A Conceptual Model to Support Integrated Early Intervention Practice for Children with Disabilties

Abstract

Background: Early Intervention (EI) for infants and prechoolers with disabilities is seen as essential in ameliorating the impact of the impairments on their development. Providing integrated, family-centred, culturally appropriate and socially inclusive EI services is complex. Presently the Irish Health Service Executive is reshaping the style and delivery of these services. These changes need to be informed by evidence and underpinned by concepts which are grounded in praxis. This research aimed to build a model of faciliating and hindering constructs, from multiple perspectives, to support integrated care for EI service delivery. Methods:The research used a qualitative case study research design to coordinate the data from multiple perspectives. Multiple methods were used to understand the phenomenon such as interviews, autophotography and observations. Grounded Theory1 provided clear procedural steps for data collection and analysis. Results: Participants included young children with disabilities (n=5), parents (n=6) and professionals (n=17) from one EI team. This EI team was part of a bigger non-government organisation providing an EI service for children, aged from birth to five years, with intellectual disability. The child and parent participants were from different families. All families were nuclear families. In total, 31 in-depth interviews and two observations were undertaken and data were collected and interpreted in a coherent, systematic and rigorous way. Results: A complex model, Synergistic Interdependent Relationships in EI, emerged which is a synthesis of different theoretical approaches. The study indicates that the relationships within EI are interdependent. There is a balancing act between the different influences within the relationship: each person, dependence, investment, alternative services, comparison, interaction process, and relationship stages. The outcomes of the relationship can be understood in terms of rewards and the costs. Discussions: This study is timely and provides a new and unique model of process constructs for EI practice. It supports and recognises the inclusion of young children with disabilities within the data collection process adding a holistic approach to EI research. It advances thinking and creates synergy across different theoretical frames grounding social exchange theory and interdependence theory within EI praxis. Conclusions:There is a need; to understand how rewarding and enabling intervention is to all involved in the relationship, to consider the goal of the partnership as one where the rewards exceed the costs, and to balance the system influences and the people influences within the relationship. The conceptual model can be used as tool to faciliate best practice in EI service provision. Lessons learned: Involving children with disabilities to share their voice was challenging and the researcher explored ways to facilitate their participation. Limitations: The case study was based on one team in a particular cultural environment. However clear explanation and transferability were the goals, with the substantive theory being the researcher’s interpretations of the participants’ perspectives. Suggestions for future research: Test the substantive theory with other EI teams in order to develop a formal theory.