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

The Early Intervention Curriculum:
Family-Focused Intervention
Strategies, Activities, and Routines
Gerald Mahoney
Case Western Reserve University
School of Social Work
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.
Basic Components of the Early
Intervention Curriculum
1. Theoretical Model/Conceptual Framework
– Theoretical Model for EI Curricula should
explain:
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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.
Theoretical Model
• Not all theories are the same
– Sensory Integration
• Based upon a theory of information processing that
originated during the late 1950’s early 1960’s.
• 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
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
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
Theoretical Model
• Developmental Theory
– Children’s development results from their active participation in social
and nonsocial activities.
• Constructivism, Communication Theory
– Developmental learning is constrained by children’s 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.
Theoretical Model
• Ecological Theory of Development
– Children’s 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 children’s 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
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 children’s participation in developmentally
appropriate activities and experiences
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 nonautistic 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
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
Basic Components of the Early
Intervention Curriculum
2.
Intervention Goals
–
EI Curricula must address Goals that reflect the purposes of early
intervention
A goal is the long term objective/ultimate desired outcome
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Maximize children’s functioning
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Cognitive
Communication
»
literacy
Social-emotional
Motor
Adaptive Functioning
»
Home
»
School
Goal attainment is best assessed through the use of standardized
developmental tests
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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
Basic Components of the Early
Intervention Curriculum
3. Intervention Objectives
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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.
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Cognitive, Communication, Social Emotional, Motor, etc.
Intervention Objectives are driven by Theory.
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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
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
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 child’s 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
Basic Components of the Early
Intervention Curriculum
4. Curriculum Methods and Strategies
– Instructional strategies are dictated by the
nature of the objectives
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If the intervention objective is for the child to learn
specific developmental and functional behaviors
then we must use some form directed instruction:
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Modeling
Shaping
Prompting
Elicited Imitation
Extrinsic Reinforcement
Curriculum Methods and Strategies
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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:
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Turntaking
Matching
Imitating Child,
Follow the Child’s Lead
Acceptance
Expansion/Conversational recast
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
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Responsive instructional procedures are used to
increase the child’s level of engagement
Directive instructional procedures are used to teach
the child specific skills in situations in which they are
engaged.
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 children’s current level of
developmental functioning
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
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
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 children’s 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
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
Considering Commercially Available
EI Curriculum
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Lovaas
Hawaii (Portage, Carolina)
Transdisciplinary Play Based Intervention
AEPS
Floor Time
Responsive Teaching
Enabling and Empowering Parents
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 (GoodBetter)
– Evidence to support overall effectiveness of
curriculum at attaining intervention goal
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Descriptive Pre- Post- (Good)
Quasi Experimental- (Better)
Causal Model-(Better than Better)
Randomized Control– (Best)
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 children’s developmental well
being.
Lovaas (PRO-ED)
AKA - UCLA Program, ABA, Discrete Trial Training
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Theoretical Model
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Intervention Goals
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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
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Discrete Trial Training – Modeling Prompting Shaping Reinforcement, Assessment, Generalization Training
In Home or Classrooms
IFSP/Individualization
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Discrete Skills and Behaviors
Intervention Strategies and Procedures
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Self Help
Language
Play and Pre-academic
Intervention Objectives
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Learning Theory
Theoretical – good
Intervention Goals – Better to Best
Intervention Objectives – Non-existent (relies on other ABA studies)
Usability
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Moderately Detailed Curriculum guide describes instructional strategies, some objectives and some
procedures (ME Book)
Materials developed by provider
Labor intensive
Can be used in classroom settings/ Not a routines based intervention
AEPS – Birth to Three Intervention
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Theoretical Model
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Intervention Goals Comprehensive
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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
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Incidental Teaching and some Responsive Strategies
In Home or Classrooms
IFSP/Individualization
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Developmental Skills and Behaviors organized in sequence but according to Developmental domain.
Intervention Strategies and Procedures
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Motor Fine & Gross
Communication
Cognitive
Social-Emotional
Intervention Objectives
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Hybrid – Naturalistic intervention – Learning and developmental theory
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
Intervention Objectives – Non-existent (Based on assumption that activity based intervention is more effective
than traditional ABA instructional strategies) AEPS_Citations.pdf
Usability
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Attractive, highly detailed curriculum guide describes instructional strategies AEPS_SampleInterventions.pdf
Materials developed by provider
Curriculum embedded in routine play and child care activities.
Some evidence that it is difficult to target multiple objectives in early childhood special education classroom
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.
• 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.
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.
• Evidence based practices do not mean an
effective curriculum.
•
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.
• 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.
•
Author(s): Guralnick MJ Source: JOURNAL OF APPLIED RESEARCH IN
INTELLECTUAL DISABILITIES Volume: 18 Issue: 4 Pages: 313324 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.
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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.
• Meaningful OUTCOMES
– Functional Outcomes
– Developmental outcomes
– Process outcomes
• 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.
•
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.
•
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.
• 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?