Students will complete the case study activities on Kavon and answer questions indicated in the assignments. Students will respond to the questions on a Word document with the original qu

Janet Thomas, MEd, OTR/L Toby Long, PhD, PT Rachel Brady, MS, PT

Georgetown University Center for Child and Human Development University Center of Excellence in Developmental Disabilities

District of Columbia Early Intervention Program Office of Early Childhood Development

P Early Intervention

ersonnel Preparation

Training Activities

Early Intervention Personnel Preparation Training Activities i

Personnel Preparation Training Activities Overview . . . . . . . . . . . . . . . . . . . . 1

Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Aaron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Kavon. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Kaila. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Assignments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 ASSIGNMENT ONE: Intervention Approaches. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 for Children with Disabilities

ASSIGNMENT TWO: Research Five Journals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Outside Your Field of Expertise

ASSIGNMENT THREE: Site Observations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

ASSIGNMENT FOUR: Describe Five Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 that Impact Young Children

ASSIGNMENT FIVE: Develop Helpful . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Informational Materials for Families

Games of Early Intervention. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 To Tell the Law. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 A Natural Match. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 It’s a Great IDEA! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 What Did You Say? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Truth or Dare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Table of Contents

Early Intervention Personnel Preparation Training Activities 1

DC Early Intervention Program Comprehensive System of Personnel Development

Personnel Preparation Training Activities

Personnel preparation in the field of early intervention has become a national effort. Part C of the Individuals with Disabilities Education Act (IDEA) requires each state and jurisdiction to

develop a Comprehensive System of Personnel Development or CSPD (U.S. Code of Federal Regulations, 1997). Each state must develop a system to ensure that the personnel providing services to infants, toddlers, and their families possess the appropriate skills needed to provide service in a comprehensive, family centered, culturally competent, and community-based system of care.

The purpose of the CSPD is to ensure that early intervention providers are qualified personnel in early intervention. Each state’s CSPD needs to include a system-wide process for:

• developing minimum standards for personnel qualifications,

• coordinating pre-service and in-service training programs,

• identifying personnel needs, and

• disseminating promising materials.

The design of the CSPD should assist providers in identifying professional growth activities that support acquiring and adopting contemporary practices of service delivery.

The DC CSPD program is part of the DC Early Intervention Program (DCEIP). The DC CSPD consists of three major components: Credentialing, Training, and Resource Development.

• The Credentialing System consists of the development of a professional portfolio indicating that the applicant has met competency in six areas of early intervention:

1. Infants and Toddlers with Special Needs

2. Interaction with Families

3. Legal Mandates, Regulations, and Administration

4. Evaluation and Assessment

5. Individualized Family Service Planning

6. Program Implementation

An application packet can be downloaded from http://gucchd.georgetown.edu or requested by contacting Toby Long, PhD, PT, Georgetown University Center for Child

2 Early Intervention Personnel Preparation Training Activities

and Human Development, 3307 M Street, NW, Suite 401, Washington, DC 20007, 202-687-8742, [email protected]

• The Training includes: 1. The Annual Conference 2. DC Foundations: A basic overview of early intervention offered throughout the year

and is mandatory for all providers applying for credentialing 3. In-service trainings on a variety of issues pertinent to early intervention

• The Resources: DC CSPD and DCEIP have developed a variety of resources to assist providers in meeting credentialing requirements and enhancing knowledge in the field of early intervention. These resources include a Resource Guide for Professional Development, Family Activity Brochures, and Personal Preparation Training Activities. These materials an be downloaded from http://gucchd.georgetown.edu or requested by contacting Toby Long, PhD, PT, Georgetown University Center for Child and Human Development, 3307 M Street, NW, Suite 401, Washington, DC 20007, 202-687-8742, [email protected]

The following set of training activities has been developed to assist in personnel preparation. These materials will assist trainers of early intervention personnel in academic and continuing education settings. The activities include case studies, short-term assignments, group activities, observation and site visits, and writing assignments. The training activities were developed by: Janet Thomas, MEd, OTR/L; Toby Long, PhD, PT; and Rachel Brady, MS, PT of the Georgetown University, Center for Child and Human Development.

