TSBVI Coffee Hour: Distance Considerations for Birth to Three 10/05/2020 Transcript start >> i do want to say, just in case you do want to engage in chat, if you open up your chat and look at the bottom, there's the little dropdown menu. make sure that it says all panelists and attendees. otherwise only the 12 of us will be able to see what you type, so just make sure it says all panelists and attendees if you're trying to answer someone in the chat, they'll be able to see it. >> you'll hear me say that about a thousand times today. >> all right. i'm going to open it up. >> hello, everyone. welcome, welcome. we'll wait just a couple of minutes as everybody comes in. as always, we love to see where everybody's from in chat. make sure your drop down says all panelists and attendees so everyone can see what you're writing. make sure it says all panelists and attendees. tracie from victoria, welcome. omaha, nebraska, denver, colorado. michigan, maryland, delaware, chattanooga, new mexico, tennessee, massachusetts. tucson, arizona, oregon, alabama, victoria, texas, houston, texas. canada, virginia, el paso -- that's where karen's from. welcome, welcome. nebraska. make sure when you're typing in the chat that the -- where it says to and has a colon, click on the drop down and pick all panelists and attendees. if it just says "all panelists" only the people presenting can see what you're saying. texas, virginia, more canada. nebraska. awesome. so glad all of you are here. we'll go ahead and get started. if you have a question or a comment during the time the presenters are talking, please post that in the chat box. again, make sure it says "all panelists and attendees." your microphones and cameras are automatically muted so you don't need to worry about that. the handout for today's session will be shared in the chat for immediate viewing and will also be available for later viewing along with the recording of this and past coffee hour sessions shared through a link at tsbvi.edu/coffeehour. once you're on the coffee hour page, scroll down to under the list of sessions where it says visit the new tsbvi outreach coffee hour archives. that is a link and it will take you to recordings, handouts, transcripts, and chat information. to obtain your ceuS today, you will respond to the evaluation that will be e-mailed to you this evening from our registration website, esc works. you will entered the code given at the end of today's session and the ceu certificate will automatically generate upon colleagues of that evaluation. there is no opening code, only a closing code and it will be given at the end of today's presentation. we'll stop the presentation at 3:55 to give your code and announcements. i'm happy to introduce today's presenter, karen borg. >> oh, hey, everybody. i am excited to be -- that's kind of a lie. i'm nervous to be with you today but i have a great team with me so we're going to be great. today we're just going to do a scratch the surface look at early intervention. our purpose today is that if you got a referral today for part c and you normally do part b, that tomorrow you'll have actual information, skills, strategies that you could attack tomorrow and that it would be useful. so that's what we're going for today. oh, nathan, my powerpoint would advance. what now? >> i see that you might just like alt tab or whatever. it looks like your desktop might be highlighted or just minimize yours. so just stop sharing and start resharing and see what happens. i can see your menu bar at the bottom. >> karen: i just thought it got tired of being up there. all right. >> yeah, that looks better on my end. i don't see your menu anymore. >> but it's still not advancing. >> try clicking with your mouse on the slide. there you go. >> thank you. we are from the utah school for the deaf and blind where the parent infant program for the blind and visually impaired. we just lovingly call our team pip. i'm going to talk about the legal stuff, just, again, the survival skills you need to know if you got a referral today. nana is the one and only o&m in this group today and she has been doing birth to three o&m for quite a bit so she's got some interesting stories and experiences, but nana also recently finished her doctorate, so technically she's dr. nana, i guess. but dr. nana is going to talk about a little bit about her research which was virtual services for eivi kids. margaret is going to visit about how to build a rapport virtually. if you can't be there, you can't reach over and touch a hand, how are we going to do that? how are we going to connect with those parents? and pam christianson will talk about virtual assessment and instructional planning. we're going to wrap up today with jamie brown talking about how to conduct a virtual home visit. so first of all, if you have never had a part c referral and all of a sudden you find yourself with a referral for a 9-month-old, the first thought that might come to your mind is why would you give vision services to a baby anyway? we wanted to take a minute to talk about that. attachment is profoundly affected by vision. if a baby's not making good eye contact with mom and mom is unsure of how to read other cues, you can bet there's going to be a problem with bonding. and so if there were no other reason that would be a profound reason for working with very small children in building that attachment and teaching mom how to reach cues. vision affects every single developmental domain, every one. language, gross motor, fine motor. you all know that. vision is the primary motivation sense until about 18 months old. and it's the doorway to naturalistic learning, incidental learning. it's how we learn about our environment and how to use appropriate behavior and see what everyone else is doing. so we want to get started early and teaching those compensatory skills and those strategies for