Peter Limbrick writes: It is my belief and my experience that a whole-child approach to babies and young children who have a multifaceted condition is the most effective spur to development and learning
- and offers practitioners opportunities to reconfigure their workload. This can take pressure off them and off their agencies’ budgets.
What is not a whole-child approach? Firstly, sending the child to six different places for help with her hearing, seeing, posture, mobility, hand function, learning, etc. Secondly, providing a separate practitioner for each of these areas of development – each of whom will design a separate programme for ongoing work.
If this is not the best approach, why do we do it? I might be wrong, but I think it comes from a historical medical mindset that insists: “Many ‘treatments’ are needed and here is bunch of specialists who know what to do.” and “Multiple diagnoses must mean multiple practitioners and programmes." The mindset dictates how we are trained – whether we are preparing for work in health or education services.
For many of us, when we train we don a pair of practitioner spectacles that act almost like a kaleidoscope fragmenting the children we look at into disjointed pieces that do or do not concern us. You might argue this is an essential element of training. But afterwards, when we meet babies and young children, we need to remember we are wearing these spectacles and then see what happens if we take them off. Some of us will find this scary. Some of us will breathe a sigh of relief. What will we see?
We will see a globally-functioning child. No separate bits in her development and learning. The infant playing on the floor with a ball brings everything to it; vision, hearing, hands, posture, movement, understanding, expression, motivation, memory, mood, anticipation, anxiety, sense of fun... (Please finish this list for me.) This is the whole child and this is the only way she can be and do.
So, what about the child (still a whole child, remember) who has separate and multiple diagnoses of cerebral palsy, sensory deficits, intellectual/learning disability, communication needs, etc (and who also might suffer pain, anxiety, poor nutrition and lack of sleep)?
Take the specs off and you will see that these conditions cannot be separate at all. They are just more interconnected elements of the whole child. When the visually-impaired infant with cerebral palsy masters the task of reaching for a bright bauble, perhaps with vocal encouragement from a sibling, parent or practitioner, I imagine he has developed a single new ‘touching bauble with hand’ neurological pathway in which vision and movement elements are integrated and no longer exist as separate elements.
While I am not wearing my practitioner spectacles I can see the absolute nonsense of thinking the child needs the simultaneous presence of a cerebral palsy expert and a visual skills expert and a sibling or parent to facilitate this new skill. But is not that the mess we have got ourselves into? Is not that the way we manage to overwhelm the child, overload families and keep expensive practitioners busier that they need to be?
With my specs lodged firmly in my pocket, I can see that it is a simple process for the parent, physiotherapist and visual impairment teacher to share skills with each other so that each can help the child achieve this skill of visually-directed reaching. This is ‘collective competence’ and it brings the possibility of practitioners and parents agreeing to reconfigure the time they spend with the child.
This child with cerebral palsy and limited vision teaches us something else – that for young children with a multifaceted condition, the separate terms ‘education’ and ‘therapy’ have no validity in his development and learning. How can learning to reach for a bauble have one element that is therapy (needing a therapist) and one element that is education (needing a teacher)? The false division is a left-over from a medical mindset and does none of us any good.
But babies and infants with a multifaceted condition have an absolute right (in my view) to all the high-grade professional expertise they can get. We just need to take our practitioner spectacles off, break free of the medical-mind-set shackles and work with others to find a better way to help whole children. This will include collective competence, will integrate to some extent all education/therapy programmes and will employ a consultant model of teamwork. Over-loaded practitioners will be freed up to make better use of their time (parents and children too).
These integrative approaches are embedded in the Team Around the Child (TAC) approach and are achieved in an ongoing service-development process of change rather than in one sudden step. I have met very many practitioners who can work in this whole-child way both within and without TAC systems and I take my hat (and spectacles) off to them.
The subject also forms part of the discussions in the ECI without Tears Seminar Series. The next is in Oxford in November and there are still spaces for professionals and parents.
Peter Limbrick, October 2017
TAC Bulletin cartoon from issue No. 208: