SLP 671 Quiz #5

Risk factors for communication disorders in infants

-Any condition that places a child's general development in jeopardy also constitutes a risk for language development. Prenatal factors -maternal consumption of excessive alcohol, abuse of other drugs, environmental toxin, and in utero infections Prematurity and low birth weight -birth prior to 37 weeks' gestation with low birth weight. -low birth weights have been found to be associated with increased risk of developmental delay -more susceptible to a range of illnesses and conditions that produce developmental disabilities -intubation can affect breathing leading to trachs which can affect speech/language development -treatment of the premature child may have negative consequences for development, even though it is necessary to save the child's life: noisy/overstimulating environment, procedures can cause oral defensiveness/aversion, /trauma/tissue damage to the larynx -parents' perception of the baby as weak and sick may result in less willingness to hold, handle, and play with the child -low-birth-weight babies who receive intervention consistently show benefits over untreated groups in terms of intelligence quotient -a relatively small investment in intervention can have important effects for children who have risks associated with prematurity and low birth weight. Genetic and congenital disorders -Many congenital and inherited disorders also place children at risk for developing language and cognitive deficits -Craniofacial disorders that have adverse effects on the morphology of the auditory mechanism, as well as congenital forms of deafness, put a child at risk -A variety of chromosome abnormalities also can influence communicative development -Sex chromosome disorders Other risks identified after the newborn period -Hearing impairment is one condition that may not be identified at birth -Disorders without physical stigmata, such as autism, nonspecific intellectual disability, and specific language disorders, also are identified later in the prelinguistic or emerging language period -Children who experience abuse or neglect are also identified only after the newborn period has passed

Funding and Reimbursement

-Part C programs coordinate EI funding from federal, state, local, and private sources. -majority of funding tends to come from state -Typically, Part C federal funds cover EI administrative costs, whereas services are funded through the state, third-party payers, and families who pay fees for services -Evaluations, assessments, IFSP development, and service coordination must be provided at no cost to families -families may choose to self-pay or use their medical insurance to seek private services beyond what a school district offers.

Treatment

-Families and caregivers have a direct impact on their child's development and play a pivotal role in treatment outcomes General Treatment Approaches -Routines-based intervention (RBI) = approach that builds caregiver capacity using everyday activities as a context for embedded instruction -primary objective is to increase child and caregiver participation within their natural environment -EI providers, families, caregivers, and/or teachers collaborate to develop child-specific strategies that are practiced during daily routines -SLPs identify regular learning opportunities in family, preschool, and/or community life, work with parents, caregivers, and teachers to create communication and participation goals during learning opportunities, determine the child's interests, strengths, and motivators within daily routines, and establish techniques that maximize development and learning within these routines -emphasizes caregiver-implemented intervention using toys and objects from the home to encourage practice and facilitate generalization of strategies -Coaching = approach that guides families, caregivers, and other professionals on how to build the capacity of all care providers to implement communication and swallowing strategies in natural environments -uses clearly defined, observable, and measurable procedures to support others in their efforts to promote child learning and development -Includes: Joint planning, Observation, Action/practice, Reflection, & Feedback -Involves : direct teaching, modeling, listening, questioning, guided practice, problem-solving, and prompting -supports continuous engagement and ongoing self-assessment to improve existing abilities, develop new skills or plans, and gain an understanding of EI practices -Common in RBI -Coaching colleagues is also an integral part of EI practice Speech-Language Pathology Interventions -For prelinguistic infants and toddlers, treatment often focuses on engagement, meaningful play, and gestures -For young children with complex communication needs, implementation of some form of AAC may be indicated -SLPs often coach families, caregivers, and other team members in how to implement functional, language-enhancing strategies during daily activities -Language-enhancing strategies taught within the context of family-centered EI include: 0Quantity-based strategies—focus on varying the amount and complexity of language directed toward child, regardless of the child's communication skills 0Responsive strategies—focus on self-talk; parallel talk; and imitation, expansion, or recasting Directive strategies—focus on directing language production using open-ended questions, choice questions, or prompts Multimodal strategies—focus on providing tactile support or visual support Engagement-based strategies—focus on providing encouragement to engage in communication

Red flags in development of pre linguistic skills

-Fleeting eye contact. -Social smile is absent. -Does not use different sounds to indicate hunger, happiness, sadness. -Does not babble. -Copying of facial expressions is absent. -Using voice or sounds to get attention is absent. -Does not enjoy others participating in their play.

