Intervention: The Earlier, the Better
By Suzanne Ripley

Children develop skills as they grow—they roll over, smile, babble, begin to crawl, pull themselves up, learn a word or two, begin to walk, begin to talk. In fact, most children follow a definite pattern as they mature.

Some children walk earlier than others and some talk sooner than others, but in general, they follow a similar course of development. There are, however, some exceptions. Some children develop very late and some do not follow a common pattern. While some children may "catch up," others may suffer from a developmental delay or even a disability. The earlier such delays and disabilities are recognized, the sooner these children, their families, and their caregivers can get help. Child care providers, especially, are in a unique position to recognize a problem or delay because they have the opportunity to observe many children and to experience the full range of child development. Thus, it is important that they know about the resources available to assist them in helping children and their families.

Developmental Delay
The term developmental delay describes a child who is not doing what other children his or her age typically do. These children develop more slowly or differently from the expected. A developmental delay can be physical, cognitive, communicative, social, or emotional. For example, a child who is delayed may not begin to talk when other children typically do, may not walk "on time," or may have some other difficulties which cause concern. In some cases there may be an obvious reason-the child may not be able to see or hear or may have cerebral palsy, but in other cases the reason may be unclear. While a child may "catch up" to other children his or her age with no assistance, many will not. A child who has a hearing loss will ultimately learn to speak, but he or she may learn incorrect pronunciations of words, miss a great deal of social development, and become frustrated and angry. When hearing loss is diagnosed early, a child can be fitted with a hearing aid and work with a speech therapist to avoid falling behind. Thus, it is a good idea to get an early intervention team to examine a child experiencing learning difficulties and determine if special assistance is needed.

Early Intervention
Early intervention refers to the services designed to identify and treat a disability or developmental delay before a child reaches the age of three. Early intervention services are offered through public or private agencies and can be provided in a variety of settings, including a child's home, clinic, or child care center. The needs of the child and family will determine how and where services are provided. Early intervention is covered by the law and referred to as the Individuals with Disabilities Education Act (IDEA). This law protects infants and toddlers in need of early intervention because they: 1) are experiencing developmental delays in one or more of the following areas-cognitive, physical, communicative, social, emotional, or adaptive; 2) have a physical or mental condition that has a high probability of resulting in delay (Down Syndrome, cerebral palsy); or 3) at state discretion, are at risk medically or environmentally for substantial developmental delays if early intervention is not provided (Johnson et al., 1994, p. 255).

In early intervention programs, the family is provided with services to help them help their child. Early intervention specialists talk to the family about activities, games, and exercises they can do to assist their child and discuss the family's needs. Furthermore, an early intervention specialist can determine how much time a child needs to spend each week doing early intervention activities. A common early intervention service is speech therapy. This type of therapy helps young children whose speech is not clear and who have not begun to talk. Other services help children develop movement skills, such as sitting, crawling, walking, and picking things up. In some cases the early intervention specialist may provide special equipment for the child to use, such as a walker.

Special Education Services
After a child turns three, services similar to the ones described above are provided by the local school system or the state Department of Education. These services, however, no longer fall under the title of early intervention; they are now called special education. Local public schools offer special education and related services, like speech therapy, physical therapy, or special transportation, to eligible children. Much like the services offered in early intervention, special education services can be delivered in a variety of settings depending upon the needs of each child. Some children will enter a special preschool, while others may stay at home or attend a "regular" program. Once a child reaches kindergarten, special education services may be delivered in the regular or special classroom.

Legislation for Young Children With Disabilities
Both early intervention and special education services are covered by federal and state laws. The Individuals with Disabilities Education Act, IDEA, is the law which assures free and appropriate services for children who need them. This law has had a significant impact upon early intervention services. "In 1986, only 25 states had legal mandates for services to children under the age of six. By 1992, however, all states had established policies that ensured that all eligible children had access to early intervention services from birth" (Johnson et al., 1994, p. 257). Having a law that mandates services for very young children is effective. Guralnick (1997) found that "even when children are not enrolled in a formal service program, community expectations for children are higher, a variety of support systems are in place, information is readily available, and professional training from an interdisciplinary perspective has improved substantially" (Guralnick, 1997, p. 12).

Both early intervention and preschool special education services are designed to encourage normal developmental patterns, prevent diagnosed conditions from becoming more disabling, and improve the overall functioning of young children who have developmental delays or who are at risk of becoming disabled. Statistics reported in the U.S. Department of Education's 18th Annual Report to Congress (1996) indicate that 1.41 percent of the population, or 165,253 young children between the ages of birth to two years, received early intervention services in December 1994. This same report tells us that in the 1994–95 school year there were 524,458 children between the ages of three and five receiving special education services. This number is 9.6 percent of all school-age children ages three to 21.

