Does Early Intervention actually help?

Early Intervention is centered on looking at infant & toddler development with parents, setting appropriate goals, and making a plan to meet those goals, all for the purpose of helping children succeed in lessening or closing the gap with developmental milestones. So the question is- Does Early Intervention actually lead to success? Is it worth the putting in the effort to make the referral? Is it worth the time you spend receiving services? I wouldn't be here if I didn't believe whole-heartedly in Early Intervention. However, let me share some research so you can see what a powerful service Early Intervention truly is-

• Early Intervention research was performed on a group of mentally disabled children in 1958. This research showed that "the development of sound intelligence depends on appropriate stimulation in the environment." (Cowdery & Allen, 2009, p. 26). This piece of research lead to the formation of Head Start, but also demonstrated the power interventions can have on children with the most significant disabilities.
• Approximately one-fifth of all infants born annually are at risk for developmental disabilities (Haber, 1991). Of these, approximately one-fourth will manifest significant delays by age 5.
• Neural circuits, which create the foundation for learning, behavior and health, are most flexible or “plastic” during the first three years of life. Over time, they become increasingly difficult to change. The brain is strengthened by positive early experiences, especially stable relationships with caring and responsive adults, safe and supportive environments, and appropriate nutrition. High quality early intervention services can change a child’s developmental trajectory and improve outcomes for children, families, and communities. ("The Importace Of Early Intervention For Infants And Toddlers With Disabilities And Their Families")
• Early identification of children with developmental disabilities leads to an effective therapy of conditions for which definitive treatment is available. However, even in those instances in which the condition cannot be fully reversed, early intervention improves children's outcomes and enables families to develop the strategies and obtain the resources for successful family functioning" (Committee on Children with Disabilities, 1994, page 863). 
• “Early Intervention for a broad spectrum of communication disorders affecting young children can be very effective in eliminating those disorders or at least mitigating their impact on a child’s later speech and language development” (p. 403). 
• 71% - 76% of children receiving Early Intervention services demonstrated improvement across performance areas, including social relationships, reasoning, problem solving, feeding, dressing, and other self-care.
• 52% -64% of children receiving Early Intervention met developmental age expectations at age 3.
• 90% of parents reported that Early Intervention service had improved their ability to help their children develop and learn.
• Early Intervention provides different sources of social support to the family, which reduces the impact of stress on the family and enhances parent-child interaction and consequently child development. 
• Well-designed early childhood interventions have been found to generate a return to society ranging from $1.80 to $17.07 for each dollar spent on the program.

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Allen, E.K., Cowdery, G.E. (2009). The Exceptional Child: inclusion in early childhood education. United States of America: Thompson Delmar Learning

Derrington, T., Shapiro, B. & Smith, B. (1999). The effectiveness of Early Intervention Services. Unpublished manuscript. 

"The Important Of Early Intervention For Infants And Toddlers With Disabilities And Their Families". NECTAC. N.p., 2011. Web. 15 Nov. 2016.

Case-Smith, J. (2013). From the Desk of the Great Editor- Systematic reviews of the effectiveness of interventions used in occupational therapy early childhood services. American Journal of Occupational Therapy, 67, 379-382.

"Proven Benefits Of Early Childhood Interventions | RAND". Rand.org. N.p., 2016. Web. 16 Nov. 2016.

What on earth is IDEA?

IDEA stands for Individuals with Disabilities Education Act. So naturally, it makes sense that IDEA is a law for in the field for education for people with disabilities. 

Purpose:

• To ensure that children with disabilities have the opportunity to receive a free appropriate public education, just like other children.

Brief History:

• IDEA was enacted by Congress in 1975
• Originally called Education for All Handicapped Children Act (PL 94-142)
• IDEA 2004 Part C- Provided services for children with disabilities from birth to 3. Stated that very young children do not need a label to be served (can be served through a label/diagnosis or developmental delay). 

