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.
Dosage
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.
Transitions
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.
Failure to Support Other Environments
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.
Inclusion
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| Wolf Wolfensberger |
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.
