Infants & Young Children

Vol. 22, No. 3, pp. 224–233

Copyright  c 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

The Routines-Based Interview

A Method for Gathering Information
and Assessing Needs
R. A. McWilliam, PhD; Amy M. Casey, PhD, BCBA;
Jessica Sims, MEd
There are multiple ways to gather information from families receiving early intervention ser-
vices (J. J. Woods & D. P. Lindeman, 2008). In this article, we discuss a specific strategy for
doing this through information-gathering conversations with families. The routines-based inter-
view (RBI; R. A. McWilliam, 1992, 2005a) was developed to meet a number of needs, includ-
ing information gathering and planning interventions. A set of 6 steps and 10 quality indicators
that comprise the RBI are described, as are findings from a preliminary study on RBI implemen-
tation. The discussion contains plans for further research and implementation fidelity criteria.
Key words: assessment, family, IFSP, interview

A S suggested by many in the field of

early intervention (Bailey & Blasco,
1990; Bailey & Simeonsson, 1988; Woods &
(Thompson et al., 1997) are used, as are
various “mapping” strategies (Woods & Lin-
deman, 2008). Community mapping is one
Lindeman, 2008), there are numerous ways example in which families describe the nat-
to assess family needs and priorities when ural learning opportunities occurring within
planning intervention. Gathering information communities and identify other opportunities
from families to understand their needs and for inclusion (Dunst, Herter, Shields, & Ben-
priorities is the foundation for providing nis, 2001). Many early interventionists simply
quality early intervention (McWilliam, 2005a; ask families about their concerns, priorities,
Trivette & Dunst, 2005). Researchers and and resources, as part of the development of
practitioners continue to use and evaluate the individualized family service plan (IFSP).
various techniques for gathering information Various interview methods are also used
from families. For example, questionnaires to gather information from families, ranging
about needs (Sexton, Snyder, Rheams, from more structured methods to informal
Barron-Sharp, & Perez, 1991) and resources conversations (Bailey et al., 1986; McWilliam,
1992; Winton & Bailey, 1988; Woods &
Lindeman, 2008). For example, proponents
Author Affiliations: Siskin Children’s Institute, of positive psychology are focused on 24 em-
Chattanooga, Tennessee (Drs McWilliam and Casey); pirically based strengths and virtues needed
and University of Connecticut Health Sciences for a good life (Seligman & Csikszentmihalyi,
Center, Farmington (Ms Sims).
2000). This focus on assets has led to the
Funding for this study was provided by the Vanderbilt development of tools such as the Asset-Based
Kennedy Center. This work was conducted when all the
authors were at Vanderbilt University Medical Center. Context Matrix, which is used to design
The authors thank Lisa Comer, Jacque Davis, and Sonny interventions in natural environments and is
McWilliam for data collection or assistance in data col- based on conversations with family members
lection and the service coordinators and families who
participated in the study. (Wilson, Mott, & Batman, 2004). Another
interview process has been developed by
Corresponding Author: R. A. McWilliam, PhD, Siskin
Children’s Institute, 1101 Carter St, Chattanooga, TN proponents of solution-focused therapy, who
37402 ([email protected]). concentrate on current resources and the
224
 The Routines-Based Interview 225

