By Robin McWilliam, Ph.D.
What good is the Routines-Based Interview (RBI)? This blog will show how it can lead to positive ways of providing early intervention. In the Routines-Based Model, the development of a meaningful plan, such as an IFSP, can make a profound difference in the lives of young children and their families. On the other hand, some beautiful plans have been relegated to the oil barrel in the outhouse.
The RBI ends with the parents choosing functional and family outcomes. These 10-12 outcomes are a far cry from the pitiful 2-4 outcomes many early intervention programs have had. Child outcomes are functional when they address getting the child more engaged in his or her daily activities. Family outcomes can be either related to the child or not. Those related to the child include goals such as learning sign language or getting more written information about the child’s disability. Those not related to the child can range from basic needs to more self-actualized desires. Basic needs could be housing, clothes, food…. Self-actualized desires could be enrolling in college, working out, or spending time with one’s partner. During the outcome selection part of the RBI, all these outcomes are written down as notes and are not yet measurable, so the next step is to write child outcomes as participation-based outcomes.
The key to participation-based outcomes is emphasizing at the front of each outcome what routines the child will participate in by doing the skill. An example would be Kristine will participate in hanging out time, meal times, and bath time by using words or signs. In the Routines-Based Model, context is everything, so routines give us information about where and when there are needs, and, in turn, participation-based outcomes are written to meet those needs. They are also measured with acquisition, generalization, and maintenance criteria. For example, We will know she can do this when she uses three different words or signs during hanging-out time, one meal, and bath time daily, for 5 consecutive days.
A list of functional and family outcomes sets a team up, perfectly, to implement the primary-service-provider (PSP) approach. Although some professionals do use PSPs without having done an RBI, it is more logical to start with an RBI: PSPs work on functional child outcomes, in context, so it’s imperative to have a routines-based assessment, such as the RBI.
The PSP provides collaborative consultation to families and classroom teachers and receives information from other team members, such as therapists and teachers. Again, when the topic of consultation is the child’s functioning in the very routines the consultee has established as important for the child’s functioning, the consultee’s interest is heightened, and his or her contributions are vital to finding a solution.
This effective consultation can result in three measurable outcomes. First, if we’re going to pay attention to the quality of individualized outcomes, we should monitor how well children are actually doing on those outcomes, which goal attainment scaling can do. Second, scales of children’s functioning in daily routines do exist. One example is the Measure of Engagement, Independence, and Social Relationships (McWilliam, R. A., Hornstein, S., & Younggren, N. 2010), which has 300 items distributed across 13 common home routines. Third, we can monitor the attainment of family outcomes, which are written to be measured.
If we follow the path outlined here and shown on the diagram above, child outcomes—all three of the federal ones—should improve. Federal guidance to choose one outcome for improvement might have been misguided: Any good supports and interventions should have a generalizable effect across child (and family) outcomes and not be targeted to any one federal outcome. The point of the three federal child outcomes was that they would supposedly be functional. If so, then they would often co-occur in routines. If they co-occurred in routines, then all three outcomes would improve, even with interventions that might be weighted towards one outcome. In addition, the three federal Part C family outcomes would improve, if this functional, family-centered approach were taken. And, critically, it begins with the RBI.
In sum, the RBI isn’t the be-all and end-all, but it’s a pretty good way to develop a plan that will lead to a good service delivery model and, most important of all, will result in better lives for children and families.