ECI in DC: What do we know about Part C Implementation?

Early Childhood Interventions March 14, 2018

Early Childhood Intervention (ECI) is provided to infants and toddlers with disabilities or delays by states under Part C of the Individuals with Disabilities Education Act (IDEA). IDEA requires that services be provided in natural settings such as homes, child care centers, or community places, such as grocery stores, playgrounds, and parks, to help the child participate in community activities with other children with or without disabilities or delays.

The Georgetown University Certificate in Early Intervention Program (GUCEI) is a 9-month program that trains ECI professionals to implement evidence-based ECI services as required by the IDEA. GUCEI participants complete a team based capstone project to conclude their studies. The projects evaluate policy and procedures related to ECI programs through Strong Start, the DC Infants and Toddlers with Disabilities Program or other critical aspects of evidence-based intervention.

Ten capstone posters completed between 2014 and 2016 that focused on implementation of Part C in DC were analyzed to identify themes that support evidence-based practices. Three themes emerged: Issues related to Families, the components of the Individualized Family Service Plans (IFSP), and the priorities, concerns, and knowledge of Service Providers.

 Families

Home Visiting: What does the MIECHV Program do in DC?

ECI is grounded in what is known as family-centered care. Families play a very important role in ECI since they are the child’s first teachers. IDEA requires that service providers support families, helping them to support their child’s development, understand their specific needs, and ensure that the child is “kindergarten ready.” In addition to Strong Start, the Part C program in DC, the DC Department of Health also supports at-risk families through the Maternal, Infant, Early Childhood Home Visiting (MIECHV) Program. The MIECHV program serves pregnant women and families with children between ages 0 and 5.5  The home visiting programs support women and families to raise a child that is physically, socially, and emotionally healthy. The MIECHV home visits are voluntary.  DC has chosen to implement three evidence-based home visiting curriculums:

  • Healthy Families America (HFA) promotes positive parenting to enhance child health and development and prevent child abuse and neglect for socially at-risk families with children from 0 to 5.
  • Parents as Teachers (PAT) provides education and support for parents and families from pregnancy through kindergarten entry.
  • Home Instruction for Parents of Preschool Youngsters (HIPPY) helps parents become their child’s first teacher by providing instructions in the home to prepare their preschool aged (3-5) child for school.10

Home visitors and the MIECHV program collaborate with Strong Start regularly. As part of DC’s Early Success Framework all home visitors receive specific training on referring children to Strong Start if suspected of having a developmental delay or disability. Home visitors are often the first support families receive regarding their children thus they often need to communicate and collaborate with community-based programs to make sure intervention goals, strategies, and messages are consistent among all service providers.10 

Home visitors are also trained in a variety of screening tools, like the Ages & Stages Questionnaires (ASQ), which is used to screen infants and young children for developmental delays. Based on the age of the child and the results on the ASQ, home visitors will either refer the family to Strong Start (birth to three) or Early Stages (3 to 5).1 Strong Start or Early Stages will determine if the child is delayed and meets eligibility criteria for services and supports. Once the child is referred, the home visitor needs to follow up with family to support them in creating unique service plan based on the needs of the child. 5

Family Satisfaction with Strong Start Services

Based on the information gathered from GUCEI participants, families are generally happy with the services their child and family received through the Strong Start program. After exiting the program, almost all families who responded to an on-line survey indicated that their child and family benefitted from Strong Start services. Almost all families:

  • received support when their child transitioned out of Strong Start at age 3,
  • were given information about their child’s strengths and needs, and
  • were involved in creating an individualized family service plan (IFSP) for their child.

However, families would like to receive more information on community activities so that the children can be better integrated into the community and socialize with children with and without delays and disabilities.6

The Individualized Family Service Plan

An IFSP is a legal document that describes the resources, priorities, and concerns of the family to identify the family’s desired outcomes, which is then used to guide service delivery. It also outlines the services the team has decided will support the family in reaching the outcomes and provides information to enhance the child’s caregivers’ ability to promote the child’s growth. The IFSP also documents which environments the child will receive services in to meet the individual outcomes. Developing an appropriate strength-based IFSP is critical as the IFSP directs service provision.

