Tracy Cowles, CEO and owner of Next Step Therapy, submitted the following article:

Early Intervention Services — What Is It?

Explaining Early Intervention (EI) to people even in related profession fields is difficult on a good day, and describing it to “outsiders” for educational purposes is even more so. I am going to try to explain the program in very simple terms, and cut through as much of the extra stuff as I can.

Basically, approximately 35 years ago, the Federal Government mandated (required) all states to create and provide services to children from Birth to Three years. While the Federal Government gave guidelines regarding what kinds of services were to be provided, each state was given a great deal of leeway in how they wanted to approach these requirements. Most states decided that they would have a State level office that oversaw the implementation of the program, but allowed each County within the state to form their own office and run the program locally.

It is important for everyone to know that because of this system, what is offered, how it is offered, and how it is paid for varies widely from state to state, and moving from one state to another can result in drastic changes for a family regarding these services.

In general, Pennsylvania has been rated in the TOP Five of EI programs in the United States, consistently, for many years. That rating is based on how much money is spent on the program, how many children receive services, and the quality of services that they receive. Go PA!! So, since Next Step Therapy, Inc. is located in PA, and I am most familiar with how the program works here, I’m going to describe the PA system.

Early Intervention is an Entitlement Program. Children who qualify for it are entitled to have the services. While I understand that many readers may roll their eyes at the words “Entitlement Program,” I would ask you to understand that we are talking about infants and toddlers here….babies who did not ask to be born with the challenges that they have, and who had no choice in the matter.

Some of these youngsters automatically qualify for these services at birth – children who are born with syndromes (such as Down syndrome), Cerebral Palsy, paralysis from having a stroke, extreme prematurity and low birth weight, blindness, and deafness. These children are often referred to the County EI office while still in the hospital so that services can begin as quickly as possible after the child is released to the home.

Services that are available in PA include Speech Therapy, Physical Therapy, Occupational Therapy, Special Instruction Teacher, Teacher of the Hearing Impaired, Teacher of the Visually Impaired, and Nutritionist.

Your first question should be, how do we KNOW that the child born with a syndrome is going to have developmental delays? How do we KNOW that the child with right sided paralysis won’t just recover and “outgrow” it? We KNOW because the research is very clear that 100% of children with Down syndrome do not hit developmental milestones on time, and we KNOW that adults typically don’t recover from a stroke without therapy.

Let me give you an example: A child is born deaf to two hearing parents. It’s rare. The parents don’t know sign language. When that baby comes home, the parents are still in shock regarding the diagnosis. They are tearful, angry that this has happened to them, and potentially having a hard time bonding with this baby that they don’t truly understand. Meanwhile, they were so shocked at the hospital that they now only remember fragments of what they were told….is she completely deaf? If we talk real loud will she hear us? Is there surgery for this? Will she ever be able to talk? Does she need hearing aids? Where would we get them? I have a card here that says we have an appointment in Pittsburgh with an Audiologist….what is that?

The County that took this referral would send a Service Coordinator to the house to meet the parents and the little tyke. A medical and family history would be recorded, and the parents would have the opportunity to discuss their concerns in the comfort of their own home. An evaluation would be scheduled, and ultimately, this particular baby would start having a Speech Therapist and a Teacher of the Hearing Impaired come to the house to work with the baby, and the parents. We want this child to start communicating with her parents close to the time “normal” kids do….pointing, gesturing, and making babbling sounds by nine months or so, and “saying” her first word at close to twelve months (but in this case with sign language). The only way that is going to happen is for mom and dad to be introduced to sign language, being shown by the therapists modeling the behavior how to use it consistently, and providing support for this family.

In this instance, and for most children involved in the Birth to Three program, the Pediatrician and Specialists that this child sees are crucial to their health, but it is the therapists that work with the child and parents who will see the day to day progress, frustrations and fears.

Therapists working in EI with the Birth to Three crowd do work directly with the child. A Physical Therapist will stretch, massage and exercise a child, while working hands on with skills such as rolling over, sitting, and balance. However, in addition to working with the child, at least one parent or caregiver is expected to be present for the sessions, learning to do these things themselves so that they can follow through until the next visit. EI therapists and teachers provide a huge amount of counseling and support to the families.

Many children are not referred at birth for the program. Many are referred after they have missed developmental milestones and appear to be “delayed.” At that time, the Pediatrician or family can call the County office to arrange for an evaluation.

Some children only need one therapist, such as a speech therapist, while other children need five different therapists. It depends on the nature and severity of their challenges.

All therapists and teachers that work in this program are highly qualified, licensed professionals, who are required to have twenty-four hours of training annually to remain working in the program. Early Intervention services are provided in Pennsylvania at no cost to families and in the comfort of the home, child care center or babysitter.

The second part of Early Intervention is the three to five program. While birth to three and three to five programs are sisters, and both are under the umbrella of the Office of Child Development and Early Learning (OCDEL) out of Harrisburg, they are two separate entities. Children in the birth to three programs are discharged from the program the day before they turn three and can transition to the three to five program if they qualify. Parents also have the option of pursuing Head Start, Pre-K Counts or private preschool.

When asked, many people state that a child’s period of most learning is probably around kindergarten, or maybe at puberty going to high school. Absolutely not true. A child’s biggest period of growth (physically, mentally, emotionally, socially, learning to take care of themselves) is from birth to three. Think about it. An infant starts out as a six or seven pound armload of twitchy nerve endings, incapable of doing anything but sucking and crying. Three years later (for those on the “normal” end of development) they are walking, running, feeding themselves, taking their own clothes off, toilet trained and speaking in full, mostly grammatically correct sentences. Children at three have already learned how language works, the rules of making words plural (I have two shoes!), the concept of cause and effect, and many have learned the art of manipulation!

The second “biggest” period of growth for children is from 3-5 years. Again, think about it. The three year old is still talking some baby talk, needs his mom, and is probably still taking a nap….fast forward two years later…he’s ready for a full day of school.

THIS is the reason for these programs. Attempting to get kids on track as soon as possible, while they are very young and in this growth mode, has been shown by research to be the best predictor of future success in school (for kids with impairments). Can you imagine if we just left that previously mentioned deaf child alone until she was five? Starting school with potentially no way to communicate, five years of language learning lost? Some parents would have found a way without Early Intervention, but most probably wouldn’t. They wouldn’t know where to start, wouldn’t be able to afford to travel to a large city for a School for the Deaf.

It has been my experience, and again, there is some research to back it up, that kids that “fail” in Kindergarten and first grade, either because of Intellectual Disabilities, Delays, or Behavior Issues find it almost impossible to recover from that….they have a hard time feeling that school is important. Sometimes an extremely gifted, kind teacher comes along and helps a child turn the situation around, but, for most kids, “failure” early on leads to lack of self-esteem and disruptive behaviors that continue throughout the school years. Therefore, anything that we can do to help a child be able to “function” adequately at the beginning of school is considered (in our world) a positive.

Early Intervention programs are a priority in Pennsylvania and are funded through tax dollars and medical assistance. We are lucky to live in a state that places a high priority on early care and education!! The research has shown that kids that have issues addressed very young ultimately do better, and are less impaired than kids with the same problems who don’t receive therapy. Pennsylvanians are lucky to have such a strong program for our littlest citizens!

~Tracy

To learn more about Next Step Therapy and its services, visit Next Step Therapy’s website here.