TRANSCRIPT - TSBVI Coffee Hour: Teaching a ChildŐs First Teacher: Adult Learning in Early Intervention -3-3-22 >>Paula Landry: Thank you. I am Paula Landry, a teacher of the visually impaired. I have a daughter who is blind. I can't believe she's almost 20. Time goes by fast. She was born blind. That is how I got into this field. I worked at Aker for about ten years and about six years ago with Steve and another colleague of mine, we started a shared vision here in Colorado so we could focus on specifically early intervention and providing services for children in their homes. >>Steven Lindauer: It is great that Paula is here because she is clearly the subject matter expert, the smartest person in the room between the two of us here. So I'm Steve. I'm one of the cofounders. I come to us more from the business side. I'm a change management consultant, human performance consultant. A company you may recognize by name is Accenture. I was there for quite a few years as competency lead for their human performance practice. I'm also a merged management associate. I mention that because we'll get into that as we move later into this conversation. It's really going to be a conversation. That's much of what we want to do here is to talk about this from an early intervention perspective, talk about this from an adult learning perspective, from my historical background and hopefully have some interesting challenging conversations as we go through this. I pulled some data and I appreciate all of you that filled out that presurvey sent out a couple of days ago just to get a sense of who is there. I think we had 90-some people respond as of this morning to that. And you can see the disciplines that people self-identified. The other thing that was a key question for us -- and I need to hide this part and I can't see my messages here. I don't know how to do that. Is how many of you are actually providers. About 74%, 75% are providers in early incident er vengz with families. So this adult learning piece becomes very, very important. Objectives for the meeting today, there are a couple of them here that are listed. There's one that is specifically not mentioned. First we want to help expand your knowledge about adult learning. Really would love for you to find some frameworks that you feel are interesting, value tools, techniques that you can leverage in early intervention. Third point is improve your ability to build caregivers' capabilities. And we will talk more about what capabilities are and how we are calling them out to be their child's first teacher. So you can understand and break down exactly what you're doing in the family's homes. The one thing that is not on here is we are not providing solution. We are not going to give you the answers of how you approach this in your home. It's up to you and the families you work with, but it's up to the state you work in, the country you work in, the agency that you work with. So there is not going to be answers here as much as there will be insight and information and hopefully we'll create a bit of a dialogue around what is important. Paula, when you if I first started this conversation, I come to this with six years of sitting at your knee and with the teachers that we work with learning so much. But don't have the background, the history with this. And one of the very first things, Steve, we talk about adult learning, you're talking about this in the context of these foundation pillars. So family-centered practices, child's learning, the natural environments and the quality teaming are not going the be addressed As we get into this today because we want to isolate very specifically on adult learning. So as we've talked about this, they all intertwine, but -- and it's hard to separate out. But as we're going through this and want to talk about adult learning, we're going to try to stay focused within that as much as we can. I think this was even in what we sent out to try to gauge some interest in the training that we did today. This idea, this quote, the real impact of early intervention occurs after the provider leaves the home. It's not what we do as providers. And I'll go back and forth by saying we and you. I can't help it. The impact is with what the caregivers do with their children to support their children, it's not what we're doing. We're enabling those parents to be successful. One of the comments that I constantly hear from everyone in early intervention and very much from our own team is this point that parents are the experts of their children. It's from Dr. Braiselton and his colleague, Dr. Sparrow, as well. If you look at the quote, it's not about experts of their children. It's experts of their children's behaviors. So it's not that they're experts in everything. And this may be something that's scratchy, a point of contention to some extent. Because it may go along against some of the philosophy that we have always, always heard from our organizations and, for example, here at EI in Colorado. The second thing he says is each practitioner is the expert within the context of their practice setting. So we have parents that are the experts of their children's behaviors. And teachers that are experts within their own domain. They need to come together in a collaborative way to find out and do what's is best for their child. There are times when parents just aren't the experts. They don't know. This comes from Donald Rumsfeld and others that have introduced it that there are unknown unknowns. There are things that we just don't know we don't know. We're not aware of them. We don't know what we need. So when we think about providers working with parents, we have to be willing to say to parents and to work with parents, you don't know this yet, you don't know that this is important for you yet. You don't know that these are skills that you need to acquire yet. And you may say it differently. You may work with them in a collaborative way, but there are going to be things that you have to bring to them that they're not aware of. >>Paula Landry: True. I think Steve and I, just from working together for the last seven years, we have had many spirited debates about this topic. Again, just because he has this perspective from the business world learning about -- or teaching about and understanding adult learning and this really, for me personally, and I think a lot of my colleagues, even though it is one of the five pillars of enter intervention, we don't spent a lot of time talking about it or thinking about it. So that really is sort of how the format of today came about was based on our conversations and debates back and forth on this. >>Steven Lindauer: And our dissonance. So this is part of the learning process. Dissonance is the first step of learning where you're challenging in a conversation -- if you're open for learning, you're often challenging your historical mind-set, what you learned previously, what you thought you'd been told, what you have been told, how research evolves and changes your perspective. But you and I constantly go through this and our other co-founder, Stephanie, we go through these debates, discussions, sometimes rather vocally because we don't always agree with each other on this. So we're creating some dissonance between us. Quite frankly, I hope that this conversation we're having today creates some dissonance for you all, as well, that this isn't just more information that is in line with everything that you've heard before about working with caregivers and the adult learning concepts. So the presentation itself, we have this agenda so that you understand the road map of where we're headed. So we've just gone through the welcome. We're going to get more into a little bit of a context about adult learning, talk specifically about caregiver competency and talk about adult learning principles. We haven't always been taught that much about adult learning. We'll get into those frameworks, the strategies and principles. Then get into knowing your audience. No matter what you know about adult learning, you have to relate to the caregiver Then leverage heavily on Paula's knowledge about the applied learning principle Wes caregivers in the home to gain their confidence and some best practices. So that is the schedule of the agenda of what we want to go through this morning. One of the other comments, and we first shared this and she said, Steve, you can't forget that there's other external factors affecting adults, parents, caregivers, brothers/sisters working with the children that we're working with. Absolutely right. This is a framework that talks about risk factors that are societal, with the community, and for the purpose purposes of adult learning, we are not going to change what is happening from societal perspective at that point in time at that moment. We may want to influence. We certainly have to recognize, but we're not going to be able to change it. It's gravity for us. It's just there. Similarly, knowing what is going on in the community and the supports and structures that are there can be part of that solution for the family, but when we're working with the caregivers, it's really about the family. It's about those caregivers. Again, we're taking them, recognizing there are other factors at play, but we're focused on care. >>Paula Landry: And I feel like we already take these things into consideration when we're in families' homes and working with them. On any given day, there are a million different factors that go into, you know -- that come into play for each one of our families. And I think that's sort of, you know, the beauty of early intervention. These are things we already take into consideration, so with all of this being said, what we want to talk about today with adult learning strategies, we really will be under the assumption that these things are already sort of addressed and obviously in the backs of our minds. >>Steven Lindauer: In the backs of your minds, right. You are recognizing that and working with the families as part of their context. Triadic strategies is something you brought up to me. This is a concept that you all work with early intervention are already aware of. But for the purposes of adult learning, we're taking that triadic strategy, making it very top to bottom. The reason for that is we're focused on the outcomes for the child and recognizing that our vehicle to that child is through the caregivers. So, in turn, what we are influencing at the bottom is we are those providers that are supporting those caregivers. So the caregivers work with their child and what they do and how effective they are then influences our developmental goals achieves or are they delayed. Because the caregivers aren't doing -- either they don't have the right strategies or they don't have the right capabilities, the competence so support that child. So when we are in the home, we're focused on interventions to improve the developmental outcomes of the child through those caregivers. And, in turn, what we're doing is really focusing in on the interventions that build the competence of those caregivers themselves. So that child, caregiver and then us as providers at the bottom. >>Paula Landry: I think about, again, being a provider and, you know, we can have the best relationship with kids. We can know -- we can have the best skill set and all the knowledge in the world in working with babies, but if we are not providing the information and the support to parents in a way that makes sense for them, it doesn't really matter what our skills are as much with the children >>Steven Lindauer: Absolutely. >>Paula Landry: As it does with the parents. So for us to be effective, we really do need to meet the needs of the parents and the providers. >>Steven Lindauer: So what then means is looking at the competence of the caregivers. And this can be, I think at times, you and I have gone through a debate. Is this something explicitly good that we want to talk about? I don't know, you've said you can feel judgmental about this when we talk about it. Are those caregivers competent to support their child along their journey? Paula, again, you've talked so much about the experience and I've learned so much from you as a parent with Maddie and as a teacher that what you have learned -- and we focus on early intervention. But your journey continues as you're looking at colleges, as Maddie is thinking about her transitions, there has not been anyone there who has necessarily had that. It's been a journey and it's been -- well, I think for all of our parents, recognizing that there is this larger context that we're operating can be challenging, difficult. >>Paula Landry: And I think that goes back to what you have said previously. The unknown unknowns. We don't know what we don't know. You're right, talking about caregivers competency does not feel good. We are so used to focusing on the positive and what they can do and so when I hear those types of words, it does rub me a little bit the wrong way because it feels a little bit negative. >>Steven Lindauer: But we're going to get into that. >>Paula Landry: We will. It really is, again, recognizing what the knowledge base we have from our field and what information we need to share with the parents that they just don't know yet. >>Steven Lindauer: And that's one of the questions that we asked in our survey. We asked you, do you know of a road map or framework to help guide caregivers along their journey? And 86% of you all responded, again, 97 of the people filled out the survey. 