Isn’t More Better?

Early Childhood Interventions January 15, 2014

“Isn’t more better?”- a question commonly asked by families and providers when first hearing about the Primary Service Provider (PSP) model.  Responses to these questions and more are answered below

Isn’t more better? 

Contrary to popular belief, more service is not always better.  In fact, one study found that multiple services provided at high frequencies actually related negatively to parent well-being and function (Dunst, Brookfield, & Epstein 1998).  However, more intervention is better.  Embedding strategies into daily routines increase the opportunities for practice and increases learning.  The TaCTICS website provides a detailed comparison of a traditional approach (ST and OT one time a week each) vs the PSP approach. http://tactics.fsu.edu/MIH/handouts/steps/step5/adultlearning/JamesJamaal.pdf.  It is our responsibility as providers to educate families about the way young children learn and the role they have

Is one time a week really enough? 

The PSP model does not stipulate that the primary provider can only see the family one time per week.  The frequency of the visits by the PSP model should be determined by the IFSP team during the IFSP meeting.  The decision should take into account the caregiver’s level of comfort in providing strategies and the family’s schedule.  Some professionals advocate for starting with a high frequency of service and tapering off as the caregiver’s confidence and competence increase.  Also remember that the IFSP can be changed at any time.  If the team recommends one time a week initially, but later feels an increase (or decrease) is necessary, the team can call an IFSP meeting to make the change.

Are you sure I only need one provider to meet all of my concerns?

The PSP model does not mean a family will only have one provider.  The intent of the model is not to say that families have to choose between physical therapy or speech therapy.  Remember that the primary provider has a team of professionals working with them to meet the child’s needs.  Consultation visits can occur in which the primary provider, the consultant, and the family all meet together to observe the routines and embed strategies.

How is an SLP supposed to do a PT’s job? 

The short answer is they aren’t.  The focus of early intervention services is on supporting families to increase caregiver confidence and competence.  Providers focus less on direct interaction with the child and more on educating the family about strategies to promote development.  An SLP has basic knowledge of development, including motor development, and is, therefore, capable of making basic recommendations.  Remember that a child does not work on developmental areas in isolation.  An SLP is “working on” on all areas of development all the time.  It is expected that the SLP would ask the PT to consult when questions or concerns arose that she was not comfortable answering or addressing.

For more information:

Shelden ML & Rush DD (2013). The Early Intervention Teaming Handbook The primary service provider approach. Baltimore, MD:  Brookes Publishing.

Dunst, CJ, Brookfield J, & Epstein J (1998). Family-centered early intervention and child, parent and family benefits:  Final report.  Asheville, NC:  Orelena Hawks Puckett Institute. 

– Jamie Holloway