- From 2018 Early ACCESS Family Interview Report, p.6
-- From 2018 Early ACCESS Family Interview Report, p.16
-- From 2018 Early ACCESS Family Interview Report, p.6
- Parents knew what coaching was, why it was important, and their role in the process.
- Parents were confident in their abilities to work with their children to impact change.
- They believed coaching was beneficial for them as well as their child, and they would recommend it to others.
- A final consistent theme was the importance of the Early ACCESS providers in the process.