As the name implies, Partnering for Change (P4C) also reflects the partnerships that must be formed across Ministries and service systems, if the needs of children and families are to be met. In this study, P4C involved provision of rehabilitation services, currently funded by both the health care system and children and youth services, in an educational environment.
Children and youth with special needs are supported through a broad range of intervention types: educator coaching and capacity building; one-on-one intervention, classroom based Universal Design for Learning (UDL) interventions, and parent education.
P4C health professionals collaborate with, and coach all who “circle the child”: parents, educators, and other health care professionals.
Because P4C therapists are regularly at the school and available, youth and parents are encouraged to seek out their expertise as needed; a diagnosis is not required for service. P4C health care professionals can therefore serve as the first point of contact for families. Even though therapists may change over the years, consistent delivery of the P4C service into the child’s school means that families will perceive it as seamless.
In this study, P4C was shown to negate the lengthy, intensive referral mechanisms previously in use. P4C resulted in far less paperwork for all involved when children with special needs were referred for more individualized services. It also showed that the P4C service eliminated wait lists in the schools which complements the focus on a single wait list for service and the emphasis on wait list management required by the Special Needs Strategy. Children are able to receive services when their needs are first identified.
Although not a requirement of the Special Needs Strategy, the Partnering for Change model focuses on meeting needs of the entire school and, therefore, there is increased focus on classroom-wide and group interventions. This is consistent with the literature that shows that one-on-one service provision may not be the most appropriate method of intervention for many children. This also means that children who, for a variety of reasons, might be under-identified in the current system, are able to benefit from the provision of service to the whole classroom.
When Is It Possible to Identify Children with Special Needs?
When considering the Developmental Screening Process and the early identification that is facilitated by Partnering for Change, one needs to think about the earliest age at which it is possible to identify children with different types of special needs and the intensity of services that they, and their families, are likely to require.
Tables 1 and 2 provide a simplified description of the types of developmental and/or health conditions that might be identified at different ages and stages of development. The prevalence rates are approximate and are intended to provide general guidelines only.
Children with special needs who can be identified before school entry:
|Age at which we can identify||Examples of Children’s Developmental Conditions / Special Needs||Prevalence (approximate)||Need for Rehabilitation or Healthcare Services|
|* Currently, most children with these conditions are not identified prior to school entry. The Developmental Screening Tool being developed by Dr. John Cairney et al., may be able to identify some children whose “temperatures” are high in different developmental areas.|
At or near birth
|Very preterm infants, medically-fragile, technologically-dependent, severe Cerebral Palsy, complex medical and developmental comorbidities.||Very low (<1%)||High, diverse and continuing throughout lifespan. Often require complex coordination of services.|
0 to 3 years
|Cerebral palsy, Spina Bifida, Autism Spectrum Disorder, medical and genetic syndromes.||Low (2–3%)||Initially medium-to-high for family support, then low; periodic need for specialized services.|
|Specific language impairment, Intellectual Delay, High-functioning Autism, Motor Delays, Fetal Alcohol Syndrome, psycho-social or socio-economic circumstances that are not facilitating children’s cognitive, motor, language or social/emotional development.||Not yet known: Developmental Screening Process will target the identification of children in this group.||Initially medium, to support families, then low, if children are identified (children with these types of conditions might also be identified to P4C therapists upon kindergarten entry)|
Children who are able to be identified at or near birth may have very high medical needs (Group 1) and may be more appropriately served by a different model. Children who have special needs such as those described in Groups 2 and 3 may benefit from provision of P4C; however, this needs to be demonstrated through further research.
Children with many other types of developmental and health concerns may not be able to be identified prior to school entry. Research findings suggest that the P4C service is appropriate to facilitate early identification of children who have the types of developmental conditions and special needs listed in Table 2. In this model, rehabilitation professionals are able to work with educators and families to identify children who are experiencing difficulties and to problem-solve and implement strategies that support their participation in the classroom.
Children who can be identified after school entry using the P4C model:
|Age at which we can identify||Examples of Children’s Developmental Conditions / Special Needs||Prevalence (approximate)||Need for Rehabilitation or Healthcare Services||Is there evidence for P4C?|
|JK / SK to Grade 3||Developmental Coordination Disorder, Attention Deficit Hyperactivity Disorder, Specific Language Impairments, High-functioning Autism, Asperger Syndrome, Intellectual Delay, Sensory Issues, Acquired Brain Injury||>10-15%||Initially medium, then low, and occasional, if identified. May be served at different tiers of the model||Yes|
|Grades 4 to 8||Secondary consequences of above conditions, if not recognized — Anxiety, Depression, Low Self-Esteem, Social / Behavioural Issues, Learning Disabilities, Decreased Academic Achievement, Overweight / Obesity||Prevalence, as above but children have more issues||Increasingly complex, if not identified early||Yes|
Partnering for Change: Complementing the Developmental Screening Process
One of the purposes of the Developmental Screening Process is to screen all children many times when they are young. Different types of developmental needs (physical, psycho/emotional, social, communicative, and cognitive) can be picked up at different points in time.
The P4C model of service enables provision of support in full-day kindergartens and primary classrooms to help educators and Early Childhood Educators build knowledge and skills regarding typical and atypical development and to manage expectations of children who are at different developmental stages.
P4C therapists introduce UDL strategies that support all children, including children whose “developmental temperature” is raised simply by the transition to full day kindergarten. Families may not be ready to identify that there is a problem so the UDL and small group approach works really well.
P4C therapists contribute the eyes and knowledge of a health professional within the school environment. When a child is identified as struggling, P4C involves engagement with families and educators to build capacity and support optimal development.
How Does Partnering for Change Align with the Special Needs Strategy?
The inequity currently occurring across Ontario pertains to access to rehabilitation services: wait-times for service can be lengthy; some parents choose to pay privately for rehabilitation services; and many children with special needs are under-identified and fall through the cracks.
P4C provides more equitable access because the therapist:
- is the point of first contact, which negates the need for lengthy and resource-intensive referral mechanisms before the child is able to receive support,
- works with educators and whole classrooms of students in schools, providing support that increases all children’s participation and achievement,
- observes children in the classroom context to support those who are struggling,
- works with small groups of children, tries out simple strategies, then monitors their response to the intervention,
- determines whether a child needs more individualized health care or rehabilitation services. If so, it is still provided in the school context in collaboration with educators and families, eliminating waitlists. This model enables flexibility and opportunities for care planning to ensure children’s needs are met.
Thus, P4C incorporates health promotion that permits informal developmental screening of all children for developmental and learning needs. It eliminates the need for diagnosis of health care conditions or formal psycho-educational assessments before supports can be put in place.
P4C moves away from one-on-one services that are focused on remediation of deficits and offers a health service that is needs-based, focused on participation, consistent with evidence-informed practice and that can be integrated into care plans for children with special needs. The P4C service enables support to be provided for children when required, including at times of transition, such as moving to middle or high school. Our research has demonstrated that P4C reaches more children, enables therapists to spend more time in direct service and is more efficient than a one-on-one approach.