The Early Intervention Curriculum: Family-Focused Intervention Strategies, Activities, and Routines

1
The Early Intervention Curriculum
Family-Focused Intervention Strategies,
Activities, and Routines

• Gerald Mahoney
• Case Western Reserve University
• School of Social Work

2
What is a curriculum?

• The term curriculum refers to a conceptual
  framework and organizational structure for
  decision making about educational priorities,
  instructional methods and experiences, and
  evaluation criteria.
• Curriculum models provide a defined, sequenced
  series of intervention objectives, learning
  experiences, instructional procedures and
  evaluation criteria for attaining a specific
  developmental outcome.

3
Basic Components of the Early Intervention
Curriculum

• Theoretical Model/Conceptual Framework
• Theoretical Model for EI Curricula should
  explain
• how developmental competence occurs
• factors that influence development
• factors that contribute to developmental problems
  or delays.
• Theoretical model should be explicit
• not implied or assumed.

4
Theoretical Model

• Not all theories are the same
• Sensory Integration
• Based upon a theory of information processing
  that originated during the late 1950s early
  1960s.
• Information processing theories have changed
  dramatically in the past 40 or 50 years.
• the current fund of research findings may well
  be sufficient to declare SI therapy not merely to
  be an unproven, but a demonstrably ineffective,
  primary or adjunctive remedial treatment for
  learning disabilities and other disorders (p.
  348).
• Hoehn, T, Baumeister, A. (1994) . Journal of
  Learning Disabilities

5
Theoretical Model

• Good theory is necessary but not sufficient for a
  good EI curriculum.
• Good Theory with Increasing Support
• The failure of Children with Down syndrome to
  achieve normal development is related to the
  impact that this condition has on the integrity
  of the neurological system (e.g., Transmission of
  impulses across synapses)
• No validated developmental curriculum based upon
  this theory
• No evidence that developmental interventions can
  enhance neurological functioning of any sort

6
Theoretical Model

• Learning Theory
• Development can be conceptualized as the
  accumulation of learned behaviors or responses
• Children with disabilities have developmental
  delays because they have not had the
  opportunities for learning the discrete skills
  and behaviors that they need.
• Children with disabilities may require different
  types of learning opportunities than typically
  developing children
• More structure, intentional teaching, extrinsic
  reinforcement
• With appropriate teaching (antecedent and
  consequent events) children with disabilities can
  learn anything (Bijou)
• Comments
• learning theory is generally not considered to be
  a valid description of typical development or of
  the causes for developmental problems or
  disabilities.
• The strength of this theory is that it serves as
  the foundation of an actionable, positivistic
  instructional methodology that has been used with
  some success to teach specified human behaviors
  to children and adults with mental challenges
  and/or impairments

7
Theoretical Model

• Developmental Theory
• Childrens development results from their active
  participation in social and nonsocial activities.
• Constructivism, Communication Theory
• Developmental learning is constrained by
  childrens current level of functioning and their
  innate/biological capacities to learn.
• Children with disabilities learn in the same way
  and in the same sequence as typically developing
  children
• Children with disabilities have developmental
  delays because their learning processes are
  compromised and limit their capacity to learn
• Require more practice or developmentally
  appropriate experiences than typically developing
  children
• Comments
• developmental theory is generally considered to
  provide a better description of learning and
  development and of the factors that contribute to
  developmental problems than learning theory.
• Since there is no clear relationship between
  developmental theory and instructional
  methodology, special education and early
  intervention have been reluctant to embrace this
  as the foundation for practice.
• The deterministic elements of developmental
  theory are viewed as antithetical to the basic
  purpose and tenets of early intervention practice.

