The answer to this question is that we really don’t know. There isn’t any research in our field that firmly states that a certain level of EI service frequency is most effective. When you think about it, it’s not difficult to guess why this might be. We don’t believe in a one-stop shop mentality; in fact, our field is built on a foundation of individualized decision-making. So why is it, then, that most children in EI receive weekly services? Why weekly?
I think this is actually pretty frustrating because we really cannot say that weekly services are any more effective than twice a month, or any less effective than twice a week. We continue to choose “1x/week” because that’s the trend; it’s just the way we’ve always done it. With the push in our field to implement evidence-based practices, it’s a real challenge that we don’t actually have evidence for this important decision.
A Few More Reasons Why
Here are a few more reasons why answering this question is such a challenge:
It’s not easy to do good research in EI, with so many variables to control (or that can’t be controlled) in natural environments, so many differences among child and families, different IFSP outcomes, and different provider skills and knowledge. Of course, there’s also the important fact that we can’t withhold services for some infants or toddlers as a control group to test the effectiveness of a certain frequency for others. Because research in natural environments is so complex, it would be incredibly difficult to know if it really was the difference in service frequency that made the difference in the child’s outcomes – or was it due to differences in service provider skills, parent-child interactions, materials in the environment, etc. etc.
Because of these variables, it’s very unlikely that we’ll ever find a magic service frequency that works for all services, children, families, and outcomes.
We believe that the real intervention happens between visits. Figuring out how many visits will have the best impact on what happens between visits is the question.
These three reasons all weave together into a web that makes reaching the answer to our question a real challenge.
So How SHOULD We Decide Frequency??
When it comes to this decision, until we have evidence to guide the process, we do our best to consider all of these unique variables, mixed with our professional experience and the family’s preferences. Here are a few ideas about deciding on service frequency.
Rethink the Questions You Ask
Rather than focusing on the child’s delays or disabilities, Jung (2003) suggested that we ask these two questions::
1. How often will the child’s intervention likely need to be changed?
2. How often does the family need support to be comfortable in using intervention strategies? (p. 25)
These questions move the focus from the complexity of the child’s needs (from a deficit-based view) to what the family will need to support the child’s development. The first question challenges us to remember our role to support the family’s efforts and flips our old ideas that children with more complex needs must have lots of services. If strategies are unlikely to be changed frequently (e.g., because the child can benefit from more time to practice and learn between visits or the parent is able to use strategies effectively), then maybe service frequency and/or the amount of services on the IFSP can be less intense. Or, if we expect or need intervention outcomes to be achieved swiftly (e.g., when a newborn has feeding difficulties), maybe more frequent services will be most beneficial, at least initially. The second question is a great one to ask families to include their input in the decision-making process, rather than professional team members prescribing service frequency. The parents might not know the answer, or they might feel very clear about what they want to try. These questions push us to move past our assumptions about a child’s abilities or our own importance and focus on how we can support families.
The “I” in IFSP
Look at the IFSPs you and your team members write. Are all of the outcomes generally the same (e.g., “Sam will use 50 words to get his wants and needs met…”)? If they are, work with your team to write better, more individualized outcomes. Determining services MUST wait until after outcomes are developed. If outcomes aren’t individualized, services won’t be either.
Be mindful in thinking beyond “1x/week” and consider other options. Don’t take the easy way out and make the same recommendation for everyone. Some children and families will benefit from less frequent service, some from more frequent service, and some from service frequency that changes over time. Try something else and see if it works. If it doesn’t, well, that’s what an IFSP review is for.
How do you determine service frequency? Do you see “1/week” listed frequently on IFSPs? How do you help your team think of other options?
Jung, L. A. (2003). More better: Maximizing natural learning opportunities. Young Exceptional Children, 6(21), 21-26. doi: 10.1177/109625060300600303