Parts of IDEA

• Part A: Discusses the purpose of the special education law, definitions of terms, and general provisions.
• Part B: Requires services for school-aged children, including preschoolers. Discussed funding, state plans, evaluation, eligibility, due process, discipline ad other areas relating ot direct services. Requirement of IEPs (Individualized Education Plans).
• Part C: Requires services for babies and toddlers to the 3rd birthday. Requires a comprehensive child find system and IFSPs (Individualized Family Service Plans)
• Part D: Focuses on the need to improve special education programs, preparing personnel, disseminating information, supporting research, and applying research findings to education.

IDEA & Early Intervention

• IDEA is an educational law, and Early Intervention is an educational service. We are not doctors, nurses or clinicians. We are teachers. We are here to teach you research-based strategies that you can use to help your child meet developmental milestones.
• IDEA guarantees the right to "FAPE" (free appropriate public education). For Early Intervention, this means that our educational services are free to you and your family!
• IDEA requires "Zero reject." Local schools must provide for all regardless of severity of disability. If your child meets eligibility requirements, you or she cannot be denied services.
• Nondescriminatory Evaluations. Assessment of disability is in accordance with the child's language and culture. For families whose native language is something other than English, you will be provided an interpreter. 
• Appropriate education. We (parent, Early Interventionist, and any other providers) develop an IFSP (Individualized Family Service Plan) which must be followed. The IFSP is developed around health history, developmental levels, and family priorities. We work together to develop goals and services that address the individual needs of the infant or child.
• Least Restrictive Environment. Our philosophy is that children develop at better rates when taught in the same environment as their peers without disabilities (also called the "natural" environment). Some places we provide Early Intervention services include your home, the park, the library, a restaurant, or the grocery store. Some environments that would not be considered natural and where we would not provide Early Intervention services would include a clinic, hospital, or school for children with special needs.
• Due Process. Parents have the right to object when not in agreement.
  • Parent can examine all records.
  • Parents are to be consulted about program before it goes into effect.
  • Parents are to receive written notice of proposed changes/placement.
  • Parents can request legal representation if problems cannot be resolved.

What will my first visit be like?

For me, the drive to meet a new family is kind of like the excited anticipation of Christmas Eve. I love meeting new families! I've never met a child or family that I didn't learn from. Every one is different- different strengths, different needs, different concerns...

I enjoy getting to know a family, working together with them to develop an individualized program that meets their specific needs. That is what the initial visit is all about!

Your Early Interventionist typically comes to your home for the Initial visit. When parents work outside the home, we can come to your work, meet at a restaurant, etc. Here are key components of this time together!

• Getting to know one another: We will share information with you about our company, our owners and your Early Interventionist. We take time to play with the child and start letting them become familiar with us.
• Learning about your child: If BabyNet had the assessment completed, we will review the results. We will also complete another assessment (HELP or Carolina) while playing with your child and asking questions of you. This is a great time for you to be noticing things your child is doing developmentally as well as some skills that you would like to work on. If your child has been diagnosed with a special need, we will review this as well. We will ask you to share your concerns for your child. We know that you are the expert on your child, and the sharing of your knowledge is invaluable.
• Learning about your family: BabyNet completes a Family Assessment before you are referred to a Early Intervention provide. We will go over this together in order for your Early Interventionist to find out what services you currently have, if there are siblings (we can always include siblings in our Special Instruction!), etc. 
• Complete paperwork: With the initation of a new service, there is much paperwork. Some of the documents to be gone over include:
  • Service Coordinator/Early Interventionist Provider Choice- You always have choice regarding which company you use, if you want another EI, or if you no longer wish to continue the service. By signing this form, you are consenting for the selected Early Intervention company to provide services.
  • Consent to Release & HIPAA- You sign consent regarding who we are allowed to send/receive information.
  • Written Prior Notice- You always have the right to 7 days notice before we have a meeting, complete an assessment, make any changes to the IFSP, etc. However, if you would like to complete an IFSP review before 7 days notice, you can sign your consent. This is often done at the first visit in order to get services going as quickly as possible.
  • BabyNet Child and Family Rights- A booklet stating all of your rights as a family in the BabyNet system.
  • Safety Checklist- A quick yes/no checklist informing parents of recommended practices to keep children safe.
• Developing appropriate goals: Together we will develop an Individualized Family Service Plan (IFSP). This is an educational document that plans out the services that your child will receive. The plan is individualized to your child's needs and your concerns. The assessments your child has received will be listed and then we develop IFSP "outcomes" or goals. You get to select goals, and these are what your Early Interventionist will teach you strategies for during Special Instruction.
• Developing appropriate services: After reviewed assessments and developing goals, we will review services that can be used to help meet these goals. Family Training and Service Coordination will be listed in this section. In addition, some services that might be pursued and listed are vision/hearing evaluations, foreign language interpretations, Physical Therapy Evaluation, etc.
• Reviewing the Transition process: Transition to the school district begins at age 2. At each IFSP review, we will review the process of transitioning to the school district. We will add more on Transition in a later series.
• Scheduling of 1st Family Training visit.

