a user’s guide to early intervention services seminar i realistic strategies to identify children...
TRANSCRIPT
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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
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PRESENTED BY
• Early Intervention Section, DOH
• Center for Disabilities Studies, UH
• Support provided by
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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
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ELIGIBILITY FOR EARLY INTERVENTION SERVICES
•Developmental Delay
•Biological Risk
•Environmental Risk
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DEVELOPMENTAL DELAY
• Cognitive
• Physical, including vision and hearing
• Speech/language
• Social/emotional/behavioral
• Adaptive
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BIOLOGICAL RISK
• WHEN: Prenatal, perinatal, neonatal, early development
• HOW: Biological insults to central nervous system
• RESULT: Probability of delayed development
• Diagnosed physical/mental condition
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Examples of biological risk
• 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
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ENVIRONMENTAL RISK
• Child abuse/neglect…. Healthy Start, PHN
• Teenage mom with low support……..PHN
• Substance abusing mom……………..PHN
• Cognitively impaired parent ………...PHN
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EARLIER IS BETTER
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Do early delays predict later status?
• Expressive language delay
•Motor, psycho-social and cognitive delay
• Risk factors
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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
% of children with delays at age 3-5
0 20 40 60
Language5 yrs
Social 3yrs
Readiness5 yrs
No delays
SELD
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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) - ToddlerLanguage - auditory cortex by 1 yearCapacity for logic & complex reasoning by age 4 years
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EARLY BRAIN DEVELOPMENT
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Synapse pruning: the child with developmental challenges
• 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
Causes Secondary Conditions
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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)
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Attachment Problems Influence Brain Development:
Babies with special needs
• 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
Causes Consequences
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The brain develops from lower to higher levels therefore
Early experience has more pervasive impact
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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
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• 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
Adapt child’s environment
Parent education and support
How early intervention can help
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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
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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
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Taking parent concerns seriously
• Improves rate of identification
• Builds stronger relationships with parents
• Adds data you don’t have a chance to observe
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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