You really should push to end clinic-based services under the IFSP, but, because some states have not achieved that goal yet, the location clause could be dropped while maintaining the rest. I encourage agencies to include practice requirements, even when they think they have no choice but to contract with the only provider in their region. Just remember that the longer you let the seller dictate the market, the harder it will be to implement recommended practices. Many states have effectively stopped clinic-based services under Part C. They had to bite the bullet and pay only for services in natural environments. Whether you keep or discard the location clause, please make use of this language.
Practice Requirements
A requirement for fulfilling this contract is that practitioners
will follow evidence-based family-centered practices, as outlined in the
Agreed-Upon Mission and Key Principles for Providing Early Intervention
Services in Natural Environments (Workgroup…; http://www.nectac.org/topics/families/families.asp)
and as described by the practitioners’ professional organizations for pediatric
practices for this age group. These practices are described here in terms of
location, approach, teamwork, and compliance with the law.
Location
1.
Under this contract, practitioners will provide
services in the natural environments, which are described in the law and
regulations as the places where the child would be if he or she did not have a
disability. These places are most commonly the family’s home or the child’s
child care program.
Approach
Consultation With/Coaching Caregivers
2.
Practitioners will focus their work on using a consultative
approach, also known as coaching, with the child’s caregivers to enhance those
caregivers’ ability to provide interventions to the child between therapy
sessions. This focus means practitioners
2.1.
Spend the whole session communicating with
caregivers;
2.2.
Use collaborative not expert approaches in
finding solutions (i.e., deciding on interventions); and
2.3.
Demonstrate strategies as necessary.
Focus on Functioning in Routines
3.
Practitioners will address outcomes on the
individualized family service plan (IFSP), which will have target skills aimed
at promoting functioning in routines. This means practitioners will promote
3.1.
Child engagement, including meaningful
participation, in home, school, and community activities;
3.2.
Child independence, at the level the family
wants, in routines; and
3.3.
Child social relationships, including
communication and social-emotional skills, in routines.
Teamwork
4.
Practitioners will support the primary service
provider (PSP) by
4.1.
Making joint home visits with the PSP (if the
practitioner does not practice in natural environments—see Location above, welcoming the PSP on a
visit to the clinic with the family);
4.2.
Expressing to the family confidence in the PSP’s
ability to support them in carrying out the practitioner’s suggestions; and
4.3.
Providing information to the PSP.
Compliance With IDEA
5.
Practitioners will adhere to Part C of the
Individuals with Disabilities Education Improvement Act, because this is the
law under which early intervention services are funded. Even if a third party
is paying for the practitioner’s service, if the practitioner is serving the
child as part of early intervention (i.e., because the agency or practitioner
is listed as a Part C service on the individual child’s IFSP), legally they must
follow IDEA. The law stipulates that
5.1.
The IFSP team (not a doctor or another
individual person) decides on what services are to be provided and at what
frequency and intensity (i.e., prescriptions or practitioners’ recommendations
on these matters do not dictate services);
5.2.
Services are provided to meet the needs
identified in the IFSP outcomes (i.e., not based only on diagnosis or evaluation
results for eligibility); and
5.3.
Changes in services, frequency, or intensity must
be coordinated with the service coordinator and decided upon by the IFSP team
(i.e., individual practitioners should not tell families how often they should
see the child; they should discuss a potential change with the service
coordinator first).
Failure to follow any one of these five practice guidelines
can result in immediate termination of the contract. Practitioners can obtain
more information from the contracting agency about this current approach to
early intervention service delivery.
