Characteristics of High Quality Early Characteristics of High Quality Early Childhood ServicesChildhood Services

1. Comprehensive1. Comprehensive 11. 11. IndividualizedIndividualized2. Coordinated2. Coordinated 12. Team-based12. Team-based3. Interdisciplinary3. Interdisciplinary 13. Strength-based13. Strength-based4. Family-guided4. Family-guided 14. Seamless14. Seamless5. Culturally appropriate5. Culturally appropriate6. Ecological6. Ecological7. Based on research & recommended practices7. Based on research & recommended practices8. Community-based (natural environments)8. Community-based (natural environments)9. Developmentally-based (DAP)9. Developmentally-based (DAP)10. Evaluated/outcome-based10. Evaluated/outcome-based

Characteristics ActivityCharacteristics Activity

What did you learn from this activity?What did you learn from this activity?

What Is the Physical Rationale for What Is the Physical Rationale for Early Intervention?Early Intervention?

• Discussion of Working Discussion of Working Paper #5, Center on Paper #5, Center on the Developing Child, the Developing Child, Harvard UniversityHarvard University

Reflect & Write – 15 MinutesReflect & Write – 15 Minutes

•What are the main messages you will What are the main messages you will take home?take home?

•How you will use this information in How you will use this information in your work or family life?your work or family life?

Why Should We do This Why Should We do This Intervention? -- ResearchIntervention? -- Research

• Center on the Developing Child – Harvard Center on the Developing Child – Harvard UniversityUniversity

1.1. Child development is a foundation Child development is a foundation for for community development & community development & economic economic development development

2. Creating the right conditions for EC 2. Creating the right conditions for EC development is likely to be more development is likely to be more

effective and less costly than effective and less costly than addressing problems at a addressing problems at a

later agelater age

Why Should We do This Why Should We do This Intervention? -- ResearchIntervention? -- Research

• Jean Brooks Gunn (2004)Jean Brooks Gunn (2004)

1. Enhance school readiness1. Enhance school readiness

2. Benefits strongest for children in 2. Benefits strongest for children in poverty & with parents with little poverty & with parents with little education education

3. Positive benefits continue into the 3. Positive benefits continue into the high high school years & beyond school years & beyond

4. Programs with intensity & continuity 4. Programs with intensity & continuity have the most effect have the most effect

Convince Others about These 9 Convince Others about These 9 Reasons for Early Intervention – Reasons for Early Intervention –

Group PresentationsGroup Presentations1. A legislator who cares much about children1. A legislator who cares much about children

2. A legislator not known to favor spending for children2. A legislator not known to favor spending for children

3. A wealthy business person who might donate 3. A wealthy business person who might donate money for an Early Intervention Centermoney for an Early Intervention Center

4. Parents who are eager to get help for their child 4. Parents who are eager to get help for their child with a disabilitywith a disability

5. Parents who are ashamed or fearful about their 5. Parents who are ashamed or fearful about their child’s disability & do not seek Early Interventionchild’s disability & do not seek Early Intervention

Convince Others about These 9 Convince Others about These 9 Reasons for Early Intervention – Reasons for Early Intervention –

Group PresentationsGroup Presentations• Form into 5 groupsForm into 5 groups

• Work with your group to decide what key points from Work with your group to decide what key points from the lecture are most important for your assigned the lecture are most important for your assigned audience to hearaudience to hear

• How will you convince them to act?How will you convince them to act?

• Plan to demonstrate your argument to the class by Plan to demonstrate your argument to the class by convincing me (I’m the person!)convincing me (I’m the person!)

• You will have 3-5 minutes to be convincingYou will have 3-5 minutes to be convincing

Form 5 teamsForm 5 teams

Build your caseBuild your case

Show us how you will try to convince this Show us how you will try to convince this personperson

ACTIVITYACTIVITY

What do you observe about this activity?What do you observe about this activity?

Culturally Appropriate ServicesCulturally Appropriate Services

• Listen before speakingListen before speaking• When people honor their When people honor their

own culture, then they can own culture, then they can begin to honor others’begin to honor others’

• Respect crosses boundariesRespect crosses boundaries• Services can be bicultural – Services can be bicultural –

honoring science as well as honoring science as well as traditiontradition

What else would you add?What else would you add?

