A USER’S GUIDE TO EARLY INTERVENTION SERVICES Seminar I Realistic Strategies to Identify Children Eligible for Early Intervention Services in Primary Care Practice
Dec 17, 2015
A USER’S GUIDE TO EARLY INTERVENTION
SERVICES
Seminar I
Realistic Strategies to Identify
Children Eligible for Early Intervention Services
in Primary Care Practice
PRESENTED BY
• Early Intervention Section, DOH
• Center for Disabilities Studies, UH
• Support provided by
Why DOH needs your helpto find babies who need EI help
• Where are the missing babies?
• 26% of DOE Special Education students in 3 cohorts were not served by EI programs
ELIGIBILITY FOR EARLY INTERVENTION SERVICES
•Developmental Delay
•Biological Risk
•Environmental Risk
DEVELOPMENTAL DELAY
• Cognitive
• Physical, including vision and hearing
• Speech/language
• Social/emotional/behavioral
• Adaptive
BIOLOGICAL RISK
• WHEN: Prenatal, perinatal, neonatal, early development
• HOW: Biological insults to central nervous system
• RESULT: Probability of delayed development
• Diagnosed physical/mental condition
Examples of biological risk
• Down Syndrome• Fetal Alcohol
Syndrome• HIV/AIDS• Asphyxia• SGA• < 32 weeks GA• VLBW ( < 1500 g)
• Failure to thrive• Hearing loss from
chronic otitis media• Maternal diabetes• Maternal substance
abuse• Maternal mental
illness
ENVIRONMENTAL RISK
• Child abuse/neglect…. Healthy Start, PHN
• Teenage mom with low support……..PHN
• Substance abusing mom……………..PHN
• Cognitively impaired parent ………...PHN
EARLIER IS BETTER
Do early delays predict later status?
• Expressive language delay
•Motor, psycho-social and cognitive delay
• Risk factors
Paul, R. (1993, 1996)
Expressive language delay at age 2+
• SELD: < 50 words at age 2 or
• no 2-word phrases 25-34 mos
• middle class• no hearing/
cognitive/ motor problems
% of children with delays at age 3-5
0 20 40 60
Language5 yrs
Social 3yrs
Readiness5 yrs
No delays
SELD
EARLIER IS BETTER: EARLY BRAIN DEVELOPMENT
Brainstem - Prenatal through early infancy
Limbic system (Amygdala, hippocampus: emotion, memory) - Late infancy to 4 years
Cerebral cortex (Reasoning, behavior inhibition) - ToddlerLanguage - auditory cortex by 1 yearCapacity for logic & complex reasoning by age 4 years
EARLY BRAIN DEVELOPMENT
Synapse pruning: the child with developmental challenges
• Sensory deficits prevent stimulation
• Motor delays can decrease stimulation
• Cognitive delays make choice of stimulation critical
• Excessive loss of neuronal connections
• Learning problems• Attention problems• Activity regulation
Causes Secondary Conditions
What kind of experiences affect brain development?
• Nutrition - protein, calories • Physical environment: variety across all
modalities prevents excessive synapse loss• Emotional environment: attachment problems or
stress decrease cognitive potential and behavior regulation (ADHD etc)
Attachment Problems Influence Brain Development:
Babies with special needs
• PARENT: adjustment to diagnosis/problem
• Loss of hope
• Resentment
• Fatigue
• BABY: Sensory defensiveness
• Feeding problems
sense of self ability to organize
future learning ability to form
intimate relationships empathy
Causes Consequences
The brain develops from lower to higher levels therefore
Early experience has more pervasive impact
Babies with special needs may experience high stress levels
• Sensory defensiveness, communication delays etc.
• At risk for abuse
• Parents may be more stressed by the child’s special needs
• Delays are more frequent among children whose parents are teens, poorer, less educated, incarcerated - these children live with extra stress
• Match stimulation to child characteristics
• Reduce child stress through adaptations to accommodate disability
• Improve attachment• Reduce parent stress• Improve nutrition• Increase parent/child
language interaction
Adapt child’s environment
Parent education and support
How early intervention can help
How do we know informal screening and clinical judgement
aren’t enough?
• Many children in Hawai`i with significant special needs are missed until they reach schooling
• Research shows that informal methods miss ~ 50% of delays
THESE RESOURCES CAN provide standardized screening
• Parent Line - for literate and motivated parents
• Healthy Start or Head Start - for children enrolled in these programs
• PHN - for children already enrolled
- for other children if you or parent have concerns
Taking parent concerns seriously
• Improves rate of identification
• Builds stronger relationships with parents
• Adds data you don’t have a chance to observe
Infant-Toddler Development Programs (like North Hawai`i Child Development
Program or Hilo Easter Seals) offer
Evaluation by trained and certified professionals to
determine the extent and type of developmental delays