86% said no. I find that fascinating that we don't have a larger context. And those that did say yes, some of them share that overtly, explicitly with the caregivers and many of them don't. That means as we're engaging with our families, most often we don't have this larger road map in mind. Again, I asked the survey in a very specific way. But we've talked about this. We don't have a framework and I don't know that EI Colorado, our agency that we work within, has an overall framework. So we kind of came up with our own. This started from an early education teacher. They had their skills, knowledge -- their knowledge, skills, behaviors and attributes that they were looking at. But if you think about the things that we have to help parents navigate or at least recognize that parents are self-navigating, so about their child, about early intervention strategies, there's a content area that we help them with. How do you teach your child? How do I as a caregiver assess my child? What do I know about early childhood development? Working with all the various providers in and out of my home, thinking about the health and safety of my child who may be medically involve. And then even the physical environment to support them. And self-care. How am I navigating that? You've talked about this, the recycle that caregivers go through at multiple stages, not just with the initial diagnosis. So there's all of these things that our families are going through and we focus in on that bottom right very often. We're thinking about what can we do in the home to help with specific strategies. >>Paula Landry: Right. And, again, I feel like this -- all of these things and this certainly isn't -- doesn't cover everything. >>Steven Lindauer: No. >>Paula Landry: We've missed a lot of things. >>Steven Lindauer: Absolutely. >>Paula Landry: But, again, when we're planning our visits and thinking about, again, visual impairment and strategies and what specific goals are we working on this week, all of these things still come into play at some point during our visits. Maybe not every visit, but at some point. Are we prepared to talk to families about these things? And, again, knowing sort of what the balance is, what information do we share, what are we responsible for sharing or pointing them into another direction so they can get this information? >>Steven Lindauer: Yeah. Just to help guide them as to how to navigate all of this. Another key component are stages of competentess. So as we work with caregivers and their competence level, unconscious incompetence. I'm aware of the importance of it but I'm not capable of supporting the child in that way. The conscious competence, I can do it when you're in the home with them, I can do it when you've given me some things to support that process. But we're hoping to develop a level of unconscious competentis where it's reflexive for the parents. They do this in a reactive instintive way to support them. And I've added a fifth in here because you in particular fascinate me, Paula. Your skills with Maddie, your skills as a teacher, you just do things. You just do it. And sometimes breaking it down and thinking of it as a teacher of how to be that master trainer, here is what's going into my mind, how I do things, all of those steps are a component where you need to break down and make that available so that you can teach teachers or you can think apply that with other caregivers or other providers as you're, woulding with them. >>Paula Landry: I think a lot about this can, again, in the context of our talk and our discussion today, we are talking about how we interact and use adult learning strategies for teachers. But I feel like -- and I hope that you will also find as we go through this -- that this is also sort of about us as providers and us as adult learners ourselves. And sort of, again, where we are on this continuum when we're working with families. >>Steven Lindauer: And finally when we talk about competence of caregivers, it breaks down specifically into knowledge, skills and behaviors. Sometimes you'll hear knowledge, skills and attributes. It's a term that's generally accepted. It's things that I use when I go into my clients in the business world, how do they get their workforce to do something? Caregivers are there to be the caregiver of their child. They need knowledge. They need to know things. What is known in a particular field, the facts and information. Thinking of the questions for them, what is it that I need to know as a parent to support my child? Then there's skills. It's the ability to do something well. I can do it effectively. I've got the knowledge and I've got the skills. So what do I need to do to support my child? Finally, the motivation to act in a way that's appropriate based on the stimulus on the situation. So this gets into, when you go into a parents' home, they've got the knowledge and skills, but they're still not doing it. Maybe it's the motivation, the why, maybe it's all the distractions, but they're not exhibiting the behaviors that are critical for their child' development. So as teachers and therapists, we're there to help them get the knowledge, get the skills, but build and acquire the behaviors so that they do it instintively with their child. >>Paula Landry: I think about those behaviors and specifically about the motivation. Years ago, when we had ISP meetings, we would sit around in those meetings and we would identify the goals and the reason there's been a shift in that with parents identifying goals and concerns and priorities speaks to that exactly. The motivation. If they don't have the motivation to learn, why are you here? What are we doing? >>Steven Lindauer: And they're not going to be there to support their child in the way that's needed. So a couple of key takeaways. Remember to be thinking about that caregiver's journey and the context of what we're supporting them. So we do the handoff and transition. For those of you that support children, birth to whatever age or you pick up at 3, that Those parents are on their childrenny and help them on their journey. Seek to help them become unconsciously competent. Think explicitly about knowledge, skills and behaviors to support them. >>Paula Landry: Steve? >>Steven Lindauer: Yeah? >>Paula Landry: When I think about those takeaways, again, I think about we don't -- it does feel scratchy to think about a parent's competencies. But we are already sort of making assessments of our families when we walk in the door. >>Steven Lindauer: Absolutely. >>Paula Landry: And whether it's a teen mom who has no experience and is, you know, obviously this is her first baby versus, you know, an older well educated, you know, mom who is a teacher and this is her fourth child. So just the level of knowledge, education, understanding, again, that speaks to some of these competencies. And, again, while I really -- that word doesn't always sit well with me, I understand where -- why we use it. And, you know, how that does play into what we're doing. >>Steven Lindauer: And I love your example, too. You he even made an assumption about a teen mom versus an older mom. >>Paula Landry: You're right. >>Steven Lindauer: But you think about it, the teen mom may have had the exact perfect role model. Her parents, her grandparents raised her in a way that she is now a robust, effective mom, versus the 44-year-old that may have had very bad role models and may think that she knows everything and doesn't. >>Paula Landry: Very true. >>Steven Lindauer: So you have to be able to be willing to challenge your assumptions and really evaluate, assess what that parent wants and what their needs are. And in a very EI way, we're collaboratively emotionally supportively to help those parents make their target competencies. Not your target competencies for them, but their target competencies for themselves. But they need your help. Again, they don't know what they don't know. So jumping into adult learning principles, there's a lot in here. And there is kind of an -- it's kind of a mishmash of alphabet soup on this. But I often see what we do in early intervention distill adult learning in those five pillars when we provide training. This is a direct quote from early intervention Colorado, and this is what is provided. These four points and another paragraph of information about adult learning. That's about it. That adults learn best when they're actively involved in the learning, that they have leverage their real life experiences as a basis for their learning. It's immediately relevant to help themselves and to help their child and that it's practice centered rather than content centered. So we want them to have the skills to do this. That's the adult learning training we get. So I ask from that survey is to how much adult learning training around strategies and theories have you all received? This is the response. We've talked about that. This wasn't surprising, right? >>Paula Landry: Yeah. I think I was more surprised by 14% had a great deal. I thought that number was higher than I expected, honestly. >>Steven Lindauer: But we think about our programs, but then we think about how we do continuing education and how we do work within our agency so support that, as well. So nearly 40% have some, which is great, but 46%, nearly half have little to no training in the theories and strategies. So what that means is we are taking someone else's guidance framework and saying, here, do it this way without understanding where we're doing it that way and without understanding how to, then, be nimble and make and adjust what those parents' needs might be. >>Paula Landry: What helps me is when you talked about those four key points about adult learning, in the field of blindness and visual impairment, we talk about those four points a lot with regard to a child's learning. >>Steven Lindauer: Uh-huh. >>Paula Landry: And it has to be hands on learning. It needs to be relevant, they have to be actively participating in it. So that helps me personally sort of frame it as what types of materials or how do I need to present things for families. So it is meaningful, it is impactful and they can be engaged with that learning. >>Steven Lindauer: So with our goal here to Troy to provide a little bit of that background, so for those that have had little to none or some, we're going to cover thigh through these five chef Rons here, adult learning theories, adult learning strategies, learning frameworks, learning styles and learning activities/experiences that you can bring into the home. So this is all background. This is not telling us what we need to do. That's where we get into how do we apply this to early intervention. So this is more of the background stuff. With that said, you know, I've said before that expression of don't let perfect be the enemy of good. We're not trying to find the one right strategy/framework, whatever it is. We're trying to give you the tools that you can put into your toolbox that you can bring into the situation to know how do I help those caregivers, how do I teach those caregivers, how do I engage with those caregivers to think about their competence, both where their targets are and a realivic view of where they're currently at. >>Paula Landry: The other thing I hope is that through this, that we can all identify things we're already doing that we may not have realized we're using adult learning theories. So I hope this will be validating in some ways like, oh, okay, I am doing that. And, again, maybe we didn't recognize these were, you know, key features of adult learning, but we are using it, maybe just that not as intentionally or explicitly as we should be. >>Steven Lindauer: I'm going to do a very short story about that. One time we were in a meeting at one of our boards here in Colorado and the conversation got diverted about the specific need for one of the people in the room because their daughter was about to