early intervention case study examples

Autism Case Studies: Real-Life Examples and Insights

Stepping into the shoes of individuals with autism spectrum disorder, case studies unlock a world of unique perspectives, challenges, and triumphs that reshape our understanding of neurodiversity. These real-life examples provide invaluable insights into the complex and diverse nature of autism, offering a window into the lives of those affected by this condition. By examining these case studies, we can gain a deeper appreciation for the experiences of individuals with autism and their families, as well as the various approaches to support and intervention that have proven effective.

Overview of Autism Spectrum Disorder and the Importance of Case Studies

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by challenges in social communication, restricted interests, and repetitive behaviors. Understanding Autism: Meaning, Spectrum, and Beyond is crucial for both professionals and the general public. The spectrum nature of autism means that individuals can experience a wide range of symptoms and abilities, making each case unique.

The prevalence of autism has been steadily increasing over the past few decades, with current estimates suggesting that approximately 1 in 54 children in the United States are diagnosed with ASD. This increase in prevalence has led to a growing awareness of the condition and its impact on individuals, families, and society as a whole.

Case studies play a significant role in advancing our understanding of autism. They provide detailed accounts of individual experiences, allowing researchers, clinicians, and educators to gain insights into the diverse manifestations of ASD. These studies help bridge the gap between scientific research and real-world applications, offering valuable lessons that can inform treatment strategies and support systems.

Understanding Autism Case Studies

Autism case studies serve multiple purposes in the field of autism research and treatment. They offer a comprehensive look at an individual’s life, including their developmental history, challenges, strengths, and responses to various interventions. This holistic approach allows for a more nuanced understanding of autism that goes beyond statistical data or generalized descriptions.

Typically, autism case studies include information such as:

1. Developmental milestones and early signs of autism 2. Diagnostic process and assessment results 3. Family history and environmental factors 4. Specific challenges in areas like communication, social interaction, and behavior 5. Strengths and special interests 6. Educational experiences and accommodations 7. Therapeutic interventions and their outcomes 8. Social and emotional development 9. Family dynamics and support systems 10. Long-term outcomes and quality of life

By examining these various aspects, case studies contribute significantly to autism research and treatment. They help identify patterns and trends across different individuals, highlight effective interventions, and reveal areas that require further investigation. Moreover, case studies often inspire new research questions and hypotheses, driving the field forward.

Autism Case Study Examples: Early Childhood

Early childhood case studies are particularly valuable in understanding the early signs of autism and the impact of early intervention. Let’s explore two examples that illustrate different aspects of autism in young children.

Case Study 1: Early Diagnosis and Intervention

Sarah, a 2-year-old girl, was brought to a pediatrician by her parents who were concerned about her lack of eye contact and delayed speech. After a comprehensive evaluation, Sarah was diagnosed with autism at 26 months old. Her case study highlights the importance of early detection and intervention.

Key points from Sarah’s case: – Early signs included limited eye contact, no babbling by 12 months, and no words by 16 months – Comprehensive evaluation included developmental screening, autism-specific assessments, and observations of behavior – Early intervention program started at 27 months, focusing on speech therapy, occupational therapy, and applied behavior analysis (ABA) – Significant improvements observed in communication and social skills by age 4 – Ongoing support and therapy continued as Sarah transitioned to preschool

This case underscores the potential benefits of early diagnosis and intervention in autism, as discussed in Could Autism Be Cured? Exploring Current Research and Future Possibilities . While a cure may not be currently available, early intervention can significantly improve outcomes for children with autism.

Case Study 2: Challenges in Social Communication

Alex, a 4-year-old boy, was diagnosed with autism at age 3 after his preschool teacher noticed his difficulties in social interactions. His case study focuses on the challenges in social communication often experienced by children with autism.

Key aspects of Alex’s case: – Demonstrated advanced vocabulary and memory but struggled with back-and-forth conversations – Showed intense interest in trains but had difficulty engaging in imaginative play with peers – Experienced sensory sensitivities, particularly to loud noises and certain textures – Intervention focused on social skills training, sensory integration therapy, and parent coaching – Progress noted in turn-taking and initiating interactions with peers after six months of intervention

Alex’s case highlights the complex nature of social communication difficulties in autism and the potential for targeted interventions to support skill development.

Autism Case Study Examples: School-Age Children

As children with autism enter school age, new challenges and opportunities arise. The following case studies illustrate some common experiences of school-age children with autism.

Case Study 3: Academic Challenges and Accommodations

Emma, a 9-year-old girl with high-functioning autism, excelled in mathematics but struggled with reading comprehension and writing. Her case study focuses on the academic challenges faced by many children with autism and the accommodations that can support their learning.

Key elements of Emma’s case: – Demonstrated exceptional skills in mathematical calculations and pattern recognition – Struggled with understanding abstract concepts in literature and expressing ideas in writing – Experienced difficulty with time management and organization – Individualized Education Program (IEP) implemented, including accommodations such as extra time for assignments, use of graphic organizers, and assistive technology for writing – Regular collaboration between teachers, parents, and special education staff to monitor progress and adjust strategies

Emma’s case underscores the importance of recognizing both the strengths and challenges of students with autism and providing appropriate support to help them succeed academically.

