UNIT 7 EARLY INTERVENTION

Structure
7.1 Introduction
7.2 Meaning of Early Intervention
7.3 Importance of Early Intervention
7.4 Service Delivery Models
7.4.1 Home-based Intervention
7.4.2 Centre-based Intervention
7.4.3 Eclectic Model
7.5 significance of Parent-Professional Partnership
7.6 Link with Early Childhood Education and School Readiness
7.7 Let Us Suin Up

7.1 INTRODUCTION
You would have observed the use of the term "Early Intervention" among
persons working for children with disabilities. Children with all types of
disabilities can be helped by this process. However, you may have wondered,
what exactly does early intervention mean? What does it involve? What is its
significance in the context of persons with disabilities? How early is "early"?
This Unit attempts to answer these questions.

In this Unit, we will talk about the meaning and importance of early
intervention, and the ways in which early intervention services may be provided.

Information given in this Unit will help you to:

understand what early intervention means;

appreciate why early intervention is crucial for children with disabilities,

particularly mental retardation;

become familiar with the service delivery models that exist in our country
for provision of early intervention services;

realise the significance of parent-professional partnership for the success

of an early intervention programme; and
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be aware of how early intervention is linked with early childhood education

and school readiness.
Fostering Development
in Early Years-Part-I 7.2 MEANING OF EARLY INTERVENTION
What does the phrase 'early intervention' mean in the context of persons
with disabilities? Yes. It means providing stimulationleducating/training/
helping/managing/supporting a person with disability early in life.

Early intervention refers to planned and organised efforts to enhance

the development of children, who have a disability or are at risk of
developing it. Typically, early intervention programmes focus on
children from birth to six years of age.

Early intervention implies providing appropriate stimulation, and carrying out

individualised educational and therapeutic activities with the chiid with
disability, as well as providing necessary support and guidance to the family.
The activities for the child are based upon the assessment of the child's
needs. The assessment of the child's present abilities and needs, and decisions
regarding the nature of activities that need to be carried out with him, are
usually made by professionals, in consultation with the child's parents or
primary caregivers. While some early intervention activities, particularly those
that are therapeutic in nature, are carried out with the child by professionals,
the majority are of a nature that the child's parents and other family members
can, through training, learn to carry out with the child at home. Thus, an
early intervention programme is designed to foster the child's
development, minimise potential delays, treat existing problems,
prevent further deterioration, limit the acquisition of additional
handicapping conditions, and promote adaptive family functioning. These
goals of early intervention are accomplished by providing developmental and
therapeutic services for the children with disabilities, an& support and
instruction for their families.
Now we come to the question, "How early can we intervene?-is can be
done any time right from birth if the disability is identified at that time, In
fact, there are occasions when an abnormality in the child is identified even
before birth and preventive/corrective measures are initiated. Therefore, early
means "as early as possible". Early detection makes it possible to provide
the kinds of intervention that 'at risk' and disabled children need. The specific -
intervention depends on the needs of each child and includes stimulation,
education and training activities, medical and physical treatments, as well as
therapies, such as speech therapy or physiotherapy.

7.3 IMPORTANCE OF EARLY INTERVENTION -

WHY INTERVENE EARLY?
Through early intervention, a child suspected to have a' disability or
developmental delay can be helped so that fiuther damage is arrested and
appropriate services can reach the child without any delay. With appropriate
 stimulation and treatment during the early years, most children with disabilities Early Intervention

can learn to function at higher levels.

As studies have shown, a major reason why early intervention is essential
for children with suspected mental retardation is that about 80% of the
brain development occurs in the first six years of life, and thus, the
potential for learning during this period is maximum. Thus, not only for
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normal children, but for children with mental retardation as well, the early
years are critical for development. Unfavourable experiences such as lack of
L
adequate care, nurturance and stimulation hinder development to a considerable
extent. Similarly, a nurturing and stimulating environment fosters development.
Further, the effect of deprivation or enrichment provided during this
period is long lasting. It must be appreciated that development is not simply
the result of mechanical acts of feeding and physical care. It is equally
important to provide the child a healthy atmosphere with love, warmth, and
oppovtunities Jov learning, so that overall development of the child is
fostered. This is particularly pertinent in .the case of individuals with mental
il
JP
retardation.

