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Kylie Levin

Going into my first Routines-Based Interview (RBI; McWilliam, 1992; 2009) and

initial intake with a family I had never met before was one of my most nerve-racking

experiences. I was expected to ask questions that would encourage the caregivers to open

up about their family and specific concerns they have about their child. I did not know

how I was going to build trust in such a short period of time, but the RBI process is just a

conversation that is structured so the service coordinator and primary service provider

can acquire a detailed walkthrough of the familys typical day and priorities. After

learning about the familys daily routines and where they need more support, the team

can move closer to finding embedded opportunities and effective strategies based on the

family and child outcomes.

Mason is a 2- year old boy that lives with his biological parents and two older

siblings (6- and 9-years old). Mom works part time for her familys business and Dad

works overtime, roughly 80 hours every week, and night shift. Mason and Mom spend a

substantial amount of time together. The RBI involved Mom, Stephanie the service

coordinator, and myself. Mom stated that both parents are concerned with Masons delay

in speech and had no referrals to early intervention. There were no present concerns

involving his hearing or vision.

Mason is typically the first person awake in the household. He wakes up around

6:30 in the morning, and tends to be in a grumpy mood. He gets out of his crib on his

own and will walk over to his parents room to wake up Mom. He is just now starting to

take naps during the day. Mason gets ready for the day when his siblings get ready for
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school. He is able to dress himself with occasional assistance from Mom. She allows him

to wear what he wants because he will only wear the clothing he picks out. Mom stated

Mason is good at taking off his clothing as well. Masons parents are not concerned with

this routine. Mom and Dad are working on getting him used to using the toilet, but he

currently only wears diapers. He will sit on the potty for a few minutes, but once he gets

off the seat and a diaper is put back on he will pee. If he wets or dirties his diaper he will

then bring a new diaper to Mom or Dad. This routine is not a concern at this time.

Masons mealtimes are scattered throughout the day. His breakfast routine usually

involves eating with his siblings before they go to school. He eats about six snacks

throughout the day. He will eat yogurt, fruit, cheese, and meats. Mason does not usually

eat dinner with his family, but he will sit in a regular chair at the table while they are

eating. He will drink from an open cup at the table and uses a Sippy cup during play.

When Mason is hungry, he will grab food himself. When he needs food or something to

drink from the refrigerator or pantry, he will grab Moms hand for help. He typically

chooses foods that will not hurt his stomach, as he has severe food allergies. This was

brought to light when he experienced an anaphylactic shock episode after eating cashews

that were exposed to peanuts. He was rushed to the hospital and was given steroids to

temporarily alleviate the swelling. He was later referred to an allergist that he now sees

regularly. His specific allergies include peanuts, tree nuts, and eggs and recommend him

to carry an Epi-pen. He is not able to be in the same room as these foods. Mason is also

intolerant to chicken, soy, and gluten food items. Mason is not yet verbalizing what he

wants to eat or drink.

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Mason gets along well with his older siblings and even has opportunities to

interact with their friends. He will sometimes go to the local YMCA and interact with

children his age in their childcare room. He will jabber to communicate with these

children. Mason is very affectionate towards his parents and is starting to imitate others

during daily routines. When he wants something, he will drag others to what he wants.

Mason is interested in sports including soccer, basketball, and ball tossing with Dad. He

enjoys wrestling with his brother too. Mason sometimes sits at his table and plays with

small toys like his train set or animals. He plays with musical toys like the familys full-

sized piano and enjoys pushing his toy car around outside on their play set. Mom and

Dad try to limit the amount of television Mason watches, but when he does watch it is

typically turned on to Paw Patrol, Mickey Mouse Clubhouse, and Thomas the Train. His

parents described Masons speech during play as gibberish-like.

When getting around the community, Mason is easy to get in the car but does not

seem to like riding in it. This might be due to the sun shining in his eyes. Mason goes to

work with Mom Monday through Wednesday from 8:00-1:30. He has his own computer

in the office to play games. He will imitate Mom and interact with his grandparents, as it

is their familys business. He usually falls asleep in the car on the way home from the

office. Mason will only sit in the special carts at the store, such as a car cart, and will

become upset if there is not an available one. Mom will wait until one becomes available

before going into a store. He is very active when he attends his siblings sporting events.

He tries to play when his brother has basketball practice and will run around during his

sisters gymnastic events. He enjoys the childcare room at the YMCA while his mom

uses the facilities. When it comes to bath time, Mason takes baths every other day
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because of dry skin and eczema. There are generally no issues when getting in and out of

the tub. He likes to play with the bubbles and pushes his car along the side of the tub.