Case Study 4: Behavioral Interventions in the Classroom

Michael, an 8-year-old boy with autism, exhibited challenging behaviors in the classroom, including frequent meltdowns and difficulty transitioning between activities. His case study explores the implementation of behavioral interventions in a school setting.

Highlights from Michael’s case: – Displayed strong visual-spatial skills but struggled with verbal instructions and changes in routine – Experienced sensory overload in noisy or crowded environments, leading to meltdowns – Behavioral intervention plan developed, including visual schedules, social stories, and a token economy system – Quiet space provided in the classroom for self-regulation – Teacher and staff training on autism and positive behavior support strategies – Significant reduction in meltdowns and improved ability to transition between activities after three months of consistent intervention

Michael’s case demonstrates the effectiveness of tailored behavioral interventions and environmental modifications in supporting students with autism in the classroom.

Autism Case Study Examples: Adolescents and Adults

As individuals with autism transition into adolescence and adulthood, they face unique challenges and opportunities. The following case studies provide insights into the experiences of older individuals on the autism spectrum.

Case Study 5: Transition to Adulthood and Employment

David, a 22-year-old man with autism, navigated the transition from high school to employment. His case study focuses on the challenges and successes experienced during this critical period.

Key aspects of David’s case: – Graduated from high school with strong academic performance in computer science – Struggled with social anxiety and executive functioning skills – Participated in a transition program focusing on job skills, independent living, and social skills – Secured an internship at a local tech company through a supported employment program – Benefited from workplace accommodations, including a quiet workspace and clear, written instructions – Successfully transitioned to full-time employment after six months of internship

David’s case highlights the importance of targeted support during the transition to adulthood and the potential for successful employment outcomes for individuals with autism. Inspiring Autism Success Stories: Journeys of Triumph and Transformation provides additional examples of individuals who have overcome challenges to achieve their goals.

Case Study 6: Relationships and Social Support

Olivia, a 28-year-old woman diagnosed with autism in adulthood, focused on building relationships and developing a support network. Her case study explores the social aspects of autism in adulthood.

Key elements of Olivia’s case: – Late diagnosis at age 25 provided clarity and understanding of lifelong social difficulties – Joined an autism support group and found a sense of community – Engaged in social skills training and cognitive-behavioral therapy to address anxiety – Developed strategies for navigating social situations in personal and professional contexts – Formed meaningful friendships within the autism community and beyond – Advocated for autism awareness and acceptance in her workplace

Olivia’s case underscores the ongoing importance of social support and skill development for adults with autism, as well as the potential for personal growth and advocacy.

Key Findings and Patterns Across Autism Case Studies

Examining multiple case studies reveals several common themes and patterns in the experiences of individuals with autism:

1. Diverse presentations: Each case study demonstrates the unique combination of strengths and challenges experienced by individuals with autism, reinforcing the notion of autism as a spectrum disorder.

2. Importance of early intervention: Cases involving early diagnosis and intervention often show more positive long-term outcomes, highlighting the critical nature of early support.

3. Individualized approaches: Successful interventions are typically tailored to the specific needs, interests, and strengths of each individual, rather than following a one-size-fits-all approach.

4. Ongoing support needs: Many individuals with autism benefit from continued support and accommodations throughout their lives, albeit in different forms as they age.

5. Potential for growth and achievement: Case studies frequently demonstrate significant progress and accomplishments when appropriate support and interventions are provided.

6. Impact of environment: The role of supportive families, educators, and communities is evident in many successful cases, underscoring the importance of creating autism-friendly environments.

7. Comorbid conditions: Many case studies reveal the presence of co-occurring conditions such as anxiety, ADHD, or sensory processing difficulties, highlighting the need for comprehensive care.

8. Importance of self-advocacy: As individuals with autism grow older, the ability to self-advocate and communicate their needs becomes increasingly important for their success and well-being.

Effective interventions and support strategies that emerge from these case studies include:

– Early, intensive behavioral interventions – Structured teaching methods (e.g., TEACCH) – Social skills training and peer-mediated interventions – Assistive technology and visual supports – Sensory integration therapies – Cognitive-behavioral therapy for anxiety and emotional regulation – Vocational training and supported employment programs – Parent and family education and support

The importance of individualized approaches in autism treatment cannot be overstated. What works for one person may not be effective for another, and interventions often need to be adjusted over time as an individual’s needs change. This personalized approach is crucial for maximizing outcomes and quality of life for individuals with autism.

Autism case studies provide invaluable insights into the lived experiences of individuals on the spectrum, offering a nuanced understanding that goes beyond clinical definitions or statistical data. Through these real-life examples, we gain a deeper appreciation for the challenges faced by individuals with autism and their families, as well as the potential for growth, achievement, and fulfillment.

The case studies explored in this article highlight several key points:

1. The diverse nature of autism spectrum disorder and the unique combination of strengths and challenges each individual experiences 2. The potential benefits of early diagnosis and intervention 3. The importance of tailored support and accommodations across different life stages 4. The ongoing need for understanding and acceptance of neurodiversity in society

As we look to the future, autism research and case studies will continue to play a crucial role in advancing our understanding of the condition and developing more effective interventions. Exploring Autism: Key Research Questions and Discussion Topics for In-Depth Understanding provides insight into some of the critical areas that researchers are currently investigating.

