Multi-Disciplinary Team Work in Israeli ASD-Preschools: What Does It Take for a Whole to be Greater Than the Sum of Its Parts?

Background: Best-practice guidelines for early-intervention in Autism Spectrum Disorder (ASD) call for intensive and comprehensive interventions. The Israeli special education system for preschoolers with ASD promotes an integrative-developmental model of treatment for ASD. Children attending these settings receive a 14-hour-per-week treatment package from multiple professionals, including occupational therapists, speech and language pathologists, psychologists, art and music therapists, physiotherapists and behavior analysts. These treatments are embedded in the preschool routine, which includes one-on-one and group educational interventions. This integrative model is based on the premise that no single early intervention approach was found to be the most effective in promoting development, and therefore, young children with ASD should benefit from an individualized treatment-plan that builds on elements from various disciplines.
Objectives: This study aims to examine the perspectives of professionals from different disciplines working in ASD preschools, with regards to the preschool staff's integrative work and cooperation in their settings. Using a qualitative approach, we have explored the various factors that influence the experience of collaboration and cohesion among staff members, and its relation to their perceived professional efficacy.
Methods: Twenty-four professionals working in preschools for children with ASD were given semi-structured interviews, focusing on their experience as part of a specialized multidisciplinary team in ASD preschools. The interviewees (21 females, 3 males) varied in their professional background (7 psychologists, 5 speech and language pathologists, 4 occupational therapists, 3 physiotherapists, 3 behavior analysts, 3 art and music therapists), age (M=30.1, range - 29-36), and years of experience in the field of ASD (M=2.7 years, range 1-7). Interviews were transcribed and content analysis was performed.
Results: Primary analysis revealed that the staff's collaborative dialogue plays a significant role in the professionals' satisfaction and their perceived ability to bring to favorable outcomes among treated children. Several themes emerged as influential on the perceived cohesion of the professional staff: the importance of a shared terminology and conceptual framework with regards to children with ASD and their families, with a psychodynamic terminology vs. an adaptive functioning terminology as the main competing frameworks; the staff's ability to maintain equal member participation in discussion and decision making; the staff's ability to bridge between the therapeutic and educational demands and their individual perspectives on intervention; the professionals' attitude towards learning and applying practices which pertain to different disciplines; and the robustness of the staff-member's own professional identity.
Conclusions: Our findings offer a wider understanding of the factors that support an inter-disciplinary dialogue, decision making, and collaboration in ASD preschool staff. These elements are of particular importance in settings promoting integrative intervention approaches when no single comprehensive treatment model is preferred. An association between the nature of the staff's dialogue, and the individual practitioner's self and professional efficacy is suggested.