Early Intervention Early Intervention PSY 417 PSY 417 Dr. Schuetze Dr. Schuetze
Jan 29, 2016
Early InterventionEarly Intervention
PSY 417PSY 417
Dr. SchuetzeDr. Schuetze
DefinitionDefinition
System of coordinated services that System of coordinated services that promote child’s growth and development promote child’s growth and development and supports families during critical early and supports families during critical early yearsyears
Federally mandated through the Individual Federally mandated through the Individual for Disabilities Education Act (IDEA)for Disabilities Education Act (IDEA)
History of Early InterventionHistory of Early Intervention
What is Early InterventionWhat is Early InterventionContributions from 4 FieldsContributions from 4 FieldsEarly Childhood EducationEarly Childhood Education– KindergartenKindergarten– Nursery SchoolsNursery Schools– Daycare – Lanham Act (1940)Daycare – Lanham Act (1940)
Maternal Child Health ServicesMaternal Child Health Services– Children’s Bureau (1912)Children’s Bureau (1912)– Title V (1935)Title V (1935)– Early and Periodic Screening Diagnosis and Early and Periodic Screening Diagnosis and
Treatment Program (EPSDT)Treatment Program (EPSDT)
History of Early Intervention History of Early Intervention continued….continued….
Special EducationSpecial Education– Itard – wild boy of AveyronItard – wild boy of Aveyron– SeguinSeguin– AAMR (1976)AAMR (1976)
Child Development ResearchChild Development Research– GesellGesell– PiagetPiaget– BowlbyBowlby
Recent Advances in Early Recent Advances in Early InterventionIntervention
1968: Handicapped Children’s Early 1968: Handicapped Children’s Early Education Assistance ActEducation Assistance Act
1965: Head Start1965: Head Start
1975: PL94-142 (Education for all 1975: PL94-142 (Education for all Handicapped Children Act)Handicapped Children Act)
1986: PL 99-4571986: PL 99-457– Part HPart H
Scientific Basis for Scientific Basis for Early InterventionEarly Intervention
Research on neuroplasticity (animal models)Research on neuroplasticity (animal models)Studies of extreme deprivation (orphanages,Studies of extreme deprivation (orphanages, maternal deprivation, isolation)maternal deprivation, isolation)Naturalistic and longitudinal studiesNaturalistic and longitudinal studiesRandomized controlled trials (RCTs) to test Randomized controlled trials (RCTs) to test the efficacy of a planned intervention to the efficacy of a planned intervention to alter the life course alter the life course
Randomized Controlled Trials Randomized Controlled Trials (RCTs)(RCTs)
to Improve Learning Outcomesto Improve Learning OutcomesAbecedarian ProjectAbecedarian ProjectInfant Health and Development Program Infant Health and Development Program Romanian Orphanage Studies Romanian Orphanage Studies Intensive Pediatric CI Therapy Intensive Pediatric CI Therapy National Head Start-Public School Transition National Head Start-Public School Transition Demonstration Study Demonstration Study Pre-K Curriculum Comparison StudyPre-K Curriculum Comparison StudyRITE Professional Development Study RITE Professional Development Study
The Abecedarian (ABC) Project is a The Abecedarian (ABC) Project is a randomized controlled trial (RCT) randomized controlled trial (RCT)
that tests the efficacy of early that tests the efficacy of early childhood education for high-risk childhood education for high-risk
children and their families.children and their families.
Key Research Question for Key Research Question for Abecedarian (ABC) ProjectAbecedarian (ABC) Project
Can the cumulative developmental toll Can the cumulative developmental toll experienced by high-risk childrenexperienced by high-risk childrenbe prevented or reduced significantlybe prevented or reduced significantlyby providing systematic, high-quality, by providing systematic, high-quality, early childhood education – early childhood education –
from birth through kindergarten from birth through kindergarten entry entry and/orand/or
from k through 2from k through 2ndnd grade? grade?
