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Providing Technical Assistance to Families: A Guide for State Deaf-Blind Projects
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Intensive TA

Intensive TA is individualized and ongoing and thus can be extremely time consuming.  OSEP’s definition of intensive TA specifies that it is often provided on-site and requires a stable, ongoing relationship with the TA recipient. TA services are a negotiated series of activities designed to reach a valued outcome.

The definition also states that it should result in changes to policies, programs, practices, or operations that support increased recipient capacity and improved outcomes at one or more systems levels. While this is true of systems TA to improve services for families, it’s not a realistic expectation for individualized family TA. Instead, it’s helpful to think of intensive TA for individual families as a process to help them increase their knowledge and skills, improve their quality of life, and enhance their ability to navigate service systems.  

Without careful planning and definition, the lines between targeted and intensive TA can become easily blurred for state projects and the families they serve. Targeted TA is usually a one-time labor intensive event, whereas intensive TA involves multiple interactions with a predetermined series of activities. 

Regardless of which you choose, it’s very important to establish time limits at the beginning of the TA process so the family clearly understands the time commitment and desired outcomes and does not feel abandoned.

The guidance in this section outlines a process and activities to assist you in planning your project’s intensive family TA:

  • Exploration: Assess Family Needs and Readiness
  • Exploration: Person-Centered Planning
  • Preparation: Action Planning
  • Implementation: Action Plans
  • Family Involvement in TA to Schools
  • Implementation Strategies

Exploration: Assess Family Needs and Readiness

During initial contact with a family, it’s imperative to listen to their needs, evaluate how well (and whether) those needs align with your project’s services, and assess the family’s readiness to receive information and support. 

When establishing a relationship, keep in mind how overwhelmed families can feel. Providers come in and out of their house, they have multiple medical appointments, time for self-care is minimized, relationships may be strained, and family members often feel frightened and alone. State deaf-blind project staff are just a small part of the number of people with whom they must form trusting relationships.

Determining Needs

The following are the types of topics that typically come up during initial discussions of a family's needs.

Home life. Are the child’s medical needs being addressed? Have they led to financial difficulties? Are the parents able to work?  Do they know how to connect and interact with their child and create consistent routines? Do siblings feel supported?

The child’s education. Does the family feel the educational needs of the child are being met? Is the learning environment appropriate? Do early intervention providers or educators understand the unique needs of their child? Are they skilled in deaf-blindness?

Life in the community. Has the family found activities for their child other than attending school? Are there plans in place for transition to adult life and employment?

Support from others. Does the family have both natural and paid supports?  Natural supports include help from others in the community or extended family and friends. Paid support is covered by the family or  through external sources, such as a Medicaid Waiver. Have they connected to appropriate organizations (e.g., NFADB, CHARGE Syndrome Foundation)?

Evaluating Readiness

Readiness exists on a continuum. It’s not simply a matter of “ready” or “not ready” (Scaccia et al., 2015). Be cognizant of how feeling emotionally overwhelmed affects readiness to receive TA. You may find, for example, that although a family could benefit from intensive TA, they just aren’t ready to participate at the present time. Instead, consider providing them with simple information relevant to their needs or invite them to join an upcoming event. These less intensive activities can help them begin to learn more about deaf-blindness and your project, make community connections, and increase their readiness for additional support at a later date.

Person-Centered Planning

If your initial assessment indicates that a family’s needs align with your project’s services and they are ready for intensive TA, you may find it helpful to conduct person-centered planning using one of the following tools. They emphasize positive attributes and interests of children and families rather than their weaknesses. You might use them one on one with a family or facilitate a person-centered planning process that involves key individuals such as their child’s educational team members.

Charting the LifeCourse Toolkit – Helps individuals and families develop a vision for a good life, think about what they need to know and do, identify how to find or develop supports, and discover what it takes to live the lives they want to live. 

HomeTalk: A Family Assessment of Children who are Deaf-Blind – Helps families participate in educational program planning by providing a framework in which they can record their children’s characteristics, skills, interests, and personalities. The assessment can be shared with a child’s educational team and used to inform IEP goals.

Reach for the Stars: Planning for the Future – This guidebook helps families plan positive transitions for young children with disabilities. Service providers can use it to understand a family's desires and expectations. 

The McGill Action Planning System (MAPS) – This process includes seven key questions to assist teams and family members to dream and plan for increased inclusion of children with disabilities into the activities, routines, and environments of their same-age peers.

Planning Alternative Tomorrows with Hope (PATH) – PATH  is a visual planning tool that is used to solve problems, set short- and long-term goals, and create action plans. The process begins by looking at what a family wants for the future and then works backwards to identify the first steps toward the life they want for their child and family as a whole.

Preparation: Action Planning

Information gathered from consultation with the family and the person-centered planning tools described above (or alternative tools) can be used as the basis for an action plan. Prioritizing needs and creating manageable timelines are keys to avoiding additional stress for the family. It’s best not to include too many things on an action plan at one time. Providing two or three items to work on after a consultation is usually manageable.

Make sure the plan aligns with the family’s vision for a good life. They need to be able to buy-in to the ideas and be willing to follow through.

