DOCUMENT RESUME

ED 132 804 EC 092 373

AUTHOR Moersch, Martha S., Ed.; Wilson, Ted Y., Ed.TITLE Early Intervention Project for Handicapped infants

and Young Children. Final Report, 1973-1976.INSTITUTION Michigan Univ., Ann Arbor. Inst for the Study of

Mental Retardation.SPONS AGENCY Bureau of Education for the Handicapped (DHEW/OE) ,

Washington, D.C.PUB DATE 76GRANT G007400463NOTE 52p.; A "FirstChancs" Project

EDRS PRICE MF-$0.83 HC-$3.50 Plus Postage.DESCRIPTORS *Delivery Systems; Early Childhood Education;

Exceptional Child Education; *Handicapped Children;*Identification;'*Intervention; Parent Role; *ProgramDescriptions; Screening Tests; Staff Role

IDENTIFIERS Final Reports; *First Chance; Michigan

ABSTRACTPresented is an informal report of a 3-year early

intervention project for young handicapped children in Michigan, apart of the Handicapped Children's Early Education Program, sometimesreferred to as the First Chance Projects. Sections cover thefollowing topics, an overview of the project; identification andscreening; the service delivery process; parent involvement;supportive services; evaluation; staff development activities;dissemination and training; replication and continuation;record-keeping; disciplinary roles (occupational therapist, physicaltherapist, speech and language pathologist, psychologist, specialeducator, and child development specialist) ; administrative issues;and a deScription of the early intervention developmental profile.(IM)

Documents acquired by ERIC include 'many informal unpublished *materials not available from other sources. ERIC makes every effort *

* to obtain the best copy available. Nevertheless, items of marginal ** reproducibility are often encountered and this affects the quality *

* of the microficheand hardcopy reproductions ERIC makes available ** via the ERIC Document Reproduction Service (EDRS). FDRS is not ** responsible for the quality of the original document. Reproductions ** supplied by EDRS are the best that can be made from the original. ************************************************************************

Early Intervention Project

FOR HANDICAPPED INFANTSAND YOUNG CHILDREN

Final Report1973-1976

S DEPAF.TAAENT OF HEALTH.EDUCATION a WELFARENATIONAL INSTITUTE OF

EDUCATION

THIS DOCumENT HAS BEEN RFPRo.DUCED EXACTLY AS RECEIVED PROAATHE PERSoN OR ORGANIZATIoN ORIGIN-ATING IT POINTS OF vIEW OR OPINIONSSTATED DO NOT NECESSARILY REPRE-SENT OFFICIAL NATIoNAL 'HST! TuTE OPEDUCATION POSITION OR POLICY

The project presented or reported herein was performed pur-suant to a Grant from the U.S. Office of Education, Departmentof Health. Education, and Welfare. However. the opinions ex-pressed herein do not necessarily reflect the position or policy ofthe U.S. Office of Education, and no official endorsement by theU.S. Office of Education should be inferred.

A First Chance ProjectU.S. Office of Education

Bureau of Education for the HandicappedWashington, D.C.

G007400463

Copyrieht 6-') 1976 by the University of Michigan, Ann Arbor,Michigan. except the chapter entitled "Measuring Preschools'Readiness to Mainstream Handicapped Children is reprintedby special permission of Child Welfare League of America fromCHILD WELFARE, Vol. LV, No. 3. 1976, pp, 216-220.

"PERMISSION To REPRODUCE THIS CORY-RIGHTED MATERIAL HAp BEEN DRANTED By

Martha S. MocrschTQ ERIC AND ORGANIZATIONS QBERATINGUNDER ADREEmENTs LNITH THE NATIONAL IN-

sTiTuTE OE EDUCATION EL/EITHER REPRO-DucTIDN OuTSIDE THE ERIC sysTEm RE,OuIRES pERmISSION OE THE COPYRIGHTOWNER

edited by Martha S. Moersch and Ted Y. WilsonInstitute for the Study of Mental Retardation and Related Disabilities The University of Michigan e Ann Arbor

The project presented or reported herein was performed pur-suant to a Grant from the U.S. Office of Education. Departmentof Health, Education, and Welfare. However, the opinions ex-pressed herein do not necessarily reflect the position or policy ofthe U.S. Office of Education, and no official endorsement by theU.S. Office of Education should be inferred.

A "First Chance ProjectU.S. Office of Education

Bureau of Education for the HandicappedWashington, D.C.

0007400463

Copyright (0 1976 by the University of Michigan, Ann Arbor,Michigan, except the chapter entitled "Measuring Preschools"Readiness to Mainstream Handicapped Children is reprintedby special permission of Child Welfare League of America fromCHILD WELFARE. Vol. LV ,No. 3, 1976. pp. 216-220.

CONTENTS

Introduction 1

Project Overview 2

Martha S. Moersch

Identification and ScreeningEleanor W. Lynch

Structure of the Service Delivery Pr- ess 7Diane B. D'Eugenio

Fostering Parent involvement 11

Sara L. Brown

Supportive Services 14

Carol M. DonovanEvaluation 18

Sally J. Rogers

Staff Development Activities 29Diane B. D'Eugenio

Dissemination and Training 30D. Sue Schafer

Replication and Continu- tion 33D. Sue Schafer

Record Keeping_ 35D. Sue Sclwfer and IV artha S. tthwrscli

Disciplinary Roles 36Occupational Therapist 36

Diane B. D'EugenioPhysical Therapist 37

Carol M. Donovan

Speech and Language PathologistSara L, Brown

Psychologist 38Sally J. Rogers

Special Educator 39Eleanor W. Lynch

Child Development Specialist 40Carol M. Donovan

Administrative Issues 41Martha S. Moersch

Early Intervention Developmental Profile 42D. Sue Schafer

Measuring Preschools' Readiness to Mainstream Handicapped ChildrenA. Geoffrey Abelson

Project Staff 48Index 49

from46 CHILD WELFARE

Vol. IN, No 31976, pp 216-220(Child WelfareLeague of Amer)

re"

INTRODUCTIONThe First Chance network of the Handicapped Children's Early Education Program. Bureau of Education for the

Handicapped BEH), United States Office of Education, provides support for innovative demonstration programs foryoung children which can be replicated by school systems and other community agencies. Many states have approvedlegislation for programming for handicapped children from the day of their birth.

Each First Chance project is required to disseminate information gained through implementation of its innovativeprogram. During its lifetime. the project described in this report was involved in all aspects of dissemination. from observa-tion to formal publication. The project was funded at a time when interest in and need for programming information forhandicapped infants and young children was high.

The interests and needs of large numbers of persons. representing many disciplines and many levels of involvement,who have contacted the project for information are reflected in the format of this final report. The report is an informaldescription of the project and was written by the staff members who developed and carried out the project. The reportseeks to answer the questions most often asked by visitors and correspondents.

A more formal publication from the project will he availiible early in 1977 when Dc i Ipnu nted P1 n,i ammlnt, fai Infaiitsand Knrng Children is published by the University of Michigan Press.

1

PROJECT OVERVIEWAlarthei

In 11)71 the Michigan legislature enacted Puhlic Law198. the Michigan mandatory special education law, withimplementation to begin with the 1973-74 sehool year.This law required that the schook supply an educationalprogram for all persons from birth through age twenty-fivewho required special educational programming. It wasalso the responsibility of the schools to insure that specialeducation pupils were provided with the means for takingadvantage of the educational program. This provisiondictated that the schools assume a more comprehensivemanagement program than the traditional educationalcurriculum.

By the time the law was passed. many individuals andagencies had become interested in the education of in-tant, infant stimulation programs, or in developmentalassessment and treatment of-handicapped infants. A bodyof literature was being developed, and pilot prOgramswere being carried out.

Staff members of the Institute for the Study of MenudRetardation and Related Disabilities ( ISMR RD) or theUnivep-,ity of Michigan had explored posihilitics for earlyintervention programs for handicapped infants. and a pro-posal was submitted in January 1973 to the HandicappedChildren's Early Education Program. Bureau of Educa-tion for the Handicapped, The proposal outlined an in-novative program to he carried out as a model of one of theways in which the requirements of the mandatory specialeducation law could he met for handicapped children frombirth through the age of four. At the same time the propo-sal was submitted. an internally funded pilot program wasstarted at the Institute on a once-a-week basis.

Notification of funding as a "First Chance" project wasreceived on October I , 1973, and the Early InterventionProject for Handicapped Infants and Young Children(El P) began operation at once. It was customary for thefirst year of First Chance projects to be used as a plan-ning year, but the nine months of planning and preparationby the pilot project enabled full operation to begin im-mediately upon receiving funding.

The major features of the model program were that par-ents were to he maintained as primary treatment providersfor their handicapped children and that an occupationaltherapist. a physical therapist, and a speech and languagepathologist would he primary staff memhers with a psy-chologist and a special educator serving as secondary staffmembers. Justification for the specific stalling pattern wasthat children recognized as requiring special programmingat such an early age would not have academic needs butwould require assistance in acquiring cognitive, gross andfine motor, language. social, and self-help skills. Whiletraining in teaching these skills to such young handicappedchildren had not been widespread. it was felt that taken to-gether the three primary disciplines of oecupationaltherapy. physical therapy. and speech and languagepathology did encompass the necessary background.

A small population of children had been identifiedthrough the Institute's diagnostic and evaluation serviceand had !leen enrolled in the pilot program. Upon notifica-

lion of project funding, contacts were made with areahealth departments, hospitals, clinics. physicians, volun-tary health organizations. day care centers. nurseryschools, and with the public through newspapers,brochures, and personal contact. Interestingly enough,except for four children with Down's syndrome whoranged in age from eleven weeks to fourteen months, thechildren who entered the project at the beginning wereusually both chronologically and functionally at thethree-and-four-year levels of development and had onlymildly handicapping conditions. As the project continued.the children who enrolled were progressively younger andmore severely handicapped.

Referrals were accepted from parents as well as profes-sionals, and the fact that the parents recognized that theyhad a handicapped child who needed sonic type of specialhclp was sufficient to qualify the child for initial ac-ceptimce mto the program,

Hie project accepted children from birth through theage of four, with any type of handicap, who resided withina three county area. There was no cost to the family exceptthat the family provkled transportation. Each child, withone or both parents. attended one two-to-three hourgroupsession each week and received a home visit once a week,or once every two weeks. A comprehensive evaluation ofthe child was performed. and a management plan was de-,veloped. In addition to the five disciplines represented onthe project staff, other evaluations were performed asneeded by Institute staff memhers. Those disciplines mostoften called upon were pediatrics, audiology. nutritiOn.and social work.

In addition to the king-range management plan, a set ofshort-term objectives was developed for each child andactivities for meeting these objectives were carried outboth in the group,and home sessions.

A maximum nuMber of thirty children at one time wereserved by the prOject. Three separate groups were main-tained according to the developmental levels of thechildren: infant, intermediate, and preschool_ During thesecond year of the project it was determined that thepreschool children, those both chronologically and de-velopmentally al the three and four year levels, would bemore appropriately placed in public school programs or innormal nursery school programs. During the third year.the project focused on infants and children who werefunctioning below the level of three years.

Physi Facilities fo Group Sessions

The physical facilities included a large carpeted room,an adjoining room with a tile floor, an adjacent bathroom,and a simple kitchen arca. There wits a lounge area nearbywhere the parents could visit and have coffee and relieftime away from the children. One-way observations win-dows and/or remote television viewing allowed parents,staff members, students, and visitors to observe groupactivities.

Many activities took place on the floor and equipmentrequirements were simple, i.e. tallies, chairs (regular andhigh chairs), wheel toys, mats. bolsters, mirrors, andother toys suitable for young children. Rocking chairs,both for adults and children, were added soon after theproject began. Group activities ranged from one-to-onetreatment sessions to typical nursery school schedulesdepending upon the needs of the current population; snacktime was always a part of each group session.

One or two normal children were usually included asmodels in all preschool groups and at times in othergroups. These were either children of staff members re-cruited for specific purposes or siblings of the project chil-dren. For a short time, a volunteer was assigned to lead aplay group of siblings.

Home Visits

Home visits were scheduled once a week or once everyweeks according to the needs of the child and family.e visits were made when all himily members could be

present. and others were scheduled when only the childand mother were present in order to focus on specificneeds. Home visits lasted from one to three hours. A pri-mary home visitor was assigned according to the majorneed of the child or parent, with changes being made asrequired. A staff member of another discipline sometimesreplaced or accompanied the primary home visitor forspecific purposes.

Programming

While the general program plan included group andhome sessions for each child, there was flexibility in meet-ing the needs of the specific child. Two children never at-tended group sessions: one child had a medical conditionwhich required that he not be exposed to other children;another was a post-rubella child who continued to excreterubella virus. Some children received home visits only.usually for health reasons, and group sessions were addedlater; other children attended other programs five dayseach week but continued to receive home visits by projectstaff members. Health conditions of the children often re-quired that visits he replaced by project staff visits to thehospital.

Attention was always given to determining the most ap-propriate program for each child. This ranged from assist-ing the parents in locating a more appropriate programsoon after the initial referral to the project. to graduat-ing a child when it was decided that he should associatewith normal children or move into anothei program. toassisting a family in securing residential placement fortheir child.

Since the project operated on a twelve-month basis.some children who regularly attended other programs dur-ing the school terms were accepted by the project duringthe summer months.

The basis for developing individual programs for eachchild was the Early Int ervethion Drvelupmental

Advisory Committee

An advisory comminee to the project was appointedwhen funding approval was received. Members includedindividuals in educational, health, and administrative po-sitions, and parents. Each member was chosen for theunique knowledge and skills he or she possessed, whichprovided valuable assistance to the project, ranging fromdirect clinical and training assistance to providing publicinformation. One member served as a one-day-a-weekconsultant to the project during its second year; anotherreturned to graduate school and was on an academicplacement with the project during its third year of opera-tion. Others served as referral sources for the project.

The setting of the project within the Institute providedready access to a wide variety of knowledgeable andexperienced individuals who were able to fill many ofthe roles of an advisory committee. For this reason, theresources of the advisory committee were utilized on anindividual basis more often than as a group.

Project parents provided much of the assistance usuallyexpected of advisory committees, ranging from feedbackon project operations to assistance with disseminationactivities.

Services to University Students

First Chance projects did not include the training ofpreservice students as a priority. Since the Institute, as aUniversity Affiliated Facility, had this as its top priority.arrangements were made for University students to trainwith the project. During its three years of operation, theproject offered practicum placements and early interven-tion seminars for University of Michigan students. Thepercentage of the project director's time supported by aMaternal and Child Health grant allowed this. Studentsrepresented the disciplines of early childhood education.special education. speech and language, physical therapy,psychology, nutrition. t-ursing, audiology, and socialwork. There is no occupational therapy department at theUniversity of Michigan. but occupational therapy stu-dents on field placement at the Institute from other univer-sities did receive training through El P.

Since there are few opportunities for academic study ofhandicapped infants in the United States. EIP filled aunique need. The emphasis on interdisciplinary teamfunctioning provided new experiences for many of thestudents.

In addition to the University of Michigan. EH staffmembers served as guest lecturers at Eastern MichiganUniversity, Washienaw Community College, WayneState University. Marygrove College. Mercy College.Ohio State University. and University of Queensland.Brisbane, Australia. Students and faculty from variousCanadian colleges and universities attended dissemina-fion sessions of the project.

Major Strengths and Weak_

Two o1itstauiding strengths of the project were the twomajor objectives outlined in the original proposal: sup-porting parents as the primary treatment providers for

their handicapped children and demonstrating an alterna-tive staffing pattern which differed from the usual pre-school staffing pattern. Primary staff members were fromthe disciplines of occupational therapy, physical therapy,and speech and language pathology, and supportive per-sonnel included psychology and special education. It ishoped thal- no program for handicapped infants will be im-plemented without major involvement of parents; how-ever, of equal importance is that such programs considerthe disciplines of occupational therapy, physical therapy.and speech and language pathology as primary staff.

A third major strength. closely associated with the firsttwo strengths, was the cooperation, mutual support, andcreative skill of the staff members who made the projectpossible, the team which is mentioned so often in thereport. In working with very young and handicapped chil-dren such as the project served, it must be recognized thatthere are few experts. Each program must build its ownteam through mutual respect for the knowledge of othersand through recognition of the creative problem-solvingwhich is necessary_ Staff members were equally creativein disseminating project information to others.

In addition to the immediate staff members in the proj-ect, the larger group of Institute staff members, having awide variety of knowledge and skills, made many valuablecontributions to the strengths of the project_

One factor which was recognized as a major weaknessof the project, both by persons inside and outside theproject. was that it appealed to and was suitable for thoseparents having the interest, time, and financial ability to

4

become as personally involved in the program as did theparents in the EIP. It is recommended that this weakness,or problem area, be recognized and that efforts be madeto ameliorate the weakness rather than adopting the re-verse situation of not involving parents because of thedifficulties of doing so. Program developers should as-sume that parents are interested and should includethem in problem-solving sessions to discuss how theycan be involved.

Lack of transportation was recognized as a weaknesswhich other programs are urged to remediate

Closure of BEI-I Funding Period

It was noted in the original proposal that by the end ofthe BEH funding period, the public schools would havecompleted three years under the nmndatory special educa-tion law and could be expected to provide adequate prog-ramming for infants and young children. One or the origi-nal three counties included in the geographic arca coveredby the project proved to be too far away to be feasible forchildren to attend the project sessions. The other twocounties adopted the project model within their inter-mediate school districts and will serve as demonstrationsites for an Outreach Project. also funded by B EH . Someof the project children have been mainstreamed into nor-nml settings where they might be expected to remain in-definitely or until their academic requirements make itnecessary that they return to special education settings_

DENTIFICATION AND SCREENINGEle

Unlike the Michigan Mandatory Special Education Act.(Public Act 198), the Early Intervention Project had no-child find" '.:omponent. Although the project was adver-tised in brochures, newspapers, and in presentations tocommunity organizations, there was no mandate to screenlarge numbers orchildren in order to identify children whoneeded services. During the project's three years, how-ever. staff members did provide consultation to local andintermediate school districts on community screening andchild find" activities to assist districts in meeting themandatory special education law in Michigan and inanticipation of Public Act 94-142 which mandates identi-fication and screening. These consultations includedfamiliarization of school staff with various screening in-struments, suggestions for plans of operation when initiat-ing a community-wide screening program. and linkaucwith other districts which had already initiated majorchild find projects.

When school systems were assisted in carrying out"child find activities, three major areas were stressed,including: ( ) responsibility for case-finding under themandatory special education act, (2) strategies fordeveloping adequate case-finding capabilities. and (3)screening procedures.

Responsibility for Case-Finding

Even thouuh Michigan Public Act 198. which requiresthat the public schools serve all children from birththrough age twenty-five regardless of type and extent ofhandicap. was passed in December of 1971 and imple-mented in September of 1973. many districts have had diffi-culty in locating persons who-are not receiving services.In fact, fewer children are receiving services underPublic Act 198 than prior to the passage of the mandatoryeducation act. This can be accounted for in part because oflowerinu the upper limit of the intelligence quotient re-quirement. Also, a smaller number of handicapped pre-school children appeared than was projected. In manyareas. the preschool children who needed special educa-tion have not been identified.

Case-Finding Strategies

Adequate case-finding requires a systematic. thoughtfulstrategy. knowledge of community agencies. and commu-nity trust. When asked to help districts develop strategiesfor case-finding, the project suggested that they first de-velop a plan which included a campaign time-line, insidecontacts with agencies. publicity ideas or gimmicks,and a systematic effort to build community trust.

The project suggested that the school system develop atime-line so that all major activities such as radio or televi-sion appearances and public service spot reminders,mobile unit visits, area-wide mailings, and on-going pre-sentations at meetings, such as churches and service or-

W. Lynch

5

ganizations, could be carefully and strategically timed.The project also suggested that major agencies serving thecommunity, such as social services, public health, childand family guidance clinics, industries, businesses, andlocal professional groups, be informed about the mandat-ory special education aet and be made aware of availableservices. Because school boards often have members whoare involved in other agencies or professions, they canserve as inside contacts to give visibility to the law, theservices, and the school system's efforts.

Another major strategy suggested to school systemswas that whenever families came for screening activities,they should be rewarded by having something tangible totake home: an activity book, a monthly newspaper forpreschoolers. etc. Many times, gimmicky" things work.A newspaper ad which says FREE", generally getspeople's attention; it may be helpful to demonstrate ontelevision what the screening involves in order to lessenanxiety, Or it may be helpful to link school screening withother agency screening systems that already exist such asthe Early Periodic Screening. Diagnosis, and TreatmentProgram carried out by Medicaid.

Very difficult to develop, yet most important, is thc-ommunity's trust in the school system's screening, refer-ral, and treatment programs. In order to develop trust theprogram must deliver services, must maintain opennessand encourage visitation, and must actively involve asmany consumers as possible.

Screening Procedures

After a case-finding plan has been developed, it is im-portant to determine the most accurate, yet economical,screening procedure. School districts were advised toconsider what would be most effective in terms of loca-tion, timing, allocation of staff resources, record-keeping,referral, and age levels for screening. Some districts foundit most helpful to conduct screening procedures atneighborhood schools along with kindergarten round-upor another annual, publicized event; others found that atraveling van which could move from shopping center toshopping center was most effective; still others found thatscreening at community centers or health agencies wasmost productive in finding the children.

When looking at timing, districts had to determine howmany case-finding efforts would be made each year andwhen these efforts would be carried Out. In terms of theallocation of staff resources, it was project practice to MC=ommend a team which had expertise in motor develop-ment, language development, cognitive development, andfamily dynamics. A team of these specialists had the com-bined skills necessary to identify the needs of the wholechild and his family system.

During and after the screening pr )cess, a systematic re-cord keeping system and it referral system are needed.Community trust requires that records be confidential andnot go astray, and yet that they assist others in maintaining

the system and making appropriate referrals. This, in it-self, was a job that required the attention of a number ofpeople and in most cases the direct, full-time contributionof at least one clerical person.

Another factor which was important was the age level atwhich screening would take place. Some districts wantedto screen all two-year-olds first, others all four-year-oldsfirst. In any event, the project urged that the screening sys-tem should be developed to provide a net" which wouldcatch children systematically as well as allow for referralsas problems were noticed.

