The Rural Beginnings Project

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The Rural Beginnings Project
The Transdisciplinary Team Approach
As part of The Rural Beginnings Project
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Why is the Rural Beginnings Project needed?
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• Families living in rural and remote areas have
  had lack of access to therapy services.

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• Major gaps in services exist, particularly in
  rural areas, due to difficulties in recruitment
  and retention of therapists.
• Review of Therapy Services (Maher et al, 1998)

Physiotherapist
Speech Pathologist
Occupational Therapist
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• Another concern is the lack of adequately trained
  personnel working in the area of early
  intervention (Kemp Hayes, 2005).

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• Kemp Hayes (2005) noted that no one government
  department or organisation provides the full
  comprehensive range of services making
  coordination of early intervention services very
  difficult.

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Responding to the Challenge

• KEIS has responded to these challenges by
  developing an integrated service delivery model
  in which a team of professionals in the fields of
  health and education work with families.

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An Independent Evaluation of KEIS by Charles
Sturt University in 2002 stated that

• This integrated service delivery model is
  regarded as a lighthouse program and has created
  a great deal of interest both within the state
  and nationally as a viable alternative to the
  ubiquitous separate services model.
• (Hill, Hemmings and Davies, 2002).

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• Kurrajong Early Intervention Service (KEIS) was
  successful in obtaining a grant over four years
  (2004-2008) under the Australian Governments
  Early Childhood Invest to Grow initiative as
  part of the Stronger Families and Communities
  Strategy to operate the Rural Beginnings
  Project.

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• The Invest to Grow initiative is designed to
  build on the evidence of what works for
  Australian families and to then refine and
  develop a model, such as Rural Beginnings, for
  national application.

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Evaluation

• The Rural Beginnings Project is being evaluated
  by the Charles Sturt Universitys (CSU) Centre of
  Rural for Social Research under the leadership of
  Professor Margaret Alston.

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• The Rural Beginnings Project is an expansion of
  our existing successful model of early
  intervention to include therapy and family
  support to families living in the nine Local
  Government Areas around the regional city of
  Wagga Wagga, NSW.

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Features of the Rural Beginnings Service Model

• Hub and Spoke model used to deliver coordinated
  services to rural communities.
• Family centred practice as the most important
  principle of our service delivery using family
  empowerment and developmental framework
  integration and coordination inclusion.
• Transdisciplinary team approach used as the most
  effective model of integrated service delivery.

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Hub and Spoke Model

• The service model used to deliver the Rural
  Beginnings Project out to rural and remote
  families is the hub and spoke model.

Temora
Cootamundra
Lockhart
Narrandera
Junee
Coolamon
Gundagai
Wagga Wagga
Tumut
Tumbarumba
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Three Areas and Three Teams for the Rural
Beginnings Project

• Tumut, Tumbarumba, Gundagai LGAs
• Temora, Cootamundra, Junee, LGAs
• Narrandera, Coolamon, Lockhart LGAs

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The project allows for the equivalent of

• One Occupational Therapy position.
• One Physiotherapy position
• One Speech Pathology position
• One Psychology position
• One Educator position
• One Project Assistant
• across the nine Local Government Areas

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Composition of the three teams

• Each team comprises of
• A Speech Pathologist, Occupational Therapist and
  a Physiotherapist for two days each and an
  Educator for three days
• with the Family and Behavioural Support Unit,
  Manager, Project Assistant, working across all
  teams.

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• Strong commitment to professional development and
  training.
• A structure of supervision and mentoring for
  staff.
• Each team consists of a blend of expertise and
  experience.
• Every outreach worker has a mixed case load eg.
  50 outreach and 50 centre based.

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How many families will benefit from the Rural
Beginnings Project?

• In total between 60 to 70 families each year
  with over 200 families in total receiving a
  service from KEIS.

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Family CentredFamilies are an integral part of
the early intervention team. They are skilled
up to become their childs most important early
intervention worker.
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The importance of family centered practice

• Before your service can become
  transdisciplinary, families must be at the centre
  of your practice.

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The Transdisciplinary Team Approach
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Three main models of team structure

• Multidisciplinary
• Interdisciplinary
• Transdisciplinary

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Transdisciplinary Team Approach
The transdisciplinary team approach means that
different disciplines work together with the
family to provide a coordinated, integrated,
holistic service for the child and family. Team
members develop shared meaning.
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New Way of Team Work

• If the complex needs of families today are to
  be met, a coordinated and coherent approach is
  necessary. This approach requires new ways of
  working that are neither multidisciplinary nor
  interdisciplinary but are trans-disciplinary
• (Carpenter, 2005, p.31).

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The transdisciplinary team model Best practice
for early childhood intervention.
Source Does this child need help?
Identification and Early Intervention 1st
Edition (1993)
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Why is transdisciplinary team practice the
preferred model in early childhood intervention?

• The transdisciplinary team model (TDM) recognises
  the family as an equal and valued member of the
  early intervention team.
• Families who have children with disabilities have
  very complex needs and therefore require a
  diverse range of disciplines and services to meet
  their needs. TDM allows for coordination of
  services.
• Because families have children with complex
  needs, there are often large numbers of
  professionals and services in their lives. Role
  release allows the family to interact primarily
  with a key worker.
• Through multiskilling, role release and
  coordination of services, all team members
  including the family develop shared meaning.