For more information on DC CSPD or DCEIP please contact:

Toby Long, PhD, PT Coordinator, DC CSPD Georgetown University Center for Child and Human Development 3307 M Street, NW, Suite 401 Washington, DC 20007 Phone: 202-687-8742 Fax: 202-687-8899 E-mail: [email protected]

Program Manager DC Early Intervention Program Department of Human Services Office of Early Childhood Development, 717 14th Street, NW, Suite 800 Washington, DC 20005 Phone: 202-727-1839 Fax: 202-727-5218

or

Early Intervention Personnel Preparation Training Activities 3

Case Studies

The following case studies are designed to stimulate discussion on a variety of issues in early intervention. Each case is followed by several questions on current issues in early

intervention. These cases can be used as individual assignments, small group assignments, or as a part of classroom discussions. The case studies are vehicles for enhancing knowledge in three core areas related to early intervention: evaluation, eligibility, and service provision within the natural environment.

Objectives In completing the case studies the provider will be able to:

1. Describe the evaluation process used to determine eligibility for early intervention services.

2. List eligibility criteria.

3. Understand the importance of the family as the focal point of intervention.

4. Describe early intervention services that can be helpful to families.

5. Describe the characteristics of autism and developmental delay.

6. Describe the components of providing service in a natural environment.

There are three case studies: Aaron, Kavon and Kaila. The story of Aaron is written to highlight the characteristics of autism and the various treatment approaches and options that are available to families. The story of Kavon highlights the eligibility determination process and the need to consider natural environments in the context of service delivery. The story of Kaila describes the evaluation process and focuses on pre-evaluation planning, anticipating a variety of factors that can influence services and service delivery, including mental health services.

Aaron is an 18-month-old who was diagnosed with autism at 17 months of

age. His parents were devastated to learn that Aaron had autism. He had been diagnosed with epilepsy by a neurologist when he was 15 months old. Aaron has been on medication for his seizure disorder since his diagnosis. His seizures have been under control.

His birth was much anticipated and uncomplicated. Aaron was the first born to his young parents. His parents describe him as a fussy baby who did not like to cuddle. His mother and father first became concerned when Aaron did not smile. His grandparents attributed this to his parent’s inexperience. Aaron also experienced some early feeding issues. These included some vomiting and slow weight gain.

At his six-month medical checkup Aaron’s parents brought up their concerns to his pediatrician. Aaron’s pediatrician was also concerned about Aaron’s slow weight gain. Some tests were ordered. He was found to be anemic but otherwise healthy. He was placed on an iron supplement.

Aaron’s parents became increasingly concerned, as he did not seem to be meeting his developmental milestones. For example, Aaron was 8 months old when he sat; 11 months old when he crawled; and 15 months old when he first started to walk. Additionally, he was not responding to his name. His parents brought up concerns about deafness to their pediatrician. Although he was uncooperative with his hearing test, he did not appear to have a significant hearing loss.

Aaron experienced his first seizure at 15 months of age while he was on vacation with his parents. He was rushed to an emergency facility. After running some tests, a pediatrician made the diagnosis of epilepsy and recommended to the family that Aaron see a neurologist and receive an interdisciplinary evaluation when he returned home.

Although he was seen immediately by a neurologist, it took the family a couple of additional months to receive the interdisciplinary

evaluation. An occupational therapist, psychologist, and speech language pathologist evaluated him in consultation with the neurologist. The evaluations were conducted in a clinical setting. The evaluation consisted of administration of standardized tests, a series of questionnaires, and informal observations.

During the evaluation Aaron demonstrated fleeting eye contact. He did not respond to his name when called by either his parents or the examiners, nor did he follow simple commands such as “come here”, “give me” or “sit down”. He did not use gestures or words to communicate during the evaluation. Aaron was quiet, although some vocalizations, mostly vowel-consonant combinations, were heard. Aaron did not attempt to gain the attention of other people. He often maintained an open mouth posture with a protruding tongue. Some drooling was also noted.