getting along in the world. so let's get our ducks in a row and talk about some legal stuff. part c is just as mandatory as part b. it's my experience that when we are -- when we do both part b and part c there can be a tendency to back off a little bit on the part c, to put it on the back burner to somehow think it's maybe not quite as mandatory as part b, but it is every bit a legal requirement. so if you had any confusion about that, i wanted to remind you. in part c you have 45 days, 45 calendar days from the time you get your referral to determine eligibles. and there are procedural safeguards just like there are in part b. in part c the parents drive the bus. really. they can combine services. they can decline services. they'll have a lot to say about the whens, the whys, and the what times. each of the ladies that you're going to hear from today has had the experience of serving families in the evening, in the very early morning, even on saturdays because that mutually-agreed upon time isn't tied to school hours, as you might feel that they are in part b. best practice in part c is parent coaching. from whatever time we are in the home -- and for us that's two or three times a month, generally -- or whatever that time is, our whole purpose is making sure that those strategies are being implemented in our absence. and so very best practice is going to be parent coaching and empowering that family to enhance their child's learning experiences. ifsp instead of iep, and it stands for individual family service plan. so family training, family goals, that can all be part of the ifsp document. current levels of function instead of plaafp, outcomes instead of goals and natural environment. according to idea part c, a natural environment is an environment where you will find other children of the same age who are not disabled. so if you intend to do group services in your center, for example, instead of going into the home as a child care center, which would more typically be a natural environment, as defined by law, you must make part of the ifsp a justification or a rationale for why you're taking the child out of the natural environment. that rationale has to be because you're working on a goal or an outcome that you cannot be successful at in the home. some of those might be peer interactions, for example or navigating an unfamiliar environment. some of those things could be the basis for taking a child out of their natural environment, but you need to give some thought to that. when you write a placement for outside of the natural environment, you also have to write the date you're going to be back in the natural environment. you don't plan for that to go until the child exits part c. you need a beginning and an end in the ifsp. in part b you almost always know exactly what to do, right? you have a state educational agency that is taking care of things, and you have an lea in your school district that takes care of things. and there's a system there. in part c across the country there's a gazillion different formats. you have providers who are grantees, you have private corporations, you have private providers. you might have an slp who contracts directly with the state to provide part c services. sometimes part c is done by school districts. sometimes by universities, sometimes by health departments, sometimes by a hospital. so you need to figure out part c in your own state and the line of communication. there is no fape in part c. states are allowed to charge parents for part c services, and they do sometimes -- like in utah, some services are free. sensory services in utah, vision and hearing are free to parents in part c, but other services may be charged for. and so it is important for you to understand how that's going to work in your own state. okay. before i turn it over to nana, were there any questions, kaycee, i should be aware of? >> there are no questions so far. >> take it away, nana. >> hi, everyone. i am going to cover a little bit about research in the field. thanks, karen, for that brief introduction on how services in part c works. so now that we're a month deep into trying to provide services to families during this time of covid-19, many of us have been trying -- excuse me, have been exploring or using virtual visits. so before we go into that, let's briefly talk about this type of service delivery model. so the virtual visit service delivery model involves using technology to deliver services from a distance. in early intervention we have been using a variety of videoconferencing tools, as you all probably have been using, such as zoom, google meet, facetime, and whatsapp. but we have also been using phone calls, text messages, and e-mails with our families. next slide, karen, please. so virtual home visiting is not a new thing in the field of early intervention. a lot of research has actually been conducted in other disciplines such as the field of deaf or hard of hearing and speech language pathology, but there has been scant amount of research done in the field of vision impairment. as karen said before, i just finished my dissertation a little while ago and the research item was actually one of the first research studies in our field using virtual visits. so the result of the research that be done has shown that virtual visits do promote best practices and early intervention, particularly the coaching piece of service and they do empower parents to work with their children and support their development. and so through the research, here are some of the highlights of the benefits and cautions. looking at some of the benefits, it does provide quality family-centered practices and early intervention services. it allows a continuation of services, if there's a break somehow. you know, when the pandemic started here, virtual visits helped us kind of move through that spot to continue seeing our