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

Issues in Early Intervention:
Science, Intervention, Policy & Reality
Four Points Sheraton
Iowa Department of Education
April 20-21, 2006
Part I: Beyond Policy:
Big Picture-Little Details
Michael 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 childcenteredness
 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 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)
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 Issues
Professional time
Accountability
Documentation
Travel
Family needs/demands
Reimbursements
Teaming
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-disciplinary
Intra-disciplinary
Multi-disciplinary
Inter-disciplinary
Transdisciplinary
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
Child
PT
Educ.
SLP
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
Assessment
PT
Educ.
SLP
Discuss Results and Set Goals
OT
PT
Educ.
SLP
Child
Report Report
Report Report
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.
 Characteristics
Information
Sharing
Skill sharing and
development
Role release and
role sharing
Consultative model
of service
Levels of Transdisciplinary
Services
Role/discipline
instruction
Role modeling
Role sharing
Role release
Swapping
Enrichment
Extension
support
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 expectations
Discomfort with
conflict
Lack of negotiation
skills
Territoriality
Insecurity
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 reinvited)
 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
Resources
Family
Interactions
Family
Functions
Family Life
Cycle
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
Family Resources
 Characteristics of the  Characteristics of the
family
child’s exceptionally




size and form
cultural background
socioeconomic level
geographic location
 Personal
Characteristics



members’ health
coping style(s)
interaction style(s)




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
Severity
Medical complications
Necessary intervention intensity
Behavioral concerns
Physical appearance
Perceptions 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 disability
Family members’ coping styles
 action
oriented
 reframing
 denial
Family Interaction Subsystems
Partner
(marital)
Sibling
Parental
Extra-familiar
Family Functions
Economic
Daily Care
Recreation
Socialization
Self-Identity
Affection
Education/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 Hall
University of Delaware
Newark, DE 19716 USA
[email protected]
+1 302 831 6974
www.udel.edu/cds