Video: Christopher’s Story

1. Self awareness2. Awareness of other culture3. Services in that culture

What observations do you have about What observations do you have about this?this?

Relationships Are the Keystone of Relationships Are the Keystone of Child Development – Child Development – Working Paper #1Working Paper #1

• Relationships are what makes learning happen Relationships are what makes learning happen and self concept flourishand self concept flourish

• Work with 1-3 classmates. Pull out the main ideas Work with 1-3 classmates. Pull out the main ideas from what the research says about Relationships from what the research says about Relationships and children’s development. Write them in bullet and children’s development. Write them in bullet formform

• Be sure to say what kinds of Be sure to say what kinds of

relationships help and which hurtrelationships help and which hurt• Turn in one paper with the names Turn in one paper with the names

of all the writersof all the writers

What is the most important idea in this What is the most important idea in this article?article?

Emotional Development Is Built into Emotional Development Is Built into the Architecture of the Brain– the Architecture of the Brain– Working Working

Paper #2Paper #2

• Emotional development begins early in lifeEmotional development begins early in life• It is critical to the development of overall brain It is critical to the development of overall brain

architecturearchitecture• Social competence is initiated during the first 5 Social competence is initiated during the first 5

yearsyears• Emotions are highly related to learning in school, Emotions are highly related to learning in school,

to forming friendships, and to success in lifeto forming friendships, and to success in life• Emotional development is as importantEmotional development is as important

as cognitive developmentas cognitive development• Ignoring emotional development Ignoring emotional development

hurts the societyhurts the society

Next Time: Supporting Children’s Next Time: Supporting Children’s Social-Emotional DevelopmentSocial-Emotional Development

• Shauna Tominey will share social Shauna Tominey will share social

learning gameslearning games• Meanwhile check outMeanwhile check out

CSFELCSFEL

http://www.vanderbilt.edu/csefel/http://www.vanderbilt.edu/csefel/

CEBP http://challengingbehavior.fmhi.usf.edu/CEBP http://challengingbehavior.fmhi.usf.edu/

Three Cases for Early InterventionThree Cases for Early Intervention

Substance Affected Children --Substance Affected Children --

a special case of toxica special case of toxic

impacts on the brain impacts on the brain

Motor ImpairmentsMotor Impairments

Autism Spectrum DisordersAutism Spectrum Disorders

Video: Fetal Abuse

The Drug Affected InfantThe Drug Affected Infant(Drugs Here Includes Alcohol & Tobacco)(Drugs Here Includes Alcohol & Tobacco)

• FactsFacts– Up to 221,000 babies (5.2%) born each year in the Up to 221,000 babies (5.2%) born each year in the

U.S. to mothers (5-11%) using illegal drugs. 48,000 U.S. to mothers (5-11%) using illegal drugs. 48,000 newborns are affected by these drugs. The increase newborns are affected by these drugs. The increase rate exceeds 400% per decade.rate exceeds 400% per decade.

– Up to 75% of babies placed in foster care have been Up to 75% of babies placed in foster care have been affected by drugs.affected by drugs.

– Exposure impacts neurological & milestones Exposure impacts neurological & milestones developmentdevelopment

– Risk for premature birth increases, with associated Risk for premature birth increases, with associated problemsproblems

– Care is complicated by withdrawal symptomsCare is complicated by withdrawal symptoms– 1:10 drug addicted pregnant women receive drug 1:10 drug addicted pregnant women receive drug

treatment.treatment.

Source: Dicker & Leighton, Trends in the US prevalence of drug-using parturient women and Source: Dicker & Leighton, Trends in the US prevalence of drug-using parturient women and drug-affected newborns, 1979 through 1990 drug-affected newborns, 1979 through 1990 Am J Public HealthAm J Public Health. 1994 Sep;84(9):1433-8. . 1994 Sep;84(9):1433-8.

