ERIC Identifier: ED313867 Publication Date: 1989-00-00
Author: Source: ERIC Clearinghouse on Handicapped and
Gifted Children Reston VA.
Early Intervention for Infants and Toddlers: A Team Effort.
ERIC Digest #461.
The early intervention program established by P.L. 99-457, The Education of
the Handicapped Act Amendments of 1986, has brought the nation one step closer
to a national policy of access to services for all handicapped and at-risk
children, birth through 5 years of age, and their families. Part H, the
Handicapped and Toddlers Program, created a new federal program for handicapped
and at-risk children from birth to 3 years of age and their families. The
purpose of this program is to provide financial assistance to states to:
1. Develop and implement a statewide, comprehensive, coordinated,
multidisciplinary, interagency program of early intervention services.
2. Facilitate the coordination of early intervention resources from federal,
state, local, and private sources.
3. Enhance states' capacities to provide high-quality early intervention
WHO IS ELIGIBLE FOR SERVICES?
The new Infant/Toddler
Program is directed to the needs of children, from birth until their third
birthdays, who need early intervention because they:
1. Are experiencing developmental delays in one or more of the following
areas: cognitive, physical, language and speech, psychosocial, or self-help
2. Have a physical or mental condition that has a high probability of
resulting in delay (e.g., Down syndrome, cerebral palsy).
3. At state discretion, are at-risk medically or environmentally for
substantial developmental delays if early intervention is not provided.
WHAT MUST SERVICES INCLUDE?
For each eligible child, early
intervention services must include a multidisciplinary assessment and a written
individualized family service plan (IFSP) developed by a multidisciplinary team
and the parents. Services provided must be designed to meet the developmental
needs of the child and be in accordance with the IFSP. Case management services
must be provided for every eligible child and his or her parents. Because
eligibility definitions are so broad, service providers need a comprehensive
knowledge base and a diversity of skills to serve these children. Staff
providing services to any one family may represent multiple disciplines, and
collaboration among professionals from different agencies is often necessary.
New definitions of "staff," "team," and "collaboration" have begun to emerge.
EARLY INTERVENTION TEAM MODELS
The growing acceptance and
implementation of the team approach are not solely the results of federal
mandates. They also reflect early intervention professionals' view of human
development that regards a child as an integrated and interactive whole, rather
than as a collection of separate parts (Golin & Ducanis, 1981). The team
approach also recognizes that the multifaceted problems of very young children
are too complex to be addressed by a single discipline (Holm & McCartin,
1978). The complexity of developmental problems in early life (Fewell, 1983) and
the interrelated nature of an infant's developmental domains are prompting early
intervention specialists to recognize the need for professionals to work
together as a team.
Although different team models are in use, most are composed of professionals
representing a variety of disciplines: special education; social work;
psychology; medicine; child development; and physical, occupational, and speech
and language therapy. All teams also involve the family in varying ways and
degrees. Team members share common tasks including the assessment of a child's
developmental status and the development and implementation of a program plan to
meet the assessed needs of the child within the context of the family.
What may best distinguish early intervention teams from one another is
neither composition nor task, but rather the structure for interaction among
team members. Three service delivery models that structure interaction among
team members have been identified and differentiated in the literature:
multidisciplinary, interdisciplinary, and transdisciplinary (Fewell, 1983;
Linder, 1983; Peterson, 1987; United Cerebral Palsy National Collaborative
Infant Project, 1976).
On multidisciplinary teams,
professionals from several disciplines work independently of each other (Fewell,
1983). Peterson (1987) compared the mode of interaction among members of
multidisciplinary teams to parallel play in young children: "side by side, but
separate" (p. 484). Although multidisciplinary team members may work together
and share the same space and tools, they usually function quite separately.
Interaction among team members in the multidisciplinary approach does not
foster services that reflect the view of the child as an integrated and
interactive whole (Linder, 1983). This can lead to fragmented services for
children and confusing or conflicting reports to parents.