Further, many research studies have shown that when the child is young,
especially during the first two years of life, there is 'plasticity of the brain '.
Now what do we mean by brain plasticity? Well, as you probably know,
different parts of our brain perform specific fbnctions. Thus, if one part gets
damaged, the function it performed would get affected. However, early in
life, the brain is still plastic and adaptable. In other words, if stimulated early,
the brain cells adjacent to the damaged cells learn to take up the
responsibilities of the dead cells. However, when plasticity decreases; which
happens as the child grows older, other parts of the brain, even on stimulation,
are unable to take on the functions performed by the damaged part. Those
abilities may be lost forever. Training of the adjacent cells will not be possible.
This is a major reason for the emphasis on early intervention.

Another important reason for focusiilg on early intervention is to mould

parental attitude in a positive manner, so as to have them accept their
child better, and provide appropriate training and stimulation early, rather
than wasting time feeling guilty or blaming fate or others, or resorting to
seeking faith healing and other inappropriate methods.
One more significant reason is that early intervention is easy to carry out
at home, if guided well. It does not always require hi-tech materials and
methods which only specialists can use. Most of the early intervention
prograrnines can be carried out at home using materials around and within the
house, by parents and family members. All one has to have, to carry out early
intervention, is the "awareness of the need" and the "know-how".
The early years of life are crucial for all children, but for the child who
is lagging behind in reaching developmental milestones, these years
are especially critical. If the early years are not adequately utilized, precious
Bodering Development learning time passes and opportunities for providing vital early intervention
in Early Years-Part-I
experiences are lost by the time children reach school age. Hence, you
should try to seek intervention services early in the life of the child, rather
than wasting the precious years of childhood going to people ranging from
quacks to faith healers or not taking any measures at all, in the wrong belief
that 'as the child grows up, he will be alright'.
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When a ebild is bob with the 'risk' of h a g mintally retarded, or

has a delay in dc4eiopiuent, stimulating the cttiM early hefps in
reducing the extent of the problem.
Let us now take a look at the following cases to understand the importance
of early intervention:
Prakash was two years old and had not started to walk. He said only
one word - 'amma', and that too not meaning;fully. He repeated the
word for everything and for everybody. Prakash's parents were a
little concerned about his inability to walk or talk. His grandmother,
however, brushed aside their concern, saying "the child'sfather spoke
only at four years and he walked only at three years. So do not
worry. He will be alright as he grows". The child hgs crossed five
years, but he has not started to walk or talk.
Sudha could not sit by herseZf and did not speak at all even at three
years of age. Her parents heard of a Swamiji who could do miracles
and took her to the Swamiji. And that is all they did about her condition.
She is seven years old now and still does not walk or talk.
Ranga could not sit independently or speak any word even at the age
of one-and-a-haZf years. His parents were worried and sought help
from the Primary Health Centre (PHC) of their area. The PHC, in
turn, referred the child to an early intervention staflmember-let us
call the staff member "early intervener". An early intervener works
either in a centre or visits homes to give training to children directly,
bnd to teach the parents and family members as to how they can train
the child. Thus, Ranga received the he& of the early intervener who
visited his house and trained his mother with regard to. how to 'help
the child to walk and how to stimulate the child's language
development at home. Ranga is five years old now. He walks and can
talk in 2-3 word sentences and he is attending a pre-school centre
with other children. He is slower than other children, but he has
certainly improved and is continuing to learn.
What da you understand from these examples?'Write down your opinion in
the space provided below:
On the basis of what you have read so far, what do you think are the aims of Early Intervention
early intervention? Yes, the primary aims of early intervention are as
follows:
1) To foster the child's development, particularly in the areas of motor,
language and communication, cognitive, social and self-help skills.
Through esrfy irsttrventfon, one aims to use yoang children's bigb
potential - for Icrtndmg to the fultest. *

2) To prevent, and detect early, secondary disabilities, and initiate suitable

action for the sajne.

3) To help the parents and family members become the child's first and
best teachers.
Thus, while it is true that mental retardation is a condition which
cannot be cured, and the mentally retarded person's mental development
will remain slower than that of a normal person even as he grows
older, it is also true that timely and-appropriate intervention can help
the mentally retarded person to learn several skills. Training the child
will improve his performance level. And the earlier the training is
started, the better are the chances of improvement in the child.

Early training is very important.

You must now be keen to find out the kind of activities that should be
carried out in the course of early intervention. In other words, what are
the activities that you should carry out with the mentally retarded child
in order to stimulate his overall development; right fiom the early years
of life? Well, the remaining Units in this Block and in fact the rest of the
course material, focus on just that. As you go through them, you would
Jind out about a large number and variety of activities in which you may
engage the child to foster development in various areas - motor, language,
cognitive, social and so on, fiom early infancy onwards.
In this Unit, we shall proceed to look at the various arrangements or models
for providing early intervention services at the professional level.

