FAMILY & RELATIONSHIPS / CHILDREN WITH SPECIAL NEEDS

“What a tremendous resource for the field! The emphasis on working in collaboration with families to provide services to infants and toddlers where they live, learn, and play is outstanding!” Childress Raver & —Laurie A. Dinnebeil, Ph.D., University of Toledo; Editor, Journal of Early Intervention

“Presents essential theory, research, practice, and reflection to help providers apply the science and art of early intervention to achieve optimal outcomes for children and families.”

—Naomi Younggren, Ph.D., Early Childhood Consultant; Department of Defense Army EDIS Personnel Coordinator

Family-Centered Early Intervention

Aligned with DEC recommended practices and CEC standards!

must for future early interventionists, this introductory text prepares professionals to support

A infants and toddlers with special needs and their families—and address the OSEP child outcomes

so critical to a program’s success. Focusing on the needs and challenges of children from birth to 3 who have or are at risk for developmental delays, the book teaches readers the foundations of

• **** addressing the three OSEP Child Outcome Indicators: positive social-emotional skills, acquisition and use of knowledgeWith student- and skills, and using appropriate behaviors to meet needsfriendly features:
• **** developing and implementing IFSPs • “Best Practice
• **** weaving intervention strategies into a family’s established Highlights” with specific routines intervention suggestions
• **** empowering parents to successfully guide and support their • Helpful discussion child’s development questions
• **** conducting interventions that support motor, cognitive, social-• Case studies that emotional, communication, and adaptive skills illustrate recommended
• **** making the most of natural learning opportunities in natural strategies environments
• **** working in teams with professionals from diverse disciplines
• **** meeting the specific needs of children with all disabilities and/or risk areas, including autism, sensory disabilities, and cognitive and/or motor disabilities Featuring the expertise of a dozen contributors, this book will get professionals ready to conduct family-centered, evidence-based intervention—and ensure the best possible outcomes for infants and young children. ABOUT THE AUTHORS Sharon A. Raver, Ph.D., is a professor of special education at Old Dominion University and has worked in the area of early childhood special education for more than 35 years. Dana C. Childress, M.Ed., is Early Intervention Professional Development Consultant with the Partnership for People with Disabilities at Virginia Commonwealth University and has worked in the field of early intervention for almost 20 years.

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Family-Centered Early Intervention Supporting Infants and
Toddlers in Natural Environments

by

Sharon A. Raver, Ph.D.

and

Dana C. Childress, M.Ed.

Baltimore • London • Sydney

Excerpted from Family-Centered Early Intervention: Supporting

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PAUL H BROOKES PUBLISHING C?

Paul H. Brookes Publishing Co. Post Office Box 10624 Baltimore, Maryland 21285-0624

www.brookespublishing.com

Copyright © 2015 by Paul H. Brookes Publishing Co., Inc. All rights reserved.

“Paul H. Brookes Publishing Co.” is a registered trademark of Paul H. Brookes Publishing Co., Inc.

Typeset by Auburn Associates, Inc., Baltimore, Maryland. Manufactured in the United States of America by Sheridan Books, Inc., Chelsea, Michigan.

Cover image ©istockphoto/andipantz

The photographs that appear at the beginning of each chapter are ©istockphoto/monkeybusinessimages (Chapter 1), ©istockphoto/bo1982 (Chapter 2), ©istockphoto/Vita-lina (Chapter 3), ©istockphoto/akurtz (Chapter 4), ©istockphoto/lostinbids (Chapter 5), ©istockphoto/120b_rock (Chapter 7), ©istockphoto/ andipantz (Chapter 8), and ©istockphoto/NolanWynne (Chapter 10). The photographs in Chapter 6 and Chapter 9 are used by permission of The Anchor Center for Blind Children, Denver, CO.

Per the Cincinnati Children’s Hospital Medical Center: The contents of Figure 9.1, including text, graphics and other materials (“Contents”) is a recitation of general scientific principles, intended for broad and general physician understanding and knowledge and is offered solely for educational and informational purposes as an academic service of CCHMC. The information should in no way be considered as an establishment of any type of standard of care, nor is it offering medical advice for a particular patient or as constituting medical consultation services, either formal or informal. While the Contents may be consulted for guidance, it is not intended for use as a substitute for independent professional medical judgment, advice, diagnosis, or treatment.

The Library of Congress has cataloged the print edition as follows: Raver, Sharon A. Family-centered early intervention: supporting infants and toddlers in natural environments/Sharon A.

Raver, Sharon A. Family-centered early intervention: supporting infants and toddlers in natural environments/Sharon A. Raver, Dana C Childress. pages cm Includes bibliographical references and index. ISBN 978-1-59857-569-9 (paperback)—ISBN 978-1-59857-746-4 (epub3)

1. Children with disabilities—Education (Early childhood)—United States. 2. Early childhood education—Parent participation—United States. 3. Early childhood special education—United States.
2. Family services—United States. 5. Children with disabilities—Family relationships—United States.
3. Children with disabilities—Services for—United States. 7. Infants—Services for—United States.
4. Toddlers—Services for—United States. I. Childress, Dana C. II. Title. LC4019.3.R39 2015 371.9—dc23 2014031812

British Library Cataloguing in Publication data are available from the British Library.

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Contents

About the Authors ... vii Contributors ... viii Foreword Karin Lifter. ... ix Preface ... xi Acknowledgments ... xiii

I Foundations of Early Intervention

1 Early Education and Intervention for Children from Birth to Three Sharon A. Raver and Dana C. Childress. ... 2 2 Collaboration and Teamwork with Families and Professionals Sharon A. Raver and Dana C. Childress. ... 31

II Supporting Families in Natural Environments

3 The Individualized Family Service Plan Process Corinne Foley Hill and Dana C. Childress. ... 54 4 Implementing Intervention in Everyday Routines, Activities, and Settings Dana C. Childress. ... 75

III Enhancing Infant and Toddler Development and Participation

5 Developing Positive Social-Emotional and Communication Skills Corrin G. Richels and Sharon A. Raver. ... 108 6 Acquisition and Use of Knowledge and Skills Mary Beth Bruder, Erika M. Baril, and Anne George-Puskar. ... 136 7 Using Appropriate Behaviors to Meet Needs Toby M. Long. ... 167

IV Supporting Children with Diverse Abilities

8 Infants and Toddlers with Autism Spectrum Disorder Dana C. Childress, Lori E. Meyer, and Hedda Meadan. ... 190 9 Infants and Toddlers with Sensory Disabilities Tanni L. Anthony (visual section), Mallene P. Wiggin (hearing section), Christine Yoshinaga-Itano (hearing section), and Sharon A. Raver. ... 216 10 Infants and Toddlers with Cognitive and/or Motor Disabilities Jonna L. Bobzien, Dana C. Childress, and Sharon A. Raver ... 255

Index ... 285

v

Excerpted from Family-Centered Early Intervention: Supporting Infants and Toddlers in Natural Environments By Sharon A. Raver, Ph.D., & Dana C. Childress, Ph.D.

About the Authors

Sharon A. Raver, Ph.D., a professor of special education at Old Dominion University, has worked in the area of early childhood special education (ECSE) for more than 35 years. She has worked with infants, toddlers, preschoolers, and school-age children with special needs and their families. Dr. Raver has administered programs, served as an international ECSE consultant, and published extensively. Her other books include Early Childhood Special Education (0–8 Years): Strategies for Positive Outcomes (Pearson, 2009), Intervention Strategies for Infants and Toddlers with Special Needs: A Team Approach, Second Edition (Pearson, 1999), and Strategies for Teaching At-Risk and Handicapped Infants and Toddlers: A Transdisciplinary Approach (Prentice Hall, 1991). She has been a Fulbright Scholar three times and received a number of awards for excellence in research and teaching. She currently lives in Norfolk, Virginia.

Dana C. Childress, M.Ed., has worked in the field of early intervention for almost 20 years as an early childhood special educator, service coordinator, supervisor, professional development consultant, and writer. As an early intervention professional development consultant with the Partnership for People with Disabilities at Virginia Commonwealth University, she works as part of Virginia’s early intervention professional development team. Ms. Childress develops resources, conducts web-based and in-person training, and manages the content for the Virginia Early Intervention Professional Development Center’s web site (http://www.veipd.org/main). She also writes and manages the Early Intervention Strategies for Success blog (http://www.veipd.org/earlyintervention). Ms. Childress’s interests include family-centered practices, autism spectrum disorder, supporting family implementation of intervention strategies, and finding ways to bridge the research-topractice gap through interactive professional development for in-service early intervention practitioners. She regularly presents workshops in Virginia and has presented at state, national, and international conferences. She currently lives in Chesapeake, Virginia, with her family.

Contributors

Tanni L. Anthony, Ph.D. Director of Access, Learning, and Literacy Team Exceptional Student Services Unit Colorado Department of Education 1560 Broadway, Suite 1175 Denver, Colorado 80202

Erika M. Baril, M.A., CCC-SLP Doctoral Fellow University of Connecticut Health Center The University of Connecticut 263 Farmington Avenue, MC6222 Farmington, Connecticut 06030

Jonna L. Bobzien, Ph.D. Assistant Professor Department of Communication Disorders and Special Education Old Dominion University 111 Child Learning & Research Center Norfolk, Virginia 23529

Corinne Foley Hill, M.Ed. Virginia Early Intervention Training Specialist Partnership for People with Disabilities Virginia Commonwealth University 34 Hermitage Estates Road Waynesboro, Virginia 22980

Mary Beth Bruder, Ph.D. Professor and Director A.J. Pappanikou Center for Excellence in Developmental Disabilities Education, Research, and Service University of Connecticut Health Center The University of Connecticut 263 Farmington Avenue, MC6222 Farmington, Connecticut 06030 Anne George-Puskar, M.A.

Toby M. Long, Ph.D., PT, FAPTA Associate Professor Center for Child and Human Development Georgetown University 3300 Whitehaven Street NW, Suite 3300 Washington, DC 20007

Hedda Meadan, Ph.D., BCBA-D Assistant Professor Department of Special Education University of Illinois at Urbana– Champaign 1310 South Sixth Street Champaign, Illinois 61820

Lori E. Meyer, Ph.D. Assistant Professor Department of Education University of Vermont 633 Main Street Burlington, Vermont 05405

Corrin G. Richels, Ph.D. Assistant Professor Department of Communication Disorders and Special Education Old Dominion University 111 Child Learning & Research Center Norfolk, Virginia 23529

viii

Mallene P. Wiggin, M.A., CCC-SLP Speech-Language Pathologist Speech, Language & Hearing Sciences University of Colorado Boulder 409 UCB Boulder, Colorado 80309

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Foreword

Family-Centered Early Intervention: Supporting Infants and Toddlers in Natural Environments provides an important contribution to serving vulnerable young children—infants and toddlers with, or at risk for, delays and disabilities—and their families. It is written for service providers, teachers, administrators, and families, and it is especially useful for these stakeholders. It also serves as an excellent text for university faculty in personnel preparation— those who prepare students to be service providers. This volume goes a long way to describe and explain, quite clearly, the early interven-

those who prepare students to be service providers. This volume goes a long way to describe and explain, quite clearly, the early intervention system and the children and families served within it. It invites stakeholders into the world of early intervention in a way that is both accessible and meaningful. The book is organized into four sections, beginning with the system of early intervention; then detailing the services and participants; and ending with child development, including milestones and various threats to development. This organization introduces the reader to the beliefs and values embodied in the system of early intervention and the ways those beliefs and values are translated to practice (e.g., creation of the individualized family service plan, or IFSP). Theories and research that underlie development, as well as various methods of assessment and intervention, are emphasized in the chapters on typical and atypical child development. More specifically, the first section introduces the overarching system of early

More specifically, the first section introduces the overarching system of early intervention—the laws, policies, and practices in which early intervention services have been conceptualized and are being administered. It begins with a chapter on the founda-

been conceptualized and are being administered. It begins with a chapter on the foundations of early intervention, followed by a chapter on collaboration and teamwork with families and professionals. Raver and Childress provide a comprehensive and straightfor-

tions of early intervention, followed by a chapter on collaboration and teamwork with families and professionals. Raver and Childress provide a comprehensive and straightforward introduction to early intervention: where these services came from, what they are,

ward introduction to early intervention: where these services came from, what they are, why they are important, and who provides them. Each chapter begins with a case study

why they are important, and who provides them. Each chapter begins with a case study of an infant or toddler served through early intervention. These cases are extended as new concepts are presented, which serves to deepen readers’ understanding. The second section focuses on supporting families in natural environments. The two

mented in everyday routines, activities, and settings (Chapter 4 by Childress). The three chapters in the third section, which are focused on the developing child, are explicitly organized around the three broad child outcomes specified by the Office of Special Education Programs (OSEP) of the U.S. Department of Education. The three child outcomes are children have positive social relationships (Chapter 5 by Richels & Raver), children acquire and use knowledge and skills (Chapter 6 by Bruder, Baril, & George-Puskar), and children take appropriate action to meet their needs (Chapter 7 by Long). Chapters 5–7 describe the developmental domains specified in federal law. They

Long). Chapters 5–7 describe the developmental domains specified in federal law. They include typical development, the effects of experience on these domains, and relationships among the domains. Also included are assessment and intervention methods to use when

among the domains. Also included are assessment and intervention methods to use when development is threatened or delayed and clarification of the role of the service provider in natural environments. The chapters are supported by the theories and research that frame descriptions and explanations of child development.