families. even though we couldn't go in the homes. it has be shown to increase the frequency and service of freaks from providers to families, and it reduces travel times. some of the cautions we want to consider is that virtual visits are not to replace in-person home visits but it's a great complement. consider using a hybrid approach of in-person visits and virtual visits. there's a need for more research in the field of blindness and vision impairment. there's not a lot of research in our field when it comes to virtual visits. it could cause equity issues. so not all families may be able to access services through the service delivery model. and we also have to consider hipaa and ferpa compliance issues and to make sure that we are doing a safe home visit with our families, if we're doing them virtually. so it's important for us to be aware of the requirements and guidance locally and nationally. next slide, karen. sorry. so that's all i have for research. i just wanted to give you a little bit of info. does anybody have any questions? >> no questions regarding that. >> okay. thank you, kaycee. >> we're stuck again. >> karen, if you go to the bottom left hand corner of your slide, does it help? >> whoops. come back. so margaret, it's your turn. >> great. i'm margaret from utah. been working in parent infant program for almost 20 years. i'm excited to talk to you about building a rapport with families. definitely love working with the family as a whole unit. not just with the mom and the baby. so i do want to bring your attention to this cute picture of this mom and her baby. and i work with this family right now and i just love how in love this mom is with her baby. she's just absolutely in love with her. she adores her and i really know that that's a key to building a rapport with the family because they know that you're in love with their baby as much as they are, then they will definitely let you in the door. and they will trust you and they will be ready to hear what you have to say because they know that you care. and i just put this quote on here from teddy roosevelt that he just hit the nail on the head when he said people don't care how much you know, until they know how much you care. and that really is the key. that you absolutely care about their family, you care about the well-being of their child and you're ready to deliver your services in their -- well, now we're doing it virtually, but you're still in their home through the computer. so they're welcoming you into their space. and the first thing that we want to look at for building that rapport is gathering information ahead of time. the most important key is just knowing about the family beforehand. before you contact them. glean as much information as you can from the referral source, from the chart, anything that you can get from them. the medical background, how long the child was maybe in the hospital after they were born, were they preemie, if there is a visual diagnosis. maybe there's not yet, and that's okay too because if you're getting in the door early on sometimes the things are still in question. and so even with some kids that have different medical conditions they may not have had a diagnosis yet, but it's good to just gather all that information as much as you can and any information about the family is very helpful. next slide. so before you call them, it's good to maybe send a text to introduce yourself before and then just find a time to call the mom and the dad. they often are at medical appointments sometimes when we're calling or they're sleeping. so it's always good to just send a text or two letting them know you got the referral, letting them know you're excited to meet them or to call them to set up some services. and even just that initial visit and just see if they qualify. getting on the phone and talking with them casually is great to let them hear your voice and get to know them and talk with them about setting up an appointment. so when you can meet with both parents, that is ideal, if there is any extended family that lives close by, it's always helpful to have grandparents there just so they can find out who we are as service providers. we are often the first teachers in the special ed world that they get to know and they're entering into a whole new world, so it's brand new for them. so also to meet with both parents, that's so great. remind them where you got the referral from and what their concerns were and why you're there. and just discover their concerns about their child's vision and also their overall development. and just take that time during that initial visit to really get to know the family. see if there's any siblings in the home. see if they have a good support network. just ask simple direct questions so you can get to know them and maybe take some notes down so you remember the sibling's names or grandma and grandpa's names. anybody that's involved in that child's world. continue to ask the parents about their concerns about their child's medical issues. as you can, do a little bit of an assessment through the computer and ask and share your concerns explaining about services that can help. just being really clear on any terminology that we use, because we don't want to use a lot of special ed jargon acronyms that may confuse parents, so just using very simple language is very helpful, especially early on. talk about what you see, talk about what you observe with their child, their strengths or how cute they are. it's just fun to really fall in love with that baby as you would just -- a neighbor or friend would. and include the siblings. i cannot stress that enough that it's so important to ask the siblings, how do you like your brother or sister? are you taking good care of them? and include them in the visit. and just express your enthusiasm. get excited about working with a family and, you know, get