have surgery for vision. And you talked through that in a very caring, emotionally supportive and providing great information for that. And I'm there listening going, oh, that was super easy. You did it great. But then Stef afterwards, she pulled me aside and said Steve, do you realize how nuanced that was, what Paula did. That is breaking down your reflexively unconscious competent style. Stef was able to help me understand, this is what Paula did there, how she communicated with that parent at that time. So we're hoping you can take this and apply this to the tools that you're already using, already doing. I hope there's some dissonance in here and I hope there's some questions around what am I going to do with this? So there are adult learning theories that you can choose from. The Andragogy is like pedagogy. Andragogy focuses more on adults from an academic perspective. We do a lot of Internetal learning. Transformative is thinking more about your underlying beliefs. Self-directed learning is when parents don't have a guide to help them. They then have to do it themselves. So a lot of our caregivers are going through that. And project-based learning can be when you are working on a project to support you through this. Now I'm going to -- there would be a couple of slides in here every once in a while where this is going on highlight. There's a packet of material that you can download that we're calling handouts and early performance support for you as providers for you to think about. But this one talks about the adult learning they're ryes, a summary and what is best. So from the theories now, you get into how does that work from a strategy perspective? What do I do? One is setting goals. Caregivers are going to set their own goals. This is where your influence and how effect.ive you are as a provider come in because you need to help them potentially readjust those goals. Are they focused on the right goals? You think if the ISP you've gone into and thinking that is not exactly the goal that I would be thinking of, but that's true for the parents and we oshg with that. But we still have to adjust to make sure we can focus on the things that will have a larger impact for their child. Discussing their why. What is going to be that motivator? What will be the reason that they continually come back and listen and invite you into their home and be focused on learning these techniques, support strategies for their child? It's their why, what is motivating them personally for whatever reason that might be. Reviewing information regularly, we'll talk more about why this is so important, but we forget what we learn. And you have to find a way to help parents remember what they're doing, but repetition is so critical in working with caregivers. And then finding a multitude of experiences. We kind of have our favorite tips and tricks, the way we like to teach things. Often based on what we have learned, the way we've learned ourselves and what our own preferences are, but we have to do this in a way and mix it up in a variety of ways that you're engaging those care give sxers checking on different neurons that are going off in their head. Keeping your lessons relevant, telling stories. I actually do this all the time, to not only engage with the caregivers, but our other teachers. When we're in meetings with foundations and potential financial support opportunities, tell stories that are meaningful and relevant and for caregivers, understand what other families have come from, what they've been to go through. Those stories are critical. >>Paula Landry: When I'm thinking about these adult learning strategies and how I implement them or need to be better about implementing them, what I think about is the parents of families that I haven't been getting my point across in the way I need to. This helps me reframe things to think about what am I doing wrong? It's not necessarily that I am -- that the parent doesn't get it or they're not interested. It really could be that I am just not meeting their needs. I'm not expressing myself in a way that makes sense to them or, yeah, that they can remember and put into practice themselves. So keep in mind how we play a big role in that. We are half of that equation. >>Steven Lindauer: Yeah. And being willing to be self-critical, to really understand am I doing the things -- again, I've heard other teachers talk about it at times. There are families that can be difficult. Is it that the families are difficult or we're just not finding a way to really connect with them in the right meaningful way? Breakout information, avoid cognitive overload. So helping parents, caregivers, break that task down. There's a lot going on in their heads. A lot going on in their minds. So helping them with those lessons in the appropriate structures, providing feedback in the moment of need. Paula, I have said this one so many times. This can be probably one of the most frustrating things when I say that you have to be willing to give negative feedback. Adults learn best through their mistakes. You talked with me the other day about how that feels uncomfortable for you. So I went out and did some more research on that. There is a boat load of research out there. And in the sports world, and I like to come up with my game films, the reason we do game films, people need to see what they did wrong and they need to understand that it was wrong and here is the impact of doing that wrong. So you may need to frame it. But you have to be willing to help caregivers understand when it's just not wrong. >>Kate: Steven, this is Kate. The good news is this is all interesting and people are learning a lot, but we have a couple of requests if you can slow down just a little bit. >>Steven Lindauer: You know what? Paula just gave me a little note that said that. Thank you so very much. I get excited about this. So I will do my best. So, Paula, about that feedback, being willing to give what could be perceived as negative feedback to caregivers. >>Paula Landry: And you're right, that is very difficult for me, being able to offer anything that I feel may be perceived negatively or hurt somebody else's feelings. So after discussions, it's self-reflection. Thinking about how you can do that in a way that feels comfortable for you in that moment. Maybe it's not in the moment. Maybe it's at the next visit where you can say, you know, I was thinking about, you know, what we talked about at our previous visit. What would you think about or -- there's different way toes approach giving negative feedback. So, again, just making sure you feel comfortable in the way you approach it. Yeah, so it doesn't become awkward and uncomfortable for everybody. >>Steven Lindauer: A young child's brain really responds to positive feedback. They want to do what is right. They model what is right based on what they see. Adults need to know and learn from their mistakes. And being willing to help call out those mistakes in a very appropriate way. Maybe the material visually stimulates. So think of a variety of ways that you do this. We'll get into more of this later on, but having the auditor conversation, the conversation with someone is not always enough. Drawing pictures, even stick figures as you're working with people, giving them something to look at. And I think you do this all the time, the modeling that you show, the visual aspect is so critical. >>Paula Landry: Right. And even Kate just now interrupting, thank you, Kate. Hey, we didn't perceive that as negative, but it could have been. Steve, you handled that so beautifully. Hey, Steve, in the moment, let me offer you some feedback and how quickly you can adjust. >>Steven Lindauer: Absolutely. Encouraging questions and discussions. And we'll talk again later on in items of different types of personalities and behaviors with this. Sometimes people just don't ask questions. And you really need to prompt. You really need the take the time. Just like wait time in the BVI world. Wait time with caregivers is as equally important for a lot of caregivers that we're working with. >>Paula Landry: And when you're in the homes, too, when you ask a question, sometimes we feel like, gosh, we're only in there once a month, a couple of times a month. We have a lot of information we need to pass along in a really short amount of time. So sometimes we do feel a little bit rushed. Making sure that you are taking the time, just feeling comfortable with a little bit of silence, which will allow parents to sort of process in their own time and respond the way we want to. Again, another parallel with, you know, strategies we use for our kids. >>Steven Lindauer: Absolutely. And knowing yourself and being comfortable with that wait time is challenging. And we all know this. Be flexible. So whatever we're going to talk about here today, adult learning recognizes the critical need for flexibility and working with families. Going where the family goes, going where the child goes, but not -- don't let that be the excuse for not planning and not doing things that you know need to be done and you need to help the parents with. Be flexible in how you approach that. So what Paula and I just went through, there's another handout for you, another performance tool that articulates these. I think on all of these documents, if you want to know the source where I got that from, they're on those documents, those handouts for you. Now moving into frameworks, for me, frameworks -- by the way, is my pace better now? >>Paula Landry: Yes, thank you. >>Steven Lindauer: Thanks, Kate. Frameworks for me are visual images that I drop down in front of me as I engage with someone, engage in the topic. There are frameworks that help me remember key pieces, principles, knowledge components of what I -- how I need to be reacting and engaging. So one of these is called the forgetting curve. This is not anecdotal. There's research that adults, people, forget 80% of what they've learned, what they've heard in a 30-day time frame. Think about how much you share with caregivers. Particularly if you're working with them once a month, you don't have that opportunity for repetition with them, the need for repeating and repeating and repeating, that's, in fact, the guide that goes along with this is the importance of spacing out and providing repitive information, interactions, opportunities to learn, activities, so that they can then not forget everything, all that really good stuff that you're bringing into the home. >>Paula Landry: In any one given day, we might share the same strategy across three, four, five different visits with families. And think about, my gosh, I've been saying the same thing all day for each of these families. So we do feel like we repeat things over and over and over again. But, again, to this point exactly, remembering that even though we say it a million times, our families are only hearing it once, maybe twice and so, again, the importance of repeating, reviewing, going back to, hey, we talked about -- whatever it is. Hand under hand, whatever strategy it is, a month or two ago. Let's revisit that. How is that working? What questions do you have? Let me remind you of things we talked about. Again, not in a way that you say you just aren't getting it, but in a way that, hey, I want to make sure you understand and I'm answering the questions you have. >>Steven Lindauer: It's almost better to have them say, Paula, I get it. I've said this so many times, I get this one point. But don't assume that they are getting it. And I think that's exactly right. It's not only repeat, it's giving them information in a variety of on different ways which, again, we'll talk about in a little bit. Blooms taxonomy is one of the frameworks that I really like and it's extremely relevant in understanding how people build knowledge over time. That we start with that remember and understand. We move to the apply and analyze and finally to evaluate and create. It's not that it's -- it's not that you focus in on or just do one technique to -- because you could jump into application right away. And allow failure to occur. So allow learning to occur. But recognize that you have to help them with basic information that they can remember, the facts and basic concepts, that they can then, they themselves can demonstrate to you that I understand by explaining those ideas and concepts back to you. So as you think about your objectives, you have objectives at each level of the Blooms taxonomy as you go into caregivers. You want them to apply that knowledge in skills and applications. And finally, I can make judgments and is this even working? Is this the right thing to do and creating the new solutions on my own? We don't have to create master