ASHA Leader

You have accessThe ASHA LeaderASHA News1 Mar 2020Take Action on Federal Laws That Have Big Effects on You—and Your Clients Erik Lazdins Erik Lazdins Google Scholar More articles by this author https://doi.org/10.1044/leader.AN9.25032020.64 SectionsAboutPDF ToolsAdd to favorites ShareFacebookTwitterLinked In In Washington, D.C., spring means appropriations season for the federal government. Congress must fund the federal government for the upcoming fiscal year, turning the president’s budget request into law. This process determines funding for critical programs affecting you and your clients, like special education services through IDEA, newborn hearing screenings, and research grants. Your voice is critical in advocating for increased funding for these vital programs. If appropriations bills are not passed by Congress and signed by the president before Oct. 1 (the start of the new fiscal year), the government shuts down. However, Congress has a workaround—it can pass a continuing resolution, a temporary measure that funds the government for a specific amount of time, giving Congress more time to negotiate. In the past 20 fiscal years, Congress has passed 100 continuing resolutions. Last year, we had victories in the appropriations process. A $1.4 billion increase for the Department of Education included a $400 million increase in special education funding, and also language to address the administrative burden for school-based members who must complete IDEA and Medicaid paperwork. ASHA will continue to advocate for FY 2021 appropriations in a number of areas. Special education Despite its 1975 promise to fund up to 40% of the costs associated with IDEA services, the federal government has never fulfilled this commitment. Even with last year’s funding bump, the federal share for special education is still less than 20%. Underfunding IDEA threatens the ability of school-based members to provide a free appropriate public education (FAPE) for students with disabilities. Increased IDEA funding is high among ASHA’s advocacy priorities. Newborn hearing screenings and early intervention services The Early Hearing Detection and Intervention (EHDI) program provides early screening, diagnosis, and treatment for infants and young children who are deaf and hard-of-hearing. When the program was first authorized in 1999, only 46.5% of infants were screened for hearing loss; today, 98% of infants are screened. EHDI funding has been flat since its 2017 reauthorization. With increased funding, EHDI initiatives can work on raising the number of diagnosed infants with services, as only 67.3% of infants receive early intervention treatment. Research Each year, the National Institute on Deafness and Other Communication Disorders and National Institute on Disability, Independent Living, and Rehabilitation Research award millions of dollars to support groundbreaking research in communication sciences, disorders, and rehabilitation. Continued advocacy for research funding is essential to support research that generates treatment evidence. Take action You can advocate for funding increases by contacting your members of Congress and sharing your support for special education, EHDI, and research funding. Visit takeaction.asha.org to get started! Author Notes Erik Lazdins is ASHA’s associate director of federal affairs. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 25Issue 2March 2020 Get Permissions Add to your Mendeley library History Published in print: Feb 28, 2020 Metrics Downloaded 258 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2020 American Speech-Language-Hearing AssociationLoading ...