These services make a difference. Child development research has established that the rate of human learning and development is most rapid during the preschool years. Timing of intervention becomes particularly important when a child runs the risk of missing an opportunity to learn during the state of maximum readiness. "Over 50 years of research on children with many types of disabilities receiving a range of specialized services in many different settings has produced evidence that early intervention can: 1) ameliorate (meaning to make the situation better), and in some cases, prevent developmental problems; 2) result in fewer children being retained in later grades; 3) reduce educational costs to school programs; and 4) improve the quality of parent, child, and family relationships" (Salisbury & Smith, 1993, p. 1). With assistance from intervention services, a two-year-old child who is deaf can begin to communicate through sign language, a three-year-old who isn't walking yet can work with a physical therapist, and a four-year-old who is having difficulties pronouncing Rs can get help from a speech pathologist.

Processes for Getting Help
When there is concern that a child's development is not typical, a referral must be made to a medical or child development specialist. This specialist can observe and test a child for developmental delays and disabilities. After the observation and testing phase, a child can be formally evaluated and assessed for possible placement in special services. A meeting with the child's teacher and parents along with the medical or child development specialist will decide where a child can receive assistance and how his or her progress can be monitored. Referrals and assessments can continue as the child changes and grows. The child may be referred to other professionals and programs as needed.

Evaluation and Assessment
Evaluation and assessment make up the formal process of delay and disability identification. They tend to be used interchangeably when referring to the process that determines a child's strengths and weaknesses. Evaluations and assessments consist of informal and formal testing; use of standardized tests; and observations made by parents, caregivers, and medical or child development professionals.

Doctors, nurses, early childhood development specialists, audiologists (who test hearing), optometrists (who check vision), or speech/language pathologists can all perform an evaluation. Assessments may include social, psychological, and educational evaluations and are usually done at clinics, schools, or by private agencies, depending upon the state's policies and age of the child. You can learn about a state's policy regarding evaluations and assessments by calling your family doctor or local hospital, local school district's special education department, or the state Department of Education.

Assessments provide medical and early childhood development specialists with information that can be incorporated into the goals and objectives of an intervention program (Johnson et al., 1994). Information for the assessment can come from all or some of the following:

  • doctors' reports;
  • results from developmental tests given to a child;
  • a child's medical history;
  • observations and feedback from members of the multidisciplinary team evaluating a child, including parents and caregivers; and
  • any other important observations and/or reports about a child.

The assessment results direct the intervention or specialized services the child will receive. "While assessment results provide partial evidence of a child's abilities and needs, intervention activities are planned to fill in the gaps, providing for specific needs, and at the same time building on a base of the child's abilities rather than disabilities" (Peck et al., 1993, p. 68). If, for example, a child's assessment showed that he or she could not stack blocks, the child would be given objects he or she could manipulate more easily, like soft toys or adaptive crayons.

The Referral Process
More children than ever are spending part or all of their weekdays in child care settings due to the increasing number of women with children under the age of six entering the workforce (Peck et al., 1993). Therefore, very young children may in fact be identified as having developmental delays and disabilities in the child care setting. Certainly, observations and reports from child care providers are an important part of the assessment process.

Because a child care provider may be the first to notice delays in a child's development, he or she may want to discuss his or her observations and concerns with the child's parents. The parents may have noticed a developmental delay also, but they may not know how to get help for their child or want to admit their child is having difficulty learning. In fact, a child care professional can provide a great deal of support to a family during the formal assessment process and the emotional turmoil of finding out that a child is having difficulties. This can be a painful and confusing time for families who want the best for their child, but are afraid of what the future might hold.

"The early childhood programs that care for children of employed parents often do not provide care for children with disabilities, and parents, regardless of income level, have a difficult time arranging for full-time care for these children" (Peck et al., 1993, p. 86). This reality may add to parents' fears and even result in a reluctance to have a child assessed. Assurance that help is available and that there are other families in the same situation whom they can talk to will be very helpful. "Service providers who provide emotional, educational, and informational support to families provide a vital link between the family and the service system" (Tocci et al., 1997, p. 4).

If a child care provider believes a child in his or her care has a developmental problem or disability, the child should be referred to someone who can perform an evaluation and assessment.

"Referral is the process whereby a child's family is directed to specific services by an individual or agency...the legislation includes a system for referrals to service providers that delineates time lines and provides for participation by professionals from primary referral sources such as hospitals, physicians, public health facilities, and related agencies. Community sources include private agencies, schools, and individual community members" (Johnson et al., 1994, p. 66). Referrals can be made any time and simply require a means of contacting specialists to determine a child's needs. However, it is important to discuss your concerns about a child's development with the family; explain what seems to be the problem; and suggest that parents consult with a pediatrician, clinic, or health department about their child's developmental delays.

To whom children are referred varies, both by the age of the child and the state's systems. Children over the age of three can be referred to the local public school. The special education administrator usually serves as the contact person. If there is no special education administrator, the school principal should be able to identify someone in the school district office who can answer questions about disability issues and preschool children. For children under the age of three, a referral can be made to that state's lead agency for early intervention programs or the Child Find office. Child Find is a service directed by each state's Department of Education or lead agency for identifying and diagnosing unserved children with disabilities. The National Information Center for Children and Youth with Disabilities, NICHCY, can provide information about each state's agencies, disability organizations, and parent groups. NICHCY also has fact sheets on specific disabilities and other publications (in both English and Spanish) to assist families, caregivers, educators, and other professionals.

