[ROBIN SITTEN] Prior to moving to Washington, DeEtte worked at the Foundation for Blind Children in Phoenix, Arizona for 16 years, both as an educator and a program administrator for children aged birth to five and their families.

She has an MS in Special Education for the Visually Impaired from Portland State University and is a certified teacher in visual impairment and early childhood special education. DeEtte is currently a doctoral student in special education at the University of Northern Colorado with a focus on visual impairment, early childhood, family education, and educational leadership. DeEtte, welcome to Perkins.

[DeETTE SNYDER] Thank you. I guess this is my cue to get started. This is the first time I have ever done a live webinar, so I'm a little nervous, but I think we will get through this together. I will be running the PowerPoint, so if I go too quickly, please tell me so, okay?

Thank you, Robin. It's nice to be able to do this webinar and I am so pleased that there are so many people from around the country listening in. I hope this is beneficial. The goals for today are real basic; we wanted to do something very foundational and present some basic principles of routines based early intervention, so we just want to describe what that is and also discuss why that's really important for children with blindness and visual impairment, and really teach some of this language and some of these principles for teachers of the visually impaired who provide early intervention services so they can support families and they can also work collaboratively with their early intervention teams.

Sometimes we all need to just get on the same page and learn the same language so that we can talk with one another, so that's what our goal is today.

I wanted to start out with just a basic mission of Part-C services of IDEA or Early Intervention Services. This mission statement was

written by a workgroup on principles and practices in natural environments by OSEP, which is this country's federal agency that runs the Office for Special Education Programs.

So, this is their mission; that Part-C early intervention builds upon and provides support and resources to assist family members and caregivers to enhance children's learning and development through everyday learning opportunities. That's what we're really talking about today is everyday learning opportunities.

We're also talking about that we are providing the support to families and caregivers to enhance children learning, and not directly to the children themselves. That's kind of the shift that we're going to talk about today. We're not talking about direct instruction to kids; we're talking about services and supports to the families of the kiddos.

If you want to get more information about that, you can go to the Early Childhood Technical Assistance Center and look at the mission and look at the seven key principles and some of the agreed upon practices.

I also like the seven key principles; what it looks like and what it doesn't look like, so it kind of gives us a little bit more information about the implementation of these principles, but I do want to note that four out of the seven key principles are really geared toward this idea of routines based early intervention, so that's a place where you can go to get some more information above and beyond what we're going to talk about today.

We're going to skim the surface since we only have an hour. What is Routines Based Early Intervention? It's really interventions that are focused on naturally occurring activities - what is going on in the family and child's daily life? These are meaningful and repeated experiences, and that's how we learn.

Again, focus of the intervention is based on the people who interact most with the child and not the professional. Of course, participation is engagement, and engagement is critical for learning, which is routines based intervention. That's really what we're focused on.

Let's focus our intervention and our supports on what the child is already doing because their participating, their engaged, and that is a critically important part of learning. We know this is a lot of other different things and we might hear it in different ways. In special education, we hear it as imbedded instruction or incidental teaching, and in early intervention we might look at it as activity based early intervention or participation based early intervention. It's really called multiple different types of things, but we're really kind of talking about the same thing - how do we provide services and supports for children during daily routine activities? That's really what we're talking about.

So Robin McWilliam; and this is a great resource so if anybody really wants to get more in deep about this topic, this is what I used for this presentation, was this book by Robin McWilliam, and he really talked about the four principles of routines based early intervention.

It's a family centered practice. Family centered practices put emphasis on strengths, not deficits, of families and children. It really promotes family choice and their control over resources. They are the lead people, and it also really focuses on the collaborative relationship between parents and professionals. We're doing this together - we're helping them and they're helping us. It's a collaborative relationship.

When you think about family centered practice, you're also thinking about the family, the family system. It's not just about the child; it's about the family. The family is the unit of intervention, not just the child, so we have to figure out and learn about that family structure and that family system, and they're all different. Every family is different.

