Principles and practices in early intervention: A literature review for the Ministry of Education
The purpose of this literature review is to identify and review research and studies that illustrate effective and/or evidence-based principles of early intervention practice which can be linked to improved child outcomes for children from birth to six years of age, who have special education needs. The resulting resource will be used to inform decision-making in regard to the future direction of early intervention services in New Zealand.
Author(s): Louise Alliston, Research New Zealand
Date Published: July 2007
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In New Zealand, the Ministry of Education, Special Education (GSE) is responsible at national, regional and district level for strengthening the Ministry of Education’s overall special education direction and for providing special education services to children and young people with educational, social, behavioural, and communication needs.
Under the Special Education 2000 policy, early intervention services are provided to approximately four percent of young children (aged from birth up to school age) in homes and early childhood education settings. The Ministry of Education, Special Education defines special education needs in early childhood as:
“those that cannot be met within a regular early childhood setting, home or family, without extra support. The need may be a physical disability, a sensory impairment, a learning or communication delay, a social, emotional or behavioural difficulty, or a combination of these” (Ministry of Education, 2007).
The bulk of the literature identified for this review focuses on the values of a family-centred approach, and this appears to have been accepted internationally as a key principle in the delivery of early intervention services. However, over the last 5 – 7 years, there has also been discussion of other principles and practices in early intervention that will result in the best outcomes for children.
This review attempts to bring together the key findings and points from the literature. As the focus is on recent literature, the aim is not to encompass all the available evidence on a particular aspect of early intervention provision, but rather to provide an update on some issues and introduce other recent ideas in early intervention. The review highlights a number of recent research projects both from New Zealand and other countries. It is not intended that including these projects in the review be considered evidence of their efficacy unless that evidence is explicitly stated, but rather they provide examples of current research and issues that are being addressed.
The focus of the review is on the child as a learner and for this reason, the review aims to identify generic, effective early intervention practices that are applicable across special education needs.
The term early intervention can broadly cover the provision of services to infants, toddlers and young children who are considered vulnerable for reasons of disability, the risk of disability, social disadvantage, child abuse, and other factors (for example, in programmes such as Sure Start, Early Head Start and Family Start). However, it can also be used to describe those services provided solely to those with special education needs or disabilities, such as those provided by the Ministry of Education in New Zealand. The United States, the United Kingdom, Australia, and New Zealand have seen the development of approaches along both tracks.
Establishing a comprehensive model of early intervention that integrates health, social service and education interventions is complex and challenging. However, jurisdictions, such as the United Kingdom, are moving to develop greater synergies between special education and broader early intervention approaches.
Increasingly, in the U.S., Australia, England, Europe, and New Zealand, jurisdictions have moved towards a more inclusive approach to early intervention for children with special education needs, that acknowledges the importance of children with disabilities being included in mainstream early childhood and community settings. However, while teachers accept the principle of inclusion, they also recognise challenges in its implementation, including their lack of knowledge about children with disabilities and the need for training, skills and resources to help them to provide an appropriate programme.
Benefits of early intervention
There is a general acceptance in the literature that quality early childhood intervention services for children with disabilities can have beneficial effects on the functioning of children as well as on the adaptation of their families. Researchers are now emphasising the need for research that determines what types of intervention are most effective for children with different types of disability, for children of different ages, and for children from different family backgrounds. Efforts are also necessary to ensure that early intervention is equally accessible and effective for families from diverse cultures.
It has been suggested that the development of recommended practices in the U.S. signals the start of a more intellectually rigorous approach to early childhood intervention practices, while also incorporating practice-based evidence.
Family-centred approaches to early intervention
While the benefits of family-centred practices for child outcomes have not been empirically validated, there is evidence that family-centred practices can contribute to positive parent and family outcomes. Increasingly, early intervention has, in principle, accepted a need to base services on those needs and priorities identified by parents and to engage parents as partners in decisions about priorities and intervention strategies.
