Infant Toddler Development Training
Module 2, Lesson 3
One of the foundations for Florida's Early Steps system is a model called "Collaborative Consultation." In describing the model, Fine and Gardner (1994) state:
The concept of collaboration seems applicable to describing parents and professionals forming a working relationship. The concept of consultation speaks to the involved professionals as possessing expert skills in communicating and problem-solving and in bringing those skills in a respectful and caring way to the development of a collaborative relationship (p.295).
Collaborative consultation involves 1) the formation of a collaborative team which consists of the caregiver and various early intervention professionals, and 2) a process of professional consultation, whereby early intervention professionals share knowledge and skills with each other and with the caregiver.
Fine and Gardner (1994) contend that through such collaboration, caregivers are able to increase their confidence and their skills. Professionals on the team also increase their knowledge and skills through information-sharing across disciplines.
In this model, all team members, including the caregiver, are on equal footing. The team as a whole generates goals and intervention strategies. All team members share resources and are equally accountable for outcomes (Fine & Gardner, 1994). Moreover, the model requires that team members assume multiple roles. In discussing this issue, Fine and Gardner (1994) state: There is a tendency for professionals to narrowly define themselves in terms of roles and functions. 'Turf issues' then get created as one discipline steps across a line into someone else's territory. While some boundaries to service are reasonable based on competencies, service needs, and time constraints, it may be more useful for professionals working with families to be willing to broaden and diversify their roles (p. 298).
In other words, there is little room for rigid professional roles or boundaries in this model. Professionals working within this model must be flexible, willing to share information, willing to learn information, and willing to assume different roles. At any given time, professionals on the team may function as 1) mediators between the family and an outside contact, 2) experts who impart information, knowledge and skills, or 3) counselors who provide support and advocacy (Fine & Gardner, 1994). Collaborative communication is used extensively by transdisciplinary teams (see Lesson 1).
Advanced Communication Skills
In order for collaborative consultation to work, team members must develop advanced personal and communication skills. Some of the more challenging skills include the ability to learn from each other, role exchange, role release, and role support. These concepts are outlined below. Keep in mind that these skills are usually practiced by members of transdisciplinary teams, consisting of one primary service provider, the primary caregiver, and various early intervention professionals.
- Learning from each other: Team members must be willing to give and receive information. They must be willing to expand their knowledge bases beyond their own discipline-specific boundaries. For example, a physical therapist who focuses mostly on gross motor development must be willing to learn about fine motor development from an occupational therapist, speech and language development from a speech/language pathologist, and cognitive and behavioral concepts from a psychologist. He or she must also be willing to share information about gross motor skills with the other team members. This process can be challenging for people who are inclined to protect their professional domain. They must be willing to relinquish 'exclusive rights' to discipline-specific knowledge.
- Role exchange: According to Briggs (1997), role exchange occurs when "team members, equipped with the knowledge and skills from other professions...implement intervention strategies under that discipline representative's supervision" (p. 96). During role exchange, supervised practice occurs. For example, an ITDS acting as the primary service provider may work with a speech/language pathologist on issues related to cleft palate. The ITDS would provide information and support to the caregiver. The speech/language pathologist would function as a supervisor and a consultant to the ITDS.
- Role release: Over time, team members will gain confidence in the knowledge and skills that they have acquired from other disciplines. At that point, role release occurs and the team member is able to function independently. Frequent consultation among team members continues. There is an ongoing exchange of information across disciplines.
- Role support: It is very important to note that there will always be some skills which cannot be easily transferred across disciplinary boundaries. There are clearly some roles and responsibilities that professionals cannot and should not release. "Specialized training acquired by one discipline member may dictate that certain treatments only be performed by that person" (Briggs, 1997, p. 97). In those instances, role support is provided to the primary service provider. The team member with the expertise will step in and provide the appropriate intervention or procedure.
Early intervention professionals have worked very hard to acquire the knowledge and skills of their disciplines. It is not always easy to step aside and allow others access to this knowledge. In order to do so, the professional must be able to see the big picture; that is, they must understand that the caregiver is the primary person in a child's life. As Hobbs observed nearly three decades ago, "it is the parent who truly bears the responsibility for the child...and the parent cannot be replaced by episodic professional service (Hobbs, 1975, pp. 228-229)".
The goal of the team is to enhance the confidence and competence of the caregiver. Collaborative consultation and transdisciplinary teams offer a means for achieving that goal. The primary service provider establishes a special relationship with the caregiver, enabling the caregiver to implement useful strategies in natural settings. The family has the dual advantage of a primary contact person, and a supportive team of early intervention professionals to consult when needed.
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