A decision about what screening instruments to use wasanother major factor in developing a good case-findingprogram. The qualities of a good screening device include:speedy and easy administration, predictability, and a widerange of applicability. To be effective, screening instru-ments had to be predictable yet easily and quickly ad-ministered without extensive training. This precludedmany of the standard psychological instruments and

1 0

suggested some of the less refined instr iments whichcould provide the necessary results for decision-making.The project suggested that, at a minimum, screeningprocedures should investigate vision, hearing, motor,language, cognitive, social, and self-care development.Although many instruments have estahlisned nationalnormative data, it was often helpful to develop commu-nity norms in order to investigate how well children ina specific community were performing.

Commonly used screening instalments included. theDenver Developmental Screening Test. the WashingtonGuide for Promoting Development in the Young Child, theSlosson Intelligence Test, and the Caldwell PreschoolInventory. The project ureed that as other screening in-struments are developed, those involved in preschoolcase-finding keep abreast of the most recent literature.As children were identified, it would be the screeningteam's responsibility to refer them for further evalua-tions and to maintain accurate records on the children.

STRUCTURE OF THEDELIVERY PRC?

Diane H. D. Eugenio

Over the first year of the Early Intervention Project, aprocess and structure for delivery of service emerged. Asthe project entered its second year, the staff felt the neces-sity of clearly defining the steps in that process to insure asystem for complete service delivery to current and pro-spective client-patients. Along with this, a definition of theprocess wouk C. allow uniform gathering of information oneach child which could he used to continuously evaluatethe children's developmental progress and the appro-priateness of their individual program. and would providea system of data collection for research purposes.

This section will describe the components of theprocess and structure of the Early Intervention Project'sservice delivery system from the time a child entered theproject to the time he exited.

There were eight major components in the structure ofthe project which are depicted on the flow chart in Fig-ure I. These components were: referral, initial home visit,team evaluation. parent informing, individual program-ming, treatment delivery, re-assessment, and exit.

Entry

A child could be referred to the Early Intervention Proj-ect from any source ranging from a physician to a neighbor

ERVICEES

of the handicapped child. The greatest number of referralswere received from the public health nurses of the CountyHealth Department. I:: most instances, the child andhis family had been referred to the health department byhospital staff following the child's discharge from thehospital.

In some cases the child was referred by a family pediat-rician who had diagnosed a problem after the child wasdischarged from the hospital. Other sources of referral tothe project included hospital social workers, other proj-ects within the University of Michigan, parental self-referrals, referrals from parents of children already in theproject, local school districts, and physicianF. Thenumber of referrals from physicians increased as the proj-ect into its third year. While the exact reason forthis was not clear, perhaps it had taken about two years t.tfthe project's work to establish credibility within the medi-cal community through the feedback to physicians fromthe parents served by the project.

Initial Home Visit

When the project wits notified of a referral. an intakeworker (staff memher) was assigned on a rotation basis tofollow up the call. The assigned intake worker followed up

Referral to El

Initial HI. me Visit

V

Evaluation hy EIP Team

Parent informing

vt,

Chik doesnot cn er EIP

FIGURE 1FT:own-IA.1am- EIP SERvICE DriA irv PROCL

Child erne El P

Re-evaluation every sk months

Child reprofiled & new object'written every three months

reatment Delivery throughweekly home visits and group sessions

Chikl exitstrum EIP

Individual Programming:ehild profiled and three month

objectives v, ritten

7

1 1

the referral by calling the family to arrange a home visit inorder to have a more relaxed setting than meeting at aclinic. The initial home visit served several functionsFirst, it provided the parents with a description of theInstitute and the Early Intervention Project. This initialdescription highlighted the project's emphasis on paren-tal involvement and communicated to the family that theirinvolvement was not only desired but was the only pre-requisite for service delivery to their handicapped child.

The second major function of the initial home visit wasto gather pertinent information about the handicappedChild and his family which could be shared with other staffmembers. Depending upon the preference of the intakeworker and the appropriateness to the situation, the intakeworker conducted either an informal or formal assessmentof the child. In the case of an informal assessment, the in-take worker observed the child and asked questions to findout general information about the child's development,such as feeding behaviors (Does he drink from a cup?),play behaviors (What is her favorite toy and how does sheplay with it?), and motor development (Can he sit?). In thecase of the more formal assessment, the intake workerbegan to complete the Early Intervention DevelopmentalProfile.

A third component of the initial home visit was to obtainbackg;cand information on the child. Not only did thisprovide the intake worker with medical information aboutthe ehild, but it a!so gave the worker some insight intowha .. the parents had been told about their child's hand-icapping condition and what they understood about thecondition in relationship to the child's development.

Finally, as with all programs, the initial visit was used tofill out other necessary forms.

Initial home visits lasted aproximately an hour to athour and a half. If parents expressed interest in the proj-ect, they were invited to come to the Institute to view agroup session, and arrangements were begun for a teamevaluation. The intake worker then wrote a report sum-marizing the initial home visit which was distributed to theEarly Intervention Project team.

Team Evaluation

The next step in the process was the formal, com-prehensive evaluations by the Early Intervention teamwhich were conducted at the Institute. The completedevaluation consisted of disciplinary assessmeet,, bypsychology, speech therapy, physical therapy, ar )c-cupational therapy and included a special educationassessment if the child was at a three- or four-year devel-opmental level. Additional evaluations available throughthe Institute were scheduled when indicated, especiallyaudiology, pediatrics, nutrition, and social work.

The team evaluation was structured so psychologicaltesting was done first in order to yield maximum cognitiveinformation. If the child had a motor handicap and re-quired special handling and/or positioning to maximize thechild's manipulation skills, the occupational therapist orphysical therapist was present to assist the psychologiston the item presentations. During this part of the evalua-tion, the speech therapist observed the child's languagethrough a two-way mirror and recorded the verbalizationsmade and the reCeptive language demonstrated by thechild.

After the psychologist had completed her portion, thespeech therapist worked with the child to complete the in-formation needed for her assessment. The motor person(OT or PT) had developed a general idea of the child'smotoric functioning level based on observations of theprevious assessments. The motor evaluation was com-pleted at the end of the session, since the handling whichoccurred during motor assessment, e.g., reflex testing.range of motion measurement, and spasticity evaluation.was often tiring and/or upsetting for the child.

This evaluation format was often modified to meet theneeds of the child, his family. or the evaluator. For exam-ple, the speech therapist usually made a visit to the child'shome as part of her evaluation process to gather informa-tion on the type, quality, and extent of the child's express-ive and receptive language. In some cases, it was neces-sary for the psychologist to see a child several times bothat the Institute and in the child's home to convince theparents that she had seen a good representation of thechild's abilities. This was especially true in cases in whichthe parent knew her child was showing a severe delay in allareas of development but was defensive about hearingthose perceptions from another person.

No matter where the evaluations took place or howmany sessions were needed to complete the evaluation,the parents were always present and involved in the proc-ess. Their skills in facilitating their child's responses wereutilized by having them administer some of the test itemsand position the child. When the parents were not directlyinvolved in the testing, they watched the evaluationthrough a one-way window. While watching the evalua-tion, the intake worker or another staff member explainedwhat the evaluator was doing. In all cases, the evaluationwas videotaped for later professional or student observa-tion and was shown to the parents at the parent informing,if either the father or mother had not been present at theevaluation. When the evaluations were completed, timewas scheduled by the intake worker for the results of theevaluation to be discussed with the parents.

Parent Informing

Parent informing was structured so that team evaluationinformation could be easily understood by the parents.One format had all team members present to report theirdisciplinary findings and recommendations to the parents.Some families preferred this format because all teammembers were available to answer questions about theirchild's development.

For other families the number of people present was toooverpowering. A second format was then used in which asmaller group met either at the Institute or in the family'shome. In these cases the intake worker and the psycholo-gist presented the evaluation results from the. team to theparents. The smaller group format provided good oppor-tunity for assisting the parents in beginning to understandtheir child's developmental progress in relation to hishandicapping condition. For some parents these meetingswere the first time they had heard the term -retardation-applied to their child. The smaller group allowed the par-ents to express their feelings. concerns, and questionsmore freely.

During parent informing, interdisciplinary and discipli-

12

nary recommendations were made. Interdisciplinary rec-ommendations related to general programming to meet thechild's and patents' needs; disciplinary recommendationswere more specific and related to each evaluator's disci-plinary expertise. The overall question dealt with at theparent informing was whether or not the Early Interven-tion Project would meet the needs of the child and familyand, if not, what other program would best meet thoseneeds. In most cases. the child's and family's needs couldbe met by the project or by the project's services sup-plemented by community resources. However, in somecases, the services available through the project werenot appropriate to meet the child's and/or family's needs.For ekample, some children required more intensiveprogramming than the project provided, i.e., a five-day-per-week program, or a program in which parentscould get the respite provided by a 3 to 5 day-per-weekprogram. In a few cases the child was not thought to behandicapped enough to need the Institute program with itsobvious title as a project for handicapped children. In allcases in which the project was not recommended, the in-take worker followed the case until an appropriate pro-,gram or preschool was found, and the process was begunto enroll the child in that program.

When admission to the project was recommended, acase coordinator was selected. She made home visits andmanaged the case for the time the child and family wereinvolved in the 7oject. The case coordinator was usuallyselected to match the primary needs of the child and thefamily. For instance, a child whose primary handicap wasa motor problem would have the occupational therapist orphysical therapist as case coordinator; a language hand-icapped child, the speech therapist; a child with behaviorproblems or emotional problems, the psychologist or spe-cial educator. If the parents required counseling, the psy-chologist served as case coordinator.

The case coordinator's role was sometimes shared bytwo of the team members. An example of this was a case inwhich the occupational therapist and psychologist were

.co-case coordinators for an anophthalmic child who re-quired developmental programming in all areas and whoseparents required counseling. On alternate weeks the oc-cupational therapist visited the home to work with theparents and the child; on the other weeks the psychologistworked with the parents on their relationship as it affectedthe care of the child. The assignment of a case coordinatorwas sometimes based on the geographic location of thefamily home for efficiency of service delivery.

Individual Programming

The next step in the process was to write a program ofobjectives to facilitate the child's development. The proj-ect developed and used the Early Intervention Develop-mental Profile as the basis for programming for each child.TheProfile was designed to present a picture of the child'sdevelopmental status between birth and 36 months in theareas of language, self-care, perceptual/fine motor, grossmotor, cognitive, and social/emotional development. Onthe basis of this information, objectives to facilitate thenext developmental milestone to emerge were written ineach of the above six areas.

The Prqfile was administered every three months by the

child's case coordinator during a home visit. Short-termobjectives for the next three-month period were written onthe basis of the Prqfile results with input from each teammember and the child's parents. The case coordinatorsought advice from other team members in the formulationof objectives when she needed additional specific discipli-nary expertise. The parents were consulted to determinewhich objectives were important to them. For example,while the team members may have felt it was importantto begin toilet-training the child, the parents may have feltthat it was more important to concentrate solely on self-feeding.

The project's program was set up so that every threemonths each child was re-profiled, evaluated on whetherhe had passed or failed each objective, and had new objec-tives written. If a child entered the program in the middleor towards the end of a 12-week program cycle, interimobjectives were written for him to accomplish in the timeremaining in the cycle.

TV.eatment Delivery

The short-term objectives were the basis of the child'sprogram for each three-month period. Activities whichfacilitated meeting the objectives were taught to the par-ents or other primary care givers (babysitters, grand-parents, etc.) during home visits and group sessions.

Each family was visited weekly or once every twoweeks by the case coordinator for approximately onehour. During the visit, the case coordinator modeled andtaught the parents specific disciplinary skills needed tocare for the child. Positioning, handling and relaxationtechniques, behavioral management, oral-motor facilita-tion, and structured play situations were taught as neces-sary to help facilitate the accomplishment of objectives inall programmed areas.

Home visits had several unique advantages. They pro-vided the home visitor with a sense of what the familycould realistically accomplish with their child when theeconomic or emotional limitations existing in the home orfamily were considered. Some home visits were madewhen the child's entire family was home. This allowed theworking parent and siblings to be invob ed in the child'scare. Also, depending upon what tini .? of day the visitswere made, they were used to teach feeding and dressingskills within the child's established routine.

Objectives were also worked on during weekly groupsessions. Most of the children attended a group sessiononce a week for two hours with either his parent(s) or pri-mary care giver. During the sessions each child and parentworked on a one-to-one basis while the staff members cir-culated to each :ehild, suggesting activities or modelingtreatment techniques for the parent.

The group sessions had the following advantages: theyallowed each member of the team to apply his disciplinaryskills to the child's needs which could then be supportedand carried out by the home visitor; they provided a set-ting in which parents could spontaneously share with eachother the experiences they had with their child or ideaswhich they found useful in working with their child; andthey provided an opportunity for parents to give emotionalsupport to each other through their child's successful aswell as difficult moments.

9

1 3

Reassessment

Each child was re-evaluated every three months on theProfile and new objectives were written. Every six monthseach child received the same full-scale, formal discipli-nary re-evaluations as when he entered the project.followed by another parent informing and recommen-dations for the kind of program needed by the child andhis family. This process of reassessment was continuedevery six months as long as the child was in the program.

1 4

10

Exit

Children were exited from the project when anotherprogram seemed to be more appropriate, when the familymoved out of the geographic area, and when the projectended. Exit reports were written. These reports brieflyoutlined the child's involvement in the project. the clinicaland developmental status of the child at exit, and the pro-gram to which the child was referred.

FOSTERING PARENT INVOLVEMENTa L. Bro

Philosophy of Involvement

From the beginning. the EIP staff attempted to involveits parents in a variety of ways and at a variety of skilllevels. The philosophy upholding this attempt was basi-cally threefold: (I) children in the attachment period needparents rather than teachers; (2) parents need skills in de-aling with their child's unique needs; and (3) childrenshould be handled as part of a total family system.

Many handicapped children move through the attach-ment-separation stages at delayed rates either becauseof their own handicaps or because of parental shelteringduring the early years. Recent research indicates thatthe most effective intervention occurs during the earlyyears (birth to three) in the natural environment with thenatural surrogate or parent. This is also a time whenmany parents are unwilling to separate from their childrenfor educational or therapeutic placements.

The intervention plan, therefore, not only included theparents but provided the parents with the opportunity andthe skills to become primary treatment givers. During thethree years of project operation, the ELF staff involvedparents in all aspects of planning, evaluation, and pro-gramming for their child, depending on parental knowl-edge, skill, and desire to participate. All parents weretrained to handle and stimulate their child in ways individ-ualized to their child's strengths and weaknesses. Allparents received counsel and information regardingtheir child's handicapping condition and normal childdevelopment. All mothers and a number of fathers par-ticipated in the weekly group sessions and were involvedin treating their own child during the sessions. Many par-ents assisted during the psychological, speech, and devel-opmental evaluations. Some took part in writing theirchild's objectives every three months.

Most parents are genuinely concerned for the welfare oftheir children. They are with their dhild on a day-to-daybasis and best know his needs, handicaps, and dailyschedule. Probably the greatest need that parents expressis to feel competent in dealing with their child on a dailybasis. Parents of severely handicapped children are vul-nerable to heightened insecurities regarding the psy-chological and physical development of their child. Themother of a spastic cerebral palsied child may be con-cerned about the daily handling and physical positioningof her child. The father of an autistic child may be con-cerned about his role in the daily care and discipline of hischild. Parents of a Down's syndrome child may be eager toenhance their child's growth in all areas of development.

Professionals dealing with parents are challenged to en-hance the parents' knowledge and skills in order to pro-mote feelings of successful parent-child interactions andcompetencies on the part of the parents. It is the parent,not the therapist, who cares for, stimulates, and interactswith the child on a twenty-four-hour a day basis and whomust have the skills necessary to do so successfully.

Like the normal child, the handicapped child is part ofa total family unit. The EIP staff operated under the

rationale that intervention which attempts to separate achild from his natural environment is apt to be unsuccess-ful. Intervention which attempts to consider the total fam-ily constellation, its interactional patterns, its uniquestyle, and its problem areas, is more likely to be effective.Many families have other problems as intrusive as the onerepresented by their child's handicap and must have helpin dealing with these before they can begin to handle theirchild's handicap as a major priority. Such problems as roleexpectancies, financial or marriage crises, and extendedfamily illnesses all tend to cloud a family's immediatepriorities. On the other hand, some families need help inplacing their handicapped child's needs into perspectivewith the needs of the total family unit. Siblings, spouse,and parental self-fulfillment are all needs which have to beconsidered if the handicapped child's needs are to be ac-cepted as a legitimate part of the whole.

Project parents demonstrated their abilities to handleand stimulate their children in a number of unique andcreative ways. One father built a special highchair for hisspastic daughtei ; another cared for his child when he washome from work in the evenings. Some mothers sharedtheir problems and mutually solved them. The most obvi-ous area of et training, however, was seen in rela-tion to the corn. Pity where parents became advocatesfor themselves ano :ir children regarding such issues aseducation, respite carL, nd financial help. Because ofMichigan's mandatory education act, handicapped chil-dren have a right to educational services between the agesof birth and twenty-five. EIP parents were involved in anumber of committees (including their own child's Educa-tion Planning and Placement Committee) through whichthey sought services for their children. As a result, manychildren received _;ervices that would not otherwise havebeen provided, such as bus service, transportation reim-bursement, financial assistance for attendance at normalnursery schools, and direct or consultation services fromancillary professionals (speech, occupational and physicaltherapists and other special resource consultants). Pa-rents also assisted one another in finding appropriateplacements and services for their children. One motherwas particularly helpful in contacting new mothers ofDown's syndrome children and in supporting and coun-seling them with regard to available services.

The Ell] staff encouraged parents to participate inadditional activities related to the project. Several tookpart in group discussions, and others gave lecture presen-tations during conferences or workshops. A few wrotearticles for lay or professional periodicals.

Strategy and Rationale for Involvement

The strategies for involving parents were structured tomeet each individual parent's needs, level of skill, educa-tion, and time available for involvement. Families wereassigned a case coordinator who was responsible for mak-ing home visits, contacting other appropriate resources

and agencies, and monitoring the child's and family's pro-gress. As the project continued, the staff saw a need forinvolving other staff members in home visit consultationsin their areas of disciplinary expertise. in psychologicalcounseling and support. or in contacts with other agenciessuch as school districts and medical centers. Co-casecoordinators were appointed and eased some of the pres-sures created when one staff member carried a particu-larly involved family. i.e.. a family with severe health ordynamic problems. This alleviated the risk of strong at-tachment and dependence on a single staff member.

Another strategy for involving parents was direct train-ing in handling, stimulating, and interacting techniques.The stafT felt that the more knowledgeable a parent be-came abotit his child's handicap and the more skills he ac-quired in dealing with that handicap. the more he wouldincrease his involvement in the daily care-and stimulationof his child. For most parents this was a valid assumption,although a few tended to intellectualize and were often un-able to interact with their child on an emotional level.

In addition to knowledge. parents need skills. The groupsessions and home visits involved parents in play activi-ties with their child which met specific developmentalobjectives. Initially, staff members modeled various activ-ities which were appropriate to the child's level andabilities; later parents modeled and verbalized for oneanother. Normal children and other handicapped childrenserved as developmental models for each other and forparents at various levels of skill development in six areas:cognition, language, social/emotional, gross motor.perceptual/fine motor, and self-care. Parents were en-couraged to work with other children to gain knowledge

,)ther handicapping conditions and to gain competency.ylapting activities to different skill levels.

.roughout the home visits and group sessions, em-phasis was placed on fostering mothering skills. The staffemphasized "mother- and attempted to de-emphasize"teacher.- The rationale for this strategy was based onrecent attachment theory and on realistic expectations.Parents spend twenty-four hours a day with their child.and it often becomes difficult for them to separate roles.The staff encouraged the parents to incorporate all thechild's developmental objectives into his normal dailyroutine and play periods. Most therapeutic activities wereeasily worked into the home schedule. For instance, rangeof motion exercises were done during bath time and dia-pering. oral motor activities during feeding, and correctpositioning of the motorically impaired child throughoutthe day.

Attitudes

Because the successful rearing of a handicapped child isdetermined in part by parental attitudes, any programdealing with families should attempt to identify and dealwith a variety of attitudes ranging from rejection and angerto martyrdom. Parents who have worked through a hier-archy of emotions can aid other parents in expressing theirown feelings of anger, frustration, fear, and helplessness.All professionals working with families of the handi-capped. from obstetricians to teachers, should he awareof the variety of feelings and ambivalent emotions eachparent has toward his own child, particularly those cen-

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tered around the child's handicapping condition. Parentscome in many varieties. They do not all have the samereactions or the same needs, but they all have to workthrough their own feelings at their own rate.

The Eli:. parents expressed their needs to hear whatthey were ready to hear. Several mothers were happy tohave had some time with their infants as "normal- babiesbefore learning that they were "handicapped.- Anothermother said she wished she had had more time before shewas informed that her daughter had Down's syndrome.Other parents said that they knew something was wrong,but nobody would tell them. Most parents agreed that theyexpected honesty, but only to the extent that they couldhandle it. One mother suggested asking the new parent,-How much do you want to know about your child's con-dition?-

These suggestions from parent's are appropriate notonly during the postpartum and infancy period butthroughout the child's life. Professionals in a variety ofmedical, educational, and support fields have contact withand should be aware of the needs of parents throughout ahandicapped child's life-span. The parent ()fa school-agedchild will need a sensitive professional to deal with ongo-ing educational programming. The parent of a prepubertychikl will need help in dealing with sexual issues from aperson who will be sensitive to that particular parent'slevel of acceptance. When the child reaches adolescenceor adulthood, the parent again needs sensitive professional help with regard to community placement and re-lated issues.

The question of labels was brought up by several par-ents. One parent noted that the label -retarded- had hadso many negative connotations that she wasn't ready toaccept it. Other mothers on hearing labels such as Down'ssyndrome. cerebral palsy. etc., applied to their child, bor-rowed hooks from the library and became voraciousreaders, often of obsolete materials. A few mothers neverleft the stage of intellectuali7ing the problem. They ac-cepted the child's handicap on a rational level hut were toovulnerable to cope with it emotionally. One child waslabeled as having -a progressive metabolic syndrome,-hut very little other advice or counsel was given the par-ents. After several months of aqjusting to the child's diag-nosis and after reaching the acceptance stage. they weretold that the medical test', did not confirm the syndrome.The child had, however, by this time hecome severely de-layed. The mother expressed her frustration in having todeal with a handicap of unknown nature; she actually pre-ferred the label, even with all its connotations.

