Several years ago in North Carolina, there was talk about moving to a primary provider model for delivering early intervention services. This came out of a long period of concentrated study that drew upon the work of nationally-recognized experts on early childhood intervention service delivery. Chief among the resources that informed this work was the Seven Key Principles: Looks Like / Doesn’t Look Like document, developed by the Workgroup on Principles and Practices in Natural Environments (OSEP TA Community of Practice-Part C Settings, March 2008). One of the key principles cited indicates that “the family’s priorities needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support.” There were plans for a pilot demonstration, and a working model was developed to show how teams of publicly employed early interventionists and privately employed therapists might work together. The notion was met with intense reaction (it seems that people either loved it or hated it), and plans got put on a back burner in favor of other, more pressing, issues facing the early intervention system.
So, where does that leave us in relation to a Primary Provider model? Definitions as to what constitutes a primary provider model vary, but in general, we are talking about having one provider who forms a primary relationship with a family to meet most of their support needs, while relying on the expertise of other team members as needed. In a recent survey conducted by the national IDEA Infant & Toddler Coordinators Association (Part C Implementation: State Challenges and Responses: 2013 ITCA Tipping Points Survey), the median number of planned service hours per child per month (excluding service coordination) is five, based on responses from 26 states. We don’t know from the data how often this represents a single provider doing home visits once a month versus multiple providers seeing the same family on a less frequent basis.
At the Mecklenburg County CDSA, we know from ongoing surveys of aggregate IFSP data over time that, on average, our families have one service on their IFSP, in addition to service coordination. In essence most families are working with one provider. Sole providers are working with families on a variety of routines-based outcomes that cut across multiple developmental domains. So are we “doing” primary provider intervention, and we just don’t know it? The answer is probably yes and no, depending on which aspect you take and what you require as the burden of proof. We continue to work with our network of providers on creating better teams at the individual IFSP level, as well as creating better opportunities for teaming between and among public early intervention employees and private network practitioners. We are proud of what we have accomplished and of the energy that continues to exist around practice improvement. So what are we still missing? There may be a number of answers to this, and we invite you to weigh in with your thoughts on where we are as a community of providers in Mecklenburg County, or as a network of providers across the state, in incorporating the spirit of this early intervention key principle. For our friends outside of North Carolina, please let us know where your views lie and the successes and challenges you see toward putting this particular principle into practice. Leave us a comment – inquiring minds want to know!