Learner Objectives

• Participants will be able to identify diverse routines individualized for child and family interests that provide a framework for embedding social and communication outcomes.
• Participants will be able to identify benefits of child and caregiver interventions within typical routines.
• Participants will be able to describe strategies to enhance use of routines to teach new and expanded skills to replace challenging behaviors.

Rationale

What we know works:

• Embedded intervention
• Planning within typical contexts: classroom schedules, family routines
• Joining into the classroom or family preferred contexts
• Problem solving, team based decisions

What we see happening:

• Pull out intervention
• Created lessons or training activities: flash cards, special toys and materials
• Taking over and becoming adult directed
• Professionally driven, discipline specific recommendations

Natural Environments…

• … the places, activities, and interactions where ALL children live, learn, and play
• Children go many different places and do many different things regularly… communication and social skills are needed
• … the what that occurs, the activities, events, and routines in addition to where are important
• Plus, it’s the who and how it occurs!

Embedded Intervention

• Using the places and activities that occur in the child’s life
• Planning opportunities for systematic instruction within the child’s contexts
• Incorporating meaningful and logical outcomes appropriate to child and activity
• Identifying potential evidence-based intervention strategies and supporting child – success with use of strategies

Importance of Embedded Intervention for Children with Challenging Behaviors

• Provides practice with meaningful activities that may be motivating or interesting… gives children a chance to practice being competent
• Uses functional skills and natural reinforcers
• Promotes child initiation and peer interaction
• Gives opportunities to develop more sophisticated communication and social interaction skills in predictable settings
• Facilitates maintenance and generalization

Process of Embedded Intervention in Everyday Activities

• Identify everyday activities and expectations
• Learn about child’s preferences, participation, and current behaviors
• Observe careprovider(s) and child in activity
• Identify current instructional strategies, potential adaptations, skills developing, and new opportunities
• Develop functional and meaningful plans that embed opportunities to practice conventional and more sophisticated communication and social skills

Steps to Identifying Activities and Outcomes

Location: Backyard or playground swing

Activity: Swinging

Possible Outcome: Turn-taking with friends, and/or siblings, Request help, more comprehension of up/down, on/off, stop/go, high/low, slow/fast, Sitting with balance, Getting on & off

- Dunst, C.J., Bruder, M., Trivette, C.M., Raab, M., McLean. M., (2001), Natural Learning Opportunities for Infants, Toddlers, and Preschoolers. Young Exceptional Children, 4(3), 18-25

Steps to Identifying Activities and Outcomes

Location: Door (at home or childcare)

Activity: Brother (or mom) is leaving

Possible Outcome: Giving a hug or showing affection, Waving or saying goodbye, Comprehension of simple directions

- Dunst, C.J., Bruder, M., Trivette, C.M., Raab, M., McLean. M., (2001), Natural Learning Opportunities for Infants, Toddlers, and Preschoolers. Young Exceptional Children, 4(3), 18-25

Your Morning Routine

• On your note sheet, list the sequence of activities you undertake on a typical morning between the time the alarm goes off and when you walk out of your home for work!

“Routine”

• Customary or regular course of procedure
• Commonplace task, chores, or duties done regularly or at specified intervals
• Typical or everyday activity
• Regular, unvarying, habitual rote procedure
• Unvarying, constantly repeated formula, predictable response

– Webster’s Dictionary

Components of a Routine

• Beginning and ending
• Outcome oriented
• Meaningful
• Predictable
• Sequential and systematic
• Repetitious

Logan’s Mom

“We have many daily activities. We get up and he has breakfast. We play on the floor and watch TV. He helps me vacuum and clean-up and then we go outside and play. Then in the middle of the afternoon, if we don’t go to town, we go in and have a snack and wait for his brother to come home from school.”

– Logan’s mom

Gus’ Dad

“Our routines vary. It just depends. There are different days that we have people coming. Our work schedule varies. He comes to the office with us. We usually don’t have a typical stay at home day.”

– Gus’ dad

Variables that Impact Individual Routines...

• Family history, culture, and values
• Personality or style of caregiver(s)
• Number of people at home or in classroom
• Environmental arrangements including space, material availability, physical layout
• Logistics, such as school schedules, staffing patterns, transportation, family work schedules
• Physical and mental health of caregivers and other family members
• Abilities and disabilities of caregivers…
• And the child, the child’s behavior…
• And…..

Process of Embedded Intervention in Everyday Activities

• Identify everyday activities and expectations
• Learn about child’s preferences, participation, and current behaviors
• Observe careprovider(s) and child in activity
• Identify current instructional strategies, potential adaptations, skills developing, and new opportunities
• Develop functional and meaningful plans that embed opportunities to practice conventional and more sophisticated communication, and social skills

Getting into the Routine

• Children are often engaged (or can be) in the routine because it occurs to meet their needs or interests!
• It’s up to the family member, careprovider, or teacher to identify the routines as an opportunity to practice specific skills or outcomes with the child.
• As a team, the best opportunities can be identified and supported so that teaching and learning can occur as part of the routine.

