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From Tiers to Outcomes: Putting the Pyramid Model Framework into Practice in Early Intervention
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In this episode, we explore how the Pyramid Model framework supports social-emotional development in early intervention. Our guests, Naomi Grinney and Cori Hill, share practical ways to apply the tiers of the Pyramid Model with infants and toddlers, examples of writing meaningful social-emotional outcomes, and tips for partnering with families to promote positive relationships and emotional growth from the start.
Resources:
Virginia Early Intervention Professional Development Center: https://veipd.vcu.edu/
Infant & Toddler Connection of Virginia: https://itcva.online/pyramid-model-framework/
National Center for Pyramid Model Innovations: https://challengingbehavior.org/resources/
Outcome Examples:
Outcome that focus on relationships: “Jin will call for his mom when he wakes up at night using her name consistently each time every night for one week.”
Outcome around emotional regulation: “Bertie will use calming strategies modeled by her foster mom when she is waiting for food to be placed on her tray (e.g. blowing bubbles) twice per day for one week.”
Outcome supporting social interactions: “Aiden will give his dad a high five when he comes home from work 5x a week over 2 weeks.”
Family outcome: "Asako will identify 5+ strategies that she can use to redirect Jin when he is climbing to give him an opportunity to expend his energy inside and outside the house 10+ times a week for two weeks."
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Transcript
Introduction to Pyramid Model Framework
00:00:10
Speaker
Welcome everyone to Meaningful Moments, connecting infant mental health to early intervention. I am super excited about this podcast episode. Today, we are going to be talking about from tiers to outcomes, putting the pyramid model framework into practice in early intervention, because we've had a lot of questions about what that looks like, right?
Sponsorship and Collaboration
00:00:32
Speaker
Especially in Virginia.
00:00:33
Speaker
and so Before we get started, let's start with our sponsor message. This podcast is a collaborative effort from the Virginia Department of Behavioral Health and Developmental Services. That is through a contract with the Partnership for People with Disabilities at Virginia Commonwealth University.
Meet the Hosts and Guests
00:00:51
Speaker
and My name is Lisa Terry. I will be your host today. I am endorsed in infant mental health as a mentor for faculty and research. I am a professional development consultant,
00:01:02
Speaker
with early intervention through the Virginia Early Intervention Professional Development Center. And I have my supervisor on with me today, Corrie Hill. i will go ahead and let you introduce yourself first, Corrie. Go ahead.
00:01:16
Speaker
Hi, everyone. I'm excited to join you. As Lisa said, I'm Corrie Hill and I am the director of the Virginia Early Intervention Professional Development Center.
00:01:27
Speaker
What that means is we oversee professional development for Virginia early intervention providers. um And as Lisa said, through a contact ah contract with the Infant Toddler Connection of Virginia.
00:01:42
Speaker
Again, happy to be here. Thanks, Lisa. Thanks, Corey. And we also have Naomi with us today, who's like our infant mental health guru of all things social emotional development. So bit welcome, Naomi. I'm so glad you're here today. If you want to go ahead and give a little bit of background information.
What is the Pyramid Model Framework?
00:02:00
Speaker
i am so excited, Lisa and Corey, that we're getting to do this together today. This is going to be so much fun. hi everybody. My name is Naomi Grinney. I am I'm a licensed clinical social worker. I work um in Northern Virginia. I also have an infant mental health endorsement.
00:02:16
Speaker
um And I love talking about all things social, emotional development in babies and young children and within families. So today is just going to be such a joy. I'm so excited.
00:02:28
Speaker
Thank you. I think we all three love talking about social emotional development. We could probably geek out a lot with each other about it. hope This will be a great topic because like I said, i think that a lot of people have just been wondering, like, you know, we're hearing all about the Pyramid Model Framework in Virginia, especially because that's part of our state systemic improvement plan.
00:02:47
Speaker
And we have to really implement that. And a lot of questions have come up about, well, what does that look like? How do we do this? And so let's kind of like go through that today and give everyone a better explanation of what that looks like.
00:03:01
Speaker
um But I want to start with you, Corey, first, and kind of, you know, thinking about the pyramid model framework, just kind of define it. Like, what is the pyramid model framework? You know, we had to do a lot of work kind of figuring this out. And it was sort of along with the tiered process of the pyramid model itself, we had to kind of figure out where that falls in Virginia.
00:03:22
Speaker
And so we took information from the Pyramid Model Innovations Group, who have done just fabulous work on infant mental health and social emotional development, so many wonderful resources.
00:03:37
Speaker
but then trying to figure out what does this look like in Virginia? How does this align with what we're thinking? And so the idea of a framework is really ah set of beliefs. It can be rules, but But it really helps to make it guides practices to make decisions.
Guiding Practices with the Pyramid Model
00:03:59
Speaker
And so when we decided to talk about the pyramid model framework, what we are really saying is Virginia is taking all these fabulous resources about the pyramid model
00:04:11
Speaker
and tying them as evidence-based materials and practices that really help to support families with social-emotional development.
00:04:23
Speaker
It allows us to be individualized. It gives practitioners flexibility to use their expertise along with tools that really do align with evidence-based practices.