Effects of early communication intervention on speech and communication skills of preterm infants in the neonatal intensive care unit (NICU): A systematic review

-Having a preterm infant is challenging for parents and families, with increased risk of psychological stress -As preterm infants are at risk of speech, language and communication difficulties, providing parents with information about language development and strategies to promote communication are essential to integrate into neonatal care -Infants born preterm are at risk of developing speech, language and communication problems -NICU can lead to parent stress which parent-child and early interaction skills -Language, cognitive and emotional development is closely linked to parent affect, and consequently any early negative experiences can impair the development of these early skills -Learning to develop attachment to an infant through involvement in everyday care activities in the neonatal environment can support physical and emotional closeness for both the infant and carers, and therefore act as an important precursor for developing early parent - infant interaction and communication -vocal stimuli from carers can improve preterm infants' stability w/ feeding development -Promoting early communication strategies to enhance maternal/carer sensitivity to an infant through use of eye contact; initiating talking with and responding to the infant and using natural gestures can increase attachment and bonding, support improved parent well - being, and improve the interpretation of early infant communication signals during everyday care -Preterm birth is a risk factor for a range of difficulties, including language development -children born preterm can have other problems which can impact on communication development; an increased risk of autistic spectrum conditions ; an increased risk of learning and executive function problems in school, attention and listening difficulties, an increased risk of learning disabilities, and increased risks of visual and/or hearing problems -Preterm infants spoken to when on a neonatal unit have better language and cognitive outcomes at 7 and 18 months -familiar voice and intonation/motherese helps w/ communication -Cue - based feeding involves learning to read and understand what the infant is attempting to express, and as such, this approach could be an important method to support, promote and integrate methods to support early parent - infant communication skills -The importance of neonatal interventions to improve responsive parenting, approaches which include bonding and relaxation and programmes such as individualised family based care are important in supporting both parent and infant mental health and well-being, and may well provide opportunities for the development of early communication skills

Eligibility

-IDEA states that children with established risk (diagnosed medical condition or disorder that has effect on development) are eligible for services under Part C -states have some discretion in setting eligibility criteria for Part C services, including how to define "developmental delay" - definitions of eligibility for Part C services can differ significantly from state to state. -states can serve children w/ no delay, but "at risk" for developmental challenges b/c of biological or environmental factors -When diagnostic assessment tools alone do not establish eligibility, informed clinical opinion must be independently considered -For children not found eligible, families may pursue EI through private or community resources and other federal or state-funded early childhood programs -families can request a re-evaluation

Management

-If the child's communication development does seem on target, this does not imply that we can stop providing advice or support to the family of an at-risk infant -we need to encourage parents to learn how to scaffold or support the child's move toward more conventional communication. -parent responsiveness is a significant predictor of language development -"Upping the ante" is Bruner's (1981) term for the techniques that parents normally use to elicit a higher level of response from a child, once a response of some kind has been evoked. -Warren and Yoder (1998) introduced prelinguistic milieu teaching (PMT) to help in making the transition to intentional behavior. -PMT involves, first, arranging the environment by putting things that the child wants in view but out of reach or by violating the order of events that the child has come to expect.The next step is to follow the child's attentional lead and focus on the child's item of focus -Contingent motor imitation is an exact, reduced, or slightly expanded imitation of a child's motor act performed by the adult immediately after the child does it -Contingent vocal imitation occurs when the adult follows a child's vocalization with a partial, exact, or modified vocal imitation. -increase child initiation by using three types of prompts: time delay, verbal, and gaze intersection -Another technique is modeling -natural consequences, in which the child's communication is rewarded with its intended goal. -Book-reading situations are particularly apt settings for encouraging communication. -communication temptations. These involve creating situations in which the child is strongly motivated to try to get a message across to the adult and then responding swiftly and positively when the child does attempt to communicate. -want to provide experiences in which the child can develop comprehension of language -using baby games to pair words with gestures and referents. -The key, in our opinion, is to keep the focus on responding to the baby's needs and interests, making the parent's communication contingent on the infant's actions, and making sure that the parents and baby are still enjoying each other.

