Lost in the language of Intervention:

 

Know your EIP, from your IEP, from your IDP, and from your IVP.

eipiepidpivpMany professions, including education and psychology, use acronyms to describe processes performed. For the parent of a child with special educational needs, a new language needs to be learned. And in addition to the language you will soon become a pseudo expert in terms and intervention strategies. Here is our quick guide to what some common terms mean and what you need to consider.

EIP – Early intervention programme.

The early intervention programme is usually written around the time of initial diagnosis. It will typically involve a form of assessment of your child relative to their same age peers in regarding to gross motor capabilities, fine motor skills, language use and communication skills, social behaviours, number knowledge. At this point of the programme you are quite likely to be overwhelmed with the amount of work that has to be done, and where to start. That is normal. Take a breath.

You may have received a diagnosis from a developmental paediatrician if your child is under 4 years old. If your developmental paediatrician doesn’t help you write a plan you can seek a psychologist who has experience in special educational needs to help you. There is a lot to do, and much to manage, utilise support whenever you can.

Essentially the goal is to plan out a series of intervention steps to help your child catch up. Early Intervention is key to setting your child with special needs onto a more favourable performance path.

Your expert should help you decide on the priorities that you will work on (and what you can leave for later). Depending on the disability that is being explored in relation to your child there should be a series of benchmark areas you want to consider – for example if your child is suspected of having autism, the programme may focus on language and communication development, certain behaviour modifications, emotional regulation around sensory situations, gross and fine motor development.

The term ABA (applied behaviour analysis) may be suggested. ABA has a bad rap as a sometimes-mindless intervention technique which can be disrespectful to the purpose of a child’s behaviours (especially stimming). There are alternative therapies such as Floortime which use similar techniques. In general, your child always deserves respect, so you set the course of intervention. I personally like ABA but do not believe that children should be forced to stop stimming behaviours or engage in extensive eye contact. So called normal people stim and avoid eye contact and we aren’t getting them to sit on their hands or look at us intently when we talk. The goal of intervention should be to stretch with respect.

The whole EIP process can overwhelming. Use an expert to help you break down the intervention strategy into smaller steps. This helps you break down the seemingly insurmountable task of “catching up” into smaller discrete, less soul destroying, steps,

Traps: there are three traps that I would like to highlight to parents.

1) Snake oil salespeople. Learning that your child has a disability (or may have a disability) is extremely stressful. Unscrupulous ‘experts’ may offer treatments which will cure your child. It may be tempting to jump on the magnetic therapy bandwagon. Find a community, in real life or online, who have travelled the road that you now find yourself on. As them about therapies and their efficacy for their children. Be informed.

2) Take care with Well-wishers’ wishful thinking. Paradoxically, the worse advice I got when my coming to terms with my daughter’s autism diagnosis was the well-wishing thoughts of some friends. They recounted stories of children they had heard of who spontaneously developed full language, and told me to relax and things would be fine, she would speak when she was ready.  I understand their desire to wish for the best for us, but their words are not practical support. Early intervention, as the words suggest, is most effective when it is EARLY. Don’t delay on suitable, reputable treatments. Ethical treatments do no harm to your child.

3) Early Intervention doesn’t mean constant intervention. In Hong Kong at least, I hear recommendations for children to receive 20-30 hours of ABA a week. I am sceptical that this many hour is necessary for a young child. If you are told that your child requires this extent of intervention ask for more details, and challenge if less hours could not achieve the same result.

 

The IEP – get your Individual Education Plan right.

When a child with a disability enters the school system, they may be offered an IEP. IT would be ideal if this was the case. An IEP sets standards regarding the functional performance of students. This performance can be academic or non-academic (for example communication, social skills, problem solving abilities, on task behaviour). These reports are usually updated 2-3 times a year and cover goals related to communication, language use, numeracy, and behavioural challenges. They are not easy documents to write, but regardless they need to be as meaningful as possible.

I have seen a few IEPs in my time and many of them miss some very important details, and run the risk of becoming mandatory checklists that work it being done, rather than that work is being done right.

Here are some guidelines for parents to get the most for their child out of an IEP:

The importance of benchmarks and expectations: The IEP should have include a comment regarding the child’s present level of performance. How is the child’s disability affecting their involvement in general education and how do we expect a child a child with this disability to perform? In this way a child can be measured relative to his same age peers and also against developmental expectations within our knowledge of that disability.

Knowledge about the specific disability, its symptoms, and the way it typically effects children is important. This allows us to set the all-important benchmark of achievement for a child. I’ve seen benchmarks left of IEPs because educators believe that it upsets parents to see that their child is behind. Whilst I understand the desire to be sensitive, it is helpful to see where your child is so that you know what needs to be done. Understanding that your child reads at the level of a child 2 years below them, will make you focus on reading ability for longer than you might with a typical child, and even into adulthood. I see many older teen children who have not engaged in reading for several years. It was simply assumed that they should stop reading logs when they left primary school, when continuing this primary practice would have been of enormous benefit.