00:04:37
Speaker
Absolutely. And I think, you know, i like how you said it kind of like just guides us because I feel like for some reason, there's been a lot of pressure about the pyramid model framework, like, oh, like I have to do A, B, C, D and E to really implement it And it's really all about supporting the social emotional well being of children and families, right, that we're working with. And, and how do we do that? And so I love that idea. And how you kind of like explain that of kind of just guiding our practices, right? and I think people just need to take a deep breath and just
00:05:08
Speaker
Just give them a little bit. Yeah, just breathe a little bit because it's okay. And it's just guiding us, right? um So ah I kind of wonder then too, like what do you think makes the pyramid model framework so powerful when we're supporting young children's social emotional development?
Understanding Children in Family Contexts
00:05:25
Speaker
And I guess maybe Naomi, if you want to kind of like start.
00:05:28
Speaker
Yeah, and you know, i I love Corey the way i I've heard you talk about the pyramid model and I love the way that you describe it because I think, you know, the, the way that we can understand kids and families, right? So when we understand kind of kids in the context of the family that they live in when we understand, you know, the, the beliefs of a family, when we understand their kind of priorities for their child's development. And so when we kind of can, can understand this framework, first of all, we all, all of us, right.
00:06:01
Speaker
As early interventionists, We are kind of the base of this framework. And so it's it's the work that we're doing in our systems. And all of us have that capacity to be therapeutic and empathetic and responsive in our practices.
00:06:17
Speaker
And so when that's kind of how we come in, right, and we say, okay, this is kind of what I know about development or what I know about young children or what I know about kind of family systems.
00:06:28
Speaker
And then we're able to learn from the family and we really develop that partnership. Right. And so we're able to kind of join together and say, you know, these are the goals that you might have, or or these are the things that maybe you're concerned about.
00:06:41
Speaker
um And it's a way that we can all kind of understand, right. When I'm describing a family, say in a teaming meeting with my you know colleagues and I'm talking about some of the challenges and someone else says,
00:06:56
Speaker
oh yeah, it seems like you know you're you're doing so much work on you know those prevention strategies that we've talked about, right? You're really focusing in on um how are we kind of providing those supports.
00:07:09
Speaker
Everybody's kind of having the same conversation. and so we're able to kind of look to one another and support each other. And we're also able to understand what social emotional development looks like, right? Because I think sometimes when you say social emotional development, people are like, I don't know.
00:07:25
Speaker
That's not my area, right? But when we talk about things like, you know, helping parents to develop responsive um interactions with their children, that's something all of us can do, right? And we're doing it in different ways, but it's a way that we're all understanding kind of what that social emotional development looks like.
00:07:44
Speaker
um And it's also a way that we share that with families, right? So when we talk to parents about their child's social emotional development, and we say something like, you know, when your baby's crying, and you pick them up and you hold them, that's being really responsive to their needs. And the parents are like, oh, I do that all the time. and we're like, yes, exactly.
00:08:03
Speaker
Right. And so we're building those skills that families have and and giving them this way that they feel really empowered. um And that's such ah a wonderful thing to be able to do for them during a time when they might be feeling overwhelmed or when they might be feeling really discouraged.
00:08:21
Speaker
Yeah, absolutely. And i feel like, too, there's so many different things that can impact families, right, throughout the time that we're with them. And so we have to, we like exactly how you said, we all play a role in this, right? And so we have to be mindful of that throughout the process because,
00:08:38
Speaker
as we're going on this journey with families, things can come up, right? And it can impact though that family. Like we talk about stress a lot, right? We talk about like, you know, these behaviors that might emerge as children are getting older, right? And they're trying to exert their independence. And so i think it's really important that you said that, that everybody plays a role in supporting that social emotional wellbeing, like really of all families and and really being aware of that.
00:09:04
Speaker
Corey, did you want to add anything? Yeah, you know, I think you all kind of put a perfect segue to this idea that the pyramid model has these tiers and families move up, can move up and down um on those
Importance of Effective Workforce
00:09:21
Speaker
tiers. But what Naomi said just really strikes me as so powerful.
00:09:26
Speaker
The base, the strongest support of the pyramid model is having an effective workforce, having people who understand what we're talking about,
00:09:37
Speaker
But as we have said, this is not new stuff. This is good early intervention practices. And part of the pyramid model is um they have six key practices, but I'm going to highlight just a few of them. And really what early interventionists should be thinking is, oh yeah, i ah I already do that.
00:10:01
Speaker
We already talk about having effective relationships with families. with using coaching as an interaction style with families, with looking at the relationships between the caregiver and the child and where early interventionists fit in All of those kind of things really help build that social emotional development to support those families.
00:10:25
Speaker
And then with the with the tiers on the pyramid model, again, we start with that effective workforce. The next year is really What we do for all children, we use good screening tools, we support all families, we look at high quality environments.
00:10:48
Speaker
That is not about what does the family's house look like or what does the child care center look like. It is about ah supportive environment where there are nurturing relationships.
00:11:03
Speaker
And then the next tier is if we need some more targeted supports. If the if the family says, we're struggling with this particular thing.
00:11:14
Speaker
And we're going to talk about some examples with goal writing with families who are on different, you know, different levels. ways of thinking about their child's development.
00:11:25
Speaker
And then the top tier is more intensive. um Usually fewer children are in that top tier. But again, we don't ever think about this family is at tier two or this family is at tier three, it's the level of support and what they need from early interventionists.
00:11:46
Speaker
And I know Naomi's gonna, she has this great spiel about who can provide those kinds of supports and she's gonna get to that. So that's kind of not only the tiers of the pyramid model, but also those practices that are already built in that we're already doing as early interventionists.
