early childhood intervention - ecpcta.org itard ... materials to match sensitive periods . mid 1900s...
TRANSCRIPT
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Early Childhood Intervention
Mary Beth Bruder, PhD
University of Connecticut A.J. PappanikouCenter for Excellence in Developmental Disabilities
Education, Research, and Service
263 Farmington Avenue, MC6222
Farmington, CT 06030
Phone: (860) 679-1500
Fax: (860) 679-1571
E-mail: [email protected]
Maureen Greer
Emerald Consulting
6545 North Olney
Indianapolis, IN 46220
Phone: 317/251-0125
Fax: 317/251-1510
Cell: 317/281-9834
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Definition of Expert
One who knows a lot about a subject
OR
One who has a powerpoint
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If you treat an individual as he is he will stay as he is, but if you treat him as he ought to
be, and could be, he will become what he ought to be
and could be.
~ Goethe
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Early Childhood Intervention: Defined
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Early childhood intervention refers to
therapeutic (excluding drug or surgical
manipulation) or educational
intervention... of a planned nature aimed
at eliminating a current or anticipated
deficiency in a target population.
(Bricker, Bailey, & Bruder, 1984, p. 374).
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About one in six children
in the U.S. have one or
more developmental
disabilities or other
developmental delays.
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Attention-Deficit/
Hyperactivity Disorder
Autism Spectrum Disorders
Cerebral Palsy
Fetal Alcohol Spectrum
Disorders
Fragile X Syndrome
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Hearing Loss
Intellectual Disability
Kernicterus
Muscular Dystrophy
Tourette Syndrome
Vision Impairment
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Historical Roots
Special Education
And
Early Childhood
And
Maternal and Child Health
And.......
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1800s
Jean-Marc Itard
Intervention with Victor through systematic instruction
Edouard Sequin
Extension of Itards’s work focusing on motor
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1900s
Maria Montessori
Prepared environment, and using stimulating/meaningful learning activities and materials to match sensitive periods
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Mid 1900s
Jean PiagetCognitive theory and genetic epistemologyInsights regarding children’s learningprocesses/products
Harold SkeelsIQ gains resulting from early stimulationAttention to the importance of nurture in thenature-nurture debate
Rene SpitzIQ and other benefits of early stimulationEffects of lack of stimulation on physical and mentaldevelopment
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Mid 1900s Continued
William GoldfarbIQ and other developmental benefits ofearly stimulationEffects of lack of stimulation on social and adaptivedevelopment
Samuel Kirk Preschool versus no early intervention Effects of preschool experience on IQ
J. McVicker HuntBook: Intelligence and ExperienceImportance of early years and optimizing earlyinteractions as critical
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Later 1900s
Benjamin Bloom
Stability and Change in Human Characteristics
Initial learning easier than trying to replace
inappropriate behaviors
Arnold Sameroff
Transactional Model of Development
Bidirectional influences of biological makeup and
environmental experiences
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1990-now
Urie Bronfenbrenner
Ecological model: focus intervention on the
interaction of the environment ( including
caregivers) as well as the child
Arnold Sameroff
Complex lifespan interaction of biology and the
environment
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Historical Roots:
Legislation for Those with Disabilities
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MR and Developmental Disabilities
Mental Retardation Facilities and Construction Act of 1963 (P.L. 88-164):
to plan activities and construct facilities to provide
services to persons with ‘mental retardation’
Disabilities Services and Facilities Construction Amendments of 1970 (P.L. 91-517):
First Congressional effort to help people with
developmental disabilities
Definition of developmental disabilities included
individuals with ‘mental retardation’, cerebral palsy,
epilepsy and other conditions related to ‘mental
retardation’, prior to age 18, and a severe disability
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Amendments and Expansions
1975 Amendments (P.L. 94-103):
“Rights of the Developmentally Disabled” in law
1978 Amendments (P.L. 95-602):
Functional definition of developmentaldisabilities as having a life-long impact in 3 ormore major areas
Self-care
Communication
Learning
Mobility
Self-choice
Independent living
Economic self-sufficiency
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DD Act
Developmental Disabilities Act of 1984 (P.L. 98-527):
Added new emphasis – persons with developmental
disabilities receive services to achieve their best
through living and working in the community
1987 Amendments (P.L. 100-146):
Yearly Report to Congress on the Developmental
Disabilities program - amount and quality of services
being provided and whether consumer is satisfied
UAFs became University Affiliated Programs (UAPs)
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Amendments and Expansions
1990 Amendments (P.L. 101-496):Added purpose to say that persons with severedisabilities can live and work and contribute to society
Amended functional definition to include infants andyoung children
1994 Developmental Disabilities Act (P.L. 103-230)
Respect for the individual, services should be what
the individual wants and consider a person’s culture
when planning and providing services (unserved and
underserved)
Persons with developmental disabilities and their families should make the decisions for that person
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Developmental Disabilities Assistance and Bill of
Rights Act of 2000 ( P.L. 106-402)
to assure that individuals with developmental disabilitiesand their families participate in the design of and have
access to needed community services, individualized
supports, and other forms of assistance that promote
self-determination, independence, productivity,
integration and inclusion in all facets of community life,
through culturally competent programs [Section 101(b);
quality assurance, education and early intervention,child care, health, employment, housing, transportation,
recreation and other services available or offered to
individuals in a community, including formal and informal
community supports, that affect their quality of life)
[Section 153(a)(1)].