8
Theoretical Model

• Ecological Theory of Development
• Childrens development is affected by the quality
  of interactions they have with parents and other
  socializing agents
• Adverse psychosocial/familial conditions can
  affect childrens
• Frequency and quality of interactions with
  parents and other socializing agents
• Frequency and quality of opportunities for
  developmental stimulation
• Children with disabilities can be a unique and
  significant source of stress for parents and
  other socializing agents
• The developmental outcomes attained by children
  with disabilities can be enhanced by addressing
  this psycho-social factors that interfere with
  childrens opportunities for quality interactions
  and other developmental experiences.
• Comments
• Ecological theory is the cornerstone for family
  services in EI
• No child focused curricula are based directly on
  ecological theory
• Recent emphases on parent education and
  parent-child interaction have evolved for
  ecological theory

9
Theoretical Model

• Hybrid Model Combination of Theories
• Naturalistic Intervention
• Learning Theory Developmental Theory
• Uses incidental teaching model to promote
  specific skills in the context of
  child-initiated, developmentally appropriate
  activities
• Relationship Focused Intervention
• Ecological Theory Developmental Theory
• Focus on enhancing the quality of parent-child
  interaction (e.g., parental responsiveness) as a
  means of encouraging childrens participation in
  developmentally appropriate activities and
  experiences

10
Theoretical Model

• Eclecticism
• Pragmatic (What Works) versus Theory Driven
• Based on notions that
• different practices (curricula) work with
  different children and families
• Different practices are required to address
  different developmental concerns
• Derived more from clinical experience than
  empirical research
• Little reliable evidence to indicate that
  different practices are effective with different
  populations
• e.g. Autism requires more structured
  interventions than non-autistic children
• Different from using a curriculum to address the
  individualized needs of children
• Can result in interventionists using practices
  that are incompatible with each other

11
Eclectic Autism Programs

• Combine various curricula and services commonly
  used with children with ASD
• IBI
• Floortime
• Sensory Integration
• Developmentally Appropriate Practice
• Speech Therapy
• Studies show that this is not as effective as the
  use of IBI alone

12
Basic Components of the Early Intervention
Curriculum

• Intervention Goals
• EI Curricula must address Goals that reflect the
  purposes of early intervention
• A goal is the long term objective/ultimate
  desired outcome
• Maximize childrens functioning
• Cognitive
• Communication
• literacy
• Social-emotional
• Motor
• Adaptive Functioning
• Home
• School
• Goal attainment is best assessed through the use
  of standardized developmental tests
• Frequently not done in EI because of training and
  requirements for standardized testing
• Tests may not be standardized for or appropriate
  for use with children with certain disabilities
• Tests may not measure what children are taught

13
Basic Components of the Early Intervention
Curriculum

• Intervention Objectives
• Outcomes that are promoted to help achieve a
  goal.
• Intervention objectives are what we are trying to
  help children and parents learn and do in order
  to attain a desired goal.
• Cognitive, Communication, Social Emotional,
  Motor, etc.
• Intervention Objectives are driven by Theory.
• Behavioral Theory- discrete developmental and or
  functional skills
• Developmental Theory- general developmental
  activities or behaviors such as play,
  communication, joint attention, trust,
  cooperation
• Ecological Theory - parent, family or community
  outcomes such as parent-child interaction,
  reduced parental stress, family support, access
  community services and supports

14
Intervention Objectives

• Confusion between Intervention Goals and
  Intervention Objectives
• many perceive the objective to be the goal
• The Goal of an EI Curriculum is not merely to
  achieve an objective- It is to promote the goal
  of EI
• EI goal is not attained
• If a child learns the words that are targeted as
  his/her objectives but does not improve their
  rate of communication functioning or rate of
  development.
• If a child is included in a classroom but does
  not increase his rate and quality of interaction
  with peers

15
Intervention Objectives

• Intervention Objectives must be measurable
• Requirement of IFSP or IEP
• Accountability
• Program modification
• YET, Measurability does not mean that
• intervention objective is good or bad
• intervention objective has actually been
  achieved.
• The more measurable an objective, the more
  concrete it is, and the more likely it will be
  attained
• Yet very measurable objectives can be attained
  without
• impacting the childs general level of
  functioning
• achieving the goals of EI.
• 8/10 mastery criteria is an objective rating
  that is often a poor indicator of whether this is
  an objective that children will remember and use
  spontaneously.
• Subjective ratings can be used to measure
  intervention objectives but less reliably
• Intervention curricula could be effective and
  valuable even though they target intervention
  objectives that are difficult to measure

