One States Approach to Systems Change in Early Intervention

1
One States Approach to Systems Change in Early
Intervention

• Babies Cant Wait
• Part C of Individuals with Disabilities Education
  Act (IDEA)
• Division of Public Health
• Georgia Department of Human Resources

2
Learner Objectives

• An increased awareness of the current direction
  of systems change in early intervention
  nationally
• An increased understanding of the process of
  systems change
• An increased knowledge of strategies that support
  systems change

3
Courage is moving forward even when youre
unsure of what will happen next.
4
Current Direction of Systems Change in EI
Nationally

• 1997 IDEA re-emphasized the importance of
  providing services to eligible infants and
  toddlers in natural environments
• Shift from segregated, clinic-based programs to
  environments typical to children without
  disabilities
• Purpose of law
• To discourage segregation to encourage active
  participation of children with disabilities and
  their families in their communities.
• Thats why we are beginning here
• All state and program policies must comply with
  federal regulations and laws.

5
Whats Driving Systems Change Nationally?

• Research in early childhood
• OSEP guidance
• IDEA statute re-authorization language
• Communities of Practice

6
Research in Early Childhood

• The purpose of early intervention
• To provide regular caregivers with the support
  needed for them to provide the best learning
  opportunities for children
• Working with families
• Providing emotional, material, and informational
  support
• How children learn
• Through repeated interactions with their
  environment, usually dispersed over time
• The role and/or qualities of providers
• To enhance the competence and confidence of
  caregivers

McWilliam, R. (2004)
7
OSEP Guidance

• OSEP vision and expectation (07/2003)
• Natural Environments means supporting families
  in promoting the childs learning opportunities
  in the context of daily routines, activities, and
  events of everyday life.

8
OSEP Guidance

• Change providers roles and responsibilities
  related to their interaction and communication
  with children and families including
• Increase childrens learning opportunities by
  integrating intervention in the context of
  family/community life
• Modeling and coaching families rather than using
  traditional clinical approaches to intervention

9
IDEA Statute

• To the maximum extent appropriate, early
  intervention services are (to be) provided in
  natural environmentssettings that are natural or
  normal for the child's age peers who have no
  disabilities.

10
IDEA Reauthorization Guiding Principles

• Stronger Accountability for Results
• Simplify Paperwork Increase Flexibility
• Doing What Works implement research-based
  practices proven to help children with
  disabilities learn
• Increase Choices Meaningful Involvement for
  Parents

US Secretary of Education Rod Paige 2/25/03
11
Communities of Practice

• To address key IDEA implementation challenges
  and to promote state improvement and performance
• Co-facilitated by the Regional Resource Centers
  (RRC), OSEP-funded TA specialty centers, and
  Regional Parent Technical Assistance Centers
  (RPTAC).
• Goals are to encourage sharing of expertise and
  discussing solutions.
• www.TAcommunities.org
• Teleconferences, listservs, discussion forums,
  meetings, work groups, resource development, web
  pages, think tanks and conferences

12
The Process of Systems Change
13
Elements That May Influence Decisions to Adopt or
Reject Certain Practices

• State economy
• Existing policies
• Political climate
• Department in which lead agency is located
• Centralized vs. locally driven system
• State leadership
• State agency staff beliefs and values
• Funding mechanisms
• Current infrastructure of early childhood system
• Geography
• Population base

• Collaboration among agencies, e.g. early
  childhood, health, education, mental health,
  disabilities, family support, child care, etc.
• Institutions of higher education programs,
  curriculum, and participation
• Personnel resources
• Licensure/certification requirements
• Statewide interpretation of IDEA
• Current system approaches to IFSP process,
  service coordination, intervention
• History
• Edelman, L. (2004)

14
Lots of ways to learn

• List serves,
  chat groups, bulletin boards
• Learning
  communities
• Web sites
• Reading books,
  journals, newsletters, reports
• Videos, CD-ROMs, DVDs
• Continuing education
  courses Web and face-to-face
• Workshops, conferences
• Participating in pilot
  projects
• Talking to colleagues, families
• In-service training face-to-face,
  web, audio, video
• Mentoring relationships
• Coaching relationships
• Consultation
• Co-visits
• Observation, Shadowing
• On-the-job
• Pre-service Training

