Model for the Coordination of Services to Children and Youth
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Model for the Coordination of Services to Children and Youth

Background Information


Co-ordination of Services

The Department of Health and Community Services, Education, Human Resources and Employment and Justice have agreed to the implementation of the Model for the Coordination of Services to Children and Youth. To facilitate the implementation process six regional teams have been set up throughout the province. The teams are comprised of consumers as well as representatives from each of the four departments. A standing member on each team is the regional child health/services coordinator. A provincial integrated services management team is in place as well and has been assisting the regions in their efforts in implementing the Model.

The Model is mandated to support children and youth from birth to 21 years. The Departments recognize that services cannot be fully effective if provided to a child/youth in isolation. Children/youth must be served within the context of families and communities where they live. The integrated service approach is intended to build on existing services, avoid duplication and at the same time enhance the role of parents/guardians and their children. All of this can be accomplished through the Individual Support Services Plan (ISSP), a child centered approach designed to meet both the individual and service needs of the child/youth. All partners are now able to share information about the child/youth through the development of an Information Sharing Protocol. All Departments and agencies will use a common consent form which will greatly enhance the ISSP process.

Another component of the Model is the development of a process whereby children and youth will be profiled if identified to be at risk by a professional or parent/guardian or once an ISSP is completed for a child/youth. The profile is designed to capture information on the needs of children/youth for the purpose of service and resource planning and problem solving. The information from the profiles will enable the Regional Integrated Services Management Teams to; identify the needs of each community in the region, identify barriers to service delivery, and to accurately represent the needs of the regions to the provincial team and the Departments.

May 1993

NLTA brought four issues to Government's attention.

Issues were:

  1. Quality of work life
  2. Integration of children with special needs
  3. Description in the classroom
  4. Gender equity

June 1993

Memorandum of Understanding signed between NLTA and Government agreeing to formally structure a committee to study the issues.

October 1994

Classroom Issues Committee formed

Chaired by Assistant Deputy Minister from Department of Education

Other members

  1. Newfoundland and Labrador Teachers' Association
  2. Newfoundland and Labrador School Boards Association
  3. Administration - Health and consultants
  4. Administration - Social Services and representatives from various divisions
  5. Lawyer - Justice and the police when necessary
  6. Cabinet accepted 68 of 69 recommendations
  7. Model for Coordination of Services to Children and Youth was one of these recommendations

September 1995

Coordinator appointed to oversee implementation of the recommendations

Departmental representative appointed from each department

21 working committees formed to action the recommendations

June 1996

Committees submitted final reports/documents

Examples

  • Child Maltreatment
  • Teaching Methods
  • Discipline, Safe Schools, Teams, Discipline Policies
  • Individual Support Services Planning
  • Profiling Needs of Children/Youth

Provincial Team held 6 regional consultations

September 1996

Pilot began in western region

Regional boundaries are very similar to those of the Community Health Board

What are the basic principles of which the Model is based?

  • prevention
  • seamless services
  • holistic approach
  • collaboration
  • needs met
  • existing services
  • context
  • planning
  • transdisciplinary

PRINCIPLES

Prevention The Model is based on a philosophy of prevention and early intervention.

Seamless Services  
When risks or needs are identified by any agency the agency should ensure that the child's/youth's needs are profiled and the child's progress monitored.
If and when other services are required each professional is expected to make the appropriate request for consultation, assessment or support services.

Holistic Approach  
Caregivers must participate in the decision making process ensuring a holistic rather than a splintered approach to service delivery. Children/youth benefit from a coordinated, consistent, and efficient team approach which minimizes disruptions to their daily routine and enhances communication between/with professionals and parents.

Collaboration The Model is designed to clarify the process for service providers and district/regional administration to collaboratively support children/youth with special needs and/or at risk.

Collaboration is necessary at three levels:

  • child

  • community

  • region

Needs Met
  For the purpose of this Model a child with a special need is one who is identified to be at risk or has a special need as determined by one or more of the service partners.
The decision making processes used by the Regional Teams and Child Specific Team should be collaborative in nature and the child's/youth's needs should be met in a timely and proactive manner utilizing the Integrated Services Management Approach. It is not meant to compromise the authority or mandate of any of the individual team members but to complement the normal responsibilities of good practice. Teams must ensure that the child's specific needs are profiled annually and the information sent to the Regional Child Health Coordinator.
 
Existing Services  
The approach outlined in the Model is intended to build on and enhance existing services including those initiatives and activities of the preschool period which are vital parts of the continuum of services to children and youth.
The Model recognizes that many children require supports or interventions for specific periods during or throughout their preschool and school lives. Those supports often require input from many professions represented within the Department of Education and/or Health and/or Justice and/or Human Resources and Employment. The Model recognizes that such professional supports are meant to complement and enhance the role of parents, who along with their child have a leadership role as team members in the implementation of the support services planning process. Professionals, involved in meeting the needs of children throughout the preschool and school-age period (0-21), must be willing to participate flexibly in a support services planning process.

Context  
The Model recognizes that services cannot be fully effective if provided to a child/youth in isolation. Child/youth must be served within the context of the families and communities where they live. Parental involvement is a critical component in the implementation of all aspects of the Model.

Planning

  • Children, unless compelling reasons exists, should be involved in the support services planning process

  • Vocabulary, utilized by all agencies, should be consistent

  • The leader of a child specific team is known by all agencies and consumers as an Individual Support Services Manager.