16
Basic Components of the Early Intervention
Curriculum

• Curriculum Methods and Strategies
• Instructional strategies are dictated by the
  nature of the objectives
• If the intervention objective is for the child to
  learn specific developmental and functional
  behaviors then we must use some form directed
  instruction
• Modeling
• Shaping
• Prompting
• Elicited Imitation
• Extrinsic Reinforcement

17
Curriculum Methods and Strategies

• If the intervention objective is for the child to
  become more engaged in developmental learning
  activities such as initiation, exploration,
  practice, communication, then we must use some
  form responsive instruction to attain these
  objectives
• Turntaking
• Matching
• Imitating Child,
• Follow the Childs Lead
• Acceptance
• Expansion/Conversational recast

18
Curriculum Methods and Strategies

• Hybrid curricula (activity based/incidental
  teaching/pivotal response training) evolved from
  learning theory
• often target specific behaviors and skills as the
  intervention objectives
• Responsive instructional procedures are used to
  increase the childs level of engagement
• Directive instructional procedures are used to
  teach the child specific skills in situations in
  which they are engaged.

19
Curriculum Methods and Strategies

• Environment
• Related partly to nature of objectives
• Learning Theory Skills and behaviors
• Environment arranged to maximize the probability
  that child will engage in behaviors that are
  associated with the skills and behaviors that are
  targeted as intervention objectives
• Toys and materials selected as props for teaching
  targeted behavior
• Developmental Theory- General developmental
  behaviors
• Environment arranged to maximize opportunities
  for child initiated play and communication.
• Diversity of play experience is emphasized over
  specificity of play experiences
• Emphasizes providing children developmental
  appropriate toys and materials that are matched
  to childrens current level of developmental
  functioning

20
Curriculum Methods and Strategies

• Environmental Arrangement
• Related partly to nature of objectives
• Hybrid Skills and behaviors
• Environment arranged to maximize opportunities
  for child initiated play and communication.
• Diversity of play experience is emphasized over
  specificity of play experiences
• However, toys and materials embedded in
  environment as props for teaching targeted
  behavior

21
Curriculum Methods and Strategies

• Activities and Routines
• Generally driven more by EI policies and funding
  than by curriculum
• Family Centered Practices
• Parent Participation versus Professional
• Family Choice
• Natural environment
• Home
• Child care
• Daily activities and routines
• Intensity
• Multidisciplinary vs. Transdisciplinary
• Contemporary EI Curricula must be adaptable to EI
  policies and funding constraints

22
EI Curriculum and Early Intervention Policies

• IFSP
• Must be capable of being responsive to parents
  concerns about their children
• Individualized Instruction
• EI Curricula
• Individualized Planning
• Can not be aged based
• Must be adaptable to childrens current level of
  functioning
• Often associated with developmental assessment
• Must be capable of addressing child's unique
  learning style or abilities
• Autism
• Down syndrome
• Sensory/ Motor Impairments
• Must be adaptable to learning style and
  constraints of families

23
Utility

• Manualized clearly described, detailed
  procedures for planning, conducting and assessing
  intervention.
• Comprehensive- curriculum addresses a broad range
  of outcomes
• Practical
• resources necessary to implement the curriculum
  are easily accessible
• Evidence that providers can implement
  intervention
• Field Tested
• Certification
• Intervention is appropriate for population
• SES, Mental Health
• Available resources

24
Considering Commercially Available EI Curriculum

• Lovaas
• Hawaii (Portage, Carolina)
• Transdisciplinary Play Based Intervention
• AEPS
• Floor Time
• Responsive Teaching
• Enabling and Empowering Parents

25
Evidence Based

• Nearly every EI curriculum is evidenced based
• Different Kinds of Evidence
• Evidence to support theoretical model (Good)
• Evidence to support effectiveness of intervention
  methods to promote intervention objectives
  (Good-Better)
• Evidence to support overall effectiveness of
  curriculum at attaining intervention goal
• Descriptive Pre- Post- (Good)
• Quasi Experimental- (Better)
• Causal Model-(Better than Better)
• Randomized Control (Best)

26
Evidence Based

• If you implement a fully developed curriculum,
  that is useable and compatible with EI policy,
• but there is no evidence of effectiveness,
• you have no idea that what you are doing or
  asking parents to do will actually help to
  enhance childrens developmental well being.