It is important for you to know that while an Individualized Family Service Plan is a legal, educational document, it is also a plan for current services and needs. As your child progresses or your concerns change, we can always revisit the IFSP to adjust goals and services to make updates!

The Initial visit typically requires 1.5-2.5 hours.

What did my child just qualify for?

"My child qualifies for Early Intervention services. What does that mean?"

Early Intervention is really a two part service including Special Instruction & Service Coordination. If someone asks me what Early Intervention is or what an Early Interventionist does, my one sentence explanation is-

We equip parents with strategies and services in order to help children meet developmental goals.

Special Instruction is a time where your Early Interventionist will share research-based strategies with you to help your child meet developmental goals. Lets pick this apart a bit more-

• Special Instruction, also known as Family Training. You may hear both terms, but they're the same thing.
• Time: Special Instruction is provided four times a month, for an hour each time.
• Research-based activities: So much of what we do will look like play first glance. However, all of our activities are based on research. Your Early Interventionist is there to teach you the most effective means of accomplishing goals. We'll share the research with you and teach you the benefits!
• Goals: Much more on this later, but... You select the goals for your child. We are here to teach you what skills come next developmentally, but you choose the specific goals based on the concerns you have for your child.  

Service Coordination is when your Early Interventionist connects you with services that meet the needs of your family and your child. What types of services might your Early Interventionist help you get connected with?

• BabyNet 16 Services such as speech therapy, occupational therapy, etc. (look for future blog post!)
• Medicaid, TEFRA
• Housinge
• Autism Testing
• ABA Therapy
• Parent Support (i.e. Family Connections)
• Head Start, Early Head Start, Private Preschool
• Transition to the School District at age 3

Special Instruction (Strategies) + Service Coordination (Services) = Early Intervention

How do I get Early Intervention services?

We've been discussing what Early Intervention is and how infants/children can qualify. The next logical question is, What do I do? Our discussion today is all about making the referral and what comes next for families residing in South Carolina!

1. Making the Referral- The first step is to actually make a referral. Anyone can make a referral- parents, doctors, teachers, Early Interventionists, etc. Who to call depends on the age of your child:
   • Birth - 3: These children are referred to BabyNet. The telephone number is 1-877-621-0865. You will also complete a Referral Form.
   • Ages 3 - 6: Older children are referred to DDSN (Department of Disabilities and Special Needs). You will soon have two choices for making your referral- by phone or online! The toll free screening for those who prefer to call is 1-800-289-7012. The online "Request for Services" is expected to be made available in early December. We will announce when it is made available! DDSN referrals are a bit different from BabyNet referrals. Whether you request DDSN services online or by phone, you will be contacted by staff of the "DDSN Eligibility Divisions for Medicaid Outreach." They will offer you choice of an Intake provider and refer you to your chosen provider. Tiny Feet Early Intervention is on the list of Intake providers for Greenville & Pickens County. We would love to come alongside you, helping make the Intake process seamless for you and your family!
2. Once BabyNet receives your referral,  they will contact the parent/caregiver to schedule an Intake/Orientation meeting. In addition, they will briefly describe BabyNet's services.
3. At Orientation & Intake, you will complete initial paperwork, including consents & releases of information to help get a full picture of your child's development. For children with a suspected developmental delay, a screening will be completed. If your child already has a diagnosis , this screening may not be necessary.
4. If the the screening shows developmental concerns, the child will receive a multidisciplinary evaluation in order to determine initial eligibility that is consistent with South Carolina's definition of "infants and toddlers with disabilities." BabyNet works with local Evaluation & Assessment teams to complete this step.
5. You (the parent/caregiver) will be notified within 2 days of your child's eligibility status. At this time, and if your child qualifies, you will be given a booklet of providers for Early Intervention in your area. You will select your provider who will get in touch to schedule your first visit!

