Family Stories: Setting the Stage for Parent Implemented

Interventions ASHA 2015 Session # 1466

Emily D. Quinn M.S., CCC-SLP ● Tatiana Peredo Ph.D. ● Ann P. Kaiser Ph.D.

Vanderbilt University

Relevant Disclosures

Financial –We have no relevant financial or nonfinancial relationship(s) within the products or services described, reviewed, evaluated or compared in this presentation.

Nonfinancial –

• Dr. Kaiser's research is supported by the following grants: ACEGrant 1R01HD073975, HRSA Grant R40MC27707, IES Grant R324A090181, NIH Grant HD073975, and a Merck grant

• Ms. Quinn's training is support by ECSE Doc Training Grant H325D100034

• Dr. Peredo's research is supported by the following grants: ACE Grant 1R01HD073975, HRSA Grant R40MC27707, a Merck grant, and a Peabody College Grant

Session Goals

• Provide rationale for family story

• Define and demonstrate counseling strategies

• Discuss benefits of family stories in the evaluation process

• Share a protocol for conducing a family story

Creating a Collaborative Partnership

•  Growing body of literature demonstrates the efficacy of parent implemented interventions

•  Building trusting relationships with parents is essential to training caregivers as co-interventionists

•  Developing intervention plans reflecting parent goals remains difficult

•  Family story as a method to individualize intervention

Crais, Roy, & Free, 2006; Kaiser & Roberts, 2013; Kashinath, Woods, & Goldstein, 2006 ; Kemp & Turnbull, 2014; Roberts & Kaiser, 2011; Romski, Sevcik , Adamson, Cheslock, Smith, & Barker, 2010 Turnbull, Turnbull, Erwin, & Soodak, 2006 ; Woods, Wilcox, Friedman, Murch; 2011 Mom offers a choice

between an apple and pear

Describing the Family Story

•  Adapted from principles associated with •  Narrative of Life Stories (Withrell & Nodding, 1991)

•  Therapeutic Conversations (Freedman & Combs, 1993)

•  Routines-Based Interviews (McWilliam, 2010)

•  Storytelling as a context to understand important life events in child and families life

•  Family Values

•  Family Routines

•  Platform for goal setting

Introducing the Family Story

•  Emphasize the conversation is used to learn about the child and family

•  Stress the caregiver is in control of sharing information

•  Inform parents of question focus

•  Significant events

•  Successful interactions and routines

•  Caregivers perspectives of the child

•  Meaning of child communication

•  Parent and family strengths

Introducing the Family Story

Family Story Question Stems

•  What were significant events during pregnancy?

•  What have been some significant life events for [CHILD’S NAME]

•  Tell me about when you first began feeling connected to [CHILD’s NAME].

•  Who do you think is [HIS/HER] favorite person, besides you?

•  How do you know when [CHILD’s NAME] likes someone?

•  Tell me about [CHILD’s NAME].

•  What are some things you love about your child?

•  What are things you are doing well in terms of parenting right now?

•  What are some challenges you face with [CHILD’s NAME]?

•  What are some things you wish your child could do in terms of communication?

•  What types of activities are motivating for your child to communicate?

•  What are some ways you’ve felt supported to help your child in the past?

Skills for Facilitating a Family Story

Family Stories: Do’s and Don’ts

Do Don’t

Allow plenty of time Rush through it

Make it a conversation Make it an interview

Focus on positives Focus on negatives

Ask open questions Ask closed questions

Reflect content Offer advice

Reflect feelings Avoid feelings

Summarize Add in personal stories

Skills to Facilitate a Family Story

• Encouraging Questions and Statements

• Reflecting Statements

• Reframing

Encouraging Questions & Statements

•  Encouraging Questions: •  Open-ended questions

•  Example: instead of asking, "Has family been supportive?" ask, "What has been supportive?"

