1. Research in Early Childhood Intervention FuJen Catholic University Professors Sharon Rosenkoetter & Pauline Su Fall 2008 – Set #1

2. This Weekend Introductions Introductions Syllabus Syllabus What is Early Intervention? What is Early Intervention? Why intervene early? Why intervene early? Kinds of risk Kinds of risk Risk factorsIssues at birth Risk factorsIssues at birth Home visiting Home visiting Characteristics of ECI Characteristics of ECI Reflections on readings Reflections on readings Substance exposed children Substance exposed children Adapted sport Adapted sport

3. Students Introduce Selves

4. Here’s Professor Pauline Su

5. Here’s Dr. Sharon Rosenkoetter

6. SOP – Standard Operating Procedures We will start and stop on time We will start and stop on time Please turn off cell phones Please turn off cell phones We will hold classroom comments in confidence We will hold classroom comments in confidence We will avoid side conversations We will avoid side conversations We will try to encourage fearful colleagues We will try to encourage fearful colleagues Food and drink in class are OK Food and drink in class are OK Please voice questions and comments Please voice questions and comments Others? Others?

7. Syllabus Go over requirements * * * Use PEOPLE FIRST language!!!!! Child with a disability, NOT disabled child Mother living in poverty, NOT poor mother Father who is not working, NOT out-of-work dad Use the person first, description last

8. Early Childhood Intervention is… entering into typical family & entering into typical family & early childhood activities early childhood activities with individualized support with individualized support to help the family to help the family accelerate the child’s accelerate the child’s development development

9. Young Children Are at the Center of ECI BUT families are VERY important in ECI! – Families LOVE their child & are the child’s best teacher – Families seek information & use it to make decisions – Families guide choice of program & services – Families have needs that ECI can help them meet

10. Young children may be called… typically developing typically developing or or at-risk at-risk

11. 3 Kinds of Risk 1. Biological risk 2. Established risk 3. Environmental risk Each may exist alone or with another kind of risk

12. 1. Biological Risk physical possibility of a problem physical possibility of a problem but it has not yet led to developmental difficulties but it has not yet led to developmental difficulties Example: preterm birth, genetic predisposition, weak immune system)

13. 2. Established Risk Child shows a condition or diagnosis that is known to lead to developmental difficulties Child shows a condition or diagnosis that is known to lead to developmental difficulties Examples: Down Syndrome, missing arm or leg, cystic fibrosis, Failure to Thrive

14. 3. Environmental Risk Issues Issues – Poverty – Adolescent parenting – Parental mental illness or substance abuse – Maltreatment – Community or domestic violence – Unsafe surroundings that may lead to developmental difficulties These may exist alone or with other risks These may exist alone or with other risks

15. Programs may be designed for one kind of risk (e.g., poverty) but most serve CHILDREN, not RISKS

16. Every Child Has… Risks that endanger the developing child -- may or may not cause actual harm Risks that endanger the developing child -- may or may not cause actual harm Resilience, or protective factors that counter the effects of risks Resilience, or protective factors that counter the effects of risks Always we want to lower the risks & increase the resilience

17. Small Group Activity Form into 4 groups Form into 4 groups Two groups list all the risk factors that you can think of that may lead to bad outcomes for a child Two groups list all the risk factors that you can think of that may lead to bad outcomes for a child Two groups list all the protective factors that you can think of that may help the child avoid bad outcomes Two groups list all the protective factors that you can think of that may help the child avoid bad outcomes You will report back You will report back REPORT BACK

18. Prevention Trying to increase resilience & Decrease risk

19. 3 Levels of Prevention – from Public Health 1. Primary prevention – teach all people to use good health practices to reduce risk factors & reduce the number of new problems (cases) Example: teach women to avoid alcohol during pregnancy

20. 3 Levels of Prevention 2. Secondary prevention – use intervention to make the condition less serious and perhaps help it end sooner Example: Speech therapy to help a child with Fetal Alcohol Spectrum Disorder talk better

21. 3 Levels of Prevention 3. Tertiary prevention – intervention to reduce related effects of the problem, direct or indirect 3. Tertiary prevention – intervention to reduce related effects of the problem, direct or indirect Example: Behavioral planning & environmental arrangement to help a child with Fetal Alcohol Spectrum disorder avoid serious behavior problems

22. Early Intervention Does All 3 types of Prevention #1 – teaches all people so problems don’t happen #2 – intervenes to address a problem #3 – intervenes to prevent secondary problems that are related to the initial problem

23. Why is Early Intervention the right thing to do?

24. 1. Humans can be shaped during the early years 2. The early years set the pattern for later learning and behavior 3. During the early years, children learn best 4. This is the time to minimize disability & prevent secondary disabilities 5. The environment & early experience are significant in determining life outcomes

25. Why is Early Intervention the right thing to do? 6. Early Intervention succeeds in improving outcomes – it works! 7. Families need support to help their children learn 8. There are economic benefits – Early Intervention saves money for the society over the child’s life 9. There are social benefits – it is the right thing to do to help vulnerable children

26. Provide examples of these 9 on wall charts You may write in Chinese! Then we will go about and read what others have written COMMENTS FROM PROFESSOR SU

27. Reflect & Write – 15 Minutes What are the main messages you will take home? What are the main messages you will take home? How you will use this information in your work or family life? How you will use this information in your work or family life?