the child qualified, obviously, and then just setting up another time to come again just to be really clear with them that you'll be in their lives and you'll be able to support them. so just keep in mind that it does take time with some families. you know, some families will just be ready for services. some it may take a little bit of time to get in the door, you know, on the computer, get them to keep appointments with you. just listen to them with empathy and really find out about those medical issues, because those are top priority. you know, if that child isn't sleeping well, eating well, functioning well, if those are the top priority before we are actually able to deliver services. so if any appointments conflict, just know that rescheduling is great. the parents appreciate that. and just know sometimes they are overwhelmed, if they have a very fragile baby then it may take even longer to be able to deliver services. just really support them as much as you can with that fragile baby. to be sensitive to their needs with these parents that might feel overwhelmed or sleep deprived or have other stressors like financial needs. remember to just validate their experience. with having a child with special needs it's a fun new journey and we're here to walk beside them and to really praise them for the good work that they're doing. even just caring for them. oh, you read your child a book, and that's so great. that's so wonderful for their development for them to get those early, early experiences with literacy and to have them explore and to have fun playing and learning. and so just point out how these parents, especially the young parents, you know, caring for their baby and those compliments will go a long way with building the rapport and building that relationship of trust. any questions for me? >> first of all, the baby is so adorable. then we have one question from sally. she asks if you have any tips about meeting with the family when the child does not qualify for services. >> that's a good question. if they still have concerns, if the child doesn't qualify but they still have concerns about their vision, then i always keep the door open. i say i'm happy to consult with you. if you have any questions, feel free to text me, call me. i'm happy to go over any eye reports from the eye doctor, if you do go to the eye doctor down the road. you know, if they don't qualify then i direct them to other service providers in early intervention. if they have other concerns that are more for their overall development. any others? >> not at this time. thanks. >> thanks, margaret. okay, pam. you're up. >> okay. so i'm pam christianson and i've been in early intervention in the vision program for 14 years, i'm thinking. and i just did preschool prior to that. i'm in the salt lake utah area and out west. my part is talking about the virtual assessment and screening planning. we're going to go through that just briefly. so there are three ways that we in utah can qualify a child for vision services. and that is through assessments and an assessment tool, that's through a medical diagnosis for vision, and that's through an informed clinical opinion. so we'll talk a little bit about those. we want to definitely get consent from the parent to have a virtual visit and to complete assessments online, because it is different than being there personally, and we can do that through a phone call or a text and we would want to follow that up with getting a paper form signed by a parent, whether that's digital, and they can do it online through their phone and send it back, that's great. okay. again, like margaret was talking about, when you're prepping for the visit, and that's to gather the information about the child and the initial contact with the parent is also going to give you some information about that child. and it's usually at that time that you're going to decide where you're going to meet and if you can meet in person. obviously not at home, but perhaps you can meet at a park or in the front yard or backyard and be outdoors so that you can maintain social distancing and being -- taking all the precautions necessary during this time. if those are not options or possibilities then of course we do our best online. some parents like to have a copy of the assessment or the checklist for an idea of what the visual behaviors are that you're looking for or i'm looking for. and sometimes i will send that out by e-mail or take a photo as a text with my phone and text it to them of the assessment tool -- or parts of the assessment tool, depending on whether or not those assessment tools are copyrighted. so with our online visit, generally i like to start by just asking questions. as margaret so eloquently described and talked about, and that is to get information on the parent concerns and how is their child using or not using their vision. are there any unusual vision behaviors or a head tilt. did their child meet any early visual milestones. and this is especially the case if some of the referrals are for older children. have they seen an eye doctor? and, if they have, does the parent have an eye report or can the parent sign consent forms so you can get a copy of the eye report and look at that as well. and, again, how was the pregnancy and the birth? and this ties back to the medical records. you're looking for any medical events that perhaps might tend to give you information with regards to the vision development. then i'll use an assessment tool, and that could be a vision checklist, vision development sequence, some sort of checklist to go through and look at what the visual development process is and you can go through those and hopefully you're observing some of these things with the child. a lot of times it might be questions just for the parent and their response is back. if they're not sure you can say can we try this and