TRANSACT--a model for integrating clinical practice and longitudinal research.

To effectively deal with the high-risk infant and his outcome, it would appear that clinicians and researchers must, in a sense, place themselves "at-risk." They must recognize the limitations of a reductionistic, biomedical model when applied to this population and its problems. They must move beyond this traditional model to a so-called "biopsychosocial model" which acknowledges the uncertainties of human development and its transactional character. To do so, they must also seek to break down many traditional "boundaries" that have served to inhibit a better understanding of the high-risk infant. These boundaries include those between disciplines, between clinicians and researchers, between assessment and treatment, between cost efficiency and comprehensiveness, and those between quantitative and qualitative methodologies to name a few. This process must not be one of all or none exclusion, where a uniform perspective is adopted in isolation and applied to all aspects of the problem. Rather it must be a combination and synthesis of many perspectives. In essence, the construct used to understand and study the high-risk infant and his outcome should be consistent with the transactional and multifactorial nature of the problem. These tasks are formidable and threatening to undertake, particularly when they do not always yield the type of outcomes we have been conditioned to expect: "hard" data; narrow etiologies; and successful cures. However, failure to take such "risks" would seem to impede a further understanding of the at-risk infant. The T.R.A.N.S.A.C.T. model presented here is offered as a working construct which has yet to be fully operationalized. Its perceived limitations will reflect the background, biases and perspectives of the reader. Hopefully, it will serve to stimulate those interested and involved in the high-risk infant and his outcome to modify, refine or build upon their current approaches.