28. Continuum for Early Childhood Development – and Risk Prenatal period shapes the brain architecture Prenatal period shapes the brain architecture Natal events predispose child to later challenges Natal events predispose child to later challenges Birth to age 3 – period of most rapid growth – foundational for later development Birth to age 3 – period of most rapid growth – foundational for later development Ages 3-5 – development of complex skills – basic for a lifetime Ages 3-5 – development of complex skills – basic for a lifetime “Bottom up” learning

29. In the Beginning… A normal pregnancy is 38-42 weeks after conception A normal pregnancy is 38-42 weeks after conception A birth before 38 weeks gestation is pre-term (sometimes called premature) A birth before 38 weeks gestation is pre-term (sometimes called premature) A birth after 42 weeks gestation is post-term A birth after 42 weeks gestation is post-term 25-29 weeks gestation 25-29 weeks gestation See video: The Miracle of Life

30. What message do you take from that video?

31. In the Beginning… In the Beginning… Major brain development happens 25-29 weeks gestation Major brain development happens 25-29 weeks gestation Too early birth means that development must happen outside the womb Too early birth means that development must happen outside the womb Toxic exposure in utero can harm the brain forever Toxic exposure in utero can harm the brain forever Brains are built over time Brains are built over time Interactive influence of genes & experience literally shape the architecture of the developing brain Interactive influence of genes & experience literally shape the architecture of the developing brain The medium for that is the turn taking of relationship with caregivers The medium for that is the turn taking of relationship with caregivers

32. What Can Go Wrong? Mortality – death happens Mortality – death happensOR Morbidity – some part of the body is harmed Morbidity – some part of the body is harmed

33. Times When the Child Is Most Vulnerable Times when biology or environment (or both) may assault the developing child Prenatal – prior to birth Prenatal – prior to birth Perinatal – around the time of birth Perinatal – around the time of birth Postnatal – at least 18 hours after Postnatal – at least 18 hours after birth birth

34. 3 Levels of Hospital Nursery in the U.S. Level 1 -- typical care center for newborns Level 1 -- typical care center for newborns Level 2 -- more intensive care for newborns Level 2 -- more intensive care for newborns Level 3 -- neonatal intensive Level 3 -- neonatal intensive care care – NICU – only a few in each region

35. NICU Baby lives in a controlled environment -- round the clock observation Baby lives in a controlled environment -- round the clock observation “Procedures” honor baby’s natural “Procedures” honor baby’s natural biological cycles biological cycles Transdisciplinary team serves Transdisciplinary team serves baby and family baby and family Video: The Neonatal Experience

36. Newborn Conditions that May Lead to Mortality or Morbiditity Sepsis -- infection Sepsis -- infection RLF – vision impairment RLF – vision impairment RDS – respiratory distress RDS – respiratory distress IVH – brain bleed IVH – brain bleed PDA – heart defect PDA – heart defect NEC – intestinal decay NEC – intestinal decay For families, the NICU is an unforgettable experience Video: The Neonatal Experience

37. What is your reaction to this video? For families, the NICU is an unforgettable experience. What experience have you had with this?

38. Sometimes infants are “stepped up” or “stepped down” in nurseries within a hospital or are transported by helicopter or ambulance to a facility that provides more or less intensive care

39. Early Intervention Begins Early Medical and social work in NICU Medical and social work in NICU Home visits soon after Home visits soon after Support for family, connection to other families, help in understanding the condition Support for family, connection to other families, help in understanding the condition Therapy for baby Therapy for baby Information! Information!

40. With a Troubled Pregnancy… Efforts now to get the mother to the hospital with a Level 3 nursery (NICU) before the baby is born Efforts now to get the mother to the hospital with a Level 3 nursery (NICU) before the baby is born Most important in rural areas

41. When the Baby Comes Home – Home-Based Services Parents need even more support Parents need even more support Team of health care professionals, therapists, teachers Team of health care professionals, therapists, teachers Use evidence-based approaches & take data on their effects with this child Use evidence-based approaches & take data on their effects with this child Early Intervention can come into the home Early Intervention can come into the home – EI, Early Head Start, Healthy Start, Parents as Teachers – Must be frequent enough – Must focus on child’s needs and the home context

42. History of Home Visiting Began in the 1850s in city slums – visiting nurses Began in the 1850s in city slums – visiting nurses 1900 – social workers aiding families in poverty 1900 – social workers aiding families in poverty 1935 – 1st U.S. maternal & child health law with home visits 1935 – 1st U.S. maternal & child health law with home visits 1950s – U.S. home visits for children with 1950s – U.S. home visits for children with disabilities; expansion of visiting nurses disabilities; expansion of visiting nurses 1970s – growth of War on Poverty home visits 1970s – growth of War on Poverty home visits 1985 – expansion of Early Intervention (disabilities) & 1985 – expansion of Early Intervention (disabilities) & child abuse prevention home visits; Parents as Teachers child abuse prevention home visits; Parents as Teachers 1990s – Early Head Start – most effective when starts with prenatal1990s – Early Head Start – most effective when starts with prenatalTAIWAN?

43. Rationale for Home Visiting 1. Parents are the most important teachers & home is where they largely teach; services should largely teach; services should happen there 2. Parents can learn more effective ways to relate to their children 3. Supporting parents will lead to improved child outcomes

44. Possible Emphases for a Home Visit 1. Basic care skills, immunizations OR 2. Reduce parent stress OR 2. Reduce parent stress OR 3. Education & development 3. Education & development

45. Issues 1. Should professionals or paraprofessionals serve? Which kind(s) of professionals? 2. Does home visiting “work”? 3. Better – under what conditions does it work? 4. Better – who does it work for? 5. What intensity is necessary for home visiting to have the desired impact? Video: Home-Based Services

46. What observations do you have about this?