Early Childhood Intervention without Tears- Improved support for infants with disabilities and their families. Peter Limbrick
Book Review: By Dr Emma Johnston- Clinical Psychologist, currently working in a child and adolescent learning disabilities team, with a career history (12 years) of working within disabilities and in early years support.
What a truly brilliant book. Peter Limbrick’s thoughts and ideas and the ways in which he has organised them into a coherent model of service development are excellent. I am right behind the need to reconfigure how we currently support families who have infants with disabilities and think that this way of working would be a significantly different but manageable way forward. It holds the families and children at the centre of everything that services offer, seeking to empower them to work and support themselves and their child within their own capabilities.
So why do we need a new approach?
Peter tells us that most practitioners and academics are divided into different camps depending on their areas of specialism. E.g. they specialise in, for example children’s language skills, children’s movement skills or children’s cognitive development. But any young child cannot really be divided up like this. Separating and dividing children up in this way is in a way convenient for practitioners and academics. However, if you watch a child playing they bring posture, movement, the use of their hands, feet, mouths, sensations, perceptions, socialising, communication, memory, motivation, anticipation, preferences, pleasure etc to their play. Trying to pull apart an interconnected and interactive whole cannot really be done with any usefulness. He says we need to look beyond the disability and see the whole valid infant and respond to them in the same relaxed, warm and excepting manor we would a typically developing child.
Peter believes that the work practitioners do should first and foremost be looking to support and develop the parent-infant bond, using attachment theory and to respect a family’s quality of life before the family falls into exhaustion, stress and strain and then need to be rescued.
What could a new approach could look like?
Peter, therefore proposes that we need a ‘Team around the child approach’ (TAC) which is truly collaborative and in which parent’s, practitioners (and I believe- the academic evidence base) around a child come together and share observations and ideas to develop a unified coherent plan of action. The focus is on what the child is ready for at the time and what is useful for them and what the family can sustain, rather than offering lots and lots of ideas and interventions and expecting everything at once. New skills, e.g. washing and dressing, need to be incorporated into a child’s natural activities as these are more meaningful to a child. Special therapy sessions should be avoided.
Using the Family Partnership Model, encompassing the values of familiarity, respect, honesty, trust, humility and genuiness, the TAC meeting should be made up of a core of 3-4 people who embrace those values and who meet to share and collaborate. Meetings should be shaped by the current needs of the family and child with no set agendas. He suggests an outline meeting of a meeting to be:
1. start by asking how everyone is
2. find out what has changed since last time
3. find out how the child’s parents have experienced the activities of living and learning that have been agreed in previous TACS and
4. plan the next steps
Peter goes on to propose an Infant Activity book should be made for every child, detailing their programme goals with comments from anyone supporting that child with them. This book should go with the child to hospital, on short breaks, to nursery, and to child groups so that living and learning can continue as appropriate for each child and be consistent.
Peter dedicates the last chapter to supporting services to think about how to reconfigure themselves with useful ideas about inviting observations from families who have been supported by services in the past to reflect on what was useful and what was less so. He also talks about the complexities of truly integrated approaches and offers suggestions to support this process.
Peter concludes that although families currently receive unsatisfactory support from early childhood intervention services, this is in both our views because of the way support is delivered rather than from any lack of commitment or effort from practitioners or their managers. Ineffective early childhood intervention support can get in the way of the parent-child bond, be disrespectful to children and their families and reduce an infant’s opportunities to develop and learn and impede the family’s drive to a new version of liveable family life.
Peter Limbrick writes: Interconnections is running a series of low-cost seminars to discuss the topics raised in Early Childhood Intervention without Tears. These are for family members, child development practitioners, child mental health practitioners, service managers, service directors and academics. The next one is in Shrewsbury, UK
From the back cover:
Early childhood intervention services for babies and infants with disabilities have evolved with two in-built assumptions:
· Disabled infants can be treated very differently from typically developing infants
· Families must accept exhaustion and stress, often to the point of family breakdown
Peter Limbrick argues that both of these assumptions are wrong
This essay describes an enhanced Team Around the Child (TAC) approach that supports families in finding a workable balance between interventions for the infant and quality of life for the whole family. Early intervention teams are invited to look afresh at how their work impacts on the infant and family.