level competence in these caregivers to go out and teacher other parents. They have to be sufficiently competent to support their child. So understanding the blooms taxonomy and the objective gives you the anchor point of where you are providing targeting your training at that point in time with that caregiver. >>Paula Landry: I remember way back several years ago -- I don't want to say how many -- in college learning about this in psychology classes. You think about it and you learn it for class and then, again, as you've brought this up in our discussions, this has been helpful just visual for me to sort of, again, think about that. You're right, parents don't have to be at a master level, but where do we want them to be? Sometimes they don't even have to apply a strategy. They just -- we just want them to understand or, you know, any topic. Maybe it isn't even a strategy. But the understanding piece sometimes even more -- sorry, in addition to more not in addition to the application. >>Steven Lindauer: And, again, another handout for you. We're full of handouts. We hope you'll use these as you carry them through. This one happens to be blooms taxonomy verbs. If there's things you remember them to remember, understand, apply, analyze. These are things you can put into what adult learning situation you're in. What we're talking about here is relevant for us with caregivers, but it's relevant for us with other providers. And it's relative for us within our agencies. And it's relevant for us with our partners that we have. So this can help you think about what are the verbs that go along with what it is I want to teach and being able to create the experience, the teaching experience to achieve that objective. We talked about dissonance at the beginning of this. And it comes from Taylor and Handry. Specifically, this is how people learn. Often it is going to be dissonance. What you are presenting to them is different than the way they appeared around the world in the past. So they have to reflect, say, okay, I get it. I can understand. I can take that and organize it in the way I need to be thinking about it. I can experiment and ar particular Utah late so I can consolidate it down and refine even further and build furthermore knowledge on top of that. And going into the dissonance cycle yet again. Again, I hope that this may -- some of the things that we're going be talking about would create some dissonance. So that means there is learning that is actually occurring here. And as you and I continue to go on, as we talk within our team, there will be times when teachers are just going to say, Steve, I just don't agree and here is why. And we've got to get through that and understand what is the basis for that and say is that middle ground or where do I need to shift my thinking? >>Paula Landry: Absolutely. And I think when I look at this slide, thinking about, you know, maybe the families with whom there's just a disconnect, you don't feel like you're quite getting through. And, again, why is that? Is it that I'm not -- we have a disagreement? Is it that that parent just wants to challenge and I maybe feel uncomfortable with that? But I've really started trying to have a conversation, you know, maybe that first visit or two when I see families, but pretty early on with families to say, hey, what is your learning style? How do you learn best? Do you want handouts? Do you want me to show you what to do? This should be a give and a take. That's really been helpful for me in hopefully trying to meet those parents where they are and recognizing that everybody is so different. >>Steven Lindauer: Got a handout for you that's in your packet. One of the other frameworks, the last of my favorites is the Kirkpatrick Evaluation Model. . We see this all the time. You did it in school. You do it in your job where you start with levels of reaction, levels of learning, levels of capabilities. So the first one is the smile sheet that you often fill out in a survey. Am I enjoying the training itself? If we were to ask all of you, is this format, the conversation between Paula and me, is that working for you? Is it fun? So then the second level we want to get to is actual real learning occurring? Are you picking up the information and are you able to not just remember it, but got back to Blooms, am I able to convey to you my understanding, am I able to apply it? So that is -- and is that learning happening? The third level then is back to competence. Do I now demonstrate the behaviors? So I have the skills, I have the knowledge, but do I have the behaviors? So it's the training that you yourself, that you as a provider providing to those caregivers, are you seeing a shift in how the caregivers are behaving? So you are explicitly looking at that caregiver. Say is it working? Not only can you do it when I'm here, but are you doing it when I'm not there? Finally, is it having the results? Is it moving the needle on your child's development? That he is because that's the ultimate goal. If it's not, you may have the best training against the strategy that you identified but the straltgy wasn't chiefing the outcomes for the child. So you needs to rethink the strategy. >>Paula Landry: An example of this, years ago, I had a Mama I worked with who was having just a tough time reading her baby's cues. And he would tell her in so many different ways, which was obvious to me, stop, I want more of that or I don't want to do that. She didn't understand what he was trying to tell her. We tried to play games, like singing songs and stop and go games where she could really start to, like, understand, oh, gosh, he turned his head away. I think he's done. I don't think he wants that. So we sort of kept progressing through this model, oh, gosh, now she's getting it. We've brought in music. We brought in some different strategies for mom to learn, not just baby to learn. And did that change her behavior? Absolutely. Very -- once she got it, she got it. And then she was really able to identify those cues across, you know, not just play time, but meal time, bath time, and the level four, the results. Does that influence her performance? I wouldn't call it performance, but it did influence her reactions and how she interacted with her child. And was able to say say, gosh, I recognize you're telling me no. We ended the activity. >>Steven Lindauer: And in turn it helped the child. >>Paula Landry: Of course it did. >>Steven Lindauer: A hand out for you there. Just to remember. These frameworks and models are there for you to refer back to in your conversations as you do your own planning and in your conversations with other providers you may be working with and within your agencies as to how you may not to -- if you start to have the conversation on what are the best practices that we want to incorporate into this. Kate I'm going to paut here in just a little bit to see if there's any questions. Let us get through these next two pieces here. So talk about learning styles. I think everyone in the EI world understands these three learning styles we've talked about. >>Paula Landry: Yes, we all know there's more learning styles, but for today's purposes, we are just focusing on these. >>Steven Lindauer: And in the adult world, these are the three, throw, that are consistently brought up as the meta ones. So visual learning, that they learn through more visual stimulation. The you atory learners and the kinestetic learners. When you and I were going through this, the third bullet point jumps out to me. As you are working with a caregiver, do you take notes on a piece of paper that is for you and the caregiver to see together where you're writing down key points and drawing stick figures and doing things? Because that information is visual for the adult to then hang an anchor on to, remember what is going on here and leave that with them so they can go back and reflect on that later. So taking notes, writing key points can be a powerful technique in a family's home. >>Paula Landry: And when you say taking notes, you're not talking about just your progress notes. >>Steven Lindauer: No. >>Paula Landry: Here is what we did today, here is what we worked on, here is what to try in the next week or so. These are really notes that they're on the fly -- >>Steven Lindauer: As you're discussing something, yeah. >>Paula Landry: So parents can know and I obviously should be better about doing that. >>Steven Lindauer: Again, I am not calling you out. >>Paula Landry: No, but it's, again, sort of realizing what your own style and what you're comfortable with. And you sort of get into that. And it's hard to break out of that rut or that routine that you've already established for the way you do things. >>Steven Lindauer: And if you've never had a mentor that did this, you wouldn't necessarily now it's something to do. Auditor learners, for the one in here is that idea of just reading aloud, asking someone to read their notes aloud to them. There's just so many aspects of the -- I love the knew nomic devices and devices, kinesthetic learners, the physical activity. Physical activities, they can take their own notes. >>Paula Landry: Yes. Maybe they like their own notes better, have their own pictures. One thing that has been nice with the virtual visits is the recordings. I've had a lot of sessions where, you know, maybe a PT is explaining how to help a baby work on transitioning from sitting to their tummy or something. And -- or it's been in person and, you know, mom is just not quite getting it. PTs always make things look so much easier. But we've been able to record some of those clips like, hey, do you want me to record this? I'll send it to parents after the fact. I've gotten really good feedback from that. Sometimes in the home, you don't want to whip out your phone and you don't want to interrupt that moment when you're there working with a family. Especially via Zoom, it's been great to do that. >>Steven Lindauer: If you find that's a technique that is working, then that parent will be very flexible and say, yeah, please do. Please record this. I'd love to have that feedback. Finally now, from theory to strategy, frameworks and styles, what are the activities and experiences? From an adult learning standpoint, I'm going bring this down into three different types of what we do. We think about the coaching model. And the coaching model is the model that is the be all end all for what we do at home. There are self-study materials that we can give to caregivers that we can help them to self-reflect on. There's leader-led things. It's you as the teacher, you as the therapist, you are the leader of the information. And then the active learning -- what is her name? It's different than the active learning and -- it's not Lily Nielson's definition of active learning. This is adult active learning that is a concept that is out there in the -- you don't like it when I say business world, but in the adult learning world around us. So from a content of self-study text based materials, podcasts, videos, recorded trainings that people can go back and do on their own. So the text-based materials might be a handout that you give to them. And maybe something that you handwrite and type up and leave for them later on, but things they can go back and read. Leader led, presentation, modeling, story telling we talked about, the demonstration. Active learning. Active learning is engaging that caregiver with you. So the others are more passive, right? I'm telling you, caregiver, here is information for you. The active is now I'm engaged and participating. So I'm participating in the discussion which also allows me as the teacher to understand are you discussing it, you know, eloquently and appropriately and giving you the information that's right for your child? Practicing, role playing. I love the concept of when you have two caregivers and asking them to do the role play. You teach the other person. >>Paula Landry: I like that. When I think about role play, I am not a fan of that, but when you frame it that way, I understand it and I get that. And I do like that. You're working on a specific strategy with mom and dad comes on and you can say, here, now you teach dad. That would be an example of a role play that doesn't feel so contrived, I guess. >>Steven Lindauer: Right. So you're not going off every bullet point. You are going to do these things naturally. And I think you probably do do them naturally. But it's recognizing all three of those categories. So we asked in a survey, do you as caregivers provide self-study materials to help prepare for a visit. 