Defining and Assessing Quality in Early Intervention Programs for Infants and Toddlers with Disabilities and their Families: Challenges and Unresolved Issues

Historically, child care quality research has focused primarily on typically developing children cared for in center-based programs. Findings from this research suggests that variations in quality of care have an effect on children's well-being and developmental outcomes. In this paper, we draw on child care quality research to inform our understanding of quality in early intervention services for infants and toddlers with disabilities and their families. Conceptual issues in defining quality and methodological challenges for assessing quality of early intervention services are presented. In the final sections of this paper, we discuss our efforts to design a measure of quality for early intervention programs and present some of the unresolved issues related to the assessment of quality in early intervention programs.     

Measuring the Quality of Early Intervention Services for Infants and Toddlers: Problems and prospects

Comparable scales to measure quality of early intervention services for infants and toddlers as perceived by parents and service providers were developed based on the Recommended Practices in Early Intervention. Each scale consisted of four subscales focusing on: home-based therapies/instruction, centre-based therapies/instruction, medical/ health services, and service coordination. The scales were administered to 209 parents and 177 of their service providers. A sample of 24 parents completed the instrument twice during a two-week interval to assess test-retest reliability of the parent scale. Test-retest reliability for the parent scale was .785. Validity of the scale was assessed by examining the correlation of parent and provider perceptions of quality with family demographic and early intervention service characteristics. Parents' perceptions of quality were related to family centredness of services. Neither parents' nor providers' perceptions of quality were related to family socioeconomic status. Problems and prospects for measuring quality of early intervention services are discussed.     

Early Intervention Programs in Korea for Children with Disabilities

A national survey of 53 early childhood special education teachers in Korea was conducted to investigate their knowledge and perceptions regarding various aspects of kindergarten and preschool programs for children with disabilities. Results from the study indicated that (a) children in the age range of 3 to 7 years were the group most frequently served by early childhood special education in Korea, (b) teachers reported infrequent assessment and scarcity of curriculum resources, (c) most teachers reported using a self- or school-developed curriculum, and (d) confusion exists regarding the concept and use of the Individualised Education Program (IEP). Because of a somewhat lower than expected teacher response rate further study is needed to determine if the results of this study are representative of programs nationally. Also, evaluative steps should be taken to ensure that curricula are appropriate for the various ages and types of learners. Likewise, research is needed to identify those factors that facilitate inclusion of children with disabilities in their schools and communities with peers as early childhood special education programs expand.     

Seven-Year Outcome of the Vermont Intervention Program for Low-Birthweight Infants

We compared 24 low-birthweight subjects of an experimental intervention (LBWE), 32 no-treatment controls (LBWC), and 37 normal birthweight (NBW) subjects. The intervention involved 7 hospital sessions and 4 home sessions in which a nurse helped mothers adapt to their LBW babies. At age 7, LBWE scored significantly higher than LBWC on the Kaufman Mental Processing Composite (p less than .001), Sequential (p = .02), and Simultaneous (p = .001) Scales, after statistical adjustments for socioeconomic status. LBWE did not differ from NBW (F less than 1). These results bear out a divergence between the LBWE and LBWC that first became statistically significant at age 3. The findings suggest that the intervention prevented cognitive lags among LBW children, and that long-term follow-ups are needed to evaluate the developmental effects of efforts to overcome major biological and environmental risks.     

Early Intervention for Behaviour Problems in Young Children with Developmental Disabilities

This article reviews research on intervention for young children with dual developmental and behavioural problems. It makes a case for intervention to include family variables and to occur in the preschool years. Behaviour problems are common in young children with developmental disabilities. If untreated these problems are likely to persist and become more challenging and severe in adulthood. Behaviour problems interfere with cognitive, social and emotional development, create additional family stress, often lead to exclusion from community services, and result in additional financial costs to the community. Intervention research provides some support for the effectiveness of parent management training and interventions based upon applied behaviour analysis. However, randomised controlled trials with adequate follow-up periods are required, along with the measurement of outcomes for the family as a whole.     

Mastery Motivation in Toddlers with Developmental Disabilities

Prior research on school-age children with mental retardation indicates that they are less motivated on tasks than mental-age-matched peers. In this study, mastery motivation on two tasks was compared for 1- and 2-year-old children with motor impairment ( n = 25), developmental delay ( n = 25), and typical development ( n = 25), matched for mental age. The groups did not differ significantly on any measure of mastery motivation. The relative contribution of premature birth, a history of seizure disorders, severity of cognitive delay, and maternal didactic interaction in predicting mastery motivation was examined for toddlers with developmental delay or motor impairment. Maternal didactic interaction added a significant proportion of variance above and beyond other variables in predicting several aspects of mastery motivation in toddlers with developmental disabilities.     

Early Intervention with Medically Fragile Infants: Investigating the Age-at-Start Question

Very few studies have investigated the age at which early intervention should begin. Similarly few studies have examined the effects of early intervention for infants who are medically fragile. The present study responds to these two critical issues by longitudinally comparing groups of infants who are medically fragile. These infants were randomly assigned to receive developmentally appropriate programs beginning at either 3- or 18-months adjusted age. Analysis of measures of child development and family functioning for the first three annual assessments indicated that the two groups were similar on measures of child functioning at the first and second assessment. However, at the third assessment, children who received the intervention at an earlier age scored significantly higher than did children whose intervention began 15 months later. No significant group differences were found on measures of family functioning at any of the assessments. Implications of these results for future research and practice are discussed.     

Early Intervention with Medically Fragile Infants: Investigating the Age-at-Start Question

Very few studies have investigated the age at which early intervention should begin. Similarly few studies have examined the effects of early intervention for infants who are medically fragile. The present study responds to these two critical issues by longitudinally comparing groups of infants who are medically fragile. These infants were randomly assigned to receive developmentally appropriate programs beginning at either 3- or 18-months adjusted age. Analysis of measures of child development and family functioning for the first three annual assessments indicated that the two groups were similar on measures of child functioning at the first and second assessment. However, at the third assessment, children who received the intervention at an earlier age scored significantly higher than did children whose intervention began 15 months later. No significant group differences were found on measures of family functioning at any of the assessments. Implications of these results for future research and practice are discussed.     

Making the Case for Early Identification and Intervention for Young Children at Risk for Learning Disabilities

The early identification of children with learning disabilities (LD) is difficult but can be accomplished. Observation of key behaviors which are indicators of LD by preschool and kindergarten teachers can assist in this process. This early identification facilitates the use of intervention strategies to provide a positive early experience for children at risk for academic difficulties.     

A Study of Infant Developmental Outcome with a Sample of Korean Working Mothers of Infants in Poverty: Implications for Early Intervention Program

Using a sample of 42 Korean mothers whose infants are cared for by someone at non-maternal child care facilities, this study first examined both main effects and interaction effects between maternal knowledge of infant development and maternal self-efficacy on parenting behavior. Second, the combined effects of variables of interest in this study including maternal knowledge of infant development, maternal self-efficacy, and parenting behavior on the child developmental outcome were investigated. Significant relationships between maternal knowledge of infant development and parenting behavior and child development outcome were detected. Only main effects of maternal knowledge of infant development were detected. Furthermore, maternal knowledge of infant development was the only significant predictor of infant developmental outcome. Research implications were discussed both on the continuum of findings from previous studies with Western samples and in terms of provision of effective early intervention programs for this targeted population.