Friday, February 1, 2013

Making Teams out of Individuals

Early intervention for infants and toddlers in some communities is almost devoid of teamwork, even though multiple people might be in the on-paper team for a child and family. The on-paper "team" is simply the list of people providing services. If those people come from different agencies or are sole providers and they each do their own thing, they aren't a true team.

In my book Routines-Based Early Intervention, I discuss virtual teams, which are very much like what M'Lisa Shelden and Dathan Rush call geographically based teams. See their books on the primary service provider and on coaching.

This is how it works: Professionals from different disciplines, often education/child development, OT, PT, and SLP, and different agencies agree to form a team that will use evidence-based practices and the primary-service-provider (PSP) approach. Any member of the team can serve as the PSP for a child and family. All members of the team agree to support each other. In Shelden and Rush's model, they actually attend meetings together. They sometimes go on joint home visits with the PSP. The secondary service providers don't make separate visits: That defeats the purposes of the PSP approach.

Azusa, Laurie, and Tania
Each team member bills back to his or her respective agency, insurance company, Medicaid, and so on for their services. They have an agreement with the service coordinators to have the referral go to the team, so the team, not the service coordinator, decides who the PSP will be.

The thorny question becomes who decides on the individual services, with frequency and intensity: the service coordinator or the team? Ideally, the team does, with the family, and they inform the service coordinator. In this ideal world, the service coordinator trusts the team because they're using a transdisciplinary model and therefore not piling on services. Technically, however, the service coordinator is responsible for completing the IFSP, so this arrangement can become a power issue.

The different agencies involved in the virtual team (perhaps as many as four) need to approve this approach, whereby their people are sometimes the primary and sometimes the secondary. It shouldn't be an issue, because they bill for every visit, regardless of role. In some places, though, you can't bill for each person's hour of service on joint home visits ("co-treats"--dreadful term; "co-visits"). Some people know how to be flexible with this approach, essentially ignoring the other person at billing time, whereas others are sticklers and have to agree to payment for half the time.

The virtual or geographically based team is a great way to restore teamwork to early intervention, but it requires individual professionals to take the initiative and get it done. It also requires service coordinators to cooperate and help.