33% rarely or never. I think how important this is. I think of my wife who saves every piece of information that is given to her about a topic. When she's learning something, she captures all of that and goes back and has something to reflect on and how important it is to give the caregivers the option. Even the idea of saying, do you want me to give you something and they say no, find out with new families, does it work? If they say Paula, please, no, don't send me any more Emails. Fine. But err on the side of do giving them information because that is so important for certain people and the way they learn. >>Paula Landry: And when we're saying give them this information, this doesn't mean every single visit. >>Steven Lindauer: Right. >>Paula Landry: This means, you know, hit the highlights and maybe some of the other things they've addressed or, you know, a concern they brought up or a question they've had. But we're not suggesting you bring, you know, handouts to every single visit with you to pass along. >>Steven Lindauer: Right. Not surprisingly, when it came down to leader-led methods, you all do the vast majority of this. So always and usually totals up to 54%, so more than half, presentation, story telling, modeling, demonstrations. Even more so from this active learning, you all are engaging your families in active learning. So the take away for me was think about the self-study materials you can do, focused materials you want to give them. >>Paula Landry: And I wonder, too, now that we've gone through this and explained what these questions really are, if we would have different answers to some of these. >>Steven Lindauer: Absolutely. I think it would be a fun project to find out what people do. This is -- I like the anonymity of it, as well. Because people can answer the question without being judged by this. There's a four category, and I've used the terms a couple of times around performance support. Performance support with tools and information that you give to caregivers that help them in the moment of need to perform a task. If a family is having difficulty with bath time and you work with them on that everyday routine and you come up with what is working for them, if you say I'm going to summarize all the stuff that's working for you. Preparation, you know, the temperature of the water, how you want to talk to your child ahead of time, the bath toys you want to have in place, I'm going on laminate that and we're going to stick it on the side of the bathtub. That's a performance support tool. So those are things that are job aids or even things they can go back and reference, FAQs, websites, info graphics. For me, what was interesting, almost 20% rarely or never share something like that with families. I would bet you if you had somebody looking over your shoulder, that they're going to say, Paula, there is an opportunity for a job aid here that you could stick on the refrigerator, stick in the bathtub. >>Paula Landry: I think how many times do we go into a home and say, you know, exactly what you just said. Let's walk through your routine. Tell me how that is. Let's talk about how we can tweak certain pieces of that routine to help support your child's learning. And do I always follow that up with a job aid? Admittedly, no. But that is a great example of, gosh, how easy would that be to, you know, let me write this schedule down for you. And let's do it right here in this visit so it's not extra work I have to do at the end of the day. It's not -- or, you know, Saturdays or whenever I remember because I will probably forget. But let's do it together. And that's okay. That's good time spent in that visit. >>Steven Lindauer: So one more job aid for you, a performance support tool that describes, then, the different types of self-study active learning types avenue assessments that you can do and performance support. So a couple of key takeaways here. The leverage adult learning strategies, fair. The techniques that meet the needs of different learning styles. You will encounter learning dissonance and seek out that dissonance. Leverage a variety of techniques and teaching methods. Mix it up as you engage with parents. Design training that meets their specific outcome and objective need. So leverage blooms. Think about the training you're trying to do and built competencies specific to that. So, Kate, before we go on to this one, are there questions we should address at this point? Comments? >>Kate: There's been a great discussion. Alain na said I would think families receiving guidance in front of their child or with their child would be more willing to interact physically or orally than note taking, especially since our families tend to be hands on with their children. It may be uncomfortable to have their hands otherwise busy. Claire responded I agree, but I feel some parents are hesitate to perform with their kids and just want info from us so they can practice it later. And this one, I love having the option of telehealth for these types of learners. And then just some continued discussion about the substantiation of telehealth and in-person. Elena said I love the idea of calling it a job aid. And then Florence just commented, I love the idea about using a good routine. We use the safer and the MEISR to find a routine where a family or child needs help to make the IFSP. Never do we ask ourselves how we can use a great routine to work on a goal. >>Steven Lindauer: Good point. >>Steven Lindauer: So I don't know enough about how to make or even comment on the last one. I can comment to the other points about that about note taking or doing other things. I mean, to me, that's showing dissonance that, no, that doesn't work. It's not what I do. I don't want parent toes take notes. I would rather have them focus on practicing. If you want to build their competence with knowledge, times having to take notes and capturing that may be something you want to do. Not all the time, but something that you want to help them do. So I like the fact that there's going to be some stretch and push and pull here as people are going through this. One of the things at the end we're going to talk about is, well, what do we do with this? As a team, how do we challenge the way we approach our home visits? What could we be doing differently to be more effective? So I'll make one key point here. As I listen to what is going on within early intervention Colorado and how oftentimes we're not hitting our metrics as a state, maybe we're not approaching intervention in home activities the right way at times. Maybe we need to think about how we engage with the parents a little bit differently. So there's organizational decisions people might make, but as an individual practitioner. So what I ask is don't just toss it out. Challenge yourself and think about it when you're in the home. What was the last one? >>Paula Landry: Think about using a good routine to teach a specific goal. So identify what parents -- and I think. I'm just interpreting here. Something the parents are doing really well within their good routine and, again, how do we tweak those pieces of that routine to work on a specific strategy and support that goal? >>Steven Lindauer: Yeah. That's the context. Yeah, that's going to be the goal and the why and then the context of what you're actually hoping that they accomplish. Thanks, Kate. Appreciate it. >>Kate: For early intervention programs that are making the transition from provider centered model to a coaching model, do you have any ideas to present as compromises or first steps for families who have providers on the team who each use different models? >>Steven Lindauer: Oh, this is the fifth pillar of the five pillars. That is effective teaming. So, Kate, I love the question. It's -- I have thoughts on -- I have tons of thoughts and ideas about that one. It's outside the concept of adult learning itself other than to recognize there's adult learning taking place for each of the providers. And perhaps what we're about to get into of knowing the audience. Effective teaming is one of the five pillars and it needs be addressed. I'll give, all, one story you've told me. And I'm watching my clock here with the time. There is a -- sometimes as you go into a home, there can be a provider that just dominates and doesn't stop and listen. That is not effective teaming among the providers that benefits the caregivers. So how do we -- well, let me stop at a moment and let's get this, understanding your audience. Kate, can I move on at this point? >>Kate: Yes. That is all that's in the chat. >>Steven Lindauer: So knowing your audience, knowing the other care providers and knowing what it is they need and want. And can you connect me with somebody else? Somebody else may feel -- just get to the point. What is the bottom line? It's a conversation you and I have all the time. You love the details. I love just the summary, get it to me, ourselves I can't even listen to you. I want all the details to do something and I need people to talk through. I process information externally. So all of that becomes important because as you think about all of the training that we're doing with these caregivers, and if it's leveraging the coaching model, it's still training. It's just called the coaching model. It's still training. That we have an intent of what we want to accomplish with those caregivers. And then there's the reality of the impact and are we actually getting to them? There often is this gap and we need to close that gap. We're going to talk through a couple of points here and leverage through a particular model to help us. This is oversimplification. But one of the questions that we asked in our survey is who has taken a personality profile? And check all that apply. And I think one of the things, right, that struck you was that -- >>Paula Landry: I was surprised at how many people hadn't taken one, that a third of us had not taken any type of personality profile just to see what is your learning style? How do you approach a situation? >>Steven Lindauer: How do you engage? >>Paula Landry: Yeah, how do you engage with others? So I thought that was fascinating. >>Steven Lindauer: And the other one, 43% of you used Myers-Briggs. Myers-Briggs is an accepted tool. How often are we pulling out our profiles and talking about how we work with each other? So having that level of understanding, then, can help us understand better ourselves and how we engage with others. So I'm going to ask a favor frul all for a moment. I'm going to use emergeanetics as the profile system to talk to. If you have a preference for another one, just work with me on this. I'd love to have a conversation later on as to let's think of this as more of a Myers-Briggs style. So we're going to first start with behaviors. That's what you see first as you engage with people and then you get into thinking styles. Behaviors, expressiveness, the outwart displace of emotions towards others and the world at large. Aseriousistness. Starting with expressiveness and there's a big body of knowledge here, so let me try to hit on just the key pieces for this. Paula, keep me going if I'm hitting too much on it. So there's a third, a third, a third here. There are people that are on the -- and there's data out there to show this. I can show you the report if you'd like. But there are people that are the quiet, calm, intrough veteraned. You don't even know if they're working with you because their face is blank. Then outgoing, they're engaging. They're expressive. So you have these different approaches. What does that mean when you are in the home? Some people like one-on-one. They're really good on that primary provider model. Versus others on the right-hand side where they may want the -- they're going to have a party in their home. They want all the providers in there with a lot of lively discussion. The people on the left are quiet atmosphere versus an energizing atmosphere. And your role as a teacher or a therapist with those caregivers to help find the right environment that will work for them. Assertiveness, the style and pace at which you advance your thoughts, feelings and beliefs. There are those of us that are peacekeepers. We don't like conflict. We don't like debate. Versus a third. By the way, the third in the middle depends. They can go either way depending upon the stimulus of the situation. So the determined, telling, forceful, driving, they learn through conflict. They discuss through conflict. And as a provider, not necessarily if you're on the left side, shying away from the conflict and discussion that they may need to have. So from a learning standpoint, some people need that peaceful environment and negotiated resolution moving at a gentle pace versus people on the right-hand side who are going, come on, let's go, fast. Give me more. They may think it's working for