Peter Limbrick writes: In parts 1 and 2 of this essay, I described collective competence and the consultant model within multidisciplinary and multiagency team work – the TAC approach.
When practitioners decide to join their efforts together around a child and family (remembering the parent is fully with them in the TAC), they create welcome flexibility in where, when and how often each of them will see the child for direct interventions.
This helps take the pressure of children, families and practitioners at the same time as giving fuller expression to everyone’s concern, wisdom, knowledge and skills.
Let’s go to Australia where much good work in ECI is being done. This will show us how the consultant model and collective competence can best be applied to help children develop and learn naturally in the real world beyond the clinical/medical domain.
ECIAs’ National Guidelines ‘Best Practice in Early Child hood Intervention’ tell us on pages 12 and 13:
Engaging the Child in Natural Environments: promotes children’s inclusion through participation in daily routines, at home, in the community, and in early childhood settings…
Interventions are more effective when they reflect everyday activities and routines such as getting dressed and mealtimes.
This is an authoritative document and contains a valuable list of references for anyone wanting to get up to date in ECI.
Their second publication is a Family Booklet ‘Choosing Quality Early Childhood Intervention Services and Supports for Your Child: What you need to know’. The Booklet advises on Page 14:
Routines and everyday activities are a perfect opportunity for your child to practice and build their skills with your support. Many routines happen every day, or many times a day, providing lots of learning opportunities and practice for your child. Research shows that repetitions improve the brain’s ability to learn and retain new skills.
I wish every family and every practitioner could read this Family Booklet!
If we follow this good practice we will support families, when they ask us, in helping their child develop new understanding and practice new skills while, for instance, getting dressed or having lunch at home or playing on the floor amongst other children in an early years setting.
The first step is to think about who is equipped to support the child and family in this way. The speech and language therapist will not get very far at lunch time without listening to the parent’s experience of the child’s tastes, likes, dislikes and methods of communicating wants and preferences. She or he will also need to know from the physiotherapist and occupational therapist about how to help the child’s posture, head control and hand functions, and about utensils and seating. If the child has intellectual disability, help will be needed from an early year’s teacher.
We can apply the same considerations to the child on the floor with other children. The practitioner trying to help will have to think about the child’s emotional state, motivations, degree of comfort with other children, favourite toys – and then their posture, movement, hand function, communication, understanding…
In very many cases, these are the activities and goals of practitioners already supporting the child either separately or in some degree of teamwork. But we cannot have them all sitting around the table at lunch time or surrounding the child on the floor in the nursery.
The answer is for the practitioners to get organised so that, when the family asks for help, there will only be one practitioner at the occasional lunch time and only one on occasions supporting nursery staff. Collective competence, the consultant model and the role release within it will ensure that the practitioner is fully briefed and competent to support the child as a whole child. The practitioner helping a child and family in this way becomes the primary provider or primary interventionist for that period of time.
Whether we focus on getting dressed, a meal time, play activity with other children or another natural activity, will depend on what parents feel is important at the time. But, to be clear, I am suggesting this focus on natural activities becomes the preferred therapy/education approach to help children develop and learn outside the clinic setting.
There can be no compulsion in this. Adopting the approaches I have described in the three parts of this essay is the decision of the child’s TAC and, for their success, it is essential that TAC members – parent and practitioners – respect and trust each other. But ECI and early support practitioners might want to consider these approaches as antidotes to:
- treating a child in bits instead of as a whole child
- overwhelming the child with too many people and separate programmes
- overwhelming the family with too many interventions in too many places
- overwhelming practitioners who have large caseloads and feel they must offer direct interventions to every child on a regular basis.
In the end, TAC is only a mechanism for the main people around a child to arrive at collective decisions in the best interests of the whole child and family. That is all it is.
The subject also forms part of the discussions in the ECI without Tears Seminar Series: Seminar series (UK) - new work with infants with disabilities ‘ECI without Tears’ Bristol, Wakefield, Liverpool, Exeter, Sheffield & Manchester in 2018
Peter Limbrick, November 2017