Tenacity and Strength of Helen Keller

No matter how skilled an individual may be, how much they excel in a given field or how determined they are, their efforts can almost always be aided by joining forces with others. As Helen Keller, a woman whose tenacity and strength of character cannot be rivaled, notably said: “alone we can do so little, together, we can do so much.” The fact is that no individual can have all of the characteristics necessary to achieve a goal; we each bring unique strengths to the table, but at the same time we also bring our weaknesses. When we come together as a team, we take advantage of all of these strengths — and offset any weaknesses. Collaboration brings out the best in all of us. And when the undertaking is as important as Early Childhood Intervention (ECI), we can’t afford anything less than the best. Shonkoff and Meisels (2000) discuss the importance of the early childhood years, in their book, “Handbook of Early Childhood Intervention”:

“children are touchstone of a sustainable and a healthy society. How a culture or society treats its youngest members has a significant influence on how it will grow, prosper, and be viewed by others.” (p 4)

Optimizing quality early childhood programs for this type of culture of prosperity has not been kept a secret. NPR (2016) highlighted this in their segment titled, “How Investing in Preschool Beats the Stock Market, Hands Down”. Another headline “Do We Invest in Preschools or Prisons?” ran as an opinion piece in the New York Times (2013). A 43 page document was released for the Obama Administration in 2014 titled, “The Economics of Early Childhood Investments” highlights the benefits to society and families including: tax revenue increases and transfer payment decreases due to high earnings, savings in remedial education, reduced involvement with the criminal justice system, and improvements in health. A RAND (Research and Development) researcher, Lynn Karoly, seeks to inform the public/policy makers of the high return on Early Childhood programs (2006). Karoly (2017) found that in one home visiting program in New Hampshire, an $800,000 investment is estimated to provide 3.2-4.7 million dollars in return. The estimated ROI (return on investment) is largely based on the quality of these early childhood programs, specifically, using practices that are evidence-based were vital in the attainment of the societal, family, and child benefits highlighted (Karoly, 2017).

The early childhood years are typically referred to as children aged birth to eight years old (National Association for the Education of Young Children, 2009). Robust growth and development occur during these first eight years of life (Bruder, 2010). The National Association for the Education of Young Children (NAEYC) (2009) utilize developmental milestones to track the typical development for a child within the early childhood years. There are a variety of factors in which a child may not meet expected milestones in which ECI can provide help. ECI provides specialized support and services for infants and young children with disabilities or developmental delays, using a variety of approaches to aid in their development and set them up for a fulfilling life. Because each child presents unique challenges, as well as all the complexities of family dynamics, there’s no cookie-cutter approach that always works, and no one person will always have the answer. ECI providers need to think creatively and recognize the holistic nature of each child and family, which means that a team approach is ideal. “Teaming” acknowledges that a single provider cannot adequately address the multifaceted needs of children and families.

The approach of using a team in ECI is not new. Teaming became more and more widespread in the 1980’s, gaining support among early intervention professionals (Woodruff & McGonigel, 1988). Teams are a commonplace in other industries, including business and healthcare (Cohen & Bailey, 1997, Borrill et al., 2001). Sheldon and Rush (2013) refer to the benefits of teams in ECI, in the Early Intervention Teaming Handbook, “Team task(s) should allow members to use a variety of skills, result in meaningful work, and have significant consequences for other people (Bell, 2004, Brill, et al. 2001, Hackman, 1987).” The embodiment of the purpose of teaming is in its benefit in helping children and families (Sheldon & Rush, 2013).

In 1975, the passage of the Education for all Handicapped Act (EHA; P.L. 94-142, 1975) reauthorized in 1990 as Individuals with Disabilities Education Act (IDEA) (P.L. 101-476, 1990) required that assessments and program plans be developed by professionals from multiple disciplines and by families, made the team approach the standard for ECI programs. Support for the team approach went far beyond the federal mandate, however. In 1978, Holm and McCartin praised the team approach for its ability to recognize that the multifaceted problems of very young children are too complex to be addressed by a single discipline; in 1981, Golin and Duncanis noted that teaming reflects the professional understanding that the child is an integrated and interactive whole, rather than a collection of separate parts. Teaming was also developed as strong component in DEC recommend practices (Sandall, S., Hemmeter, Smith, & McLean, 2005).

