*3.5. Organization and Reorganization*

The geographic and administrative organization of services-especially change in organization-can wreak havoc on implementation of the RBM. For example, Portuguese early intervention is overseen by three ministries, which is extremely challenging. Mississippi moved from nine regions to three. A change like that requires much energy and time, distracting from implementation. In New Zealand, the national practice support network, which had been active early in implementation, was disestablished, reducing the amount and quality of communication among districts.

#### *3.6. Checklists*

Implementation of the model over time requires people to observe and provide feedback—actual training and maintenance. This presents a challenge in terms of who is available and of scheduling. In Poland and New Zealand, for example, they are concerned about who will have the time to make all the checklist-based observations. Implementers, such as York Region and our Portland, OR, site, have found it difficult to find the time to ensure interobserver agreement.

### *3.7. You Are Doing It Wrong*

Popular on the internet are articles about what we are doing wrong, from parenting to cutting cucumbers to facing the future. With the RBM, some experts and practitioners believe that they are using the model when they are not. We see this challenge all over the place. This phenomenon is known as the Dunning–Kruger effect, where implementers with little knowledge of the details of the model have much confidence in their ability to execute the practices (see Figure 2) [43]. It is particularly difficult because the believers see no reason to change, and it is bad for the model: people see bad practices and hear they are part of the RBM. We often have to be clear about what does *not* constitute the RBM.

In Spain, we have been concerned that professionals obtain some of the increasingly available materials and tools and use them with no training. For example, professionals have been known, not only in Spain, to conduct an ecomap and then file it away, never to use it in supporting the family.

In general, change is often difficult. For some professionals, the change is welcome: they get to do what they instinctively would do or they have a structure for what they were doing. For others, it is simply a change, and accommodating to new ways of doing things is inherently difficult. For yet others, the focus on child functioning in routines and the empowerment of families is not what they believe early intervention should be about. For them, the change is the hardest. It does not help when some families want the expert approach [45].

#### **4. Implementation Successes**

International implementers of the RBM report successes in a number of outcomes.

#### *4.1. Professionals Feeling Useful*

When professionals use the RBM, they feel more useful than before they adopted the model. They feel they make a difference in the areas of child and family functioning that matter to families. Before, they were focused on what they or their assessment procedures identified as deficits in child development. With the RBM, they focus on children's meaningful participation in everyday routines and on things that families care about. In Portugal, we actually saw improved goals, in terms of functionality and measurability, improved team functioning, and more collaborative consultation [46]. Similarly, in New Zealand and Ontario, goals became more functional and not arbitrary. In Singapore, professionals report parents' finding goals now easier to understand, leading to better "family engagement." Professionals also find the goals more functional and meaningful in the lives of children and families and more easily attained, which has led to greater work satisfaction.

In Taiwan, 218 professionals attended training on the RBM. The outcomes were based on McWilliam's 12 mental shifts (www.naturalenvironemnts.blogspot.com) and 10 mistakes in early intervention [47]. Professionals with less experience shifted their mindsets more than did those with more experience (*p* < 0.05) [48]. Those who had ever attended any presentations on the RBM or who had read anything about the model were more aware of the practices at pretest (*p* < 0.05) compared to those who had not. Those who received job-embedded professional development were more likely to have shifted mindsets compared to those who received other forms of professional development (*r* = 0.56–0.82). High interrater agreement on the mental-shifts scale was reported.

In Paraguay and Singapore, professionals report listening more to families' concerns and needs; constructing interventions in partnership with families, building on their strengths; collaborating more with each other; seeing progress using goal-attainment scaling. In Singapore, the RBI, specifically, resulted in parent engagement and empowerment as well as professionals' feeling empowered to understand and empathize with families. Paraguayan, Australian, and New Zealand professionals have found the model works well in aligning early intervention with indigenous ways of perceiving the family system (whanau in M ¯ aori). In Paraguay, implementers are using a smiley-face version of ¯ goal-attainment scaling with Guaraní families who do not read.

In New Zealand, the well-being of staff improved, because they did not have to have all the answers. In addition, professional support has become more purposeful and focused. Our colleagues in New Zealand also reported an outcome we have seen in different parts of the world, including the U.S.: Principles of the model have been adopted in other areas of the agency's or district's work.

In Poland and Singapore, they have begun to see the value of really listening to parents, rather than simply giving them instructions. Furthermore, they have seen a shift in professionals' mentality towards supporting families rather than "repairing" children. York Region reports child care staff and families more engaged and feeling they are an integral part of the team.