We want to use a trans-disciplinary service delivery model, not a multi-sensory. I mean, we're using multiple disciplines to provide these services, but they're not in isolation; they're not fragmented services. The teams are all working together; the early childhood specialist, the teacher of the visually impaired, the physical therapist, the occupational therapist, and the family are all working together. A primary component of this is joint home visits. We're not visiting the family and telling them different things at different times; we're all doing it together.

Sometimes that includes the use of a primary service provider, where many states are using primary service providers and then the other services are supporting that primary service, but it's really looking at the trans-disciplinary service delivery model.

Then we have to think about the complexity of home visits. Not only are all families different, but a service provider who walks in that door with a plan, that plan might go right out the door considering what's going on in that family's life at that given time. So, home visits are very complex and they change and you've got to be flexible and you've got to be available to do what the family is requesting and what the family needs; not what the professional feels that they need.

That's kind of the principles of Routines Based Early Intervention that we're talking about. Why is this important for children with blindness and visual impairment?

Lots of TVIs know Berthold Lowenfeld and his three basic limitations of visual disability, so this is a repeat for them, but this might be really great information for some of the folks that are participating today that are general educators or special educators or service providers in early intervention.

Number one - the range and variety of experiences. We think about incidental learning; we think about concept development; we think

about the use of other senses. Sometimes that is limited when a child can't see. We think about a child who can't see is not going to have a full concept of a little tiny bug, and they also might not have the concept of a great, big jet airplane.

If we think about the processes of learning, people who see learn whole and then they break it down into parts. Children who are visually impaired have a very opposite way of learning in terms of they explore the parts, and then are able to put them together to create the whole, and that might be different; that's very different. The range and variety of experiences is a big limitation.

The ability to get about; so our motivation to move through our environment is sometimes dependent on vision, and when you don't have that, you may not have that motivation to go to your mommy or a favorite toy across the room.

Also, our safety and avoidance of obstacles is a limitation. We may not see the safety issues of walking over toys in our living room, or finding stairs or steps, so our ability to get about might be a little limited with a vision disability.

Also, our interaction with the environment and the people within it. When you think about little, tiny babies, the very first social interaction and attachment and bonding that they have with their mommies and daddies is through eye contact, and when that doesn't really happen, the mommy might have difficulty bonding with the babies, so those are some limitations that we need to be aware of as we support families, and the best way to do that is through repeated and meaningful hands-on daily activities with the family members and the kiddos.

So let's get into what exactly is a routine. What are we talking about here?

We're talking about activities that have a beginning and an end, and sometimes I like to add a middle into that, so a beginning, a middle, and an end. They are outcome oriented - what are we trying to accomplish? They are meaningful.

Meaningful activities are what's going to get engagement, and we need to have meaningful experiences. They need to be predictable; children need to know what's happening next. Again, that beginning, middle, and end. They need to be sequential, so the end doesn't happen before the beginning. We need to have steps and sequences that help with that predictability and that anticipation. And they need to be repetitive. They need to happen all the time. Not just one time, but maybe every day. Maybe it's the same routine every time. Our diaper changing is the same every time across people and each time. Those are kind of the basics of what a routine is.

I believe our very first poll is to help us get a definition in our brain about what is a routine, so here is a list of activities, and I want your guys to decide yes or no if this activity is a routine. So go ahead and look at the objects Bath time - is that an example of a routine? A trip to the zoo - is that an example of a routine? Everybody click on your yes or no, well not yes or no, but just chose the activity that you believe is a routine. Don't click on it if you don't think it's a routine, just if you think it's a routine. We'll just wait a couple of seconds.

Click on the ones. You guys are doing pretty good so far! And we're going to talk about some of these answers.

So bath time; I think that's pretty obvious. Yes, 98.5% of you say yes, that is a routine.

Trip to the zoo - that is not a routine. It does not happen every day, it's not sequential, it's not predictable, it's just something fun that we do, but we need to remember that is not necessarily a routine.

Breakfast - we eat breakfast every day, don't we? That's a routine. That's something that's repetitive, it happens all the time, and it's sequential.

A visit from Grandma who lives in another state - not a routine. Grandma comes to visit; that's something different.

