Early Childhood Intervention Views from the Field: Report of a Workshop (2000) / Chapter Skim
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Early Childhood Interventions: Views from the Field
Early Childhood Interventions: Views from the Field
Pages 1-36
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Craig Ramey Workshop participants were selected to represent the following distinct service streams: primary health care; chilc3 care/ early education; programs for children living uncler conditions of poverty; chilc3 welfare services, including foster care anc3 adoption; substance abuse treatment programs; interventions for children with, or at risk for, developmental disabilities; anc3 chilc3 mental health services. Drawing on the diversity of perspectives around the table, the workshop planners sought to elicit both common themes that cut across multiple service streams anc3 issues that are unique to specific areas of service delivery.
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· 1 1 · · 1 1 1 ~ , 1ncluumg primary health care and child care/early education. The second panel focused on targeted interventions designed to address family-centered vulnerability, such as programs for children living under conditions of poverty and child welfare services.
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They generally agreed on aspects of early childhood development that can and should be changed, although they did not always agree on what it takes to achieve specific impacts. The most pervasive concept articulated throughout the proceedings was the universally supported view of child development as a -- - - - r continuous process influenced by reciprocal transactions between children and their caregivers, caregivers and the caregiving .
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For which children, at what points during development, are programs most effective in counteracting disadvantage and promoting health and well-being? What biological and social risk factors serve as a focus for service delivery, and what protective factors and sources of resilience do services aim to foster?
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With respect to the task of evaluating child competence, representatives from all of the service streams acknowlecigec3 that traditional measures have focused largely on the domains of cognitive, motor, anc3 language skills. Workshop participants agreed, however, that the assessment of social anc3 emotional development anc3 the evaluation of underlying functional capabilities (e.g., mastery motivation, exploration, play, problem-solving skills, memory, attention, anc3 social interaction)
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Establishment of Early Relationships Workshop participants were consistent in their conviction that the establishment of stable anc3 secure relationships is a central feature of healthy human development, anc3 6 therefore a critical goal of developmental promotion anc3 early chilc3hooc3 interven' tion. Beginning with the infant's attach' ment to his or her primary caregivers, anc3 extending to the bonds that young children develop with other adults, siblings, anc3 peers, early relationships were viewed as both the foundation anc3 the scaffold on When children [earn that they can trust their primary careg~ver' they develop expectations that they can generally trust others.
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While acknowledging that this legacy continues to dominate most early childhood settings (from generic child care centers to specialized programs for children with environmental and/or biological vulnerabilities) , the workshop participants pointed out that greater importance should be placed on the social and emotional aspects of development, and on the assessment of underlying functional behaviors rather than simply the mastery of observable skills.
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FAMILY FACTORS THAT INFLUENCE EARLY DEVELOPMENT Workshop participants were asked to reflect critically on the current knowledge base in order to address the following questions: What is the nature of the family and family processes that are the focus of services in each field? If not the direct focus of intervention, what is the role of the family in each area of service delivery?
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. substantive interaction among programs that target children living in poverty, services for children with developmental disabilities, preschool mental health services, and child welfare services (including foster care)
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related to family violence, substance abuse, economic stress, or constitutional illness. Child behavior may be affected adversely by prematurity, poor nutrition, illness, disability, or temperamental difficulties.
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Less well appreciated is the disproportionate prevalence of children with biologically based developmental disabilities in low-income and less educated families. Workshop participants acknowledged the significance of these patterns, but were clear in their conviction that demographic markers alone provide limited guidance for effective interventions.
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Particular concerns were raised about the powerful adverse impacts of family violenceanclparentalsubstanceabuse. For example, children who witness domestic violence, or who are the victims of physical abuse clirectly, experience serious consequences, such as psychosomatic clisorclers, anxiety, fears, sleep clisruption, excessive crying, ancl school problems.
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Craig Ramey different beliefs about disability and mental illness, which may influence service delivery strategies and the developmental course of a child with special needs. Although each of the diverse service streams represented at the workshop acknowledged the central importance of "cultural competence" as a cornerstone of state-of-the-art practice, much of the underlying science remains to be developed.
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The concept of community has been clefinec3 in multiple ways as a network of social connections, a target for resource allocation, or simply a physical space. The hypothesized impacts of community factors 14 on child health anc3 development range from the positive effects of an environment rich in social capital to the adverse influences of one that is burclenec3 by poverty, violence, substance abuse, anc3 other threats to human survival.
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These include the adverse consequences of limited recreational facilities, inadequate child care, substandard schools, and a message of social exclusion as a result of racism or discrimination based on ethnic status, social class, or the presence of a developmental disability. Research was cited that demonstrated positive outcomes for children as a result of relocating their families to eliminate the influence of concentrated neighborhood risk It is the supportive context of development that matters.
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16 Facilitators of Growth-Promoting Opportunities Parallel to the discussion on high-risk and clearly detrimental environments, workshop participants identified a number of community characteristics that have been shown to correlate positively with healthy child development. These include supportive social networks for families (particularly for mothers)
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and service streams (e.~., health care, child care/early education, mental health, child welfare. early interven .