Erik Lazdins

Take Action on Federal Laws That Have Big Effects on You—and Your Clients

采取行动应对影响你和你的客户的联邦法律

You have accessThe ASHA LeaderBottom Line1 Mar 2020Clarifying Coding and Payment for Early Intervention ServicesCoding depends on what the services are, where they are provided, and other factors. Laurie Alban Havens andMA, CCC-SLP Neela Swanson Laurie Alban Havens Google Scholar More articles by this author , MA, CCC-SLP and Neela Swanson Google Scholar More articles by this author https://doi.org/10.1044/leader.BML.25032020.30 SectionsAboutPDF ToolsAdd to favorites ShareFacebookTwitterLinked In In early intervention (EI), services can take place in any number of settings and may take any number of forms. As a result, audiologists and speech-language pathologists may be confused as to how to bill for these services. In an effort to help clear up potential confusion, we offer some pointers here—based on generally accepted coding and payment principles for outpatient services. The goal of EI is to lessen the effects of a disability or delay by addressing identified needs of young children across five developmental areas: Cognitive development. Communication development. Sensory development, including vision and hearing. Social or emotional development. Adaptive development. Most EI programs are controlled by the state. However, although programs are state-mandated, services may be carried out by contractors, such as managed care organizations. Clinicians should consult the EI program or payer for clarification of coding or coverage on a specific case. Place of service (POS) reporting requirements Where services are provided is a key piece of information for payers, especially for EI providers, as they serve clients in a variety of settings: the home, office, daycare, school, or other specialized program setting. Providers report settings on the claim form with a two-digit place of service (POS) code (for example, POS “3” indicates a school setting, “11” is used for office settings, and “12” indicates services provided in the home). Although most POS codes seem self-explanatory, providers should consult directly with the EI program or payer regarding the appropriate code to use, especially when services are provided outside the traditional office or clinic setting. Determining the correct POS code to report can be especially challenging when treatment is provided in the home (POS 12). Some payers use POS 12 when a patient is homebound (cannot leave the home) and services are provided under a home health plan of care. For EI however, the child may not be homebound, but rather is receiving service in the most appropriate, natural setting. For billing purposes, the EI program may instead require providers to use POS 11 for an “office” because it is the location where the clinician “routinely” provides services. Another common POS code used to report EI services is POS 3 for school settings. Daycare settings, however, do not have their own POS, so payers may require POS 99 for “other place of service.” It is important to establish the appropriate POS with the payer prior to billing for services, as there is variability across EI programs. Evaluation and treatment Current Procedural Terminology (CPT © American Medical Association) codes used to report audiology or speech-language pathology services are identical for all clients, regardless of the diagnosis or patient population. CPT codes reported on the claim should describe the service provided and should be supported by the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes describing the patient’s diagnosis. ASHA’s website includes extensive information on CPT and ICD-10 coding for audiologists and SLPs. Some EI programs or payers may also use Healthcare Common Procedure Coding System (HCPCS) Level II codes to describe specific EI services. Alphanumeric HCPCS Level II codes describe devices and durable medical equipment (such as hearing aids or speech-generating devices) as well as some services that aren’t already described in the CPT code set. HCPCS Level II codes typically used by EI programs include codes that start with T or H. These codes describe family or paraprofessional training, meetings, and home assessment, and provide more options than the available CPT codes (for example, T1023 is for screening to determine the appropriateness of consideration of an individual for participation in a specified program, project or treatment protocol). Some programs may also require a modifier to append to CPT or HCPCS Level II codes to indicate that it is an EI service (modifier TL) or that a specific type of provider rendered the service (for example, modifier GN for an SLP). Evaluation and testing CPT codes commonly used for audiologic testing can include 92550–92587 (comprehensive audiometry, acoustic immittance, and auditory evoked potentials testing). Some programs may also cover evaluations for hearing implant-related evaluations (92626 and 92627) or potential for auditory rehabilitation. However, it is important to note that initial audiologic diagnostic testing for children could also be covered under a different program, such as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Find out more on coding for pediatric audiology services. For comprehensive speech and language evaluations, SLPs typically use CPT code 92523 (evaluation of speech sound production and language comprehension and expression). However, in the EI population, SLPs may find it useful to report CPT codes 96112 and 96113 (standardized developmental test administration, first hour, and each additional 30 minutes) when assessing preverbal communication abilities. Although these codes are more commonly included in EI programs, SLPs should check with payers before using them, as coverage still varies. Additionally, ASHA does not recommend billing 96112 and 96113 in conjunction with other speech and language evaluation codes, unless the payer allows it. The services of 96112 and 96113 often are captured in a more comprehensive code that is also being reported, such as 92523. Treatment Traditional EI treatment is direct treatment provided to a child or a group in an office, at home, or school/center. For example, once the need for speech-language treatment is established following evaluation, SLPs frequently use the broad CPT code that captures speech, language, voice, communication, and auditory processing treatment for individual (92507) or group (92508) therapy. However, following the federal mandate to provide more family-centered care, treatment has shifted to more collaborative and consultative models, with more disciplines represented (see “Giving Families a Go-To Therapist”). For example, some programs may allow providers to report intensive, extended multidisciplinary services using HCPCS Level II codes T1025 (per day) or T1026 (per hour), in addition to the appropriate modifier indicating the team member billing that service (such as modifier GN for an SLP). In some situations, clinicians participate in medical team conferences following evaluation or treatment. CPT codes 99366 and 99368 (medical team conference with interdisciplinary team of health care professionals, with or without patient/family present) are available to report medical team conferences of at least 30 minutes. However, the ability to bill for conferences or multidisciplinary services is at the discretion of the setting and the payer. Find more online about codes for medical team conference and other case-management services. Often, children needing multiple EI services may be seen in small group sessions with more than one clinician. It is important that the time billed captures direct face-to-face treatment time with the patient, and not clinician time. For example, if an occupational therapist (OT) and SLP are co-treating a session that lasts an hour, each one would bill only for part of that hour, in accordance with the individualized family service plan (IFSP). For speech, it might be one unit of 92507 (untimed code) and for OT it might be two 15-minute units of 97112 to equal one hour of time. Learn more on coding and payment for co-treatment. EI program examples The following are a few examples of specific programs and associated coding policies. Harvard Pilgrim provides an EI program of coordinated educational, therapeutic, and social developmental services. This plan uses only one CPT code, 96153, health and behavior intervention (15 minutes), and requires a modifier to identify level of service. The program mostly uses codes from the HCPCS Level II T group for screening, evaluation, treatment, and family training and counseling. Unlike CPT 92507, an untimed code, most of these codes are unit-based, 15-minute codes. By contrast, the Illinois EI Program uses CPT codes and two HCPCS Level II T codes specific to developmental therapy and for a developmental therapist professional. However, Illinois has also changed the untimed CPT codes into timed codes for this population. For example, aural rehabilitation is included under 92507 (usually an untimed code) as a 15-minute unit, and the reimbursement rate differs based on where the treatment is provided. Because of the different types of services, providers, and locations, coding for EI poses unique challenges. Understanding the specific program, along with payer practices, is essential to successful billing for these services. Author Notes Laurie Alban Havens, MA, CCC-SLP, is director of ASHA private health plan and Medicaid policy. [email protected] Neela Swanson is director of ASHA health care policy, coding and reimbursement. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 25Issue 2March 2020 Get Permissions Add to your Mendeley library History Published in print: Feb 28, 2020 Metrics Downloaded 2,746 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2020 American Speech-Language-Hearing AssociationLoading ...

