10:48:57 Pam Christiansen,  Luanne store dollkj.
11:00:33 >> Hello and good morning.  We'll get started in a minute.   If you are coming in, please go ahead and in your chat box  change that little drop down menu to say all panelists and  attendees.  That way everybody can see your comments or  questions.  Again, we'll get started in just one minute.
11:01:30 If you want to, in the chat, let us know where you're  joining us from, that's always fun to see.  Hello from  California, Alabama, some Texas.  Luanne, we're seeing a  gray box where your chat window is open.  I'm so sorry.   It's gone now.  It looks good.  We'll go ahead and get  started.  We'll have more people join us in the next couple  minutes.
11:01:57 We've got a lot of good content.  I want to make  sure that we've got the full-time dedicated to this coffee  hour and session.  So welcome, everyone.  We are excited to  have another one of our western regional early intervention  conference and coffee hour collaboration sessions.  In fact,  I think the keyword for the day is partnership because not
11:02:21 only are we partnering with this conference to bring these  coffee hours, but we're going to have a great presentation  for both New Mexico and Utah schools for the blind and the  early intervention programs who have partnered to bring us  this presentation.  Just a couple of announcements and notes  before I turn the time over to them.  Please, if
11:02:46 you have a  question or comment during the presentation, post that in  the chat box.  Make sure that, again, that little drop down  menu says all panelists and attendees.  We'll have some of  our panelist members in the chat to answer questions, and  may also, you know, pull some to answer towards the end.   That is where we'll engage with you is in
11:03:10 that chat.  Your  microphones and cameras are automatically muted.  You don't  need to worry about that.  You're not going to spontaneously  pop on to the screen.  No worries.  There will be a couple  of handouts.  We'll share that link in the chat so you can  access those documents that our presenters will be referring  to.  We are recording
11:03:39 this session, and you will be able to  access that in a few days through a link on our coffee hour  page at TSBVI.edu/coffee hour.  Once you're on that page.   You will scroll down to where it says visit the TSBVI  archives.  That's the link that will take you to all of the  recordings, handouts, transcripts, and chat information for  this and our
11:04:06 other coffee hour sessions.  Just a note on  professional development credits or CEUs, you will respond  to an evaluation that will be e-mailed to you from our  registration website, and you'll enter the code that I will  give you at the end of today's session.  So there's no  opening code.  Just that closing code.  Then once you finish  that, your
11:04:34 CEU certificate will automatically generate.  So,  again, no opening code.  Just that closing code.  We'll stop  the presentation at 12:55 central time to give you that code  and announcements.  So I am going to turn it over first to  Amy Fletcher and Margaret Caulford.  They'll introduce the  rest of their colleagues.
11:05:04 >> Good morning.  So like Kate said, we have the parent  infant program and New Mexico school for the blind.  There  are six of us presenting today.  There's going to be a lot  of discussions about the early intervention and how we, you  know, have gone through the pandemic, but first off, it's  going to be Margaret and I.  We're going to be discussing
11:05:31 building a rapport virtually.  So Margaret is actually an  early intervention vision specialist, and I am a  developmental vision specialist as well as certified  mobility and orientation specialist.  This screen is asking  why.  Let's start off with asking ourselves why.  Why are we  an early intervention?  I just wanted to go ahead and  Sharmistha
11:05:57 share  my why.  This little guy is part of my why.  He taught me so  much in those two and a half years I had him.  He was the  first child I ever evaluated and qualified for vision  services in EI.  I referred him to orientation and mobility  services to my coworker, Lynn, and she's in pink in that  image.  So you know, getting to collaborate
11:06:17 with Lynn and  observe her providing those services to this guy little was  part of why I wanted to become an O and M specialist.  Over  the months, I saw him progress.  His family was working on  the strategies that we shared.  Before we knew it, he was  ready for Pre-K with his cane in hand.  Such a cute little  guy in his suit in that last picture.
11:06:39 I get to work with so  many families around the state of New Mexico, and I'm happy  to include that they are my why.  I get to share resources  and strategies and have conversations about their child, get  the opportunity to encourage these families.  That's my why.   Whether I've been with the family for three months or almost  three years, they are
11:07:11 all my why.  Giving these families as  many tools to add to their toolbox before they transition is  an exciting task.  That's my why.  So take a few seconds and  think about your why.  Why are you in early intervention?   Later today, if you want to share those thoughts with a  colleague, get a chance and reflect, you know, those ideas  with your colleague
11:07:18 later today on what is your why.  Now  we're going to go ahead and go to Margaret.  These going to  share her why.
11:07:49 >> It's good to be with you all this morning.  I am so  excited to share my why.  I grew up in a large family with  lots of children and lots of siblings.  Actually, my parents  adopted children with special needs.  A lot of them had  visual impairments.  So, you know, as family life goes,  there were good days and hard days, and some frustrating  times,
11:08:18 but also, some really amazing bonding times that we  had with a lot of adopted siblings.  I have an older brother  with Down syndrome that you see there in the top corner.  It  was just fun to learn from all of them.  Definitely  including learning Braille and sighted guide and leisure  activities for the blind that I didn't know existed.  It was  just
11:08:47 really fun to get these ideas from other professionals  in the field.  I watched as carrying and skilled  professionals worked with my brothers and sisters, teaching  them academics and social kills, adaptive skills and  independent living skills.  I knew then that I really  wanteds to give back and for families in some way just as  these
11:08:59 professionals had supported my family over the years.   So here I am.  If you'll switch to the next slide..
11:09:27 We're excited to talk about building rapport with families.   This is at the heart of early intervention.  We serve the  entire family.  This quote by Teddy Roosevelt really says it  all.  People care how much you know until they know how much  you care.  With us being in the field and knowing all that  we know, sometimes it takes some time to get to
11:09:52 know the  families and have them get to know us and to trust us with  their babies and with them being on this new journey with  them.  So I just want to point out this cute picture of this  family that I'm working with right now.  Obviously in the  picture, you can tell that the mom has a really good  relationship with her baby, and they are bonded.
11:10:25 They are  just excited.  Every time I go and see them, they are  excited to learn new strategies.  They can put things into  place now that will just help her in the future and have her  become more independent and have her learn all the things  that she needs to know.  This baby is deaf and blind, the  little baby that is so smart and so capable.
11:10:41 So that's kind  of our goal in early intervention, to get families on the  path to bond with their kids and have everyone know how to  best support them, the entire family.
11:11:13 As we look at building rapport with families, it's really  important to just take some time to just check in with  ourselves and to see how we are as a provider.  Being an  effective provider is really -- it's a process, and we learn  through our mistakes and we learn through our experience.   We learn from other families and other teachers, and there's
11:11:45 so many people that we work with in this field.  So, you  know, take some time to ask yourself some of these  questions.  We went go through all of them, but I love the  top three.  Just ask yourself.  Am I truly family centered?   Am I truly collaborative?  Am I working with the other team  members?  Am I including the parents in that team?
11:12:15 Do I  demonstrate respect for each family?  As we go along today,  we'll talk about the different kinds of families that we  serve.  Each family is in their own unique situation.  I  love this quote.  This is not a solitary journey, but a  shared Odyssey of discovery.  I cannot betray their trust.   As we build rapport, it is about trust.
11:12:34 >> The families we work with are all on different  rollercoasters.  Some are ready for the fast and furious,  going through tunnels, enjoying all the fast turns.  As you  can see in the image on the left.  Some are just arriving  and still deciding, you know, whether or not to buy a  ticket.  Maybe they feel more comfortable just walking  around
11:12:55 and taking it all in, as you see in the image on the  right.  We have to remember that the family is inviting us  on their ride, whether that's the rollercoaster or something  a bit slower.  We have to be mindful in maintaining good,  safe pace to support them as we all embark on the journey  together.
11:13:22 >> So gathering information ahead of time, we want to ensure  we've collected all the medical information on the child  beforehand as much as possible, review their medical  records, whatever is available at that time.  We want to  find out what the vision concerns are for maybe the team   members, if that's possible, to check with OTs,
11:13:48 PTs,  anybody who was on the team.  We want to know who are the  main caregivers in this child's life.  We want to find out  from the family service coordinator if there's any unique  family circumstances that we need to be aware of ahead of  time.  The best way to contact, you know, caregiver is the  child in foster care, is there a history of CPS
11:13:57 involvement?   Just gathering as much as we can before we make that call.
11:14:31 >> There are bumps along the road as we're providing  services, and I definitely have learned so much through my  experience, things to do again, things not to do.  I just  want to share one experience really quick about a few weeks  ago, I got a bunch of new referrals with things opening up  again in Utah.  I was a little overwhelmed with so many  referrals
11:14:56 coming in and I was doing my homework and  gathering information like we're supposed to and trying to  remember which service provider went with each family that I  was calling.  I just remember one day I just -- it was at  the end of the day and I called a family and I realized as  I'm on the phone with the mom, oh, I didn't really look at  this child's
11:15:25 file and find out really what's going on with  this baby.  So I just simply asked the mom, you know, what  concerns do you have with your child and her vision?  The  mom just replied, you know, she just has a lazy eye.  I'm  going to take her to the ophthalmologist.  Would you mind  calling me in about a month to check back after we go to  that visit?
