Working Together

Introduction

The complexity of the needs of children with Autism Spectrum Disorder requires the integrated efforts of a community. This includes family, educators, health care providers, and others. It is important to facilitate collaboration among the child’s family and professionals in order to work towards established goals to best support the child and his/her family.

Who are the Team Members?

Most children are born into families with community support. When a child has extra support needs they become part of a larger community. This community may include different professionals and services such as child care centres, early intervention programs, health care services (e.g., speech-language pathologists, psychologists, physiotherapists, physicians, occupational therapists, nurses), community services (e.g., social workers), and recreational programs. Each part of the community plays a specific role and brings a different expertise to developing a good, integrated program.

Parents are the experts and guardians of their child. They live with the child and know his/her likes, dislikes, tendencies, and personality. The family’s input is essential in the development of goals for a child’s program.

A few principles to guide interactions with parents and family members:

• Treat the parents’ views with respect. It is important to ensure that the relationship between families and professionals is collaborative and respectful.
• Maintain an objective perspective. Every family is unique and there may be many factors involved when making decisions. Treat the family as a unit, focusing on balancing the needs of all members involved, including siblings.
• Keep in mind that being a parent of a child with ASD brings new stresses to a family’s daily life.
• Professionals are guides, not experts
• Collaborative relationships involve a cooperative approach to problem solving and support. They require openness and sharing.
• Ultimately, the family will maintain responsibility for decisions involving the child with ASD. Professionals must realize that their involvement typically constitutes only a fragment of the total picture for the child and family
• Our goal is to create a partnership with the parents while working with the child. Creating shared goals for the child and respecting what every professional and parent/family member brings to the table helps the child to reach those goals.

Modified from Working with Families: A Developmental Perspective, 1987.

Team Members:

Family

Family members will typically have detailed knowledge about the child’s daily life. It may be helpful to obtain information about:

• Play activities the child enjoys
• How the child communicates at home
• How you can communicate best with the child
• Activities the child does not enjoy
• Strategies that help the child to calm down
• Rewards or reinforcers that motivate the child to learn a new skill
• Times of the day the child prefers to rest and relax and times the child prefers to be active
• The child’s preferences related to the following: positioning, diet, temperature, lighting, and sound level
• Special needs related to health and development such as toileting, dressing, and grooming

It would be beneficial to maintain ongoing communication with the family about their hopes and dreams for their child and anything that may be of concern. Families are a great source of information and resources about ASD to be shared with other team members.

Clinical Psychologist

A clinical psychologist has in-depth graduate training in learning and behaviour. S/he has the necessary training to administer and interpret formal psychological tests, diagnose, and provide intervention services for individuals with ASD. Psychologists examine children’s verbal and nonverbal cognitive skills and adaptive behaviours (e.g., self-care, social, motor, play). With training in behavioural-intervention methods, they can assist in developing and teaching programs for children with ASD. They are also equipped with professional skills to provide families with coping strategies to get through stressful circumstances.

Early Interventionist

Early interventionists are trained and experienced in working with families and children with special needs. They come from a variety of backgrounds, including special education, psychology, and early childhood education. They help families identify goals and organize resources. Activities are designed by early interventionists to complement the family and the child’s routine.

Occupational Therapist

Occupational therapists focus on functional and developmental needs. They examine a child’s fine motor skills, sensory processing, visual perception, organizational difficulties, oral/motor development, and seating/mobility needs. They pay particular attention to motor planning abilities related to the development of self-care, play, and social interaction skills.

Physician

Several different types of physicians may be involved in a child’s care, depending on his/her individual needs. The family physician makes referrals to specialists such as pediatricians, developmental pediatricians, neurologists, and psychiatrists. A pediatrician has special training in children’s health needs. Pediatric neurologists, developmental pediatricians, and child and adolescent psychiatrists have additional training and experience in diagnosing and managing certain aspects of child development and behaviour. Physicians are responsible for the management of medication. Neurologists typically also become involved when a child has a seizure disorder. In different centres, one or more of these specialists may be involved in the care of children with ASD.

Social Worker

Social workers have specialized training in family functioning. They gather information about the family history, relationships, and supports. They also provide support for the management of family stress and communication. Social workers typically have a good appreciation and awareness of community supports. They are strong advocates for families to access additional financial and recreational help, respite care, and social support.

