The consultant model becomes a natural way forward when a child’s TAC wants to reduce the load being put on the child, the family and the child’s practitioners.
Peter Limbrick writes: In Part 1 (TAC Bulletin issue 208), I argued that we have to sometimes move beyond our professional compartments (for example, vision, hearing, learning, movement, posture, communication, etc.) in order to perceive and support the whole child, whether a baby or pre-school infant.
When the child has a multifaceted condition, early childhood intervention becomes a collective effort because none of us has high-level training in the whole set of topics into which we divide a young child’s development and learning.
I offered collective competence as a first step when a child’s parent, teacher and therapist decide to join their efforts into a whole approach. This can be formalised into the consultant model in which members of a child’s TAC agree to hand over some of their work to one or more of the others. The reasons for using the consultant model include:
- Taking another step towards a genuinely whole child approach
- Integrating interventions for communication, movement, etc. so that each area of development can support the others – and in anticipation of their fusion in the child’s neurological development
- reducing the number of non-family people the infant is asked to accept and relate to
- reducing the number of practitioners the family has to organise regular appointments with
- helping busy practitioners to reduce their workload while being assured the child is getting regular practice in developing the particular skill or skills TAC is focusing on
I am fairly sure practitioners will not be able to succeed in this unless they know each other well and respect and trust each other’s professionalism. These professional-professional and professional-parent relationships are built into the TAC approach using Hilton Davis’ model of the helping relationship*.
Nor will the consultant model succeed without proper planning in the child’s TAC discussions. This planning must answer the following questions (remembering that the child’s parent is a member of the TAC):
- Is there clarity about why the consultant model is going to be used at this time?
- Is there a firm decision about which TAC member is handing over some work to one or more other TAC members - and about what the work is?
- Is the ‘receiving’ TAC member(s) able to take the work on in terms of competence, space, time, etc?
- How will the necessary training and instruction be given to the ‘receiver(s)’? Can there be notes and video to refer to when necessary?
- What is the mechanism for the receiver asking for help after the initial training?
- How will the TAC member who is handing over some work remain available to the parents?
Perhaps if you are in a TAC embarking on this consultant model, you will have your own questions to add to the above list. The consultant model between two or more members of a TAC is a short-term reconfiguration of how TAC members are using their time. It has clear expected outcomes for the child, family and professionals. Each member of the TAC must feel comfortable with this way forward and be confident that it is not subverting how they see their role as professional or parent.
The consultant model is not new. Professionals are long accustomed to handing over work to parents (and in some cases would do well to apply the questions above); Particular therapists and specialist teachers hand over work to staff members in schools they visit. Here are a few examples of work that can be handed over from a TAC member who has relevant higher-level skills to another or others who can be trained for this particular child:
- Promoting a child’s movement across the floor to the toy corner (which she can see or hear)
- Encouraging a child to release grasp to let a toy fall into the adult’s hand and then attending to the ‘thank you’.
- Asking the child to attend to two things offered (socks, drink, etc) and indicate a preference.
Once one or more TAC members (parent and professionals) have become competent, they can integrate these tasks into their own work with the child. This has the dual advantage of giving the child more opportunities to practice and facilitating the new skill being integrated with the child’s other skills – a whole approach to the whole child.
It is my experience that when education or therapy professionals adopt the consultant model for a baby or infant with a multifaceted condition, they are using their professional skill to the utmost and fulfilling their responsibility to be part of a collective effort to treat or teach the whole child.
I made my case in Part 1 that traditional systems in education and health services divide development and learning in disabled babies and infants into unreal compartments and that this medical mindset is detrimental to both the child and family as well as putting unnecessary added pressure on practitioners. A change of culture is needed towards a whole-child approach. TAC offers a circularity in this: a genuine multiagency effort in a locality will build a TAC system, and then each TAC team within it will help multidisciplinary practitioners (in therapy and education) learn to trust each other and thereby deepen and extend the culture change.
* See ‘The Family Partnership Model’ in Early Childhood Intervention without Tears p. 61.
The subject also forms part of the discussions in the ECI without Tears Seminar Series: Seminar series (UK) - new work with infants with disabilities ‘ECI without Tears’ Oxford 2017, then Bristol, Wakefield, Liverpool, Exeter, Sheffield & Manchester in 2018
Peter Limbrick, October 2017