Where is Your Courage?

Written by John Ellis, Director, Mecklenburg County CDSA

I had the experience recently of being invited to do a brief presentation on early intervention to a local parents’ group for families with infants and toddlers with disabilities.  I was excited to get the invitation, as I had been trying to meet with their new parents’ group for some time, and this was the first time I had been invited.  In the past, it was often the case that we would receive new referrals for families that were involved in this group, and they often seemed to think we were out to deny services to their family.  They came to us with the belief that their child needed multiple services, multiple times a week, even as infants, and talking to them about their needs gravitated quickly to how many hours of service that they were going to get.  This did not help our relationship get off to a good start, and I wanted to do whatever I could to assure these parents of our good intentions.  I was told that there were multiple presenters on the agenda and that I was allotted 10 minutes.  How can I possibly explain early intervention in 10 minutes, I wondered.  I’ll give it my best shot.

On a beautiful early spring Saturday morning, I made my way across town to attend the group meeting.  The group was small, but I got meet seven wonderful families and their children and had lots of time to chat with them prior to the formal meeting.  When my turn came up on the agenda, I got up and crammed all that I could into the 10 minutes I had.  I talked about the importance of families and our desire to enter into mutual relationships with them.  I talked about the importance of natural environments and that children’s best learning occurs with familiar caregivers in familiar places during the course of familiar routines.  I talked about the development of skills within these routines and the value of functional outcomes in supporting and improving day-to-day situations.  Before I knew it, my time was up (are you sure that was 10 minutes?), but I thought I got most of the important stuff in there.

Following me on the agenda were staff (3 of them) from a local children’s outpatient therapy practice.  They had 10 minutes too (x3) and talked about what therapy “looked like” when they were doing it.  They talked a lot about techniques and different kinds of problems with skills or deficits to be corrected.  They also talked about being able to see a child in a controlled environment with all of the equipment that they need to do their work.  They did mention early intervention in order to point out how they were different.  One difference they noted was that children didn’t have to “qualify” for a certain service, like they do at the CDSA, by getting a low score on the test for that service.  This, of course, isn’t true; services are identified based on the supports that families need, not on a child’s skill deficits.  They also explained that you could get a service multiple times a week, unlike at the CDSA, where you could only get a service once a week (also not true; frequency is based on need).  They further expalined that, as long as insurance would cover it, you might as well maximize your insurance benefit because, after all, the more therapy your child gets, the better they will do (which is not borne out by research).  Immediately following the program, the three therapists were down on the floor with the children, showing the families what they (the therapists) could do.

In the moment, I was dumbfounded.  Made me wonder what they might have said about early intervention if I hadn’t been there.  In retrospect, I realize that I was too polite.  I was trying to avoid a controversy in front of these families and didn’t want to “take over” the agenda.  So, I sat quietly while misinformation was shared for the sake of keeping the peace.  I could kick myself.  A friend of mine in early intervention talks about needing to have your courage in the right place when it comes to standing up for practices that you believe in.  I wonder where my courage was that day.  I convince myself that I shouldn’t have to stand up for practices that evidence supports, and in polite company, we don’t address conflict, especially not in front of families.  Instead, I let the opportunity go by to help parents get information that they need to provide the best possible support for their children.  I’ll be better prepared next time.

Where is your courage today?  What will you choose to confront or take on in the best interests of families?  Will you stand up in the face of conflicting information to share what you think is important?

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6 Responses to Where is Your Courage?

  1. Betsy April 24, 2014 at 9:03 pm #

    You and your organization have shown courage in so many ways over the years as the Infant-Toddler program has evolved. It took courage to insist providers use only evidence based interventions. It took courage to provide training and support for professionals as they loosened their grip on toy bags. It took courage to hire people to provide services in different languages. It took courage to provide leadership through the chaos of ever changing policies and budget restraints. The Mecklenburg CDSA has shown courage in so many ways. Thanks for that and so much more!

    • John April 25, 2014 at 12:14 pm #

      Thanks Betsy! This story for me was really all about how easy it is to be caught off guard by conflicting information that is so ingrained in how we have always done things that we don’t even think to step in and correct it when we hear it. It is something we ask our staff to do all the time and this was an instance where I partially missed it. It reminds me of a provider meeting we had a couple of years ago where one brave provider stood up in front of the whole group and said that those in the network who weren’t changing their practice were making it hard on everyone else in the network who were. That was a real moment in courage.

  2. Tina April 26, 2014 at 12:37 pm #

    This reminds me of 2 Timothy 4.
    I’m sure there will be many other opportunities for you to speak up for what you KNOW to be best practice for children and families. Be prepared in season and out of season…I may orchestrate an opportunity for you to practice 🙂 LOL. Hang in there, don’t be too hard on yourself. The CDSA is what it is because of your great leadership.

  3. Jennifer Barrett-Zitkus March 17, 2015 at 7:28 pm #

    Great article and I needed courage today. The IFPS service plan includes once a week everything and PT and SLP want to increase to twice a week. UGH

    • EI Excellence March 23, 2015 at 8:03 am #

      So glad this was helpful! I’m not sure what role you play on the IFSP team or where everyone is on the spectrum of best practices, but keep up the good work, and keep up your courage!!! 🙂

    • EI Excellence March 23, 2015 at 8:07 am #

      One more thought, Jennifer – in a couple of weeks, we’re having our next Table Talk Wednesday event here in Charlotte, NC, and we’ll have a Recap that will post shortly after. We’ll be talking about how services end up on the service delivery page in the IFSP. 🙂 You can sign up to get our blogs in your inbox automatically – stay tuned!! 🙂

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