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Education Legislation for Those with
Disabilities
1966-Elementary and Secondary Education Act (P.L. 89-
750):
Amendments to ESEA created the Bureau of Education
for the Handicapped and consolidated all education
programs in disability
1968- Handicapped Children’s Early Education Assistance Act
( P.L. 90-538):
Created Model Demonstration Programs for children b-
8 and a TA Network
1972-Amendments to the Economic Opportunity Act to
extend Head Start services to children with disabilities
(P.L. 92-424)
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EHA
1975- The Education for All Handicapped Children Act
(P.L. 94-142):
Established special education and related services
for eligible children ages 6-18 with guarantees of
rights including Zero Reject; LRE; Nondiscriminatory
Testing; IEPs; Due Process for Families.
Preschool Incentive State Grants that could include
3- through 5-year-olds
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EHA AMENDMENTS
1986-amendments (P.L. 99-457):
required states to provide a free and appropriate
public education to preschoolers (Section 619) and
providing incentives for serving infants and toddlers
and their families (Part H).
1990- amendments (P.L. 101-476)
renamed the Education for all Handicapped Children
Act as the individuals with Disabilities Education Act
(IDEA).
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EHA AMENDMENTS
1997- reauthorized IDEA ( P.L. 105-17):
restructured it into four parts: Part H was
redesignated to Part C and all services for
preschooler were included in Part B.
2004- reauthorized IDEA ( P.L. 108-446):
authorized Local Education Agencies to use up to 15
percent of IDEA funds for supportive services to help
students who have not yet been identified with
disabilities but who require additional academic and
behavioral supports to succeed in general education
settings.
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ADA
1990- The Americans with Disabilities
Act (P.L.101-336):
Gave all individuals with disabilities (including
infants and preschoolers) the right to equal access
and reasonable accommodations in public and
private services ( E.G. child care).
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Current Thinking:
Theoretical Framework
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Understanding Risk and Influence on Developmental Outcomes
Established Risk
Biological Risk
Environmental Risk
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Ecological Model for Viewing Sources of Learning
Experiences and Opportunities
Larger Society
Early Childhood Programs
Community
Family
Child
Home Routines
Community Activities
Program Practices
Cultural Beliefs/Values
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Neurons to Neighborhoods
Influence of brain research on understanding
resilience and recovery in the context of
environmental influences.
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Science of Learning
The brain is adaptable and can be
influenced by positive experiences;
The brain is vulnerable and can be
harmed by negative experiences
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Needs of At Risk
Infants and Young Children
Enough to Eat
Consistent Family/Caregivers
A Safe and Consistent Place to Live
Medical Home
Mental Health/Behavioral Strategies for Self
Regulation
Learning Opportunities
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Current Thinking:
Practice
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ECI Practices
Family Centered Philosophy
Collaborating and Teaming Multiple
Disciplines
Family/ Community
Activity Settings
Learning and Development
Outcomes Learning
Opportunities And Instruction
Early Childhood Environments
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Family-Centered Philosophy
Care that recognizes and respects the pivotal role of the
family in the lives of children. It supports families in
their natural caregiving roles, promotes normal
patterns of living, and ensures family collaboration and
choice in the provision of services to the child.
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What the best and wisest parent wants for his own child, that must be what the community wants for
all its children John Dewey
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Social Support
Well-Being
Parenting Styles
Intrafamily Factors
Child Behavior and
Development
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Family Characteristics
Personal characteristics of parents. Characteristics not related to child’s disability or biological risk status (e.g., social support,
marital relationship, financial resources).
Family Patterns
Quality of parent-child transactions. Family orchestrated child experiences. Health and safety provided by family.
