 It's about change, change, change, change. And why? Why all the change? And I think both Sue and I wanted to start this morning with just kind of a reflection on, you know, where is the field of early intervention in and where is it really going and why are you having to go through all of these changes and looking for new ways of doing things. And when we look back to really early intervention in the 80s, it's a pretty new field. And we were asked to serve infants and toddlers in preschoolers with disabilities and you just have to get started and do what you know how to do and do it. And what we knew how to do was to teach older children and there we go. It's what we knew how to do. So it is what we started with and I think that's okay. You have to get started. As a field, though, then, you know, researchers begin and is there a better way of doing business? Are we accomplishing what we set out to accomplish? And really for probably 10 years in the 80s and 90s, there was quite a bit of research done on early intervention and are we doing things the way that we'd really like to be doing things? And the upshot of that is that in all honesty, people didn't think we were. We really were not getting the gains that we hoped to get and we really weren't supporting families in the way that we were hoping to support families. And there was a lot of input from the field to federal legislation and federal legislation in the 90s changed. And it really said, you know, we are not going to be child focused in birth to age five. We're going to be family centered. And it's not going to be about therapy in clinic programs or special programs for kids. It's going to be services provided to children and families in natural and least restrictive environments. Whew, okay. So we got started again, taking what we knew how to do into natural environments, working with children and families. And we did that for some years, again with some research happening at the same time. And what many of us tried to do with what we knew how to do was we moved our therapy sessions to homes and we worked with children and kind of looked at the adults knowing we probably weren't doing this right but doing the best that we could do. And I think there was tremendous debate over those 10 years, especially in the 90s, different models for how we could do this better. Came out primary service provider model, coaching model, five component model, transdisciplinary model, multidisciplinary models. There's all kinds of models and a lot of debate and discussion over which would be the best for early intervention and how to do what we were trying to do better. There was a lot of debate in our own state for those of you who were old enough to along with me that have gone through a lot of that training. That debate wasn't just in Nebraska, it was national. And in 2007, not very many years ago but 2007, the National Early Childhood Technical Assistance Center I guess at the federal level pulled together a lot of the early intervention lead researchers into a workgroup and they just said, okay, let's take a look at where we're at, the research that we have, what is it telling us? Let's at least come to some common agreement about what are the principles, the mission and the principles of what we want early intervention to be. I'm not going to go through all seven principles, but I'm going to highlight a couple of them because they'll frame what I think we want to accomplish. And the principles I want to key into the very first one was all of the researchers agreed that infants and toddlers learn best in everyday experiences and interactions with familiar people. We're right there that really did emphasize non-clinical settings, non-specialized programs, not working with special people. It's kids learn best with the people that they know that they interact with every day in the settings that they live in every day, agreed upon principle. The second is that IFSP and IT outcomes have to be functional and they have to be based on the child and family needs, okay, and they have to be the family priorities. Okay, that sounds really pretty simple, but I'll tell you what, in my experience, that is really tough. It's really tough because as much as we try to be functional and get a good look at child needs and family needs, we don't have a very good way to assess family needs. And when we have to identify our goals on the basis of family priorities, how do we find out what the family priorities are? And if you say to me as a parent or as we've said to families and I know all of you have asked this question, what would you like your child to do? That's how we get it. What are your priorities? Tell us. What is the standard response? I want my child to talk. I want my child to walk. And we don't get much more. So doing what we've always done isn't giving us very good information. We need a better way to, I think, help families identify what it is their priorities are, what it is they would really like to see. And I'm confident that we can do that. I think that really to our own experiences as parents, our daughter was a ninth grader starting in a new high school, and it was that school's practice to send someone out from the school to do a home visit, which we thought was sort of weird. So we looked at each other and said, well, okay, and so this person knocked on the door and we invited her in, and it just was awkward. So she proceeds to say, tell us about your daughter. Well, my husband and I looked at each other and just drew a blank. This was like, well, she's pretty nice. I mean, how lame is that? We just didn't know what they were asking or what information to give. Not that we don't know our daughter. We just didn't. And then her next question was, you know, as she starts in this new school and high school, what would you like to see her do or have her learn? I have to tell you again, we just looked at each other like, I don't know, tenth grade, ninth grade stuff. I mean, I don't know, get her ready. We couldn't answer the question. And I immediately, just in that situation, thought back to all of those families that I asked those questions. And I thought it's not that they don't know and it's not that they don't know their child is that we're not asking the right questions or we're asking the question in a way that's not giving them enough of a framework to give you what you're looking for. And so I think we have to find a better way of doing that. The other key principle I wanted to just address is family priority needs and interests are most appropriately addressed by a primary service provider. It's an agreed upon principle by the leading researchers in early intervention in our field over the last 25 and 30 years. Do we ever struggle with that? It's a struggle nationwide and it's a struggle in our state. But I guess I just want to highlight, there it is. The national early intervention researchers all agree as a principle that primary service provider is the best way of accomplishing what we want to accomplish in early intervention, which