Question
Are there guidelines for or questions an IFSP (Individualized Family Service Plan) team should ask themselves when deciding whether an infant or toddler with developmental delays or disabilities, under the age of 3, needs direct speech therapy or whether
Answer
This has been a "hot" question for as long as I have worked in early intervention. Sometimes it is fueled by a shortage of speech-language pathologists or a limited understanding of what speech and language services look like in the birth to age three population, instead of addressing what services best meet the needs of the child. In a "best practice" scenario, the team would use a transdisciplinary model. This model is based on the theory that a child does not perform skills in isolation but that multiple needs are interrelated. Use of this model requires a sharing of information and skills across discipline-specific boundaries. With this model it is possible that one discipline will be the primary family contact and the others will serve as consultants. (Visit www.ericdigests.org/pre-9213/early.htm for descriptions of the three team models of intervention.)
There are few programs that exercise a true transdisciplinary model in assessment and intervention. It requires a group of professionals who are accustomed to working together as a team. It requires professionals to surrender discipline-specific boundaries and to have a working knowledge of the other disciplines. So your question as stated above does not have a simple answer. The IFSP team should include an SLP who has evaluated the child if this question is even to be asked. The age, medical diagnosis and prognosis, risk for future delays, current delays, disabilities, and general function of the child all need to be discussed and considered in answering this question. Other important questions are: What are the skills of the developmental therapist? What will "support" from an SLP look like in practice? If SLP support is recommended, describing the support services should be detailed in the IFSP. There should be frequent reexamination of this support role and modifications made as needed. Changes in frequency of support visits, communication between the SLP and the developmental therapist, and change to direct SLP services should be considered periodically.
Cheryl Stewart has been a speech-language pathologist for 15 years. She is the Clinic Coordinator for the Speech & Hearing Clinic at Miami University in Oxford, Ohio. She worked for four years as part of a transdisciplinary team in a NICU and NICU-to-home program in New York City.
Cheryl Stewart, M.A.,CCC-SLP
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