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x Foreword

The final section presents specific intervention strategies for facilitating development and learning in children with particular delays and disabilities, such as autism spectrum disorder (Chapter 8 by Childress, Meyer, & Meadan); sensory disabilities, such as visual impairments and hearing loss (Chapter 9 by Anthony, Wiggin, Yoshinaga-Itano, & Raver); and intellectual and motor disabilities, such as Down syndrome, cerebral palsy, and spina bifida (Chapter 10 by Bobzien, Childress, & Raver). These chapters provide very useful information on the impact of these disabilities on various developmental domains and what service providers, teachers, administrators, family members, and even researchers can do to promote development and learning. As the field moves forward, stakeholders need to consider how the components of the

As the field moves forward, stakeholders need to consider how the components of the early intervention system fit together and, in particular, how their beliefs and values intersect with theory and research. The larger culture’s beliefs and values created the system of early intervention services, and the importance of promoting the development of children with delays and their families cannot be denied. Nevertheless, early intervention services must be evidence based and derived from evidence-based assessment activities that have been linked to intervention goals. These intervention activities, in turn, must be linked to the IFSP outcomes. Ensuring the connections among assessment, intervention, and outcomes is a tall order for administrators and practitioners. Researchers must be stakeholders in this process. An ongoing collaborative effort among research, policy, and practice would contribute to the productive linkage among components. This volume contributes substantially to the understandings that stakeholders need about the divergent perspectives and histories of each other, which affords increased opportunities for collaboration. Theory and research heavily influence knowledge about child development. In describ-

which affords increased opportunities for collaboration. Theory and research heavily influence knowledge about child development. In describing the IFSP process in Chapter 3, Hill and Childress note that outcomes, among other things, should be “strengths-based,” encouraging families and service providers to “start with skills the child already has and build toward the next developmental steps” (p. 65). This description of a strengths-based approach is very important in that it incorporates the child development perspective. Bruder, Baril, and George-Puskar (Chapter 6) invoke Piagetian theory to explain development, which conceptualizes children as active participants in their learning. This perspective, along with Vygotsky’s zone of proximal development, is fundamental to understanding development. Early intervention assessments accordingly must capture the developmental steps in various developmental domains; in turn, the assessment activities must take into account where the child is along these continua of developmental steps to tap into the zone of active engagement. Intervention activities are enhanced when goals are finely tuned to the child’s level of active engagement and interest. Early intervention activities are largely based on behavioral theories—to manage the

Karin Lifter, Ph.D. Northeastern University

Northeastern University Boston, Massachusetts

tuned to the child’s level of active engagement and interest. Early intervention activities are largely based on behavioral theories—to manage the environment to promote development and learning in children who are developing more slowly than their peers. The linked components of assessment, intervention, and outcomes must be embedded into our knowledge of theory and research on the developing child and also in the context of the family. Raver and Childress contribute substantially to that effort in Family-Centered Early Intervention.

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Preface

Family-Centered Early Intervention: Supporting Infants and Toddlers in Natural Environments covers knowledge and skill competencies service providers need to promote optimal development in children with and at risk for developmental delays and disabilities from birth through age 3. This introductory methods book uses the application of evidence-based strategies, family-centered approaches such as coaching and teaming, and services provided in an array of natural environments as thematic threads. Each chapter uses a case study to bring to life disability definitions and characteristics, informal and formal assessment practices, and practical strategies for supporting families as they foster the development and learning of their children. The book is unique in that it is organized around the three Office of Special Education Programs (OSEP) child outcomes or indicators that early intervention programs must address when assessing the impact of their program. This book is designed to meet the unique professional development needs of in-service and preservice early intervention providers across disciplinary and agency boundaries. It provides information and intervention strategies needed to ensure well-prepared, effective practitioners in the field of early intervention. This book embeds techniques from early childhood special education, speech-

This book embeds techniques from early childhood special education, speechlanguage pathology, occupational and physical therapy, and vision and hearing education so that service providers can develop and implement integrated, comprehensive, and meaningful services for very young children and their families. Competencies identified by the Council for Exceptional Children (2014); Division for Early Childhood (2014); and Sandall, Hemmeter, Smith, and McLean (2005) are systematically incorporated throughout the book. There are four major sections to this book. Section I examines the legal, philosophical,

REFERENCES Council for Exceptional Children. (2014). Special education cation. Retrieved from http://www.dec-sped.org/recom early childhood specialty competencies. Retrieved from mendedpractices http://www.cec.sped.org/Standards/Special-Educator- Sandall, S.R., Hemmeter, M.L., Smith, B.J., & McLean, Professional-Preparation/CEC-Initial-and-Advanced-M. (2005). DEC recommended practices: A comprehen- Specialty-Sets sive guide for practical application in early intervention/ Division for Early Childhood. (2014). DEC recommended early childhood special education. Longmont, CO: Sopris practices in early intervention/early childhood special edu-West.

REFERENCES

out the book. There are four major sections to this book. Section I examines the legal, philosophical, and instructional foundations of serving infants and toddlers with and at risk for special needs in early intervention programs. It discusses the historical perspective supporting early services, working in teams with professionals from diverse disciplines, supporting families, assessing young children, and utilizing evidence-based practices and strategies in a variety of settings. Section II discusses the rationale and development of the individualized family service plan and how to provide services within families’ everyday routines. Section III describes practical techniques for maximizing communicative, cognitive, fine and gross motor, adaptive, and social-emotional development in young children using the three OSEP major child outcomes as a framework. Section IV emphasizes specific intervention strategies for promoting development and learning in children with specific needs, such as autism spectrum disorder, sensory disabilities, and cognitive and/or motor disabilities. It is our hope that service providers in early intervention, teachers in early childhood education, administrators, and families will find this book immediately useful.

Acknowledgments

We extend appreciation to the families who allowed aspects of their stories to be shared in the case studies. A special thanks to our colleagues who contributed to the writing of this book: Tanni Anthony, Erika Baril, Jonna Bobzien, Mary Beth Bruder, Anne George- Puskar, Cori Hill, Toby Long, Hedda Meadan, Lori Meyer, Corrin Richels, Mallene Wiggin, and Christine Yoshinaga-Itano. We would like to thank our families, whose daily support aided the completion of this project, and our colleagues in the Department of Communication Disorders and Special Education at Old Dominion University and the Partnership for People with Disabilities at Virginia Commonwealth University for their encouragement. Furthermore, sincere appreciation is extended to the reviewers who guided the completion of this book. A thank you goes to our copyeditor, Lori Barrett, for her work on the manuscript, and

A thank you goes to our copyeditor, Lori Barrett, for her work on the manuscript, and to our editor, Johanna Schmitter. However, our deepest appreciation goes to the infants and toddlers, and their families, who have enriched our lives. This book is the outcome of what they continue to teach us each day.

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To Greg, my husband, and Emmy, my daughter, who provide me with continual support, love, and laughs —SAR

To Michael and Caden, who balance me with their love, laughter, and patience

—DCC

Excerpted from Family-Centered Early Intervention: Supporting

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I

Foundations of Early Intervention

Early Education and Intervention for Children from Birth to Three

Sharon A. Raver and Dana C. Childress

This chapter discusses the foundations of early intervention, including the following:

• Definitio and key principles of early intervention

• Current practices in infant and toddler intervention • History of early intervention

• History of early intervention • Provisions of the Individuals with Disabilities

• Provisions of the Individuals with Disabilities Education Improvement Act (IDEA) of 2004 (PL 108-446) • Prevalence of children receiving early

• Prevalence of children receiving early intervention • Importance of early intervention and inclusive

• Best practice highlights

As you explore this field and acquire strategies that will help you support children and families, remember that, as a service provider, you have the special opportunity to make

elcome to the world of early childhood intervention, a field of study and practice that focuses on supporting the development of infants and toddlers, age birth to W36 months, who have developmental differences, delays, or disabilities. Support for these services is provided through partnership and collaboration with a child’s caregivers and a team of professionals, all of whom are in the position to make a difference in the life of a child. As a professional in this field, you will play a significant role by working with caregivers to enhance their confidence, competence, and ability to meet the needs of their children. Whether you are training as an early childhood special educator, therapist, child care provider, or early childhood teacher, there is much you can do to help infants and toddlers grow, learn, and participate in their families’ lives. In this book, you will learn about teamwork and collaboration, the individualized family service plan (IFSP) process, implementing interventions in the context of a family’s everyday routines, techniques for enhancing development across key child outcomes, and strategies to support the development of very young children with a variety of specific developmental strengths and needs. As you explore this field and acquire strategies that will help you support children and

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Early Education and Intervention: Birth to Three

Ê«ÀœvœÕ˜ÊˆvviÀi˜Viʈ˜ÊÌ…iÊ•ˆviÊœvÊi>V…ÊV…ˆ•Ê>˜Êv>“ˆ•ÞÊÞœÕÊi˜VœÕ˜ÌiÀ°ÊÞÊÃ…>Àˆ˜}ÊÞœÕÀÊ Ž˜œÜ•i}iÊœvÊiÛi•œ«“i˜ÌÊ>˜ʈ˜ÌiÀÛi˜Ìˆœ˜ÊÃÌÀ>Ìi}ˆiÃÊ>˜ÊÃÕ««œÀ̈˜}ÊÌ…iÊivvœÀÌÃÊœvÊv>“ˆ•ˆiÃÊ ˜ÊV>Ài}ˆÛiÀÃ]ÊÞœÕÊV>˜Ê…i•«Êi>V…Êv>“ˆ•ÞÊLÕˆ•Ê>˜Êˆ˜ÌiÀÛi˜Ìˆœ˜ÊÃÞÃÌi“Ê>˜Ê>Ì̈ÌÕiÊœvÊ>Ûœ ‡ V>VÞÊÌ…>ÌÊ܈••ÊÀi>V…Êv>ÀÊLiÞœ˜ÊÌ…iÊ first 3 years of a child’s life. Now, let us meet Makeba and her family, who provide one example of what early childhood intervention looks like.

Case Study: Makeba

Makeba is 30 months old and lives with her family in a small apartment near the city park. Makeba’s father recently lost his job, and her mother works the evening shift at the local grocery store. Makeba spends her mornings at a local preschool program and her afternoons with her parents and older brother, who is 4 years old. Her mother, Imani, has noticed that Makeba is not talking like Makeba’s brother did when he was the same age. Makeba is only saying five words but seems to understand most of what she hears. She is starting to have tantrums by screaming, crying, falling on the floor, and kicking her legs when her parents have difficulty understanding what she tries to say. Imani shared her concerns about Makeba’s communication and behavior with the family’s pediatrician, who suggested a referral to the local early childhood intervention program. Soon after the referral was made, Makeba’s family met with a service coordinator, who

suggested a referral to the local early childhood intervention program. Soon after the referral was made, Makeba’s family met with a service coordinator, who shared information about the early intervention program. The service coordinator gathered information about Makeba’s development and discussed a convenient time for a developmental evaluation. Based on information gathered during the evaluation, Makeba was found to be eligible for early intervention services due to developmental delays in her expressive communication and social-emotional development. Child and family assessments were also conducted, during which Makeba’s parents expressed their desire for Makeba to learn to talk so that she is less frustrated. They expressed an additional concern about being able to continue to pay for Makeba’s preschool while her father searched for a new job. They asked if the service coordinator knew of community resources that could help them pay for preschool so that Makeba could continue to attend. An IFSP was developed, which focused on Makeba’s family’s priorities. The IFSP team, which included the family, decided that Makeba would receive intervention once per week, provided by an early childhood special educator at the family’s home and at Makeba’s preschool on alternating weeks. A speech therapy consultation once per month was also added to the IFSP, as well as service coordination. Makeba’s family agreed to this plan and signed the IFSP. Services began the following week.