However, while the notion of family-centred services is widely accepted, it is not clear whether they are always implemented. Studies suggest a considerable gap between recommended family-centred practice and actual practice, with many services continuing to be child-oriented and professionally driven.
While a family-centred approach was broadly accepted as a fundamental principle of early intervention service in the literature reviewed, there was also a recognition of the need for further research; for example to develop measures and strategies to assess family-centred practice, and clarification and development of measures of expected outcomes.
Best practice principles for family-centred practice were identified in the development of recommended practices by the U.S. Council for Exceptional Children:
- Families and professionals share responsibility and work collaboratively.
- Practices strengthen family functioning.
- Practices are individualised and flexible.
- Practices are strengths- and assets-based.
A strengths perspective is one of the key components of family-centred practice. One of the principles of the DEC recommended family-based practices is that families and early intervention professionals share responsibility and work collaboratively. The involvement of parents in early intervention can be at a variety of levels to accommodate the different needs and circumstances of families. Parents and other family members can be an important resource for early intervention professionals. This can be through the role they play with their own child or in a more formal role; for example, as advisors for early intervention professionals, or as support coordinators for other families.
As with many other indigenous and ethnic groups around the world, Māori children with special education needs are over-represented in special education. Yet, there is a relatively small amount of research and literature addressing the specific needs of young Māori children who have special education needs.
The Treaty of Waitangi should be considered in the development and implementation of all national special education policy. Another guiding principle is whanaungatanga, recognising the kinship ties that bind whānau, hapü and iwi together in reciprocal relationships.
Further research and investigation would be needed to determine how a whanaungatanga approach relates to the family-centred practices discussed in this review.
Consultation with köhanga reo has shown that Māori may have a broad concept of special needs including components such as physical, sensory and communication needs, but also others, such as needs associated with giftedness and with socio-economic circumstances and geographic location.
Common components of culturally appropriate and effective programmes and services in New Zealand are identified as incorporation of cultural content, the inclusion of parents, whānau, the Māori community, Māori organisations and Māori workers, along with the need for ready accessibility to services.
Challenges when providing services for Māori children with special education needs are identified as: insufficient funding to provide the required workforce and resources; a lack of culturally appropriate resources and people with the cultural and professional expertise; a lack of culturally appropriate, relevant training; and Pākehā-centric attitudes towards special needs provision.
Identification and point of access
Early intervention is based on the assumption that the earlier services and supports are provided, the better. Intervention is likely to be more effective if it begins early in the life of a child or soon after the onset of the factors that place their development at risk. Also, very early support may increase the chance that a family at risk is able to engage or re-engage with mainstream services, such as education and health.
This means that children with special education needs must be identified in a timely way. However, this may not occur, particularly if a child doesn’t have contact with anyone with a sound knowledge of development, when a child has only a marginal delay in development, or if parents are encouraged to “wait and see” before seeking further advice. Early identification may also be delayed through fragmented and confusing system entry procedures.
Early childhood education professionals, along with others (such as GPs and Plunket nurses), need skills and appropriate guidelines and tools to recognise potential issues. They also require a sound grasp of typical development in the first five or six years of life, information on the earliest presenting signs of various disabilities, and skills in talking with and listening to families.
While families tend to state a preference for a single point of access, it is likely that a more realistic approach is an integrated and coordinated system that takes advantage of a wide range of resources and supports from a diverse range of providers. Additionally, until services meet the needs of culturally diverse families, they may remain hesitant about referring their children to any outside agency.
Teamwork and collaboration
Early intervention has moved from a traditionally multidisciplinary approach towards interdisciplinary and transdisciplinary practice.
An interdisciplinary model is one where members of a team employ their own perspectives, assessing and working with children separately, but then discussing their finding and reaching decisions collaboratively. A transdisciplinary model requires early intervention professionals involved in a team to provide integrated interventions. One person, in collaboration with team members, accepts the primary responsibility for implementing a child’s individualised plan. An “exchange of competencies” between team members is usually achieved through role release.
Advantages of a transdisciplinary model include the fact that it is less of an intrusion into family systems, and encourages increased communication among team members and consistency in the implementation of the intervention plan.