•  Avoid asking "why" questions

•  Encouraging Statements: •  Statements that convey you are attentively listening

•  Examples: "I see", "right", "say more about that", a non-verbal head nod

Reflecting Statements

•  Reflection of Content •  Listen and give a condensed and nonjudgmental version of

facts that the parent has communicated

•  Reflection of Feeling •  Identify the feeling and communicate the emotion back to

the parent

How might you respond to this?

“When I’d go in for a checkup the nurse would give me a sheet of all the things that she was supposed to be doing, and I finally said please stop giving me these because she’s not doing any of it and it upsets me; it just reminds me of what she’s not doing”

Reflection Statements

•  Reflection of content: “You kept being given information on developmental milestones that she wasn’t hitting”

•  Reflection of feeling: “It was frustrating to be given all this information and know your child wasn’t doing it”

How might you respond to this?

“All these people came in, geneticists, counselors, social workers, case workers, and every person had all this paper work… and to be honest I didn’t read any of it”

Text a reflection of content or reflection of feeling response!

How might you respond to this?

“I didn’t know what I was doing anyway this being our first child and then you throw in a special need that I know nothing about and it was just overwhelming”

Text a reflection of content or reflection of feeling response!

Let’s Practice!

•  Introduce yourself to the person next to you.

•  Ask:

•  Tell me about yourself ?

•  What were some significant events that led you to becoming a _________(SLP, psychologist, teacher, ect)?

•  What have been some of your successes?

Reframing

•  Reframing allows parents to think about their child and their experiences in positive terms

•  Listen for and comment on parent's strengths

•  Frame questions in a way that gets parents to talk about positives

Example Questions that Contain a Reframe

•  “What are some things you enjoy doing with your

child?”

•  “How do you feel supported in meeting your child’s needs?”

•  “How do you feel empowered to meet your child’s needs?”

Comparing the Family Story with Child Focused Assessments

Summarizing the Benefits of a Family Stories

Family Routines Preferences

Standardized Assessment Measures

Language and Communication

Sampling

Parent Questionnaires

MCDI Family Story

vocabulary communicative and symbolic gestures games routines actions with objects

overall communication skills games, routines, activities strengths Parent Wishes and Goals for communication

Capturing Parent Perceptions

Language and Communication Sampling

Language Sample Family Story

vocabulary articulation phonology grammar pragmatic skills

communication skills in familiar activities interactions across environments and people

Mom and child sign yummy for ice cream during language sample.

Standardized Assessments

Standardized Assessments

Family Story

normative comparison developmental level performance on discrete decontextualized tasks

family goals and expectations growth over time Individualized growth Participation and performance in daily activities

Acknowledgements We want to thank our staff and families for their

participation. Our research would not be possible

without their collaboration.

Contact

•  Contact: Emily.d.quinn@Vanderbilt.edu tatiana.n.peredo@Vanderbilt.edu

•  Website: vkc.mc.vanderbilt.edu/kidtalk

•  Friend us on facebook @ Vanderbilt kidtalk

Questions

References

Crais, E. R., Roy, V. P., & Free, K. (2006). Parents’ and professionals’ perceptions of the implementation of family-centered practices in child assessments. American Journal of Speech-Language Pathology, 15, 365–377.

Friedman, M., Woods, J., & Salisbury, C. (2012). Caregiver coaching strategies for early intervention providers: Moving towards operational definitions. Infants and Young Children, 25, 62-82.

Hancock, T. B., & Kaiser, A. P. (2006). Enhanced Milieu Teaching. In R. McCauley & M. Fey (Eds.), Treatment of Language Disorders in Children. (pp. 203-236). Baltimore: Paul Brookes.

Kaiser, A. P., & Roberts, M. Y. (2013). Parents as communication partners: an evidence-based strategy for improving parent support for language and communication in everyday settings. Perspectives on Language Learning and Education, 20, 96.

Kaiser, A. P., & Roberts, M. Y. (2013b). Parent-implemented enhanced milieu teaching with preschool children who have intellectual disabilities. Journal of Speech, Language, and Hearing Research, 56, 295–309.