WHAT IS EARLY INTERVENTION?

Makeba was referred to her local early childhood intervention program (sometimes also known as an infant-toddler program) by her pediatrician due to her mother’s and the doctor’s observations regarding Makeba’s development. Children like Makeba are referred for intervention for many different reasons and have a range of abilities and needs. Each state in the United States operates early childhood intervention programs, as do many countries across the world, such as China, Australia, Sweden, Germany, and Canada (Guralnick, 2008). States and countries establish their own eligibility criteria and operational procedures for their programs. In the United States, there is a federal law that guides how early intervention is provided. This federal law is known as the Individuals with Disabilities Education Improvement Act of 2004, or IDEA (Trohanis, 2008).

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Foundations of Early Intervention

Early Intervention Under the Individuals with Disabilities Education Improvement Act

Under Part C of IDEA, early childhood intervention is referred to as “early intervention.” For consistency with the federal regulations that describe this set of services, the same term will be used throughout this book. The term early intervention describes the process of offering family-oriented services for children from birth to age 3 who have disabilities, have identified special needs, or are at risk for developmental delays, as well as services for their parents or caregivers and other family members. Early intervention is a specialized area of early childhood special education (ECSE) that provides services for children with special needs who are between the ages of birth to 9 years. ECSE has a theory of practice and shared values rooted in evidence-based practices (Odom & Wolery, 2003). Evidencebased practice refers to decisions and activities that are grounded in published empirical research that documents the relationship between practices and outcomes for children, families, professionals, and systems (Buysse, Wesley, Snyder, & Winton, 2006; Klingner, Boardman, & McMaster, 2013). Evidence-based services in early intervention are noncategorical in nature, meaning that services are not organized by disability (e.g., children with motor impairments) but are individualized for a child’s and family’s strengths and needs. The individualized nature of early intervention services is a federal requirement and underlies effective practices with children and families. The definition of early intervention services in the federal law includes nine important

The definition of early intervention services in the federal law includes nine important features. According to Part C of IDEA, the phrase early intervention services refers to developmental services that include each of the following characteristics.

1. Services Are Provided Under Public Supervision Early intervention programs for infants and toddlers with developmental delays and disabilities are federally funded, meaning that funding is granted to states that choose to operate these programs within the parameters of Part C of IDEA. Providing early intervention services is discretionary, so states can choose whether or not to accept federal funding and offer these programs. All states currently provide early intervention programs using federal funding, and some states provide additional funding at the state and local levels. When states accept Part C funds, they also accept supervision and monitoring by the Offi e of Special Education Programs (OSEP)—the federal agency that is responsible for the implementation of IDEA. If a state is found to be noncompliant with OSEP or IDEA requirements, then that state’s federal funding for early intervention services could be withdrawn.

2. Services Are Provided at No Cost, Except Where Federal or State Law Provides for a System of Payments by Families In some states, all early

3. Services Are Selected in Collaboration with Parents The determination of which early intervention services most appropriately meet a child and family’s needs is a team decision that includes the family, the service coordinator, and any other service provider who is assisting the family with developing the IFSP. The inclusion of this provision in the federal law emphasizes the essential role that the family–professional collaboration plays in early intervention.

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Early Education and Intervention: Birth to Three

v>“ˆ•ÞÊ“>ÞÊ>•ÃœÊLiÊÀi뜘ÈL•iÊvœÀÊ«>Þˆ˜}ʈ˜ÃÕÀ>˜ViÊiÕV̈L•iÃÊœÀÊVœ«>ÞðʘÊÃÌ>ÌiÃÊÜ…iÀiÊ ÃiÀÛˆViÃÊ>ÀiÊLˆ••>L•i]Ê>Ê sliding-fee scale must be available to families. The sliding-fee scale is used to calculate reduced costs based on factors such as a family’s income and the number of people in the family. Even when services are billable, families cannot be denied services due to their inability to pay.

4. Services Must Meet the Developmental Needs of an Infant or Toddler with a Disability and the Needs of the Family to Assist the Child’s Development as Identified by the Individualized Family Service Plan Team Early intervention is designed to address the development of infants or toddlers who are found to be eligible for services and their families. Part C of IDEA defines an “infant or toddler with a disability” using three categories of eligibility. An infant or toddler is eligible for early intervention if he or she

Is experiencing developmental delays, as measured by appropriate diagnostic instruments and procedures in one or more of the areas of cognitive development, physical development, communication development, social or emotional development, and adaptive development; or has a diagnosed physical or mental condition that has a high probability of resulting in developmental delay. (IDEA 2004, § 303.21[a])

States may also choose to include children who are at risk for delay in their eligibility criteria; this option is the third category of eligibility. Depending on the state, a child may be eligible for early intervention due to a certain

teria; this option is the third category of eligibility. Depending on the state, a child may be eligible for early intervention due to a certain percentage of delay (e.g., 25% delay) or level of deviation when compared to children with typical development (e.g., one standard deviation), a diagnosed condition (e.g., Down syndrome or cerebral palsy), or atypical or at-risk development (e.g., atypical sensorimotor development or a child who has been removed from his family due to abuse). Developmental delay is the term used to describe a child’s eligibility when that child is demonstrating a significant delay in one or more domains of development. As defined in IDEA, a diagnosed condition refers to a physical or mental condition that has a high probability of resulting in a developmental delay. States determine the level of delay and which diagnosed conditions qualify a child for early intervention services. If they choose to serve children with atypical development or children who are at risk, states also define these parameters. All early intervention programs that operate under IDEA must consider a child’s

A child’s eligibility for early intervention services is determined by an evaluation, which is conducted by a multidisciplinary team of at least two professionals. These professionals must be qualified in their disciplines to conduct the evaluation and may include an

development or children who are at risk, states also define these parameters. All early intervention programs that operate under IDEA must consider a child’s functioning in each of the five areas, or domains, of development referenced in the federal definition: physical development, cognitive development, communication development, social-emotional development, and adaptive development. The area of physical development includes gross and fine motor development. Gross motor development deals with large muscle planning and coordination, such as squatting and walking. Fine motor development addresses small muscle planning and coordination, such as picking up small objects. Cognitive development involves thinking, solving problems, and communicating what one knows. Communication development includes both a child’s expressive communication (the ability to produce language) and receptive communication (the ability to understand the communication of others). Interacting with others in meaningful ways and understanding and communicating emotions appropriately are aspects of social-emotional development. Adaptive development, also known as self-help, involves the ability to do things for oneself, such as dressing and eating. These five domains are examined during an evaluation of the child’s development (Greenwood, Carta, & McConnell, 2011). A child’s eligibility for early intervention services is determined by an evaluation,

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Foundations of Early Intervention

i>À•ÞÊV…ˆ•…œœÊëiVˆ>•ÊiÕV>ÌœÀ]Ê>Ê«…ÞÈV>•ÊÌ…iÀ>«ˆÃÌ]Ê>˜ÊœVVÕ«>̈œ˜>•ÊÌ…iÀ>«ˆÃÌ]Ê>ÊëiiV…‡ •>˜}Õ>}iÊ «>Ì…œ•œ}ˆÃÌ]Ê >˜ÉœÀÊ œÌ…iÀÊ >««Àœ«Àˆ>ÌiÊ «ÀœviÃÈœ˜>•Ê i«i˜ˆ˜}Ê œ˜Ê Ì…iÊ V…ˆ•½ÃÊ ˜iiðʘÊ>``ˆÌˆœ˜]ÊÜ…i˜Ê>««Àœ«Àˆ>Ìi]Ê>ÊvÕ˜V̈œ˜>•ÊV…ˆ•‡Ê>˜Êv>“ˆ•Þ‡ˆÀiVÌiÊ>ÃÃiÃÓi˜ÌÊ ˆÃÊ >•ÃœÊ Vœ˜ÕVÌiÊ ÌœÊ iÌiÀ“ˆ˜iÊ ÃÌÀi˜}Ì…ÃÊ >˜Ê ˜iiÃÊ ˆ˜Ê iÛiÀÞ>ÞÊ •ˆvi°Ê /…ˆÃÊ ˆ˜vœÀ“>̈œ˜Ê LiVœ“iÃÊ«>ÀÌÊœvÊÌ…iÊ individualized family service plan (IFSP) development process. Once the early intervention team confirms that the child is eligible, the IFSP is developed so that the child and family can receive services to help them work toward the outcomes (goals) that are outlined in the plan. At the time of the initial evaluation and assessment, a child’s development is also

At the time of the initial evaluation and assessment, a child’s development is also compared to same-age peers to determine how the child is functioning in three indicators of overall child development. These indicators have been determined by OSEP (2010) and are also referred to as child outcomes. This can be confusing because the OSEP child outcomes are not the same as the outcomes written in the IFSP. The child outcomes identified by OSEP refer to the functional outcomes that are expected to improve as a result of the child’s participation in early intervention. The OSEP child outcomes are a global measure of a child’s progress that the program reports to its funding agency, whereas the IFSP outcomes are an individualized measure that is specific to a child’s strengths and needs and the family’s particular priorities for that child’s development. The three OSEP child outcomes that are listed in Box 1.1 relate to a child’s posi-

The three OSEP child outcomes that are listed in Box 1.1 relate to a child’s positive social-emotional skills, how the child gains and uses knowledge, and how the

BOX 1.1. The three child outcomes from the Office of Special Education rograms for comparing all children’s broad developmental changes over time

2. Acquisition and use of knowledge and skills (including early language and communication): How a
   

child uses thinking and reasoning, memory, problem solving, and symbols and language; how a child understands the physical and social worlds. Includes the following:

Using motor skills to complete tasks Self-help skills, such as dressing, feeding, and toileting Acting on the environment to get what one wants

From The Early Childhood Technical Assistance Center. (2009). The child outcomes. Retrieved from http://ectacenter.org/eco/assets/pdfs/Child_Outcomes_handout.pdf; adapted by permission.

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V…ˆ•ÊÕÃiÃÊ…ˆÃÊœÀÊ…iÀÊ>Lˆ•ˆÌˆiÃÊÌœÊ}iÌʘiiÃÊ“iÌ°Ê/…iÃiÊœÕÌVœ“iÃÊ>ÀiÊÌ…iÊÃ>“iÊvœÀÊ>••Ê V…ˆ•Ài˜Ê>˜Ê>ÀiÊÕÃiÊLÞÊ"-*Ê>ÃÊ>ÊLÀœ>Ê“i>ÃÕÀiÊœvÊV…ˆ•Ê«Àœ}ÀiÃÃÊ>VÀœÃÃÊi>À•Þʈ˜ÌiÀ ‡ Ûi˜Ìˆœ˜ÊÃÞÃÌi“ÃÊ->À•ÞÊ…ˆ•…œœÊ"ÕÌVœ“iÃÊi˜ÌiÀ]ÊÓääx®]ÊœvviÀˆ˜}Ê>ÊØ>«Ã…œÌÊœvÊÌ…iÊ Ü…œ•iÊV…ˆ•Ê>˜Ê…œÜÊÌ…iÊV…ˆ•ʈÃÊVÕÀÀi˜Ì•ÞÊvÕ˜V̈œ˜ˆ˜}ʈ˜Ê“>˜ÞÊÃiÌ̈˜}ÃÊ>˜Ê܈̅ˆ˜Ê Ài>•Ê ÈÌÕ>̈œ˜Ã°Ê /…iÞÊ >ÀiÊ Vœ˜ÃˆiÀi`Ê ÌœÊ LiÊ functional outcomes because they refer to things that are meaningful to the child during his or her everyday living rather than isolated assessment skills, such as stacking three blocks when asked. These outcomes describe integrated behaviors or skills that allow the child to achieve important daily goals (Early Childhood Outcomes Center, 2005). Functionality means that the child is able to perform a series of integrated behaviors that include multiple domains. For example, it is clear from Box 1.1 that each of the OSEP outcomes involves language and communication. States are required to report to OSEP the percentage of children who make

States are required to report to OSEP the percentage of children who make improvements in each of these three outcomes as a result of their early intervention experience. The data are collected when children enter and exit the Part C system and are used by OSEP to determine the efficacy of early intervention across the United States. They are also measured when children enter and exit early childhood special education (ECSE; preschool) services, which are provided under Part B of IDEA. The three OSEP outcomes are considered to be a more holistic way to view devel-

The three OSEP outcomes are considered to be a more holistic way to view development, reflecting its interrelated nature in the blending of domains into three functional, overarching outcomes of typical development. Because of this, the OSEP child outcomes are also used as a framework for developing the IFSP and providing intervention to children and families. Much work is being done in the field to integrate this framework into actual intervention practices. This book is organized around the skills and strategies necessary to implement this framework. In particular, Chapters 5, 6, and 7 address multiple ways to support this new vision of promoting positive development in young children.