The pathway should be part of the plan: IEPs can get caught up with minute detail without a plan for the big picture. An IEP benefits from including short term goals, probable benchmarks and longer-term goals (that can be changed).

Particularly when a child enters high school the parent should have the opportunity see the general plan for a child, if they will be considered for standardised exams, what kinds of indicators would we explore on the way. The IEP is not just for today, it is part of a plan to tomorrow.

Educators may not want to highlight a pathway element within the IEP that parents may be disappointed. Whilst this may be true, I am yet to meet a parent of a special needs child who doesn’t appreciate empathetic pragmatism. We simply need to see if xx can do this task by this age, in order to determine if he can try this exam route, or another.  My fear is when this is not clearly stated there can be ‘drift’, we wait to see what the child can do and then determine what exam (or not) to give them, rather than pushing children with disabilities as we would with typical children.  This can set our SEN children up to think they do not need to strive to do well.

Helicopter parents of SEN children are the opposite extreme, and just as problematic. Overmanaging disabled children teaches them that they are not responsible for themselves. Additionally, setting parent driven goals for children can stifle the development of an authentic skill for that child. My own girl with ASD decided she wanted to learn to sing when she was around 14. Two years later she is an accomplished singer both inside and outside school. This was a skill that seemingly fell out of the blue. I needed to give her the space to demonstrate that this was her path.  Having a clear pathway with check in points helps everyone involved keep a health(ier) perspective on the potential accomplishments of their child.

Meaningful behaviour assessed in a step by step manner: In order for an IEP to be useful the parent should be able to clearly see what their child is doing well, and what are the next couple of steps that teachers would like to see in their performance of growth areas.

Performance never occurs in a vacuum – it is contingent on certain conditions so these should be included. For example, if a child needs to stay on task during a writing assignment, they may receive instructions from the teacher at the outset, a visual guide to follow stuck to their desk, and the occasional prompt to keep them on task. For written work they may have a working scaffold provided or a set of instructions and it is important for the parent to understand these components as part of their child’s success.

The goals and assessments on an IEP must be meaningful:  The goal behaviours should be clear to all working with the child, and the steps required to achieve those goals clear to parent and educators alike. It is no point to say that certain math tasks are in line with the curriculum. That does not explain why it is important. For example, I read an IEP that said, “XX is familiar with money and can give correct change”, having worked with that child I can tell you she can give correct change if she knows the amount of change to give, and the coins in front of her are all of equal value (ie all $1.00). The understanding outlined does not help us really understand the tasks that this child needs to understand with money numeracy. Money numeracy is an important life skill as well as academic skill so we hope all children can learn this at school

Discrete steps need to be made clear, rather than simple global understanding so that the IEP has meaning. For example. If we identify some of the early steps of money math to be the following what tasks can this child perform.

  • First identify that different units exist and represent different values of money.
  • Learn how to add different values of money (full dollars only, no cents)
  • Learn how to subtract different values of money (full dollars only, no cents)
  • Ascertain if you have enough money to buy a single object (ie is the amount of money I have more or less that the price of that item)
  • Determine using subtraction the amount of change that would need to be given to by this single object. (full dollars only, no cents)
  • Identify the different units to represent the change that should be given (full dollars only, no cents).
  • The next step would be to determine this process for either a) buying two objects or b) using coins, to be determined by the child’s readiness a that the task above.

Whenever possible the tools that are being used should be listed and shared with the home environment.

Measurements of success: Whenever possible use numbers and assessments to help determine progress. Having data helps decide if a problem is really a problem or mastery has been accomplished.

For example, if a child is experiencing issues around emotional regulation, in particular becoming angry and shouting at teachers and classmate, deciding to include a goal on the IEP should be included. It would not be enough to expect these behaviours to be eliminated immediately. Observations off a few instances should provide meaningful measurements that help.  The main elements or consequences can be measured and the goal will be to reduce these, over a particular time set. A behavioural plan may be used in coordination with an IEP to capture this data.

Celebrate the positive: An IEP might help parents and teachers document the strengths that a child possesses as well as their weaknesses within the school environment. Strengths become more and more important as the child ages. When children are young intervention does not need to focus on their strengths, but from the teen years on, these strengths offer keys to the future.

Generalisation is considered: An IEP is usually written inside the context of a school, but opportunities to change behaviour and learn skills exist in more than one environment. The home and the school environment both need to be involved in planning activities. Mastery in one setting can not be assumed to generalise (ie be transferred) to another setting, or be treated as an afterthought. In the example above, where money skills are being taught, this should be echoed in the home or out of school environment. The child given chances to pay for a drink with coins at the store, to reinforce the behaviour learned at school.

