The EARLY –er the INTERVENTION, the better.

Correct? 

Prevention is the best course for all possible dire consequences.

Well, sometimes.

Maybe mostly.

I am reluctant to sign-onto always early.

This is the first in my new series of posts on early intervention services (with reference to the United States – that is all I can competently reference. Parents from other countries, please chime-in a comment.)

Early intervention is another requested topic from my solicitation-post late last year. In comments there, Jeanette said “How about the difference between ECI and OT, PT, ST and when and why you need them.”

I will write posts on EI (ECI in the state where Jeanette lives) until I tire have no more to say, and then I will summarize the posts just like with my series on healthcare insurance.

BTW – I realized while reviewing the responses to “Fire!”, that I might NOT have answered Maddy’s request fully. Maddy has been ever so polite and not pointed-out my incomplete response. Her question referred specifically to insurance funding for therapy. I will fit therapy costs somewhere in the EI series - Maddy deserves a complete response! 

Early intervention services are written into law under Part C of IDEA. Being part of the Individuals with Disabilities Education Act  is significant for noting services are intentionally educational vs. medical. EI regulation is also significantly different from Special Education, Part B of IDEA.

This stuff is not rousing news to most of you, but be kind to those are just learning.

OhmyGOSH but there is a slew of regulation within IDEA. 

I also start with IDEA to emphasize the point that early intervention services are managed under an educational model – not a medical model. Here’s another situation where OT and PT and ST professions morphed to include not only mandated services but a particular set of rules.

While my state’s EI website does not even mention IDEA in its historical page, I encourage you to read the perspective given. The beginnings of both special education and early intervention were grass-roots movements from mothers of children with special needs. Having established the right to a free and appropriate public education in 1975 with Public Law 94-142, parents began to see the benefit of having services earlier for their children. 

Honestly, professionals saw this need, too.

While I’m taking you back in time, some stories from my memory of the development of early intervention services….. [Didn’t see that coming, didja?]

Schools used to have ‘child find’ programs – where young children came in for ‘testing’ prior to kindergarten. It was a rough sorting, but parents did not seem to hate them as much as I read in blogs now. I participated in some of these screenings (really more accurate than testing) – one time in a mall. I was given a set of motor skills to observe and score. I would not support this kind of situation now. Too public. Too impersonal.

But it was easy to see that children would do better if they had more help before kindergarten.

Efforts to extend special education services to younger children really hit a head-wind (or the fan, depending on your perspective) in the mid- 1980’s. One of the best jobs (employment situations) of my career was in the Great NW [raise your hand, my Friend in Oregon]. The ‘bestness’ of my job was mostly due to my boss, who plainly explained to me many key concepts in the education culture. She was the one who told me that the educational community did not want to include children with disabilities in the public schools. [Does that explain some of the struggle?] 

Special preschools were slowly becoming mandated. With resistance at many levels, the government offered seed grants to begin preschools for children who met criteria for delay or risk of delay. I guess the thinking was to tempt resisters with money and once in place, a preschool would be difficult to disintegrate.

So the same plan was used for early intervention, but with the public schools not biting. Early intervention became its own entity under IDEA and the grants-to-contracts process evolved inside a wide variety of other (usually non-profit) organizations.

Another difference between Parts B and C was that Part C was written with much more state-level management. The not-final but baseline resolution of what early intervention services would look like – it looks different in every state.

The state I where I live has comparably the most organized early interventions services available.  In a way, EI variety is similar to the variances of Medicaid across states. 

About 6 years ago I agreed to give the EI presentation in a course sponsored by the APTA to prepare PTs to take the pediatric specialty exam. In a group of about 40 there were a few who had some bones to pick with the way EI was implemented in their particular states. [I have shared my bias that therapists should be paid for their work.] Therapists from New Mexico and Florida who had been practicing under one set of rules were being handed new rules that squashed any ability to receive compensation AND offer best practices. [I might’ve done my best group-emotion-diffusion evah that day.] 

In a format similar to special education’s Individual Education Plan, EI services revolve around the Individual Family Service Plan or IFSP. Not just the child, but the context of the child’s life is given codified importance in early intervention.

Again, this stuff is not rousing news to most of you, but be kind to me – because I think it is necessary to represent the context of law governing EI services to best answer Jeanette’s question.

Contrasting EI with special education is another way of contextualizing the topic. Many of you have experienced ‘the transition’ from EI to special preschool (with varying amounts of angst and joy).

Despite transition ‘experts’, many parents still find it difficult when their children age-out of EI services and are expected to attend school. Terri has a really nice post on the difficulty of transitioning from one level of education to the next. 

Have you ever wondered or learned how children were educated before 94-142? I may not have the complete story [I’m not that old! Hrrmph.] but services were mostly offered through special treatment centers, and not everyone had access to the centers. In some places or families, children with diagnoses were a source of social shame (some literally came to school for the first time out of their closets). Included in the context of the development of EI services were the efforts to save premature infants, starting in the 1960s (with a specific effort made after President Kennedy’s premature son died).

The next post in this series on early intervention services will focus are babies who come (too) early.

Now, Jeanette, see what you started?

Comments

[Stacey Harris]

I hate being the first to comment,
since I am-- here goes~

In my lovely state of OR-- services for EI are like a lovely coccoon -- if there is even a bit of discomfort there is one person to call -- But once you transistion out of EI into preschool-- you end up with help but now it's more like a big fish net-- there are holes that you can fall through.

In my experience, you do a lot of praying between preschool and kindergarten.