them, but as you are assessing their competence, you may find, we need to back up, we need to try it again and do do something differently. >>Paula Landry: And, again, recognizing where you fall on this. And we're not suggest all of your parents have to take this test or any of these things, but, again, if you -- you can pinpoint sort of where families you work are on -- where they are on this spectrum and where you fall. Honestly, even other team members. So if you're going into a family's home and they're really fast paced and you are not like that, again we're not saying that you can't flex over to be fast paced with that family. It's probably going to take more energy to do it. But, again, recognizing where you as a provider, teacher, therapist need to step out of your comfort zone to meet that family where they are. >>Steven Lindauer: Sometimes you have to get yourself into the right head space as you're walking into a family's house or into telehouse. And going to where the parents are. Don't expect the caregiver is going to accept your style. You have to help them. As you said, the mom may be different from the grandparent or the dad may be different from the older brother. There are different styles that you're working with even among those caregivers. And then flexibility. The willingness to accommodate the thoughts and actions of others. So there are people that are firm focused. A decision has been made. Let's stick with it. Let's keep doing what we've been doing versus a third on that right-hand side who are saying, well, I'm willing to try an idea. Again, if you have two caregivers that are at opposite ends of the spectrum, you have to navigate this to figure out how you accommodate the person who says, no, I want to keep going with what we've been doing and someone else says, no, I'm really excited. Again, trying to recognize both and supporting both and maybe explicitly acknowledging both with the caregivers and saying to the husband, you know, your wife is fast paced. You may not slow on this one. And you would never say it that way, but we're going to work with both of you in an appropriate that's effective. >>Paula Landry: I think, too, about even other providers coming in. Not necessarily caregivers, but if you have a focused firm parent and a very, you know, outgoing, outspoken gregarious provider, I'm there as another provider and you may feel the -- you know, that disconnect between those other providers. And then, you know, is there a way you can sort of, you know, bring them both in the middle a little bit? Again, you're recognizing is the other provider getting -- again, not to be judgmental, but are we being effective in this moment for this family? Again, my approach is much more like, hey, you just made a really good point. Maybe slowing down a little bit to say to the mom, did you get that? Or even using myself, hey, will you explain that again because I don't think I caught that. Just as a way to, you know, sort of go back and make sure the parent really is getting that. Again, sometimes those team dynamics are a little tricky. >>Steven Lindauer: Yeah. I would love to have a session on that effective teaming and leveraging some of these concepts. So from a learning style, options changes easily. Again, recognizing that we're dealing with both. Of course, there's a handout in here. This handout has a ton of information. So the next few handouts I'm going to give you are a little bit of real goal for you as you want to think about how you engage with families. Understanding yourself and how you engage. So we're going to do a very brief self-reflective activity here. Think of yourself as the provider, the therapist, the teacher, whomever you are. And think of the caregiver or another provider that you struggle with just a little bit. And how you present yourself from an expressiveness, assertiveness and flexibility. And understanding on the spectrum where you are versus where they are and how you -- if you're working with a caregiver, might need to flex to them or if you're working witexli So we don't have any way of sharing the results of this, but take just a moment. If it's a conversation you would want to have later on. Paula and I would love to catch up with anyone later. I'm practicing wait time. >>Paula Landry: You are. >>Steven Lindauer: Once we've worked through the behaviors, then we get into the thinking styles and the thinking preferences that people have. We'll talk about the combination in just a second, as well, but the analytical brain that seeks logic, data, understanding, wants to know the relevance of something, wants the bottom line, structural thinkers who seek process, rules, guidelines, seek a ton of details. Social thinkers who really seek working with others and through others, have an empathetic style to them, have a gut feeling about what's going on with the people that they're with. And then conceptual thinkers who are the -- really seeking the big picture, the vision, the new ideas. So these four styles that people bring into a situation, they bring in different ways. So you're not isolating this. 58% of people have two different styles. 35% have three different styles. But 6% have one. And what people don't have is as important to know as what they drof. Because you need to work with -- work through and with your style to them. Paula focuses on the details. I focus on the -- I'm at the 50,000 foot level. She's on the ground. We at times struggle in our communication, but when we make the connection, it's very powerful. We're bringing in the very different perspectives with us. So recognizing that those differences exist, similarly recognizing the conversion thinkers. And I think in early intervention how we talk about what is evidence-based practices. There is a right way to do something. Versus the divers and thinkers, smnl someone who is saying where else can we go? How else can we do this? Stef is a beautiful divergent thinker. She is a wonderful therapist and wonderful teacher, but she's a very divergent thinker. So recognizing that those differences exist. So when you get into the home, then, what do you do? Paula, with me, analytical thinking, bottom line. Get right to the point. Talk about key facts up front. Make sure that you have credibility or the data that is with you has credibility. Structural thinker. Make sure you have a home visit plan in place. Not going to use the word agenda. A home visit plan in place so people know what is coming up. Getting all the detail that you need to provide. Social thinker. Everyone wants rapport, but social thinkers live through rapport. The stories, the importance of that, really personalizing information and being emotional and recognizing the importance of emotion. And conceptual thinkers, showing information graphically, but allowing them that third one. Letting them fants size and visualize for it, be creative as to what they're thinking about with this. So all of that, again, is available in this handout. And the handout -- I love about this one is that there's -- one of the sections in here is problem solving for each of those thinking styles. Because when you think about what our parents are doing, our caregivers are doing, tier trying to solve a problem, a problem that they have that exists with their child. So how are they going to fix that? So, again, just a quick moment here if we can. Think about yourself and your most preferred and least preferred preferences and another provider or a caregiver and where your differences might be of how you approach. Paula, I know our approaches are so different. >>Paula Landry: I recognize how I tend to teach, the way I think, obviously. I think we all do that. But this really is about flexing out of your comfort zone to meet the parents where they are. Several years allege, I saw this little guy. I had only seen him a few times. We were outside doing finding curve drop-offs and for a variety of medical reasons, he hadn't been outside much. And he was not interested in finding the sidewalk drop off. He could care less. He wanted to play in the grass. So, of course, this is wonderful. So I sat right down with him and started playing in the grass and realized very quickly that his mom was standing over us not looking very happy and I realized mom was standing over us not looking happy. And I said are you okay? And she said, are you going to see anything? And in that moment, I was like, oh, my gosh. I have been watching and observing all these different things your child has been doing and I did not communicate any of that to you. So she thought I was sitting down on the job, literally, not doing anything. So it was a very good reminder in the moment not only about explaining what we're doing, but this was a Mama who needed to know, what are we doing during this visit? What is the beginning? What is the end? And how I can lisp to you through the middle part of it. >>Steven Lindauer: I love that one. Again, you do so much, Paula, through that unconscious competence. It's like narration. To key takeaways. Each shield's caregiver has a unique profile. So recognize moms, dads, grandparents, brothers, sisters, all have their own profiles. You tend to teach base odd what you're comfortable with and how you work. You really need to teach based on what they need. Providers must recognize those differences and flex. You know it's going the be a challenging teen or provider that you're working with. So with all of that said, applying these principles in early intervention. We're going back to the triadic model here. And recognizing when you walk into a home, especially early on, you're assessing and evaluating that child. But even throughout all those home visits, you're evaluating and assessing the child and thinking, are the strategies working? Where is the child based on their developmental goals, where is their current level and what strategies do we need to employ? Just as explicitly, you're evaluating the caregivers. And I know that term evaluating the caregivers can be tough to swallow, using the term strategy that you've been using. But understanding and getting through conversations with them, what is their target competence? What goal do they want to get to? So it's current to target and anything in between, whether you want to call it gap or not, that's what you need the address. So just as you're assessing and evaluating the child, you're assessing and evaluating the caregiver. >>Paula Landry: We think about the children, the families, but ultimately the children. What are we doing to have an impact on them? What goals are we working on? How are we getting them through their stages of development? This, for me, especially, is such a different way of thinking about this. Until I had -- you and I started having these conversations, I never -- I thought of myself as the provider, teacher of the visually impaired, but never in the role of assessing a parent. That role feels very judgmental to me in some ways. But in this context, I do understand it and appreciate it where -- I think I've said this before. We are already internally assessing a parent. Do they understand? What are they doing now? What do I need them to learn? What strategy do I need them to apply right here? So there is a level of assessment that happens. I just have never done it explicitly or really intentionally. >>Steven Lindauer: So just to make it a little bit -- this is not trying to put -- I hate that expression, but it's to minimize it, anyway, but it's working with the parents so that you're come up with what the tarlth competence is together. You're bringing in your knowledge, your guidance, but it's working with them so it becomes less judgmental. It becomes less you saying to them you don't know what you're doing, you're not smart, you're not capable. >>Paula Landry: Again, it's recognizing that they don't know what they don't know. That's not judgmental. That's just a professional opinion. And knowing the things they need to know to help them achieve the goals they've identified. >>Steven Lindauer: So we did this example. And you're going to walk through this now to get to what would be the target competence for a caregiver. So we came up with this. Let's go through the process. >>Paula Landry: So this would be, you know, I think we can all recognize a child on our case loads. This way, mom and dad, PT, and an EI-TVI on the plan, challenges for families are sitting, they want their baby to be sitting, using his vision, using his hands and vision together. So reach for toys, look at them, play with them. And then the overall goal is being to integrate the sitting and they use the hands and vision at the same time. That hand/eye coordination. Ultimately, we want that little guy to be