00:12:07
Speaker
Yeah, and I think that's a good point is that these are things that we're already doing, right? These are practices that we're already implementing. We already have our natural learning environments, our family-centered practices, our coaching interactions, right?
00:12:19
Speaker
And so it just really just focuses on that emphasis of that social-emotional development and and where we are. And I like how you talked about where it just kind of fluctuates. So I guess, you know, like thinking about, you know,
00:12:33
Speaker
how we're implementing this. What are some ways that early interventionists can implement the pyramid model framework with families in everyday routines?
Implementing the Pyramid Model in Routines
00:12:43
Speaker
What do you think, Cori?
00:12:46
Speaker
Well, you know, again, i think the family-centered practices and recognizing responsive caregiving is sort of the key of of helping to support those families.
00:12:58
Speaker
I don't think it is about having a certain number of letters behind your name, having an an endorsement. I think it is good early intervention that is evidence-based.
00:13:13
Speaker
You know, we know from the literature that families, when they think about their early intervention experience and the impactfulness of the people who provide it. It's about building those relationships and helping to support the families so that they can then support their children.
00:13:33
Speaker
um And doing this all within the family's everyday routines and activities. We're not asking them to do things that they wouldn't typically do with their child. We're building on what they already do and how they interact and what's typical for their family.
00:13:54
Speaker
Yeah. And Naomi, I know you're still, um you know, seeing families too. If you think about it as being like a provider, how do you use these strategies like during a home visit? Like what are some examples of that, what that might look like?
00:14:08
Speaker
And, you know, I love Corey that you, and we talked about this, right? We use that relationship. And so we think about like the, the relationship that we build with families and,
00:14:20
Speaker
We do this in a really unique way, right? Because we go into families homes. And so it's different than if we were seeing families in a center or we were having them come into a clinic, right? Or we were only seeing their kids in daycare.
00:14:33
Speaker
We see kind of a really different part of their lives. um But it also allows for kind of that relationship piece really to develop, right? Because we're we're sitting in their living rooms.
00:14:46
Speaker
We're, you know, playing in the yard, like we're kind of going into the places that families are spending their time. And so, you know, as a provider thinking about um even, you know, things like um observing what you're seeing, right? Mom, I saw that when, you know, Susie started to cry, you looked over at her, you know you um picked her up, you use a really calm voice with her, right?
00:15:15
Speaker
um Those are things that every provider can do. All of us can can kind of talk about that. We can be responsive to those questions that families ask. So when families ask, you know, she seems really fussy and I don't know what to do, right? We can engage in that kind of reflective conversation with families.
00:15:34
Speaker
um When we might notice a difference in behavior, right? um you know, mom, I'm wondering, you know, I know that we've talked about some of the concerns that you've had with X, y or z right?
00:15:50
Speaker
I'm wondering how you're feeling about those, right? And so I think, you know, a lot of times just picking up on the things that families are telling us. And for some families, you know, we see a lot of kiddos that have some really complex medical needs, right? And so we might be the only people that are coming in that are asking a parent, you know, dad, how are you doing?
00:16:13
Speaker
You know, grandma, what's been going on this week. Right. And sometimes it's just, Oh, another adult is asking me how my week is going. Oh, I'd love to tell you. Right.
00:16:24
Speaker
um And so I think some of those ways to just um even really gently reframe. Right. So when mom says every time he's done with his food, he just throws it all over the floor.
00:16:39
Speaker
Hmm. I wonder what he's trying to communicate, right? I wonder what might be happening for him in that moment. I wonder if maybe he's communicated something a little bit earlier. Maybe we missed it, right?
00:16:52
Speaker
And so I think just even having some of those conversations, it allows parents and caregivers to kind of maybe see things a little bit differently, but we're not coming in and saying, oh, do do it this way, do it this way, right? We're really thinking about What is that routine? and Corey, like you were talking about, what is the way that they were already kind of participating in this activity together?
00:17:14
Speaker
and And do we maybe offer a different lens? Or do we help a family to, you know, try a different strategy? um But so often, you know, we say this in early intervention all the time, like the families and the caregivers, those are the individuals who are the experts.
00:17:29
Speaker
on their kids, right? And so what we're doing is we're really looking for that opportunity to build that relationship so that we can come alongside rather than coming in and saying, well, here's what we know and just do it our way, right? Because that's not going to be effective in the long term. That partnership is really what's going to drive that change to happen.
00:17:50
Speaker
i agree. i think that partnership with the family and to be able to establish that trust and make them feel safe enough to really be vulnerable with you is so important. Like I'm thinking about, you know, the other day I had a family that I was working with and mealtimes are really frustrating for them.
00:18:12
Speaker
and I could just see on the parent's face, like just really checked out because the child wasn't really eating what He wanted him to, and he was just frustrated, right?
00:18:23
Speaker
And so I was able to kind of like just pause in that moment and just check in with them too and really have a good conversation about how it's impacting even that caregiver's feelings and their mental health and and what's going on with them, right? And really unpacking that. um And I feel like that helps us get so much further and make so much more progress then when we're being...
Building Trust and Partnership with Families
00:18:49
Speaker
open and vulnerable. Did you have something to add for us? Yeah. You know, I think what both of you are saying is with this relationship between the caregiver and the early interventionist, it's an equal, it's an equal partnership. It's not a hierarchy. It's not that we're coming in as early interventionists as the expert.
00:19:11
Speaker
It's that we're taking the family's expertise on their child and their family and we're what life looks like. And we are bringing our skill set of understanding child development, social emotional development, and having an opportunity to really have a conversation.
