Friday, September 4, 2009

Preschool Services Need Attention

It has become fashionable at early intervention/early childhood special education conferences to decry the supposed sorry state of affairs in Part C. In some places, criticism is warranted; in others, it's not. Many communities--the State of Missouri being one--are making significant strides towards excellent service delivery models.


Preschool services (Section 619 of Part B of IDE[I]A) have always been in a strange position. On the one hand, they receive much attention; on the other, they receive scant attention. They receive much attention in training in university programs for young children with disabilities, where much of the training is directed at preschool-aged children. In part, this emphasis is because of location: Students can be placed in classrooms for internships and student teaching, whereas placing students in home-based programs is much more problematic. Attention to preschool services is supposedly also revealed in conference presentations, where organizers and attendees alike are concerned about whether enough of the program is devoted to infants and toddlers and their families.

The scant attention I have noticed is in service delivery models.

  • Just how are preschool services organized?
  • What is the rationale?
  • How much are administrators paying to dosage issues?
  • Who are the targets of services?
  • What philosophies underpin services?
  • How much focus is on the influences of children's learning--children's learning opportunities?

These questions are related, and I will attempt to answer some of them. Others are for decision makers, practitioners, and families to consider, because my experience is that they often fail to consider them.

First, we can assume that, owing to what we now know about young brains and have long known about successful parenting, young children learn throughout the day better than they do in "lessons." This is related to the power of natural discriminative stimuli and to the difficulty young children, particularly those with developmental delays, have with generalization or "transfer."

Second, we can assume that what they are learning is far more than preschool behaviors (sitting, playing with play dough, negotiating with peers, etc.): They are still learning language, what their growing bodies can and cannot do, and how the world works, which is why learning opportunities exist throughout the day. This concept of alocated learning time is critical for understanding the difference between early childhood education and later education. The older children get, the more their learning can be concentrated into "school" (or Sunday school or piano lesson) time. In the preschool years, caregivers have the opportunity to teach throughout the day. This should make early childhood special educators think about their roles and opportunities.

Third, family systems theory, helpgiving theory, social support theory, and behavioral-ecological theory do not come to a grinding halt when the child turns three years of age. In Part C, there is some understanding that the whole of a child's waking hours is potential intervention time and that the environments in which the child finds him- or herself influence learning. Unfortunately, even though this understanding exist in theory, even in Part C it does not always translate into action. The situation is even worse in preschool, however, where service coordination is no longer a mandated service and where the (special) education mentality is pervasive.
  • If family systems theory were acknowledged, preschool services would be organized to provide emotional, material, and informational support to families, including the systematic assessment of their needs and accountability on the IEP (if that document must continue to be the driving document) for developing family-level goals and providing supports to meet those goals.
  • If helpgiving theory were acknowledged, preschool services would have an expanded view of family-centered practice, so they would attempt to meet families' needs for emotional, material, and informational support, rather than thinking that "parent participation" in school activities was most important.
  • If social support theory were acknowledged, preschool services would see the link between child learning and family well-being and family well-being (quality of life) and their social support, especially informal support. Early childhood special education would therefore spend at least a little time getting to know families' ecologies and helping families preserve and, if they desire, expand their informal-support networks.
  • If behavioral-ecological theory were acknowledged, preschool services would assess children's functioning throughout their typical day, through a family interview, and develop intervention plans that followed our knowledge of how young children learn. These plans would use children's interests and natural learning opportunities to teach them skills so they can participate successfully (i.e., be engaged) in their home, community, and school routines (activities).
Now let's discuss the number of hours that preschool services are provided to a child. If the child can go to school five mornings a week (e.g., 20 hours, allowing for a full 4 hours a morning instead of the measly 2.5 hours some preschool programs offer) or three full days a week (e.g., 15 hours, allowing for a full 8 hours), the school environment becomes a true learning environment. The child spends enough time there for learning opportunities to be distributed across time, and the child's "caregivers" during that time (i.e., teaching staff) spend enough time with the child that they become direct instructional or intervention agents themselves. This can be labeled the classroom model.

If these classrooms are self-contained (i.e., having only children with disabilities), they represent a dated approach that potentially violates moral and legal positions. If they are inclusive (i.e., at least half the children in each classroom have no disabilities), these classrooms are defensible and potentially excellent. This article is not about inclusion; it is about attention to children's learning opportunities and to their families.

Many preschool services are offered on a much leaner schedule, such as one to four 2.5-hour mornings a week, with the number of mornings being related to either the severity of the child's disability or the number of services the child has on the IEP. When a child is "at school" for such a small percentage of his or her waking time, we have to ask what the point of this service time should be. The child is transported in, sometimes by school bus, which is another whole discussion, sometimes by parents. Usually, the child is left "at school" for these short bursts of early childhood special education and related services. Family communication is limited to (a) notebooks, (b) intermittent home visits, or (c) discussions at arrival and departure, sometimes, with those families who do drop off and pick up their children. Often, that communication is about what the school people are working on, what the child did, and what the family can do to support the school's efforts. Sometimes, these short sessions at school are thought of as the times the child comes in for his or her therapies and special ed. Short times at school (i.e., fewer than 15 hours a week) can be thought of as the playgroup/clinic model.