 

The big picture – the IDP – Individual Development Plan

The IEP is usually a school-based document. The IDP is a general setting document. The IDP is like an extended IEP to include a snapshot of skills in multiple settings, more global goals, and additional categories. Usually a school contributes to an IDP through the IEP. The IDP will use that segment as a snapshot of education, but may add a variety of out of school classes depending on the child’s skills.

Comprehensive: An IDP will assess elements such as self-care, independence, emotional and behavioural regulation outside of school, social skills, theory of mind, and additional education to be considered.

Age related: As such an IDP may be written by a psychologist outside of school. Assessments such as measures of personal functioning, emotional wellbeing, intelligence, may be included. The purpose of an IDP is to ensure that the child continues to develop towards their greatest level of independence in life, future education, employment. As such an IDP is recommended when your child becomes a teen rather although they can be used at a earlier age as well.

deficit vs strengthsChange of model of focus: As a psychologist working with children with special needs at all ages, I believe in working on a deficit model of interventions before the age of 13, and sometimes after that age moving to a strengths model. What that means is that for younger children we look at how their performance (in any category) differs from their same age peer and we work to try to bring them within the expected boundaries of performance. We focus on the areas of DEFICIT. A strengths model expands our focus, and is more appropriate with older children when strengths have had a chance to appear. We do not stop looking at the areas that the teen needs to catch up, but we spend some of our resources expanding their STRENGTHS as well. This involves identifying areas of strength. A psychologist may help you identify these areas if you are not aware of these for your child.

The focus for an IDP are generally more global than an IEP, however the guidelines are much the same. Detail, data, and benchmarks remain essential. The focus on strengths and the pathway aspects are more important than they are in an IEP because the IDP creates a backbone of potential career and future education pathways.

 

The long-term plan – the Individual Vocation Plan

The IVP is sometimes referred to as an IEP (particularly in the United States) which can be very confusing. For the purpose of simplicity, I will use the term Vocation rather than Employment as this also incorporates what we know about the future of work, as well as the use of hobbies as well as job training to help build a career.  Many young adults and teens with disability leave school before they are fully cooked, and need support to decide what to do next, even if this includes going onto tertiary education.

 The need to plan. To better prepare the next generation of special educational adults, we as parents and educators need to provide ample services to those young adults as they launch from high school into the next stage of their careers. The majority of areas in which disabled individuals in Hong Kong find employment (hospitality, some retail, office work) unfortunately also carry a high risk of redundancy according to future of work analyses.

In Hong Kong, at this time, there is a gap for young adults who have different areas of strength and varying levels of motivation from those covered in the vocational channels on offer – perhaps they are great artists, mathematicians, photographers, early childhood teaching assistants, even have extremely good knowledge of music or ability to sing.

The IVP details: The Individual Vocational plan builds a customised plan around to help these young adults in particular*. It includes the following aspects:

  • The strengths of the person and potential careers which utilise these strengths. There may be more than one.
  • The future of work assessment for these careers – so that we focus on evolving or permanent jobs. Different formats of these jobs.
  • The soft skills and hard skills that are required for the jobs identified.
  • The performance of the child in these soft skills and hard skills. This will then include a lot of details regarding the process that the young person will need to undertake. What the learning mechanism will be. What will the key steps, assessment techniques be involved?
  • Prioritising skills (academic, professional, personal, organisational) that this young adult needs to develop to achieve these goals.They may need a basic entry level of English or Math in order to start their career in a suitable arena, and this needs to be made possible within a setting that also teaches the requisite social skills and independence skills. Private tutoring provides the content but not the context.
  • A timeline and proposed plan including potential work experience, future exams and key goals.
  • Certain independence and self-care skills may also be included, and these may be part of the IDP or the IVP depending on who is running the programme.

We launch teens and young adults into a world of work which can be overwhelming to navigate. We need to plan customised programmes that offer opportunities that fit with the future of work. For more information see our article on this topic. https://reddoor.hk/2019/03/21/whats-next-the-need-for-vocational-and-continuing-education-for-young-adults-with-special-educational-needs/

I hope that these terms are clearer to you know. Becoming a special needs parent will entitle you to an education that others never have to navigate. If you get confused reach out for professional support and the input of other parents. You are not alone.

*These kinds of plans are not frequently offered in Hong Kong by psychologists. I am happy that the RED DOOR team can provide this service, and does currently.

#futureofwork #reddoor #mentalhealthessentials #individualeducationplan #earlyintervation #individualdevelopment #individualvocation #specialeducationalneeds #autism

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