Future directions for autism research and case studies may include:

– Long-term follow-up studies to better understand outcomes across the lifespan – Exploration of the impact of various interventions on brain development and functioning – Investigation of the experiences of underrepresented groups within the autism community – Development and evaluation of new technologies to support individuals with autism – Examination of the economic and societal impacts of improved support for individuals with autism

As our understanding of autism continues to evolve, it is crucial that we maintain a commitment to supporting individuals on the spectrum and their families. By fostering acceptance, providing appropriate interventions, and creating inclusive environments, we can help ensure that individuals with autism have the opportunity to reach their full potential and lead fulfilling lives.

Autism for Dummies: A Comprehensive Guide to Understanding and Supporting Individuals on the Spectrum offers additional resources for those seeking to learn more about autism and how to support individuals on the spectrum.

In conclusion, autism case studies serve as powerful tools for understanding, empathy, and progress in the field of autism research and support. By continuing to share and learn from these individual stories, we can work towards a more inclusive and supportive world for all individuals on the autism spectrum.

References:

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2. Baio, J., Wiggins, L., Christensen, D. L., et al. (2018). Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years — Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2014. MMWR Surveillance Summaries, 67(6), 1-23. https://www.cdc.gov/mmwr/volumes/67/ss/ss6706a1.htm

3. Dawson, G., Rogers, S., Munson, J., et al. (2010). Randomized, controlled trial of an intervention for toddlers with autism: the Early Start Denver Model. Pediatrics, 125(1), e17-e23.

4. Kasari, C., Gulsrud, A., Freeman, S., Paparella, T., & Hellemann, G. (2012). Longitudinal follow-up of children with autism receiving targeted interventions on joint attention and play. Journal of the American Academy of Child & Adolescent Psychiatry, 51(5), 487-495.

5. Landa, R. J. (2018). Efficacy of early interventions for infants and young children with, and at risk for, autism spectrum disorders. International Review of Psychiatry, 30(1), 25-39.

6. Lord, C., Brugha, T. S., Charman, T., et al. (2020). Autism spectrum disorder. Nature Reviews Disease Primers, 6(1), 1-23.

7. Magiati, I., Tay, X. W., & Howlin, P. (2014). Cognitive, language, social and behavioural outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood. Clinical Psychology Review, 34(1), 73-86.

8. National Research Council. (2001). Educating children with autism. Washington, DC: National Academy Press.

9. Reichow, B., Hume, K., Barton, E. E., & Boyd, B. A. (2018). Early intensive behavioral intervention (EIBI) for young children with autism spectrum disorders (ASD). Cochrane Database of Systematic Reviews, (5).

10. Roux, A. M., Shattuck, P. T., Cooper, B. P., Anderson, K. A., Wagner, M., & Narendorf, S. C. (2013). Postsecondary employment experiences among young adults with an autism spectrum disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 52(9), 931-939.

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Early intervention for children with developmental disabilities in low and middle-income countries – the case for action

Tracey smythe.

International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK

Maria Zuurmond

Cally j tann.

Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK

MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda

Melissa Gladstone

Institute of Translational Medicine, University of Liverpool, Liverpool, L69 7TX, UK

Hannah Kuper

In the last two decades, the global community has made significant progress in saving the lives of children <5 y of age. However, these advances are failing to help all children to thrive, especially children with disabilities. Most early child development research has focussed on the impact of biological and psychosocial factors on the developing brain and the effect of early intervention on child development. Yet studies typically exclude children with disabilities, so relatively little is known about which interventions are effective for this high-risk group. In this article we provide an overview of child development and developmental disabilities. We describe family-centred care interventions that aim to provide optimal stimulation for development in a safe, stable and nurturing environment. We make the case for improving opportunities for children with developmental disabilities to achieve their full potential and thrive, including through inclusive early childhood development intervention. Finally, we call for the global research community to adopt a systematic approach for better evidence for and implementation of early interventions for children with developmental disabilities in low-resource settings.

Introduction

Substantial global progress has been made in reducing child deaths since 1990 and the mortality rate of children <5 y of age has decreased in all world regions. However, non-communicable morbidities and disabilities have not been addressed to the same extent. This review discusses the urgency of taking actions to narrow the inequality gap in early childhood developmental care, especially for the 53 million children <5 y of age living with disabilities and developmental disorders such as epilepsy, intellectual disability, sensory impairments, autism spectrum disorder and attention deficit hyperactivity disorder. 1 A focus on supporting children with disabilities to thrive during their early years is important, as this period is critical for maximising their development. Furthermore, under the United Nations Convention of Rights for a Child and the United Nations Convention of the Rights of Persons with Disabilities, governments are duty-bound to provide early years services that are inclusive of and available to all children. 2 , 3 This article will describe child development and developmental disabilities and make the case for which equitable early childhood development (ECD) interventions may be optimal for helping children with developmental disabilities to achieve their potential.