In many cases, early intervention professionals will also collaborate closely with early childhood education staff to deliver an intervention. However, early intervention professionals must be aware of the possibility of excluding early childhood teachers by adopting the role of the “expert” in their interactions with both children and teachers. Effective collaboration requires the establishment of positive relationships among early intervention professionals, early childhood education teachers, and parents (or other caregivers).
Key principles of the DEC recommended practices for interdisciplinary models are that:
- teams, including family members, make decisions and work together
- professionals cross disciplinary boundaries
- intervention is focused on function, not services.
Factors impacting on the delivery of integrated servicesProviding integrated services adds complexity and may necessitate training, system change, and incorporating the views and input of families.
Early intervention professionals working in early childhood education settings may face difficulties if there is no overall (e.g. national) framework for how services in early education and intervention should be provided. There appears to be a move towards the development of core curricula, where professionals/services share a common core of knowledge, skills and values.
Families frequently identify service coordination as a major concern. A key worker can act as a single point of contact for a family, helping the family to coordinate their care across systems. However, the effectiveness of this approach is not well documented, with available evidence mainly in the form of satisfaction surveys and focus groups.
Early Support, England
Early Support is for families who have a baby or young child with additional support needs because of a disability or emerging special education need. Programme goals include better joint assessment and planning processes for individual children and their families, better information for families, and the use of key worker services to improve the continuity and co-ordination of support available to families.
An independent evaluation concluded that, overall, Early Support is a very successful programme. In particular the evaluation found that Early Support benefits families, either through information materials only or through information accompanied by a key worker service. The evaluation also found a significant demonstrable improvement in co-ordination of support for families, multi-agency planning/working together, and smoother processes of identification, referral and initial assessment.
An important challenge ahead for the early intervention field is to understand the relative effects of different approaches for children with different developmental needs.
There is debate in the literature about the role of parent education and training in early intervention. On the one hand, parents appear to want parent education, and studies show a relationship between mother-child interactions and early intervention effectiveness. On the other, there is concern about the potential of parent education to alter the nature of the home, changing it from a natural environment to an unnatural one, and disrupting family relationships. One meta-analysis found that children receiving direct educational experiences showed larger and more enduring benefits than those in programmes relying on intermediary routes, such as parent training.
Another mediating view is that parent education can be seen as a particular kind of parenting support – one of a number required by parents - and that professionals’ interactions with families should emphasise support as well as education, when this is identified as a priority for parents.
Social skills in children with special education needs
While inclusion aims to maximise the participation of children and families in typical home and community activities, children with special education needs have a relatively higher risk for peer rejection than typically developing children.
A synthesis of research concludes that social skills programmes can be effectively integrated into class and home routines with positive benefits for children with disabilities. It identified that interventions that included modelling, play-related activities, rehearsal/practice, and/or prompting were associated with positive social outcomes for children with disabilities.
Child-initiated and adult-initiated activities
An emphasis on child-initiated activities versus adult-initiated activities appears to result in increased child engagement. However, the types of activities engaged in are likely to differ, depending on whether they are adult-initiated or child-initiated, suggesting a balance may be needed between the two. A child’s interests can be the basis for modifying activities in order to increase child involvement in the activity or production of adult-desired behaviour.
The fact that some children show greater benefit from participation in early interventions than others appears to be related to aspects of the individual child’s initial risk condition. This may mean different individuals may need different programmes to achieve similar outcomes.
An increased focus on natural environments
A natural learning approach is one where early intervention professionals aim to identify and use the natural learning opportunities that occur in a child’s everyday routines.
There is continued debate on how to interpret “natural environments” and how to implement the practice. One challenge to the concept that natural environments can only be inclusive environments suggests that policy should not come before the needs of individual children and families, and that other non-inclusive options may need to be considered.
However, the concept of natural environments can refer to how as well as where services are delivered. The philosophy of natural environments not only identifies where the child spends their time but also addresses developmental concerns by embedding interventions into the everyday experiences that occur within that setting.