  • The team is known as an Individual Support Services Planning Team.

  • The Regional Team which is known as a Regional Integrated Services Management Team oversees the effective implementation of the Model utilizing an integrated services management approach which means an approach that coordinates the actions/supports of all service providers, and one which allows for coordination of various services into a common and cohesive program plan for the child and family.

This integrated services management approach provides the following advantages:

  • It reflects the regional/provincial circumstances of multiple service providers and the commitment to provide coordinated services to the child/youth at the community level.

  • It allows for effective practice. Coordinated service provision will see the joint development and monitoring of an individual program plan. It is also an opportunity to plan supportive strategies from a preventive rather than from a crises management perspective.

  • It is collaborative. One of the present challenges of working with children and youth who are experiencing difficulties is having to do so in isolation of other professional support or at cross-purposes with other service providers. Stress is also paced on the importance of the full, participative involvement of families.

  • It defines a process which can sustain continuity of service to meet individual needs. Although individual members of a program planning team may come and go, the process will be continuous, and the child/youth and family will always know some of the members.

  • It facilitates and maximizes an efficient use of the existing limited resources.

  • It builds on the support services planning process and other communication mechanisms already in place and formalizes the involvement of personnel in the Department of Education, Health, Human Resources and Employment and Justice. Through the support services process, the team members are expected to reach consensus selecting a single set of priority goals and objectives. The plan integrates input from all involved team members, identifies supportive strategies, time frames and mechanisms for evaluation.

An integrated service management approach ensures that input of a specialized nature supports the child's support services plan. It limits the number of service providers with whom the child/youth and/or his/her family interact to a manageable number, and it facilitates the acknowledgment and sharing of skills and information. It includes the child/youth in the decision making process and in ensuring that appropriate services are made accessible, unless compelling reason(s) exist.

This approach further ensures that the following premises are adhered to by professionals from Education, Health, Justice and Human Resources and Employment:

  • Parent/guardian or person operating in locus parentis and/or child are considered equal to other members of the team.

  • Information shared is in the best interests of the child/youth/family.

  • Information which would affect the safety or well-being of a child/youth, is communicated to the Individual Support Services Manager and the parent/guardian.

  • All provincial agencies will communicate to the Individual Support Services Manager and/or designated professional and the parent/guardian.

  • Information affecting the best interests of the child/youth/family or individual operating in locus parentis will not be withheld from the Individual Support Services Manager. Confidentiality does not imply secrecy.

  • Where expertise varies, members with similar competencies will be given the authority to represent the specific area of expertise at the team meetings, enabling numbers of team members to be kept to a necessary minimum.

Transdisciplinary Process  
The transdisciplinary approach is based on a number of theoretical assumptions including the following:
  • Multiple factors converge to produce any given symptom complex. The development of a symptom is the result of a complex series of interrelated multidirectional forces, with all elements in the system affecting and being affected by each other in linear and nonlinear ways.

  • The child is understood as a whole person in an environmental context. For example, familial and social factors cross over to affect development and are often the most critical factors in tipping a child over the line from functional to dysfunctional.

  • Because of the unity of development in infancy, intimate crossing-over effects among the zones of development promote or prevent optimal progress.

  • The concept of cumulative adversity (McCrae, 1986) implies that a developmental disability is a result of the accumulation of multiple misfortunes set in motion over time, rather than the result of some single unitary event.

Operational Principles  
Service delivery in the transdisciplinary approach is characterized by role expansion and role release.

Role Expansion  
Role expansion refers to the educational, conceptual, and administrative adjustments that must occur to support transdisciplinary practice. In terms of education (staff training), role expansions implies an ongoing formal and informal instructional process through which team members elaborate their theoretical knowledge across disciplinary boundaries. Operationally, this occurs as team members train one another in the theoretical and conceptual aspects of their respective disciplines. Aimed at preserving individuality within a matrix of shared knowledge and skill, this process services as a foundation for transdisciplinary practice. The result is the development of a common vocabulary, an expanded repertoire of theoretical constructs, and an implied capacity for the team to generate multiple hypotheses and integrated interventions.

Role Release  
Role release refers to the process of transferring specific skills, strategies, and techniques across disciplines with the aim of achieving comprehensive and integrated intervention through a primary provider (and parents), thereby reducing multiple handling and individual therapies. This approach, however, does not preclude that some children may require individual therapies/interventions as well.
During the intervention stage, the primary provider, with parents, delivers as comprehensive and integrated a program as possible. This means that one interventionist, implements movement experiences, learning opportunities, language encounters and the like, from across disciplines. When primary providers deliver interventions traditionally considered outside the boundaries of their own disciplines, they are operating in the role release mode. However, the ultimate responsibility for the proper execution of these strategies remains with the professional who trained (role-releasing professional) the primary provider (role receiving professional) to implement the intervention (Haynes, 1983). Thus, it behooves both role-releasing and role-receiving professionals to work together carefully and cooperatively in the selection and training of strategies as well as the ongoing supervision of their implementation. It is imperative, that administration recognize these activities (role-release training and supervision) as legitimate parts of the transdisciplinary teams' job description and allocate sufficient time for their implementation.
  • The discipline of the individual chosen to be primary provider is typically based on experience training, and the best match with the child's disability. The emotional goodness-of-fit between the professional and family is an important consideration.

April 1997

 

 

 

 

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