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• The TDM recognises the importance of skilling
  up the family to become their childs most
  important early intervention worker.
• The TDM recognises how the family and each
  discipline contributes to the overall picture of
  the child.
• Early childhood intervention practitioners,
  particularly new graduates, like to work within
  transdisciplinary teams.
• A transdisciplinary approach is a very efficient,
  cost effective way of delivering services to ever
  increasing numbers of children requiring early
  intervention.
• This approach addresses the personnel shortage of
  therapists particularly in the country by
  alleviating the need for face to face time with a
  series of therapists.

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Second Generation of Transdisciplinary Team
Practice

• the most positive aspects of the
  transdisciplinary model (ie. role release,
  parental involvement in assessment and
  programming, and provision of instruction in the
  context of naturally recurring environments) have
  been adopted to a significant extent by all three
  models. In effect, the interdisciplinary and
  multidisciplinary team models have become blended
  with transdisciplinary elements.
• (Lamorey Ryan 1998, p.329).

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Refinement of Transdisciplinary Model by KEIS

• The model of transdisciplinary practice used by
  KEIS modifies and refines the transdisciplinary
  model, incorporating best practices of the
  transdisciplinary model to meet the needs of our
  families, our service and our community.
• Every service should review the research on
  teaming models and adapt the model to suit the
  needs of their individual client families.

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The Transdisciplinary Approach at Kurrajong Early
Intervention Service

• sharing of information and skills across
  disciplines,
• recognising the family as equal members of the
  team,
• collaboration and partnership between all team
  members,
• coordination of services and programs by a key
  worker,
• flexible and responsive service delivery to
  assist the family to meet their own needs,
• skills up the family so that they can be their
  childs most important early childhood
  intervention worker.

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• Activity One
• Turn to your workbook. Use the Table of the Key
  Components of a Transdisciplinary Team and use
  the KEIS model as a guide then look at yourself
  as a team member and list some activities you
  could do to become more transdisciplinary.

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Myths and Misconceptions

• Myth one
• To be called a transdisciplinary team you need a
  full complement of educator, physiotherapist,
  occupational therapist, speech pathologist and
  family support worker.
• Clarification
• Transdisciplinary simply means sharing skills
  across the disciplines with coordination of
  services by a key worker. Transdisciplinary means
  everyone that is in the team around the child.
  This team can vary greatly depending on the needs
  of the child and the availability of resources.
• Teams committed to sharing meaning across
  disciplines including the family and coordinating
  services with a key worker can call themselves
  transdisciplinary.

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• Myth two
• The key worker will become a supertherapist
  with no need for other therapy involvement
  there will be a loss of professional identity.
• Clarification
• In transdisciplinary team models therapists
  enhance their professional identity. When
  therapeutic input is shared and integrated
  meaningfully into educational programs, other
  team members tend to increase their knowledge,
  respect and value for other therapists.

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• Myth three
• A transdisciplinary approach involves
  exclusively indirect therapy services. Therapists
  do not work directly with the child, and the
  child receives less intensive therapy.
• Clarification
• An effective transdisciplinary model cannot be
  maintained if therapists are removed from working
  directly with children. Effective indirect
  services require a direct hands on component
  with retained accountability. However with a
  transdisciplinary approach it doesnt always need
  to be as frequent contact as other team members
  are skilled up to carry out some parts of the
  therapy program.

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• Myth four
• In the transdisciplinary model individual
  disciplines do not perform their own discipline
  referenced assessments.
• Clarification
• Each discipline still assesses the child in
  their specific discipline but the planning,
  process and assessment report is integrated and
  coordinated. One team member acts as a play
  facilitator working with the child to gather
  information across all disciplines whilst another
  team member acts as the parent facilitator.

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• Myth five
• By role releasing part of the therapists role
  to another team member, there will then be
  questions of litigation and liabilities when a
  team member is implementing an intervention they
  are not specifically trained in.
• Clarification
• Role release involves both trust and respect for
  the other team members and being able to let go
  of their specific role when appropriate. Role
  release also involves role support from other
  team members. The therapist only role releases
  appropriate intervention under supervision. Role
  release also involves role support. Role support
  provides specific interventions that are too
  complicated, too new and beyond the skills of the
  key worker.

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• Myth six
• You need to have a lot of paediatric experience
  prior to being able to work in a
  transdisciplinary manner.
• Clarification
• Providing you have a team with members who have
  differing levels of experience so that those with
  more experience can act as mentors and all team
  members are prepared to share knowledge and
  experience then an individual team members level
  of experience isnt a prerequisite for working in
  a transdisciplinary team.