Factors Affecting Service Provision in EI

-Infants, toddlers, and preschoolers do not have a single point of entry into a system for treatment. Treatment can be reviewed for eligible clients through state Part C agencies in the family's natural environments, or ineligible clients in their natural environments, in clinics, or in inpatient or outpatient programs. -Access to EI may be affected by logistical factors such as geographic location, transportation, or family responsibilities. If eligible, transport must be provided -Family beliefs, perspectives on disability, and understanding of the child's needs, levels of acceptance, grieving, and/or stress can also impact access -Some families and providers may need to develop a new understanding about their roles

Populations (Key Issues)

-May include infants / toddlers with a disability / diagnosed physical or mental condition that has a high probability of resulting in developmental delay, including those who: 0have congenital and/or developmental conditions (e.g., autism spectrum disorder, cerebral palsy, Down syndrome, fetal alcohol syndrome, hearing loss) 0have acquired conditions (e.g., traumatic or other acquired brain injuries, illnesses or postoperative complications, abuse or neglect, hearing loss). -Dual language learners with difficulties in acquisition of their native language and a second language may be eligible for services. -Asian, Black or African American, or those w/ multiple racial/ethnic group infants and toddlers = less likely to receive services under IDEA, Part C than Native Hawaiian or Other Pacific Islander and White -American Indian or Alaska Native and Hispanic/Latino infants and toddlers were as likely to be served as all other racial/ethnic groups combined

Individualized Family Service Plan (IFSP)

-Once eligible, an IFSP is developed by an interdisciplinary team, including the family and service coordinator -IFSP = document detailing the EI services and supports provided, and outcomes desired IDEA requires that the IFSP include: -the child's strengths, needs, and current levels of functioning; -the family's concerns and priorities; -services that the child and family will receive; -frequency, intensity, and method of delivering the services, including who will provide them, where they will occur, and in which language(s); -outcomes that the family desires, timelines for achieving results, and methods of outcome measurement; -a notation of the transition plan date; and -a statement that EI services are based on peer-reviewed research The required timeline for IFSP development and review is as follows: - IFSP must be developed 45 days from referral. - EI services must begin within 30 days of the IFSP - IFSP must be reviewed at least every 6 months or if goal achieved or new concern arises -families can invite others to meeting and request to review IFSP -states can extend an IFSP beyond the child's third birthday through age 5 years, when child is eligible for preschool special education and related services as a child with a disability.