able to play independently. >>Steven Lindauer: And Paula, we assume everybody understands with CVI, there is some vision. It's just a matter of what vision. >>Paula Landry: Correct. >>Steven Lindauer: Okay. >>Steven Lindauer: >>Paula Landry: So just an example of goals you may see or may have written with families on IFSPs, participating in play time by using hands and vision to explore a variety of toys. Then participating in meal time by making a choice between two different options. Here would be the strategies, again, that are typically offered on an IFSF. You know, assisting during supported positioning, giving him that support so he can look and reach at the same time, placing toys against a solid color background, using lined up toys, using hand over hand, all of those different strategies for play time. Then what about meal time? Presenting those two different options, giving them, you know -- using simple words, labelling them. Here is your bananas, here is your blueberries. And the most important part, we want our baby to be talking to us, we better be able to figure out what he's saying to us. >>Steven Lindauer: So we've identified the goals. We've identified the strategies. Now you jump into the home and the PT jumps into the home, sometimes together, sometimes individually. >>Paula Landry: Right. Here is the parent-coaching model. This is the way a lot of us have done it. This is the way I've done it in the past where parents are sort of the center. We do joint planning together. We do the observation. We maybe -- depending on the home visit and my modeling, are we role playing? What are we doing in shah visit? Reflection, feedback, all with the goal at the end of the day supporting and understanding those strategies on -- that have been identified on >>Steven Lindauer: So to make this, then, more adult learning focused, orrer to consciously drop in the adult learning piece, we are separating out from the IFSP goals and strategies to what you immediately do in the home to start identifying those target competencies with the caregiver. >>Paula Landry: Yes. So with any of those strategies, with all of the goals, taking a moment to sit back and think about what is the knowledge of the parent? What do they need to know? What specific pieces of this do they need to know? What are their behaviors? What are they doing right now based on their knowledge and skills? So, again, breaking it down even further, I use this as my new job aid for thinking about that, breaking it down from those specific strategies we've already talked about. This would be something I would use to, again -- I don't like the word assess, but think about the target competencies for parents. So, of course, we know that they need to have an understanding of CVI and its implications. We want them to understand and have knowledge in their child's functional vision, in their preferences. Do they have a field of vision or a color preference, any of those things? What is non visual communication? Let's talk about that. We probably have a general understanding, but what does that mean when we're talking about non visual communication with our children? And then just the basic strategies. Once they have that knowledge, then what are the skills that we're trying to build within that family, within those caregivers? Best placement so child can use their vision. Where do we need to put those toys. How are they interpreting those cues? Are we using hand under hand? Are we using good strategy toes support the independent play skills with that child. And from there, what behaviors do we want to see? At the end of this six-month period, what behaviors do we want those parent toes be doing when we're not in the home? 99% of the time when we're not there, we want them to be able to respond to those cues immediately. Oh, you've turned your face away, that means you're not hungry. We're listening to our child. Are we not approaching him from the side where he has no vision? So he gets startled every time. Are we consistently using hand under hand? And not just during play time, but now are we starting to use that skroos routines and using it at meal time and bath time. >>Steven Lindauer: Paula, let me ask you a question on this. You are a provider that's been doing this for a long time. You're reflexive on this. Versus a new teacher who may need to go through and think explicitly about this. now this concept of creating the knowledge, skills and behaviors as you're thinking about going to the home, would you do this? Is this something that you would consciously do? Would you take time to write this down or are you so far down the path that you -- for example, might you overlook something that's critical for the parent if you didn't before I this down? >>Paula Landry: Well, now that we've created this and I have been using this and implementing this, I feel like, oh, my gosh, how many years did I miss out on these skills that I should have really made sure or we sort of glossed over that or didn't read this at them. Again, you get a -- you write an IFSP and you look at the goal for six months out. And we don't always reflect back on those IFSP goals. But, of course, we're all working towards them, but do we ever -- how often do we sit down with each of those strategies we've offered and really target what parents need to know, understand, what skills they need and what behaviors? What changes do we need them to make? Again, I have not always been good about doing that and making sure we have covered all of these areas. >>Steven Lindauer: And communicated with the parents, as well. >>Paula Landry: Absolutely. >>Steven Lindauer: So you telling them it's through the conversation, through getting a joint perspective on what it is that I as the parent or my child need to be -- know, be able to do and have behaviors to demonstrate. So from this, then, now we think about, well, what am I actually going to do in the home to teach the parent the knowledge, the skills, the whatever is? >>Paula Landry: So this, to your point point, really brings in all of the adult learning strategies to what we're doing in the home. So as far as the self-study, if we're working on hand under hand or a specific strategy, am I sending, you know, an article ahead of time? Can they preread something? Do they have more information to fall back on than I could even cover in an hour? The importance of routines, podcasts, video clips, any of those things that I can share. And then, of course, the leader led. Let's do this activity, let's practice. Let me show you how to do hand under hand. Let's set up this play space so, you know, there is not a lot of busy, you know, a lot of toys and a lot of distractions. Let's minimize things that are happening here. Let's work on this together. And then the active learning piece. What am I doing? Again, practicing helping them do that. Are we role playing? How does this feel? How does this look? Can you see yourself doing this when I'm not here? Will this be something that's easy for you to do or do you just think I'm crazy? And if that is the case, let's talk about this and approach this activity from a different way. >>Steven Lindauer: And even thinking about it, on the extreme side, I don't go into family's homes, I'm not a teacher or a therapist that goes into families' homes and does this. So thinking about as I give the caregiver what they need to know, I do the demonstrations, the practice, we do some feedback together, then in a home visit I say to them, today I'm just going to watch you. Because I want to spend the next hour with you watching you interact with your child thinking about all the things that you said you wanted to be competent at. And at the end of this, I will share with you your feedback. Think about the trust that you have to have with a caregiver. It's almost like a contract. We have a personal relationship. The caregiver recognizes you, your skills, your credibility. They believe you're giving them good feedback. So for them to be willing to say, okay, Paula, watch me. I think I'm ready and I really do want the harsh feedback. >>Paula Landry: I hear what you're saying, but that sends me -- that makes me so uncomfortable. I truly cannot imagine going into a home and saying I'm going to watch you and make sure you're competent. I would never in a million years -- >>Steven Lindauer: I would never frame it that way. >>Paula Landry: I know. But when I hear you saying that, that's how I think of it. So, again, I don't think I would do it for a full hour, but I might say, hey, show me what you've been doing or if a mom says -- >>Steven Lindauer: Perfect. >>Paula Landry: I've been struggling with this. I might say show me what that looks like. Tell me what that looks like. Let me watch what is happening and then we can talk about it or I can offer some strategies that way. So I think maybe it's a matter of semantics, but, again, personally, I would approach it differently. But with the end result being probably the same thing. >>Steven Lindauer: This is a conversation I love to have with our teachers about how do we do this. How do we do vision support in Colorado to see if they're -- again, how my -- where do we get that des Nance with our teachers and find out where do we start to craft our own new best practices with this. So you did then say, in all likelihood, this would be in your mind things I would think about doing with a family. >>Paula Landry: Right. And I touched on this. These would be something, again, thinking about the end result are those goals that have been identified and how would I work towards, you know, the parent strengths, to their learning styles even if I don't feel comfortable with that. So, yeah, again, handouts, favorite articles, cues or skrshgs VI, those types of things, And then giving mom a turn to do that. Maybe if grandma comes over, showing grandma how to do that and talking about that. Talking about color contrast. Observing together. Hey, you know what? Let's let little Nicholas play for the next few minutes and we're not going to say anything. We're just going to watch him. And afterwards, we're going to talk about what do we think he was doing, what do you think he was trying to tell us? So I'm leading it, but really, it is a joint activity together. And then, yeah, helping mom label those -- and interpret those cues, mom can give her feedback, what she thinks, how she has interpreted. And then a performance support, gosh, maybe dad is colorblind and he has no idea if there's contrast. So is there, you know, a picture or something written out, a handout I can give them? Again, another job aid to support whatever it is we've talked about. >>Steven Lindauer: So the idea here is to take that thinking from FISP, break it down, what are the competences that are parents have agreed to that they want? Of provided some support to shape what those competencies should be. And coming up with the training approaches with them. Again, always be flexible. Walk into a home. You're not always going to say this is exactly what we have to do. So building their unconscious competence in the process. >>Kate: A question came in, talking about these tough and crucial conversations. Sonia asked, how do you suggest approaching a situation where you suspect a probably tough diagnosis, such as autism, and the parents appear to be in denial and do not wish to pursue further evaluation or treatments? >>Paula Landry: Aren't those the hardest situations? Because you really, at the end of the day, you're really on the fence. You need to support that child and hard or not, it is your responsibility to offer that information, provide that information for parents. And maybe it's a slow conversation. Maybe it's a little bit of information at a time. But you have the responsibility, again, to the child so you can help them the best way you can. The best way to do that is to give hard information to families. I wish I had a one size fits all, here is how I approach it. The two words I say all the time is it depends. But it really does. Depending on the team you're on, who has the best relationship? Is there a way from each discipline you can approach it or, you know, start walking towards that information where you're setting up foundation? Sometimes it's just, you know what, you have to say it and have the hard conversation and acknowledge it. I know this is going the be really hard for you to hear, but as your teacher, as your provider, I have to tell you this. >>Steven Lindauer: And two things I would add on that is recognizing the grief cycle that they're going through and what is the natural progression through grief and helping the parents through that. The second thing is that sometimes these conversations