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Children's Medical Services - Special services for children with special needs
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Module Two: Lesson Three

Service Decisions

Despite common practice, services should be decided only after outcomes have been decided upon. With the PSP approach, deciding on services is largely based on how much help the PSP needs to address each outcome. For example, consider the following outcomes, which are listed in the mother's order of importance.

  1. Bryce will communicate at mealtimes, in the morning, in the evening, and at other times when he has needs and wants.
  2. When Bryce walks fast, inside, and barefoot, he will do so without falling.
  3. Bryce will put on his shirt independently and pull up his pants.
  4. Bryce will play and listen to stories without sucking his thumb.
  5. Bryce will help with bathing.
  6. Sandy will teach Calista to communicate without screaming.
  7. Sandy and Rusty will find acceptable child care for the children so they can spend time together without the children.

father feeding babyThe team would determine who the PSP would be and then would ask how much help that particular PSP needed to support the family in teaching Bryce to communicate. If either the PSP or someone else on the team felt that the PSP needed help, the next question would be who that helper should be. Sometimes, that would be decided on the basis of discipline (i.e., the person with the appropriate training) and sometimes it would be decided on the basis of aptitude (i.e., the person who had the most interest or background, which might be different from formal training). If Bryce's PSP was a very experienced early intervention provider, he or she might not need a speech-language pathologist. On the other hand, if Bryce's PSP was someone right out of school who did not know how to address these outcomes, the PSP and the speech-language pathologist (SLP) might agree that speech therapy would be on the list of services. They would then ask the intensity question: How often would the PSP and the family need the SLP to visit to get the communication program started? Again, that would depend on the PSP's confidence. Having answered these questions for Outcome 1, the team would consider what services were needed for Outcome 2. Again, the question would be the extent to which the PSP would need help in supporting the family to teach Bryce to walk without falling. These questions would be asked down the list of outcomes.

Dr. McWilliam's Service Decisions Flowchart illustrates how service decisions are made in both a multidisciplinary approach and the transdisciplinary/primary service provider approach used in Dr. McWilliam's Early Intervention in Natural Environments (EINE): Five Component model and in the Early Steps service delivery system.

When making decisions about services, it is advisable to watch for three kinds of professionals:

  • The PSP who lacks confidence or tries to curry favor with specialists (e.g., "I need these people all the time"). This so-called need for constant consultation could result in every PSP visit being a joint home visit, which is described later.
  • The specialist who cannot release his or her role (e.g., "No one else can support the family in carrying out these interventions but moi").
  • The specialist who confuses intervention with service (e.g., "This child needs therapy more than once a month").


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