development of goals rather than on a history how satisfied the adult family members are
of problems and a diagnosis (Iveson, 2002). with the routine. These follow-up questions
Regardless of the process used to gather in- require considerable knowledge of child de-
formation for early intervention from families, velopment and family functioning and require
the construct of family centeredness should the interviewer to have good people skills.
always be considered. Family centeredness The RBI was developed to meet a num-
is a construct in early intervention that ad- ber of needs, including gathering information
dresses 2 issues: How to interact with families and planning interventions. The purpose of
and what to do with them. Family-centered structuring the interview around family rou-
interactions have been found to be posi- tines is to identify what the family already
tive, responsive, oriented to the whole family, does and what the family wants to do (ie,
friendly, and sensitive (McWilliam, Tocci, & family outcome setting). Attention is paid to
Harbin, 1998) as well as enabling and empow- the needs of all family members and the
ering (Dunst, Trivette, & Deal, 1988). Family- needs of everyday life. The stress on routines
centered actions include assessing families’ is because of the behavioral-ecological no-
needs and helping them meet those needs tion that routines are the context in which
(Bailey et al., 1998). the need for intervention is “authentically”
In addition to family centeredness, func- determined (Gallimore, Weisner, Bernheimer,
tionality has been identified as a desired Guthrie, & Nihira, 1992). Horner, Sugai, Todd,
attribute of intervention planning with fam- and Lewis-Palmer (1999) have written that
ilies (McWilliam et al., 1998). Child assess- routines are especially important when work-
ments with more functional (ie, routines- ing with young children with challenging be-
based) items are more helpful than those haviors, but the principle is the same as it is
with nonfunctional items. One method that with children with other developmental dis-
can capture needs, resources, functional task abilities. In the field of positive behavior sup-
demands, family-level needs, and family pri- port, identification of problem routines is a
orities is the routines-based interview (RBI; central feature of the functional behavior in-
McWilliam 1992, 2005a). The purpose of this terview that occurs as part of the functional
article is to describe the RBI in detail for use behavior assessment. Although they did not
in early intervention. consciously mature together, it has been inter-
The RBI is a specific application of the esting to see the parallels between the fields
principles described by Woods and Lindeman of positive behavior support and early inter-
(2008). It is a semi-structured interview with vention in natural environments. They both
3 purposes: To develop a list of functional out- focus on support to natural caregivers, guid-
comes, to assess child and family functioning, ing caregivers to embed interventions in nat-
and to establish a positive relationship with urally occurring home activities and assessing
the family. The basic structure is questions the goodness of fit between the child and the
about daily routines, from the beginning of a demands of the routine.
typical day to the end of the day. At the be- Assessment of goodness of fit and family
ginning of the interview, families are asked needs is what is missing in traditional early in-
what their main concerns for their child and tervention practice. The use of an interview
family are. Then the interviewer asks the fam- to assess needs has been undertaken by Wing,
ily to proceed through a discussion of a typi- Leekam, Libby, Gould, and Larcombe (2002)
cal day. The follow-up questions within each in their development of the Diagnostic In-
routine are to find out what the whole family terview for Social and Communication Disor-
does, what the child in question does, what ders. Unlike the RBI, however, the Diagnostic
the child’s engagement or participation is like, Interview for Social and Communication Dis-
what the child’s independence is like, what orders includes scores for the child’s abilities
the child’s social relationships are like, and and is used for diagnosis. It includes not only
226 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2009

some routines for self-care items (eg, feeding, Table 1. Six steps for completing a routines-
dressing, personal hygiene) but also general based interview
nonroutine domains (eg, receptive communi-
cation, imitation, imagination). The RBI, on
1. Beginning statements
the other hand, can assist with the “quintu- 2. Routines as the agenda
ple effort”described by Turnbull and Turnbull 3. Information from routines
(2001, p. 59). They have found that it is neces- 4. Satisfaction with routines
sary to maximize individual and family quality 5. Concerns and priorities
of life by (1) taking “stock of what is impor- 6. Outcome writing
tant to them in terms of individual and family
quality of life across all domains” (p. 59), (2)
deciding what is currently available, (3) deter-
otherwise discovered who was in the family’s
mining what needs to change “to create a bet-
ecology (Bronfenbrenner, 1979). The family
ter match”between child and family character-
should be prepared before the RBI about
istics “and what currently exists” (p. 59), (4)
the process and understand the reason for
developing action plans, and (5) securing indi-
participating in the conversation (Woods &
vidualized funding. It explicitly elicits what is
Lindeman, 2008). Nevertheless, before asking
important to the family, in priority order, and
questions, the interviewer introduces the pro-
it addresses quality of life in terms of families’
cess with a statement such as
satisfaction with their routines. The needs as-
sessment embedded in the interview is about Today, I would like to ask you about your day-to-
the goodness of fit between the child and the day life to get a picture of what Raúl and the rest of
demands of the routine, which is parallel to your family need, so, at the end of the discussion,
the third point in the Turnbulls’ list. The RBI, you can decide what you want the team to focus
therefore, is more than a tool for gathering in- on. If there’s anything you don’t want to say, then
don’t say it. It’s all right. Going through your day-
formation about family needs and priorities: It
to-day life will also help us make suggestions that
is also a method for assessing and measuring
make sense in your life. Is this okay by you?
the family’s quality of life.
The first question in the RBI is What are
DESCRIPTION OF THE RBI your main concerns for Raúl and your fam-
ily? These concerns are written down, and the
The RBI has evolved in the 14 years since interviewer tells the family that details about
the publication of Family-Centered Interven- them will be addressed as routines are dis-
tion Planning (McWilliam, 1992) to a set of cussed. These concerns are often similar to
well-articulated steps and quality indicators. what service coordinators use for actual out-
The 6 steps are as follows and are contained comes, because they derive them from the
in Table 1. same question. Notably, outcomes emanat-
ing from the RBI are often markedly dif-
Beginning statements ferent from the main concerns, suggesting
Starting the RBI, the interviewer should that main concerns are superficial, com-
know, minimally, who lives in the home with pared with a more analytic look by the fam-
the child. The interview is generally with 1 or ily at their needs.
more adults in the parent role, living with the
child, and it is conducted by 1 or 2 profes- Routines as the agenda
sionals. One interviewer takes the lead, and After main concerns have been identified,
the other might take notes, help with child the majority of the 90-minute conversation is
care and distractions, or check off items on a about routines, which in this process are de-
developmental assessment. Ideally, the inter- fined as typically occurring daily events. The
viewer would have conducted an ecomap or times when they occur are not important.
 The Routines-Based Interview 227

