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).

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.

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. As shown in Figure 3.1, each component is directly linked to the next component, or in the case of monitoring progress, linked back to assessment, goal development, and intervention efforts.

Screening

As indicated, screening as the first component of the linked system framework. 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 (Bricker et al., 2013). 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. Efficient and effective screening programs can be thought of as a subsystem embedded in the more comprehensive linked system framework.

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.

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). In our framework, assessment can be perceived as two steps. First, a child’s eligibility for services must be established. Second, the content for developing relevant and essential intervention goals and objectives must be defined. Many programs are developing strategies to combine these two steps into a more efficient procedure that simultaneously permits establishing eligibility and 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. In the United States, most jurisdictions require that children demonstrate significant developmental problems (e.g., Down syndrome) or developmental delays (e.g., a performance at least two standard deviations below their age norm in two or more developmental areas). Therefore assessment can be defined as collecting information to determine a child’s eligibility for services and for the development of appropriate goals and intervention content.

Goal The assessment component has two important goals. The first is to reliably determine those children who meet stipulated state and federal criteria for eligibility to receive services. The second goal is to collect a range of developmental information that will permit the intervention team to develop appropriate, functional, and individualized developmental goals.

Goal Development

The third component of the linked system is goal development. The purpose of goal development is to individualize and prioritize a set of goals and objectives that are developmentally appropriate, functional, and significant behaviors that will advance children’s behavioral repertoires.

Definition Goals (or objectives) are written statements that serve to describe an endpoint or developmental target for a child. Goals can be formulated as general statements (e.g., the child will learn to walk), or they can be formulated as precise and specific statements (e.g., the child will take at least six steps consecutively by alternately lifting feet off the ground and propelling the entire body forward while remaining in an upright position).

Intervention

The fourth component of the linked system framework is intervention. The purpose of intervention is to assist children in acquiring and using prioritized individualized goals and objectives. Specifically, ABI is designed to assist caregivers and interventionists in using daily activities as the context for delivering specially designed instruction that will produce desired change in children.

Definition Intervention refers to the planning and executing of actions and events by caregivers and teachers/interventionists/therapists that are designed to assist children in the acquisition of their individual developmental goals and the program’s general curriculum goals.

Table 3.1. Sample items from the Assessment, Evaluation, and Programming System (AEPS) with their associated goals

Monitoring Progress

Monitoring progress is the final component of the linked system framework and refers to documenting key behaviors in which children’s previous performance in an area is compared with later performances. This component is designed to permit comparisons of children’s behavior over time to determine whether or not the offered intervention is being effective.

Definition Monitoring progress in the linked system framework refers to tracking the child’s progress toward targeted goals and objectives. Monitoring progress can be defined as a cyclical process that involves the systematic comparison of the child’s current behavior with previous performance(s). Useful progress monitoring requires the collection of objective information or data.

Goal The goal of the monitoring progress component is the systematic collection of objective data to document and compare children’s performances of targeted goals and objectives over time.

Summary

This chapter described a linked system framework that provides the broader context for situating ABI as an intervention approach. The linked system framework encompasses five essential components: screening, assessment, goal development, intervention, and monitoring progress. These five components are critical to the delivery of effective services for young children and for the use of ABI in particular.