11:15:53 I said, yeah, sure.  So I started to document  that in her file and then later a couple days later, I went  back and looked at her file, and I realized oh, wow.  This  baby has a lot more going on that the mom didn't even  mention on the phone.  I'm reading this chart and noticing,  this baby has a brain malformation.  She's macro app that  will Mia.
11:16:20 That would have been really nice to know.  I  called and talked to this mom on the phone.  So it made me  realize the importance of gathering the information  beforehand.  Obviously has really the way to go.  It's going  to propel us forward as we start to write our services for  the families and I had to backtrack a little bit.   Hopefully,
11:16:34 you know, I can build a good rapport with this  mom and move forward with services for this family.
11:16:56 >> So when we're making that initial contact with the  family, we could consider possibly texting them before  making that initial phone call just to see when it would be  a good time to talk with both parents present.  If you call  and maybe no one answers, voice mail might not be working,  we've also found it very helpful to send a text message
11:17:17 with  all the spam calls coming through on the rise, I know  myself, I've ignored many phone calls just because I don't  recognize the phone number.  We provide an example here on  the right just of an example text that you can send out.  We  could include our name, our program's name just letting the  family know we served a referral for their
11:17:39 child and then  they can respond either by calling or if it's easier to text  back.  This text will also alert them to possibly adds your  contact information into their phone so when future calls or  texts are made, they will know exactly who you are, what  program you're with.  Just a side note, I never include the  child's name in this initial text
11:17:49 message just to be on the  safe side.  Just in case the phone number has been changed  or maybe there was a mistake on the referral.
11:18:18 >> So after that initial contact, we definitely put the ball  in the family's court.  We open up that line of  communication for that family.  As we proceed with our  services, we definitely need to take into account everyone's  unique circumstances.  The Maslow's hierarchy of needs  really does -- if you haven't studied this, this is a great  model
11:18:52 to look at as we look at families and seeing where  they are at and if their basic needs are being taken care  of.  That's the bottom rung, you know, food, water, sleep,  shelter.  Then we move up and hopefully families have those  needs met for safety, and they have a support system in  place with having a child with special needs, things are  fluctuating
11:19:16 within this hierarchy with these new families.   Maybe they're just getting out of the hospital.  Some of  them are getting their bearings with new medical procedures  with their baby.  Are sleep deprived or have new financial  stressors.  So we want to make sure that as you contact  these families and if you don't hear back from them, just be  patient.
11:19:43 Maybe wait a few days.  Also, contacting them at  different times of the day, also for families that have up  at night, it might not be great to contact them first thing  in the morning.  Just sending those friendly reminders, you  know, just want to know if you got my message and here's my  number.  Feel free to call me on text me back as it works  for
11:19:54 you.  So they feel okay with how these new services are  going to proceed.
11:20:18 >> So let's fast forward to after we've made our initial  contact with the -- or initial contact phone call with the  family.  You can you can send a text confirming when the  vision evaluation will be held.  This is another example  that we have of something we may send out.  We can include,  of course, our name, the program name, when the evaluation
11:20:40 will take place, which format we decided upon, whether that  be Zoom, face time, et cetera.  Then reminding them to check  for release forms.  Then a short statement just talking  about rescheduling, if needed.  We want to provide our  families especially the new families who might be a little  overwhelmed, that we're
11:20:49 flexible, that we're here to support  them, and rescheduling is perfectly okay.
11:21:12 >> So ways to build a rapport.  Like I mentioned earlier, we  really want to stress, try and meet with both parents.   Sometimes that's not always possible.  I did have an example  to share.  I had a family who shared custody of a child.  So  I scheduled it where I would meet with mom and baby one  week.  Then meet with dad and baby the following
11:21:34 week.  We  would try and work on the same strategies.  Both parents  were given the same information, and we were all working  towards the same goal.  We want to discover each parent's  concerns about the child's visual.  Some cases, you might  discover that one parent is ready to go and ready for that  rollercoaster ride and maybe the other parent
11:21:59 might not be  there.  They need more time to process and get through a few  things.  So we just need to take time to get to know the  families, ask simple direct questions when you can.  Ask  questions about who their support network is.  It's a great  time to explore if additional supports are needed such as  play groups.  I know our state in New Mexico,
11:22:18 I believe the  plan is to start those back up in August.  Maybe support  groups in the community, maybe they're more comfortable with  online parent support sites, or even talking about former  families that were in the program who want to share their  experiences with others.
11:22:46 So this is a family guided routines-based intervention, also  known as the FGRBI.  It's an approach that the early  intervention services and supports, the family centered  practice, adult learning and coaching and feedback that is  evidence based intervention on functional and meaningful  outcomes for everyday activities and routines.
11:23:09 A professor  at Florida State University developed this approach.  We use  this in our program.  Below this image is -- it highlights  the setting the stage portion.  On their FGRBI website,  there's a list of 15 questions that a provider can ask in  order to gather more information about the child's routines,  the family's routines.  The exchange of
11:23:33 information really  does need to be purposeful, collaborative, and supportive  between both the caregiver and the provider.  So  conversations with caregivers is more than just asking  questions.  It's listening to and encouraging the  caregiver's participation to increase their understanding of  their child's learning within that embedded
11:23:59 intervention.   Having this available can assist us and remind us to ask  important questions at the beginning of our visits.  This  approach helps with rapport building.  It ensures we stay  consistent with checking in with all of our families.  The  website has been included in a handout, and Luanne will be  touching more on this later on in the presentation.
11:24:25 >> Is one thing that I found really helpful, I really wish I  would have done this a long time ago, but it just kind of  occurred to me through the pandemic with meeting with  families online to start recapping the visit, giving them  bullet points in a text message right at the end of the  visit or just right after as we get our services started.   This
11:24:54 is for a family that is just starting out and I  mentioned a few strategies, so I just sent this really quick  in a text message to the mom as a good reference point for  her to go back to.  I feel like it's keeping the line of  communication open with that brand new family that it's just  something that they can refer back to really quickly.  Oh,  what
11:25:05 was it we talked about in our visit?  Oh, okay.  They  can find that text thread in their phone.  Next slide.
11:25:33 There's another example of a family that's on the  rollercoaster and this mom just was ready for ideas.  Her  son had just gotten glasses right as I -- he had his glasses  actually on order when I first saw them.  The mom was really  worried about getting glasses and how that was going to be  for her baby and everything.  But these were all the things
11:25:58 that we were able to talk about in my second visit with this  family.  He has siblings.  So some of these ideas I was able  to show to the siblings.  So these ideas were not just for  the mom but for the whole family to have.  It was just so  nice to be able to jot those down really quick in a text  message.  Then I can refer back to it as well really
11:26:23 quickly, and the mom can.  So it has made a world of  difference that I know families have been really  appreciative of these little recaps.  And it also assists me  with going back and filling out my visit report.  So it's a  win-win for everyone involved.
11:26:44 >> So here are a few screens shots that I've taken -- that I  took with permission from the family.  All of these were  taken during our visits.  I was using an iPad for these.   It's a great way for us to highlight what occurred during  that visit, kind of what Margaret just mentioned.  Just a  way to kind of document, and it's through an image.
11:27:07 So you  actually get to see the child and what we were doing.  In  the images below, you can see a child batting the a his toys  on his play stand, supported by mom.  Another child is  scooping water beads with a spoon.  A child is exploring  sticky foods.  Another is walking on uneven surface.   They're at the park with a family member.  Then a
11:27:34 child  being patched while looking at my Play-Doh rainbow on the  screen.  On the next slide, we have a child kicking a soccer  ball in the yard, a mother bringing -- helping her child  with hand assistance to assist him with locating his toys.   A child practicing taking steps with a push toy, even  another child enjoying a sensory activity with cool
11:28:02 whip on  a baking sheet.  So all these screen shots -- we'll go to  the next one.  These screen shots can even be converted into  a Word document.  So I had a child in this image here who  was seen a majority of the time with the grandmother who was  Spanish speaking.  My coworker was brought in as her new  specialist but also a translator.  We
11:28:20 wanted to make sure  the correct translation was made for the grandmother who was  a huge support for this child and family.  We were able to  take these screen shots of our visits and convert them into  a Word document for the child's parents to review.  In the  screenshot, we were discussing glasses I had brought in, the  little girl was also wearing.