Control Group Control Group __Adequate nutritionAdequate nutritionSupportive social servicesSupportive social servicesLow-cost or free primaryLow-cost or free primaryhealth carehealth care
Abecedarian Preschool ProgramAbecedarian Preschool Program
Treatment Group Treatment Group __Adequate nutritionAdequate nutritionSupportive social servicesSupportive social servicesFree primary health careFree primary health carePreschool treatment:Preschool treatment:Intensive (full day, 5 days/week,Intensive (full day, 5 days/week,
50 weeks/year, 5 years)50 weeks/year, 5 years)““Learningames” CurriculumLearningames” Curriculum
Cognitive / Fine MotorCognitive / Fine MotorSocial / SelfSocial / SelfMotorMotorLanguageLanguageIndividualized paceIndividualized pace
Campbell & Ramey, 1995American Educational Research Journal
Scores for High-Risk Preschool Treatment Scores for High-Risk Preschool Treatment and Control Children in the Abecedarian Project and Control Children in the Abecedarian Project
at Nine Preschool Measurement Occasionsat Nine Preschool Measurement Occasions
Ramey et al, 2000 Ramey et al, 2000 Applied Developmental ScienceApplied Developmental Science
Percent of Abecedarian Sample in Normal IQRange (>84) by Age (longitudinal analysis)
Martin, Ramey, & Ramey, 1990American Journal of Public Health
Key Findings from Abecedarian ProjectKey Findings from Abecedarian Project(“Abecedarian” …one who learns(“Abecedarian” …one who learnsthe basics such as the alphabet)the basics such as the alphabet)
18 Months to 21 Years Old18 Months to 21 Years Old• Intelligence (IQ)• Reading and math skills• Academic locus-of-control• Social Competence• Years in school,
including college• Full-time employment
• Grade Repetition• Special Education
placement• Teen Pregnancies• Smoking and drug
use
Plus benefits to mothers of these children (education, employment)
Ramey et al, 2000
The Infant Health and The Infant Health and Development ProgramDevelopment Program
(IHDP)(IHDP)
Designed to replicate the Abecedarian ProjectDesigned to replicate the Abecedarian Project
applied to premature, low birthweight childrenapplied to premature, low birthweight children
gestation and < 2500 gm at birthgestation and < 2500 gm at birthConducted at 8 sites (N=985 children & families)Conducted at 8 sites (N=985 children & families)Intervention modified for biological risk factorsIntervention modified for biological risk factorsEducational intervention only until 3 yrs old (CA)Educational intervention only until 3 yrs old (CA)
Stanford-Binet IQ Scores at 36 MonthsHeavier LBW Group (2001-2500gm)
Infant Health and Development, JAMA, 1990 Ramey, AAAS, 1996
Infant Health and Development, JAMA, 1990 Ramey, AAAS, 1996
Stanford-Binet IQ Scores at 36 MonthsLighter LBW Group (<2000gm)
Children’s IQ at 36 months: Children’s IQ at 36 months: Maternal Education X Treatment GroupMaternal Education X Treatment Group
70
75
80
85
90
95
100
105
110
Some HighSchool
High SchoolGraduate
Some College CollegeGraduate
Control
Intervention
(n=232)(n=162) (n=166)(n=104) (n=134)(n=63) (n=76)(n=48)
Infant Health and Development Program
Ramey & Ramey (1998), Preventive Medicine
Outcomes Affected Positively (*p<.01) Outcomes Affected Positively (*p<.01) by the Infant Health & Development Programby the Infant Health & Development Program
12 Months 24 Months 36 Months
Cognitive Development NS + +
Adaptive and Prosocial Behavior - - +
Behavior Problems - + +
Vocabulary - + +
Receptive Language - + +
Reasoning - - +
Home Environment NS - +
Maternal Interactive Behavior - - +
Maternal Problem Solving - - +
Ramey 1999, adapted from Gross, Spiker, & Haynes, 1997, Helping Low Birth Weight, Premature Babies
Differential response to early Differential response to early educational interventioneducational intervention
The children who benefited the most had:The children who benefited the most had: mothers with IQs below 70mothers with IQs below 70 mothers with low levels of educationmothers with low levels of education poor birth outcome indicators poor birth outcome indicators
(PI, Apgar, LBW)(PI, Apgar, LBW) teen mothersteen mothers
(Martin, Ramey, and Ramey, (Martin, Ramey, and Ramey, American Journal of Public HealthAmerican Journal of Public Health, 1990; Ramey , 1990; Ramey
& Ramey, 2000)& Ramey, 2000)
Romanian Orphanage StudiesRomanian Orphanage Studies
Designed to replicate the ABC Project Designed to replicate the ABC Project when modified to meet the needs of when modified to meet the needs of children who had sustained extreme children who had sustained extreme learning and social-emotional learning and social-emotional deprivationdeprivation- conducted for 2 different age groups- conducted for 2 different age groups- part of a capacity building program in - part of a capacity building program in RomaniaRomania
Romanian StudyPersonal Social (Study 1)
Romanian StudyLanguage (Study 1)
Denver Developmental Gain Scores (months) by Treatment Condition (study 2)
Although all children can learn,Although all children can learn,when exposed to good teachingwhen exposed to good teaching,,
extremely low levels of academic readinessextremely low levels of academic readinessamong children from low resource familiesamong children from low resource familieswill notwill not change change without vigorous investmentwithout vigorous investment
in their early experiences,in their early experiences,their health, and continued support for later their health, and continued support for later
learning and positive lifestyles.learning and positive lifestyles.
