Promising Practice Profiles

Rural Beginnings Project

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Project practice

Team Around the Child

Project undertaken by

Kurrajong Early Intervention Service, 2 Grampian Place, Wagga Wagga NSW 2650

Start date

January 2005

Focal areas

Healthy young families

Creating child friendly communities

Supporting families and parents

Early learning and care

Program

Invest to Grow (ItG)

Issue

The evidence clearly states that if a child has a disability or delay in their development, early intervention and providing the necessary therapy and education in the first few years will help the child reach their maximum potential. It is also evident that there are limited early intervention services for children with disabilities in rural areas. Early intervention services in rural areas are often hampered by skills shortages in some disciplines. Further, there is evidence to suggest that families receiving early intervention services can feel disempowered, overwhelmed or confused as a result of services delivered by multiple professionals working in isolation from each other.

Program context

Rural Beginnings is an expansion of Kurrajong Waratah's innovative and successful early intervention and prevention model delivered through their Kurrajong Early Intervention Service (KEIS).

The Rural Beginnings project assists families in nine local government areas in the Riverina Region of New South Wales. It covers a total population of approximately 5,000 children aged between birth and school age within a catchment population of approximately 45,000 people. The project is committed to providing quality early childhood intervention services to around 60-70 families in rural areas per annum.

Practice description

Rural Beginnings has adopted the 'Team around the Child' concept, which was established by Limbrick (2005), as a central tenet of their transdisciplinary practice. A transdisciplinary team approach, brings together a team of professionals from the allied health, education and social welfare disciplines. The team provides individually tailored early intervention services, including early education, therapy, counselling and parent training to families who have babies and children with disabilities and developmental delays. The following describes the key ingredients of this practice.

Figure 1: Team Around the Child Example

Rural Beginnings - Team around the child

Family centred practice and the family role

The transdisciplinary team model is seen as a family friendly approach, operating within a family centred practice model. Families are always members of the team and are respected and valued as equal members. Although all team members participate equally, the family is the final decision maker.

Discipline involvement and co-ordination

The transdisciplinary team at KEIS consists of Physiotherapists, Occupational Therapists, Speech Pathologists, Family Support Workers and Educators who work together as a team with the family sharing, learning and working across disciplines, with a key worker for each family coordinating services. Flexible boundaries and interchangeable roles and responsibilities encourage the exchange of information, knowledge and skills.

To be effective each team member needs to be knowledgeable and 'upskilled' firstly in their own discipline and then in other disciplines (ie. multi-skilling). Once team members are multiskilled, the team can 'role release' consistent with the training and expertise of individual member. Role release involves the sharing of expertise. It is where 'a team member puts newly acquired techniques into practice under the supervision of team members that have accountability for those practices' (McGonigal et al, 1994). The emphasis is on a more holistic approach in which all team members (including parents) feel comfortable in following through program recommendations across disciplines.

It is not possible to work in an effective transdisciplinary model without the upskilling of all staff involved in the teams. This requires management to provide the necessary inservice time and training for the development of the individuals and teams. Newly formed teams or ones with relatively inexperienced members will need more time initially. Teams need to work on clear processes and guidelines for assessment and intervention, including feedback to the primary therapist.

Shared meaning, co-ordination and open communication

At KEIS, workers view creating 'shared meaning', or the development of a mutual vision among the team and family, as the most important feature of the transdisciplinary team approach. In addition, team members develop shared meaning about the terminology and principles about disciplines other than their own. This facilitates a shared understanding and good communication for the child, family and team across disciplinary boundaries.

Co-ordination of activity and planning is also an essential aspect. In other models of service delivery opinions from different therapists can be conflicting and families can be left to try to work through the different programs suggested and reach their own compromise. By contrast, within the transdisciplinary model, early childhood intervention service is integrated, meaning that transition between disciplines and other services is as 'seamless' as possible.

Although all team members may not be involved in direct service delivery for every family, all members are involved in planning and monitoring aspects of intervention. The team works together in an arena assessment where members will take roles either as facilitators or observers / assessors within their own discipline. After assessment and planning, the team meets regularly to share information and to teach and learn across disciplines.

Key worker

The transdisciplinary approach to service delivery creates a more ideal social situation for genuine inclusion of the family as a 'team member' by appointing a key worker from the outset. The key worker is the primary contact for the team, and it is their role to develop a relationship with the family based on a thorough understanding of their background, situation and needs. There needs to be careful and thoughtful selection of the key worker, taking into consideration the concerns and priorities of the family as much as possible. Ideally, the key worker is chosen in consultation with the family. The role of the key worker includes advocating with (rather than for) the family within the organisation in order to obtain services and resources within their local community. The key worker also co-ordinates the assessment process, report and feedback to the family, along with all interventions delivered to the family to meet their needs.

Using Individual Family Service Plans

Families are serviced according to their individual needs as detailed in the Individual Family Service Plans (IFSP). This is the family's plan of action for the year for their child. From the IFSP, an Individual Education Plan (IEP) is also developed for each child.