00:19:31
Speaker
i love what Naomi use and uses frequently, I'm wondering, or i'm thinking about, or what does this... What does this feel like for you is such a nice way of having a conversation with a family that maybe they are in the midst of it. Like Lisa's example, they're frustrated. They can't step away, but somebody can help them think through some of that. so I love those examples.
00:20:00
Speaker
Yeah. And I always tell my family, I'm like, we're both detectives here, right? We're just trying to get a good understanding of what's going on. Like, I'm wondering with you and, you know, like kind of encouraging them to just keep wondering too and and be that detective when they're working with their child. and So Naomi, I wonder, um do you have any like real world kind of like example of maybe like a family or a situation like where their pyramid model framework kind of made ah meaningful difference?
00:20:30
Speaker
Yeah. um I mean, so many, but there's there are a couple that really stand out for me. And, you know, when we think about kind of, Corey, I'm going back to, you know, earlier when you were talking about kind of where, you know, what are the supports that families need, right? And and we had a kiddo that came in 16 months old.
00:20:48
Speaker
sixteen months old um had been in several out-of-home placements when they when they came to us. And there was a real um difference between kind of where um the child's temperament and and the caregiver's temperament.
00:21:05
Speaker
And also this kiddo that was coming in had experienced um some significant disruptions with their attachment. And so they had, you know, been initially living with their parents and then they had been cared for by their grandparents.
00:21:20
Speaker
And now they were being cared for by another um extended family member. And so, you know, we were kind of almost um approaching the family at at a lot of different places, right? Because we were talking to them and kind of building that responsive relationship, right?
00:21:40
Speaker
um But each of the family members, really what we found was, because many of them were still involved in this this little person's life, Everybody really had a different approach to parenting and caregiving and also to understanding behavior.
00:21:56
Speaker
And so we were it was a large team of us. It was myself and a speech pathologist and an OT who are all supporting this family. um And really, you know, i feel like the first many, many sessions um were just building that relationship, right? Just developing some trust.
00:22:15
Speaker
um Sometimes when people hear the word social worker, they've got some different.
Family Example and Collaborative Efforts
00:22:20
Speaker
experiences that they've had, right? And so developing that trust, um but really also thinking about, you know, so much of the focus with the family had been on what their differences were.
00:22:31
Speaker
And when we got in there, we realized that there were actually a lot of things that were the same, right? All of them cared really deeply about this kiddo. um And all of them wanted kind of what was best for that person.
00:22:44
Speaker
And so it was this opportunity to really look at, you know, what is some of the meaning behind this behavior, right? How are we helping to build these communication skills?
00:22:55
Speaker
What are we doing to to develop some secure attachment? And a lot of that happens through consistency, right? Through kind of understanding what the child's needs are, looking at what supports we could build in for the family as well. um And it was, you know, it took a lot, a lot of time, um but it also was a way for family members to improve their communication with each other.
00:23:23
Speaker
um And so it was this really wonderful way that we also collaborated with um some of our external partners. um So we were working with some of our foster care providers. We were working with the court system.
00:23:36
Speaker
um We were working with a daycare center um to really kind of shift from a lot of, you know, blame and shame and frustration and overwhelm and into, you being more collaborative together. um and And the priorities for this kiddo also shifted while we were working with them. So initially when when they came in, the goal was for them to return to living with their parents.
00:24:03
Speaker
And that goal shifted um to where then the grandparents were going to be the ones that were going to be um the more permanent primary care providers. And so being able to kind of think about, you know, how can we help to support this kiddo in keeping all of these relationships now with their family while also having one kind of person who was responsible for their day-to-day care.
00:24:30
Speaker
um And it was a really, like, what I loved so much about working with this kiddo was being able to see the way that so many people cared for them And also being able to be really collaborative with other systems that were involved.
00:24:43
Speaker
So internally, sometimes we're like, right, oh, I can call the PT who's working on this case, or I can call the OT and we can kind of come up with a plan. um And that's wonderful when that happens within your system. But when you're also working with an outside partner, sometimes they don't always understand child development, right? they' They're looking at kind of from their lens.
00:25:04
Speaker
And so when we can take a little bit more of this whole child approach, um it really gives us this opportunity to say, okay, you know, what are ways that we build the partnership? And what are ways that we kind of keep that child in mind, right? Because the child is really our focus.
00:25:20
Speaker
um And it it allows us to kind of shift a little bit. um And the other thing I'll say too is that, you know, oftentimes in early intervention and Corey, you were talking about this, you know, when we come in and we develop this partnership, what we're really doing in a lot of ways is we're modeling, right? So we're modeling as an early intervention team in this kiddo that I was just talking about, we were modeling how we collaborate together how we support each other, how we partner together.
00:25:48
Speaker
And so when we were in meetings, when we were talking about this kiddo and this case, other agencies started to shift a little bit, right? And I won't say it was entirely because of our efforts, but I think the fact that we were really encouraging that communication, and I think that that happens in families, right? When we come in and we say,
00:26:08
Speaker
Hmm, I'm wondering about this behavior. You know, the next time that food gets thrown off a tray, the the parent has a little bit more of that capacity to say, I'm wondering about this behavior.
00:26:19
Speaker
And even that small shift, right, even that pause in saying and I'm curious, can completely change the way that they react or respond, right, which then can completely impact the outcome of that situation.
