Early childhood intervention

Early childhood intervention (ECI) is a support and educational system for very young children (aged birth to six years) who have been victims of, or who are at high risk for child abuse and/or neglect as well as children who have developmental delays or disabilities. Some states and regions have chosen to focus these services on children with developmental disabilities or delays, but Early Childhood Intervention is not limited to children with these disabilities.
The mission of early childhood intervention is to assure that families who have at-risk children in this age range receive resources and supports that assist them in maximizing their child's physical, cognitive, and social/emotional development while respecting the diversity of families and communities.
Definition.
Early intervention is a system of coordinated services that promotes the child's age-appropriate growth and development and supports families during the critical early years. In the United States, some early intervention services to eligible children and families are federally mandated through the Individuals with Disabilities Education Act. Other early intervention services are available through various national, regional, and state programs such as Crisis Nurseries and Healthy Start/Healthy Families America. Starting with a partnership between parents and professionals at this early stage helps the child, family and community as a whole.
Early intervention services delivered within the context of the family can aid with the below through the services of physical, occupational, and speech therapy. Some examples include:
The earlier children at high risk for abuse or neglect, of children with or at risk of disabilities receive assistance and the sooner their families receive support towards their child's development, "the farther they will go in life".
History.
Early childhood intervention came about as a natural progression from special education for children with disabilities (Guralnick, 1997). Many early childhood intervention support services began as research units in universities (for example, Syracuse University in the United States and Macquarie University in Australia) while others were developed out of organizations helping older children.
In the 1990s, many states in the US put into place a program where the child's pediatrician can recommend a child for early childhood intervention screening. These services are usually provided free of charge through the local school district or county, depending on the state.
Individuals with Disabilities Education Improvement Act (IDEA) Part C.
The Part C (originally Part H) program mandates a statewide, comprehensive, multidisciplinary service system to address the needs of infants and toddlers who are experiencing developmental delays or a diagnosed physical or mental condition with a high probability of an associated developmental disability in one or more of the following areas: cognitive development, physical development, language and speech development, psychosocial development, and self-help skills. In addition, states may opt to define and serve at-risk children. The therapies provided by IDEA can be found in the home, child care, early head start, and community settings such as the county. Commonly cited factors that may put an infant or toddler at risk of developmental delay include low birth weight, respiratory distress as a newborn, lack of oxygen, brain hemorrhage, infection, and prenatal exposure to toxins through maternal substance abuse.
Every state now implements Part C fully. The original legislation provided a five-year phase-in period for states to develop their comprehensive system of service for the affected population. Although IDEA does not mandate states' participation in Part H/C, powerful financial incentives from the federal government have led every state to participate. States were provided extensions of the 5-year period as they struggled with the logistic, interagency, and financial demands of developing a statewide system. To ensure a coordinated approach to service delivery and financing of services, federal regulations of Part C require that states develop interagency agreements that define the financial responsibility of each agency and impanel a state interagency coordinating council to assist the lead agency in implementing the statewide system. Regulations also prohibit the substitution of funds and reduction of benefits once the plan is implemented in each state (United States Department of Education, 1993). As states and federal territories (for example, Guam, Puerto Rico, the Virgin Islands) began to plan for implementation of P.L. 99-457 and later IDEA, their first obligation was to designate an agency that would provide leadership in the planning and administration of the state's comprehensive system. In 1989, 22 states or territories had the department of education as lead agency, 11 others had the department of health, another 9 had the department of human services, and the remaining states had combined departments or departments of mental health or developmental disabilities (Trohanis, 1989).
Meeting developmental milestones.
Every child is unique, growing and developing at his or her own rate. Differences between children of the same age are usually nothing to worry about. However, for one child in 10, the differences can be related to a developmental delay. The sooner these delays are identified, the quicker children may be able to catch up to their peers.
Identifying these delays early is also important because the most critical time for brain development is before the age of three. The brain develops in an experience-dependent process. If certain experiences are not triggered, the pathways in the brain relating to this experience will not be activated. If these pathways are not activated, they will be eliminated.
Milestones birth to three.
At age one month most children can:
At age three months most children can:
At age six months most children can:
At age 12 months most children can:
At age 18 months most children can:
At age 24 months most children can:
At age 32 months most children can:
However, if a child is premature it is not correct to compare them to this list of developments to be achieved by the age of three. Their chronological age of a premature child needs to be considered. That is, if a child is 12 weeks old but was born four weeks early, then the child's chronological age is only eight weeks. This is the age that needs to be considered when comparing the child's developments to others.
