You’re sitting in an IFSP meeting discussing outcomes that the family would like to see for the child. The child is eligible for early intervention (EI) due to global developmental delays as well as cerebral palsy. The IFSP outcomes include the child learning to move about independently, feed himself, and learn to ask for what he wants, like when he’s hungry. After all of the outcomes and short-term goals are developed, the team discusses services. There is a rich back-and-forth discussion with the family about the types of services available and who could best help the family address the child’s outcomes. The team decides that an occupational therapist is best suited to support the family as the primary provider with a speech language pathologist consulting less frequently. These services are recorded on the IFSP.
A scenario like this plays out many times in early intervention, but it can go against how many providers were trained. Under some medical models of service delivery, an evaluation is completed, a service is recommended, THEN goals are written to guide the service. Why don’t we do it that way in early intervention??
We say that early intervention services are “outcome-driven” meaning that the outcomes and goals are what guide the intervention that is provided. EI takes the approach that we need to know what to do before we determine who can help work towards that outcome. This makes sense when we think of all service providers as “early interventionists” who work with the whole child, rather than providers who focus only on motor, communication, or cognition. All of development intersects so you cannot really work on one area of development without affecting other areas. Even though we do have specific training in particular areas of service delivery (such as motor development for the physical therapist), all early interventionists think from a “whole child” perspective and need to be prepared to address development from multiple perspectives.
Thinking about the scenario above, if the team had completed the evaluation then determined services, the child might have looked like he needed lots of services because he had lots of areas of concern. Maybe he needed speech therapy because he wasn’t talking, occupational therapy because he wasn’t self-feeling, and physical therapy because he wasn’t yet moving independently and because he had a motor disability. After working out his family’s priorities for the child’s development, and considering the results of the evaluation, the team determined that an OT could address the outcomes because the OT had experience working on positioning, mobility, self-feeding, and communication. The SLP could provide support to the OT and the child’s family as the child’s communication development grows. An outcome-driven approach to service determination resulted in a good match between IFSP outcomes and service provider skills, fewer people in the family’s home, and an integrated perspective that did not divide the child up by developmental areas or disability.
Medical models that determine services before outcomes are not “bad” models. They are just different from the way we do business in early intervention. We flip things around a bit so that we are well-informed about how to support the child and family and so that we see the child from a strengths-based, whole child perspective.
A few thought questions:
What are other benefits of an outcome-driven approach to services?
What do you do when an IFSP team member recommends a service before the outcomes have been determined?
Hopefully this post will help you know what to say if this ever happens on your IFSP team!