Find out in this Q&A with the authors of The Early Intervention Teaming Handbook: The Primary Service Provider Approach
About the authors
M'Lisa L. Shelden, PT, Ph.D, serves as director and researcher at the Family, Infant and Preschool Program (FIPP) in Morganton, North Carolina. She works alongside Dr. Rush providing ongoing technical assistance to statewide early intervention programs to implement evidence-based early intervention practices in natural settings.
Dr. Shelden has 29 years of experience as a physical therapist and special educator. She received a 2000 National Institute on Disabilities and Rehabilitation Research (NIDRR) Mary E. Switzer Merit Fellowship. She also is a graduate fellow of the ZERO TO THREE: National Center for Infants, Toddlers, and Families.
Dr. Shelden has presented nationally on topics related to IFSP development and implementation, transition, inclusion, evaluation and assessment, coaching, primary service provider approach to teaming, and natural learning environment practices.
Dr. Rush previously served as clinical assistant professor at the University of Oklahoma Health Sciences Center, teaching early childhood intervention in the graduate program. He has more than 25 years of experience as a practitioner and early intervention program director.
Dr. Rush has presented numerous workshops nationally on topics related to writing and implementing individualized family service plans, team building, using a primary service provider approach to teaming, coaching, and supporting young children with disabilities and their families in natural learning environments.
Q: What is the "primary service provider" approach?
A: With a primary service provider (PSP) approach to teaming, team members from an early intervention program select a lead resource to serve as primary point of contact with the family. In consultation with the other team members, the PSP takes the lead on providing support to families using coaching in natural learning environments to strengthen parenting competence and confidence.
With a PSP approach, team members are expected to be knowledgeable about not only their own discipline but also typical child development, family systems, parenting supports, natural learning environment practices, and coaching.
Q: Who are the team members?
A: Each regional program has a group of early intervention practitioners consisting of, at a minimum, an early childhood educator or special educator, an occupational therapist, a physical therapist, a speech-language pathologist, and a service coordinator who is responsible for all referrals to the program. The team members for a specific child's Individual Family Service Plan (IFSP) are drawn from this group depending on the individual needs of his or her family.
Q: How does the team select who will be the primary service provider?
A: The person selected to be the primary service provider is the member of the team who is the best possible match for a family. When considering who should be the primary provider, the best vision of the long-term view is very important. It should incorporate all outcomes that the family has prioritized and take into account what is known about conditions, diagnoses, and specific developmental disabilities. The long-term trajectory assists the team in choosing the best person available for the duration of the family's involvement with the program and decreases the likelihood of needing to change the primary service provider as priorities and outcomes change.
The team will then assist the primary service provider, child, and family through joint visits, team meetings, and coaching. The final decision for who will be selected as the primary service provider occurs at the IFSP meeting after the development of all of the outcome statements. In The Early Intervention Teaming Handbook (Chapter 5), we provide a worksheet and process for assisting teams to identify the most likely primary service provider.
Q: What are some misconceptions about a PSP approach?
A: The use of a PSP approach does not equate to only one practitioner supporting a child and family, nor does it imply any prescription for frequency and intensity of service provision. In this approach to teaming, the child and family have access to any and all team members as needed via joint visits with the primary service provider and team meetings as needed.
Use of a primary service provider approach to teaming is not intended to limit a family's access to a range of supports and services, but instead to expand support for families of children with disabilities.
Q: . What happens when the child needs support that is not in the primary service provider's area of expertise?
A: When the primary service provider or another team member realizes that the primary provider does not have sufficient knowledge and skills to provide adequate support, the practitioner and team may decide to bridge the gap with assistance from other team members. This could occur during a team meeting, joint visit, colleague-to-colleague coaching opportunity, or through some type of formal training.
The second option the team may consider is to replace the primary service provider with another team member. Changing the primary service provider is the option of last resort. Due to the relationship-based nature of early intervention, this option should be considered only when role assistance is determined to be inadequate or because of the significance, urgency, or seriousness of the situation.
Q: In your experience, what is the benefit to families of a PSP approach?
A: The rotation of multiple practitioners in and out of a family's life on a regular basis has been found to negatively impact family functioning. Research shows that those families receiving their services from a single provider as compared to families receiving services from multiple providers reported less parenting stress and better developmental outcomes for the children.
Other studies have found that the more services that a family received [from multiple providers], the less satisfied they were with early intervention, the less family-centered the respondents rated the program, and the more negative the effects on personal and family well-being. The families reporting receipt of services that were not family-centered also reported less child progress.
Additional studies indicate that those families with multiple providers experienced increased parental stress, unmet needs, and confusion. Parents were confused about which practitioner to access regarding specific questions or supports needed.
Q: What is the benefit to early intervention team members themselves?
A: Team members using a PSP approach report the benefit of accessibility of other team members from different disciplines for support and coaching regarding their expertise and knowledge. Team members also appreciate the opportunity to participate in regular team meetings.
Administrators of teams using a primary service provider approach report having fewer contracts to manage and a more highly specialized and skilled workforce. In the pilot study referenced in chapter 2, outcomes indicated that services provided using a PSP team were less expensive than those provided outside of this approach. Practitioners in the study not only met all federal requirements for Part C, but also exceeded timeframes for reviewing IFSP documents; and, fewer practitioners were involved in the lives of families, resulting in less disruption to family life.
Q: What sort of training is necessary to support a PSP approach?
A: A PSP approach to teaming involves interaction among members from various disciplines. This is a particular challenge with preservice preparation, which is discipline-specific and often lacks opportunities for interaction with students from other fields who would likely work together on an early intervention team.
A common rationale for the lack of interdisciplinary training is an absence of space/time within the curriculum for teaming content and cross-disciplinary learning opportunities. Many Leadership Education in Neurodevelopmental Disabilities (LEND) programs and University Centers for Excellence in Developmental Disabilities (UCEDD) provide meaningful interdisciplinary experiences for the students involved that include a focus on teaming. The number of students able to participate, however, is often limited to a select number of graduate students with a focus on lifespan issues and with only a brief amount of time available to address early intervention.
Q: What about inservice training?
A: Professional development activities that offer evidence-based information for practitioners currently in the workforce are limited due to availability or fiscal issues. Inservice opportunities that focus on teaming are almost non-existent. Many of the same challenges that exist for preservice education also exist in the inservice arena, including the need for time, acquisition of knowledge beyond one's own discipline, and access to interdisciplinary learning experiences.
Availability of training topics for practitioners who work in early intervention is often limited to content that is non-evidence-based and/or focuses on practitioner-implemented techniques that promote dependency on the practitioner. This type of training shifts the focus from parent-implemented interventions that promote child participation in everyday activities.
When selecting inservice training events, practitioners should have filters in place to assist them in determining whether the information being provided is based upon sound, current research. In conjunction with consideration of evidence-based interventions, practitioners must always consider the guidance provided by IDEA, Part C, and the Mission and Key Principles for Providing Services in Natural Environments for how early intervention services should be provided.
Q: What changes would you like to see regarding training for implementing a PSP approach?
Understanding how to use a team-based approach in early childhood intervention should begin at the preservice level and continue as a part of ongoing professional development. Preservice and inservice faculty should teach practices based on current research to ensure that learners are good at what works. Faculty must also implement evidence-based teaching practices and provide conceptual and theoretical frameworks when teaching promising or controversial practices.
Critically important, all learners (preservice and inservice) should have interdisciplinary experiences (rather than being trained in silos) in which they become familiar with other disciplines and how to work together to ensure positive outcomes for children with disabilities and their families.