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Within this broac3, cross~system context, five characteristics of effective interventions were iclentifiec3: ~ ~ ~ incliviclualization of service delivery; (2) quality of program implementation; (3 ~ a family~centerec3, community~basec3, coorclinatec3 orientation; 18 (4)
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Several participants reported that services that directly target the everyday experiences of children at risk appear to be more effective than those that seek to promote child development indirectly by enhancing either parental competence or the general quality of the caregiving environment. Others emphasized an important role for parent-moderated influences on the achievement of individually tailored goals for young children with disabilities, although it was noted that intervention effects vary significantly depending on the severity of the child's impairment.
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Mark Wolery 20 tively limited data that have been collected on the actual services received by families. Family Centered, Community Based, Coordinated Orientation The principles of family-centerec3, community-basec3, anc3 coorclinatec3 services are firmly embeciclec3 in the knowledge base that guides all early chilc3hooc3 programs, from the generic child care facility to the most highly specialized intervention for young children with complex developmental clisabilities or severely compromised life circumstances.
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For children with developmental disabilities, the promotion of competence within normative community contexts is particularly important as a vehicle for both learning how to generalize newly acquired functional skills anc3 for gaining social ac' ceptance. The problems associated with service fragmentation have been endemic to the world of early chilc3hooc3 intervention for clecacles, anc3 the workshop discussions reef' firmed the wasteful anc3 counterproductive burdens of this legacy.
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Some workshop participants noted that research on child care has clearly linked well-trained, qualified teachers and staff to better child outcomes, particularly for lowincome children at risk for educational underachievement. Others reported that child care providers and early childhood educators frequently express concerns about the inadequacy of their professional training and the paucity of available expert consultation to help them address the needs of children with disabilities.
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Timing, Intensity, and Duration of Services Received The research literature on service inten· 1 · 1 ~ · · · S1ty, duration, and age ot 1nltlatlon was identified as perhaps the most complex and inconclusive aspect of the knowledge base examined in this workshop. Some presenters expressed confidence in selected intervention data that supported the value of "earlier" and "more." Others questioned the validity of such data and cautioned against the dangers of advocacy-driven program evaluation research.
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For young children with developmental disabilities, intensity is measured by the time spent with families focused on cleveloping anc3 maintaining relationships anc3 on acquiring knowledge. These measures in.
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CHALLENGES FOR POLICY AND PRACTICE Inter two days ot intensive discussion, the workshop participants identified a common knowledge base and a core set of shared challenges facing the broau-baseu and highly diverse field of developmental promotion and early childhood intervention. Seven issues were identified as in need of increased attention: ( 1 )
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The work' shop discussion on this issue noted two con' sequences for the field one for service delivery anc3 the other for evaluation of service effectiveness. In the first case, the failure of families to continue in programs indicates the need to reevaluate both the goals of the program anc3 the nature of the services that are proviclec3.
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. from the interventions that are designed to assist and advance childhood development.
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For mothers, the diagnosis of depression or a substance abuse problem acicis an enormous burden to the stresses of parenting, anc3 necessitates services that go beyond the simple provision of aclvice anc3 support. For families that confront severe economic hardship or ongoing domestic violence, the needs of their young children extend beyond the reach of educational enrichment activities.
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Children whose clevelopmental vulnerability is rooted largely in a stressful caregiving environment often respond positively to enriched experiences in a structured intervention program, but changing problematic parental interactions is often difficulty All children, with or without biological vulnerabilities, c30 best when they are reared .
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influencing and Assessing the Impacts of Postintervention Environments The clemancis of policy makers for eviclence of long-term impacts from investments in early chilc3hooc3 programs have put professional service providers anc3 program evaluators in a difficult bind. Central to this dilemma is the well-supportec3 assertion that effective early intervention floes not serve as an inoculation that confers a lifetime of immunity to the adverse effects of later experiences.
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To this end, both early childhood intervention and public school education require strengthening to ensure consistent quality within and across developmental stages. Minimizing Unintended Adverse Consequences Several workshop participants raised concerns about the extent to which some early childhood interventions may have unintended negative impacts.
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Strengthening the Service Infrastructure As noted above, services to promote the health anc3 well-being of all young children 32 anc3 early intervention programs for those who are developmentally vulnerable constitute a highly diverse enterprise. Nevertheless, despite the persistence of significant fragmentation at both the policy anc3 service delivery levels, two clays of rich anc3 lively discussion among the workshop participants confirmed the proposition that there is a common body of knowledge that cuts across the multiplicity of service streams.
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For example, preparation to deal effectively with the specialized needs of children with disabilities or the challenges facing families coping with severe economic hardship is rarely addressed adequately in the training of child care providers and early childhood educators, many of whom will be faced with these concerns daily. Converselv.
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Second, there is a serious gap between the cutting edge of child development research and the limited availability of appropriate instruments to assess child comnetence in the delivery setting, particularly in the emotional and social domains. The paucity of reliable and valid methods to evaluate important family and community variables was also underscored.
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Despite divergent opinions about the criteria for defining "hard" knowledge, there was remarkable convergence across all service streams on the nature of the desired child outcomes (with more emphasis on social and emotional development) , the most important family-based and community-based mediators of child development, and the broadly defined characteristics of effective interventions.
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