The IFSP process involves the key worker and family developing functional development goals. This process includes setting a 'baseline' statement about the child/family's level of functioning at the beginning of the IFSP, for use as a comparison later. In effect, the Individual Family Service Plan sets the family's goals, which guide the therapeutic team's treatment strategies. The plan is reviewed at six months and again at one year. The family comments on the amount of progress they believe has been made with respect to their individual goals and the child's former level of functioning. This review opens the way for discussion around how the family have been agents in their child's progress, and the way in which the service can better assist the family.

Research base

Key components of the KEIS transdisciplinary model have been adapted from the work of Linder (1983); Peterson, (1987); Garland et al, (1989), Fewell; (1983); United Cerebral Palsy National Infant Project (1976) and based on the KEIS experience with family centered practice and transdisciplinary team work.

The transdisciplinary approach was developed in the mid 70s in response to budget constraints as a way for under staffed and under funded teams to pool their knowledge and skills to provide better, more cost-effective services. This led to a service where all team members were involved in planning and monitoring services for every child and family but all were not involved in direct service provision (UCP National Collaborative Infant Project, 1976). Transdisciplinary teams share roles, crossing disciplinary boundaries to maximise communication, interaction and cooperation among members. Team members make a commitment to teach, learn and work together across disciplinary boundaries to implement coordinated services (UCP National Collaborative Infant Project, 1976; Orelove and Sobsey, 1991; McGonigel et al., 1994).

Since its emergence in the 1970s, the second generation research of Briggs (1997); Guralnick (2001); Carpenter, (2005) and Bruder (2000) in early childhood intervention recognises the transdisciplinary approach as best practice for early intervention and the key worker role as essential in the provision of coordinated, integrated services for families. As Doyle highlights, 'if we aspire to be truly family centred, we should aspire to the transdisciplinary approach' (1997, p.151). This suite of research recognises the importance of services being responsive, flexible and inclusive of the families whom they are working with.

The transdisciplinary team model overcomes many of the disadvantages of other predominant approaches, such as the multidisciplinary model (and to a lesser extent) the interdisciplinary team model. These disadvantages include fragmentation of services, confusing and conflicting reports for families and lack of service coordination. It is the model that best meets the needs of families who have children with complex needs and therefore have many disciplines involved, as it provides an integrated and coordinated service for the family (Carpenter, 2005).

Recently, Limbrick (2005) in England applied the transdisciplinary model to develop the 'Team around the Child' concept as a way of coordinating early interventions for young children who have complex needs and require intervention from a number of practitioners. It has helped to explain and simplify best practice elements of the transdisciplinary team approach including the key worker role, the empowerment of the family as an equal member of the team and the importance of a collaborative and coordinated team.

Outcomes

Evidence of outcomes

The Rural Beginnings project has been externally evaluated by the Centre for Rural Social Research at Charles Sturt University. Whilst it is difficult to attribute outcomes solely to the 'team around the child' practice approach, this evaluation reported a range of positive outcomes.

Positive outcomes for children and families

The external evaluation found that one hundred percent of parents of children continuing to participate in the project reported in September 2006 that the service they received from KEIS has made 'a big difference' to their children and families. Similarly, most parents of children exiting the project reported a positive impact as a consequence of Rural Beginnings, with seventy five percent reporting the service made 'a big difference' to their family and twenty five percent reporting the service made 'a little difference' (Alston et al, 2007).

There is evidence to suggest that levels of service outcomes in the Rural Beginnings project are equitable with those in the larger centre in Wagga Wagga. A generic outcome measurement tool based on Goal Attainment Scaling was used to assess the progress each child and family makes against the yearly goals set by the family. In February 2007, the KEIS team conducted structured interviews with a combined total of ninety-six Wagga Wagga and Rural Beginnings families to assess the families' progress against the goals they had set for themselves and their child in February 2006. Scores were collated and standardised t-scores were calculated to allow comparisons across locations. Overall, there appeared to be similar levels of outcome attainment across services, with the Rural Beginnings families achieving higher scores in two categories than families receiving services in the larger regional centre (Alston et al, 2007).

Increased parent capacity: uptake of interventions by parents

Therapists and Educators in the Rural Beginnings project are consistently reporting much greater uptake of their interventions by parents between visits and with greater consistency because of the common understanding and reinforcement of strategies (Alston et al, 2007).

High parent satisfaction and engagement

The external evaluation utilised surveys and interviews with parents to evidence a significant level of satisfaction with communication with Rural Beginnings staff. One parent reported: 'KEIS team have always listened and explained everything and make sure I understood…'

The evaluation found that parents consistently reported they are consulted and directly engaged in the development and implementation of IFSP's and this continues regularly throughout their participation in the project. Most parents report they find the IFSP useful, to varying degrees, in clarifying numerous aspects of their relationship with KEIS staff. This includes the role of different therapist interventions and the progression of their child toward agreed objectives (Alston et al, 2007).