One of the principle models of teaming in ECI is the Primary Service Provider (PSP) approach. In this approach, the child and his or her family works with a team of intervention professionals, but one professional is designated as the primary support and liaison to the family. The PSP approach was designed to expand the support for children and their families (Sheldon & Rush, 2013). Sheldon and Rush (2010) operationally define the PSP approach with the following components:

“An established team consisting of multiple disciplines that meets regularly and selects one member as the primary service provider who receives coaching and support from other team members, and uses coaching as an interaction style with parents and other care providers to support and strengthen their confidence and competence in promoting child learning and development and obtaining desired supports and resources in natural learning environments” (Sheldon & Rusg, 2010, p. 176)

The PSP consults with the other team members to gain their perspective and expertise, using adult learning strategies and coaching as a way to interact with them and including the family and caregivers in the process. Through this approach, the goal is to build the family’s or caregivers’ capacity, competence, and confidence in their ability to support their child’s growth and development. The need for this approach has risen from the ineffectiveness that the deficit –based model with focus on multiple disciplines has recognized (Dunst, Bruder, Trivette, Raab, & McLean, 2001, McWilliam, 2000). The PSP approach is mentioned as one of the 7 key principles (2007), by the National Early Childhood Technical Resource Center (NECTAC), as featured in the chart below:

The PSP approach provides some significant advantages over the other teaming models (ie; multidisciplinary, interdisciplinary). While all types of teaming approaches have their benefits and their drawbacks, the PSP teaming approach takes the best aspects of both, and avoids their pitfalls. By drawing from a diverse, transdisciplinary team, the PSP approach gets all the benefits of multiple minds and perspectives, in a collaborative method (York, Rainforth, & Giangreco, 1990, McGonigel et al., 1994) Perhaps due to this vast supply of collaborative expertise, responsibility, and ideas, Shonkoff et. al found that developmental outcomes for infants were better when using the Primary Service Provider approach. The PSP approach allows for a shared responsibility off all providers, with one person designated at the PSP, and the family an fundamental component in the process (Rush & Sheldon, 2013).

By having one person designated as the family’s primary support, the PSP approach retains the security, stability, and confidence of the individual approach; families know who they can turn to when they have questions, and feel confident that there is one person looking out for their best interests (Sheldon & Rush, 2010, Sheldon & Rush, 2013). Conversely, in a more fragmented model, a family could possibly have 4 service providers, each with separate meeting times and purposes for visiting, the family then must systematize these visits and remember each time and purpose for all 4 providers (Rush & Sheldon, 2013). In 2004, Bruder and Dunst found that families with one provider rated that provider as helpful 96% of the time; for families with two providers, the number was 77%; for families with three or more providers, the number dropped to 69%. Families perceived ECI as less “family centered” the more services that they received (Dunst, et al., 1998). Rush and Sheldon (2013) indicated several benefits when families received services through the PSP approach: less family disruption, IDEA (Part C) timelines were met more frequently, and IFSP outcomes were met more consistently, compared to the other teaming approaches. The PSP model has the potential to allow for more family –focus, in which one individual can take the time required to understand the family on a deeper level (Sheldon & Rush, 2010). Rush & Sheldon (2013) highlight the three fundamental differences of the PSP approach, the most popular transdisciplinary model, opposed to other models:

1. One team member is chosen as the Primary Service Provider and commits to consistently interact with the child and family
2. Members of the team must collaborate to meet the needs of the child and family
3. All team members must commit and learning, teaching, and working across all disciplines

The PSP approach was not designed to use in isolation. PSP must be used in the context of all components of an evidence based approach, which are as follows: using child interests/everyday activity settings in the natural environment, as well as facilitating family capacity building in coaching practices (Sheldon & Rush, 2013). These evidence-based components (adapted from Sheldon & Rush, 2013) are depicted below as gears, they are inter- related and require each other to function:

FIGURE

The Primary Service Provider team approach appears to be an extremely promising model for Early Childhood Intervention practitioners nationwide, and it’s now widely used in many states. Numerous National Organizations have endorsed the PSP approach, including: (American Speech and Hearing Association (ASHA), American Occupational Therapy Association (AOTA), American Physical Therapy Association (APTA), Division of Early Childhood (DEC) – Recommended Practices (2014), National Early Childhood TA Center (NECTAC) – Key Principles and Practices). Pilkington (2006) noted, on behalf of The American Occupational Therapy Association (AOTA), the implications of approaching the family and team using “coaching and guiding” techniques versus “directing and doing” (p.13).

Despite the Primary Service Provider team approach’s promising endorsements within the research and organizations, there are still refinements to strategically address. It’s important to note that the PSP approach doesn’t prescribe which intervention strategies to use. It is the responsibility of the team to develop a thorough and thoughtful Individualized Family Service Plan (IFSP) to ensure that strategies planned for the child and family draw on evidence-based models. Because of this lack of specificity and “wiggle room,” there are many variables that come into play when it comes to the success of the PSP approach. One of them is training providers for this approach as it differs greatly from the other models.

One other consideration of the PSP approach is the dynamics within each team. As Fewell noted in 1983, “ Unfortunately, teams are made, not born .” This means that the team cannot function optimally unless every member agrees on the goals, and there is a strong team leader who helps maintain motivation and inspiration. The interpersonal dynamics and morale of the team in the PSP approach has to be cultivated, it will be important to continue looking at the influence of a team’s makeup on results for the child and their family. However, there is evidence to suggest that the model provides a strong framework for holistic, family-centered care.

When we come together, we’re stronger and accomplish more than when we work alone. The Primary Service Provider approach to teaming provides an encouraging model for taking advantage of the strengths of teams, while giving families the confidence and personalized care they so need when it comes to supporting their child.

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