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Are we focusing on the best things so we can improve our early intervention program?

Posted Feb 11 2010 8:49am
The value of anecdote is not in capturing a comprehensive analysis of a system's problems - but rather in making an example of a small issue that reflects a broader pattern. I understand that use of anecdote as a tool can also be fundamentally incorrect or even dangerous but I hope that I have documented enough other information about the early intervention program (in places like here and here ) so that this presentation will be honest and fair.

I also understand that any 'for the children' rhetoric causes large swaths of people to immediately tune out of a conversation but it is difficult to frame this discussion about early intervention services outside the context of how it actually impacts children and families. The truth is that the future is a little uncertain about early intervention services in New York State.

Today's anecdotal evidence comes from this situation: one of my therapists had to write a progress report for a child who is enrolled in the early intervention program. Before submitting the report I reviewed it and found it to be satisfactory. I saw the statistical notations in the report and internally cringed - but we are mandated by the State to use certain guidelines for determining eligibility . I accept this; I need to function within the system even though I don't always agree with the way that the system is set up.

Anyway, through absolutely no fault of the person receiving the report, it was noted that a word was omitted on the paperwork. Now I don't imagine that this person has some particular investment in such technicalities of diction, but it is the person's job to make sure that things are done the way that they are supposed to get done. So, the report was sent back to us with the friendly request to include the missing phrase.

The error was that it was not adequate to state "Thirty minute session." Instead, the correct diction needed to be "Thirty minute basic session."

Now before anyone begins to worry that perhaps the word "basic" has some particularly discriminating function in this context - let me make you an assurance: in early intervention terms in NY State, a "basic" session MEANS THE SAME THING as a "30 minute" session.

Making such a change is really not that big a deal - and as I said I really am not impugning the worker who sent the report back to us for editing because after all they are doing their job and actually doing a rather good job to notice the error.

The problem is that there are things that could have been criticized in the report - most notably the statistical eligibility criteria. The worker might also have noted that in this particular situation there were complex family factors that might merit team discussion or planning. None of that happened though - and instead the concerns were reduced to having to make edits to satisfy the inexplicably tautological documentation rules.

Now I know better than to enter into a conversation with the worker about how inane the situation is - because after all I really do respect them and as I said they do a fine job - and they are also doing what they are supposed to do!

But what if someone suddenly stood up in the room and asked the question: "Are you all focusing on the best things so we can improve this system?"

The system is enormous and complex and rather uncaring of single voices most of the time - and as with all bureaucracy I think that is how it sometimes gets reduced to inanity. We all have a chance to give our input though. There is some new rulemaking being proposed for the Early Intervention program and there is an opportunity to provide feedback.

The issues are big and there are so many to choose from. You might go and ask that the program only employ practitioners who pass national certification examinations. You might go and lobby about consistent entry and exit criteria for the program. You might go and express some concern about parent co-pays and ensure that we only ask for contributions from people who really have the resources to contribute. There is a lot to be concerned about - and maybe if enough people go we can get to substantive issues.

I'll be at a public hearing. Maybe I'll see you there too?
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