Is it appropriate in early child and family support to offer each family just one practitioner?

‘we can combine the role of keyworker and primary interventionist in the time between birth and the child entering a nursery or school’

Peter Limbrick writes:

There can be much bewilderment, confusion and even chaos for a new family whose child has some sort of disabilities and special needs. This can be so even before any formal diagnoses. A growing group of practitioners might get involved, in some cases from the time of birth. These practitioners all come with a genuine desire to help the child and perhaps the family.

The situation will be different in each country and region. In my country (UK) parents might soon be overwhelmed by too many practitioners and programmes making life very busy and exhausting. The result is something very different from their normal family life. The baby or infant can be overwhelmed with too many strangers, too many interruptions to infant routines and too many unfamiliar places to be in. The result is something very different from normal childhood.

For these families there is a downturn in quality of life and reduced opportunities to develop bonds of attachment between child and parents.

How do we help parents make sense of this before it all comes to be too much to bear? We have known for a long time that keyworkers [1] can be a great help. Whether we call them keyworkers, key workers, link workers or something else, they can provide emotional support, help find answers to questions and help organise all appointments and treatment into a sensible pattern that is less disruptive. The keyworker becomes a trusted ‘friend’ to the family and can function as the interface between them and the host of services and practitioners that need to be involved.

We know too that some families benefit from a practitioner who functions as a primary interventionist [2]. This is one person they get on well with who works more directly and more often with the child than the others. Ideally, it becomes a close partnership involving the child, parents and primary interventionist working and playing together.

The other practitioners who might have worked directly with the child now take a back seat. They stay involved but their role is to support the primary interventionist. We can think of the primary interventionist as a coffee grinder who takes in all the different education and therapy programmes, processes them and then delivers them to the child and family as a whole and enjoyable activity. The primary interventionist’s main work is to help the parents as they bring up their baby or infant – not to take over from them.

Moving towards my ideal of supporting new families with just one main practitioner, we can combine the role of keyworker and primary interventionist in the time between birth and the child entering a nursery or school. This would certainly be a helpful approach to a new mother who is lacking in confidence with her special baby. I have found it is a successful model for parents who have intellectual disability as well as for parents who have busy professional lives. I have used the approach with families of terminally ill young children.

It is a very demanding professional role which requires familiarity with local networks, great empathy, good listening skills, a sound knowledge of child development and an understanding of how babies and infants learn. It also requires trusting partnerships between this practitioner and the others around the child and family.

This model of ‘just one practitioner’ can work well in countries with well-developed economies rescuing child and family from overload. But there will be many people in other countries with lower economic levels who already work in this sort of way. I feel there is a great opportunity here for sharing experiences, learning from each other, and perhaps coming to a basic approach to early child and family support that is generally applicable. It would create base that could be modified for each individual child and family and added to as resources allow.

The just-one-practitioner approach begins by acknowledging and respecting parents’ role, respecting the rights of the child, promoting bonds of attachment and preserving quality of life of child and family. This is an appropriate start with families in any country.

Peter Limbrick, May 2020

[1] The Keyworker: A practical guide

[2] Primary Interventionists in the Team Around the Child Approach

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