Some preschool services are offered through itinerant services, which have the potential to acknowledge the theoretical bases I earlier described. Itinerant teachers can consult with a child's regular caregivers/teachers in  child care or other classroom-based settings, such as Head Start. If the consultation is done well, using an individualized-within-routines approach and not a pull-out approach, this model of service delivery has the potential to expand intervention throughout the child's classroom day every day. Unfortunately, sometimes itinerant services are restricted to special education, with the therapies still happening in clinical types of settings at a school. If therapists can also travel to children's regular-early-childhood classroom settings and adopt a "consultative approach to direct services" (which is not as contradictory as it sounds), we really have the potential to provide meaningful intervention. There's still the family piece though.... This approach is labeled the itinerant model.

School districts fear that the itinerant model is too expensive, compared to keeping all the personnel in centralized locations and shipping the children in, in groups. For the reasons given above, this solution has to be considered pragmatic but atheoretical, if the playgroup/clinic model is adopted. Beginning steps for preschool administrators can include the following.
  1. Become familiar with the literature on the theory and research related to the concepts described in this article, so decisions are made on intellectually and empirically defensible grounds.
  2. Work towards converting the playgroup/clinic sessions into family support sessions. After all, because they consist of such short bursts, many families are presumably available to transport the children or to care for them when they're not "at school." Do not call this "school" time, because that has the connotation of teachers working directly with children, and these family support sessions will be much more than that.
  3. Take all the FTEs currently devoted to preschool special ed and related services, acknowledging that some therapists might work also with older children, and divide that number into the number of children with IEPs. Consider this then to be potential caseloads, with one professional serving as the primary interventionist with that child and family in whatever location seems appropriate. This is a radical but highly commonsensical approach to resource distribution--and defensible on child-learning and service delivery grounds.
  4. Expand itinerant services, once caseloads are reallocated to a primary service provider. Ensure this is done with both therapies and special education, not just the latter.

Monday, May 11, 2009

What to Study

A colleague of mine was pondering what research question to ask next, which got me thinking about what I believe really needs to to be tackled.

If I were my colleague, I’d be curious about the actual amount of intervention children get—what we sometimes call the dosage question. Usually, this is measured in terms of the amount of time a child attends a program, but I’m interested in (a) how much intervention, typical or compensatory, does a child get from his natural caregivers and (b) how much program time is actually what Fisher, Berliner, et al. called “academic learning time” or true instruction. Part of my question is a political one: I simply don’t believe that only professional time counts. And I believe that a lot of professional time is incomplete teaching.

So what? First, if we could measure what children get from natural caregivers, we could count this as a buffer or asset that the child has. Second, if we could show that complete incidental teaching (setting up an engaging environment, following the child’s lead, eliciting elaboration, and ensuring there’s a consequence) is better than incomplete incidental teaching, which is better than nonelaborative responses, which is better than nonresponsive directives, we’d know more about the whole package of interventions children get and need.

Tuesday, March 10, 2009

Service Coordinators as Evaluators

I need some insight and thought you can help. We are facing some challenges at the Early Intervention System in XXXX because of service provider shortages. We never seem to have enough service providers … We’ve been brainstorming alternatives because the way our system was conceptualized is that our service providers use some of their time to do initial child assessments before the IFSP meeting and I would prefer that they use their time to provide services!!!!

We have a group of Service Coordinators that have different educational backgrounds (ex., Social Workers, Pschology, Counseling, etc.) All of them have a Bachelor Degree and most have been working for the EI System for an average of 3 yrs. and it is my perception that they have the skills to carry out child assessments. Would it be appropriate to train Service Coordinators so that they can do the initial Curriculum Based Assessment? We use the HELP (Hawaii Early Learning Profile). I checked the Regulations and they basically talk about state licenses and certifications regarding providing services but I’m not sure if it also applies to the assessment process?????

Are your service coordinators just service coordinators, not providers? If so, by and large, they are not necessarily trained early interventionists; most importantly, sometimes they are not trained in child development or disabilities (see McWilliam, 2006). On the other hand, neither was I when I was doing child assessments as a home visitor. And the HELP does not require any kind of licensure. So my conclusion is that, if the service coordinator knows child development and disabilities, he or she can do the evaluation. You are talking about evaluation for eligibility, aren’t you? If so, remember they are just trying to answer the question in or out? If your state allows the HELP, then they’re not that particular about the exactitude of the evaluation, since the HELP isn’t norm referenced. So that’s another argument for allowing the SCs to do the evals, if they’re knowledgeable. The Part C regs do not prevent service coordinators or anyone else from doing the evals.

McWilliam, R. A. (2006). What happened to service coordination? Journal of Early Intervention, 28, 166-168.