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

Four Points SheratonIowa Department of Education

April 20-21, 2006

Part I: Beyond Policy:Big Picture-Little Details

Michael Gamel-McCormick

Goals of Early InterventionWhat 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

Early Intervention Goals

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

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)

Foundations of Early InterventionFamily-centered servicesNormalizationServices in natural environmentsDiversity of children and families servedVariety of service delivery modelsInterdisciplinary and transdisciplinary servicesFunctional and developmental programmingIndividualized programmingBlending of philosophical perspectives

(developmental, behavioral, ecological/functional)

National and Local Issues in EI

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

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

Big IssuesProfessional timeAccountabilityDocumentationTravelFamily needs/demandsReimbursementsTeaming

Teams:Models, Approaches and Key

Elements

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.

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

Team 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 Team Approaches

Uni-disciplinaryIntra-disciplinaryMulti-disciplinaryInter-disciplinaryTrans-

disciplinary

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

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

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

OT PT Educ. SLP

Child

Report Report Report Report

OT PT Educ. SLPAssessment

Discuss Results and Set Goals

Complete Report

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

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 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.

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

Transdisciplinary Approach

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

CharacteristicsInformation

SharingSkill sharing and

developmentRole release and

role sharingConsultative model

of service

Levels of Transdisciplinary Services

Role/discipline instruction

Role modelingRole sharingRole release

SwappingEnrichmentExtensionsupport

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

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

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

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

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

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

Barriers to Effective Teamwork

Role expectationsDiscomfort with

conflictLack of negotiation

skillsTerritorialityInsecurity

Possible 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: Communication, Collaboration,

and Consultation

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.

Teamwork 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 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.

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.

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.

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

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.

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.)

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.

Keeping the Family Central

The U.S. Family in 2006 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

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.

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.

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.

Components of Family Systems

Family ResourcesFamily InteractionsFamily FunctionsFamily Life Cycle

Family Systems Model

Parental Marital

ExtendedSibling

Resources/CharacteristicsFamily Form Special Challenges

Disability CharacteristicsMember Characteristics

FamilyFunctionsDaily CareRecreationEconomicSocialAffectionEd./VocationalSelf-definitionSpiritual

Life Span

Early Childhood (0-5)

Early School/Childhood (6-12)

Adolescent (13-18/21)

Adult (>21) Family InteractionsCohesion

AdaptationCommunication

Family Resources

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

Characteristics of a Child’s Disability that may effect family resources

SeverityMedical complicationsNecessary intervention intensityBehavioral concernsPhysical appearancePerceptions of child’s needs and outcome

Family member characteristics that may affect response to a child with a disability

Family member’s health physical mental

Parental disabilityFamily members’ coping styles

action oriented reframing denial

Family Interaction Subsystems

Partner (marital)

SiblingParentalExtra-familiar

Family Functions

EconomicDaily CareRecreationSocializationSelf-IdentityAffectionEducation/Vocation

Family Life Cycle Stages in Relation to a Child with a Disability

Birth and Early Childhood (Birth to 5 yrs.)

Childhood (5 to 12 yrs.) Adolescence (13 to 18

yrs.) Adulthood (18 yrs. and

older)

Critical family events which can effect how 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 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)

Connecticut Coalition for Families of Persons with Disabilities Principles Statements

Families should receive the supports necessary to maintain their family member with a disability at home. Family support services should be based upon the principle “whatever it takes.”

Family support should maximize the family’s control over the services and supports they receive.

Family supports build on existing social networks and natural sources of support.

Family supports should support the entire family.

Contact Information

Michael Gamel-McCormick, Director

Center for Disabilities Studies

166 Graham HallUniversity of DelawareNewark, DE 19716 USAmgm@udel.edu+1 302 831 6974www.udel.edu/cds