Learning in natural environments promotes “generalizability”, or the ability to respond appropriately in unrehearsed conditions, whereas interventions that are built on non-functional skills may not facilitate the transfer of learning from one environment to another. Identifying learning opportunities in the home also supports a family’s ability to implement an intervention plan.
Family life, community life and early childhood programmes can provide multiple opportunities (either pre-planned or through serendipity) for learning experiences. Early intervention professionals can assist parents and families to identify activities that already provide learning opportunities for their children.
Assessment principles and planning
The use of individualised planning in the assessment process is a key component of inclusive practice in early intervention in the jurisdictions discussed in this review, and in many European jurisdictions.
Among DEC recommended practices in assessment are the following:
- Professionals and families collaborate in planning and implementing assessment.
- Assessment is individualised and appropriate for the child and family.
- Assessment provides useful information for intervention.
- Professionals share information in respectful and useful ways.
Other key principles identified in the literature include the need for multiple measures and multiple sources when assessing young children, developmental appropriateness, and viewing the child from a framework of competency embedded within a cultural context.
International approaches to assessment that direct teaching to targeted developmental objectives may not be wholly appropriate in a New Zealand context, where the socio-cultural foundations of Te Whāriki focus on an holistic integration of a child’s strengths and abilities.
New Zealand research on using a learning stories approach to assessment identifies that this can empower parents and early childhood educators to participate more fully in the process, particularly as they are already familiar with this approach to assessment, and the language used is more inclusive, reducing the “expert” model.
The learning stories approach may also contribute to the enhancement and strengthening of team relationships, through an increased knowledge of the perspectives of other team members, a shared language and a climate of support amongst team members.
Children can experience horizontal transitions (moving between professionals and services) as well as vertical transitions (moving between service types, e.g. early childhood education and school) as they grow and develop.
These transitions can be frequent and particularly stressful times for young children with disabilities and their families.
Families appear to find it particularly challenging to move from a family-centred model to a child- and school-focused model.
Research suggests that parents who are knowledgeable about the transition process are likely to experience less stress than families who are not informed.
The literature emphasises a view of transition as an evolving process that requires commitment from both the school and those in the early childhood education and early intervention services. Key factors in the transition process appear to be planning and preparation for children, families and professionals, effective communication and collaborative partnerships, and procedural supports (such as key workers). In addition, the literature suggests that transition services should not stop once a child is in a new setting.
Information, resources and supports for families
Having a child with special needs can have positive impacts on families but can also pose challenges. Persistent stress can compromise positive coping and the enjoyment of daily life, impact on marital and family relationships and, in some cases, have adverse effects on child outcomes.
An emphasis on family-centred service delivery may require from policymakers and professionals an understanding of the personal stressors with which families contend, such as information and resource needs, interpersonal and family distress, and threats to confident parenting.
The literature suggests that helping families to access information is a key part of a family-centred approach to early intervention, particularly on issues such as child health and development, specific disabilities, learning and development, and possible future needs. The role professionals play may differ depending on the family involved.
Parent support groups, national organisations and advocacy groups can also offer emotional and informational support to families.
Social supportThere is evidence that the extent to which family members have adequate formal and informal support systems is associated with successful adaptation to having a child with a disability, and that the relational climate of the family is a predictor of children’s developmental trajectories.
Formal services such as early intervention programmes are likely to have relatively less impact on family functioning than extended family and friends. Early intervention professionals can help families to identify and build informal support networks or create conditions that are conducive to the development of networks. However, social support that is imposed can have significantly negative effects on parents, especially on those whose need for support is low.
Family information gathering (also known as family assessment)
A family-centred approach to early intervention suggests a need to gather information about the family in order to develop collaborative and supportive relationships. Formal survey tools will probably not provide enough information for professionals (or be widely accepted) and professionals will need to rely on further conversations with families to determine their information needs. Family preferences should dictate the strategies used. More formal measures should only be used if the family sees the information gathered as an effective part of the process, such as setting family goals or making referrals.
