Early Intervention

 

Early Childhood Intervention (ECI) is a universal term used to describe services for developmentally delayed infants and toddlers.  ECI serves a heterogeneousness population including children whose, “development has been compromised and they are experiencing a delay between what is expected behavior for their age and what they are able to do across one or more developmental domains” (Bruder, 2010).  Early Childhood Intervention incorporates many disciplines serving infants and toddlers including (but are not limited to) audiology, nutrition, occupational therapy, psychological services, social work and speech and language pathology (www.dds.ca.gov).   In this essay I will outline several structural problems to ECI services using Oregon and California as examples.  I will discuss three specific problems resulting from structural design such as a growing need for services, challenges to collecting effective outcome data and work force development. 

The Individuals With Disabilities Education Improvement Act (IDEA), Public Law 99-457 first secured federal funds for ECI services in 1986.  Part B specifically mandated funds for preschool age children age three to five.  A later provision to IDEA, Part C, expanded the coverage to infants and toddlers birth through age three (Bruder, 2010).  Early Childhood Intervention is unique in its processes by working with children in their natural environments (i.e. home) and focuses on educating the parent to work with the child’s special needs.  ECI believes that the primary caregiver is best suited to helping their child overcome disabilities, therefore the primary caregiver is the targeted focus of training. 

The structural challenges to Early Childhood Intervention originate with the original passage of IDEA.  After IDEA passed in 1986, the federal government allowed each state to design and implement services within the context of the law.  In Oregon, matching funds from the federal government are directed through the Oregon Department of Education.  Early Childhood Intervention (IDEA, Part C: Age 0-3) and Early Childhood Special Education (IDEA, Part B: Age 3-5) are seamlessly integrated as a birth to age five program.  This streamlined, integrated system helps limit transitions for children while maximizing the skills of service coordinators responsible for implementation of services. 

In California, though Early Childhood Intervention (IDEA, Part C; Age 0-3) and Early Childhood Special Education (IDEA, Part B: Age 3-5) both have funds originating from the Department of Developmental Services, they are treated as unique entities (Lesley Goodman, personal communication, December 4, 2012).  A child qualifies for ECI if they, “have a developmental delay in either cognitive, communication, social or emotional, adaptive, or physical and motor development including vision and hearing and are under 24 months of age at the time of referral, with a 33% delay in one or more areas of development or are 24 months of age or older at the time of referral, with a 50% delay in one area of development or a 33% delay in two or more areas of development; or have an established risk condition of known etiology, with a high probability of resulting in delayed development.” (www.dds.ca.gov)  Oregon has a similar, but not exact, method of determination based on the deviation from normal process. 

Early Childhood Intervention serves a specific age range and not an etiology. Early Childhood Intervention “integrates a child’s developmental needs across the major developmental domains and requires that team members from different disciplines address all developmental domains during the design of interventions”(Bruder, 2010). 

Some conditions ECI specialists work with include Autism Spectrum Disorder, Fetal Alcohol Syndrome, Brain Abnormalities and Brain Injuries, Sensory Impairments, extreme prematurity (weighing less than 1200 grams) and a wide range of medical problems that could lead to developmental delays (Mary Ross, personal communication, December 12, 2009).  The heterogeneity of conditions ECI specialists encounter requires a diverse skill set.  As early childhood conditions become more greatly specified, the need for Early Childhood Intervention services increase.  This heterogeneity of conditions makes execution increasingly difficult at state and local levels (Bruder, 2010). 

The structural challenges originating with Early Childhood Intervention and IDEA in addition to the heterogeneity of conditions ECI specialists encounter make collecting outcome data very difficult.  Each state has different guidelines and implementation expectations within what the federal government mandates.  Additionally, with such a broad list of etiologies served, comparing the effective results of each individual child (i.e. an Autistic child to a child with Sensory Impairments) is like comparing apples to oranges.  Recently, the U.S. Office of Management and Budget (OMB) examined Early Childhood Intervention services.  OMB found little effective statistical data showing any results from ECI programs.  A subsequent recommendation to ECI was that “child measures need to be collected in a consistent, valid and reliable manner to demonstrate accountability and effectiveness” (Bruder, 2010).  Yet, if you ask a parent if they feel ECI is effective, many will wholeheartedly agree. 

As a result of the original structure of IDEA mandating states in develop their own programs and the heterogeneity of conditions this has significantly affected the workforce development of Early Childhood Intervention specialists.  The lack of integration between states limits the training opportunities to individualized state resources.

Based on my reading of a few articles, several interviews and our texts, I propose several structural changes.  First, recognize the root structural problems originating with IDEA and create a cohesive funding structure across all states while maintaining the web-like unobtrusive nature that is currently in play (Helgesen, 1995).  Secondly, interview early intervention specialists that are currently working in the field of ECI on ways to effectively collect the data that is necessitated for research.  The best and brightest minds are in the field working as teachers or therapists to serve young children.  Finally, once the structure at federal and individual state levels are simplified and become cohesive, offer interagency and interstate training opportunities for Early Childhood Intervention specialists to maximize their training. 

As a parent who spent a year and a half with ECI in Oregon and a year and a half with ECI in California, the research I outlined is fairly accurate.  My son graduated Early Childhood Intervention on 12-12-12 at Age 3 and weighed in at 36 ½ pounds and 39” today (90th percentile).  Giovanni was born at 2 ½ pounds (1131 grams) and started ECI at 6 ½ pounds.  Though he has been developmentally delayed at every six-month Individualized Family Service Plan (IFSP) I clearly can see his areas of improvement in relation to the goals we set. There is consistency between his IFSP and what I see daily.  ECI gives me the tools and I work with Giovanni daily (if not hourly).  In January we start Preschool Early Education Program (PEEP), or IDEA – Part B and continue the work Early Childhood Intervention so successfully began. 

   

References:

BRUDER, M. B. (2010). Early childhood intervention: A promise to children and families for their future. Exceptional Children, 76(3), 339-355. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=pbh&AN=48897209&site=ehost-live

Helgesen, S. (1995) The Web of Inclusion

Washington D.C.:  Beard Books, Inc.