providing early intervention services using the primary service provider approach

1. Providing Early Intervention Services Using the Primary Service Provider Approach Team Member Roles and Considerations July 10, 2008

2. This topic was introduced at the spring regional meetings. This is a follow-up Wisline designed to more thoroughly discuss this topic, including the literature supporting this way of serving children and families.This topic was introduced at the spring regional meetings. This is a follow-up Wisline designed to more thoroughly discuss this topic, including the literature supporting this way of serving children and families.

3. Materials Power Point Presentation Early Intervention Team Information document List of references Available at WI Department of Health Services website: http://dhs.wisconsin.gov/bdds/b3etn/2008/200807/index.htm

4. Agenda Background Relationship-Based Intervention EI Service Delivery Models Transdisciplinary Model Primary Service Provider Approach Team Member Considerations Parents Therapists Educators Service Coordinators Physicians Administrators Discussion

5. Relationship-Based Early Intervention: What is it? Intervention that is primarily concerned with fostering growth-producing� parent-practitioner and parent-child relationships. Kelly, 1999 ;Mahoney, Boyce, Fewell, Spiker, and Wheeden, 1998; Greenspan and Wieder, 1998; Affleck, McGrade, McQueeney, and Allen, 1982, Relationship between a parent and service provider has been shown to be a potential predictor of the success of interventionRelationship between a parent and service provider has been shown to be a potential predictor of the success of intervention

6. Relationship-Based Early Intervention: What is it? Central focus on parent-child relationships and parent-professional relationships is a shift� From deficit-based, child focused model To a strength-based, transactional model in which mutually satisfying parent-child interactions are supported by professionals Weston, Ivins, Heffron, and Sweet, 1997; Kelly and Barnard, 1999; Woolfson, 1999 Relationship between a parent and service provider has been shown to be a potential predictor of the success of interventionRelationship between a parent and service provider has been shown to be a potential predictor of the success of intervention

7. Relationship-Based Early Intervention:Why is it important? Parent-child relationships form the foundation for a child�s early development and intervention that supports these relationships can enhance children�s development.

8. Relationship-Based Early Intervention:Why is it important? Intervention effects on child development unlikely to occur unless parents increased their level of responsive behavior with their young children. Mahoney et al, 1998, 1999, 2004, 2005 Four EI evaluation studies Supports shift in emphasis from child-directed activities to supporting the parent-child relationshipsFour EI evaluation studies Supports shift in emphasis from child-directed activities to supporting the parent-child relationships

9. Relationship-Based Early InterventionWhat are the implications for EI professionals? Practitioners use strategies that support parents in their relationships with their child as the vehicle for intervention. support parents� competence and confidence to increase their child�s learning and participation in daily life. Bruder and Dunst, 2000

10. Relationship-Based Early Intervention Relationships = Organizers of development Basis for all intervention Weston, 1997

11. IDEA�s Goals for EI 1. Enhance the development of I/T with disabilities to minimize their potential for developmental delay 2. Enhance the capacity of families to meet the special needs of their I/T with disabilities Building relationships with families helps us achieve bothBuilding relationships with families helps us achieve both

12. Relationship-Based Early Intervention Practitioners attend to not only what they do, but how they do it. Practioners can most effectively share their knowledge, perspectives and resources with a family in the contect of a trusting relationships. The way that the expertise is delivered becomes an essential aspect of the work.Practioners can most effectively share their knowledge, perspectives and resources with a family in the contect of a trusting relationships. The way that the expertise is delivered becomes an essential aspect of the work.