Having predictable routines has been identi- of the child’s interests or abilities with
fied as decreasing the need for new decision the demands of the routine.
making in families (McCubbin & McCubbin, 3. What the child’s engagement is like; this
1988). In many families, the daily routine includes the extent to which and the
begins with waking up (parents’ and chil- quality with which the child participates
dren’s), diaper changing, and breakfast. The in the routine.
first routines-based question is, How does 4. What the child’s independence is like;
your day start? The way to move on to a obviously, this is the extent to which the
new routine is to ask the parent what happens child can perform the demands of the
next. This avoids revealing any preconception routine by himself or herself.
about normal routines and allows the family to 5. What the child’s social relationships are
tell their own story in the order their routines like; this consists of information about
typically occur. how the child communicates and gets
The RBI always consists of an interview along with others.
of home routines. If the child attends a 6. How satisfied the family is with this rou-
classroom-based program, such as child care tine or how well the teacher perceives
or preschool, a significant portion of his or the routine to work for the child. Satis-
her week (eg, >15 hours) consists of extrafa- faction with routines is discussed next.
milial learning opportunities. The interview As the interviewers proceed through the
then includes information from that child care times of the day, seeking this informa-
provider or teacher. If the teacher can be tion, they complete the RBI Report Form
present during the interview, he or she is (McWilliam, 2003) or keep running notes, or-
interviewed immediately after the home rou- ganized by routines. The RBI Report Form is
tines interview and before outcomes are se- a tool to guide interviewers through the pro-
lected. If the teacher cannot be present, cess and to record information. It has space
he or she is interviewed before the fam- for main concerns and the other components
ily RBI, so that the interviewers can report of the interview described here. Because con-
what the teacher said. The interview with cerns or other possible intervention targets
the teacher is equally detailed as the one are mentioned, interviewers mark them, such
about home routines: Teachers are asked as with an asterisk or a star, for easy retrieval
what the other children do during the rou- later in the interview.
tine, what this child does, how this child is
typically engaged in the routine or activity, Satisfaction with routines
and his or her independence and social re- Asking families about their satisfaction with
lationships. The final question for each rou- each routine is very important, because (a)
tine is How well does this routine work for it helps them solidify how much they really
Raúl? want to change it and (b) it provides some
insight into the family’s quality of life. In re-
Information from routines cent years, we have been asking families to
In the discussion of each routine, the inter- rate their satisfaction on a scale of 1 to 5,
viewers obtain information about 6 items: which is included in the RBI Report Form.
1. What everyone does at this time; this The most common way of asking for this rat-
provides the normative information and ing is now, On a scale of 1 to 5, how well
an idea about the task demands of the is this time of day working for you? Note
routine. that the term “routine,” which has connota-
2. What this child does; this begins the tions of invariability or structure, is not used,
assessment of ecological congruence and the question is asked in terms of “work-
(Thurman, 1985) or goodness of fit ing for you,” rather than for Raúl. This re-
(Simeonsson, Bailey, Huntington, & flects the orientation of the RBI in family
Comfort, 1986), which is the interaction systems theory (Bronfenbrenner, 1986) and
228 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2009

