As the idea of conducting functional assessment takes root here in Virginia, there have been some worries about what it means. Does it mean that we won’t do our more traditional assessment anymore? How will we determine a child’s age-equivalency? How will we get all of the information we need? Who will do the functional assessment? When will we do it? How will we find the time to do both???

Some level of anxiety is very normal as a new process is introduced and we strive to figure out how it fits into what we already do. An important thing to remember is that functional assessment actually fits beautifully with the principles and best practices of early intervention. Think about it this way…we’ve always known that viewing a child’s development from a functional point of view is best practice. We’ve always known that traditional assessment provides us with just a snapshot of what a child can and cannot do. We’ve also always known that the results of a traditional assessment, while they may help us confirm eligibility, don’t otherwise mean much unless they are translated into what they mean for a child’s interactions and participation in activities that are relevant to everyday life. These are things we can agree on. The difference now is, our state (and many others) is looking to ensure that we always have a functional perspective and use it with each child to ensure that early intervention truly is individualized and appropriate.

Authentic Assessment

Just this morning, I read a great article entitled “Authentic Assessment – What’s It All About?” Sometimes the terms “authentic” is used to describe the type of assessment we are working towards – authentic meaning that we consider development in the context of the child’s experiences in naturally occurring activities and routines. The authors of this article made a powerful point – that we don’t have to use one type of assessment over another, that we don’t have to worry that this is an either/or discussion. Instead, they suggest that this can be a both/and decision. There is a place for traditional assessment, especially in the early intervention context. Learning about a child’s development, as it compares to other children, is useful in helping us confirm eligibility (like when it can’t be determined from medical records). It helps us figure out why an infant or toddler is struggling when we find gaps in skills or atypical developmental patterns. We can then use that information to focus on how these differences impact the child’s everyday experiences and interactions – the functional assessment piece. Knowing about the child’s developmental status in combination with an understanding of how the child participates in daily routines like bath time, meals, playtime with others, and going out in the community will lead to better IFSP outcomes, more individualized EI services, and hopefully intervention that improves child and family quality of life. That’s what EI is really all about. Yes, we still have to figure out the answers to some of the above questions, and I’ll be exploring them in future blog posts, but the good news is that we are going to do that together.

How do you feel about combining traditional and functional assessment? What do you think it’ll look like in your system?

What questions do you have about implementing functional assessment? 

If you are already using it (and many of you are), share what it looks like and how you’ve woven it in to your assessment and intervention processes.

Share your thoughts by leaving a comment below!

Check out a few other great resources from the ECTA Center and DEC to learn more:

Authentic Child Assessment (practice guidelines) (PDF, New Window)

Authentic Child Assessment Practices Checklist

The post Functional AND (not or) Traditional Assessment appeared first on Early Intervention Strategies for Success.

Marco was recently referred to early intervention (EI) due to suspected global delays. His family is living in a homeless shelter and only has one more week left before they must leave. His father is trying hard to find employment but is challenged by his lack of childcare. He is the sole caregiver for three children under the age of four.

Nellie was discharged from the hospital three days ago following a very lengthy stay of 16 months. She is a preemie with many medical complications. Weight gain has been a challenge for her and will need to be closely monitored now that she is home. Her family is eager to get EI in place to assist with Nellie’s feeding skills and encourage her overall development.

For both Marco and Nellie, time is of the essence. Both families are newly referred to EI, and both would benefit from immediate support. But wait…the assessment calendar is full and it might take the whole 45 days allowed for the timeline to assess these children and develop their IFSPs. Can they wait that long??

The Interim IFSP

Both situations are examples of when writing an interim IFSP would be very appropriate. Interim IFSPs aren’t written very often. They can be viewed as sort of an emergency measure for eligible children who need supports and services to begin immediately. In Marco’s case, his family could benefit from service coordination to help them find housing immediately. A service coordinator may also be able to link Marco’s father locate child care options so that he is able to find employment. Because of Nellie’s extensive medical history and current feeding needs, initiating services for her is of utmost importance. Both families are in need of support, Both children are eligible for EI – Marco, based on his developmental delays and Nellie, based on her extended NICU stay, prematurity, and delays. Fortunately for them, you don’t have to wait until the assessment calendar is open to get the ball rolling.