The mental and motor scales from the Bayley Scales of Infant Development-II were given to Aaron as well as the Receptive and Expressive Emergent Language Scale (REEL). His adaptive and social emotional abilities were informally assessed. Results revealed that Aaron demonstrated global developmental delays with atypical behaviors. His cognitive abilities were measured at the 7-month level. His motor skills were at the 12-month level. Aaron’s language skills were at the 6-7 month level. His feeding skills were considered significantly delayed. He had not started feeding himself; ate mostly stage two baby foods; and continued to drink from a bottle. The atypical behaviors that were observed included hand flapping and staring at the lights. Additionally, he did not play with the examiners. He did seek out his parents occasionally for some comfort.

The evaluation concluded that Aaron had epilepsy, autism, and global developmental delays. Early intervention services were recommended and Aaron was referred to the District of Columbia Early Intervention Program.

4 Early Intervention Personnel Preparation Training Activities

Case Studies

Aaron

Early Intervention Personnel Preparation Training Activities

Discussion Questions—Aaron 1. Is Aaron eligible for services through the District of Columbia’s Early Intervention Program?

Why or why not?

2. What are some of the characteristics of autism?

3. Since the diagnosis of autism is based on clinical rather than laboratory findings, what do you think the clinical assessment should include? What other assessments and or methods would you recommend for an evaluation of a child suspected of having autism?

4. What are some of the common and uncommon treatment strategies used with children who are diagnosed with autism?

5. What intervention strategies are used with children with autism? Select one intervention approach used with children with autism and discuss the evidence that supports its use.

6. What are some questions you can think of that would be appropriate to ask Aaron’s parents in order to obtain more information about him?

5

Case Studies

Kavon is a 21⁄2-year-old boy whose mother is concerned about his speech, language,

and behavior. She indicated that Kavon uses two syllable words, but frequently cuts off the beginning and ending of words; thus he is very difficult to understand. Kavon’s mother also said that her 4-year-old child had speech and language difficulties. Her 4-year-old received intervention services, which were helpful. Also, Kavon’s mother reports that Kavon will have “screaming fits” or tantrums mostly at home that will last for 20 to 30 minutes. She is very concerned about this and doesn’t know what to do.

Kavon is one of many siblings. His mother is single and has recently put her children in child care so that she can pursue work and school. She indicated that if Kavon is eligible for early intervention services these services would need to be provided for him at his child care setting.

Kavon was born early at 34 weeks gestation. He did not receive any type of developmental follow-up. He had some difficulty with breast- feeding and was put on the bottle, which he continues to seek out. He has a younger sibling so it is difficult to prevent him from getting a bottle. His mother indicated that she tries to fill the bottle with water.

Kavon had obvious dental problems at the time he was evaluated. His mother reported that he has had many ear infections, but he has not seen an ear, nose and throat specialist. Kavon also has a history of asthma and allergies, but again has not seen any specialists about either of these conditions.

His mother accompanied Kavon to the evaluation. He was a friendly and engaging little boy who had much energy. For the most part he complied with formal testing, especially when instructions were given with visual cues. He was patient and persistent with the tasks. Toward the end of the testing, however, Kavon had a harder time attending to the tasks and following directions. He became active by running and jumping around

the room. When redirected and given several breaks he was able to complete the formal testing. His mother indicated that his behavior during the evaluation was fairly typical of how he is at home.

The mental and motor scales from the Bayley Scales of Infant Development-II were given to Kavon. The Receptive and Expressive Emergent Language Scale (REEL) was administered as well. His adaptive and social emotional abilities were also determined by use of the Vineland Adaptive Scale. The results of the evaluation follow.

Cognitive Development: Kavon achieved a developmental index of 81 with a developmental age of 26 months on the mental portion of the Bayley. Tasks that involved thinking and problem solving with his eyes and hands were a strength. He struggled more with the language items on the cognitive test. He was often echolalic. He had difficulty with many abstract concepts including spatial concepts, quantitative concepts, and descriptors.