Laurie Alban Havens

Neela Swanson

Clarifying Coding and Payment for Early Intervention Services

明确早期干预服务的编码和支付

You have accessThe ASHA LeaderASHA News1 Mar 2020Try These 10 Tips to Streamline Your ASHA Website Searches Gail Brook Gail Brook Google Scholar More articles by this author https://doi.org/10.1044/leader.AN8.25032020.63 SectionsAboutPDF ToolsAdd to favorites ShareFacebookTwitterLinked In Use these basic tips to effectively search the ASHA website (www.asha.org) to get the information you need faster. Quick Links Use the “Quick Links” section of the home page to access EdFind, CE courses, the ASHA Community, the Practice Portal, and other frequently visited areas. A–Z Topic Index Use the A–Z Topic Index on the home page to quickly find information. Quote marks Use quotation marks to search for specific phrases or adjacent words (“speech perception” rather than speech perception). Plus or minus sign Use the plus or minus sign in front of the word you want to include or exclude in your search. (+Children finds only pages that contain children; -adults finds pages that do not include adults.) This “OR” that To find pages that contain at least one of the terms specified in your search, use OR. (Type screening OR testing to find pages that contain either “screening” or “testing.”) NOT Use NOT to find pages that contain your first term but not your second. (Fees NOT fiberoptic will find pages that include “fees” but not “fiberoptic.”) Keywords Avoid using very broad or narrow keywords in your search. (“Supervision courses” will likely be more effective than “supervision.”) Left navigation Left navigation options of the webpage narrow search results. For instance, if interested in a journal article on hearing loss in children, select the box in the left navigation for Journals and Perspectives. Most relevant website ASHA’s website includes several websites, such as the NSSLHA (information for students) and ASHFoundation (information on giving or grants) sites. Bookmark Don’t forget to bookmark the pages that you access most often. Author Notes —Gail Brook is an ASHA research associate [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 25Issue 2March 2020 Get Permissions Add to your Mendeley library History Published in print: Feb 28, 2020 Metrics Downloaded 159 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2020 American Speech-Language-Hearing AssociationLoading ...