Working with families
The provision of social support as part of family-centred service provision presupposes that early intervention personnel are comfortable working with families. However, many will have been trained to work with children, rather than with families. Professionals should be prepared to interact meaningfully with fathers, grandparents, siblings, extended family members, and whānau, as well as with families who self-define their supporting social system.
Parent-to-parent support can be provided informally by providing parents with opportunities to meet other parents or through more formally organised programmes. Formal parent-to-parent support can increase parents’ acceptance of their situation and their sense of being able to cope.
Using technology to deliver information, resources and social supports to families
Health-related and child development information has increasingly become available online. Professionals can use the Internet to support and guide parents in their information-seeking and also by developing their own Internet resources for parents to use.
While it can be challenging for parents to assess the reliability of individual sources, they appear to be responsible searchers. Professionals also need to be able to support families in evaluating information.
Cultural competence and culturally-appropriate practice
Western models of development heavily influence early intervention service delivery, with the potential for bias in identification, service delivery and assessment systems.
In 2002, the DEC position statement on responsiveness to family cultures, values and languages stated that, “for optimal development and learning of all children, individuals who work with children must respect, value, and support the cultures, values, and languages of each home and promote the active participation of all families” (Horn, Ostrosky & Jones, 2004, p. 1).
Factors that impact on family participation in early intervention may include: language issues; acculturation levels; attitudes towards disability; religious beliefs and family traditions; a lack of language-appropriate information materials; a shortage of trained bilingual and bicultural personnel; and a lack of culturally responsive service models that systematically address relevant cultural orientations and behaviours that affect service use.
Service delivery to culturally and linguistically diverse families
The DEC recommended practices note the importance of understanding intragroup as well as intergroup difference. Factors that can impact differently on different members of a cultural group include gender, occupation, discrimination, socio-economic status, and age.
Barriers to culturally appropriate practice which have been identified include a lack of time, obtaining culture-specific information and resources, a lack of training, and a lack of materials.
Outcomes for children and families
In early intervention, much of the literature on outcomes has focused on the individual outcomes for children assessed against individualised plans, although there has been ongoing debate about what outcomes should be sought for children at this level.
There has also been work undertaken to identify the outcomes that the system should aim to achieve for children with special education needs. In New Zealand, Better outcomes for children is an internal plan for the New Zealand Ministry of Education. The plan describes important outcomes for children, ways to collect better information on these outcomes within the Ministry, and key actions to strengthen service provision in order to improve outcomes. The focus of the plan is on three outcomes for children that contribute to achievement - presence, participation and learning.
In the U.S., states have to report to the Office of Special Education Programs on three outcomes for children. The outcomes address three areas of child functioning considered necessary for each child to be an active and successful participant at home, in the community, and in other places like a child care programme or preschool. States must report the percentage of infants and toddlers with IFSPs or preschool children with IEPs who demonstrate improved positive social-emotional skills (including social relationships), acquisition and use of knowledge and skills (including early language/communication and early literacy ), and use of appropriate behaviour to meet needs
States are required to measure and report on the progress children make between the time they enter a programme and the time they exit in each of the outcome areas.
Increasingly, attention has been drawn to the outcomes of early intervention for the families of children with special education needs. In the U.S., an evidence-based process with stakeholder input resulted in the identification of five family outcomes:
- Families understand their child's strengths, abilities and special needs.
- Families know their rights and advocate effectively for their children.
- Families help their child develop and learn.
- Families have support systems.
- Families access desired services, programmes and activities in their community.
It is clear from the literature reviewed here, that not only have early intervention practice and principles evolved over the period covered by this review, but that they continue to evolve.
The last few years have seen the cementing of family-centred approaches as a key principle of early intervention, with the literature identifying a growing acceptance that early intervention needs to reflect the ecological context in which the family operates. This has meant an increasing focus on family-centred models, including research on how they are perceived by parents and professionals, how to achieve family-professional partnerships, and the gaps that exist between principles and practice.
