Integrated
Developmental Intervention
Stanley Greenspan (1998) has
published an integrated developmental intervention model to guide professionals
working with infants, children, and families with a variety of special needs.
Greenspan has identified a five-level pyramid that names key components of developmental
intervention for children with disabilities.
Case
Study Alyssa (click to open a separate window; review
a short case study that will recap some of the key course points)
Instant
Feedback:
Nurses
working with families of children with disabilities need to stay focused on
the childs physical health and development, not allowing themselves to
be sidetracked by other family issues.
- Formation of ongoing
trusting relationships: This second level of Greenspans pyramid
addresses the regular consistent relationships that children need in order
to develop emotional and cognitive competency. Many times, children with disabilities
express unusual verbal and nonverbal behaviors that are difficult for parents
to understand. Often, these abnormal behaviors drive a wedge between the child
and the parent. Children with autism, for example, may avoid eye contact and
hugging. Emotionally distant, they send out messages that can cause the parent
to back off. Nurses can play an invaluable role by referring the family to
behavioral services, specialists in autism, and therapists who are well-versed
in autistic spectral disorders. Its also important to support the childs
ability to relate, while validating and then re-framing the parents
responses.
Case Study Beth (click
to open a separate window; review a short case study that will recap some of
the key course points)
Instant
Feedback:
Nurses
working with families of children with special needs should immediately refer
all behavioral and emotional concerns to professionals who specialize in those
areas.
- Implementation of
relationships geared to the childs individual differences: Greenspan
describes the need to accommodate individual differences in sensory reactivity,
processing, and motor planning in the parent/child relationship. Nurses working
with the family can provide coaching, relevant teaching materials, resources,
and referrals to help parents learn effective strategies to meet their childs
needs.
Case
Study Austin (click to open a separate window;
review a short case study that will recap some of the key course points)
Instant
Feedback:
Nurses
working with children with special needs should consider sensory reactivity
and processing issues when behavioral issues arise.
- Techniques to promote
development: At this level, family relationships and interactions are
planned so that they are developmentally-appropriate for the child with disabilities.
Parents learn to accurately assess the childs ability to carry out specific
activities, and interact with the child in a manner that supports the activity.
Nurses working with the family can provide information about normal developmental
sequences, teach assessment skills to the parents, and role model developmentally-appropriate
interactions with the child.
Case
Study Catherine (click to open a separate window;
review a short case study that will recap some of the key course points)
Instant
Feedback:
Parents
and siblings of a child with disabilities will intuitively know how to alter
their relationships and interactions to meet the needs of that child, and need
no feedback from the nurse.
- Specific interventions:
The apex of the pyramid includes therapeutic or educational techniques that
build on a foundation of developmentally based family, relationship, and interactive
approaches. This level also includes medications, educational, auditory-processing,
and nutritional approaches. Nurses working with families of children with
disabilities need a working knowledge of these approaches. Nursing strategies
at this level vary considerably, depending on the nurses position and
role responsibilities. School nurses, for example, will be more involved with
educational resources and accommodations. Nurses working on an inpatient unit
may be highly involved in family teaching about medications or nutritional
interventions.
Case Study Caleb (click
to open a separate window; review a short case study that will recap some of
the key course points)
Instant
Feedback:
Although
nurses in many settings have a fairly limited role in the life of a child with
disabilities, they should have a basic understanding of developmental, educational,
and therapeutic approaches that are beneficial to the child.