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Li, 3 years old p. 58

Background

Li is three years old and lives in a beach community. A quiet, sweet-natured little girl with a lot of determination, she was born prematurely and, as a result, has a significant visual impairment and mild delays in language and cognitive development, including having difficulty feeding herself. Li lives with her parents, Tran and Phuong, and is an only child. She has been attending the Jackson Family Child Care Home since she was fourteen months old. Li’s parents had previously used Tran’s mother to care for their daughter, but when the grandmother developed health problems, they needed to find other care. Although nervous about using someone who was not a member of the family, they both needed to work. The family found the Jackson Family Child Care Home through their early intervention provider, who had offered intervention services there in the past.

Terry Jackson has 12 children enrolled in her family child care home and employs two helpers, one in the morning and one in the afternoon. Terry had provided care for another child who had been born prematurely; however, that child had different needs than Li. This left Terry wondering how she would address Li’s visual and developmental needs. She did know that the ideas from the early intervention specialist had been very helpful when caring for the previous child, so she was optimistic about taking advantage of the same resource in providing effective care for Li.

Services

Li received Early Start early intervention services through an Individualized Family Services Plan (IFSP) until she was three years old. Through this service, an early intervention specialist made visits to the Jackson Family Child Care Home every other week, and a vision specialist made visits monthly. Li also received visits from the early intervention team at her home on alternate weeks. The early interventionist and service coordinator worked with the family and provider designing a transition plan since service providers changed at age three.

Li had transitioned to receiving services from the local school district through an Individualized Education Program (IEP). Terry Jackson was able to attend the IEP meeting with the family, the early interventionist, the service coordinator and representatives from the school district. After development of the IEP, the team discussed where the services would be provided. The family requested that Li remain at the Jackson Family Child Care Home with support from the district, as they had become quite comfortable with this arrangement. Before this instance, the school district had not provided services in a family child care home, but the personnel agreed on the arrangement.

Strategy

Because Li has a visual impairment, the environment was the primary area that needed modification. She could make some visual distinctions: she could see shapes that were within six inches of her eyes and could distinguish between strongly contrasting colors. However, many environmental modifications were needed to support her inclusion. The Jackson family home’s several transition points were the beginning, since it was important that these were made visible to Li. This was accomplished first by moving furniture so that it acted as a border between the family room and dining room, which was up one step, thus protecting Li from tripping up or down that step. Additionally, large removable stickers were placed on the sliding glass door that led outside, ensuring that Li would not walk into the glass. The toys that Li liked to play with were kept in the same place every day, and other children were encouraged to return them to the same shelf to help Li locate them independently. Containers that held the toys were in colors that contrasted from the toys inside. This also helped Li find what she was interested in.

Toys and materials themselves required modification as well. For example, Li liked to play with containers, take objects out of them, then put the objects back into the containers. Many containers were adapted so that the edges were more visible by coloring them with a permanent marker or by applying colored tape to darken the edge. Li also needed clear contrasts between her food and the plate or bowl she was using. Terry planned which color of plates and bowls to use, depending on the food being served. Beyond her need for contrasting colors, Li preferred that her food did not have mixed textures (like a casserole). As an accommodation, Terry worked with Tran and Phuong to develop ideas for menus. Terry also asked the specialist for resources on feeding for children with disabilities. 

In addition to her own learning, Terry made sure that both of her helpers had a chance to learn from the specialists, since Li’s needs required the attention and involvement of everyone at the home. For example, an adult needed to keep a special eye on Li when the children were all playing. To help everyone contribute to the learning process, Terry keeps a list of questions as they present themselves in the setting. 

One thing everyone learned was that the activities at the family child care home needed to be adjusted, since Terry noticed that Li was hesitant to join in with the larger groups. She made a special point of keeping the groups small by having more than one interesting activity going at a time. The specialists offered helpful ideas about ways to encourage Li to use her body when

moving through the environment. An orientation and mobility teacher from the school district went so far as to create an obstacle course that Li especially enjoyed. As it turned out, all the other children also seemed to enjoy it. Terry was able to participate in one of the IFSP meetings and was actively involved in planning for the transition-to-school services and the IEP for Li at age three. With the knowledge she had gained from the early intervention specialists and the developing relationship with the preschool specialists, Terry was very sure that she could continue to provide a quality learning environment for Li.

Supporting Factors

· The family had a strong relationship with the family child care home educator.