Why Some Well-Intended Preschool ProgramsWhy Some Well-Intended Preschool ProgramsHave Failed to Close the Achievement GapHave Failed to Close the Achievement Gap
Poorly prepared teachers, weak professionalPoorly prepared teachers, weak professional developmentdevelopment Educational programs not intensive enough Educational programs not intensive enough Failure to document program quality and Failure to document program quality and impact onimpact on childrenchildren Not enough teaching of language and Not enough teaching of language and academic skillsacademic skills Inattention to children’s health and health Inattention to children’s health and health promotion promotion Limited or no programs in summer and before Limited or no programs in summer and before andand after schoolafter school
Benefits of Early InterventionBenefits of Early Intervention
E.I. services that are delivered within the E.I. services that are delivered within the context of family can:context of family can:– Improve developmental and educational gainsImprove developmental and educational gains– Reduce future costs of special servicesReduce future costs of special services– Reduce family feelings of isolation, stress and Reduce family feelings of isolation, stress and
frustrationfrustration– Help children with disabilities grow up to be Help children with disabilities grow up to be
productive and independentproductive and independent
Early Intervention StepsEarly Intervention Steps
Referral (unless parent objects)Referral (unless parent objects)– Made when referral source suspects delay or Made when referral source suspects delay or
disabilitydisability– Family is informed of benefitsFamily is informed of benefits– Child is referred to Early Intervention Officer Child is referred to Early Intervention Officer
(EIO) within 2 days(EIO) within 2 days– EIO assigns Initial Service CoordinatorEIO assigns Initial Service Coordinator
Initial Service CoordinatorInitial Service Coordinator
Provides information about Early Provides information about Early Intervention Program (EIP)Intervention Program (EIP)
Informs family of rightsInforms family of rights
Reviews list of evaluatorsReviews list of evaluators
Obtains insurance/Medicaid informationObtains insurance/Medicaid information
Obtains other relevant informationObtains other relevant information
EvaluationEvaluation
Determine eligibilityDetermine eligibility
Family assessmentFamily assessment
Gather information of IFSPGather information of IFSP
Summary and report Summary and report
Individualized Family Service Plan Individualized Family Service Plan (IFSP) Meeting(IFSP) Meeting
Conducted if child is eligibleConducted if child is eligible
Family identifies desired outcomesFamily identifies desired outcomes
EI services specifiedEI services specified
Develop written planDevelop written plan
Family and EIO agree to IFSPFamily and EIO agree to IFSP
IFSP ComponentsIFSP Components
Statement of present level of developmentStatement of present level of developmentStatement of family resources/ability to meet Statement of family resources/ability to meet developmental needsdevelopmental needsStatement of major outcomes expected with Statement of major outcomes expected with procedures and timelines of follow-upsprocedures and timelines of follow-upsStatement of specific EI services including Statement of specific EI services including frequency, intensity and methodsfrequency, intensity and methodsDates and durations of servicesDates and durations of servicesName of service coordinatorName of service coordinatorMust be reviewed every 6 months – revised as Must be reviewed every 6 months – revised as needed needed dynamic plan dynamic plan
EI ServicesEI ServicesAssisting technology devices and servicesAssisting technology devices and servicesAudiologyAudiologyFamily trainingFamily trainingMedical services – for diagnostic or evaluation purposes onlyMedical services – for diagnostic or evaluation purposes onlyNursing servicesNursing servicesNutrition servicesNutrition servicesOccupational therapyOccupational therapyPhysical therapyPhysical therapyPsychological servicesPsychological servicesService coordinationService coordinationSocial work servicesSocial work servicesSpecial instructionSpecial instructionSpeech/language pathologySpeech/language pathologyVision servicesVision servicesHealth servicesHealth servicesTransportation/related costsTransportation/related costs
TransitionTransition
Plan for transition included in IFSPPlan for transition included in IFSP
Service Model OptionsService Model Options
Home and community-based visitsHome and community-based visits
Facility or center-based visitsFacility or center-based visits
Parent-child groupsParent-child groups
Family support groupsFamily support groups
Group developmental interventionGroup developmental intervention
Eligibility for EIEligibility for EI
Under 3 years of ageUnder 3 years of age
Disability: child has diagnosed physical Disability: child has diagnosed physical condition that often leads to problems in condition that often leads to problems in development (e.g., Down syndrome, development (e.g., Down syndrome, autism)autism)
Delay: child is behind in at least one area Delay: child is behind in at least one area of developmentof development
Areas of Development/Functional Areas of Development/Functional AreasAreas
Cognitive: remembering, reasoning, Cognitive: remembering, reasoning, understanding and making decisions, understanding and making decisions, learning, thinkinglearning, thinkingPhysical: vision, hearing, growth, gross Physical: vision, hearing, growth, gross and fine motor abilitiesand fine motor abilitiesSpeech-languageSpeech-languageSocial/emotional: relating to othersSocial/emotional: relating to othersAdaptive development: self-help skills the Adaptive development: self-help skills the child uses for daily livingchild uses for daily living
New York State’s Definition of New York State’s Definition of Developmental DelayDevelopmental Delay
12 month delay in one functional area12 month delay in one functional area
33% delay in one functional area or 25% 33% delay in one functional area or 25% delay in each of two areasdelay in each of two areas