Research in Early Childhood Research in Early Childhood

InterventionIntervention

FuJen Catholic University FuJen Catholic University Professors Sharon Rosenkoetter & Pauline SuProfessors Sharon Rosenkoetter & Pauline Su

Fall 2008 – Set #1Fall 2008 – Set #1

This WeekendThis Weekend

• Introductions Introductions • SyllabusSyllabus• What is Early Intervention?What is Early Intervention?• Why intervene early?Why intervene early?• Kinds of riskKinds of risk• Risk factorsIssues at birthRisk factorsIssues at birth• Home visitingHome visiting• Characteristics of ECICharacteristics of ECI• Reflections on readingsReflections on readings• Substance exposed childrenSubstance exposed children• Adapted sportAdapted sport

Students Introduce SelvesStudents Introduce Selves

Here’s Professor Pauline SuHere’s Professor Pauline Su

Here’s Dr. Sharon RosenkoetterHere’s Dr. Sharon Rosenkoetter

SOP – Standard Operating SOP – Standard Operating ProceduresProcedures

• We will start and stop on timeWe will start and stop on time• Please turn off cell phonesPlease turn off cell phones• We will hold classroom We will hold classroom

comments in confidencecomments in confidence• We will avoid side We will avoid side

conversationsconversations• We will try to encourage We will try to encourage

fearful colleaguesfearful colleagues• Food and drink in class are OKFood and drink in class are OK• Please voice questions and Please voice questions and

commentscomments• Others?Others?

SyllabusSyllabus

Go over requirementsGo over requirements

* * ** * * Use PEOPLE FIRST language!!!!!Use PEOPLE FIRST language!!!!!

ChildChild with a disability, NOT disabled child with a disability, NOT disabled child

MotherMother living in poverty, NOT poor mother living in poverty, NOT poor mother

FatherFather who is not working, NOT out-of-work who is not working, NOT out-of-work daddad

Use the person first, description lastUse the person first, description last

Early Childhood Intervention is…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

developmentdevelopment

Young Children Are at the Center of Young Children Are at the Center of ECIECI

BUT families are VERY BUT families are VERY important in ECI!important in ECI!

– Families LOVE their child Families LOVE their child & are the child’s best & are the child’s best teacherteacher

– Families seek Families seek information & use it to information & use it to make decisionsmake decisions

– Families guide choice of Families guide choice of program & servicesprogram & services

– Families have needs that Families have needs that ECI can help them meetECI can help them meet

Young children may be called…Young children may be called…

• typically developingtypically developing

oror• at-riskat-risk

3 Kinds of Risk3 Kinds of Risk

1.1.Biological risk Biological risk

2.2.Established riskEstablished risk

3.3.Environmental riskEnvironmental risk

Each may exist alone or Each may exist alone or with another kind of riskwith another kind of risk

1. Biological Risk1. Biological Risk

• physical possibility of a problem physical possibility of a problem

but it has not yet led to developmental but it has not yet led to developmental difficultiesdifficulties

Example: preterm birth, genetic predisposition, weak Example: preterm birth, genetic predisposition, weak immune system)immune system)

2. Established Risk2. Established Risk

• Child shows a condition or diagnosis that is Child shows a condition or diagnosis that is known to lead to developmental difficulties known to lead to developmental difficulties

Examples: Down Syndrome, Examples: Down Syndrome, missing arm or leg, missing arm or leg, cystic fibrosis, cystic fibrosis, Failure to ThriveFailure to Thrive

3. Environmental Risk

• IssuesIssues– PovertyPoverty– Adolescent parenting Adolescent parenting – Parental mental illness or substance abuseParental mental illness or substance abuse– MaltreatmentMaltreatment– Community or domestic violenceCommunity or domestic violence– Unsafe surroundings that may lead to Unsafe surroundings that may lead to

developmental difficultiesdevelopmental difficulties

• These may exist alone or with other risksThese may exist alone or with other risks

Programs may be designed Programs may be designed for one kind of risk (e.g., poverty)for one kind of risk (e.g., poverty)

but most serve CHILDREN, not RISKSbut most serve CHILDREN, not RISKS

Every Child Has…Every Child Has…

• Risks that endanger the developing child -- Risks that endanger the developing child -- may or may not cause actual harmmay or may not cause actual harm

• Resilience, or protective factors that Resilience, or protective factors that counter the effects of riskscounter the effects of risks

Always we want to lower the risks & increase Always we want to lower the risks & increase the resiliencethe resilience

Small Group ActivitySmall Group Activity

• Form into 4 groupsForm into 4 groups• Two groups list all the risk factors that you Two groups list all the risk factors that you

can think of that can think of that maymay lead to bad outcomes lead to bad outcomes for a childfor a child

• Two groups list all the protective factors Two groups list all the protective factors that you can think of that may help the that you can think of that may help the child avoid bad outcomeschild avoid bad outcomes