is not child focused. It's family centered and it doesn't happen in clinical settings with professionals. Intervention really happens at home and in childcare centers and in parks with the people that those kids live with. It's a different animal and it requires different tools, different strategies, different ways of doing business that many of us are just simply not trained in and we don't know the questions to ask or the tools to use. So here we are today trying to figure out what to do next. I think in the state we've looked at those seven principles, the three of which I've highlighted, but I want you to go to the Nectar site and or a website that we can talk about in a little bit to really to read through those seven principles and they're really important to us because Nebraska as you know does not mandate that you use a particular model. We don't mandate that you use certain tools or processes, but we do promote the use of tools, practices, processes that line up with those seven principles. So the tools that we share on the website or process that we talk about or things that we put money into for trainers are things that we truly believe will help us do early intervention better and that they match up with those seven principles of early intervention. I think that it's really important that we are focused really today and on the website as well and the technical assistance that we're providing in the state is primarily focusing in two areas and that is intake and assessments. Why? I think really the intake process is for two reasons super important. One is that it sets the stage for what families can expect just like our visit from that high school. It sets the stage, we at that little visit lasted about 20 to 30 minutes and my husband and I have never forgotten it. Ever. This happened probably 10 years ago. We've never forgotten it. We remember the person, we remember the questions she asked, we remember what she told us about that high school. It's that first intake where it's critically important that we set the stage for what the process is going to be. The second reason is that it's really the place that we probably need to do better than we have been doing in terms of finding out about informal supports. What's the big deal about informal supports? That's why we're promoting the use of an eco-map or some way of talking with families to get at what their formal and informal support systems are. Why? Why is that critical? Well, going back to my example with, you know, once Meg left our home, what do you think happened? My husband and I looked at each other and said, holy mackerel, can you believe that we start never-nattering about this person, about the school, about the process? It's not 10 minutes in the phone rings and it's my mom. How did it go? I mean, how did it go? I can't believe it. Work the next day, what am I sharing over noon? Yes, it came to our house yesterday. That's what happens. We did, we started to just feel out. What do people who are important to us think about what we just went through? It's even more important in early intervention when you're going into their homes and you're telling them and giving them information and recommendations and suggestions, you can be sure that when we leave, they're processing that information and they're processing it with people who are important to them, who will make or break in a way that we can't, the suggestions that we're giving. It's important that we know who those people are. And we even have those people because that's their support system. That's what's going to help them through the process. It's going to help them through the situation that they find themselves in, the trials and tribulations that they're going to have, the challenges and successes that they're going to face. It really isn't us. It's when we leave that the process begins and this is going to work, what they're going to try, what they should say if it's not working. So how that intake goes, the information that we get is really vital to how successful our practice, our process is going to be. And then assessment is the next area that we're really focused in and really our purpose in that is that when we look statewide at our IFC and IUP goals, we still don't see really functional, meaningful, family prioritized outcomes that really are going to support kids to participate and engage in everyday activities. So why not? And sometimes when you sit down, not sometimes, I would say most of the time, I think you would agree with me, that when we sit down to write the outcomes, we have to use the assessment information that we have in front of us. So we're beginning to think that if these are the outcomes that we're writing, then we're writing them probably from the assessment information that we have in front of us. So maybe the assessment tools that we're using aren't giving us the kind of information that we need in order to write the functional and meaningful goals that we want. The other thing that we're finding in reviewing the IFCs and IUPs is that we're not seeing a lot of family goals. It's a family centered service. It's about the whole family. It's about supporting families who are in some cases devastated by the birth of a child with a disability. We should be seeing something about families. And if we aren't, then is it because we don't know how to get that information? If our assessment tools are really looking at child assessment information, how do we get at more of a family information? So we're starting to look at practices that we think would help us do a better job at intake and practices and tools that would help us do a better job at gathering the assessment information that we need in order to develop functional and meaningful child outcomes and functional and meaningful family outcomes. The last thing I want to say is that we're also looking for how to get what do we need to ask or provide families in order for them to really think through what they would like to see for their child. What is important for their family and what priority would they put those in and how to get started as opposed to us telling them what we think? How do we get them to have enough information, hear themselves talk enough so that they can reflect on what they're saying and come up with what is really important to them? And the RBI is one tool. There are others. But the RBI is one tool that we really feel can accomplish those objectives. It's a way of getting more from a family than I just want my child to talk. And we want it to we hope that it will give us the child information, the family information the a way for families to prioritize all within everyday routines and environments working with the people that the kids are with everyday. So that's really why we are promoting change and a little bit of a different way of going through the assessment process in all honesty so that we end up with programs and services and supports and plans that really do support children and families in a way that is important to children and families.