This chapter will discuss early identification, examination, evaluation, and intervention services for children from birth to 3 years of age with disabilities. The federal legislation that guides these services and current evidenced-based practice in early intervention will be discussed. Guiding principles for this chapter include family-centered services, support-based (contextual) models, interdisciplinary and transdisciplinary team models, evidence-based practice, providing services in natural environments, and using activity-based instruction whenever possible.
What Do We Mean by “Early Intervention”?
The term early intervention (EI) is used in a variety of ways in a variety of disciplines. Conventional wisdom tells us it is best to intervene quickly when problems are suspected, before major problems occur. In medicine, competent physicians practice EI when they strive to provide intervention for illness as soon as symptoms are detected. The kindergarten teacher practices EI when he or she screens the class at the beginning of the school year to determine which children may need extra help learning to read. Even the wary homeowner who watches for signs of a leaky roof or basement is practicing early identification and intervention in an effort to ward off major and expensive household repairs. In other words, EI involves early detection and intervention of problems to minimize negative effects and reduce future potential problems as cost-effectively as possible.
When physical therapists engage in EI with infants and young children with delays, disabilities, or potential disabilities, they are doing essentially the same things as the individuals previously described. Pediatric therapists work with families, physicians, and others interested in the well-being of young children to identify potential or emerging problems or established developmental physical and cognitive problems as early as possible and to intervene quickly and efficiently to correct or minimize the problem/delay and to maximize the child's developmental potential, whatever that may be.
Definitions of Early Intervention
Federal legislation (PL 99-457), adopted in 1986, provided federal funding to the states for provision of early identification and intervention services to infants and young children aged 0 to 36 months who have, or are at risk of having, disabilities, and their families. This legislation was part of the Individuals with Disabilities Education Improvement Act (IDEA) and is discussed in this and the following chapter.
"The term ‘early intervention services’ means developmental services that:
are provided under public supervision;
are provided at no cost except where Federal or State law provides for a system of payments by families, including a schedule of sliding fees;
are designed to meet the developmental needs of an infant or toddler with a disability, as identified by the individualized family service plan team, in any 1 or more of the following areas: (i) physical development, (ii) cognitive development, (iii) communication development, (iv) social or emotional development, or (v) adaptive development" (IDEA, 2004, 20 U.S.C.1432 § 632).