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