What is Early Intervention?
Early intervention (EI) services provide specific resources and professional help to families with children between 0-3 years of age. Services are provided based on concerns of developmental delay or signs of autism or for children with an identified conditions such as cerebral palsy or Down Syndrome. EI services are similar to special education services in that a team of professionals will collaborate with parents to determine where a child is performing and develop goals for the child to improve their abilities. The main difference between EI services and special education services is the age of the child. Children between 0-3 will usually receive services in the home or community environment versus a school setting.
The first three years of life serve as a significant developmental time period where many exciting abilities begin to appear. However, all children develop in unique ways and some may not meet the expected milestones on time. This is called a developmental delay, and is usually seen in one or more of the areas concerning cognition, communication, social and emotional skills or physical development. EI services are provided catch such delays at an early age so children can receive services to optimize everyday functioning as soon as possible. Research has show that the earlier the identification of a delay, the less impact it has to a child’s future development with proper intervention.
While a delay in milestones may not be cause for alarm, it is always important to take notes of what you are seeing to discuss with your pediatrician. Sometimes, it may be your pediatrician who notices something and makes a referral. But in many cases, a parent’s instinct or “gut” feeling should be followed up on. With the right amount of support, milestones can typically be reached, especially if caught at an early age.
In addition, it is important to note that some children may skip milestones as well. An example would be a child who didn’t crawl, but went straight to walking. While this might seem like a something to be proud of, learning the process of coordinating arms and legs to crawl is foundational for many other types of coordinated movement.
Missing this learning opportunity can lead to deficits in later emerging skills that rely on elements of this type of coordination. One might see this child performs certain activities at a slower pace or in an awkward manner. Fortunately, different types of professionals can identify areas of concern and facilitate milestone development for your child. The Individuals with Disabilities Education Improvement Act (IDEA) details specific criteria that states must comply with or risk losing federal education dollars.
Individuals with Disabilities Education Act, Part C
Occupational therapists (OT) provide primary services to children and support their family/caregivers under part C of the IDEA. Part C focuses on enhancing the skills of a child by providing the means to facilitate the highest level of independence in their daily occupations. Outcomes of intervention are heavily reliant on what is taught and modeled during OT sessions with parents and caregivers applying recommended strategies. The more prepared and educated the child’s support system is, the more a child will thrive despite any conditions or delays.
Individualized Family Service Plans
Under the IDEA, children under 3 years of age with an identified delay are provided with a team, headed by a service coordinator and an Individualized Family Service Plan (IFSP). This is a detailed plan that lists all of team’s findings as well as the recommended services and functional outcomes for a child. IFSPs prioritize family support and their involvement in both creating and understanding recommended goals for the child. Information from family interviews and collaboration lead to answered questions, recommendations and treatment goals that are child-centered. Family understanding and involvement almost always leads to the greatest gains in the intervention process.
Does My Child Qualify for Early Intervention Services?
All states have varying requirements to qualify for EI services. A family who’s child was tested and didn’t qualify for intervention services, but still have concerns can request further testing and evaluation three months after their initial assessment. Testing is free of charge and you may still decide to seek services (occupational therapy, physical therapy, speech therapy, etc.) to address any concerns if your child does not qualify. The cost will vary for these services if they are not provided under IDEA. However, if your child does qualify, under IDEA there is no cost to you.
Who Might be on Your IFSP Team?
The member of your child’s IFSP team will vary depending on your child’s needs. You and your service coordinator will review the IFSP every 6 months so goals and services remain current with your child’s skill level.
- Speech Language Pathologists (SLP)
- Physical Therapists (PT)
- Occupational Therapists (OT)
- Counselors (for both the child and parents/caregivers)
- Social Worker
- Service coordinator
Cost of Services
Fortunately, families of children with identified needs will receive services for free, or at a significantly reduced cost due the public funding provided for these programs. For the state of California, no state system has been proposed to require payments from families for EI services. As of 2020, parents in California are not responsible for any deductibles or copayments relating to their child’s services. These services remain free of cost as long as parents allow regional centers to use private insurance as a means of payment. Below is a list of free services provided in every state, as required by the IDEA:
- Identifying “at risk” children or those who already require services
- Screening: To see if your child requires further testing
- Assessments/Evaluations by the appropriate profession(s).
- Ongoing Assessments: To determine service continuation
- Family Assessment: To determine needs of the family (counseling, resources)
- Individualized Family Service Plan (IFSP)
- Service coordination
- Transition Services: For a seamless transition from EI to services needed in school settings
Regional centers are nonprofit private corporations that work to identify and provide accessible resources to the families/caregivers and children. They work with the state of California to ensure compliance with the mandates of the IDEA. There are 21 regional centers located throughout California. The types of services offered at a regional center are listed below (Network of Care, 2020):
- Assessment and diagnosis
- Lifelong service coordination
- Financial management of necessary services
- Community resources
- Advocacy for the protection of legal, civil and service rights
- Early intervention services for at risk infants and their families
- Genetic counseling
- Family support
- Planning, placement, and monitoring for 24-hour out-of-home care
- Training and educational opportunities for individuals and families
- Community education about developmental disabilities
Families in San Diego can contact their regional center here.