Communication Development: Kavon achieved a receptive language level of 20-22 months on the REEL. He also achieved an expressive level of 20-22 months. Based on informal assessment of his speech, Kavon’s articulation was felt to be similar to his language abilities. His relative language strengths included his abilities to imitate environmental sounds, use two word combinations, and use some personal pronouns. His difficulties included expanding his understanding of the meaning of longer verbal information, pointing to smaller body parts, and understanding questions related to the functional use of objects such as “What do you eat with?”. He also needs to learn to ask for help verbally for some of his personal needs.

Motor Development: Kavon achieved a developmental index of 86 with a developmental age of 27 months on the motor portion of the Bayley. His gross motor skills are a strength. Kavon was age appropriate in

6 Early Intervention Personnel Preparation Training Activities

Case Studies

Kavon

Early Intervention Personnel Preparation Training Activities

running, jumping and negotiating the stairs. He did not do as well with fine motor skills such as grasping small objects and manipulating a pencil. Kavon tended to grasp the pencil in his palm and he was not able to imitate or copy simple lines or circles.

Adaptive Development: Kavon achieved a standard score of 81 for an age equivalent of 2 years, 2 months on the Vineland Adaptive Scales. Kavon can feed himself, but at 2 1⁄2 he is

still using the bottle and a sippy cup. He is also struggling with toilet training, as he has expressed little interest in using the toilet. This has become an issue at his child care setting.

Social-Emotional Development: Kavon achieved a standard score of 100 for an age equivalent of 2 years, 6 months on the Vineland Adaptive Scales. Kavon is described as friendly and outgoing and plays well with other children.

7

Case Studies

Discussion Questions—Kavon 1. How could you summarize the evaluation findings in reader or family-friendly terms?

2. What percent delay, if any, is Kavon demonstrating in the various areas of development for which he was assessed?

3. In your opinion should Kavon be found eligible for early intervention services? On what bases are you making your judgment?

4. What services, if any, do you think would benefit Kavon and why?

5. How could Kavon’s services be delivered?

6. What other recommendations do you have for Kavon and his family?

The District of Columbia Early Intervention Program has referred Kaila to you for an

evaluation. Kaila is 15 months old. She attends an Early Head Start program. Her mother, who is described as having some cognitive limitations, dropped out of high school at 15 years of age and now at 22 is attending a program for adults with developmental disabilities. Her mother is also homeless and lives in transitional housing. Kaila’s mother and her teacher at the Early Head Start program think an evaluation is appropriate.

Although she consented to have Kaila evaluated, her mother is not very concerned about Kaila nor her development. She did express some frustration with Kaila’s “fussiness” and her lack of sleeping, however.

Kaila’s primary child care provider is extremely concerned about Kaila’s physical growth. Kaila appears very small for her age of 15 months. Kaila’s mother is not sure how much Kaila weighs but did indicate that her pediatrician is following Kaila for her growth.

Kaila is described as being a picky eater. She is bottle-fed and is difficult to feed. Although her mother indicated that she has no trouble feeding her at home, the primary child care provider indicated that Kaila often gags and throws up at child care.

Kaila’s primary child care provider is also concerned about her temperament. She describes Kaila as having a “flat” affect. Kaila often wants to be held and cries when other children approach her.

Her development sounds as though it has been generally slow all around, although not likely 50% delayed. Kaila has just started to walk by herself. She babbles and says “ma ma”. She will wave “bye bye” as well. She will finger feed but will not use a spoon or drink from a cup.

Her mother and social worker will accompany Kaila to the evaluation. Her primary child care provider will not be able to attend the scheduled evaluation. The evaluation is scheduled for the upcoming week.

8 Early Intervention Personnel Preparation Training Activities

Case Studies

Kaila

Early Intervention Personnel Preparation Training Activities

Discussion Questions—Kaila 1. You are assigned to be the service coordinator for this child and family and will have the

opportunity to speak with the mother by phone prior to conducting the evaluation. What additional information would you like to obtain prior to conducting the evaluation on Kaila? Based on the information provided above make a list of questions you would like to ask.