11:28:49 It was Easter time.  So we  had some fun with that.  The bottom image has -- we were  searching and scanning the room for colorful balls that she  could place into her basket.  These provide the child's  parents a glimpse of what's happening during our visits  since they are not able to attend.  It's a great way to  share positive notes,
11:29:17 exciting improvements.  I was just  able to document under each picture what was happening.  The  Word document also reviews the skills and strategies that  are being discussed with an image to support that.  This  document can be e-mailed to the parents.  They can continue  e-mailing it out to more family members, whoever
11:29:41 is in that  network, that family network and support system, possibly we  could use these to discuss in the future.  It can be shared  with team members, PT, OT, speech.  Then added also to their  file to highlight and can document the child's progress.  So  if you're interested in using the screenshot option, always  ensure that it's okay with the
11:30:03 family ahead of time, which  it was in this case.  Get with your program and see if they  have a release form to get signed ahead of time.  Then just  research how to use your device in order to complete this  task.  It seems like every device can be a little bit  different from one another.
11:30:34 >> So just friendly reminders, in our in-person visits or  virtual visits, as we observe the child, really to point  those out to the parents especially early on, you know.  The  parents may not be noticing what their baby is communicating  or they may not notice that their baby really has amazing  listening skills or that they are starting
11:31:04 to feel with  their hands.  Just those little things could go a really,  really long way with these parents.  I've done this so many  times with moms, and I'm like, oh, look at how  your baby is  turning their head and listening to you.  They just have a  whole new outlook on their child and what their child can  do.  So that
11:31:36 makes a really big difference as we are  starting out.  Also to just really be mindful of those  medical conditions, of these little babies and to really  talk with the parents.  That's a huge priority in their  lives right now.  Oftentimes we're starting out with these  babies under one year old.  There's a lot of medical  concerns.  So we want
11:31:58 to keep updated with the parent.  Then  ask them and can follow up with them on those to see if  things are getting better or easier.  Then just to really  check in with the parents.  We're not just serving the  child.  We're serving the whole family as we've talked  about.  Check in with them.  Ask them simple questions.  How  are you today?
11:32:31 How are you doing?  How are you feeling  about -- if they have a diagnosis.  How are you feeling  about your child's diagnosis with optic nerve hypoplasia  or albinism?  Is it how are you feeling about that?  After  we ask those questions, it's important to just sit back and  listen and to really be present with the families and these  caregivers
11:32:54 to make eye contact and really listen to what  they are saying and also repeat back, reflect what they are  saying to you so that you know -- so they know that you're  getting that message.  Then ask follow-up questions so that  you can get to know what's going on with the family as a  whole.
11:33:23 The results from just listening to families is phenomenal.   Of course they will know that you care.  You'll build that  relationship of trust.  It opens the doors for future  positive interactions bringing in other professionals in the  field or having them do some more challenging activities.   It really opens the door for our services
11:33:54 long-term.  Of  course this is a big one, especially starting out with brand  new families.  We know all the acronyms and everything  that's going on in early intervention and the school for the  blind and everything.  Just remember that they are brand new  to this field, and this is -- services are overwhelming.   Then they've got to learn terminology
11:34:31 and they've got to  learn medical things for their child.  So really remember to  just explain -- especially IFSP or EI.  Really explain those  acronyms for them.  Kind of ease them into the jargon.   Eventually a lot of parents learn it, you know.  But it does  take some time.  So just know like, for example, for our  program, it's the PIP program
11:35:00 and that's very confusing for  parents.  So I will I come in and say, PIP stands for  parent, infant program.  If somebody says PIP, that's me.   That's our program so they can link that and know where I'm  coming from.  Then they'll eventually see it more on the  paperwork and can things and feel more comfortable.   Definitely ease them into
11:35:05 this whole new world.
11:35:35 Again, me being a sibling and meeting a lot of providers  over the years, I've just learned the value of including  those siblings.  They are a huge part of these kids' lives.   They are great teachers and great ones to follow through  with a lot of the strategies that we give the parents, if  they are old enough.  This little boy is just two and
11:36:03 a  half, you know.  He's taller for his age, but he wasn't  talking yet.  But he understood that he could hold up the  block for his sister and just those little things go a long  way.  I know that really is helpful for the parents.  I know  they really appreciate that when we take the time and we  introduce ourselves and we remember even the siblings'
11:36:04 names  and we ask them questions.
11:36:23 Did you try this with your sister?  How did she like it?   Did she like the red pompom?  Did she like the yellow ball?   Did she not?  Asking them those questions just to involve  them in the services that we give.
11:36:52 So just keep in mind that it does take time to build trust  with parents.  Every family is different.  Some build a  great relationship on that first visit.  For some, it might  take a few months or maybe even up to a year.  Just be  patient and meet the parents where they're at.  The big one  for early intervention is to really, really empower those
11:37:29 parents and caregivers to be the directors in the services  that we're offering, to empower them, that they are the ones  in charge.  They can direct -- if there's too many people  coming in, tell them, coach them, let them know, it's okay  to cancel.  It's okay to cut our visit short.  It's okay to  reschedule and figure out things.  So I just really
11:38:01 up front  always tell the parents, you know, you're in the driver's  seat for us as service providers.  You let us know how you  want things to play out in these next three years that we  have until your child is three years old.  As you know,  they'll be having long-term services.  Be their coach and  their guide to have them be the directors.
11:38:27 Then, of course, best practice for us is to really validate  these parents' experience about having a child with special  needs.  You're not alone.  You can do this.  This is going  to be fun.  It's just going to be so exciting.  I'm so  excited to work with your family.  Those little phrases go a  long way with working with these oftentimes young parents.
11:38:51 We get older parents.  Sometimes we work with a lot of  young, brand new families.  This can be a scary time, a very  rocky time.  Just let them know that you're there to support  them and can to praise them for all they're doing for their  baby.  You have to be really positive and, of course, the  result is that they will know that
11:39:20 we care as you're  stepping into their world and introducing them into a really  amazing experience and hopefully it will be a really  positive experience for them as they have those early  intervention programs in their lives to support them.  Also,  one thing I want to mention that I didn't earlier, but we've  talked a lot about how other parents
11:39:49 really do support  parents.  That's something that we can really empower  parents to do is to get some other parents on their team and  in their support system so that they feel connected and they  feel like they are not alone.  It's a new challenge.
11:40:20 >> Let's go ahead and turn it over to Pam and Luanne.  Pam  is an early intervention vision specialist with the Utah  parent infant program.  Luanne is with the New Mexico school  for the blind.  They will discuss virtual assessments and  instructional planning.
11:40:47 >> Sorry about that.  I was muted.  I'm Pam Christensen, and  I am going to take the first part of this portion.  We're  going to look at virtual assessment and instructional  planning.  So when we prepare for our assessment visit,  we've already made that first contact that Margaret and Amy  have talked about.  We've gathered information from the  parents.
11:41:16 We've talked about their concerns.  Hopefully  we've had a chance to look at the EI files and the medical  records, and at this point, we also want to prepare any  additional paperwork that we might have for the parents to  fill out.  That could include consent to do visits online  through Zoom or whatever online platform you might be using.   It also
11:41:45 might be consent for taking photos, as you will be  hopefully taking screen shots and sharing some of that  information that you've gleaned and gathered from those  meetings online.  We also want to determine at this time  where to meet.  Here in Utah, we're kind of in that position  now where we're -- it's more of a hybrid where we're doing  some visits
11:42:08 in-home and still some visits online.  But for  this initial assessment visit, it depends on what your  program is doing or what your state guidelines might be at  this time.  I know New Mexico at this point is not doing any  at-home visits.  In Utah, we are, as long as we're taking  precautions and following guidelines.
11:42:40 We also have the option to meet at a park or in the yard at  home.  In Utah, we have a toddler classroom at our schools.   So that center-based location is also available for us.  The  so, again, it's just determining what best meets the  parents' needs, what their preferences are, what the health  of their child might be, and how all that dictates
11:42:45 where  you're going to meet for that assessment visit.
11:43:15 Okay.  As we gather, as we prepare for that visit, we want  to help the parents also prepare for that visit.  We want  them -- we want to encourage them to find a place at home  they can put their phone or their laptop or computer webcam,  whatever they are using so that they are free to work with  their child without worrying about having to hold their
11:43:33 phone especially if you're doing this online and you're not  there in person.  We also have the -- some families use a  tripod.  So they have that option as well to just kind of  set it up, have it off to the side, and then they can work  with their child and play with their child without worrying  about that.
11:43:59 For this assessment visit, we also want to prepare them  ahead of time to see if they have any particular toys that  they might need if you are doing this assessment online.  If  necessary, you might have something specifically that you  would like to drop off for them to use.  So that's an option  as well.  When you're preparing for this assessment
11:44:26 visit,  consider seating and that positioning for their child.  It  could be a high chair.  It could be a booster.  It could be  a tumble form.  Or sitting on the floor or lying on the  floor.  So just what is the best position for that child to  be in so they can use their vision?  Then, again, what's the  best time of day?  Is it convenient for the
11:44:56 family to do it  in the morning or afternoon?  Are they constrained by their  work hours?  Do you need to meet at 5:00 or 5:30 or later in  the afternoon to visit with them?  Is lighting an issue for  their little one?  Are they more alert after a nap or after  eating?  Consider the best time of day for that meeting.   Also,
11:45:24 encourage the parents to send you any videos or  pictures of some concerning behaviors that their child might  be showing with how they are using or not using their  vision.  That's always nice to have.  If they could send  that to you ahead of the visit or if you could record it  during the visit and then you guys could discuss that.  Just  having
11:45:40 that extra information is great.  It includes that  parent to participate more and to really point out some  things that they are seeing.