00:26:33
Speaker
And so I think remembering that we are kind of we can use ourselves and just kind of who we are as people to support those systems, to support those relationships.
00:26:44
Speaker
um You know, it doesn't matter how many letters you have after your name or how long you've been in this field. What matters is is kind of how you use the tools that you have. Yeah. And, you know, I think you bring a good point to especially like in that example, because the ultimate goal, I think, is for children to feel safe and secure. Right. And we know that children, unless they feel safe and they feel secure in their environment, that they won't explore unless that happens. Right. And so we see that a lot with kids that um are going through multiple health issues.
00:27:20
Speaker
homes and have a variety of different caregivers. And so even if you are working on motor skills, that child might not make any of that progress because they don't feel safe, they don't feel secure. And so that's why they really aren't exploring. They don't have that confidence, right? And so I think, you know, we have to really dig in and figure out what's going on with these underlying, you know, reasons of where that child is developmentally at that point.
00:27:47
Speaker
So another thing that always comes up, we're going laugh because I feel like this comes up a lot and lately, is writing social emotional outcomes and what that actually looks like.
Writing Social-Emotional Outcomes
00:28:00
Speaker
And so I think, you know, when we think about the pyramid model, it can help us, right, kind of think about that a little bit more. So Naomi, I'm just kind of curious if you could kind of explain, like, how does that pyramid model framework help practitioners to think about or maybe just observe some of those social emotional skills?
00:28:18
Speaker
Yeah. And, you know, Lisa, you were talking about the state systemic improvement plan earlier, right? And just kind of how we're shifting kind of across the state, right? And and what this is looking like in terms of how we're writing goals.
00:28:30
Speaker
And I think really, you know, when we look at, um and I'm a little bit biased, right? Because I think everything kind of, we can trace everything back to those social emotional skills. But when we even think about something like um you know, a kiddo that might, um their goal might be, um you know, taking steps independently, right? Like that's their goal.
00:28:53
Speaker
And so if we're thinking about, okay, well, yeah, you know, the goal is that they're going to stand up and they're going to, you know, move their body forward, right? And take those independent steps. um But then we also think about, you know,
00:29:06
Speaker
as they're walking toward their caregiver, right? What's the caregiver response? What's the way that the caregiver, right? Sometimes when our kids are learning to walk, we have this like, like and right?
00:29:18
Speaker
And I would imagine, I don't remember when I learned to walk, but I would imagine if I was walking towards someone whose face was like, I might not be real confident in doing that. Right. Because I'm like, oh, they, they're freaked out.
00:29:30
Speaker
I should freak out. We should all freak out together. Right. um So I think about, you know, even a um kind of a response to that behavior, right. You know, mom will X, y or Z, right? in In a response to that behavior. Or, you know, if we've got a kiddo who um gets ah dysregulated maybe more easily, right? They're they're ah a kiddo who, um you know, gets frustrated or maybe they they prefer things to be a particular way.
00:30:01
Speaker
um You know, how do we support that, right? Because sometimes when we're asking kids to do something that feels harder for them, if they're not regulated, it's going to be tough for them to do it, right?
00:30:12
Speaker
And so we think about, okay, as a practitioner, how could i look at, okay, what is this kiddo's regulation, right? Are they kind of calm right now when we're asking them to to do this thing that's that's more difficult? How are we setting up that environment for them, right? How are we giving them those skills to practice?
00:30:30
Speaker
um And so just even being able to kind of slow it down just a little bit to say, okay, I know our goal is for them to take 15 steps across the room, right? What's happening right before that happens? What's happening right after that happens?
00:30:45
Speaker
um Because I think sometimes, you know, in the busyness of parenting, right? And when you're really focused on wanting that goal to happen, sometimes even as a parent, right? I had, it my daughter was in early intervention um and you get so focused on the goal and you're like, yes, we're going to take the steps, right? You might not be thinking about your own emotional reaction in that moment.
00:31:06
Speaker
um or your own emotional response in that moment. And so I think even kind of breaking it down just a little bit and and talking through that with the parents and the caregivers um helps to kind of think about, you know, in addition to those kind of PT goals, what how are we infusing that social emotional skill development um alongside of of some of those other skills?
00:31:30
Speaker
Yeah. And I think you kind of broke that down nicely too, because when we're looking at it, we're thinking about those relationships, those parent-child interactions and what that looks like. We're thinking about that emotional regulation piece and just their interactions, right, that they're having with those around them.
00:31:45
Speaker
So before we even get into writing examples in Virginia, we do have certain criteria for writing outcomes. Corey, can you tell us a little bit more about that? Yeah. Sure.
00:31:56
Speaker
You know, I think one of the things before I go into those details, I think one of the things that you all have really highlighted is that idea that if you use a social emotional lens, when you're thinking about regardless of what the goal is, if you keep that, and that that does require that you have some knowledge, child development, knowledge about social emotional development. But again, it doesn't have to um It doesn't have to be a specific discipline. Everybody should understand social emotional development.
00:32:30
Speaker
So in Virginia, we have actually taken the work of Dr. Robin McWilliams. So I'll give a little shout shout to him. And we have a format that we use on our IFSP that we've done so much training on goal writing, and it's called the ACC.
00:32:49
Speaker
Acquisition. context and criteria. Acquisition means the skill. What is or the thing that we want to see?
00:33:00
Speaker
Johnny will do what? That's the acquisition. The first C is the context. That's what we were talking about when we first started, the everyday routines and and activities, um the natural learning environments that, you um you know, where that's going to be. Is it at childcare? Is it with grandma? Is um it using the toys that are the favorite thing for that child?
