A new family is referred to your program and they bring with them a prescription for therapy. The prescription lists physical therapy 5x/week. The parents request this level of service because that’s what their pediatrician says the child needs. When you explain the difference between a medical model of therapy and the family-centered methods used in early intervention, the parents still insist that their child will need more therapy. What do you do? What do you say to the parents? To the physician?
The Source of the Problem
This problem is common in early intervention and is usually based in the differences in philosophy between medical or clinical models of therapy and how early intervention is provided. The medical model of therapy is not a bad thing, and is the model many therapists were trained in during their preservice education. The medical model of therapy focuses on the therapist’s interaction with the patient during sessions. There is usually a “home program” of exercises but the main work happens when the therapist and patient are together. In contrast, early intervention focuses on the interactions between the parent and child during and between sessions. The main work of intervention happens between sessions or visits when the parent and child interact during daily activities. When the parent (or other caregiver) gets appropriate support during visits and knows what to do between visits, the child receives much more intervention than he could receive in, say, 5 one-hour sessions with the therapist. He receives intervention throughout the day, which we know is more effective with infants and toddlers.
What Do You Do?
This model of providing intervention is an important thing for parents AND referral sources, such as physicians, to understand. If you were in this situation, what would you do?
How do you explain the way early intervention is provided to families?
Would you call the physician’s office? What would you say? (I once had a physician tell me that he was in the business of evaluating kids and that it was my job to treat them – that deciding what they needed was not my job. Yikes. We never cracked that nut but we did send him information about early intervention because he was a family practice doctor who I don’t think knew much about EI.)
How do you consider the physician’s recommendation when developing the IFSP?
What would you do/say if the family insisted that they wanted a higher frequency of therapy than what is recommended in the IFSP?
How do you build a supportive relationship with the family when it starts out like this?
Share your thoughts and ideas!