A trip to the grocery store - yes, that is a routine. We have to go to the grocery store. That's part of our experiences out in the community. Mom and dad need to buy food; baby needs to go with mom and dad; so that is a routine.

Weekly visit from the EI service provider - 79% of you, oh, now 80% of you say that is a routine. I'm not really considering that a routine, however, it could be a routine if you think about those components. What's the objective? What's the sequence? What's the predictability? Does it have a beginning, middle, and end? Is the child going to anticipate the steps of that routine? We can make that activity a routine if we think about the concepts of a routine.

Great! Good job you guys! Let's go to the next slide.

We talked about what the answers were, so now we're going to watch a video of Joel and his mom in a diaper changing routine. Again, I want you to look for the beginning, middle, and end, what's the outcome, meaningful, predictable sequence, and is it repetitious? So, let's take a look.

And remember to turn up your volume a little bit to hear this.

[VIDEO PLAYING] Ready to Change.

How does a consistent routine prepare a child to be a more active learner?

Mom: "Can I change your diaper?" "Change your diaper? Let's go get a diaper, OK? Let's go get a diaper.”

Joel: "Ahh.."

Mom: "Oh, there they are. Give Mommy a diaper."

Mom: "Good, you got a diaper." Joel: "Ha ha."

Mom: "Ha ha. Can you lay down? Sit down. Sit down. Oh, you can just lay down. OK."

Joel's Diaper Routine: Use a touch cue and the spoken word "diaper." Guide Joel to the diaper bag. Let Joel take out the diaper. Ask him to "sit" or "lie down."

How does a consistent routine prepare Joel to be a more active learner?

When his parents use the same routine and same words every time, he can begin to anticipate what's next.

Knowing what's next helps him adjust to the change, and not be startled by a sudden action.

He can relax and enjoy the predictable repetition of their shared routine.

The routine helps him learn where the diapers are kept, so he can start to build visual and spatial memory.

Watch again. How many times does Joel's Mom repeat the word "diaper"?

Once he has "diaper," how could they adapt his routine to expand his receptive vocabulary?

Joel has cortical visual impairment (CVI) and a moderate hearing loss.

[SNYDER] So that was the sequence, and it happened all the time, so Joel doesn't get his diaper changed just one time a day. It's like multiple times a day. What a wonderful opportunity to learn mobility

skills, and visual spatial skills, and independent skills, so that's a great activity to work on multiple different skills to learn.

Some of us might be thinking to ourselves, "Well, why should we assist parents in some of these daily basic activities?" I want to start to think about the shift, or the paradigm shift, in terms of the differences between working with school-aged kids and Part-B services and then also working with babies and toddlers.

We are really working on parent priorities, not just concerns about the child's deficit. We want kids and parents to be successful in their daily lives, so it's the parents' priorities, not necessarily the child's deficit. We need to really think about the activity, the diaper changing activity, and not necessarily the skills that are used. This is something that's really difficult for educators, such as myself, who are trained in developmental tools and assessments where we can really point out, "Oh, this is a skill that needs to be worked on." Then we think about, "Oh, okay, well what activity can this skill be practiced?" We need to switch our thinking to the activity first and what are the skills needed for that activity to be successful.

So for Joel and diaper changing, walking across the room, locating a diaper, sitting down on the ground when his mom asks him too. Those are the skills that are needed for that activity to be successful, so kind of opposite thinking. We are also thinking about it's coaching for parents. We're helping this mommy be successful during this activity, and she's the one helping the child learn some of these skills, and it's not direct instruction to the actual child, but actually more coaching for the parents.

We also, as professionals, need to realize that learning occurs when we're not there. That's when most learning happens; is when these children are doing these daily activities with their mommies and

daddies; not our one hour a week or our one hour a month. So, learning that happen in between our visits.

When we think about that and we think about the IFSP, we need to remember that these are goals and objectives that are owned by the caregivers and the parents. It's their goal; it's their priority. It's not necessarily the professional's responsibility. We are there to help and support them, but really, the parents and the caregivers are the ones that own the goal; they carry it out. They are the active participants in that. We need to think about that as early intervention transitions out of this medical model of providing services, and is actually more of a help-giving practice for support and resources for parents. So, just a little bit of a paradigm shift for us who are trained in the education mode.