13. What is the research evidence that relationship-focused EI improves child and family outcomes? The style of parent-child interaction plays a central role in developmental outcomes of the child Mahoney, Boyce, et al. (1998) Girolametto, Verbey, and Tannock (1994) Mahoney, Wiggers, and Lash (1998) Mahoney, Wheeden, and Perales (2004) Mahoney and Perales (2005) Solomon, Necheles, Ferch, and Bruckman (2004) Gerald Mahoney (Case Western Reserve U. OH), Boyce, Fewell, et al. (1998) reviewed four major early intervention evaluation studies on the outcomes of relationship-based approaches to improve parent-child interaction. Data from these four large outcome studies indicated when mothers modified their style of interaction and increased their level of responsiveness their children were more likely to have more positive developmental outcomes. Girolametto, Verbey, and Tannock (1994) investigated the effects of a 12-week intervention using parent training (Hanen approach) on the joint engagement of children with developmental delay and their mothers. The mothers were trained to encourage their children�s participation in social interaction by being highly responsive and child-centered. Results indicated the intervention group experienced significantly more episodes of joint engagement than did the control group. Mahoney, Wiggers, and Lash (1998) conducted a small study of the efficacy of a relationship-focused early intervention on father involvement. The fathers were taught strategies they could use to increase their level of responsiveness while interacting with their children. Four of the 5 fathers made significant changes in their style of interacting with their children and their spouses reported these fathers spent more time interacting with their children at home than prior to the intervention. Mahoney, Wheeden, and Perales (2004) evaluated the developmental outcomes of children (n=71) in preschool special education in relationship to the instructional approach used by their teachers and their parents� style of interaction. No significant differences were found between the different instructional models on the children�s rate of development. However, the children�s rate of development at the end of intervention was significantly related to their parents� style of interaction. Mahoney and Perales (2005) compared the effects of relationship-focused early intervention on toddlers and preschool-age children with either pervasive developmental disorders (PDD) or developmental disabilities (DD). Intervention consisted of weekly individual parent-child sessions for one year that focused on helping parents use responsive teaching strategies to encourage pivotal behaviors in their children. Comparisons made before and after intervention showed significant improvement in parents� responsiveness and children�s pivotal behavior. Children with PDD made statistically greater improvements on the developmental measures than children with DD. Solomon, Necheles, Ferch, and Bruckman (2004) investigated the outcomes of a parent training program for 74 young children ages 18 months to 6 years with autism. Based on the DIR/Floortime approach, home consultants trained parents for eight to twelve months through structured monthly home visits to use play and language-based methods while interacting with their children. At the end of the training, 45.5% of the children demonstrated good to very good progress as measured by the Functional Emotional Assessment Scale. Significant increases were noted in the Child Sub-scale scores; however, the Parent Sub-scale score of parent�s abilities to interact contingently with their children showed no statistical differences. Parent satisfaction with home consulting services was 90%. Gerald Mahoney (Case Western Reserve U. OH), Boyce, Fewell, et al. (1998) reviewed four major early intervention evaluation studies on the outcomes of relationship-based approaches to improve parent-child interaction. Data from these four large outcome studies indicated when mothers modified their style of interaction and increased their level of responsiveness their children were more likely to have more positive developmental outcomes. Girolametto, Verbey, and Tannock (1994) investigated the effects of a 12-week intervention using parent training (Hanen approach) on the joint engagement of children with developmental delay and their mothers. The mothers were trained to encourage their children�s participation in social interaction by being highly responsive and child-centered. Results indicated the intervention group experienced significantly more episodes of joint engagement than did the control group. Mahoney, Wiggers, and Lash (1998) conducted a small study of the efficacy of a relationship-focused early intervention on father involvement. The fathers were taught strategies they could use to increase their level of responsiveness while interacting with their children. Four of the 5 fathers made significant changes in their style of interacting with their children and their spouses reported these fathers spent more time interacting with their children at home than prior to the intervention. Mahoney, Wheeden, and Perales (2004) evaluated the developmental outcomes of children (n=71) in preschool special education in relationship to the instructional approach used by their teachers and their parents� style of interaction. No significant differences were found between the different instructional models on the children�s rate of development. However, the children�s rate of development at the end of intervention was significantly related to their parents� style of interaction. Mahoney and Perales (2005) compared the effects of relationship-focused early intervention on toddlers and preschool-age children with either pervasive developmental disorders (PDD) or developmental disabilities (DD). Intervention consisted of weekly individual parent-child sessions for one year that focused on helping parents use responsive teaching strategies to encourage pivotal behaviors in their children. Comparisons made before and after intervention showed significant improvement in parents� responsiveness and children�s pivotal behavior. Children with PDD made statistically greater improvements on the developmental measures than children with DD. Solomon, Necheles, Ferch, and Bruckman (2004) investigated the outcomes of a parent training program for 74 young children ages 18 months to 6 years with autism. Based on the DIR/Floortime approach, home consultants trained parents for eight to twelve months through structured monthly home visits to use play and language-based methods while interacting with their children. At the end of the training, 45.5% of the children demonstrated good to very good progress as measured by the Functional Emotional Assessment Scale. Significant increases were noted in the Child Sub-scale scores; however, the Parent Sub-scale score of parent�s abilities to interact contingently with their children showed no statistical differences. Parent satisfaction with home consulting services was 90%.

