The Georgetown University

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The Georgetown University Center on Health and
Education
Exemplary clinical and educational programs
Interdisciplinary research training Research
on human development Effective information
dissemination Technical assistance/Outreach/Pa
rtnerships Policy analysis and development
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What is Policy?

• Affirmation of what matters/values
• Mechanism for ensuring implementation of agreed
  upon values, commitments
• Blueprint for the future
• Hoped for solution to a problem
• Idea of what should be done

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What is Practice?

• What happens when policy is implemented
• What happens in nature
• What professionals/experts do to help solve a
  problem, improve a condition
• A set of procedures, interventions, supports,
  protective strategies with intended positive
  outcome(s)

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Are Policy and Practice Issues Important for
Scientists?

• Connection to research funding
• Potential to do good by
• Promoting well-being and competency
• Eliminating ineffective efforts
• Improving societal outcomes
• Identifying problems that warrant more vigorous,
  innovative scientific inquiry

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Basics of Development

• Controlled by multiple systems
• biological, social, environmental
• internal, external
• Responsive to experiences
• Dependent on age/stage
• Modifiable

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Randomized Controlled Trials

• Nonambulatory children with profound MR
• Adults in groups homes, institutions
• Children with neuromotor disorders
• Children from very low resource homes
• Children in orphanages
• Former Head Start children
• Very high risk pregnant women

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Naturalistic Studies

• Statewide surveys of persons in all residential
  and training settings
• Prenatal exposure to teratogens
• Observations in community settings
• Evaluations of early interventions
• Statewide epidemiology
• Follow-up of large birth cohorts

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What Ive Learned Pragmatically(as a scientist
in MR/DD)

• Theres no substitute for a good design
• Its okay to study things that matter
• Always use the very best methods
• Seek help from your fiercest critics
• If you learn something and dont share it, it
  doesnt count
• Stay connected with the real world

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Intensive Movement Therapy With Casting for Young
Children With Hemiparetic Cerebral Palsy A
Randomized Controlled Crossover Trial
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Spillover Effects

• Increased positive social-emotional
  responsiveness
• Reduced behavioral problems
• Improved communication skills
• Decreased sensory aversion to touch
• Improved gross motor and mobility skills
• Increased self-confidence and independence

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Abecedarian Preschool Program
Treatment Group
Control Group
Nutritional supplements
Nutritional supplements
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Supportive social services
Supportive social services
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Free primary medical care
Free or low-cost medical care
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Preschool treatment
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Intensive
(full day, 5 days/week
50 wks/yr, 5 yrs)
"Partners for Learning" curriculum
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Cognitive/Fine Motor

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Social/Self
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Motor
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Campbell Ramey, American Educational Research
Journal, 1995
Language
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Individualized pace
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Long-term Benefits of Intensive Early Educational
Intervention

• Higher IQs
• Higher reading
• Higher math
• Increased education
• Increased employment
• Increased interactional skills
• Spillover to mothers (ed, jobs)

• Decreased special ed
• Decreased grade retention
• Decreased teen parenting
• Decreased criminal activity

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Science, policy, practice linkages

• Poor quality experiences take a serious
  cumulative toll on behavior and health
• The right environment brings forth a lot
• Intensity of treatment is crucial to consider
• To create sustainable change, what happens next
  also counts
• Spillover and interaction effects are important
• The human factor in service delivery
  (preventing institutionalization in the community)

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How Science has Fuelled Policy and Informed
Practice

• Universal education and treatment
• Early intervention and neuroplasticity
• Quality of Life considerations
• Behavioral teratology
• Limits of prenatal care
• Invisibility of intellectual disability

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Major challenges for the field

• Eliminating policy mistakes
• Conveying key findings to inform practice
• Getting direct caregivers to provide intensive
  supports over time
• Helping advocates use science well
• Covering costs of high quality behavioral and
  educational interventions

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Basics of Development

• Controlled by multiple systems
• biological, social, environmental
• internal, external
• Responsive to experiences
• Dependent on age/stage
• Modifiable

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Seven Essentials in ChildrensEveryday
Experiences

• 1. Encourage exploration
• 2. Mentor in basic skills
• 3. Celebrate developmental advances
• 4. Rehearse and extend new skills
• Protect from inappropriate disapproval
• Communicate richly and responsively
• 7. Guide and limit behavior

Ramey Ramey (1999), Right From Birth, 1999
Ramey Ramey (1999), Going to School, Goddard
Press
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