quality of life theory (Mitchell, 1993), in portunity for the child. The goodness of fit
which it is understood that Raúl’s develop- question is asked in terms of how well the
ment and behavior are inextricably linked to routine is working for the child. The ratio-
the emotional well-being of his family. This nale is that problems with engagement, in-
is a critical area for the suspension of judg- dependence, and social relationships can be
ment in the interview. Sometimes, families considered a mismatch (ie, poor fit) between
are very satisfied with routines that might the abilities or interests of the child and the
seem dysfunctional or chaotic to the inter- demands of the routine. This is a more posi-
viewer. It is important to remember whose tive stance than assuming there is something
routines these are and never to pit the par- wrong with the child. After all, the interven-
ent’s satisfaction with the routine against tion options are to teach the child, to change
what is “in the child’s best interest.” If fam- how the routine is managed, and to change
ilies mention some level of dissatisfaction expectations for the child. The goodness of fit
with the routine, such as a child’s inabil- question is very helpful to the family in iden-
ity to do something independently, it opens tifying what to work on—outcomes.
the door for discussing changes to the rou-
tine. But, in general, interventionists need to Concerns and priorities
respect how families manage their daily ac- After routines have been discussed, focus-
tivities. Research shows that families find a ing on the 6 items described earlier, the inter-
homeostasis that works for them (Gallimore, viewer reminds the family what concerns and
Bernheimer, & Weisner, 1999). aspirations the family identified during the
If all is going well for the family, that is cause discussion of routines (ie, the items marked
for celebration, except an IFSP still needs to with a star). This list can be quite long, such
be developed! In such situations, the inter- as 15 concerns and aspirations, sometimes
viewer asks what the family would like the with repetitions. It is important that this not
child to be able to do, in the routine, next (ie, be considered the list of potential outcomes.
what should be learned in the next 6 months). That selection is what happens next: After the
If the family does not know, the interviewer summarizing of concerns, the family is asked
can give some options. Thus, families’ high to choose “things they would like the team
satisfaction with the routine is maintained but to help with.” Families already receiving early
families’ aspirations for their children are still intervention sometimes hesitate to list family-
identified. This is one of the ways the RBI is level concerns, because they consider these
asset not deficit driven. concerns outside the bounds of early inter-
Ratings of satisfaction with routines can be vention. Interviewers might need to reassure
used for program evaluation, in that a goal of them that it is the family’s plan and that all
early intervention is to improve families’ qual- concerns and aspirations can be listed. The in-
ity of life. Teams should therefore revisit rat- terviewer encourages the family to choose 6
ings of satisfaction with routines (not satisfac- to 10 informal outcomes, which are written
tion with early intervention) every 6 months. down more or less verbatim. Once chosen,
If such ratings are desired outside the context the family is asked to put the outcomes (goals)
of the RBI, the Satisfaction with Home Rou- into priority order. The concerns and priori-
tines Evaluation (McWilliam, 2005c) can be ties component of the RBI therefore consists
used. Ratings have therefore proven useful for of summarizing concerns, listing informal out-
understanding families’ priorities and for pro- comes, and putting the outcomes into priority
gram evaluation. order.
In classroom routines, the question is about
the goodness of fit, rather than satisfaction, Outcome writing
because the goal is not to improve the The interview and outcome selection are
teacher’s quality of life but it is to help make now over. Next, one team member is respon-
every routine the best type of learning op- sible for turning the informal outcomes into
 The Routines-Based Interview 229