5. Services Must Meet the Standards of the State in Which They Are Provided States that receive federal funding must follow the guidelines established at

6. Service Options Must Include Those Services that Are Identified in the Law A variety of services are available to eligible infants and toddlers and their

Provided States that receive federal funding must follow the guidelines established at the federal level. Among these guidelines is the requirement that states set standards for how early intervention programs are implemented. These state-level policies and procedures describe how each state interprets federal guidance on the operation of programs. State-specific procedures may include state- and program-level infrastructure, eligibility criteria, service billing systems, monitoring and compliance procedures, and requirements and standards for service providers.

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BOX 1.2. Early intervention services available to families under Part C of the Individuals with Disabilities Education Improvement Act of 2004

• Family training, counseling, and home visits • Special instruction

• Special instruction • Speech-language pathology and audiology services, and sign language and cued language services

• Speech-language pathology and audiology services, and sign language and cued language services • Occupational therapy

• Occupational therapy • Physical therapy

• Physical therapy • Psychological services

• Service coordination services • Medical services, only for diagnostic or evaluation purposes

• Medical services, only for diagnostic or evaluation purposes • Early identification screening, and assessment services

• Early identification screening, and assessment services • Health services

• Health services • Social work services

• Social work services • Vision services

• Vision services • Assistive technology devices and assistive technology services

• Assistive technology devices and assistive technology services • Transportation and related costs

• Transportation and related costs

7. Services Must Be Provided by Qualified Personnel Each state determines the qualification standards of service providers who work within its early intervention system. These standards include minimum education, licensing, and competency re quire ments. Professional requirements vary greatly across states and may include requirements for state-level certification and ongoing professional development. Box 1.3 lists some of the professionals who may provide services and supports.

BOX 1.3. Qualified early intervention personnel who provide services to children and their families under Part C of the Individuals with Disabilities Education Improvement Act of 2004

• Special educators • Speech-language pathologists and audiologists

• Speech-language pathologists and audiologists • Occupational therapists

• Occupational therapists • Physical therapists

• Registered dietitians • Family therapists

• Orientation and mobility specialists • Pediatricians and other physicians

• Family therapists • Vision specialists, including ophthalmologists and optometrists

• Pediatricians and other physicians

Source: Individuals with Disabilities Education Improvement Act (2004).

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Early Education and Intervention: Birth to Three

8. To the Maximum Extent Appropriate, Services Must Be Provided in Natural Environments The natural environment refers to settings that are important to a specific child and family, as well as places and activities that the child and family would engage in if the child did not have a delay or disability. Early intervention services are provided in natural settings where children and families spend time, such as the home, child care center, local park, library, or the grocery store. These services are provided during intervention visits when the caregiver and service provider work together to enhance the child’s development in the location where support is needed. This provision of the law has an inclusive component that describes how services are provided, emphasizing the importance of helping caregivers embed intervention into routines and activities that are familiar and natural for the child and family (Dunst, Hamby, Trivette, Raab, & Bruder, 2000). It also emphasizes the importance of encouraging the delivery of services in community placements where children and families without special needs participate. Specific ways to conduct intervention visits in natural environments are explored further in Chapter 4. The majority of infants and toddlers with disabilities (80.6%) receive early interven-

to conduct intervention visits in natural environments are explored further in Chapter 4. The majority of infants and toddlers with disabilities (80.6%) receive early intervention services in their homes, with their parents and families present (OSEP, 2010). Services are provided by early intervention professionals, therapists, and/or health care providers. Many service providers believe that this is the most effective model for delivering services because infants or toddlers are in a familiar, stress-free environment (Torrey, Leginus, & Cecere, 2011). Although this approach is the most common, there has been a shift toward a more community- and resource-based model. According to OSEP (2010), approximately 7.6% of infants and toddlers receive early intervention services in an established child care setting and approximately 5.6% receive center-based services. A resource-based model is built on the notion of providing intervention services in parks, libraries, child care centers, and/or community centers physically located in the family’s community (Mott & Dunst, 2006). Families then have the opportunity to take their child to new environments to play and explore, and they may feel more comfortable taking their child into the community. In addition, parents may have the opportunity to see their child react and play differently in the presence of other children (Torrey et al., 2011). Similarly, some early intervention programs offer additional center-based or clinic-based services; families must bring their children to a center or clinic to take advantage of these services. Center-based services might include intakes, initial meetings with families, parent support groups and classes, and child playgroups.

9. Services Are Provided in Conformity with the Family’s Individualized Family Service Plan The IFSP is a written document that serves as a foundation for

Family Service Plan The IFSP is a written document that serves as a foundation for the early intervention process. The IFSP includes information about the child’s development based on a team evaluation and assessment; the family’s priorities, concerns, and resources related to the child’s development; the outcomes to be expected from the child’s and family’s participation in intervention; the supports and services the child and/or family will receive; and the transition plan for when the child exits the system. The IFSP is discussed in detail in Chapter 3. The federal guidelines outlined in Part C of IDEA were established by the U.S. Con-

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10 Foundations of Early Intervention

}i˜VˆiÃÊ ÌœÊ ºˆi˜ÌˆvÞ]Ê iÛ>•Õ>Ìi]Ê >˜Ê “iiÌÊ Ì…iÊ ˜iiÃÊ œvÊ >••Ê V…ˆ•Ài˜»Ê -Ê Óää{]Ê ÅÊ ÈΣ®°Ê œ˜}ÀiÃÃÊÀiVœ}˜ˆâi`ÊÌ…iʈ“«œÀÌ>˜ViÊœvÊÌ…iÊ first 3 years of life on a child’s brain development. It also recognized the importance of supporting caregivers so they are able to meet their own needs, including those of their children. With the guidance in Part C and the financial assistance provided to implement it, a wide network of early intervention services and supports are now available to children and families who choose to participate.

KEY PRINCIPLES OF EARLY INTERVENTION

According to the Workgroup on Principles and Practices in Natural Environments (2008a), the mission of early intervention is to build on and support the efforts of families and caregivers as they enhance the development of their children. The context for early intervention is the activities of everyday life, recognizing that all children learn best during interactions and experiences with the important people in their lives. As is seen with Makeba, infants and toddlers spend most of their time with their families, who naturally engage in activities that affect development. Early intervention is a supplement to these family activities and interactions, and it is most effective when provided within the family context. The Workgroup (2008b) described seven key principles that guide the provision of

interactions, and it is most effective when provided within the family context. The Workgroup (2008b) described seven key principles that guide the provision of early intervention. These principles focus on the importance of a flexible, family-centered, individualized, and evidence-based early intervention process that supports the capacity of families and caregivers to meet the needs of their children. Service providers are described as supports to families and children, rather than as the primary agents of change in the child’s development. Each of these principles represents a foundational professional belief and standard that drives all interactions and assistance provided to very young children and their families (Pletcher & Younggren, 2013). Table 1.1 describes how these principles should be implemented with children and families.

Key Principle 1: Infants and Toddlers Learn Best Through Everyday Experiences and Interactions with Familiar People in Familiar Contexts

All children, including infants and toddlers with developmental delays and disabilities, learn within the context of the interactions and activities that occur during their daily lives. Early intervention services can help families and caregivers learn additional strategies to use in their daily routines to support a child’s development. This focus on learning in the context of natural daily routines with familiar people also reflects the importance of facilitating learning between visits, when the service provider is not with the family to provide support. Because most learning happens when the service provider is not with the family, intervention must focus on helping family members make the most out of these everyday experiences and interactions using the materials and activities that are natural to their family patterns and traditions. In practice, this principle is implemented when service providers respect the importance of unique family interactions, problem-solve with families, and help family members practice strategies during visits so that they are prepared for how to interact with the child between visits. Key Principle 2: All Families, with the Necessary Supports and

This principle reflects the family-centered, strengths-based foundation of early intervention. Every family has strengths, and every family has the capacity to have a positive impact

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Early Education and Intervention: Birth to Three

}i˜VˆiÃÊ ÌœÊ ºˆi˜ÌˆvÞ]Ê iÛ>•Õ>Ìi]Ê >˜Ê “iiÌÊ Ì…iÊ ˜iiÃÊ œvÊ >••Ê V…ˆ•Ài˜»Ê -Ê Óää{]Ê ÅÊ ÈΣ®°ÊTable 1.1. Examples of how to implement the seven key principles of early intervention

(continued)

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12 Foundations of Early Intervention

Table 1.1. (continued)

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14 Foundations of Early Intervention

on their children's development. It is the job of the early intervention practitioner to recognize each family's strengths and build on them. Some families may want many supports or resources, whereas others may only want minimal supports. Families are part of the decision-making process and help identify how much support they think they need to help their children grow. When supports are implemented, service providers show respect for all families, use family-centered practices, and individualize the early intervention process to each family's priorities, needs, and resources.

Key Principle 3: The Primary Role of the Service Provider in Early Intervention Is to Work with and Support Family Members and Caregivers in a Child’s Life

This principle is especially important for early intervention service providers to understand. The role of the provider is not to focus on “working with the child” by playing

stand. The role of the provider is not to focus on “working with the child” by playing with educational or therapeutic toys that teach developmental skills missed on the child’s assessment, such as teaching the child to stack blocks. Instead, the role of the service provider is to collaborate with caregivers to identify and practice intervention strategies that support the child’s development and ability to participate in and learn from everyday experiences. In the case of stacking blocks, this can be accomplished just as easily by the child helping the babysitter put canned goods away in the cabinet. The service provider should share his or her knowledge and expertise in instructional strategies that enhance development with the child’s caregivers—those important people who are in the best position to make the biggest difference in the child’s life. The implementation of this principle reflects a strong family–provider partnership that is built on the shared goal of increasing the family’s competence and confidence with meeting the needs of the child.

Key Principle 4: The Early Intervention Process, from Initial Contacts Through Transition, Must Be Dynamic and Individualized to Reflect the Child’s and Family Members’ Preferences, Learning Styles, and Cultural Beliefs

Key Principle 5: Individualized Family Service Plan Outcomes Must Be Functional and Based on Children’s and Families’ Needs and Priorities

Although the steps of the early intervention process are similar across families, each family’s experience in early intervention is unique. The process, much like the IFSP, should be flexible to adjust to the family members’ changing priorities, resources, activities, and outcomes for their child. The process should also consider the family’s cultural beliefs and values, which affect how the family members choose to participate and the decisions

and values, which affect how the family members choose to participate and the decisions they make. This is not a “one-size-fits-all” approach. Rather, early intervention adjusts to fit families by considering their priorities and working together to implement meaningful

fit families by considering their priorities and working together to implement meaningful and individualized supports that fit their lives. One key aspect of this principle centers on the idea that early intervention is only one part of family life and should not be its focus. Families should not have to rearrange their lives around intervention. When done well, early intervention blends into the family members’ daily lives and becomes a part of how they interact with each other, rather than adding “therapy time” to their day.

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…iÀÊv>“ˆ•Þ°Ê/…ˆÃʈÃÊÛiÀÞÊˆvviÀi˜ÌÊvÀœ“ÊÜÀˆÌˆ˜}ÊœÕÌVœ“iÃÊL>ÃiÊœ˜ÊÃŽˆ••ÃÊÌ…iÊV…ˆ•Ê“ˆÃÃiÊœ˜Ê

ÃÃiÃÓi˜ÌðʘÊ-*½ÃÊvÕ˜V̈œ˜>•ÊœÕÌVœ“iÃÊLÕˆ•Êœ˜ÊÜ…>Ìʘ>ÌÕÀ>••ÞÊ“œÌˆÛ>ÌiÃÊ>˜ʈ˜ÌiÀ ‡ iÃÌÃÊÌ…iÊV…ˆ•`]Ê fit into existing family routines, and help families learn to take advantage of natural learning opportunities as they happen to help their child develop because they see the importance of working on these outcomes for their child.