Here is a sample action planning form to adapt as needed. Some of the items will be steps to be taken by the state project in support of the family and some will be steps for the family to work on themselves. Once a plan is created, a copy is shared with the family and used in state project follow-up to measure family outcomes.

Examples of state deaf-blind project action steps include:

  • Staff will send information to the family about an upcoming PTI event
  • Staff will share information with the family about the child’s etiology and possible environmental modifications for the home and community  

Examples of  family action steps include:

  • Family member will complete a Medicaid Waiver application 
  • Family will use hand-under-hand prompting strategy with their child
  • Family will try using “more” and “finished” signs with their child

Implementing Action Plans

Once you and the family have developed and agreed upon a plan, set a date and time to check in to discuss how it’s going. Allow enough time for family members to complete their action items, but not so long that they forget to make them a priority—six to eight weeks is typical.

Check-ins might involve a home visit or could potentially be handled with a phone call, online conference, or email. If you are not providing coaching on routines in the home where observation is needed, a subsequent face-to-face meeting is probably not necessary.

During check-ins, go through the action items, evaluate the need for additional support, and make changes to the plan as needed. Complete the code column on the action plan and update the comment column with pertinent details about what has or has not been achieved and why.  

If the family hasn’t worked on any items in the plan, it’s important to determine why. For example, they may:

  • Not understand what to do
  • Need more support
  • Have encountered unforeseen competing demands on their time
  • Have decided the goals are no longer a priority

For goals that have been partially completed, confirm that the family is on track to achieve them.  

For goals that are completed, make sure to capture anecdotal information about how achieving the goal has improved their lives.  

Check-ins are also a time for you, as the TA provider, to evaluate if it's feasible to continue working with a family, based on your project’s time constraints, the needs of the family, and their readiness. As a TA provider, you can’t give all of your attention to only a small handful of families for an endless amount of time, so reevaluating your support to ensure it aligns with your project’s family activities and outcomes is essential for setting time limits for individualized consultations.

Family Involvement in TA with Teams

The TA you provide to a family may involve ensuring their understanding of and active involvement in the TA you provide related to early intervention services in the home or at their child’s school.   

  1. Parents or guardians should be notified about your visit—date, time, desired outcomes (e.g., why the team has asked you to come).
  2. Prior to your visit, have a conversation with them about how they feel early intervention services or the school is doing and gather their insights.
  3. Any report or information you share with early intervention or educational staff should also be shared and discussed with the parents or guardians. Ideally, you would have a debrief at the end of the visit with both the team and the parents (either in person or via phone) to review your observations and suggestions. If this isn’t feasible, knowing the needs of the family prior to your visit will help ensure that what gets discussed includes an understanding of their perspectives.

Why is including the family in the TA visits so important? Because simply put, families are the real experts on their child and oftentimes there is a disconnect between what a team thinks they need to be working on with a child and the family’s desires. If the early intervention providers or educators are headed in one direction and the family in another, it can lead to potential confusion even though both parties feel they are doing what’s best for the child.

Implementation Strategies

Home Visits 

Home visits range from one-time events to multiple visits depending on a family’s needs. At a first visit, you may realize that all that is required is a single visit, a few resources and tips, and a follow-up by email or phone to make sure their needs were addressed. Alternatively, you may find that the family requires intensive support on a topic such as creating meaningful routines in the home or identifying and securing community support. This article (see page 3), Home Visits with Families and Their Infants Who Are Deaf-Blind, is geared toward practices with infants, but has useful information about home visits in general. 

Coaching 

The purpose of coaching is to help families acquire skills to use high-quality practices with their child. It involves establishing rapport, explaining specific strategies, modeling and practice, observation, and feedback (NCDB, 2018).  This type of TA is intensive because it requires follow-up to ensure a family is implementing the strategies effectively and feels confident in their skills.  

Be sure to provide detailed information about each strategy, including (NCDB, 2018):

  • A rationale for its use, relevance, or importance 
  • A written or verbal description of each step required for correct implementation (this can be incorporated into a checklist and used both to describe the strategy and evaluate whether each step is followed)

Coaching Parents Using Distance TA is a recorded webinar that provides an excellent and engaging overview of how to coach families to use routines to teach their children. You must be logged into the State Deaf-Blind Project Basecamp Group to access it.

This Coaching Best Practice Example, developed to describe the coaching process between a TA provider and educational practitioner, outlines the basic elements of coaching using hand-under-hand technique as an example. 

Consultation 

Consultation is a collaborative problem-solving process between a state deaf-blind project staff member and an individual family. It may also involve educational team members. A consultation typically focuses on resolving a specific set of issues or concerns. 

Family members are most likely to benefit from consultations that involve brief modeling of a strategy during naturally occurring routines, an explanation, resource sharing, and limited feedback (NCDB, 2017b). There is some overlap between coaching and consultation, but unlike coaching, consultation can be targeted TA, as it often does not require extensive direct support. For more information, see this consultation factsheet. 

Consultation can also be conducted using distance technology. It’s a way to provide real time feedback, rather than waiting until you can make a home visit. It can include:

  • Having the family film a video and upload or email it to you
  • Informal live video chat while a routine is happening  

This not only increases the immediacy of your support, but can be a huge time and money saver for your project. Furthermore, having video clips that capture small improvements in a child’s progress over time can be very inspiring for a family.