Gail Brook

Try These 10 Tips to Streamline Your ASHA Website Searches

试试这10个技巧来优化你的ASHA网站搜索

You have accessThe ASHA LeaderMake it Work1 Mar 2020Help Kids With Autism Plan, Not Just ExecuteIn our efforts to support them, sometimes we over-prompt clients with autism spectrum disorder. Here’s how we get them to practice skills, in addition to carrying them out. Jessie GinsburgMS, CCC-SLP Jessie Ginsburg Google Scholar More articles by this author , MS, CCC-SLP https://doi.org/10.1044/leader.MIW.25032020.34 SectionsAboutPDF ToolsAdd to favorites ShareFacebookTwitterLinked In Think about when you were learning to ride a bike. You’ve graduated from your training wheels, and you’re ready to try this thing. “Don’t worry,” your dad reassures you. “I’m going to be holding on to the back of the seat. I’ve got you. I won’t let you fall.” Eventually you’re riding so straight and smooth that it’s time for Dad to let go. And you’re off! How did you learn to ride that bike in the first place? Was that the first day you got on the bike? Certainly not. You worked on that for months, maybe years. There are so many steps involved—maybe a tricycle first, then a two-wheeler with training wheels, then your dad holding on to the back of the seat, and finally riding on your own. What would happen if your dad tried to teach you how to ride a bike by putting you on it and giving it a shove? You would fall, no doubt, because you hadn’t yet developed the necessary skills to ride independently. So why do we sometimes assume that’s how kids with autism spectrum disorder (ASD) learn language and how to navigate social situations? Let the client do the work We clinicians are, all too often, the bike-shovers. We are the over-prompters. We want so badly for our clients to succeed that sometimes some of us may do all the work for them. We skip the tricycle and the training wheels, and we set them up on that bike. But without us there to hold them steady, they fall off. The child on that bike doesn’t have enough skills to ride off on his own. Let’s look at a typical situation of over-prompting: You enter a classroom with one of your clients, an 8-year-old named Charlie who has ASD. You: “Oh, Robert’s here today. Let’s go say ‘hi.’” You pull Charlie’s hand and walk over to Robert. You: “Here’s Robert! Charlie, say ‘Hi, Robert!’” Charlie: “Hi, Robert.” Here’s my question: The next time Charlie walks into that classroom without you or another adult, do you think he will be able to approach Robert and say hello? Most likely not. And it’s not because he doesn’t have the skills to execute. It’s because he hasn’t had the practice with the planning. In the bike analogy, the steps to riding the bike (tricycle, training wheels) represent planning. In Charlie’s situation, we’ve done all of the planning work for him. We’ve put him up on that bike. However, he won’t be able to ride without us holding on to the back of his seat and helping him pedal, because he hasn’t developed the skills he needs to do so. Planning and executing are very different, and both very important skills to develop. Sometimes we are so busy prompting children to execute that we forget about how important it is to give them practice planning. Three tips Say you and the child are playing with a toy farm. The cow falls off the roof and gets hurt. Let’s look at three ways you can promote planning and ideation in this instance. Ask open-ended questions Instead of telling the child your ideas, encourage the child to generate his own ideas by asking open-ended questions. The fewer cues you give the better. In the toy farm example, you can start with general questions, such as “What should we do?” If the child needs more support, you can ask more specific questions, such as “Where should we go for help?” or “Who can make the cow feel better?” Encourage the child to draw on past experiences Ask the child what he did the last time he was in this situation. For example, “When you get hurt, who do you go to for help?” or “When you’re hurt, what makes you feel better?” Be the child’s peer play partner When we ask lots of questions, it’s easy for kids to get overwhelmed or disinterested. Try talking to him as his peer to keep him excited about making the plan. You can do this simply by asking questions with “we,” rather than giving directions with “you.” For example, instead of saying “You need to help the cow,” you can ask, “How can we help the cow?” A better way Using these tips, let’s revisit the interaction with Charlie in a way that can be more effective and more meaningful: You walk into the classroom with Charlie. You: “Oh, look, Charlie. Who’s here today?” Charlie: “Robert’s here.” You: “Yeah, Robert’s here. What should we do?” Charlie: “Go say ‘hi.’” You: “Good idea! How should we say hi?” Charlie: [Comes up with an idea—say hi, give a high-five, ask him to play—as there are many ways to say hi!] I know this change seems simple, but it makes such a big difference. In this second scenario, the child is the one generating the ideas and making the plan. We are stimulating his brain by asking him questions so that he can come up with ways to interact in this situation. We are helping him with his ideation. So before you tell your young clients to say this or do that, see if they can come up with their own ideas. Don’t put the child on the bike and give him a shove. Instead, go through all the steps so that he can ride the bike on his own. Author Notes Jessie Ginsburg, MS, CCC-SLP, is the owner and director of clinical services at Pediatric Therapy Playhouse, a multidisciplinary clinic in Los Angeles. [email protected] Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 25Issue 2March 2020 Get Permissions Add to your Mendeley library History Published in print: Feb 28, 2020 Metrics Downloaded 1,177 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2020 American Speech-Language-Hearing AssociationLoading ...