In Focus: Acts of Omission: An Overview of Child NeglectIn Focus: Acts of Omission: An Overview of Child NeglectAuthor(s):  National Clearinghouse on Child Abuse and Neglect Information (HHS) (2001)Author(s):  National Clearinghouse on Child Abuse and Neglect Information (HHS) (2001)

http://www.nida.nih.gov/EconomicCosts/Chapter4b.htmlhttp://www.nida.nih.gov/EconomicCosts/Chapter4b.html

How Many Mothers in Oregon are How Many Mothers in Oregon are Using Illegal DrugsUsing Illegal Drugs

• 2,140+ women a year are using 2,140+ women a year are using illegal drugs during their pregnancy in illegal drugs during their pregnancy in OregonOregon

• 50% are using amphetamines and 50% are using amphetamines and heroinheroin

• Only 18% of treatment slots are Only 18% of treatment slots are designed for mothers. This is designed for mothers. This is sufficient for 13% of current userssufficient for 13% of current users

• 78% of mothers using illegal drugs 78% of mothers using illegal drugs received prenatal care.received prenatal care.

Source: Shaster, Smith, Higginson & Fleming. (1993). Recognizing illicit drug use by pregnant Source: Shaster, Smith, Higginson & Fleming. (1993). Recognizing illicit drug use by pregnant women: Reports from Oregon birth attendents. American Journal of Public Health, 83(1), 61-women: Reports from Oregon birth attendents. American Journal of Public Health, 83(1), 61-64.64.

And the Problem Is Growing…And the Problem Is Growing…

• Methamphetamine use by parents has Methamphetamine use by parents has grown from 10% of referrals to child grown from 10% of referrals to child welfare services in 2001 to 59% of referrals welfare services in 2001 to 59% of referrals in 2003in 2003

Of Mothers Using Drugs During Of Mothers Using Drugs During Pregnancy…Pregnancy…

• Tobacco: 74%Tobacco: 74%• Alcohol: 22%Alcohol: 22%• Amphetamines and opiates together Amphetamines and opiates together

(heroin, meth, crack, crank & cocaine): (heroin, meth, crack, crank & cocaine): 59%59%

• Meth alone: 23%Meth alone: 23%• Cocaine alone: 23%Cocaine alone: 23%• Poly use: 23%Poly use: 23%

Maternal Risk for Fetal Alcohol Maternal Risk for Fetal Alcohol SyndromeSyndrome

Typical userTypical user• Age of mother: >25Age of mother: >25• Number of children: >3Number of children: >3• Pattern of drinking: Binging & regular Pattern of drinking: Binging & regular

useuse• Family useFamily use• Unstable marriageUnstable marriage• Accepts culture of over drinkingAccepts culture of over drinking• Other children in foster careOther children in foster care

Maternal Risk Factors for Maternal Risk Factors for Methamphetamine -- MethMethamphetamine -- Meth

Typical userTypical user• SmokerSmoker• Uses alcoholUses alcohol• UnmarriedUnmarried• No or limited prenatal careNo or limited prenatal care• Uses public assistanceUses public assistance• Less than a high school educationLess than a high school education• Less than 25 years oldLess than 25 years old• Minority ethnic groupMinority ethnic group• Lives in a city, BUT rural usersLives in a city, BUT rural users increasing fasterincreasing faster

The BabiesThe Babies

• 1 to 2: 1000 will have Fetal Alcohol 1 to 2: 1000 will have Fetal Alcohol Syndrome (FAS)Syndrome (FAS)

• 5:1000 will have Fetal Alcohol Effects (FAE)5:1000 will have Fetal Alcohol Effects (FAE)• 4% of those exposed to amphetamines will 4% of those exposed to amphetamines will

need to be medically treated for need to be medically treated for withdrawalwithdrawalhttp://www.nida.nih.gov/EconomicCosts/Chapter4b.htmlhttp://www.nida.nih.gov/EconomicCosts/Chapter4b.html

Studies on Outcomes of Drug Studies on Outcomes of Drug (Including Alcohol) Abuse(Including Alcohol) Abuse

• Outcomes derived from three areasOutcomes derived from three areas– Animal studiesAnimal studies– Human studiesHuman studies– Comparison to studies from similar Comparison to studies from similar

drugs (i.e., cocaine and crack)drugs (i.e., cocaine and crack)

Results…Results…

• Animal StudiesAnimal Studies– Increased fetal deathsIncreased fetal deaths– Visual defectsVisual defects– Cleft palateCleft palate– Bone abnormalitiesBone abnormalities– Delayed development.Delayed development.

