Transcript: Early Intervention

Presented by Alicia Sebastian

Parenting Together Pathway, Trying Together

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>> Hello everybody. Thank you all for joining for our session today for Trying Together. My name is Alicia Sebastian and I am an Early Head Start coach. You can see my information listed below with my cell phone number and my email address. You can shoot me an email after our presentation today, ask any questions you may have and we will talk more about early intervention during our presentation. 

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This video is a part of the Parenting Together Pathway, a series of sessions to provide high-quality information on early childhood development to parents and caregivers in Allegheny County and surrounding areas. Today we will be talking about early intervention in Allegheny County. After the completion of today’s presentation, I am hopeful that you will be able to better understand the Allegheny County early intervention processes, ways that parents and caregivers can track developmental milestones and connect with community resources, and strategies and resources that can be used to encourage development. Before we get started let’s quickly define some terms that you might be hearing me say throughout today’s presentation. 

First off we’ll start off by defining what is a developmental milestone? We define these as the markers that parents and caregivers use to understand how the child should be developing. When we think about developmental milestones, we’re talking about what 90% of a child is able to do at a certain age. Next we want to define early intervention. This is defined by the CDC as services and supports available to babies and young children with developmental disabilities and their families. An important piece of early intervention is viewing the child as a whole. This means looking at their family, their community, and their culture. 

Lastly we’ll be defining developmentally appropriate practices or also known as DAP. These are defined as the methods used to promote each child’s optimal development and learning through a strength-based, play-based approach to learning. Developmentally appropriate parenting involves the use of DAP but applies them to the daily life with small children because it is believed that parents are the first teachers. 

Early intervention is a state funded service that provides support to families and children ages birth to five years old. Children who are born in the foster care system or may have been born premature are examples of children who automatically qualify for these services. We’ll talk more about qualifications later in our presentation. These services are state funded and free of cost to families and caregivers. These services are protected under the Individuals with Disabilities Education Improvement Act also known as IDEIA under part C. 

One of the most important pieces of EI is the use of practice-based coaching. This form of teaching allows for the professional to transfer their skills to a caregiver or a parent so they can implement the strategies easier throughout day to day routines. 

It is essential that there is a transfer in skills to encourage long-term learning and success. The coaching is done primarily by the therapist who is assigned by one of several early intervention providers in the county. The therapist works in collaboration with the service coordinator to ensure that the IFSP is being used effectively. When we think about early intervention services in Allegheny County, I view it as an umbrella covering a range of services, providers, and teams. 

This visual shows us the two sides of early intervention. On the left side we see that there are birth to three services and these fall under the Alliance for Infants and Toddlers also known as AFIT. These services are provided by the Alliance and include service coordination and evaluations to determine eligibility. Service coordinators work with families and a team of therapists to implement a collaboratively created service plan to set goals and outcomes focusing on development. The team includes therapists from independently owned therapy providers in Allegheny County and currently there are about six of these. 

Next, on the right side of the umbrella we see services for children ages three to five. Under this category we have the Allegheny Intermediate Unit also known as the AIU3, DART, and specialized early intervention classrooms. The services provided for infant and toddlers all fall under this category of early intervention. But as you can see there really are two different sides to this equation. 

Several weeks before a child is expected to turn three, the team will work towards the child’s transition from the zero to three services to three to five services. Although they work together as a whole you can see that they are an entirely different entity and that is what I’m going to be doing next is breaking down the umbrella further throughout the rest of the presentation. You or your pediatrician suspect your child between the ages of birth to three years of age has a developmental delay. 

Now what? So, during the first few years of your child’s life your pediatrician will schedule for regular well-visits. These visits will help both you and your doctor keep track of your child’s developmental trajectory. An example of a concern for a delay that might arise during one of these visits could be that your 11 month old child is not yet crawling. 

The next steps would be to contact the Alliance for Infants and Toddlers to request a free evaluation. An evaluation using a standardized developmental screening tool will be administered in the child’s least restrictive environment by trained professionals. The screening will include a series of questions, activities, and tasks that will be presented to the child to complete in all developmental domains. 

These milestones can be broken down into several domains that are listed here. We have cognitive, physical, adaptive, personal/social, and speech and communication. These domains all have their own markers and ways to measure progress. A child must receive a 25% delay in at least one area of development to qualify for services unless there is a pre-existing condition. 

