Agenda

Review best practices from the field of Early Intervention Discuss the Primary Service Provider (PSP) model Describe local district Early Intervention service delivery Discuss the impact of PSP on children, families and service providers Discuss lessons learned

Robin said…

• We have made a mistake! • We have plonked Early Intervention into health and education systems so we follow mostly rehab, special education or therapeutic preschool models • Early Intervention was not intended to be a program that provided direct intervention to children Dr. Robin McWilliam, in a presentation at Oakland Schools, August 2009, 2009

Robin also said…

• Early Intervention is supposed to: • support those who are already in place to provide direct intervention to children: parents, caregivers, teachers • be a consultative, technical assistance, and adult education program

Mission of Part C

Early Intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children’s learning and development through everyday learning opportunities TA Community of Practice: Workgroup on Principles and Practices in Natural Environments

Ideas to consider…

Primary Service Provider (PSP) Model

One

professional provides weekly support to the family, backed up by a team of other professionals who provide services to the child and family through joint home visits with the primary service provider. The intensity of joint home visits depends on child, family, and primary-service-provider needs.

McWilliam, in press

A PSP Approach Is NOT…

• “Watered-down” service delivery.

• Teaching the care provider to implement a therapeutic model.

• A speech-language pathologist providing physical therapy.

• Used because a particular discipline is not available.

McWilliam, R. (2004). Enhancing service in natural environments . Retrieved March 5, 2007, from http://www.nectac.org/~calls/2004/partcsettings/partcsettings.asp

A Similar Idea: Primary Coach Approach

• A process in which one person is the lead for supporting families of young children with disabilities among a team of individuals from multiple disciplines.

• The team lead receives coaching from other team embers through ongoing planned and spontaneous interactions. • Uses coaching as the key intervention strategy to build capacity of parents and other care providers to use everyday learning opportunities to promote child development.

Multi-disciplinary Teams

Professionals from several disciplines work independently of each other Team may work together and communicate, but function separately (side-by-side but separate) Interaction with family is typically discipline or “expertise” based Burden of coordination is typically the family’s

Interdisciplinary Teams

Professionals from several disciplines, along with parents, work together to plan and implement early intervention Each specialist is generally is responsible for the assessment and intervention plan that is related to his/her professional discipline Multiple providers typically interact with the family Team communicates regularly to share information, discuss results, and develop plans

Transdisciplinary Teams

Made up of parents and professionals from several disciplines. All team members (including parents) share responsibility for the development of the service plan. Families are seen as a critical part of the decision making process.

One team member, referred to as the primary service provider, supports the family in carrying out the early intervention plan. Other team members are available for consults when necessary.

Requires team members to cross discipline-based boundaries and share roles

Multidisciplinary vs Transdisciplinary

• Multi-disciplinary • Intervention happens only when child is with service provider • • Views development in domains, rather than integrated • Families interact with several service providers/taxing on family’s time • Takes a lot of staff time and resources Transdisciplinary • Intervention takes place BETWEEN visits, not only DURING • Development is integrated, not segmented • • Family centered approach; fewer providers less time More reasonable allocation of staff resources

Royal Oak Early Intervention Historical Perspective

• School based • Group • Goals were domain specific • Multi-disciplinary • Laden with transitions

Royal Oak EI New Model Guiding Principles 2009-2010

100% Natural Environments Routines based intervention Family driven goals Transdisciplinary Primary Service Provider Model (Coaching) Dedicated Early Intervention Team Joint home visits

What does it look like?

Informal Qualitative Summary

Interviewed families in Early Intervention Looked for patterns in data and identified themes Anticipated AND unanticipated findings…

Impact on Families

Families are able to address needs in familiar environments Familiar materials Families are empowered Families are comfortable within their own home and not in competition with other children or their families Personal and private Whole family is involved

What has been most beneficial for you and your family this year?

Family Centered Practice 26% Home Visits/Natural Environments 16% Child Outcomes/Progress 21% Primary Service Provider Model 37%

Benefits of Family Centered Practice

Family-focused activities Parents learning to embed strategies within daily routines Less competition among families More confidentiality Flexible scheduling Less parental anxiety Individualized intervention Less risk of sickness and infection Builds on child's strengths

Less distracting environment than classroom for children and staff Parent more comfortable learning/seeking support Individualized instruction relevant to daily activities Safer

Benefits of Home Visits

Natural for infants/toddlers to be at home Child can work at own pace Individualized instruction using materials/toys available in home

Understanding child's strengths Provide material/emotion al support and follow up

PSP Model

One service provider works with family Access to multi disciplinary team Easier to track child progress with one professional Knowledge and expertise of staff match child's needs

In the parents words…

• Individual attention in a “safe” environment was not only crucial for my son, but also impacted how well I, as a parent, was able to learn and work better on our own.

• She is saying twice as many distinguishable words as I had hoped for in just over 4 months! I very much enjoy hearing information about core strength and coordination and how it relates to my daughter’s speech delay.

In the parents’ words…

• This program helped me feel like I had a personal coach to help me keep my spirits up, navigate the medical jargon, and keep doing things to help my son’s development rather than just giving up.

• In our home, I felt free to ask dumb questions. I also felt less stress because we were measuring progress against his own development, rather than another child’s.

• A lot of the tools in the classroom are not common in a baby’s home.

Impact on Children

Children and families display a greater sense of comfort, relationships and attachments Decreased transitional behavior Learning opportunities occur within the framework of daily routines Opportunities exist to try things out where they will be implemented High degree of progress noted, we find we are updating goals Better sense of family needs and interactions Able to use family members in various roles

What surprised you about your child's progress in Early Intervention?

Increase in child's skills Relationship between child and staff Increase in independence Flexibility of staff Immediacy of change

Increase in independence

Child Outcomes

Better results as a result of 1-1 attention Problems/concerns resolve quickly Enhancing development w ithout using compensatory strategies Increase in skills

Impact on Service Providers

Challenges skills and knowledge Removes some of the barriers we surround ourselves with in classroom and clinical situations Develops strong relationships and a commitment to families and their needs Expands our ability to share ownership of our professional skills Increases the feelings of responsibility Old issues are NON issues now

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Questions for Us?

Dawn Koger, Ph.D.

Early On Coordinator Oakland Schools Susan Wit, M.Ed., OTR/L Occupational Therapist Royal Oak Schools 248-209-2266 [email protected]

[email protected]