Requirements for the Interim IFSP

An interim IFSP is a relatively simple document. Only four pieces of information are required: the name of the child, the name of the service coordinator, the service the child will receive, and the parent’s signature. The corresponding pages of the IFSP form can be used for the interim IFSP, with the words “Interim IFSP” written at the top of the first page. With the interim IFSP in place, services can begin immediately. It’s extremely important to remember that having an interim IFSP in place does NOT extend the 45-day timeline. A full IFSP must still be in place within 45 calendar days after the date of referral.

Using an Interim IFSP

Let’s check in on both situations to see how developing an interim IFSP helped:

Marco – Once Marco was found eligible, an interim IFSP was developed with Marco’s father to initiate more intensive service coordination to assist the family. The service coordinator completed other required documentation with Marco (such as procedural safeguards and release of information forms so she could speak with the social worker at the homeless shelter), and began the process of arranging the assessment for service planning and IFSP meeting. Marco’s father and the service coordinator worked together closely, talking almost everyday. The service coordinator helped obtain a one month extension with the homeless shelter. Within two weeks, though, Marco’s father had accessed several programs through his local Department of Social Services for rent assistance and a subsidy for child care so that he could look for employment.

Nellie – Following the intake, Nellie was found eligible for EI based on a review of her medical records. An interim IFSP was written and physical therapy began three days later. The physical therapist was able to assist Nellie’s parents and her nurse in determining positioning options for safe feeding. A speech-language pathologist also began seeing Nellie and worked closely with her family and nurse to monitor her caloric intake and begin working on oral motor exercises to help Nellie learn oral feeding. Nellie’s assessment for service planning was held about a month later and a full IFSP was developed. The PT and SLP continued to support Nellie’s family, and were happy to report at the assessment that Nellie was gaining weight and holding her head in midline better during feeding times.

The interim IFSP allowed both families to receive immediate support that helped to stabilize their challenging situations. While this type of IFSP is not used very often, it can be an important tool that allows eligible children and their families to receive the support they need right away.

Have you written an interim IFSP before? How did you know that it was the right thing to do? 

Share you experiences using an interim IFSP in the chat below. Be sure to protect family confidentiality if you share a specific experience. 🙂

The post Writing an Interim IFSP appeared first on Early Intervention Strategies for Success.

On March 3, 2015, I was honored to present a Talk on Tuesday (ToT) webinar entitled, It’s Almost Never Apraxia: Understanding Appropriate Diagnoses of Speech in Early Intervention, that addressed appropriate diagnoses of speech sound disorders in infants and toddlers.  The participants had some great questions and we wanted to ensure that the conversation continues…so here I am!  My March ToT was just Part 1 of 2. The second half will be presented on May 5^th and will focus on outcomes and intervention in regard to speech sound development!  But in the meantime, it seems as though a big misconception from my March Talk is that I am advocating for fewer services for infants and toddlers…this is not the message that I intended to convey and I am hoping to begin this blog series by clearing that up!

First, let’s begin with a quick review of the facts:

When Should We Become Concerned about the Development of Articulation?

Typically, a speech-language pathologist (SLP) will diagnose an articulation disorder if a child is demonstrating a delay of at least 6-12 months in regard to the production of certain sounds, based on the age at which mastery of the sounds is expected.  To put this in perspective, because the /k/ and /g/ sounds are expected to be mastered by the age of 4 years, a child should not be differentially diagnosed with an articulation disorder characterized by errors of these sounds…until the child is at least 4 and a half years old.

What about Phonology?!