14. What is the research evidence that relationship-focused EI improves child and family outcomes? Parent-Child Interactions Influence Family Outcomes Woolfson (1999) Hauser-Cram, Warfield, Shonkoff, Krauss, Sayer, and Upshur (2001) Using a model of transactional developmental regulation, Woolfson (1999) explored how an early intervention program may effect family outcomes as well as child developmental progress in a sample (n=15) of young children with motor impairments. Results of the study suggest that redefinition (i.e., changes in parental perceptions and expectation of their child�s difficulties that allowed parents to apply usual, rather than special, caregiving practices) may be at least as important outcome as remediation (i.e., child progress) or re-education (i.e., parent learning). Hauser-Cram, Warfield, Shonkoff, Krauss, Sayer, and Upshur (2001) conducted a large, longitudinal study of child outcomes and parent well-being in a sample (n=183) children with developmental disabilities. Data were collected at the time of early intervention entry up to the child�s 10th birthday. Predictor variables were measured at age 3 when the children exited from the early intervention program. Mother-child interaction not only predicted multiple domains of children�s development (e.g., language, cognitive, adaptive skills, etc.) but also predicted the fathers� child-related stress.Using a model of transactional developmental regulation, Woolfson (1999) explored how an early intervention program may effect family outcomes as well as child developmental progress in a sample (n=15) of young children with motor impairments. Results of the study suggest that redefinition (i.e., changes in parental perceptions and expectation of their child�s difficulties that allowed parents to apply usual, rather than special, caregiving practices) may be at least as important outcome as remediation (i.e., child progress) or re-education (i.e., parent learning). Hauser-Cram, Warfield, Shonkoff, Krauss, Sayer, and Upshur (2001) conducted a large, longitudinal study of child outcomes and parent well-being in a sample (n=183) children with developmental disabilities. Data were collected at the time of early intervention entry up to the child�s 10th birthday. Predictor variables were measured at age 3 when the children exited from the early intervention program. Mother-child interaction not only predicted multiple domains of children�s development (e.g., language, cognitive, adaptive skills, etc.) but also predicted the fathers� child-related stress.

15. Skills Needed for Relationship-Based EI Expertise in child development Training in a specific discipline Interpersonal skills Edelman, 2004 Interpersonal skills needed to build individualized, respectful, responsive, and supportive relationships with families outlined on next slideInterpersonal skills needed to build individualized, respectful, responsive, and supportive relationships with families outlined on next slide

16. Relationship-Based Early Intervention, Interpersonal Skills Skills Needed to Support Parent-Child Relationships Include Capacity to: Listen Demonstrate Concern and Empathy Promote Reflection Observe and highlight the parent/child relationship Respect role boundaries Respond thoughtfully in emotionally intense interactions Understand, regulate, and use one�s own feelings Gilkerson et al, 2005

17. Other relationships crucial to effective EI support and service delivery Practitioner - Practitioner Supervisor - Practitioner Organizational support for relationships

18. Practitioner � Practitioner Relationships, Key Ingredients Building authentic relationships by being direct, honest and supportive Having consistent, predictable, regularly scheduled meetings Support from a supportive facilitator Poulsen & Colem 1996 Without collaboration and communication, greater risk of fragmentation, duplication of services as well as unmet family needs Team meetings: team members establish and maintain close communication, identify issues to address, express needs/feelings/ideas, participate in group problem solving and decision-making Relationships built over time ESSENTIAL that transidsciplinary teams have regularly scheuled meetings to build their capacity to do the workWithout collaboration and communication, greater risk of fragmentation, duplication of services as well as unmet family needs Team meetings: team members establish and maintain close communication, identify issues to address, express needs/feelings/ideas, participate in group problem solving and decision-making Relationships built over time ESSENTIAL that transidsciplinary teams have regularly scheuled meetings to build their capacity to do the work

19. Supervisor � Practitioner Relationships Supervisory relationship ideally models the interpersonal interactions characterizing other relationships Can be supported through the approach of reflective supervision Thoughtful dialogue Active listening McCollem et al, 2001 RS can be accomplisted through individual, group, and/or peer supervisionRS can be accomplisted through individual, group, and/or peer supervision

20. Organizational Support for Relationships �A relationship-based organization is one in which quality relationships characterized by trust, support, and growth exist among and between staff, parents and children; these relationships form the foundation for all the work that�s done.� Parlakian, 2001

21. Organizational Support for Relationships �Relationships are valued, not as a �touch-feely� nicety, but as a foundation for doing business.� Parlakian, 2001

22. Ways of Providing Relationship-Based EI Early Intervention Team Models: Multidisciplinary Teams Interdisciplinary Teams Transdisciplinary Teams ERIC, 1989