see what the child's responses are. i also like to try and do the grading acuity test, and that's using the lea panels and that's more successful if i'm able to meet them in the park or in the yard than it is if i'm trying to do that online. and then of course we're observing the child's behaviors on screen during play. and it's always nice to comment what you're observing or what you're looking for and when you do see it, you can share that with the parent. i just saw them do this, are you seeing this? that sort of thing, so you guys are sharing that information back and forth. so the testing materials that i might use for testing would be general the toys that the family has around the house. obviously the parents are usually more than willing to help. if there's a particular part of the test that they weren't able to answer and maybe they don't have the assessment materials for. like, for example, those lea paddles, if the parents are in a location where i can drop those off and then next week or whenever you schedule the second eval. and just remember we've got 45 days that we can evaluate this child, so we can go early and then you might need some additional materials. i can drop those off and have another assessment meeting as well online. so dropping off those materials for the parents to use and for that next visit is also a good idea. sometimes too if the parents can take a video or two and share those with you to review, that's another good way to get information on how the child is using their vision. and then it's just good to remember that you may not have a medical diagnosis, a visual diagnosis for them, for them to qualify automatically for services. your assessments may be on range on age level but you know that there's something going on. there's something different about how they're using their vision. again, you have 45 days so you can come again or you can come two or three more times to kind of assess that over time. but also remember, too, that you have the icu, which is the informed clinical opinion. and sometimes it doesn't hurt to err on the side of caution and possibly pick up that child, even for a short term, like six months or so, with vision services. and then, you know, fade out once you can determine whether they don't need services anymore. okay. so with instructional planning, just as part of adding services to the ifsp. so, again, we do have procedural safeguards in the early intervention. the goals are based on the family concerns for their vision or how they're using their vision to functionally play in their environment. also, the goals that we write are routines based and so we want to look at different routines throughout the days that the family has and how is that child using their vision -- or not using their vision currently and how can we help coach the families to encourage the child to use their vision more during those routines. and at this point we're determining the intensity of services, so perhaps there's a guideline where you can review and determine the intensity of services that you might need or want to provide to that family. okay. some of the resources that you might want to think about for instructional materials. again, is using the family toys. modify them, if necessary. and that could include dropping off or mailing some materials, mylar and things you could tie to their family's choice to increase visual attention and awareness to a toy. you could deliver materials in person. you could send them by e-mail or regular slow mail to the family, if they're needing things, especially things that might need to be printed. you might want to find out if the family can print a particular item you're sending, or if they don't have access to a printer or they're out of ink or out of paper, perhaps you can print them and send them the whole document. another thing is we might want to bring in special materials that might include a brailler, braille books, things to give opportunities and experiences for the child to start exploring braille. things like switches, tactile books, things that the parents may not necessarily have there at home. and of course your dollar store has lots of things that are available and work really well. another resource would be collaborating with your ifsp team members. i like to team with a pt and an ot, sometimes speech as well for communication, and we do some of our visits together online. and then also i have invited colleagues to come to an online visit, again to just brainstorm and to come up with different strategies. any questions? >> we had lots of great questions this time. alley asked how do you determine the frequency and amount of virtual service time versus in-person service time for babies? >> that's a good question. and that i have seen change with us. some of us, because it's hard to keep a child's interest for any long period of time online, sometimes they're super bored. again, we're coaching the families and so sometimes that might look differently where we're meeting every week for shorter amounts of periods and have it consistently over time. or the one, two, or three times a month. it really does depend on what the family needs are and what they would like, as far as bringing us into their home. >> perfect. the next question is if a child is already on an active ifsp for another reason, not as an automatic qualifier for vision, can't you address visual concerns/add vision services to ifspS as a family outcome? >> the question is can we add vision services as a family outcome? >> yes, i believe so. if there's vision concerns for a kiddo that is qualified for an ifsp for a different reason. >> i think we would want to still have that referral for vision and do an assessment so we can determine what the needs are and what the parent concerns are. the goals, as far as the goal of adding vision services -- i mean, that could