Pre-existing conditions can be Down syndrome, fetal alcohol syndrome, or if a child is born prematurely. After the evaluation is completed and scored, the evaluator and service coordinator will work with the parents and caregivers to create goals and outcomes for the child’s Individualized Family Service Plan or IFSP. 

An example of an outcome for the child that I had mentioned above, the 11 month old who is not yet crawling, could read, “The family would like for Johnny to use arms and legs to crawl simultaneously so that he is able to independently access materials and toys in the home and child care settings.” 

Now let’s break this down quick. We hear a few things in the statement, one being who, the child and the family. Two being why is this skill important? So that the child is able to independently access his materials. And the last piece is where? The child’s least restrictive environment is both the child care and the home. Least restrictive environment can also mean the child’s natural environment or where they spend the majority of their time. 

After the IFSP is created along with outcomes and recommended services, the family will be assigned a therapist who will work closely with the child and the family and caregivers to help provide coaching in implementing strategies to achieve the outcome. You see on the screen the commonly listed therapies that will be used in early intervention. 

We have physical therapy which is focusing on motor movements such as crawling, standing, and walking. There is speech/language therapy focusing on encouraging sounds and making different gestures. There is occupational therapy where we are focusing on the use of fine motor skills such as encouraging children to pick up items using their fingers and also focusing on some sensory integration, so helping them become more comfortable using their hands with sand or Play-Doh. 

Next we have behavioral or developmental therapy and this focuses on helping the child learn how to follow directions and complete tasks. And the last two would be eating and nutrition support from a nutritionist and mental health support from an infant mental health therapist. Services provided by the therapy team will occur until the team has agreed that a goal or outcome has been achieved or if the child is approaching their third birthday. 

Then a transition plan will be put into place for the switch over to three to five services. You or your pediatrician suspect your child between the ages of three to five years of age has a developmental delay, now what? Your doctor might recommend an evaluation or referral to the Allegheny Intermediate DART program or preschool early intervention program due to a possible delay in the development. The evaluation and referral process is similar to that of the zero to three early intervention realm but the service providers change. 

If a child is currently receiving EI services a few months before a child’s third birthday, an evaluation will be done to check progress and development. If a child still shows delay in a developmental area, they will transition to three to five services provided by the Allegheny Intermediate Unit. DART, which stands for discovery, assessment, referral, and tracking, is free to families and also provided in the least restrictive environment. 

However, instead of the zero to three early intervention focusing on home based therapy where parents are heavily involved in the coaching and implementation of the strategies, the three to five therapists are providing more support in classroom settings. The classrooms could be something like a specialized early intervention classroom where therapists work directly in the classroom or a general education preschool classroom where itinerant therapists provide services based off of the needs of the child’s IEP. Itinerant services provided are similar to that of the zero to three realm and also include speech therapy, physical therapy, occupational therapy, and behavioral therapy. 

I spoke previously about the IFSP or the Individualized Family Service Plan. However, when a child transitions to three to five, the plan is converted into an IEP or Individualized Education Plan. To compare these plans, the IFSP is focused on the family and the child while the IEP focuses on the child and their least restricted education setting. 

How do you as a parent, caregiver, or early childhood provider track and understand developmental milestones? There are many different tools than can be used to keep track of your child’s skills and development. There are virtual apps that you can download to your phone or your tablet. There are charts and visuals, pamphlets, and brochures that can be found at doctors’ offices, child care settings, preschools, and early intervention providers may also have some shared resources that they can use as tools to help track development. 

One of the most valid and recognized trackers used is developed by the CDC called the CDC Developmental Milestones Tracker App. Why is it important for us to track milestones and development? Research shows that the sooner development services start, the better the progress and overall outcomes it is so that children can develop appropriately and increase their chances of learning and maintain development throughout their later years in life. 

By maintaining regularly scheduled visits with your pediatrician, you are being proactive in the development of your child. One important takeaway from this presentation is to keep in mind that when you’re tracking your child’s development that each child develops in their own way. Some children may skip over a milestone entirely while others just take more time to develop that skill. 

This visual representation of a pathways to development breaks down the skills developed between six months to four years of age. You can see the order of skills starting from the beginning. We have a six-month old starting with copying sounds, beginning to sit without support, and then it goes down the line such as using simple gestures, waving bye-bye. 