Service Plans for Prelinguistic Clients

-Recent changes in federal policy have helped to move clinicians in the direction of family-centered practice. -IDEA establishes the requirement for an Individual Family Service Plan (IFSP) for children in the birth-to-3 age range that must include services needed not only to maximize the development of the child but also to optimize the family's capacity to address the child's special needs. -The IFSP should include information about the family's resources, priorities, and concerns for the child's development. -The elements that are required by law to be included within an IFSP include: • Information about the child's present level of physical, cognitive, social, emotional, communicative, and adaptive development • A statement of the family's resources, priorities, and concerns related to enhancing the development of the child • A statement of the major outcomes expected to be achieved for the child and family, and the criteria, procedures, and timelines used to determine progress and whether modifications or revisions of the outcomes or services are necessary. • A statement of the specific early intervention services necessary to meet the needs of the child and the family to achieve the specified outcomes, including (1) the frequency, intensity, and method of delivering the services; and (2) the environments in which early intervention services will be provided and a justification of the extent, if any, to which the services will not be provided in a natural environment, the location of the services, and the payment arrangements, if any. • A list of other services, such as (1) medical and other services that the child needs, and (2) the funding sources to be used in paying for those services or the steps that will be taken to secure those services through public or private sources. • Projected dates for initiation of the services as soon as possible after the IFSP meeting and anticipated duration of those services. • The name and discipline of the service coordinator who will be responsible for the implementation of the IFSP and coordination with other agencies and persons. • A plan for transition to preschool services. -important = including caregivers as significant partners in the assessment and using culturally sensitive procedures and naturalistic observations of play and other daily routines within the assessment process. -any infant at risk for a developmental disorder in general is at risk for language deficits in particular -When working with high-risk infants, primary and secondary prevention are the predominant goals -hope that working with these families to enhance the baby's communicative environment can help avoid/minimize some of the deficits for which they may be at risk -Many high-risk infants present with feeding problems, hearing losses, and neurological and behavioral difficulties that can influence communication development

Monitoring Interventions and Outcomes

-SLPs need to regularly monitor changes in language, communication, and/or feeding and swallowing, as well as the effects of interventions and progress toward outcomes. -also monitor priorities and needs, strategies and approaches, and models and locations of service delivery -Qualitative and quantitative data collection can assist in monitoring interventions by: 0validating the conclusions from the initial evaluation/assessment; 0developing a record of progress over time; 0identifying facilitators or barriers; 0attending to levels of engagement 0determining whether and how to revise intervention plans 0ensuring fidelity of the intervention plan -monitoring by measuring participation-based outcomes is meaningful to families because it facilitates conversations related to real-world expectations and functioning

Family-centered practice

-The burden of caring for and fostering the development of infants at risk for communication disorders falls on their families, who may already be experiencing a great deal of stress -When we deal with infants at risk for communication disorders, we are dealing with the family in which the infant finds a home -When thinking about the needs of the high-risk infant, we need to think about the needs of the family, too, to provide that infant with the best environment for growth and development.

Assessment and Intervention for Infants at prelinguistic stages of communication: 9-18 months)

-They move from being participants in interactions to being intentional communicators -these children are in the illocutionary stage of communication when they express intentions through signals to others but do not yet use conventional language Assessment -How do we know that the infant has made this transition to intentionality? -When the child achieves a developmental level of 9 to 10 months or more on one of these instruments, readiness for intentional behavior can be inferred. -ntentionality also can be assessed through observation of the child's play. This can be done using one of the formal play assessments -can be done informally by providing the child with common objects that invite conventional and pretend play -observation can be used to determine whether the child is demonstrating some recognition of common objects and their uses -If these conventional uses of objects and early representational behaviors are observed during the play session, the clinician can be confident that the child is ready to engage in intentional communication. -we can use a parent-report instrument to elicit information about early communicative behaviorwe can use a parent-report instrument to elicit information about early communicative behavior -This information also can be used to help determine whether the child is demonstrating behaviors that imply intentionality. -If intentional behaviors are neither observed nor reported, the clinician can attempt to elicit them by modeling conventional use of objects and engagement in simple pretend schemes and observing whether the infant can use the models in his or her own play -Once it has been established that the infant can benefit from a program focused on intentional communication, assessment may be useful in determining the frequency and types of communication that the baby is demonstrating. -The Communication and Symbolic Behavior Scales = a formal instrument for assessing infant and toddler communication skills. This procedure involves video recording the baby engaged in play interaction and using a standard format or video to assess intentional communication -point of assessing communicative behavior in the child with a developmental level of 9 to 18 months old is simply to determine whether any functional communication is present -Typical functions expressed at this level include requesting objects or actions; attempting to get the adult's attention on what the child is interested in; and initiating social interactions through greeting, calling, or showing off. If this does not happen, we can infer that communication development is beginning to lag.