A child’s speech development is not just about his or her articulation skills.  When SLPs are assessing a child’s speech, we are also looking at the sound patterns—the phonological processes–that a child is, or is not, producing.  As you can imagine—and as most of you have experienced!—in addition to developmental articulation errors, these processes often wreak havoc on our ability to understand what children are saying.  And yet…should we be concerned when working with children under the age of 3 years old?  Well…not really.  A phonological delay or disorder refers to when a child continues to simplify his or her speech by using these phonological processes well beyond the typical age expected.

Unless we consistently observe a toddler demonstrating the following red flags:

• initial sound deletions;
• distortion or consistent difficulty with vowels;
• deletion of LOTS of sounds—the child uses only one or two consonant sounds…

…we should not diagnose an articulation or phonological disorder prior to the age of 3 years. Again, since most of the processes that we monitor are expected to be present in a child’s verbalizations until the age of 3 or older, we really just want to monitor the patterns in a child’s words and phrases until they are 3 years old.

And What about the Role of Intelligibility? 

Well, again, since we now know that children are going to be difficult to understand prior to the age of 4 years, an SLP will determine just HOW unintelligible a child is at a given point in time.  If a child is less than 25% intelligible by 2 years of age or less than 50% intelligible by 3 years old, we should be concerned.  It is then the role of the SLP to determine what the roadblock to the child’s intelligibility really is.  Otherwise, it’s important to keep in mind that a 2 or 3 year old IS going to be difficult to understand…often!

Now that We’ve Reviewed the Expectations, Let’s Address the Misconception!

I am certainly not advocating for FEWER services for infants and toddlers…instead, I am advocating for FUNCTIONAL services for our children and their families!

Stronger services = functional services!

Functional services will be based on appropriate diagnoses of the young children with whom we work.  These kids DO need services—but when we are diagnosing appropriately and accurately, our services for infants and toddlers will be based on the diagnosis of a language disorder versus a speech sound disorder. We should, therefore, be providing services that FOCUS on language development rather than on speech sound development…or better yet, we should be providing best practices by coaching families to facilitate speech sound development within (rather than separate from) outcomes and activities that target functional communication by and with the child!

If you did not have the opportunity to participate in the live March 2015 ToT webinar, I invite you watch it now!  I would love to hear what you think about the information that I presented and where we should go from here!

What strategies do you use to facilitate speech sound development within everyday functional activities?

Share your ideas in the comments below!

If you missed either of Corey’s webinars, visit the Talks on Tuesdays 2015 recordings page on the VA Early Intervention Professional Development Center, or click below:

It’s Almost Never Apraxia: Understanding Appropriate Diagnoses of Speech in Early Intervention

Ditch the Animal Sounds: Writing Appropriate Outcomes that Lead to Effective Implementation

If you’d like to catch up on all of the posts in this series, visit:

Address the Language: The Speech Will Follow!

ICD-10 Codes and Insurance Reimbursement in EI: The Fun Stuff?!?

Ditch the Animal Sounds! – Who’s Ready for the Next Talks on Tuesday?!

The post What’s the Bottom Line Regarding Articulation in EI?! appeared first on Early Intervention Strategies for Success.

Preemie Pop Quiz

Do you know the stats on prematurity? Take this pop quiz to see what you know and keep reading for answer and tips you can use when supporting preemies and their families!

1. A premature birth is one that occurs before ___ weeks gestation.

2. Approximately how many children are born premature each year?

3. When do most premature births occur – before or after 34 weeks gestation?

4. We correct for prematurity up until a child turns _______ years of age.

5. Almost ___% of pregnancies with multiples (twins, triplets, etc.) result in preterm births.

6. True or False: Prematurity is the leading cause of long-term disability related to the nervous system  in children.

7. True or False: Most preemies will eventually catch up to their full-term peers in terms of developmental abilities.

Answers:

1. Premature birth is defined as a delivery that occurs prior to 37 weeks gestation. (Source: CDC, 2014)

2. Approximately 1 in 9 children are born premature each year. In 2012, 455,918 children were born premature. (Source: CDC, 2014)

3. In 2012, about 8% of premature births occurred when the infant was between 34-36 weeks gestation. Approximately 3% of premature births occurred when the infant was under 34 weeks. (Source: National Vital Statistics Report, 2013)

4. According to the Infant & Toddler Connection of Virginia, we correct a child’s age for prematurity up until 18 months of age. Other programs and medical professionals might correct up until a child turns 2-2 1/2 years of age, depending on guidelines for that program. (Source: I&TC of VA Practice Manual)

5. Approximately 60% of births of multiples occur before 37 weeks gestation. (Source: healthychildren.org)

6. The earlier a child is born, the higher the risk that the child will experience developmental and medical challenges. Even in children born as late-term preemies (between the ages of 34-36 weeks), research has found that they are at significantly higher risk for negative outcomes (Source: NIH, 2014). Being born premature places a child at higher risk for intellectual disabilities, visual and hearing impairment, respiratory challenges, feeding issues, and cerebral palsy. (Source: CDC, 2014)

7. It’s important to remember that, while preemies are higher risk for many conditions, most preemies eventually catch up to their same-aged peers!

Preemies & Early Intervention

All EI programs support preemies and their families at one time or another. Of course, not all preemies are referred to EI, or will even qualify for services, but EI can be a wonderful resource for families of those who do. When supporting families of preemies, here are a few important things to keep in mind:

Take time to listen to the family’s story – For most families, a premature birth marks a significant, unexpected and often frightening event in their lives. The family has had to adjust their lives to accommodate an unexpected hospital stay for the mother and child, quickly prepare for a child they might not have expected to arrive for months, adjust work and child care schedules, etc. They might have been visiting the child at the hospital for months following the delivery and be anxious about bringing a fragile child home. Taking the time to let them share their experience can be a powerful way to begin the early intervention relationship. I remember meeting a family of a very premature baby and in listening to their story, finding out that this child had a twin sister who died shortly after the delivery. This information was not provided in the referral paperwork and really shaped their perspective on the child we were supporting – and their underlying fear of losing her too.

Remember the family system – Because the referral we receive is for the child, it can be easy to forget the effects of the premature birth on the whole family. Parents, siblings, and extended family are all impacted by this event. It’s important to keep this in mind when considering service delivery options and how best we can support the child and family.

Keep the parent-child attachment in the forefront – Preemies are often whisked away to receive medical care immediately after delivery. Opportunities to hold and bond with the child may be different than they would have been with a child born full-term. While we don’t ask “do you feel attached to your baby?” we can observe and support that attachment process. Many believe that all relationships are based on early attachments, so keeping an eye on infant mental health with preemies is important. Observe how the parent holds, feeds and comforts the child and provide support if the parent struggles with early care.

Monitor the child’s reactions & adjust the environment – Use careful observation to monitor how the infant reacts to environmental stimuli. If needed, help the parent adjust the environment to avoid overstimulating the child. Preemies can be fussy and struggle to regulate themselves, but with a little help, can adjust well. If the child startles easily, cries often, or shows signs of overstimulation (e.g., arching, yawning, sneezing, gaze aversion, fanning out the hand), help the parent look for ways to adjust noise, lighting levels, or interactions to a tolerable level. For some preemies, using one sense at a time for interaction can help. For example, talking to and touching the preemie at the same time might be too much, so help the parents and siblings learn to do one or the other while interacting until the baby can tolerate more.

Keep a close eye on development – In Virginia, preemies qualify for EI if they’re born less than or equal to 28 weeks gestation or if they have a NICU stay greater than or equal to 28 days. Because we know that all preemies are at higher risk for developmental delays or disabilities, it’s so important to monitor development and health closely. Encourage families to keep all follow-up appointments. Monitor vision, hearing, and motor development especially closely. As the child grows, watch for any signs of delay across development. Keep in mind that correcting for prematurity up to 18 months really isn’t a magic number for catching up. It’s just a benchmark for eligibility; some preemies won’t qualify after 18 months of age as the gap between their chronological age and adjusted ages closes, but others may continue to show developmental delays and benefit from intervention.