11:46:09 So now that we determined where we're going to meet, we now  want to figure out what assessment tools we're going to use.   So those tools really do vary by state and they vary by  program.  So in Utah, we use the vision development  sequence.  We use a functional vision assessment.  We also  have the CDI range and the NAVAG assessment.  They
11:46:26 also use  the birth to six skills inventory.  And your programs may  have something similar or something completely different,  but just using what the assessment tool that you have to  determine eligibility for the child.
11:46:52 All right.  We also know that you've gathered some of this  information already from that initial contact with the  parent.  Again this is information that you can also add to  the functional vision assessment, and if you haven't  gathered it prior to, it could be something that could be  discussed during that assessment visit as well.  How is  their
11:47:19 child using their vision or not using their vision?   Do they have any unusual visual behaviors?  Are they missing  things in their visual fields?  They are not seeing brother  come in from the side or they seem to startle easily until  someone is right out in front of them.  Do they have a  particular head tilt?  Those are all things to just note on
11:47:21 your documentation.
11:47:49 You could also review, did they meet their early visual  milestones?  Are they making eye contact?  Are they reaching  for toys?  Have they seen an eye doctor?  Is there an eye  report or a visual diagnosis?  If they have seen an eye  doctor, can you, at this point, have them sign a release to  get a copy of that eye report or send it after the visit
11:47:56 is  done if you're doing everything online through a digital  platform.
11:48:24 You can also review how the pregnancy and the birth, were  there any medical events or medical issues during those  periods of time?  Was there a chronic lack of oxygen or  other issues that are related to pregnancy and birth that  may have impacted the development of their child?  You,  again, could also collect family history of any vision  issues.
11:48:45 Then just note if there are any characteristics of  cortico vision impairment that the child might be showing.   Do they have any behaviors and gaze, that sort of thing,  where they are not fixating.  These are all important  informations to collect during your assessment.
11:49:14 All right.  This is just a picture of an online assessment  tool.  This particular mom of this little gal actually does   have a medical diagnosis of cortico visual impairment.  We  were doing an assessment online, and mom pulled out  Christmas bows, and we were using just a variety of  different things to work on tracking and to look at visual
11:49:27 fields.  So this was just a nice example of using what mom  has at home for some of those assessment questions and  determination.
11:49:48 Okay.  This next one is -- this is another assessment that's  done online.  So there are two providers online and then the  parent here with her little one.  They are talking about  visual fields assessment.  So this is just a really nice  example.
11:50:04 >> He'll hold it and just keep looking at it.  Whereas like  if I put it over here, he'll glance at it, but then he  has -- he kind of struggles with holding it up there.
11:50:06 >> That would be on his left.  Right?  He has a harder time?
11:50:16 >> Yeah.  No.  On his left it's -- on his left, yeah.  On  his left -- his right is preferred.
11:50:18 >> Okay.
11:50:19 >> Yeah.
11:50:22 >> I always get confused with the video, which side --
11:50:25 >> I know.
11:50:27 >> He's looking to his left side right now?
11:50:31 >> It's on his left side right now.
11:50:34 >> Easier to hold gaze on the right.
11:50:46 >> He'll glance at it for sure, but then if I hold it over  here, he'll just stare at it.
11:51:11 >> Thank you.  So that was a really nice video to just show  the two different providers who were working on the  assessment with the mom, and it's just -- it shows you how  it is.  The back and forth and the verification, it's just a  nice video.  After that visit, what's next?  Now it's  important to determine if that child was eligible or is  eligible
11:51:12 for vision services.
11:51:42 So in Utah, we have three ways to qualify a child.  In New  Mexico as well.  And those ways are assessments.  Again, we  use the vision development sequence and the functional  vision assessment to determine eligibility.  We use the  Oregon assessment later down the road.  But not necessarily  to determine eligibility but to work on ongoing assessments
11:51:45 the with the child once they qualify for services.
11:52:22 Another way that we can qualify a child for vision services  is through a medical diagnosis for vision.  There is a list  of vision diagnoses that our lead agency, the department of  health in Utah, determined is the vision diagnoses.  That's  an automatic qualifier.  There is a variety of other --  there is just a lot -- vision impacts everything.
11:52:52 So there's -- what do I want to say?  Vision, it's just  important to check and see how vision is impacting that  development, but there's an automatic qualifier list.  The  third way is to look at an at risk child.  In Utah, you call  it informed clinical opinion.  That is where the assessments  may be pretty well on target and they don't have a medical
11:53:10 diagnosis, but there's something that's off with how they're  using their vision.  So we have that flexibility and that  ability to qualify a child under an informed clinical  opinion or an at risk as they do in New Mexico.
11:53:46 Next slide.  Thank you.  In Utah, we have 45 days to  determine a child is eligible for vision services.  We will  get that referral and we have 45 days to visit the child  multiple times to see if they need vision services.  In New  Mexico, it's a little bit different.  They are -- vision  services is added to the child's IFSP prior to that
11:54:13 first  assessment.  Then once that's added and the provider has  been given that information, the child needs to be seen  within 30 days to determine whether the child qualifies for  ongoing vision services or if they don't qualify.  Okay.   And then once we've qualified a child for vision services,  we want to determine how often should
11:54:42 we see the child?  In  Utah, we are using a service intensity guidelines chart to  guide and determine how often we should visit and work with  that child and their family.  This is not available yet.   It's in it its validation process.  So I'm hoping it will be  available at some point.  But what we do is we look down on  the left side.  There's a
11:55:10 whole list of mitigating factors  that we can look at.  Then across the top, we look at how  those mitigating factors impact that child as far as that  vision information goes.  You can see from no impact to  severe impact, there's a score.  What we do is we then mark  the score on the right and then at the end of all the report  looking at all the
11:55:42 mitigating factors, we get a total.  Then  we have a score chart to determine whether we would see the  child once, twice, or three times a month.  Again, it's a  guideline.  There are so many things that can impact the  child and the family.  So it's just a nice starting point to  look at how to approach our level of services that we  provide.
11:55:45 >> Thanks, Pam.
11:55:45 >> Sure.
11:56:07 >> Okay.  Sorry.  I am the screen flipper.  So there we go.   We've got that figured out.  Hi, everybody.  So we've talked  about building rapport with families, and you've done an  awesome assessment.  Even though it was online and we've had  to learn a new way to do that.  So the next thing we want to  think about is really that instructional planning
11:56:33 piece.  So  that starts with IFSP.  As Pam said, I think it varies state  to state.  Often in New Mexico, we get put on to the IFSP  before we see the child most of the time, not all of the  time.  So we get a call saying, hey, can you go assess this  kid and then let us know and then we let the service  coordinator know how many times we want to see
11:56:56 them so we  can be added for ongoing service to the IFSP.  But we want  to make sure that when we're talking about IFSP goals with  the family, that we remember that it's based on the family's  concerns and their priorities and what they really want for  their child.  We want to really encourage them to think  about routines and having goals that fit
11:57:19 into their everyday  family routines.  Some early intervention agencies are  really good at explaining that to families.  Some aren't as  good at explaining that.  So I just like to make sure that  families understand our philosophy about routines-based  services and making sure that the goal fits their priority  and then also really is focused
11:57:47 on the child's  participation.  We believe strongly in that active learning  piece.  We know that kids are learning best when they are  taking part in their own learning.  So we want to make sure  that also gets built in to any of the IFSP goals.  How can  we include the providers in the goals and process?  I loved  with Margaret
11:57:50 said about the siblings.  So true.