7.4 SERVICES DELIVERY MODELS

There are different ways in which training for intervkntioi, and intervention
itself, can be provided -in the home setting, in a centre, or by adopting an
approach that combines the two. What would be suitable for a particular
family depends upon the circumstances of that family and the condition of
that child.
As intervention is best started in infancy, it is important that the service
delivery system, that is, the arrangement for providing intervention, be flexible. 9
Fostering Development One needs to reinember that the mother of the child is also a wife, the
in Early Years-Part-l
inother of other children, a daughter-in-law and so on. Thus, she would
essentially be hlfilling many other roles and duties that demand her time and
attention. This aspect has to be seriously considered and alternatives have to
be found. One alternative is accepting her varied roles and providing support.
The whole family should shoulder and take up the responsibility for
the child with special needs. All family members should get trained in
early intervention. Therefore, the professional intervener should focus on
training the family members, so that they in turn can become early interveners
for the child. To do this, the model of training, and the intervention itself,
should ideally be home-based.

Sometimes, children with mental retardation have additional disabilities such

as epilepsy, or other deformities or defects by birth, that require medical
support. In such cases, centre-based intervention will be essential as expert
support is needed, which cannot be made available at home.
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A combination of centre-based and home-based intervention, called the

eklectic model, is appropriate in many instances where a variety of*'.*;
interventions are required.
Now, let us see how each arrangement works.

7.4.1 Home-based Intervention

* .+*. .a,$- *

This is a coinmon method of providing intervention. The trainer visits mi.-.-

house of the child with disability or developmental delay. She interacts w h : .
the family members, observes their routine, practices, cultural and social
activities, available resources in terms of family members, finances, material
resources and so on. This helps her to understand the background of the child
with disability. She also finds out the strengths and needs of the child. For
this, she first carries out an assessment of the child's present skills. Thus,
she determines what skills and abilities the child has already acquired and
which are the ones that the child is ready to acquire and should be helped to
acquire. If the child needs any medical help due to epilepsy, deformities or
similar reasons, she arranges for medical help. Many-a-time, her home visit
would have been a referral fi-om the Primary Health Centre (PHC) where the
medical needs are takeri'care of. In such cases, the home intervener will
ensure follow up of medical requirements, such as taking medicine on time.
After understanding the family and its environment, assessing the child, and
ensuring inedical intervention (if needed), the home trainer begins the
intervention. She works with the parents to prioritise the training needs, and
to plan the required training activities. Further, she demonstrates to the parents
and others how to carry out intervention and help the child acquire skills. She ,

explains to them how a number of stimulation activities can be carried out

with materials available at home. For instance, auditory discrimination training ,

(that is, training the child to differentiate sounds) can be carried out using
 Early Intervention
cups and spoons, empty tins with stones or seeds in them, by tapping a stick
on various surfaces and by drawing the child's attention to common household
sounds such as water falling into a bucket, vegetables being fried, dishes
being washed etc. She watches them carry out the training activities to make
sure that they have learnt well and then informs them to carry out the activities
with the child everyday. She also teaches the parents how to monitor the
child's progress and accordingly proceed with the training activities.

The trainer makes periodic visits to the house-normally one to three times
L
a week, depending on mutual convenience, to provide the training and to
monitor progress. She also maintains a record, in simple form, of her..
assessment of the child, his progress, and the present activities being carried
out.

Thus, basically, in the home-based intervention model, the parents become

the child's primary teachers. This type of programme demands much of
parental time, dedication and motivation. Thus, it is important for the home
trainer to identify at least one other person at home, apart from the mother,
for example the grandfather or aunt, to give the Gaining. Ideally, all family
members should be invqved and sensitized. Even siblings (brothers and
sisters) can be trained to give hoine-based training to the brother or sister
with disability. The siblings can be taught play-way methods of stimulating
the child.
Advantages of home-based intervention
The child learns in a natural environment. The training is provided in the
home setting, and therefore, what is learnt is directly applicable. There
is no need for transferring the learning from a centre-based situation to
home conditions.
Parents are fully involved in their child's learning. It is convenient for
, them as there is minimal disruption, for,example, with respect to looking
after other children, making transport arrangements, etc.
I Materials needed for stimulating the child ar'e available at home and easy
to use.
1 All family ineinbers can learn the intervention skills and carry them out
: with the chi@. Thus, the child receives the stimulation and the mother is
relieved of'full time responsibility of the child.
Because of the home visits, the intervener h.as a good understanding of
the family and its strengths and problems. Through this, she is able to
adapt the training procedures and activities on the basis of the strengths
and resources of the family, and the needs and abilities of the child. The
training programme is thus individualized.
The method is cost effective as the only investment is remuneration for
I the intervener for her time, skill and expebses on transport.
Fostering hvelopment . Home-based programmes are most appropriate for rural areas and in
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in Early Years Part-1
those places where transportation is a problem, making it difficult for
the parent to bring the child with disability to a centre on a regular basis.
Limitations of home-based intervention
m A home trainer can cover only a limited number of children due to the
distances, travel time and individualisation of the programme. Therefore,
if she has more children to attend to, she might visit a child just once
a week, or even less frequently than that.
A large number of home trainers are needed to reach out to the population
through home training.
The family will ^nothave a chance to meet other such families and have
an exchange, which is a very important process in accepting the child's
disability and developing parents' self-help groups.
. Unless there is a system of coordination and monitoring, the home-
based training provided may differ fiom one intervener to another and
thus the training may not be standard.
The child may need the services of more than one expert, which a home
trainer may not be able to provide.