be a goal. i imagine that that would be a goal that would be met fairly quickly once you signed on, and we would want to continue. karen, do you have any comments? >> yeah. oops, sorry. yeah, i do. so we have found here in utah, there was a time when our early intervention colleagues did their ifsps and vision did their own and we operated pretty separately and we found that to be not very family friendly. and so what happens here in utah and in some other states i'm familiar with is vision becomes almost like a related service. so the ei may be the case holder but they send the referral to us. we qualify them for services and we just add our outcomes on to our ifsps and most of time those are child outcomes, not family outcomes. occasionally they might be family outcomes like getting the family in a situation where they can take the child to an eye doctor, for example. but generally when we're writing vision outcomes, it's outcomes from the children. >> perfect. have any of you on this panel been doing in-person coaching/visits with families? >> yes. everyone. everyone on the panel has done both. >> you mean during this time of covid? >> i think that's what they mean. >> the same. everyone. >> it started out that for a couple of months we did not, and everything was virtual. we did assessments online with virtual and then we moved back into face-to-face. so now we do a combination of face-to-face or virtual or a hybrid of both. >> do you guys have suggestions for resources for the coaching model to use with families? >> yes. yes. and we could send some along. >> okay. would the michigan scales work to determine frequency/intensity of services? >> i am so glad you asked that question, and i'm going to tell you why and we probably need to move on to jamie. we took the michigan scales as well as the early intervention intensity instrument, and we've actually built an intervention intensity instrument to use because it doesn't dip down that young. and so we are in the process of having that validated now and we should have, i hope, have it out a year from now and it will be just open domain. it will be free online to use, but we're very excited about it. we've been using it kind of piloting it in-house for about a year, year and a half and now we're in the process of getting it officially validated and it will be out to you soon. okay. jamie, are you ready? >> i'm ready. okay. i'm going to talk to you a little bit about conducting a virtual home visit. these are new to us. we started doing them in march, obviously, when we weren't allowed to go back into homes. and like was talked about a little bit, we're kind of doing a combination right now. we were strictly virtual, then we went to some outdoor visits, some in-home visits. in a county i work in the numbers spiked and so we're back to virtual. so we're still doing a lot of virtual visits. and so i just wanted to kind of talk to you about some things that have been working. obviously, every visit's different. every family's different, but hopefully we can kind of talk about some things that have ended up being helpful as we've been learning how to do these visits. and so i'm going to talk just briefly about kind of before the visit. just some things that have worked. i'm saying zoom invite because the majority of my visits are on zoom. it might be a different platform for you. when i first started visits in march, the easiest thing for me was just to look at all my visits for the next few weeks and just send out all of the zoom invites. and i quickly figured out that they were getting buried in families' e-mails and so now i'm sending them out either the day of or the day before and that seems to be working really well. and sometimes you find yourself on the virtual visit all by yourself. and recognizing that families have a lot going on right now. so much going on right now. i try to just, rather than being like they didn't show up, just send them a text, hey, did you get that link? and more often than not they are like, oh, shoot. i forgot. and they hop on. but just try to keep it reminders, because this is different for them as well. and then i was just going to touch briefly on co-visits. i am having a lot of opportunities, actually, to do co-visits with occupational therapists, physical therapists at the early intervention programs and they have been going really well. the one thing that has been difficult is when it ends up being several providers. we have found that it can be overwhelming. we're not sure when to talk. it's kind of a lot of information for the family. and so what i've kind of gone to is just one other person, like me and the ot, for instance, and that's been working pretty well. okay. and i've divided the visit into -- we're going to talk about the opening, the middle that i call the goals, and then the ending. and so the opening of the visit, we'll screenshot of when we first got on. this is an occupational therapist, me, and a family. when we first start out we have the family facing towards the camera and we just ask them how are things going. like i said, families have a lot going on so we're checking with them on is everybody staying healthy? how are your jobs going? just life in general, how's schooling going with the other children? and we kind of transition that into just a little follow-up from the first visit. so for this little guy, we the week before had worked on the shape sorter. i was able to say, hey, we worked on the shape sorter last week, were you able to do that this week? and give mom an opportunity to tell us how the week had gone. then i like to ask the family about their priorities for that day. so what would you like to work on today? or i might ask them, because we do routine based intervention, are there any routines that had been going well that aren't going well now? and sometimes, usually always family have really good