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
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.