Kashinath, S., Woods, J., Goldstein, H., (2006). Enhancing generalized teaching strategy use in daily routines by parents of children with autism. Journal of Speech, Language, and Hearing Research, 49, 466-485.

Kemp, P., & Turnbull, A. P. (2014). Coaching with parents in early intervention: an interdisciplinary research synthesis. Infants & Young Children, 27, 305–324.

McWilliam, R. (2010). Routines-Based Early Intervention: Supporting young children and their families. Baltimore, MD: Paul Brookes.

Noddings, N., & Shore, P. J. (1984/1998) Awakening the inner eye: Intuition in education. New York, NY: Teacher College Press.

Roberts, M. Y., & Kaiser, A. P. (2011). The effectiveness of parent-implemented language interventions: A meta-analysis. American Journal of Speech-Language Pathology, 20(3), 180–199. http://doi.org/10.1044/1058-0360(2011/10-0055)

Roberts, M. Y., Kaiser, A. P., Wolfe, C. E., Bryant, J. D., & Spidalieri, A. M. (2014). Effects of the teach-model-coach-review instructional approach on caregiver use of language support strategies and children’s expressive language skills. Journal of Speech Language and Hearing Research, 57(5), 1851. http://doi.org/10.1044/2014_JSLHR-L-13-0113

Romski, M. A., Sevcik, R. A., Adamson, L. B., Cheslock, M., Smith, A., Barker, R. M. (2010). Randomized comparison of augmented and nonaugmented language interventions for toddlers with developmental delays and their parents. Journal of Speech, Language, and Hearing Research.53 350–364

Witherell, C., & Noddings, N. (1991).Stories lives tell: Narrative and dialogue in education. New York, NY: Teachers College Press.

Woods, J. J., Wilcox, M. J., Friedman, M., & Murch, T. (2011). Collaborative consultation in natural environments: Strategies to enhance family-centered supports and services. Language Speech and Hearing Services in Schools, 42, 379. http://doi.org/10.1044/0161-1461(2011/10-0016)

Solomon, M., Pistrang, N., Barker, C. (2001). The benefits of mutual support groups for parents of children with disabilities. American journal of community psychology, 29, (1). 113-132.

Young, M. E. (2009) Learning the art of helping: Building blocks and techniques (4th ed.). New Jersey: Pearson Education.

References

     

Family Stories Protocol

Copyright 2015

Vanderbilt Kidtalk

All Rights Reserved

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

     

Family Stories Protocol

To prepare BEFORE the session with the family:

1. Make an appointment at a convenient time for about 1½ hours. Choose a time when both you and the caregiver can be relaxed and focused on the interview (preferable if the child is NOT present).

2. Review the child’s assessment data and the family file. 3. Come prepared with knowledge of some positive characteristics of the child and the family.

It may be helpful to come with a list of skills the child already has. Consider the child’s strengths as a learner and a communicator.

4. Get the needed equipment together for the interview: camera, questions/protocol, chart paper and pen.

Starting the family story:

Say, “The purpose of this family story is for us to gain a better understanding of (CHILD’s NAME) and your family. This will be an informal conversation about (CHILD’s NAME) history, personality and strengths, as well as (HIS/HER) current skills and your goals for (CHILD’S NAME). You can choose what information you want to share. This information will be treated with respect and confidentiality. We videotape these stories, but you can ask me to turn off the camera at any point. You do not have to share any information that you wish to keep private.”

(QUESTIONS  FOR  STORY  ARE  ON  THE  NEXT  PAGE)  

 

 

 

 

 

 

     QUESTION PURPOSE OF QUESTION POSSIBLE FOLLOW UP

QUESTIONS TO PROBE FOR MORE INFORMATION

NOTES

Tell me about your family.

Who lives in the home with [CHILD’s NAME]?

• Learn about family members

• Think about who should be involved in intervention

• Tell me about your extended family.

What were significant events during pregnancy?