Many EIP parents expressed difficulty in dealing withtheir other children. Many siblings became jealous be-cause of the time each parent had to spend with the hand-icapped child's medical problems, physical handling,feeding, physical therapy. etc With the help of FIP staffmembers, sonie parents began to use the siblings as mem-bers athe "team.- Siblings, for the most part, respondedvery favorably to such reliance upon them. Few parents,however, were able to deal with the attitudes of their nor-mal children toward the handicapping condition. Suchfailure may have been due in part to the desire to sheltersiblings from the hurt parents felt when they themselveswere initially informed: it may also have been due to theuncertainty as to hear to tell them. In reply to questions ofhow siblings might be informed, the El P staff suggested

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that parents be honest with siblings[ions at -the appropriate level of uwere advised to provide the siblirthem in verbalizing and explainintfriends (retarded. -cerebral palsthe parent is free from connotation ;weapon for siblings and the childfriends.

One of the most successful waywas through the use of the Early ,inewol Pr ()file. Parents assisted intering some of the items on the Prihowever. the Po,file was seen asvelopment and helped to temper pi

r

ques- the six developmental areas covered by the Profile. Withrents professional guidance, the parents were helped to viewhelp the child's strengths and weaknesses in various areas andtheir to work toward the next goal. Parents were trained to

en by analyze a task and to hreak it down into its componentnsive parts and required levels of skill. When they saw the com-from plexity of a task, many parents became satisfied, and even

excited, when their child achieved a small step toward arents larger behavior milestone.

Working with parents as members of the treatment teamwas not only challenging, hut rewarding. Without excep-

lant. hon. parents proved deserving of the respect given them.1 de- and responded well to efforts to involve them as importantns in members of the planning and treatment team.

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SUPPORTIVE SERVICESCarol M. Donovan

EDITOR'S NOTE: it eon he anticipated that children lun,ing a wide range of complex problems, as did ElP childr n, willneed many supportive services. The project's setting (a university affiliated facility which emphasized interdisciplitutrytraining of numy disciplines) gave the project access to a wide variety of supportive services. Relationships with non-university community agencies and programs. such as health departments, school systews, advocacy groups, and parentassociations-, opened other possibilities for services. A third source of supportive services resulted from the initiative andingenuity of OP staff members, underlining the fact that program personnel for very young and multiply luindicappedchildren must assume many roles and responsibilities ivhich are usually outside the responsibilities Qf school personnel.EIP staff members provided a model of such services.

As schools develop and implement programs for hand-icapped infants and young children, they must be preparedto provide supportive services, either directly or indi-rectly.

Because of the major objective of supporting theparents as the major treatment providers for their handi-capped child, it was necessary to focus as much on theparents' needs as on the children's in the providing of sup-portive services.

The handicapped child who is identified very early typi-cally has a wide variety of needs due to the complexity orseverity of the handicap. Infants identified soon after birthmay be children with (I) the obvious stigmata of geneticsyndromes which have a variety of defects associated withthem, such as Down's syndrome, (2) obvious congenitalmalformations, such as myelomeningocele, or (3) a sus-picious birth history and postnatal course with signs whichindicate severe brain damage. These children are usuallymultiply handicapped and may present a variety of prob-lems such as cardio-respiratory defects, musculo-skeletaldeformities, hearing and vision deficits, seizures, and/orfailure to thrive" problems: Elence, both child and fam-ily may require supportive services to cope with a varietyof needs.

Supportive Services for Children

The majority of the children served by the Early Inter-vention Project could accurately be described as multiplyhandicapped. Some children had disabilities secondary totheir major handicap, e.g., strabismus in a Down's syn-drome child, mild conductive hearing loss in a cerebralpalsied child, and legal blindness in another Down's syn-drome child. Some of these secondary conditions wereobvious when the child entered the project; others wereidentified later. The experience of the EIP showed thatpediatric, audiological, ophthalrnologicv." dental, and nut-ritional services were required as assz. .,ted health prob-lems of the children were identified. Assistance from thesedisciplines was obtainable through the Institute and theUniversity of Michigan.

Audiology

All EIP children were routinely screened by the au-diological services at the Institute. Referral for thoroughevaluation was immediate for the child with a primarydiagnosis such as post-meningitis brain damage, un-

explained language delay, or a history of chronic ear infec-tions. In other cases, the staff carefully monitored thechild's response to sound and then initiateil a referral if thechild's responses seemed to be questionable.

Since it was extreE.ly difficult to judge accurately thedegree of hearing loss in children who were as young or asmultiply handicapped as those the project covered, thestaff worked with the parents to help them become moreaccurate observers of their child's sensory functions. Theparents' accurate input plus staff evaluations thus pro-vided the clinicians doing the audiological examinationswith more data on which to base their clinical judgment. Inone case, hearing loss was discovered in an infant asyoung as one month who was served by the project forother referring conditions. Other less dramatic cases alsoshowed hearing losses at early ages.

Ophthalmology

Ophthalmological examinations were scheduled in thesame way as audiological examinations, i.e., children whohad obvious strabismus, nystagmus, or had been labeledby pediatricians as cortically blind were immediately re-ferred. Others were carefully observed for evidence ofvinual problems. It is important to monitor the rapidchanges of any young,_ developing child, and those withspecial problems require even more diligence. For -ex-ample, although one Down's syndrome child had hadophthalmological services almost from birth, it was notuntil near the end of her fourth year that legal blindnesswas diagnosed. A significant increase in her visual atten-tiveness was noted after she started to wear glasses.

Nutrition

Another component of the Institute which the projectstaff found invaluable was nutrition consultation services.The E1P benefited from a number of nutrition interns whowere on year-long placements at ISM R RD. These internscollected nutritional data on the children, includingmonthly height and weight records, and were availableduring group sessions to answer general dietary questionsfor the parents. Three-day food recalls were collected foreach child, and feedback was given to parents on the con-tent of the child's diet with advice on how to increase orcut hack on caloric intake and still continue to providesound nutritional balance.

A number of the children had such severe nutritionalproblems that they took precedence over anything else.

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1 8

The nutritionist worked with each child's parents, the In-stitute pediatricians, and the child's own pediatrician toalter the child's diet. One infant who was referred to theproject at age seven months was being fed only with anaso-gastric tube due to his poor sucking ability. Hismother wanted to feed him in a more normal way. With thepediatrician's permission and with close monitoring of thechiZtl's weight by the home visitor, public health nurse,and nutritionist, the tube was removed. The nutritionist'ssuggestion of putting the baby on Jello milk and feedinghim on all solids was useful in view of his difficulty in suck-ing.

Two other children i:ad severe dietary problems, athree-year-old cerebral palsied child who weighed onlyten pounds. eight ounces, and a two-year-old cerebralpalsied child who had been hospitalized frequently forgastrointestinal- problems. Referral to an Institutepediatrician who specialized in problems of childhoodallergies resulted in both children being placed on a lamb-based tbrrnula and Benadryl. Close teamwork of par-ents, nutritionist, pediatrician, and Elf' staff resultedin weight gains for both children

The nutritionists were also available for consultationwith communiiy personnel who Ind contact with children,suo,h as private pediatricians, public health nurses.teachers, and day care staff.

With the help of the nutritionists. the EIP staff gainedenough knowledge to advise parents on ways of startingchildren on table foods, balanced diets, and nutritionalsnacks. They also pined an ..Increased awareness of whendirect nutritional counseling to parents should be recom-mended,

Dentistry

Project parents had access to the Institute's dentalhygienist and dentisl. These dental personnel often cameto group sessions to chat informally with parents. In manychildren with developmental disabilities, tooth eruption isOften slowed down, and the teeth do not always appear innormal sequence. This kind of information helped parentsunderstand why, for example, at age eighteen monthstheir child had only two teeth. The dental hygienist in-structed parents in proper care of their child's gums andteeth. This was of particular concern to the parents ofchildrcn who were on seizure medication which affectedthe child's gums, causing overgrowth and a hazard to ahealthy mouth. The hygienist also worked directly withthe older preschool children and taught them how to brushcorrectly. The dentist advised EIP staff and parents whenthe child should start seeing a dentist for on-going dentalcare. The parents were given lists of pedodontists in theirarea as well as the opportunity to attend the Institute den-tal clinic.

Uitric.v

One of the pediatricians at the Institute was regularlyavailable to El P staff and parents during the group ses-sions to answer questions on a variety of things that wereof immediate concern. She also supplied orders for physi-cal therapy treatment when children entered the project.She was able to document and confirm when the staff andparents suspected a case of possible breakthrough seizure

15

activity and a case of lung congestion. Children under thecare of a private pediatrician were referred to that physi-cian to check on the medication or receive acute caretreatment. When this was not the most practical solution,the Institute pediatrician prescribed or gave the physicaltherapist specific treatment orders, such as teaching post-ural drainage to the parents.-

The Institute pediatrician also worked in the PediatricRehabilitation Clinic at University Hospital. Project chil-dren such as the myelomeningocele and amputee childrenwere seen there with the Institute pediatrician serving asliaison. In this way both the clinic and the project had ac-curate information on each child's condition. The pedia-trician directly advised parents as to the need for high-topshoes, Thomas heels, and other appliances when the phys-ical therapist suggested moving to such support. This wasa more practical solution than waiting for an appointmentat the Pediatric Rehabilitation Clinic.

The EIP staff encouraged its parents to locate a privatepediatrician who could provide on-going medical care totheir child. The project staff and Institute pediatricianscompiled a list of local pediatricians who were available toaccept new referrals, in addition to local pediatricians, theInstitute pediatrician also made referrals to orthopedists,cardiologists, neurologists, psychiatrists, and generalpractitioners.

Psychological Co Aultation

A direct service to children that the El P staff psychol-ogist and other Institute personnel provided waspsychiatric-psychological consultation and treatment.They consulted with other EIP staff and parents onmethods for enhancing on-going programming based onthe children's psychological needs. More specifically,when two preschoolers who had initially been referred tothe project because of language delay were judged to haveoverlying emotional problems, the EIP psychologist am'another psychologist provided on-going play therapy ses-sions on a twice weekly or weekly basis. The parents werealso offered alternative services through community men-tal health clinics or private practitioners.

Indirect Support

In addition to the direct services described above, indi-rect services were available which benefited the childrenby providing E1P staff with consultation. For example, anE1P staff member could request the help of her own discip-linary associates at the institute. A specific child, an areaof disability, or a constellation of behaviors might be pre-sented to the disciplinary group for suggestions of man-agement or general problem-solving. Other Institute fac-ulty and staff were often asked to provide consultation tothe El P staff member as they related to specific children,

Community Support Servi

A variety of school programs, both public and private,were the major community resources which benefited El Pchildren. The project staff decided that some childrenwould benefit more from a full-time school placement ineither a structured special education program or a normalnursery school or kindergarten than they would from theEIP program.

Several full-time programs were identified. WashtenawIntermediate School District provided programs for train-able and severely mentally impaired children. Localschool districts provided speech and hearing consultantsto normal nursery schools. The Rackharn School of East-ern Michigan University's Special Education Departmentprovided an intensive neurodevelopmental program forcerebral palsied children, High Scope Foundation inYpsilanti conducted a -First Chance- project whichintegrated handicapped children into its cognitively-oriented preschool program. The ElP staff assisted theparents m referring the child to an appropriate program.

A list of possible normal nursery school or day careplacements which would take handicapped children wascompiled as a result of a surVey designed and carried outby the El P staff. This survey consisted of three parts:( I) data on school size, location, tuition, and staffing pat-tern: (2) evaluation of equipment. programming, andstaff-child interaction; and (3) interview with the directoron the center's willingness to accept handicapped chil-dren. The compiled list provided specific informationwhich could be used as a basis for referring parents to de--sirable. normal placements.

Some of the children were exited froin -the El P whenthey had been successfully integrated into a new program."with the new school and local school districts supplement-ing the program with appropriate support services. Inother cases, the children attended normal nursery school,,or another special program. and took part in El P programs -with EIP staff members providing consultation to theother centers. Consultation to other agencies focused onhelping each center mesh the needs of the El P handicap-ped child with the agency's capabilities. Strong emphasiswas placed on getting eachagency to involve parents moreeffectively by setting up more efficient communicationpatterns between parents and agency. The centers fornormal children were urged to set performance expecta-tions in keeping with the child's ability to function in astructured group situation.

It sometimes happened that what appeared to be an ap-propriate setting did not prove to be so after a trial period.In these cases, children were discontinued in the new set-ting and returned to the El P. In some cases the reason forinappropriate placement may have been the deterioratingcondition of the child's medical status.

Since many of the community programs operated on aschool year calendar and the El P was operating all year.some children were accepted during the summer monthsonly. This was done after careful consideration and dis-cussion with the parents and personnel of the other center.A specific reason for entry into the EIP for the summeronly was required, such as preparing a child to go into aregular kindergarten, allowing for ongoing diagnosis overa period of time, or providing a period of specializedtreatment.

Supportive Services for Parents

When one first thinks about the term 'early interven-tion,- what instantly comes to mind is immediate inter-vention for the child. Professionals from medicine, alliedhealth, and education stand ready to assist the child.However, the child is never alone in his need for help. The

16

child is an int gral part of his family structure. Familymembers themselves may actually have a higher require-ment for "early intervention- than the child in terms oftheir needs as individuals or -s parents of a handicappedchild.

Many parents were referred to the project by hospitalsocial workers or public health nurses. In son-re cases,these professionals had heen able to deal with parentalconcerns and questions about the meaning of variousdiagnostic labels used in medical, developmental, or edu-cational findings. In other cases, they had served only as aconduit to facilitate a referral from a diagnosis to a serviceprogram. Part of the EIP case coordinator's responibilityduring the initial home visit was to ascertain the family'simmediate needs and their knowledge of community;re-sources. This information was extremely valuable in'try-ing to build rapport with parents of newly identified hand-icapped children, because El P staff served as a resourcelink from the start. Parents were often relieved to hearabout the variety of services that might be available totheir family and child. Families were routinely told aboutthe provisions of the Michigan Mandatory Special Educa-tion Act for alternative programs. If families required re-lief from financial burdens, they were °Uteri 'referred toCrippled Children's Services and were told of the variousSocial Services programs.

Transportation was not provided by the UP and was onarea of real need for some hmilies. Volunteer organiza-tions were contacted for help with transportation. Parentswere also referred to the local Red Cross. to Soca Ser-vices, and to church groups. Volunteer drivers hroughtsome children and parents to group sessions on a regularbasis, Some parents started to contact these agencies ontheir own for help with transportation for clinic visits anddoctor's appointments. Sonic -chool systems providedhelp with transportation, especially if they had been un-able to implement their own mandatory special educa-tion requirements by the target deadline.

In addition to community re:vurces, the home visitorexplored with the parents what information they hadabout their child's diagnostic labc1. Sonic parents wishedto hear a full explanation of their condition; otherswished to have only specific questions answered. Thehome visitor could either supply the facts or direct theparents to persons or reading materials. Parents who hadchildren with genetic syndromes were referred back to thegenetic clinic at the University of Michigan Hospital foradditional counseling, The Institute's Training ResourcesCenter (library) was made available to parents who wishedto read further.

Other parents had concerns that dealt with more spe-cific problems regarding the care and management of theirchild. For example, finding the right nipple so their babycould suck better or helping to eliminate undesirable be-havior, e,g., tantrums, were specific ways in which theproject supported parents. As the parents developed trustin the project staff, they became more willing to expresstheir feelings. Sometimes sharing of feelings occurred onthe first visit, because the parents were ready to havesomeone listen. In other eases, the building of a trustingrelationship took longer. The home visitors learned tolook for subtle cues that parents were ready to discusstheir concerns. Many parents acknowledged the supportthat the project staff and other parents gave them. Be-

2 0

cause the home visitor functioned in a supportive as wellas therapeutic role, visits were also made to the hospitalwhen some of the children became acutely ill.

The primary home visitors learned to cope with crisissituadons by acquiring new skills which had not been in-cluded in their professional training. Evictions, lack ofheat or light, acute alcoholism, a mother's desire for anabortion, truant siblings, and other problems often took onfar more importance than the family's handicapped child.The staff was working with a dynarnic system in which thepriorities were constantly changing. High priorities ofgrave concern had to be dealt with before the mother couldfocus on her handicapped child's need for a stimulatingplay period. Due to the truly complex nature of some ofthe families and their needs, the project sought assistancefrom the Institute social work program. Social work stu-dents under the supervision of staff members wereassigned to families on an on-going basis. The social workprogram staff also served as consultants to the projectstaff on ways of dealing more effectively with families.

Families included not only parent(s) and child but alsosiblings and other extended family members. Ona numberof occasions, the E1P home visitor had concerns about achild's siblings and mane reterrals to appropriate commu-nity agencies. For example. a pregnant fifteen-year-oldsibling was referred to a teenage mothers' program and aneight-year-old brother to a "Big Brother program.

Some of the problems which the parents faced were soinhibiting to normal functioning that referrals were madeto mental health clinics and private therapists for help insolving marital and personal difficulties.

The ultimate goal of the home visitor was to get parentsto the point of feeling competent enough to work with theirchild within the context of their family system for the ben-efit of the entire family. This process involved teachingparents about normal child development and how to focuson their child at his current level of development. The par-ents were then helped to set appropriate expectations fortheir child's next logical goal and to determine ways inwhich they could help the child reach the goal. Parentseventually became more aggressive and active in lookingfor community resources and in becoming advocates fortheir child in medical, social, and educational systems.

The project staff members often accompanied parentsto hospital clinic visits, where the staff member could bothgive and get direct input from physicians as well asencourage parents to ask appropriate questions of thephysicians in order to understand medical terms usedto describe their child. En the educational system, parentswere encouraged to take active parts in program discus-sion and decisions during the Education Planning andPlacement Committee meetings held for their child. Par-ents were advised of the role of the advocacy project ofthe local Association for Retarded Citizens for assistingparents in securing appropriate services for their handi-capped child.

Many parents became active members in local andnational groups such us the Association for RetardedCitizens, where their roles as parents grew from beingadvocates for their individual child to being articulatespokesmen for all handicapped children-.

21

17

EVALUATIONSally J. Rogers

The Early Intervention Project attempted to evaluate itseffectiveness in positively affecting the children'sdevelopment and in parent training. The questions thatwere explored focused on: (a) descriptions and changes inthe children's developmental patterns and rate: (b) theparents' attitudes and parenting behaviors, and (c) in-teractions between (a) and (b). In order to answer thesequestions, the project collected data which would answerthe following specific questions:

For Children

What were the characteristics of the children referred tothe project?How stable were the children's test results?What was the general trend in developmental rate overtime?What were the correlations among changes in cognitive,social, motor, and language areas?Did developmental level predetermine performance onindividualized objectives?How did the Early Interve,iiion Dcompare with standardized tests?What were the characteristics of children whosedevelopmental rates increased?

lopmental Profile

For Parents

What was the mothers' behavior when working withtheir children?What was the relationship between a mother's behaviorand her child's age?What were the attitudes of the parents about having ahandicapped child?Did mothers and fathers differ significantly in theirattitudes?Was there a relationship between attitude and behavior?

For Co ns Between Children's and Parents' var-iables

What parent behaviors and attitudes correlated with in-creases in their child's development rate?Was there a difference between the father's andmother's attitudes as correlated with their child's levelof development?

Methodology

Many of the current, well-known intervention programsfor the 0-3 age group include parent training, hoping toteach parents skills that will be carried over to the homeenvironment, thus increasing the quantity and/or qualityof stimulation that the child receives in all settings. Yet,data on such parental effects are absent from the litera-ture. While more and more programs are recognizing theneed to work with parents in order to adequately intervenein children's development, it has not been recognized that

18

2 2

such an approach places the parents in a treatment pro-gram.

The hypothesis that parent involvement is critical to op-timum child treatment needs to be evaluated, for althoughcommon sense dictates its rightness, the amount of timeand money involved requires that the hypothesis be criti-cally examined. If parent training proves to be an integralpart of optimum child treatment, then the effectiveness ofvarious approaches to parent training needs to be deter-mined so that optimal models of parent training can beidentified. Such effectiveness measures are not difficult toapply to parent training, for while changes in infant be-havior due to program effects are notoriously difficult toevaluate, changes in adult attitudes and behavior due toprogram effects are more suited to measurement andcomparison.

For these reasons, the evaluation of the Early Interven-tion Project's effectiveness focused on both parent train-ing and child development. Standardized data on all as-pects of child development were gathered at frequentintervals in order to allow the exploration of developmen-tal patterns over one to two-year periods. Data on parentalattitudes and behaviors were also gathered at set intervalsduring enrollment to provide some measure of the effectsof the Early Intervention Project's approach to parenttraining.

The children's treatment consisted of stimulation activi-ties in the areas of cognitive, motor, language, social, andself-care, presented via a playful medium. The stimulationactivities were carried out in several ways: (I) during aweekly two-hour session at the treatment center, themother provided the stimulation, supervised by the staff;(2) during a weekly hour and a half home visit, the homevisitor provided most of the stimulation; and (3) during thechild's daily home routine, both parents provided stimula-tion activities.

The parents' treatment consisted of ( I ) the acquisitionof general information about the nature of' handicappingconditions and their child's handicap in particular, viaformal presentations at parent meetings, formal and in-formal meeting .. with the staff, literature made available tothem, and discussions with other parents; (2) acquisitionof techniques for child treatment via instruction, demon-stration, and modeling by staff members and other par-ents; films and discussions at parent meetings; and variousbooks and pamphlets. Such training occurred at theweekly center-based sessions (attended primarily bymothers), weekly home visits, and monthly two-hour par-ent group meetings.

Meas ires Developn Used

A total of 69 children, 0-5 years old, with handicaps incognitive, language, motor, or social development werereferred to the project. Some 41 chiklren received treat-ment ranging from 3 months to 33 months in duration,while 25 other children (for reasons largely beyond theproject's control) received evaluation services only. Be-

cause the evaluation plan was put into effect during theproject's second year, the number of children for whomcomplete data was available is somewhat smaller. The ac-tual number of children involved in various comparisons isreported in each of the tables.

The children were referred to the program from manysources (parents, pediatricians, public health nurses) andrepresented a wide range of handicapping conditions. Allchildren who received treatment were from Washtenaw,Livingston, or Monroe counties and represented a mix-ture of ethnic and socio-economic groups.

Several sets of data were used to monitor the children'sprogress. The first set, the objectives, concerned the be-havioral objectives written for each child receiving treat-ment. These objectives, generally 12-18 in number, werewritten to cover a three-month period, and at the end ofthree months each objective was scored either pass (P) forsuccessful fulfillment of the objective, pass/fail (PF) fornear-completion or inconsistent success on the objective,and fail (F) for inability to perform the desired behavior.The total of P's. PF's, and F's attained during their treat-ment was summed for each child.