00:33:30
Speaker
And then the second C is the criteria. And the important thing to remember, if you're not in Virginia, but in Virginia, our IFSP is our payer document, which means that's what we submit for reimbursement, for for coverage, for services. And so what we always talk about the criteria is how will we know, how will the family know, how will the early interventionist, the childcare provider,
00:34:03
Speaker
the insurance company, how will they know when progress has has has been met? And so we try to do that in very natural ways. It's not about trials.
00:34:15
Speaker
It's not about the percentages of times because who lives their life in 75% of the time? we and Like, I don't know what I'm doing half the time. So it's not about those percentages, but it's about what would this look like for it to be successful?
00:34:32
Speaker
um You know, that Johnny will do something like be able to pick up small pieces of food. How many? um How often? At what meals? Those are things that families can really answer.
00:34:48
Speaker
But everybody can have a ah picture of how's that progress going? So again, the acquisition context and criteria or ACC is how we write our goals.
Virginia's Criteria for Writing Outcomes
00:35:02
Speaker
And social emotional goals are absolutely no different than a goal about a child walking like the example that Naomi gave, a child not tossing food every time at a mealtime.
00:35:19
Speaker
It's all the same. Nothing different than what we've trained you know we've trained and talked about with writing goals across Virginia. Yeah, and it's really important that it relates back to the family's priorities and concerns, right? So can you tell us a little bit more about the importance of that?
00:35:40
Speaker
Yeah, I think, you know, I think the important thing to remember is we know that pretty much all families have these these ideas and their goals. They want their child, excuse me, they want their child to walk. They want their child to talk.
00:35:54
Speaker
and They want their child to eventually have friends and have social relationships. Those are important things. But what is it that is causing some challenges in their daily routines?
00:36:09
Speaker
So, um you know, we use this one example in our service coordination training. where this mother has a toddler and a very small baby, and she wants to go to the mall. She wants to give her toddler opportunities to do some motor development.
00:36:29
Speaker
But getting from the car into the mall play area is challenging with two little ones and trying to figure that out. So we're really looking at her priority is for her child to walk, but how are we going to get there? And so we're really thinking about those kinds of um those things. Priorities, everybody has those sort of priorities, but what does it look like?
00:36:57
Speaker
for that family that can make it individualized. The very first word in our IFSP, what does it mean for that child and that family?
00:37:08
Speaker
Yeah. And sometimes we have to really kind of explain some of those foundational like level things for families too, especially when we're thinking about social. like For example, like you know I want my child to talk, but the child has no joint attention. The child avoids all of the interactions. And so sometimes it's just you know really having those hard conversations, those honest conversations with families about, okay, like this is what your child...
00:37:33
Speaker
has to build to get to this point um and and starting there. So Naomi, I wonder if you could kind of give us examples. I think people will be really excited to hear examples about well-written outcomes that are reflecting those social emotional goals. Like what is that look like? like Absolutely. And, you know, I think,
00:37:52
Speaker
if If anything that, you know, you walk away from this podcast, if it can feel a little bit less overwhelming to write a goal, this podcast is going to be time well spent, right? Not only because I got time with the two of you.
00:38:05
Speaker
um But I, you know, when we think about, I'll use a really common example. So oftentimes we get kiddos that are coming in um and I won't, I won't kind of use babies in this example because we all know that like infant and like new baby sleep is kind of all over the place, right? But when we think about a little kids that are a little bit older,
00:38:23
Speaker
So those 18-month, 24-month kiddos, right? Sometimes what we're hearing from families is, you know, in addition to some of the things they're working on, you know, language development, maybe some self-regulation pieces, sleep is a big one, right? And sleep for all of us, right? It's how we rest our bodies.
00:38:41
Speaker
It's how we get our energy for the next day, right? And so we hear that pretty often that kiddos are um maybe not sleeping or when they wake up from sleep, they're having a harder time kind of getting back to sleep, right?
00:38:53
Speaker
And so we have a kiddo um where sleep is the biggest challenge, right? That the parents have reported, we're really having a hard time with sleep in addition to working on language, right?
00:39:05
Speaker
And even just knowing kind of those two things, if that's all you know about a kiddo coming in, right? And the parents have just said like, if we could just sleep, please. our lives would be would be very different, right?
00:39:17
Speaker
um So and an outcome would um kind of target a couple of different areas. So one, you know, when um anyone's not sleeping, first of all, no one goes to sleep because someone else told them to in the history of people on the planet.
00:39:33
Speaker
um And when you're not getting that sleep, sometimes the way you feel about another person, right? Think about you know if if any of you have experienced a partner who snores, right?
00:39:44
Speaker
The way that you feel about that individual um when you have been in the room with them, when they're snoring and you are trying to sleep, might change, right? You might really love them before bedtime and then you wake up in the morning and you feel a little bit differently, right?
00:39:59
Speaker
I just met my partner. Yeah, yeah. know So that can also impact the way we feel about our kids, right? Because if we're trying to sleep and we kind of need to sleep to be able to care for them the next day, that relationship piece is being impacted, right?
00:40:14
Speaker
So a way we might write an outcome would be that A child, if they woke up, right? um So our little friend in this case, his name was Jen. So when Jen wakes up, he'll be able to call for his mom using her name every single time he wakes up, right? And so that's addressing a couple of different areas. One, when he wakes up, he's able to use that word that he has for mom to call her that he knows, right? He's secure in mom is going to respond when I call her.
