The Art and Science of Home Visits A basic tenet of family-centered intervention is a commitment to help families—to navigate the early intervention system, to identify resources, to learn new information, and to adopt strategies to use at home with their young child. In family-centered intervention, the early interventionist establishes a relationship with family members and becomes ... Features
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Features  |   January 01, 2005
The Art and Science of Home Visits
Author Notes
  • Arlene Stredler Brown, is the director of Early Education Programs at the Colorado School for the Deaf and the Blind, where she directs the Colorado Home Intervention Program (CHIP) and provides technical assistance to preschool programs serving deaf and hard of hearing children statewide. She is also the Early Intervention Coordinator at the Marion Downs International Hearing Center, providing consultation and technical assistance to programs around the country and internationally that work with infants and toddlers with hearing loss. Contact her by e-mail at arlene.brown@colorado.edu.
    Arlene Stredler Brown, is the director of Early Education Programs at the Colorado School for the Deaf and the Blind, where she directs the Colorado Home Intervention Program (CHIP) and provides technical assistance to preschool programs serving deaf and hard of hearing children statewide. She is also the Early Intervention Coordinator at the Marion Downs International Hearing Center, providing consultation and technical assistance to programs around the country and internationally that work with infants and toddlers with hearing loss. Contact her by e-mail at arlene.brown@colorado.edu.×
Article Information
Professional Issues & Training / Features
Features   |   January 01, 2005
The Art and Science of Home Visits
The ASHA Leader, January 2005, Vol. 10, 6-15. doi:10.1044/leader.FTR1.10012005.6
The ASHA Leader, January 2005, Vol. 10, 6-15. doi:10.1044/leader.FTR1.10012005.6
A basic tenet of family-centered intervention is a commitment to help families—to navigate the early intervention system, to identify resources, to learn new information, and to adopt strategies to use at home with their young child. In family-centered intervention, the early interventionist establishes a relationship with family members and becomes their consultant. Through this relationship, family members discover their natural strengths. They then capitalize on these strengths as they learn what they need to do to facilitate their child’s growth.
Family members also engage in a reciprocal relationship with their early interventionist. This relationship between equal partners depends on establishing trust. Serving as a coach, the early interventionist helps family members actualize their roles as primary facilitators of their child’s development.
Addressing Family-Centered Needs
Many professionals received their pre-service training long before family-centered practices were defined. While these professionals are veterans in child-centered treatment programs, they often seek guidance when they are called upon to deliver family-centered intervention. This need is common to rehabilitation audiologists, SLPs, early childhood special educators, and others working with infants and toddlers under three years of age.
Recognizing similar needs in their own programs, a consortium of directors of several family-centered intervention programs in the United States met repeatedly to identify specific strategies to enhance the delivery of family-centered practices. These productive meetings gave us all an opportunity to articulate our experiences, collect evidence that supports family-centered practices, and identify the content to be taught to the early interventionists in our programs.
Our videotape, “The Art & Science of Home Visits” (for more information, visit the Boys Town Press Web site), provides professionals with information about effective family-centered practices and a practical guide for conducting home visits with infants and toddlers with disabilities. While the information was created specifically for interventionists working with families who have young children who are deaf or hard of hearing, the principles and strategies are appropriate for professionals working with any family that has a young child with any disability.
Components of the Home Visit
Our working group created a rubric, or a guide, identifying the discrete components of the home visit (see sidebar, p. 15). These five components are: reconnect and review, address priorities, show the craft, assess and evaluate, and reflect on the visit. Each of these elements has a specific purpose.
Reconnect and Review
The home visit starts when the early interventionist connects with the family. One way this is done is by asking each family member what has transpired since the last home visit. The early interventionist learns from family members what they are experiencing with their young child, both practical and emotional. During this part of the home visit, interventionists often need to set aside their professional agenda to address the current events in the family’s life. The value here is to honor each family member, to listen to their needs, and to tailor the session to meet these needs.
This connection sets the tone for the entire session. It assures parents that you, the professional, are listening to their questions, that you are comfortable with their issues, and that you are available to support them.
Address Priorities
Next, priorities for the home visit are established. Although the professional brings a well-developed plan to the session, the family’s questions, concerns, and accomplishments also need to be considered. The specific strategies that will be taught must be appropriate not only for the child, but for the family. And the work must be valued by family members. To assure this happens, the professional needs to rely on the family’s knowledge of their infant/young child. The professional listens carefully to the family’s questions and concerns and combines this new knowledge with his or her professional knowledge and experience. Together, family members and the early interventionist identify the topics to be addressed that will support the family’s goals for their child.
For each of my home visits, I come prepared with three or four strategies, or techniques, to teach family members. I select strategies appropriate for the developmental domains affected by the disability. These strategies may address language, speech, cognition, listening skills, motor skills, or behavior, among others. From the professional’s point of view, these are strategies that are developmentally appropriate for the child. From the family’s point of view, these strategies are the ones that support the outcomes they desire for their child.
Show the Craft
This step in the rubric is the part of the home visit that is most familiar and comfortable for most professionals. After briefly explaining a specific strategy that will be taught, the play begins. The early interventionist demonstrates the technique while actively engaging the parents in the discovery process. This is when all attention is focused on the child, discovering the appropriateness and effectiveness of the technique being explored. Everyone is working together and experimenting. Which prompts work well? What can be changed to extend the duration of the activity? In what other ways can the outcome be accomplished? Where and when can the strategy be used?
