The purpose of this study was to determine (a) the major challenges in providing specialized therapies to infants, toddlers, and preschoolers with disabilities; (b) what models of service delivery are used and why; (c) what makes the provision of therapy services go well; and (d) what strategies are used for overcoming barriers to effective services. Focus groups were conducted with early intervention therapists, nontherapist professionals, administrators, and parents. Results showed that a shortage of pediatric therapists and policy/administrative constraints caused services to be of lower quality than desired. We also found that concepts of “needing” therapy were muddled and that most people said that “more is better” as long as the quality is high enough.
Get full access to this article
View all access options for this article.
References
1.
Achilles, J., Yates, R. R., & Freese, J. M. (1991). Perspectives from the field: Collaborative consultation in the speech and language program of the Dallas Independent School District. Language, Speech, and Hearing Services in Schools, 22, 154–155.
2.
Bricker, D. (1995). The challenge of inclusion. Journal of Early Intervention, 19, 179–194.
3.
Campbell, P. H. (1987). The integrated programming team: An approach for coordinating professionals of various disciplines in programs for students with severe and multiple handicaps. Journal of the Association for Persons with Severe Handicaps, 12, 107–116.
4.
Cole, K. N., Dale, P., & Mills, P. (1990). Defining language delay in young children by cognitive referencing: Are we saying more than we know. Applied Psycholinguistics, 11, 291–302.
5.
Cole, K. N., Harris, S. R., Eland, S. F., & Mills, P. E. (1989). Comparison of two service delivery models: In-class and out-of-class therapy approaches. Pediatric Physical Therapy, 1, 49–54.
6.
Cole, K. N., Mills, P. E., & Kelley, D. (1994). Agreement of assessment profiles used in cognitive referencing. Language, Speech, and Hearing Services in Schools, 25, 25–31.
7.
Cole, K. N., Schwartz, I. S., Notari, A. R., Dale, P. S., & Mills, P. E. (1995). Examination of the stability of two methods of defining specific language impairment. Applied Psycholinguistics, 16, 103–123.
8.
Council for Allied Health in North Carolina. (1994). The allied health crisis in North Carolina: Executive summary. Chapel Hill: Author.
9.
Giangreco, M. F., Edelman, S., & Dennis, R. (1991). Common professional practices that interfere with the integrated delivery of related services. Remedial and Special Education, 12(2), 16–-24.
10.
Gilligan, C. (1982). In a different voice: Psychological theory and women's development. Cambridge, MA: Harvard University Press.
11.
Goodman, M., Rothberg, A. D., Houson-McMillan, A. E., Cooper, P. A., Cartwright, J. D., & Van der Velde, M. A. (1985). Effect of early neurodevelopmental therapy in normal and at-risk survivors of neonatal intensive care. Lancet, 2, 1327–1330.
12.
Hinojosa, J. (1990). How mothers of preschool children with cerebral palsy perceive occupational and physical therapists and their influence on family life. The Occupational Therapy Journal of Research, 10, 144–162.
13.
Hollingshead, A. B. (1975). Four-factor index of social status. Unpublished manuscript. Yale University, Department of Sociology, New Haven, CT.
14.
Hull, K., Capone, A., Giangreco, M. F., & Ross-Allen, J. (in press). In R. A. McWilliam (Ed.), Rethinking pull-out services in early intervention: A professional resource. Baltimore: Brookes.
15.
Lawlor, M. C., & Cada, E. A. (1993, Spring). Partnerships between therapists, parents, and children. OSERS News in Print, pp. 27–30.
16.
McWilliam, R. A. (1995). Integration of therapy and consultative special education: A continuum in early intervention. Infants and Young Children, 7(4), 29–-38.
17.
McWilliam, R. A. (Ed.). (1996). Rethinking pull-out services in early intervention: A professional resource. Baltimore: Brookes.
18.
McWilliam, R. A., & Bailey, D. B. (1994). Predictors of service delivery models in center-based early intervention. Exceptional Children, 61, 56–71.
19.
McWilliam, R. A., Lang, L., Vandiviere, P., Angell, R., Collins, L., & Underdown, G. (1995). Satisfaction and struggles: Family perceptions of early intervention services. Journal of Early Intervention, 19, 43–60.
20.
McWilliam, R. A., & Sekerak, D. (1995). Integrated practices in center-based early intervention: Perceptions of physical therapists. Pediatric Physical Therapy, 7, 51–58.
21.
McWilliam, R. A., & Spencer, A. G. (1993, December). Integrated versus pull-out speech-language services in early intervention: A mixed-method study. Poster presented at the International Early Childhood Conference on Children with Special Needs.
22.
McWilliam, R. A., & Strain, P. S. (1993). Service delivery models. In Task Force on Recommended Practices, Division for Early Childhood, Council for Exceptional Children, DEC recommended practices: Indicators of quality in programs for infants and young children with special needs and their families (pp. 40–49). Reston, VA: Council for Exceptional Children.
23.
Notari, A. R., Cole, K. N., & Mills, P. E. (1992). Cognitive referencing: The (non)relationship between theory and application. Topics in Early Childhood Special Education, 11(4), 22–-38.
24.
Odom, S. L., McLean, M. E., Johnson, L. J., & LaMontagne, M. J. (1995). Recommended practices in early childhood special education: Validation and current use. Journal of Early Intervention, 19, 1–17.
25.
Palmer, F. B., Shapiro, B. K., Wachtel, R. C., Allen, M. A., Hiller, J. E., Harryman, S. E., Mosher, B. S., Meinert, C. L., & Capute, A. J. (1988). The effects of physical therapy on cerebral palsy: A controlled trial in infants with spastic diplegia. The New England Journal of Medicine, 318, 803–808.
26.
Piper, M. C., Kunos, I., Willis, D. M., Mazer, B. L., Ramsay, M., & Silver, K. M. (1986). Early physical therapy effects on the high-risk infant: A randomized controlled trial. Pediatrics, 78, 216–224.
27.
Sontag, J. C., & Schacht, R. (1993). Family diversity and patterns of service utilization in early intervention. Journal of Early Intervention, 17, 431–444.
28.
Strain, P. S., Smith, B. J., & McWilliam, R. A. (1996). The widespread adoption of service delivery recommendations: A systems change perspective. In M. E. Lamb & M. E. McLean (Eds.), Early intervention for infants and young children with disabilities and their families: Recommended practice. Austin, TX: PRO-ED.
29.
Striffler, N. (1995). Selected policies and practices under Part H of IDEA. Chapel Hill, NC: NECTAS.
30.
Tomes, L., & Sanger, D. D. (1986). Attitudes of interdisciplinary team members toward speech-language services in public schools. Language, Speech, and Hearing Services in Schools, 17, 230–240.
31.
Wolery, M., Venn, M. L., Holcombe, A., Brookfield, J., Martin, C. G., Huffman, K., Schroeder, C., & Fleming, L. A. (1994). Employment of related service personnel in preschool programs: A survey of general early educators. Exceptional Children, 61, 25–39.
32.
Yoder, D. E., Coleman, P. P., & Gallagher, J. J. (1990). Personnel needs: Allied health personnel meeting the demands of Part H, P.L. 99--457. Chapel Hill: University of North Carolina at Chapel Hill, Carolina Policy Studies Program, Frank Porter Graham Child Development Center.
