Implementing a Primary Coach Approach to Teaming

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Implementing a Primary Coach Approach to Teaming

• MLisa Shelden, PT, PhD
• Family, Infant Preschool Program
• Morganton, North Carolina
• Mlisa.shelden_at_ncmail.net
• Dathan Rush, EdD, CCC-SLP
• Family, Infant Preschool Program
• Morganton, North Carolina
• Dathan.rush_at_ncmail.net
• http//www.coachinginearlychildhood.org

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Evidence-Based Paradigm

• Evidence-Based
• Promotion
• Capacity-building
• Strengths-based
• Resource-based
• Family-centered
• Dunst, 2000

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Operational Definition of the Primary Coach
Approach

• The primary coach approach to teaming is when
  one member of an identified multidisciplinary
  team is selected as the primary coach, receives
  coaching from other team members, and uses
  coaching with parents and other care providers.

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Characteristics of Primary Coach

• An identified team of individuals from multiple
  disciplines having expertise in child
  development, family support, and coaching is
  assigned to each family in the program.
• One team member serves as primary coach to the
  care provider(s).
• The primary coach receives coaching from other
  team members through ongoing planned and
  spontaneous interactions.

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Primary Coach Implementation Conditions

• All therapists and educators on the team must be
  available to serve as a primary coach.

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Primary Coach Implementation Conditions

• All team members attend regular team meetings for
  the purpose of colleague-to-colleague coaching.
  Coaching topics at team meetings are varied and
  include specific information for supporting team
  members in their role as a primary coach to the
  families in the program.

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Team Meeting Guidelines

• One team member serves as team meeting
  facilitator
• Announcements are provided in written form and
  not discussed
• Scheduling occurs at the end of the meeting
• Families know when/why their primary coach brings
  questions to the team meeting
• No decisions are made at team meetings without
  parents
• When families participate, meetings are held at
  convenient times locations for the family

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Primary Coach Implementation Conditions

• The primary coach is selected based upon desired
  outcomes of the family, rapport/relationship
  between coach and learner, and knowledge and
  availability of the coach and family.

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Primary Coach Implementation Conditions

• Joint visits should occur at the same place and
  time whenever possible with/by other team members
  to support the primary coach.

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Primary Coach Implementation Conditions

• The primary coach for a family should change as
  infrequently as possible. Justifiable reasons for
  changing the primary coach include a request by a
  family member or other care provider or when a
  primary coach believes that even with coaching
  from other team members he or she is ineffective
  in supporting the care providers.

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Implementation Tools

• Primary Coach Rating Scale
• Team Meeting Agenda format
• Team Meeting Minutes format
• http//www.coachinginearlychildhood.org
• http//www.fippcase.org

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Characteristics of Teaming

• Teams should consist of individuals who
• are agreeable
• are conscientious
• have high general mental ability
• are competent in their area of expertise
• are high in openness to experience and mental
  stability
• like teamwork
• have been with the organization long enough to be
  socialized
• (Bell, 2004) (cont.)

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Characteristics of Teaming

• Team task(s) should allow members to use a
  variety of skills (Bell, 2004)
• Team task(s) should result in meaningful work
  (Bell, 2004)
• Teams work should have significant consequences
  for other people (Bell, 2004)
• Team should generate feedback about how the team
  is performing (Bell, 2004)
• Number of team members should be appropriate for
  the task (Bell, 2004 Larsson, 2000)
• Teams should have some degree of self-managing
  abilities (Bell, 2004)
• Teams should have a common planning time
  (Flowers, Mertens, Mulhall, 1999)

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Strategies for Establishing a Team

• A team must consist of a team leader and the
  equivalent of at least one FTE from the following
  roles special educator/early childhood educator,
  occupational therapist, physical therapist,
  speech-language pathologist, service coordinator
  (in a dedicated SC model). All roles must be
  represented.

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Strategies for Establishing a Team

• Team members may also include dietitian, nurse,
  orientation and mobility specialist, teachers of
  children with vision or hearing impairments,
  psychologist, social worker.