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Team Around The Child
PHYSIOTHERAPIST KEY WORKER Key Worker
integrates and coordinates programs for the
family and child.
FAMILY Family to monitor progress and implement
ideas provide information on how best to approach
problem with child (as they know them best).
EDUCATOR In early learning groups the educator
to provide activities where the child can
gradually increase his time in the wheel chair.
CHILD Child with severe spastic quadriplegia CP
has a Mullholland GGS wheelchair and is not
tolerating it for very long. After approximately
10 minutes he uses an extensor thrust to indicate
he wants to get out, when doing so he rotates his
pelvis and gets stuck with his pelvis pushing on
positioning (pelvic bar sub ASIS bar). He then
becomes quite upset and is only calmed by taking
him out of the wheelchair.
FAMILY BEHAVIOUR SUPPORT UNIT To provide
behaviour strategies to support team in
increasing tolerance of the chair. Brief direct
counseling for the familys experience of a
childs distress.
CHILD
PHYSIOTHERAPIST/ OCCUPATIONAL THERAPIST The
Physiotherapist works with the Occupational
Therapist ensure seating system is adjusted
appropriately and to experiment to increase
comfort and tolerance to also increase control
eg. using seating system on a power base teach
use and correct positioning within it.
PRESCHOOL Inservice preschool re positioning
child in wheelchair in preschool setting.
SPEECH PATHOLOGIST The Key Worker consults
with The Speech Pathologist work on alternate
means of communicating discomfort/desire to get
out.
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Activity Two - Workbook

• Team Around The Child.
• Think of a child and family you are working with
  then look at one of the priorities from the
  familys IFSP. Now put your team around the child
  using transdisciplinary practice to help you with
  this priority.

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Challenges for Professionals Working in the
Transdisciplinary Team Model

• working collaboratively in a team context,
• seeing components of the development of the child
  in isolation without an holistic view of how a
  delay in one area of development will affect
  development in other areas,
• viewing the child within the context of the
  family and of the wider community,
• viewing families as equal partners in the
  therapeutic process.

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Gate Keeping and Turf Guarding
Source Does this child need help? Identification
and Early Intervention (1993) 1st edition
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New Skills for the Early Childhood Intervention
Worker

• Technical knowledge and skill,
• Help giving behaviours,
• Participatory Involvement
• Dunst and Trivette (1997).

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Emotional Intelligence Essential for Operating in
a Transdisciplinary Team

• Emotional Intelligence is the ability to manage
  ourselves and our relationships effectively.

Activity Three Rate your own emotional
intelligence in your workbook.
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New Skills for Leadership of Transdisciplinary
Team

• Leadership is not just about the management of
  the service, it is being able to inspire
  professionals from different disciplines to work
  together with families as a coordinated, well
  functioning team based on mutual respect and
  trust.

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Team Around The Child! Working Together in
Early Childhood Intervention.

• As part of the Rural Beginnings Project KEIS is
  publishing a book to assist other early
  childhood intervention services.
• This book will be available
• in May, 2007.

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• In conclusion
• The Rural Beginnings Project will not only make a
  difference for children and their families living
  in the Riverina area but it will make a
  difference by contributing to a national evidence
  base and enhancing early childhood intervention
  service delivery in rural and remote areas across
  Australia.

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References

• Carpenter, B. (2005) Real prospects for early
  childhood intervention Family aspirations and
  professional implications. In Carpenter, B.
  Egerton, J. (eds.), Early Childhood Intervention.
  International perspectives, national initiatives
  and regional practice. West Midlands SEN Regional
  Partnership. Great Britain.
• Dunst, C.J., Trivette, C.M. and Jodry, W.
  (1997). Influences of social support on children
  with disabilities and their families. In
  Guralnick, M.J. (Ed.), The effectiveness of early
  intervention. Baltimore, Maryland Paul H.
  Brookes.
• Hill, B. Hemmings, D. Davies, S. (2002)
  Meeting Diverse Needs An evaluation of an early
  childhood intervention service. A Report for
  School of Education CSU and Kurrajong Waratah
  Board.
• Kemp, C. Hayes, A. (2005) Early intervention
  in Australia. The Challenge of systems
  implementation. In Guralnick, M,J. (ed). The
  Developmental Systems Approach to Early
  Intervention. Paul H Brookes Publishing Co,
  Baltimore, Marylands.
• Lamorey, S. Ryan, S. (1998) From contention
  to implementation A comparison of team practices
  and recommended practices across service delivery
  models. Infant Toddler Intervention. The
  Transdisciplinary Journal (Vol. 8, No 4, pp.309
  331) Singular Publishing Group.
• Johnson, C. (1993) Does this child need help?
  Identification and Early Intervention (1993), 1st
  edn. Sydney.
• Limbrick, P. (2005) Team around the child
  Principles and practice. In Carpenter, B.
  Egerton, J. (eds.), Early Childhood Intervention.
  International perspectives, national initiatives
  and regional practice. West Midlands SEN Regional
  Partnership. Great Britain.
• Maher, L. et al (1998) Review of therapy
  services. NSW Department of Ageing and
  Disability.
• McGonigel, M., Woodruff, G.,
  Roszmann-Millican, M. (1994). The
  transdisciplinary team A model for family
  centred early intervention. In Johnson, R et al
  (eds.). Meeting the early intervention challenge
  Issues from birth to three (2nd edition,)
  Baltimore Paul H. Brookes.