Early Early Intervention Intervention

GoalsGoals

Early Intervention Early Intervention GoalsGoals

• to support families in achieving their own goals for their children

• to promote child engagement, independence, and mastery

• to promote development in key domains• to build and support children’s social competence• to promote generalized use of skills• to provide and prepare for normalized life

experiences• to prevent the emergence of future problems or

disabilities

Roots of Early Intervention in the Roots of Early Intervention in the

United StatesUnited States

• Special Education (Behavioral analysis and therapeutic services)

• Compensatory Education (e.g., Head Start)

• Early Childhood Education (traditional preschool, developmentally appropriate practice, child-centered curricula)

Foundations of Early Foundations of Early

InterventionInterventionFamily-centered servicesNormalizationServices in natural environmentsDiversity of children and families servedVariety of service delivery models Interdisciplinary and transdisciplinary servicesFunctional and developmental programming Individualized programmingBlending of philosophical perspectives

(developmental, behavioral, ecological/functional)

National and Local National and Local Issues in EIIssues in EI

Recommended Practices in Early Recommended Practices in Early

InterventionIntervention• Inclusion• Blending of EI and DAP principles• Naturalistic assessment• Play-based orientation• Individualized, small group

instruction• Focus on interactions and process• Activity-based intervention• Lightly structured• Child initiated, adult supported• Integrated therapy• Collaborative/consultative roles

Teams:Teams:Models, Approaches and Key Models, Approaches and Key

ElementsElements

Early Intervention Early Intervention TeamworkTeamwork

• It is a MAJOR assumption of early intervention that NO ONE person, discipline, program, or agency can provide the support necessary for a family with a young child with a disability.

Essential TEAM Essential TEAM ComponentsComponents

• All members share the same goals and purposes for working together

• The team functions by consensus decision making

• The team consistently carries out decisions jointly made

Team CharacteristicsTeam Characteristics• Overall team goals• Level of cohesion• Level of sensitivity• Openness of

communication• Handling of

conflict• Valuing of members• Evaluation of self

and team

• Decision making abilities

• Participation of members

• Implementation of decisions

• Responsibility to get work accomplished

• Source of control

Some Assessment Some Assessment Team ApproachesTeam Approaches

• Uni-disciplinary• Multi-

disciplinary• Inter-

disciplinary• Trans-

disciplinary

Multidisciplinary Multidisciplinary TeamsTeams

• Professionals from two or more disciplines working independently of each other toward the same purpose.

• Assessment multidisciplinary teams usually evaluate children separately, write their reports separately, then contribute their sections to the final complete report.

OT PT Educ. SLP

Child Child Child Child

Report Report Report Report

Drawbacks of Drawbacks of Multidisciplinary Multidisciplinary

TeamsTeams

• The team may view the child as a set of “pieces” representing each discipline

• Specialists may be duplicating efforts or even contradicting each others’ efforts

• Evaluation, goal setting, and interventions may be fragmented

• Families may be confused and overwhelmed by the number of professionals working with their children

Interdisciplinary Interdisciplinary TeamsTeams

• Multiple professionals and family members working toward common goals

• Separately assess children

• Jointly discuss results and develop plans for intervention

• Individually write own sections of reports

OT PT Educ. SLP

Child

Report Report Report Report

OT PT Educ. SLPAssessment

Discuss Results and Set Goals

Complete Report

Drawbacks of Drawbacks of Interdisciplinary Interdisciplinary

TeamsTeams• Communication

and interaction among team members, especially parents and family members is sometimes difficult

• Professional “turf” issues; lack of understanding of other disciplines

Transdisciplinary....Transdisciplinary....• “across disciplines”• studying, learning,

working, sharing, providing within one’s own discipline and other disciplines with which one has had exposure and knowledge

Transdisciplinary Transdisciplinary ApproachApproach

• a team approach to assessing and delivering services

• team members are willing to both teach others about their own skills and to learn and take on the roles from other disciplines;

• team members continuously communicate their expertise to others so that team members from other disciplines can use that knowledge.

Characteristics of Characteristics of Transdisciplinary Transdisciplinary

InterventionIntervention• One primary provider works with family

members• Consultation occurs with other professionals

as needed• Co-intervention (treatment, teaching) occurs

in order to share information and teach skills to both each other and the family

• Family members are also primary team members

Transdisciplinary ApproachTransdisciplinary Approach

• A team approach based on sharing of information and skills across disciplines in order to better serve the young child and her family.