7.4.2 Centre-based Intervention

A centre-based approach provides varied types of help at a central location.
This is a system where the parents or caregivers of the child take the child
to a centre. At the centre, a group of experts, including a doctor, social
worker, special educator and therapists for speech and motor aspects, attend
to the child .and train the parentslcaregivers to carry out tasks at home to
foster the development of the child. There are three ways in which the expert
team at the centre may interact with the parents and the child:

i) Each member of the expert team meets the parents and the child and
provides intervention.
ii) The team of experts, together, attend to the child and the family and
provide intervention.
iii) All experts meet and discuss the child's case, and one team member
receives information from all of them and in turn interacts with the child
and the family to transfer the skills of training.
Any of these three ways of functioning, or a combination, can be found at a
centre. The last arrangement can be applied for home-based training also,
where the home trainer goes to the child's house and provides the training
after consulting the experts and incorporating their input.
 Each of the above ways of functioning of the expert team at the centre has Early Intervention
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its own strengths and limitations. Depending on the centre and the resources
available, one or a combination of arrangements can be used.

Irrespective of the model of interaction adopted, in centre-based training, the

child and the family receive help with methods and materials suitable for the
development of the child. The child may visit the centre periodically, say,
once a week, or more/less frequently, depending on the distances, convenience
of the family and the centre, as will as the need of the child, to receive the
interventibn and guidance on training to be carried out at home. As the child
progresses, the next level of training is provided by the experts.

In some places in India, where the centre is too far for the parents, family
cottage facilities are available. Here, the parents can stay with the child for
a period of time, say, one week, take the training and come back for a visit
every three months or so, for the next level of training. Some such centres
are KEM Hospital, Pune; NIMH, Secunderabad and Spastics Society of
Tamilnadu, Chennai. This helps in reaching out to parents in far off areas
without wasting precious early years of life. You can collect information
regarding various such centres froin PHCs and hospitals in your area.

Advantages of centre-based intervention

Centre-based programmes have facilities, equipment, instructional

materials and toys that parents would not have at home. Thus, the major
advantage of centre-based early intervention is that the child gets direct
services from the experts using suitable aids, appliances &d assistive
devices. The parent/caregiver learns and clarifies doubts from the experts,
and therefore, feels more confident about the intervention.
The parents have an opportunity to meet other parents of children with
developmental delays, which helps them to feel "I am not alone" . In
turn, it helps in developing a positive attitude. Many-a-time, very young
mothers gain confidence in handling their child better from the older
mothers who also have a child with developmental delay. It helps parents
to gain competence in handling their child better as well as helping
another parent in need.
The children learn from other children and also develop social skills by
playing with other children.
Limitations of centre-based intervention
Transportation may be a major problem in centre-based programmes.
Parents have to travel with the child to reach the centre, which may mean
a day's wages apart from the travel expenses.

If not properly planned, having too inany people to guide the parents may
, confuse them.
Fostering Development a It may be expensive in some centres.
in Early Years-Part-I
a All experts may not be available in all the centres.

a As the programme is at the centre, t h e e are practical issues of whether

similar resources will be available at home and whether the child will be
able to transfer the learning from the centre to the home situation.
There is a likelihood of a lesser degree of parent and family involvement.

7.4.3 Eclectic Model

The eclectic approach is simply a combination of home-based and centre-
based intervention strategies. Under this model, the parent and the child
receive a combination of services. That is, the child visits the centre
periodically, say, once a month. During the'other days the home trainer, who
is the link between the centre and the family, visits the child at home once
every 2-3 days and provides services. Thus, the child receives both kinds of
services - home-based and centre-based.

