Providing Primary Provider Early Intervention Services Shining Stars Creating Connections July 2012

Dunst, Brookfield, and Epstein, 1998 “The total amount of child and family services received was negatively related to both personal and family well being; the more services received the poorer parent and family functioning”

Dunst and Bruder, (2004) Findings From National Survey of Service Coordination in Early Intervention. “Preliminary survey data of a parent report of the helpfulness of early intervention providers indicate that 96% of the parents having one provider rated him/her as helpful, 77% of the parents having two providers rated them as helpful, and 69% of parents having three or more providers rated them as helpful (p<.001). “

What is a team? A group of people with a full set of complementary skills required to complete a task, job, or project. Team members (1) operate with a high degree of interdependence, (2) share authority and responsibility for self-management, (3) are accountable for the collective performance, and (4) work toward a common goal and shared rewards(s). A team becomes more than just a collection of people when a strong sense of mutual commitment creates synergy, thus generating performance greater than the sum of the performance of its individual members.

What is a team? Two or more professionals from different disciplines who draw upon their areas of expertise to provide assessment and treatment to children with disabilities.

Types of Teams in Early Intervention Multidisciplinary Teams Function independently from one another. Conduct separate assessments. Develop and implement their own intervention plans. Use an informal style to communicate with other team members. Meet with parents individually. Team members recognize the importance of information from other disciplines. Staff development focuses on independent learning and discipline specific strategies.

Types of Teams in Early Intervention Interdisciplinary Teams Conduct separate assessments. Parents meet with the entire team or a representative of the team. Share information with others to develop a plan. Implement their discipline specific portions of a plan. Are willing to share and be responsible for providing comprehensive services when comfortable to do so. Meet together formally to inform all members of their role in the plan implementation. Staff development is provided both within and outside of specific disciplines.

Types of Teams in Early Intervention Transdisciplinary Teams Team members and family conduct a joint assessment. Team members work together to develop a joint plan based on family priorities and needs. Team members are jointly responsible and accountable for how the plan is implemented. One team member referred to as the primary provider implements the plan with the child and family across traditional discipline boundaries. Team meetings are held regularly to exchange information, knowledge, and skills among team members. Team members are committed to teaching, learning, and working across traditional discipline lines to implement a joint service plan. Staff development considers training and learning across discipline boundaries to be key for team building.

What is the functioning of your teams? Remember your team may be working as all three “types” of teams within different situations.

AGREED UPON MISSION AND KEY PRINCIPLES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS Developed by the Workgroup on Principles and Practices in Natural Environments MISSION 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. KEY PRINCIPLES 1. Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts. 2. All families, with the necessary supports and resources, can enhance their children’s learning and development. 3. The primary role of a service provider in early intervention is to work with and support family members and caregivers in children’s lives. 4. The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child’s and family members’ preferences, learning styles and cultural beliefs. 5. IFSP outcomes must be functional and based on children’s and families’ needs and family- identified priorities. 6. The family’s priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support. 7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.

Discussion of Principle 6 Looks Like/Doesn’t Look Like 8.pdf

What do we say in Virginia? To Providers: Early intervention supports and services are available to all eligible infants and toddlers and their families through the Infant & Toddler Connection of Virginia regardless of the family’s ability to pay. The purpose and focus of Part C supports and services are to increase the child’s participation in family and community activities identified by the family and to support the family in identifying learning opportunities and enhancing their child’s development. Consideration of family routines, activities and natural settings occurs throughout the early intervention process from child find, assessment, and delivery of entitled services on through transition from services. Supports and services occur in the context of and are integrated into the normal daily activities, routines and environments of each child and family. Supports and services fit into the family’s life and build effectively on the resources and supports already in place. Parents already do things to teach their children everyday – they are the primary agent of change in their child’s development and the experts on their child and family. Part C providers add their specialized skills and knowledge and work as a team with the parents and other caregivers to identify and use existing learning opportunities and create new ones as needed to address the outcomes that the family and Part C providers have developed together.