There are excellent programs for children who need special assistance which are staffed by professionals trained in early childhood special education. However, many young children who have been found eligible for early intervention or special education services may remain in the child care setting for a variety of reasons, not the least of which is to have them with other children their age. These children may need some special assistance in certain areas, but for most of the day they need the same stimulation and support other children their age receive. For example, a three-year-old who is not yet talking may enjoy all the activities other three-year-olds enjoy and benefit from having other children around who are talking. Children want to be with other children and specialized services can be provided in a child care setting as well as in a classroom. "It is clear that the special education and related service needs of young children with identified or at-risk conditions can be appropriately met in settings that include normally developing children, such as day care" (Salisbury & Smith, 1993, p. 2).

Including Children With Disabilities
Educating children with disabilities together with typical children defines inclusion. Including children in settings for typically developing children requires a system that supports the children's special needs with money, staff, training, and equipment. "In attempting to implement seamless and inclusive service systems, all states are using a variety of collaborative and creative strategies to address a number of implementation challenges posed by the early childhood provisions of the IDEA legislation...Interagency Collaboration. All states and jurisdictions have or are developing coordination plans and interagency agreements with other initiatives such as Head Start, developmental disabilities, GOALS 2000, maternal and child health, child care and development, mental health, Healthy People 2000, Title 1 and Even Start, and Medicaid" (Trohanis, 1997, p. 4). Such collaborations bring together federal and state agencies, families, and caregivers and encourage the sharing of resources and skills, so that all participants benefit, most of all the children receiving the special services.

Personnel is another important component to including children with disabilities. There are both formal and mentorship training opportunities at all educational levels, including training for personnel who have no previous college education. In many instances a trained teacher or therapist can demonstrate certain activities or provide special devices to assist a child. The caregiver can learn how the child should sit or walk, help the child become more socially involved with the other children, provide tapes of stories instead of books, bring a special chair for the child to sit on, or provide a special spoon and fork to assist the child in eating. Formal training courses are offered at many colleges, community colleges, and in-service programs through the public school systems.

Whether called integration, mainstreaming, or inclusion, the placement of children with disabilities into settings designed for their non-disabled peers is an important goal. It is a goal in which all children are valued and individual differences are accepted. It is not necessarily easy; it takes understanding, commitment, training, and sometimes financial support. For example, a child care center that accepts a two-year-old who is blind may need additional staff, training, and some special toys. The challenge is not to "just do it" but to do it in ways that maximize children's growth in critical areas of development and foster communication, understanding, and acceptance between children with and without disabilities (Bricker, 1995, p. 193). Conclusion
The child care provider plays a very important role in the life of a young child and his or her family. The caregiver's attention to the needs of each child will help to shape his or her development, and create an awareness of the resources available for specialized assistance for those children whose development is not normal. The presence of a child with a disability in your program presents some challenges that you can meet. With time, "you realize why you have been given this little person. It isn't because you're some kind of saint. He is here to teach you never to take a spoken word for granted or consider a child's step ordinary. He is here to teach you about a strong spirit, acceptance, loyalty and love in the face of difficulty" (Rafferty, 1994, p. 26–27).

Suzanne Ripley is director of the National Information Center for Children and Youth with Disabilities (NICHCY). NICHCY is a national information and referral center which answers questions about children, ages birth to 21 years, who have disabilities. You can call NICHCY at 800-695-0285 to talk to an information specialist or visit the Web site at www.nichcy.org.

References
Bricker, D. (1995). The challenge of inclusion.Journal of Early Intervention. 19(3), 179-194.

Guralnick, M.J. (Ed.) (1997).The effectiveness of early intervention. Maryland: Paul H. Brooks.

Johnson, L.J., Gallagher, R.M., & LaMontagne, M.J. (Eds.) (1994).Meeting early intervention challenges. Maryland: Paul H. Brooks.

NICHCY. (1994).Accessing programs for infants, toddlers, and preschoolers with disabilities. A parent's guide.

NICHCY. (1996). Special education and related services: What the laws say.News Digest. Interim Update.

Peck, C.A., Odom, S.L., & Bricker, D.D. (1993).Integrating young children with disabilities into community programs. Maryland: Paul H. Brooks.

Rafferty, T.M. (1994). A graduation for two.Exceptional Parent, 24(2), 26-27.

Salisbury, C.L. & Smith, B. (1993). Effective practices for preparing young children with disabilities for school.ERIC Digest, #E519.

Tocci, L., McWilliam, R.A., Sideris, J., & Melton, S. (1997).Families' reflections on their experiences with early intervention services. Early Childhood Research Institute: Service Utilization.

Trohanis, P.L. (1997) Progress in providing services to young children with special needs and their families. NEC*TAS NOTES. U.S. Department of Education (1996). Eighteenth annual report to congress on the implementation of the Individuals with Disabilities Education Act. GPO: Washington, DC.