• Human studiesHuman studies– Delayed or altered Delayed or altered

developmentdevelopment– Poor intrauterine Poor intrauterine

growthgrowth

• Comparison studiesComparison studies– Increased irritabilityIncreased irritability– Decreased attentionDecreased attention– Abnormal motor Abnormal motor

developmentdevelopment– Increased incidence of:Increased incidence of:

• Co-occurring medical Co-occurring medical conditionsconditions

• HIVHIV• HepatitisHepatitis• SIDSSIDS

The Biggest Risk of Abuse….The Biggest Risk of Abuse….

• The environment the abuser entersThe environment the abuser enters– Poverty, chaos, mental health disorders, Poverty, chaos, mental health disorders,

domestic violence, & sexual assaultdomestic violence, & sexual assault– Drug addicted parents struggle to choose Drug addicted parents struggle to choose

parenting over addictionparenting over addiction

Source: Wouldes, T. (2004). Exposure to methamphetamine in the womb causes Source: Wouldes, T. (2004). Exposure to methamphetamine in the womb causes adverse developmental effects. Medical Study News, 2004.adverse developmental effects. Medical Study News, 2004.

Exposure to Drug LabsExposure to Drug Labs

• HighHigh exposure toexposure to– Hydrochloric acidHydrochloric acid– IodineIodine– Volatile compoundsVolatile compounds– Methamphetamine powder even days after Methamphetamine powder even days after

“cooking”“cooking”• The biggest risk is for the crawling childThe biggest risk is for the crawling child• Result: respiratory problems, irritation, Result: respiratory problems, irritation,

& neurological toxicity& neurological toxicity

Facial Features May Be Present with Fetal Facial Features May Be Present with Fetal Alcohol SyndromeAlcohol Syndrome

• Epicanthal Epicanthal foldsfolds

• Low nasal Low nasal bridgebridge

• Small head Small head sizesize

• Flat midfaceFlat midface• Short noseShort nose• Flat philtrumFlat philtrum• Thin upper lipThin upper lip

Why Do Drug Affected Babies Have Why Do Drug Affected Babies Have Problems?Problems?

• Neurological development affected from Neurological development affected from first month of gestationfirst month of gestation

• Cardiac development starts at week 4 of Cardiac development starts at week 4 of pregnancy. Premature birth impacts pregnancy. Premature birth impacts cardiac transitioncardiac transition

• Prematurity impacts lung development Prematurity impacts lung development and functionand function

• Drugs can decrease oxygen to baby at Drugs can decrease oxygen to baby at any time from pregnancy to birth to early any time from pregnancy to birth to early infancyinfancy

• Drug use can increase mother’s risk for Drug use can increase mother’s risk for poor nutrition, pregnancy complications poor nutrition, pregnancy complications (i.e., toxemia) and infections(i.e., toxemia) and infections

Common Outcomes for InfantsCommon Outcomes for Infants

• Infant characteristicsInfant characteristics– Congenital defectsCongenital defects– Drug withdrawalDrug withdrawal– PrematurityPrematurity– Difficult deliveryDifficult delivery

• HypoxiaHypoxia• InjuryInjury

– Infection: HIV and Infection: HIV and HepatitisHepatitis

– Poor feedingPoor feeding– Neurological irritabilityNeurological irritability– Neurological damageNeurological damage– SIDSSIDS

Symptoms that Affect ParentingSymptoms that Affect Parenting

• Neurological irritabilityNeurological irritability– Increased crying or lack of crying and Increased crying or lack of crying and

excessive fatigueexcessive fatigue– Difficulty organizing statesDifficulty organizing states

• Sleep- wake statesSleep- wake states• Eating patternsEating patterns

– High sensitivity to stimulationHigh sensitivity to stimulation• TouchTouch• NoiseNoise• MovementMovement

– Prolonged or abnormal newborn reflexesProlonged or abnormal newborn reflexes– Difficulty establishing midlineDifficulty establishing midline

Other Common EffectsOther Common Effects

•Digestive immaturity or Digestive immaturity or hypersensitivityhypersensitivity

– GasGas– DiarrheaDiarrhea– Reflex or “spitting”Reflex or “spitting”– Poor growthPoor growth

