Change Management from Federally Serviced Therapy to Private Therapy

 

Early Childhood Intervention (ECI) is a universal term describing federally provided services for developmentally delayed children Ages 0-5 years old.  ECI serves a heterogeneous population including children whose, “development has been compromised and they are experiencing a delay between what is expected behavior for their age and what they are able to do across one or more developmental domains” (Bruder, 2010).  Early Childhood Intervention incorporates a wide range of therapies including speech & language pathology, occupational therapy, psychological services and social work (to name a few) (www.dds.ca.gov). 

Federal funding for Early Childhood Intervention originates with the Individuals with Disabilities Education Improvement Act (IDEA-1986).  Early Childhood Intervention is split in to Ages 0-3 (IDEA, Part C) and Ages 3-5 (IDEA, Part B) creating a significant change from individualized in-home therapy that educates parents on therapeutic strategies to preschool-readiness (group) therapy where parents are minimally involved. 

In December 2012 our son Giovanni transitioned from Early Childhood Intervention, Part C to Early Childhood Intervention, Part B.  We were presented with an exit Individualized Family Service Plan (IFSP) outlining Giovanni’s occupational and speech delays and an Individualized Education Plan (IEP) offering speech-only services.

According to the California Department of Developmental Services children must exhibit a delay of 33% or greater in one or more areas of development (www.dds.ca.gov).  Giovanni graduated with delays less than 33% in occupational therapy and greater than 33% in speech leading us to seek speech-only therapy without recognizing the continued need for occupational therapy.

Fast forward to November 2013.  Our family is preparing for Giovanni’s annual IEP (to occur near his 4th birthday on December 12th) and what started with little convincing evidence that he’s receiving the therapies needed from PEEP (IDEA, Part B) I started researching private therapies available on a pay-for-service or insurance-paid model.  As a parent-caretaker, I play a role as a “pair-of-hands” consultant implementing what leadership (physicians, therapists, educators) develop as a systems thinking therapeutic approach (Distelhorst, N.D.)

Using John P. Kotter’s Leading Change: Why Transformation Efforts Fail I will be applying these steps towards transformational change of our support team.

·      Establishing a Sense of Urgency:  In the year we’ve participated with PEEP we’ve seen little growth in Giovanni’s speech and language.  Recently I have identified several private practitioners; experts in A.D.H.D., Speech and Occupational Therapy yet without establishing a sense of urgency to our team it has been an exceptionally slow process with little support.     

·      Forming a Powerful Guiding Coalition:  as a parent-caseworker I am learning the federal and state laws relating to the services offered.  After speaking with three practitioners this afternoon, all referred me back to Giovanni’s pediatrician to complete all referrals for intake evaluations.

·      Creating a Vision:  as a parent-caseworker my vision is to prevent the need for Attention Deficit Hyperactivity Disorder medications through Early Childhood Intervention therapies such as sensory integration (occupational), speech therapy and behavior therapy (coaching). 

·      Communicating the Vision: at Giovanni’s age it’s taboo to mention A.D.H.D. forcing many to wait until well in to elementary school years to seek services (by that time a child is very delayed or emotionally traumatized) It takes significant effort to outline my vision for: collaboration, strength-based approach and intervention in lifestyle, well being, psychology, education, alternative modalities (holistic) and only if absolutely necessary is a child medicated (www.flatonaddeptcenter.com). 

·       Empowering Others to Act on the Vision:  as a parent-caretaker, empowering Giovanni’s father (my husband) to engage in the early intervention of A.D.H.D. as a family (Dr. Flaton’s requirement to be seen) when just a few years ago A.D.H.D. was a wait-and-see approach has slowed this process significantly.  

·      Planning for and Creating Short-Term Wins:  raising a former micro-premature infant and fully expecting a A.D.H.D. or Sensory Processing diagnosis requires a series of short-term wins ranging from sitting for 3-minutes at the dinner table to dressing himself without distraction.  This requires even more from me as a parent-caretaker to see the systems thinking approach to Giovanni’s development with occupational, speech and behavior therapy and the support of his preschool teacher and parental involvement. 

·      Consolidating Improvements and Producing Still More Change: new research points to a myth that people outgrow A.D.H.D., many of whom are misdiagnosed other sensory related issues.  Approximately 3/4ths of people never outgrow A.D.H.D. yet cease to receive treatment leading to pervasive challenges throughout life.  Communicating the life journey aspect of what we are embarking on requires identifying the genetic component of Giovanni’s A.D.H.D. that we believe stems from my husband, from me and research that points to 90% of micro-premature infants being diagnosed with A.D.H.D. Being diagnosed at Age 47 and Age 35 is wholly different then being diagnosed at Age 4 years old. 

·      Institutionalizing New Approaches:  Dr. Flaton, ADDept Center, states she has A.D.H.D. yet being in her presence brings immediate calm and a sense of meditation to those around her contrary to the hyperactivity of an individual with A.D.H.D.  Once my husband John and I receive diagnosis and treatment (if indeed we are the genetic components), identify Giovanni’s therapy needs with occupational, speech and behavior therapy and short plus long term plans with Old Mission Preschool and Elementary School can we begin institutionalizing and embracing this new, effective and holistic lifestyle. 

Federal law provides for early intervention therapy but only if the individual meets delays of 33% or greater.  As a result, federal law limits Early Intervention from a systems thinking approach as they are limited by federal funding.  If Early Intervention admits to the need for additional services, they immediately become liable to provide stated services.  As a parent-caregiver it’s on me to create change to the system through being an informed and knowledgeable parent-caseworker that sees the systems thinking approach others do not see. 

 

 

 

References:

Bruder M.B. (2010). Early childhood intervention: A promise to children and families for their future. Exceptional Children, 76(3), 339-355. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=48897209&site=ehost-live

 

Distelhorst, D. J.  (n.d.). Module 2: Change management principles.  In An OD     practitioner’s tool kit: Twenty years of accumulated OD wisdom & methodologies.

Kotter, J.P. (2006). Leading Change: Why Transformation Efforts Fail. In J. V. Gallos (Ed.), Organization Development – a Jossey-Bass Reader (pp. 239-251).  San Francisco, CA: Jossey-Bass.