Sunday, August 27, 2017

Teamwork Can Succeed Through Collaborative Consultation

We finally get to the 12th mental shift I have proposed as necessary to make early intervention focused on child and family functioning. In this post, I'll discuss teamwork, which I addressed somewhat in the last mental-shift post, how it can work in home-based and classroom-based or itinerant services, and what it means to be a collaborative consultant.
Sunrise from atop Diamond Head, Oahu
12 Mental Shifts

  1. All the intervention occurs between visits.
  2. Whose child is it anyway?
  3. Children are learning from their caregivers, whether you want them to or not.
  4.   Anyone spending time with the child has the opportunity to teach the child.
  5.   Passing judgment on parents or other caregivers is a self-fulfilling prophecy.
  6.   Parent failings don’t exist; only professional ones.
  7.   What matters is how children function in their everyday lives. Function = participation = engagement = learning.
  8.   The rush to get ahead leads to failure in early intervention.
  9.   It’s about getting children engaged, independent, and in social relationships.
  10.   It’s about helping families feel confident in their competence with their children.
  11.   Too many cooks spoil the broth.
  12. Teamwork can succeed through collaborative consultation.


What happened to teamwork in early intervention 0-5? If we ever had it, it certainly is missing in many places. The paper team is the myriad of people on the IFSP/IEP, but they don't necessarily communicate, as I mentioned in the last post. The "geographic team," as Rush and Shelden describe it are the people who actually function as a team: They work together, usually with numerous shared children and families. In the classic format (i.e., true to the coaching approach developed by Dathan and M'Lisa), every child and family have a team of an educator (or similar generalist), an OT, a PT, and an SLP. In the Routines-Based Model (RBM), we don't necessarily have all these people: We have only those needed to address the outcomes. We start with the primary service provider and add others who are needed to support the PSP for specific outcomes/goals. The coaching approach and the RBM, which are more similar to than different from each other, emphasize that professionals helping the family need to interact in supportive ways and, most important, in ways that support the caregiver (e.g., parent, teacher) who's actually intervening with the child.

Home-Based Teamwork

In the RBM, home-based interdisciplinary team work occurs through the joint home visit. When the family and the PSP decide they need to call in someone with particular expertise, that expert--the secondary service provider--accompanies the PSP on a home visit. The focus of the visit is using that secondary's expertise. The secondary assesses the needs, which actually usually begins in consultation with the primary before the visit--maybe even in the car. During the visit, the two of them get assurance from the family about their questions. The secondary undertakes more assessment, asking more questions of the parent or interacting with the child directly. In our model, we emphasize that what a child does for a visiting professional is only relevant if it reflects what the child does in ordinary routines. But sometimes a physical therapist might need to handle a child to ascertain tonicity, for example. Or a speech-language pathologist might examine a child's mouth to determine if the palate is highly arched. Or an occupational therapist might elicit the child's grasp of her finger to test the child's grasp strength. The secondary is there to help answer the questions Why is the child doing or not doing something? and What might caregivers do about it?

The extent of collaboration involved in the secondary's consultation can vary. Secondaries trained in the RBM, for example, would use our procedures for collaborative consultation, which involves asking many questions before arriving at a solution. It is acceptable, however, for the secondary to put forward a number of suggestions in a somewhat non-collaborative manner, in the spirit of giving information. "You could try this, or perhaps that. Maybe this." The primary would follow this up with the family using what we call family consultation, which is collaborative consultation with the family. The joint home visit is primarily for the secondary to impart information; write to me for a copy of the Joint Home Visit Checklist.

Classroom-Based Teamwork

Joint home visit in eastern Paraguay
If the child is served in a classroom (e.g., child care program, Head Start classroom, preschool), the teamwork is between the teacher and the person visiting the room. Two types of visitors are (a) the usual person who comes to the classroom to support the teacher, who might be a PSP, and (b) a specialist. When using a PSP approach, with a generalist helping the classroom staff with any outcomes/goals on the plan, the secondary specialists make joint visits, like joint home visits. Most visits, however, consist of the primary visiting the teachers. In the RBM, we provide guidance both for the visitor and the teachers. The visitor uses collaborative consultation, meaning he or she asks questions before making a suggestion. The teacher gives context to the conversation, sometimes comes to an intervention conclusion simply based on the conversation, assesses whether a suggestion the visitor makes is likely to work, and determines the feasibility of carrying out the intervention. In the process of discussing an intervention, the visitor might demonstrate the intervention or observe the teacher trying it out. Visits to classrooms are not to work with the child; they are to build the capacity of the adults who spend hours with the child.

Other situations and opportunities abound for professionals to work together for the good of the child and family, such as team assessments, meetings, communication (e-mail, phone, text, etc.). The principles on which I have based this post are 
  • Team members should be building caregivers' capacity in all their work;
  • Team members should give freely of their expertise, when that's what's wanted; and
  • When finding interventions, professionals should consult collaboratively with caregivers.
Sorry about the font. Blogger is being uncooperative about allowing me to change it all to Arial.