Jessie Ginsburg

Help Kids With Autism Plan, Not Just Execute

帮助自闭症儿童规划，而非仅执行

You have accessThe ASHA LeaderFeature1 Mar 2020Giving Families a Go-To TherapistWhat does the rise of the primary service provider approach in early intervention mean for speech-language pathologists? Possibly a chance to enhance services—if implemented as intended. Dathan RushEdD, CCC-SLP Dathan Rush Google Scholar , EdD, CCC-SLP https://doi.org/10.1044/leader.FTR1.25032020.44 SectionsAboutPDF ToolsAdd to favorites ShareFacebookTwitterLinked In When I first heard about it 30 years ago, it seemed blasphemous. I sat listening, horrified, as a conference presenter extolled the virtues of a transdisciplinary model of service delivery in early intervention. I sensed similar distress in the audience, which included speech-language pathologists and clinicians from other disciplines. The lecture hall had tiered seating like the Colosseum in Rome, so we surrounded and looked down on the presenter. Much like Caesar, we were ready to send in the lions to remove this therapist traitor, as she seemingly instructed us to surrender our Certificates of Clinical Competence and spurn our licensure laws. Was she really suggesting that we all become "unitherapists"—created to meet all the needs of any child enrolled in the early-intervention program? I decided out of either fear or intrigue to listen to her plea. She did make some good points about working with caregivers of infants and toddlers with disabilities, and she had clearly done her homework on evidence-based early-intervention (EI) practices and the law. "Why would this be happening?" I thought to myself. "And if it's going to happen, how will we ethically do it without training someone else or being trained to do something outside our scope of practice?" As it turns out, this transdisciplinary model was not a new idea. It has been around since before EI's inception in the 1980s, offering the appeal of streamlining supports through use of a primary service provider (PSP) who works most closely with the family. According to the Early Childhood Technical Assistance (ECTA) Center, the model's use has grown over the years. Meanwhile, it has undergone a change in nomenclature, shifting in most descriptions from transdisciplinary model to PSP approach, with a refined definition: A teaming process in EI whereby one member of a multidisciplinary team is selected as the PSP, with other team members supporting as needed. The PSP works closely with the child's caregivers, using a capacity-building coaching interaction style to help them use everyday learning opportunities to promote child development. Shifts in favor of harnessing such everyday learning opportunities by providing EI services in children's homes, communities, and child care settings have led to wider acceptance of the PSP approach. But this rise has also spurred questions like the ones I initially had—regarding its efficacy and ethicality, requirements for interprofessional collaboration, and potential scope of practice issues. So, what are the overall pros and cons? And can we make it work better? Let's dig into it. Rise of the PSP approach What is it, exactly, that causes the resistance to a PSP approach that I saw at the lecture I attended? It's the notion of one team member performing a clinical task that is traditionally implemented by a provider from a different discipline, giving rise to concerns about work outside one's scope of practice and violation of licensure laws. This approach is, however, perfectly legal under the Individuals With Disabilities Education Act (IDEA) when used appropriately. IDEA requires that eligible children and their families have access to a team of professionals from a variety of disciplines. The three common models identified in the teaming literature are multidisciplinary, interdisciplinary, and transdisciplinary (see sources). These models vary based on levels of team interaction and parent involvement, and approaches to assessment and intervention. The shift from multidisciplinary and interdisciplinary teaming models to transdisciplinary and now PSP over the past 30 years has been driven by two factors. First, IDEA Part C requires that services be provided in the child's "natural environment" (such as home, community locations, and child care program) because young children learn in the context of everyday activities with the important people in their lives (see sources). Second, a child's learning is not restricted to when the EI practitioner is present. The practitioner's role, therefore, is to help caregivers know how to promote the child's participation and development during everyday natural learning opportunities, such as mealtime, diaper changes, and dressing. The PSP's focus is on the caregiver, not on conducting traditional block practice drills, exercises, and activities with the child. Instead the provider teaches caregivers strategies they can use, such as following the child's lead or modeling words. The PSP bases the time and frequency of visits on when these activities naturally occur and how much support the caregiver needs from the PSP. PSP pros Pro: Every family gets a team Under IDEA Part C, the PSP approach provides caregivers with access to an EI team. The team minimally includes an early childhood special educator (ECSE), occupational therapist (OT), physical therapist (PT), SLP, and service coordinator (SC). The team may also include an audiologist, nurse, nutritionist, behavior specialist, social