Early intervention programmes for children with developmental disabilities

NATHANIEL SCHERER: Early childhood disability-focused interventions are designed to assist a child’s impairments and maximise developmental outcomes. Such intervention programmes aim to reduce limitations to functioning and participation and may work with children across one or more areas of development, such as communication or cognition. Early intervention typically takes place during a child’s first three years, as these are the most critical developmental years, during which children have the opportunity to learn core functions and skills. These years are also known as the critical period. Evidence consistently shows that early intervention in this critical period can have long-lasting benefits. Early intervention programmes will comprise of a range of coordinated multi-sector and multidisciplinary services and can take many forms, including parenting support and home-based childhood therapies.

For children with cerebral palsy, for example, an early intervention programme may combine elements of home-based physiotherapy and hospital-based speech and language therapy. Interventions are typically provided through primary health centres, hospitals, schools, community centres, and in some settings, specialised early intervention services. Evidence puts us in no doubt as to the importance of early intervention. A child with a developmental disability who receives early intervention is likely to demonstrate a significant gain in developmental skills, allowing them to engage more effectively in everyday activities and tasks. Early intervention strengthens the cumulative process of development, helping children acquire new skills and behaviours to reinforce and strengthen learning.

There is a window of opportunity to realise this gain, and if missed, the gain will not be made. In addition, early childhood programmes help establish support networks for parents, helping build their knowledge, confidence, and coping strategies. Parents regularly report a high level of appreciation for early intervention programmes. Early intervention programmes are most effective when adequate resources are available. But there is evidence that early intervention programmes are a sound financial investment for governments and local authorities, as funding in early intervention reduces the need for ongoing support for children in later life. This improves the case for early intervention beyond the benefit to individual children and expands benefit to society as a whole.

When thinking about early intervention programmes, there are certain key principles which can enhance programme efficiency and effectiveness. Firstly, early intervention programmes need to place an emphasis on empowering parents with a focus on both the child and family-centred care. Interventions need to be tailored to the specific needs of each child with a focus on developing their specific skills and behaviours. As we know, family has a powerful effect on a child’s development, and services should involve families as equal, active partners. In order to create effective, tailored interventions, healthcare professionals should encourage families to examine and monitor their child’s developmental strengths and needs.

By involving family members in this process, early intervention can be flexible to a family’s needs and allow them to better support their child. For example, should a family live far away from a health care service, they may require more home-based therapies, making it easier for them to be involved in their child’s care. It’s also important to note that early intervention services should not neglect the care of family members who may be undergoing psychological distress and are in need of mental health support. A second key facet of early intervention is a focus on inclusive and natural learning environments.

Although many interventions will require individualised therapy, it’s important that components of the early intervention programme occur in places where one would usually find typically developing children. They should not be solely delivered in places that will isolate children with developmental disabilities or their family. Children with developmental disabilities benefit from inclusive play and group participation with other non-disabled children. Aside from the obvious benefit of social inclusion and friendship, early intervention services focused on inclusive interventions offer children with developmental disabilities a greater number of learning opportunities with which to enhance their development.

For instance, children with developmental disabilities learning in a natural environment are more likely to develop appropriate and effective social skills, and they are more likely to develop a sense of belonging. The final principle to consider is that of collaboration, both between health disciplines and other relevant sectors such as education, social care, child protection, and so on. Depending on their condition and impairment, a child with a developmental disability may require support and expertise from a number of healthcare professionals ranging from occupational therapists to psychologists. These professionals are likely to be based in different services, and they may hold different therapeutic values and intervention delivery methods.

Although attending to a diverse selection of experts can benefit a child, the fragmentation of services can also hinder progress in development if there is a lack of continuity between services. Adopting an integrated, collaborative model to early intervention is a more effective framework. We will discuss this principle of collaboration in more detail later in the week. For now, let’s finish our discussion on early intervention by thinking about service delivery components. The first stage of any early intervention programme is the timely and correct identification of children with developmental disabilities, as we discussed in previous steps. Once diagnosed, health care professionals will be heavily involved in early intervention programmes across three components, referral, delivery, and transition.

As a first stage, referral will occur after an assessment of developmental functioning and need for early intervention. Healthcare systems need efficient referral mechanisms to ensure that a child receives timely intervention with appropriate specialists. Health professionals will need to be aware of the referral systems and other services in their setting and maintain good communication with other healthcare service providers. It will also be necessary to ensure parents have information on the referral service and receive written information regarding their appointment date and time. Text message reminders, for example, can help parents reach these referral services. The second stage of delivery requires the collaborative approach to service provision between different healthcare professionals and other service providers that we’ve discussed previously.

Early intervention programmes do not comprise of only medical interventions. Programmes need to link healthcare interventions with parental participation and parental support as well as including the community. The final component to consider is that of transition. Early intervention typically occurs before the age of three, but the majority of children require ongoing support throughout their life. Healthcare professionals need to work with other service providers and agencies to plan the successful transition of a child from early intervention services to ongoing paediatric care. It is vital that this transition does not result in the disruption to ongoing intervention support to facilitate a smooth, painless transition. In this presentation, we have presented an optimistic outlook on early intervention and an ideal framework.

But establishing these early intervention programmes is a complicated task. Each needs to be tailored to a specific setting, taking into account resources, personnel, and need. Complexity and diversity of need shown by children with developmental disabilities makes it difficult to establish consistent intervention packages. Not least, a major challenge to effective intervention is the need for a diverse portfolio of skilled, specialised health professionals. There are also important financial costs to consider. And although early intervention is seen as a cost effective strategy, there is an initial funding requirement for healthcare providers and government agencies. Of course, these challenges can be overcome, and the next step will provide some specific examples of early intervention programmes from different parts of the world.