We would love if you pick Tiny Feet Early Intervention!

How do I know if my child will qualify?

If you were to call me up and ask me if your child would qualify for Early Intervention services (Which you are more than welcome to do!), here are the questions I'd ask you:

1. What are your concerns? God has given parents some incredible intuition. Often, we know in our gut that there is something to be concerned about. I know with my kids, my mom knew with my sister & me, and my grandma knew with my mom & aunt.
2. How old is your child and what skills is he or she demonstrating? At this point, I can direct you to yesterdays post on The Blog to address whether your child is developing normally, or if we are seeing some red flags.
3. Have you spoken with your doctor? Sometimes parents have already been to a doctor (or lots of doctors) and the child has a diagnosis such as Down Syndrome, Cerebral Palsy, Spina Bifida, etc.  BabyNet has a list of "Established Risk Conditions." If your child has been professionally diagnosed with any condition on this list, he or she is already eligible for BabyNet services based on "established risk." We just need to make the referral!
4. Would you like help making a referral? There is simply no way I can guarantee that your child will qualify for Early Intervention based on signs of a developmental delay. However, I am more than happy to assist in making the referral. Where to send a referral changes, depending on the age of your child.
   • Birth - 3: These children are referred to BabyNet. The telephone number is 1-877-621-0865. You will also complete a Referral Form. 
   • Ages 3 - 6: Older children are referred to DDSN (Department of Disabilities and Special Needs). The telephone number is 1-800-289-7012.

BabyNet & DDSN are the two state agencies in South Carolina for Early Intervention. Each county has a Local DSN (Department of Special Needs) Board who provides Early Intervention services as well as private providers. Tiny Feet Early Intervention is one of those private providers.

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In a Nutshell--- How do children qualify for Early Intervention services?

• Through a diagnosis (Established Risk)
• Through an assessment that finds your child has a developmental delay

How do I know if my child is delayed?

The first thing that should be mentioned is that all children develop differently. While one child learns to walk at 9 months, another may not be walking until 13 months. Even our bi-annual assessment has a range shown for each skill (i.e. Names one or two familiar objects, 13-18 months). Children develop on their own timeline, and often this is within the normal range. However, the concern arises when there is a more significant delay in the acquiring of skills, which we call "red flags." Spotting concerns sooner rather than later is key if your child does have a true developmental delay.

My goal is to give you a resource of when skills should  acquired. If your child is not developing within these "normal" time-spans, you can discuss concerns with your pediatrician. Sometimes doctors recommend waiting to see if skills emerge on their own. However, as a parent you can refer your child for Early Intervention services on your own if you continue to have concerns. Please see our Referral page or feel free to give us a call! We would be more than happy to help you get connected and assist in making the referral! 

Common signs of Development Delay in Infants & Children:

Language/Communication Skills (Speech)

• 3-4 Months: Does not respond to loud noises
• 4 Months: Begins babbling but does not try to imitate sounds
• 7 Months: Does not respond to sounds
• 1 Year: Does not use any single words (like "mama")
• 2 Years: Cannot speak at least 15 words, does not use two-word phrases without repetition, only imitates speech, does not use speech to communicate more than immediate needs

Gross Motor Skills

• 4 Months: Does not support his or her head well, does not push down with legs when his or her feet are place on a firm surface 
• 5 Months: Doesn't roll over in either direction
• 6 Months: Cannot sit up without help
• 7 Months: Stiff or very floppy muscles, flops his or her head when pulled into a sitting position, does not bear weight on his or her legs when you pull him or her up to a standing position
• 1 Year: Does not crawl, drags on side of his or her body while crawling, cannot stand when supported
• 18 Months: Cannot walk
• 2 Years: Does not develop a heel-to-toe walking pattern or only walks on toes, cannot push a wheeled toy