Attitudes and beliefs of families.
Child Development Outcomes
(Guralnick, 1998)
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Family Centered Helpgiving
Provide families with choices, and opportunities
to act on their choices, to increase the self-
efficacy benefits of practitioner helpgiving
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Family We all come from families. Families are big, small, extended,
nuclear, multi-generational, with one parent, two parents, and
grandparents. We live under one roof or many. A family can be as
temporary as a few weeks, as permanent as forever. We become
part of a family by birth, adoption, marriage, or from a desire for
mutual support. As family members, we nurture, protect, and
influence one another. Families are dynamic and are cultures unto
themselves, with different values and unique ways of realizing
dreams. Together, our families become the source of our rich
cultural heritage and spiritual diversity. Each family has strengths
and qualities that flow from individual members and from the family
as a unit. Our families create neighborhoods, communities, states,
and nations.
Developed and adopted by New Mexico’s House Memorial 5 Task Force on Children and Families and the Coalition for Children. 1990.
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Collaboration
1. to work together, especially in some
literary, artistic, or scientific
understanding;
2. to cooperate with an enemy invader.
WEBSTER’S NEW WORLD DICTIONARY
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Collaboration Between People:
The process whereby two people
create something each thinks is his
own.
Frank A. Clark
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Personnel Disciplines who provide early intervention services include ...
Special educators
Speech-language pathologists and audiologists
Occupational therapists
Physical therapists
Psychologists
Social workers
Nurses
Registered dietitians
Family therapists
Vision specialists, including ophthalmologists and optometrists
Orientation and mobility specialists
Pediatricians and other physicians
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General Role of Service Providers
( Part C)
To the extent appropriate, service providers in each area of early intervention services included in paragraph (d) of this section are responsible for:
Consulting with parents, other service providers, and
representatives of appropriate community agencies to ensure
the effective provision of services in that area;
Training parents and others regarding the provision of those
services; and
Participating in the multidisciplinary team’s assessment of a
child and the child’s family, and in the development of
integrated goals and outcomes for the individualized family
service plan.
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DEC Recommended Practices:
Interdisciplinary Models
Teams including family members make decisions
and work together.
Professionals cross disciplinary boundaries.
Intervention is focused on function, not services.
Regular caregivers and regular routines provide the
most appropriate opportunities for children’s
learning and receiving most other interventions.
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Natural Environments
To the maximum extent appropriate to the needs ofthe child, early intervention services must be
provided in natural environments, including the
home and community settings in which children
without disabilities participate
Natural environments are settings that are natural or normal for the child’s age peers who have no
disability
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"So, how come I get "adapted leisure skill /gross and fine motor skill therapy"
and you get to just "play"?
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Activity Setting
Everyday family and community experiences, events, and
situations providing children learning opportunities that have
development-enhancing (or development-impeding) qualities
and consequences.
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Family (Home) and Community Natural Learning Environments and children’s Learning Opportunities
Family Settings (Examples) community Settings (Examples)
• Family Routines (Cooking, food, running errands, shopping, animal care, car or bus rides, weekend chores)
• Parenting Routines (Child’s bedtime, family outings, shopping, eating out and bath time, visiting friends)
• Child Routines (brushing teeth, dressing, play activities, outdoor playgrounds, eating, indoor playlands)
• Literacy Activities (Looking at books, community activities, libraries, fairs, listening to stories, reading, festivals)
• Play Activities (Drawing, lap games, physical activities, horseback riding, playing with toys, swimming, sledding)
• Physical Play (Roughhousing, ball games, children’s attractions, petting zoos, nature swimming, centers, pet stores)
• Entertainment activities (Dancing, singing, art/entertainment activities, watching tv, theatre, storytellers, music activities)
• Family Rituals (Family talks, spiritual church/religious activities, Sunday readings, saying grace at meals, school, church services)
• Family Celebrations (Holiday dinners, organizations and groups, karate, birthdays, decorating the house, movement classes, parent/child groups)
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Natural Learning Environments Are:
The places where children experience everyday, typically
occurring learning opportunities that promote and enhance
behavioral and developmental competencies.
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Activity Setting Recording Form
Interventionist: Date:
Parent’s Name: Child’s Name:
EXISTING ACTIVITY NEW ACTIVITY SETTINGS SETTINGS
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Learning Paradigm
Interests
Mastery Engagement Learning
Opportunities
Competence
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Learning Opportunities Recording Form
Parent’s Name: Child’s Name:
Interventionist: Date:
Location Why is it Important? Learning Opportunity Activity Setting
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Current Systems Thinking:
Child and Family
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Figure 1. The Developmental Systems Approach for early intervention. Modified from “A Developmental Systems Model for Early
Intervention,” by M. J. Guralnick, 2001, Infants & Young Children, 14(2), pp. 1–18. Copyright 2001 by Lippincott Williams & Wilkins.
