Early Intervention System Research Articles

Sustainable Development Goals in Ireland: How Public Health Nurses Are Contributing Through Engagement in an Interagency Community Pediatric Clinic.

United Nations Sustainable Development Goals (SDGs) were adopted as a plan of action for people, planet, and prosperity by 2030. SDG 3 aims to ensure healthy lives and promote well-being for all ages, and other goals focus on reduction of inequality, abolition of poverty, decent work for all, and building effective, accountable, and inclusive institutions. A community pediatric clinic, Kidscope, was established in a vulnerable Irish community offering free developmental assessment and onward referral of children 0 to 6 years. The Kidscope model involves multiagency input with local public health nurses (PHNs) acting as fundamental partners in the provision of specialist early years support to vulnerable children and families. This study evaluates PHN involvement in Kidscope in the context of SDGs. To record and understand PHN roles within Kidscope and to capture their contribution to achieving SDGs in a disadvantaged Irish community. Qualitative stakeholder analysis and mapping design. Snowball sampling identified participants. Data collection involved scoping interviews, questionnaires, one-to-one interviews, and a focus group. A Stakeholder Matrix Table was developed in line with the guiding framework. Transcripts were thematically analyzed. PHNs are key stakeholders in Kidscope contributing to clinic development, delivery, and sustainability. Six themes were identified: lead referrers, in-clinic support, learning and education, child and family follow-up, specialist early years role, and partnership working. PHNs contribute to six SDGs through the Kidscope model. PHNs are fundamental partners in achieving SDGs in a disadvantaged Irish community through ameliorating childhood developmental delay by intercepting the gap within Ireland's early intervention system and disrupting the impact exclusion to healthcare has on vulnerable children and their families. Findings underscore a shift from the current "cradle to grave" model of working toward a specialist early years PHN role.

장애위험 영유아의 조기발견 및 조기개입에 대한 국공립 장애아통합어린이집 보육교사의 인식과 실태 및 지원 요구

In this study, a survey was conducted to find out the perception and support needs for early identification and early intervention of at-risk young children, targeting child care and education teachers of public inclusive child care and education centers for young children with disabilities. A total of 116 questionnaires were used as final analysis data. And using SPSS 29.0, frequency analysis, multiple response frequency analysis, and content analysis were performed according to the characteristics of the items. The research results are as follows. First, participants at public inclusive child care and education centers for young children with disabilities collected information on at-risk young children through regular observation and anecdotal records, and then diagnosed them using a screening tool. Second, participants mainly recognized the behavioral characteristics of young children with autism as well as developmental delays as behavioral characteristics of at-risk young children. Third, participants are aware of the needs for early identification and early intervention, but they are experiencing difficulties due to lack of related knowledge and differences in views between parents and public inclusive child care and education centers. Fourth, participants requested support from special education experts, training to strengthen child care and education teachers’ competency, reduced teacher-to-child ratio, and systematic and professional institutional support for early identification and early intervention of at-risk young children. This study is meaningful in that it provided basic data for the establishment of a support system for early identification and early intervention of at-risk young children.

Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems.

Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.

The KidScope Study: An Analysis of a Community Paediatric Clinic Set in a Disadvantaged Area of Ireland

The most critical period of human development is from conception to age six years when important brain structures develop. These structures influence child development, well-being, learning, and behaviours that follow. Research shows children from economically disadvantaged areas have poorer developmental, health, and lifelong outcomes. A considerable proportion of developmental delay is avoidable and early detection and intervention can improve child, family, and community outcomes. Ireland’s disjointed early intervention system sees children from more affluent communities access services faster through paid private assessment and intervention. KidScope is the only community paediatric clinic in Ireland to offer assessment and onward referral from birth to six years within a disadvantaged area. The clinic intercepts the gap within the early intervention system and breaks the cycle of intergenerational poverty by disrupting the impact exclusion to healthcare has on vulnerable children and families. We aim to evaluate KidScope in order to contribute to the evidence on addressing avoidable developmental delay in disadvantaged areas through early detection and timely referral to services. Findings to date highlight the challenges vulnerable families face when accessing paediatric healthcare, the healthcare needs of children experiencing adversity, and how community paediatric clinics identify and support developmental delay.