Early Intervention Overview

-children ages birth to 3 years and their families/primary caregivers -Early intervention (EI) is the process of providing services & supports to infants, toddlers, and their families when a child has/is at risk for a developmental delay, disability, or health condition -Goal of EI = lessen the effects of a disability/delay by addressing five developmental areas: 1.Cognitive development 2.Communication development 3.Physical development, including vision and hearing 4.Social or emotional development 5.Adaptive development (Individuals with Disabilities Education Act -earlier that services are delivered = more likely children are to develop effective communication, language, and swallowing skills and achieve successful learning outcomes -The Program for Infants and Toddlers with Disabilities, also called Part C of IDEA, is a federal grant program that helps states operate comprehensive systems of interdisciplinary EI services -EI services can also be provided in neonatal intensive care units, pediatric rehabilitation hospitals or clinics, preschools, and private practices. -Services in these settings may not be covered by federal/state $ but can go to public / private insurance or to the family.

Roles and Responsibilities of Speech-Language Pathologists

-qualified to provide services to families and their young children who demonstrate, or are at risk for developing, delays or disabilities in communication, speech, language, cognition, emergent literacy, and/or feeding and swallowing -Demonstrate knowledge of typical developmental norms from birth to age 5 years across domains -Engage in prevention and early identification activities -Understanding federal, state, agency, and professional policies and procedures related to screening, evaluating, and assessing -Conducting screening, evaluation, and assessment -Establishing eligibility for services and guiding the development of an intervention program -Making referrals to other professionals and informing the referral source of the outcome of the eligibility process, with the family's consent -Developing a plan for implementing services and supports -Gathering and reporting treatment outcomes and documenting progress -Revising intervention plans and determining appropriate discharge criteria -Collaborating with families, caregivers, agencies, and other professionals involved in IFSP team to help implement intervention strategies in everyday routines -Supporting family interactions that reflect cultural beliefs, values, and priorities -Coordinating services and ensuring they are implemented as agreed upon by the team -Participating in transition planning -Advocating at the local, state, and national levels regarding public policy, funding, and infrastructure -Raising awareness about importance of EI -Remaining informed of current EBP in EI -Helping advance the knowledge base related to the nature and treatment of speech, language, cognitive-communication, and swallowing development and disorders in infants and young children -SLP should be considered a primary provider when the child's main needs are communication, emergent literacy, and/or feeding and swallowing

Screening, Evaluation, and Assessment

-services must be provided to families in their native language -may be developmentally appropriate to use the language(s) typically used by the child Screening -refers to the process of identifying children who may need further evaluation to determine the presence of a developmental delay or disability -Not mandatory under part C (done by state decision) -a parent can request that the EI program conduct an initial evaluation, even if the results of screening do not indicate the need for further evaluation. Evaluation -refers to the procedures used to determine a child's initial and continuing eligibility for EI services. -Evaluation considers data gathered from the following procedures: 1. Administering an evaluation instrument 2. Taking the child's developmental and medical history 3. Identifying the child's level of functioning in each of the five developmental areas 4. Gathering information from other sources—such as caregivers, health care providers, and educators—to get a holistic view of the child's strengths and needs 5. Reviewing medical, educational, or other records Assessment -refers to the formal and informal in-depth procedures used to (a) identify a child's strengths and needs and (b) determine the appropriate EI services to meet those needs throughout the period of eligibility -ongoing process -Culturally sensitive / linguistically appropriate assessments identify resources, priorities and concerns, and the supports and services needed to enhance the family's capacity to meet the child's developmental needs

Problems because of pre linguistic difficulties

1. Comprehension of language (receptive language). 2. Use of expressive language. 3. They may show behavioral problems such as temper tantrums. 4. Social skills are also affected. 5. There is a delay in use of words to communicate. 6. Attention and concentration are affected. 7. It also affects play skills.

