Coaching in
Natural
Environments:
Beyond the
Bag of Tricks
Corey Herd Cassidy, Ph.D., CCC-SLP
Radford University
A Change in Thinking
Early intervention that is most
effective reaches far beyond the
traditional “home visit.”
The Medical/Clinical Model
versus
A Supports and Services
Approach
What’s the Difference?
Medical/Clinical Approach
Supports & Services
Approach
Work with child/family to
address IFSP outcomes
Work with child/family to
address IFSP outcomes
Provider uses knowledge to help
child develop new skills
Provider uses knowledge to help
family apply strategies in daily
life to enhance the child’s
development
Limited in time and scope of
intervention
Is flexible and explores
activities & routines in “real
time”
May focus on isolated skill
development
Focuses on strategies family can
use between visits
Natural Environments
• IDEA Part C (2004):
 Settings that are
typical for infants
and toddlers without
disabilities or delays
Most frequently identified natural
environment location for families is in
their homes (NEILS, 2007)
A New Meaning for
“Home Visit”
WHAT the visit looks like and WHERE
it occurs depends on the IFSP outcome
& activity being addressed.
Examples:
• Informal play session at home
• Lunchtime at McDonalds
• Observation of bath time
• Shopping trip to the mall
It is not what the service provider does in
the home that will make the difference in
the child’s development;
it is what the family, child care providers,
etc. learn during the sessions and use
during their activities and routines
throughout the week that facilitates the
child’s learning and development.
McWilliam, 2000
“A child, on average, can be expected
to find himself or herself in some 16
different home and some 25
community locations where learning
takes place. These 40 or so different
locations, on average, result in child
participation in about 150 activity
settings, which, in turn, give rise to
more than 200 different kinds of
learning opportunities promoting child
development.”
Dunst & Bruder, 1999
What are some of
the routines that a
child and his/her
family engage in on an
everyday basis?
Which of those routines
might serve as meaningful and functional
opportunities for learning?
A Process…not a place
Consider this…
• Knowledge and skills are best developed under
conditions that are authentic and reflect the reality
and demands of daily living. (Brown, Collins, Duguid,
1989)
• Real activities and
purposeful interactions
help children become
more effective communicators.
(Bricker, 1986)
And this…
A child needs repeated
opportunities to
experience a desired
behavior
• within the context of an
activity
• across different
activities
• Ukrainetz
(2006)
But what about our bags of toys?!
Fact or Fiction?
The toy bag/toys are used for direct instruction; the materials in
the natural environment are for generalization of outcomes.
Some homes have nothing-no materials or activities or everyday
routines-with which to address outcomes.
Parents WANT us to bring toy bags/toys into the home. The
children LOVE our toys!
The use of a toy bag is an addiction and we depend on those toys to
do our jobs.
The toy bag carries our toys…
and a message…
“Your stuff isn’t good enough.”
Intervention only occurs during the
visit.
10 Step Program to
Decreasing Your Toy Bag
Dependence!
FACETS: http://facets.lsi.ku.edu/
1. Conduct a functional assessment of the
home/natural environment.
2. Use social and daily routines that are
already occurring to join the caregiver
and child upon your arrival.
3. Plan activities for
your next visit
before leaving.
4. Plan a special activity with the caregiver.
5. Organize a play
date with other
children and
caregivers.
6. Ask the child to show you/get toys or
preferred objects from another room
in the house. Follow the child’s lead
and move into other rooms of the
house.
If you are STILL feeling the
need to carry a bag into the
natural environment…
7. Fade your
dependence by
decreasing the size
of the bag over
time.
8. Demonstrate the use of a toy that
includes opportunities to practice a skill.
Then look around the home for toys or
other materials that might provide
additional practice for the same skill.
9. Use “hybrid approaches”:
 Forgetfulness is
always an option!
 Provide a choice.
 Sabotage the bag.
10. Leave the toy bag by the door and
join the child’s activities. Use the toy
bag only when and if needed.
So…FACT or FICTION???
The toy bag/toys are used for direct instruction; the materials in
the natural environment are for generalization of outcomes.
Some homes have nothing-no materials or activities or everyday
routines-with which to address outcomes.
Parents WANT us to bring toy bags/toys into the home. The
children LOVE our toys!
The use of a toy bag is an addiction and we depend on those toys to
do our jobs.
Coaching the Caregivers
5 considerations for
working with the
ADULTS!
(Knowles, 1995)
Agree on priorities and clarify roles.
Join in; try not to take over.
Encourage the
caregivers to identify
opportunities that
they already enjoy!
From there, build on
the caregiver’s
strengths within
those routines and
activities.
Provide specific and meaningful
feedback.
THE RELATIONSHIP DOES MATTER!
Coaching Take Away Message
What happens BETWEEN visits is far
more important than what happens
DURING visits!
Ask Yourself
• Have I provided this family with
practical strategies to try in their daily
life when I’m not here?
• Does the caregiver understand the
strategies and feel competent to
incorporate them into the family’s
routine?
Life isn't a matter of
milestones, but of moments.
Rose Kennedy
Share an “a-ha” moment with the
person sitting next to you that
you want to take away from this
session.
YOU touch the lives of
families every day!
Help them make most
the of every moment!
References
• Campbell, P.H., Milbourne, S., & Wilcox, M.J.
(2008). Adaptation interventions to promote
participation in natural settings. Infants &
Young Children, 21(2), 94-106.
• Orientation to Part C online training module.
(2007). Retrieved October 20, 2007, from
http://www.infantva.org/prTrainingResourcesArchive.htm
• Snow, K. (2009). People first language.
Retrieved February 3, 2009, from
http://www.disabilityisnatural.com/peoplefirs
tlanguage.htm
Contact Me!
Corey Herd Cassidy, Ph.D., CCC-SLP
Associate Professor/Speech-Language Pathologist
Radford University
(540) 831-7637
[email protected]