23. Multidisciplinary Teams Professionals from several disciplines work independently of one another Approach does not foster services and supports reflecting view of the child as integrated whole Can increase the burden of coordination and case management on family Linder, 1983 Like parallel play in children: side by side, but separate Can lead to fragmented services, conflicting reports for parentsLike parallel play in children: side by side, but separate Can lead to fragmented services, conflicting reports for parents

24. Interdisciplinary Teams Include parents and professionals from several disciplines Have formal channels of communication (i.e., team meetings) to share information and discuss individual results Peterson, 1987 Vs MD: Different interaction among team members; ID = regular team meetings Solves some problems, but communication and inveraction probls may influece the team processVs MD: Different interaction among team members; ID = regular team meetings Solves some problems, but communication and inveraction probls may influece the team process

25. Transdisciplinary Team Parents and professionals from several disciplines Goal = To form team that crosses disciplinary boundaries Team members accept and accentuate each other�s strengths Goal = To form team that crosses disciplinary boundaries so that communication, interaction, and cooperations among members is maximizedGoal = To form team that crosses disciplinary boundaries so that communication, interaction, and cooperations among members is maximized

26. Staff Development on Transdisciplinary Teams Sharing general information Teaching others to make specific judgments Teaching others to perform specific actions First 2 bullets: sharing of information� Third: sharing of rolesFirst 2 bullets: sharing of information� Third: sharing of roles

27. Fundamental Beliefs Behind Transdisciplinary Model Children�s development is integrated and interactive. Children must be served within the context of a family. ERIC, 1989 Families seen as a CRITICAL part of transdisciplinary team, involved in goal setting, decision making All decisions made by team consensusFamilies seen as a CRITICAL part of transdisciplinary team, involved in goal setting, decision making All decisions made by team consensus

28. Transdisciplinary Service Delivery All team members share responsibility for development of service plan Service plan carried out by the family and one other team member (primary service provider)

29. Why is this approach especially beneficial to serving children with developmental disabilities and their families? Building relationships with parents is of equal importance to the content of developmental interventions. Service fragmentation and family isolation occur when systems focus on deficits and fail to integrate services of various professionals. Parents of children with developmental disabilities are especially vulnerable in these environments because they may be receiving services of two or more different professionals or early interventionists. Need for relationship-based work, transidisc. Taming Kristine Ovland Pilkington Need for relationship-based work, transidisc. Taming Kristine Ovland Pilkington

30. Primary Service Provider Considerations Designation of PSP Team decision Individualized for each family Carefully consider which team member offers the best match of expertise and relationship with the family Not based only on logistics (such as availability and cost) Team must communicate regularly to support one another and ensure maximum progress Woods, 2008

31. Primary Service Provider Considerations All team members focus on the interactions between the caregiver and child, rather than direct service delivery to the child. Woods, 2008 All team members = PSP, consultants, parents Relationship �based EI tie Embedded intervention into family�s identified routines t/o the day = core feature of NE service deliveryAll team members = PSP, consultants, parents Relationship �based EI tie Embedded intervention into family�s identified routines t/o the day = core feature of NE service delivery

32. Implications of the Transdisciplinary Model for Staff Commitment to supporting one another through� Giving time and energy necessary to teach, learn, and work across traditional disciplinary boundaries Working toward making all decisions about the child and family by team consensus team consensus = giving up disciplinary controlteam consensus = giving up disciplinary control

33. Implications of the Transdisciplinary Model for Staff Commitment to supporting one another through� Supporting the family and one other team member as the child�s primary service provider Recognizing the family as the most important influence in the child�s life and including them as equal team members Parents have a say in all decisions about the child�s programParents have a say in all decisions about the child�s program

34. Individual Team Member Considerations, Parents Must feel empowered and recognize the value of their contribution toward their child�s development One example describing this approach to families from Nevada http://health2k.state.nv.us/BEIS/ProvidingServices&Support2006ENG.pdf

35. Individual Team Member Considerations, Speech and Language Pathologists 2008 article on this issue in ASHA Leader, Providing Early Intervention Services in Natural Environments Juliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EIJuliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EI

36. Individual Team Member Considerations, Speech and Language Pathologists PSPA (Woods, 2008) ��One professional on the team is designated as the primary service provider (PSP); this model helps avoid fragmentation of services and frequent home visits from multiple professionals (e.g., audiologists, educators, occupational and physical therapists).� �With this approach, which involves �role release� and �role extension,� one professional is designated to provide services across disciplines, and the other professionals provide consultation to this designated primary provider.� Juliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EIJuliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EI