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Screening Program or Referral
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Developmental Screening
Since September 2010, ACA requires insurance plans to cover 26 preventive and primary care
services to children at no cost to the family.
Must follow periodicity schedule of the AAP
Bright Futures recommendations for pediatric
preventive health care
Developmental Screenings at 9, 18 and 30 months
Autism Screening at 18 and 24 months
Screenings are covered in Medicaid under EPSDT
benefit
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Birth Cohort: Percentage of
Children Referred
2009* 15.68
14.86
2008 15.65
15.37
2007 15.26
Average
Median 14.98
2006 15.52
14.52
13.5 14 14.5 15 15.5 16
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Birth Cohort: Percentage of
Children Evaluated
2009* 12.25
9.82
2008 12.92
12.47
2007 12.36
Average
Median 12.18
2006 11.85
10.99
0 2 4 6 8 10 12 14
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Birth Cohort: Percentage of
Children Eligible
2009* 9.21
7.83
2008 9.6
8.6
2007 9.23
Average
Median 8.8
2006 9.75
9
0 2 4 6 8 10 12
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Child Count: Median Percentage
Served
Birth Cohort
Cumulative 9.75% 9% 9%
Point in Time
5% 5% 5%
2.48% 2.68% 2.77%
2009 2010 2011 2009 2010 2011 2 0 0 6 2 0 0 7 2 0 0 8
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Count Comparison
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Point of Access
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Lead Agency
619- Department of Education
Part C
Department of Education=11
Department of Health=28
Other Departments (DD; Offices of EC)=17
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Comprehensive Interdisciplinary
Assessment
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Assessment of Risk and
Protective Factors
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Develop and Implement
Comprehensive Program
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Intervention Planning Model
• Family centered practices of listening and being responsive
• Team collaboration supporting a primary provider
• Plan derived from child participation in family identified activity settings as the context for learning
• Evaluation of outcomes
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Monitoring and Outcome
Evaluations
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S
"My question is: Are we making an impact?"
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We can collect data on the effectiveness
of different interventions with different
children and then use these data as the
basis of future interventions.
Ysseldyke & Algozzine, 1982, p 258
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The Three Functional Child Outcomes
Children have positive social-emotional skills (including social
relationships).
Children acquire and use knowledge and skills (including early
language/communication and early literacy).
Children use appropriate behaviors to meet their needs.
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Transition Planning
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Current Systems Thinking:
State Components
Hebbeler, Spiker, & Kahn, 2012
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Key Elements that Need to be Addressed in Comprehensive System Building
Adapted from Early Childhood Systems Working Group Graphic
Financing
to assure
comprehensive quality
services based on
standards
Monitoring/
accountability
to track performance
and results based on
outcomes and
standards
Governance
to set policy
direction for the
comprehensive
system
Standards
reflect effective
practices, programs,
and practitioners and
are aligned across
the system
Families
Strengthened and Children
Thriving
Communications
to inform families,
providers, and the
public
Provider/
practitioner support
to offer technical
assistance and
promote professional
development
Family leadership
development
providing parents and
other family members
opportunities to enance
their leadership skills
311 rivii 0 91111°1
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Current Systems Thinking:
Foundation First
Finance Models
Personnel
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Structure for Developing and Sustaining a Part C Finance System E
sta
blis
hin
g a
Vis
ion
agreements, negotiations, applications for use of funds: MOUs? Waivers?
Demographic information
about the population of Part
C eligible children in the
state:
What proportions of
children are likely to be
eligible for which
sources of funds?
Where are they in the
state?
Information about possible
fiscal resources:
Requirements?
What can each pay for?
Who is eligible?
Design a finance
and data system
based on the
demographics,
political and
economic
context of the
state
Infrastructure to support the documentation of use of funds and/or billing
Existing and potential
political and economic
context in the state:
Traditional, current uses
of funds?
Existing resources?
Competing priorities?
Anticipated political
changes?
monitoring: +Changing demographics? +Changing political and economic context? +Need new interagency agreements? +New funding sources? +Revised policies? +Better support and guidance? +More state funding? +Narrower Part C eligibility criteria?