Key Principle 6: The Family’s Priorities, Needs, and Interests Are Addressed Most Appropriately by a Primary Provider Who Represents and Receives Team and Community Support

Early intervention is implemented by a team that includes the family, the service coordinator and service provider(s), and any other people who are important in the family’s life, such as a child care provider, neighbor, or grandparent. Professional team members are included based on who has the appropriate expertise to support the child and family, rather than being assigned based on the child’s impairments. The primary service provider’s role is to collaborate closely with the family, keeping up with any changes and supporting the family in using intervention strategies between visits that are adapted for the child based on the team’s input. The primary provider also communicates regularly with other team members to ensure that he or she is well prepared to coach the family on how to address the child’s needs across developmental areas. When needed, other team members are brought in to meet with the family. The team’s primary service provider may also change. For example, Makeba had delays in communication and social-emotional areas

For example, Makeba had delays in communication and social-emotional areas of development. Rather than receiving weekly services from both the educator and the speech-language therapist, the educator acted as the primary provider with support from the speech therapist. When early intervention services are implemented using a primary provider, families are less likely to feel overwhelmed, the child is more likely to be viewed from a whole-child perspective, and services tend to be better coordinated.

PROFESSIONAL COMPETENCIES

Key Principle 7: Interventions with Young Children and Family Members Must Be Based on Explicit Principles, Validated Practices, the Best Available Research, and Relevant Laws and Regulations

Providing high-quality services to all children and families must be a priority for all service providers. This principle stresses the importance of service providers making a commitment to keeping their discipline-specific knowledge current, as well as staying current in the field of early intervention. Being a lifelong learner helps providers to stay aware of changes in the laws and emerging evidence-based practices. Early interventionists must be committed to ongoing professional development so that they are ready to make good practice decisions when working with an array of very different children. These key principles help service providers take the intention of federal regulations

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Foundations of Early Intervention

early interventionists must demonstrate the following professional competencies, which were adapted from a position paper from the Council for Exceptional Children, Division for Early Childhood Task Force (1993), titled "Personnel Standards for Early Education and Early Intervention":

• View each family as unique and as being a part of a larger community • Offer services and supports that enhance each child’s and family’s social networks and

• Offer services and supports that enhance each child’s and family’s social networks and address the family’s concerns, priorities, and needs • Support and partner with families and caregivers to enhance the child’s development

• Support and partner with families and caregivers to enhance the child’s development • Ensure that families are key decision makers

• Ensure that families are key decision makers • Use communication that is respectful, unbiased, and focused on person-first languag

• Use communication that is respectful, unbiased, and focused on person-first languag • Recognize a continuum of services and supports based on a child’s needs

• Recognize a continuum of services and supports based on a child’s needs • Understand the right of children to receive services with their peers in natural or inclu-

• Understand the right of children to receive services with their peers in natural or inclusive environments • Focus on inclusive practices that include the child with disabilities into the activities of

• Focus on inclusive practices that include the child with disabilities into the activities of his or her peers with and without disabilities, individualizing for the child’s developmental status and age • Facilitate a continuum of collaborative services and supports for children and their

• Facilitate a continuum of collaborative services and supports for children and their families • Honor diverse backgrounds and develop cultural competence

• Honor diverse backgrounds and develop cultural competence • Maintain ethical conduct at all professional activities

• Maintain ethical conduct at all professional activities • Engage in advocacy activities

• Engage in advocacy activities

Competency standards are intended to ensure that all service providers in the field have a similar foundation of knowledge and skills to best service children and families. These competencies may be developed through both education and experience and require ongoing professional development in order to stay current with best practices. Because the field of early intervention is relatively young and what is known about quality practices is constantly evolving, a commitment to remaining current in knowledge and skills is a necessity for all early interventionists.

CURRENT PRACTICES IN INFANT AND TODDLER INTERVENTION

Early intervention employs an ecological approach to supporting children and families by attempting to strengthen the following (Bronfenbrenner, 1986):

2. The family’s resources, such as improving access to services, information, skills, and knowledge for supporting a child’s development

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Early Education and Intervention: Birth to Three

3. The family's social supports, including those who assist a family in meeting the needs of the child and family

/…ˆÃÊ>««Àœ>V…Ê…ˆ}…•ˆ}…ÌÃÊÌ…iʈ“«œÀÌ>˜ViÊœvÊÌ…iÊV…ˆ•`½ÃÊv>“ˆ•ÞÊœ˜Êˆ˜ fluencing the child’s development. Because learning and development for all infants and toddlers occurs within the con-

Because learning and development for all infants and toddlers occurs within the context of the family, early intervention is described as being family centered. Family-centered practice refers to a way of organizing and delivering assistance and support to families based on distinct, interconnected beliefs and attitudes that are expressed through the behavior of service providers (Pletcher & McBride, 2004). This practice has been described as using families’ strengths, encouraging collaborative partnerships with families, supporting in formed family decision making, and developing families’ independence and competence (Keilty, 2008; Tomasello, Manning, & Dulmus, 2010). Box 1.4 shows the assumptions rooted in family-centered practices. This approach is discussed further in subsequent chapters.

Interventions in Natural Learning Environments

According to Dunst, Trivette, Humphries, Raab, and Roper (2001), natural learning environment interventions are intervention methods and practices that focus on teaching and providing support in settings that are common, natural, and familiar to a child and family. These interventions can be conceptualized by thinking about the degree to which they are contextualized (provided in the context of natural or contrived activities), adult or child focused, and implemented by the interventionist or the family during or between visits. These three distinctions will be discussed further in Chapter 4. Natural learning environment interventions focus on helping families learn to use the many natural learning opportunities that occur in their daily lives. The routines and activities that are part of a family’s life offer many natural learning

The routines and activities that are part of a family’s life offer many natural learning opportunities, in which the child can practice a skill or learn a new one during a regular routine. Guiding caregivers so they recognize and seize natural learning opportunities whenever they occur is a primary goal of early intervention. When families are able to successfully use the natural learning opportunities that occur during their daily lives, they become more competent in supporting their child’s development between intervention visits (McWilliam, 2010).

BOX 1.4. Assumptions grounding family-centered practices and services

• All people need support and encouragement. • All people have different but equally important skills, abilities, and knowledge.

• All people have different but equally important skills, abilities, and knowledge. • All families have hopes, dreams, and wishes for their children. • Families are resourceful, but all families do not have equal access to resources.

• All people have strengths. • All people need support and encouragement.

• Families should be equal partners in the relationship with service providers. • Service providers work for families.

From Pletcher, L.C., & McBride, S. (2004). Family-centered services: Guiding principles and practices for delivery of family-centered services. Retrieved from https://www.educateiowa.gov/sites/files/ed/documents Family%20 Centered%20Services.pdf

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18 Foundations of Early Intervention

Prior to this current focus on interventions in natural learning environments, early intervention was child focused, with the service provider working with the child while the caregiver passively observed (Campbell & Sawyer, 2007). Intervention centered on what could be accomplished during the brief intervention visit, and the caregiver was given "homework" to do with the child between visits. This approach focused on what could be accomplished with the child during visits and provided limited support to caregivers for the time between visits. Early intervention has evolved to a more triadic approach, in which the service provider helps the caregiver practice strategies during visits with the child in the context of a target routine. The natural learning environment is broadened beyond the intervention visit. The visit is used as a practice session so that the caregiver learns strategies he or she can use every day with the child when those learning opportunities occur. The focus of intervention visits now supports the child's development through the parent-child interaction, as opposed to through the service provider working primarily with the child (Woods, Wilcox, Friedman, & Murch, 2011).

ˆ•ÞÊ܈̅ÊÌ…iÊV…ˆ•Ê-7œœÃ]Ê7ˆ•VœÝ]ÊÀˆi“>˜]ÊEÊfiÕÀV…]ÊÓ䣣®°Ê œÀÊiÝ>“«•i]ÊfiÕ••ˆ˜ÃÊ-ÓääÓ®]ÊÌ…iÊ“œÌ…iÀÊœvÊ>ÊÌœ``•iÀÊ܈̅ʜܘÊÃÞ˜Àœ“i]ÊÃÌ>ÌiÊ Ì…>ÌÊ…>Ûˆ˜}Ê…iÀÊV…ˆ•ÊÜ>•ŽÊ>•œ˜}ÊÌ…iÊL•i>V…iÀÃÊÜ…ˆ•iÊ>ÌÊ…ˆÃÊLÀœÌ…iÀ½ÃÊL>ÃiL>••Ê}>“iÃÊ>••œÜiÊ …ˆ“Ê̜ʅ>ÛiÊv՘ʫÀ>V̈Vˆ˜}ÊÜ>•Žˆ˜}ÊÜ…ˆ•iÊÀiˆ˜vœÀVˆ˜}Ê>ʘ>ÀÀœÜÊVi˜ÌiÀÊœvÊ}À>ÛˆÌÞ]ÊÜ…ˆV…Ê ˆ“«ÀœÛiÊ…ˆÃÊ}>ˆÌ°Ê/…ˆÃÊ>V̈ۈÌÞ]Êi“Li``i`ʈ˜ÌœÊ>ÊÀi}Õ•>ÀÊv>“ˆ•ÞÊÀœṎ˜iÊœvÊL>ÃiL>••Ê«À>V̈ViÊ

˜Ê}>“iÃ]Ê>••œÜiÊÌ…iÊV…ˆ•Ê̜ʫÀ>V̈ViÊ>ʘiÜÊÃŽˆ••Êˆ˜Ê>ÊÜ>ÞÊÌ…>ÌÊÜ>ÃÊi˜•œÞ>L•iÊvœÀÊ…ˆ“Ê ˜Ê…ˆÃÊ«>Ài˜ÌðÊ/…iÊL>ÃiL>••Ê field was one of this family’s natural environments at that point in their lives. Mullins stated that early intervention in natural environments allowed “learning to be embedded into our daily activities … so intervention became a part of our lives” (p. 23). In this example, the service provider might have joined the Mullins family at the baseball field for the intervention visit. The service provider could help the mother think about and try out ways to help her child practice walking, rather than constraining intervention to therapeutic exercises for the child during the intervention visit in the family’s home. This example is contextualized because the intervention is provided in the context of the family’s routine of visiting the baseball field. The intervention, which is adult and child focused, can be implemented by the family because the mother knows how to support the child’s walking between visits.

Routine-Based Intervention

The mother of a toddler with motor delays stated the following about her child’s physical therapy:

Routine-based intervention uses a family’s routines and activities as the context for intervention (McWilliam, 2010). Everyday caregiving routines such as mealtimes, dressing, diapering, and other family activities such as camping, child care, and “mommy and me” groups are common settings for caregivers to embed parent-selected outcomes and objectives. Many families find that embedding the teaching of needed skills into their routines feels comfortable and generally saves them time. When routine-based intervention is not used, many natural learning opportunities are overlooked, and intervention can feel as if it is “owned” by the service provider.

When therapists and service providers support parents as they learn the “how” and “why” of learning activities, the child benefits from the extra time learning and practic-

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Early Education and Intervention: Birth to Three

ˆ˜}ÊÃŽˆ••ÃÊLiÌÜii˜Êˆ˜ÌiÀÛi˜Ìˆœ˜ÊۈÈÌÃÊLiV>ÕÃiÊÌ…iÊ«>Ài˜ÌʈÃÊVœ˜ fident in how to use those strategies. Routine-based intervention encourages all family members or friends who wish

Routine-based intervention encourages all family members or friends who wish to be involved to participate in assisting the child’s development. Intervention that is contextualized in child and family routines makes sense because the consistent adults in a child’s life—not the early interventionist—have the greatest influence on learning and development.

Participation-Based Intervention

In participation-based intervention, the emphasis is placed on a child’s participation in natural family and community activities and daily routines, rather than only teaching skills missed on assessments (Campbell, 2004; Campbell & Sawyer, 2007). In other words, the focus is on increasing a child’s involvement and participation with his or her family, and other people important to the child, by increasing the child’s functional skills and learning opportunities. The service provider’s interactions with parents and caregivers should be relaxed, structured, supportive, and professional. The service provider must have the intent of enhancing parents’ or caregivers’ confidence in their role of fostering their child’s development. Functional outcomes improve participation in meaningful activities for both the child and parent because they build on natural motivations to learn and participate. The family comes to understand that collaboratively determined strategies and outcomes are worth using because they lead to practical improvements in the child’s development and, consequently, in the family’s life.

Coaching and Consultation

Coaching and collaborative consultation involve the use of specific strategies and interactions to support and guide the learning of adults who can be of assistance to a child with special needs (Rush & Shelden, 2011; Woods et al., 2011). Both of these strategies are types of indirect services because the service provider is training another adult who will be implementing the interventions with the child when the service provider is not present. Although the service provider may work with the child to model or demonstrate how to play with a toy or engage the child, the objective is to support the other adult in feeling confident in performing these interventions when the provider is not in that setting. Using coaching and collaboration with parents or caregivers involves helping them reflect on what they currently are doing with their child, engaging in shared problem solving and planning to develop intervention strategies that can be used during those interactions, developing a joint plan for how the family or caregivers will implement intervention in their daily routines, and following up at each intervention visit to answer questions and provide support (Rush & Shelden, 2011). Helping families understand how their toys, activities, and interactions can be used or adapted to promote positive developmental changes in their child is a key focus of coaching and collaboration. Examples of this are evident in Makeba’s case.

