AgendaReview 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 TeamsProfessionals 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 TeamsMade 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 ModelGuiding Principles 2009-

2010100% 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 FamiliesFamilies 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?

Child Outcomes/Progress

21%

Primary Service Provider Model

37%

Family Centered Practice

26%

Home Visits/Natural Environments

16%

Benefits of Family Centered Practice

Parents learning to embed strategies within

daily routines

Flexible scheduling

Builds on child's strengths

Less risk of sickness and infection

Individualized intervention

Less parental anxiety

More confidentiality

Less competition among families

Family-focused activities

Benefits of Home VisitsSafer

Less distracting environment than

classroom for children and staff

Parent more comfortable

learning/seeking support

Child can work at own pace

Individualized instruction using

materials/toys available in

home

Individualized instruction

relevant to daily activities

Natural for infants/toddlers to be at home

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

Provide material/emotion

al support and follow up

Understanding child's strengths

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 ChildrenChildren 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 independence

Relationship between child

and staffIncrease in child's skills

Flexibility of staff

Immediacy of change

Child Outcomes

Enhancing development w ithout using compensatory

strategies

Increase in skills

Problems/concerns resolve quickly

Increase in independence

Better results as a result of 1-1

attention

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

Questions for Us?

Dawn Koger, Ph.D.

Early On Coordinator

Oakland Schools

248-209-2266

dawn.koger@oakland.k12.mi.us

,

Susan Wit, M.Ed., OTR/L

Occupational Therapist

Royal Oak Schools

wits@royaloakschools.com