The second set of child data consisted of each child'sperformances on the Early Intervention DevelopmentalProfile (Rogers, D'Eugenio, Brown, Donovan, Lynch.1975). Each child receiving treatment during the last twoyears of the project was evaluated on the Profile everythree months, and a performance level for each of the sixProfile scales was computed according to the proceduredescribed by Rogers and D'Eugenio (19.77) for each-evalu-ation. This procedure provided useful data on the validityand reliability of the Profile as well as illustrating be-havioral attainments made by each child during a three-mont h period.

The third set of child data standardized dataconsisted of the results of formal psychological, speechand language, and occupational/physical therapy as-sessments. Each child was assessed formally every sixmonths, beginning with the diagnostic assessments pre-ceding the child's enrollment in the project, and endingwith an exit assessment when the child left the project.The formal assessments provided the child's developmen-tal age on standardized infant and preschool instruments.Tests used included the Bayley Scales of Infant Devel-opment, the Stanford-Binet Intelligence Scale. the LeiterInternational Performance Scale, the Vineland SocialMaturity Scale, and the Bzoch-League Receptive Ex-pressive Emergent Language Scale (REEL).

In order to examine the children's performances onstandardized tests, it was necessary to find a method ofrepresenting each child's paformance which could beapplied to all test scores, reflect chronological age dis-crepancies, and allow test performances across time to becompared. Although deviation I.Q. (or D.Q. in the case ofthe Bayley) scores would meet these criteria forpsychological assessments, assessment tools in languageand social areas did not provide'deviation scores. Also, forthose children functioning at less than a D.Q. of 50 on theBayley. deviation scores did not exist.

Therefore, because of the need to compare test results,it was decided to use an index of developmental rate, cal-culated by dividing developmental level by chronologicalage, to represent performances on all standardized tests.The raw scores were converted to the normal develop-

19

2 3

mental level most closely corresponding to the raw score,and that developmental level, divided by the child'schronological age in months, yielded the developmentalrate for each test. Six categories of developmental ratewere used:

Profound delay: a developmental rate less than V5 thenormal rate (normal rate: developmental age equal tochronological age).

Severe delay: between '/5 and V3 the normal rate.Moderate delay: V:i to V2 the normal rate.Mild delay: V2 to 2/3 the normal rate.Borderline delay: 2/3 to 4/5 the normal rate.Normal range: 4/5 to greater than the normal rate.

It is recognized that five of those categories have beendefined as levels of retardation by the American Associa-tion of Mental Deficiency (AAMD) (Grossman, 1973).Though classification into the AAMD categories would bedependent on deviation I.Q. scores and adaptive behaviormeasures, it was decided to use those categories toclassify the index of developmental rate. For the purposesof evaluating the project, these categories closely reflectthe degree of developmental delay demonstrated by thechildren according to AAMD standards.

Measures of Parent Behavior and Attitude Used

The parents of the 41 children receiving treatmentformed the population from which parent data weregathered. Because parental data were gathered in the sec-ond and third years of the project, the actual sample issmaller. Behavior samples were gathered on 24 mothers,and attitude forms were completed by 23 sets of parents.

Two instruments were used to examine parental be-haviors and attitudes. The Behavior Recording Form,adapted from Leary, Kaufman and Balsam (1969) for useon this project, was a behavioral time sample form whichallowed one to note the presence or absence of 10 parentalbehaviors occurring during interactions with the child.Twenty-four mothers were observed and scored duringtreatment sessions, firg during a session shortly after theirchild's entrance into-the project, and again six monthslater. Scoring occurred during twenty 10-second timesamples. When a parent and child were together in someactivity, scoring was begun, and ten saMples were takenwithout pause. A 15-30 minute period was allowed toelapse and the procedure was repeated. There were tenpossible behaviors which could be scored at the end ofeach ten-second observation: five positive behaviors(physical contact, verbal contact, facial contact, properhandling, and redirecting attention) and five negativebehaviors (negative physical contact, verbal contact,facial contact, handling techniques, and absence of anyinteraction). All behaviors occurring at the end of theten-second sample were scored.

The Parent Survey Form was developed by Hoffmanand Salant (1974) as a sell-report scale to measuremothers' attitudes about having a handicapped child andwas revised by this author to include both parents. The pa-rents of all children in the treatment program completed aParent Survey Form every six months, beginning at thetime of the child's enrollment in the program and ending athis exit.

Data Collection Procedures

All data on parents and children were collected bymembers of the treatment staff: a speech and languagepathologist, an occupational therapist, a physicaltherapist, a psychologist, and a special educator. The be-havioral objectives were scored by the rater who carriedout the home treatments for each child, the home visitor.TheProfile was administered and scored by the home vis-itor either during home treatment or center sessions. Eachof the raters was trained to administer and score all scalesof the Profile by the entire team until percent agreementamong team members reached .85 or better, after whicheach rater administered and scored the Profile indepen-dently. The standardized evaluations for each child werecarried out by members of the appropriate discipline: themotor evaluation was carried out by the occupationaltherapist or physical therapist, the language evaluation bythe speech and language pathologist, and the intellectualand social evaluations by the psychologist. These evalua-tions-were conducted individually in small evaluationrooms at the center, with the parent either observing orpresent in the room.

The Behavior Recording Form was initially adminis-tered by two raters, the psychologist and the specialeducator. Once inter-rater reliability reached 95 percentagreement, one rater, the psychologist, gathered all Be-havior Recording Form data. The Parent Survey Formwas filled out by the parents in their home. When thegathering of parent data was initially planned, each familyreceived a letter explaining that the Behavior RecordingForm was an observation of the kind of interactions pa-rents and children use, and that the Parent Survey Formwas a description of the feelings and thoughts.

Before the findings themselves are discussed, somecomments about the evaluation process seem in order.Data gathering in the early months of treatment was

relaxed, and the evaluation process itself was not fullyformulated until the second year of the project. Thesecircumstances could not be helped and data for childrenand their parents entering the project after December1974 were not affected.

Although the children were to be evaluated every sixmonths, this schedule was somewhat difficult to adhere tostrictly because of frequent illnesses, holidays, and limita-tions of the evaluator's time. Determining the averageindex change rates for the Children would have beensimplified if the time intervals were evenly spaced.

A third area of difficulty in data collection involved theparent data. Since the attitude forms were filled out by theparents at home, the collection of this data was hamperedby parental forgetfulness, resistance, and inadvertent lossof forms. Since the forms were to be mailed in rather thancollected, it was difficult to keep tight controls on theprogress of data collection. Behavior observation datawas likewise not as tightly controlled as it might havebeen. The sometimes rapid turnover of parents and theconstant flow of new parents made pre-treatment,andpost-tceatment observations difficult.

Findings Regarding the Children

What we re 1/ic cljarucicrisiie.v children referred tothe project?

As can be seen in Table I, approximately 50% of thechildren evaluated and treated, and 77% of the childrenwho were only evaluated, had cognitive delays in theprofound to miid range.As can be see-n inTables I and 2, theevaluated and treated group demonstrated slightly highercognitive indexes than the evaluated only group. The dif-ference in means for the two groups was the result ofchance rather than any selection process

TABLE I

CHILDREN REFERRED TO PROJECT BY AGEAT REFERRAL AND DEGREE OF COGNITIVE DELAY

Age at Referralin Months Profound Seve

Level of Cognitive DelayModerate Mild Borderline Normal Total

Childrenevaluated

_

& treated 0-121 0 7

13-24 4 4 2 1425-36 0 1

1 737-48 2 0 4 849-64 0 0 0 2 3

Total 10 6 7 12 39

Childrenevaluatedonly 0-12 1 (1

1 313-24 0 1 1 3 7

25-36 2 1- 2 0 737-48 049-64 1 0 0 0 4

Total 4 4 5 4 4

20

2 4

TABLE 2

INITIAL COGNITIVE INDEXES OF CHILDRENREFERRED TO PRoJECT

Group

Evaluated& treated 39

Evaluatedonly

Ran vP ofLioexes

.17-L06

.06-1.00

MeanStandardDeviation

.49 .19

In addition to cognitive delays, most children referredto the project exhibited profound to mild delays in otherareas as well. in general, the degree of cognitive delay wasclosely related to the degree of delay in other areas.Table 3 illustrates the relationship between the level ofcognitive delay and the level of delay in language, motor,and social functioning. Percentages were calculated forthe number of children for whom data was available ineach area.

Of children with profound to mild cognitive delays, allhad language delays in the profound to mild range, allbut one had social dela ys, and all but two had motor delaysin the profound to milS range. Of the 24 children with bor-derline or normal cognitive rate of development, 42% hadlanguage delays in the severe to mild range, 42% (some ofthese were emotionally disturbed children) had socialdelays in the moderate or mild range, and 17% had mildmotor delays.

Cluster analysis of the total population revealed two dis-tinct groups of children: a smaller group with mild hand-icaps and a larger group with severe handicaps. The sec-ond group also seemed to contain a larger proportion ofyounger-at-entry children, perhaps because the severityand multiplicity of their handicaps made them identifiableas handicapped earlier than the more mildly handicappedcluster.

The relationships between social, motor, and languagelevels of delay and cognitive delay illustrated in Table 3are fairly strong. Rank order correlations (Kendall's tau-Band_Goodman-Kruskal gamma) were performed for eachof the three comparisons shown in Table 3, Kendall's tauranged from .6492 on the cognitive and motor index levelcomparisons to .7234 on the social and cognitive levelcomparisons. For the total group of children seen by theproject, the mean level of delay on standardized tests in allfour areas, cognition, language, social, and motor, fell inthe moderate level. In Table 4 appear descriptions of thegroup's initial test results converged to indexes of de-velopmental rate.

As was demonstrated in Table 3, fairly strong relation-ships existed between the levels of delay in language, so-cial, and motor areas as compared to the level of delay inthe cognitive area. The i-elationships among the indexes ofdevelopmental rate and levels of delay in the children'sperformances on standardized tests of cognitive, social,motor, and language function were further explored.Table 5 demonstrates the Pearson product moment (rho)correlations among the language, social, cognitive, andmotor indexes for the total group of children seen by theproject. The correlations are both strong and highly sig-nificant, ranging from a low of rho .7242 (p < .0001) forthe relationship between language and social indexes to ahigh of rho .8529 (p< .0001) between social and cogni-tive indexes.

The high correlation of standardized cognitive, social,motor, and language assessments for this population mayindicate that a strong single factor influences developmentof many different skills. This factor is perhaps matura-tional, probably organismic. lt,may mean that there arenot in fact different areas of development in infancy, thatlanguage, motor, social, and cognitive skills are varioussigns along a single developmental path, which can beused to determine the distance a child has progressed.

TABLE 3

LANGUAGE, MOTOR, AND SOCIAL LEVELSCOMPARED TO COGNITIVE LEVELS

Cognitive LevelsProfound Severe oderate Mild orderline Normal=

v_

a zg-

-I

ProfoundSevereModerateMildBorderlineNormal

4 (7.8%)I (2.0%)

0000

3 (5.9%)1 (2.0%)1 (2.0%)

000

2 ( .9%)5 (9.8%)

8 (15.7%)000

1 (2.00

6 (11.8%)1 (2.0%)

00

00

-- I,(2.0%)4 (7.8%)

01 (2.0%)

0I (2.0%)2 (3.9%)2 (3.9%)I (2.0%)

6 (11, )

6, II

Z0

,T)

ProfoundSevereModerateMildBorderlineNormal

4 (6.72 (3.3%)

0000

5 (10.2%)0000

1 (1.7%)2 (3.3%)2 (3.3%)

0o0

4 (6.7%)7 (11.7%)3 (5.0%)

00

1 (1.7%)

2(3.3%)2(3.3%)3(5.0%)3(5.0%)

00

000

5 (8.3%)3 (5.0%)1 (1.7%)

000

1 (2.0%)3 (6,1%)3 (6. I%)

0

.0%)2 (3.3%)2 (3.3%)

8 (13.3%)

II:0 au0

ci]

ProfoundSevereModerateMildBorderlineNormll

1 (2.0%)I (2.0%)1 (2.0%)

00

3 (6.1%)1 (2,0%)

8 (16.3%)00

1 (2,(%)

1(2.0%)1(2.0%)3(6.1%)3(6,1%)1(2.0%)

(1 ,

000

3 (6.1%)1 (2.0%)

8 (16.3%)

21

TABLE 4

INITIAL DEVELOPMENTAL RATE ONSTANDARDIZED ASSESSMENTS

Area

LanguageSocialCognitiveMotor

Range

5751

6265

.02-i. i44-1.28.06-1,06.03-1.00

.42.53.58.47

StandardDeviation

.26

.30

.2719

TABLE 5

CORRELATIONS BETWEEN STANDARDIZED ASSESSMENTS

Area N Social N MotorLanguage 45Cognitive 49Motor 49

0001

.7242*"

.8529***

.8034*

55 .7509*"60 .7600***

51 .7938***

How stable. reliable, titici predictable tvere the children'stest results?

Changes in developmental rate might result from eitherunstable test results or improved performance. In normal0 to 2-year olds, for example, there is little relationshipamong developmental rates measured at various ages, andon that basis one might hypothesize that the same findingwould hold true fbr the children referred to the project. Iftrue, comparisons of periodic test scores in 0-2 year oldswould be meaningless. lf, in contrast, children with sub-normal developmental rates for some reason producedstable, reliable test results, then an increase in their de-velopmental rates would indicate a degree of success forthe project. Though there is some indication (Knoblochand Pasamanick, 1974) that standardized tests producestable results for handicapped infants, such results are stillconsidered preliminary (Brooks and Weinraub, 1976).

In order to explore this area, the indexes computed forpsychological test results were compared over time acrossperiodic administrations of the tests. Because there is agreat difference in the stability of IQ scores for normal 0 to2-year-old children as compared to IQ scores for normal 2to 5-year-old children across testings, the group of chil-dren was divided into two groups, those children 0-23months of age at initial psychological assessment, andthose 24-60 months at initial psychological assessment.The retests occurred at slightly different intervals for allchildren.' In order to control for different retest intervals,the children were also grouped according to time intervals

between tests. Four interval groupings were used: 3 to6-month retests, 7 to 9-month retests, 11 to 15-month re-tests, and 16 to 21-month retests. Although the groupswere small (N ranged from 4-12). the test-retest correla-tions were surprisingly strong and highly sigr,Icant, rang-ing from a low of rho .8573 (p < .05) to a high of rho.9953 (p< .01), as can be seen in Table 6. These longitudi-nal data resulting from six-month reassessments were ofgreat value and interest.

These results document the stability of standardizedtest results across relatively lengthy periods of time.While it has been thoroughly documented over the past 30years that infant tests administered in the first two yearsshow very little correlation with tests given in 6-12 monthintervals, there have been indications that abnormal in-fants show higher predictability of test scores over time(Brooks and Weinraub, 1976). In the present study, thecorrelations of test-retest data from psychological testsover a 6-18 month period were in the .80's and .90's forboth the 0-2 year old age group and the 2-5 year old agegroup, demonstrating very high predictability over time.

In addition to the high test-retest reliability, scores ontests of differing developmental areas-psychological,language. social, and motor-were strongly related.Bayley reports mean correlations of .23 to .75 betweenstandard scores on mental and motor scales on the BayleyScales of Infant Development (Bayley, 1969) for normal2-30 month old infants. For the children referred to theproject, the correlation between Bayley mental and motorindexes (developmental level over chronological age) fellat .76. Similar relationships existed for the Vineland socialindexes and REEL language indexes-all four measureswere highly and significantly correlated. What may beemerging in these results is a unitary factor involving de-velopmental patterns in the early years of life, reflected tosome degree on all four developmental tests. This may in-dicate that one general developmental test, theBayley, provides a valid measure of a child's developmen-tal patterns across all areas, thus decreasing the need forso many measures with this kind of population.

A similar finding was seen in the data gathered on theEarly Intervention Developmental Profile. The high andsignificant correlations between the Profile scales indexesand standardized tests indexes (Rogers and D'Eugenio,

'Two children in the trezitment group were eliminated from calcula-tions involving change in developmental rates over time. These children.one six months old and one three years old, both suffered profound braindamage during the treatment period. and their scores thus could not illus-trate typical developmental patterns of handicapped young children.

TABLE 6

TEST-RETEST COMPARISONS

Age atFirst TestAdministration -6 mon h

Intervals between Test and Retest

7-9 month 11 1 16- 1 month_

0-23 months .9161* 7 .9, 6 .9601" 4 .931124-60 months 5 .9953" 5 .9701** 6 .9746** too lew

lotal Trot, .9537*** _12 .9520"* 12 .9511"* 8573*

*p.05"p<.01

22

TABLE 7

CHANGE IN DEVELOPMENTAL RATE FORLANGUAGE, COGNITIVE, SOCIAL, AND MOTOR AREAS

AreaPositive Change

.04)Negative Change

.041 No Change TotalLanguage 11 (45.8%) 4 (16.7%) 9 (37.5%) 24Cognitive 6 / 1.4%) 10 (41.( 24Social 4 (18.2%) 6 (27.3%) 12 (54.5 22Motor 6 (30%) 9 (45%) 5 (25%) 20

1977) for this population indicate that for the project'spurposes, daLi from the Profile would have been sufficientfor monitoring children's developmental levels an-d pat-terns. Additional testing via standardized tests added nonew information. This finding strengthens the validity ofthe Profile as an infant assessment tool.

What was the general trend in developmental rate overtime?

Two methods were used to determine change in de-velopmental rate over time. First, changes over time weresummed and averaged over the number of assessments foreach child for each of the four areas separately. Thus, foreach child there was an -average rate change" for cogni-tive, language, motor and social areas. An average ratechange of less than ± .04 was considered no change,greater than or equal to +.04 a positive change, and lessthan or equal to .04 a negative change. Table 7 presentsthe results.

The second method of determining the general patternof change in developmental rate over time was simply togroup together children who made positive changes in atleast two of the four areas as positive, those who madenegative changes in at least two of the four areas as nega-tive, etc. Those who made both positive and negativechanges were grouped together under fluctuating.change." (Two children in the group received three scoresless than or equal to .04 and one greater than or equal to.04. Because of the predominantly negative scores, theywere also included in the negative group.)Table 8 presentsthe results.

TABLE 8

GENERAL PATTERN OF CHANGEIN DEVELOPMENTAL RATE

Number andpercentageof children

Positive Negative No FluctuatingChange Change Change Change Total

75c ) 4 (20%) 7 (3 20.

'For five children, average rate change scores were availablein only three of the four areas due to missing data.

These results show that (with the exception of two chil-dren, eliminated because they suffered profound braindamage during the treatment period) developmental ratedid not increase or decrease but was quite stable over timefor children treated by the project. As Lewis (1976)pointed out, this finding (a typical finding for various in-tervention programs for the type of population treated by

23

this project) is often mistakenly used to judge an interven-tion technique as unsuccessful. Lewis argued for asubject-treatment interaction approach, in which treat-ments would be examined for effects on certain groups ofchildren. In view of the developmental rate change group-ings described in tables 7 and 8, one sees that 6 childrenaveraged an increase in developmental rate of .04 or morefor a six-month period (or .08 in a year) on cognitive tests;11 children had a similar increase on language tests, 4 chil-dren on social tests, and 6 children on motor tests. Fourchildren demonstrated an increase as great or greater than.04 on two or more tests. Thus, at least some childrenmade significant developmental gains while enrolled in theprogram.

Because the above procedure did not completely con-trol for differing intervals between testings, a second ver-ifying procedure was used. The computation of the aver-age of developmental rate change was also carried out onthe developmental rate indexes obtained at each assess-ment. First, the rate index, developmental age/chronological age, obtained at each assessment was com-puted for each area for each child. The difference betweenrate indexes from one assessment to the next was found,summed over all administrations, and divided by themonths elapsed. This gave the average rate of change permonth for each child in each area. This number was thenmultiplied by six to represent the expected change in asix-month period (length of time between assessments)and the resulting number was the average developmentalrate change. Table 9 provides a description of the averagedevelopmental rate change. As can be seen, there was lit-tle overall change in the group, with only the area of lan-guage demonstrating an average positive change of .04 orbetter.

TABLE 9

AVERAGE DEVELOPMENTAL RATE CHANGEFOR A SIX-MONTH PERIOD

Area ax. _a- Std. Dev.Language 73 .165 .288 .044 .087Social 64 .154 .520 .020 .115Cognitive 74 .098 .240 .005 .069Motor 65 .240 .300 .013 .100_

What were the correlations among changes in cosocial, motor, and langaage areas?

In general, more children increased their developmentalrates in language skills than in any other. There was astrong relationship between cognitive and social in-creases, a moderate relationship between motor and Ian-

guage increases, and slight relationships between cogni-tive and language increases, and between cognitive andmotor increases. These relationships, though not as strongas the interrelationships among the test indexes in thesefour areas, again point to a single factor affecting de-velopmental patterns across the four areas, as discussedabove.

Since the correlations among scores on cognitive, lan-guage, social, and motor indexes were so high, it was ex-pected that the average developmental rate changes wouldalso be correlated. However, this was not the case. Asseen in Table 10, only the correlations bntween the cogni-tive and social index rate change scores were strong andsignificant, with those between language and motor scoresshowing a moderate, non-significant relationship, andthose between cognitive and language scores and cogni-tive and motor scores demonstrating a slight, non-significant relationship.

TABLE 10

CORRELATION AMONG CHANGES IN DEVELOPMENTAL RATE(correlation Coefficient rho)

N Language N Social N Motor

CognitiveLanguageSocial

15 .4044 15

15

.7652*

.2890

14

14

14

.4140

.5027

.2585

*p.= .001

Did developmental level predeier,nine performanceindividualized objectives?

The final area of child data studies was the children'sperformance on objectives. Although it had been assumedthat less retarded children would pass more objectives dueto their faster rate of development, the findings did notsupport this hypothesis.

The percentage of P's. PF's, and F's for each child wascomputed and compared to the child's cognitive index oninitial standardized testing. The correlation between thesum of percent Fs and percent PF's with cognitive indexeswas rho = .1830, (p > .05) indicating that there was noclear relationship between the two.