Depending on the location of the centre, residence of the child, availability

of resources, practical convenience/difficulty, needs of the child and
availability of services, a parent can choose an eclectic programme. This will
have the advantages of both home-based and centre-based programmes.

7.5 SIGNIFICANCE OF PARENT-PROFESSIONAL

PARTNERSHIP
Effective early intervention programmes for disabled and at-risk children
essentially involve:
- full participation of parents
- starting intervention at a very early age
- effective partnership of parents and professionals
The child's first teachers are his parents. Parents can help their young child
feel loved, competent, and better able to cope with the challenges in life.
Basically, the success of any early intervention prograinme depends upon
what the parents and other family members are able to do to facilitate the
growth and development of the young child with disability. However, parents
do need help and guidance to know what specific activities they should carry
out, as well as how they should carry them out. The stimulation and
opportunities of learning provided to the child should be appropriate and help
in promoting his development. Therefore, it is important to begin
intervention onl? after taking professional advice. The professionals, in
turn, should assess the abilities and needs of the child carefully, and explain
to the parents, in simple terms, the intervention activities that should be
 Early Intervention
carried out with the child. The parents and family members, for the sake of
their own child, must carry out the home activities recommended. It is also
important to maintain a systematic record of intervention. The parents must
meet the experts periodically to report progress or problems and get
further support. As the child grows, the needs vary. Therefore, regular
consultation is essential. They must also remember to follow the medical
prescription, if any (for ailments such as fits), as advised.
r
Coordination between parents and professionals is essential for early
intervention to be successful.

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7.6 LINK WITH EARLY CHILDHOOD EDUCATION

AND SCHOOL READINESS
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~ r a d u a l lthe
~ , child with developmental delay should be prepared to attend
a preschool centre, as it is the first step for inclusion in school. Initially, the
teacher and other children may need to be oriented and sensitized so that the
child with mental retardation is accepted by them.
For the first few days, the parent may take the child to the centre for a short
period, stay with him and bring him back. Gradually, as toilet control is
achieved, he can be in the centre for a longer time without the parent staying
along. However, the parent may occasionally visit the centre, work with the
child, and help the teacher to carry out activities with the child. '

Slowly, school readiness activities should be introduced to the child so that

he can be sent to primary school later. These would include learning to take
care of belongings, self-feeding, toiletting, cleanliness and hygiene, greeting
others, waiting for turn, communicating pain or distress to the adult and
avoiding danger and hazards.
On the academic side, pre-reading, pre-writing and pre-number concepts
should be introduced to the child through play-way methods along with rhymes,
songs and games. Most of 'the activities chosen for non-disabledvchildren
will be suitable for these children also. Only, you have to break the activity
into smaller steps, teach a little at a time and use a lot of hands-on experiences
and examples to make the child understand a concept. You have read about
task analysis in Unit 6. You will need to use this strategy when teaching
anything to the child.

In the forthcoming Units, you will read about a number of activities that can
be carried out to foster the motor, personal-social, language and cognitive
development, as well as development of daily living skills, of the child with
mental retardation. As you would go through them, you would appreciate that
an activity often leads to learning a combination of skills. An activity of
Fostering Development threading beads, for example, can contribute to fine motor coordination,
i n Early Years- Part-1
learning cognitive skills and concepts of colour and number, as well as social
and language skills involved in waiting for one's tum and sharing the materials
'
to carry out the activity, or simply talking to each-other when playing. You
may use your creativity, and plan out a number of activities to facilitate the
overall development of the child. In the following Units, several examples of
activities have been given, that will give you an idea about how you may
facilitate the child's development in different areas.

7.7 LET US SUM UP

a Early intervention refers to individualised educational and therapeutic
activities that aim to enhance the development of a child who has a
disability, or is at risk of suffering from it.
Typically, early intervention programmes serve disabledat risk children
from birth to six years of age. Involving the family members and enabling
them to carry out appropriate activities for the child at home is usually
an integral part of such programmes.
a Early detection and intervention helps to prevent further damage, and
facilitates the development of the child.
a The first six years of life & crucial, as 80% of the brain develops
during this period, and thus the potential for learning is martiartinbn.
:@
a Once a delay in development is suspected, professional
sought without wasting time.
a There are various models for provision of intervention services.
Intervention could be home-based, centre-based or it could be a
combination of the two (eclectic model). Each model has its advantages
and limitations.
a Coordination between the parents and professionals is essential for early
intervention to be successfbl.
a Prepare the child for school by, initially, sending him to a preschool
yentre. To facilitate his inclusion, sensitize the staff and children at the
preschool regarding the special needs and abilities of the child. Try and
develop school readiness skills in the child.