Development of policies and procedures
for accessing resources and supports
and/or billing
Development of guidance and
provision of ongoing support for
localities and service providers in
implementing policies and
procedures
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State Identified Sequestration Cuts
In order of significance:
Personnel Development;
State Administration;
Child Find/Public Awareness;
Data Systems;
Monitoring;
Regional Administration; and
Local Administration
July 2
8, 2
013
83
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ComprehensiveSystem of Personnel
Development
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If the Child and Family
Outcomes are the Dependent Variables
Personnel Are the............
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Independent Variable
Mediator
Moderator
All of the Above
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The Conclusion Being:
Personnel Can Have a
Powerful Impact. . . .
o r NOT
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Roles of the Infant Early Intervention Specialist
Facilitator/Consultant
Infant Specialist
Parent Educator
Team Collaborator
Program Developer and Advocate
Geik, Gilkerson & Sponsetter, 1982
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Early Childhood Intervention Personnel
Competencies
Assessment
Family Involvement
Program Implementation
Teaming
Program Administration
Program Planning
Typical Development
Atypical Development
Evaluation of Program Effectiveness
Case Management
Medical Management
OtherBruder & McLean, 1988
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Comprehensive System of Personnel Development
Recruitment and RetentionPreservice
Personnel Standards Inservice
Leadership and SustainabilityEvaluation
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Preservice
Preservice degree programs for personnel to provide services for infants and young children with disabilities and their families.
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Recruitment and Retention
Assuring that there is adequate numbers of a well qualified workforce
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Personnel Standards Licensing and certification of
personnel who provide services
to infants and young children
with disabilities and their
families.
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InserviceOngoing training for those
personnel who provide services to infants and young children with disabilities and their families.
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Leadership, Coordination and
SustainabilityA cross sector leadership team is
in place that can set priorities and
make policy, governance, and
financial decisions.
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EvaluationFormative and summative
measures of CSPD component
activities
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Part B 619
or Part C Count
CSPD Components
Ongoing
Needs
Assessment
Appropriate
Licensing
and
Certification
IHE programs
to provide
pre-service
training
Ongoing,
Systematic and
Effective PD in-
service
opportunities
Evaluation
A Data
System for
Personnel
TA Availability Dissemination
Part B 619
(47 states) Total V 15 (32%) 34 (72%) 33 (70%) 28 (60%) 16 (34%) 25 (53%) 31 (66%) 28 (60%)
Part C
(46 states) Total V 24 (52%) 33 (72%) 30 (65%) 26 (57%) 16 (35%) 24 (52%) 33 (72%) 32 (70%)
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CALVIN AND HOBBES
NI6RE. lou KtAcM, TuE iiARDER. n- ks TO TAKE CCosk\IE ACTlotA
lok) BECOME 114voRVIED. ‘(OU SIART 5VEII\IG ANI) Stif \ps OF GRA1
PrP"-"N".
IOU REALIZE. HIM NOM% 15 AS AND 5111\ftE AS IT F 1RSI APPEARS UL TIMM-, Ktn‘fiLuK)E
Is I>ARAL_NIzitIG
BEItAG A MA OF AcTRA, I CMT AFfOIZO R) TAKE IIIM kV-AC
rsfou'RE iGRORAIAT, BUT AT LEAST YOU ACT ON IT
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The Challenge: ECI and EC
Where and How Do We
Meet;
Meld;
and Work Together?
for
All Infants and Young Children
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A paradigm is a set of rules and
regulations that:
Define boundaries
Tell us what to do to be successful
within those boundaries
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"Gramps, why do you always wear
your cap backwards?"
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+ 111E L !IRONIC!. I.. ull• L1211CA I III I
.kt:OhtE W ARMS I kONt,
"I see only a little snow at the poles. Obviously, this planet can't support intelligent life."
AUGUST I , 1997
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We see things not as they are
But
As we are
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“The way we see the problem may be the problem”
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High above the. hushed crowd, Rex tiled to rernainifocused. Still, he couldn't shake one
naing thought He was an old dog and thiswas a new trick.
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Goal Setting “Can you tell me please which way I ought to go from here?”
“That depends a good deal on where you
want to go to,” said the Cat.
“I don’t much care where,” said Alice.
“Then it doesn’t matter which way you
walk,” said the Cat.
Lewis Carroll
Alice’s Adventures in Wonderland
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Change is not magic or inspiration.
It’s completing many undramatic, small steps successfully.
Danziel & Schoonover, 1988
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Elements of Change
Where are we now?
Where do we want to be?
What do we need to do to get from here to
there?