6 Musts for Effective Tele-Intervention with Families of Young Children

Over the past few months, social distancing and public health guidelines have rapidly elevated tele-intervention from niche to normalized. Once reserved for bad weather, illness, geographical necessity, or the regular outsourcing of certain specialized services, tele-practice is now common practice for early interventionists.

With many states increasingly uncertain about when in-person assessment and intervention can safely resume, virtual home visits may remain a major part of your daily work for the foreseeable future. With that in mind, we’re presenting a few “musts” that will help you fine-tune your remote coaching and tele-assessment skills, and ensure that the developmental needs of young children continue to be met.

Note: If you’ve never used video conferencing technology to deliver early intervention (EI) services, check out the end of the article for some great resources you can use to familiarize yourself with the tele-intervention process.

#1: Practice empathy

Approaching parents and caregivers with heightened compassion is more important than ever, so prior to that first text, email, or phone call, spend some time reviewing the family’s records.
Ask yourself questions like:

What additional stressors might they be facing?
Have one or more adults in the household become unemployed due to COVID-19?
Are they or someone close to them experiencing health problems or fears?
How can I best support them and address their child’s EI priorities without adding to their stress?

Use these questions to guide your initial conversation with families, put yourself in their shoes, and be sensitive to their needs during tele-intervention. And once a parent has agreed to a virtual home visit, you might want to spend a few minutes doing an “emotional check-in” at the beginning of each session. Ask about how the family has been doing in general, any special milestones they have coming up, or other significant life events that aren’t necessarily related to their child’s development.

Adapted from 7 Technology Tips for Tele-Intervention, Strategies for Engaging Parents (Not Children!) During Tele-Intervention Webinar & Family Guided Routines-Based Intervention’s Mobile Coaching Tip Sheet

#2: Demystify the process

In this age of social distancing, most families with small children have at least some experience using Skype, FaceTime, Zoom, and other video conferencing platforms to safely connect with loved ones. Despite that level of relative comfort with online interactions, you may still have to convince a reluctant caregiver that participating in tele-intervention is the best way to keep their child’s development on track.

To demystify the process and help alleviate doubts on the part of the caregiver, try sharing a video that walks you through a virtual home visit, like this one from the Early Childhood Technical Assistance Center. Encourage the parent to ask questions and share any concerns they might have after watching the video. Put them at ease by telling them about your own nervousness and uncertainty when you first started navigating this new frontier, and assure them you’ll figure it out together.

You might also let the parent know right up front that the child doesn’t have to be onscreen and in one room for the entire virtual visit. One of the best features of tele-practice is its mobile nature: parents can pick up their tablet, phone, or laptop and “take you along” if the child becomes restless and decamps to another part of the house. That kind of flexibility makes tele-intervention a great fit for families with active young children.

If a parent is still hesitant to agree to a home visit via video conferencing, see if they’d be more comfortable starting with a phone session, or if they’d be willing to share a short video of a routine or activity that you can watch and follow up with feedback.

#3: Be prepared for technology hiccups

Frozen video. Loss of video. Audio lags and drop-outs. Tech glitches and video conferencing go hand-in-hand, but there are things you can do to help minimize the impact these inevitable snags will have on your virtual home visit:

Practice in advance. If you’re unfamiliar with the video conferencing platform you’ll be using, try it out a few times with friends or colleagues beforehand, and make sure you know how to use the chat function so you can troubleshoot with families if you experience glitches during the tele-visit. If you’re totally new to tele-intervention, and you know someone with a child in the appropriate age range, you can even conduct a practice session with them to acclimate yourself to the process.
Do a pre-visit tech check. Regardless of the video conferencing platform you’ll be using, it’s a good idea to schedule a 10- to 15-minute tech check with the family before the actual session to make sure your devices “play well” together and determine audio and lighting levels. It’s also a great opportunity to discuss how to best position their device so you can have a clear, unobstructed view of the routines you’ll be observing.
Give time for them to respond. Audio lag time is perhaps the most common issue experienced over video chat, so to avoid talking over a parent, provide ample time for a response after you’ve made a statement or asked a question. To help increase caregiver comfort, try to mirror their rate of speech, keep your comments as simple as possible, and only ask one question at a time.
Have a back-up plan. Despite best efforts, there are times when technology refuses to cooperate. Successful troubleshooting can be as simple as logging out of the chat session and logging back in, or switching browsers. If the tech issues are insurmountable, encourage the parent to send you a brief video or two of whatever routine was interrupted, and continue the session over the phone. Sometimes a choppy connection stems from a family having multiple demands—like older children doing remote learning—on limited data or bandwidth. In that case, try rescheduling the session for a time when others in the household are logged off.

Adapted from Family Guided Routines-Based Intervention’s Mobile Coaching Tip Sheet, Strategies for Engaging Parents (Not Children!) During Tele-Intervention Webinar, 5 Tele-Intervention Tips for Supporting Families of Young Children with Disabilities, VEIPD’s Early Intervention Tele-Assessment, Video Chat #1

#4: Stay flexible

Having a loose framework for your session is helpful, but it’s also important to stay flexible and be prepared to switch gears if things aren’t working, or if an opportunity arises during the session to embed new routines and increase child engagement.