formal ones. For child outcomes, numerous Table 2. Key indicators of quality interviews
measurable criteria for completion should be
included. For family outcomes, usually one
1. Active listening
measurable criterion suffices. Measurability is 2. In-depth follow-up questions
important, so the team knows what it is aim- 3. Continuing the conversation
ing for and so it has some method for judg- 4. Proactive questioning about child
ing progress, but it is also something that development
does not require obsession. The professional 5. “Smart questions”
converting the informal outcomes into formal 6. Nonverbal behaviors
ones uses judgment, on the basis of listen- 7. Social milieu of routines
ing to the interview answers. It is practical to 8. Seeking evaluative and interpretive
write these outcomes back at the office and opinions
9. Managing the conversation
present them to the family at the beginning
10. Empathizing
of the next meeting, which might be consid-
ered “the IFSP meeting.” That is somewhat of
a misnomer, however, because the develop-
ment of the IFSP begins with the gathering above. The interviewer helps the parent paint
of relevant information, which includes the a picture of the routine and the child’s func-
RBI, if not before. Regardless, it is important tioning in the routine. He or she does not sim-
to note that the common rule of not writing ply listen to the parent’s initial description and
outcomes (goals) in advance of the meeting is then move on to the next routine.
designed to ensure that professionals do not
predetermine outcomes. When using an RBI Continuing the conversation
correctly, the outcomes are clearly the fami- Despite the name (routines-based inter-
lies’, and converting the families’ priorities to view), we agree with Woods and Lindeman
formal outcomes is merely an administrative (2008) that conversations are better strategies
step to ensure the outcomes meet account- for gathering information from families than
ability standards. are structured interviews. The RBI should
have almost no pauses, and definitely not
QUALITY INDICATORS OF INTERVIEW while the interviewer writes. It should con-
tinue as though it were a conversation with
As the use of the RBI has become more a new neighbor, without any forms. Avoid
widespread, treatment fidelity has had to be the sequence of ask, listen, write, ask, listen,
balanced with local-preference variation. The write. The parts of the sequence focused on
following are key indicators of acceptable- writing should be eliminated, which is why it
quality interviews and frequently made is often helpful to have a second interviewer.
mistakes. These also are listed in Table 2.
Proactive questioning about child
Active listening development
The interviewer repeats what the parent When all is going well, the interviewer asks
has said to ensure that he or she understands about the future—what the child is likely to
and to let the parent know he or she is be- do next. This makes the RBI inclusive for all
ing listened to. The interviewer does not sim- children, including those without disabilities.
ply say, “Okay,” in response to the parent’s The interviewer does not confuse all going
answers. well with no opportunity for outcomes.
In-depth follow-up questions ‘‘Smart questions’’
The richness of the interview comes from Smart questions reveal understanding
the within-routines discussion as described about family functioning. When parents hear
230 INFANTS & YOUNG CHILDREN/JULY–SEPTEMBER 2009

the interviewer ask a question that shows he ions about the child’s and family’s function-
or she really “gets” families, they feel more ing. Examples would be asking why a child
confident about the help they are receiving. does something the parent has reported and
Some of these questions might be What’s it asking how the parent feels about a routine.
like when your husband comes back in—is
Managing the conversation
it a relief or like you have another child
on your hands? When she lifts her arms to The interviewer needs to maintain control
you in the morning, does this make you feel of the conversation, skipping over routines to
great as a mother? and When do you have speed it up or asking detailed questions to
time for your shower? All these questions slow it down. The interviewer who does not
have to be asked with friendly informality, so control the pace will wind up with a very long
that the family feels the interviewer under- (eg, over 2 hours) or very short (eg, less than
stands them, not that he or she is intrusive. 1 hour) interview. Management of the conver-
As Woods and Lindeman (2008) suggest, sation also involves dealing with distractions
families’ feelings of being intruded upon are a and putting the conversation back on track.
concern when using conversations to gather
information from families; however, feelings Empathizing
of intrusion are typically a failure of the Ultimately, the RBI is an intense, solution-
interviewer’s social nuance in establishing finding (see Iveson, 2002) clinical interview.
relationships. Establishing a bond with the parent is es-
sential, and this occurs with a combination
Nonverbal of the above indicators along with empathy.
The interviewer uses nonverbal messages Although it is important to remain neutral
as much as verbal ones to convey accep- when the family reports surprising informa-
tance and interest, which requires a high rate tion, it is equally important to convey under-
of smiling and nodding. Nonverbal language standing and emotional connection with both
conveys informality and friendliness more hardships and successes. The interviewer
strongly than verbal language. The inter- who remains “professionally objective” is un-
viewer who does not convey amiability by his likely to engender connection with the family.
or her style is less likely to gain the family’s
trust. PRELIMINARY EVIDENCE