Edelman, L. (2004)
15
Ideas to consider

• In light of the complexity and variety of
  approaches at hand, be sure to achieve your own
  clear understanding of the innovations that you
  are promoting.
• Be thoughtful (cautious!) if adapting,
  re-inventing, and piecing together various
  approaches.
• Think systemically when adopting and promoting
  new service models.
• Infuse key practices in ALL of the steps of the
  early intervention and IFSP processes.
• Articulate clear guidance to the field.
• Remember that training is essential, but not
  sufficient.
• Support practitioners by offering a variety of
  accessible learning opportunities beyond
  classroom-based training.
• Consider implementing pilot projects.
• Build your states capacity to provide training,
  technical assistance, mentoring, and coaching.

Edelman, L. (2004)
16
What have we done or tried?

• Identify who has the greatest stake in changes,
  who is likely to feel most threatened by change
  and engage them.

17
What have we done or tried?

• Identify those most likely to be your greatest
  advocates and allies for change and involve them.

18
What have we done or tried?

• Provide organization and forums to encourage and
  welcome questions, doubters, challengers!

19
Do one thing every day that scares you
- Eleanor Roosevelt
20
Stakeholder Input Involvement

• Public forums
• Listening Panels for Service Providers
• Family Input Information Sessions
• Opportunities to provide input via E-mail,
  phone, fax

21
Stakeholder Input Involvement

• Regional Stakeholder Meetings
• Teams of program managers, early intervention
  specialists/special educators, service
  coordinators, occupational therapists, physical
  therapists, speech-language pathologists, and
  parents
• Facilitated planning and problem-solving for
  their own district or region self-assessment and
  action planning to move practice forward

22
Stakeholder Input Involvement

• Produce reports of proceedings, meetings,
  forums, findings.
• Include the good, the bad, and the ugly.
• Make reports public and share with participants
  and broader audiences.
• Use Findings to guide Next Steps, FAQ document,
  and continued dialogue

23
Stakeholder Input Involvement

• Professional (Therapy) Associations
• Liaisons
• Meetings with Officers, Designees
• Meeting with Legislative Staff, Lobbyists
• Presentations at meetings conferences
• Funding for special training initiatives
  national experts within their own fields
  workshops web-based course

24
Stakeholder Input Involvement

• Sent letters inviting information sharing and
  open dialogue to the therapy association
  presidents, therapy licensure board directors,
  and faculty in higher education programs that
  train therapists throughout Georgia.

25
Focus on Families

• Parent Education
• Parent Educators
• Parent Conferences

• Non-English Speaking Families
• Non-Traditional Families

26
Targeted TA for Personnel

• Local Lead Agency Program Managers
• Service coordinators
• State ICC members
• Local ICC members
• Service providers

27
Presentations for Target Audiences

• District Health Directors
• Administrators/Supervisors within Public Health
• Governors Council on Developmental Disabilities
• Higher Education Consortium
• Partners in Policymaking, parent leadership
  initiatives, etc.
• Other conferences, agencies focused on young
  children families

28
Outreach to Community Partners

• Georgia Chapter of American Academy of Pediatrics
• Public Health programs and services for children
  and families
• Department of Education
• Child Care

29
Sharing of Resources Materials

• FAQ document
• Use of websites
• Books, videos, articles, bibliographies

30
Pilot Projects

• Sites were selected to represent diversity of the
  state (urban, rural, multicultural, etc.)
• Intensive training, TA, ongoing support

31
Pilot Projects

• Data collection analysis
• Coaching logs
• Parent/Family surveys
• Provider surveys

32
Special Projects Activities

• Local programs applied for funding for projects
  they defined resulted in increased buy-in!
• Topical Training TA based upon
  locally-identified needs
• Incentives
• Outreach and collaboration activities
• Enhancements to infrastructure
• Etc.