37. Individual Team Member Considerations, Speech and Language Pathologists SLP may serve as either primary provider or consultant ASHA recommends a SLP as the primary provider if the child�s main needs are communication or feeding and swallowing Juliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EIJuliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EI

38. Individual Team Member Considerations, Speech and Language Pathologists �The designation of the PSP should be a team decision and individualized for each child and family. It is a viable model if it includes careful consideration of which team member offers the best match of expertise and relationship with the family, and is not based only on logistics, such as availability or cost. When using the PSP model, the team must communicate regularly to support one another�as well as the child and family�to ensure maximum progress.� Woods, 2008 Juliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EIJuliann Woods: prof in College of Communication at FL State U. and a memver of ASHA�s Committee on the Role of SLP in EI

39. Supporting parents in communication strategies Increasing evidence supports parents as effective communication and play partners Kaiser et al, 2007; Mahoney et al, 2005 From Wood�s article in ASHA Leader Kaiser, A. P., Hancock, T. B., & Trent, J. A. (2007). Teaching parents communication strategies. Early Childhood Services: An Interdisciplinary Journal of Effectiveness, 1(2), 107-136.From Wood�s article in ASHA Leader Kaiser, A. P., Hancock, T. B., & Trent, J. A. (2007). Teaching parents communication strategies. Early Childhood Services: An Interdisciplinary Journal of Effectiveness, 1(2), 107-136.

40. Facilitating Learning for Caregivers Five adult learning strategies: 1. Agree on learning priorities and roles 2. Join in rather than take over 3. Build on the caregiver�s strengths 4. The relationship does matter 5. Provide specific and meaningful feedback to enhance competence. Woods, 2008 From Malcom Knowles, theorist in adult ed As trust in the consulting relationship increases, so does the likelihood the adult learner will try new ideasFrom Malcom Knowles, theorist in adult ed As trust in the consulting relationship increases, so does the likelihood the adult learner will try new ideas

41. Individual Team Member Considerations, Physical Therapists Maximizing Your Role in Early Intervention, publication from APTA website http://www.apta.org/AM/Template.cfm?Section=search&template=CM/HTMLDisplay.cfm&ContentID=8534 Most prevalent model in EI program across the country (Jeffries, 2002) is transdisciplinary, requiring role release Legal, ethical concerns about �releasing� aspects of their discipline Goal: teach others activities not requiring the expertise of a therapist Important: Family, other team members performing activities taught to them by therapist, only doing activities, not providing PT Author: Michelle Vanderhoff Transdisciplinary--Today, the most prevalent model is the transdisciplinary�one, according to a 2002 survey reported by Jeffries.1 This model calls for one team member to provide all the interventions. To accomplish this other members must teach the service provider aspects of their discipline. This is called role-release. Taken literally, therapists would have legal and ethical concerns "releasing" aspects of their discipline. Taken in a broader perspective, therapists may teach others activities or intervention strategies that do not require the expertise of the therapist. The Guide to Physical Therapist Practice3 provides for this practice in coordination, communication and documentation, and patient-client-related instruction. It is important that the family and other team members understand that when performing the activities the therapist taught them, they are only doing activities, not providing physical therapy.� Author: Michelle Vanderhoff Transdisciplinary--Today, the most prevalent model is the transdisciplinary�one, according to a 2002 survey reported by Jeffries.1 This model calls for one team member to provide all the interventions. To accomplish this other members must teach the service provider aspects of their discipline. This is called role-release. Taken literally, therapists would have legal and ethical concerns "releasing" aspects of their discipline. Taken in a broader perspective, therapists may teach others activities or intervention strategies that do not require the expertise of the therapist. The Guide to Physical Therapist Practice3 provides for this practice in coordination, communication and documentation, and patient-client-related instruction. It is important that the family and other team members understand that when performing the activities the therapist taught them, they are only doing activities, not providing physical therapy.�

42. Individual Team Member Considerations, Physical Therapists Primary Service Provider "One reason the primary service provider evolved is that young children should not have to tolerate the interaction with four or five different professionals every week. With a primary service provider, a child can develop a significant relationship with one provider who is collaborating with the other team members."� Toby Long, PT, PhD More from Maximizing Your Role in Early Intervention, publication found on the APTA website Author: Michelle Vanderhoff Primary Service Provider-This is an example of the transdisciplinary�model. In this model, a single, long-term service coordinator is assigned to a family from the point they enter into the program. The selection of service provider should be determined by the area of greatest need. The provider establishes a relationship and works with the child and family throughout the duration of the child's care. Long notes, "One reason the primary service provider evolved is that young children should not have to tolerate the interaction with four or five different professionals every week. With a primary service provider, a child can develop a significant relationship with one provider who is collaborating with the other team members."� More from Maximizing Your Role in Early Intervention, publication found on the APTA website Author: Michelle Vanderhoff Primary Service Provider-This is an example of the transdisciplinary�model. In this model, a single, long-term service coordinator is assigned to a family from the point they enter into the program. The selection of service provider should be determined by the area of greatest need. The provider establishes a relationship and works with the child and family throughout the duration of the child's care. Long notes, "One reason the primary service provider evolved is that young children should not have to tolerate the interaction with four or five different professionals every week. With a primary service provider, a child can develop a significant relationship with one provider who is collaborating with the other team members."�

43. Individual Team Member Considerations, Physical Therapists Primary Service Provider (Barbara Connolly, PT, EdD, FAPTA; President of APTA's Section on Pediatrics) Physical therapists collaborate on a regular basis when teaching others on how to physically manage a child on a day-to-day basis. Example, a PT may not always be available when it is necessary to position or reposition a child during speech therapy, so the PT must demonstrate to the speech pathologist the appropriate ways to position the child during therapy.� Alternatively, a physical therapist might need to teach the child sucking/swallowing in order to give the child fluids or food during a session. Sucking/swallowing is not something exclusive to speech pathologists, as it also qualifies as an oral-motor skill and is part of the APTA Section on Pediatrics' "Competencies for Physical Therapists in Early Intervention"�and is included in functional training in self-care and home management in the Guide to Physical Therapist Practice.� More from Maximizing Your Role in Early Intervention, publication found on the APTA website (Barbara Connolly, PT, EdD, FAPTA; President of APTA's Section on Pediatrics) "Physical therapists, Connolly says, collaborate on a regular basis when teaching others on how to physically manage a child on a day-to-day basis. For example, a physical therapist may not always be available when it is necessary to position or reposition a child during speech therapy, so the PT must demonstrate to the speech pathologist the appropriate ways to position the child during therapy.� Alternatively, a physical therapist might need to teach the child sucking/swallowing in order to give the child fluids or food during a session. Sucking/swallowing is not something exclusive to speech pathologists, as it also qualifies as an oral-motor skill and is part of the APTA Section on Pediatrics' "Competencies for Physical Therapists in Early Intervention."4�and is included in functional training in self-care and home management in the Guide to Physical Therapist Practice.3� More from Maximizing Your Role in Early Intervention, publication found on the APTA website (Barbara Connolly, PT, EdD, FAPTA; President of APTA's Section on Pediatrics) "Physical therapists, Connolly says, collaborate on a regular basis when teaching others on how to physically manage a child on a day-to-day basis. For example, a physical therapist may not always be available when it is necessary to position or reposition a child during speech therapy, so the PT must demonstrate to the speech pathologist the appropriate ways to position the child during therapy.� Alternatively, a physical therapist might need to teach the child sucking/swallowing in order to give the child fluids or food during a session. Sucking/swallowing is not something exclusive to speech pathologists, as it also qualifies as an oral-motor skill and is part of the APTA Section on Pediatrics' "Competencies for Physical Therapists in Early Intervention."4�and is included in functional training in self-care and home management in the Guide to Physical Therapist Practice.3�

44. Individual Team Member Considerations, Physical Therapists Empowering Parents (Barbara Connolly, PT, EdD, FAPTA; President of APTA's Section on Pediatrics) Critical to the early intervention process because parents ultimately are the ones who will facilitate their child's progress. "Remember, this is the parents' child, not your own. We are not with the child 24 hours a day; the parents are. It's our job to empower the parent. It's not your hands�that make the difference, it's your brain that makes the difference.� When a PT is successful in teaching the parent how to work with their child, the child is more likely to develop the necessary skills. More from Maximizing Your Role in Early Intervention, publication found on the APTA website Empowering the parents is critical to the early intervention process because parents ultimately are the ones who will facilitate their child's progress. Connolly advises PTs: "Remember, this is the parents' child, not your own. We are not with the child 24 hours a day; the parents are. It's our job to empower the parent. It's not your hands�that make the difference, it's your brain that makes the difference." When a PT is successful in teaching the parent how to work with their child, the child is more likely to develop the necessary skills, Connolly says.� More from Maximizing Your Role in Early Intervention, publication found on the APTA website Empowering the parents is critical to the early intervention process because parents ultimately are the ones who will facilitate their child's progress. Connolly advises PTs: "Remember, this is the parents' child, not your own. We are not with the child 24 hours a day; the parents are. It's our job to empower the parent. It's not your hands�that make the difference, it's your brain that makes the difference." When a PT is successful in teaching the parent how to work with their child, the child is more likely to develop the necessary skills, Connolly says.�

45. Individual Team Member Considerations, Physical Therapists �The therapist needs to think about her role within a system of care. A system of care for children with disabilities is large and varied. It could include the family, the medical community, the education or early intervention system, the social service system, community-based resources such as libraries, parks, and activities. The providers of all these systems and activities could have skills to help the family reach their goals for their children and realize their dreams." Toby Long, PT, PhD More from Maximizing Your Role in Early Intervention, publication found on the APTA website Toby Long, PT, PhF Long also says that early intervention has prompted PTs to reevaluate their own role. She says, "Health care providers have assumed, 'If the person is in the room, they must need me' instead of asking 'What does this person need?' Even if he or she has a disability, what they need may have very little to do with your skills and abilities. The therapist needs to think about her role within a system of care. A system of care for children with disabilities is large and varied. It could include the family, the medical community, the education or early intervention system, the social service system, community-based resources such as libraries, parks, and activities. The providers of all these systems and activities could have skills to help the family reach their goals for their children and realize their dreams." � More from Maximizing Your Role in Early Intervention, publication found on the APTA website Toby Long, PT, PhF Long also says that early intervention has prompted PTs to reevaluate their own role. She says, "Health care providers have assumed, 'If the person is in the room, they must need me' instead of asking 'What does this person need?' Even if he or she has a disability, what they need may have very little to do with your skills and abilities. The therapist needs to think about her role within a system of care. A system of care for children with disabilities is large and varied. It could include the family, the medical community, the education or early intervention system, the social service system, community-based resources such as libraries, parks, and activities. The providers of all these systems and activities could have skills to help the family reach their goals for their children and realize their dreams." �

46. Individual Team Member Considerations, Occupational Therapists Side by Side: Transdisciplinary Early Intervention in Natural Environments, AOTA publication, 2006 http://www.aota.org/Pubs/OTP/1997-2007/Features/2006/f-040306.aspx �We depart from therapist-directed interactions to a side-by-side collaboration with families, creating the agenda together. The outcome we seek under Part C is to support parents' capacity to �captain their own ship� and not become dependent on professionals for all decision making.� Kristine Ovland Pilkington, OT Kristine Ovland Pilkington Kristine Ovland Pilkington

47. Individual Team Member Considerations, Occupational Therapists Supporting Parents �Occupational therapy practitioners can bring their �therapeutic use of self� to all team and family interactions, coaching and guiding rather than directing and doing.� Kristine Ovland Pilkington, OT Kristine Ovland Pilkington Kristine Ovland Pilkington

48. Individual Team Member Considerations, Occupational Therapists Team Interactions �To become comfortable moving beyond traditional practice (i.e., teaching children new skills in a therapy session), we realize that our interactions with teammates and families must play a central role in our early intervention. As we interact with our teammates, so will they interact with each other and the families they support.� Kristine Ovland Pilkington, OT Kristine Ovland Pilkington Kristine Ovland Pilkington

49. Individual Team Member Considerations, Occupational Therapists Transdisciplinary Services This model assumes that any given team member can incorporate basic things into his or her interventions that other members may have expertise about. Evaluation and planning are shared across disciplines and team members. This model does not assume that all team members can provide the same services, although some role release is expected. Team building, ongoing communication, and collaboration are required for this model to be successful.

50. Individual Team Member Considerations, Occupational Therapists Example of Transdisciplinary Services For example, if the educator is working on play, and the occupational therapist has concerns about the child using two hands, basic activities from the occupational therapist can be incorporated into those sessions.

51. Individual Team Member Considerations, Educators and Service Coordinators Division of Early Childhood, Recommended Practices (2005) Family-based practices Interdisciplinary models Transdisciplinary model recommended Transdisciplinary model: critical value embedded in transdisciplinary practice is the exchange of competencies between team members. � The expertise that individual members bring to the team is vital; without it, the team lacks specificity, resources, and the wisdom of knowledge accumulated through a field of concentrated study (i.e., a discipline). Transdisciplinary model: critical value embedded in transdisciplinary practice is the exchange of competencies between team members. � The expertise that individual members bring to the team is vital; without it, the team lacks specificity, resources, and the wisdom of knowledge accumulated through a field of concentrated study (i.e., a discipline).