Speech-Language Pathologist

Speech-language pathologists observe, evaluate and develop interventions to promote children’s communication skills. They will examine the child’s ability to understand communication (receptive language), ability to communicate with others (expressive language), social use of language (pragmatics), ability to control their tongue, lips and jaw (oral-motor functioning), ability to produce speech sounds (phonology/articulation), pitch, loudness, resonance (voice), and smoothness of speech (fluency). The speech-language pathologist may also assess and develop interventions to promote social interaction and play skills.

Other Professionals

Many other professionals may be involved, depending on the child’s needs. Physiotherapists provide support for the development of gross motor, mobility, and play skills. Nutritionists provide counselling and support regarding the dietary challenges that are common in children with ASD. Audiologists assess hearing and ophthalmologists assess vision. Geneticists are often involved when examining possible causal factors in the child’s disorder, as well as when families are considering having more children.

In the wider community, children with ASD and their families may also benefit from extended family, informal or formal support groups (e.g., autism societies, Association for Community Living), spiritual counselling or membership in a religious community, recreational programs (inclusive or specialized), opportunities to access respite care providers, and a variety of other supports. Each family will differ in how they define the team of essential supports for their child and themselves.

Behavioural Therapist

Many children with ASD access behavioural therapy in a group setting or on a one to one basis . Behavioural therapy can help the child to learn more appropriate behaviours and ways to express him/herself and work at decreasing challenging behaviours.

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Exercise: Describing Team Members’ Roles

THINK about a child with ASD at your centre.

TRY to generate a list of the various professionals involved in the child’s care of which you are aware.

Describe your understanding of each team member’s discipline and role in the child’s care. Remember that not all information needs to be shared with everyone, so you may not be involved personally with all of the child’s team.

Click here to see a sample answer

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How Does the Team Communicate?

It is helpful to have discussed methods of communication with family members before the child enters a child care centre. This ensures that the parents will know how to communicate their concerns to you when they arrive. It also helps parents to know how you will share your observations with them. It may be beneficial to consider keeping a formal record of the communication strategies a family would like to follow.

Program Plans

A program plan is a document designed to facilitate communication among members of a team that formally identifies plans for a child’s program. Different terms are applied to program plans based on the specific goals and objectives of the plan. For example, a child may have a very specific behavioural program plan to teach a particular skill.

This plan might include details such as the following:

• Teaching Objective
• Environment/Setting
• Activity
• Equipment/Material
• Prerequisite Skills
• Teaching Method
• Step 1
• Step 2
• Step 3
• Consequence(s) for correct performance
• Consequence(s) for incorrect performance
• Plan for generalization and maintenance
• Mastery criteria

Although you may develop some specific behaviourally-based program plans, you are likely to also need a plan to cover various components of a child’s program. Routine-based program plans are often developed in conjunction with early interventionists to incorporate teaching strategies into a child’s day-to-day routine. Staff members in early childhood education centres typically develop Individual Program Plans (IPPs) or Individual Education Plans (IEPs) to describe a child’s individualized education, or centre-based program. Increasingly, as intervention teams are developed, there is a focus on the development of Individual Family Service Plans (IFSPs). As part of the IFSP development, the family, centre staff and other team members meet to create a document that focuses on the family and the child’s development across a variety of natural environments.

There are many resources available to assist families and professionals to develop IFSPs and IPP/IEPs (see end of Module). It is recommended that early childhood educators and/or professionals working with children with special needs pursue additional training to gain experience in understanding and developing these important documents. As a guideline, here is a brief outline of the features of an IFSP and an IEP that has been adapted from The Individual Family Service Plan, 2000 and Creating Useful Individualized Education Programs (IEPs), 2000.