Child development

Early childhood is a period of great opportunity for optimum brain growth, but it is also a period of vulnerability. Development in language, cognition, motor and socio-emotional domains occurs rapidly in these first years. These areas of development do not operate or develop in isolation, but enable each other and mutually interact as the child learns to become more independent. For instance, as a child learns to see, she will increasingly reach for and play with objects and thereby develop motor skills and coordination. Biological, psychosocial 4 , 5 and environmental factors also crucially affect the structure and functioning of the brain as it is developing. 6 For example, if a child experiences adequate nutrition and is provided with opportunities to play, she may progressively explore her environment and interact with her caregiver and by doing so, reinforce her psychosocial development. Furthermore, the time period when these factors influence brain growth are critically important, as there are particular early windows of opportunity that if not harnessed, may prevent optimal brain development and lifelong well-being. 7

It is increasingly apparent that optimal early child development has lifetime beneficial consequences for educational achievement, adult productivity and population health. 8–10 Conversely, exposure to biological and psychosocial risks negatively affects the developing brain and compromises the development of children. 5 Many structural factors determine these early child circumstances. These factors include a lack of nurturing care (nutrition, stimulation, good health) in the early years, as well as inadequate cognitive and psychosocial stimulation. 5 , 11 Children <5 y of age in low- and middle-income countries (LMICs) may be particularly at risk of poor development due to poor health and nutrition. 7

Child development can be encouraged through intervention in early childhood. 11 A number of mutually important elements are needed for maximising children's development. These include supporting responsive relationships, reducing sources of stress in the lives of children and families, building executive function and self-regulation skills and reinforcing contexts in which learning is most achievable across all developmental domains. 12 , 13 ECD interventions work to improve development through integrating family support, health, nutrition and educational services and providing direct learning experiences to young children and families. 14

The strategic focus of the World health Organization (WHO), United Nations Children's Fund (UNICEF) and World Bank ‘Nurturing Care Framework’ is therefore timely. 15–17 This action plan provides a framework for helping children survive and thrive through five strategic actions—lead and invest, focus on families and their communities, strengthen services, monitor progress and use data and innovate—and thereby aims to transform health and human potential. We know that urgent action is necessary to improve early childhood outcomes and ensure that all children reach their full potential as adults. Children with developmental disabilities must be included in this agenda, as they are a marginalised group with additional and specific needs and will otherwise be left behind.

Developmental disability

Developmental delay and developmental disability are two distinct concepts. Developmental delay is often defined as a deviation from normative milestones; this may be in terms of delayed cognitive, language, motor and/or socio-emotional development. 18 The term developmental disabilities covers a range of childhood conditions and is used differently across different settings and cultures. 19 In this article we define developmental disability as a heterogeneous group of conditions that can impact on the development of children's function (e.g. sensory, cognitive, physical), with a very wide range of effects. 20 Developmental disability is the most common cause of childhood disability, with an estimated 53 million children <5 y of age living with developmental disabilities globally. 21 This estimate is based on only six conditions (epilepsy, intellectual disability, vision loss, hearing loss, autism and attention deficit hyperactivity disorder) and on present reporting of these conditions. It is likely therefore that the true number of children with developmental disability is much higher than this estimate, particularly if a broader age range is considered.

The majority of children with developmental disabilities live in LMICs, 21 and the prevalence is higher among families with high levels of poverty and low education. 27 However, there remain data gaps for the prevalence, epidemiology and causes of developmental disabilities in LMICs. 28 One reason for the uncertainty in the estimates is that identification of children with or at risk of developmental delay requires assessment using valid developmental evaluation tools to measure ECD 29 (Box (Box1), 1 ), and these facilities are often not available in LMICs.

Identification of children with developmental disabilities

In order to meaningfully measure thriving and well-being of children globally, developmental assessment tools need to be culturally relevant and age appropriate and cover the spectrum of developmental domains, including sensory impairments and educational outcomes. Examples of tools with high validity and reliability to measure several developmental domains include the Bayley Scales of Infant and Toddler Development (BSID II or Bayley-III). Regionally developed instruments include the Malawi Development Assessment Tool and the Kilifi Developmental Inventory. However, a recent review found variability in translation, adaptation, piloting and standardisation of tools, with important domains such as vision, hearing, functioning and disability often omitted, which limits holistic understanding of a child's progress. In addition, no tool covers all domains of development and is accurate and feasible in all contexts.

The impacts of developmental disabilities extend far beyond functional abilities. Children with developmental disabilities and their families are at high risk of social exclusion, exclusion from education and even stigma and violence. 30 Furthermore, looking after a child with developmental disabilities potentially places an enormous strain on families, and caregivers experience high levels of stress, anxiety, depression, physical exhaustion, stigma and discrimination. 31 This further increases the risk of mental ill health and social isolation in caregivers. A recent systematic review found caregivers of children with intellectual and developmental disabilities, when compared with caregivers of children without intellectual and developmental disabilities, experienced elevated levels of depressive symptoms (31% vs 7%, respectively) and anxiety symptoms (31% vs 14%, respectively). 32 There are also substantial costs to childhood disability, both the cost of additional services and resources required by the child and the lost income from parents who are caring for their child. Consequently, childhood disability may exacerbate poverty. 33 , 34 However, there is generally a lack of available services and support for children with disabilities and their families, especially in LMICs, which further compound these risks.

Early intervention for children with developmental disabilities

Evidence is limited, but growing, on the effectiveness of ECD interventions for children at risk of and with developmental delays, particularly in LMICs. 35 Indeed, many programmes and studies actively exclude children with developmental disabilities, as additional considerations may be required, and children with developmental disabilities may be unable to show progress when using developmental progress as the primary outcome 9 , 36–38 (Box (Box2 2 ).