However premature a child is, do your best to provide support that is individualized for the child and family while taking into account the risks associated with prematurity. Be hopeful about the future and keep in mind that the support you provide to this tiny person and his or her family could make a lifelong difference!

Let’s celebrate National Prematurity Awareness Month by sharing tips for supporting preemies and their families in the comments below! What’s your best strategy for engaging a preemie?

For more information, visit the Virginia Early Intervention Professional Development Center website to find a Prematurity topic page with links to a prematurity resource landing pad (PDF, New Window), an archived webinar (Prematurity and Early Intervention: Prevalence, Issues and Trends), a free online module (An Early Interventionist’s Guide to Prematurity), and tons of other great resources!

The post Preemie Pop Quiz & Tips appeared first on Early Intervention Strategies for Success.

Meet Chris – He and his family have moved 7 times since he was born and are now staying with friends. Chris was referred to your program by his mother at the suggestion of her friend’s mom. The referral said that Chris was 29 months old and not walking. When you arrive for the screening, you see that Chris’s legs are scissoring and he’s experiencing high muscle tone. Turns out that Chris hasn’t been to a doctor since he was 5 months old and living in another state.

Meet Aliyah – Aliyah was taken to the doctor regularly but saw a different medical professional each time, rotating through whoever was available. She is 33 months old and is using mostly “ah” sounds to mean many things. She makes great eye contact and is very social and very bright. Recently, her child care provider completed a screening at her mother’s request, which resulted in a referral to EI. Her mother was frustrated because she’s been worried for a while. Because Aliyah is so social and “so smart,” she’d been repeatedly told by many people that Aliyah would eventually talk so to just wait a little longer…

Sigh…Why’d It Take So Long to Find Chris and Aliyah?

Okay, I know I’m preaching to the choir. We’re early interventionists…early screening and identification are what we DO. Yes, we know all about it, but do others? I think an important job of every early interventionist is to help spread the word about the importance of early screening to our community partners. We want our choir to grow to include more home visiting program staff, medical partners, child care providers, social services folks, and of course families!

The reality is that no early identification system is perfect. There are so many variables that influence whether or not a child is identified early and appropriately referred for evaluation. Family preferences or instability, screener error, the “wait and see” approach, follow-through after the referral is made (by the family and the receiving program) – so many cracks in the system. We can’t fix all of the cracks but we can do our best to be sure that the information is available to those who are helping us find children who may benefit from early intervention.

Spread the Word about these Early Identification Resources!

Rather than going on about the importance of finding children and families early, I thought I’d highlight some wonderful resources. Check out these links and please, share them with your community partners!

Birth to 5: Watch Me Thrive – A federal effort to support families and providers in celebrating milestones, accessing universal developmental and behavioral screenings, increasing early identification of delays and concerns, and enhancing developmental supports.

Centers for Disease Control and Prevention (CDC) Resources – The CDC website has a plethora (love that word!) of resources for early developmental screening, too many to list, really. Check out these pages for a start:

• Child Development – Tons of resources about screening tools, research, recommendations, etc. Includes info for medical providers about how to manage screenings in their practices. You can also order lots of free materials to support your screening efforts! One interesting fact – according to the CDC site, did you know that only 1 in 5 parents report that their child has received a developmental screening??
• Learn the Signs. Act Early. – Great resources for early screening and identification of children with autism spectrum disorder.
• Hearing Loss – This is one example of a topic page that’s full of info about screening and diagnosis. Be sure to search for other similar topics too.
• Facts about Vision Loss (PDF, New Window) – This is one example of a fact sheet that community partners can use during screenings. The CDC site has lots of other fact sheets so search the site for other topics.

Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening (AAP) – Share this resource with your local medical partners to get a conversation started about how to support screening and referral.

Developmental Screening and Assessment Instruments with an Emphasis on Social and Emotional Development for Young Children Ages Birth through Five (NECTAC) (PDF, New Window) – This booklet includes info about many screening tools, including a description, age range, time frame, scoring, psychometric info, and who may administer. A great place to start if you’re looking for good tools.

Infant/Toddler Development, Screening,and Assessment (Zero to Three)(PDF, New Window) – This training module/booklet is designed to be used with child care providers to support their knowledge.

Talking to Families of Infants and Toddlers about Developmental Delays (NAEYC) – This handout is another resource to help community partners start that conversation with families when there is a developmental concern. (The link I have for this doc is acting a little funny today but I wanted to include the handout anyhow. Try searching by the title another day to get to the handout. It’s a great one.)

There are tons of other screening resources out there. Even though we know about them, we need to continue the effort to get the word out in our communities. Let’s grow our choir and help others know about the benefits of early screening for children and families. Let’s help our community partners make sure children like Chris and Aliyah get what they need as early as possible!

Share your favorite screening and early identification resource in the comments below and let’s see if we can add to this list! Share your experiences and struggles with early screening and identification – have you met a child like Chris or Aliyah? I know I have…

You can also find more info about Screening and Assessment on the Virginia Early Intervention Professional Development Center website.

The post Preaching to the Choir about Early Screening Resources – Spread the Word! appeared first on Early Intervention Strategies for Success.

On your first visit you ask, “Is Tyler saying any words?” 

“Oh sure, Tyler has lots of words! He can say ball, mama, doggie, outside. He probably says 20-30 words!” his mother replies.

When you ask for more information, you realize that Tyler’s words are almost exclusively said in imitation after his mom prompts him. He only has 2 words that he actually uses: mama and doggie. Tyler is 18 months old.

Have you ever been in this situation? Families don’t always understand that when we (or the pediatrician) ask about how many words a toddler has, that we mean how many words the child spontaneously USES to communicate, comment, get his needs met. There is a huge difference!

Why the Answer Matters

For Tyler, if we use his mother’s estimate without gathering more information, we might conclude that Tyler is on target for his communication development. However, if we dig deeper, we will see that he actually only uses 2 words, which would be considered a developmental delay. This distinction isn’t always made during well-child check-ups at the pediatrician’s office either where the screening often relies on parent report. Relying on parent report can be a great thing; in fact, some studies have found that parent report is typically pretty accurate. The key here is asking the right question to help the parent understand what we are asking so that he or she can give us accurate information.

Knowing a child’s word count really isn’t all that helpful by itself, though. Sure, it can inform us about sounds the child is able to make and maybe even words he can understand. It also helps us identify whether or not the child has a variety of words that include nouns, verbs, and adjectives which are needed before the child begins combining words into phrases. In addition to knowing which words a child SAYS, we really need to know which words a child USES.

How Do You Help Families Understand the Difference?

Here are a few ideas:

Use specific language – Rather than asking the vague question above about whether Tyler is saying many words, a better, more specific question might be “What words does Tyler use to tell you what he wants?” Think about how you phrase questions so that your intent is clear.

Ask the next question – You might ask Tyler’s mother to tell you how he uses his words. You could ask a clarifying question like “How does Tyler use his words to talk to you?” or “Are these words that Tyler repeats or do you hear him use them on his own?”

Ask for an example – Ask Tyler’s mother for an example of when she hears Tyler use his words, like during a daily routine or activity. You can also ask about routines or activities that are a source of frustration for Tyler or his mother because he is not able to use his words.

Give pragmatic examples – You might provide Tyler’s mother with a specific example to put using words in context, like asking if Tyler uses “outside” to say that he wants to go outside to play. You could ask if he calls their family pet by saying “doggie” or says the word when he sees a picture of a dog.

