The Journal of the Arkansas Medical Society Med Journal Aug 2019 Final 2 | Page 13

AFMC: A CLOSER LOOK AT QUALIT Y
tance of family engagement and
effective communication.
How is each team member
helping meet his goals? If team
members communicate well and
work closely together, parents and
teachers understand what therapists
are working on and can provide
opportunities to practice those skills
throughout the day. This therapeutic
“carryover” not only multiplies
exposure to intervention, but also
ensures the child is practicing
skills in different contexts. Skill
“generalization” can be especially
difficult for children with autism. It
is important that all team members
realize this to avoid mistrust among
caregivers who may doubt each
other’s versions of the child’s abilities.
How does the team
communicate? Do parents
communicate directly with the
therapists and therapists with
teachers? How often? Does the
family feel like an important part
of the therapeutic team? Do they
feel welcome observing therapy
sessions or asking questions?
Effective team communication
is a key marker of service quality.
It is necessary for therapeutic
carryover and integration of skills
across settings. Asking about
and providing suggestions to
improve team communication is
one of the most important things
a PCP can do in a follow-up visit.
Some teams communicate well
through a long-standing email
conversation. A low-tech option is
a communication notebook that
travels with the child across activities
and providers. However, written
communication cannot take the
place of face-to-face meetings where
parents, teachers and therapists
develop trusting relationships.
Where does he spend the day
and what’s that like for him?
Services, both at home and in a
group setting, should align with
the Individuals with Disabilities
Education Act’s (IDEA) guidance
to provide a “free and appropriate
education in the least restrictive
environment possible.” 2 To a phy-
sician, appropriate services should
provide necessary supports for the
child to successfully engage in their
environment. Services must include
targeted, evidence-based interven-
tions to improve the child’s delays. 3
Intensity of intervention frequently
requires a higher adult-to-child
ratio and higher provider expertise
than is found in a typical daycare or
classroom. The challenge is always
to balance effective intervention and
adequate support with the benefits
of a naturalistic, inclusive setting.
Therapy services integrated into
daily home and classroom routines
enhance therapeutic carryover,
build effective team relationships,
decrease behavioral problems asso-
ciated with transitioning in and out
of therapy settings, and effectively
utilize naturalistic, child-led interven-
tion strategies.
After discussing these issues with
GD’s parents, you arrive at a shared
plan for them to set up a team meeting
with his therapists and teachers.
You help them list topics for that
meeting, including a communication
notebook and specific things they
can do at home to improve his social
engagement. You encourage them
to apply for the AAP Waiver program.
They have not done this because
they’ve heard the waiting list was too
long. You provide contact information
and encourage them to speak
directly with program personnel. You
reinforce that his progress in other
areas is limited by his poor social-
communication skills. You emphasize
that the interventions provided by the
AAP, such as ABA, have been shown to
improve the core social engagement
delays associated with autism.
Acknowledge that it is ultimately
the family’s decision but strongly
recommend this program. The family
agrees to this plan and a follow-up
visit with you in three months.
Parents understandably worry
about doing everything they can
to optimize their child’s future. It’s
important for PCPs to regularly
check with families about their
concerns, and be a knowledgeable
and trustworthy ally in the family’s
efforts. Reviewing the child’s service
plan and reassuring the family that it
seems appropriate, or offer sugges-
tions for how to intensify it, benefits
the child and the whole family. s
The authors are faculty in
Developmental-Behavioral Pediatrics
at UAMS.
REFERENCES
1. Houtrow, et. al., “Prescribing Physical,
Occupational and Speech Therapy Services
for Children with Disabilities: Amer Acad
of Peds Clin Rept,” Pediatrics 2019; 143(4):
e20190285.
2. Findings and Conclusions: National
Standards Project: Assessing the Need for
Evidence-Based Practice Guidelines for Autism
Spectrum Disorder, Phase 2. National Autism
Center, a Center of the May Institute,
Randolph Mass.; 2015.
3. Lipkin P. and Okamoto J.; the Council on
Children with Disabilities and the Council
on School Health, “The IDEA for Children
with Special Education Needs,” Clinical
Report of the Amer Acad of Peds; Pediatrics
136 (6), 2015.
AFMC WORKS COLLABORATIVELY WITH PROVIDERS,
COMMUNITY GROUPS AND OTHER STAKEHOLDERS TO
PROMOTE THE QUALITY OF CARE IN ARKANSAS THROUGH
EDUCATION AND EVALUATION. FOR MORE INFORMATION
ABOUT AFMC QUALITY IMPROVEMENT PROJECTS,
CALL 1-877-375-5700 OR VISIT AFMC.ORG.
AUGUST 2019
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