Social milieu of routines The RBI has existed in one form or an-
The context of the child’s engagement, es- other for over 20 years (McWilliam & Dunst,
pecially with adults and peers, is important for 1986) and has gradually become widespread.
needs assessment and then for intervention. Presentations on the RBI have been made in
The presence of other people can affect how about half the states, and a number of these
well the routine goes, so it is important to de- programs have incorporated it into their Part
termine who is typically present in each rou- C services. In Kentucky and Tennessee, for ex-
tine. The interviewer who asks only about the ample, the RBI is now part of the official IFSP
child and perhaps the mother could miss vital process. Similarly, in a number of states and
topics to discuss with the family. communities, it is used with varying amounts
of treatment fidelity.
Seeking evaluative and interpretive In addition to this model-adoption sup-
opinions port (Hall & Loucks, 1977), empirical sup-
What takes an RBI beyond a simple descrip- port for the RBI is beginning to emerge. We
tion of a typical day into a form of conjoint be- recently completed the first study on the ef-
havioral consultation (Sheridan, 1997) is the ficacy of using the RBI for IFSP development.
interviewer’s ascertaining the family’s opin- We hypothesized that the RBI would result in
 The Routines-Based Interview 231

greater family satisfaction with the IFSP devel- NEXT STEPS AND APPLICATION
opment process, more outcomes, and more TO THE FIELD
functional outcomes than traditional IFSP de-
velopment procedures. Sixteen families par- The future of the RBI requires 3 efforts: re-
ticipated; they were randomly assigned either search, the development of training materi-
to receive the RBI or to receive the business- als, and definition of implementation criteria.
as-usual IFSP development process. In the Studies of the efficacy of the RBI need to
state where this study was undertaken, ser- be conducted to provide the evidence base
vice coordinators are dedicated solely to the for this particular practice: The empirical
service coordination role. They were the pro- validity needs to catch up with the face va-
fessionals doing the interview in this study, so lidity. In terms of the fidelity of the imple-
they received training from the authors. mentation of the process, training materials
This preliminary study showed that an need to be refined and validated. Currently,
RBI produced better outcomes than did the training requires investment by a relatively
traditional approach to IFSP development. small number of people with the requi-
As planned, when service coordinators site experience to provide intensive training.
worked with the experimental group, they A larger cadre of trainers with materials is
implemented the steps in the RBI process needed. Finally, the RBI is not a quick dis-
(M = 16.29, SD = 3.25), whereas when cussion of a family’s typical day; to make
they worked with the contrast group, they matters difficult, it is a semi-structured but
did not (M = 12.63, SD = 2.20, d = 1.34). detailed interview with 6 components or
This difference was found by examining the steps and 10 quality indicators; these should
number of steps correct on the Routines- be invisible. In other words, when it is con-
Based Assessment and Intervention Planning ducted as designed, the family perceives it as
Checklist (Individualizing Inclusion in Child a conversation that almost magically results in
Care Project, 2001). The families in the RBI a list of concrete, functional goals (outcomes)
group were more satisfied with the IFSP for the child and family. The minimum cri-
development process (M = 61.80, SD = teria for implementation fidelity need to be
3.83) than were the families in the contrast discovered.
group (M = 55.43, SD = 8.30, d = 1.05), The RBI is a promising method for gath-
and the contrast group had more variable ering information on the everyday routines,
responses, as indicated by the larger standard activities, and events of children and fami-
deviation. The number of outcomes was lies, which is important for outcomes and in-
greater, as expected, as a result of the RBI terventions that make a difference for chil-
(M = 4.25, SD = 1.04) than as a result of an dren and families (McWilliam, 2005a; Trivette
IFSP developed without an RBI (M = 2.63, & Dunst, 2005; Woods & Lindeman, 2008).
SD = 1.30, d = 1.38). Finally, outcomes Furthermore, early intervention profession-
written because of the RBI were more func- als have said that the RBI has given them a
tional (M = 3.21, SD = 0.83) than outcomes structure for refocusing their professional ac-
written because of the standard process tivities. Once they conduct these interviews
(M = 1.65, SD = 1.16, d = 1.57), as measured (with high fidelity), they connect better with
by the Goal Functionality Scale (McWilliam, the family and attend to more meaningful in-
2005b). terventions.

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