Observe – Observation is always a good option when you have a child who is comfortable talking in front of or to you. We all know, though, that many toddlers are quiet when they first meet us. In that case, we must rely on what the parent tells us.

Specifically explain the difference and why it’s important – Be specific and talk about how developmentally, we want toddlers to move from imitating words to using them. Once a child can spontaneously use a word to get a need met, label something or make a comment, he or she really “has” that word. Imitating is the first step. This is especially important for children with echolalia, who often need extra help to get past the imitation stage.

Ask the parent to make a two-column list – Work with the parent to make a list of the child’s words. Divide the paper in half and list the imitated words on the left and the spontaneously used words on the right. Explain to the parent that the goal is for the words on the left to eventually move to the right. This list provides a visual example of the difference between the types of words. It’s also a great way to track progress.

What are other ways you help families understand the difference between imitated and spontaneously used words? How do you gather this information at intake and assessment?

Share your insights by leaving a comment below!

For more information about expressive and receptive communication development, visit the VA Early Intervention Professional Development Center to find these resources:

Speech and Language Resource Landing Pad (PDF, New Window)

Communication Delays & Disabilities topic page (articles, handouts, archived webinars and more)

If you know of other great resources, please share them in the comments too!

The post Does Tyler Imitate or USE his Words? – Why the Answer Matters appeared first on Early Intervention Strategies for Success.

Miguel is 19 months old and lives with a large family that includes his parents, three older siblings, an aunt, and his grandparents. He qualified for early intervention due to delays in gross motor development and low muscle tone. He’s also showing some slight delays in his expressive communication. During his assessment and subsequent intervention visits, you notice that Miguel’s family often carries him around or keeps him in a pack-n-play during the day. His family is also very skilled at meeting his needs, so much so that he barely has to vocalize to get what he wants. The more you get to know the family, the more you wonder…does Miguel truly have developmental delays or are his developmental differences due to how he is cared for?

What’s Causing Miguel’s Delays?

Wondering why Miguel is showing delays is a normal part of the detective work we do as early interventionists. We believe that when we can find an environmental factor, then maybe we can help the family make changes to eliminate it. Sometimes this is true, such as when a child is in an under-stimulating child care environment and we can help the family find a better option. Other times, though, the factors in the environment are grounded in family values and cultural beliefs that are much harder to change. We have to question whether or not it is even appropriate to try to change family values or beliefs? Is that our place?

Cultural Differences in Child Rearing & Independence

Based on their cultural beliefs, Miguel’s family defines their role in his child rearing as taking complete care of him and ensuring his safety. Miguel is included in all family activities and is well-cared for and very well-loved. The female caregivers in his life (mom, aunt, sisters, grandmother) all share the responsibility of caring for him, carrying him around, and meeting his needs. They use the pack-n-play to keep Miguel safe from all of the traffic in the home, fearing that he would be stepped on if left on the floor to play since he can’t move out of the way yet. Developing Miguel’s independence is not a priority for them as, in their culture, he is considered a baby for the first few years of his life. This is different from our typical American view of infancy and early milestones. This difference doesn’t make their cultural view wrong. It does complicate matters, though, since our assessments and intervention processes don’t often adequately consider cultural differences.

Does It Matter?

You might be thinking “does the cause really matter?” and I’d say that yes, it does. Perhaps a more important question to ask is what Miguel’s parents think. Asking them when children are expected to walk and talk in their culture can give you an important clue. If they say that they think Miguel should be walking and talking by now, then the door is open to discuss intervention. If they say no, then talk about their interest in early intervention. It’s fine to talk about what we expect developmentally in typical American culture so that they understand why we are concerned (our perspective) and have information on which to base their decision. It’s important to have this discussion, though, with respect for their cultural values and beliefs.