27
Lovaas (PRO-ED)AKA - UCLA Program, ABA, Discrete
Trial Training

• Theoretical Model
• Learning Theory
• Intervention Goals
• Self Help
• Language
• Play and Pre-academic
• Intervention Objectives
• Discrete Skills and Behaviors
• Intervention Strategies and Procedures
• Discrete Trial Training Modeling Prompting
  Shaping Reinforcement, Assessment, Generalization
  Training
• In Home or Classrooms
• IFSP/Individualization
• Designed to address skills and behaviors that
  are most concern to parents
• Can be responsive to parent identified concerns
• Parent participation recommended but difficult
  for parents to implement on their own.
• Evidence Base
• Theoretical good
• Intervention Goals Better to Best
• Intervention Objectives Non-existent (relies on
  other ABA studies)

28
AEPS Birth to Three Intervention

• Theoretical Model
• Hybrid Naturalistic intervention Learning and
  developmental theory
• Intervention Goals Comprehensive
• Motor Fine Gross
• Communication
• Cognitive
• Social-Emotional
• Intervention Objectives
• Developmental Skills and Behaviors organized in
  sequence but according to Developmental domain.
• Intervention Strategies and Procedures
• Incidental Teaching and some Responsive
  Strategies
• In Home or Classrooms
• IFSP/Individualization
• Curriculum based assessment
• Can be responsive to parent identified concerns
• Parent participation a major feature of 0-3 but
  can also be used in child care/ classrooms
• Evidence Base
• Theoretical good loosely connected to child
  development theory and research
• Intervention Goals No evidence regarding the
  effects of AEPS on Goal Attainment with 0-3

29
Family outcomes Bailey, DB Hebbeler, K Spiker,
D, et al.Source PEDIATRICS   Volume 116
  Issue 6   Pages 1346-1352 2005

• At the end of early intervention, most parents
  felt competent in caring for their children,
  advocating for services, and gaining access to
  formal and informal supports. They also were
  generally optimistic about the future. Most (82)
  parents believed that their family was better off
  as a result of early intervention. Parents were
  somewhat less positive in their perceived ability
  to deal with their child's behavior problems or
  gain access to community resources, and lower
  family outcome scores were found for parents of
  minority children, children with health problems,
  and children who were living with a single adult.

30

• Author(s) Dunst CJ, Bruder MB, Trivette CM,
  Hamby DW Source PSYCHOLOGICAL REPORTS    Volume
  96    Issue 1    Pages 231-234    Published
  FEB 2005   Times Cited 0     References
  7     Abstract 1,000 parents of infants and
  toddlers enrolled in early childhood intervention
  programs were surveyed about the number of
  learning opportunities provided their preschool
  children using different approaches to early
  intervention. Findings showed that more learning
  opportunities were reported when participation in
  everyday activity settings was conceptualized as
  a type of intervention rather than as settings
  for professionals to conduct their interventions.

31
Odom SL, Wolery JOURNAL OF SPECIAL
EDUCATION    Volume 37    Issue 3    Pages
164-173    Published FAL 2003  

• Abstract Over the last decade, the field of
  early intervention/early childhood special
  education (EI/ECSE) has emerged as a primary
  service for infants and preschool children with
  disabilities and their families. Systems for
  providing early intervention for infants and
  toddlers exist in every state, and all state
  Departments of Education are responsible for
  special education for preschool children. In
  EI/ECSE, a unified theory of practice has emerged
  and draws from a range of psychological and
  educational theories. A strong, evidence-based
  set of practices that service providers and
  caregivers use to promote the development and
  well-being of infants and young children with
  disabilities and their families underlies this
  theory of practice. The purpose of this article
  is to describe the tenets of this theory and
  identify evidence-based practices associated with
  each.

32

• Evidence based practices do not mean an effective
  curriculum.