Pre-linguistic skills

1. Eye contact : It is a very important pre - linguistic skill. Babies start to make eye contact around 6 - 8 weeks. It helps babies to recognise faces and voices. It also helps to understand things around them. 2. Responding : Babies start responding to facial expressions and voices by smiling at you or cooing. Laughing and squeals emerge around 3 - 4 months of age. This indicates that babies begin to understand their reactions means something. 3. Purposeful noises : Babies begin to make purposeful noises around 4 months. They have established the understanding that if they make a particular sound, their caregiver will smile at them. 4. Turn taking : This develops when the parents make a sound or smile at the child. Then they wait for the child to respond. Eventually, the parent and the babies start to take turns with actions and sounds. 5. Imitation : Babies start to imitate sounds or actions around 6 months of age. For example, you may say 'ma ma'. The baby also repeats 'ma ma'. They also start copying your actions like clapping. 6. Joint attention : Joint attention means interacting with the same object. It means the child first looks at the object, then at the caregiver and again at the object. For example, both of you are looking at the teddy bear. The child first looks at the teddy bear. He/she will then look at the caregiver and back at the teddy. It is the unsaid version of 'do you see what I see'. It emerges around 9 months of age.

Activities to improve pre - linguistic skills

1. To improve eye contact, games such as peek a boo, play with balloons, and use bubbles. 2. To enhance imitation skills, action songs, sing songs, clapping games, & daily chores can be done with the babies. 3. To work on turn taking, many pre-linguistic skills activities can be done. You can play pass the ball, use blocks, talking & waiting for response for taking turns. 4. Indulge in stop and pause to improve the baby's joint attention. This involves pausing before giving an item or resuming an action so the child will look at you.

Guiding Principles of Early Intervention

5 principles: 1. Services are Family-Centered -refers to a set of beliefs, values, principles, and practices that strengthen a family's capacity to enhance their child's development and learning -responsive to each family's unique circumstances and provide families with complete and unbiased information to make informed decisions -EI providers must involve families in all aspects of a child's services -family as whole receives EI services that build upon their strengths -Families collaborate with professionals to design and implement individualized services to support both the child's and family's needs, achieve mutually agreed upon outcomes, and promote family capacities 2. Services are Culturally and Linguistically Responsive -must have access to culturally competent services -EI services must be provided to families in their native language -EI services and supports are provided in the language(s) most likely to yield an accurate picture of the child's skills -for multiple languages, EI providers work with families and interpreters to support the home language(s) as well as acquisition of the language needed for academic success. 3. Services are Developmentally Supportive and Promote Children's Participation in Their Natural Environments -Developmentally supportive EI practices address family routines, concerns, and priorities through active exploration, authentic experiences, and interactions consistent with the child's age, cognitive-communication skills, strengths, and interests -requires services to be in natural environment to max extent appropriate -Familiar everyday experiences, events, and places used to promote natural learning and incidental teaching -if natural environment is not optimal for a child, justification must be included in service documentation 4. Services are Comprehensive, Coordinated, and Team-Based -prevent fragmented service delivery and to maximize child and family outcomes. -members of the IFSP team must coordinate their approaches, consult with one another, and recognize that child and family outcomes are a shared responsibility. -service coordinators monitor family needs, child progress, team dynamics, and implementation of the IFSP -the service coordinator and other team members need to promote collaboration to facilitate communication and avoid redundancy. -develop interventions that complement one another rather than contradict or duplicate services 5. Services are Based on the Highest Quality Internal and External Evidence Available -Internal evidence includes policy, informed clinical opinion, values and perspectives of both professionals and consumers, and professional consensus -External evidence is based on empirical research published in peer-reviewed journals -Evidence-based practice in EI evaluates all of these considerations to deliver services to achieve positive outcomes for young children and their families.

