PCI in Practice
Ideas for Practice using the Feeding and Teaching Scales
For those of you who have mastered the Feeding & Teaching scales and are certified and reliable, here are some ideas for practice and intervention. The comment we hear quite often is:
“Now I have this green or blue sheet in the client file… what do I do with it?”
First of all, it is very important to read the administration portion of each of your manuals. There are clear, easy to read guidelines on page 132 of your Teaching Manual and on page 129 of your Feeding Manual. We promise that the more you use the scales, the more comfortable you will become with administering them and the more they will influence your practice. This has been expressed over and over by many of the 13,000 plus users from around the world!
When you first complete the scoring of a scale, it is important to give the parent or caregiver some immediate positive feedback. They are waiting to hear what you have to say! There are so many items, it is easy to pull out some positives, e.g. “Jack looks back at you and smiles so big when you smile at him while he is eating. It’s nice how you let him eat at his own pace and express his cues about how much and how fast he wants to eat.”
Back in your office, when evaluating the scale further, there are several ideas for how to implement the information you gathered into your practice. One of the quickest is to compare the client’s scores with the norms established in your manuals beginning on page 107 of the Teaching and page 111 of the Feeding. Using the PCI Standard Deviation Calculator or Worksheets you will quickly be able to identify how the total score and/or subscales compare with other caregivers with similar educational backgrounds and/or within ethnic groups. We know that education is a significant predictor so using the Age/Education tables would be most appropriate. If the mother/caregiver scores are low (>1 standard deviation below the mean) compared to other women in her group, you may want to evaluate further for depression. Data collected from the WA State Nurse Family Partnership Consortium show that mothers who are depressed (CES-D >16) have less eye contact, less en face positioning, fewer verbalizations and fewer smiles. By only 2 months of age, infants of these mothers are showing fewer alert periods, less eye contact, fewer vocalizations, and look away more from the mother. (K. Barnard, October 2004 PCI Instructor Workshop, Seattle, WA)
A Feeding scale done in those first weeks can give you an important window into this relationship and help you intervene effectively and early and support the devloping parent-child relationship.
The scales are broken down by elements or constructs as well. Those areas are: contingency, positioning, verbalness, sensitivity, affect and engagement/disengagement.
When looking at contingency, it is easy to notice whether the contingency score is low when you total your scores in the summary box. Starting a discussion about the importance of reciprocity and how neural pathways are reinforced if you respond quickly would be a natural follow up to a low contingency score. Assisting with positioning can quickly improve the interaction if eye contact was not possible previously. When a mother scores no on many of the verbal items, you might pose some questions to engage her in a discussion. “Some parents think that it isn’t important to talk to babies since they can’t understand words. What are your thoughts about that?” Teaching parents about the importance of recognizing and sensitively responding to their child’s potent disengagement cues is a valuable gift. Responding appropriately to distress helps children learn emotion regulation and being able to alleviate that distress promotes parental competence and confidence. Keys to Caregiving Parent Booklets can be an excellent reinforcement of the teaching done during your contact with the client.
These are ideas to promote your use of the scales in your practice. We are confident that you have many ideas and effective interventions. If you would like to share a story about using the scales in an effective manner with a family, feel free to send your story to firstname.lastname@example.org for review and possible posting. Be sure to eliminate any identifying information to protect confidentiality. Please consult your PCI Instructor when you have specific questions or concerns about your client/family scores.