Early Childhood Intervention Natalia Mufel, Education Specialist, UNICEF, New Delhi Developmental delays z z z Child is assessed to have atypical behaviour or does not meet expected normal development for actual or adjusted age in one or more of the following areas of development: perceptual, fine or gross motor, social and emotional, adaptive, language and communication, or cognitive. A delay is measured by using validated developmental assessments. Delays may be mild, moderate or severe. Caused by: poor birth outcomes, inadequate stimulation and nurturing care from birth onward, malnutrition, chronic ill health and other organic problems, psychological and familial situations, or other environmental factors. Disabilities z z Child has a physical, health, sensory, psychological, intellectual or mental health condition or impairment that restricts functioning in one or more areas, such as physical movement, cognitive and sensory functions, self-care, memory, self-control, learning, or relating to others. Many national and international typologies (classifications) of disabilities exist that list impairments by type. On the numbers • By one widely used estimate, some 93 million children – or 1 in 20 of those aged 14 or younger – live with a moderate or severe disability of some kind. • From 21% to 31% of young children in OECD countries are affected by developmental delays and disabilities. • They are derived from data of quality too varied and methods too inconsistent to be reliable. Definitions of disability differ by place and over time, as do study design, methodology and analysis. • No one really knows how many children have disabilities Children with disability are invisible affecting resources and services available for them: • In comparison with high-income countries, fewer premature or very low birth weight infants survive in LAMI countries, and a larger proportion have significant developmental difficulties. • Children with disabilities and their families are too often invisible—in statistics, in policies, in societies. According to the World Disability Report, there are 25 percent people disabled in India . However, according to the data of Census 2001, India has only 2.1% i.e., about 20 million or 2 crore disabled people. One of the critical ways of ensuring children with disabilities can develop to their full potential is through health screening and early intervention. • Nearly, 6 percent of children in India are born with birth defects and 10 percent children are affected with developmental delays leading to disabilities. However, many children with developmental delays are not identified until the age of three or even primary school age, and by then their delays and learning disabilities have become permanent or are very difficult to reverse. • Child Health Screening and Early Intervention Services can reduce the extent of disability, improve quality of life and enable all children to achieve their full potential. • Inclusive health and education services have a critical role to play in building a solid foundation on which children with disabilities can build fulfilling lives. Legal Framework/Operational Guidelines in India • • • • India became seventh country to ratify the UN Convention on the Rights of Persons with Disabilities. Government enacted the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act in 1995 providing equal opportunities for people with disabilities and their full participation in the nation building. The Government has also set up National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities in 2001 and a National Handicapped Finance and Development Corporation in 1997 to promote economic development activities, including self-employment programmes, for the benefit of persons with disabilities. Right to Education mandates schools to become child-friendly, inclusive spaces where children from diverse backgrounds can actively participate in learning through child-centered activities. In 2013, Government of India has launched the Rashtriya Bal Swasthya Karyakram (RBSK) aimed at screening over 270 million children from 0 to 18 years for 4 Ds Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities. Children diagnosed with illnesses shall receive follow up including surgeries at tertiary level, free of cost under NRHM. ECI should be established in collaboration with WCD and MHRD (School Health). UNICEF Guidance z In the early years, early detection and intervention, as well as family support come to the fore. Early intervention is critical and holds tremendous potential for success. It requires high awareness among health professionals, parents, teachers as well as other professionals working with children. Family- and community-based early intervention services should be linked with early learning programmes and pre-schools, which meet the needs of children with disabilities and facilitate their smooth transition to school. z Early Childhood Intervention (ECI) z ECI programmes provide a system of early childhood services and support for: z z z Vulnerable children at high risk for developmental delays or with confirmed developmental delays or disabilities, and Their parents and families. The primary goal of ECI programmes is to support parents in helping their children use their competencies to achieve their full developmental potential and attain expected levels of development, to the extent possible. ECI Approach • Child-centred services build on each child’s strengths and abilities, strive to meet the current and emerging needs of each child, provide individualised services. • Family-focused