Infant Toddler Development Training
Module 2, Lesson 1
First contacts with a family should take place face-to-face, in a typical setting. A service coordinator and/or another trained team member meets with one or more family members and conducts a family assessment. Emphasis is placed on gathering information about the family's everyday routines and activities. What are the family's strengths and challenges? What are the family's concerns? What are the family's goals? The types of information gathered must be with the concurrence of the family. McWilliam and Scott (2001) suggest that developing an ecomap may help professionals build rapport with families during first contacts.
For children without an established condition, a developmental screening instrument is administered at this time. If the child appears to be functioning at age level, the family may decide against further participation in Early Steps. If possible delays are detected, the family may decide to participate in a more in-depth evaluation and assessment.
At this stage, teaming occurs primarily between the family and the service coordinator. Both the results of the screening and the family's stated concerns are used to build the evaluation and assessment team. Members of the evaluation and assessment team will receive summaries of the information collected during first contacts. These summaries will be used to help team members prepare for the evaluation and assessment.
Evaluation and Assessment
Evaluation and assessment have two distinct purposes. The purpose of the evaluation is to determine eligibility for early intervention services. The purpose of assessment is to obtain detailed information about a child's unique strengths and needs. The results of the assessment are used for intervention planning.
During evaluation and assessment, team participants will ascertain valuable information for use during the IFSP meeting. At this stage, family members may be unsure about the role they should play on the team. A team member familiar to the family, perhaps a service coordinator, should take time at this stage to clarify role expectations. He or she should emphasize the central role that families play as a team member during evaluation and assessment.
Family involvement and participation is vital in all stages of the early intervention process. During evaluation and assessment, family members are not silent observers. They do not sit passively and watch the team at work. Instead, they share information and observations with their fellow team members throughout the evaluation and assessment period. Input from family members has special value and family members should be made aware of this.
During assessment, families and professionals come together with the purpose of determining the child's strengths and challenges. Observations are shared and processed and a great deal of information is exchanged.
In the field of early intervention, three primary types of teams have been described in the literature. These include the multidisciplinary team, the interdisciplinary team, and the transdiscipliniary team. Below is a description of how these different types of teams operate during the assessment process.
The Multidisciplinary Team
In the multidisciplinary approach, different professionals evaluate the child independently. For example, a psychologist, a physical therapist and a speech/language pathologist may all conduct separate evaluations of the same child. Information from the separate evaluations is reported to a single 'leader' or 'coordinator' and discussed with the family. In most cases, the various evaluators do not share information or discuss results with one another (Thomas, Correa & Morsink, 2001).
One benefit that families derive from this approach is the opportunity to meet with various professionals individually. Family members are able to express their observations, opinions and concerns with each evaluator and hear each professional's perspective.
However, the multidisciplinary approach presents a number of pragmatic problems for families. Typically, the family travels to the evaluator rather than the evaluator meeting the family in a natural setting. In addition, families must provide similar information to two or more evaluators on two or more occasions. This can be exhausting, exasperating and time consuming for families.
The outcome of multidisciplinary evaluations can also be problematic. The various evaluation reports often contain redundant background information. Worse yet, conflicting results and contradictory treatment recommendations can occur. This puts family members in the awkward position of having to decide which recommendation is 'best.'
Finally, because evaluators do not discuss their observations, they are not able to benefit from an open exchange of knowledge. This may result in a narrow, discipline-specific understanding of the child's development.
Like members of a multidisciplinary team, members of an interdisciplinary team conduct their evaluations independently. Family members are able to privately consult with the different evaluators. The main difference between the multidisciplinary and interdisciplinary approaches lies in the exchange of information among evaluators. Members of a multidisciplinary team do not typically share information with one another, but members of an interdisciplinary team do. The interdisciplinary team meets to share and discuss the results of the various evaluations. Family members are included in this discussion. The team then produces an integrated evaluation report.
The opportunity to share information in the interdisciplinary team model is a vast improvement over the rather fragmented multidisciplinary approach. However, since the evaluations are conducted separately by different members of the interdisciplinary team, the process remains quite time-consuming for families. Moreover, Briggs (1997) has observed that contributions from the various professionals on an interdisciplinary team tend to be isolated and discrete. The lack of true cohesion can sometimes result in a fragmentation of services (Briggs, 1997, p. 94).
Transdisciplinary teams are unique to the field of early intervention (Briggs, 1997). The transdisciplinary approach is fundamentally different from the multidisciplinary and interdisciplinary approaches. The foundation of the transdisciplinary team is collaboration. One assessment is performed by the team and one integrated report is written by the team. This minimizes the inconvenience to families.
An appropriate transdisciplinary team is organized prior to the evaluation and assessment. The selection of particular team members is based on the family's reported concerns. For example, if a family expressed concern with their son's language development, sociability and behavior, the assessment team might include a parent, a service coordinator, an Infant Toddler Development Specialist, a psychologist and a speech/language pathologist.
In the transdisciplinary model, family involvement is key. Families actively participate in the assessment process and play a central role in the development of the IFSP, intervention planning and evaluation.
Transdisciplinary teams typically conduct arena-style assessments. In an arena assessment, a single primary facilitator interacts with the child while parents and other team members observe and assist. Details of the arena assessment are presented in the Observation and Assessment Module (Module 3).
Members of transdisciplinary teams tend to have flexible boundaries. They are comfortable exchanging roles, providing information and sharing observations (Stepans, Thompson & Buchanan, 2002). Collaboration, consensus building and the transfer of information across disciplines are central to the transdisciplinary approach. Because the assessment process is collaborative and integrated, service planning and implementation tends to be cohesive as well.
The Florida Early Steps system advocates the use of transdisciplinary teams and arena assessments. Pilkington and Malinowski (2002) offer the following guidelines for members of transdisciplinary teams:
- The team should adopt a "strengths over deficits" approach
- Assessments should be conducted over time, in natural environments
- Emphasis should be placed on the process vs. the product
- Emphasis should be placed on building and maintaining positive relationships with families
Transdisciplinary assessments culminate in a single integrated report. The contents of the report incorporate information from many sources including 1) the family's stated concerns, priorities and resources, 2) observations of the child's behavior during the assessment, 3) the family's statements about what the child is able to do, 4) the results of the assessment instrument that is utilized, and 5) professional opinions and recommendations. The report is created through a process of dialogue, observation and collaborative exchange among team members, the most important of which is the caregiver.
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