33

• Author(s) Bailey DB, Aytch LS, Odom SL, Symons
  F, Wolery M Source MENTAL RETARDATION AND
  DEVELOPMENTAL DISABILITIES RESEARCH
  REVIEWS    Volume 5    Issue 1    Pages
  11-20    Published 1999   Times Cited
  18     References 85     Abstract Early
  intervention for infants and toddlers with
  disabilities was established as a national
  commitment in the form of federal legislation in
  1986. Since then, we have witnessed steady growth
  in the number of children and families served,
  although the most recent report to Congress
  indicates that only about 1.7 of the population
  of infants and toddlers is served in early
  intervention programs. All states and territories
  currently are participating in this optional
  program. Federal regulations stipulate the
  components of an early intervention system that
  must be in place if states are to receive federal
  funding. However, a great deal of flexibility is
  allowed in how these broad regulations are
  implemented, resulting in considerable
  cross-state variability in who is served and the
  amount and type of services received. This
  article describes the current status of early
  intervention and discusses five issues we believe
  to be critical in the coming decade (1)
  determining the outcomes expected of early
  intervention (2) determining appropriate models
  and intensity of treatments (3) factoring
  quality into the efficacy equation (4)
  accounting for child, family, and community
  variables in determining efficacy and (5)
  integrating emerging perspectives and knowledge
  from neuroscience and genetics. (C) 1999
  Wiley-Liss, Inc.

34

• Author(s) McWilliam RA, Young HJ, Harville K
  Source TOPICS IN EARLY CHILDHOOD SPECIAL
  EDUCATION    Volume 16    Issue 3    Pages
  348-374    Published FAL 1996   Times Cited
  15     References 32     Abstract The purpose
  of this study was to determine (a) the major
  challenges in providing specialized therapies to
  infants, toddlers, and preschoolers with
  disabilities (b) what models of service delivery
  are used and why (c) what makes the provision of
  therapy services go well and (d) what strategies
  are used for overcoming barriers to effective
  services. Focus groups were conducted with early
  intervention therapists, nontherapist
  professionals, administrators, and parents.
  Results showed that a shortage of pediatric
  therapists and policy/administrative constraints
  caused services to be of lower quality than
  desired. We also found that concepts of
  ''needing'' therapy were muddled and that most
  people said that ''more is better'' as long as
  the quality is high enough.

35

• Author(s) Guralnick MJ Source JOURNAL OF
  APPLIED RESEARCH IN INTELLECTUAL
  DISABILITIES    Volume 18    Issue 4    Pages
  313-324    Published DEC 2005   Times Cited
  5     References 98     Abstract The field of
  early intervention is vibrant, generating
  expectations that systematic, comprehensive,
  experientially based interventions will alter
  developmental trajectories and prevent secondary
  complications. In this article, the existing
  knowledge base in the field is reviewed. It
  emphasizes the importance of an overall
  developmental framework, what is known through
  intervention science and the emergence of guiding
  principles for programme design and development.
  This is followed by a discussion of future
  prospects for improving early intervention
  outcomes in four areas. First, the importance of
  designing studies that provide information about
  carefully defined subgroups is discussed. This
  issue of specificity of outcomes is crucial in
  order to determine boundaries for effectiveness
  and to direct attention to areas of special
  concern. Second, prospects for translational
  research are discussed with particular reference
  to our knowledge of the core developmental
  processes affected. Third, the need to focus on
  the increasingly apparent mental health and
  social competence difficulties of even young
  children with intellectual disabilities is
  considered. Finally, the complex problems and
  potential solutions associated with the transfer
  of model intervention programmes to communities
  as part of early intervention systems are
  described.

36

• Theories of child development have served as the
  principal foundation for curriculum model
  development. Variations among curriculum models
  reflect differences in values concerning what is
  more or less important for young children to
  learn, as well as in the process by which
  children are believed to learn and develop. These
  variations inform the role of teachers, the
  curriculum's focus, the classroom structure, and
  the ways in which children participate in
  learning. 
• Early childhood curriculum models also vary in
  terms of the freedom granted to teachers to
  interpret implementation of the model's
  framework. Some curriculum models are highly
  structured and provide detailed scripts for
  teacher behaviors. Others emphasize guiding
  principles and expect teachers to determine how
  best to implement these principles. Curriculum
  models, regardless of their goals and the degree
  of flexibility in their implementation, however,
  are designed to promote uniformity across early
  childhood programs through the use of a prepared
  curriculum, consistent instructional techniques,
  and predictable child outcomes. 

