A child is learning and developing new skills all the time. In addition, all areas of development are intertwined. Children do not learn motor skills in isolation of cognitive or communication skills in isolation. As a child learns to crawl, he is also exploring his environment (cognitive). He may also be responding to communication from mom as she says “come here.” Each routine a child participates in allows for opportunities for growth across all areas of development.
One of the seven key principles of natural environment services is that the family’s priorities are best addressed by a single, primary provider who has support from a team and community resources. In the PSP model, one primary provider works with the family and child on a regular, ongoing basis. Other disciplinary providers who are needed support the primary provider through consultation in team meetings or during sessions with the family and primary provider. Because routines involve skills across all developmental areas, it is unlikely that a single provider would address an isolated area of development when embedding strategies into the routine. For example, the list below describes a few of the developmental skills that children are learning during the bath time routine.
Gross Motor—Practicing independent sitting
Cognition—Learning about the properties of water, color, movement, temperature, space, etc.
Fine Motor—Practicing reaching and grasping, building arm strength through splashing, pushing through water,
Communication—Learning body parts when caregiver is washing different areas
Social—Reciprocating interaction while playing with sibling or caregiver
Using routines-based intervention, the primary provider addresses all areas of development within daily routines. Other providers are used as consultants. For example, a developmental specialist looking at a child’s bath time routine might be very comfortable providing ideas about social games, water play, and communication but may want to consult with a physical therapist on the team about adaptive seating in the bath tub. Or, if the primary provider was a physical therapist, she may be very comfortable giving strategies related to adaptive seating, water play, and social games, but may need to consult with a speech-language pathologist for ideas about increasing the child’s communication with mom. The primary provider may change over time (as the family’s concerns move more toward communication, the PT may no longer be the appropriate primary provider).
There are many benefits to the PSP model. Having one provider visit on a regular basis means the parent can focus on developing trust and rapport with one person. This model also encourages teaming, thereby increasing coordination of services. Gaps in communication (OT says “I thought speech was addressing feeding all this time”) and service overlaps (PT and OT are both addressing sitting balance) are decreased. The model promotes consistent, collaborated service. The primary provider is aware of all strategies that have been offered or tried and is able to update the team on what is working or not working.
The PSP model is based on information about the way children and adults learn. It promotes communication between team members to help achieve IFSP outcomes and increase caregiver confidence and competence.
Why do you like this model? If you have concerns about the model tell us why? What evidence is available that supports or refutes any service delivery model?
For more information:
Shelden ML & Rush DD (2013). The Early Intervention Teaming Handbook The primary service provider approach. Baltimore, MD: Brookes Publishing.
Woods J (2004). Enhancing services in natural environments. NECTAC Conference Call. retrieved on March 21, 2013 from: http://ectacenter.org/~calls/2004/partcsettings/woods.asp.
Workgroup on Principles and Practices in Natural Environments (February, 2008) Seven key principles: Looks like/doesn’t look like. OSEP TA Community of Practice-Part C Settings. http://www.nectac.org/topics/families/families.asp
– Jamie Holloway