· The family child care home educator had a prior relationship with the specialist and was comfortable asking for help and ideas.

· The specialists were able to visit the environment where the child spent much of her time and offer ideas for modifications.

· All providers at the child care were involved in providing support and creating modifications for Li.

· The child care provider was able to play an active role in the planning meetings (IFSP and IEP) as well as be involved in the transition discussion.

· As a result of the above factors, Li and her family received continuity in care and services and experienced a smooth transition between early intervention and special education.

Danny, 2 ½ years old, p. 63

Background

Danny is two-and-a-half years old and lives on a military base. Very talkative and social, Danny was born with spina bifida, a spinal defect that affects his ability to move his legs and control his bladder and bowels. He also has hydrocephalus (increased fluid around the brain), which has been treated with a shunt (a tube that allows fluid to drain and be absorbed into his body). He has had several hospitalizations for surgeries on his shunt and feet, but none in the past eight months. Danny seems relatively healthy now. He wears leg braces to keep his legs straight and protected. He moves by rolling and scooting on his bottom. He talks quite well, mainly in phrases of two or three words. While he seems to understand what is said to him, he does not have a very long attention span. He lives with his mother, Crystal, who is in the Marine Corps. He began attending the early learning and care center on the military base when he was twenty-two months old.

Services

Danny receives early intervention services from a public school early intervention program. He is visited by an early interventionist weekly at the early learning and care center and occasionally at home. He is also seen in his home by physical and occupational therapists from the early intervention program. The doctors on the base and at the spinal-defects clinic of the local children’s hospital all closely follow his medical care.

Strategy

As Danny became more and more interested in playing with the toys and children in the center, the early learning and care providers asked for help in making the materials accessible and usable for him. At the invitation of the staff at the center, the therapists and early interventionist made visits to observe Danny in the environment and then held a meeting with Crystal and the providers to share ideas. 

As a result of their suggestions, materials at the center were modified in several ways. Some toys and art supplies were placed on lower shelves to give Danny easier access. After careful observation of his interests, a toy car area was moved from a tabletop to the floor. A table easel also was also moved to the floor so that Danny could sit and paint. Nonskid backing was added to the paint tray so that the paint did not tip as Danny scooted over to it. The sensory table was waist- high to children who were standing. This was used when Danny had an adult available to hold him or get a chair for him. Since sensory toys were a high-interest activity for Danny, smaller tubs were filled with his favorite sensory toys and materials and made available on low shelves for him whenever he wanted. Because heavy toys were difficult for Danny to hold while scooting, lighter- weight toys and blocks were also provided. The lighter toys also enabled him to initiate play with other children and join in their play.

Danny also was encouraged to ask his friends and teachers for help when he wanted something. The providers agreed to pay attention to his requests and interests when thinking about what other materials to adapt. His IFSP team (parent, specialist, and child care provider) also decided to explore some type of wheeled toy that Danny could use when he wanted to join in with the other children when they were riding tricycles. After hearing all of these ideas, Crystal became interested in also getting a wheelchair for Danny. Supporting Factors • The child’s interests were observed and respected. • Specialists were available to observe and give ideas. • Materials were provided in a different form or adapted to meet the child’s needs.

Carlos, 4 years old, p.65

Background

Carlos is four years old and lives in a rural community. While very outgoing and friendly, he is more like a two-year-old in most areas of development. Carlos was diagnosed with Down syndrome shortly after birth. He had heart surgery that successfully corrected a heart problem when he was eighteen months old, and he has had no additional health problems. Carlos lives with his mother, Maria, his two older sisters, and one older brother. His mother primarily speaks Spanish, and his siblings are bilingual. His fourteen-year-old sister often cares for him. Carlos was enrolled in the Head Start center at the beginning of the year and attends it four afternoons every week.

Services

Carlos attends a special education class three mornings a week. He attended that class last year as well. His mother had her other children in Head Start and wanted Carlos to attend when he turned four. She has asked that his special education teachers work with the Head Start staff so that Carlos can receive bilingual speech therapy at the Head Start center with other children from his class.

Strategy

Carlos plays with toys like a child younger than four. He often puts toys in his mouth and has trouble using his hands and fingers on small objects. His Head Start teachers are interested in how to modify materials so Carlos can play with them alongside his peers in the class. They also want to support his growth and development in his play with toys and his small muscle movement. One of the Head Start teachers was able to visit Carlos’ special education class and get ideas for toys and activities. The Head Start disability specialist had previously supported many children with Down syndrome and had several ideas to contribute. Carlos’ mother and his sister also helped by letting the team know what his favorite toys were at home.