Thus success on objectives was unrelated to the child'sdevelopmental rate or developn- ,evel. Performanceon objectives was relatively ill- ndent of the child'scognitive level; that is, the more retarded children passedthe same proportion of objeciives as the less retardedchildren. No relationships wer_f discovered between per-ceritage of objectives passed an _ cognitive index or chron-ological age. This is quite an encouraging finding, for itindicates that even a profoundly retarded, multiply hand-icapped child can make visible, leasurable progress inmany areas in as short a time sp ;.. as three months, proTviding much positive feedback f ; the parents and staffworking with the child. Probably much of the credit for achild's success on objectives is due to staff members andparents who are knowledgeable enough about an individ-ual child's developmental rate that they can choose indi-vidualized objectives which have a high probability ofbeing passed.

How did the ElF Deve ',mental Profile compare rvithstandardized tests?

All children treated by the project after December 1974were assessed on the Early Intervention DeveloptnentalProfile as well as on standardized developmental tests. Itwas necessary to convert the raw Profile scores into in-dexes of developmental rate by dividing the developmen-tal level achieved on each scale by the child's chronologi-cal age at the time of testing. The resulting ratio for each ofthe six scales was used as an index of developmental ratefor the area measured by that scale. The children's meanindexes on the Profile, as seen in Table 1 I , closely resem-bled the population's mean indexes on standardized tests,as shown in Table 4.

TABLE 11

PROFILE SCORES AS INDEXES OF DEVELOPMENTAL RATE

Profile Scale N Mean index Range Std. Dev.Language 17 .46 .17-1.00 .13Social 17 .51 .09-1.07 .32Self care 17 .57 .22-1.00 .23Cognition 16 .53 .09-1.14Fine motor 16 .42 .09- .85 .26Gross motor 17 .33 .04- .67 ..19

This stability of children's performances on the Profileover time was also examined by correlating the develop-mental age attained by each child on each Profile scaleacross administrations. The correlations, as reported byRogers and D'Eugenio (1977) and shown in Table 12, wereextremely high and attest to the stability of this group ofchildren's scores over time.

TABLE 12

TEST-RETEST CORRELATION COEFFICIENTS FOR PROFILE

Profile ScaleThree Month Interval Six Month Interval

N gamma rho gamma rhoLanguage 15 .83* .93** .77*** .93Social 15 .98** 12 ,93s" .97Self care 13 .92*** .98** 12 .87*. .95**Cognitive 14 .95*** .97**

11 .90**Fine motor 15 .96*** .98** 12 .91*** .97**Gross motor 15 .92*** .97** 17 .96**

gamma Goodman Kruskal rank order correlationsrho = Pearson product moment correlations**p<.01

"*p.001

What were the characte if-children whose develop-mental rates increased?

It would be helpful if one could generalize about thecharacteristics of the children who made gains, so that onemight begin to specify certain groups of children. How-ever, the children were not similar in cognitive indexes,ages, or other child variables examined. Thus, a generaldescription of the group which improved was not possible.

However, there were some similarities among their par-ents. These are described below in the section on correla-tions between parent and child variables.

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TABLE 13

MOTHERS' BEHAVIOR SCORES

Behavior Scores+Physical contact+Verbal contact+Facial contact+Handling+Redirecting attention-Physical contact

Verbal contact-Facial contact-Handling-Absence of interaction

First Administration (N-24Mean Std. Dev. Min.

--cond Administration (N.17

19.0 8.875 6.12 0. 14.0 5.235 4.55O. 15.0 5.125 3.68 1.0 13,0 7.588 3.61O. 20.0 9.625 6.35 O. 19.0 12.471 5.010, 16.0 4.458 4.12 0. 11.0 4.647 3.84O. 3.0 .500 .83 O. 1.0 .118 .33O. O. O. O. 0. 0.O. 1.0 .042 .20 0. 2.0 .176 53O. 1.0 .083 .28 O. O. 0.O. 3.0 .208 .66 O. 0. 0.

17.0 5.958 4.99 19.0 4.647 4.84

Findings Regarding the Parents

What was the mo hers behavior ;vhen working with theirchildren?

The data gathered on the Behavior Recording Form in-cluding the ranges, means, and standard deviations of thetwo sets of scores are shown in Table 13. In general, themothers achieved highly positive scores with very fewnegative scores in any category except Ab (absence of in-teractions). There was little change in the group averageon the second set of observations, though what changesoccurred were in a positive direction.

On the Behavioral Record Form observations, themothers were in general quite positive, using absence ofbehavior-or withdrawal-rather than overtly negativebehavior-scowling, scolding, or physical punishment.

The changes in scores were examined to find whetherthe scores all tended to fluctuate in the same way orwhether there were any patterns of change over time. Theresulting percentages of behavior change in the expecteddirection ranged from a low of 20% to a high of 75% with amean of 52.06 and standard deviation of 16.96 (N = 17), apattern slightly in the positive direction.

From these percentages, three groupings were de-veloped: mothers who demonstrated the expected change(percents were greater than 60% or + 1/2 S.D.), motherswho demonstrated negative changes (whose percentswere less than 45%, -1/2 S.D.), and mothers who de-monstrated little or no change (whose percents fell bet-ween 45% and 60%). These three behavior groups werecompared to various aspects of the data on the children toexplore possible relationships and the findings are discus-sed below.

A second measure of the mothers' performance on theBehavioral Recording Form was also developed for com-parisons with the data on the children. It was hypoth-esized that the total number of positive scores wouldbe negatively related to high Ab scores. This assump-tion proved correct, with rho = -.7484 (p .0001) onthe first test administration, rho = -.8486 (p ----:.0001) onthe second test administration. The mothers were not neg-ative; they were either positive in their interactions orthey did not interact.

The mothers' mean number of positive scores was fairlystable as a group over time. However, this may be so be-cause those who were less positive initially became more

25

so, while the more positive mothers tended to become lessso over time. Correlations between the total number of ini-tial positive scores and behavior groups were moderatelyand significantly negatively correlated (Kendall's tau =

.6552, p = .003). Thus, the preliminary findings (Rogers,1976) received further support, i.e. that the initially mostpositive mothers tended to be less positive over time, to beperhaps less anxious and intense with their child, while theinitially least positive mothers became more positive overtime. Perhaps an averaging factor is at work here, in thatthe groups at each extreme (most positive and least posi-

- tive) became less extreme-moved more to the middle, astime progressed.

2 9

What was the relationship between a mother's behaviorand her child's age?

There was a moderate, significant correlation betweenchildren's ages and behavior groups (tau = .4690,P < -04).Over time, there was a moderate positive relationship be-tween a mother's behavior change and her child's age,which probably reflected the mother's increasing comfortand positive feelings for the handicapped child during thelength of enrollment in the project, due perhaps to supportfrom staff and other mothers as well as the opportunity towork out negative feelings and participate in her child'sgrowth.

There was also a moderate, highly significant negativerelationship (tau = -.5063, p-------_ .0001) between themother's initial positive score and the child's age at en-rollment in that the younger the child, the more positivethe mother's initial scores. A parallel finding was themoderate, highly significant relationship between absenceof behavior and the child's age. That is, with older chil-dren, the mothers more frequently withheld all interac-tions for 'periods of time-perhaps to ignore maladaptivebehaviors, perhaps to reduce the intensity of their mother-ing. Increased interest in other children and mothers mighthave also removed their attention from their own children.

What were the attitudes ( he parents about having ahandicapped child?

A modified version of the Parent Attitude Survey wasadministered at six-month intervals. As can be seen inTable 14, the means of the total scores showed littlechange over time. What change did occur was probably

due to incomplete forms on the first two administrations(seen in the low minimum scores).

TABLE 14

PARENT ATTITUDE SURVEY SCORESAT SIX-MONTH INTERVALS

Range _Mean S.D.Administration 1 42 38-157 132.79 20.03Administration 2 31 32-158 133.66 21.68

Administration 3 18 110-162 142.61 13.08Administration 4 9 102-158 141.89_ 17.21

The percentages were then used to sort the parents intothree groups: the group (N 9: showing the greatest in-crease 50%, +1/2 S.D.), the group (N =5) showing theleast increase (* 46%, 1/2 S.D.), and the group (N = 17)showing little difference in scores with a percentage in-crease between 46.82% and 50.00%.

In addition to these groupings which indicated rate ofchange across administrations, the initial total score wasalso used to explore the possible relationships betweeninitial general attitudes and other parent and child vari-ables. In order to see if the total score at first adnunistra-don Was related to patterns of attitude change over time,the initial total score was correlated with the attitudegroupings. However, the rank order correlation wasquite low (tau = .1841) and nonsignificant.

In March, 1976, an item-by-item analysis was con-ducted of the changes in scores on each of the Parent At-titude Survey's first 25 questions (Lynch, 1976). Pre-treatment and post-treatment scales were completed by 20parents, and a one-way analysis of variance was per-formed on the scores for the first 25 questions. Two of the25 questions, #14 and #11, demonstrated significantchange (p .05) in the parents' scores before and aftertreatment. One question reflected an increase in the par-ents' evaluation of the importance of parental stimulationof a handicapped child. The second reflected a decrease inthe mother's willingness to accept the responsibility forher child's difficult behaviors. However, the change in an-swers to these two questions was unrelated to either thechildren's cognitive indexmor the length of treatment.

Did mothers and fathers differ signi candy in theirattitudes?

It was felt that there might be differences betweenfathers' and mothers' attitude scores or changes in thosescores, since the mothers received far more treatment ex-periences and had much closer relationships with staff andwith other mothers than the fathers did. It was found thatat the time of enrollment in the project fathers and mothershad very similar total attitude scores, with moderate cor-relations and very high significance (tau = .6401, p.002). However, there the parallelism ended. The changein attitude scores between mother's and father's scoreswas unrelated (tau = .0861, p > .05).

Was there a relationship between attitude and behavior?

In general, the findings on the attitude questionnaire didnot parallel those on the behavior observations. Changeon the mothers' attitude questionnaires was not related to

26

their change in positive behaviors (tau .1325, p .05).It seems as if these two facets of parental adjustment tohaving a handicapped child are relatively independent.Furthermore, there was no relationship between the par-ents' initial scores on the attitude questionnaire and thechange in those scores over time (tau .1841, p .05).

These results confirmed one of the more interesting pre-liminary findings, the lack of relationships betweenchanges on the attitude scale and on the behavior observa-tions. As has been found before in studying results of at-titude questionnaires, what people report they feel is notnecessarily related to how they act, and that seems to bethe finding here.

Findings Regarding CorrelationsBetween Parent and Child Variables

What parent behaviors and attitudes correlated with in-creases in their child's developmental rate?

Several important relationships between parent at-titudes and behaviors and children's levels of progressemerged. An unexpected negative relationship occurredin several different comparisons concerning the children'simprovement in rate of language development. There wasa slight, negative, non-significant correlation (tau

.4360, p > .05) between the child's change in languageindex and the mother's positive change in behaviors.There was also a moderate, negative relationship ap-proaching significance (tau= .4771, p = .08) betweenpositive change in the mother's attitudes and increase inthe child's index of developmental rate for language.There was little relationship between the father's positivechange in attitudes and his child's increase in index of de-velopmental rate for language (tau = .1849, p > .05).

This is a complex interactional finding, for which two in-terpretations come to mind. It may reflect a child's de-creasing skills with which the parents are learning to cometo terms, both attitudinally as they learn to cope morepositively with the realistic handicaps the child demon-strates, and behaviorally, seen in the mother's increasedpositive interactions, in an effort to provide more stimula-tion. In this way of thinking, the mother's increased posi-tive behaviors may reflect her more positive attitudes, al-though the findings indicate that the two are not related forthe population of this project.

The second intemretation assumes the child is in factgaining language skills, as the children's data indicate. Innormal children, the child's development of languagemoves him out of the infant category, and his new de-mands for care and independence create new conflicts anddifficulties for the parents. It may be that as these hand-icapped children develop language, the parents can nolonger consider them infants and ignore the effects of thehandicap in future years. They are now faced with re-evaluating the child and the effects of his handicaps on theparent's life, which may create conflicts and anxietieswhich, at least temporarily, have a negative effect on theparent's attitudes and behaviors regarding the child.

However, an added dimension was uncovered whensuccess in performing on individualized objectives wascompared to various parental variables. The positivenessor negativeness of parental attitudes had no observable ef-fect on a child's successes. Hence. how the parents felt

about having a handicapped child did not seem related tohow well the child succeeded on his objectives. However,how mothers (fathers were not included in the behavioralobservations) acted towards their children had a strongand significant relationship (tau .4030. p < 002) with thechild's success on objectives. The mothers with the high-est initial positive scoresthose who, at the time of en-trance to the program had many positive verbal, facial, andphysical interactions with their childrenhad childrenwho passed the most objectives, regardless of their age orfunctioning level. These same mother's initial behaviorswere the best available predictors ot' child success onobjectivesan extremely important finding in view of thefact that using parents as treatment-givers is the exceptionrather than the rule in child treatment.

Other similarities occurred among parents of childrenwho showed developmental increases. For example, in-creases in the motor average index change scores weremoderately and significantly related (rho = .5594, p = .03)to parent's initial total attitude scores, but negatively(though nonsignificantly) related (rho = .0931, p > .05) tothe mother's behavior changes over time when comparedvia Pearson product moment correlations. These findings,unaccompanied by other similar relationships whichmight help make the meaning clearer, are not interpretableat this time.

No other parenthelumior variables were found to corre-late with any other changes in children's scores. Forexample. in the cognitive area, no relationship was foundbetween parent behavior change groups and children'scognitive indexes (tau = .0922, p > .05) or between posi-tive parent behavior and change in their child's rate ofcognitive development (tau = .0657. p > .05). Nor wasthere a relationship between initial positive parent be-haviors and their child's cognitive index (tau = .1409.p > ,05) or cognitive change groupings (tau = .0577.p > .05). Nor did parent behavior correlate significantlywith any other children's variables not mentioned above.

Likewise, no other parent attitude variables were foundto correlate significantly with any other changes in chil-dren's scores. For example, in the cognitive area no rela-tionship was found between parent attitude change groupsand change in their child's rate-of cognitive development(tau = .1543, p > .05 for fathers; tab = p > .05 formothers). Although there was a slight, nonsignificant rela-tionship between initial parent attitude scores and changesin their child's rate of cognitive development (rho = .4233,p > .05) using Pearson product moment correlations, anda similar correlation was found between initial parent at-titude scores and changes in their child's rate of motor de-velopment (rho .5594. p = .03), no pattern emerged asclearly as the one di.;cussed above for the language area.

Was there a difference holt ccii the jather's and themauler's attitudes as carrel(' v' 1 their child's de-velopment?

A child's variables appeared to correlate differentiallywith his mother's and father's attitude scores. There was amoderate relationship approaching significance (tau =.4685. p = .07) between fathers' attitude changes and thechild's initial cognitive level in that the more retarded thechild, the more negative the fathers' attitude changescores. No such relationship existed for the mothers,

whose attitudes appeared unrelated to the degree ofthe child's handicap (tau = .1544, p > .05). One won-ders whether the common view of fathers as moreachievement-oriented than mothers is strengthened bythis finding. As was stated before, there was a moderate,negative relationship between mothers' attitude scoresand the children's progress in rate of language develop-ment. Paternal attitude scores and changes in those scoresappeared to be unrelated to all aspects of the child's var-iables except the cognitive index, as stated above. Forparents' total initial attitude scores, there was a moderateand significant relationship with increased rate of child'smotor development (rho 5594, p .03) and a slightnonsignificant relationship to increased rate of child'scognitive development (rho = .4233, p > .05). Other childvar;ablesage and social progressshowed no relation-ship to parent attitude scores.

These are complex relationships, further complicatedby the vast differences in treatment received by mothersand fathers. Controlling for treatment differences wouldallow comparisons between mothers' and fathers' be-haviors toward children to be made, and more solid con-clusions to be drawn. The current data supply interestinghypotheses about the complex effects that the mothersand children have on each other. But due to the lack of be-havior measures and treatment experiences for thefathers, the relationships between child variables andfather variables produced no viable interpretations.

Summary

From the great amount of data generated from the EarlyIntervention Project, some interesting general findingsemerged. First was the general stability of the children'sdevelopmental rates over time. The extremely high, sig-nificant correlations of children's test scores over 6-monthto I 8-month time intervals contrasted markedly with nor-mal infant and pre-schooler test-retest correlations.

Second, although the group as a whole showed no sig-nificant positive developmental rate changes after treat-ment was initiated, 25% of the treated group demonstratedsignificant positive gains in motor rate and cognitive rateand better than 45% demonstrated significant gains in rateof language development, indicating that a considerablenumber of the group demonstrated increased develop-mental rates during treatment in the project.

A third unexpected finding was the lack of relationshipbetween cognitive level and rate of change. The most pro-foundly retarded children made as much relative progressas the non-retarded children, and the older children intreatment made gains similar to the younger children. It isencouraging that neither "lost time (late onset of treat-ment) nor extreme retardation necessarily limited positivegains made during treatment, seen also in the 76% successon objectives demonstrated by the most retarded and theleast retarded.

It appeared that parental behavior with the children hadsignificant effects on the child's successful performanceon individualized objectives, and on rate increases in lan-guage development as well. While parental attitudes andbehaviors tended to be quite stable over time, they variedin relation to child variables in interesting and complexways, influenced in part by the child's age, cognitive level,and changes in developmental patterns over time.

27

31

It is hoped that further information about the complexeffects of a handicapped child on his family, the effects ofthe parents' attitudes and behaviors on the child's de-velopment, and the effects of this particular treatment ap-proach will be gathered by others involved in a total familyapproach to treatment. Further studies need to control forthe ditTerential amounts of treatment received by fathersand mothers, and to document fathers' behaviors withtheir children, both initially and over time. Another vari-able needing further exploration is the long-term effect ofintervention on children's development, parent-child in-teractions. and parental attitudes.

As Lewis (1976) has pointed out, it will be by thoroughdocumentation of child-treatment interactional effectsthat we will begin to know which infant treatment ap-proaches yield optimum results when applied to certaingroups of children and their families. This report marks aninitial attempt at such documentation.

References

Bayley, N. Bayley scales of infant developm N Yo k:Psychological Corporation, 1969,

Brooks, J. and Weinraub. M. A history of infant intelligencetesting. In Lewis. M_ (Ed.)Origins ofintelligence. New York:Plenum Press, 1976.

Grossman. H. ( Ed.)Manurd on terminology and classijicathm inmental retardation. [Washington, D.C.]: American Associa-tion on Mental Deficiency. 1973.

78

Hoffman, H. & Salant, C. Parent att .vForni M.Suffolk, Long Island: Suffolk Rehabilitation Center for. thePhysically Handicapped, 1974.

Knobloch. H. & Pasamanick, 13. (Ed.) Gesell and Amatruda'developmental diagnosis. New York: Harper and Row, 1974.

Leary, K., Kaufman, K., & Balsam, P. Procedures for observa-tion of teachers and children. l'sychology Department, Stair..University of New York at Stoney Brook, 1969 (mimeog-raphed).

Lewis, M. What do we mean when we say "infant intelligencescores? A socio-political question. In M. Lewis, (Ed.). Ori-gins of intelligence. New York: Plenum Press. 1976.

Lynch, E. Measuring parental involvement in an ventionproject. Paper presented at the meeting of the InternationalCouncil for Exceptional Children, Chicago. Illinois, April 7,1976.

Rogers, S. J. Prelitninary look at effectiveness o fan early inter-vention program. Paper presented at the meeting of the Michi-gan Chapter Council for Exceptional Children, Grand Rapids.Michigan, March 4, 1976.

Rogers, S. & D'Eugenio, D. Assessment and application (Vol. 1)of Schafer, D. S. & Moersch. M. S. (Eds.), Developmentalprogramming Pr infants and young children. Ann Arbor:University of Michigan Press, 1977.

Rogers, S., D'Eugenio, D., Brown, S_ Donovan. C., & Lynch.E. Early intervention developmental profile. Ann Arbor.Michigan: University of Michigan. 1975.

STAFF DEVELOPMENT ACTIVITIESDiatu, B. D'Et

The j,rojects st.itl development activities provided op-portunities for staff members to increase the skills neededto carry oul their responsibilities. Activities for assessingand meeting staff needs were as follows:

Each staff member completed a needs assessment formwhich was used to analyze individual and eroup needs fortramme. A sample of staff responses to the needs assess-ment appears below.

Individual NeedsLanguage developmentGeneral infant developmentPiaget's theory of cognitive developmentPsycholovy evaluation of quadriplegic cerebral palsiedchildrenCounseling parentsWorking with low socioecomEncotiraging parents to work with other parents

Group NeedsInterdisciplinary assessment of multiply handicappekchildren

Training of stalT to administer the Early In -ventionDevelomncntal Profilesystems consultation, including entry. readiness totchange. implementation of change. and follow-upCoordination of agency services

enng Nee Is

in order to iteet the needs identified. released time wasallowed for staff members to attend conWences. work-shops. and courses. A limit to the number of days or hours

29

for aff development was not set. Attendance at confer-ences, workshops. or courses depended upon whether ornot the staff memher's responsibilities could be ade-quately covered.

Inservice [raining included group sessions on teambuilding, systems intervention, medical aspects of mentalretardation. and administration of the Early InterventionDevdopmenial profile and the I3ayley Scales of InfantDevelopment.

During the project period, October 1973 to June 1976..staff members spent over 1000 hours attending meetingsand training sessions on infant programs, parent involve-ment, identification and screening of children, evaluation,dissemination, proposal writing, project administration,treatment techniques. and con ,:itation. Distribution ofhours spent in these activities were: conferences-550hours, workshops-249 hours, courses-48 hours, andinservice training-220 hours. Project staff spent ap-proximately one day per month on staff developmentactivities.

Evoluation of Maning Oppormnifies

The effectiveness of each training opportunity wasevaluated hy the staff member in a report to the project.

In reporting these training opportunities. staffmembersevaluated how well their expectations were met: ratingsnoted [Nit 22% were -exceptional," 35rX were -good,-3 I% were -fair." and 12% were "poor.-

Through informal inserviee training, staff membersshared with others portions of their disciplinary skills sothey could assist parents in all areas of development dur-ine home visits and be able to administer the entire Profile.

DISSEMINATION AND TRAININGD. Sue Sclu

Dissemination activities began five months after thestart of the project. These early se.zsions were held in re-sponse to numerous inquiries, primarily from publicschool personnel who were attempting to comply withMichigan's Mandatory Special Education Act, which re-quired school systems to provide services for handicap-ped children from birth. The project's design was continu-ously tested, modified, and strengthened by presenting itsfindings to and incorporating reedback from those whowould ultimately implement programs for infants andyoung children in Michigan schools.

