A common method of service delivery for preschoolers with disabilities is for them to attend a public preschool of some kind for a few hours a morning, for perhaps 4 days a week. Therefore, the dosage of this particular intervention is 10-12 hours, sometimes 15 hours, a week. This has become so common, so ingrained, that some administrators are unwilling to examine the flaws of this method. Unfortunately, they should look at the four significant problems with this method.
We don’t know how much time you need to spend with a child to have a significant impact on his or her learning and development. It depends on what’s going on during that time and on a host of child characteristics. If the rate of teaching during the 10-15 hours of service is high, which our research has shown not to be the case, presumably the impact would be high. If the child has severe intellectual disabilities, presumably the impact of 10-15 hours would be less than if the child had mild intellectual disabilities. The cruel truth is that this dosage of intervention is probably too low for children who are learning throughout the day. If they were school-aged children, it would be another matter. The younger the child, the more learning happens in a spread-out fashion (i.e., distributed trials versus massed trials).
The dosage issue is put in stark relief when we see how children in these formal programs spend their time. The first of the following two pie charts show the hours in a day for a child who attends a formal preschool for 619 services, attends child care when the formal preschool is not in session, is at home awake, and is sleeping. The second pie chart shows the hours in a week, including weekends, for the same settings and events.
This time model shows that a child whose day looked like this would spend 8.93% of his or her week in the 619 service, 14.88% of the week in child care, 30.36% of the week awake at home, and 45.83% of the week sleeping. If we assume that learning potential is equal across environments, which is not necessarily true, we see that home provides twice as much opportunity for learning as child care, which provides 3/5 more opportunity than the 619 service. Therefore, the amount of time the child is in the 619 program might be insufficient to have a significant impact, at least compared to other settings.
A second problem with part-time 619 services is the transitions children have to make. Some children have before-“school” care, sometimes in a different classroom from their preschool program. Then, at 12, for morning kids, they are transported to child care, usually by a family member. Then they make the transition to the home. Ironically, children with no particular problems in learning and behavior usually have to go to only one day-time setting (e.g., one child care program), but children with disabilities, who often are less able to make transitions smoothly, have to go to two. Transitions are difficult for some children, require the family to interrupt their day, and might not be used as learning time, thereby resulting in a decrease of engagement.
If the 619 program is providing its services through the preschool programs, it rarely also provides supports to the other environments. It uses up its resources on the 10-15 hours a week, rather than on the remaining 75% of the child’s waking day. The child care programs including children with disabilities often get insufficient support (i.e., no support) from an itinerant teacher. As for all that time in the home: It’s a disgrace that our federal policies and therefore more local ones are developmentally inappropriate. I’m talking about the use of the IEP, with no provision for (a) child-level goals related to functioning in the home, (b) family goals related to the child, or (c) family-level goals only indirectly related to the child. The part-time service delivery model leaves the child’s major supports unsupported by the early childhood special education establishment.
Why are children going to two classroom settings, a formal preschool and a community child care program? In full inclusion, they would be going to the places they would go if they didn’t have disabilities, which presumably would be the community child care program. It’s helpful to think about inclusion in terms of normalization—an old concept from Bengt Nirje and Wolf Wolfensberger. Twenty-four years ago, Don Bailey and I wrote an article called “Normalizing Early Intervention,” in which we argued that professionals could make (a) the physical environment, (b) teaching and therapeutic strategies, and (c) family-focused services as natural as possible, but that the twin values of normalization and effectiveness might sometimes be at odds with each other. Fortunately, in the last two decades we have studies and models that give us direction for effective inclusive practices (see my post of July 26, 2013).
In conclusion, preschool special education programs need to examine carefully the old familiar method of providing low-dosage classroom experiences, more daily transitions than typically developing children have, and lack of support to community child care and to families. Our field might have pulled off part-time, minimally consultative services for years, but it’s time to pay attention.