Let's talk about the role of the TVI in early intervention. Sometimes we talk about who is the generalist or the specialist. The generalist is usually that primary provider; the person who goes into the home on a weekly basis who is the generalist; the person who the family goes to for everything. And then TVIs are sometimes, I don't want to say regulated, but they're the specialists. They're the ones that come in and consult with that primary provider, that generalist, that family, on everything related to vision and it's impact on learning. We are talking about information. We are talking about instruction and coaching for parents, and we're also talking about emotional support.

The person who is experienced in vision can really give that family a lot of hope about yes, your child might not see very well, but let's focus on some other stuff that your child does really well. Using their sense of touch, using their sense of hearing. How is their learning different? Their learning is not necessarily impaired, it's just different, so we need to teach our parents how to do that. Part of the ways that we do that is we do functional vision assessments. That's a critical piece of all three of those types of support. Specific information about

the child's vision condition and what that means for that child. And then how they are using all of their senses, and how do we provide some environmental modifications or material accommodations to enhance all of their sensory learning, not just their vision.

We're going to consult and collaborate with all members of the team and how vision affects their particular discipline that they're focusing on. How does vision affect the ability to walk? The ability to talk? The ability to feed themselves? How does vision play a part and we are going to consult with all of those teams in those disciplines. We're going to address specific visual issues related to the expanded core curriculum. We're going to talk about expanded core curriculum in a minute.

The social interaction and attachment, incidental learning, differences, and maybe interpretations, of adaptive behaviors, such as if I hear my mommy from across the room, I might not turn and look at her, but I'm going to stop and I'm going to listen for what she's saying. That intention my look very very different. And again, how are we going to use our variety of senses?

Teachers of the visually impaired, TVIs, are very schooled in the expanded core curriculum. Some other service providers might not be, so let's explore expanded core curriculum.

The ECC are disability-specific skills or vision related skills, and they complement the common core, or core curriculum, so math, science, English, reading. The expanded core curriculum complements this. The expanded core curriculum is necessary for accessibility to that learning environment or accessibility to the core curriculum. These skills are taught by TVIs and Orientation and Mobility specialists. COMS stands for Certified Orientation and Mobility Specialist.

And, it begins in early intervention, and I think that is an important piece. It begins at that infant and toddler stage. It introduces the

parents to these particular skills in the expanded core curriculum. The parents are the child's first teacher. Parents are teaching expanded core curriculum, and also, we need to teach them this language of expanded core curriculum so parents can become good advocates for their kiddos when they do get to that school system.

FamilyConnect.org is a great resource for TVIs, for general service providers, and families on what the expanded core curriculum is. I want to emphasis that is begins in early intervention. What are the nine areas and how do they relate to babies and toddlers?

So, compensatory skills. This is the use of other modalities, and we talked a little bit about that before, so using touch to play with toys, not just our sight, but also how do we learn how to use our sense of touch, which is very very important pre-literacy skills, in order to be able to learn to read Braille when we get older. We have to be really good at using our hands to interact with toys.

Orientation and Mobility - how is a baby learning to reach out and reach towards noise-making toys, or reach toward toys that they see. Reaching out is the beginning of orientation and mobility, and moving my body through space.

Social interaction is very important, and for babies it's attachment and bonding and how do we learn to interact with our parents and our families and our siblings

Independent living.

Babies hold their own bottle, so how do we teach babies to hold their own bottle? That's an independent living skill.

Recreation and leisure. Being alone, being able to play on my own, not being held all the time, having some self-regulation skills -that's recreation and leisure.

Sensory efficiency; we talked about that a little bit - using sight and sound and recognizing the words mom and dad, maybe learning where sound comes from so I can move towards sound.

Technology -sometimes we just think of that as computers, but it's also the use of tools. How do I use my bottle? How do I use a spoon to eat? How do I use my hands to eat and interact with toys? Technology goes even lower than just computers. Career education actually begins in infancy. So, mommy and daddy have to leave me and I go to the daycare center when they go to work. Also, everybody has roles. Toddlers learn how to put their toys away when they're done playing with them. That's the beginning of career education.

