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

Why DOH needs your help to 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

ELIGIBILITY FOR EARLY INTERVENTION SERVICES Developmental Delay Biological Risk Environmental Risk

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

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

Examples of biological risk 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

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

EARLIER IS BETTER

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

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

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

EARLY BRAIN DEVELOPMENT

Synapse pruning: the child with developmental challenges 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 Causes Secondary Conditions

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)

Attachment Problems Influence Brain Development: Babies with special needs 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 CausesConsequences

The brain develops from lower to higher levels therefore Early experience has more pervasive impact

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

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 Adapt child’s environment Parent education and support How early intervention can help

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

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

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

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