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Collaboration With Other Services

Three important services need to be integrated into the home visiting program: child care, therapies and service coordination.

Child Care or Family Day Care
If a child spends 15 hours or more a week with a child care provider, the developmental therapist visits that care provider, whether it's a child care center, a family day care home provider or a nanny. Usually, either the parent or the child care provider will receive a visit in the week—not both. Even if the home visitor usually visits the child care setting, some visits will be with the parents (including evenings and weekends, if necessary).

Ideally, services are organized so one person (typically the home visitor) is the primary service provider and visits the child/family weekly. Other team members would provide consultation and programming less frequently, such as every three months. In this approach, families don't get more than one visit a week because one hour a week is enough time for the family to learn techniques and get other kinds of support. The consultation visits happen with the home visitor present, so he or she can support the family in carrying out the interventions.

In Tennessee, we have two situations that currently make this approach difficult to implement. First, some services are delivered in clinics, which violates the natural-environments principle in the law governing federal support of early intervention (i.e., the Individuals with Disabilities Education Improvement Act). This means that it is very unlikely that clinic-based therapists will make home visits, with or without the regular home visitor. Therefore, families sometimes have to take their children to one, two, or three places during the week, in addition to being home for the home visitor. Second, even if therapists do make home visits, they are often planned to be at separate times from the home visitor's appointments.

Service Coordination 
Service coordinators are in charge of the IFSP, with the family, and they represent the lead agency providing early intervention in the state (the Tennessee Department of Education). As the people in charge of the IFSP, they provide information on resources, including services, and they plan and coordinate services. Home visitors work with them to ensure family level needs are met, to establish and maintain open communication with other early intervention providers (e.g., therapists), and to plan transitions for children as they turn 3 years old.