37

• Meaningful OUTCOMES
• Functional Outcomes
• Developmental outcomes
• Process outcomes

38

• Author(s) Shelden ML, Rush DD Source INFANTS
  AND YOUNG CHILDREN    Volume 14    Issue
  1    Pages 1-13    Published JUL 2001   Times
  Cited 11     References 131     Abstract The
  Individuals with Disabilities Education Act
  (IDEA) has always contained the provision that
  early intervention services for eligible infants,
  toddlers, and their families be provided in
  natural environments. The reemphasis on natural
  environments in the 1997 reauthorization of thr
  IDEA, however, has caused states and early
  intervention programs to increase efforts to
  ensure that Part C services provide and support
  learning experiences within the context of the.
  child's family and community. This emphasis on
  natural environments and, in some cases, the move
  away from segregated, clinic-based service
  delivery models have been challenging. This
  article presents 10 common myths about service
  delivery in natural environments and the
  literature available to refute them.

39

• Author(s) Abbeduto L, Boudreau D Source MENTAL
  RETARDATION AND DEVELOPMENTAL DISABILITIES
  RESEARCH REVIEWS    Volume 10    Issue
  3    Pages 184-192    Published 2004   Times
  Cited 1     References 101     Abstract In
  this article, we consider the theoretical debates
  and frameworks that have shaped research on
  language development and intervention in persons
  with mental retardation over the past four
  decades. Our starting point is the nativist
  theory, which has been espoused most forcefully
  by Chomsky. We also consider more recent
  alternatives to the nativist approach, including
  the social-interactionist and emergentist
  approaches, which have been developed largely
  within the field of child language research. We
  also consider the implications for language
  development and intervention of the genetic
  syndrome-based approach to behavioral research
  advocated by Dykens and others. We briefly review
  the impact and status of the debates spurred by
  the nativist approach in research on the course
  of language development in individuals with
  mental retardation. In addition, we characterize
  some of the achievements in language intervention
  that have been made possible by the debates
  spurred by nativism and the various alternatives
  to it. The evidence we consider provides support
  for all three alternatives to the nativist
  approach. Moreover, successful interventions
  appear to embody elements of several of these
  approaches as well as other theoretical
  approaches (e.g., behaviorism). We conclude that
  language intervention must be theoretically
  eclectic in its approach, with different
  strategies appropriate for teaching different
  features of language, at different points in
  development, and for children displaying
  different characteristics or learning histories.
  (C) 2004 Wiley-Liss, Inc.

40

• Author(s) NOVICK R Source TOPICS IN EARLY
  CHILDHOOD SPECIAL EDUCATION    Volume
  13    Issue 4    Pages 403-417    Published
  WIN 1993   Times Cited 9     References
  43     Abstract In the current controversy over
  the appropriateness of using developmentally
  appropriate practice (DAP) with young children
  with disabilities, the philosophies of early
  childhood special education (ECSE) and early
  childhood education (ECE) have frequently been
  characterized as incompatible. This article
  contrasts the differences between the two
  disciplines and discusses a service delivery
  approach, known as activity-based intervention
  (ABI). Combining strategies from both ECSE and
  ECE, this model utilizes behavior analytic
  techniques within child-directed activities.
  Although ABI and DAP appear to be compatible in
  many ways, DAP's emphasis on emotional
  development creates a dilemma. In part, because
  emotional development is difficult to evaluate,
  it has not been a focus of ECSE. This dilemma, as
  well as its implications for intervention, is
  discussed. It is argued that the continued
  comparison and integration of the philosophies of
  ECE and ECSE may enhance education for all young
  children.

41

• Empirical comparisons of early childhood
  curriculum models have been dominated by two
  questions
• (1) To what extent are the programs experienced
  by children really different from each other? and
  
• (2) Are some programs better than others in
  producing desired outcomes?