Early Intervention

Early InterventionPSY 417Dr. Schuetze

DefinitionSystem of coordinated services that promote childs growth and development and supports families during critical early yearsFederally mandated through the Individual for Disabilities Education Act (IDEA)

History of Early InterventionWhat is Early InterventionContributions from 4 FieldsEarly Childhood EducationKindergartenNursery SchoolsDaycare Lanham Act (1940)Maternal Child Health ServicesChildrens Bureau (1912)Title V (1935)Early and Periodic Screening Diagnosis and Treatment Program (EPSDT)

History of Early Intervention continued.Special EducationItard wild boy of AveyronSeguinAAMR (1976)Child Development ResearchGesellPiagetBowlby

Recent Advances in Early Intervention1968: Handicapped Childrens Early Education Assistance Act1965: Head Start1975: PL94-142 (Education for all Handicapped Children Act)1986: PL 99-457Part H

Scientific Basis for Early Intervention

Research on neuroplasticity (animal models)Studies of extreme deprivation (orphanages, maternal deprivation, isolation)Naturalistic and longitudinal studiesRandomized controlled trials (RCTs) to test the efficacy of a planned intervention to alter the life course

Randomized Controlled Trials (RCTs)to Improve Learning Outcomes

Abecedarian ProjectInfant Health and Development Program Romanian Orphanage Studies Intensive Pediatric CI Therapy National Head Start-Public School Transition Demonstration Study Pre-K Curriculum Comparison StudyRITE Professional Development Study

The Abecedarian (ABC) Project is a randomized controlled trial (RCT) that tests the efficacy of early childhood education for high-risk children and their families.

Key Research Question for Abecedarian (ABC) ProjectCan the cumulative developmental toll experienced by high-risk childrenbe prevented or reduced significantlyby providing systematic, high-quality, early childhood education from birth through kindergarten entry and/or from k through 2nd grade?

Abecedarian Preschool ProgramTreatment Group _Adequate nutritionSupportive social servicesFree primary health carePreschool treatment:Intensive (full day, 5 days/week,50 weeks/year, 5 years)Learningames CurriculumCognitive / Fine MotorSocial / SelfMotorLanguageIndividualized paceControl Group _Adequate nutritionSupportive social servicesLow-cost or free primaryhealth careCampbell & Ramey, 1995American Educational Research Journal

Scores for High-Risk Preschool Treatment and Control Children in the Abecedarian Project at Nine Preschool Measurement OccasionsRamey et al, 2000 Applied 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 Project(Abecedarian one who learnsthe basics such as the alphabet)18 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 usePlus benefits to mothers of these children (education, employment)Ramey et al, 2000

The Infant Health and Development Program(IHDP)Designed to replicate the Abecedarian Project applied to premature, low birthweight children gestation and < 2500 gm at birthConducted at 8 sites (N=985 children & families)Intervention modified for biological risk factorsEducational 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

Childrens IQ at 36 months: Maternal Education X Treatment Group(n=232)(n=162)(n=166)(n=104)(n=134)(n=63)(n=76)(n=48)Infant Health and Development ProgramRamey & Ramey (1998), Preventive Medicine

Differential response to early educational intervention The children who benefited the most had:mothers with IQs below 70mothers with low levels of educationpoor birth outcome indicators (PI, Apgar, LBW)teen mothers

(Martin, Ramey, and Ramey, American Journal of Public Health, 1990; Ramey & Ramey, 2000)

Romanian Orphanage StudiesDesigned to replicate the ABC Project when modified to meet the needs of children who had sustained extreme learning and social-emotional deprivation- conducted for 2 different age groups- part of a capacity building program in Romania

Romanian StudyPersonal Social (Study 1)

Romanian StudyLanguage (Study 1)

Denver Developmental Gain Scores (months) by Treatment Condition (study 2)

Although all children can learn,when exposed to good teaching,extremely low levels of academic readinessamong children from low resource familieswill not change without vigorous investmentin their early experiences,their health, and continued support for later learning and positive lifestyles.

Why Some Well-Intended Preschool ProgramsHave Failed to Close the Achievement Gap Poorly prepared teachers, weak professional development Educational programs not intensive enough Failure to document program quality and impact on children Not enough teaching of language and academic skills Inattention to childrens health and health promotion Limited or no programs in summer and before and after school

Benefits of Early InterventionE.I. services that are delivered within the context of family can:Improve developmental and educational gainsReduce future costs of special servicesReduce family feelings of isolation, stress and frustrationHelp children with disabilities grow up to be productive and independent

Early Intervention StepsReferral (unless parent objects)Made when referral source suspects delay or disabilityFamily is informed of benefitsChild is referred to Early Intervention Officer (EIO) within 2 daysEIO assigns Initial Service Coordinator

Initial Service CoordinatorProvides information about Early Intervention Program (EIP)Informs family of rightsReviews list of evaluatorsObtains insurance/Medicaid informationObtains other relevant information

EvaluationDetermine eligibilityFamily assessmentGather information of IFSPSummary and report

Individualized Family Service Plan (IFSP) MeetingConducted if child is eligibleFamily identifies desired outcomesEI services specifiedDevelop written planFamily and EIO agree to IFSP

IFSP ComponentsStatement of present level of developmentStatement of family resources/ability to meet developmental needsStatement of major outcomes expected with procedures and timelines of follow-upsStatement of specific EI services including frequency, intensity and methodsDates and durations of servicesName of service coordinatorMust be reviewed every 6 months revised as needed dynamic plan

EI ServicesAssisting technology devices and servicesAudiologyFamily trainingMedical services for diagnostic or evaluation purposes onlyNursing servicesNutrition servicesOccupational therapyPhysical therapyPsychological servicesService coordinationSocial work servicesSpecial instructionSpeech/language pathologyVision servicesHealth servicesTransportation/related costs

TransitionPlan for transition included in IFSP

Service Model OptionsHome and community-based visitsFacility or center-based visitsParent-child groupsFamily support groupsGroup developmental intervention

Eligibility for EIUnder 3 years of ageDisability: child has diagnosed physical condition that often leads to problems in development (e.g., Down syndrome, autism)Delay: child is behind in at least one area of development

Areas of Development/Functional AreasCognitive: remembering, reasoning, understanding and making decisions, learning, thinkingPhysical: vision, hearing, growth, gross and fine motor abilitiesSpeech-languageSocial/emotional: relating to othersAdaptive development: self-help skills the child uses for daily living

New York States Definition of Developmental Delay12 month delay in one functional area33% delay in one functional area or 25% delay in each of two areas