Primary Coach Approach to Teaming

Teaming is defined as the practices used by a group of individuals with complementary skills and abilities who have shared purposes and objectives, and who use shared practices for both achieving desired outcomes and holding team members accountable for practicing in ways consistent with stated intentions (Katzenbach & Smith, 1993). The particular approach to teaming practices of focus is the use of a primary coach approach to teaming. A primary coach approach to teaming assigns one member of a multidisciplinary team as the primary coach, where he or she receives coaching from other team members, and uses coaching with parents and other primary caregivers to support and strengthen their confidence and competence in promoting child learning and development. A primary coach approach to teaming differs from other approaches to teaming in which one practitioner serves as the primary liaison between the family and other team members (Woodruff & McGonigel, 1988; York, Rainforth, & Giangreco, 1990) by its explicit focus on the type and content of interactions between team members and their roles for promoting parent skills, knowledge, and attributions.

Dunst (2000) depicts a framework defining features of contrasting approaches for implementing early intervention. We have found this framework extremely helpful in assisting practitioners, even state systems, in promoting the use of scientifically-based practices, including the use of a primary coach to support families in caring for their children. With the focus of implementing early intervention supports in natural learning environments, we have suggested (Shelden & Rush, 2001), as have others (Dunst, Bruder, Trivette, Raab, Hamby & McLean, 2001; Dunst, Trivette, Humphries, Raab, & Roper, 2001) that focusing on services and multiple disciplines implementing decontextualized, child-focused, deficit-based interventions is not effective early intervention and is, in fact, bad practice. Dunst described a "rethinking" of early intervention and compared a traditional paradigm to a new paradigm for implementing early intervention. The new paradigm depicts a set of expected practices that are scientifically based and serve as the theoretical and conceptual framework for early intervention. In short, the new paradigm embraces practices within promotional, capacity building, strength-based, resource-based, and family-centered models.

For practitioners functioning within a more traditional paradigm, the primary coach approach appears that one practitioner is implementing all of the treatment recommendations of the other disciplines thus bringing forth claims of practice beyond the scope of legal or ethical disciplinary boundaries (Rainforth, 1997; Shelden & Rush, 2001; York, Rainforth, & Giangreco, 1990). Within the new evidence-based framework, however, practitioners focus on promoting the child's and family's assets and interests within the context of natural learning opportunities. The practitioner joins with the care providers to identify strategies that support the child's participation within and across family, community, and early childhood contexts rather than targeting skills based upon identified child deficits that must be treated by practitioners from multiple disciplines. The new paradigm assists in further defining the role of the primary person selected as the representative of the team. When using a primary coach approach, the selected individual uses coaching as the intervention strategy to mediate parents' and other care providers' abilities to enhance child learning opportunities in existing and desired activity settings.

 Rationale

Research shows better outcomes for children in early intervention programs when a family-centered approach is used that: 1) is based on family support principles, 2) is focused on the child's interests and assets, 3) supports and empowers parents in their role as the child's primary care provider, 4) addresses the priorities of the family, and 5) implements a holistic approach with each child and family.

 Indications for Using a Primary Coach Approach to Teaming

The primary coach approach to teaming is used when a program is identified as a formal resource for early childhood intervention and has multiple staff with diverse knowledge and experiences from which to choose to support the care provider(s).

Role of the Primary Coach

The role of the primary coach is as a mobilizer and mediator of resources to support the family and other care providers. The primary coach mediates the family's and other care providers' skills and knowledge in relation to a range of needed or desired resources. The primary coach acts as the principle program resource and point of contact between other program staff, the family, and other care providers. The primary coach focuses on coaching of the identified learners (i.e., parents, other care providers, pivotal people in the life of the child) as the primary intervention strategy to implement jointly developed, functional, discipline-free, IFSP outcomes to promote increased child learning and participation in real-life activity settings with coaching and support from other team members.