00:40:47
Speaker
And then he's going to be able to to build that consistency, right, Corey, like you were talking about. So when he wakes up, he knows he can be secure in when I wake up, I call for my mom and mom is able to respond, right?
00:41:01
Speaker
And so over time, what that looks like is maybe he doesn't have to call for her, right? Maybe he wakes up and he knows, My mom is going to be here. If I need her, I can lay back down and go to sleep.
00:41:12
Speaker
Right. Or mom comes in and maybe I don't need to be picked up. Maybe just mom coming in the room and and me seeing her, I can settle back down. Right. And so we're building that skill over time.
00:41:25
Speaker
um So then for like the, Naomi, if I could just jump in. So then for thinking about what Corey said with like the ACC, so like the actual goal might be then that Jen will call for his mom when he wakes up at night using her name consistently, right? Each time every night for one week. So we have that criterion then. Hey, you're pretty good at this, Lisa. That was pretty good off the couch.
00:41:48
Speaker
Yeah. i do think yeah I think what you just said, you hit the acquisition, call for his mom, what he's doing, the context, his mom um at bedtime yeah ah or whenever, nap time. Yeah, when he wakes up.
00:42:08
Speaker
And then the the criteria, what would you say? Every every night for one week. Every night for one week. You got it. Yeah. Yeah. Yeah. and And the part of that too, that I really like is it's building that relationship, right? So that's kind of our focus is yes, the sleep piece and the language piece.
00:42:27
Speaker
But if we think about it from that social emotional lens, it's also the relationship, right? It's the consistency, it's the responsivity, it's the security of knowing my mom is here, right?
00:42:39
Speaker
Um, And so, you know, I think for kids especially, you know, that's so important um because those are those foundational skills that we're talking about, right?
00:42:50
Speaker
um You know, another example might be when we think about some of that emotional regulation, um We have a kiddo that, um you know, we'll use our our food throwing, right? So that's pretty common when kids maybe don't have the language right yet to be able to um throw their food, right? Or to be able to use their words to talk about um how they might be done with a meal or they just don't want to eat this particular food or they're just not ready, their bodies aren't ready to sit down, right?
00:43:21
Speaker
Right. That they could, so an example might be, you know, Lisa will use some calming strategies that are modeled by mom or by dad when she's waiting for food or when she's done eating food twice a day for a week, right? And so again, we're thinking about we're calm enough to be able to communicate, right? Maybe we're using a sign like all done. Maybe we're pushing away. We're thinking about the way that that parent and that caregiver is responding.
00:43:53
Speaker
And that knowledge of, hey, if I communicate, right, what I what i might need, someone is going to see that and respond to that communication. And so there's lots of ways that, yes, the goal is, right, food is not being thrown off the tray.
00:44:08
Speaker
um But there's a way that we can focus on that emotional regulation.
00:44:16
Speaker
Thanks, Naomi. And I love um those examples too, because I do feel like, especially in the first one, we always get the ones where parents want to, we just want them to say mama or dada, right? And so it's giving a little bit more context to that. It's making it meaningful. Like it's a meaningful outcome, something that would matter versus just saying,
00:44:33
Speaker
I want them to say mama, dada, to get their needs met. right yeah It's a lot more individualized in those ways.
Advice on Family-Centered Outcomes
00:44:41
Speaker
So I love that. And even the last outcome that you said, you can flip it right to make it like a family outcome where it's maybe like the parent is going to identify those strategies right in order to um support the child.
00:44:53
Speaker
So I think a lot of people are going to be appreciative of hearing some examples of outcomes. We do have a lot of work and I'll add some resources and of other resources that we've had that have gone out, like the workshop you did, the DEC infant mental health community practice webinar you did, Naomi, like that was really great.
00:45:11
Speaker
So I'll add all of those resources and our links too. But if we are thinking about like any kind of advice that you all would give and practitioners that want to write outcomes that kind of capture functional family-centered social emotional goals, like what advice would you give them? Like, how do they get to that point of writing a good social emotional outcome that's still functional and family-centered?
00:45:37
Speaker
I can take a start with that. i You know, I think... um The key takeaway for me would be this is no different than writing any other kind of outcome that you are doing every time you are writing an IFSP with families.
00:45:55
Speaker
What you are bringing is your knowledge about social, emotional development, your good evidence based practices with learning natural learning opportunities.
00:46:08
Speaker
family-centered practices, coaching, you're bringing all of those things and you are putting it in what we have adopted in Virginia in a format to help with the payor document. I think, again, we started this with kind of take a breath. This really isn't that different with writing outcomes. that's That's kind of my takeaway, I think.
00:46:35
Speaker
Yeah. And I think I love that, you know, take the pressure off. Right. But I think also it's a little bit of practice. um So if it's something that you're, you know, if, um if you're thinking about, okay, you know, mom's goal is, you know, that Corey's going to say mama.
00:46:52
Speaker
Right. and And that's so important. OK, well, what's a way that I write that kind of from a language perspective? What's a way I might write that, you know, when I think about that relationship? Right. So mom's going to model it.
00:47:04
Speaker
Right. um And so I think it's really. Important to um always kind of keep that social emotional lens. Right. What's going to help build that attachment? What's going to help build the interaction? And also to think about, you know, we can.