input. sometimes they will say something like, whatever. and then we can lead that conversation by reminding them of some of the outcomes and maybe giving them choices. would you like to work on the shape sorter or crawling today? so that's what we do for the opening. okay. and so now we know that we call goals outcomes in early intervention. but just to be clear, i've called the middle part of the visit the goals, just because it's when we're working on what the family has identified as their priorities for their routines. and so i like to ask the family, some families come to the visit, they show up in front of their computer with lots of supplies and stuff, but not all families do. and so i try to keep it really low pressure. i don't want them to feel like they have to spend an hour before the visit prepping for the visit. and so i might say something like, do you have the shape sorter we used last week? and i can wait while you get it. if we were working on bending, i might say do you think you can grab that pen from the kitchen? and i'll wait here. i don't want them to feel a ton of pressure like they have to get on and perform. and then there's always the adjustments. you got to kind of ask for what you need and let the family ask for what they need. a lot of times it's camera stuff. i can't see you. can you tilt your camera down a little bit? it's new for all of us. the families, we're all learning together and the most important thing is to be flexible, keep it happy. and then we're trying to keep our visits -- we use a coaching model and we want these visits to be parent-child focused. when i very first started, it was kind of hard because the little ones are so drawn to the screen. and so what we've figured out is we can kind of orient the camera so that it's off to the side. and so i can see the family but the parent and the child are actually looking at each other, not at the screen the whole time. and they're having this really great interaction together. and then i try not to distract, which i don't know about you but my natural inclination is to talk. and so if i was, you know, in this family's home and this little guy reached out and did something, i might say something like, oh, you're handing mom the lid. you want mom to help you. and i have had to pull back on that and not talk, which is very hard for me, and let that natural interaction happen so that i don't pull the child's attention back to the screen, whatever the screen is. and then when there's kind of like that natural break, then talk with mom. how do you feel about that? ask her questions, give suggestions. and always throughout the visits we're reminding the family of the ifsp goals and letting them know we can work on them virtually. i don't want the family to think anything's off the table. so if feeding is a concern and they haven't brought it up, i might say one of your concerns when we wrote our outcomes was feeding. can i join you for lunch next week? could you set me up on the counter and i can watch and see how things are going and we can brainstorm afterwards? we're trying to come up with ways where we can make it work for families, even though it's new and different for all of us. continuing on with kind of the goal section. we're trying to use what's in the home. so with this little guy, we were working on some getting into a crawling position. and i was able -- sorry -- so say to the mom, it looks like he could use a little support under his arms. do you have a pillow he could use? it was super easy for her to grab a pillow. he kept looking off in the distance. and i have a pretty limited view. it's not like when i'm in the home. i was like i keep noticing that he's looking over in this direction. and on this particular instance she was able to say i put out these new bright orange pumpkins. i was able to say, cool, he loves those. can we bring those down on his eye level? you have a limited view into what you can see on the screen but we can be asking the families questions and trying to figure out how to make work whatever is in the home. and then of course you always come up with things that, as you talk with the family you decide there are these items that could help the family. and so we have been doing dropping stuff off at the homes. i know those rules are different for every program and every state depending on numbers and what's going on with the pandemic. but things like mylar just stuffed in a pillow or a switch toy or braille books. those things we're still dropping off at the home and the family can pull those out and use them for the next visit. okay. and then i've called this part the closing, which this is kind of we've had that opening part. we've done the meat of the visit, the goals, we've worked on stuff and this is how we're wrapping it up in the end. and so i like to review what we did during the visit. so this cute little guy, i would probably say something like, you know, he did so well with the shape sorter. it was awesome to see how much you guys have been working on it. i would review a little bit about when he was working on the kneeling and talk about what the family will work on. this mom, we had decided it would be a good idea with the shape sorter if she outlined the circle and the square and covered up some of the other shapes to help with visual complexity. i would remind her, hey, we have this idea that you were going to outline the shapes, so that she has a reminder of what they're going to be working on that week. and then i would make a plan, if i'm going to be dropping things off at the home, like on tuesday, you know, before 3:00 i'll have those things on your porch. you don't need to come to the door. i'll leave. i'll text you and you can come get them and sanitize them, that type of thing. and then i always like to wrap up by confirming the next visit and talking about what we're going