Characteristics of the Primary Coach Approach to Teaming

Using the evidence-based approach for documenting characteristics of specific practices described by Dunst, Trivette, and Cutspec (2002), we have clearly defined the characteristics of a primary coach approach.

Implementation Conditions

The following is a list of implementation conditions to ensure a primary coach approach to teaming.

Traditional vs. Primary Coach Approach to Teaming

Take for example, a traditional approach to a situation of a family living in an apartment in a suburb of a large metropolitan area. The Taylor family consists of a Debra (mother), Willis (father) and Felicity, their two year old daughter. The Taylors like to watch television and have a new puppy. Willis is in the Air Force and Debra stays home with Felicity. Felicity was diagnosed with cerebral palsy shortly after birth and currently receives occupational therapy twice weekly for one hour, physical therapy twice weekly for one hour, and speech language therapy for one hour a week. Although each of these visits takes place in the family's apartment, which is helpful because they only own one car, which Willis drives to work, the focus of the intervention is to remediate Felicity's problems and help her to achieve new developmental milestones. For example, Felicity weighs 20 pounds and her parents and physician are worried about her difficulty gaining weight. She drinks from a bottle, but vomits most of the formula soon after eating. She is held for eating and is unable to join the family at the table for dinnertime. She requires support to sit, use her hands, and is unable to move around the apartment independently. Felicity indicates she is happy by smiling and sad by crying. Debra considers the therapies necessary, but is frustrated by the fact that she must plan her day around the therapists' visits. She is also feeling consumed by the amount of "homework" each therapist expects her to complete prior to their next visit. This same situation using a primary coach approach to teaming would look quite different. The family would meet with the team of therapists jointly and discuss their interests and priorities for Felicity. They would identify outcomes that promote Felicity's participation in family activities and routines (e.g., joining the family at the table for dinner, bathing, watching T.V., going to the grocery store, visiting the apartment complex playground). The family and therapists would determine a primary coach whose frequency of visits would be based on the level of support desired by Debra and Willis. The role of the primary coach would be to focus on the family and Felicity's interests and assets to increase her participation in activities that are important to Debra and Willis and interesting or necessary for Felicity. Initially Willis' and Debra's priority for Felicity was to gain weight and join them at the dinner table. The team chose the occupational therapist as the primary coach for the family. Initially, the focus of the primary coach was on how to support Felicity's participation during mealtime. This included adapting a highchair and subsequently a booster seat for Felicity to use during mealtime in home and community settings, exploring options other than bottle feeding for Felicity, and identifying resources in the community to assist the family in nutritional support for Felicity. The team felt it was important for frequency and intensity of services to be higher initially, then decreased as priorities were achieved and Willis' and Debra's confidence increased in supporting Felicity. The primary coach received coaching from the other team members to assist her in building the capacity of Debra and Willis to help Felicity gain weight and sit at the dinner table at mealtime. Initially this involved the physical therapist joining the primary coach for a visit to adapt the highchair and booster seat and brainstorm ideas for sitting during bath time, play time with Debra, and being comfortable in her car seat. This support resulted in support of Debra's idea to look for a laundry basket at garage sales for Felicity to sit in during bath time, making a foam-in-place seat insert for Felicity's infant walker, attainment of a new car seat, and use of the car seat in the home as another comfortable position for Felicity during the day. Debra and Willis were then able to identify new priorities for interacting with Felicity during daily activities and promoting Felicity's development as a result of her new interests and availability to participate in activities.

In the traditional scenario, the support of the Taylor family was focused on all of the challenges facing Felicity. The family was dependent upon outside specialists who came at separate times and implemented separate treatment plans that focused on remediating Felicity's developmental problems. The therapist also had expectations of Debra to carry out extensive exercises for Felicity between sessions. In the primary coach approach to teaming, the Taylors were supported by the primary coach (who received coaching from other team members) to use everyday experiences based upon interests as learning opportunities for Felicity. The Taylor family had access to all of the same team members (i.e., expertise and knowledge), but were not constrained by the time it took for separate visits and were able to experience the benefits of using everyday situations as powerful learning opportunities that inherently had therapeutic benefits. Previously the coordination of communication among the therapists had been Debra's responsibility as well as making sense of how the therapy sessions fit into the family's everyday life (or not). In the primary coach approach to teaming, the responsibility was placed back on the full team, especially the primary coach, to coordinate communication, schedule joint visits, and receive coaching from other team members.

