A. Consider Perspectives and Contexts

Step 3 provided an opportunity to consider sources of general evidence about embedded interventions. Now you will need to think about that general knowledge in light of Luke’s unique situation. To help you understand the contexts further, listen to the perspectives of Luke’s family and the other members of Luke’s team.   These perspectives will help you gain an understanding of the family’s values and priorities, additional characteristics of Luke’s early childhood program, and the available supports related to this particular situation.

Audio 1.2: Christine’s perspective (Luke’s mother)

The mother of Luke, a three year old boy with developmental delays, shares her perspective a few months later after he has enrolled in a childcare program. She discusses her feelings about using embedded interventions both at home and in the program (running time: 2 min. 32 sec.).

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I know how hard it can be.  At home, it was difficult day in and day out, using hand-over-hand assistance to show my son how to communicate with me.  Over and over, I would help him make the sign for “more,” or take his hand and push the big button of a voice output device to make an animal sound, with the hopes that one day, someday he would talk back on his own.  My son has a rare chromosomal abnormality.  No other cases like his are known.  So no doctor can say what he will or won’t be able to do.  But isn’t that true for all children?  We are all different.  So I went on blind faith, and one day my son did sign back to me.  One day he asked for “more” and more is what I gave him.  We kept working, every day, using embedding interventions all throughout the day, and now my son speaks to me in 3- or 4-word sentences.  Sure he doesn’t use his voice, but I understand him nonetheless.

I sometimes think that my son’s easy-going laid-back attitude does him a disservice.  If my son can’t reach out to someone, or has trouble engaging them, he doesn’t get upset or frustrated.  He’s content to turn and play in solitude.  He’s quiet, non-disruptive, and ideal for a teacher, I would think.  But if the teachers just practiced with him, every day, even if only a little, to use his talking device, or use signs with him, he would learn that he could reach out to them and become part of the classroom community.  And from there, who knows where it could lead?  I would love to see my son attempt to talk to a classmate.  To my knowledge, he has never once attempted to say anything to another child.  His teachers are in the unique position to embed peer support activities into his daily routines and encourage that interaction.

My husband and I differ on our views about embedded interventions.  He’s not as concerned as I am that Luke work towards these goals, and thinks that as long as Luke is loved and happy, he will gain these skills naturally.  But one thing we both agree on is that the sky is the limit for Luke.  We have seen our son come so far, and we know that his only limits are those we put on him.  I want Jackie and the rest of the staff to learn from our experience and help us all continue to grow.

Audio 1.3: Maggie’s perspective (program administrator)

The administrator of a childcare program in which Luke, a three year old boy with developmental delays, has recently enrolled, shares her perspective. She discusses her attitudes and challenges to support the use of embedded interventions in the classroom (running time: 2 min. 10 sec.).

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As the director of a high quality early childhood program, I take great pride in the fact that we work together as a team to serve each child and family as best we can.  My staff is committed to working with families to honor and support each child as an individual.  All that said, our task has become more challenging as we’re now providing services to children with significant disabilities.

This isn’t going to be easy because I am dealing with teachers’ attitudes, biases and fears about their own abilities to work with children with disabilities.  In addition, we need to coordinate our services with those agencies outside our program that will be providing funding and support services.  I know that Jackie and her team are going to need some professional development on teaching strategies to support Luke’s participation in the classroom. I need to try to find someone who can come and do some training for the whole staff on communication devices. That way others who interact with Luke on the playground will feel comfortable using this tool too. But I am confident that we can find the resources to make this work.

One of my biggest challenges is going to be finding the time in our already busy schedule for the teachers, therapists and parents to meet. I know that communication is key in coordinating the services that are essential to Luke’s progress.   Between myself and our floater, we’ll need to provide coverage in that classroom for service coordination and collaboration to take place. I hope that we’ll be able to provide this on a regular basis. Otherwise I may need to find financial resources to hire some extra help.

Everything that I am reading and hearing from the national association that accredits our program is that providing inclusive services is best practice and the way to go.  So we’re going to work hard to reach those standards and maintain a high quality program for all children, families and the practitioners who work with them.

Audio 1.4: Kathy’s perspective (speech therapist)

A speech therapist in a childcare program shares her perspective on serving Luke, a three year old boy with developmental delays who recently enrolled. She discusses the challenges of using embedded interventions in the classroom (running time: 2 min. 03 sec.).

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For a child like Luke who has little to no speech, it is hard to truly participate in the community.  Giving him tools to reach out and communicate with others not only empowers him, but gives us a much better idea about what he is thinking and feeling so we can all be more appropriately responsive and know him better.

But showing Luke these tools, providing opportunities for him to work on these skills—it’s hard work and can only happen with the collaboration of all the team members.  I know that Luke’s mother is concerned that he might not be receiving enough individual therapy with me.  I understand her worries and I have similar concerns.  I don’t have the time to be in the classroom every day, so I rely heavily on Jackie and her co-teacher to implement the strategies I suggest.  Are they using embedded interventions with Luke every day?  How often does it really happen?  I realize that they are trying, and they have other children to teach.  But what they are doing with Luke—is it enough?

If I can give the teachers the supports they need, implementing the embedded interventions will be much easier on them.  I should offer training on Luke’s communication device.  I could create picture boards, special books, and other adapted material that would not only help them execute the activities, but provide visual reminders of best times and places to embed those activities.

The other children in Luke’s class provide wonderful opportunities for social interactions and peer-modeling of speech.  But my therapy sessions with Luke in the classroom are sometimes pulled off track by the other students.  It can be challenging to manage the other children and the classroom environment. I do my best to create a positive learning experience for all the kids, but sometimes I feel like pulling Luke out for an individual session still might be best for some activities.  It can sometimes be frustrating given that I have such a limited amount of time with him.

Audio 1.5: Jackie’s Perspective (Luke’s Teacher)

A teacher in a childcare program shares her perspective a few months after Luke, a three-year old boy with developmental delays, has joined her classroom (running time: 1 min. 53 sec.).

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Over the past several months Luke’s made some great progress in the classroom, both on his communication goals and with peer interaction. I think he’s a lot smarter than what people give him credit for.  We just need to find more specific strategies to help him use his own voice and express himself. And that’s where I need more help.

Usually I work one-on-one with him, while my co-teacher handles the rest of the class.  During circle time, my co-teacher will lead the group, and I try to keep Luke engaged.  I’ll whisper little comments to him, that sort of thing.  Without the individual attention, Luke struggles to play or participate like the other kids.  He’ll go back to spinning bowls or fixate on a favorite car, and isn’t interested in the group activity.

I see Kathy, the speech therapist using play sequences so I’ve been trying those out as well.  I think it’s starting to help.  I really wish she could be in the classroom more and teach us how to use his spring board.  That way we could use it in more activities. Right now we only use it at meal time.  He’ll ask for foods and tells us when he’s finished.

Another thing I am still getting used to is understanding how the people in other agencies outside our program, fund and support Luke.  I am learning that there are a lot of requirements around his IEP and I need to communicate and collaborate with those folks as well.

But seeing the smile on Luke’s face coming into school every day – that really makes it easier and fun doing our job.  The other morning, I arrived late to class and Luke noticed. He left a favorite activity to come over and greet me.  He gave me a nose kiss and said “Hieeee”.   It meant a lot to me that he knew I was there.