Training Design

Most of the project's trainees were school personnel in-volved in establishing or expanding programs for youngchildren. Therapists (occupational, physical, and speech),teachers, and psychologists were the core trainees. Ad-ministrators, nurses, social workers, community agencypersonnel, parents, students, and service group represen-tatives (e.g., Association for Retarded Citizens) were alsowell represented. During the three-year life of the project.more than 750 individuals participated in project trainingsessions.

Project staff were the primary trainers. Project parents.however, participated on panels, prepared didactic mate-rial based on their experiences, and assisted when theirchildren were used for demonstrations. In addition, Insti-tute staff were asked to participate on several occasions.particularly those whose disciplines differed from those ofthe project staff (e.g,. social work, nutrition, pediatrics.etc.).

Project training activities were publicized primarilythrough direct mail. Every intermediate school districtspecial education director in Michigan was informed of alltraining sessions. Announcements of activities were alsosent to appropriate professional, community, and parentnewsletters. The 1nstitute's State and Community Serv-ices Division's newsletter also announced planned events.

Dissemination and training activities were designed forboth individual and team participation. Training for indi-viduals continued throughout all three project years, butteam training began only in the third project year after themodel had been fully developed. Team training was en-couraged for those agencies which were interested in rep-licating the project model. but the goal of every sessionwas to stimulate program development based on all or partof the project model.

Sessions for Individun

These sessions were designed to increase the pa ici-pant's awareness and knowledge of the project's approachto early intervention. The major strategies used were: ob-servation, conferences, seminars and short courses, simu-lation exercises. and presentations.

30

Group sess;ons could be observed by visitors throughone-way gtass or via remote-view. All visitors received athorough orientation to the project and to its goals and ob-jectives. Some individuals, particularly students, wereable to try out newly-acquired techniques during the proj-ect's group sessions; others participated in the weeklyhome visits. In addition, many individuals viewed video-tapes prepared by the project, observed disciplinary andteam evaluations, and studied the project's record-keep-ing system. The project accommodated approximately500 visitors over a three-year period.

Coulerences

A national conference entitled "Early Intervention forHandicapped Infants and Young Children," was held incooperation with the Institute in October 1974, and at-tracted 340 participants.

The project also collaborated with other FirstChance" projects in Michigan in a conference to presentproject models to personnel of the Michigan Public SchoolSystem in September 1975.

Seminars and .SIurt Courses

The popular Seminar in Early Intervention metweekly for four semesters, reached 44 University stu-dents, and used the project as its clinical base.

A week-long course, "Early Intervention for Hand-icapped Children," was held in June 1975 and was re-peated in June 1976. It attracted 50 professionals(therapists, teachers, psycholoeists, etc.) who were in-terested in starting or expanding early intervention pro-grams.

Denumvtrat ion of Techniques

The project prepared didactic materials and demon-strated project techniques in twelve sessions in a varietyof settings entitled "Methods in Early Intervention." Themajor areas covered were infant assessment and pro-gramming, family (parent) involvement, and team func-tioning. The most successful training approach was theuse of simulation exercises which encouraged group par-ticipation, stimulated deeper thinking, and provided moreuseful feedback for project modification.

Presentations

During the st_ -ond and third years of the project, staffmembers made presentations at workshops and confer-ences on general descriptions of the model or on specificfacets of project philosophy or operations. Presentationswere made at regional and national meetings of the Ameri-can Association on Mental Deficiency. Council on Excep-tional Children, American Occupational Therapy Associ-ation, American Physical Therapy Association, andAssociation of University Affiliated Facilities. More than1000 persons attended. Additional presentations werescheduled for the American Occupational Therapy

Association and the Amen an Physical Therapy Associa-tion during 1976-77.

Sessions for Teams

Workshops

Twenty-seven teams participated in live workshopsheld during the project's third year, which were designedto move the participants through the awareness andknowledge stages of learning so that skill developmentcould be emphasized. Skill training focused primarily onuse of the Early Intervention Developmental Profile as anassessment and programming tool. In addition to skilltraining, these sessions were designed to foster team de-velopment which became the 'key' to making the proj-ect model work. Each participating team was required tohave at least three members: one motor person (occupa-tional or physical therapist), one speech therapist, and oneperson trained in cognitive development (special educa-tion teacher or psychologist).

Special Training Relationships

In addition to conducting these team workshops, proj-ect staff worked closely with specific teams interested ineither long- or short-term training relationships. Specifictraining sessions were developed after each team had be7come thoroughly familiar with the project componentsand approach. A needs assessment was then conductedand a training program developed. Three teams elected toestablish long-term training relationships; two of theseteams replicated the project model (see the chapter belowentitled Replication and Continuation), and the thirdplanned to complete the replication process during the fol-lowing year.

Seven other special training sessions were designed forother agencies based on their needs. Table I summarizesthe project's training sessions over a three-year period.

Evaluation and Impact

After each training session, participants were asked toanswer a series of questions concerning the activity's con-tent and format. The purpose of these evaluations was todetermine whether the participants' needs had been metand to help the project determine future training needs andstrategies. By far, the need for methods of evaluating andhelping the very young handicapped child under age three(36 'mOnths) consistently outweighed all others. Otheroft-expressed needs included:

1. how the school can get the family involved;2. how to organize service delivery to handicapped in-

fants in the home;3. how to meet the specialized needs of the very young

multiply handicapped child;4. how to develop and implement screening programs

fOr identifying children needing intervention; and5. how to overcome the scarcity of written materials re-

lated to the needs of young handicapped children andtheir families.

By the third year, the project's interdisciplinary teamapproach had become the hallmark of the El P. and an ef-

31

35

fort was made to follow the progress of the twenty-seventeams who were trained by the E1P during that third year.The team approach was fostered from the start by requir-ing the workshop attendees to participate as a team, not asindividuals. The Early Intervention Developmental Pro-

file was used both as an evaluation and programming tooland as a facilitator for team functioning during the trainingprocess. The continued use of the Profile after trainingwas a measure of maintenance of the team approach, amajor project impact criterion, as well as a measure ofadoption of this project's design in its own right.

Fifteen teams were sent a follow-up questionnaire eightweeks after training. The project ended before eight weekshad elapsed for the remaining teams. Of the fourteen re-sponses, 100% stated that they would be using the Profileduring the 1976-77 school year. They reported that theyhad used the Profile to evaluate over one hundred childrenand had developed sixty-seven individualized programsfrom the Profile data.

In addition to introducing the Profile during the or-ganized team training sessions, the project began dis-tributing it at cost in February 1976. The acceptance of theProfile was widespread throughout the United States. Or-ders from other countries had begun to come in by the endof the project. It is impossible to measure the project's im-pact at this level except to cite the high number of copiesdistributed. The high interest in the Profile and accom-panying materials prompted the project to enlarge thescope of this publication and submit it for commercial pub-lication.

Materials Produced

The EIP accumulated a large collection of slides whichdepicted all aspects of project activities. A comprehensiveslide-tape description of project activities was producedduring the third year. (Due to the confidential nature ofslides and videotapes of project children, these materialscan be used only for Institute training purposes and fortraining outside the Institute when accompanied by anInstitute staff member.)

Videotapes were made of several aspects of projectactivities, parts of which were used during disseminationactivities. The collection included longitudinal prog-ress of project children, group sessions, parent panels,team evaluations, disciplinary evaluations, and others.A videotape entitled It's Child's Play was producedduring the project's third year and depicts the parentcomponent of the project.

A project brochure, table display, and abstract wereused as publicity materials. A variety of bibliographiesand toy, equipment, and book lists were compiled andwere also used throughout the project as needed. Threesimulation training activities were developed and tested:two on family intervention and one on developing skill inwriting individualized objectives.

By far, the most popular materials were the Early Inter-vention Developmental Profile and DevelopmentalScreening of Handicapped Wants: A Manual. Over2100 copies of these books had been distributed by theend of the project and will continue to he available atcost until the final revision is published in 1977.

Conclusions

The success of the EIP's dissemination and trainm -tivities resulted directly from the fact that sharing theproject's activities began early, i.e. within the first sixmonths, and continued throughout the project's life. Thefeedback derived from all trainees was invaluable in defin-ing the needs of the major target groups. particularlyMichigan school districts. As the project responded tothese needs, its model components became more clearlydefined. A capable project statT molded the most unique

feature, interdisciplinary team functioning, into a salableproduct by demonstrating, writing about, and teachingothers the team process. Simultaneously, the project'steam process led to the development of the Prqfile andManual which fulfilled the trainees' greatest need, i.e., atool for evaluating and planning programs for handicappedinfants. The flexibility of the project's training approachhelped strengthen its model of service delivery. Early rec-ognition of the model's key features paved the way forpublications which the staff hopes will live beyond the lifeof the project.

TABLE 1

EARLY INTERVENTION PROJECTTRAINING SE

Date Content of Session

IONS

3/74- Methods in Early Intervention6/75 (12 monthly sessions)3/75 Identification and screening of handicapped

infants8/75 Inservice on cognitive, s ial/ motional,

and motor development8/75 Orientation to Ell) model9/75 Participation in EIP home visits; discussions

with disciplinary colleagues; observation ofElPgroup session; program implementation

10/75 Workshop: EIP family intervention model andsensitization experience to family developmentalstages

10/75 Orientation to E1P model10/75 Orientation to EIP model11/75 Visit to EIP group session and discussions con-

cerning implementation of EIP model at WISD12/75- Workshop: Team evaluation and programming2/76 for handicapped infants and young children

12/75 Visit to ElPgroup session and discussionsconcerning implementation of EIP model atLISD

12/75 inservice to discuss disciplinary roles.development, and parent involvement ininfant program and applications to W1SDprogram

/76 Evaluation procedurand young children

2/76 Programming procedures for handicappedinfants and young children

2/76 Team evaluation and progra ming for handi-capped infants

3/76 E1P program evaluation strategicsapplication to LISD program

5/76 Team evaluation and programming for haridicapped infants

for handicapped infants

5/76 Assessment based programming (seminar)5/76 Assessment based programming for handi-

capped infants5/76_ Parent involvement in early intervention

Agencies Participating Hours ParticipantsProfessionals from various agencies.particularly Michigan school districts

92 265

Bloomfield Hills School District 17

Upper Peninsula Preprimary Institute 11 50

Preprimary Institute, YpsilantiCass Intermediate School District (ISD) 16 6

V: ious sionals 42

Washtenaw ISD (High Point) 30

Lapeer ISDWashtenaw ISD 11

Beekman Center-Lansing, Bloomfield Hillsschools, Carrollton schools, Clinton ISD,

48 89

Garden City schools. Hillsdale !SD. KalumazorValley ISD,"Lenawee 1SD. Midland ISD,Multicap Program-Muskegon, Newaygo ISD.Ottawa ISD. Walnut Street School, andWayne-Westland schools

Livingston ISD

Washtena ISD I()

-htenaw ISD, Livingston !SD 3 13

Washtenaw ISD 15

East Upper Peninsula IS D 8

Li ngston ISD

Char-Ern 1SD. Alpine Center. Traversi_ 16 55Area ISD. Mecosta-Osceola 1SD, Mason !SD.Wexford-Missaukee ISD. Manistee ISD.C.O.O.R. !SD. C.O.P. ISDNisonger Center. Columbus. OhioEaster Seal Society; Pontiac Waterford Dev. 8 21

Center; and United Cerebral Palsy. DetroitState of Ohio. Div. of Special Education 3 20

Totals 245 769

3 6

REPLICATION AND CONTINUATIOND. Sue Selz

Replication

The Early Intervention Project (EIP) established tworeplication sites which developed programs based on theproject model. The sites were Washtenaw intermediateSchool District (WISD), located at 1819 South WagnerRoad, Ann Arbor, Michigan, and Livingston IntermediateSchool District (LISD), located at 1425 West Grand RiverAvenue, Howell, Michigan. Each district provided thenecessary staff and space needed to establish the programand met the following replication criteria:

I. Developmental programming based on the Early In-tervention Developmental Profile;

2. Team evaluation and programming with a minimumof three team members whose combined expertisecovered the areas of motor, language and cognitivedevelopment; and

3. Parent training using a home-based and/or center-based service delivery model.

These replication sites were a result of the project's con-tinuous contact with them regarding the eventual referralof EIP children to them at the termination of the project.Both centers chose to establish early intervention pro-grams based on the EIP model for children transferredfrom the project as well as for other handicapped infants intheir respective counties who were not already receivingservices. Each district carefully studied other programsthat were currently available before choosing the EIPmodel.

The first major step in the process of establishing a rep-lication site was to acquire administrative approval fromeach school district to establish a new program. Once ac-quired, an orientation program for selected professionals,parents, and other interested persons was held. The pur-pose of the orientation session was to introduce theagency staff members to the EIP model and to begin pre-liminary discussions regarding the model's application ineach facility.

Each school district selected a coordinator whose re-sponsibility was to assist the project's training coordinatorin assessing and carrying out appropriate training activi-ties. The goal was to establish a viable program at eachagency within six months from the orientation date.

A training program for each agency was developedwhich emphasized skill training, team development, andprogram design, and was carried out by the EIP projectstaff. Where possible, the training sessions were heldsimultaneously for both replication sites, but the majorityof the sessions were individualized according to eachagency's needs and stage of program development (seeTable 1).

These formal training sessions were supplemented withongoing consultation between EIP staff and individual dis-trict team members, particularly regarding childrenshared with the EIP. Typical activities were joint homevisits and collaboration on writing objectives. This com-bination of informal and formal contacts eventually pavedthe way for each district to feel competent to implement

TABLE 1

MAJOR TRAINING EVENTS

Content of SessionDate of Session

WISD USDOrientation to EIPVisit to El P group session; initialdiscussion of implementation concernsDiscussion of disciplinary roles, team 12/11/75development, and parentinvolvementDemonstration of evaluation procedures 1/9/76 1/9/76for handicapped infants and youngchildren (joint session)Explanation of programming procedures 2/6/76 2/6/76for handicapped infants and youngchildren (joint session)Explanation of early intervention pro-gram evaluation strategies

10/30/75 10/1 /7512/11/75 111/75

3/19/76

the early intervention program in its respective setting.Livingston ISD began its group sessions on March 12,1976, and Washtenaw ISD on March 26, 1976. Eachschool district received continuous consultation regardingprogram implementation throughout the 1975-76 schoolyear.

The implementation process was totally the responsibil-ity of the school district's coordinator and varied accord-ing to each district's policies, e.g., fiscal, administrative,etc. The project monitored the implementation processthrough continuous consultation with each school's coor-dinator but did not interfere with the internal affairs ofeither school district.

The data in Table 2 were supplied by each school districtat the request of the project and cover the period fromApril through June 1976. They cannot be directly com-pared since the two districts' policies were not identical,but they do suggest the extent of impact of the ELF modelin a relatively short period of time.

Parents routinely took part in evaluations and pro-gramming in both programs. Neither program had yet in-volved parents in dissemination or publicity activities, buteach planned to do so during the next school year.

Continuation

Both districts planned to suspend their programs overthe summer and resume them in the fall of 1976. Childrenin both programs were provided with summer objectivesfor the parents to carry out. Re-evaluations werescheduled for the beginning of the 1976-77 school year.Livingston ISD was developing a plan to measure childprogress which was to include progress achieved onthree-month objectives as well as evaluation withstandardized instrilments, such as the Bayley Scales of In-fant Development, every six months. Washtenaw ISD had

3 7

TABLE 2

IMPACT OF PROJECT ON REPLICATION SITES

Sources of Referral toReplication Programs

EIPPhysicianParentPublic Health NurseU-M (Pediatrics)Local School DistrictsChild and Family ServicesOther

Total number of referralsAge range

iv ngston5

Washtenaw2

1

31

6

34 14

9 months 6 months6 years_ to 5 years

Me' r andicapping ConditionsDown's SyndromeOther Genetic DisordersCerebral Palsy 5

Spina Bifida 5Emotional Impairment 8Vision Impaired 3 0Hearing Impaired 1 0Language Delay 6 0Seizure Disorder 2 0C.V.A. 0Hydrocephaly 0Etiology Unknown

Disciplinary AssessmentsPsychology 6Social Work 6 14Occupational Therapy 1 10Physical Therapy 4 11

Speech 12 10Vision and Hearing 3 0

PlacementsEIP Replication Program 26 4Internal ISD Program 7Other In-County Program 0 7Other Out-County Program 1 0Incomplete Placements 3

Services DeliveredChildren Assessed with Profile 34Individual Programs Developed

from Profile17 7

Home Visits Per Child:MinimumMaximum

Center Visits Per Child:Minimum 2Maximum 14 8

Other Visits (while child washospitalized, etc.)

Parent and Family InvolvementNo. Parents in Group Session 38 5No. Extended Family in

Group Sessions 4No. Parents Involved in

Home Visits 34+ 5+No. Parents Involved in

CounselingFormal Parent Group MeetingsInformal Parent Group

Meetings 14 0

not developed its evaluation plan at the end of the project.Each school district had begun to develop its publicity

campaign. Both had held orientation sessions for their re-spective ISD personnel and parents and had contactedtheir local school districts about their programs.Livingston ISD had prepared a flier and slide-tape presen-tation which had been seen by the community at large andseveral special interest groups. Both districts had accom-modated visitors to their programs and planned to in-crease this aspect during the 1976-77 school year.

Both districts expected to maintain their programs dur-ing the 1976-77 school year based on the EIP model. Bothdistrict teams were to include the following disciplines:physical therapy, occupational therapy, speech therapy,psychology, and special education. Livingston ISD'steam was also to include social work. The basic design ofeach program was to include a weekly center visit for eachchild coupled with regular home visits, 1-4 per month,based on need and staff availability. Parent involvementwas to remain a high priority in both programs.

Washtenaw ISD was to continue its 1976-77 program ascarried out in spring 1976 and was to accept all childrenwho were identified as severely mentally impaired, traina-bly mentally impaired, or multiply impaired who residedin Washtenaw County.

Livingston ISD planned to expand its 1976-77 programto include a two-day per week program specifically de-signed for learning disabled and emotionally impairedchildren. This program was to use the EIP's team/parenttraining approach and was to be adapted to fit the specialneeds of these children. Livingston ISD was to continue toaccept referrals for all children who had or were expectedto have a handicapping condition.

The relative success of these replication sites could notbe clearly measured with less than a complete school yearof experience. However, they did show that the replica-tion process used by the EIP was a viable one and shouldbe continued by the Institute's Outreach Project. The keyelements which stand out in the EIP's replication processare:

1. Adherence to replication criteria with flexible ac-ceptance of performance based on each site'sstrengths and constraints;

2. Replication site administrative support;3. Well-planned formal training activities based on

each site's specific needs;4. Active informal contacts between trainees and train-

ers regarding specific implementation problems; and5. Program evaluation strategies which allow for fast

and effective modification of training activities ateach site.

The two replication sites described were to provide thecontinuation and demonstration programs on which theEarly Intervention Outreach Project will be based. Fund-ing approval for this Outreach Project was received byISMRRD in June 1976, for the 1976-77 fiscal year.

3834

RECORD KEEPINGD. Sue Sel ler ul Martha S. Alo 1

Each developing program will he well advised to con-struct early in its operation a record keeping system whichreflects its need for accountability while providingenough data for decision-making and for communicationwith team members, with the agency in which the programis situated, with parents, with agencies which share re-sponsibilities for the children, and with the fundingagency. In addition to supplying necessary information forroutine reports. records also provide information which ishelpful and/or necessary for replication programs, valida-tion studies, and for research purposes both during andafter the life of the program.

No one record system can he transferred directly to anew setting without some modification. However, theproject's system was effective in its University setting andshould he adaptable to most other settings.

Children Records

Clinical records, which were used for purposes of ac-countability, statistical access, and specific training us-age, were kept for all project children and housed in theInstitute chart files. Limited access and confidentiality ofthe children's records were maintained by the Instituteaccording to appropriate legal definitions.

The project maintained a file on each child which con-tained information necessary for monitoring ongoingtreatment programs and collecting accountability data.The records in the project file were used only by El P statTmembers and selected students who were involved inchild treatment and included: referral information, rec-ord(s) of initial home visit observations, disciplinaryevaluation reports. long-term objectives. short-term(three-month) objectives, parent objectives, case log, in-formation about other agencies involved, pertinent medi-cal information for day-to-day activities, correspondence.completed Profile data, parent informing report(s), andfinal exit report.

A third file was kept in the form of a notebook whichcontained only non-confidential information and was usedas a communication mechanism front staff to staff, staff toparent, and parent to parent. This notebook containedeach child'3 current objectives to which staff and parentscould refer as necessary during the weekly group sessions.Space was provided for an anecdotal record by parentsand staff regarding observations made of the child's per-formance during the past week. Attendance records werealso in the notebook. The notebook was used as a trainingvehicle for parents to help them become more observant

of their child's abilities while working toward a betterunderstanding of their child's development over time. Thenotebook also served as a convenient place to record thenames of visitors to group sessions.

Project Reiords

Financial records were kept by the Institute accountingslice, and monthly statements were prepared for the

project director by the Institute.Records of all workshops. inservice training sessions,

and group consultations were maintained by the dissemi-nation coordinator.

Staff members maintained records of their own clinicalactivities, consultations, professional presentations, andprofessional development activities.

The agenda of weekly staff meetings was maintained ina file for future reference; minutes were not kept but nota-tions ofdecisions were recorded.

lnformal reports of evening parent meetings were pre-pared and contained the names of parents. visitors, staffmembers present, speakers or other program information,and plans for future meetings As the numbers of parentsinvolved in the project increased, these informal reportswere often distributed to those unable to attend. Theywere always filed with other project records and were usedin planning future meetings and in accountability reports.

Since the evaluation plan for the project included dataon children, parents, and staff members, the evaluationcoordinator either maintained her own records on appro-priate items or periodically collected the information fromother record sources within the project.

The records noted above made up the formal recordkeeping process of the project. Since it may be difficult todetermine at the beginning of a new program what will heneeded by those requesting reports, various informalmeans of record keeping were used by the FIP which maybe useful to others. For example, monthly calendar sheetswere mounted on the wall. These contained space inwhich staff members noted planned events, equipmentreservations, vacation days. and appropriate deadlines tobe met. The calendars were useful in compiling reports atlater dates. Individual appointment calendars were usefulsources ?or answering some unanticipated requests for in-formation. Maintenance of a file of original or duplicatecopies of bibliographies, handouts for dissemination activ-ities, report forms, und various program plans and reportscan save both time and money.