• More detailed medical history of child

• Gives us context of child within family system

• What were other significant life events that occurred while you were pregnant?

What have been some significant life events for [CHILD’S NAME]

• More detailed medical history

• More family info (e.g.

sibling births, deaths in the family, moves, adoptions)

• Child’s social context

• Are there other children in the family?

• Where does the child fall in birth order?

• What prompted or concerned you to have your child evaluated?

• Have there been any major illnesses or hospitalizations?

Tell me about when you first began feeling connected to [CHILD’s NAME].

• Highlight positives about the child

• Get information on child’s more subtle communication indicators (smiles, reaches,

• What would it look like if you did feel that connection?

• What would your child do to indicate a connection to you?

     

touches, hugs, pulls caregiver towards what they want)

• Learn what would be important for the child to be able to do for caregiver to feel connected.

• Offer examples of caregiver/child behavior you’ve noticed (e.g. His eyes lit up when you walked into the room)

Who do you think is [HIS/HER] favorite person, besides you?

• Who are people that may be important to involve in intervention

• What are ways child engages with others

How do you know when [CHILD’s NAME] likes someone?

• How does child communicate/indicate likes (and dislikes)

Tell me about [CHILD’s NAME].

• Child strengths • Opportunity to find

caregiver’s strengths (give caregivers credit for some of child strengths, opportunity for caregivers to hear that they are doing things well).

• How would you describe [CHILD’s] personality

• What are things [CHILD] likes?

• What are things [CHILD] dislikes?

• What are [CHILD’S] strengths?

What are some things you love about your child?

• Good personality characteristics

• What is something that is special just between you and

     

• Normalizing that their child is still just a kid and can be funny, silly, hard-working, etc. (child is still a child, not just an individual with a disability)

[CHILD’S NAME]?

What are things you are doing well in terms of caregiving right now?

• Getting caregivers to reflect on their strengths

• Opportunity for them to hear that they are the experts on their child, that they still know what’s best even with a child with special needs

• You’ve already mentioned X which is a great strength of yours, what else do you think you are doing really well in terms of child rearing?

• Summarize from the rest of the interview things you’ve picked up on as strengths (e.g. caregiver’s persistence, resourcefulness, insightfulness of their child’s abilities and skills, advocacy, resilience, etc.)

Tell me about your support system.

• Besides (people already mentioned), are there other friends or individuals that have been supportive?

• Are there other things or systems that are supportive (services, therapies, religion)?

     What are some activities that you do with your child?

• Information on routines and activities that can be used for intervention

• Give examples of activities if caregiver does not know how to answer this question, for example, some families eat meals with their children, or give the child a bath daily, or go to the park or grocery store. What are some things you do with your child?

What home activities are fun and enjoyable for you and your child?

• Information that can be used for child goals

• What would a fun and enjoyable activity look like for your child?

What home activities are a challenge for you and your child?

• Information on things that should be targeted in intervention, particularly around communication and behavior.

• What are some home or community activities that are difficult for you and your child?

• If there was one home or community routine that could look different for you and your child, what would it be? What would you want it to look like?

What are your goals for [CHILD’s NAME]?

• Goal setting • How would (your life/this routine/ your day) be different if we accomplished this goal?

 

     Summarize the story in a supportive way. Emphasize the positives and thank the caregiver for sharing his/her story. An example statement might be, “Thank you so much for sharing your family’s story with me. I loved hearing about how excited [CHILD’s NAME] gets when she sees her grandfather, it’s wonderful that she is so connected to your dad. It was also so great to hear that you and [CHILD’s NAME] already have some established activities that are fun for both of you. That story about how [she/he] plays and communicates with you in the bathtub is so cute and a great place to start teaching some language. I heard you say how challenging having a child with a disability has been for you and that you often feel like you do not know if what you are doing is the best for her. It also sounds like to me that you are very resourceful and involved. It’s great that you started getting her intervention at such a young age and are so involved with all of her therapies.”