Individual Family Service Plan (IFSP)

• Records and guides intervention program
• A written document to facilitate communication among team members
• Includes information about the child’s developmental status (e.g. physical, cognitive, communication, social, and adaptive skills)
• Includes information about the family’s strengths, concerns, priorities, and resources
• Contains a plan to achieve goals/desired outcomes
  • Focus on developing particular skills to achieve functional outcomes
  • Procedures and timelines are identified
  • Service providers and the frequency of service delivery is identified
• Promotes intervention within natural environments
• Identifies a coordinator for contact as well as contact numbers for other people/professionals available for support
• Provides a dynamic document that is regularly reviewed and revised

Individual Education Plan (IEP)/Individual Program Plan (IPP)

• Records and guides education program
• Creates a written document to facilitate communication between the student, family, teachers and other service providers
• Includes information about the child’s current academic performance and may include additional information regarding strengths, weaknesses, behaviour, and school history
• Identifies expectations regarding the child’s learning that are modified from, or alternative to, those of the typical program curriculum
• Will include a transition plan to school and/or other appropriate services
• Contains a plan to achieve the goals and objectives
• Identifies aids, services (service providers and frequency of service delivery) and modifications
• Includes information regarding how communication occurs with parents/family
• Provides a dynamic document that is typically reviewed at least annually
• Includes information regarding transition services

IFSPs and IEP/IPPs have many common features. The IFSP focuses more specifically on the family. The IFSP also has an emphasis on intervention in natural environments. Typically the IFSP has been developed by a team from a variety of settings and therefore facilitates communication among all those involved in a child’s life.

It is important to prepare accordingly when you work with families and facilitate or attend an IPP/IEP or IFSP meeting. The degree of preparation you need will depend upon whether you are facilitating or attending. Some of the following guidelines may be helpful for your preparation, particularly if you are the facilitator:

• Communicate first with the family regarding its preferences for participation, a meeting time, and which individuals to invite.
• Invite all pertinent team members (have a list of names and telephone numbers), using the input from the family.
• Gather relevant documentation and review it prior to the meeting (e.g., reports, work samples).
• Prepare and circulate an agenda
• Arrange seating to facilitate communication.
• Welcome all attendees.
• Identify a “recorder” to take minutes of the meeting and ensure they are distributed to all members afterwards.
• Create a positive environment and encourage each member to express his/her opinions.
• Keep to the schedule (e.g., start and stop on time).
• End on a positive note with documentation of the intervention plan and agreed upon date(s) for follow-up meeting(s).

Regardless of your role you are most likely to have a positive meeting when you are able to participate in an open dialogue, respect and value the input of others.

Communication Books

A communication book helps to promote two-way communication between centre staff, families, and other professionals. A home-school communication book provides an opportunity for parents to share information about a child’s home routine that may affect the child’s behaviour at the centre. For example, if a child has had a short sleep and is likely to be tired the next day you may decrease the expectations placed on the child. A communication book also provides an opportunity for you to learn about significant events the child has experienced. One may use this information to provide activities that cater to the child. For example, if you know the child went to the swimming pool on Saturday, you might notice the child’s splashing gesture (which can be elaborated), or you can talk about how the water feels.

A communication book also helps families know more about what the child does during the day. Children with ASD may have challenges communicating about the day’s events. Short written notes, work samples, and photographs are all helpful ways to communicate. It may be useful to talk to parents to learn which details they would be most interested in learning. It helps to be specific about the events of the day and to share accurate and positive information. For example, rather than reporting that today was a “bad day”, try to say what triggered the behaviour of concern, what the child did exactly, and how it was handled. Then you might report how you are considering managing the situation if it arises another time.

Parent Visits

It is helpful for parents to observe their child interacting with others. Having an “open door” policy so that parents feel welcome to observe their child and the program helps to encourage a collaborative approach. Other professionals may also wish to observe the child in the centre. This may provide the professional with a broader understanding of the child, and create a good opportunity for an on-site consultation about specific issues.

Communicating with the Team to Meet a Challenge

When a child is making progress with their learning objectives, the program plan team may only be periodically involved. When there is cause for concern about changes in behaviour or progress, however, the need for collaboration becomes necessary for all team members.

Members of the child’s team may decide to meet for a number of reasons. For example, they may need to revise a learning objective due to changes in progress or new behaviours. The concern must be clearly stated and communicated among the team members. Be as specific as possible in describing the ABC’s of the situation of concern, or the nature of the child’s difficulty with a particular objective (e.g., Are previous rewards no longer effective? Has the child come to rely on a specific prompt?).

In cases of behaviours you want to reduce/eliminate, use the information from your observations to evaluate the function of the behaviour. That is, carry out a functional analysis (see Module 4). This preliminary information may be invaluable in helping you to define the problem and to decide which team members’ assistance would be beneficial. You may need the parents’ permission to contact other members of the team. Consult your director if in doubt.