52. Individual Team Member Considerations, Educators and Service Coordinators �A critical value embedded in transdisciplinary practices is the exchange of competencies between team members.� McWilliam, 2005 Transdisciplinary model: critical value embedded in transdisciplinary practice is the exchange of competencies between team members. � The expertise that individual members bring to the team is vital; without it, the team lacks specificity, resources, and the wisdom of knowledge accumulated through a field of concentrated study (i.e., a discipline). Transdisciplinary model: critical value embedded in transdisciplinary practice is the exchange of competencies between team members. � The expertise that individual members bring to the team is vital; without it, the team lacks specificity, resources, and the wisdom of knowledge accumulated through a field of concentrated study (i.e., a discipline).

53. Individual Team Member Considerations, Educators and Service Coordinators Transdisciplinary Model Team members share responsibilities and information to the extent that one team member can assume the role of another Interventions focus on the whole child and family, are provided by a primary service provider McWilliam, 2005 Division of Early Childhood, Recommended Practices (2005) Division of Early Childhood, Recommended Practices (2005)

54. Individual Team Member Considerations, Educators and Service Coordinators Transdisciplinary Model Specialists share knowledge and skills with PSP and parents Professionals provide guidance; they trust regular caregivers to implement the interventions effectively McWilliam, 2005 Division of Early Childhood, Recommended Practices (2005) Division of Early Childhood, Recommended Practices (2005)

55. Other Team Member Considerations, Physicians Understanding approach and rationale behind it essential in creating appropriate expectations in parents One example describing this approach to physicians from Georgia http://health.state.ga.us/pdfs/familyhealth/FAQ%20for%20Physicians%20-%20Service%20Delivery%20for%20web.pdf

56. Other Team Member Considerations, Administrators Understanding approach and rationale behind PSPA essential in supporting staff A Relationship-Based Approach to Early Intervention (Edelman, 2004) http://www.earlychildhoodconnections.org/files/relationship_based_approach.pdf Emphasizes the levels of relationships: Parents-professionals Professional-professional Professional-supervisor/administrator Also emphasizes that Emphasizes the levels of relationships: Parents-professionals Professional-professional Professional-supervisor/administrator Also emphasizes that

57. Other Team Member Considerations, Administrators �Society�s commitment to ensuring healthy development of every child begins with the parent-child relationship, and requires that the broader institutions affecting the family stand alongside parents in their efforts to ensure the well-being of young children.� Thompson, 2001 Emphasizes the levels of relationships: Parents-professionals Professional-professional Professional-supervisor/administratorEmphasizes the levels of relationships: Parents-professionals Professional-professional Professional-supervisor/administrator

58. Other Team Member Considerations, Administrators Importance of regular team meetings to support this method of service children and families �Collaborative assessment, planning, service delivery, evaluation, decision making, problem-solving, and conflict resolution require strong, trusting committed relationships among the team members. Such relationships are built over time; it is essential that transdisciplinary teams have regularly scheduled meetings to build their capacity to do the work at hand.� Edelman, 2004 Emphasizes the levels of relationships: Parents-professionals Professional-professional Professional-supervisor/administratorEmphasizes the levels of relationships: Parents-professionals Professional-professional Professional-supervisor/administrator

59. In Summary Relationship-based intervention approaches are generally effective in increasing parents� responsiveness toward their children and improving outcomes in children with developmental challenges There is strong, consistent evidence in the research literature over the past 30 years that relationship-based intervention approaches are effective in increasing parents� responsiveness toward their children and improving the social, emotional, and communication outcomes in children with developmental challenges (MacDonald, 2004).There is strong, consistent evidence in the research literature over the past 30 years that relationship-based intervention approaches are effective in increasing parents� responsiveness toward their children and improving the social, emotional, and communication outcomes in children with developmental challenges (MacDonald, 2004).

60. In Summary The Primary Provider Approach to service delivery is a relationship-focused approach designed to strengthen the connection between the professional and parent the parent and child so that parent interactions best promote the child�s development. There is strong, consistent evidence in the research literature over the past 30 years that relationship-based intervention approaches are effective in increasing parents� responsiveness toward their children and improving the social, emotional, and communication outcomes in children with developmental challenges (MacDonald, 2004).There is strong, consistent evidence in the research literature over the past 30 years that relationship-based intervention approaches are effective in increasing parents� responsiveness toward their children and improving the social, emotional, and communication outcomes in children with developmental challenges (MacDonald, 2004).

61. Discussion Time What would this approach mean for� Your program? Individual team members within your program? Children and families served by your program? Open phone lines (620#)Open phone lines (620#)

62. More Information on the Primary Service Provider Approach to Service Delivery Fall 2008 Birth to 6 EVENTS newsletter Giving it Away Additional professional development activities in spring of 2009