33
Strategies for Presenting Information That Might
be Controversial

• Old Paradigm vs. New Paradigm
• Federal Law Citations
• Citations from Professional Journals
• Citations from Professional Standards, Practice
  Acts, Licensure Laws
• Research, Best Practices,
  Evidence-based practices

34
Old Paradigm vs. New Paradigm

• Treatment models
• Expertise models
• Deficit-based models
• Service-based models
• Professionally-centered models

• Promotion models
• Capacity-building models
• Strengths-based models
• Resource-based models
• Family-centered models

Dunst, 2000
35
Federal Law Citations

• Definition of Early Intervention Services
  Early intervention services are developmental
  services that, to the maximum extent appropriate
  to the needs of the child, are provided in
  natural environments, including the home and
  community settings in which children without
  disabilities participate. (CFR 303.12)

36
Federal Law Citations

• Role of Service Providers in Early Intervention
• Assessment
• Consultation
• Training
• (CFR 303.12)

37
Federal Law Citations

• Definition of Team Processes
• The involvement of two or more disciplines or
  professions in the provision of integrated and
  coordinated services, including evaluation and
  assessment activities and development of the
  IFSP
• (CFR 303.17)

38
Federal Law Citations

• Responsibility Accountability
• Each agency or person who has a direct role in
  the provision of early intervention services is
  responsible for making a good faith effort to
  assist each eligible child in achieving the
  outcomes on the IFSP.
• (CFR 303.346)

39
Citations from Professional Journals

• From physical therapy literature
• Contemporary best practice might incorporate
  the view that therapists need to consider
  themselves more as advisors, counselors and
  purveyors of information to families of children
  with disabilities than as direct care providers,
  and that they need to maintain a long-term
  perspective.
• (Campbell, 1997)

40
Citations from Professional Journals

• From physical therapy literature
• When physical therapists delegate relevant
  intervention strategies to family members,
  children are allowed to receive more consistent
  and comprehensive intervention. This is
  delegation, not abdication, and each therapist
  maintains accountability for the information and
  skills shared
• Beverly Rainforth, 1997
• Pediatric Physical Therapy

41
Citations from Professional Journals

• From occupational therapy literature
• Service providers should move to a different
  position alongside the parent as a coach rather
  than a lead player.
• (Hanft Pilkington, 2000)

42
Citations from Professional Standards, Practice
Acts, Licensure Laws

• In many cases individuals are best served when
  speech-language pathologists work collaboratively
  with other professionals.
• ASHA Scope of Practice in Speech-Language
  Pathology, 2002

43
Citations from Professional Standards, Practice
Acts, Licensure Laws

• Competencies for Physical Therapists in Early
  Intervention, APTA, 1991
• 7.9 Develop an individualized family-focused
  intervention program to enhance the growth and
  development of the child through a partnership
  with the family.
• 8.4 Function as a consultant by providing
  technical assistance to other early intervention
  team members, community agencies, and medical
  facilities.
• 8.6 Demonstrate skill in formal and informal
  teaching of students, families,
  paraprofessionals, and professionals concerning
  physical therapy in early intervention.

44

Citations from Professional Standards, Practice
Acts, Licensure Laws

• AOTA Position Paper on Occupational Therapy
  Services in Early Intervention and Preschool
  Services. (Dunn, Campbell, Oetter, Hall, Berger,
  Strickland 1988)
• The AOTA supports a family-focused approach to
  early intervention and preschool services. When
  families needs are successfully addressed,
  children make more progress as well.
• Occupational therapy supports the concepts of
  family-centered approaches, best practice, and
  professional collaboration in the provision of
  early intervention and preschool services.

45
Research, Best Practice, Evidence-Based Practices

• Federally-funded demonstration projects
• Multi-year research institutes
• Recommended Best Practices (e.g., DEC Recommended
  Practices in Early Intervention/Early Childhood
  Special Education)

46
What have we learned?
47

• You have to have confidence in your ability and
  then be tough enough to follow through. -
  Rosalyn Carter

48
What have we learned?

• Stakeholder involvement input is a lot of work
  but its critical
• Provide multiple opportunities, venues, formats
  for information exchange
• Proceed slowly Allow reasonable time for people
  to get on board with change
• Keep key stakeholders involved every step of the
  way

49

• No leader can be too far ahead of his
  followers. - Eleanor Roosevelt

50
What have we learned?

• Be able to articulate your conceptual framework
  or vision, even if the details arent finalized
• Stand firm in your commitment to change
• Keep the lines of communication OPEN!
• Do whats right not whats easy!