Early Intervention and Early Diagnosis of Specific Learning Disabilities: Response to Intervention

Özel öğrenme güçlüğü olan öğrencilerin okuma, yazma ve matematik alanlarında güçlükler yaşadığı bilinmektedir. Bu güçlükleri sergileme riski olan öğrencilere erken müdahalenin sağlanması ileri dönemdeki okul performansları açısından kritik rol oynamaktadır. Özel öğrenme güçlüğünün değerlendirilmesi ve tanılanmasının Türkiye’deki durumu incelendiğinde özel öğrenme güçlüğü olan öğrencilerin tanılanmasında zekâ testlerinin etkin olarak kullanıldığı bilinmektedir. Fakat özel öğrenme güçlüğü olan öğrencilerin tanılama öncesindeki eğitsel gereksinimlerine yönelik bilimsel dayanaklı ve sistematik uygulamaların yetersiz olduğu görülmektedir. Bu çalışmanın amacı bilimsel dayanaklı ve sistematik bir uygulama olan ve özel öğrenme güçlüğü riski olan öğrencilere yönelik erken müdahale ve erken tanı amaçlı kullanılan Müdahaleye Tepki Modeli (MTM)’nin açıklanarak ulusal alan yazına kazandırılmasıdır. MTM, öğrenme problemleri yaşayan öğrencileri belirleyen ve bu öğrenciler akranlarından geride kalmadan öğrencilere eğitsel destek sağlayan çok aşamalı bir erken tanı, müdahale ve destek sistemidir. MTM’nin amacı, yalnızca özel öğrenme güçlüğü olan öğrencilere değil tanılanmamış ve/veya özel öğrenme güçlüğü olma riski olan öğrencilere de erken müdahale sağlamaktır. MTM çok aşamalı bir model olsa da yaygın olarak üç aşamalı olarak uygulanan bir modeldir. Her bir aşamada müdahalenin niteliği değişmekte ve müdahale daha da yoğunlaşmaktadır. Bu çalışmada MTM’ye yönelik bilgiler sunularak geçmişten günümüze değin özel öğrenme güçlüğü olan bireylerin tanılanma ve erken müdahale süreçlerindeki değişim ele alınmaktadır. Ayrıca Türkiye’de MTM’ye ilişkin durum açıklanarak öneriler sunulmaktadır.

Latinx Families’ Experiences Navigating Early Intervention Services for Their Children with Developmental Delays

ABSTRACT The first three years of a child’s life are of critical importance to the development of the brain. Children identified as not developing at a pace that is age level appropriate may be referred to early intervention services. This study identifies the successes as well as the various challenges that Latinx families encounter as they navigate the early intervention system. Through one-on-one interviews, the researchers in the current study explore the attitudes, values, and concerns of nine Latina mothers who accessed and received early intervention services for their children with developmental delays. Results from this study provide direction for the development of strategies and guidance for practitioners in the application of recommended practices.

Overcoming tensions between family-centered care and fidelity within Early Intervention implementation research.

Early Intervention systems provide therapeutic services to families of young children birth to 3 years with developmental delays and are considered a natural access point to services for young children and their families. Research studies in the autism field have been interested in training providers to deliver evidence-based practices in Early Intervention systems to increase access to services for young children with an increased likelihood of being autistic. However, research has often overlooked that Early Intervention systems prioritize family-centered care, an approach to working with families that honors and respects their values and choices and that provides supports to strengthen family functioning. This commentary points out that family-centered care deserves greater attention in research being done in Early Intervention systems. We describe how family-centered care may shape how interventions are delivered, and discuss directions for future research to evaluate the impact of family-centered care alongside intervention delivery.

Timeliness of Early Identification and Referral of Infants with Social and Environmental Risks.

The Early Intervention Parenting Partnerships (EIPP) program is a home visiting program that provides home visits, group services, assessments and screenings, and referrals delivered by a multidisciplinary team to expectant parents and families with infants who experience socioeconomic barriers, emotional and behavioral health challenges, or other stressors. The present study examines whether EIPP successfully meets its aims of screening families for social and environmental factors that may increase the risk of children’s developmental delays and connect them to the larger statewide early intervention (EI) system relative to families with similar background characteristics who do not receive EIPP. Coarsened exact matching was used to match EIPP participants who enrolled between 2013 and 2017 to a comparison group of families identified from birth certificates. Primary study outcomes including EI referrals, evaluations, and service receipt for children from 3 months to 3 years were measured using EI program data. Secondary outcomes included EI referral source, EI eligibility criteria (e.g., presence of biological, social, or environmental factors that may increase later risk for developmental delay), and information on service use. Impacts were assessed by fitting weighted regression models adjusted for preterm birth and maternal depression and substance use. EIPP participants were more likely than the comparison group to be referred to, evaluated for, and receive EI services. EIPP facilitated the identification of EI-eligible children who are at risk for developmental delays due to social or environmental factors, such as violence and substance use in the home, child protective services involvement, high levels of parenting stress, and parent chronic illness or disability. EIPP serves as an entry point into the EI system, helping families attain the comprehensive supports they may need to optimize their well-being and enhance children’s development.

