Summarizing....
Early intervention services are written into law under Part C in a slew of regulation in IDEA. “I wish that EI wasn't so fraught with bureaucracy.” (datri in comments)
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.
Part C was written with much more state-level management which leads to early intervention services that might look different in every state county, town, agency.
In my lovely state of OR-- services for EI are like a lovely cocoon -- if there is even a bit of discomfort there is one person to call -- But once you transition 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. (Stacey in comments)
Current early intervention services implementation is explained in part by regulation that has changed over the 30-year-history of Part C. What used to be has been changed to (something) and is now (something else). [Feels like a time warp.]
“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.” (Lisa, in comments)
Time warp happens to parents, too. “When they're small it's hard to see the progress.” (Mrs. Mac in comments)
Concurrent with the history of EI was the development of the medical specialty neonatology - medical care to save children born early (and earlier).
Being born early increases the risk of developmental delay but does not predict delay that is not recoverable. Many babies born earlier than 40-weeks-gestation have (genetically related or prenatally caused) diagnoses at birth. No matter when they are born, any child with a diagnosis known to cause delayed development is eligible for early intervention services.
Whether or not a child receives therapy as part of their EI services is decided within a complex set of circumstances. Here I emphasize that nearly all therapy can be considered intervention, but not all intervention is therapy or therapeutic. In the development of EI services over time, therapists have had to morph long-held tenets of practice into the philosophical context of educational law and social services.
Ooops! I just realized I promised to post on how I make decisions on therapy dosage for children under the age of 3-years. (Very abbreviated and not absolute) I recommend (within a stupefying small range of frequency choices) based on the potential I perceive I can influence a particular child’s outcome. I will recommend more therapy for a child who has the most potential and less for a child who has less potential.
[Do NOT try to pin me down on this. I am experienced with dosage arguments discussions and will not submit to any hypothetical situation.] Final note on this: potential has as much to do with the family as it does with the child. If the family is disengaged from the therapy process or unable to participate actively or only slowly, less frequent visits will fit their lifestyle.
You might have been thinking….hmm, “I thought the diagnosis would be the most predictive factor for frequency of therapy. No?” You were not thinking wrong – diagnosis can offer some expectation for each child – but remember that prognosis is less prophecy than educated guess prediction. I have read plenty of “my child proved the doctors wrong!” posts in the past 2 years. [Feeling like I’m in a time warp again.]
Or as Julie correctly commented: “Diagnostic categories have done more than morph into a social descriptive. They have morphed into a requirement for funding of services.”
Returning to the idea that the family figures significantly in decisions regarding therapy intervention – a reminder that most parents experience extreme emotions with the diagnosis of their baby/child. I call this time “the throes of cure and care”. The parents’ emotional status must be considered with every therapy decision.
“I am still learning to accept life with a child who has a disability.” (Katie Sharp in comments)
datri (in comments) correctly sees irony in my thinking on frequency of therapy visits:
Parents who are clamoring for more therapy, are probably the parents who would do fine with less therapy because they are the one who follow through on suggestions by the therapists. But the people who may not have the understanding of why therapy and therapist suggestions are important and probably won't follow through are the one the service coordinators stick with fewer services because they won't complain about it.
However, datri, they don’t complain because they truly do not want more inter(ference)vention than is provided. I long ago realized how to read disinterest from parents – no point in trying force unwanted services.
I often use the single word “therapy” instead of specifying OT, PT and ST. Each of these therapist-professions provide specific (but overlapping) areas of developmental intervention. Ideally the therapists who come to your home work well with each other on a team. (Or not. Personality is a significant variable in EI service provision.)
For all their individual-ness, therapists have worked hard to earn their titles. I encourage you all to inquire about the educational and career background of the therapists who work with your child. You will want to know, for instance if your therapist will be supervising an assistant to work with your child, or will provide services herself.
Now about all the other people who provide intervention but are not therapists….do the best you can with them try to get a clear understanding of their role from them. [And then come back here and tell me, please.] Well, Jeanette did say (in comments)
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.
[Are you getting the message that commenting and reading the comments here might be a good idea?]
“Why does my friend's child with DS go out to speech and PT every week and Ralph has EI at home MAYBE twice a month?” (Stephanie, in comments – where I answered her question.)
Some of my thoughts about EI have been judgmental. For instance, the term ‘natural environments’ seemed like spin for implementing dramatic change (at the time this change was enforced). At the same time, I believe there are benefits to offering therapy in the home (of any patient).
One down-side to providing services exclusively in the home (or daycare) was that mothers (and fathers) were more isolated with their child with a diagnosis. But “Our home was not just ‘safe’ for Trevy...it was for me as well. It takes time for the heart to come to terms...and each parent moves through it differently.” (danielle in comments) Danielle also wrote (in comments), the broadest range of options – home, small group, and outpatient therapy in a clinic - is what we think is best. [Means I agree with danielle.]
Alternatively, henry’s mommie shared (in comments):
however, at six months i started taking henry to private outpatient therapy and i noticed a huge difference. he started accomplishing goals a lot faster. one thing that is a huge positive, especially for when a child gets older, is the private therapy [clinic] has lots of equipment to better help a child reach goals.
So is therapy in a clinic an early intervention service? Revisit the title of this post.
Medical vs. educational is a sort of philosophical difference. I easily think in terms of continuums vs. dichotomies. So these two terms are not opposites but relatively different and not mutually exclusive.
On the meaning of natural environments, I think Maureen said it best (in comments):
Natural environment is not simply the location. We first received services in a clinic, then in our living room and FINALLY in the natural enviromment. And let me assure you that when we finally found a practitioner who understood NE, my son made significant gains and I felt more competent and confident to care for me (a goal of IDEA). NE means providing functional services to support a child and their family doing all of the things in all of the different places that they would if that child did not have a disability. Thus it is about supporting a mom to take her child with sensory issues to the grocery store, helping the mother with a child with motor disabilities to attend the local gymboree, assisting the Dad with a child with a hearing impairment to attend storytime at the library. It is helping families to stay connected to their local community--houses of worship, neighbors, extended family.
And this is the natural end of my summary on early intervention. Much thanks, Jeanette!
