The outcomes have been written, so now it’s time to determine services. The team
sorts through possibilities for Arnold, a two year old with global developmental delays, and his family. Multiple team members recommend multiple services, then Winnie, the service coordinator, suggests they consider a primary service provider (PSP). The team decides that Patrick, the physical therapist, is the most appropriate choice for the PSP. The speech-language pathologist will provide monthly support to both Patrick and Arnold’s family. Other professional team members will also be available for support if needed in the future. The IFSP is signed and everyone goes on their way.
In the car, Patrick wonders what being the primary service provider really means…is he supposed to be the speech therapist, educator, and occupational therapist all rolled into one? Isn’t that expecting more of him than what he can do under his license?
What It Means To Be a Primary Service Provider
Understanding just what it means to be a primary service provider is important for all early interventionists. Let’s think about what being a PSP IS and what it ISN’T:
The PSP is the team member who will be the family’s primary contact for EI services. This means that, while there may be more than one service listed on the IFSP, the PSP is the person who will see the family most often.
The PSP is a collaborative partner who keeps in touch with other providers on the team. The PSP stays in regular contact with all team members, including the service coordinator, to keep everyone updated on progress and family questions.
The PSP is the team member who helps the family address the child’s development from a holistic perspective. One of the hallmarks, and great benefits, of using this approach is that the PSP takes a holistic view of development. The child is not viewed from a discipline-specific or domain-specific perspective – meaning that we don’t compartmentalize the child into developmental pieces. For example, we don’t only address motor skills during a physical therapy visit or communication skills during speech therapy. Instead, Patrick will help the family find ways to address Arnold’s communication and movement during daily activities. He might join the family while they prepare for lunch, helping Arnold’s mother prompt him to use words to request a food choice, then coaching her on how to help Arnold carry his plate to the sink. The PSP helps the family and all team members consider how all aspects of development intersect during the child’s everyday life.
The PSP is not a lone wolf. The PSP practices with the support of other team members. The PSP is not expected to intervene on developmental concerns that he or she is not comfortable addressing. For example, if a developmental services (DS) provider is asked to be the PSP with a child who has global delays and feeding concerns, but the provider has no training in feeding, then using the PSP approach may not be appropriate. OR, that DS provider isn’t the right choice to be the PSP for that child. However, if the DS provider is comfortable monitoring feeding with the support of an OT who joins visits on a regular basis, then it could work well.
The PSP is not the lone decision maker. Just because Patrick is the PSP, this does not give him liberty to make service decisions by himself. He is still part of a team that includes Arnold’s family, Winnie (SC), and the SLP. Decisions regarding the frequency, intensity, type, or end of services are made by the team, with Patrick as an important participant.
With the support of his team, Patrick settles into his role. He realizes that he is an early interventionist first – and an early interventionist is someone who sees the child as a whole and the family as providing the context for the child’s learning. He is an early interventionist with specialized training and expertise in physical therapy. He is an asset to his team, bringing his knowledge and experience and sharing his expertise in a way that builds the family’s capacity to encourage Arnold’s development. As the PSP, he also shares his expertise with other team members so that the team works as a unit to support the family. His role is rich, holistic, and responsive and he is ready.
How do you describe what a primary service provider IS and ISN’T?
When do you use a PSP approach and how do you know when it’s working well?
Share your experiences in the comments below!
In my state, PSP is the primary model we work with- expectations are made, but for the most part, there is one provider. One way we really made it wok was weekly team meeting, with every therapist and service coordinator in the district present. Cases would be presented and the PSP would have time to ask for coaching, suggestions, etc. It was great and an added benefit was that it created more of an “office” atmosphere in what can sometimes be an isolated job.
As a side note, I am new to the field (started a year ago, just relocated and am interviewing for positions) and I LOVE this blog. I’ve learned so much!