Addressing challenges at the intersection of early intervention and child welfare

BackgroundThe Keep Children and Families Safe Act amendment to the Child Abuse Prevention and Treatment Act (CAPTA) of 2003 mandated children under age three who are involved with Child Welfare (CW) to receive a referral to the system for early intervention (EI). While there is strong rationale for providing developmental services to young children and families impacted by maltreatment, the early implementation of this policy brought about many challenges related to interagency coordination and readiness of providers to provide cross-systems care. Currently, as the system and providers within the system recover from the effects of Covid-19, a predicted increase in need of services may exacerbate historical gaps in the provision of services to families involved with CW. Participants and settingThis policy-focused paper explores issues impacting CW and EI providers who coordinate care between CW and EI services. MethodsThis paper provides a historical examination of these challenges and proposes an approach for improving developmental services for families referred from CW, specifically through the lens of addressing resources and supports available to providers. ResultsThe proposed approach includes an increase and reprioritization of resources to support provider readiness and well-being. ConclusionsBy focusing on support for providers, the authors propose a reduction of stress and improvement of services at each level of the “well-being” system.

Finding Common Ground: Medical Professionals and Special Education Providers Supporting Young Children and Families

Several types of professionals support families of young children with disabilities as they navigate the early intervention and early childhood special education systems (EI/ECSE). Medical professionals are often the first to discuss service provision with families, while EI/ECSE providers are responsible for evaluating, determining eligibility, and providing services. The alignment between these two groups can directly influence child and family outcomes. We explored the experiences of medical professionals and EI/ECSE providers working in one large Northeastern U.S. city to understand how each group views their respective roles within the system and to gauge the degree to which they collaborate. Our findings revealed that both groups are committed to the families they serve but are often frustrated by conflicting recommendations for EI/ECSE service delivery. We provide suggestions to improve opportunities to communicate and collaborate to increase the effectiveness of support for children and their families.

Routine‐based interview in early intervention: professionals' perspectives

The Routine‐Based Interview is a promising method to collect information in Early Intervention, since it focuses on all members of the family and their routines, while seeking to highlight what parents consider a priority in the intervention. For that reason, in this paper, we aim to analyse the kind of benefits and difficulties that may be found in the Routine‐Based Interview's implementation process. The present research comprises the qualitative interview method, according to which semi‐structured interviews were carried out by eight Portuguese professionals enrolled in the Portuguese System for Early Intervention. The professionals highlight the benefits of the Routine‐Based Interview as a way to clearly and objectively evaluate and identify the concerns and priorities of the family, as well as the child's competencies and the functional goals that will be included in the intervention plan. All participants stress the need for more training in the Routine‐Based Interview process.

Parent Coaching in Early Intervention for Autism Spectrum Disorder: A Brief Report.

Coaching caregivers of young children on the autism spectrum is a critical component of parent-mediated interventions. Little information is available about how providers implement parent coaching for children on the autism spectrum in publicly funded early intervention systems. This study evaluated providers' use of parent coaching in an early intervention system. Twenty-five early intervention sessions were coded for fidelity to established caregiver coaching techniques. We found low use of coaching techniques overall, with significant variability in use of coaching across providers. When providers did coach caregivers, they used only a few coaching strategies (e.g., collaboration and in-vivo feedback). Results indicate that targeted training and implementation strategies focused on individual coaching components, instead of coaching more broadly, may be needed to improve the use of individual coaching strategies. A focus on strengthening the use of collaboration and in-vivo feedback may be key to improving coaching fidelity overall.