Embedding within the Routine

Back to our rationale…

• Identifying preferred (or problematic) routines
  • Motivating (child and caregivers)
  • Frequently occurring throughout day
  • Repetitive
• Joining in and not taking over
  • Maintaining sequence and format
  • Incorporating functional and meaningful outcomes
  • Using instructional strategies already in place
  • Adding or changing only as much as needed to support the child’s learning

Teaching and Learning Principles for ALL

• Use developmentally appropriate communication and learning environments
• Engage the child
• Provide attention
• Follow the child’s lead
• Expect participation
• Combine new and familiar routines

Process of Embedded Intervention in Everyday Activities

• Identify everyday activities and expectations
• Learn about child’s preferences, participation, and current behaviors
• Observe careprovider(s) and child in activity
• Identify current instructional strategies, potential adaptations, skills developing, and new opportunities
• Develop functional and meaningful plans that embed opportunities to practice conventional and more sophisticated communication and social skills

Identifying Instructional Strategies

• There are many evidence-based instructional strategies available to use in natural environments for communication and social skill development.
• Key to success is the match between the child, the skill to be taught, the context, the careprovider, and the instructional strategy used.
• Systematic planning and progress monitoring by the team increases the outcomes for the child and the success for the careprovider.
• Using the instructional strategies that are natural and comfortable for the careprovider is a good starting point.
• Additional instructional strategies can be introduced as needed for the child’s success and for increasing the complexity of communication and interaction.

Specific Responsive & Directive Instructional Strategies

• Contextual support
• Balanced turn-taking
• Descriptive talking
• Increasing opportunities with activities & environmental arrangements
• Model/request imitation
• Waiting/expecting a response
• Prompts/fading

Maximizing Routine Components for Embedded Intervention

• Identification
  • need or interest is communicated (Jamaal fusses as he enters kitchen where mom is cooking)
• Preparation
  • materials gathered, location specified (Mom takes his hand, he chooses snack, and cup for juice)
• Implementation
  • routine purpose undertaken (eating and drinking)
• Completion
  • activity ends, materials cleared (cup in sink, napkin in garbage)

Increasing Opportunities for Communication and Social Interaction Skills in Routines

• Include the child in the set-up and clean-up for the activity as well as the actual activity
• Use a visual schedule or social stories to review the sequence of the activity before it occurs
• Retell the events after they occur
• Include a new or novel item to increase attention or interest
• Identify friends or family members to participate in the routine to increase conversational turns and roles

Process of Embedded Intervention

• Identify everyday activities and expectations
• Learn about child’s preferences, participation, and current behaviors
• Observe careprovider(s) and child in activity
• Identify current instructional strategies, potential adaptations, skills developing, and new opportunities
• Develop functional and meaningful plans to embed opportunities to practice conventional and more sophisticated communication and social skills

Activity/Routine Matrix

• A visual reminder of outcomes and routines for each child
• A method for joint planning
• A strategy to enhance consistent implementation
• A communication tool between caregivers and service providers
• A system to monitor and document the implementation of intervention throughout the day

About Gus!

• Gus “gets out of things” he doesn’t like:
  • He screams, throws himself (and objects), and hits. He doesn’t use his words or gestures to make requests.
  • He also avoids interaction with others… preferring to be “left alone” to do his own thing.
• Prevention strategies have included:
  • Visuals and social stories to prepare him for upcoming activities
• Replacement behaviors include:
  • Using words to request help
  • Making choices between preferred activities
• Responses to Gus include:
  • Using verbal and visual prompts to cue Gus to use easy “words”
  • Encouraging Gus immediately when he uses words

Activity/Routine Matrix
Gus's Home Routines

Outcome: Use words to request help

Bike riding: Put the bike on the porch and wait for Gus to ask you to help him move it to the sidewalk.
Bathtime: Have Gus’ bathtime materials available within sight but out of reach. Wait for him to ask. If he doesn’t, ask him what he wants.

Outcome: Name actions and objects

Bike riding: Walk by Gus as he rides. Label what you see and pause. Give Gus at least 3 seconds to make a comment.
Bathtime: Post Gus’ visual schedule. Point to the activity and have Gus name it before he begins and at the end.

Routine/Activity Matrix for Jamaal

• After watching the brief video and reading the story, develop an activity matrix for Jamaal for his early education program or for his after-school time at the family childcare.
• Identify routines and strategies consistent with the outcomes you identify.
• Be creative in your small groups… discuss how you should begin to communicate between team members.

Summary of Key Points

• Typical routines and activities provide a framework for teaching and learning throughout the day
• Caregivers can use a variety of evidence-based instructional strategies within routines and activities to support the child’s use of new or more sophisticated communication to replace challenging behavior
• Embedding intervention into typical routines is most effective when matched to the caregiver’s and child’s interactions, expectations, and preferences