The first and most important modification was to carefully examine all of the toys available in the classroom, looking for small parts that could be dangerous if Carlos put them in his mouth. Any toys that were considered dangerous were used only under careful adult supervision. Second, toys that Carlos enjoyed were provided in larger form along with similar toys. Teachers were initially worried that they would be forced to use “baby toys” to meet Carlos’ needs, but they were pleasantly surprised at how easy it was to find age-appropriate materials. For example, in a tub that was filled with one-inch cube blocks, larger blocks were added, some with magnets or Velcro that allowed Carlos to successfully stack them. Cars, trucks, and airplanes with large wheels and removable people were brought in near other wheeled toys. Cardboard books (some in Spanish, others bilingual) were placed alongside the paperback books.

Some books were taken apart and put into photo albums, resulting in pages that were thicker and therefore easier for Carlos to turn. In the arts and crafts materials area, three sets of special loop scissors were borrowed from special education personnel; these allowed Carlos to cut with minimum effort; the extra scissors also allowed his friends to try them as well. Larger markers and crayons were added to the supply. The handles of sponge paintbrush were made larger by wrapping duct tape around them. While helping Carlos work through activities, staff members also gave Carlos only the materials he needed for one step at a time, while at the same time helping him think methodically through the directions for any activity. They found that they were often able to simply repeat directions they had given the other children—but one at a time.

The teachers kept Carlos and all of these new strategies in mind when they thought of new materials and activities. As a result, he continued to gain skills while having fun playing with his friends. Carlos blossomed at Head Start and his teachers from the special education class came to observe him. They were able to encourage his new skills in the special education classroom and learned some new things about Carlos.

Supporting Factors

• The family was involved in planning for toys and materials. • The internal resources available supported access to various toys. • The Head Start staff and special education class staff learned by observing Carlos in a different setting.

Luke, 11 years old, p.68

Background

Luke is an eleven-year-old boy with cerebral palsy. He lives with his mother, Joy, and his younger brother in a large city. Luke has always received support in the regular class from the special education teacher. Luke has learning disabilities, and his mobility is affected by his cerebral palsy. He is able to walk and run for short distances but loses his balance on occasion and gets tired when walking long distances. He and his brother attend an after-school child care program on the campus of their elementary school.

Services

Luke is in fifth grade and receives services from the resource specialist, speech therapist, and adaptive physical education teacher at school. He has been attending the after-school program for two years. In the past, there has been little overlap between the specialists and the after- school program. At first, the after-school providers were uncomfortable with Luke’s lack of balance, which resulted in his occasionally falling. Because the providers wanted to avoid an injury, they tried to restrict his outdoor activity by placing him with a group of younger children when the older group was outside or on field trips in the neighborhood. However, he did not like their indoor games and started getting into trouble.

Strategy

After talking with his mother, the after-school providers decided to spend some time talking with Luke about what he wanted to do after school. They discovered that he wanted to play basketball and go on field trips with the oldest group. He also was very good at computer games and wanted the program to have some for him to play. Looking carefully at Luke’s preferences, it was clear that he was asking to do very different things than the after-school providers had been offering him. The first thing they did was receive permission from Joy to talk with the adaptive physical education teacher at the school site and get some ideas for ways to handle the occasional falls and what to do if Luke was injured. Then, on field trip days, his mother brought in his bicycle so that he could go out with the group and keep up. Next, the program, which had previously had a policy against computer games, obtained some games for a donated computer and made playing the computer games one of Luke’s choices during the time he spent inside. This provided Luke with an opportunity to demonstrate the skill he possessed at many of the games. As a result, he was also given leadership responsibilities for teaching and supervising the younger children as they played those games. To support continual efforts to adapt Luke’s after-school setting, the family also requested that regular consultations to the after-school program be written into the IEP, with reciprocal visits for information, ideas, and support.

Supporting Factors

• Luke was able to participate in his program development by sharing his interests and ideas. • The after-school child care provider was open to new ideas from the child, the family, and other adults working with Luke. • The special education program and the child care program shared information, with consultations planned for the future.

Video:

1. https://youtu.be/b6E7njkCSto

2. https://youtu.be/H4OCYtqRLJY

3. https://youtu.be/4GZq4ao-7gE

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