How Can Occupational Therapy Help Your Child?
Your child participates in many occupations that contribute to typical development, including ADLs, sleep, education, social participation, and most importantly, play. An occupational therapist works with your child to facilitate engagement in these meaningful occupations in a natural environment for easy learning. Resources and supports are always available for family members. To begin, occupational therapists have eight core principles to keep in mind when creating an intervention plan for your child.
Your OT will work with the family and child on ways to increase participation in meaningful and purposeful daily routines. Such a simple idea is crucial because everyday interaction with people, environments and routines introduce new stimulus to promote optimal learning and regulation.
Any activity completed throughout the day is an occupation as any activity you engage in is something you need or want to do and provides meaning to your life. It is extremely important to encourage independence in your child to promote independence, self-efficacy and a sense of accomplishment.
The family-centered approach emphasizes the family’s concerns and their knowledge about the child and integrates this information into the intervention plan. Together, the family and therapist can identify the child’s strengths and barriers to success. It directly correlates with the client-centered approach that OTs use in practice. The client-centered approach promotes collaboration with the client to ensure their needs and meaningful occupations are taken care of. In this approach, the client is the expert.
Family Capacity and Resources
A family’s capacity consists of the resources, knowledge and skills required to facilitate their child’s developmental needs, “Capacity is the amount of physical, emotional and spiritual energy necessary to support the development of a child” (Stoffel & Schleis, 2014, p. 1-2). Resources can be medical or financial in nature and generally relate to the needs of the child. Although each familial situation is unique and some may not have access to as many resources as others, this does not mean that all families cannot be resourceful.
Providing services in settings that the child will need to engage in is crucial for implementing an effective treatment plan. A child’s success in therapy is already a great achievement. However, transferring a newly learned skill from one environment to the next can result in frustration and setbacks. In order to ease the learning curve, it is optimal for services to be provided in the child’s natural environment, such as the home, community, or even the playground. Natural environments are crucial to developing interventions so the child is not forced to give up an occupation because they lack the skills to engage with their environments safely.
Family Routines and Rituals
- Routines provide structure for everyday life. OTs encourage the child to participate in their family’s daily routines to promote functional engagement in their social environment. Types of routines include morning, night time, bath time, meal time and playtime.
- Rituals are symbolic and performed because of their meaning to the individual. They provide an identity and can be passed down through generations, which helps to build stronger relationships throughout the family.
Maintaining cultural competency is key when developing interventions because each family will have their own set of household “rules.” These rules pertain to preferred ways of communicating or parenting. Interventions will yield more success if they align with the family’s cultural values, even if they differ from the practitioner’s, “Service providers should seek to understand, not judge” (Stoffel & Schleis, 2014, p. 1-2).
In order to provide the best service possible, practitioners are required to remain up to date on the latest research. Occupational therapy is a science driven to produce the most effective interventions.
Early Intervention and Special Education
Some parents are concerned that by seeking help, their child will be “labeled” as they enter preschool and kindergarten. EI services do not automatically qualify your child for special education. Information about your child’s past EI services are not shared with the school system and your child will only receive special education if necessary. In addition, there is no set amount of time that your child has to receive services. They may only require temporary services to address a developmental delay and will be discharged before even starting school. If your child requires services after age 3, your service coordinator will help with the transition to IDEA, part B, which provides services from ages 3-21.
What Will Happen to My Child’s Services After Their 3rd Birthday?
As mentioned above, you do not need to worry about the discontinuation of services for your child as they “age out” of EI. A transition meeting will be arranged by the service coordinator to discuss whether to seek special education services (otherwise known as part B of IDEA). If recommended and if you agree, these new services will pick up right where EI left off to ensure there are no gaps in the child’s learning. This meeting will take place a few months before your child’s 3rd birthday to ensure that everything is in place for the transition and any concerns are addressed.
“Developmental Milestones.” Center for Parent Information and Resources, 8 Mar. 2019, www.parentcenterhub.org/milestones/.
“Improving Systems, Practices and Outcomes.” ECTA Center, ectacenter.org/.
“San Diego Regional Center.” Sdrc.org, sdrc.org/.
Stoffel, A. & Schleis, R. (2014). What is the Role of Occupational Therapy in Early Intervention? The American Occupational Therapy Association. https://www.aota.org/~/media/Corporate/Files/Practice/Children/Browse/EI/Role-of-OT_1/Early-Intervention-FAQ.pdf
“What Are Regional Centers?” The California Department of Developmental Services Napa County, California, napa.networkofcare.org/mh/library/article.aspx?id=488.