Considerations and Challenges to the Field of Early Childhood

One of the most exciting challenges facing the early intervention system and the first step in moving to a primary coach approach to teaming is establishing identified teams to support families and their children. Although all families enrolled in programs under the IDEA must have access to a variety of professionals representing specific disciplinary expertise, due to the design of many early intervention programs the opportunity for families to have access to teams has been diminished ( Perry, Greer, Goldhammer, & Mackey-Andrews, 2001). Alternatively many states have resorted to a "fee for service" approach in which children are assigned services based on the priority deficits unveiled during the eligibility determination process. The role of the service coordinator in these situations is largely relegated to a broker of services. The service coordinator must not only identify these services, but also serves as a monitor and evaluator of the appropriateness of the service provider by the practitioner. A primary coach approach to teaming works effectively in models of service delivery with and without a designated service coordinator position. When a program uses a model in which the service coordinator position is separate from that of the other practitioners on the team, the primary coach and service coordinator must work closely together to coordinate resources for the family.

Conclusion (but really just the beginning)

Moving to a primary coach approach to teaming in early childhood intervention is a dynamic process. Systems and programs may begin this process by first identifying individuals from multiple disciplines who are willing and interested in becoming a team. Second, the team begins to modify its practice to use a promotional, capacity building, strength-based, resource-based, and family-centered approach through weekly team meetings and other opportunities to work together. Third, team members gather the necessary information from the family through the intake and assessment process necessary to develop functional, discipline-free IFSP outcomes. Fourth, the team selects a primary coach to support the family in promoting the child's learning and development within the context of everyday activities. Finally, team members support one another and families through ongoing coaching opportunities.

References

Dunst, C.J. (2000). Revisiting "rethinking early intervention." Topics in Early Childhood Special Education, 20, 95-104.

Dunst, C.J., Bruder, M.B., Trivette, C.M., Hamby, D., Raab, M., & McLean, M. (2001). Characteristics and consequences of everyday natural learning opportunities. Topics in Early Childhood Special Education, 21(2), 68-92.

Dunst, C.J., Trivette, C.M., & Cutspec, P.A. (2002). Toward an operational definition of evidence-based practice. Centerscope, Volume 1, Number 1.

Dunst, C.J., Trivette, C.M., Humphries, T., Raab, M., & Roper, N. (2001). Contrasting approaches to natural learning environment interventions. Infants and Young Children, 14, 48-63.

 Katzenbach, J. R., & Smith, D. K. (1993). The wisdom of teams. New York: Harper Business Publishers.

Perry, D.F., Greer, M., Goldhammer, K., & Mackey-Andrews, S.D. (2001). Fulfilling the promise of early intervention: Rates of delivered IFSP services. Journal of Early Intervention, 24(2), 90-102.

Rainforth, B. (1997). Analysis of physical therapy practice acts: Implication for role release in educational environments. Pediatric Physical Therapy, 9(2), 54-61.

Shelden, M.L. & Rush, D.D. (2001). The ten myths about providing early intervention services in natural environments. Infants and Young Children, 14, 1-13.

Woodruff, G. & McGonigel, M.J. (1988). Early intervention team approaches: The transdisciplinary model. In J.B. Jordan, J.J. Gallagher, P.L. Huntinger, & M.B. Karnes (Eds.), Early childhood special education: Birth to three (pp. 163-181). Reston, VA: Council for Exceptional Children and the Division for Early Childhood.

York, J., Rainforth, B., & Giangreco, M.F. (1990). Transdisciplinary teamwork and integrated therapy: Clarifying the misconceptions. Pediatric Physical Therapy, 73-79.