Diane Paul, PhD, CCC-SLP Director, Clinical Issues In Speech-Language Pathology American Speech-Language-Hearing Association

 Family of documents (technical report, position statement, guidelines, and knowledge and skills) related to the role of the speech-language pathologist in the assessment and treatment of communication and swallowing disorders in the infant and toddler population.  Address issues related to specific cultural and linguistic needs of infants and toddlers and the need for culturally-appropriate practice.

 Position Statement  Technical Report  Knowledge and Skills  Guidelines

 About 17% of children in the United States have had a developmental disability (Centers for Disease Control and Prevention, 2007)  Many children with developmental disabilities have communication and feeding/swallowing problems needing SLP services.  limited interest in social interactions  failure to respond to speech or name  reduced or atypical babbling  restricted prelinguistic communication acts (sharing attention or engaging in reciprocal “baby” games)  limited use of communication gestures such as pointing  delayed acquisition of first words  slow growth or regression in vocabulary or utterance length  poor speech intelligibility for developmental level  limited or poor feeding and swallowing skills

 Speech-language pathologists have a central role in providing services and supports for families and their infants or toddlers with disabilities as members of the early intervention team.  Families with infants and toddlers (birth-36 months) who are at risk for or have disabilities should receive developmentally supportive care that addresses a broad spectrum of priorities and concerns.

 Four guiding principles should be considered in the design and delivery of services to infants and toddlers with disabilities.  Reflect current consensus about optimal practices for infants and toddlers (birth - 3 yrs)

 Early intervention services are family-centered and culturally and linguistically responsive  Align services with each family’s unique situation, culture, language/s, preferences, resources and priorities

 Early intervention services are developmentally supportive and promote children’s participation in their natural environments  Appropriate for child's age, cognitive level, strengths, family concerns and preferences

 Early intervention services are comprehensive, coordinated, and team-based  Effectively integrated to meet all of the needs of the child and family

 Early intervention services are based on the highest quality evidence available  Merger of highest quality and most recent research with professional expertise and family preferences  Mix of internal and external evidence ▪ Internal Evidence (experience, policies, informed clinical opinion) ▪ External evidence (scientific literature and assessment of quality of study)  Challenges  Be able to sort out internal and external evidence  Understand how to evaluate the strength of evidence  Know how to proceed when there is minimal evidence  Know how to monitor progress in different settings

 Prevention  Screening  Evaluation  Assessment (to determine intervention programming)  Intervention planning, implementation, and monitoring  Consultation  Service coordination  Transition planning  Advocacy  Awareness and advancement of the knowledge base

Service Delivery Models  Location  Natural environments—home and community settings  Type  traditional, one-to-one, direct clinical model (pull-out)  more indirect collaborative approaches  Team-based  Multidisciplinary  Interdisciplinary  Transdisciplinary

 Characteristics  Involves multiple professionals  Complete separate assessments and provide independent services  May meet to discuss child  Drawbacks  Not cohesive  Limited number of opportunities for professional to interact with one another and the family

 Characteristics  Professionals work together  Consistently coordinate information and resources  Collaborate with the families and other to achieve priority outcomes  Tools may be a single integrated assessment, discipline-specific tools, or some combination.  Communicate findings and recommendations  Share responsibility for providing services

 Characteristics  Team members work together for assessment and intervention  Some type of “role release” occurs  Professionals may serve as consultants to team lead  Sometimes referred to as a primary service provider (PSP) model  Possible benefits  Learn new skills across domains simultaneously and synchronously rather than in isolation.  Team’s message is unified by lead member working closely with the family.  Less fragmentation  Concerns  Role release without training  Lack of involvement of SLP when needed

 How is the team lead selected?  Based on the needs of the child, relationships developed with the family, and special expertise  In consultation with the family  PSP should be SLP when feeding/swallowing and communication are primary concerns  May be other discipline such as special education, nursing, or occupational therapy, and the SLP will play a support role  Should not be established by prior program policy or based on logistics such as travel or caseload

 Early Intervention is a field with many disciplines.  It is not appropriate for SLPs to train others to perform professional level services unique to SLPs or for SLPs to perform services outside of their scope of practice.

Help family enhance child's communication development through consultation and education  Provide information  cognitive, social, and communication development  developmental course and characteristics of a disability  intervention approaches and strategies  Promote parent and caregiver abilities to implement communication-enhancing strategies during everyday routines

 Seamless transition process for families moving between programs  Timely access to appropriate services  Need for transition plan  Families play an active role

Knowledge of  continuum of service delivery models to meet the needs of the individual child and family (e.g., direct service, collaborative consultation, playgroup-based). Skills in  facilitating collaborative problem solving with families, caregivers, and other team members to deliver and monitor interventions.

Knowledge of  community resources, how to access them, and strategies to empower families' and caregivers' accessibility. Skills in  collecting information about family priorities, resources, and concerns.