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Recommended Resources

• A Road Map for Facilitating Collaborative Teams
  (P. Hayden, L. Frederick, B. Smith, 2003
  Sopris West)
• www.sopriswest.com
• or [phone]

53
Recommended Resources
Coaching Families and Colleagues in Early
Childhood(Barbara E. Hanft, M.A., OTR, FAOTA,
Dathan D. Rush, M.A., CCC-SLP, MLisa L.
Shelden, Ph.D., PT, 2004 Brookes
Publishing) www.brookespublishing.com or
1-800-638-3775

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Rethinking Intervention
http//www.poweroftheordinary.org
55

• http//www.coachinginearlychildhood.org

56
http//www.nectac.org/calls/2004/partcsettings/pa
rtcsettings.asp
57
Just Being KidsJFK PartnersUniversity of
Colorado Health Sciences CenterWestern Media
Productswww.media-products.com1-800-232-8902
58
Our Top Ten Must Reads

• Campbell, S. (1997). Therapy programs for
  children that last a lifetime. Physical and
  Occupational Therapy in Pediatrics, 7(1), 1-15.
• Cripe, J.W., Venn, M.L. (1997). Family-guided
  routines for early intervention services. Young
  Exceptional Children, November, 18-26.
• Dunst, C.J., Bruder, M.B., Trivette, C.M., Raab,
  M., McLean, M. (2001). Natural Learning
  Opportunities for Infants, Toddlers, and
  Preschoolers. Young Exceptional Children, 4(3),
  18-25.
• Dunst, C.J., Harter, S., Shields, H. (2000).
  Interest-Based Natural Learning Opportunities.
  Young Exceptional Children Monograph Series No. 2
  (pp. 37-48). Denver, CO Division for Early
  Childhood of the Council for Exceptional
  Children.

59
Our Top Ten Must Reads

• Hanft, B.E., Pilkington, K.O. (2000). Therapy
  in natural environments The means or end goal
  for early intervention? Infants and Young
  Children, 12(4), 1-13.
• Jung, L.A. (2003). More is better Maximizing
  natural learning opportunities. Young
  Exceptional Children, 6(3), 21-26.
• McWilliam, R.A. (2000). Its only naturalto have
  early intervention in the environments where its
  needed. In S. Sandall M. Ostrosky (Eds.),
  Young Exceptional Children Monograph Series No. 2
  (pp. 17-26). Denver, CO Division for Early
  Childhood of the Council for Exceptional
  Children.

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Our Top Ten Must Reads

• Mullis, L. (2002). Natural environments A
  letter from a mother to friends, families, and
  professionals. Young Exceptional Children, 5(3)
  21-24.
• Rosenkoetter, S.E. Squires, S. (2000). Writing
  outcomes that make a difference for children and
  families. Young Exceptional Children, 4(1), 2-8.
• Shelden, M.L., Rush, D.D. (2001). The ten
  myths about providing early intervention services
  in natural environments. Infants and Young
  Children, 14(1), 1-13.

61

• At first people refuse to believe that a
  strange new thing can be done. Then they begin to
  hope it can be done. Then they see it can be
  done Then it is done and all the world wonders
  why it was not done centuries ago.

- Author unknown
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Contact Information

• Stephanie Moss
• Part C Coordinator
• 2 Peachtree Street NW
• Suite 11-206
• Atlanta, GA 30303
• 404-657-2721
• Skmoss_at_dhr.state.ga.us

• Paula Forney
• TA Specialist
• 2 Peachtree Street NW
• Suite 11-206
• Atlanta, GA 30303
• 404-463-3479
• Peforney_at_dhr.state.ga.us

63
Thank you for your attention!
64
Questions???
65
Additional References Cited Today

• Dunst, C. (2000). Revisiting rethinking early
  intervention. Topics in Early Childhood Special
  Education, 20, 95-104.
• Rainforth, B. (1997). Analysis of physical
  therapy practice acts Implication for role
  release in educational environments. Pediatric
  Physical Therapy, 9(2), 54-61.