If you were Miguel’s service provider, how would you support his family? Would you address your observations? How would you provide intervention suggestions that were sensitive to his family’s cultural beliefs? 

Does it matter that his delays might be related to his caregiving and culture? Why or why not?

For more information about cultural competence, visit the VA Early Intervention Professional Development Center’s Cultural Competence topic page and the Cultural Competence (PDF, New Window) resource landing pad.

The post Are Cultural Differences Truly Developmental Delays? appeared first on Early Intervention Strategies for Success.

Did you know that how a child qualifies for early intervention (EI) differs depending on where he lives?? How do children qualify in your state or country?

Early Intervention Eligibility in the US

In the US, Part C of the Individuals with Disabilities Education Act outlines two ways that children qualify for early intervention services: 1) developmental delay in one or more area of development (cognition, communication, motor, self-help, and social-emotional), or 2) a diagnosed condition with a high probability of developmental delay (e.g., cerebral palsy, Down syndrome). States also have the option to serve children who are at-risk for developmental delays. In Virginia, children must have a 25% delay in one or more area, a diagnosed condition, and/or atypical development (based on specific criteria).

States designate how children qualify under each of these categories – they determine the level of delay or standard deviation, which diagnosed conditions qualify, whether or not at-risk children are served and under what criteria. This is important for service coordinators and providers to know when transitioning children and families to other states and countries.

To find out about different eligibility criteria across the US, check out this resource: Summary Table of States’ and Territories’ Definitions of/Criteria for IDEA Part C Eligibility (2012) (PDF, New Window) from the Early Childhood Technical Assistance (ECTA) Center.

Early Intervention from an International Perspective

Many countries, such as Canada, Australia, and China also have early intervention programs and they define their own eligibility criteria as well. Since we have international readers on this blog, I would love to know how children qualify for early intervention where you! Share your location and eligibility criteria in the comments below!

If you’re interested in more info about EI internationally, check out these resources:

• International Resources on Early Intervention (ECTA Center)
• International Society on Early Intervention – You can register to be a member for free, share and request resources, and access a large professional training resource library.
• Early Childhood Development and Disability: A Discussion Paper (PDF, New Window) (World Health Organization)

Best Practices for Determining Eligibility

While eligibility criteria may differ by state or country, best practices are universal. Here are a few best practices for determining eligibility:

Use more than one source of information – Child development is complex and interconnected, and there is no one assessment tool that provides complete information. Many tools did not include children with disabilities in their norming sample, and some are more reliable than others. Be sure to use more than one tool when looking at development to gather the most accurate picture possible.

Listen to parents – Some tools allow the use of parent report for scoring purposes, while others do not. Research has found that parents are generally very accurate in their knowledge of their child’s strengths and needs, so listen to what they say even if you can’t use their information when scoring the test. You can use that information to understand the child’s development in the context of daily life.

Use informed clinical opinion – Combining the use of well-designed assessment tools with informed clinical opinion helps makes the eligibility information meaningful and links it to real life, which is how we connect the dots between the evaluation and the outcomes and services developed on the IFSP. This is also an IDEA requirement for programs in the US.

Use a multidisciplinary team – Having at least two people from different disciplines (i.e., educator and physical therapist) determine a child’s eligibility is part of the team approach and ensures that no single person makes this important decision alone.

Remember that the child is more than the delay or disability that qualifies him/her – Designate how the child qualifies then move on. Once a child has qualified for early intervention, put that “category” aside and look at the child’s individual strengths and needs. Develop intervention based on what is unique about the child and family, not based on how he qualified for services.

What tips and tools do you use in your program to determine a child’s eligibility?

How do children qualify for services where you are??

For practitioners in Virginia, visit these resources for more info about eligibility:

• ITC of VA Eligibility Criteria and Diagnosed Conditions (PDF, New Window) (Quick Reference Guide)
• Infant & Toddler Connection of VA Practice Manual – Chapter 5: Eligibility Determination (PDF, New Window)

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