Issues in Early Intervention: Science, Intervention, Policy & Reality

1. Issues in Early Intervention:Science, Intervention, Policy & Reality Four Points Sheraton Iowa Department of Education April 20-21, 2006

2. Part I: Beyond Policy:Big Picture-Little DetailsMichael Gamel-McCormick • Goals of Early Intervention • What are the most important? • National and Local Issues • Team Models for effective Early Intervention • Communication, Collaboration, and Consultation • Family- and child-centeredness • When it works; when it doesn’t

3. Early Intervention Goals

4. Early Intervention Goals • 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

5. Roots of Early Intervention in the United 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)

6. Foundations of Early Intervention • Family-centered services • Normalization • Services in natural environments • Diversity of children and families served • Variety of service delivery models • Interdisciplinary and transdisciplinary services • Functional and developmental programming • Individualized programming • Blending of philosophical perspectives (developmental, behavioral, ecological/functional)

7. National and Local Issues in EI

8. Old Recommend Practices in Early Intervention • Segregation • Special education orientation • Traditional assessment • Academic orientation • 1:1 instruction • focus on skills and products • Mass trial instruction • Highly structured • Adult initiated • Isolate therapy • Classroom teacher role

9. New Recommended Practices in Early Intervention • 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

10. Big Issues • Professional time • Accountability • Documentation • Travel • Family needs/demands • Reimbursements • Teaming

11. Teams:Models, Approaches and Key Elements

12. Early Intervention Teamwork • 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.

13. Essential TEAM Components • 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

14. 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 Team Characteristics

15. Some Assessment Team Approaches • Uni-disciplinary • Intra-disciplinary • Multi-disciplinary • Inter-disciplinary • Trans-disciplinary

16. Multidisciplinary Teams • 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

17. Drawbacks of Multidisciplinary Teams • 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

18. Interdisciplinary Teams • 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 Assessment OT PT Educ. SLP Discuss Results and Set Goals OT PT Educ. SLP Child Report Report Report Report Complete Report

19. Drawbacks of Interdisciplinary Teams • Communication and interaction among team members, especially parents and family members is sometimes difficult • Professional “turf” issues; lack of understanding of other disciplines

20. Transdisciplinary.... • “across disciplines” • studying, learning, working, sharing, providing within one’s own discipline and other disciplines with which one has had exposure and knowledge

21. Transdisciplinary Approach • 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.

22. Characteristics of Transdisciplinary Intervention • 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

23. A team approach based on sharing of information and skills across disciplines in order to better serve the young child and her family. Characteristics Information Sharing Skill sharing and development Role release and role sharing Consultative model of service Transdisciplinary Approach

24. Levels of Transdisciplinary Services • Role/discipline instruction • Role modeling • Role sharing • Role release • Swapping • Enrichment • Extension • support

25. Transdisciplinary Role Release • 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

26. Transdisciplinary 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 child’s abilities • Consensus is formed regarding a child’s abilities, concerns, and possible methods of intervention • 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

27. Transdisciplinary Organizational 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

28. Integrated, Cross-Domain Goals 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

29. Practices to Avoid for Transdisciplinary 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 • 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

30. Possible Drawbacks of Transdisciplinary Teams • The approach is initially time intensive • 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

31. Barriers to Effective Teamwork • Role expectations • Discomfort with conflict • Lack of negotiation skills • Territoriality • Insecurity

32. 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 Possible Assessment Team Members

33. Professionalism: Communication, Collaboration, and Consultation

34. Primary 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.

35. Teamwork Basic Guidelines • Guideline1: 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.

36. A Proposed Teamwork “Constitution” • 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.

37. Proposed Teamwork “Constitution” (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.

38. Proposed Teamwork “Constitution” (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.

39. Team 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

40. The Team Meeting • A proposal: • Team meetings are held regularly and are the number one priority of the team. • They are missed for no reason other than severe illness or personal emergency of the most significant nature. • Permission to miss a team meeting must come from the team and can only occur in advance.

41. Team Meeting General Structure • Step 1--Share information, observations, and perceptions (20 min.) • Step 2--Identify priorities and set the agenda (10 min.) • Step 3--Problem solving and decision making (60 min.) • Step 4--Review the program schedule (10 min.) • Step 5--Administrative business (10 min.) • Step 6--Evaluation of the team meeting (10 min.)

42. Problem Solving and Decision 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.

43. Keeping the Family Central

44. 18% of the people in the U.S. currently speak a language other than English in their homes; by 2010 the estimate is 24% By 2010, 37% of all children in the U.S. will be children of color. At least 3.2 million Americans are homeless and families with children comprise the fastest growing segment of that group. Over 1 million children are abused or neglected each year; for each reported case, two go unreported. Everyday, more than 3,000 girls become pregnant and 1,300 babies are born to adolescents. Combining divorce, widowhood, and single parent hood, 67% of the children born in the U.S. will be raised by one parent for some portion of their childhood. 47.2% of married couples with a child with a disability end in divorce; 48.1% of married couples with children end in divorce Over 23% of children aged 3 and younger are poor ($17,450 for a family of four); during the preschool years 25% lack medical, nutritional, and early learning resources. 13.5% of the U.S. population has a disability; by 2010 the estimate is that 15% will have a disability The U.S. Family in 2006

45. Family Systems Model of 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.

46. Family-Centered Principles • 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.

47. Family-Centered Principles(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.

48. Components of Family Systems • Family Resources • Family Interactions • Family Functions • Family Life Cycle

49. Family Systems Model Resources/Characteristics Family Form Special Challenges Disability Characteristics Member Characteristics Life Span Early Childhood (0-5) Early School/ Childhood (6-12) Adolescent (13-18/21) Adult (>21) Family Functions Daily Care Recreation Economic Social Affection Ed./Vocational Self-definition Spiritual Parental Marital Sibling Extended Family Interactions Cohesion Adaptation Communication

50. Characteristics of the family size and form cultural background socioeconomic level geographic location Personal Characteristics members’ health coping style(s) interaction style(s) Characteristics of the child’s exceptionally type of exceptionality severity of exceptionality demands of exceptionality perception of exceptionality Special Circumstances poverty abuse rural areas parents with disabilities Family Resources