California Early Start Program

Eligibility: -Children birth to 3 years old. -Residents of San Diego or Imperial County. -Developmental delay in one or more of the following five areas: Cognitive; Communication; Social/Emotional; Physical; Adaptive. -33% delay in at least one developmental area. -No financial qualifications necessary. -Established Risk for developmental disability At risk for developmental disability (two or more factors): 0Less than 32 weeks gestation and/or birth weight less than 1500 grams. 0Assisted ventilation for 48 hours or longer during first 28 days of life. 0Small for gestational age. 0Asphyxia neonatorum. 0Severe and persistent metabolic seizures during the first 3 years of life. 0Neonatal seizures or non-febrile seizures during the first 3 years of life. 0CNS lesion or abnormality. 0CNS Infection. 0Biomedical insult (injury, accident or illness) which may affect developmental outcome. 0Multiple congenital anomalies. 0Prenatal exposure to teratogens. 0Prenatal substance exposure, positive tox screen or withdrawal. 0Clinically significant failure to thrive. 0Persistent hypertonia or hypotonia. -Parent of the infant/toddler is a person with a developmental disability.

Components of Screening

Factors related to the child and family -Background—developmental and medical history -Language(s) used -Family concerns, priorities, and available resources/supports -Family/caregiver-child interaction -Environmental stressors Factors related to the child's abilities -Hearing status -Functional listening skills -Sensory, motor, and cognitive skills (including play and problem solving) -Speech, language, and emergent literacy skills -Feeding/swallowing -Emotional and social functioning Screening -important component of prevention, family education, and support -Hearing screening as part of comprehensive speech-language evaluation -Hearing screenings after the newborn period (0-6 months) are important for early identification and management of the hearing status -Speech, Language, Cognitive-Communication, and Swallowing Screening Screening typically includes: -direct interaction with the child; -observation of interactions between child and caregiver(s) in natural contexts; -interviews with family members or early childhood teachers regarding concerns about the child's skills; -professional-administered and parent-completed measures.

Service Delivery

Format refers to the structure of the treatment session. -Consultative and collaborative formats support inclusive practices and focus on the child's participation and functional communication during daily activities and routines -services are usually structured within the context of the child's home, community, and group care settings, so the format regularly includes key people in those settings -Outside of Part C, format selection depends on treatment setting, stage of intervention, severity of disorder, and the primary goals of the team at different points in the EI process -important to implement formats that are flexible and dynamic -Telepractice can also be used Provider refers to the person providing the treatment -Primary service provision emphasizes a transdisciplinary approach to EI service delivery that involves a team of professionals and a primary service provider (PSP), who serves as the primary point of contact for the family -The intent is to address the child's development from a holistic perspective in the context of the family -PSP helps the family and other team members consider how all aspects of development overlap in life -less intrusive approach Dosage refers to the frequency, intensity, and duration of service. -some families and caregivers require more frequent contact and more concrete support, whereas others prefer more freedom to foster their own learning -Intervention characteristics often guide decisions about dosage needs more than the severity of a disorder -Matching the strengths of providers to the needs of individual families and children is also essential to determine effective dosage Setting refers to the location of treatment -Factors such as the family's geographical location, child and family needs and resources, and family preferences will help determine where services and supports occur -intervention services and supports must be provided to the maximum extent appropriate in natural environments (unless justification & documentation) -natural environments for EI services and supports may change over time -some children may receive EI services in more than one setting

Why is intervention needed if pre-linguistic skills are delayed ?

Help the child develop play skills Aid in the development of social skills Develop the ability to understand language Enhance turn taking skills Improve joint attention Help improve imitation skills Improve their ability to express themselves