Inclusion of children with developmental disabilities in clinical trials

Our review of the first 100 titles of registered clinical trials of ECD interventions (Appendix ), and inclusion of children with disabilities, demonstrated that 50% of the trials exclude children with disabilities, 22% of trials target children with disabilities, 3% of trials target children in general and include children with disabilities and 25% of trials do not specify whether children with disabilities are included or excluded.

Consequently, risks to delayed development are compounded for children with developmental disabilities, as they potentially receive less stimulation and fewer learning opportunities through other health service or care routes. 39 Exclusion of children with developmental disabilities from ECD thus perpetuates an already fragile cycle of development. We know that early childhood developmental intervention for these children is imperative, but we cannot inform planning and delivery of inclusive services for all children without better research in this area. For example, there are gaps in evidence-based approaches to monitoring and evaluation of ECD projects in LMICs, such as challenges in measurement of outcomes in routine programmes, which limit comparative understanding of impact, and in defining and monitoring quality and coverage. 25

Early identification of children with developmental disabilities, as well as early childhood intervention (ECI), improves children's opportunities to maximise their developmental potential and functioning as well as their quality of life and social participation. 40 , 41 Early identification and intervention are two distinct complementary strands; timely identification of children with developmental disabilities is required for early intervention, which strengthens the cumulative process of development, helping children acquire new skills and behaviours to reinforce and strengthen learning. In addition, some ECIs may have wider benefits for caregivers, such as through establishing support, thus helping build their knowledge, confidence and coping strategies, 32 with positive impacts for their mental health. However, data are lacking from LMICs and there is a paucity of implementation evidence to guide policymakers and donors. 33

ECI for children with disabilities can comprise a range of coordinated multidisciplinary services and can take many forms, including hospital- or clinic-based care, school-based programmes, parenting and community support and home-based childhood therapies. In high-resource settings, we know that family-centred interventions are more likely to result in the greatest satisfaction with services and improve psychosocial well-being for the child and caregiver. 42 With regards to impact, a systematic review of ECIs for children at risk of cerebral palsy demonstrated improved cognitive outcomes up to preschool age and improved motor outcomes during infancy, although variability in interventions limited the identification of which interventions are most effective. 43 Nevertheless, without such ECIs in LMICs, years lived with disability will be more than 3.3 million. 1

There are broadly two approaches to providing ECI for children with developmental disabilities, including children with disabilities in mainstream ECD interventions and targeted intervention programmes for children with disabilities. These approaches take many different forms, as they are used to support children and families with different needs. For example, universal programmes in the UK, such as the five mandated health visits for young children, are offered to all families. In contrast, targeted programmes, such as the Disabled Children's Outreach Service (DCOS), are aimed specifically at vulnerable families of children with a disability where the children are at higher risk of poor outcomes in later life. 44

While both inclusive and targeted efforts for children with disabilities at the level of early childhood centres have increased, 45 weak country health systems and conflict settings are major impediments to delivering high-quality services. 46 There remains a need for inclusive approaches for children with developmental disabilities in mainstream services, as well as within specialist ECIs. This means that the role of families can be particularly crucial to fill existing gaps in service availability.

Case studies of ECI for children with developmental disabilities

A number of case studies have been identified for ECI for children with developmental disabilities. The following have been selected for description, as they illustrate different approaches for children with different developmental disabilities in several LMIC settings.

The WHO has developed Caregiver Skills Training (CST) for caregivers of children with intellectual disabilities. 47 , 48 The CST consists of nine group sessions and three home visits. The programme teaches strategies to promote communication and learning and address challenging behaviours. However, sustainable and scalable quality delivery of the group format by a lay facilitator remains a challenge due to limited integration in health systems. 49 Evidence of effectiveness is currently lacking, but randomised controlled trials are under way in Pakistan (Family Networks [FaNs] for Children with Developmental Disorders and Delays 50 ) and Italy, with future trials planned in China, Ethiopia and Kenya. 51

Interventions that aim to provide contextualised psychological support to caregivers of children with intellectual disabilities include ‘Titukulane’, a community group intervention that aims to reduce mental health problems among the parents of affected children. 52 This community-based intervention consists of eight modules that have been developed and piloted to help parents cope with the challenging role of caring for a child with intellectual disabilities.

Learning through Everyday Activities with Parents (LEAP-CP) is a family-centred intervention delivered peer to peer at home during 30 weekly 2h visits that aims to improve the mobility of children with cerebral palsy. 53 Visits include therapeutic modules (goal-directed active motor and cognitive strategies and LEAP-CP games) and parent education. Randomised controlled trials are currently under way in India. 54 The trial also provides nutrition and health support to all families in the study, which may influence the findings.

The London School of Hygiene & Tropical Medicine (UK) has developed three caregiver group interventions under the ‘Ubuntu’ umbrella (resources available from www.ubuntu-hub.org ). The interventions consist of 10 sessions, the content of which includes information about essential care practices, such as feeding, positioning, communication and play, offered through a local support group format. ‘Getting to know cerebral palsy’ was developed as a resource to empower families using a participatory approach at the community level. 31 , 55 The ABAaNA Early Intervention Programme (EIP) was developed in response to a recognised need to support families of very young children (<2 y) with an evolving developmental disability. 56 ‘Juntos’ was developed for children with congenital Zika syndrome and their families in Latin America and integrates a strengthened component on caregiver emotional well-being, arguably fundamental to a child's early development. 57–60

Interventions for children with autism spectrum disorder include PASS, a parent-mediated intervention for autism spectrum disorder in India and Pakistan. 61 The intervention uses video feedback methods to address parent–child interaction and was adapted for delivery by non-specialist workers. As PASS is focused on improving a child's social communication, common mental health comorbidities such as sleep difficulties will be important to integrate into wider intervention programmes.