11:58:16 Really thinking about how we can include siblings in these  IFSP goals as well.  I'll say one thing that's been sort of  a silver lining about the pandemic and doing telehealth  services is the ability to collaborate with IFSP teams a  little bit more easily.  So New Mexico is a big state, and  it's really a rural state.  So some of us can drive, you
11:58:43 know, two, three hours one way to see a child.  I once drove  four hours one way, and they no showed me.  Anyway, so with  IFSPs, sometimes it's difficult to block out three or four  driving hours to attend an IFSP, but being able to do it via  telehealth over Zoom has just been kind of career altering.   I feel like I've been able to really better
11:59:06 participate in  all of those meetings.  The other thing that we do in New  Mexico, which is pretty cool, I think, is we participate in  something called TTA meetings, which stands for trans  disciplinary teams approach.  They are kind of staff  meetings, but we're included as part of the IFSP team.  So  depending on the child, you might meet once a
11:59:28 month or once  every other month, anywhere from 15 minutes to an hour.   It's really a time for staff to come together and be able to  share ideas.  The PT can say, we're working on standing and  I notice when standing, that it's much harder for him to use  his vision than when he's sitting supported or the OT might  say we're working on putting things
11:59:54 in a container, but I  just noticed he's missing when he's grabbing for things.   It's just a great chance for us to all share ideas.  It's  also a great chance for us to speak the same language and  use the same wording when working with families.  Because  when a family has four or five, six sometimes I've seen  providers that are working with them
12:00:19 and the PT says one  thing and the nutritionist says another thing and you're  saying another thing, it can be very confusing.  So the  staffings really give us the chance to be able to kind of  come together and share a specific message with families.   So instructional planning, so when I was first thinking  about instructal planning, the first
12:00:43 thing I thought was,  how am I going to kind of plan out my visits and we need to  remember that we also need to prepare families for this  instructional planning.  They have had their IFSP.  But now  they might wonder what's next?  What's it going to look  like?  How are you going to work with me and my child  especially via computer
12:01:17 screen?  When the pandemic hit and  we had to scramble, I didn't have any experience with  telehealth.  I was a little freaked out at first.  But then  I realized, we're pretty lucky.  In New Mexico, also in  Utah, we're already using a routines-based model of  intervention.  In Utah, they use the matrix.  In New Mexico,
12:01:39 we use what Amy mentioned at the beginning of the  presentation.  If you don't hear anything else I say for the  next ten minutes, please write down and visit the FGRBI.com  website.  It is amazing.  The wealth of information there is  just immense.  There's wonderful examples on using  routines-based intervention and the coaching model.
12:02:06 You can  watch videos.  They have a whole section of information on  adult learning styles, which is something else that I think  we've learned is really key.  So when Margaret and Amy were  talking about this rollercoaster ride, boy, is that true.   We don't really know any given day where a family might be  and how they might be feeling.  So learning
12:02:30 how to kind of  read a family, read a parent, and see kind of where they are  during that visit and then also understanding kind of their  learning style, some parents want you to hand them a  handout.  They want to read about it.  They want you to give  them a website that they can go to.  Some families want to  watch you do something with their
12:02:56 child and then practice.   Some families need to do it hands on themselves.  So really  understanding where that parent is and how they learn best  really, really makes services so much more effective.  So  when we're introducing services to families, we want to  really help them understand our philosophy  around routines-based services
12:03:19 and understanding what is a  routine?  I think all of us have different ideas when we  think about routines.  There are child-centered routines  like diapering, feeding, bathing.  But there's also family  routines, things that you just do.  You don't even think  about doing them during your day, like picking up the mail  or walking the dog
12:03:38 or watering the flowers or working in the  garden.  Maybe you're feeding the cat.  Things that you just  do every day.  Those are routines.  We want families to  start thinking about how can we include our kids in these  kinds of routines that we're doing all of the time?
12:04:03 So this is a copy of the intervention matrix that Utah uses.   It's just a nice place where you can help families look at  their outcomes from their IFSP and look across and saying,  this is would be an easy one to work on during meals or bath  time.  Just helps them start thinking about this goal  doesn't have to be separate like something I have to
12:04:11 do to  my child during the day.  I can work it in to things that my  child is already doing during their routines.
12:04:40 This is a form from the FGRBI we've been talking about.  I'm  not going to spend a lot of time because I'm really hoping  you guys will go to the website and learn more.  But this is  what's called the SSOOPPRR.  Amy alluded to the SS which is  setting the stage.  There is also the OO, which is  observation and opportunities to practice.  Then the PP
12:05:06 stands for problem solving and planning.  That's the other  one.  Then the RR is reflection and review.  So it's a nice  way to help families understand how a visit might be  structured and how a routine can be used to really help the  family with learning activities and opportunities for their  child.
12:05:35 So the coaching model is really key to -- it goes hand in  hand with this routines-based intervention.  I think  explaining to families ahead of time what that is and what  that means is really powerful and helps kind of set the  stage for your visits moving forward so that they understand  that our role isn't to do something to their child.  Our  role
12:06:00 is to observe a routine and then brainstorm with them  and help them come up with ways they can work on a new skill  or make a routine easier or just help their child enjoy  something about their day a little bit more.  So helping  families kind of shift their way of thinking maybe, I've  heard -- I've done this a long, long time and I've heard  over
12:06:27 the years lots of parents.  They can become a little  stressed about feeling like they need to do therapy or do  something, you know, to their child or with their child in  order for them to improve their skills in a certain area.  I  think if we just help families shift their thinking to this  idea that really you're already doing it.  Let's look at
12:07:00 it  and talk about of the things your kid is learning while  doing it.  It's pretty powerful.  I think explaining to  parents ahead of time gets their minds ready for that.  I  love this picture because this mama, you saw him in the clip  with the assessment.  He has other developmental issues by  the CVI.  We made him a Costco box desk.  I go to Costco
12:07:28 just for the boxes.  I'm the person taking everything out of  the box and then taking the box.  Anyway, he sat in this  rocker chair which is one of his favorite places to sit.  We  made him a desk that we could attach toys to or put sensory  objects on.  The mom observed it was hard for him to use his  right hand.  He rarely used it.  So I
12:07:50 showed up on computer  for a visit with her, and she said check this out.  She  built up the right side of the box so that she could attach  some of his favorite sensory boards to the right side which  really encouraged him to use his right hand.  When I see  things like that, I think that's what it's about because me  seeing them twice a month
12:08:16 or once a week for an hour just  doesn't do anything.  When a parent kind of can take that on  and they're seeing all these opportunities and they are  empowered, then it's just -- it's the best.  That's really  the result that we hope for.  The other thing we introduce  to families getting ready to start visits is the expanded  core curriculum.  In
12:08:40 New Mexico, several years ago, we  started looking at the ECC and importance of the that with  our youngest kids.  I was working with a parent who said,  well, I know you're a vision teacher.  Right?  Developmental  vision specialist or teacher of the visually impaired.  But  she said, my child is blind.  So how are you going to work  on vision?  Boy,
12:09:03 right she was.  Really, we're not just  working on vision.  With some kids, we're never working on  vision.  What we're really working on is the expanded core.   We're working on all of these other skills on that child's  whole development, on that child's inclusion with their  family.  So we introduce that right away with our families  in New Mexico.
12:09:30 The other thing we introduce is what we lovingly call the  triangle.  This is adapted from the FGRBI website.  So one  way to help parents start thinking about routines is  thinking about, well, where do you spend time?  Maybe it's  in your living room.  Maybe it's in your backyard, in the  car, in the bathroom.  What are things
12:09:50 we do there?  We  might brush our teeth or take a bath in the bathroom.  We  might be bathing older brother or sister in the bathroom.   We might be in the backyard tending with the garden or  playing with the dog.  Just help families think about those  things during their day that they are already doing and then  we're going to help them understand
12:10:00 all of the learning  opportunities, all of the potential that exist in those  routines.  Sorry.  By the way, this is one of your handouts.
12:10:24 This is another one of your handouts.  This is the expanded  core curriculum handout that we give our families.  It just  explains the nine areas of the expanded core and how we view  those in our kids.  Some of the skills that we might be  working on and how they relate to the expanded core.
12:10:52 So I just really want to quickly give you an example of what  this triangle might look like.  So Andrea, who is one of my   coworkers and amazing, this is one of their families.  The  older siblings like to play candy land.  So she was able to  get a video of them playing candy land, but rather than  having their little sister kind of sit
12:11:06 off to the side while  they were playing, they decided to include her in that  family routine.  I want to show you a video clip of what  that looks like.
12:11:13 >> Two orange.  Two orange.
12:11:19 >> It's her turn again.  Two orange.
12:11:21 >> She's going to win.
12:11:22 >> She loves this.
12:11:24 >> Two yellow.
12:11:37 >> Me.
12:11:41 >> Reyna's turn.
12:11:46 >> Blue.
12:12:06 >> There we go.  I just love that video.  It's a very little  piece of a longer clip, but what a cool thing.  So many cool  things happened during that interaction.  Really, all it  took to include her was mom initially getting her kind of  settled on her lap where she was comfortable and then they  just played the game.  Of course, the siblings are
12:12:28 like  she's lucky.  She's going to win, spoken like true siblings.   Look at all the things they were working on without really  realizing it.  Right?  Visual attention.  She was shifting  her gaze around looking at everybody, smiling.  She was  working on head control.  Of course social interaction,  communication.  The coolest thing, she was included.
12:12:49 She  was a part of that activity that they did regularly, but had  never really thought, you know, she could be included, too.   It might look different.  Maybe she doesn't roll the dice or  pick up the cards, but she can be part of this.  Then you  can take it further if you want and look at all the areas of  the ECC.
12:13:13 So some of the resources in addition to the ECC handout and  triangle handouts that you have access to, some is of the  other things are the teaching life differently expanded core   curriculum which is wonderful.  Utah does a calendar for  families so they have ideas of things to do at home during  their daily routines.  And then both of our programs
12:13:21 use the  vision skills in the natural environment including really  awesome parent lessons included as part of that.
12:13:41 So next up, we have Jamie with the Utah program.  She's  going to talk about conducting a virtual home visit.  Then  Lynn Little from our birth to three program is going to end  with the benefits and challenges of telehealth.