Another concern about the multidisciplinary model is the lack of
communication between team members that places the burden of coordination and
case management on the family. In contrast, both the interdisciplinary and
transdisciplinary approaches avoid the pitfalls of multidisciplinary service
fragmentation by having the team develop a case management plan that coordinates
both their services and the information that is presented to the family.
Interdisciplinary teams are
composed of parents and professionals from several disciplines. The difference
between multidisciplinary and interdisciplinary teams lies in the interaction
among team members. Interdisciplinary teams are characterized by formal channels
of communication that encourage team members to share their information and
discuss individual results (Fewell, 1983; Peterson, 1987). Regular meetings are
usually scheduled to discuss shared cases.
Representatives of various professional disciplines separately assess
children and families, but the team does come together at some point to discuss
the results of their individual assessment and to develop plans for
intervention. Generally, each specialist is responsible for the part of the
service plan related to his or her professional discipline.
Although this approach solves some of the problems associated with
multidisciplinary teams, communication and interaction problems (e.g., influence
of "professional turf") may impinge upon the team process.
Transdisciplinary teams are also
composed of parents and professionals from several disciplines. The
transdisciplinary approach attempts to overcome the confines of individual
disciplines in order to form a team that crosses and recrosses disciplinary
boundaries and thereby maximizes communication, interaction, and cooperation
among team members.
Fundamental to this model are two beliefs: (1) children's development must be
viewed as integrated and interactive, and (2) children must be served within the
context of the family. Since they have the greatest influence on their
children's development, families are seen as a very critical part of the
transdisciplinary team and are involved in setting goals and making programmatic
decisions for themselves and their children. All decisions in the areas of
assessment and program planning, implementation, and evaluation are made by team
consensus. Although all team members share responsibility for the development of
the service plan, it is carried out by the family and one other team member who
is designated as the primary service provider.
Another characteristic of a transdisciplinary team is that team members
accept and accentuate each other's knowledge and strengths to benefit the team,
the child, and the family (Lyon & Lyon, 1980). Staff development in the form
of mutual training may occur at three increasing levels of complexity: (1)
sharing general information; (2) teaching others to make specific judgments; and
(3) teaching others to perform specific actions. The first two levels pertain to
the sharing of information while the third level pertains to the sharing of
IMPLICATIONS OF THE TRANSDISCIPLINARY MODEL FOR
Because transdisciplinary team members are interdependent, all must
commit themselves to assist and support one another. This commitment is
demonstrated by the following behaviors:
(1) Giving the time and energy necessary to teach, learn, and work across
traditional disciplinary boundaries.
(2) Working toward making all decisions about the child and family by team
consensus--that is, giving up disciplinary control.
(3) Supporting the family and one other team member as the child's primary
(4) Recognizing the family as the most important influence in the child's
life and including them as equal team members who have a say in all decisions
about the child's program.
Fewell, R. R. (1983). The team approach to
infant education. In S. G. Garwood & R. R. Fewell (Eds.), Educating
handicapped infants: Issues in development and intervention (pp. 299-322).
Rockville MD: Aspen.
Golin, A. K., & Ducanis, A. J. (1981). The interdisciplinary team.
Rockville MD: Aspen.
Holm, V. A., & McCartin, R. E. (1978). Interdisciplinary child
development team: Team issues and training in interdisciplinariness. In K. E.
Allen, V. A. Holm, & R. L. Schiefelbusch (Eds.), Early Intervention -- A
team approach (pp. 97-122). Baltimore, MD: University Park Press.
Linder, T. (1983). Early childhood special education: Program development and
administration. Baltimore MD: Brookes.
Lyon, S., & Lyon, G. (1980). Team functioning and staff development: A
role release approach to providing integrated educational services for severely
handicapped students. The Journal of the Association for the Severely
Handicapped, 5(3), 250-263.
Peterson, N. (1987). Early intervention for handicapped and at risk children:
An introduction to early childhood special education. Denver CO: Love.
United Cerebral Palsy National Collaborative Infant Project (1976). Staff
development handbook: A resource for the transdisciplinary process. New York:
United Cerebral Palsy Associations of America.