IFSP Development, Practical Strategies, Service Coordination, What Would You Do?

Dr. Smith Recommends PT 5x/week…What Do You Do?

A new family is referred to your program and they bring with them a prescription for therapy. The prescription lists physical therapy 5x/week. The parents request this level of service because that’s what their pediatrician says the child needs. When you explain the difference between a medical model of therapy and the family-centered methods used in early intervention, the parents still insist that their child will need more therapy. What do you do? What do you say to the parents? To the physician?

The Source of the Problem

This problem is common in early intervention and is usually based in the differences in philosophy between medical or clinical models of therapy and how early intervention is provided. The medical model of therapy is not a bad thing, and is the model many therapists were trained in during their preservice education. The medical model of therapy focuses on the therapist’s interaction with the patient during sessions. There is usually a “home program” of exercises but the main work happens when the therapist and patient are together. In contrast, early intervention focuses on the interactions between the parent and child during and between sessions. The main work of intervention happens between sessions or visits when the parent and child interact during daily activities. When the parent (or other caregiver) gets appropriate support during visits and knows what to do between visits, the child receives much more intervention than he could receive in, say, 5 one-hour sessions with the therapist. He receives intervention throughout the day, which we know is more effective with infants and toddlers.

What Do You Do?

This model of providing intervention is an important thing for parents AND referral sources, such as physicians, to understand. If you were in this situation, what would you do?

How do you explain the way early intervention is provided to families?

Would you call the physician’s office? What would you say? (I once had a physician tell me that he was in the business of evaluating kids and that it was my job to treat them – that deciding what they needed was not my job. Yikes. We never cracked that nut but we did send him information about early intervention because he was a family practice doctor who I don’t think knew much about EI.)

How do you consider the physician’s recommendation when developing the IFSP?

What would you do/say if the family insisted that they wanted a higher frequency of therapy than what is recommended in the IFSP?

How do you build a supportive relationship with the family when it starts out like this?

Share your thoughts and ideas!

 

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5 Comments to “Dr. Smith Recommends PT 5x/week…What Do You Do?”

  1. Oh boy! I’ve had this situation more times than I can count. I DO think it is about educating our referral sources and I think as early interventionists, we need to be really good at explaining what EI IS and what EI IS NOT. I would work really hard to ask questions of the family to determine what are their outcomes and what support do they really need. No parent wants to think he/she is not giving his/her child the best so it is important to determine WHY so many PT sessions is how they would define “the best.”

    • I know, me too! I agree, that this really starts with referral sources and is an ongoing effort, particularly when the points of contact and physicians change. Like you said, too, digging a little deeper with the family is a great way to approach this rather than saying something like “we don’t do therapy that often” which I’ve heard people say before. The frequency of services is a team decision that’s made with everyone’s input. Helping families and referral sources understand this is key!

  2. Offering to connect a family to private therapy options is a good idea too, in some situations! Oftentimes parents who push and push and don’t seem to “get EI” I very politly will explain that they are more than happy to pursue therapy outside of our program as well, and we talk about it, and I provide them information on community options. I would only say 5% of the time they actually pursue the private services, but that is an option….

    • Good point, Jennifer. Yes, parents can certainly access private therapy. When I’ve had parents who want therapy through EI plus private, I would talk to them about coordinating between the two therapists. They also needed to check with their insurance provider too to see how this would work. Sometimes treatment can get tricky if the child is seeing two different therapists in the same discipline. Like you said, I didn’t have many families who chose to do both – except when there was a medical reason like when additional medical therapy was needed post-surgery. Offering it as an option so that parents know it’s a possibility can be very helpful.

    • We have quite a few who seek additional clinical services. And then they decline for us to use their insurance so they can double up on therapies. I try to explain the EI model and difference between medical model and educational model, but at the end of the day we can’t enforce any specific frequency as the plan is supposed to be individualized. SO with enough using a parent can usually get what ever services they think they need.

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