I have been in many discussions lately about what makes an intervention effective and was asked the difficult question: How do you narrow it down to just 1 or 2 words? This is very tough because effectiveness of intervention is dependent on many things including the scientific integrity, social validity, usability, motivation for students, funding and resources, etc. The 2 things that I felt were critical for real effectiveness for children were accessibility and implementation. No matter how many papers are published on it, no matter how many professionals insist you do it, and no matter how much you think it will help your child, if you do not have quick accessibility to it and are not able to appropriately implement it, the intervention will not be effective.
So, what makes an intervention accessible or not? First, if the intervention can ONLY be implemented by a particular person or agency, it is not accessible to most people. Interventions should be readily available in various parts of the country (or even in other countries) and the intervention should be one that can be replicated easily by people not associated with the agency. Second, an intervention should not require extensive amounts of training. Training is necessary and critical for success for any intervention, but some of the popular treatments require time-consuming and very expensive training programs in order to implement. In addition, training sessions are not often available to many people who want it and waitlists for these trainings is way too common. If you cannot get training, the intervention is not really accessible to you and so, obviously, it won’t work. The third barrier to accessibility is money. If the intervention requires an immense amount of 1:1 time from a qualified professional, or requires a large amount of materials, it can get very costly and many people do not have access to these kinds of intervention. If a parent or school cannot afford it and the government or insurance do not cover it, the intervention is not accessible to most people. The final and perhaps biggest problem is lack of resources. In an ideal situation where you have access to all of the above, you are most likely going to find yourself on long waiting list (which can be up to 2 years in some places). This problem prevents many children from getting the necessary intervention that they need and is an even bigger problem in rural areas where there is a paucity of service providers.
If you do not experience problems with any of the above accessibility issues, you should consider yourself extremely fortunate. However, you should always think about the quality of implementation. I have seen many programs start out great and basically fall apart over time. This is because of staff turnover, difficulty finding and training staff, and clinical drift (i.e. the therapist is either not keeping up with the science, losing interest, or in some way losing focus on moving the intervention forward). Another common problem with implementation is that most children’s needs change as they develop. Interventions should grow with the child or you should move on to something else when that intervention is no longer appropriate. Another problem with implementation is keeping up with all of the materials, data collection, and reporting. This is a huge burden on therapists, parents, and schools.
Reading this may make you feel a bit like there is not hope for a quality intervention, but there most certainly is hope! Many clinics and school programs are well aware of these issues and are doing the necessary research and product development to help by increasing accessibility and developing plans for effective implementation over time. Technology is one solution that may address many of these issues. For instance, the use of video and the internet allows us to provide web-based training for providers. This technology also allows for remote consultation for individual children. Portable devices such as cell phones and iPods may allow for quicker access to video modeling, learning programs, and data collection and sharing. Computers have opened the door to interventions that are not only accessible to most people, but that are also effective, motivating, and provide richer data and reports than other interventions. The future of intervention must plan for accessibility and implementation, and technology may be the best road map for getting us there.