The literature suggests that helping families to access information is a key part of a family-centred approach to early intervention, particularly on issues such as child health and development, specific disabilities, learning and development, and possible future needs.
There is also evidence that the extent to which family members have adequate formal and informal support systems is associated with successful adaptation to having a child with a disability, and that the relational climate of the family is a predictor of children’s developmental trajectories. Early intervention professionals can help families to identify and build informal support networks or create conditions that are conducive to the development of networks.
The idea that children should, where appropriate, receive early intervention services in natural environments is another key principle well accepted in the early intervention literature (although there is continued debate on how to interpret “natural environments”). The philosophy of natural environments not only identifies where the child spends their time but also addresses developmental concerns by embedding interventions into the everyday experiences that occur within that setting. Learning in natural environments promotes “generalizability”, or the ability to respond appropriately in unrehearsed conditions, whereas interventions that are built on non-functional skills may not facilitate the transfer of learning from one environment to another.
While the principles of family-centred practices, inclusion and natural environments can provide an overall framework for early intervention, this does not answer the question posed in this review about what and how children should learn or what are the characteristics of effective early intervention services. It is these issues that are the subject of continued, and often passionate, debate and, in fact, research suggests that different individuals may need different programmes to achieve similar outcomes. An important challenge ahead for the early intervention field is to understand the relative effects of different approaches for children with different developmental needs.
New Zealand research is particularly valuable as it can consider the relevance of best practice identified by other jurisdictions; for example, research on social skills training for education support workers is an important first step in developing interventions for a New Zealand context.
What also becomes apparent from the literature is that, while there have been significant advances in developing recommended practices for early intervention, there is a very clear gap between many recommended practices and what actually happens in the field. Also, in many cases, because of the newness of some of the concepts, best practices are only just emerging rather than being established. For example, the provision of social support as part of family-centred service provision presupposes that early intervention personnel are comfortable working with families, whereas many will have been trained specifically to work with children. Therefore, despite the existence of models, principles and recommended practices, it seems likely that one of early intervention’s greatest challenges will be to integrate these concepts into the everyday work of all early intervention professionals.
During the writing of this review it became clear that the literature is dominated by material from the United States. Even material that is written from an Australian, English or New Zealand perspective refers extensively to work published by U.S. researchers. The amount of funding and support that is available for research in the U.S., means that it is likely to continue to be a key source of ideas, recommended practices and evaluation.
However, perspectives from specific countries are critical. For example, the review shows an increasing move towards authentic assessment practice in the U.S. but, as one New Zealand researcher has pointed out, these are not necessarily authentic once transferred to New Zealand’s early childhood education and early intervention settings.
There are also many aspects of early intervention practice which are unique to New Zealand and require research. For example, how early intervention services can be appropriately provided to Māori and Pasifika children with special education needs and their families and whānau. Once again, international literature is of great interest but is no substitute for Māori and Pasifika perspectives. Common components of culturally appropriate and effective programmes and services in New Zealand have been identified as incorporation of cultural content, the inclusion of parents, whānau, the Māori community, Māori organisations and Māori workers, along with the need for ready accessibility to services. Another issue is how early intervention practice in New Zealand sits alongside early childhood education generally. For example, many of the principles of Te Whāriki are being incorporated into assessment practice in New Zealand, and it is a document with wide-ranging support in the sector.
As this literature review shows, the resources that families with young children with special education needs require are likely to extend beyond the services provided by the special education system in New Zealand. Other countries as well as New Zealand have early intervention systems sitting alongside more wide-ranging attempts to support families with young children, and there may be lessons to learn from programmes, such as Head Start (U.S.), Sure Start (England) and Family Start in New Zealand. There may also be synergies to develop to ensure children with special education needs and their families receive integrated and seamless services. However, this should not be at the cost of diluting the support available to those families with children with special education needs.
In conclusion, it appears that the identification of key principles and recommended practices is an important step forward for the early intervention field. In addition, there is an active research agenda considering not only how to implement those practices, but also how to identify more explicitly what works for individual children.
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