00:47:21
Speaker
um We can all kind of be a part of writing those goals. I think also use the support of your team, right? If you're thinking like, oh, I really want to be able to write this, right? I really want to be able to think about, you know, the strategies that we're working to help mom learn as well.
00:47:39
Speaker
Let's think about how we can incorporate that, right? And and talk to the parents. What are some things that you do now when they're communicating with you, right? So I think being really collaborative is another way that we can help kind of break down the stigma a little bit, um but just have that opportunity to practice writing those goals and kind of thinking them through together.
00:48:00
Speaker
Yeah, I think practicing is probably like one of the biggest ways to get there, right? Because you just have to do it. Like even if you are seeing a family now, like I have one um child and sometimes like when I get those outcomes, I'm like, oof, those are like really high, right? Like outcomes, goals, and but they're not things that were as meaningful to the family. Like I had one where the family, like the dad was like, I just want him to give me a like a high five.
00:48:25
Speaker
So maybe it's, you're gonna give... or he's going to give his dad a high five, right? um When he comes home from work and he'll do that five times um a day or five times a week over two weeks, right? So just thinking about what is it that's meaningful for that family, but practicing as you're working with the families, even if it's not something that you're changing right away, but just think, okay, if if we could write some goals based off of their concerns and priorities, like what are, let me just write some down and jot and just practice because I think that it's it's intentional practice and that you're doing.
00:48:58
Speaker
You know, and I think, Lisa, as again, kind of a follow up to that is sometimes when we write those goals, as you said, that are so high, then it's very easy to say the family is not following through.
00:49:12
Speaker
But maybe maybe we've written a goal that's really not their their it it's not what they're interested in or it it doesn't fit into what they automatically do.
00:49:25
Speaker
So we had this service coordinator one time um who said, i always ask a family if this was going well, what what would it look like? What would it look like if it was lovely? i loved that she used lovely.
00:49:40
Speaker
And it's so powerful because ah family A family, dad who says, I just want him to give me a high five, he's written his goal.
00:49:52
Speaker
He's written what he wants. And we have to learn how to take that information from our discussions, from as we're gathering information, and then make it into an outcome.
00:50:07
Speaker
I think that's important. we have to be good detectives and ask really good questions, right? Good open-ended questions, good reflective questions with families. Yes. Well, I just wanted to thank both of you for being here. and Before we wrap up, is there any other like last piece of advice or takeaway that you would like any early interventionists like to remember about supporting social emotional development and thinking about that pyramid model framework?
Final Advice and Resources
00:50:35
Speaker
I think for me, It might be, Lisa, I love that you're gonna include resources, is there are so many resources. Pyramid Model Innovation Work, their stuff is fabulous. Use some of those.
00:50:50
Speaker
um The Virginia Early Interprofessional Development Center has lots of tools and resources. um The Infant Toddler Connection of Virginia has dedicated a whole page to resources to support what um early interventionists can use. So there's good stuff out there. And I encourage you to take a few minutes to check things out that might be helpful to either you yourself as a provider or as um somebody who supervises or trains people.
00:51:23
Speaker
Yeah. And I love that, Corey, just knowing that there are so many resources that are out there to support because I think, you know, it's where do I go to learn more um is always an important question to be able to answer. And I think that, you know, I always go back to you know, when, when all of us kind of came into this field, right. One of the things that kind of brought us here was our desire to kind of help and support, right. Our desire to kind of build those relationships.
00:51:51
Speaker
And so I think really being able sometimes to take a step back because, you know, when we're face to face with families, and that's like, we want to help support all of these things, right. We want to do it all. We want to get you family to where you want to be. Right. And sometimes that feels, it can feel like pressure,
00:52:07
Speaker
It can be like there's a lot to get done, you know, in our hour long session. um But really just thinking about kind of the skills and talents and abilities that you have, right? Because all of us do kind of come to this field and we've got this ability to work with people. We've got this ability to you know, see things in kind of unique ways. And so really using those skills and thinking about, right. And in a lot of ways, developing relationships with families is no different than, you know, when you meet a friend for the first time, right. You're curious, you're interested, you're invested in that friendship. And so um I think rather than, you know, I think sometimes we can get stuck on like, this feels like it's too much or I get overwhelmed.
00:52:52
Speaker
Right. sometimes taking a step back and saying, okay, what can I do in this moment, right? I can't build all of these skills in this one hour, but I can be a responsive listener, right? I can't help to completely take away the frustration that a caregiver is feeling, but I can empathize with it, right? i can I can be responsive to that. And I think those are skills that as we continue to use them in the field,
00:53:19
Speaker
that you know we will continue to kind of with that practice of building those really strong relationships. um And I always go back to this quote, um you know that people will kind of forget what you said, but they'll never forget how you make them feel.
00:53:36
Speaker
And so I think walking away from those interactions and you know how did I make someone feel today? How did I impact the way that maybe they went through the rest of their day? um It's a really powerful tool that we have as interventionists.
00:53:50
Speaker
Thanks, Naomi. That's beautifully sad Well, that is it for today's episode of Meaningful Moments. Thank you for listening. And thank you, Naomi and Corey, for just kind of sharing your expertise with us today.
00:54:05
Speaker
um Make sure that you all subscribe to the podcast on iTunes or Spotify. For more information, you can visit the EIPD's website for resources, tools, archived webinars. I will also drop a whole bunch of additional resource links for you. So feel free to grab those.
00:54:22
Speaker
And thank you all. Have a great day. Thanks for having us, Lisa. Thank you, Lisa.