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Strategies for Establishing a Team

• Team Load (number of families)
• Dedicated service coordination model
• Service coordinators 3 _at_ 30-35 per SC
• ECSE, OT, PT, SLP 25 families per discipline
  per FTE (full-time equivalent position)
• Blended service coordination role
• ECSE, OT, PT, SLP 15 families per discipline
  per FTE (minimum)

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Strategies for Establishing a Team

• Determine distribution of eligible families
  across catchment area
• Identify the area the team is to cover (i.e.,
  counties, zip codes, school districts) based on
  family distribution
• Determine the number of teams necessary to cover
  the catchment area
• Assign available practitioners to teams beginning
  with those who can give the most time to the
  program
• Develop mechanism to pay for team meeting time

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Moving to a Primary Coach Approach

• Two opportunities
• Newly referred children and families
• 2. Currently served children and families

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Newly Referred Children

• 1. During the initial conversation with family
  members and care providers identify activity
  settings, child interests, and family priorities
  in order to determine the expertise necessary for
  the assessment.
• 2. Conduct assessment across activity settings to
  identify the supports necessary to promote the
  childs participation.

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Newly Referred Children

• 3. Develop functional, discipline-free
  participation-based IFSP outcomes to reflect
  childs interests and care providers priorities.
• 4. Select primary coach and determine frequency,
  intensity, and duration of supports based on the
• best match between coach and learner expertise
• availability of necessary coaching to
• achieve IFSP outcomes as quickly as possible.

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Currently Served Children

• Identify families who have expressed interest in
  this type of an approach or frustration with
  having multiple practitioners.
• Review all team members caseloads to identify
  overlaps among other families in the area.
• Select a few children who have the most overlaps
  and discuss with care providers implementing the
  new approach for a trial period.

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Currently Served Children

• 4. Conduct an IFSP review to ensure the outcomes
  are
• participation-based
• discipline-free
• functional/contextualized (i.e., not impairment
  oriented), and
• based on care providers priorities and childs
  interests.

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Currently Served Children

• 5. Select primary coach and determine frequency,
  intensity, and duration of supports based on the
• best match between coach and learner expertise
• availability of necessary coaching to
• achieve IFSP outcomes as quickly as possible.

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Implementation Data

• Matched Sample Study (Shelden Rush, 2006)
• Experimental design
• 21 matched pairs
• Controls were child age at entry into study,
  child diagnosis, length of time served by
  program, simultaneous participation in program,
  family SES
• Diagnoses included developmental delay, seizure
  disorder, cerebral palsy, Down syndrome, visual
  impairment, severe disabilities, autism/PDD
• Shelden Rush, in preparation

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Implementation Data

• Matched Sample Study cont.
• Mean age at entry
• Experimental 11.9 months
• Control 12.4 months
• Mean age at exit
• Experimental 19.7 months
• Control 21.9 months
• Data collected (both groups) all developmental
  testing, IFSPs, actual billed units for all IFSP
  services, (experimental group only) team meeting
  minutes, team meeting time by child per team
  member, documentation of joint visits, coaching
  logs
• Shelden Rush, in preparation

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Implementation Data

• Matched Sample Study cont.
• Results
• Experimental group had significantly fewer
  service hours including team meeting time than
  control group
• IFSP outcomes were met more often by children in
  experimental group
• IFSP outcomes were more participation based and
  care provider focused for children in the
  experimental group
• Shelden Rush, in preparation

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Implementation Data

• Matched Sample Study cont.
• Results
• No differences noted between the experimental and
  control group for child developmental outcome
  data
• Early intervention services and supports provided
  using the evidence-based practice model were
  significantly less expensive and of higher
  quality as defined by current research than those
  services provided outside of this model
• Shelden Rush, in preparation

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What Happens

• From clinic-based, segregated, decontextualized
  environments to natural learning environments
• From no teams to dedicated regional teams
• From no regular contact among practitioners to
  weekly team meetings, joint visits, and ongoing
  interactions (i.e., phone calls, email)
• From limited insight and speculation to actual
  administrative knowledge of practices occurring
  during visits