These examples provide good case studies of diverse interventions for different children with developmental disabilities in different low-resource settings. These case studies indicate that in LMICs, the gap in meeting the holistic needs of children with developmental disabilities may be addressed through the use of community-based group interventions facilitated by trained and supervised health or peer support workers. Commonality is the focus on caregiver involvement, which is critical, particularly where there are few health services. Yet formal evaluation of their effectiveness and cost-effectiveness is lacking, in addition to limited implementation with education and social welfare, which hampers scaling of these services.

The case for action

The number of children with developmental disabilities is large and the impacts on the child and family are extensive. There are valuable lessons learned from case studies, yet there remains insufficient progress in ECI for children with developmental disabilities and unmet needs are widespread. The causes of this gap are complex and diverse. An important reason is that in many settings health services are often fragile, poorly coordinated and overstrained, with concerns about the availability and quality of healthcare workers capable of delivering the intervention. Health systems gaps are particularly important in fragile states, including those affected by war and famine, as they experience many competing pressing needs. Furthermore, the policy agenda supporting a focus on children with developmental disabilities is weak internationally and nationally in many cases, limiting the priority given to this issue and the availability of funding for developing services. Ensuring inclusive education is a clear responsibility for United Nations member states under international treaties and Sustainable Development Goal 4, to ‘ensure inclusive, equitable quality education for all’. However, investing in inclusion prior to schooling is not mandated and consequently becomes optional. Cultural challenges also exist, such as widespread stigma and discrimination around children with disabilities and their families. 62 Finally, the evidence base on needs for and effectiveness of services is currently weak and needs to be strengthened. Enhancing environments that provide equal opportunities for children with developmental disabilities for ECI therefore requires a systems approach with global collaboration.

Accordingly, priorities for future research to ensure that all young children reach their development potential include assessment of the effect of interventions for children with developmental disability and their families in different low-resource settings. Further identification of barriers to accessing general services (e.g. primary healthcare) as well as specialist services is also required, as poverty remains a major issue for affected families in LMICs. Furthermore, studies that identify how to maximise the reach and cost-effectiveness of ECD interventions for children with developmental disabilities are warranted. Evaluation of how these interventions can be embedded within health systems are needed to strengthen the service delivery strategies. Global collaboration in these efforts are required in research, and critical steps include providing best evidence on practices to improve knowledge and skills at local levels to avoid children with developmental disabilities being turned away from existing services and evidence of ‘what works’ to provide sustainable, inclusive ECD interventions with impact in resource-constrained settings. We call for international research communities, including funders, to adopt a systematic approach for better evidence.

ECD interventions are aimed at improving the development of children. However, children with developmental disabilities are often excluded from these programmes, even though they have the greatest need for support. There is still a dearth of research about what interventions are effective in improving outcomes for this marginalised group and an even greater lack of evidence on cost-effectiveness and what can be successfully implemented at scale. A two-pronged approach is likely to be optimal, encouraging the inclusion of children with disabilities in mainstream ECD programmes, while also offering targeted approaches, most likely through caregivers. We call for global collaboration among international research communities, including funders, to adopt a systematic approach to strengthening the available evidence base of interventions for children with developmental disabilities and their families. We call for greater attention for this marginalised group, to prioritise public policies and hold governments accountable to ensure that multisectoral services centred around the child and his/her family are provided during this crucial time. This will contribute to ensuring that all children have an early foundation for optimal development, a key factor in equitable long-term health.