Project staff state that parents are reporting more consistent and focussed interventions by KEIS workers and that these are more related to the parents' needs and hopes for their child.

Summary of outcomes for children and families

The external evaluation made the following conclusions.

The findings to date reveal that this project is having a profoundly positive impact on the targeted children and subsequently their families. Parent's quality of life is improved due to:

Positive outcomes for staff

The external evaluation collected data from staff on four occasions through surveys ad focus groups over two years. Alston et al (2007) report that a significant finding is that staff have an increasing commitment to the service model of Rural Beginnings. This commitment is fostered through a strongly collaborative organisational culture that staff report as being the most appealing feature of working for the organisation. Staff favourably contrast KEIS as an organisation with other practice contexts.

Staff also report significant benefits for each other and their clients from the trans-disciplinary approach. These include a more positive response from clients during visits; a decreased burden of rural visits as these are shared among colleagues; and resulting flexibility and responsiveness to the needs and circumstances of the child and their family. All staff affirm the adoption of IFSPs as critical and report a more positive relationship with parents as a result (Alston et al, 2007).

Policy analysis

Rural Beginnings has expanded the ready-established early intervention and prevention program, KEIS, and has demonstrated improved outcomes for young children with a disability or delays in their development, contributed to the Australian evidence base about what works in early intervention in early childhood, and has developed tools and resource materials for use by families, professionals and communities supporting families and young children with a disability or developmental delays.

Resources that have come out of the project, particularly the 2007 publication Team Around the Child: Working together in early childhood intervention, as well as various conference papers, provide an evidence base about what works to a wide audience, provide the capacity for others to learn about transdisciplinary approaches, and create the scope for the approach to be employed more widely

Evaluation

The Rural Beginnings project has been evaluated by the Charles Sturt University's Centre for Rural Social Research under the leadership of Professor Margaret Alston. An interim report was released in 2007 reflecting an evaluation at a three quarters point of project duration.

Project related publications

Davies, S.(2005) 'Rural Beginnings Project' The Bulletin, The Australian Government's Stronger Families and Communities Strategy, No. 7 Spring.

Davies, S., Harrison, J. & Luscombe, D. (2006) 'A Transdisciplinary Team Approach – Combining Practice with Theory in the Australian Context' presented at Australian Early Childhood Intervention Conference.

Davies, S. & Harrison,J. (2006). 'The Rural Beginnings Project: Innovations in Early Childhood Intervention'. Early Links, Musec Early Intervention Network, Vol. 11, No. 1, June.

Davies, S. (2006).'An Innovative Model to Attract and Retain Allied Health Professionals in Rural Areas' presented at SARRAH Conference (National Conference for Rural and Remote Allied Health, September.

Davies, S. (2007). Team Around the Child: Working together in early childhood intervention. New South Wales: Kurrajong Waratah.

Davies, S. (2007). 'Team Around the Child: Relating practice to research and theory'. Key note address, Victorian Early Childhood Intervention Association Conference, November.

References

Alston, M.; Barber, N.; Mlcek, S.& Witney-Soanes, K. (2007). Draft Interim Invest to Grown Evaluation Report. Wagga Wagga: Charles Sturt University.

Carpenter, B. (2005) Real prospects for early childhood intervention: Family aspirations and professional implications. In B. Carpenter & J. Egerton (Eds.). Early Childhood Intervention. International perspectives, national initiatives and regional practice. Great Britain: West Midlands SEN Regional Partnership.

Doyle, B. (1997). Transdisciplinary approaches to working with families. In Carpenter, B. & Egerton, J. (Eds.). Early Childhood Intervention. International perspectives, national initiatives and regional practice. Great Britain: West Midlands SEN Regional Partnership.

Haynes, U. (1976). The UCP National Collaborative Infant Project. In T.D. Tjossem (Ed.). Intervention strategies for high risk infants and young children. Baltimore, MD: University Park Press: 509-534.

Limbrick, P. (2005). 'Team around the child: Principles and practice'. In Carpenter, B. & Egerton, J. (Eds.). Early Childhood Intervention. International perspectives, national initiatives and regional practice. Great Britain: West Midlands SEN Regional Partnership.

McGonigel, M., Woodruff, G., Roszmann-Millican, M. (1994). The transdisciplinary team: A model for family-centred intervention. In L. Johnson, R.J. Gallagher, M.J. LaMontagne, J. Jordan (Eds.). Meeting Early Intervention Challenges: Issues from Birth to Three. Baltimore: Paul H Brookes Publishing Co.

Orelove, S.P. and Sobsey, D. (1996). Educating children with multiple disabilities: a transdisciplinary approach, 3rd edition, Baltimore: Paul H Brookes Publishing Co.

Contact

Sue Davies
Project Manager

Phone: (02) 692 62466

Email: sdavies@kurrajongwaratah.org.au

Website

http://www.kurrajongwaratah.org.au

More information

More information on the Promising Practice Profiles can be found on the Communities and Families Clearinghouse Australia website.