DISCIPLINARY ROLES

EDITOR'S NOTE: One objective of the Ell' was to demonstrate the appropriateness of using .cupational therapy.physical therapy, and speech and language pathology as the primary di.wiplines with the young, liandicapped populationoldie project. As a result, it was often incessary to plaCe undue emphasis on separate and specific disciplinaryfUnctions,and similarlyfOrpsychology aml special education. This disciplinary emphasis was requiredlOr dissemination activities inorder to exphthi (i/u/to denumstrate each disciplhie's role in consultations, workslups, inservice training sessions, andlectures.

Another instance of emphasis on specific. disciplines was in the initial development ofthe Profileand Manual. hulividu-als or pairs of staff members assumed mujor responsibility ji,r specific skill areas of the Profile. They were responsible jardetermining which items to include, for developing criteria for assessing the child's status on each item, and fOr makingsure that the other staff members thoroughly understood the meaning, the value, and the method ofassessing each iteni.

In reality, the day-to-day project activities stressed the team concept rather than indivUlual disciplines. By the end of thefirst rear of the project, all staffmembers were not only convinced of the value of the various disciplines, ther were all wellgrounded in niany skills of the other disciplines.

Otherjactors which influenced the team concept were that three of the Ell) stufftnembers also had degrees in a seconddiscipline, and all of-the stoff members had had previous experience in working in interdisciplinary settings.

For the benefit of persons who may not be familiar with the various disciplines, the role of each HP disciplinary suiljmember is outlined in this chapter. Since the project physical therapist also had a degree in child development and since itis usual to find child development specialists in programs Pr young children, the role of thiv discipline is included.

One aspect Qf the role of each discipline within the project is not mentioned in an V Of these descriptions. Staff membersattempted to acquaint other members of their profession, their discipline, with the specific responsibilities of that disci-pline within a project Jar handicapped young children. All staff members made fOrmal presentations to their own discipli-nary groups at conferences and workshops. The presentations emphasized the contributions of that specific discipline tothe success of an huerchsciplinary team.

ROLE OF THE OCCUPATIONAL THERAPISTDiat- , B. D'Eugenio

The role of the occupational therapist with the El P in-cluded the areas of evaluation, treatment, consultation.and team functioning.

Evaluation

In the area of evaluation, the occupational therapistconducted both specific clinical and developmental evalu-ations. Clinical evaluations included range of motionmeasurement, determination of muscle strength. evalua-tion of sensation, determination of muscle tone includingthe presence and extent of spasticity, evaluation ofpathologic patterns of motion and reflexes. and evaluationof oral-motor functioning as it related to feeding. Theseclinical assessments allowed for monitoring of muscularchanges in the child which indicated the need for changesin programming and treatment.

Developmental evaluations included finc motor. reflex,early gross motor, self-care, social-emotional, and per-ceptual motor development. Most of the assessments inthese areas were based on reference norms and recog-nized sequences of development rather than on

36

40

standardized tests, although such formal tests as theSouthern California Sensory integration Tests, the GesellDevelopmental Schedules, and the Bayley Scales of In-fant Development were used with some children. Obser-vations of the child's behavior and the interactions of fam-ily members were also made.

Treatment

Treatment included facilitation of general developmen-tal skills in the perceptual/fine motor, reflex and grossmotor, self-care, and social areas. Specific program plan-ning and treatment methods were implemented fordevelopment of these skills in specific motorically handi-capping conditions. Treatment techniques were used tonormalize the child's movements to allow for the emer-gence of the next level of developmental skills.

A major contribution of the occupational therapist wasto determine the appropriate position which would alloweach handicapped child to use his maximum ability tofunction. Such positioning techniques were shared withthe child's parents and with other staff members.

The occupational therapist focused on programs whichcould be carried out within the activities of the normaldaily routine of the child and family. The occupationaltherapist also provided suggestions and ideas .to parentsand other staff members on adaptations of toys and adap-tations in test item presentations necessary for the child'saccomplishment of developmental skills and performanceon tests. Also, the occupational therapist recommendedadaptations of equipment or the use of special equipmentas indicated.

Consultation

The occupational therapist provided consultation ontwo levels: the first was that of teaching appropriate andnecessary therapeutic skills to persons interacting with

Evalua

The Early Intervention Project physical therapistshared with the occupational therapist the responsibilityfor carrying out both initial and on-going gross and finemotor evaluations. These assessments were based on bothstandard clinical instruments, such as the Bayley Scales ofInfant Development, the Gesell Development Schedules,and the Hoskins and Squires, and on clinical observations.The physical therapist paid particular attention to generalmovement patterns, presence or absence of postural re-flexes, muscle tone and strength, range of joint motion,skeletal posture, gait analysis, and cardiac/respiratorystatus associated with both activity and resting breathingpatterns.

The physical therapist also evaluated general coordina-tion, balance, agility, and strength involved in the moreadvanced gross motor skills such as climbing, jumping,hopping, running, tricycle riding. and ball handling.

Responsibility for evaluation of perceptual and finemotor skills was shared by the disciplines of occupationaltherapy, psychology, special education, and physicaltherapy. The physical therapist used informal gross motorstrategies in observation of the child's body awareness,orientation in space, laterality, directionality, and motorplanning abilities. Simple toys and games, such as puz-zles, parquetry blocks, or ring toss were used to determineeye-hand coordination and visual-shape discrimination.

the child, such as parents and other staff members; thesecond level was that of consultant to other agencies re-lated to the child such as the school or medical commun-ity.

Team Functioning

By her training in general early child development aswell as in the more specific areas already described, theoccupational therapist brought with her an appreciationfor treating the whole child rather than dividing the child'streatment into disciplinary parts. With this appreciationcame the feeling of the necessity for working on an inter-disciplinary team with the respect for and sharing of know-ledge and skills by all team members.

ROLE OF THE PHYSICAL THERAPISTCar 1 Al. Dona

Treatment

The physical therapist was responsible for incorporat-ing specific physical therapy findings into the child'streatment program which was implemented by parentsand staff members.

A major role of the physical therapist was to instruct thespeech therapist, special educator, and psychologist in theprinciples of positioning to increase the child's functionand decrease undesired tone and abnormal movements,

thus allowing evaluation and/or treatment by these discip-lines to produce maximum results.

The physical therapist organized games and activities toincrease gross and fine motor skills of the preschool groupof children, always being aware of the need to adapt tospecific handicapping conditions.

Consultation and Parent Education

The physical therapist worked closely with variousmedical specialties and implemented specific therapeutictreatment orders. Individualized programs were taught toeach child's parents and monitored in both the home visitsand group sessions. Parents were taught relaxationtechniques, postural drainage, ways to position the childto facilitate head and trunk control, how to elicit appro-priate higher level reflexes, and ways to encourage higherlevel locomotor skills such as creeping and walking.

The individual child's motor program was based on theobjectives that were written in both the gross and finemotor areas. In addition, some parents were given ex-panded home programs in the motor areas which incorpo-rated information on positioning the child and moving himin and out of positions as well as specific exercises whenneeded. Because of the physical therapist's knowledge ofadaptations and appliances and of the practice of both or-thopedics and physical medicine, she was able to facilitatecooperative relationships between the family and thephysician.

Many of the EIP children had severe medical problemswhich required frequent hospitalization. The physicaltherapist's knowledge of hospital niutines allowed her toassist the family's adaptation to and understanding ofnecessary medical procedures.

During weekly group sessions and home visits, thephysical therapist monitored the child's motor status andphysical condition. She was able to detect emerging spas-ticity, seizure activity, respiratory problems and the needfor re-evaluation or medication.

37

4 1

ROLE OF THE SPEECH AND LANGUAGE PATHOLOGISTSara L. Brow

The speech and language pathologist filled a variety offunctions on the Early Intervention Project including di-rect therapy, consultation, programming, evaluation, andreferral.

Therapy

The great majority of the multiply impaired or develop-mentally delayed children enrolled in EIP exhibited lan-guage delay. The speech and language pathologist plannedand carried but language therapy for a number of the olderchildren (3 to 5 years). Specific therapy included oral andlanguage stimulation for both a dysarthric child and alanguage-withholding child, behavior modification for aretarded child, and Signed English vocabulary for a

. Down's syndrome child under two years of age with atracheostomy. Home language programs were written outin detail for several children under three.

Consultation

It was virtually impossible for the speech and languagepathologist to serve all 80 children directly. However, shedid serve as a consultant to other staff members and to par-ents in the areas of language reception and comprehen-sion, language development and acquisition, non-verbaland social communication, and oral-motor skills. Much ofher time was spent modeling and describing for parentshow to improve the language learning environment fortheir child.

Programming

As part of the programming team, the speech and lan-guage pathologist helped develop the total therapeutic andeducational program with regard to the language level andlearning style of each individual child. Because communi-cation is the basis for many areas of development, thespeech and language pathologist's input into the familyenvironment by monitoring daily stimulation was critical.

Evaluation -

The initial and final evaluations of each child were areaswhere the speech and language pathologist filled a uniquerole. The therapist evaluated the child's total communi-cation abilities, including non-verbal as well as verbalskills. Her input helped in the differential diagnosis of theretarded, deaf, psycho-social, and aphasic disordersbased on communication behaviors of each child. Chil-dren under the age of three were given the Receptive-Expressive Emergence of Language Scale every 6months. Language development rate and level were as-sessed for each child by comparing separate test results. Aphonological analysis of the child's spontaneous babblingwas done, and suggestions were made regarding expec-tancies and recommendations.

Some of the less severely involved children were givensubtests of the Illinois Test of Psycholinguistic Abilitiesand the Peabody Vocabulary Test. A language sample wastaken for the children exhibiting verbal language andanalysis made with regard to types of words and sentencestructures used, appropriateness of language, and otherparalinguistic features.

The evaluation of oral-motor skills became especiallyvaluable because a number of children served were cere-bral palsied, retarded, or brain damaged. Such childrenoften exhibit oral-motor or laryngeal dysfunctions whichmay be incorrectly diagnosed. In the case of apraxic anddysarthric children, appropriate evaluation is critical tothe child's proper educational placement.

Re erral

Finally, the speech and language pathologist had thetraining and expertise to seek out resources and referralsources when appropriate. The speech pathologist was theperson trained to recommend specific language, speech orcommunication therapy, or to carry out direct treatmentservices when deemed appropriate.

ROLE OF THE PSYCHOLOGISTSally J. Rogers

The psychologist with the Early Intervention Projecthad responsibilities in the areas of evaluation, treatment,consultation, and evaluation of research design and im-plementation.

Evaluation

The psychologist carried out a comprehensivepsychological evaluation for each child prior to enrollmentand every six months thereafter, until the child ceased toparticipate in the program , Standardized instrumentswere used to evaluate intellectual and adaptive behavior

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development. Because of the wide range of handicappingconditions demonstrated in the children referred fortreatment, the ability to use a wide range of instrumentswas necessary. Instruments used in assessing children re-ferred to the project included: Bayley Scales of Infant De-velopment, Stanford-Binet Intelligence Scale, WeschlerPreschool and Primary Scale of Intelligence, Merrill-Palmer Scale of Mental Tests, Leiter International Per-formance Scale, and Vineland Social Maturity Scale.

In addition to standardized assessments, many non-standard techniques were evolved in order to assess cog-nitive skills in the children whose severe multiplicity of

handicaps precluded the use of standardized techniques.Various adaptations of testing techniques were developedfor these multiply handicapped children. A presentation atthe American Association on Mental Deficiency confer-ence in June 1976 described the evaluation approachesdeveloped by the Early Intervention Project.

In light of the project's concern with the child as a partof the family unit as well as a complete entity within him-self,. the developmental assessment was only one part ofthe psychological assessment. Two other aspects wereconsidered equally important: the child's dynamic (emo-tional) functioning in relation to his family and importantothers and the family's dynamic characteristics, particu-larly as they pertained to the handicapped child. Thosetwo aspects provided a basis for staff interaction with thechild within the family system, viewing the family as acomplex network of interactions, all of which were af-fected in some way by the entrance of an intervenor intothe system. Information gained during the psychologicalevaluation provided an initial grasp of the problems,needs, and potential approaches for families needed by thehome visitor. Clinical training in early emotional de-velopment, family dynamics, and interviewing techniquesprovided the skills necessary for this aspect of thepsychological assessment,

Treatment

The second set of psychologist responsibilities involvedtreatment skills and, as in evaluation, a wide rangingknowledge of both theoretical and practical approachesbecause of the extreme diversity Of the handicappedchildren and their families. One major aspect of the treat-ment involved assisting other project staff to writeeducational/treatment objectives for each child, particu-larly in the cognitive, social, and self-care areas. Develop-ing objectives required: (a) a thorough knowledge of eachchild's developmental skills; (b) an ability to project eachchild's developmental progress over a three-monthperiod; (c) ability to translate evaluation data into rele-vant, clearcut objectives; and (d) a thorough knowledge of

normal developmental sequences in the cognitive, social,and self-care areas.

Traditional psychological treatment techniques wererequired for several children and families; approaches asdiverse as behavior modification.and traditional playtherapy were used successfully with other children whoneeded individual treatment. A knowledge of availablecommunity treatment programs was also necessary forthose children who required more intensive or specifictreatment than could be provided by the project. Severalfamilies received psychological intervention via indi-vidual counseling of one parent, conjoint counseling ses-sions, training in behavior modification techniques, andreferral for ongoing counseling or therapy.

Consultation

The project psychologist provided consultative servicesto many diverse groups: (a) other project staff membersregarding all aspects of psychological functioning of chil-dren and families; (b) agencies providing treatment forhandicapped young children regarding assessment -tech-niques and results, treatment needs, and managementissues; and (c) to the parent group by acting as their ad-visOr. Knowledge of group process and group dynamicsprovided important input to these consultations; theknowledge also contributed to the format of dissemina-tion activities.

Project Evaluation

The final area of responsibility of the project psycholo-gist concerned evaluation of the entire project, both interms of the-project's fulfillment of requirements andguidelines of the funding agency and of the project's effec-tiveness in meeting its major goals. An evaluation plan, orresearch design, was developed, implemented, and inter-preted. This required a basic knowledge off researchdesign, statistical procedures, evaluation tools andapproaches, and the ability to interpret and describeresearch results in narrative format.

ROLE OF THE SPECIAL EDUCATOREleanor W. Lynch

For the first year and a half of the EIP, the majority ofthe children were both chronologically and developmen-tally at the three- and four-year age levels; they partici-pated in a group identified as the preschool group. Duringthis period, the role of the special educator focused on di-rect involvement with individual children.

Evaluation

The special educator evaluated preschool children todetermine their preacademic skills and suggested educa-tional plans for developing school readiness. These werecarried out in group and home sessions of the project. If itbecame evident that the project was not the most appro-

priate program for a specific child, the special educatorexplored alternative settings and discussed these with theparents. If children were placed in other programS, thespecial educator assisted in_ the transition period, espe-cially in those settings in which_there had been few previ-ous placements for children with special needs.

Treatment (Ind Parent Education

The special educator assumed responsibility for treat-ment of individual preschool children who had learningand behavior problems. This was done by modeling duringgroup sessions and home visits, by working with parentsin developing a structured management plan for the child,

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and in_providing consultation to preschool teachers whenthe child entered another program.

At the end of the second year of the project, the pre-school group was _discontinued because of the increasednumber of referrals of younger and more seVerely hand-icapped children. The special educator continued to play amajor role with school systems. She provided_ consulta-tion to project members on Public Act 198, available pro-grams _and services, appropriate educational contacts,educational objectives, state planning activities, and dis-semination design.

The special educator provided consultation and trainingto individual parents_and to the EIP parent groups on Pub-lic Act 198, available programs and services, books andmaterials, management Jechniques, and teaching tech-niques. She participated in Educational Planning andPlacement Committee meetings and encouraged parentsto become advocates for their children.

Cons/that/ )

The Eli, received many requests from schools for con-sultation on various aspects of developing programs foryoung children, including management techniques, train-ing techniques, community-wide screening techniques,team building activities, the use of interdisciplinary teams,needs assessment strategies, and service delivery models.The special educator was able to offer consultation inthese areas.

The special educator accepted appointment to twocommittees having responsibilities for developing modelservice delivery systems for handicapped infants andyoung children: Preschool Advisory Committee of theAnn Arbor Public Schools and Guidelines for PreschoolEducation, a subcommittee of the Michigan Associationof Administrators of Special Education.

ROLE OF THE CHILD DEVELOPMENT SPECIALISTCarol M. Donoval

A person trained in child development can add a differ-ent perspective to a project for handicapped children. Allof the therapists are skilled in evaluating and treating vari-ous disabilities. The child development specialist, how-ever, has studied the child as a whole. Thus, this person ismore of a generalist with a background in all areas of de-velopment: personal, social, physical, and cognitive. Thisviewpoint allows for a focus on the child's strengths aswell as his weaknesses, and emphasizes his needs as anormal child.

Professionals who deal exclusively with handicappedchildren can easily lose their perspective on what is nor-mal. A child development specialist has been trained toobserve and work with normal children. This training isoften done in a group setting which is another advantage,since most therapists are accustomed to working withclients on a one-to-one basis. Children behave differentlyin a group, and specific skills are needed to successfullymanage a group and still meet individual needs.

The child development specialist with the Early Inter-vention Project was also trained in the use of various testinstruments to assess preschool skills, such as Peabody

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Achievement Test, Illinois Test of PsycholinguisticAbilities, Detroit Test of Learning Aptitudes, WechslerPreschool and Primary Scale of Intelligence, and SlossonGeneral Intelligence Test. These tests were necessary toplan intervention strategies for more mildly handicappedpreschoolers.

Training in child development differs from training inearly childhood education which emphasizes ways to edu-cate the preschool child. Child development training isbroader because it focuses on the child as he developswithin his family system. The family as an ecological sys-tem is a unique and complex unit; all parts of the systeminteract with each other to produce change and growth.The system is viewed as an entity with unique and indi-vidual elements which interface with the economic, so-cial, educational, medical. and community systems. Theinterface of these community systems with one element. ahandicapped child, will have ramifications for all familymembers. This fact should be a major consideration forany system which delivers services to that child. The in-tervention of a child development specialist will assist inthe interface of the family and community systems.

ADMINISTRATIVE ISSUESMartha S. Moersch

Questions often asked by correspondents and visitors tothe project concerned administrative issues, from interestin funding sources and proposal writing to interest in theday-to-day conduct of the project. Since the specific needsand individual circumstances of persons asking thesequestions covered such a broad spectrum, each discussionor consultation on project administration followed a dif-ferent format. For this reason, no attempt will be made toaddress the issue of project administration except for afew general comments.

There are numerous ways in which interested personscan obtain information on grant writing, such as dis-cussions with individuals who have obtained funding fol-lowing submission of proposals for specific programs;study of the various books, manuals, and journal articleson grantsmanship; participation in workshops, confer-ences, or courses on grantsmanship; examination of re-quests for proposals, announcements, and guidelines forfunding possibilities from various state and federal gov-ernmental agencies; study of foundation directories to befound in mostlibraries; and by seeking out and becomingknowledgeable about the Federal Register, Commerceand Business Daily, and other publications whichroutinely announce the availability of funds throughgrants or contracts. Most universities and large agenciesemploy someone to assist staff members in writing grantrequests.

A project such as the EIP is almost certain to emerge asa part of an already existing organizational structurewhich dictates many parameters of project activities. Or-ganizational parameters can be both facilitory and inhibi-tory to project operations, facilitory to the extent of offer-ing resources and inhibitory in that the number of personsand systems to whom the project must be accountable in-creases in direct proportion to the number and value of theresources.

The placement of the EIP within a University AffiliatedFacility assured the availability of many resources, rang-ing from personnel, to services, to physical equipment.Assistance was readily available for proposal writing,budgeting, negotiating with funding sources, media pro-ductions, space allocations, and for consultationon a widevariety of topics. In order to assure maximum advantagefor both the home organizational system and the projectitself, it was necessary for the project administrator to be abuffer, mediator, and advocate. This role assured that theproject contributed to the home system's ability to meetits goals and also that the project personnel were able tofocus on project goals. Creative project operation requiresthat this buffer role be filled.

The project director of the EIP also served as the coor-

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dinator of all project activities and supervisor of all projectpersonnel. Responsibilities were delegated to individualstaff members who were encouraged to be creative inmeeting their responsibilities. The successful results ofthe project confirm their creative contributions.

The nature of the EIP program required intimate associ-ation with families having all the responsibilities of otherfamilies plus the added responsibility of a handicappedchild. This called for special emotional support for staffmembers. The move from a center based program into ahome based program, or a combination of the two, im-mediately placed the home visitor in the position or a par-ticipant in both the joys and the sorrows of the families,including critical illnesses and death as well as the suc-cessful attainment of program objectives.

As schools and other community agencies develop earlyintervention programs, it will be both necessary and desir-able that we share findings and contribute to the neededbody or knowledge related to such programs.

EARLY INTERVENTIONDEVELOPMENTAL PROFILE:

APPLICATION IN ATRANSDISCIPLINARY PROGRAM

D. Sue Sau

EDITOR'S NOTE: The Early Intervention Developmental Profile played an important role in the project. The Profile is. being published as a three volume set by the University of Michigan Press under the title Developmental Programming forInfants and Young Children, D. Sue Schafer and Martha S. Moersch, editors.

The three volume series is a guide to help the teacherltherapist bridge the gap between assessment and program im-plementation for children functioning in the 0-36 month developmental age range. The series was designed to be used bymultidisciplinary teams who have combined skills in rnotor, language, and cognitive development and who incorporateparents as part of the treatment team. Individual professionals will also find it helpful. Six areas of development are ad-dressed: perceptuallfine motor, cognition, language, sociallemotional, self care, and gross motor. The series can headapted to normal, high risk, and handicapped populations.

Volume I, Assessment and Application, provides detailed instructions for the use of the Early Intervprition Develop-mental Profile including administration and evaluation techniques, scoring and interpretation of results, validity and re-liability findings, and cwnplete item descriptions. This volume suggests a inethod for translating the profile findings intobehavioral programs for handicapped infants and young children.

-Volume 2, Early intervention Developmental Profile, is a scoresheet and is designed so that small increments in achild's skills can he frequently noted. The last page j'eatures a chart on which a child's development can be graphicallydisplayed.