Acknowledgements

Completed clinical trials with a focus on developmental outcomes

	Title	Start date	Country	Target children with disabilities	Includes children with disabilities	Does not include or exclude	Excludes children with disabilities
1	The Pakistan Early Childhood Development Scale Up Trial	2009	Pakistan				1
2	Iron Treatment for Young Children With Non-anemic Iron Deficiency	2012	Canada				1
3	Project Grow Smart: Intervention Trial of Multiple Micronutrients and Early Learning Among Infants in India	2012	India				1
4	Early Child Development and Nutrition in Guatemala	2015	Guatemala				1
5	Strong Families, Thriving Children “Sugira Muryango”_Activity C	2018	Rwanda			1
6	Implementation and Adoption of Care for Child Development in Day Care Centers	2015	Lebanon				1
7	CASITA Intervention for Children at Risk of Delay in Carabayllo, Peru	2013	Peru			1
8	Family Inclusive Early Brain Stimulation	2014	Nigeria				1
9	Applying Mindfulness for Economically Disadvantaged Families	2016	Hong Kong				1
10	Promoting Child Development Practices in the First Year of Life Through a Video Administered at Two Different Times	2008	Italy			1
11	Promoting Early School Readiness in Primary Health Care	2005	USA				1
12	Improving Early Childhood Development in Zambia	2014	Zambia			1
13	Early Intervention for Developmental Delay	2014	Taiwan				1
14	A Family Centered Intervention to Promote Optimal Child Development	2013	USA			1
15	Family Strengthening Intervention for Early Childhood Development (ECD)	2014	Rwanda			1
16	Screening for Therapy and Empowering Parents: A Pilot Study	2015	USA				1
17	Alliance for Family Strengthening: Improved Early Childhood Development in Rwanda	2017	Rwanda			1
18	Efficacy of Tools of the Mind for Enhancing Self-Control in Preschoolers	2012	Canada				1
19	Early Literacy Promotion Intervention	2016	USA				1
20	Zinc and Biobehavioral Development in Early Childhood	2004	Peru				1
21	The Effect of a Cash Transfer Program and Preventive Nutrition Packages on Household Welfare and Child Nutritional Status in Mali	2014	Mali				1
22	Enhancing Ugandan HIV-Affected Child Development With Caregiver Training	2012	Uganda				1
23	Early Intervention for Preterm Infants	2006	Taiwan				1
24	Effect of Improving Caregiving on Early Mental Health	2000	Russia			1
25	Testing the Effectiveness of Telephone-based Early Childhood Developmental Screening	2015	USA		1
26	Early Family-Centered Prevention of Drug Use Risk (Aka Early Steps)	2003	USA			1
27	Effect of Power Wheelchairs on the Development and Function of Young Children With Severe Physical Disabilities	2002	USA	1
28	Effect of Community Based Depression Management and Child Development	2014	Bangladesh				1
29	Play and Pre-Literacy Among Young Children	2015	Canada				1
30	Social and Communication Outcomes for Young Children With Autism	2009	USA		1
31	The Anemia Control Program: Early Intervention	1992	Chile				1
32	Early Psychosocial Stimulation Program for Children of Depressed Mothers	2009	Pakistan			1
33	Promoting Infant Mental Health in Foster Care	2007	USA			1
34	Addressing Systemic Health Disparities in Early Identification and Treatment of Autism Spectrum Disorder (ASD): ABCD Project	2014	USA		1
35	The MOM Program at the Children's Hospital of Philadelphia	2001	USA			1
36	Translating Evidence Based Developmental Screening Into Pediatric Primary Care	2008	USA				1
37	Improving Parental Psychosocial Functioning and Early Developmental Outcomes in Children With Sickle Cell Disease	2014	West Indies			1
38	Promoting Healthy Development With the Recipe 4 Success Intervention	2013	USA			1
39	Long Term Effect of Early Iron Supplementation and Psychosocial Stimulation on Growth and Development of Iron-deficient Anaemic Infants	2015	Bangladesh			1
40	Reduce Childhood Maltreatment and Promote Development	2015	Bangladesh				1
41	The Impact of Cash and Food Transfers Linked to Preschool Enrollment on Child Nutrition and Cognitive Outcomes	2010	Uganda			1
42	Effects of Family-Centered Intervention for Preterm Infants at Preschool Age	2015	Taiwan				1
43	Effectiveness of Parent-Child Interaction and Emotion Development Therapy in Treating Preschool Children With Depression	2007	USA				1
44	The Effects of Iodized Salt on Cognitive Development in Ethiopia	2011	Ethiopia		1
45	An Intervention for Enhancing Early Attachment in Primary Health Care	2013	Chile				1
46	The MOM Program: 5 Year Follow-up Study of a Home Visiting Program at the Children's Hospital of Philadelphia	2004	USA				1
47	Small Step Intervention for Infants With Cerebral Palsy and Other Neurodevelopmental Disorders	2014	Sweden	1
48	Intervention Effects of Intensity and Delivery Style for Toddlers With Autism	2008	USA		1
49	Motivational Interviewing to Increase Parent Engagement in Preventive Parenting Programming	2013	USA				1
50	Intensive Intervention for Toddlers With Autism (EARLY STEPS)	2013	USA		1
51	Optimizing Social and Communication Outcomes for Toddlers With Autism	2008	USA		1
52	Primary Prevention of Allergic Disease in Early Child by	2001	Sweden			1
53	Intervention for Toddlers at Risk for Autism Spectrum Disorders (ASD)	2008	USA		1
54	Promoting Development in Toddlers With Communication Delays	2007	USA				1
55	Early Intervention, Supervision, Quality and Outcome in ASD	2013	Sweden			1
56	Differential DNA Methylation as a Function of a Parenting Intervention	2013	USA				1
57	Early Connections, Early Detection and Intervention in Infants at Risk for Autism	2008	USA		1
58	Early Characteristics of Autism	2003	USA		1
59	School- and Home-Based Early Intervention for Toddlers With Autism	2003	USA		1
60	Follow-up of Families in Early Preventive Intervention	2000	USA			1
61	Parent Training Program for Preschool Children With Autism Spectrum Disorders	2015	Taiwan		1
62	RESPECT-PLUS: Services for Infants With Prenatal Opiate Exposure	2013	USA				1
63	Early Nutritional Intervention in Patients With Autism Spectrum Disorders	2010	Qatar		1
64	Maximizing Language Development in Children With Hearing Loss	2013	USA				1
65	Mother and Child Education Program in Palestinian Refugee Camps	2014	Lebanon			1
66	Early Intervention and Autism: Transformation From Research to Practice Through a Competency Based Model	2017	Sweden		1
67	Mindfulness Training and Parent-coaching Interventions for Autism Spectrum Disorder	2015	USA		1
68	Impact of an Intervention Program on Parenting Stress After Preterm Birth	2006	France				1
69	Efficacy Trial of the Kids in Transition to School (KITS) Program for Children With Developmental Disabilities and Behavioral Problems	2008	USA				1
70	Social-emotional Under 4’s Screening & Intervention S.U.S.I.	2016	USA		1
71	H3: Healthy Minds, Healthy Children, Healthy Chicago Project Evaluation	2014	UK			1
72	Reproducibility Inter-session of the Measurement Elastography of the Passive Stiffness of Medial Beams of Gastrocnemius Muscle of the Hemiplegic Cerebral Child	2017	France	1
73	Transition to Scale of Nutrition and Psychosocial Stimulation Program for Malnourished Children	2014	Bangladesh				1
74	Electronic Patient-reported Outcomes (e-PROs) in Early Intervention	2016	USA	1
75	Iron Deficiency Anemia and Psychosocial Stimulation	2007	Bangladesh				1
76	Omega Tots: A Randomized, Controlled Trial of Long-chain Polyunsaturated Fatty Acid Supplementation of Toddler Diets and Developmental Outcomes	2012	USA			1
77	Zinc, Iron, Vitamin A and Psychosocial Care for Child Growth and Development	1998	Indonesia				1
78	Middle Ear Disease Before Age 3, Treatment With Ear Tubes, and Literacy and Attentional Abilities at Ages 9 to 11	2002	USA				1
79	The Effect of a Deworming Intervention to Improve Early Childhood Growth and Development in Resource-poor Areas	2014	USA				1
80	Comparing Parent-Implemented Interventions for Toddlers With Autism Spectrum Disorders	2007	USA		1
81	Strengthening Families and Reducing Risk Thru Developmental and Legal Collaboration	2011	USA				1
82	Social Cognitive Development in Young Children With Autism	2012	USA		1
83	Evaluation of the Healthy Families Alaska Program	1999	USA			1
84	Initial Efficacy Study of Supporting Play, Exploration, & Early Development Intervention	2011	USA				1
85	Healthy Habits, Happy Homes: An Intervention to Improve Household Routines for Obesity Prevention	2011	USA				1
86	Age 12 Follow-up of Early Preventive Intervention (Memphis)	2003	USA			1
87	Project ASPIRE Efficacy Pilot: Achieving Superior Parental Involvement for Rehabilitative Excellence	2009	USA				1
88	Interventions for Communication in Autism Network	2012	USA		1
89	The Effects of a Parental Intervention on Electronic Media Exposure and Sleep Patterns in Adolescents	2011	Israel				1
90	A Trial of Sertraline in Young Children With Autism Spectrum Disorder	2015	USA		1
91	A Randomized Controlled Trial of PCIT-ED for Preschool Depression	2014	USA				1
92	Psychomotor Therapy for Very Premature Infants	2007	France				1
93	A Website to Teach Children Safety With Dogs	2015	USA				1
94	Early Physical Therapy Intervention in Preterm Infants	2017	Spain				1
95	The Children in Action Feasibility Study	2007	USA				1
96	Development of Appetite Measuring Tool and Appetite Status of Stunted Children	2016	Bangladesh				1
97	Early Pharmacotherapy Aimed at Neuroplasticity in Autism: Safety and Efficacy	2004	USA		1
98	Study and Development of Application Models of “Therapeutic Education to the Patient” (TEP) in Asthmatic Children	2007	Italy			1
99	Development and Effectiveness of Home-based Programs for Preschool Children With Developmental Delay	2017	USA				1
100	Digital Literacy Promotion	2016	Bangladesh				1
	TOTAL			4	21	25	50