InfectionsInfections

• Immature immune Immature immune systemsystem

• HIVHIV• HepatitisHepatitis

Drug WithdrawalDrug Withdrawal

• TremorsTremors• Neurological irritabilityNeurological irritability• SeizuresSeizures• Excessive sleeping or Excessive sleeping or

inability to sleepinability to sleep• High pitched cryHigh pitched cry

Child Abuse & NeglectChild Abuse & Neglect

• Most at riskMost at risk– Premature infantsPremature infants– Disabled infantsDisabled infants– Difficult temperament of infant Difficult temperament of infant

and/or parentand/or parent– Stress in the homeStress in the home– Violence in the homeViolence in the home– Unplanned & unwanted pregnancyUnplanned & unwanted pregnancy– Immature personality of parentImmature personality of parent

Shaken Baby SyndromeShaken Baby Syndrome

• Cranial bleedingCranial bleeding• Visual damage: Visual damage:

Vision center of the Vision center of the brain & retinal brain & retinal damagedamage

• SeizuresSeizures• Long term: learning Long term: learning

disabilities, even disabilities, even deathdeath

Common Long-Term OutcomesCommon Long-Term Outcomes

• Attachment disordersAttachment disorders• Learning disabilitiesLearning disabilities• Communication difficultiesCommunication difficulties• Behavioral disordersBehavioral disorders• Attention and impulsivity disordersAttention and impulsivity disorders• Difficulty developing social skills (i.e., play, Difficulty developing social skills (i.e., play,

interaction, affection)interaction, affection)• Poor growthPoor growth

Outcomes of Early Intervention?Outcomes of Early Intervention?

• Parents become more knowledgeable about Parents become more knowledgeable about developmentdevelopment

• Getting help earlyGetting help early– Decreased excessive cryingDecreased excessive crying– Improved feeding and/or growthImproved feeding and/or growth– Decreased health problems (rashes, Decreased health problems (rashes,

respiratory infections, etc.)respiratory infections, etc.)– Decreased parental excessive fatigueDecreased parental excessive fatigue– Identification of tremors-Identification of tremors- seizures seizures– Developmental interventionDevelopmental intervention

• Language and communicationLanguage and communication• MotorMotor• SocialSocial• CognitiveCognitive

– Social supportSocial support

Summary of Common ChallengesSummary of Common Challenges

• Feeding problemsFeeding problems• Neurological irritabilityNeurological irritability• Abnormal growthAbnormal growth• Respiratory: asthmaRespiratory: asthma• Cardiac/respiratory: Cardiac/respiratory:

apnea and cardiac defectsapnea and cardiac defects• Attachment disordersAttachment disorders• Neurological disordersNeurological disorders• Developmental delayDevelopmental delay• SIDSSIDS

Remember…Remember…

• Drug & alcohol related disabilities are Drug & alcohol related disabilities are 100% preventable!100% preventable!

• We don’t always know We don’t always know when a child is drug when a child is drug exposedexposed

• Knowing common risk Knowing common risk factors and symptoms factors and symptoms can assist in providing can assist in providing help earlyhelp early

• Knowing how to Knowing how to support parents support parents supports their childrensupports their children

• Children can’t wait!Children can’t wait!

Summary of Common InterventionsSummary of Common Interventions

• Feeding techniquesFeeding techniques• Sensory & Sensory &

developmental developmental stimulation & stimulation & modulationmodulation

• Infant massageInfant massage• MedicationsMedications• Monitors & record Monitors & record

keepingkeeping• KnowledgeKnowledge• SupportSupport

Where To Get HelpWhere To Get Help

• Case workerCase worker• Pediatrician/ pediatric Pediatrician/ pediatric

nursenurse• ColleaguesColleagues• Support groupsSupport groups• Parenting educationParenting education• Relief nurseriesRelief nurseries• Child development centersChild development centers• Diagnostic teamsDiagnostic teams• Disability servicesDisability services

Take Time Now…Take Time Now…

Reflect on what you knew when you Reflect on what you knew when you came todaycame today

Reflect on what you learned and will Reflect on what you learned and will take with you todaytake with you today

Reflect on what you still want to Reflect on what you still want to knowknow

Because I Want To Send Because I Want To Send Us Off Hopeful…Us Off Hopeful…

Let’s SOAR with some very special Let’s SOAR with some very special children!children!

Video: The Sky’s the LimitVideo: The Sky’s the Limit

See you next weekSee you next week