Module 4 Interdisciplinary Approaches To address the increasing complexity of public health and medical care, national and international entities and scholars have encouraged educators and clinicians to develop programs that enhance the capacity of professionals to collaborate. A variety of groups have suggested that some combination of dedicated interdisciplinary, or interprofessional, education and intentional practice are critical to creating competent professionals. Interdisciplinary practice, defined as ‘collaborative practice that combines the insights of several professional disciplines, consumers, and community members-in designing care or programs" (Margolis, Rosenberg, Umble, & Chewning, 2013) Schwarz’s (2013) assumptions about teaming include the following: 1. | have information; so do other people. 2. Each of us sees things that others don't. 3. Differences are opportunities for learning. 4, People may disagree and still have pure motives. 5. | may be contributing to the problem. These assumptions are highly relevant to engagement with and around the population of children with disabilities. For interdisciplinary practice to be effective, individuals from the many clinical and educational disciplines who interact must recognize that other disciplines, including families and self-advocates, bring their own perspectives and expertise, as well as personal preferences and challenges, which can make the ‘translation of theoretical skills in the clinical practice setting daunting. According to Cohen and colleagues (2011, p. 529) children with medical complexity {CMC} have ‘medical fragility’ and require “intensive care," two elements that alonedemand the collaborative skills and perspectives of many disciplines and family members. The demand for a well-developed competency in interdisciplinary practice is further underscored by the additional phrase, ‘not easily met by existing health care models.” The Role of Families The intense demands on parents and family members in the care of children with developmental disabilities underscore the importance of interdisciplinary skill development for parents as a key discipline. It is crucial to recognize that parents are likely to bring salient insights from the many social determinants (Artiga & Hinton, 2018) that influence their capacities to manage effectively the care of their children Imp: terdisciplinary practitioners must recognize that economic determinants, such as a parent's need to work both a day shift and an evening shift to pay a mortgage, may well impede their ability to follow through with well-meaning therapeutic recommendations for daily exercise regimens or parental social engagement. Similarly, inadequate community infrastructure, such as a lack of available transportation or the availabilty of affordable respite or child care, may prohibit parent attendance at meetings. ‘As emphasized by Reeves and colleagues (2015) and the Institute of Medicine (2015), ‘there is an extensive literature on the effects of interdisciplinary training. There are, however, relatively few studies that speak to outcomes; that is, the effects of interdisciplinary care on service delivery and/or patient care. Many studies focus on ‘the development of perceptions and attitudes; knowledge and skills; and, to some degree, behaviours.Early Intervention Services Services and supports available include habitation therapies, family counselling, early childhood educational services, and others as determined by a multidisciplinary team in collaboration with the child's family. This array of services is provided in many settings, in collaboration with a variety of agencies, and utilizes various models of service delivery. The primary goals of El are to enhance the development of infants and toddlers and minimize the potential for developmental delay by supporting the family to promote ‘their child's optimal development and facilitate the child's participation in family and community activities, (Dunst, Bruder, & Espe-Scherwindt, 2014; Workgroup on Principles and Practices in Natural Environments, 2008). Within those goals, E! focuses on encouraging active participation of families in the intervention by embedding strategies into everyday activities and routines and by delivering services in a manner that is +Family centered and culturally and linguistically competent; - Developmentally supportive, strengths based, and helpful for promoting children’s participation in their natural environments; - Comprehensive, coordinated, and team based; - Individualized, flexible, and responsive to the changing needs of young children and families; and, - Based on the highest quality evidence available. Early Intervention Services Assistive Technology Devices and Services Family training Health services Medical services (for diagnostic or evaluation purposes only)Speech and language pathology Physical therapy/Occupational therapy Psychological services Service coordination Transportation and related costs Key Principles for Providing Early Intervention Services in Natural Environments 1. Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts. 2. Alll families, with the necessary supports and resources, can cnhanot ther childse’s eaming and development. 3. The primary role ofa service provider inearly inter- vention is to work with and support family mem- bers and caregivers in children’s lives. 4. The early intervention process, from initial con tacts through transition, must be dynamic and individualized to reflect the child’s and family members’ preferences, learning styles, and cul- tural beliefs. 5. IFSP outcomes must be functional and based on children’s and families’ needs and family-identified priorities. 6. The family’s priorities, needs, and interests are addressed most appropriately by a primary pro- vider who represents and receives team and com- ‘munity support 7. Interventions with young children and family mem- bers must be based on explicit principles, validated practices, best available research, and relevant law's and regulations. These models all support the following: 1. The critical roles of families as teachers of their children and practitioners as facilitators and teachers of both families and their children (Boyer & Thompson, 2014) 2. The use of common activities and routines as contexts for children’s learning (Chai, Zhang, & Bisberg, 2006; Stremel & Campbell, 2007) 3. The need for practice and repetition in order for learning to occur (Ulrich, 2010)This approach often departs from the traditional discipline-specific model of a set frequency per week. Meaningful outcomes go beyond specific disciplinary goals to effectively address the child's participation in family and community activities and routines. Different types of services as well as levels of service may be needed depending on the number of caregivers (¢.g., parents, grandparents, and child care providers) and ‘the learning contexts. On the one hand, a biweekly visit with a parent and child who spend the day together at home may suffice to accomplish the desired outcome. On ‘the other hand, a multiplecaregiver situation often requires more frequent contact to demonstrate strategies and allow for more collaboration with key adults. Contemporary Practice Models Contemporary practice models support intervention in a natural environment by stressing the critical roles of the family as the child's teacher and the El provider as ‘the family’s educator. Traditional service delivery is child focused; families often simply observe the service, or the professional teaches the family to execute a specific strategy (Peterson, Luze, Eshbaugh, Jeon, & Kantz, 2007). Intervention strategies that assist families and other caregivers to promote the child's development within the context of naturally occurring learning opportunities are consistent with the concept of natural environments and the intent of family-centred El (Boyer & Thompson, 2014; Bruder, 2000; Peterson et al, 2007) Taken together, it is evident that a comprehensive El system composed of well-defined structural components can be found in states and communities throughout the United States, providing services and supports to infants and toddlers and their families. However, it is recognized that such a complex and evolving system can be substantially improved to more effectively and efficiently meet the needs of children and families (Boavida, Aguiar, & McWilliam, 2014; Boyer & Thompson, 2014; Dunst, 2007; Tomasellio, Manning, & Dulmus, 2010)