Thanks Caty! I’m so glad you’re learning from our blog! The teaming approach you describe is fantastic! I love the concept of a weekly team meeting to support the PSP model. I don’t think we are there yet in Virginia. It’s particularly challenging with larger programs that work with multiple agencies who employ their service providers. When you said everyone in your district was present, did they all work for the same entity or for different agencies? I’d love to know how your program got everyone to actually come to the team meetings! 🙂
Our county was made up of 6 different “districts”, with 20-30 people on each district. We were all independent contractors for the state. Our county does evals on Fridays, as well, so it’s pretty easy to have all the team not schedule visits on Fridays. As I mentioned, that was my first (and so far, only) EI position, so I can’t compare! I am hoping to get back into the program in my new state and it will be interesting to contrast different programs (now I just need to nail the interview I have on Friday!).
Wow, that’s still an amazing feat to get everyone together each week! I’m really impressed. I’ve worked in 4 different EI programs and it’s always fascinating how different things can be. I’m sure you’re going to ace your interview! Good luck on Friday! 🙂
Hi Dana:
Just this year the APTA decided to provide public access to APTA Fact Sheets. For therapists that may be concerned with this approach it might be helpful, and reinforcing, to read this fact sheet on primary providers.
https://pediatricapta.org/includes/fact-sheets/pdfs/13%20Primary%20Service%20Provider.pdf
I believe I am correct to say that each (PT, OT and SLP) national organization endorses the primary provider approach or similar practices in EI. As a PT, I have been using the basic tenants of this approach with good success, while I wait for our local system to be able to put the infrastructure in place for true/best practice teaming.
Thanks so much for posting this link, Pam! I’d forgotten all about it. Have you watched the APTA panel discussion on using the PSP approach? I haven’t watched it yet but heard it was great. Here’s the link in case you’re interested: https://youtu.be/k4_KoNa9-WE
I agree with you that we can practice the tenets even if we don’t yet have the teaming in place!
It is always nice to have a great refresher about a word that gets used often. The practice of primary provider is often confused by both providers and families alike. It is so important that the teaming aspect of the approach be EMPHASIZED and not overlooked. A single provider without a team is just that…a single provider. But a primary provider has the opportunity to develop a strong relationship with the family by sharing the information from the entire team and bringing in support as needed! It is important for any agency that is using a primary provider approach to determine how they are going to conceptualize the infrastructure and promote the team. As an agency leader I know it is a challenge but well worth the work!
Thanks Susan for making this important point! I completely agree! I feel like many people are trying to implement the primary provider approach without the teaming aspect established (like what Pam said above). That makes it so much more challenging and is probably the basis for the discomfort some folks have. Do teams in Fairfax meet regularly? How does the teaming work in your locality?
Thank you for publishing this post, and a very big thank you to those who included links for the APTA Fact Sheet and Google Hangout video in the comments – as a PT working in EI (who loves her job in large part to her program’s implementation of the primary service provider model), I found those two resources to be extremely valuable in explaining the benefits of a PSP approach to services. I’ll definitely be sharing all of this with my colleagues!
So glad to hear that, Ashleigh! When you think about how your program implements the PSP model, what do you all do that makes it work? Any advice for others? I’d love to hear more about your experience!
My favorite part of this post is “He is an early interventionist with specialized training and expertise in physical therapy.” I think that recognition that we are ALL early interventionists first and we all have specialized skills and training.
My second favorite part of this post is all the rich discussion, comments, and useful sharing of info!
I agree, Cori! I’m really enjoying the variety of perspectives and resources popping up in the comments too!
Dana. We have worked hard to make sure that teaming is part of what is valued across our providers. We have written a requirement for teaming into our RFP- but you know when you really know it is working?? When people start to complain that they are missing teaming! Then you know that it has really become a valuable part of what they do in their job. We are all working together to make this model work for the families while being a rewarding way for the providers to support them.
That sounds fantastic, Susan! I love it that you’ve added it to your RFP. That really demonstrates the priority you place on teaming. The reaction from your providers is impressive too!
I am excited to start using the coaching style of intervention
I truly enjoy working as a team and collaborating with my co-workers. Great information on team work and showing respect and trust with co-workers!!
I’m glad you found it helpful, Sarah! It sounds like you have a great team. 🙂