Applying systems thinking to support an infant with ‘multiple disabilities’, Part 2. Designing a multifaceted intervention system for each child
This follows How to apply systems thinking in support of an infant with ‘multiple disabilities’ – moving on from the old ways in TAC Bulletin 196
In that earlier piece I suggested that separate diagnoses of hearing or vision impairment, learning disability, cerebral palsy, autism, etc. cannot be considered as separate from each other when a child is learning or practising a multi-component task. Such tasks for an infant include rolling to reach a toy, pulling off a sock, putting a brick in a box, getting spoon to mouth, climbing to a parent’s lap and signing for a drink.
Those supposedly separate disabilities each with their own label, are interconnected in the child’s learning and exist now as separate entities only in the minds of the child’s teachers, doctors, parents and psychologists. It is more productive to think instead of each child having a single and unique multifaceted condition.
Systems thinking then logically leads us to providing for each child a single and unique multifaceted intervention system in which programmes and the professionals that offer them are interconnected into a coherent whole.
Part of this is to integrate each infant’s education programmes and therapies as far as appropriate and the forum for doing it is the child’s TAC meeting. The following is an extract from Early Childhood Intervention without Tears (p 35):
How the infant’s programmes for development and learning can be integrated
An integrated intervention system requires that the main practitioners involved with the infant’s development and learning integrate as appropriate their approaches and goals instead of working separately from each other. The infant’s TAC meetings are the ideal forum for planning this and offer graded opportunities for this integration. The degree of integration is always a TAC decision – not forgetting that parents are full members. Stages of increasing integration are as follows:
Stage 1:
Practitioners and parents tell each other what they are working on with the child. This brings the benefit of seeing the pattern of interventions as a whole, resolving contradictory approaches and avoiding wasted time and effort when two people are offering similar work to the child. Judgements can be made about whether the child is being offered too many or too few people and programmes. Similarly, whether parents are being asked to do too many things at home. Parents, typically, are concerned when their infant’s practitioners do not talk to each other, leaving the parent as the go-between. This is disrespectful to the infant and family and puts yet one more demand on the parent.
Stage 2:
Practitioners and parents adopt relevant parts of each other’s approaches. This can increase the infant’s opportunities for learning and practising particular tasks and facilitate the interplay between their various activities and abilities. For instance, each can offer the infant practice in the agreed signs, symbols or spoken words, each can incorporate the same postures and movements into their work with the child when it is appropriate.
Stage 3:
Practitioners and parents can work towards some degree of actually joining together the infant’s development and learning programmes. This can be helped by agreeing to move from planning a discipline-based ‘physiotherapy programme’ or ‘speech and language therapy programme’ to a child-based ‘getting dressed programme’, a ‘mealtime programme’ or ‘a playing on the floor and moving around the room programme’. In this way the infant gets whole-child learning opportunities in relevant situations and times and with natural opportunities to join abilities together. One outcome of this sharing process is ‘collective competence’ as explained below.
Stage 4:
It might be decided that one person could take on the work of another using the ‘consultant model’ in which one person hands over some part of their work with an infant to another TAC member who is competent to take it on with necessary support. This will reduce the number of people doing regular hands-on work with the child. This has direct advantage to the child, reduces the number of necessary sessions at home or in clinics, and supports service providers in their efforts to make the best use of their limited resources.
Stage 5:
The consultant model described above can progress, by TAC decision, into agreeing one of the team as the single primary interventionist who becomes for an agreed period of time the one practitioner doing most of the regular hands-on work with the child. The working unit now becomes a team of three (or four) – infant, parent (or parents) and primary interventionist.
Collective competence, mentioned above, answers the question, ‘Who can be competent to offer whole-child development and learning opportunities to an infant who has a multifaceted condition?’ Taking, for example, a baby with early diagnoses of blindness and cerebral palsy: the mother knows a lot more than anyone else about her baby but still has much to learn about both of these conditions and how they will impact on the growing infant. The paediatric physiotherapist might well have very little experience of blind children. Similarly, the vision specialist teacher might not yet have worked with any children with cerebral palsy. Competence only comes when these three people and the infant bring what they know and what they can do into a shared effort. Collective competence requires a degree of trust, shared aspirations and humility.