What do we say in Virginia? To Providers: Individualized outcomes are relevant for the family, focus on the child’s participation in activity settings that are important to the family, and focus on the whole child rather than specific developmental skills. Service delivery options, including specific supports and services, service providers, and locations of service delivery are determined after the desired outcomes and potential learning opportunities have been identified. Providers partner with families to make an individualized determination about the supports and services that are necessary to support the child’s ability to participate in family and community activities. Service providers use multiple methods, including accommodations, adaptations, coaching with parents/caregivers, and expanding activity settings, to accomplish outcomes. Effective Part C early intervention requires an active parent-provider partnership that includes involvement by the family/caregiver in each early intervention session. The focus is on expanding the parents’/caregivers’ confidence and competence to help the child learn during everyday activities. The State Lead Agency for the Infant & Toddler Connection of Virginia monitors local system status on statewide performance and compliance standards to promote timely and effective Part C early intervention services for all eligible infants, toddlers and families. Infant & Toddler Connection of Virginia - Practice Manual, Chapter 1 (8/17/11) 1

What do we say in Virginia? To Providers: Work as a team member to support the child and family in achieving the IFSP outcomes. Team members consult and team with each other and with the family to ensure that services are coordinated and consistent with one another and support functional development of the child as a whole. This is true whether multiple providers are visiting the family or there is a primary provider. If the IFSP team determines that one primary provider will work with the family, then other team members support the primary provider and the child and family by providing consultation to the primary provider, participating in joint visits with the primary provider to the child and family, and/or suggesting strategies and techniques to enhance progress toward outcomes. Infant & Toddler Connection of Virginia – Practice Manual, Chapter 8 (6/12)

What do we say in Virginia? To Providers: Consider whether one primary provider can address all of the outcomes, with support from other team members. This is often the case since there is significant overlap in training and scope of practice across disciplines. Identify on the IFSP not only the primary service provider(s) but also the role of other team members in supporting the family and other service providers. These other team members may participate in joint early intervention visits with the primary provider(s) to the child and family and/or provide consultation to the primary provider(s) by suggesting strategies and techniques to enhance progress toward outcomes. Infant & Toddler Connection of Virginia – Practice Manual, Chapter 7 (6/12)

What do we say in Virginia? To Families Early intervention supports and services in Virginia are provided through the Infant & Toddler Connection of Virginia. These supports and services are available for all eligible children and their families regardless of the family’s ability to pay. Early intervention supports and services are for infants and toddlers from birth through age two who are not developing as expected or who have a condition that can delay normal development. Early intervention supports and services focus on increasing the child’s participation in family and community activities that are important to the family. Supports and services also focus on helping the parents and other caregivers know how to find ways to help the child learn during everyday activities. Each locality in Virginia has a “central point of entry,” which connects children and their families to early intervention supports and services. Every child and family referred to the Infant & Toddler Connection is provided a service coordinator who helps guide them through the early intervention process. To find out if a child is eligible for early intervention supports and services, the child’s development is evaluated by at least two professionals who come from different professions or areas of development. If a child is found eligible for early intervention supports and services through the Infant & Toddler Connection, then the family and professionals work together to develop an Individualized Family Service Plan (called an IFSP, for short). This plan will list the outcomes (changes) the family and the rest of the IFSP team would like to see for the child and the early intervention supports and services needed to meet those outcomes. The IFSP team, which includes the family, will come up with outcomes that are just for this one child, that are important to this family, that focus on helping the child be a part of family and community activities, and that look at the whole child rather than specific developmental skills.

What do we say in Virginia? To Families Early intervention supports and services are based on the outcomes the IFSP team lists. Supports and services fit into the family’s life and take place as part of the daily activities, routines, and environments of each child and family. Since most of the child’s learning happens during everyday activities (between service provider visits), early intervention supports and services are provided at a frequency that matches the family’s and other caregivers’ need for support to be comfortable in using intervention strategies. For most children and families, one primary service provider will be working in partnership with the family to address the outcomes listed on the IFSP. Other team members support the primary provider and the child and family by consulting with the primary provider, coming on joint visits with the primary provider to the child and family, and/or making suggestions to help the child make more progress toward the outcomes. Parents teach their children everyday – they are the ones who make the most difference in their child’s development. In order for early intervention supports and services to work best, there needs to be an active partnership between the parents and the service providers. This partnership includes the family and other caregivers being involved in each early intervention session. By the time they leave early intervention, some children have gotten all the help they need and no longer need special services. Others still need some more help. A transition plan helps each child and family move smoothly from early intervention to whatever comes next. Transition plan activities will be included in every IFSP for each child and family

The Primary Service Provider Approach: Points to Consider Capitalizes on the formation of a close relationship with an individual. Uses specialists as efficiently as possible. Uses our limited resources most effectively. Emphasizes how children really learn. Supports and empowers parents in their role as care provider. Is focused on building on the strengths and capacities of colleagues as well as of families.