We see in 18th-month realm where kids are walking alone. They then begin to start to kick a ball. We then see around three years of age they’re beginning to climb and down where we see four years of age they’re beginning to hop and stand on one foot. This visual provides a wonderful look at the journey through developmental milestones but it is also a very broad tool. This is an easy to use checklist that parents can use to take to doctors visits but it doesn’t go in-depth with all of the domains of development. 

The last piece of our presentation is how do we support development? Parents, caregivers, teachers, and professionals working with infants and toddlers can help support their development in ways that can be intentional or unintentional. Some things to remember when supporting a child’s development is meeting them where they are at. We don’t want to teach a child how to start to walk if they have not yet learned how to crawl. Simple and easy ways to support your child’s development is through the use of age appropriate books and literature. 

When we use the word age appropriate, we want to keep in mind that a book for a six-month old might look differently than a book for an 18th-month old. Infants are still exploring using all of their senses, their hands, their mouths, their eyes, their nose. So when giving a six-month old a book we want to give them something that’s soft, maybe made of fabric, and has mostly pictures so the drool won’t ruin it. 

The caregiver can begin by labeling the pictures found in the book using simple words such as cat, ball, or cup. Then as the child gets older we can start to introduce different books that have more words and less pictures. Infants and young toddlers are still learning ways to communicate with others in their environment. Ways that we can help support communication skills is by offering children different means of communication. This could include modeling sign language, modeling gestures, or modeling verbal communication. 

By offering various modes of communication we are decreasing the possibility of frustration and behaviors. This also ties in to responding appropriate to the children’s cues and actions. Like I stated before, children are still figuring out ways to communicate so if you see a child struggling to place one of the pieces on the peg board shown below, you can approach them and give their actions meaning by saying I see that you are becoming frustrated, can I help? 

Here we are labeling the child’s emotion, offering a word to define what is happening, and offering our support by sitting in close proximity to let them know that you are there for help. Positive attention involves giving children positive support to encourage the probability of there being more positive behavior in the future. One phrase that follows with me is being proactive versus reactive. 

Last but not least, using age appropriate toys is an easy way to teach beginning skills. Most toys you will see in the stores with have a general age range saying something along the lines of this is for zero to three months of age or 12 to 24 months of age. But keep it easy. Babies want to play with soft, colorful, lightweight items that they can learn how to grab and hold and reach for. As they get older they begin to use their hands more functionally and they want to use toys such as the peg board shown below. 

This is something that they would need to have the dexterity with their hands to manipulate to put on the peg board and they would also need to be able to differentiate between the shapes, the colors, and the ability to place the items directly onto the peg board. So here are some wonderful resources for parents and caregivers that they can check out. 

We have the CHOP which is the Children’s Hospital of Philadelphia, primary care developmental milestone checklist. The next website is from the CDC and this one is a really easy tip and checklist reader that goes from ages two months all the way up to two years. The next you can see here is the number and information for free developmental screening for birth to three years old. Next below that we see a free developmental screening for three to five years old with their number and their website information. Next we have my references. 

Thank you for participating in this session. There are a number of other sessions available on the Parenting Together Pathway website for you to view. Additionally, there are a few resources that Trying Together provides to families. Allegheny Child Care, if you are a caregiver seeking child care for early learning, after school, out of school, summer camp, and virtual programs, you can use this tool to search all available spots in Allegheny County. Early Learning Resource Center 5, families can utilize the ELRC to gain information and services that support high quality child care and early learning programs.

 The Homewood Early Learning Hub and Family Center, families in Homewood or surrounding areas can utilize the Hub and Family Center for activities for their children, individual, and group support for parents. The Developmentally Appropriate Parenting Series utilizes the developmentally appropriate parenting series on the Trying Together website to navigate a variety of topics related to early childhood with new content added throughout the year. 

As part of the DAP series, families can opt in to receive cards with helpful information mailed directly to them as they are developed. To enroll in this program and provide feedback on the Parenting Together Pathway series please visit the link on the next slide. Please share your feedback by filling out this survey and you can receive your series cards via mail. 

Again, my name is Alicia Sebastian. I am an Early Head Start coach for Trying Together and below you can see my contact information for any questions that you may have for me. And I just want to say thank you today for joining us for the Parenting Together Pathway series from Trying Together.