2. What information should you share with Kaila’s mother prior to her visit?

3. What areas should be addressed during the evaluation and how will you address these areas?

4. Who should conduct this evaluation?

5. Do you think there may be any mental health issues described? If so how will these be addressed?

6. If Kaila is not 50% delayed is it possible that she may still be found eligible for early intervention services? On what basis?

7. Are there any other community-based personnel you would like to talk to about Kaila and her mother?

8. Develop a comprehensive care plan that addresses the needs of Kaila. Include in the plan the services that can be utilized to help meet those needs, who should be assigned responsibility for them, and a timeline for plan implementation.

9

Case Studies

Early Intervention Personnel Preparation Training Activities 11

Assignments

The following five assignments were designed to broaden an individual’s knowledge of early intervention, research, program planning, legislation and resource development. Specific

guidelines and detailed instructions are provided for each assignment. Descriptions, purposes, and objectives for each assignment are also given.

The overall purpose of the assignments is to provide a variety of activities that facilitate learning about the core areas of early intervention. The activities range from site visits to analysis of research, to development of new materials. The range of learning activities caters to the styles of the adult learner and the needs of trainers. Trainers can choose which of the activities are useful for their purposes.

The assignments can be used individually or as group projects. Products such as papers and presentations can be generated from the assignments. The trainer should decide on how to use and/or modify any one or all of the assignments.

Objectives Following completion of the assignments, students of early intervention will be able to:

1. Research traditional and non-traditional early intervention strategies.

2. List and discuss journals outside their specific field of expertise.

3. Describe the types of settings in which infants and young children receive care.

4. Understand the federal legislation related to early intervention.

5. Develop helpful tools for parents.

12 Early Intervention Personnel Preparation Training Activities

Assignment One: Intervention Approaches for Children with Disabilities

Purpose To become familiar with the variety of intervention approaches provided to children with disabilities.

Format Each presenter will have 10 minutes to present a succinct review of an intervention approach. The review should include:

• Purpose of the intervention. • Population of children the intervention is designed for (disability, age). • General description of the intervention including: who performs the intervention,

where the intervention is conducted, what the intensity level is and the cost, equipment needed, special expertise, certification, training, etc.

• Research related to the intervention approach. • Critical analysis: from literature, own experience, family experiences, etc. • Local practitioners who practice the approach. • Web site or other internet resources pertaining to the intervention approach.

Documentation Each presenter will provide a one-page summary in bulleted format on the intervention approach she/he examined. The summary should include the above information as well as the names and contact information for local practitioners, if known; and three citations from the literature that describe, critique, or analyze the approach.

Intervention Approaches The following includes a partial list of early intervention approaches. Trainers may add others.

Assignments

• Sensory Integration • Developmental, Individual

Differences, Relationship Based Model (DIR)

• Neurodevelopmental Therapy (NDT)

• Developmental Optometry • Discreet Trial Training-

Lovaas • Developmentally

Appropriate Practice (DAP)

• Auditory Integration Training: Berard, Tomatis, Samonas

• Cognitive-Developmental Systems Approach: Miller Method

• Lindamood Phonemic Sequencing Program: Lindamood-Bell

• Movement Opportunities Via Education (MOVE)

• Myofascial Release (MFR) and Cranial-Sacral Therapy (CS)

• Applied Behavioral Analysis • MEDEX • Fast Forward • TEACCH • Conductive Education • Activity Based

Intervention (ABI) • Phonographics/Earopics • Nutritional Supplements/

Diets • Advanced Neuromotor

Rehabilitation

Early Intervention Personnel Preparation Training Activities

Assignment Two: Research Five Journals Outside Your Field of Expertise

Purpose To become familiar with a variety of publications outside your field.

Format Each student/trainee will produce a summary of a journal outside their field, but within a field that they would potentially work.

Documentation Generate a one-page summary on each of the journals researched that includes the following information:

• Name of the journal • Purpose of the journal • Editor of the journal • Publication information • Frequency of the publication • Types of articles • Affiliation of the journal with a professional association • Target audience • Subscription rate • Critical analysis of the journal: Is it worth spending the fee for this journal?

Why or why not? • How to order the journal

Publications The following includes a partial list of publications from a variety of organizations. These journals c

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