12:14:03 >> Thank you, Luanne.  So I'm excited to be able to talk  about how we have been conducting virtual visits.  Like most  of you in Utah, we've been doing this for a year now.  We're  starting to move back into homes.  Every area is a little  different.  We're just beginning to do that.  We found some  value in virtual visits and sometimes when we'll probably
12:14:25 continue to do those.  We'll talk about how we make those  effective.  Okay.  So first we're going to talk about a  little bit just before the visit.  First off, when we  thought about when should we send the Zoom invites?  When we  very first started, I me and colleagues, we were kind of at  the beginning of the month scheduling all the appointments
12:14:47 or even the beginning of the week and sending out all the  Zoom invites.  Or Google meets, whatever it is.  We were  finding they were getting buried in the family's e-mail and  they were having a hard time finding those.  What's proved  to be more effective is the day before or even the very  morning of, sending out invites.  Our families are used
12:15:08 to  someone showing up to the door and knocking and reminding  them.  So even though sometimes they might remember in the  morning, they have a visit, you know how the day goes and  you kind of forget.  So if you get on the -- you started up  your Zoom meeting, the family isn't there, I called it here  on this slide, what if the family no shows, what
12:15:30 did you do?   I found it really helpful to just send a little text that  says, did you get the link?  Do you need help connecting?   Something like that.  A lot of times families are like, oh,  I forgot.  I'll hop on right now.  Then the other thing that  we've been able to do with virtual visits is a little more  co-visiting.  New Mexico, they've found
12:15:51 that they've been  able to do the same thing.  When we're talking about are  they a good idea, are they effective, it has seemed to be  really effective when we have two providers and one family,  like the picture over here on the left.  It's easy to know  whose turn is it to talk, what's going to happen in the  visit.  Sometimes when you get more people
12:16:09 in that, it gets  kind of confusing.  You're not quite sure when should I  talk?  Who is going to go next?  But that being said, there  have been times when it has been helpful.  In this picture  that I have here, this was the mom's request.  She had a  very specific purpose in mind.  She had a very specific  question that she wanted the whole team
12:16:30 to brainstorm on.   So we went into this knowing what our goal was, what we were  each going to be working on.  So in this situation, we found  it to be effective for the visit.  But you do kind of have  to be careful because it can get confusing when you have so  many people.
12:17:01 Okay.  So now we just have this picture of -- they Ms.  and  an occupational therapist.  We ask the parent, how are you  doing?  This has been a crazy year.  Are they  healthy?  Do  they still have their jobs?  Taking time to stop and listen.   Once we've established that relationship,
12:17:20 we like to follow  up from our last visit.  We would review what we worked on  and ask, were you able to follow through with the things  that we talked about?  Sometimes they are able to, some  sometimes life is just crazy and they are not.  We want our  families to be able to know that they can tell us.  They can  honestly tell us how things are going.
12:17:23 Then we like to ask  the families about their priorities for the visit.
12:17:43 So what would you like to work on today?  A question that we  found to be really helpful is, are there any routines that  aren't going well for you guys right now?  Things are  different for families.  Is there anything not going well?   Sometimes you get more information with that question than  you do with, what would you like to work on?  Sometimes
12:17:53 you  ask, what part of your day isn't working well or is there a  part of day you need help with?  We can get more  information.
12:18:16 Okay.  So we've kind of said hi.  If you noticed in the  beginning, we have the parent and the child and their  attention was directed to us and we were looking at each  other.  We were doing the initial part of our visit.  Now we  want to try to get into where we're trying to facilitate  more parent-child interactions rather than children focusing  on
12:18:39 us and the camera.  If a family has a computer or an  iPad, it's been pretty easy for them to set that up.  But  so many families are using phones for everything.  When we  very first started, our visits were so difficult for  families especially a mom with twins who are both receiving  vision services.  She's trying to hold the phone and two  little
12:19:04 ones.  She would prop the phone up.  You know how it  goes.  So our program, we ended up purchasing these tripods.   Our secretary did a great job, found them for us and we were  able to give them to families.  So this picture that I have  here is what it looks like for me when mom has her phone set  up on a tripod just backed up so I can
12:19:20 see what's going on.   Then we have to be flexible and laugh about it.  Sometimes  kids move and we want the children to be moving.  Then we  have to say oh, I can't see you anymore.  We kind of laugh  about it and the family can readjust.
12:19:47 Okay.  So our camera is set up.  We've said hi.  We're ready  to do the visit.  Some families -- you guys know this.  This  goes back to one of my new favorite analogies is  presented  at the beginning of the presentation today, joining them on  their ride and where they are on their journey.  And some  families are going to have
12:20:09 everything ready for the visit.   They are going to have the shape sorter there and the toys  and know what they want to work on.  That's fantastic.  You  just get right into the visit.  Some families are not going  to.  They are going to come and it's going to be mom or dad  or grandma and a baby.  We want to know what can we do so  that the family
12:20:29 does not feel a lot of pressure?  The last  thing I wanted my families to feel on these visits is that  it's like they have to come ready to perform or something.   Set up the camera and perform for me.  We try to take all  the pressure off and just say things like, do you have that  shape sorter that we used last week.  It's
12:20:50 really not a big  deal.  The maybe we're going to work on banging.  So do you  have a pan in your kitchen that you could grab we could use  for that?  Then also sometimes if we ask questions about  positioning that will help the family.  So if we were to say  something like, what would be the best position today for  Johnny to play?  Maybe there's a
12:21:05 certain seat.  Maybe  there's a stander or a gait trainer they would like to use.   By them bringing up the position, that points us in the  direction with what equipment we would like to use for that  visit.
12:21:27 Okay.  We are trying to use what's in the home, just like  when we are doing our visits in person, we're trying to do  that with our virtual visits as well.  When we use what's in  the home, we build confidence in the families.  We let them  know that they have what they need to meet their child's  needs.  So ways we can do that are by asking, what
12:21:49 does your  child respond to in their home.  If parents aren't sure, we  can ask them what is your child responding to?  I've heard  things like he always responds to grandpa's orange cup.   Every time he picks up this water cup, my child responds.   We were able to build off that, letting them know, we can  find things in your home.  We can also notice
12:22:08 what the child  is paying attention to during the visit.  When we're doing  virtual visits, we have a more limited view on -- we can  only see what's in front of us on the screen.  I've had  visits where they are glancing away the whole time.  I  haven't been able to see.  If I was in the home, I could  say, it looks like he's looking at whatever
12:22:30 this object may  be.  In October, I had a little guy whose mom was trying to  engage with him and he was looking off.  She said I just put  out these new orange pumpkins for Halloween.  I said would  you mind grabbing those and we'll use those in the visit.   We can draw the parents' attention to that.
12:23:02 Of course, because what we do is pretty specialized, we're  always considering, are there things that need to be dropped  off at the home to supplement what the family has?  That  might be a toy or paper, things that children respond to  that maybe families haven't had experience with.  This chair  had recently been donated to this
12:23:25 family by another family  whose child had outgrown it.  This little one fit perfectly  in this chair, but she loves switch toys and was having a  really hard time playing with it.  Mom was trying to hold  it.  It kept slipping and falling.  So I love that Luanne  brought up the box desk.  In this situation, I just -- in  fact, I think I showed a picture.
12:23:51 I was able to show a  picture of a desk being used -- a box being used as a desk,  and gave the mom the idea.  On the next visit, this is the  setup.  She had it all set up.  They found a box and cut it  out to make it work.  It built the family's confidence that  they had -- even though I brought the switch toy in, even  though someone donated the chair
12:23:57 to the family, they were  able to make this work.  They were able to figure it out.
12:24:20 Okay.  The so now we just have -- these are just and screen  shots I've taken of our visits that show different setups  that the families have been able to use and ways they are  using a combination of what's in the home and what we've  dropped off.  So the top one we've got the play frame with  the slinky.  They are always popular.  Same thing for this
12:24:44 guy.  This is a switch toy that I dropped off at the home.   It does seem to be -- I know that different programs have  had different rules during COVID for dropping things off.   Stick with your program's rules.  We had been able to  sanitize toys, drop them off and ask the family to sanitize  them as well.  This guy is using a switch toy.
12:25:05 During our visits, as much as possible, we want to keep it  parent-child focused.  It's so easy for us to draw the  attention back to us.  I feel like especially virtually.   It's hard to read the room a little bit when you're not  actually in the room, when you're trying to figure out  what's going on in the interaction virtually.  I don't know  if
12:25:31 you guys, but I'm a talker.  I like to talk.  When mom  and baby start to interact, I like to say, oh, she's  listening to what you're saying.  Her body just stilled  because she is enjoying hearing your voice.  I found  especially virtually that it's so important if we can try to  keep our voices down and keep the attention between mom or  dad, whoever
12:25:53 is there, with -- so between parent and child.   You know there will natural be those breaks in the  interaction where you can give that feedback.  I'm not  saying don't do any feedback because it's so important for  the families.  This was just a beautiful day of this mom and  this little girl engaging with each other and I did not want  to interrupt
12:26:14 that.  I really liked -- and I pointed out to  mom when there was the natural break in the interaction that  I appreciated so much that she was focused on her daughter  rather than focused on me.  So we had the camera set up so  that I could see both of them, but they could truly engage  with each other.