Get family members involved. Including other members of the household in tele-intervention offers more chances for interactions, social communication, and the practice of new skills. For instance, if an older sister kicks a ball into the living room while you’re observing the caregiver and child engaged a routine, work together to involve both siblings and the ball in a new game that aligns with the child’s intervention goals. If there’s another parent or relative at home, ask if they’d like to join in the session. Having a second adult on the video call can be very useful. While one caregiver facilitates play with the child, the other person can ask you questions, take notes, and hold the phone or device.
Take advantage of your lack of “presence.” During a tele-visit, a parent might let you “sit in” on certain routines, activities, and interactions they’d be hesitant to share—or ones that would be awkward for you to participate in—if you were physically present. Dropping in on mealtime might be intrusive during a typical home visit, but during a virtual visit, it can be as simple as finding a way to stabilize the device on the kitchen counter. To model flexible thinking, try asking the caregiver, “What would you typically be doing right now?” and then “Do you mind showing me?” or “Can I watch that?”
Pay attention to details. Scan the scenery in each room and look for items that can be integrated into the play routines. If you see a specific toy, book, rolled-up blanket, or anything else that might help the child practice a targeted skill, find a way to use it!

Adapted from Family Guided Routines-Based Intervention’s Mobile Coaching Tip Sheet, Strategies for Engaging Parents (Not Children!) During Tele-Intervention Webinar, & 5 Tele-Intervention Tips for Supporting Families of Young Children with Disabilities

#5: Flex those coaching muscles

Tele-intervention can help a parent blossom into a self-reliant play facilitator, significantly boosting their child’s development in the long run. With the caregiver occupying the play facilitator role during the virtual home visit, you’ll have the chance to strengthen your coaching skills. Here are a few tips to help you thrive in this role:

Alternate types of feedback. Strike a balance between supportive, strengths-based feedback (telling the caregiver what they’re doing right and letting them know you hear what they’re saying) with informational feedback (sharing new information and strategies in response to something the caregiver does or says). The goal isn’t to tell the parent what to do, but to observe the parent and child during an activity or routine and then offer suggestions or subtle indirect prompts. For example, if a child is struggling with a manipulative during play, you could say, “I wonder what would happen if you encourage him to keep trying and wait before helping him.” A supportive, strengths-based statement might be, “That’s wonderful! He’s really figuring it out!”
Problem solve using open-ended questions. Effective coaching is predicated on collaboration and reflective problem solving. If the parent and child are struggling with a specific routine, ask questions like, “What could we do differently in this situation to support a better outcome?” Help the caregiver think it through, brainstorming together to find a solution. Replace “Have you tried…” with “What have you already tried?” Ask them to describe what they’ve tried, if it was successful or not, and what might be changed to make it work. Open-ended questioning scaffolds onto the caregiver’s existing knowledge and stimulates capacity-building and adult learning.
Continue reflection between tele-visits. After the session, reach out to the parent over text, email, or phone and ask them questions to facilitate further reflection: What do you think went well/not well? Did you try something different this time that worked better than you expected? What stood out to you the most? Did your child do something new or unexpected? What’s something that you’d like to work on between now and next visit? What do you need from me to help make that happen? Use the caregiver’s answers to inform the joint plan for the next virtual home visit.

Adapted from Virtual Transdisciplinary Play-Based Assessement-2: Responding to COVID-19, Family Guided Routines-Based Intervention’s Mobile Coaching Tip Sheet, Strategies for Engaging Parents (Not Children!) During Tele-Intervention Webinar, Indiana Institute on Disability and Community Early Childhood Center’s Tele-Intervention for Early Intervention: Session Guidance, & Breaking the “Have You Tried…?” Habit

#6: Look though a functional lens

Not being able to rely on your usual assessment kit during tele-intervention will make the process more challenging in some ways, but it’s also a great opportunity to examine assessment items through a functional lens and deepen the parent’s understanding of their child’s development. Explain to the caregiver what you’re looking for (and why) and then troubleshoot creative ways to observe the same skills and behaviors using items the family has around the house.

No blocks? No problem! Help the parent understand that when you ask to see their child stack blocks, it’s not the blocks that are important, but the fine motor and cognition skills the child is using. If the family doesn’t have blocks in the house, Cheerios or other stackable items make a fine alternative.
No pegs and bottle? No worries! It’s not about seeing if the child can get the pegs out of the bottle, it’s about assessing their problem-solving and wrist rotation skills. You can observe the same skills with a shape sorter the family has, or you can have the child pick up pieces of a puzzle (or those endlessly useful Cheerios!) and drop them in a cup or toilet paper tube.

Adapted from EI Tele-Assessment Video Chats & Strategies: You’ve Got This! & VEIPD’s Early Intervention Tele-Assessment, Video Chat #1

We’re still in the early stages of refining the tele-intervention process, but the strategies outlined in this article will help you sharpen your coaching skills, strengthen your relationship with families, and maximize parents’ potential to support healthy development—positive outcomes that will persist long after the pandemic is over.

Additional resources

If you’re new to the delivery of EI services using video conferencing technology, this webinar from the Infant & Toddler Connection of Virginia is a nice place to start. In addition, this resource page from the Early Childhood Technical Assistance Center, and the Virginia Early Intervention Professional Development Center’s round-up of blog posts and video chats feature plenty of practical tips and strategies you can use as you prepare for your first virtual home visit.