When Mason gets his hair washed, he does not like when the soap gets in his eyes and

might say no. He does not prefer having water dumped over his head. He talks to

himself by making sounds when he is in the tub. Mason watches his siblings brush their

teeth and listens when Mom says brush your teeth. He will help cleaning up for the

most part and likes to be helpful. Masons night routine usually begins with a warm

bath, brushing his teeth, and lying down with some milk. Mom will read him a book as

Mason falls asleep in his crib. He falls asleep around 7:00 each night in a room by

himself.

The conversation that we had with Mom provided us with insight on the familys

priorities and concerns. Moms concerns are prioritized in order below.

1. He gets frustrated when others cant understand what hes saying/what he

wants, so he drags them over to what he wants and shows them

2. Jabbering during play, but no real words

3. When they know what he wants, his siblings will bring him food or a drink

4. Fussing at the store and not sitting in a cart when a special one is not accessible

From this discussion, we were able to construct functional outcome goals for

Mason. He is turning 3 years old in July, so a transition goal was also developed. Two

possible outcome statements were created based on the familys top 2 priorities and are

listed below.

1. Mason will communicate requests with simple sounds and eventually words

like please or I want. We will know he can do this when he uses

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words at least twice a day and before he transitions to Part B at the end of

July.

2. Masons siblings will allow him to use his sounds or words to make a request.

We will know they are doing this when they wait at least 10 seconds for

him to make a sound every time he is asking for something.

I was full of nerves and suspense going into the Routines-Based Interview. I went

into the family visit with a copy of the RBI Report Form (McWilliam, 1992; 2009)

including questions for each routine to facilitate our conversation. I came prepared to

write down all of the information Masons parents were going to give me, and Stephanie

was next to me jotting down her own notes in case I missed any of the details. I thought a

lot about how I would introduce and provide reasoning behind why we complete the RBI.

As noted by Raver & Childress (2014), The RBI helps the IFSP team to better

understand the childs and familys needs, prioritize, and choose outcomes that will

become part of the IFSP. Once I met the family and the conversation began, most of my

nerves went away. I noticed a lot of back and forth talk and not just a one-sided

conversation. I would ask some in-depth questions outside of the prompts, which

provided even more detail about the familys daily routines. Mom was very open to

talking about what their everyday life looks like and the areas that are a concern for her

and her husband. I was responsive to Moms comments by using nonverbal

communication skills like nodding, eye contact, and just listening to what she had to say.

I like how the RBI includes open-ended questions that can be individualized to every

family. It is truly a family-centered tool that service coordinators and other professionals

in the early childhood special education field can utilize to aid in IFSP or IEP outcome
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writing. The family-centered approach is individualized to meet families where they are,

meaning that time is taken to build rapport with family members and ensure that supports

revolve around their priorities and strengths (Childress & Raver, 2014). It was helpful

and also necessary to keep my cultural beliefs out of the meeting so we could really focus

on Mom and Dads priorities. The one principle of partnership that I took into

consideration was respect. Treating students and families with dignitytreating them as

honored, worthy, and esteemedshows how you respect them. Families want you to

regard their child as a person rather than as a person with a diagnosis or a disability label

(Turnbull et al., 2014). Stephanie and I mentioned to Mom several times that we have the

utmost respect for her since she is home with the kids by herself, as Dad is working

overtime, and working part time. We discussed her ecomap after discussing the daily

routines, and it seems like she has great support from her parents and friends. If I could

add anything to the Routines-Based Interview, I would emphasize and encourage all

families to draw their own ecomaps, this way they can visualize the supports they have

since the diagram is meant for the family. The next RBI I complete will come off as more

naturalistic and conversational. I kept catching myself looking through all of the

questions to make sure I did not forget any content, but I spent too much time looking

through each individual question. Conversations with families will seem more natural

once I gain more experience doing the RBI in the field. I would like to work on asking

open-ended questions for future visits. I can work on this skill by reviewing a familys

file and preparing more for the RBI visit.

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References

Childress, D.C. & Raver, S.A. (2014). Family-centered early intervention. Baltimore,

MD: Paul H. Brookes Publishing.

McWilliam, R.A. (1992; 2009). Protocol for the routines-based interview. Baltimore,

MD: Paul H. Brookes Publishing.

Turnbull, A., Turnbull, R., Erwin, E.J., Soodak, L.C., & Shogren, K.A. (2014). Families,

professionals, and exceptionality (7th edition). Upper Saddle River, NJ: Pearson

Education.