Early Intervention: Referring Infants and Toddlers for Services - June 2006
What is Early Intervention?
Part C (PL 99-457) of the Individuals with Disabilities Education Act (IDEA) (PL 94-142) mandates that services be provided to infants and toddlers with disabilities age birth to three. Specifically,Part C requires that states provide a statewide, comprehensive, coordinated, family-centered and culturally sensitive system of services designed to meet the needs of infants, toddlers and their families who are experiencing developmental delay and/or have an established risk (a condition with a high probability of developmental delay).
In California, children who are considered “at risk” for developmental delay are also eligible for early intervention services. The lead agency responsible for overseeing provision of early intervention services is the Department of Developmental Services. They contract with 21 area “Regional Centers.” Part C of IDEA requires that children who are identified be referred; free of charge, for a comprehensive, multidisciplinary team evaluation and that the family and medical team working with the child determine which services are needed.1 Children can be referred to the local Regional Center for this evaluation and treatment.
The provision of health and developmental services has evolved from a medical model to a model that recognizes the vital role of the family as the child’s primary caregiver. Part C of PL 94-142 was developed based on the philosophy that in order to maximize a child’s developmental potential and enhance a family’s ability to cope, intervention should begin as early as possible. Further, it posits that families know their child best and should be an integral part of a multidisciplinary team treating the child. Services should be provided by professionals of varying disciplines who collaborate to provide comprehensive delivery of services. In recent years, the legislation has been amended to state that to the greatest extent possible, children age birth to three with disabilities receive services in community-based settings with non-disabled peers.
What are the Benefits of Early Intervention?
A literature review from the past five decades shows a shift in the way we think of infants and their capabilities (Stone, Smith & Murphy, 1973) (Skeels, 1966) (Sameroff and Chandler, 1975) and has drawn attention to the idea of early environment and its impact on developmental outcomes. Piaget’s theory of cognitive development occurring in stages—starting at birth and unfolding in sequences built upon preceding stages—has furthered the notion that one’s early years are a critical period of intellectual growth and development. More recent neuro-cognitive research demonstrates that there are critical periods of brain growth and development, and has confirmed the importance of early, comprehensive and appropriate intervention for babies or toddlers with disabilities or who are at risk.
From an early intervention perspective, the primary goal of therapies is to:
1. maximize a child’s developmental potential in all developmental domains;
2. teach children functional skills which are generalizable across people and settings;
3. enhance a family’s ability to adapt and cope to having a child with a disability;
4. create a normalized environment in which children can learn and grow; and
5. teach, educate and support parents and family members in caring for their children.
What Services are Provided Under Part C?
The list of services that can be provided under Part C is extensive. The most commonly funded services can include but is not limited to: physical therapy, occupational therapy, speech and language therapy, nursing services, transportation to and from therapy services, respite care, therapeutic swimming, assistive technology, vision services (e.g. Off to A Good Start, Blind Babies Foundation), infant massage training, family training and counseling, service coordination, social services, diagnosis and medical evaluation, behavior modification and daycare (IDEA, PL 105-17, 1997).
Role of the Pediatrician
Though early intervention efficacy studies suggest considerable variability in cognitive outcomes of children with disabilities, they have consistently demonstrated improvements in families’ overall functioning and ability to adapt having a child with a disability. The American Academy of Pediatrics (AAP) asserts that the pediatrician, as a central individual in providing medical care for children, has a unique and vital role in acting as the “case coordinator” for children with disabilities and their families. The pediatrician’s role is multi-faceted and includes being a health care provider, referring children for assessment, diagnosis and necessary clinical services, and acting as an advocate. The pediatrician’s primary responsibilities as recommended by the AAP includes: screening and evaluating infants who are at risk for disabilities using appropriate tools, promptly referring children for services, arranging for medical diagnostic testing, being aware of appropriate services available to the child and family, advocating for a child’s access to appropriate medical and surgical specialists, prescribing medical and rehabilitative therapies, and monitoring the child’s progress.2
When to Make the Referral
Children should be referred for intervention as early as possible according to the large community of therapists who provide services to young children with disabilities.
When there is a concern regarding development, the benefits of intervening as early as possible are numerous. First, early and appropriate intervention provides the opportunity to maximize a child’s developmental potential. Second, early intervention can prevent development of secondary disabilities. Third, the needs of the child’s family can be addressed (e.g. sibling support, supportive services etc.) and finally, studies have demonstrated that children who receive early intervention require less intensive special education services later, resulting in a cost savings.
References
1. The Individual with Disabilities Education Act, PL 105-17 (1997) (codified as 20 USC § 1431-§1445)
2. American Academy of Pediatrics. Committee on Children with Disabilities. Role of The pediatrician in Family-Centered Early Intervention Services. Pediatrics 2001; 107; 1155-1157.
This information provided by Dawn Saborit, M.A.., Child Development Center, California Pacific Medical Center's Department of Pediatrics.