12:26:39 These are some pictures from the same visit where, because  the camera was kind of set up back a little bit, mom was  able to completely engage with her daughter.  I was still  able to see what was happening, to be able to offer feedback  and give ideas, but she was really -- the mom was in charge.   She was leading this visit.  She was deciding what
12:26:45 to do  with her daughter.  She was taking the lead.
12:26:51 Of course it's always all about our IFSP outcomes.
12:27:19 We're always working on the outcomes.  We know those are  what are directing our visit.  During virtual visits, we  have to let families know we will figure out a way to work  on the IFSP outcomes.  I don't want them to feel like we  can't work on feeding or taking steps or we've even dust  visits at parks.  I wanted them to know whatever it is,
12:27:42 I  even did a bath time one to make a bath chair work.  So we  just want to reassure the families, whatever it is, we'll  figure out how to make it work.  It might be tricky.  It  might take a little bit of work, but whatever it is, we will  figure out how to make the IFSP outcomes.  We will figure  out how to address those even virtually.
12:28:05 Okay.  So now we've had this fantastic visit because all  visits are always fantastic.  But no matter what happens  with the visit, we've given the family lots of reassurance,  that they're doing a great job, and now we're kind of trying  to wrap up that visit.  We want to review what we did during  the visit.  We want to remind the families what we
12:28:35 did.  So  maybe something like, I really liked the way you used the  desk with the switch toy on top.  That was a great idea.   Let's continue working on that throughout the week.  Then  ask the family, when would be a time when that would fit in  with routines to work on this?  So the family has a good  plan
12:28:58 of how the things we worked on during this visit can  fit in with what they are going to be doing all day every  day.  If we are going to be dropping things off at the home,  we like to make a plan for that so they know what to expect.   I'll drop it off Tuesday morning.  I'll leave you a text  once it's on your porch.  Then we always want to confirm
12:29:19 our  visit for the next time.  Then we can talk about what the  family's going to be working on and then what they would  like to show us for that next week.  So if it is a family  that wants to have things prepared for the visit, they'll  know what to have ready and what to have pulled out for that  visit.  Everyone is different, but making sure the
12:29:43 families  have your e-mail or for me, text messaging works the best,  letting them know if you have any questions until then,  these are some good ways to get ahold of me.  Send pictures  or questions or whatever it is.  But we're fortunate that we  have been able to figure out how to still provide services  during such a crazy year and time.  The most
12:30:07 unique part of  that has been that we've realized that sometimes, because of  distance or weather in Utah, sometimes it's impossible to  get to homes because of snowstorms and they live in the  mountains.  Sometimes just because maybe an ongoing illness  or if a child is going to be having surgery and they need to  not be exposed to other people, we
12:30:28 figured out now, we can  have visits.  We want to, of course, do what we can in  person.  It's been so great to realize that we can have  effective interventions and effective home visits even  virtually.  Lynn is going to talk to us about the benefits  and challenges of these virtual visits.
12:30:56 >> Hi, everyone.  I'm wrapping up this training with  benefits and challenges of telehealth.  I can say from my  own personal experience, when we began doing telehealth a  little over a year ago, I was very scared.  I am not a tech  savvy person.  I had no idea what was in store for me.  I  never heard of Zoom, Google meet, of any of these things.   It
12:31:26 was challenging, but I have definitely felt that it has  been something that I will continue with from now on.  This  is a map of New Mexico and the different counties in New  Mexico.  One of the things that happened right away was in  the counties at the bottom of New Mexico, we have five  orientation and mobility specialists.  Even through  telehealth,
12:31:52 we were able to effectively make sure the  children in these areas were covered for orientation and  mobility.  The northern part, the gray and the purple and  some of the pink, we actually only have two orientation and  mobility specialists.  One of those had become our new  director and she had to reduce the amount of kids that she  was seeing.  So
12:32:22 with telehealth, we were able to Zoom in  with the families and the therapists in those northern  counties to make sure every single child who needed  orientation and mobility in New Mexico was getting it.  That  has been successful and one of the things I'm super proud  of.  Some of the benefits to telehealth, definitely the  co-visits with
12:32:51 the therapists across the state.  In the  picture to the right is one of my coworkers -- two of my  coworkers, and we were able to bring her in to help  translate the visit.  That has been super helpful because  otherwise, how were we going to interact with this family  with the language barrier that we had?  So that's definitely  been one of the
12:33:19 benefits.  The other thing is, not only have  we been working with people within our state, we're  developing new relationships with people even out of state  like the people we've gotten to know in Utah and learned so  many amazing things they're doing there and they can see  what we're doing here.  With my coworkers that I normally  didn't work with
12:33:55 in the north of our state, I've learned  from one to be quiet and to listen and to observe and to  really hear what the family is saying.  From another  coworker, I learned how to take whatever is in the home and  make amazing devices and scratch boards and all these  awesome things that I wouldn't have known how to do before.   The other thing is,
12:34:20 when you're meeting consistently with  your coworkers and other therapists, it is so much easier to  share strategies and resources.  Telehealth definitely  allows us to do that.  When I'm going out in the field in  person, it was usually by myself and maybe with another  therapist.  But I would say with telehealth, we're doing  that a lot more.  We're
12:34:49 sharing all of these great ideas.   We're sharing different trainings to attend.  We're talking  about different sites the families and therapists can go to.   We can share pictures and videos with each other and with  the family.  It's been brought up that we've had more time  to attend team meetings.  We've been able to attend more eye  appointments.
12:35:16 In our state, we have doctors in the northern  part of the state, not a whole lot in the southern.  So we  would have to drive three, four hours to get up to these eye  appointments.  Now we can be there by phone call or  telehealth.  So that's definitely helped us out.  We're  attending more IEPs.  We're attending more IFSPs,  transition conferences.
12:35:44 All these things that were  difficult to do before because of the driving, I can say  that without having to drive to different areas for visits,  of course it's given me a lot more time to attend these  meetings.  But even when I am going to be driving back to  visits, I can pull over, join a Zoom meeting for a  transition conference without any problems.
12:36:12 Because of  that, I'm finding that a lot of our teams are all on the  same page.  We all know what everyone else is doing.  We  have similar goals, which in turn really leads to better  services for the child and family.  One of the things that  our state has had the unique opportunity for is we have an  orientation and mobility program through one
12:36:36 of the  universities here in New Mexico, and a lot -- several of our  coworkers up north are in this program.  So with telehealth,  we can now Zoom in to their visits and provide the  mentorship and training to these employees while they are  working with the families, or they can Zoom in to our visits  and observe us and get the hours that they
12:36:43 need for their  schooling.
12:37:10 One of the -- some is of the other benefits to telehealth is  you can see here, we can share pictures and videos.  So we  can show pictures and videos to other families and they can  go, wow.  I'm not alone in this journey.  There are other  children like mine who are using a cane, using an adaptive  mobility device or have some sort of cognitive or
12:37:40 motor  issues, and I think that feeling of not being alone is  really beneficial to the parents and not only that, but  we're giving them ideas.  So in the picture below, I can --  if I'm starting to talk to a parent about an adaptive  mobility device, I can show them a picture or a video of  what that looks like and how it works.  They can go, I see.
12:38:08 I understand what that is.  Or if I'm working with a family  and how to introduce a training cane with their child, how  does their child hold it?  What does that look like?   Where  should they stand?  I can show them pictures and videos of  what that would look like so that they better understand how  to do that.  One of the unique
12:38:27 situations that happened with  one of the families I was working with up north is the  orientation and mobility specialist joined a visit.  She was  from if the school that the child was going to be  transitioning to.  She joined the visit.  So she got to see  what we were working on.
12:38:57 The parents got to meet her, and she talked about what her  expectations will be at the school.  So now the family and  that provider are getting to know each other.  So when this  child goes to school, that's a familiar face.  They know  this person.  They know what their child is going to be  working on.  It makes the transition so much more smooth.
12:39:25 Probably the main thing is, with telehealth, we have to  coach these families.  We have to have active parent  participation.  In these pictures of myself, I got looking  and I thought, wow.  I am the one doing the work with the  child while the parent is observing.  I can't do that  anymore.  It has to be me helping the parent to work with  their
12:39:51 child, and we all know actually doing something is how  you learn.  So that was an eye-opener for me that it's  really encouraged the coaching method.  That's the method we  know where parents really learn how to work with their  children.  Now I'm not going to say there hasn't been  challenges.  There has definitely been challenges to  telehealth.