There is never a guarentee that you will recieve an IEP, or any services at all ~ It is very hard to stay focused on your child and their needs-(not to mention your own personal "needs")[clear communication] - when often I am just guessing at what new skills my child might need to master.

So much of what I have dealt with is teaching others' to see me as a source of critical information. It goes back to Barbara's post about bridges... don't burn them, always keep them cared for~ so, hopefully I have added to the disscussion in a helpful way!

[The Barbara who lives here]

You bet you have, Stacey!

[Stephanie Nance]

Oh boy! Another big topic. I'm in the IFSP stage with my 2 year old. I remember my head spinning when we started EI and to some extent it still is. Perhaps by the time he is grown I will have learned what I need to know to take full advantage of the services and programs available. But, then it will be too late, won't it? I vacillate between fear that I'm not doing enough for him and the laid back attitude that he'll do what he needs to do in good time.

[The Barbara who lives here]

Your "Oh boy!", Stephanie, could be interpreted as either happy or exasperated - ? I hope you will go read Terri's post - not that it is total reassurance, but she is realistic and humorous at the same time (which I greatly admire). Also, she gives fair warning. Long term potential frustration and exhilaration. I hope you will find a means for finding the middle ground or a comfortable place between your vacillations.

2-years is plenty young to make effective intervention, so you ARE taking advantage of things in good timing. 'Sofaras 'doing enough' - there is a priority list - like saving his life first - something that you participated in with all those oxygen tanks. (Note to self: mention that priority in the next post in this series.)

[datri]

I wish that EI wasn't so fraught with bureaucracy. I was speaking with Kayla's ABA teacher and she was lamenting the fact that she has been audited THREE times already this year and got two of the same citations in a row, if there is a third the county can cancel her contract. (She is the only certified ABA provider in our county) The citation? She keeps forgetting to put a paragraph at the end of her annual reports that she went over the report with the parents. Nothing to do with her skills or the service she provides, but a friggin PAPERWORK violation. It's mindboggling.

[The Barbara who lives here]

OhmyGOSH I am glad you commented, datri! Regulation = bureaucracy. Your teacher's frustration is certainly understandable. Regulation seems to take away the power (and thus ability) for anyone in charge to make common sense decisions - like NOT pull a teacher's contract for innocuous error. The power shifts to the regulation and people are lost in the process.

I'm hoping by showing some of the history of EI readers will connect good intentions with massive regulation to answer some of their individual questions. Not to be all hopeless here, but to understand the reasons in order to problem-solve for your individual circumstance.

[david]

if my old man had intervened sooner, he might still be around. maybe. the earlier the better, i'm sure that's correct.

[Lisa]

Oh goodness....look at David's comment. True though.

Anyways, we have been blessed with EI....until yesterday when I opened up a bill from them for $483.00. ouch.

Up until Feb of this year, the families were NEVER billed. Things have now changed. How unlucky for me. They have been providing services free for 20 some-odd years and as soon as Elisabeth receives services they switch their billing policy.

Oh well....it's for a good cause :)

[Sandi]

Our experience may have been the opposite of most...we were overjoyed when we found we could opt out of EI and into a special needs preschool at age 2!

We had to pay for EI -to the tune of $100/hr (insurance wouldn't cover it)- which meant we could not afford much. It was stressful to have to choose which service (PT/OT/Speech??) would be most beneficial for the small amount of time we were able to pay for. And all at a time when we were still learning about her syndrome and really had no idea what would be best! Also the turnover and vacant position rate within EI services was atrocious. There was no continuity of providers.

Anyway, the special needs preschool was awesome. Jess LOVED it. It was such a relief that she could then receive ALL services she needed...we no longer had to pick and choose.

[The Barbara who lives here]

Appreciating David's comment - gives me a chance to lob-off the extremes of 'always' and 'never' from my philosphical spectrum. Nate says to not let comments get off-topic in his tips post: http://cfhusband.blogspot.com/2008/06/blogging-tips.html

So I will leave it at that, David (who is sib to Lisa).

Heartfelt thanks to both Lisa and Sandi for their comments - gives me fodder for future posts in this series.

[JoyMama]

Has anyone written EI / IDEA history into a (readable) book?

I could see some neat possibilities for intertwining the timelines with personal anecdotes from different points in the last 30-to-40-ish years...

Not volunteering anyone to take on such a project, mind you, just wondering if it's been done!

[jeanette]

I am always stirring things up... even unintentionally. This was a great historical viewpoint. thank you for such a thorough look at it. I have always cringed at the thought of putting Sydney in "School" at 3 years old. I know more... but the thought of handing my 4 year old over to the school system still scares the %$#@! out of me. (sigh) She is about to turn two, so I still have a little time. BTW, ECI has been fabulous for us! I feel like my specialist has taught me so much about child development and she is on the same page that I am, that we should "work" through play. I know several moms who "work" their kids. One of them walked into Gymboree for a birthday party (her party) and she burst into tears because she has to "work" there for three hours/twice a week.

[The Barbara who lives here]

I just posted - within which I expressed gratitude for parents who 'stir things up', Jeanette. :)

Sadly, not all therapy is fun. But it is within the match of a parent and therapist who agree to 'work' a child, and where.

I'm glad the historical context helped. I hope you can see in the now top post where for some of the time - the billing-insurance-procedure was what caught Sandi's family and the newer rules allowing charging parents has now caught Lisa's family.

Sliding between time and regulatory changes has given me the feeling of a time warp (just after this post). A feeling unpleasant enough to declare that authoring a book on the history of EI is NOT something for which I will volunteer! Anyone interested - contact JoyMama. Hehe.