Recent discovery has also suggested that in some premature children the delays do not appear until the age of three, suggesting that all premature children receive Early Intervention Therapy rather than just those who appear to have developmental delays.
Early intervention services.
The following is a list of what early intervention can provide:
Providing early childhood intervention.
Robin McWilliam (2003, 2010) developed a model that emphasizes five components: Understanding the family ecology through eco-maps; functional needs assessment through a routines-based interview; transdisciplinary service delivery through the use of a primary service provider; support-based home visits through the parent consultation; and collaborative consultation to child care through individualized intervention within routines. "These services are to be provided in the child's natural setting, preferably at a local level, with a family-oriented and multi-dimensional team approach".
A very common form of early intervention provided is a therapist coming into the home and playing with the child with toys. Large toys such as wagons and puzzles can be used to aid the child in muscle development while toys like bubbles can be used to aid in sensory development. With services like this the care provided is in a neutral setting at a local level and the family and therapist team are present. Experts in early intervention have, however, discredited this form of early intervention in favor of using the visit to build the capability of the child's natural caregivers (e.g., parents), so the child receives much more "intervention" throughout the week than would be received in a single visit, directly from the professional. 
Early childhood intervention may be provided within a centre-based program (such as Early Head Start in the United States), a home-based program (such as Portage in Britain), or a mixed program (such as Lifestart in Australia). Some programs are funded entirely by the government, while others are charitable or fee-paying, or a combination.
An early childhood intervention team generally consists of teachers with early childhood education training, special education specialists, speech and language pathologists, physical therapists (physiotherapists), occupational therapists, and other support staff, such as ABA (Applied Behavioral Analysis) providers, music therapists, teacher aides/assistants, and counselors. A key feature of early childhood intervention is the "transdisciplinary model", in which staff members discuss and work on goals even when they are outside their discipline: "In a transdisciplinary team the roles are not fixed. Decisions are made by professionals collaborating at a primary level. The boundaries between disciplines are deliberately blurred to employ a 'targeted eclectic flexibility'" (Pagliano, 1999).
Goals are chosen by the families through the annual or biannual Individual Family Service Plan (IFSP), which evolves from a meeting where families and staff members talk together about current concerns, as well as celebrating achievements. McWilliam's Routines-Based Interview, in which caregivers talk about the details of the child's and family's day, is used in many parts of the world to develop the family's chosen goals.
A significant application of the transdisciplinary model, was developed by Relief Nursery, Inc. of Eugene, Oregon, an early pioneer of the model. Founded in 1976 as a local child abuse prevention effort, Relief Nursery became a pilot project under the National Crisis Nurseries Act of 1986 Working with early childhood experts Christine Chaille and Lory Britain and representatives from the local community, the approach was refined into a new comprehensive family services model, so successful that it was replicated at more than 30 sites in the State of Oregon. The model attracted national and international interest, recognized in 2002 by the U.S. Department of Health and Human Services, Office on Child Abuse and Neglect (OCAN), as an "innovative program with noteworthy aspects", and becoming part of a project sponsored by Holt International in 2008, to introduce the model into the Ukraine as an alternative to their existing -- and failing -- orphanage model.
Criticism.
Some criticism of early childhood intervention asserts that growing up is different for each individual, depending on genetic endowments and environmental circumstances. However, one thing is common to everyone: the process, in order to take full advantage of the species' potential, must be a natural ripening, without interference from clumsy intruders. Some critics of early childhood intervention say that no one should push healthy children to learn any skill or academic discipline before they choose to do so of their own accord. 
The family-centered ethos in early intervention programs, however, supports families' desires for their children to be engaged, independent, and social in their everyday routines. The choice is therefore not the child's but the parents', who are urged to follow the child's lead.
In the US state of Georgia, the program "Babies Can't Wait" was put in place to help parents find early intervention therapy. The program works the same as many government-mandated early intervention programs in that it first evaluates the child for free, and then deems what services the child needs to receive. 
However, this particular program has received two major criticisms, for its timeline and for the collaborative model it provides. The program has 45 days to evaluate the child, then has another 45 days to develop a plan and provide services for the child. Due to limited providers working with "Babies Can't Wait", the deadline is sometimes not met and the services are not provided.
"Babies Can't Wait" works on a collaborative model, with medical professionals communicating with each other about the services each child needs. A physical therapist would consult with a speech therapist, and then the physical therapist would provide the child with speech therapy as part of the child's physical therapy session, instead of the child having an additional therapy session with the speech therapist.