So often, families are connected with services, based on the age of the child (you must be in EI if you are under 3, or in school services if over 3), and not the needs of the child and family at the time. The difficulty is that limited resources (insurance, state funding, etc) are available, and if they are being used by one program that is not meeting the needs of the child and family at the time, they cannot be used by another.
Another issue is that families are not empowered to explore all options. Each program feels that they have the most effective, evidence-based method of helping their child. However, children change, families change and situations change.
Example, since I know I am rambling:
A child with a mild developmental delay without neurological impairment who is showing good progress and no atypical issues, and who has an engaged family, should do well in a consultative model of service with periodic visits. However, if that child has a surgery, or sudden onset of other significant issues, a burst of higher intensity intervention may be needed for a period of time. This doesn’t mean activities are not embedded in daily routines and social issues are not addressed. Therapy, done well, should be engaging families and caregivers, and working on functional outcomes.
However, this will also require a shift in thinking. One of the things I try to instill in my students is the concept of “episode of care” and a top-down model of evaluation. Any therapist could evaluate any person and come up with a laundry list of issues to work on. But are those a priority? Are they impacting the function of that person? And do we, as therapists, have the ability to say we can fix everything?
If we determine what the priorities are prior to evaluation, and then base the evaluation on what is missing to allow that to happen, we develop an episode of care focusing on those issues. Intensity can then be determined individually. And the episode may lend itself to a less intense model, or it may not.
But there are two things we have done incorrectly in the past: encouraging dependence in families of children with special needs, and fostering the thought that more is always better.
Sometimes, less is better, sometimes more, but we need to have the professional judgement and family awareness to know when.