Fine Motor Skills

• 3-4 Months: Does not reach for, grasp, or hold objects, does not support his/her head well
• 7 Months: Reaches with one hand and does not actively reach for objects, has trouble getting objects into his or her mouth

Social/Emotional Skills- How a child interacts with other children and adults

• 3 Months: Does not smile at people, does not pay attention to new faces, or seems frightened by them
• 5 Months: Cannot be comforted at night, does not smile without prompting
• 6 Months: Does not squeal or laugh
• 7 Months: Refuses to cuddle, shows no affections for parents or caregivers, shows no enjoyment around people
• 8 Months: Shows no interest in games of peek-a-boo
• 9 Months: Shows no back-and-forth sharing of sounds, smiles, or facial expressions
• 1 Year: Shows no back-and-forth gestures, such as waving, reaching, or pointing

Cognition Skills- Thinking

• 1 Year: Does not search for objects that are hidden while he or she watches, does not use gestures (i.e. waving), does not point to objects or pictures
• 2 Years: Does not know the function of common objects (i.e. hairbrush, telephone, spoon), does not follow simple instructions, does not imitate actions or words

Studies show that 10-15% of children under age 3 had a developmental delay. Your child may have a delay in one, two, or all of these areas. Early Intervention can make a huge difference for children with developmental delays. One study found that only 3% of kids were getting appropriate attention.

If you have concerns about your child's development, please speak up! Follow your instincts. At Tiny Feet Early Intervention, we understand that you are the expert on your child!

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Sources:

Boyle CA, et al. 2011. Trends in the Prevalence of Developmental Disabilities in US Children, 1997-2008. Pediatrics 127(6):1034- 42  http://pediatrics.aappublications.org/content/117/6/2304.full.pdf+html

AndrewG1999. "Know If Your Baby Is Developing Normally." WikiHow. N.p., n.d. Web. 28 Oct. 2016

"Recognizing Developmental Delays in Children." WebMD. Ed. Smitha Bhandari. N.p., 31 May 2016. Web. 28 Oct. 2016.

What is Early Intervention?

Welcome to Early Intervention 101! This entry is the first in a series where we will be delving into the world of Early Intervention. 

98% of the time I tell someone about Tiny Feet or that I am an Early Interventionist, the first thing they say is, "What's Early Intervention?" My goal for today (and this series) is to briefly describe Early Intervention without all of the professional education jargon we (those of us in this field) use unintentionally.

First, lets look at the words-

• Early- We work with children from newborn up to 5 years old.
• Intervention- Our job is to "intervene" in these early years, teaching parents activities and strategies that they can use with their children.

Two things to note from my description above

"Children learn through play!

• I did use the word "teaching." This is intentional. Early Intervention is an educational service funded through education law (more on that in another post). We are not medical. No doctors, nurses, or therapists here. We are teachers. We teach. Think happiness and rainbows here. Haha! Anyways, we teach parents or caregivers strategies and activities based on the latest research. So much of what we do looks like play, and it is! Children learn through play! However, our play is very intentional. Each activity we use is selected because of the parent's concerns and the child's current developmental skills. Much more on developmental concerns to come! 
• Use of "intervene." Why are we intervening? (SIDE NOTE- That sounds awful... Truly cringe worthy... Please don't take it that way. We are not a bunch of people from the government zooming in to take over a situation. We are simply people who have dedicated our lives to helping children in need, taking the time to become professionals. This culmination makes for a word such as "intervention" in the field of education.) Babies or children are eligible (qualify for, authorized, or entitled to) if they have a qualifying condition or have an area of delayed development such as language or motor skills. We are "intervening" in these early years to help children who are behind in development or who may have a condition that causes them to develop more slowly. The brain is more "plastic" or flexible during the first three years of life, so these interventions are critical and will have great impact down the road. 

In a Nutshell--- Early Intervention is a service for babies and children with a diagnosis/special need or developmental delay. Early Interventionists teach families strategies that will help their children reach developmental milestones.

What questions do you have?