Components of Screening Evaluation & Assessment

Pre-Assessment and Evaluation Planning Processes Prior to evaluation and assessment, EI team members must meet with the child and family to: -identify what the family wants and/or needs from the assessment process; -identify language(s) to be used in the evaluation; -identify areas and activities of strength and need for the child; -determine roles/responsibilities that family members and caregivers will take in assessment -determine times, locations, and activities that will facilitate the assessment process. Evaluation and Comprehensive Assessment -communication = required in a comprehensive evaluation -evaluation and assessment can be different or same process depending on the state -assessment usually encompasses more in-depth observations and information gathering than eligibility evaluations -evaluation process is used to determine a child's eligibility -assessment results are typically an integral part of intervention planning -a larger group of professionals may participate in the assessment process -ongoing assessment helps determine response to treatment Evaluation and Assessment Methods -IDEA requires that evaluation or assessment be completed using a range of tools in a variety of contexts -eligibility decisions cannot be based on standardized measures alone -Ethnographic / routines-based interview & assessment protocols = useful for gathering info about the family's environment and the child's participation -Info gathered from interview & assessment serves as the context for IFSP, collaborative intervention, and desired outcomes Considerations in Assessing Young Children -limited # of standardized cognitive-communication assessments for infants and toddlers; even fewer standardized tests exist for young children with acquired communication disorders -There are few non-English standardized assessments. -Cognitive and communication skills are still developing during this period; many children will be pre-verbal, impacting selection of assessment methods -Overall development is rapid, uneven, episodic, and highly influenced by the environment, with great variability within and among children; therefore, ongoing assessment is necessary -Young children often have limited attention and feel stressed or anxious in unfamiliar settings with unfamiliar people; using families/caregivers and the info is essential. Sharing Information With Families -Consider how cultural values affect information sharing with families -Before discussing assessment results, ask families to share their impressions of assessment activities, concerns, and their child's strengths and needs -Families have varying knowledge about EI; meet families where they are, follow their lead, and provide information more than once, as needed -Type and amount of info shared & the way it is shared may impact how families / professionals feel about assessment process and follow-up decisions -Families need complete and unbiased information in terms that they can understand so they can make informed decisions and actively participate in conversations about next steps. -Evaluation or assessment findings may sometimes be unexpected or difficult for families to hear. It is important to address family emotions within the assessment and intervention process

Transitioning to Part B (Special Education) or Other Services

There are various transitions in EI including: -from provider to provider -from hospital or home-based programs to community-based programs -Most significant transition = child moves at age 3 years from Part C to Part B school-based services -Federal law mandates that there be a systematic plan for transition from a Part C EI program to the child's next program -Representatives of programs involved in transition are required to take part in the planning -IDEA requires transition plan be made within 90 days of the child's third birthday (usually 2 1/2) -transition plan date must be included on the original IFSP document When SLPs are acting as service coordinators they: -have direct responsibility for oversight of transition activities -are knowledgeable about a wide range of resources in the community -ensure that families have available information on transition -ensure that families know their state's opt-out rights -In some cases, may take part in IEP meeting

Navigating the Part C Early Intervention Process

Under IDEA, EI begins when a child is referred to the Part C system and ends when a child transitions out of EI—typically at 36 months of age. Federal/State Laws and Regulations -Under Part C of IDEA, states receive federal grants to provide comprehensive, coordinated EI services -The IDEA Part C Final Regulations give states the discretion to extend eligibility for Part C services through age 5 to children w/ disabilities who are eligible for services and who previously received services under Part C -state name / requirements may differ Point of Entry and Referral -Each EI system has their own way to receive referrals from sources who suspect a developmental delay or disability in an infant or toddler -IDEA requires providers to make referrals within 7 days after the infant or toddler is identified as having a possible delay or disability. -After receiving referral, lead agency or local EI service provider has 45 days to complete the screening, initial evaluation, initial assessments, and initial team meeting to develop an initial Individualized Family Service Plan (IFSP) for the child and family -Informed written consent must be obtained prior to initiation of services & should be in the preferred language(s) of the family -After referral is received, a service coordinator is assigned to children and families to explain the EI process and help navigate next steps -service coordinator = typically family's case manager and single point of contact with the EI system.

What are pre linguistic skills ?

skills which develop before a child learns to talk a way of communicating without words includes skills such as gestures, imitation, facial expressions and joint attention These skills form the basis for development languages