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A Q&A with the Developers of the MEISR

8 Questions with the Developers of the MEISR

The practices and patterns of daily family life can sometimes seem mundane, but these routines are actually vibrant, essential training grounds where very young children begin to engage with their world—and lay the groundwork for healthy social-emotional, language, and cognitive growth.

The new Measure of Engagement, Independence, and Social Relationships (MEISR™) analyzes the functional behaviors of young children from birth to age 3 within the context of 14 typical family routines, including meal times, nap time, play, grocery shopping, bath time, and bedtime. The MEISR can be completed in about an hour by a parent or caregiver, either on their own or under the supervision of an early intervention professional. With the results, you can:

  • Empower families to enhance natural learning opportunities
  • Help families choose functional skills to address within the Individualized Family Service Plan (IFSP)
  • Help your team determine Child Outcome Summary (COS) ratings
  • Develop individualized intervention priorities

Who better to explain what the MEISR is all about than the two people who created it? We recently posed a round of questions to R.A. McWilliam, Ph.D., and Naomi O. Younggren, Ph.D., developers of the MEISR. Here’s what they had to say about the need filled by the MEISR, how the MEISR complements the Routines-Based Interview (RBI), the importance of child engagement, and more.

Q. Why did you decide to develop the MEISR?

A. The MEISR evolved out of the Routines-Based Interview (RBI), in which we ask families detailed questions about their children’s engagement, independence, and social relationships (EISR). About 20 years ago, I [Robin McWilliam] homed in on these three areas of functioning as the essence of meaningful participation by children in their daily routines. My familiarity with the skills parents reported in the RBI led me to develop a way we could monitor children’s progress, organized by EISR within everyday routines.

Q. Child engagement is a critical area of focus in the MEISR. Can you talk a little about why engagement is so important, and how it affects a young child’s overall development?

A. As my colleagues and I reported as long ago as 1985, a child cannot learn if the child is not engaged. Engagement is about how children spend time, what or whom they spend that time with, and how sophisticated their engagement behavior is. You can see how a child who is “out of it,” not attending, and not interacting with people or objects, is going to have a hard time learning. On the other hand, a child who is absorbed in what’s going on in the routine is going to catch on to what is needed to get the most out of breakfast, play time, outside time—whatever the routine is.

Q. Can you briefly walk us through a typical administration of the MEISR, including the basics of how it works and how long it takes?

A. An early intervention professional starts by explaining to the family that the MEISR is a way to develop a snapshot of the child’s everyday functioning. The professional then shows the family how the MEISR is organized by routines (times of the day) and by age. Newborn items are first and items for three-year-olds are last.

It takes about an hour for a family to complete the MEISR. The family begins around the child’s chronological age and goes “up” the items—which is to say, items typically acquired at younger ages—until they score four items in a row as 3 (mastered). All the items younger than that are considered mastered. This procedure is called establishing a basal. After this, the family then goes “down” the items—which is to say, items acquired at older ages than the starting point—until they score four items in a row as 1 (not yet). All the items older than that are considered not yet attained. This procedure is called establishing a ceiling. When the MEISR is complete, you’ll have vital information about the child’s functioning approximately relative to age functioning expectations and the demands of daily routines.

Q. How does the MEISR complement the Routines-Based Interview (RBI)? Could you describe the process for using the two together?

A. The MEISR can be used in five ways with the RBI:
It can be a useful tool for a professional involved in the RBI, such as a note taker, to prompt questions about the child’s EISR in routines.

  • It can be a useful tool for a professional involved in the RBI, such as a note taker, to prompt questions about the child’s EISR in routines.
  • It can be completed following an RBI. If some items were missed in the RBI, the interviewer can ask about those items afterwards.
  • It can be used after the initial RBI, within the first 30 days of enrollment in a program, as a quantification of the child’s functioning. This is useful for progress monitoring.
  • It can be used within 30 days before an IFSP review or annual revision to inform the team about the child’s functional needs and to prepare the family for a review RBI.
  • It can be shared with the family prior to the RBI as a way to help them understand the array of participation-based skills that are part of their day-to-day routines.

Q. How do MEISR results help with the development of IFSPs?

A. The MEISR, ideally, is done as a complement to the RBI in developing the IFSP, as described above. With or without the RBI, however, it provides the family and other team members with ideas about skills to aim for in the next 6 months that will enhance the child’s engagement—and therefore, learning—at different times of the day. The family can identify outcomes that are meaningful to them and useful for the child. These outcomes can be for skills the child is delayed in or that the child already has and the family would like to build upon.

Measure young children’s engagement and function within the context of daily routines.

Q. What are some ways that the MEISR can help enhance parents’ skills/knowledge and contribute to healthy child development?

A. Many families are interested in information about child development: They often want to know what children who are their child’s age typically do, or they want to know what comes next. The MEISR can help provide them with that information. It can also help families set developmentally appropriate expectations for their child and determine what to aim for in their parenting, which involves teaching. Parents can see what the next steps are, and what they should be focusing on, in the routines of daily home life.

Q. What are the greatest challenges professionals might encounter when integrating the MEISR into their program, and how would you recommend addressing these challenges?

A. The greatest challenge is the length of the MEISR, at around 350 items. Even with our basal and ceiling procedures described earlier, the length of the tool and the amount of time it takes could be daunting for a family busy with an infant or toddler. One solution might be to suggest that the family complete it in chunks, such as a couple of routines a day or week, to keep the process manageable.

Another challenge is coming to terms with the reality that the MEISR cannot be used for eligibility determination. It does provide information about a child’s functioning in the five domains of development, as it is crosswalked with those domains, but it doesn’t yield the percentage of delay score often needed for Part C eligibility determination. Programs are cautioned against trying to use it in that fashion.

A third challenge is English literacy—whether it’s that the family doesn’t read English readily or that the family members aren’t proficient readers. We tell professionals that they should be prepared to help families complete the MEISR in these situations. We recently heard a professional balk at the idea of spending a whole visit completing the MEISR, but that leads to an empirical question about whether time spent reviewing a child’s engagement, independence, and social relationships in routines might in fact be a very good way to spend a visit. This professional was also concerned about how one would bill for that visit. Our solution is that this is considered parent education, which is billable.

Q. What’s the biggest benefit a program might experience from adopting and using the MEISR?

A. The focus on functionality is the biggest benefit. The MEISR helps keep professionals and families focused on how children function in context, as opposed to encouraging skill acquisition for no discernible purpose, which is often what skills on developmental tests or curricula become. If used for IFSP development, as encouraged, the resulting participation-based IFSP outcomes will guide the way for routines-based intervention.

Also, early intervention teams often struggle with monitoring children’s progress across the program. The MEISR provides a systematic method for seeing how children are progressing functionally. These data allow programs to examine their results to see whether some children are making more or less progress.

For states using the child outcomes summary (COS) process for measuring the federal child outcomes, another benefit is that the functional items in the MEISR are crosswalked with the three child outcomes and organized by age. This makes the MEISR a valuable tool for age anchoring a child’s functional abilities within each of the three outcomes.

Learn more about the MEISR: see a sample, join a webinar, and more.