Self-determination is, in my opinion, the most important area of expanded core curriculum and it really is all about the person learning that I did that; that I made that happen. Cause and effect - very important part of self-determination. We talk a lot about the Fairy Godmother Syndrome, and we want to avoid the Fairy Godmother Syndrome. We don't want children to just cry and things magically appear to them. We want parents to understand that their children need to learn that they are active participants. They make things happen. Self-determination absolutely belongs and begins in infancy and toddlerhood and early intervention, and that is a primary role of any early intervention provider, and that is done with routines based early intervention.

So, when we think about, in order to focus our interventions, we need to monitor progress and we need to create some outcomes. So what's our plan? What do we do? How are we helping this family figure out what they need to do? We need to develop outcomes. It's a part of the individual family service plan, just like the individual education plan, the IEP, but this one is the IFSP.

Here is another resource that I want everybody to see, and if you haven't seen this book, this is a really great book, not just for TVIs, but also for early interventionists. It's "Essential Elements in Early Intervention" written by Deborah Chen, and it's got great information, and routines based early intervention is a part of this book. When we think about developing outcomes, there's very important components of outcomes.

Priorities and preferences. Remember we talked about earlier, family priorities and family-centered preferences and priorities. What are the family's priorities and preferences? What do they want to see happen? What do they need support and resources for? Is the outcome functional? Does it have meaning? Going back to that routine that we were just talking about.

Generality - is this skill and this outcome able to be generalized into other activities? We want to get the most bang for our buck, so we need to have general outcomes. Can this outcome be implemented by the family? What's the ease of integration? Are we able to do this in multiple activities and is there some ownership?

Is there some ease of integration of the family following through and implementing and really supporting? If it's not, then we need to re-assess our support and, again, focus back on that priority and preference. And are these skills and outcomes - is the outcome developmentally appropriate? That goes back to the functionality. If it's not developmentally appropriate, we're not going to be expecting a 3-month-old baby to get up and walk across the room, so we wouldn't be writing an outcome for that. It needs to be developmentally appropriate. Where is that child right now and what is that next step for that child and the next step for that family. Those are the things that we're looking at in terms of developing some outcomes.

We're going to watch another video of Christopher and his mom and their bedtime routine. I want you to think about this as through the lens of the TVI when we deal with all of the sensory stuff, not just vision, but touch, hearing, and sight, and all of those as we watch this video for this routine, and think about what our next steps would be to help this mom expand her routine.

[VIDEO PLAYING] Bedtime.

How do you decide what's most important to include in a routine?

First ask the child's family how they do this routine at home.

Christopher's mother developed a bedtime routine that included his favorite vanilla-scented ball.

She tells him it's bedtime and then starts their "little system."

Mom: "We tell him when it's time to change his diaper, go to bed. He likes to play in bed. That's the biggest thing, huh? (Talking to Christopher)

Mom: "Want to lay down? We have a little system, we try to do things the same so he knows what's happening. Cover him first, then we..."

His mother squeaks the ball and waits for him to reach for it.

(Ball squeaking) Mom: "You want your ball? Night night. Want to go night night? What is that? Night night."

Christopher is expected to take an active part in this routine.

His mother moves at a slow pace that allows him to respond by moving his hand to get the ball.

Christopher's bedtime: 1. Pull up the covers. 2. Squeak the ball near him. 3. Wait for him to reach for it. 4. Say "night night" and kiss him goodnight.

HIs bedtime routine grew. They added more accessible communication, one of the keys to a good routine. How do you decide where to start when building a routine?

Choose a physical routine that happens several times a day. Add a child's preference, such as the scented ball. Build in communication based on what's most accessible to the child.

Christopher has high myopia, cortical visual impairment (CVI) and a moderate-to-severe hearing loss.

[SNYDER] Alright, okay so, right after that video we have a poll where we're going to look at some possible outcomes and I want you guys to choose what outcome would be appropriate to help Christopher's mom expand this routine.

So, reach toward spoon or cup during mealtime - great. So yeah.

