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A USER’S GUIDE TO EARLY INTERVENTION SERVICES

A USER’S GUIDE TO EARLY INTERVENTION SERVICES. Seminar I Realistic Strategies to Identify Children Eligible for Early Intervention Services in Primary Care Practice. PRESENTED BY. Early Intervention Section, DOH Center for Disabilities Studies, UH Support provided by .

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A USER’S GUIDE TO EARLY INTERVENTION SERVICES

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  1. A USER’S GUIDE TO EARLY INTERVENTION SERVICES Seminar I Realistic Strategies to Identify Children Eligible for Early Intervention Services in Primary Care Practice

  2. PRESENTED BY • Early Intervention Section, DOH • Center for Disabilities Studies, UH • Support provided by

  3. Why DOH needs your helpto find babies who need EI help • Where are the missing babies? • 26% of DOE Special Education students in 3 cohorts were not served by EI programs

  4. ELIGIBILITY FOR EARLY INTERVENTION SERVICES Developmental Delay Biological Risk Environmental Risk

  5. DEVELOPMENTAL DELAY • Cognitive • Physical, including vision and hearing • Speech/language • Social/emotional/behavioral • Adaptive

  6. BIOLOGICAL RISK • WHEN: Prenatal, perinatal, neonatal, early development • HOW: Biological insults to central nervous system • RESULT: Probability of delayed development • Diagnosed physical/mental condition

  7. Down Syndrome Fetal Alcohol Syndrome HIV/AIDS Asphyxia SGA < 32 weeks GA VLBW ( < 1500 g) Failure to thrive Hearing loss from chronic otitis media Maternal diabetes Maternal substance abuse Maternal mental illness Examples of biological risk

  8. ENVIRONMENTAL RISK • Child abuse/neglect…. Healthy Start, PHN • Teenage mom with low support……..PHN • Substance abusing mom……………..PHN • Cognitively impaired parent ………...PHN

  9. EARLIER IS BETTER

  10. Do early delays predict later status? Expressive language delay Motor, psycho-social and cognitive delay Risk factors

  11. Paul, R. (1993, 1996)Expressive language delay at age 2+ • SELD: < 50 words at age 2 or • no 2-word phrases 25-34 mos • middle class • no hearing/ cognitive/ motor problems

  12. EARLIER IS BETTER: EARLY BRAIN DEVELOPMENT Brainstem - Prenatal through early infancy Limbic system (Amygdala, hippocampus: emotion, memory) - Late infancy to 4 years Cerebral cortex (Reasoning, behavior inhibition) - Toddler Language - auditory cortex by 1 year Capacity for logic & complex reasoning by age 4 years

  13. EARLY BRAIN DEVELOPMENT

  14. Sensory deficits prevent stimulation Motor delays can decrease stimulation Cognitive delays make choice of stimulation critical Excessive loss of neuronal connections Learning problems Attention problems Activity regulation Synapse pruning: the child with developmental challenges Causes Secondary Conditions

  15. What kind of experiences affect brain development? • Nutrition - protein, calories • Physical environment: variety across all modalities prevents excessive synapse loss • Emotional environment: attachment problems or stress decrease cognitive potential and behavior regulation (ADHD etc)

  16. PARENT: adjustment to diagnosis/problem Loss of hope Resentment Fatigue BABY: Sensory defensiveness Feeding problems  sense of self  ability to organize future learning  ability to form intimate relationships  empathy Attachment Problems Influence Brain Development: Babies with special needs Causes Consequences

  17. The brain develops from lower to higher levelstherefore Early experience has more pervasive impact

  18. Babies with special needs may experience high stress levels • Sensory defensiveness, communication delays etc. • At risk for abuse • Parents may be more stressed by the child’s special needs • Delays are more frequent among children whose parents are teens, poorer, less educated, incarcerated - these children live with extra stress

  19. Match stimulation to child characteristics Reduce child stress through adaptations to accommodate disability Improve attachment Reduce parent stress Improve nutrition Increase parent/child language interaction How early intervention can help Adapt child’s environment Parent education and support

  20. How do we know informal screening and clinical judgement aren’t enough? • Many children in Hawai`i with significant special needs are missed until they reach schooling • Research shows that informal methods miss ~ 50% of delays

  21. THESE RESOURCES CAN provide standardized screening • Parent Line - for literate and motivated parents • Healthy Start or Head Start - for children enrolled in these programs • PHN- for children already enrolled -for other children if you or parent have concerns

  22. Taking parent concerns seriously • Improves rate of identification • Builds stronger relationships with parents • Adds data you don’t have a chance to observe

  23. Infant-Toddler Development Programs (like North Hawai`i Child Development Program or Hilo Easter Seals) offer Evaluation by trained and certified professionals to determine the extent and type of developmental delays

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