12:40:21 In this picture, you can see New Mexico is a  very rural state.  We have a couple of big cities, and that  is about it.  So one of the challenges we had is we have  areas with no internet, really poor connection.  So some of  the things we've found beneficial is maybe they have a phone  and we can just do the visit by a phone call.  We can send a  text,
12:40:51 just anyway we can stay in contact with that family  and help keep them going.  Some local internet providers  will provide some assistance with getting a better  connection or they'll be able to share some hotspot  locations that these families can go to if they need to.  In  the case that a family doesn't have a phone or a computer,  we found that
12:41:19 there have been some assistive technology  loans.  So actually, one of the local libraries in my area  is loaning out chrome books and hotspots.  So putting  families in touch with these resources can be really  beneficial.  Then we just know families have been  overwhelmed with life during COVID.  Some of them have lost  their job.  They have their
12:41:43 other children home doing  homeschooling at the same time.  It's stressful.  Maybe they  are also having to work from home while they are managing  their school children and their little one that you're  working with.  One thing that is brought up is they have to  be flexible with the visits.  If a parent says it's not a  good day, we have to respect
12:42:10 that and say, can we  reschedule?  Or if you're on the visit and you can tell this  parent is just not into this visit, we can say, do you want  to cut it short?  Do you want to -- should we maybe try and  do a visit next month?  Just being flexible, reading their  body language.  The other challenge is, are we getting the  whole picture?
12:42:36 We have a small screen to look through.  We  may not be seeing that there really aren't a lot of toys or  books in the home.  Maybe their refrigerator is pretty bare  and we're not getting the family dynamics in the  environment.  Some of that is we are, at times, completely  relying on the family's report of what is going on and  especially
12:43:04 during evaluations that can be challenging  because we are trained to look for some things that some  parents may not understand yet.  Just like the situation  brought up at the beginning of the training.  Conducting  evaluations has definitely been challenging for me  especially with orientation and mobility.  If we are on a  computer or phone inside
12:43:29 the home, I'm getting a very  limited view of what that child can do.  They are in the  place they are most comfortable, an environment they are  very familiar with.  But I want to see them in other  environments, how they are doing outside, how they are doing  at a park, how they are doing in environments they are not  as familiar in.  So that's
12:43:54 some of the challenges I found.   Those personal connections are definitely easier when you're  in person, and you can pick up all of those cues the parents  are giving you and can you're right there and talking to  them.  Whereas sometimes on a computer screen, that's more  difficult.  Some is of the families maybe are more  disconnected.  Just remembering
12:44:17 that always taking that time  to check in with these families and make sure they are doing  okay.  Then, of course, it was brought up, some families  have requested that everybody join all the therapists join  once a month because that's all they can handle at that  time, which, of course, can be really challenging because  you've got four or five
12:44:21 people trying to give the family  ideas on what to work on.
12:44:50 Okay.  So we've been talking with, of course, our agency  here in New Mexico, what is telehealth going to look like  from this point on now that we're getting back out into the  field and we're starting to see families in person?  How  will we continue to use telehealth?  One of the things we  decided is we're definitely going to continue it
12:45:14 for  meetings, trainings.  That's less drive time.  When I can  join in in just a couple seconds for a meeting rather than  drive three hours to get there, I'm going to do that.   That's definitely something that we're going to do.  Bad  weather is brought up.  We have no reason to cancel now for  bad weather.  If there's a storm in the northern part
12:45:39 of the  state, we can just Zoom in and have that visit as planned,  which, of course, means less cancellations and rescheduling.   One thing we found is, we're going to continue a lot of our  agency trainings by telehealth.  We have found that's been  super successful.  We can Zoom in one or more agencies and  give them the training, or if they have
12:45:46 new staff, we can  take some time and train them.  With telehealth, that's  going to make that possible.
12:46:13 I had talked about that we have several people in school for  orientation and mobility.  We're going to continue that  mentorship.  We're going to continue to give them the hours  they need to get their certificates and graduate.  Also,  we're really lucky in that several of our staff members have  really good knowledge in certain areas.  For example,
12:46:42 we  have a meeting every Monday at 2:00 for cortico visual  impairment.  We'll be able to continue that in staff  training by telehealth.  Of course the one thing I talked  about is we really want to continue to promote the coaching  method with family, whether it's in person or by telehealth.   Telehealth has really helped even me to understand the
12:47:07 importance of doing that.  We're definitely going to  continue co-visits.  We've already planned if I have an  orientation and is mobility visit with a child in person,  I'm going to Zoom in the vision specialist and we're going  to work with these families on the co-visits.  So I  definitely see the telehealth continuing with the co-visits  in
12:47:08 collaboration.
12:47:32 The other thing we thought is, what a great option for these  families to always have when they need it.  If their family  member is sick, if they have a medically fragile child or  can't meet in person but they want to do the visit by  telehealth, this could always be an option for them.
12:47:47 What we're going to show right now is a video that kind of  summarizes the -- just what we do and why we love what we  do.
12:47:50 >> I'm Heather.
12:47:55 >> I'm Maddie.
12:48:21 >> When Maddie was younger, she was having severe balance  issues, and she couldn't walk until she was 18 months.  On  recommendation from her pediatrician, we took her to  an occupational therapist and had her evaluated by that and  a physical therapist.  They decided we needed services for  her gross motor delay and fine motor delay.  It was going
12:48:53 to  be expensive to go to occupational therapy once a week, and  we would have found a way to do it, but it was daunting.   But this occupational therapist referred us to DDI vantage.   It's an early intervention program, and they help with  things like this.  They help with all sorts of developmental  delays.  So we had Maddie tested in the beginning
12:49:25 of March,  and she qualified for services.  Then everything shut down.   She has had her services throughout the pandemic mainly  through Zoom.  At first, I was hesitant.  How do you do  occupational therapy over Zoom?  What does that look like?   How do you even function in that capacity?  It was a  learning curve.  I'm not going to lie.  It was me
12:49:50 holding my  phone, chasing her and, but there was some unexpected  blessings from that because I had to lead out.  I had to  listen to my team, and take what they were saying and use  what I had in my home and our own toys and our own supplies  and do her therapy.  What this did for me was helped me to  integrate it into our everyday life.  I got my
12:50:20 other  children involved.  I have four other daughters, five  daughters total, and they helped a ton in helping Maddie  with her gross motor skills, jumping on the tramp, helping  her to walk, playing with her, rough and tumble.  We pulled  in the PIP, which is the parent, infant program from the  deaf and blind school.  They were able to help us with
12:50:45 her  orientation and mobility and her perception.  They had been  running into things.  She couldn't even walk across the room  without falling over something, into something.  She was  very unstable but also we wondered about her depth  perception and peripheral vision.  The PIP program was  amazing.  So I had an awesome team.  We had our occupational
12:51:10 therapist, and then we had two people from PIP, which was  such a blessing.  With this team, we were able to help  Maddie so much.  We were able to build relationships.  They  knew my daughter.  My daughter knew them.  She would try to  feed them food on Zoom.  She would hold it up to the camera  and try to feed them food.  She totally was interacting
12:51:42 with  the team even when we had to be on Zoom.  She grew in leaps  and bounds.  They can run.  She can jump.  She can kick a  ball.  You wouldn't even be able to tell that she had as  many delays as she had.  It has been such an amazing  blessing.  Even during a pandemic, even on Zoom, I've been  so impressed with the providers.  That's a good idea.
12:51:44 I  love that, Heather.
12:51:45 >> That's a great idea.
12:51:48 >> I wonder if you need us anymore.
12:52:13 >> I know.  Right.
12:52:49 >> I just wanted to see if we have any closing remarks from  our teams from New Mexico and Utah before we wrap up.  All  right.  Again, I just want to give a lot of gratitude and  big thanks to New Mexico school for the blind and visually  impaired and Utah school for the blind and visually  impaired.  This has been great information
12:53:04 and great  strategies, and I have a new list of resources to use.  So I  appreciate that.  There's been a lot of good comments in the  chat, too.  All right.  Let me go ahead and can give closing  announcements and make sure you all have the code.
12:53:41 So today's code to close is 051321.  I will put that in the  chat so that you all have that.  So again 051321.  I am also  in the chat put a link to our coffee hour page since you all  registered to be here today, you should be able to find that  without a problem.  But that is where you can go to find the  archives to watch our previous coffee hour
12:54:05 sessions and get  the resources and chats, handouts, and transcripts for those  sessions.  Just want to let you know that on May 17th,  Monday, next week, our session will be genetic testing and  emerging gene therapies for people with inherited retinal  diseases with the foundation for fighting blindness.  On May  20th, next Thursday, we will
12:54:39 have Christine Roman doing a  Q&A.  Then on May 24th, we will have an OT review of  sensory processing with Lisa rickets who is an occupational  therapist.  You can get registered at the coffee hour  website.  Just want more time on that code, 051321.  You'll  enter that in on the evaluation.  That's what will  generate  the certificate.
12:55:00 Just to let you know, we'll be making  announcements shortly.  Pay attention to social media, our  Facebook page.  We also share on a couple forums on  Facebook.  We're going to make an announcement for what  coffee hour will look like next year.  We'll be continuing.   We're going to make some changes to the schedule.  So we'll