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What Happens

• From individual practitioner responsibility for
  use of evidence-based practices to team and
  program accountability
• From limited services to access to a full team of
  practitioners from a variety of disciplines
• From hierarchical view of roles to equality among
  team members

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What We Know

• Team Meetings
• Teams that meet weekly learn and implement the
  practices
• Teams that meet weekly have higher accountability
  among team members
• Teams meet on average less than 1 ½ hours per
  week
• When coaching occurs at team meetings, the
  practices are implemented
• Meetings are more productive when guided by a
  competent, consistent facilitator
• All team members attend the team meetings
• The order in which items occur on the agenda
  matters
• Dedicated service coordinators love team meetings

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What We Know

• Early Intervention Process
• Same team should support families from initial
  referral through transition
• Joint Visits
• 15-20 of total visits are joint visits
• Disciplines other than core, may require more
  joint visits
• Three steps are required for joint visits to be
  effective
• Changes in Primary Coach
• Primary coaches do not change frequently

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What We Know

• Time
• Moving to a primary coach approach takes
  intensive support over time
• Leadership
• Administrative support for use of the approach is
  essential
• Program administrators must attend at least some
  team meetings
• Service Coordination
• Primary coach works with any time of service
  coordination model

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What We Are Learning

• Team load
• Frequency and duration of team meetings
• Amount of time spent in team meetings per
  practitioner per child
• How to decrease the amount of time required to
  learn and implement the practices
• Comparison in cost of primary coach approach and
  traditional model
• Outcomes for families
• Outcomes for children

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Family Feedback

• I sought and I found the perfect program for my
  daughter. There was no hit and miss. I am very
  pleased that my first program for my daughter was
  ___ because this team that was sent to us comes
  second to none. My team has given our family so
  much, much more than I ever expected.

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Family Feedback

• I love working with my team!
• This is a wonderful program. Because of
  participation in the pilot program, my child is
  now able to tell us what he wants rather than
  pointing.
• Our son has grown more rapidly as a result of
  our involvement.
• The program has helped my daughter and also
  helped myself and her father.

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Family Feedback

• A team leader and sole service provider has
  been sufficient in meeting the needs of our son.
  The team leader/coach has been willing to consult
  with other therapists and then report back to us.
  She has been knowledgeable and skilled in the
  areas of need.

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Family Feedback

• July 5th will surely be a sad day in our
  housethe team will be gone, but not the
  wonderful teaching tools, advice, and early
  intervention knowledge that they have shared with
  us throughout our time together. My team
  deserves much recognition (and a really big
  raise.?) for helping us to bring (childs name)
  back to us. We love our team!

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Family Feedback

• My family has been very pleased with the
  service we have been receiving on behalf of our
  daughter. Our service provider has presented
  herself to be very professional and extremely
  knowledgeable. Whenever we have questions
  pertaining to other areas of therapy, our service
  provider never fails to consult with the team and
  return with an answer. We are very pleased with
  the coaching method and are pleased to say it is
  working extremely well for our family. Thank you.

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Family Feedback

• I have a foundation to build on that the team
  has helped to establish in order for us to work
  towards even more improvements with (my child),
  and every goal we had set has been matched to
  great satisfaction. I have no questions or
  concerns at this point, just some well deserved
  words of praise to my team for helping me to find
  my baby girl in the dark hole that held her
  prisoner.

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Questions Discussion
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References

• Bell, S.T. (2004). Setting the stage for
  effective teams A meta-analysis of team design
  variables and team effectiveness. Unpublished
  doctoral dissertation, Texas A M University,
  College Station, Tx.
• Dunst, C. J. (2000). Revisiting "Rethinking early
  intervention." Topics in Early Childhood Special
  Education, 20, 95-104.
• Flowers, N., Mertens, S.B., Mulhall, P. (1999).
  The impact of teaming Five research-based
  outcomes of teaming. Middle School Journal,
  31(1), 57-60.
• Larsson, M. (2000). Organising habilitation
  services Team structures and family
  participation. Child Care, Health Development,
  26, 501-514.