Case Study: Makeba

Makeba and her family have been partnering with the early childhood special educator and speech therapist for 3 months now. During each intervention visit, the educator talks with family members about what is going well and discusses any challenges they have faced

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Foundations of Early Intervention

regarding Makeba’s communication and social-emotional development. Together, they identify a familiar routine to target that visit, and the educator observes the parent–child interactions during the activity. The educator then coaches the parents (often both are present) in ways to interact with Makeba to encourage her to learn to use more words. The educator also has helped the parents learn strategies to manage Makeba’s tantrums. They report that ignoring her tantrums works well most of the time. When the speech therapist joins them for visits, he consults by problem solving with them on strategies and activities that will boost Makeba’s variety of sounds, use of purposeful communication, and overall vocabulary. The services focus on how to support this family by building intervention around what they are already doing with Makeba and her interests, as well as by suggesting strategies that the family members can embed in their routines to help Makeba learn. The service providers check in with the family at each visit to see if the parents have

The service providers check in with the family at each visit to see if the parents have been able to successfully use the intervention strategies between visits; then, they brainstorm and plan together for the next intervention visit. The service coordinator also visits the family about once each month; she has worked closely with the family to find a community group that provides stipends to families for preschool costs. The service coordinator has helped Makeba’s father take advantage of a local job center, where he is taking a class to gain computer skills, which he hopes will help him find a job in sales.

The early intervention services Makeba and her family received reflected the Workgroup (2008a, 2008b) practices, which emphasize the importance of parent–child interactions during daily routines. Recognizing the centrality of parent–child interactions and building interventions around supporting and adapting what families already do are the characteristics of early intervention that have most changed in recent years.

HISTORY OF EARLY INTERVENTION

The federal law known today as IDEA was originally called the Education for All Handicapped Children Act (EHA) of 1975 (PL 94-142). When originally passed, EHA represented a landmark in special education law because it afforded all school-age children the right to a free appropriate public education, regardless of disability. EHA was also important because it was the first time that federal funding was provided for the education of school-age children with special needs. The law included a voluntary option for states to serve preschoolers with disabilities under the Preschool Incentive Grant program, but this option did not include serving children younger than 3 years of age (Raver, 1999, 2009).

Before 1986 in the United States, families who were interested and could afford it sought private therapy through local hospital programs or private agencies. Families who were unable to access private services worked with their children at home using more informal family and community supports. It was not until after provisions were added to IDEA to mandate educational support for preschoolers with special needs that similar services were considered for children younger than 3 years old. The federal law known today as IDEA was originally called the Education for All

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Early Education and Intervention: Birth to Three

ÌÊÜ>ÃʘœÌÊ՘̈•ÊÌ…iÊ£™nÈÊÀi>ÕÌ…œÀˆâ>̈œ˜ÊœvÊÊÌ…>ÌÊëiVˆ>•ÊiÕV>̈œ˜ÊÃiÀÛˆViÃÊvœÀÊ ˆ˜v>˜ÌÃÊ>˜ÊÌœ•iÀÃÊÜiÀiÊ>ÀiÃÃiʈ˜ÊÌ…iÊ•>Ü°Ê1˜iÀÊ*>ÀÌÊÊœvÊ]ÊˆÃVÀ>ÀÞÊvÕ˜ÃÊ LiV>“iÊ>Û>ˆ•>L•iÊvœÀÊÃÌ>ÌiÃÊ̜ʜ«iÀ>ÌiÊi>À•Þʈ˜ÌiÀÛi˜Ìˆœ˜Ê«Àœ}À>“ðÊ/…iÊ>ˆÌˆœ˜ÊœvÊ*>ÀÌÊÊ -È“ˆ•>ÀÊÌœÊÜ…>ÌÊÜiʘœÜÊŽ˜œÜÊ>ÃÊ*>ÀÌÊÊœvÊ®ÊV>“iÊ>LœÕÌÊÌ…ÀœÕ}…ÊÌ…iÊivvœÀÌÃÊœvÊœÀ}>˜ˆâ> ‡ ̈œ˜ÃÊ>˜`Êv>“ˆ•ˆiÃÊÜ…œÊ•œLLˆi`Êœ˜ÊLi…>•vÊœvʈ˜v>˜ÌÃÊ>˜`ÊÌœ•iÀÃÊ-ÀˆVŽÃœ˜ÊEÊÕÀâ‡,ˆi“iÀ]Ê £™™™®°Ê"˜ViÊÌ…iÊÀi>ÕÌ…œÀˆâ>̈œ˜ÊÌœœŽÊivviVÌ]Ê>••ÊÃÌ>ÌiÃÊLi}>˜ÊÌ…iÊ«ÀœViÃÃÊœvÊiÛi•œ«ˆ˜}Êvi ‡ iÀ>••ÞÊ vÕ˜iÊ i>À•ÞÊ ˆ˜ÌiÀÛi˜Ìˆœ˜Ê «Àœ}À>“ÃÊ œÀÊ …i•«ˆ˜}Ê •œV>•Ê >˜Ê ÃÌ>ÌiÊ «Àœ}À>“ÃÊ “>ŽiÊ Ì…iÊ ÌÀ>˜ÃˆÌˆœ˜Ê̜ʓ>ÌV…ÊÌ…iÊÀiµÕˆÀi“i˜ÌÃʈ˜ÊÌ…iÊviiÀ>•Ê•>ܰʘʣ™™ä]ÊÊÜ>ÃÊ>“i˜iÊ>}>ˆ˜Ê

˜ÊÀi˜>“iÊÌ…iÊ Individuals with Disabilities Education Act (IDEA) of 1990 (PL 101-476). Part C of this law outlined early intervention services for infants and toddlers and their families. Part C of IDEA (2004) includes provisions for offering early intervention services.

Part C of IDEA (2004) includes provisions for offering early intervention services. These provisions have been implemented by states and include the following criteria:

1. eligibility, 2) time lines, 3) evaluation and assessment, 4) the IFSP, 5) early intervention services, 6) natural environments, 7) transitions, and 8) procedural safeguards. These criteria are discussed in the following sections.

Eligibility

As mentioned previously, IDEA provides guidance regarding eligibility criteria for early intervention, but states define the specific criteria for services in their state. Some states include children who are at risk for developmental issues, whereas others do not.

IDEA designates time lines for the completion of some parts of the early intervention process, such as the completion of the IFSP and requirements for IFSP reviews (which will be discussed in Chapter 3). IDEA also describes the need for timely initiation of early intervention services, resolution of disputes with families and/or agencies, and the development of the transition plan. Some functions, such as transition planning, do not have a specified time line, but states are responsible for choosing time lines to ensure that these actions are timely.

Evaluation and Assessment

Under the law, families have the right to a “timely, comprehensive, multidisciplinary evaluation” (IDEA 2004, 34 CFR Part 303.113) of their child’s development and a determination of the child’s eligibility for early intervention services. IDEA describes an assessment of the family’s resources, priorities, and concerns related to their child’s development and their family’s functioning. It is stipulated that evaluation and assessment must be conducted by qualified personnel and must include the use of informed clinical opinion (the perceptions and observations of professionals trained in a specific discipline), as well as the administration of evaluation instruments that determine the child’s functioning in each domain of development. Procedures for completing the evaluation and assessment are further outlined in the federal regulations.

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22 Foundations of Early Intervention

ˆ˜ÌiÀÛi˜Ìˆœ˜ÊÃiÀÛˆViÃÊÌ…>ÌÊ܈••ÊLiÊ«ÀœÛˆiÊÌœÊÌ…iÊV…ˆ•Ê>˜Êv>“ˆ•Þ°Ê-«iVˆ fic requirements related to the plan and its development are addressed in Chapter 3.

Early Intervention Services

The federal regulations designate the kind of information that must be addressed in the provision of early intervention services. Services must be outcome driven—that is, driven by the outcomes the family desires to see as a result of the child’s participation in the program. IDEA requires that service frequency (i.e., the number of sessions, such as once per month), intensity (i.e., individual or group services), method (i.e., how a service will be provided, such as using coaching), length (i.e., length of time, such as 60 minutes per visit), duration (i.e., how long the services will be provided, such as 3 months or 1 year), and location (i.e., the place[s] where the service will be provided, such as the home or child care center) must be specified.

Natural Environments

IDEA defines natural environments as settings such as the family’s home or other community places where the child’s same-age peers who do not have disabilities spend time. Services must be provided in natural environments to the maximum extent possible and must be justified in the rare circumstances where they are provided in nonnatural settings.

Each child’s IFSP must include a plan that outlines the steps to be taken to ensure a smooth transition from the early intervention system. IDEA describes the specific steps that must be included, such as developing activities that will help the child prepare for the next setting. Specific information about this process is discussed in Chapter 3.

PREVALENCE OF CHILDREN RECEIVING EARLY INTERVENTION

According to IDEA, families who choose to participate in early intervention have certain rights and procedural safeguards available to them. Some of these procedural safeguards address confidentiality, parental consent, prior notice of proposed activities, access to the child’s records, and the right to dispute resolution. The careful implementation and monitoring of each of these key provisions is vital to

The careful implementation and monitoring of each of these key provisions is vital to creating a successful early intervention experience. These provisions are discussed in more detail in later chapters. Part C of IDEA currently remains a discretionary program, meaning that states can

detail in later chapters. Part C of IDEA currently remains a discretionary program, meaning that states can choose to accept or decline federal funds and thereby agree or decline to operate this kind of program. When a state agrees to offer a Part C early intervention program, the state is also agreeing to comply with federal regulations, including these major provisions, and to federal oversight and monitoring by OSEP. Although the provision of early intervention services continues to be a priority at the federal and state levels, challenges continue as programs face inadequate funding and struggle to serve the growing number of children and families who are in need of these services.

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Early Education and Intervention: Birth to Three

˜Õ“LiÀÊÀi«ÀiÃi˜ÌiÊ>««ÀœÝˆ“>Ìi•ÞÊÓ°Ç™¯ÊœvÊÌ…iÊi˜ÌˆÀiÊ«œ«Õ•>̈œ˜Êœvʈ˜v>˜ÌÃÊ>˜ÊÌœ``•iÀÃÊ •ˆÛˆ˜}ʈ˜ÊÌ…iÊ1˜ˆÌiÊ-Ì>ÌiðÊÌÌi“«ÌÃÊÌœÊiÃ̈“>ÌiÊÌ…iʘՓLiÀÊœvÊV…ˆ•Ài˜ÊÜ…œÊ>Àiʈ˜Ê˜iiÊ œvÊi>À•Þʈ˜ÌiÀÛi˜Ìˆœ˜ÊÃiÀÛˆViÃÊ>ÀiÊŽ˜œÜ˜ÊÌœÊÕ˜iÀiÃ̈“>ÌiÊÌ…iÊ>VÌÕ>•Ê˜Õ“LiÀÊœvÊV…ˆ•Ài˜Ê Ü…œÊ>ÀiÊ«œÌi˜Ìˆ>••ÞÊi•ˆ}ˆL•iÊLÕÌÊÜ…œÊœÊ˜œÌÊÀiViˆÛiÊÃiÀÛˆViÃÊ-,œÃi˜LiÀ}]Ê,œLˆ˜Ãœ˜]Ê-…>Ü]Ê EÊ••ˆÃœ˜]ÊÓä£Î®°Ê"˜iÊÃÌÕÞÊiÝ>“ˆ˜iÊ«ÀiÛ>•i˜ViÊ>Ì>ÊvÀœ“Ê>ʘ>̈œ˜>••ÞÊÀi«ÀiÃi˜Ì>̈ÛiÊ Ã>“«•iÊœvÊV…ˆ•Ài˜]Ê>}iÃÊ™qÓ{Ê“œ˜Ì…Ã]ÊÜ…œÊÜiÀiÊi˜Àœ••iʈ˜Êi>À•Þʈ˜ÌiÀÛi˜Ìˆœ˜Ê«Àœ}À>“ÃÆÊ Ì…iÊ>ÕÌ…œÀÃÊvœÕ˜ÊÌ…>ÌʣǯʜvÊV…ˆ•Ài˜ÊÕ˜iÀÊÌ…iÊ>}iÊœvÊxÊÞi>ÀÃÊÜ…œÊÜiÀiÊ«œÌi˜Ìˆ>••ÞÊi•ˆ ‡ }ˆL•iÊvœÀÊi>À•Þʈ˜ÌiÀÛi˜Ìˆœ˜ÊœÀÊëiVˆ>•ÊiÕV>̈œ˜ÊÃiÀÛˆViÃÊˆʘœÌÊÀiViˆÛiÊÌ…i“Ê-,œÃi˜LiÀ}]Ê <…>˜}]ÊEÊ,œLˆ˜Ãœ˜]ÊÓään®°Ê"˜}œˆ˜}Ê>˜ÊVœ“«Ài…i˜ÃˆÛiÊ Child Find activities are an important part of early intervention. These programs try to identify and recruit these potentially eligible children and families who are in need of these services. To investigate who actually participates in early intervention, the National Early Inter-