Transitions Out of Early Intervention

This study was designed to describe the experience of families exiting the early intervention (EI) system and transitioning into early childhood special education (ECSE) programs. Eight mothers of children preparing to exit EI services completed semistructured interviews, which were transcribed and analyzed using interpretative phenomenological analysis. Four mothers answered additional post-transition interview questions. Interview participants experienced anxiety about the transition process but reported that they found EI personnel to be knowledgeable and supportive allies. Participants also described favorable outcomes related to a structured transition class. These findings indicate that the transition out of EI is associated with parental anxiety and uncertainty, which can be allayed through strong relationships with EI service providers.

Views of Parents of Children With Down Syndrome on Early Intervention Services in Turkey

Perceptions of parents of young children receiving early intervention are important to understand. Parents have valuable opinions on the delivery of early interventions services and can provide critical feedback that can help professionals revise their existing early intervention delivery modalities. In the current study, we examined the perceptions of parents of young children with Down syndrome on early intervention services in Turkey. Specifically, we aimed to understand the parents' views on medical and educational evaluation and diagnosis processes. The study was conducted using a cross-sectional research design, which is one of the survey design methods. Data were collected from a total of 893 parents via an online survey. The results demonstrated that children with Down syndrome were diagnosed within an average of 2.3 months from birth, but the average age for starting education was 10.5 months. The majority of the parents evaluated the process until their children were diagnosed and accessed education services as a rather slow process that proceeded with their own means and efforts. Furthermore, the parents reported that during the diagnosis processes the type of materials, equipment, toys, and settings used were not relevant and time provided was insufficient. Moreover, the majority of the parents reported that the education services presented to them and their children were not sufficient and early intervention services were not provided within a system. As a result, although the legal regulations in Turkey are parallel to those in developed countries and studies in the field have been increasingly gaining momentum, issues such as the absence of an early intervention system model, insufficient cooperation between experts and institutions, and the shortage of expert staff in the field are still present and awaiting a solution.

Receipt of Early Intervention Services Before Age 3 Years and Performance on Third-Grade Standardized Tests Among Children Exposed to Lead

Research has shown that early intervention programs can improve academic outcomes of children with developmental delays. It has been suggested that similar programs may combat the deleterious effects of lead on children's neurodevelopment. However, to our knowledge, there are no published studies examining this possibility. The objective of this study was to estimate the association between receipt of early intervention services and third-grade standardized test scores among children exposed to lead before age 3 years. Cohort study including children born in New York City, New York, from 1994 to 1998 within an administrative data linkage of birth, lead monitoring, early intervention, and education data systems. Participants had a blood lead level of 4 μg/dL or greater at any point before age 3 years and later attended public school in New York City. Any use of early intervention services from birth through age 3 years. Children who did or did not receive early intervention services were matched using propensity scores. Linear and log-binomial regression were used to estimate the association between receipt of early intervention services before age 3 years and standardized test scores in math and English-language arts in third grade. There were 2986 children exposed to lead who received early intervention services before age 36 months. Of these children, 2757 were propensity score-matched to 8160 children who did not receive services. Children who received early intervention services did 7% (95% CI, 3%-12%) of an SD better on math and 10% (95% CI, 5%-14%) of an SD better on English-language arts tests than children who did not receive services. In addition, children who received services were 14% (95% CI, 9%-19%) and 16% (95% CI, 9%-23%) more likely to meet test-based standards in math and English-language arts, respectively, than children who did not receive services. These associations became larger in magnitude when analyses were restricted to children with higher blood lead levels. By leveraging existing public health data, this study found evidence that receipt of early intervention services may benefit the academic performance of children exposed to lead early in life.

Clinical decision support system for early diagnosis and intervention in multiple sclerosis

Clinical decision support system for early diagnosis and intervention in multiple sclerosis

Modelo RTI em escolas públicas e transtorno de aprendizagem: uma revisão sistemática da literatura