• You will report backYou will report back

REPORT BACKREPORT BACK

PreventionPrevention

Trying to increase resilience Trying to increase resilience

&&

Decrease riskDecrease risk

3 Levels of Prevention – from Public 3 Levels of Prevention – from Public HealthHealth

1. Primary prevention – teach 1. Primary prevention – teach allall people to people to use good health practices to reduce use good health practices to reduce risk factors & reduce the number risk factors & reduce the number of of new problems (cases)new problems (cases)

Example: teach women to avoid alcohol Example: teach women to avoid alcohol during pregnancyduring pregnancy

3 Levels of Prevention3 Levels of Prevention

•

2. 2. Secondary prevention – use Secondary prevention – use interventionintervention to make the condition less to make the condition less serious and perhaps help it end soonerserious and perhaps help it end sooner

Example: Speech therapy to help a child Example: Speech therapy to help a child with Fetal Alcohol Spectrum Disorder talk with Fetal Alcohol Spectrum Disorder talk betterbetter

3 Levels of Prevention3 Levels of Prevention

• 3. Tertiary prevention – 3. Tertiary prevention – interventionintervention to to reduce related effects of the problem, reduce related effects of the problem, direct or indirectdirect or indirect

Example: Behavioral planning & Example: Behavioral planning & environmental arrangement to help a environmental arrangement to help a child with Fetal Alcohol Spectrum child with Fetal Alcohol Spectrum disorder avoid serious behavior problemsdisorder avoid serious behavior problems

Early Intervention Does All 3 types of Early Intervention Does All 3 types of PreventionPrevention

#1#1 – teaches – teaches all peopleall people so problems don’t so problems don’t happen happen

#2#2 – intervenes to address a problem – intervenes to address a problem

#3#3 – intervenes to prevent secondary – intervenes to prevent secondary problems that are related to the initial problems that are related to the initial problemproblem

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

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

1. Humans can be shaped during the early 1. Humans can be shaped during the early yearsyears

2. The early years set the pattern for later 2. The early years set the pattern for later learning and behaviorlearning and behavior

3. During the early years, children learn best3. During the early years, children learn best4. This is the time to minimize disability & 4. This is the time to minimize disability &

prevent secondary disabilitiesprevent secondary disabilities5. The environment & early experience are 5. The environment & early experience are

significant in determining life outcomessignificant in determining life outcomes

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

6. Early Intervention succeeds in improving 6. Early Intervention succeeds in improving outcomes – it works!outcomes – it works!

7. Families need support to help their 7. Families need support to help their children learnchildren learn

8. There are economic benefits – Early 8. There are economic benefits – Early Intervention saves money for the society Intervention saves money for the society over the child’s life over the child’s life

9. There are social benefits – it is the right 9. There are social benefits – it is the right thing to do to help vulnerable childrenthing to do to help vulnerable children

Provide examples of these 9 on wall Provide examples of these 9 on wall chartscharts

You may write in Chinese!You may write in Chinese!

Then we will go about and read what Then we will go about and read what others have writtenothers have written

COMMENTS FROM PROFESSOR SUCOMMENTS FROM PROFESSOR SU

Reflect & Write – 15 MinutesReflect & Write – 15 Minutes

• What are the main messages you What are the main messages you will take home?will take home?

• How you will use this information in How you will use this information in your work or family life?your work or family life?

Continuum for Early Childhood Continuum for Early Childhood Development – and RiskDevelopment – and Risk

• PrenatalPrenatal period shapes period shapes the brain architecturethe brain architecture

• NatalNatal events predispose events predispose child to later challengeschild to later challenges

• Birth to age 3Birth to age 3 – period – period of most rapid growth – of most rapid growth – foundational for later foundational for later developmentdevelopment

• Ages 3-5Ages 3-5 – development – development of complex skills – basic of complex skills – basic for a lifetimefor a lifetime

““Bottom up” learningBottom up” learning

In the Beginning…In the Beginning…

• A normal pregnancy is A normal pregnancy is 38-42 weeks after 38-42 weeks after conception conception

• A birth before 38 A birth before 38 weeks gestation is pre-weeks gestation is pre-term (sometimes called term (sometimes called premature) premature)

• A birth after 42 weeks A birth after 42 weeks gestation is post-termgestation is post-term

25-29 weeks gestation25-29 weeks gestation

See video: The Miracle of LifeSee video: The Miracle of Life

What message do you take from What message do you take from that video?that video?

In the Beginning…In the Beginning…

• Major brain Major brain development happens development happens 25-29 weeks gestation25-29 weeks gestation

• Too early birth means Too early birth means that development must that development must happen outside the happen outside the wombwomb

• Toxic exposure in utero Toxic exposure in utero can harm the brain can harm the brain foreverforever

• Brains are built over Brains are built over timetime

• Interactive influence of Interactive influence of genes & experience genes & experience literally shape the literally shape the architecture of the architecture of the developing braindeveloping brain

• The medium for that is The medium for that is the turn taking of the turn taking of relationship with relationship with caregiverscaregivers

What Can Go Wrong?What Can Go Wrong?