To investigate who actually participates in early intervention, the National Early Intervention Longitudinal Study (NEILS; Hebbeler et al., 2007) was conducted as a 10-year project under the U.S. Department of Education and OSEP. According to the NEILS report, children entered early intervention at an average age of 17 months. Most children were male, and most were enrolled due to a communication delay or a disability. Other common reasons for enrollment included motor delays, prenatal and perinatal factors (one third of children were premature), and global developmental delays (i.e., delays in all areas of development). Children who were found to be eligible due to a developmental delay tended to enter programs after the age of 24 months due to concerns about communication. Children who were found to be eligible due to a diagnosed condition, such as Down syndrome or visual impairment, typically entered intervention earlier, before their first birthdays. Demographically, an overrepresentation of children from low-income families was

Demographically, an overrepresentation of children from low-income families was noted, and there was a higher proportion of Caucasian children receiving intervention. Children from ethnic minorities were also represented, with children of African American and Hispanic origin representing the two other populations most often receiving early intervention. A large number of children receiving early intervention have also been found to receive foster care, have low birth weight, and be more likely to be rated as having only fair health (Scarborough, Spiker, Mallik, Bailey, & Simeonsson, 2004). The most common services received, in order of frequency, were service coordination,

Less than 1% of infants who receive services typically have low vision or blindness (discussed in Chapter 9); hearing impairment or deafness (discussed in Chapter 9); or

Children with diagnosed conditions may have received early intervention longer because many disabilities can be identified at birth. A diagnosis of Down syndrome is one example. Children with Down syndrome manifest the most common biological condition associated with intellectual disability and can demonstrate a range of intellectual abilities (American Association on Intellectual and Developmental Disabilities, 2010). During the first or second year of life, children with cerebral palsy, which results from a brain lesion or abnormal brain growth, are often identified. This condition, a disorder affecting voluntary movement and posture, is commonly served in early intervention programs. Less than 1% of infants who receive services typically have low vision or blindness

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“Օ̈«•iÊ>˜ÊVœ“«•iÝÊˆÃ>Lˆ•ˆÌˆiÃ]ÊÃÕV…Ê>ÃÊvÀ>}ˆ•iÊ8ÊÃÞ˜Àœ“iÊ-ˆÃVÕÃÃi`ʈ˜Ê…>«ÌiÀÊ£ä®°Ê Fragile X syndrome is a chromosomal abnormality associated with mild to severe intellectual disabilities; it affects males more often and more severely than females. The behavioral characteristics of this condition can be similar to those seen in children with autism spectrum disorder (ASD; Meyer & Batshaw, 2005). The incidence of children with ASD has significantly increased in recent years to 1 in 88 births (Centers for Disease Control and Prevention, 2012). As a consequence, serving infants and toddlers with this condition is becoming increasingly more common in early intervention programs. ASD is further discussed in Chapter 8.

IMPORTANCE OF EARLY INTERVENTION

It is now well established that early experiences can have significant long-term effects on the developmental outcomes of children, regardless of the level of delay or disability (Ramey & Ramey, 2004). A child’s brain is highly responsive to early experiences because these experiences directly affect the neural connections and functions within the brain. In fact, early experiences can actually change the way a child’s genes are expressed or alter the types and amount of neural connections in the brain, with both negative and positive trajectories possible (Medina, 2011; National Scientific Council on the Developing Child, 2010). This neural plasticity is why early intervention is so important, especially for children who live in impoverished circumstances and those with limited early childhood experiences. Although early intervention cannot eliminate most disabilities, it can have a positive effect on the development of many young children and lessen the effects of the disability or delay on the child’s interactions and participation in everyday life. A child’s foundation for all learning for the rest of the child’s life is established dur-

A child’s foundation for all learning for the rest of the child’s life is established during the first 5 years of life (Ramey & Ramey, 2004); as the child ages, this foundation is elaborated and refined. Early childhood specialists agree that infancy is the right time to begin providing support to children with special needs or those who are at risk for developmental difficulties. Services should generally begin as early as possible. A child’s age at the start of services has been found to be a significant variable in predicting a child’s later intellectual or cognitive progress (Lee & Kahn, 1998). This early start unfortunately does not always occur. Many children are referred to

intellectual or cognitive progress (Lee & Kahn, 1998). This early start unfortunately does not always occur. Many children are referred to early intervention later in the first 3 years of life—or not at all—for a variety of factors, including the family’s or physician’s preference to “wait and see” if the child’s development catches up, ineffective or no developmental screening efforts, a family’s choice to obtain similar services outside of the Part C system (e.g., outpatient therapy services), cultural factors, or late diagnoses. To address these issues, IDEA stipulated that early intervention programs conduct ongoing Child Find efforts to raise public awareness among potential referral sources and families regarding the positive benefits of individualized support during the first 3 years. Child Find efforts also concentrate on locating children who are in need of services. These efforts are important because of the complexity and array of challenges that can be associated with having a developmental disability early in life. A child with cognitive delays may also have motor or language delays, sensory dif-

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Early Education and Intervention: Birth to Three

Óääx>]ÊÓääxLÆÊ*Õ˜}i••œ]Ê>“«Li••]ÊEÊ>À˜iÌÌ]ÊÓääÈ®°ÊÕÀÌ…iÀ“œÀi]Êi>À•Þʈ˜ÌiÀÛi˜Ìˆœ˜Ê«Àœ ‡ }À>“ÃÊ…>ÛiÊLii˜ÊÃ…œÜ˜Ê̜ʓˆÌˆ}>ÌiÊÌ…iÊÃÌÀiÃÃiÃÊ>˜ÊV…>••i˜}iÃÊ>ÃÃœVˆ>ÌiÊ܈̅Êv>“ˆ•ÞÊ>˜Ê V…ˆ•ÊÀˆÃŽÃÊœÀÊ>ÊV…ˆ•½ÃÊˆÃ>Lˆ•ˆÌÞÊœÀÊi•>Þ°Ê/œ>Þ]ʈÌʈÃÊ>VVi«Ìi`ÊÌ…>ÌÊÌ…iÊLi˜ifits of early intervention justify its costs (Barnett, 2000; Trohanis, 2008). Makeba’s family’s story is a good example of this.

Case Study: Makeba

Makeba and her family continued to receive early intervention services until her third birthday. Just before her birthday, Makeba’s father found work at a local car dealership and the family’s concern about paying for preschool was resolved. To prepare for the transition out of early intervention, the family’s service coordinator assisted them with developing a transition plan for the services they wanted Makeba to receive after she was no longer age-eligible for the program. Because she continued to show a developmental delay, her family was interested in a referral to the local ECSE preschool program at her neighborhood school. Following her discharge from early intervention, Makeba began attending the school system’s preschool morning class four days a week, where she also received speech therapy. In the afternoons, the ECSE preschool teacher offered continued support to the teacher in the community child care preschool Makeba had been attending. As her vocabulary increased, Makeba had fewer tantrums, which made life at home and school easier. Makeba’s family was pleased with the support they received in early intervention and commented that Makeba was making progress every day.

INCLUSIVE PRACTICES IN EARLY INTERVENTION

In early intervention, inclusion refers to helping families, child care providers, preschool teachers, and other adults in a child’s natural environments to support the child’s participation in activities that are typical for a particular setting. At their core, inclusive practices for early intervention focus on the idea that all children are valued and have the right to participate in activities that are typical for infants and toddlers without special needs. Inclusive practices involve guiding adult providers to use strategies and accommodations that increase a child’s participation in the setting. For example, it could be collaboratively decided that taping down the paper for a child with cerebral palsy (see Jennifer’s case study in Chapter 10), could help the child better manage painting at the art table. Embedding sign language or a communication switch into the welcome routine may support a child with limited communication abilities in asking for what he or she wants to do during the day. These are examples of easily implemented changes, or adaptations, in a setting that will allow a child to more effectively participate.

Case Study: Makeba

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Foundations of Early Intervention

Makeba with an activity mini-schedule, a Velcro list of the four different activities that occurred during opening circle, might help Makeba, as well as the other children, feel less anxiety and have more understanding of what was about to occur. This strategy has been found to be effective in improving the attention of children with ASD, behavior challenges, or hearing loss (Raver, Hester, Michalek, Cho, & Anthony, 2013). As one activity was completed, the label for it was removed; then, the teacher pointed to the next activity to help guide Makeba’s attention to the appropriate materials. The collaborative process involved a lot of give and take, with the child care provider developing several strategies that proved to be helpful. After Makeba made the transition out of early intervention, the speech therapist from the ECSE preschool program continued this collaboration. The purpose of these consultations was to support Makeba’s inclusion in classroom activities so she could fully participate in ways that enhanced all of her development.

A principal tenet of inclusion in early childhood education and early intervention is using developmentally appropriate practice (DAP; Garguilo & Kilgo, 2000). This means creating environments that match every child’s developmental level and are also appropriate for a child chronologically. In this way, each child’s individual abilities and interests are supported (Bredekamp & Copple, 1997). The principle of DAP supports developing individualized activities for children, including those with and without disabilities. When Makeba attended her inclusive child care preschool class, her family, the program staff, and the early interventionist met frequently to discuss the type of instructional supports and accommodations necessary for Makeba to be included successfully in that program. Through observation, the service provider noted what seemed to work for Makeba and areas that presented challenges for Makeba and her child care teacher. Through indirect services, such as monitoring and consultation, Makeba’s service providers provided informal coaching to the child care staff. It was important during this process that the service providers helped the early childhood staff understand how the consultation process worked. Some early interventionists have unfortunately expressed concern about poorly coor-

BEST PRACTICE HIGHLIGHTS

childhood staff understand how the consultation process worked. Some early interventionists have unfortunately expressed concern about poorly coordinated interventions in inclusive settings and a lack of understanding regarding what early childhood staff can expect from the consultation process (Horn & Sandall, 2000; Wesley, Buysse, & Skinner, 2001). This book discusses ways to individualize inclusion so that both the child and the professional in the inclusive setting feel supported. Just like services provided to young children and their families, each inclusive situation requires a slightly different kind and style of support for the adults involved to learn ways to facilitate a particular child’s learning. By using contextualized, collaborative interventions that are embedded into the setting’s routines, professionals are supported in enhancing children’s development. Successful inclusion of infants and toddlers with special needs requires good communication, clear expectations for the consultative process, and regular monitoring by the adults in the inclusive setting.

• Effective early intervention programs focus on the importance of providing flexible, family-centered, and individualized supports that intentionally develop the capacity

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Early Education and Intervention: Birth to Three

˜ÊVœ“«iÌi˜ViÊœvÊv>“ˆ•ˆiÃÊ>˜ÊV>Ài}ˆÛiÀÃÊ̜ʓiiÌÊÌ…iʘiiÃÊœvÊÌ…iˆÀÊޜ՘}ÊV…ˆ•Ài˜Ê ܈̅ÊëiVˆ>•Ê˜ii`ð Early intervention programs provide a variety of supports to children and families—not

• Early intervention programs provide a variety of supports to children and families—not merely to children—because caregivers are the primary agents of change in a child’s development. • Programs follow seven key principles in providing early intervention (Workgroup on

• Programs follow seven key principles in providing early intervention (Workgroup on Principles and Practices in Natural Environments, 2008b):

1. Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts.

2. All families, with the necessary supports and resources, can enhance their chil-

3. All families, with the necessary supports and resources, can enhance their children’s learning and development.

4. The primary role of a service provider is to work with and support family members

5. The primary role of a service provider is to work with and support family members and caregivers in a child’s life.

6. The early intervention process, from initial contacts through transition, must be

7. The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child’s and family members’ preferences, learning styles, and cultural beliefs.