• Characteristics

o Information Sharing

o Skill sharing and development

oRole release and role sharing

oConsultative model of service

Levels of Transdisciplinary Levels of Transdisciplinary ServicesServices

• Role/discipline instruction

• Role modeling• Role sharing• Role release

o Swappingo Enrichmento Extensiono support

Transdisciplinary Role Transdisciplinary Role ReleaseRelease

• When one team member from one discipline teaches another team member from another discipline to conduct some of his or her services

• Team members share skills and learn from one another

• Role release can occur at the information level, the skill level, or the performance level

Transdisciplinary TeamsTransdisciplinary Teams• Parents and caregivers are team members• Members are from at least two disciplines• Members function as a team; decisions are

made jointly• Members share their perceptions of a chil

d ’s abilities• Consensus is formed regarding a child’s

abilities, concerns, and possible methods of intervention

Transdisciplinary Transdisciplinary TeamsTeams

• Consensus is formed regarding the services necessary to address desired goals and outcomes

• Members participate in “role-release”• Members learn different perspectives of the

child through the perceptions of their fellow team members

Transdisciplinary Transdisciplinary Organizational StructureOrganizational Structure• No “departments” (e.g., OT department,

speech department) are used in the transdisciplinary model

• Programs are organized by teams with multiple disciplines represented on each team

• Changes in approaches, interventions, and strategies are decided by all team members

• Teams are responsible for their budgeting, resource management, and outcomes

Integrated, Cross-Domain Integrated, Cross-Domain Goals and ObjectivesGoals and Objectives

• Objectives are decided upon by the child’s function, not necessarily by developmental level

• Objectives should result in the child having more independence when they are achieved

• Objectives should allow the child to participate in natural environments

• Objectives should address skills across multiple domains of development

• Objectives are usually taught in context

Practices to Avoid for Practices to Avoid for

Transdisciplinary TeamsTransdisciplinary Teams• More than one primary service provider• IFSPs that have “PT outcomes,” “speech outcomes,” etc.• Team members missing team meetings• Team members who are reluctant to share information

and reluctant to teach colleagues skills about their own discipline

• Team members who are reluctant to learn about other disciplines

Practices to Avoid for Practices to Avoid for Transdisciplinary TeamsTransdisciplinary Teams

• Planning or making changes to an intervention plan without the other team members, including the family

• Lack of time spent with fellow team members to discuss children’s progress and response to interventions

• Lack of time spent with the family; including time to teach how to be active members of the team

Possible Drawbacks of Possible Drawbacks of

Transdisciplinary TeamsTransdisciplinary Teams• The approach is initially time

intensiveo Team development takes months;

• Replacement of team members takes time to integrate the new members to the process

• Some professionals are reluctant to acquire new skills/roles

• Questions about legal liability of teaching others and implementing services not formally trained for

• Administrative budgeting questions

Barriers to Effective Barriers to Effective TeamworkTeamwork

• Role expectations• Discomfort with

conflict• Lack of negotiation

skills• Territoriality• Insecurity

Possible Assessment Team MembersPossible Assessment Team Members• Parent(s) and other

family members (essential and required)

• Educators• Physicians• Nurses• Psychologists• Nutritionists

• Occupational therapists

• Physical therapists• Speech-language

pathologists• Orientation and

mobility specialists• Social workers• Counselors• Others as identified

Professionalism:Professionalism: Communication, Communication,

Collaboration, and Collaboration, and ConsultationConsultation

Primary Teamwork BehaviorsPrimary Teamwork Behaviors

• Communication---with team members, other staff, administrators, children, families, and other agencies.

• Cooperation--with team members, other staff, administrators, children, families, and other agencies.

• Consistency--with team members, other staff, administrators, children, families, and other agencies.

Teamwork Basic GuidelinesTeamwork Basic Guidelines• Guideline 1: Staff of a program should be organized into

teams serving discrete groups of children and their families. Each team should include all staff members who regularly provide services to that particular group

• Guideline 2: The total number of adults who serve each group of children and their families should be kept to a minimum. If possible, each staff member should serve on only one team.

• Guideline 3: Teams should be the organizational unit within a program; not departments.

• Guideline 4: Teams should be the basic administrative unit for both personnel management and program budgeting.

A Proposed A Proposed Teamwork Teamwork

““ConstitutionConstitution””• To meet as a team at least once a week.• To keep accurate records of the team’s discussion and

decisions.• To share these records with the team’s administrators.• To jointly assess the needs of both the individuals and

the overall group served by the team.• To set priorities for these needs in order to plan the

team’s activities.• To develop written plans that specify the needs, long-

term goals, short-term objectives, and strategies to be used with individual children and the group as a whole.

• To coordinate the implementation of the team’s strategies, interventions, and activities, including their timing and their sequence.

Proposed Teamwork Proposed Teamwork ““ConstitutionConstitution”” (continued)(continued)

• To evaluate team effectiveness and to modify services and approaches according to outcomes.

• To provide support, encouragement, and guidance to all team members.

• To provide regular feedback to team members regarding the effects of their behavior on the children and their families and on team members.

• To jointly participate in the periodic formal evaluation of each team member’s performance.

• To participate in the evaluation and selection of new team members.