The Response to Intervention (RTI) model is an early detection and intervention system at three levels (classroom intervention by the teacher, by specialists in small groups and individual) to identify signs of Learning Disorder (LD). LD is a neurodevelopmental disorder that is characterized by persistent difficulties in reading, writing and/or math skills. In the United States the model is used and presents statistically significant results, but in Brazil there is little research and investment about it. It is common to use it to identify signs of LD, but there are no studies with consistent evidence on improvement results outside the United States. The objective is to systematically review the literature on the RTI model for the identification and intervention of signs and symptoms of LD; identify the study site, method used, assessment and intervention instruments, and results; identify methodological gaps and make suggestions for future studies; provide guidelines for possible applications in Brazil. Hypotheses: RTI indicates signs of disorders other than LD; there are variations in the assessment and intervention instruments; there is a shortage of Brazilian studies. For this, articles published in PubMed, Scielo and Google Scholar, from 2005 to 2022, will be selected, with the descriptors “RTI” or “Resposta à Intervenção", “E”, “Transtorno específico de Aprendizagem” and in English “Response to Intervention" and "AND", "Specific learning disorder". Duplicates will be removed. The review will be carried out by a Psychology evaluator and a Pedagogy evaluator. Screening will be carried out through the reading of abstracts, controlled clinical studies, randomized or not, with control groups; in Elementary Education of public schools; with N≥30. A new screening will be done based on compliance with ethical assumptions. There will be a critical analysis of the methods, results, suggestions for future studies and applications in Brazil.

Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation.

As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed.

Evaluation of the effectiveness of early intervention methods in newborns who have suffered hypoxic-ischemic CNS damage

Timely diagnosis of cerebral disorders both in the prenatal period and in the early neonatal period, as well as early rehabilitation treatment is the basis for the prevention of childhood disability. To this end, the so-called Early Intervention System is being introduced in Ukraine. The effectiveness of early intervention techniques directly depends on timely diagnosis and correctly chosen intervention tactics. Given the high neuroplasticity of the developing brain, it is advisable to start the elements of neurodevelopmental therapy from infancy. The aim of the work is to evaluate the effectiveness of methods of early intervention in children of the first 3 months of life who have suffered hypoxic-ischemic CNS damage in the neonatal period, by assessing the main indicators of psycho-motor development. 101 children who were treated in the neonatal pathology department due to hypoxic-ischemic CNS damage and did not have concomitant somatic pathology were examined. The children were in the ward for rehabilitation. To assess the effectiveness of comprehensive rehabilitation in young children, it is advisable to use adapted for Ukraine scale of Munich functional developmental diagnostics, which allows to assess the child's development in all major areas, its harmony and effectiveness of rehabilitation measures during the first 3 years of life. Statistical processing of the obtained results should be performed in the license package "Statistica 6.1 for Windows". Timely diagnosis of cerebral disorders both in the prenatal period and in the early neonatal period, as well as early rehabilitation treatment is the basis for the prevention of childhood disability. Given the high neuroplasticity of the developing brain, it is advisable to start the elements of neurodevelopmental therapy from infancy. The effectiveness of the methods recommended for use depends on timely diagnosis and correctly chosen intervention tactics. Assessment of the effectiveness of care for children at risk of deviant psychomotor development should be based on the application of the criteria and scales recommended by international expert groups, which are adapted in our country. Signs of full-fledged early intervention in the region are: perinatal diagnosis of congenital pathology, timely provision of medical and rehabilitation, social and special pedagogical services to children aged 0 to 3 years and their families. In order to achieve the set goals, in our opinion, the priority measures should be steps to implement the national protocol for care for children with perinatal CNS injuries, approval and implementation in Ukraine of the modern International Classification of Functioning, Life and Health Restrictions, providing medical care, rehabilitation and social services for young children.

Utilization of part C early intervention services for patients with cleft palate

ObjectivesTo investigate the utilization of early intervention services under Part C of the 2004 Individuals with Disabilities Educational Act for children with cleft palate and to better understand barriers these patients encounter when receiving services. MethodsA retrospective chart review was performed on children under the age of 18 who were treated for cleft palate at a single tertiary care center and referred to Tennessee's Early Intervention System (TEIS) between January 2007 and December 2018. ResultsFor the 61 patients included, developmental therapy was the most common TEIS referral made (n = 408, 28%), followed by speech therapy (n = 371, 26%). Most of these services were delivered as scheduled (n = 513, 80%); some families missed appointments without notifying the provider (i.e., family no-show)(n = 101, 2%). Children referred at a younger age were more likely to receive developmental therapy (p = 0.012) and to attend their services (p = 0.027). Patients with Medicaid were more likely to have absences with prior notification (p = 0.05) and without prior notification (i.e., family no-show)(p = 0.009) than patients with other types of health insurance. ConclusionsPatients with cleft palate often have complex needs; earlier referral to ancillary services may improve attendance at appointments and impact the services they receive. Socioeconomic factors may hinder patients from accessing these services even once they are referred.