8. IFSP outcomes must be functional and based on children’s and families’ needs and

9. IFSP outcomes must be functional and based on children’s and families’ needs and priorities.

10. The family’s priorities, needs, and interests are addressed most appropriately by a

11. The family’s priorities, needs, and interests are addressed most appropriately by a primary provider who represents and receives team and community support.

12. Interventions with young children and family members must be based on explicit

13. Interventions with young children and family members must be based on explicit principles, validated practices, the best available research, and relevant laws and regulations. An understanding of federal regulations and state procedures helps service providers in

• An understanding of federal regulations and state procedures helps service providers in presenting interventions that are respectful of families’ rights and preferences and are aligned with a state’s early intervention system expectations. • According to Part C of IDEA, effective early intervention programs do the following:

• According to Part C of IDEA, effective early intervention programs do the following:

1. Support the development of infants and toddlers with disabilities and delays

2. Reduce long-term educational costs

3. Reduce long-term educational costs

4. Maximize children’s independence

5. Maximize children’s independence

6. Enhance the capacity of families to meet the needs of their children

• The primary objective of early intervention is to offer an array of services and supports that helps families and caregivers know how to support the child’s development in his or her daily living routines so that the child learns between intervention visits, when most learning naturally occurs.

• Service providers must meet established professional competencies; commit to following explicit early intervention principles; and use validated, evidence-based practices so that interventions are effective, appropriate, meaningful, and supportive of each child’s participation in his or her family’s natural environments.

4. Enhance the capacity of families to meet the needs of their children Service providers must meet established professional competencies; commit to follow-

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28 Foundations of Early Intervention

Part C of IDEA explains, services and interventions must be tailored to the unique needs of each child and family and should begin as soon as possible. The best outcomes occur when caregivers and early intervention professionals work together because the majority of change occurs while children are interacting with their families. Early intervention service providers use coaching and consultation to guide parents or caregivers, as well as other adults who are important to the family, in developing participation-based interventions within the routines of families' natural environments. As much as possible, inclusive activities that involve children without disabilities are encouraged. Encouraging families to use natural learning environment interventions is a good way to support the learning of children. Service providers need to remember the fundamental purpose of early intervention: to help families and caregivers know how to support a child's development using individualized intervention strategies between visits, when most learning naturally occurs.

DISCUSSION QUESTIONS AND APPLIED ACTIVITIES

1. Using at least three of the Workgroup’s (2008b) seven key principles, write a oneparagraph definition of early intervention. Use common language so the definition could be shared with a parent or caregiver who is considering having his or her child assessed to determine if the child is eligible for services.

2. Write the nine provisions of Part C of IDEA (2004) and describe each as if you were

3. Write the nine provisions of Part C of IDEA (2004) and describe each as if you were sharing them with a parent or caregiver.

4. Visit an early intervention program in your community. Ask the director the following questions:

• What is the process by which a child, and the child’s family, are determined to be eligible for services? • How are services paid for?

• What is the most common type of service setting your program offers (e.g., intervention visits in the home, inclusion setting consultations, community location)? • What are the three greatest challenges your staff face in providing early intervention

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• What are the three greatest challenges your staff face in providing early intervention services? Describe how you and your team have responded to these challenges.

Young Exceptional Children, 8(1), 20–29. doi:10.1177/10 9625060400800103 Campbell, P.H., & Sawyer, L.B. (2007). Supporting learning opportunities in natural settings through participation-based services. Journal of Early Intervention, 29, 287–305. doi:10.1177/105381510702900402 Centers for Disease Control and Prevention. (2012). Autism spectrum disorders (ASDs): Data and statistics. Re trieved from http://www.cdc.gov/ncbddd/autism/ data .html Council for Exceptional Children, Division for Early Childhood Task Force. (1993). Personnel standards for early education and early intervention [Position statement]. Missoula, MT: Author. Data Accountability Center. (2011). Part C data and notes: IDEA 618 data tables. Retrieved from https://www.idea data.org/tools-and-products Dunst, C.J., Hamby, D., Trivette, C.M., Raab, M., & Bruder, M. (2000). Everyday family and community life and children’s naturally occurring learning opportunities. Journal of Early Intervention, 23, 151–164. doi: 10.1177/10538151000230030501

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Early Education and Intervention: Birth to Three

Õ˜ÃÌ]Ê°°]Ê/ÀˆÛiÌÌi]Ê°fi°]ÊÕ“«…ÀˆiÃ]Ê/°]Ê,>>L]Êfi°]ÊEÊ ,œ«iÀ]Ê °Ê -Óä䣮°Ê œ˜ÌÀ>Ã̈˜}Ê >««Àœ>V…iÃÊ ÌœÊ ˜>ÌÕÀ>•Ê •i>À˜ˆ˜}Ê i˜ÛˆÀœ˜“i˜ÌÊ ˆ˜ÌiÀÛi˜Ìˆœ˜Ã°Ê Infants & Young McWilliam, R.A. (2010). Routines-based early intervention: Children, 14, 48–63. doi:10.1097/00001163-2001140 20-00007 Early Childhood Outcomes Center. (2005). Fam-Medina, J. (2011). Brain rules for baby: How to raise a smart, ily and child outcomes for early intervention and early childhood special education. Retrieved from http:// Meyer, G., & Batshaw, M. (2005). Fragile X syndrome. In www.ectacenter.org/~pdfs/eco/Family_Outcomes_ Issues_01-17-05.pdf Early Childhood Technical Assistance Center. (2009). The child outcomes. Retrieved from http://ectacenter Mott, D.W., & Dunst, C.J. (2006). Influences of resource- .org/eco/assets/pdfs/Child_Outcomes_handout.pdf Education for All Handicapped Children Act of 1975, PL 94-142, 20 U.S.C. §§ 1400 et seq. Mullins, L. (2002). Natural environments: A letter from Erickson, M.F., & Kurz-Riemer, K. (1999). Infants, toddlers, and families: A framework for support and intervention. New York, NY: Guilford Press. Garguilo, R., & Kilgo, J. (2000). Young children with special National Scientific Council on the Developing Child. needs. Albany, NY: Delmar. Greenwood, C., Carta, J.J., & McConnell, S. (2011). Advances in measurement for universal screening and individual progress monitoring of young children. Journal of Early Intervention, 33(4), 254–267. doi: Odom, S.L., & Wolery, M. (2003). A unified theory of 10.1177/1053815111428467 Guralnick, M.J. (Ed.). (1997). The effectiveness of early intervention. Baltimore, MD: Paul H. Brookes Publishing Co. Guralnick, M.J. (1998). Effectiveness of early intervention Office of Special Education Programs. (2010). 29th annual for vulnerable children: A developmental perspective. American Journal on Mental Retardation, 102, 319–345. doi:10.1352/0895-8017 Guralnick, M.J. (2005a). Early intervention for children Pletcher, L.C., & McBride, S. (2004). Family-centered with intellectual disabilities: Current knowledge and future prospects. Journal of Applied Research in Intellectual Disabilities, 18, 313–324. doi:10.1111/j.1468-3148 .2005.00270.x Guralnick, M.J. (2005b). Second-generation research in Pletcher, L.C., & Younggren, N.O. (2013). The early interthe field of early intervention. In M.J. Guralnick (Ed.), The effectiveness of early intervention (pp. 3–20). Baltimore, MD: Paul H. Brookes Publishing Co. Pungello, E.P., Campbell, F.A., & Barnett, W.S. (2006). Guralnick, M.J. (2008). International perspectives on early intervention: A search for common ground. Journal of Early Intervention, 30, 90–101. Hebbeler, K., Spiker, D., Bailey, D., Scarborough, A., Mallik, S., Simeonsson, R., … Nelson, L. (2007). Early Ramey, C.T., & Ramey, S.L. (2004). Early learning and intervention for infants and toddlers with disabilities and their families: Participants, services, and outcomes. Final report of the National Early Intervention Longitudinal Study [NEILS]. Retrieved from http://www.sri.com/ Raver, S.A. (1999). Intervention strategies for infants and sites/default/files/publications/neils_finalreport_200 702.pdf Horn, E., & Sandall, S. (2000). The visiting teacher: A Raver, S.A. (2009). Early childhood special education— 0–8 model of inclusive ECSE service delivery. In S. Sandall & M. Ostrosky (Eds.), Natural environments and inclusion (pp. 49–58). Longmont, CO: Sopris West. Raver, S.A., Hester, P., Michalek, A., Cho, D., & Anthony, Individuals with Disabilities Education Act of 1990, PL 101-476, 20 U.S.C. §§ 1400 et seq. Individuals with Disabilities Education Improvement Act (IDEA) of 2004, PL 108-446, 20 U.S.C. §§ 1400 et seq. Keilty, B. (2008). Early intervention home-visiting princi-Rosenberg, S.A., Robinson, C.C., Shaw, E.F., & Ellison ples in practice: A reflective approach. Young Exceptional Children, 11(2), 29–40. doi:10.1177/1096250607311 933 Klingner, J.K., Boardman, A.G., & McMaster, K.L. (2013). Rosenberg, S.A., Zhang, D., & Robinson, C.C. (2008). What does it take to scale up and sustain evidencebased practices? Exceptional Children, 79, 195–212. Lee, S., & Kahn, J. (1998). Relationships of child progress with selected child, family and program variables

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Influences of resourcebased intervention practices on parent and child out- Education for All Handicapped Children Act of 1975, PL comes. CASEinPoint, 2(6), 1–8. Mullins, L. (2002). Natural environments: A letter from a mother to friends, families and professionals. Young Exceptional Children, 5(3), 21–24. doi:10.1177/109625 060200500303 Garguilo, R., & Kilgo, J. (2000). Young children with special National Scientific Council on the Developing Child. (2010). Early experiences can alter gene expression and Greenwood, C., Carta, J.J., & McConnell, S. (2011). affect long-term development. Retrieved from http:// Advances in measurement for universal screening developingchild.harvard.edu/index.php/download_ file/-/view/666/ dren. Journal of Early Intervention, 33(4), 254–267. doi: Odom, S.L., & Wolery, M. (2003). A unified theory of practice in early intervention/early childhood special Guralnick, M.J. (Ed.). (1997). The effectiveness of early education: Evidence-based practices. Journal of Special Education, 37(3), 164–173. doi:10.1177/002246690303 70030601 Guralnick, M.J. (1998). Effectiveness of early intervention Office of Special Education Programs. (2010). 29th annual for vulnerable children: A developmental perspective. report to Congress on the implementation of the Individuals with Disabilities Education Act, 2007 (Vol. 1). Washington, DC: Author. Guralnick, M.J. (2005a). Early intervention for children Pletcher, L.C., & McBride, S. (2004). Family-centered with intellectual disabilities: Current knowledge and services: Guiding principles and practices for delivery of family-centered services. Retrieved from http://www. tual Disabilities, 18, 313–324. doi:10.1111/j.1468-3148 learningace.com/doc/535648/f0944db94571fda4e 09769382cd40479/famlcntrdsrvc Guralnick, M.J. (2005b). Second-generation research in Pletcher, L.C., & Younggren, N.O. (2013). The early interthe field of early intervention. In M.J. 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Foundations of Early Intervention

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,ÕÃ…]Ê °°]Ê EÊ -…i•`i˜]Ê fi°°Ê -Ó䣣®°Êconsultants. Journal of Early Intervention, 24, 112–128. doi:10.1177/105381510102400206 Woods, J.J., Wilcox, M.J., Friedman, M., & Murch, T. (2011). Collaborative consultation in natural environments: Strategies to enhance family-centered supports and services. Language, Speech, and Hearing Services in Schools, 42, 379–392. doi:10.1044/0161-1461(2011/10- 0016) Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. (2008a, March). Agreed upon mission and key principles for providing early intervention services in natural environments. Retrieved from http://ectacenter .org/pdfs/topics/families/Finalmissionandprinciples 3_11_08.pdf Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. (2008b, March). Seven key principles: Looks like/doesn’t look like. Retrieved from http://www.ecta center.org/pdfs/topics/families/Principles_Looks Like_DoesntLookLike3_11_08.pdf

FAMILY & RELATIONSHIPS / CHILDREN WITH SPECIAL NEEDS

—Naomi Younggren, Ph.D., Early Childhood Consultant; Department of Defense Army EDIS Personnel Coordinator

Family-Centered Early Intervention

Aligned with DEC recommended practices and CEC standards!

must for future early interventionists, this introductory text prepares professionals to support

A infants and toddlers with special needs and their families—and address the OSEP child outcomes