Early-Intervention Providers’ Perspectives on Family-Guided Routines-Based Intervention (FGRBI)

PURPOSE: Early Intervention (EI) service delivery throughout the state of Iowa has shifted toward a routines-based model known as Family Guided Routines Based Intervention (FGRBI). This model has taken root throughout the majority of Area Education Agencies and is being used by a variety of disciplines including occupational therapy. The purpose of this study was to investigate the perspectives of EI home-based service providers about the use of FGRBI techniques throughout the state of Iowa. The research question asks what perspectives current service providers have regarding FGRBI within EI. Previous research supports the use of routines-based intervention in the natural environment of the home, therefore, it is important to understand how FGRBI is being delivered in the state of Iowa and examine the successes and barriers experienced by EI providers using FGRBI not only in occupational therapy service delivery, but service delivery across disciplines.

DESIGN: An electronic survey was sent to over 800 EI providers throughout the state of Iowa. Inclusion criteria consisted of being a current and active EI provider in the state of Iowa. Participants were selected using a voluntary response sample.

METHOD: The electronic survey included 24 questions regarding demographic information, level of familiarity with FGRBI, and components of FGRBI that providers implement in their practice. Survey questions were developed based on the existing literature regarding FGRBI as well as consultation with the Director of the Department of Education in the state of Iowa regarding areas of concern regarding FGRBI use in EI. The survey contained questions that yielded both qualitative and quantitative data. Qualitative data was entered into Statistical Package for the Social Sciences (SPSS) for analysis. Qualitative data was analyzed, coded for themes, and evaluated by the primary investigator.

RESULTS: Of the 214 providers included in the study, 204 participants (95.3%) reported using FGRBI to some capacity in their EI practice. The majority of providers reported an overall satisfaction with the shift toward routines-based intervention, however, 71% of providers indicated that there were challenges impacting their ability to provide FGRBI and only 58% of providers feel very confident in their ability to use naturally occurring toys and objects in the family’s home to facilitate the visit. Reported challenges most commonly included difficulty engaging families, parents’ preference of the traditional model of service delivery, team members’ inconsistent use of routines-based intervention, difficulties with the primary service provider model, challenges with timing and logistics, and difficulty using FGRBI with families with limited resources.

CONCLUSION: EI providers show a general familiarity with FGRBI, yet many providers are still choosing not to use FGRBI in their practice. Providers reported a high level of caregiver (CG) misunderstanding as to why service delivery models are changing. Providers have a role in building CG capacity and therefore should work to support families in using naturally occurring materials within the child’s environment to facilitate EI services. There is a need for CG education regarding FGRBI, its implications for service delivery, and the research that shows its effectiveness in EI service delivery. There is also a need for increased provider education and training to develop strategies for building CG capacity using naturally occurring materials and objects within intervention in order to provide consistent high-quality service delivery to young children and their families.

References

Brown, J. A., & Woods, J. J. (2016). Parent-Implemented Communication Intervention: Sequential Analysis of Triadic Relationships. Topics in Early Childhood Special Education, 36(2), 115–124. https://doi.org/10.1177/0271121416628200

Florida State University. (n.d.a). Family Guided Routines Based Intervention. Retrieved from http://fgrbi.fsu.edu/index.html