• Mortality – death happensMortality – death happens

OROR• Morbidity – some part of the body is Morbidity – some part of the body is

harmedharmed

Times When the Child Is Most Times When the Child Is Most VulnerableVulnerable

Times when Times when biologybiology or or environmentenvironment (or (or both) may assault the developing childboth) may assault the developing child

• Prenatal – prior to birthPrenatal – prior to birth• Perinatal – around the time of birthPerinatal – around the time of birth• Postnatal – at least 18 hours after Postnatal – at least 18 hours after birthbirth

3 Levels of Hospital Nursery in the 3 Levels of Hospital Nursery in the U.S.U.S.

• Level 1 -- typical care center for newbornsLevel 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 NICU – only a few in each regiononly a few in each region

NICUNICU

• Baby lives in a controlled environment -- Baby lives in a controlled environment -- round the clock observationround the clock observation

• ““Procedures” honor baby’s naturalProcedures” honor baby’s natural

biological cyclesbiological cycles• Transdisciplinary team serves Transdisciplinary team serves

baby and familybaby and family

Video: The Neonatal ExperienceVideo: The Neonatal Experience

Newborn Conditions that May Lead Newborn Conditions that May Lead to Mortality or Morbiditityto Mortality or Morbiditity

• Sepsis -- infectionSepsis -- infection• RLF – vision impairmentRLF – vision impairment• RDS – respiratory distressRDS – respiratory distress• IVH – brain bleedIVH – brain bleed• PDA – heart defectPDA – heart defect• NEC – intestinal decayNEC – intestinal decay

For families, the NICU is an unforgettable For families, the NICU is an unforgettable experienceexperience

Video: The Neonatal ExperienceVideo: The Neonatal Experience

What is your reaction to this video?What is your reaction to this video?

For families, the NICU is an For families, the NICU is an unforgettable experience. What unforgettable experience. What experience have you had with this?experience have you had with this?

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

Early Intervention Begins Early Early Intervention Begins Early

• Medical and social work in NICUMedical and social work in NICU• Home visits soon afterHome visits soon after• Support for family, connection to other Support for family, connection to other

families, help in understanding the families, help in understanding the conditioncondition

• Therapy for babyTherapy for baby• Information!Information!

With a Troubled Pregnancy…With a Troubled Pregnancy…

Efforts now to get the mother to the Efforts now to get the mother to the hospital with a Level 3 nursery (NICU) hospital with a Level 3 nursery (NICU) beforebefore the baby is born the baby is born

Most important in rural areasMost important in rural areas

When the Baby Comes Home – When the Baby Comes Home – Home-Based ServicesHome-Based Services

• Parents need even more supportParents need even more support• Team of health care professionals, therapists, Team of health care professionals, therapists,

teachersteachers• Use evidence-based approaches & take data on Use evidence-based approaches & take data on

their effects their effects with this childwith this child• Early Intervention can come into the homeEarly Intervention can come into the home

– EI, Early Head Start, Healthy Start, Parents as EI, Early Head Start, Healthy Start, Parents as TeachersTeachers

– Must be frequent enoughMust be frequent enough– Must focus on child’s needs and the home Must focus on child’s needs and the home

contextcontext

History of Home VisitingHistory of Home Visiting

• Began in the 1850s in city slums – visiting nursesBegan in the 1850s in city slums – visiting nurses• 1900 – social workers aiding families in poverty1900 – social workers aiding families in poverty• 1935 – 1st U.S. maternal & child health law with home 1935 – 1st U.S. maternal & child health law with home

visits visits• 1950s – U.S. home visits for children with 1950s – U.S. home visits for children with disabilities; expansion of visiting nursesdisabilities; expansion of visiting nurses• 1970s – growth of War on Poverty home visits1970s – 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 child abuse prevention home visits; Parents as

TeachersTeachers• 1990s – Early Head Start – most effective when starts 1990s – Early Head Start – most effective when starts

with prenatalwith prenatalTAIWAN?TAIWAN?

Rationale for Home VisitingRationale for Home Visiting

1.1. Parents are the most important Parents are the most important teachers & home is where they teachers & home is where they

largely teach; services should largely teach; services should

happen therehappen there

2. Parents can learn more effective ways to 2. Parents can learn more effective ways to relate to their childrenrelate to their children

3. Supporting parents will lead to improved 3. Supporting parents will lead to improved child outcomeschild outcomes

Possible Emphases for a Home VisitPossible Emphases for a Home Visit

1. Basic care skills, immunizations 1. Basic care skills, immunizations OROR

2. Reduce parent stress 2. Reduce parent stress OROR

3. Education & development3. Education & development

IssuesIssues

1. Should professionals or paraprofessionals 1. Should professionals or paraprofessionals serve?serve?

Which kind(s) of professionals?Which kind(s) of professionals?

2. Does home visiting “work”?2. Does home visiting “work”?

3. Better – under what conditions does it 3. Better – under what conditions does it work?work?

4. Better – who does it work for?4. Better – who does it work for?

5. What intensity is necessary for home 5. What intensity is necessary for home visiting to have the desired impact?visiting to have the desired impact?

Video: Home-Based ServicesVideo: Home-Based Services

What observations do you have about What observations do you have about this?this?