Early Intervention

1. Early Intervention PSY 417 Dr. Schuetze

2. Definition • System of coordinated services that promote child’s growth and development and supports families during critical early years • Federally mandated through the Individual for Disabilities Education Act (IDEA)

3. History of Early Intervention • What is Early Intervention • Contributions from 4 Fields • Early Childhood Education • Kindergarten • Nursery Schools • Daycare – Lanham Act (1940) • Maternal Child Health Services • Children’s Bureau (1912) • Title V (1935) • Early and Periodic Screening Diagnosis and Treatment Program (EPSDT)

4. History of Early Intervention continued…. • Special Education • Itard – wild boy of Aveyron • Seguin • AAMR (1976) • Child Development Research • Gesell • Piaget • Bowlby

5. Recent Advances in Early Intervention • 1968: Handicapped Children’s Early Education Assistance Act • 1965: Head Start • 1975: PL94-142 (Education for all Handicapped Children Act) • 1986: PL 99-457 • Part H

6. Scientific Basis for Early Intervention Research on neuroplasticity (animal models) Studies of extreme deprivation (orphanages, maternal deprivation, isolation) Naturalistic and longitudinal studies Randomized controlled trials (RCTs) to test the efficacy of a planned intervention to alter the life course

7. Randomized Controlled Trials (RCTs)to Improve Learning Outcomes Abecedarian Project Infant Health and Development Program Romanian Orphanage Studies Intensive Pediatric CI Therapy National Head Start-Public School Transition Demonstration Study Pre-K Curriculum Comparison Study RITE Professional Development Study

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

9. Key Research Question for Abecedarian (ABC) Project Can the cumulative developmental toll experienced by high-risk children be prevented or reduced significantly by providing systematic, high-quality, early childhood education – from birth through kindergarten entry and/or from k through 2nd grade?

10. Treatment Group _ Adequate nutrition Supportive social services Free primary health care Preschool treatment: Intensive (full day, 5 days/week, 50 weeks/year, 5 years) “Learningames” Curriculum Cognitive / Fine Motor Social / Self Motor Language Individualized pace Abecedarian Preschool Program Control Group _ • Adequate nutrition • Supportive social services • Low-cost or free primary health care Campbell & Ramey, 1995 American Educational Research Journal

11. Scores for High-Risk Preschool Treatment and Control Children in the Abecedarian Project at Nine Preschool Measurement Occasions Ramey et al, 2000 Applied Developmental Science

12. Percent of Abecedarian Sample in Normal IQ Range (>84) by Age (longitudinal analysis) Martin, Ramey, & Ramey, 1990 American Journal of Public Health

13. Key Findings from Abecedarian Project(“Abecedarian” …one who learnsthe basics such as the alphabet) 18 Months to 21 Years Old • Intelligence (IQ) • Reading and math skills • Academic locus-of-control • Social Competence • Years in school, • including college • Full-time employment • Grade Repetition • Special Education • placement • Teen Pregnancies • Smoking and drug • use Plus benefits to mothers of these children (education, employment) Ramey et al, 2000

14. The Infant Health and Development Program(IHDP) Designed to replicate the Abecedarian Project applied to premature, low birthweight children gestation and < 2500 gm at birth Conducted at 8 sites (N=985 children & families) Intervention modified for biological risk factors Educational intervention only until 3 yrs old (CA)

15. Stanford-Binet IQ Scores at 36 Months Heavier LBW Group (2001-2500gm) Infant Health and Development, JAMA, 1990 Ramey, AAAS, 1996

16. Stanford-Binet IQ Scores at 36 Months Lighter LBW Group (<2000gm) Infant Health and Development, JAMA, 1990 Ramey, AAAS, 1996

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

18. Outcomes Affected Positively (*p<.01) by the Infant Health & Development Program Ramey 1999, adapted from Gross, Spiker, & Haynes, 1997, Helping Low Birth Weight, Premature Babies

19. Differential response to early educational intervention The children who benefited the most had: • mothers with IQs below 70 • mothers with low levels of education • poor birth outcome indicators (PI, Apgar, LBW) • teen mothers (Martin, Ramey, and Ramey, American Journal of Public Health, 1990; Ramey & Ramey, 2000)

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

21. Romanian Study Personal Social (Study 1)

22. Romanian Study Language (Study 1)

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

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

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

26. Benefits of Early Intervention • E.I. services that are delivered within the context of family can: • Improve developmental and educational gains • Reduce future costs of special services • Reduce family feelings of isolation, stress and frustration • Help children with disabilities grow up to be productive and independent

27. Early Intervention Steps • Referral (unless parent objects) • Made when referral source suspects delay or disability • Family is informed of benefits • Child is referred to Early Intervention Officer (EIO) within 2 days • EIO assigns Initial Service Coordinator

28. Initial Service Coordinator • Provides information about Early Intervention Program (EIP) • Informs family of rights • Reviews list of evaluators • Obtains insurance/Medicaid information • Obtains other relevant information

29. Evaluation • Determine eligibility • Family assessment • Gather information of IFSP • Summary and report

30. Individualized Family Service Plan (IFSP) Meeting • Conducted if child is eligible • Family identifies desired outcomes • EI services specified • Develop written plan • Family and EIO agree to IFSP

31. IFSP Components • Statement of present level of development • Statement of family resources/ability to meet developmental needs • Statement of major outcomes expected with procedures and timelines of follow-ups • Statement of specific EI services including frequency, intensity and methods • Dates and durations of services • Name of service coordinator • Must be reviewed every 6 months – revised as needed  dynamic plan

32. EI Services • Assisting technology devices and services • Audiology • Family training • Medical services – for diagnostic or evaluation purposes only • Nursing services • Nutrition services • Occupational therapy • Physical therapy • Psychological services • Service coordination • Social work services • Special instruction • Speech/language pathology • Vision services • Health services • Transportation/related costs

33. Transition • Plan for transition included in IFSP

34. Service Model Options • Home and community-based visits • Facility or center-based visits • Parent-child groups • Family support groups • Group developmental intervention

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

36. Areas of Development/Functional Areas • Cognitive: remembering, reasoning, understanding and making decisions, learning, thinking • Physical: vision, hearing, growth, gross and fine motor abilities • Speech-language • Social/emotional: relating to others • Adaptive development: self-help skills the child uses for daily living

37. New York State’s Definition of Developmental Delay • 12 month delay in one functional area • 33% delay in one functional area or 25% delay in each of two areas