worker, psychologist, and others, depending on the child's disability. Members of the EI team, along with the family, develop an Individualized Family Service Plan (IFSP) that includes participation-based child learning outcomes and the supports necessary to help the caregivers achieve the outcomes. Based on information from the family, referral sources, evaluation and assessment results, and the IFSP outcomes, the team moves through a systematic process for identifying one member (the PSP) who would be the best match to potentially support the child and family from the point of the initial IFSP until the child transitions to another program at age 3. For guidance on selecting a PSP, including identifying and working through role gaps and overlaps, teams can use a worksheet from the Center for the Advanced Study of Excellence in Early Childhood and Family Support Practices. The team process helps to decrease potential gaps and eliminate duplication in services. The PSP is responsible to the rest of the team and family for helping to achieve the IFSP outcomes. Rather than have two or three team members working with the family on mealtimes, the family has one PSP through which to access other team members as needed. One way for the PSP to access other team members' expertise is via a required—usually weekly—meeting of the full EI team. In addition to this, the full team meets with the family regularly to ensure progress toward IFSP outcomes. A tool in "The Early Intervention Teaming Handbook" provides guidance on scheduling. Regular meetings provide opportunities for collaboration among team members and help ensure the team addresses issues. If team members determine the family needs direct access to the knowledge of another discipline, a joint visit to the family may be scheduled. For example, let's say the team chooses the SLP to serve as PSP for a child with Down syndrome. The SLP sees that the child likely needs an insert for his high chair to fully participate in the family mealtimes. At the weekly team meeting, the SLP calls on the PT to assess the situation, so the PT visits the family with the SLP at mealtime. The PT's role is not to teach the SLP to construct the seat insert—because that expertise is the PT's. As the PSP, the SLP's role is to know when to call in such expertise. If, on the other hand, the ECSE had been selected as the PSP, then the ECSE would likely ask the SLP to provide strategies to promote language development during mealtime routines. The SLP could accomplish this during a series of joint visits to educate the ECSE and parent on using the strategies and knowing when to bring in the SLP again, as needed. Pro: Every family has a PSP Multiple providers interacting with a family can result in confusion, increased parental stress, and unmet needs. The more providers working with the family, the less helpful the services can be, due to conflicting intervention approaches, recommendations, and expectations. A PSP can provide consistency across settings and may be positioned to build a trusting, long-term relationship with the family and other caregivers. The PSP can come to know the child and caregivers, how they learn, and which everyday activities can best promote the child's development (see sources). The family knows they have a team and trusts that the PSP will access support of other team members when necessary. Pro: Every team should have an SLP ASHA's Practice Portal on Early Intervention indicates that SLPs may be qualified to serve as the PSP and support another discipline as PSP for certain infants and toddlers. SLPs would neither provide a service outside their scope of practice, nor teach another team member to implement an intervention outside that professional's scope. When a highly specialized skill or intervention technique is required for example, making an orthotic, selecting and programming an augmentative communication device, or transitioning a child from g-tube to oral feedings) only team members with the required skills should provide the service. When a PSP approach is implemented within these parameters, the SLP is practicing within ASHA guidelines and state licensure laws. PSP cons Now let's consider some potential challenges of using a PSP approach in EI. Con: Every local EI program may not have a team A PSP approach requires dedicated teams serving specific geographic areas with members who know one another's strengths and can identify when they need support. Local EI programs that do not have ongoing access to, minimally, an ECSE, OT, PT, SLP, and SC cannot use a PSP approach with fidelity. If team members lack the availability to serve as a PSP, attend regularly scheduled team meetings, and participate in joint visits, a PSP approach will not work. Con: Additional requirements of team members It is true that providers serving on a PSP team must possess knowledge beyond their specialty—in the areas of, for example, typical child development across multiple domains and basic parenting supports for toilet training, sleep strategies, and community resource identification. They also should be skilled in building adults' capacity to promote child learning in their everyday activities. A PSP team requires ongoing in-service training to build shared knowledge, promote mutual accountability, and ensure use of evidence-based EI practices. To be effective and coordinated, and to eliminate potential gaps, the team will need to make extra time in already busy schedules for team meetings, joint visits, and