services help parents advocate for their child and family, ensure that parents are partners in assessments, service planning, and evaluating programme services, involve them in all services related to their child, are friendly, are sensitive to family cultural values and traditions. ECI Programmes usually include: z z z z z z z Home visits and centre-based services Parent education Balanced early stimulation and developmental services Physical, language and occupational therapies Special education and inclusive services Medical, nursing and nutritional services Support services, including social work services, referrals and protective services, if required ECI services z z z z z z Serve infants and children, from birth to 3, and up to 5 Receive referrals from Health service Identify children early through home outreach, and referrals from parents, polyclinics, and child care centres Continuous referral and tracking systems are required: identification, screening and/or assessment, individualised family service plans (IFSP), services, case management, referrals, tracking and follow-up Provide transition to inclusive/regular pre-schools and primary schools or, if necessary, special facilities Collaborate closely with rehabilitation hospitals for health/medical interventions, when needed ECI personnel include: z z z z z z z z z z z Early Interventionists Special Pedagogues/Special Educators Physical Therapists Language/Speech Therapists Audiologists Occupational Therapists Parent Educators Psychologists and Family Therapists Nurses Social Workers and Protective Services Personnel Evaluators Continuum of early childhood services Service intensity Most intensive Types ECI + parent ECI/ECD + education parent educ ECD + parent educ Child status Level of risk High risk of delay Moderate risk Low or no risk Degree of delay/disab. Delayed or disabled Mild delay or No delay or disability disability Malnutrition Moderate to severe Mild, making Normal gains nutrition Health status Severely or Improved, chronically ill but at risk Services Moderately intensive Least intensive Preventive & basic care Continuum of early childhood services (continued) Service aspects Most intensive Moderately intensive Least intensive Assessment Intensive, frequent Regular, Annual less frequent Locations Home visits & centre Centre, fewer visits Centre only, Groups only Frequency Frequent, daily-weekly Bi-weekly, monthly Upon request only Duration Continuous Depends on child status Upon request only Service providers Specialists, Early Interventionists Supervised home visitors Supervised parent educators Guidelines for establishing ECI Systems z z ECI services represent far more than a new organisational framework. They require profound changes in ways of thinking about: z z z Children and how to maximise their potential; Parental rights and empowerment; and Professional competencies and roles in supporting parents and children. Guidelines then present: main activities, guidance and comments z z z z z z z Strategic planning Initial design activities Programme organisation and inter-institutional relationships Training activities Programme implementation Programme evaluation and monitoring Preparing a Plan of Action NIMH PROJECT TEAM 2001 Mrs. V.R.P. Sheilaja Rao Principal Investigator Dr. Jayanthi Narayan Co-Investigator Mrs. Lakshmi RavindraResearch Officer Ms. Rama Cousik Research Assistant NATIONAL INSTITUTE FOR THE MENTALLY HANDICAPPED (Government of India, Ministry of Social Justice & Empowerment) Manovikas Nagar P.O.Secunderabad 500 009, A.P,India ECSE Curriculum Transaction 1. 2. 3. 4. 5. 6. Shift from Medical to Educational Model by engaging Multidisciplinary Team approach for Assessment, Programming & Evaluation Initiate Parent Training Programs for parents of students attending ECSE prior to placement in Regular Pre Schools Develop IEP & IFSP for School Readiness To develop School Readiness schedule for individualised and group learning by selecting customised placement in regular and special school settings Develop Transition Curriculum for shift from home to preschool Adaptations in core and non – academic curricular tasks Package Contents 1. CALENDAR 10 months curriculum, month - wise objectives and activities list with representative pictures. Activities are divided into 5 teaching strategies with headings: - CONVERSATION (Green) - GAMES (Brown) - SONGS (Pink) - STORY (Blue) - CREATIVE ACTIVITY (Yellow) 2. ACTIVITY CARDS Representative pictures, sequenced in steps to teach activities from the calendar. Each step is adapted to suite any disability condition with iconic representation in order to make cards more teacher friendly. 3. TEACHER’S MANUAL Background details of various disability guidelines to use the training package and impart tips to be used in teaching strategies for the disabled in regular preschools. Adapted ECSE Time Table Day 10.30 11.00 (A.M.) 11.00 11.30 (A.M.) 11.30 12.00 (NOON) 12.00 12..30 (NOON) 12.30 01.00 (P.M.) 01.30 02.00 (P.M) 02.00 02.30 (P.M.) 02.30 03.00 (P.M.) 03.00 03.30 (P.M.) MON Music My Family Creativity Out door Games TUE Music Story Indoor Games Fine motor CAI Creativity WED Vegetables Gardening THU Body parts Indoor Games Creativity Color concept Creativity Gardening Picture Reading L U N C H Rhyme Vegetables Body parts Creativity Color concept Fine motor Fine motor Music Out door Games Sand play Fine motor Picture Reading Out door Games Rhyme Vegetables Water play Music Out door Games FRI Out door Games 10.00 A.M. to 10.30 A.M. Prayer, Yoga and Physical Exercises CAI Fine motor Saturday and Sunday Holidays Thank you!