Connecticut Speech-Language-Hearing Association

March 26, 20101:30-3:30 pm

Successful Transitions From Birth to Three to

School: Roles of ParticipantsDiane Paul, PhD, CCC-SLP

Director, Clinical Issues In Speech-Language PathologyAmerican Speech-Language-Hearing Association

dpaul@asha.org

ASHA Policy DocumentsEarly Intervention PrinciplesRoles of Participants

Intervention (Including Service Delivery Models and Teaming)

ConsultationTransition Planning

ASHA Policy Documents

Family of documents (technical report, position statement, guidelines, and knowledge and skills) related to the role of the speech-language pathologist in the assessment and treatment of communication and swallowing disorders in the infant and toddler population.

Address issues related to specific cultural and linguistic needs of infants and toddlers and the need for culturally-appropriate practice.

Policy Documentswww.asha.org/policy

Position Statement

Technical Report

Knowledge and Skills

Guidelines

Characteristics of Infants and Toddlers Who May Receive Early Intervention

About 17% of children in the United States have had a developmental disability (Centers for Disease Control and Prevention, 2007)

Many children with developmental disabilities have communication and feeding/swallowing problems needing SLP services. limited interest in social interactions failure to respond to speech or name reduced or atypical babbling restricted prelinguistic communication acts (sharing attention or

engaging in reciprocal “baby” games) limited use of communication gestures such as pointing delayed acquisition of first words slow growth or regression in vocabulary or utterance length poor speech intelligibility for developmental level limited or poor feeding and swallowing skills

Role of Speech-Language Pathologists

Speech-language pathologists have a central role in providing services and supports for families and their infants or toddlers with disabilities as members of the early intervention team.

Families with infants and toddlers (birth-36 months) who are at risk for or have disabilities should receive developmentally supportive care that addresses a broad spectrum of priorities and concerns.

Guiding Principles

Four guiding principles should be considered in the design and delivery of services to infants and toddlers with disabilities.

Reflect current consensus about optimal practices for infants and toddlers (birth - 3 yrs)

Principle One

Early intervention services are family-centered and culturally and linguistically responsive Align services with each family’s unique

situation, culture, language/s, preferences, resources and priorities

Principle Two

Early intervention services are developmentally supportive and promote children’s participation in their natural environments Appropriate for child's age, cognitive level,

strengths, family concerns and preferences

Principle Three

Early intervention services are comprehensive, coordinated, and team-based Effectively integrated to meet all of the needs

of the child and family

Principle Four

Early intervention services are based on the highest quality evidence available Merger of highest quality and most recent research with

professional expertise and family preferences Mix of internal and external evidence▪ Internal Evidence (experience , policies, informed clinical opinion)▪ External evidence (scientific literature and assessment of quality of

study)

Challenges Be able to sort out internal and external evidence Understand how to evaluate the strength of evidence Know how to proceed when there is minimal evidence Know how to monitor progress in different settings

Application of Principles to Roles of Speech-Language Pathologists

Prevention Screening Evaluation Assessment (to determine intervention

programming) Intervention planning, implementation,

and monitoring Consultation Service coordination Transition planning Advocacy Awareness and advancement of the

knowledge base

Planning, Implementing, and Monitoring InterventionService Delivery Models

Location Natural environments—home and community settings

Type traditional, one-to-one, direct clinical model (pull-out) more indirect collaborative approaches

Team-based Multidisciplinary Interdisciplinary Transdisciplinary

Multidisciplinary Teams

Characteristics Involves multiple professionals Complete separate assessments and provide

independent services May meet to discuss child

Drawbacks Not cohesive Limited number of opportunities for professional to

interact with one another and the family

Interdisciplinary Teams

Characteristics Professionals work together Consistently coordinate information and resources Collaborate with the families and other to achieve

priority outcomes Tools may be a single integrated assessment,

discipline-specific tools, or some combination. Communicate findings and recommendations Share responsibility for providing services

Transdisciplinary Teams

Characteristics Team members work together for assessment and intervention Some type of “role release” occurs Professionals may serve as consultants to team lead Sometimes referred to as a primary service provider (PSP) model

Possible benefits Learn new skills across domains simultaneously and

synchronously rather than in isolation. Team’s message is unified by lead member working closely with

the family. Less fragmentation

Concerns Role release without training Lack of involvement of SLP when needed

Team Lead or Primary Provider How is the team lead selected?

Based on the needs of the child, relationships developed with the family, and special expertise

In consultation with the family PSP should be SLP when feeding/swallowing and

communication are primary concerns May be other discipline such as special education,

nursing, or occupational therapy, and the SLP will play a support role

Should not be established by prior program policy or based on logistics such as travel or caseload

Team Lead/Primary Provider Challenge

Early Intervention is a field with many disciplines.

It is not appropriate for SLPs to train others to perform professional level services unique to SLPs or for SLPs to perform services outside of their scope of practice.

Consultation and Collaboration With the Family and Other Team Members

Help family enhance child's communicationdevelopment through consultation and education

Provide information cognitive, social, and communication development developmental course and characteristics of a

disability intervention approaches and strategies

Promote parent and caregiver abilities to implement communication-enhancing strategies during everyday routines

Transition Planning

Seamless transition process for families moving between programs

Timely access to appropriate services

Need for transition plan

Families play an active role

Consultation With and Education for Team Members, Including Families and Other Professionals

Knowledge of continuum of service delivery models to meet the

needs of the individual child and family (e.g., direct service, collaborative consultation, playgroup-based).

Skills in facilitating collaborative problem solving with

families, caregivers, and other team members to deliver and monitor interventions.

Service Coordination and Transition Planning

Knowledge of community resources, how to access them, and

strategies to empower families' and caregivers' accessibility.

Skills in collecting information about family priorities,

resources, and concerns.