GUCEI participants analyzed the quality of IFSPs, assessing the quality of the outcomes written as well as the extent to which requirements of the IFSP were met. Findings indicate that all legal requirements are met, services are provided in the natural environment, and there is an emphasis on the child’s strengths rather than weaknesses. However, IFSPs need to:

  • become more family-centered
  • use less legal and medical terminology
  • prioritize the family’s main concerns
  • reflect the functional skills in the desired outcomes.2

When the outcomes were explored more in depth, the GUCEI participants found that they may be written in a way that it is difficult to interpret them across providers. This miscommunication affects consistency and supports need for clearly established guidelines on writing outcomes.7

Service Providers

Service Provider Perceptions on the Strong Start Process

Service providers play an integral role in coordinating services for children with delays or disabilities. From the first referral to transition into the Strong Start program, over 40 articles of documentation are required from multiple providers at various times. Keeping track of the timeline facilitates the delivery of effective services for children and families while following state and federal regulations. Additionally, tracking progress and effectiveness of interventions will improve efficiency and transparency.3

Strong Start has adopted coaching as an interaction style. Strong Start service providers are required to coach family members, child care workers, teachers, and other caregivers supporting them to help the child meet the IFSP outcomes.4 It is suggested that service providers receive mentoring on how best to integrate services into the classroom and daily routines. This will provide opportunities for service providers to enable the child to participate most fully in activities with other children. It builds upon the caregiver’s existing skills and knowledge to promote the growth and development of children with disabilities.4

GUCEI Graduates Perception on the Training

The GUCEI program has three clear expectations of their graduates. Each graduate is expected to:

  1. Assess infants, toddlers and young children in partnership with their families in the context of their communities
  2. Collaborate to develop a comprehensive Individual Family Service Plan (IFSP)
  3. Use of evidence-based practices to support participation in activities.8

To meet these goals, the participants learn 16 evidence-based practices. Alumni of the program report utilizing certain skills relating to the development of a comprehensive IFSP. For example, 53% of the respondents identified family concerns, priorities, and resources, 59% communicated with families to discuss routines and provide strategies, 59% built relationships with and involved caregivers and team members, and 53% participated in a team to write functional strengths-based outcomes. Alumni also reported on their use of skills relating to evidence-based strategies to promote participation. 53% of the respondents indicated documenting services provided, 42% consulted with caregivers for reflection and joint planning, and 42% monitored and collected information to determine change over time. However, alumni report that they still struggle implementing skills such as supporting families to participate in the decision-making processes and using the coaching approach with caregivers.8

Since the GUCEI program is designed for professionals with early intervention or early childhood service responsibilities, practitioners and policy makers alike, it seeks to empower students to be competent and confident in their knowledge and abilities. Proposed improvement to the program included more face-to-face on-campus interaction and decreased classroom size for the online sessions.8

Conclusion

Based on the information collected for the GUCEI capstone projects, the ECI program by Strong Start in D.C. would benefit from standardizing documentation so that services are consistent, effective, and adhere to the timeline. Using language that is family-centered and reflect family priorities. A special focus on home visiting and coaching are necessary so that caregiver’s and services providers can give children the opportunity to learn in natural environments with other children.

References:

  1. Anderson, J., Daugherty, M., & Hagley, D. (2014). Transitioning from Early Intervention: An On-line Learning Module.
  2. Chimka, J., Curry, C., & Johnson, M. (2014). Quality of Individualized Family Service Plans Created by the District of Columbia, Strong Start Program using the IFSP Rating Scale.
  3. Coates, A. & Agricola, J. (2014). Documentation: Strong Start, Start to Finish.
  4. Cobosco, J. (2016). Collaborative Care: Coaching and Early Intervention in Group Settings.
  5. Davis, E.V. (2016). Ages and Stages: Documented Referrals for DC Maternal, Infant, and Early Childhood Home Visiting Program.
  6. Jackson, J. & Nealy-Shane, D. (2016). DC Strong Start Participant Perceptions of Child & Family Outcomes.
  7. Martinez, E., Rogers, K., & Staton, C. (2015). Reliability of the Goal Functionality Scale III.
  8. Nti-Ampela, A., Brocks, N., & Wise T. (2016). GUCEI Alumni Survey.
  9. Porter, A., Strickland, J., Rogers S., & Behnke, S. (2016). Early Intervention and Center-Based Services Needs.
  10. Young, C. & Hougen, S. (2014). Linking Families to Community Resources: A Home Visitor’s Approach.

Kathleen Ryan (SNHS ’18)