Throughout this process the early interventionist uses coaching strategies to explore, with the family, the techniques that work. They experiment as they discover strategies to promote the child’s development. By being an active participant in this process, the family members gain competence and confidence. This gives them information and skills that help their young child now and continue to help as the child grows.
Once a specific strategy is taught, a second strategy is implemented with the same structure in mind. If time allows, a third strategy may be taught during one home visit.
Assess and Evaluate
As implementation of the strategy comes to a natural conclusion, assessment and evaluation commence. In an informal way, the early interventionist, along with the parents, identify the child’s skills before, during, and after the implementation of a specific strategy. This requires a conscious effort to identify the child’s current skill level and any perceived behavioral responses to the strategy. We anticipate the child will respond positively to the strategy by demonstrating new skills.
Evaluating the baby’s or young child’s achievement requires a review of developmental milestones and an objective assessment of performance compared to typically developing peers. When evaluating the specific strategies that were taught, the family can discover the child’s reaction. Did the child’s behavior change because of it? If so, how? If not, why not? For very young children, it is always best to assess the child in the context of the natural environment. This can be done easily because we are in the family’s home.
Because we’re implementing a family-centered approach, the evaluation includes an assessment of the family members as well as the child. After all, the family is learning these strategies in order to promote the development of their child. Therefore, in addition to assessing the child’s performance, the family ascertains how the use of a particular strategy felt for each of them. Was it comfortable? Can they expect to incorporate these strategies into their daily routines?
In addition to this informal assessment, formal assessment of the child’s progress provides important information about the effectiveness of the strategies. Formal assessment is typically conducted at regular intervals in order to support the development of the Individual Family Service Plan. While some programs choose to use clinician-administered tests, there are many protocols and checklists that parents can complete. Our programs make videotapes of parents interacting with their children to allow examination of the child, the parents, and the parent-child interaction. Parents learn to be critical observers of their child and the strategies they use.
Whether assessment is conducted informally during the home visit or more formally through administration of specific protocols, the evaluation process is beneficial for the parents. By learning to critically observe their child’s behavior, parents become more invested in their child’s development. Eventually, family members learn to identify the needs of their child, barriers to meeting those needs, and strategies to address them. As parents achieve this level of participation in the intervention process, they become more self-sufficient. This self-sufficiency goes a long way to improving a family’s confidence in parenting a child with a disability.
Reflect on the Visit
Toward the conclusion of each home visit, the early interventionist and family members discuss the session’s activities. The interventionist seeks feedback on the techniques used with the child and the reaction of the parents to the discussions they had. These reflections, a part of every visit, are important to determine, together, a number of things. Were particular strategies or techniques successful? Were the questions from family members answered? Were family members satisfied with the information they received? Are they ready to use the new information and novel strategies in their daily routines? The early interventionist incorporates family feedback, and considers the work that will be done in the weeks ahead. This may include gathering articles, videos, and books to discuss at the next visit.
Tools of the Trade
During home visits, early interventionists use specific techniques—we call them “tools of the trade”—to promote the effectiveness of a family-centered approach. Each of these strategies focuses on the quality of the interaction between the interventionist and family members. Use of these techniques supports the fact that family members are the primary clients in a family-centered approach. They are the ones receiving the services to benefit their child.
To support the effectiveness of the family-centered approach, the interventionist serves as an information resource, provides validation, acts as a sounding board, and takes on the role of “news commentator”—these four techniques are the tools of the trade.
Information resource
The early interventionist must be prepared to provide technical support and information on a wide variety of topics. It is the responsibility of the professional to gather information in response to questions from the family and to share this information at subsequent home visits.
Validator
Validation reinforces what parents are doing right by pointing out desirable behaviors in their interactions with their child. As the early intervention process unfolds, families take an active role in recognizing what is important and identifying what is working for them and for their child.
Sounding Board
When employing this technique, the interventionist uses active listening and reflects what is heard back to the family. The information reflects both the content of the message the family shared and the emotions they revealed. Use of this tool assures the visit is family-centered because the focus is continually placed on family members.
“News Commentator”
This term was coined by Marie Condon, a graduate student at the University of Washington. When using this strategy, the early interventionist provides an on-the-spot commentary, giving immediate feedback to the family during a teachable moment. This technique is useful when the parents and the interventionist are discovering the effectiveness of specific strategies they are using with the child.
The information provided here describes an effective home visit for early interventionists. The information is also for families, offering insight into the experience they will have during their child’s early years. The result of the relationship between early interventionist and family is mutual trust that leads to the family’s effective facilitation of their child’s development. The child, ultimately, is the primary beneficiary.
Program Directors

The program directors who contributed to this work are:

Arlene Stredler Brown, director

Colorado Home Intervention Program (CHIP)

Colorado School for the Deaf and the Blind, and

Coordinator for Early Education Programs

Marion Downs Hearing Center

University of Colorado Hospital

Mary Pat Moeller, director

Center for Childhood Deafness

Boys Town National Research Hospital

Rosemary J. Gallegos, director

Early Childhood Programs & Outreach

New Mexico School for the Deaf

Paula Pittman, director

SKI*HI Deaf Mentor Outreach Projects

Utah State University

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January 2005
Volume 10, Issue 1