When we think about number one, we think that yes, this would be a great goal. This generalizes the goal, there's an ease of integrating this skill of reaching into other activities now that he's done it during bedtime.

Reaching 10 times; that doesn't give us information and that's not a very good outcome. Christopher will repeat "night night" or give kisses in response to his mother at bedtime. So we're really looking at him and what are his communications, what's his expressive communication and how can we expand that core response. It's also cause and effect. It's also developmentally appropriate, and Christopher just saying "night night", he's already doing that so we want to expand that, and it's not giving us anymore information about other things.

So that's good. Let's talk about, everybody answered that. Some people took their answers away! One and three were really good goals, so those were really good outcomes. Okay, we can move that

poll off of there. Okay, so here are some of the answers to that poll; we need to make them meaningful and functional.

Strategies from a TVI to support goals. Usually the TVI is adding onto goals and adding strategies to support goals. We want to pay attention to all the sensory information of a goal. How is the child using their vision or their hearing or their tactile or their smell to participate in an activity? What are some environmental adaptations that we can do to encourage participation. Lighting is always one thing that I look at and that a TVI should be looking at lighting. Material adaptations - high contrast. That's always a really great material adaptation, and then instructional adaptations could be how do we help get more teaching and more coaching to the parents? We might teach the parent to do hand-under-hand approach versus the hand-over-hand approach; different instructional strategies on how to help the kiddos. That's just a couple of different strategies that we can use from a TVI.

I wanted to address all the sensory experiences in an activity. So, bath time. What are the vision experiences in bath time? Red washcloth, looking at bubbles, the yellow shampoo bottle compared to the red washcloth. Vision is happening during bath time. Auditory - we've got splashing, we've got running water, we've got a squeaky toy. There's a lot of auditory information that is happening during bath time. Tactile - the temperature of the water, hot and cold and how that changes, and the soft washcloth and feeling of shampoo in your hair. Those are tactile experiences that happen during bath time. Smell - the smell of shampoo and the smell of soap and the smell of water, and all of those smells.

You can think about any routine activity during the day and think about all the different sensory experiences and how we can clue mommy and daddy into these sensory experiences that are happening during these routines. This is just an example of a routine and how there are multiple different sensory experiences that happen.

The final thing that I wanted to talk to you about is a really great curriculum resource. It's called Vision Skills in the Natural Environment, ViSioN Program, and it was developed by two wonderful ladies in Utah from the Utah School for the Blind. This is a really great tool for teachers of the visually impaired to help early intervention teams integrate some of these concepts into routine activities or natural environments. It's available through HOPE, Inc. Go ahead and Google it. It's the same resource where the VIISA Project and the Sky High Institute is available.

It's set-up for four different scenarios of kids - kids with no vision, kids who are low vision, kids who have vision loss and have multiple moderate disabilities, and then kids with vision loss and severe disabilities. It separates that out for you. It focuses on four basic developmental areas. Sensory, literacy and readiness, visual motor, and independence, and those are the four basic developmental areas.

Then it also focuses those developmental areas during routines of child, family, play activities, literacy routines, outings, so riding in the car; that's a routine, and then different holiday and seasonal routines, birthdays, and other types of holidays. Then there is a whole section on parent lessons about how to take skills that we learn in developmental sequences and embed them within routines so that parents start to learn, how can we embed skills that professionals want them to work on or focus on during something that's already happened. I really like it because they come from the child's language, and I think that is something that parents can really relate to; that this is coming from the child's point of view and not necessarily the professional's point of view. This is a really really great tool for not only teachers of the visually impaired to help families, but also regular service providers in vision aspects and more of those sensory experiences that they might not have training on.

I wanted to share that and really point everybody to this resource, because this is a huge little binder that has all sorts of really great information.

Now that I feel like I've just talked a whole lot, I just want to open it up to questions, to other things going on, and I know there are a lot of us in this workshop, this webinar, and I just want to open it up for any kind of questions, clarification. I feel like I've gone through some really heavy information quickly, and I want to open it up to questions.

[SITTEN] Thank you so much, DeEtte. Go ahead and write questions in that box.