For optimal team interaction, a new team is not formed to support each family. Instead each family receives a team that has already been established.

Critical Characteristics for Success One staff member must be designated as primary even if multiple providers are involved. The PSP should change as infrequently as possible. Joint visits occur with other team members to support the PSP. Every therapist and educator on the team should be available to serve as primary. All members must attend regularly scheduled meetings for colleague to colleague coaching. Each team must be clearly defined.

Critical Characteristics for Success Each team must include at least one of each type of provider (PT, OT, ST, ED, SC). Highly specialized practitioners often are members of more than one team (ie vision specialists, deaf educators, mental health professionals, nutrition). Teams have the experience of working together across families over time. The PSP receives coaching from other team members through planned team meetings and spontaneous meetings.

Challenges to consider Team members must be agreeable to the approach. Systems must support the time needed for professionals to coach each other. Current designs may be limiting the families access to teams that represent different disciplinary expertise. Each local system has it’s own challenges based on their access to interventionists, geography, contracting practices, and resources. Language needs to be consistent in communicating to referral sources and families from the beginning.

Primary Service Provider Approach is NOT: Teaching the care provider to do therapy. A speech-language pathologist doing Physical Therapy. Used because you do not have a particular discipline available. Implemented only as a strategy to save money. Providing all supports through one team member who functions in isolation. Defined by choosing the team member that “matches” the child’s deficits.

The Keys to Next Steps Understanding the definition of a team. Understanding the type of team currently providing services. Putting an action plan in place to move to a primary provider approach. Providing the appropriate amount of support to staff to make the approach successful.

Things to try… Have each team develop a talking point script to tell families about the purpose of EI and how the team (which includes the family) works together. Talk with SCs and providers, are there some teams that have already developed naturally? If so why not start there? Schedule a team meeting, video tape it and take some time to critique it together. Make sure staff document the informal teaming they do, they may be surprised at how much of this they already do. Have each staff member develop a short in-service to present to the rest of the staff. After staff attend training, have them come back and present what is relevant to the rest of the staff.

Things to try… For teams that currently have more than one provider, have them get together and discuss who is the primary provider. Then discuss why they think that is (child’s needs, families needs, language, communication style, frequency). Have your providers peer review notes from another discipline. Use the checklist in the practice manual. When team members bring up concerns ask them to go out and look for the opinions or research on that issue.

IMPLEMENTING A PRIMARY-COACH APPROACH TO TEAMING.

Excellent resource to get started with training and staff development.

Excellent resource to get started with training and staff development.

References Dunst, C.J., Brookfield, J., Epstein, J. (December 1998). Family Centered Early Intervention and child, parent and family benefits; Final Report. Asheville NC: Orleana Hawks Puckett Institute. McWilliam, R.A. (2001). Routines-Based Early Intervention: Supporting Young Children and Their Families. Baltimore, MD: Brookes Publishing. Rush, D, Shelden M (1996) On becoming a team: A view from the field. Seminars in Speech and Language, 17, Rush, Dathan D., Shelden, M’Lisa L. (2008) Common Misperceptions about Coaching in Early Intervention. CASEinPoint, Volume 4 Number1. Rush, Dathan D., Shelden, M’Lisa L. (2009) Checklists for Implementing a Primary-Coach Approach to Teaming. CASEtools, Volume 4, Number (Kansas Inservice Training System) Shelden, M.L.& Rush, D.D. (2010) “A primary coach approach to teaming and supporting families in early childhood intervention. In; Working with families of young children with special needs. R.A.McWilliam (ed) Guilford Press, NY.