to work on for that visit, because we usually have kind of -- you know, we're working through that scaffolding. we have a plan for next time. so i might say something to this mom like and next time let's try that shape sorter after you've made those changes and adaptations to it. again, i try to keep that part -- if the family has those things the following week, if they have those things pulled out, fantastic. if they don't, i would just have some notes and say we said we were going to do that shape sorter with the outlined shapes. do you think you can grab that? we're just trying to make it work as well as we can for families. trying to use the coaching model as effectively as we can through virtual home visits. and just remaining flexible and doing the best that we can. and i think most of the people, most of my colleagues, as we're talking, we're surprised how well these visits are going. when it happened in march we were all like -- i was like this is never going to work. and as we've been flexible and as we've figured things out, the visits are going really well. the families are doing just a fantastic job. so that is a little review on virtual home visits. >> we've got a question for you. what do you do when the parents are not available and they have you do one-on-ones directly with a student because they're being taken care of by a nurse? >> oh, i don't have anyone like that on my case load. that's an excellent question. karen, what would you say on that? >> well, when we go into the home and they have a full-time nurse there -- sorry about the dog. if the nurse is the one that's available, we do the visit with the nurse because during the day if mom is working, for example, the nurse is going to have most of the interaction with the child and there's still strategies she should know. we've actually even gone into the icu and other places for children who were in long-term care to help bring in vision strategies. so that just seems to be the next step. if they have a nurse at home, you teach the nurse. >> yeah, and i was going to say i'm in that situation with one of my kids who we were seeing him in person in early intervention and he transferred to preschool and when covid hit, we started doing virtual visits. we try to schedule at least one session with mom or dad or together, just so we can let them know what we did during the lesson. and also sending a follow-up e-mail or text to mom or dad or both to let them know what you guys were working on during that visit with the nurse. >> that's what i have done. i currently have a couple of kiddos with nurses. they'll pull out the bag of goodies or toys. we'll try different things. and we follow up with a text to mom, maybe even a couple of photos. say look what we did today with the switches. yeah. >> karen, someone asked what the tool that you guys are working on will be called? do you have a title? >> well, you know, you build it and then you name it, right? we have kicked around the utah early intervention vision intensity scale, so it would be the utah eivi scale. we're thinking about that. >> another plea for coaching resources. >> i will send those. would you be the right person to send them to, kaycee? >> yeah, if you can send them pretty quickly we can get them added into your handout and put them up with the recording and handout. >> like the bible of parent coaching is probably the sheldon and rush stuff, so if you just go and google sheldon and rush you're going to find all sorts of fun stuff. but there's been some things recently released by the early childhood technical assistance center that i think are pretty accessible as well. >> will you scale differentiate between virtual versus in-person? >> well, it hasn't so far. we built it in the time of in-person and then virtual has hit, so we may be validating it virtually. so, there you go. >> and right now currently we're still serving the same amount of services that we were doing in the homes. we're doing the same amount of services virtually. >> or sometimes just a little bit more. >> right. >> you know, i'm seeing a little bit more even than is written on the ifsp. >> that's true for me in orientation mobility. so it has really helped increase any services with kids with o&m. >> you can reach us, any of us here. the e-mails are there, and i understand you'll get them. oh, and slides carnival, they're great. they do fun stuff. yeah, there you go. >> perfect. thank you all so much for presenting today. check tsbvi.edu/coffeehour for updates and registration information for upcoming sessions. after today, we will have a short break and we will not have a session on october 8TH due to the aph conference, which is free. we hope you'll attend. and no session on the 12TH due to columbus day. some of you will have professional development obligations. so we will be back on the 15TH of october with voiceover Ios immediate level. this session will be available through a link on our coffee hour page at tsbvi.edu/coffeehour. once you're on the coffee hour page you'll scroll down to a list under the list of sessions where it says visit the new tsbvi coffee hour archives. it will take you to the recording and transcript information. there are two boxes numbered 10 and 11. they say additional comments you would like to share with presenters and with the event planning committee. let us know if the days and times offered for coffee hour are working for your schedule or if you have other suggestions. we would also love to hear your ideas on topics for future coffee hour sessions . thank you all so much for coming. oh, carmen asked about the aph conference. yes, you can go to their website. as far as this morning when we looked, registration was still working, so hurry, hurry and register. it's going to be great. >> thanks, you guys. that was so fun to have you and so good to see you guys. >> it was almost painless.