other shared work. Con: Misperceptions about PSP use Another potential barrier to adoption of the PSP approach is misunderstanding—similar to what I experienced when I first heard about it. The way I first perceived it was inconsistent with how I came to understand it as a properly implemented approach. People may reject the approach because they misperceive that it means: Less service. Some may assume that, with a switch to a PSP, a family that traditionally would receive multiple services several times a week now would receive just one service once a week. However, the PSP should support the family as frequently as necessary, depending on the family's typical activities. The PSP team needs to base decisions about frequency and intensity of service on the amount of support the PSP and family determine as needed and helpful. Watered-down service. Some express concern that with a PSP, caregivers can access only one team member's expertise, practitioners are reduced to "generalists," and some team members may be excluded. To the contrary, with a PSP approach, caregivers may still access all team members' discipline-specific expertise. The key is to introduce that expertise as needed. For example, an SLP might help an OT/PSP boost a child's bathtime learning and participation by bringing in high-frequency, developmentally appropriate words the family can use in this context. Unable to bill for service. EI practitioners may worry that, as PSPs, they won't receive third-party reimbursement for services. In reality, team members may bill for their services in accordance with what is allowable for them as a provider. Similar to other teaming models, meeting time, joint visits, and parts of a particular visit may not be reimbursable by public and private insurers. That means state and local EI programs must identify other funds to pay for this non-billable time. How to help PSP work better The PSP approach is comparable to any other EI practice in the sense that its effectiveness depends on each team member working at making it work. Here are some specific actions you can take to help: Show what you know. Ensure other members of your team know about your knowledge and skills that would make you an excellent choice to serve as PSP for a specific child and family or to support another team member serving as PSP. Share what you know. As SLPs, we have information that we want everyone to know—such as how to promote basic language development, the importance of hearing screening, the problems associated with putting a baby to bed with a bottle. Make sure your team members have this basic knowledge and can share it with others. Also ensure you share when you need to be directly involved with the child and family. Learn from others. Hone your ability to recognize when you and a family could benefit from other team members' expertise. Learn basic information from other disciplines that all EI providers and caregivers should know, such as simple positioning techniques, low-tech assistive technology, and positive behavior supports. Ask for support. Never hesitate to request assistance from or bring questions to other team members at the next team meeting. That's what the team is there for. Returning to those initial PSP concerns I experienced 30 years back, I've since put them to rest as I learned more about the model and have seen it in action. Misperceptions about PSP are often based on hearing it described inaccurately or seeing it used incorrectly. As SLPs working in EI, we must know the implementation conditions necessary to make PSP work right—and to best help the child and family. Doing so will minimize the cons, maximize the pros, and ensure that every child and family receives the support they need. Sources Division for Early Childhood (DEC). (2014). DEC recommended practices in early intervention/early childhood special education 2014. Retrieved from http://www.dec-sped.org/recommendedpractices Google Scholar Early Childhood Technical Assistance Center (ECTA). (2014). EI service delivery approaches/models. Retrieved from: https://ectacenter.org/topics/eiservices/approaches-models.asp Google Scholar Rush, D. D., & Shelden, M. L. (2012). Worksheet for selecting the most likely primary service provider. CASEtools, 6(3), 1–9. Retrieved from: https://fipp.org/static/media/uploads/casetools/casetool_vol6_no3.pdf Google Scholar Shelden, M. L., & Rush, D. D. (2010). A primary-coach approach to teaming and supporting caregivers in early childhood intervention. In R., McWilliam (Ed.), Working with caregivers of young children with special needs. New York, NY: Guilford Press. Google Scholar Shelden, M. L., & Rush, D. D. (2013). The early intervention teaming handbook. Baltimore, MD: Paul H. Brookes. Google Scholar Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. (2008 March). Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved from http://ectacenter.org/~pdfs/topics/caregivers/Finalmissionandprinciples3_11_08.pdf Google Scholar Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. (2008 March). Seven key principles: Looks like/doesn't look like. Retrieved from http://www.ectacenter.org/~pdfs/topics/caregivers/Principles_LooksLike_DoesntLookLike3_11_08.pdf Google Scholar Author Notes Dathan Rush, EdD, CCC-SLP, is director of the Family, Infant & Preschool Program at the J. Iverson Riddle Developmental Center, North Carolina Department of Health and Human Services, in Morganton, North Carolina. 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