Volume 3, Stimulation Activities, is a reservoir of ideas for carrying out planned program objectives. Each developmen-tal area contains sequenced developmental behaviors that would be expected in a normal child with adaptations Prspecific handicapping conditions noted. This volume describes ways to handle, stimulate, and interact with the youngchild in play and during daily routines; it is designed to be used by parents with assistance from appropriate professionals.

In order to describe the Profile and the team building process necessary for Profile administration, the following paper,presented at the American Physical Therapy Association meeting in New Orleans. June 1976, is reprinted here.

Origin of the Profile

The Early Intervention Developmental Profile was con-ceived in order to fill the need for an instrument that woulddescribe the developmental status of a child in the 0 to36-month age range in six areas of development:perceptual/fine motor, cognition, language, social/emotional, self-care, and gross motor. TheProfile is one ofthe products of the Early Intervention Project for Hand-icapped Infants and Young Children, which created atransdisciplinary treatment approach to remediating thedevelopmental problems of exceptional infants. The EIPprimary treatment team (occupational therapist, physicaltherapist, and speech and language pathologist), assistedby a psychologist and a special educator, needed to gathermore detailed information about reflexive and cognitivedevelopment than was traditionally provided by infant as-sessment tools. They sought one instrument which con-tained developmental sequences in cognitive and motordevelopment as well as sensori-motor, language, and so-cial growth, so that the time and repetition involved in ad-ministering four or more separate instruments to each in-fant could be diminished.

The evaluation instrument had to fit the project'sassessment-based approach to programming which in-cluded frequent (3-month) re-evaluations. Thus it had tobe a tool which could be administered either by a single

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trained evaluator or by an interdisciplinary team in a rela-tively brief period of time (an hour or less). Also, it had tosupply detailed information in the six developmentalareas, while monitoring development of both severelyhandicapped and more mildly handicapped infants.

Initial compilation of major developmental milestonesfor ages 0 to 60 months began in August 1974, and was firstused within the project in December 1974. The initialProfile results easily led to the formulation of behavioralobjectives and helped to strengthen assessment-basedprogramming within the-project.

The first Profile revision occurred in March 1975 and in-cluded expansion of the gross motor scale to include amore detailed examination of reflexive development, en-largement of the feeding scale of the self-care section toinclude oral-motor development, as well as minor changeson the other scales. At this point, the Profile had stimu-lated the interest of numerous other professionals engagedin education of handicapped infants and preschoolers. In-creasing requests for the Profile prompted the project toconsider wider distribution and eventual publication of theProfile. Thus, the final critical examination of the Profilebegan in late 1975.

The final revision carefully considered the retention ofthe 36- to 60-month items, which seemed to duplicateseveral already-existing and satisfactory preschool assess-ment instruments. However, rather than duplicate exist-

ing materials, the Profile was revised to include only the 0-to 36-month age range, since this part of the Profile met areal need in bringing together the various aspects of infantdevelopment. In addition, the final revision, which wascompleted in November 1975, expanded the social/emotional scale to include aspects of theory from attach-ment and ego psychology literature, and enlarged theself-care scales to describe the development of feeding,toileting, dressing and hygiene skills in greater detail. Thefinal Profile revision has been in use since December 1975and is available through the University of Michigan Press.An expanded version of the Profile which includes amethod for translating evaluation data into individualizedtreatment programs and which includes suggested stimu-lation activities will be published by the University ofMichigan Press early in 1977.

The Profile contains 274 items and can be administeredin less than an hour by an experienced evaluator or mul-tidisciplinary team. The Profile yields needed informationfor planning comprehensive developmental programs forchildren with all types of handicaps who function belowthe 36-month age level? It is intended to supplement, notreplace, standard psychological, motor, and languageevaluation data.

The Profile has several unique features. First, the com-bined results of the six scales provide a comprehensiverecord of the child's skills, the breadth of which is notfound in other infant evaluation tools. Second, the com-pleted Profile lends itself well to the formulation of indi-vidualized objectives, a necessary ingredient of programsfor handicapped infants and young children. Third, theProfile not only compiles a variety of developmentalmilestones, as seen in the language and self-care scales,but also reflects current developmental theory in themotor, cognitive, and social areas. The gross motor scaleand the feeding section of the self-care scale reflect a bodyof knowledge which constitutes the basis for the currenttreatment of cerebral palsy in infants and young childrenby emphasizing neurodevelopmental theories and refle-xive development. The cognition scale provides land-marks in the development of sensori-motor intelligencedescribed by Piaget and focuses specifically on the acquis-ition of the concepts of object permanence, causal rela-tionships, spatial relationships, and imitation during thefirst two years of life. The social/emotional scale reflectscurrent theory on the emotional attachment between themother and child and the child's gradual acquisition of egofunctions during the first 36 months of life.

Multidisciplinary Team Building

The rrofile was designed to he administered by a mul-tidisciplinary team which includes a psychologist or spe-cial educator, physical or occupational therapist; 'and aspeech and language therapist. These disciplines can pro-vide the disciplinary expertise which the Profile requiresfor the language, cognitive, reflexive, and oral-motoritems.

The project has trained 27 multidisciplinary teams toadminister the Profile. These training sessions helped theproject develop a successful instructional procedure forteam evaluations. The first step was for each team member

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to become thoroughly familiar with all the items in his par-ticular disciplinary scales. The second step was for theteam to evaluate a normal infant or toddler, with eachteam member administering his disciplinary scale item byitem, explaining terminology, administration techniques.and scoring criteria to the other team members. Teamevaluations of normal children should be repeated severaltimes in order to gain experience in how normal children ofdifferent ages handle items in the Profile. The team shouldthen progress to handicapped infants and young children.

The project's team training activities always includedactivities which helped to facilitate each team's personalinteractions, since the project believed that team success(in using the Profile or whatever) depended on the de-velopment of viable group interaction. Many of the pro-fessionals who attended project workshops had not beenorganized as a team before they came; others had beenrecognized as a team but had never had the time to talkabout what it meant to be a team. The teams that attendedwere required to have a motor person (occupational orphysical therapist), a speech therapist, and a teacher orpsychologist. These groups of individuals were trulyInultidisciplinary, i.e., each team member worked fromhis own disciplinary skills and his own sets of goals andprocedures.

Interdisciplinary Team Building

The purpose of the project's team process activities wasto help the individual team members look at, recognize,and experience the components of an interdisciplinaryteam in which the team members shared common goalsand procedures, and, more importantly, to increase thelevel and amount of communication among team membersto include eventual sharing of each other's skills andknowledge.

The project used several techniques to facilitate inter-disciplinary team development. The first technique wasexamination of the components of a perfect" team. Eachteam was asked to brainstorm their ideas about a perfectteam for about 20 minutes. During a period of sharingamong teams, the requirements for a perfect teamemerged consistently among all the 27 teams who partici-pated and had the same components.

The first prerequisite for a perfect" team is willingnessand availability of each person to be a team member. Itquickly became apparent that if a supervisor did not give aperson released time to be a member of a team, it would beimpossible to fit in the necessary time that group interac-tion requires into an already-existing full schedule. Thewillingness may be there but not the availability. The re-verse can be a bigger problem. A person may be availablebut not willing to be a team member. This situation can bevery disruptive to team process, as this person may try tosubvert the team effort either knowingly or subcon-sciously. Both willingness and availability are thus neces-sary ingredients to team development.

The next component of a-perfect" team is an agreementto a common group enterprise. A group must have a pur-pose, common objectives. The process of working outgoals and procedures as a group gives the team a sense oftogetherness, a reason for being, and a chance to get to

know each other on a more personal level. The E1P staffused the development of the Profile as their commongroup enterprise. The product which they developedhelped them to understand and apply uniform treatmentfor each child; the group interaction which allowed themto agree on a final product helped to keep the child as awhole person in the eyes of all team members.

Another component of the "perfect team is a willing-ness to share one's knowledge, skills, and feelings withcolleagues, and more importantly, to be willing to learnfrom and listen to one's fellow team members.

The final component of the perfect" team is a verydifficult ingredient to achieve: a recognition and accep-tance of personal styles and skills in oneself as well as inothers. Insight into one's own skills and limitations is hardto acquire, and one must learn to trust his colleagues toprovide him with the feedback necessary to learn abouthimself. At the same time, one must learn to share his in-sights about others when it is appropriate.

Examination of the components of a perfect" teamhelped the workshop participants gain a feeling for whateach should expect in the process of becoming an interdis-ciplinary team member. All quickly learned that teammembership required a great deal of individual effort.They also realized that they still had to develop their ownteam's unique methods of problem-solving but left theworkshop feeling that it was all right to have team prob-lems in the first place.

In addition to examining the components of the perfectteam, the workshop participants were helped to examinethe facilitating as well as constraining factors in their ownsystem that would affect their team effort. Most of theteams were from Michigan schools which were developingor expanding early intervention programs in response toMichigan's mandatory special education law, which re-quires schools to provide services to handicapped personsfrom birth. The results of this exercise became highly in-dividualized for each team: some had good administrativesupport, others did not; some had community support,others did not; some had adequate facilities, others didnot. In each case they became more aware of the setting inwhich their team had to function and were able to begin toset some team objectives for themselves to begin to influ-ence their team's acceptance back home.

The last major technique which the project used tofacilitate interdisciplinary team development was havingthe teams perform a group task. In this case, we had eachteam evaluate a normal infant using the Profile. This ex-perience was used to help each team to begin to appreciatethe expertise that each discipline brought to the team.Since they had to work to complete the Profile in one hour,they were forced to rely on each other to complete thetask. These evaluation sessions were used to initiate eachteam into trying something other than disciplinary evalua-tions which not only take time, but tend to segment thechild into disciplinary pieces. At the end of the project, all27 teams were still developing their team assessment ap-proaches which would continue to be implemented duringthe 1976-77 scho81 year.

By the time the E1P team had begun demonstrating andteaching the interdisciplinary approach to assessment andprogramming, they had progressed to a more highlysophisticated level of team developmentthe tramsdis-ciplinary approach.

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Transdiseiplinary Team Building

Staff progression from an interdisciplinary team to atransdisciplinary team came about in part because of theneed for each EIP team member to represent the wholeteam during home visits to children. They used the Profileto help them solve this problem. Each E1P team memberlearned to administer the entire Profile and becamethoroughly familiar with the underlying theory for eachitem. The process of learning to administer and interpretthe entire Profile allowed each team member to explorefurther the extent of his knowledge and to identify wherehis expertise ended and that of another began. The learn-ing took place over a one-year period. At the end of thisperiod, each team member tested his Profile assessmentskills against a standard. The results of this interrater re-liability test were a 96% overall mean, which is high, andindicate the E1P team's ability to substitute for oneanother in profile administration (and probably in otherareas as well).

The ability to incorporate several disciplinary ap-proaches into one disciplinarian's repertoire of skills isanother step in the team development process, which iscalled the transdisciplinary approach to service delivery.This approach depends on a high degree or sharing andcommunication among team members as well as knowl-edge and acceptance of each other's strengths and limita-tions so that the service can be delivered to the childthrough one primary person The major team mernber re-sponsibility in this approach is to embody the knowledgeand skills of the other team members, and to quickly rec-ognize where his skills and knowledge end and when heshould call in, or consult with, another team member tohelp solve a problem.

The E1P team's development took the transdisciplinarymodel a step further and progressed to what can be called amodified transdisciplinary approach to service delivery inwhich the parent becomes an integral part of the team. Inthis model the parent incorporates an understanding of hischild's developmental needs and learns to carry out thenecessary service with training, support, and guidancefrom the other team members. This is a highly sophisti-cated level of team development and can be achieved onlyafter the evaluation/treatment team has passed throughthe other phases of team development: multidisciplinary,interdisciplinary, and transdisciplinary. All four stagesare depicted in Figure I. The E1P team's ability to pro-gress through these stages over a three-year periodstrengthened its ability to provide effective service.

The Elf' demonstrated that team development requiresas much time and priority as do procedural issues in orderfor early intervention to be effective. It is the hope of theE1P -that systems which undertake to serve young hand-icapped children will consider making team developmenta priority in the process of program development. The El Pwill continue to provide training in team developmentalong with infant assessment and' programming during itsOntreach phase, which begins July I 1976.

The El P team members found the following methods ef-fective in learning how to administer the entireProfile, theprerequisite to achieving a transdisciplinary team.

The first requirement in learning to administer and even-tually interpret the Profile is that each team member be-come thoroughly familiar and comfortable with the scales

Multidiscip nary

FIGURE I

STAGES OP TEAM DEVELOPMENT

Transdiseiplinary

which most closely represent his own discipline. The nextstep is to pair with a non-disciplinary counterpart for anevaluation of a normal child. Each teaches the other hisdiscipline-related scale, supervises administration andscoring, explains techniques, and answers questions.After proficiency and agreement have been obtained be-tween the two persons on both normal and handicappedchildren, pairing should be changed and the process re-peated for each new pair. The final step is for each teammember to attempt a total Profile evaluation of one ormore children in a situation where all team members couldbe called upon when needed.

frftftw.tea

InterdiscIplinary

ModifiedTransdiseittlinary

This.learning process can be supplemented and rein-forced in many ways, depending on the style and attitudeof the team member. Supplemental reading in other disci-plines is invaluable in learning to administer the Profile.Ask your fellow team member which publications he rec-ommends. Observing other disciplinary evaluations isanother way to learn new approaches, but practice at ap-plying these newly-learned skills is necessary. It was theexperience of the EIP staff that team interaction leads to abroadening disciplinary perspective.

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II D

Index

Abelson, A. Geoffrey, 46Administrative issues, funding sources and grantwriting, 41;

organizational context, 41; support for staff. 41Advisory committee, 3American Association of Mental Deficiency. 19. 39Assessment and Application. Vol. 1 ofDevelopmental Pro-

gramming for Infants and Young Children (D. S. Schafer &M. S. Moersch, Eds.), 42

Assessment instruments, Bayley Scales of Infant Development.19, 22, 29, 33, 36. 37. 38; Behavior Recording Form, 19-20,25-28; Caldwell Preschool Inventory, 6; Denver Develop-mental Screening Test, 6; Detroit Test of Learning Aptitude,40; Early Intervention Developmental Profile, 8, 19-20; GesellDevelopmental Schedules, 36, 37; Hoskins and Squires, 37;Illinois Test of Psycholinguistic Abilities, 38, 40; Leiter Inter-national Performance Scale. 19. 38; Merrill-Palmer Scale ofMental Tests, 38; Parent Attitude Survey Form. 19-20, 25-28;Peabody Achievement Test. 40; Peabody Vocabulary Test,38; Receptive Expressive Emergent Language Scale (REEL).19, 22, 38; Slosson Intelligence Test, 6, 40; Southern CaliforniaSensory Integration Tests, 36; Stanford-Binet IntelligenceScale. 19, 38; Vineland Social Maturity Scale. 19, 22, 38;Washington Guide for Promoting Development in the YoungChild. 6; Weschler Preschool and Primary Scale of Intelli-gence, 38, 40

Association for Retarded Citizens, 17. 30Asthma. 47Audiology, 14Autism, 11

Balsam, P., 19Blindness, 14, 47Bloom, B. 5_ 46Brooks, J.. 22Brown, Sara L., 19Bureau of Education for the Handicapped, closure of funding, 4;

Early Intervention Outreach Project, 4; Children's EarlyEducation Program. I. 2

Case-finding, responsibility for, 5; strategies, 5Child development, measures of (See assessment instruments)Child development specialist. role, 40Children referred, by age and cognitive delay (table). 20; charac-

teristics, 20-23; cognitive delay compared to language, motor,and social delays (table), 21; initial cognitive indexes of (table),21; See also developmental rate and findings

Continuation of project, 33-34Cerebral palsy, 1 1. 12, 13, 14, 15Crippled Children's Services, 15

Data collection procedures, 20Dentistry, 15Developtnental Programmimig for Infwas and Young Children,

I, 42; Volume I, Assessment and Application, 22, 24; VolumeII, Early Intervention Developmental Profile, 42; Volume III,Stimulation Activities, 42

Developmental rate, average change in a six-month period(table), 23; categories, 19: change in language, cognitive.social, and motor areas (table), 23; correlation amongchangesin (table), 24; correlation with difference between father'sand mother's attitudes, 27; correlation with parent behaviorsand attitudes, 26-27; general trend over time, 23; initial, onstandardized assessments (table). 22; pattern of change(table), 23; profile score as index of, 24; stability, 22

Developmental Scre 'fling of Handicapped Infants: A Manual,31

D'Eugenio, Diane B., 19, 22, 24Disciplinary roles, 2, 14-15, 36-40; audiology, 14 child de-

velopment specialist, 40 dentistry, 15; nutrition, 14-15;'occupational therapy. 36-37; ophthalmology, 14; pediatrics,15; physical therapy, 37; psychology, 15, 38-39; special educa-tion, 39-40; speech and language pathology, 38

Dissemination, agencies participating, 32; conferences, 30;demonstration of techniques, 30; evaluation and impact, 31;materials produced, 31; presentations, 30-31; seminars and .

short courses, 30; special training relationships, 31; trainingdesign, 30; training sessions (table), 32; training sessions forindividuals, 30; training sessions for teams, 31; workshops, 31

Donovan, Carol M., 19Down's syndrome. 2, 11, 12, 14

Early Intervention Outreach Project, 4. 34Early Intervention Developmental Profile. Vol. 2 ofDevelop-

mental Programming for Infants and Young Children (D, S.Schafer & M. S. Moersch, Eds.). 42;as index of developmentalrate (table). 24; correlation with standardized tests. 22-23. 24:in assessment, 8, 19, 20, 42; in parent training, 13; in program-ming, 3. 9; in team development, 43-45, (figure) 45; in training.29. 31, 33, 44; origin, 42-43; reliability ratings, 20: test-retestcorrelation (table), 24

Early Intervention Project, program model. 2, 11-12 : stafllist.48; staffing pattern, 2

Educational Planning and Placement Committee. 17, 40Emotional problems. 12, 15Exit, from project. 3. 10

Family unit, 1 , 16, 28, 40Feeding, 15Findings, characteristics of children referred, 20-22; charac-

teristics of children whose developmental rates increased.24-25; cognitive indexes of children at referral (table). 21; cor-relations between parent and child variables, 26-27; generaltrend in developmental rate over time (table). 23; mother's be-havior and child's age, relationship, 25; mothers' behaviorscores (table), 25; Parent Attitude Survey scores (table), 26:parent attitudes and behaviors and developmental rate, 26-27;parent attitudes about having a handicapped child. 12, 25-26;parent attitudes and behavior, relationship of, 27; parent at-titudes, differences between mothers and fathers, 26; parentattitudes, effect of difference between mothers and fathers ondevelopmental rate, 27; test results of children. stability, relia-bility, and predictability, 22; standardized assessments, corre-lations (table). 22; test-l-etest comparisons (table), 22; test .retest correlation for PrOfile (table), 24

-First Chance- network, I. 2, 16, 30Forness, S. R., 46Funding sources, 41

Goodlad, J. C., 47

Grant writing, 41Grossman, H., 19Group sessions, 2-3, 9

Hearing loss, 14, 47Hoffman, H 19

Home visits. 3, 9

Intake worker, 7-8

49

51

Kaufman, K., 19Knobloch, H., 22

Leary, K., 19Lewis, M., 23, 28Lynch, Eleanor W., 19, 26

Mainstreaming, 4, 15-16, 46Medication, 15Mental retardation, 12, 13, 47Michigan mandatory special educatfon la blic Law 198), 2,

5, 11, 16, 30, 40Moersch, Martha S., 42Motor delay, 47

Nursery school survey, 16, 46-47Nutrition, 14

Objectives, formulation of, 9, 19; performance on, 26; short-term, 9

Occupational therapy, as primary discipline, 2; evaluation, 36;role, 36-37; team functioning, 37; treatment, 35

Ophthalmology, 14

Parents, as primary treatment providers, 2, 3, 11, 18; attitudes,12, 19-20, 25-28; behavior, 19-20, 25-28; informing, 8, 12, 16;involvement, fostering, 4, 11-13; supportive services for,16-17; training in advocacy, 4, 11, 16-17; use ofFrofile by, 13

Pasamanick, B., 22Pediatrics, 15Physical facilities, 2Physical therapy, as primary LIscipline, 2; consolation and par-

ent education, 37; evaluation, 37; role, 37; treatment, 37Preschools, acceptance of handiaapped children (table), 46-47;

architectural barriers, 4-47; rnainstreaming and, 46-47;placement in, 16

Programming, group sessions, 3, 9; home visits, 3, 9; individual,3, 9; Early Intervention Developmental Profile, and, 3, 9, 13;exit, 10; reassessment, 10; rcferral, 9

Project evaluation, See also findings, and developmental rate;children, 20-24; correlations between children's and parents'variables, 227; data collection procedures, 20; measures ofchild development used, 1819, See also assessment instru-ments; measures of parent behavior and attitude used, 19-20;methodology, 18-20; parents, 25-26; references, 28; strengthsand weaknesses of project, 3-4; summary, 27-28

5 2

50

Project staff, 48Psychology, consultation, 15, 39; evaluation, 38-39; project

evaluation, 39; role, 38-39; treatment, 39

Records, children's, 5-6, 35; confidentiality, 31, 35; projectReferral, sources, 2, 7Reger, R., 46Replication sites, impact of project on (table),-3_ Livingston

County, 33-34; Washtenaw County, 33-34Rogers, Sally J., 19, 22, 24

Salant, C., 19Shafer, D. Sue, 42Schools, placement in, 116Screening procedures, 5-6Siblings, 3, 12-13, 17Social Services, 15Service delivery process, flow chart, 7Special education, consultation, 40; evaluation, 39; role, 39-40;

treatment and parent education, 39-40Speech and language pathology, as primary discipline, 2; consul-

tation, 38; evaluation, 38; referral, 38; role, 38; therapy, 38Speech delay, 47Staff development needs assessment and procedures, 29Stimulation Activities, Vol. 3 ofDevelopmental Programming

for Infants and Young Children (D. S. Schafer &M. S. Moersch; Eds.), 42

Students, University, services of project to, 3Support services, community, 15; for children, 14-16; for

parents, 16-17

Team approach, 3, 4, 5, 8, 3 15 7 39, 42-45Teeth, development, 15Tests, comlation of results, 19-23; of parent attitudes andbehavior, 20; use in evaluation, 34; use in screening, 6; useof standardized, 19; See also assessment instrumentsTreatment, children, 9, 12, 18Transportation, 2, 4, 11, 16

Weinraub, M., 22Wolfensberger, W., 46