are going to transcend early intervention. We won't be in the home because the parent is choosing not to have services. So it's back to what is that larger journey that the parents are going to go through and how can we help direct them to someone that can provide journey-level support for you. >>Paula Landry: Absolutely. And maybe they will be at an acceptance level before 3, but if not, again, at the end of the day, it's the parents' decision. And even if it's not the decision I personally would make or you as a provider would make, we have to respect that that is the decision a parent has made. And we can offer as much information, guidance or support resources as we can. And just hope that eventually they will look at it -- >>Steven Lindauer: Here is the third thing I like to add. So we are giving you? Golden job aids in here. The ones that we have about the emerge thinking styles are going to help you with how do you approach people in a different way. In fact, there are -- again, separate worlds, separate life, I have a job how do you present information to someone? So if you have a tough situation like this so you can work through the behaviors and the thinking to get to the core and get them to liste To you. >>Paula Landry: One more point, I am very, very careful about not diagnosing. I have a suspicion about something, I may -- it's a different situation where you're offering information and guiding them. But absolutely not making a diagnosis. >>Steven Lindauer: I just flipped the slide down to another one here. We are talking about even for ourselves is to create some target competency job aids that we can use to help. As we think about, we bring new teachers on to help them think about how do they approach this to have some information. I'll summarize these quickly. Once you are working with families, we've talked about from IFSP goals, the strategies to the target competencies and the teaching methods. Make sure you evaluate and incorporate that feedback. Again, is the teaching not effective? Is the teaching effective? Is it having the outcomes for the child? Is it not having the outcomes? So you can use that and go through and revise the plans that you do. So just a couple of takeaways here. Make sure that you are understanding the target knowledge skills and behaviors. We need to come up with a better word than assess. Because I think people are going to feel too scratchy about that, but knowing what those target competencies are. Seek to understand their behaviors and thinking styles so we can approach them where they are at. Develop home visit plans that specifically build to the target outcomes and incorporate a wide variety of methods and be willing to evaluate ourselves through this process, as well. The problem may be with us, not with the caregiver. So finally, best practices, a couple of things we wanted to bring into this. This is being respectful of the adult learner, not necessarily targeting adult learning. So this is -- I'm walking in from both sides here. But if we think about the home visits as what we do before we get there, what we do at the start, what we do in the body of the visit, how he we wrap up. Paula, again, we're going to get into one I know you and I really love. When you prep for a home visit, identify the learning activities ahead of time based on what the caregivers want to accomplish. Sometimes do I have a curriculum I'm bringing to my home feels like it's not EI. Knowing how we want to approach, what is the activity that we want to do that the caregiver wants to accomplish? >>Paula Landry: So you've used the word agenda. Steve has said -- >>Steven Lindauer: I'll get into than . >>Paula Landry: Okay. I'll say that. >>Steven Lindauer: Okay. Save that next one. So knowing what the learning activity is. And then providing the caregiver with the home visit plan before you show up. Let them know what you're planning on doing so that they have a way of preparing themselves mentally and getting ready for all the things you want to do. Early on, I called it an agenda and there was almost a palace revolt on that one. >>Paula Landry: Yes. First of all, an agenda seems like a very hard and fast, here is what we're doing. So I would previousance all of this by saying, even though we have a plan or should have a plan before we go into the home, we always need to recognize that we never know what is happening behind that door. We can walk in and who knows what is happening. They've gotten a diagnosis or, you know, everybody -- we have no idea. So knowing that you plan or not, sometimes you just abandon that from the second you walk in the door and you just go with the parents and that's okay, too. >>Steven Lindauer: And then the other point, again, one of the people brought up on the call about the, you know, define roles within the providers. Making sure that you know how you're going to engage. And have enough of a relationship with the other providers to give each other feedback as to who is going to lead the conversation? What is your participation in there? Also be comfortable with when you may be doing things that are lessificive for the caregivers. >>Paula Landry: I was going to say, the other thing about that is providing the plan, it's, again, not necessarily my plan. You know, at the end of one visit, I'm saying, hey, what would you like to do next time? Do you have specific questions? Are there things you want to work on? It's not my agenda or my plan. It's something that, you know, the parent has expressed interest in or concern about. And then I may have an activity or an idea to address that. >>Steven Lindauer: But I will bring one very fine point to that. It's not just the caregiver's plant, either. They may not know what they don't know. So you have to identify this together. >>Paula Landry: Would it be okay if we work on snack time next time? You've identified that as an issue. Again, so maybe it's not a hard and fast plan, but it's something to start. >>Steven Lindauer: So I found this survey results fascinating. And it may be based -- people may respond differently based on what Paula and I have been talking about. 6% of you say you always share plans with caregivers ahead of each visit. 20% occasionally share ahead of the visit. 41% say you plan, but don't share with the caregivers. 6% says that I plan just before I arrive, as I'm driving up to the house or as I'm getting set up. And 27% say I don't plan. I go where the child wants to go. To me, that's not effective from an adult learning perspective. And I will say that specifically and I'm going to get a ton of dissonance on this one. But if the fourth pillar is adult learning, preparing the adult learner for the learning process is absolutely critical. How is that for a providing statement? >>Paula Landry: I agree. >>Steven Lindauer: So what can a plan look like? Here is a text message that Paula could send out 2 to 5 days ahead of time. Confirm the visit itself. I look forward to seeing you on the day, time and we're going to do it in person or via telehealth. When we last met, to your points, together we decided this is what you wanted to do. You mentioned you'd like to work on the objective for the goal, of the meeting. In that still works for you, here are a few things to do before I will get there. So now you're being very respectful of the caregiver. The pots and pans we're going on play with, we're going on be outside with one of their favorite push toys. Whatever that might be, you're letting them know what they want to do and then if There are materials they need to have ahead of time. All this says is you're letting them know this is what you said you wanted to do. I'm providing my professional perspective on this. When you walk in the home, you're going to decide is it really what you want to do? From an activity standpoint, you can create your own activities, we at A Shared Vision are creating activities that can help people with specific everyday routines like bath times. So this happens to be called splish splash. So there are materials designed for both the caregiver as well as the teacher. But then there is that points, discussing the objective as soon as you walk in the door. Is this still what you want to do? That is exactly what we said we want to do and I'm still there. I want to do that with you. Get into the visit itself. Making sure that you provide accurate data. Some people will test you, that you said 43% of the results will come from x. Somebody is going to say, where does that 43% come from and I want to say the citation. Know they're going to do that. Encourage people who are the drivers to stop, relax and listen to others. The concept that I used to use all the time, the parking lot, when you are taking notes and when there are conversations that are going on, something is coming up that is not directly germane to what you're trying to accomplish, you can write that down and save it for later. On time, provide handouts. Finally, the key here on the documentation, not just the progress notes, but that last bullet point, how often do you and your provider team ever say we want you to give us some written feedback as to how we're doing. Some people are going to be better at giving you written feedback than visual feedback. Do you ever do that? >>Paula Landry: No. In the moment. >>Steven Lindauer: Yeah. >>Paula Landry: But never. >>Steven Lindauer: So it's something to consider there. So best practices for you, we asked -- and this is, I think, a whole other topic for us to explore. 64% of you said that you plan differently for telehealth versus in-person visits. I think there's a lot for us to still react to. We've learned so much from telehealth that we can now apply into this hybrid role that we're living in. And we need as agencies, as providers, we need to address that specifically. So challenge some of the traditional approaches to home visits. Be willing to think a little bit differently. Share your home visit plans. I can't say that enough about how important that is for people. Make sure that there's role definition among the providers. As I'm looking at time here, Kate, I've got 4 minutes still. Is that right? >>Kate: Yeah. We need to wrap up, though, with a couple of minutes left for announcements. >>Steven Lindauer: Okay. So from a learning perspective, we're all coming at this from a dissonance perspective. You're feeling justification as to why you wouldn't like the idea of what Paula and I are discussing. I think that's the stage of dissonance that we want to potentially incorporate and recognize how we address this. I hope this is what we were effective at doing today and have you remember and think about that doults don't know what they don't know. And it's really up to you to share your expertise with those caregivers. Help them understand this journey they're facing both inside and outside of intervention. And help them address those targets they want to achieve. Adopt a framework. Identify those target competencies with them. Think about your training plans before You get into the family's homes. Leverage a variety of training methods, self-study, leader-led active learning. Incorporate behaviors and learning styles so that you can close the intent and impact. We all want to do the best for the teams. But if we're not having the impact, we're not being effective. So think about those behaviors and those styles. Think about assessment so that we know what's going on effectively. And what's next coming out of this? We intentionally were not giving you any answers. That may be frustrating. But this is something we're going to do among our team and I think we should do this with EI Colorado, as well. We should spend time brainstorming as individuals, teams, agencies and organizations and think about what are the frameworks that we want to consider to improve home visits and their impact? How can we and how should we assess and community caregiver competencies? We are not on the right foot as to what this looks like? What planning/teaching methods and assessments do we need to do and caregiver assessments, as well, do we need to do and how can we enhance the structure and processes of in-home visits within context of EI foundational pillars? And I love the idea of talking about teaming and addressing these other aspectses. So much of this bleeds over into the other. We intentionally targeted this one narrow strip just for today. So if anybody is interested in doing emergenetics, there is that link that you can do. It's in the handouts that you have. And just really want to say thank you so much. Paula, it was fun. This was action different than just presenting straight out. Kate, thank you. Thank you all for taking the time to spend a couple of hours with us.