comprehensive linked system framework.pdf

Comprehensive Linked System Framework for Service

Delivery with Young Children

As noted in Chapter 1, ABI is a comprehensive approach to intervention that focuses on what young children do throughout their day. The approach is largely child-directed and embeds teaching/training into daily or routine activities, play, and child initiations. For example, for a child with a gross motor delay who frequently chooses to play with blocks, the child care worker can consistently move the blocks beyond the child’s reach so he must move to obtain them. Recognizing and using each child’s interests serves as the basic platform from which intervention efforts are orchestrated. An intervention strategy that uses children’s motivation produces significant progress in critical areas of development; however, neither ABI nor any other intervention approach can operate effectively in isolation. The effectiveness and impact of any intervention approach is enhanced by its placement in a more comprehensive framework that takes into account other factors or variables that produce systematic change in children. A review of many service delivery programs that operate in the United States provides strong evidence that many intervention efforts are not situated within a comprehensive framework. Rather, services and activities are often disconnected, producing inefficiency and oversight resulting in compromised outcomes for children and families.

The Oakdale Early Intervention Program provides services to 25 children with disabilities and their families. The children range in age from 12 to 48 months and have identified developmental delays (e.g., Down syndrome, autism, sensory impairments). The stated overall goals of the program are to 1) enhance parent–child interactions,
2) build peer interaction skills, and
3) assist children in gaining preacademic skills.
To be eligible for participation in the Oakdale Program, children must have a significant developmental delay (at least two standard deviations below mean age performance in two or more developmental areas), and therefore before entering the program, children must be assessed and their disability or delay documented. The local community does not have a screening program. Children in the community with suspected or known problems are referred to an evaluation agency for a multidisciplinary assessment. Because a community screening program does not exist, timely referral of children often does not occur. When children are referred to the evaluation agency—usually after their development or behavior is noted to be significantly atypical—they are seen by an interdisciplinary team, including a pediatrician, psychologist, physical therapist, and speech-language pathologist, and are given at least one individualized standardized test (e.g., Bayley Scales of Infant Development; Bayley, 2005). Based on the child’s performance, the team writes intervention measures, both of which require time and effort as well as delay the initiation of intervention efforts.

Once children’s goals are developed, intervention efforts focus on providing events and activities that address the children’s individual goals, as well as those goals targeted by the program’s general curriculum. At the end of the school year, each child’s progress is evaluated by the re-administration of the standardized measure that was used to determine eligibility. Unfortunately, there is little relationship between the goals the staff targets for intervention efforts and the content of the standardized measure. Consequently, caregivers and program staff have no objective way to determine the effectiveness of their intervention efforts.

Comprehensive Linked System Framework delivery that is fragmented and disconnected. A screening program does not exist, and the assessment component is not connected to the service program. The initial assessment does not provide adequate information to develop sound intervention goals, and the goals that come from the initial assessment do not reflect the overall goals of the Oakdale Program. Relevant intervention content has to be derived from other sources that are not linked to the initial assessment conducted by the interdisciplinary team. Subsequent follow-up progress monitoring is not related to the children’s goals, intervention efforts, or the program’s overall goals. Such models of service delivery do not have a coordinated system and consequently often waste resources and compromise quality.

Alternatives to service delivery programs that do not attempt to create systems are those that focus on building coordination and linkages with and between all of the necessary activities to ensure the delivery of quality services to young children and their families. The purposes of this chapter are to

1. Describe one such comprehensive system
2. Discuss how this comprehensive framework can be used with ABI
3. Present an example that demonstrates the application of a linked system framework

The Linked System Framework

We believe that the application of ABI is most successful when conceptualized and implemented within a linked system framework. That is, intervention activities cannot stand alone; rather, to be maximally effective they need to be supported by and linked to other critical components of service delivery. The linked system framework that we are proposing is composed of five interrelated components: screening, assessment, goal development, intervention, and monitoring progress (Bagnato, Neisworth, & Pretti-Frontczak, 2010; Bricker, 1989, 1996a, 1996b, 2002). These five components address all critical service delivery activities from the first step of screening for potential developmental–behavioral problems to the final activity of monitoring progress toward targeted goals.

Screening

As indicated in the linked system framework, we advocate for screening as the first component. Communitywide screening programs are essential if children with potential developmental or behavior problems are to be detected in a timely manner. Early detection is fundamental to ensuring the best outcomes for children and their families (Bricker, Macy, Squires, & Marks, 2013).

Definition Screening is a quick, simple, and economical procedure to determine if more comprehensive assessment is in order. Screening is often conceptualized as the administration of a brief test (e.g., Ages & Stages Questionnaires® [ASQ; Squires & Bricker, 2009]; Denver Developmental Screening Test II [Frankenburg et al., 1992]) or brief procedure (e.g., newborn hearing screening); however, effective screening needs to be communitywide and connected to a referral system, the administrative/operational context for conducting the actual screening, and strategies for providing feedback and taking subsequent appropriate action.

Goal In the linked system framework, the primary goal for the screening component is the early detection of children with potential problems. More specifically, screening determines if children require a more thorough, detailed assessment of their developmental–behavioral repertoire. If a child’s performance on the screening measure or procedure falls significantly below established age expectations, the family should be provided feedback and referred for follow-up assessment: the next component in the linked system framework.

Assessment

The second component of the linked system is assessment. Assessment refers to an ongoing collaborative process of systematic observations and analysis (Greenspan & Meisels, 1996 p. 23). In our framework, assessment can be conceived as two parts or two steps. First, the child’s eligibility for services must be established. Second, the content for developing relevant and essential intervention goals and objectives must be delineated. Many programs are developing strategies to combine these two steps into a more efficient procedure that simultaneously permits establishing eligibility and also generating appropriate intervention content.

Definition For children who have been screened, the next step is to determine if they meet the stipulated criteria for receiving services and, if so, to determine appropriate goals and intervention content for eligible children. Most government-sponsored programs require that children meet established eligibility guidelines in order to receive services.