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Exercise: Choosing a Team Member to Consult

Read the following scenario:

• How would you begin to examine the problem?
• What observations might you make, and what information will you need in order to develop a plan to address the problem?
• What are your initial suggestions for changes?
• If your initial plan does not produce an improvement in the situation within approximately two weeks, whose assistance (e.g., what professionals) might you consult? What would you expect their roles to be?

Click here to see a sample answer

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Transition – Preschool to School

Transitions can be challenging for individuals with ASD. Young children and families experience a variety of transitions. The change from a child care setting to school is a significant transition for any child. For those with ASD, a smooth transition may require a higher level of planning. Successful transitions are possible with careful preparation by a committed team of parents and professional partners.

In most jurisdictions, some members of the child’s team (e.g., some health care providers and other professionals) may remain part of the child’s team when they go to school, while others (e.g., early childhood educators) will not, and a new group of providers will become involved (educators and other school-based professionals). Strong transition services prepare families and children for the move, support them during the move, and maintain contact with them to address problems that may arise after the move.

As eligibility for school entry varies across jurisdictions, the child’s parents and child care providers need to be aware of the local eligibility criteria and of the transition process in your school district.

Some school districts have established steps to follow in preparing to support a child with special needs at a school. In other districts, the process could be less formal, or based more on the experience and accessible accommodations of the particular school. Parents often require support to ensure that a plan is in place for their child’s school placement. In some communities, private schools are being established for children with special needs, including ASD. Families may need support as they explore a range of options available to them and their children. During this time there may be periods of uncertainty and additional stress for the family. Preschool educators are often experienced supporters when working with families and children with special needs and can be an asset to a child’s transitional team.

Public and professional awareness of Autism Spectrum Disorder has grown a great deal in recent years. Children diagnosed with ASD vary widely in their skills and their behaviour. The staff of any given school may be unfamiliar with the wide range of abilities and characteristics of children with ASD. Information about the individual needs of the child you are working with must determine the services provided to him/her.

It is beneficial when families provide documentation about the child’s special needs in the form of reports from professionals who have assessed them or provided intervention services (e.g., speech-language pathologist, psychologist).

Usually a transition meeting will be held in the spring prior to the child beginning school. This meeting brings together parents, preschool educators, other consultants (e.g., speech-language pathologist, occupational therapist, psychologist), and those who will be contributing to the school-based program (e.g., principal, classroom teacher, resource teacher, speech-language pathologist). The goal of this initial transition meeting should be to devise a plan to introduce the child to the school, and vice versa, in as systematic a way as possible. Other meetings will be required to develop the school-based IPP (or IEP: Individual Education Plan or Program), which is often an outgrowth of the preschool IFSP.

The child’s parents may share written reports in advance of this conference, where the focus will be on facilitating a smooth transition from preschool to school. Information from the preschool program will include a description of the setting and routines, as well as the child’s individual program plan and records of his/her accomplishments. Preschool educators have the important role of sharing their knowledge about and experience with the child in a group setting. This information is crucial in ensuring a successful transition into school. Decisions such as the type and amount of support (e.g., dedicated time from an educational program assistant) may depend on a detailed analysis of the child’s ability to learn and interact within peer groups.

Remember, successful transitions are characterized by:

• Children’s positive attitudes
• Parents’ positive attitudes
• Teacher’s provision of developmentally-appropriate experiences
• Communities that provide support – sharing, cooperating, and coordinating across agencies

Try to be mindful of the differences in how preschool and school systems operate with respect to the number of children, types of learning environments (including physical spaces) and the different administrative structures and range of professionals involved. While information from the child care setting is valuable, one cannot entirely predict how a child with ASD will adapt to the demands of the school setting, based only on their preschool experiences.

Review

Families of children with ASD usually require many professionals to support the needs of their child and the family, but ultimately the goal is to meet the family’s needs. The collaborative efforts of team members should be directed toward empowering the family and helping to ensure that the child’s care and education match his/her needs. Good communication is a key to effective collaboration. When major transitions take place, special care must be taken to ensure that appropriate information is passed along at the right time, and in the most helpful way. Early childhood educators play a key role in providing observations of the child in a group setting, and in reporting the effectiveness of specific intervention strategies for the individual child.