• To generate and discuss new ideas for improving the total program of the school or program.

• To serve as a consultant to the program administrator in evaluating proposals for change.

Proposed Teamwork Proposed Teamwork ““ConstitutionConstitution”” (continued)(continued)

• To maintain regular communication of the team’s strategies, interventions, and activities, including their timing and their sequence.

• To maintain regular communication with the children’s families and collaborate with them regarding services to their children.

• To coordinate services with any other agencies and institutions working with the children we serve.

• To schedule the work of all team members, including time off, training, and supervision to not disrupt team meetings or services to children and families.

• To allocate the team’s program budget.• To solve specific problems faced by the children, their families,

and the team using group problem solving and decision making.

Team MeetingsTeam Meetings• Team meetings are the second most important

function of the job (direct service to children and families is first)

• Meetings are held weekly to bi-weekly• Progress regarding children and families is shared• Parents/family members are always invited (and

re-invited)• Teams teach one another skills and share

information during team meetings• Decisions about intervention approaches are made

at team meetings; the only place changes in approaches can be made are at team meetings

• There is no excuse for missing a team meeting

Problem Solving and Problem Solving and

Decision Making in the TeamDecision Making in the Team• Step 1--State the problem clearly. All team members need

to understand the scope of the questions to answered.• Step 2--Gather all points of view on the problem. Be sure

each team member shares his or her individual perspective.• Step 3--Make a list of alternative solutions. Don’t discuss

the good and bad points of each until all alternatives are listed.• Step 4--Discuss pros and cons of the alternatives. Seek

each team member’s views in establishing a priority listing of the choices.

• Step 5--Reach a consensus if possible. Try to avoid win or lose votes. Find a solution that everyone can support and implement.

• Step 6--Assign responsibility for carrying out the decision to specific team members. Receive a commitment to fulfill these responsibilities by a specific time.

Family Family Systems Systems Model of Model of

InterventionIntervention

Family Systems Model Family Systems Model of Interventionof Intervention

• The family is an interactional system. Events effecting any one member of the system have an impact upon all other members of the system. When serving the child with an exceptionally, services must be provided within the context of the family. Therefore, an intervention designed for the child should be evaluated from the point of view of what impact(s) it will have on the other members in the child’s system prior to implementation.

Family-Centered Family-Centered PrinciplesPrinciples

• The family is the constant in the child’s life; service systems and personnel within those systems fluctuate.

• Parent-professional collaboration should occur at all levels of service provision.

• Programs share unbiased and complete information with parents about their child’s care, development, and prognosis on a on-going basis in an appropriate and supportive manner.

• Implementation of appropriate policies and programs that are comprehensive and provide emotional and financial support to meet the needs of families.

Family-Centered Family-Centered PrinciplesPrinciples

(continued)(continued)• Recognition of family strengths and

individuality and respect for different methods of coping.

• Understanding and incorporating the developmental needs of children with disabilities and their families into the service delivery system.

• Encourage and facilitate parent to parent support.

• Assure that the design of service delivery systems is flexible, accessible, and responsive to family needs.

Components of Family Components of Family SystemsSystems

• Family Resources• Family

Interactions• Family Functions• Family Life Cycle• C, P, R

Family ResourcesFamily Resources• Characteristics of the

familyo size and formo cultural backgroundo socioeconomic levelo geographic location

• Personal Characteristicso members’ healtho coping style(s)o interaction style(s)

• Characteristics of the child’s exceptionallyo type of exceptionalityo severity of exceptionalityo demands of exceptionalityo perception of

exceptionality• Special Circumstances

o povertyo abuseo rural areaso parents with disabilities

Characteristics of a ChildCharacteristics of a Child’’s Disability s Disability

that may effect family resourcesthat may effect family resources• Severity• Medical complications• Necessary intervention intensity• Behavioral concerns• Physical appearance• Perceptions of child’s needs and outcome

Family member characteristics that may Family member characteristics that may

affect response to a child with a affect response to a child with a

disabilitydisability

• Family members’ healtho physicalo mental

• Parental disability• Family members’ coping styles

o action orientedo reframingo denial

Family Interaction Family Interaction SubsystemsSubsystems

• Partner (marital)

• Sibling• Parental• Extra-familiar

Family FunctionsFamily Functions• Economic• Daily Care• Recreation• Socialization• Self-Identity• Affection• Education/Vocation

Critical family events which can Critical family events which can

effect a child with a disabilityeffect a child with a disability

• Birth of other children• Death of important

relatives• Divorce/separation of

parents• Job loss or job changes• Moving• Siblings leaving the

household• War or other catastrophes

Family CopingFamily Coping

• Family stressors are dependent upon the manner in which family members view those stressors; an event or incident that is stressful to one family or family member may be less stressful or not stressful at all to another family or family member (Thorin & Irvin, 1992)