The Power of the Routines-Based Interview
The single most powerful conmponenet of the INTEGRATE model for conducting early intervention in natural environments is our process for intervention planning--routines-based assessment. Professionals and parents who have watched or participated in one of these routines-based interviews (RBIs) are amazed at the amount of information that emerges about:
The process consists of the following five steps.
Prepare caregivers to report on routines Whereas professionals come to intervention planning with reports and much experience, caregivers do not have a good way to prepare for the meeting. This preparation consists of their identifying their typical-day routines and coming prepared to talk about (a) what everyone does, (b) what the child does, and (c) how happy they are with the routine.
Family reports on their routines. Unlike traditional IFSP or IEP meetings, where professionals sometimes give evaluation reports, the RBI starts with the family reporting on their routines.
Actually the first question the interviewer asks is whether the family have any major concerns. The interviewer (or his or her partner) writes these down and then suggests beginning at the srat of the parent's day ("How does your day start?").
At each routine, the interviewer asks about six things, without the family's really being aware of this structure:
To move from one routine to the next, the interviewer simply says, "Then what happens?" or, "What's next?" This avoids making assumptions about how the family conducts its daily life.
During the family's report of routines, the interviewer takes notes, marking areas of concern (I use a *) or strength.
If the child is cared for outside the home for significant amounts of time, that caregiver should also be interviewed (see "Child Care Providers" on page 3.) The interviewer asks the caregiver about the routines in that environment. For example, a day care provider would go through the daily schedule.
Two powerful questions the interviewer can ask after all the routines have been discussed are:
Interviewer reviews concerns and strength areas. The interviewer goes through the marked items to refresh the parent's memory, showing the parent the paper on which notes were written.
Family selects outcomes. The interviewer asks, "When you think about all these areas of concern and strengths, what would you like the team to concentrate on? What do you want to go on the plan?"
The interviewer should be prepared to remind the parent of concern areas, without pushing the point (e.g., "You mentioned she doesn't accept chunky food at breakfast, is this something you want to deal with?"). The interviewer will have to be especially encouraging of parent-level needs (e.g., dealing with doctors, spending time alone, spending time with the partner). Many parents put "their own needs" after "the child's." From a family systems perspective, these distinctions are somewhat academic.
The list of "outcomes" should be as close to the way the parent worded it as possible. This is not the time to worry about making the wording fit the IFSP or IEP form.
This method typically yields 6-10 outcomes, some of which are directly to meet parents' needs.
Family puts outcomes into priority order. The interviewer shows the family their list of priorities and asks them to put them into the order of importance. From this point onwards, the outcomes will always be listed in priority order. This will be important in support-based home visits.
This concludes the interview. The next step is to word the outcomes to fit on the paper and to explore strategies with the other team members. Only after this list has been compiled can the team, including the parents, discuss what services are needed.
What are routines?
Routines are not necessarily things that happen routinely. They are simply times of day. It is impossible for a family to "have no routines." All families wake up, eat, hang out at home, bathe, go places.
Explaining the RBI to Parents
The routines-based interview (RBI) replaces a discussion of passes and failures on tests as the basis for deciding on intervention priorities. Or it replaces the vague question, "What would you like to work on?" which typically results in an equally vague answer.
Families who are used to either the test-based method or the vague question might be surprised at the RBI. Even more surprising might be why we're asking about family issues that seem only tangential to the "identified client."
On the other hand, one parent I interviewed identified that as the thing she liked best about the RBI. "I don't want my whole life to focus on just one of my children, so I really liked it when he asked me about what [the child's sister] was doing as well as what [the child] was doing."
The interviewer should begin the interview with a version of the following introduction:
"To come up with a plan for helping you and your child, I'd like to ask you about your day-to-day life. By talking about these things, you will then be in a good position to pick the things that are the most meaningful to your family, including your chlid. By focusing on the day-to-day things, we can make our suggestions fit in with what your child and your family are already doing."
Child Care Providers
If the child spends many hours with a child care provider other than the parent, that person has the opportunity to have a significant impact on the child's development. Therefore, that person should both provide information and be recruited to provide intervention.
Ideally, child care providers would be present at the routines-based interview and would be interviewed about "classroom" routines after the family has been interviewed about home routines. Because many child care providers cannot leave their classrooms to be at such meetings, accommodations must be made.
The interviewer can interview the child care provider before the meeting. If this happens, the interviewer would then report, routine by routine, what the caregiver had reported.
Sometimes the problem with a child care provider's attendance at the interview is the length of time, the time of day, or the location. If the parent can be present at the premeeting interview, that's even better.
The primary reason for getting the child care provider's input is so the parent has functional information from which to make decisions. A secondary reason, however, is to make child care providers realize that their input is valued. This becomes very important when recruiting them to carry out interventions.
How Many Early Interventionists Does It Take To...?
Many things happen during a routines-based interview (RBI). Someone interviews the caregivers, someone takes notes, someone entertains the siblings, someone keeps the family dog at bay...So how many interventionists does it take to conduct an RBI?
It's a good idea to have two professionals at the RBI, one to concentrate on asking questions and the other to do whatever else needs doing. Typically, this will be taking notes, but if the second person needs to do other things, then the interviewer needs to take notes.
Some programs have the second person keep track of items on an evaluation tool that can be answered through the RBI. In general, we don't recommend overwhelming the family with many professionals at the RBI. If the RBI is used as part of the multidisciplinary evaluation required in Part C, two people from different disciplines need to be involved.
The most important principle is to keep the interview conversational.
From 1997-2001, Project INTEGRATE was an outreach project funded by the U.S. Department of Education, Office of Special Education Programs. We set out to provide training and technical assistance in the area of integrated therapy and instruction in classroom-based programs, which we still do as needed. But by far the greatest demand has been for help to programs and states on the implementation of the natural environments provision of the early intervention law.
Project INTEGRATE has provided training and technical assistance in over 40 communities in 17 states plus Puerto Rico and the U.S. Virgin Islands.
Frank Porter Graham
Child Development Center
University of North Carolina
Chapel Hill, NC 27599-8180
- Former url www.fpg.unc.edu/~integrate - information here