Contributor Information

Tracey Smythe, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.

Maria Zuurmond, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.

Cally J Tann, Maternal, Adolescent, Reproductive and Child Health Centre, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK. MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda.

Melissa Gladstone, Institute of Translational Medicine, University of Liverpool, Liverpool, L69 7TX, UK.

Hannah Kuper, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK.

Author's contributions

HK conceived the study. TS carried out the analysis and interpretation of case study data. TS and HK drafted the manuscript. MZ, CJT, MG and HK critically revised the manuscript for intellectual content. All authors read and approved the final manuscript. TS and HK are guarantors of the paper. The data underlying this article are available in the article and in its online supplementary material.

This work was supported by the Wellcome Trust and Department for International Development (grant 206719/Z/17/Z to HK). The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.

Competing interests

MG is a member of expert panels for the WHO and UNICEF on measurement of childhood development and disability. This research paper was undertaken outside and separate from these duties.

Ethical approval

Not required.

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Early Intervention

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The scope of this Practice Portal page is early intervention services for children ages birth to 3 years and their families/primary caregivers. This page focuses on the overall early intervention process, but check with state and local early intervention regulations for additional guidance. Each state is required by federal law to maintain a public-facing website where additional information on the state’s early intervention program can be found.

For information about assessment and treatment of specific communication or swallowing disorders in infants and toddlers, refer to the relevant Evidence Maps and Clinical Topics in the Practice Portal.

Early intervention (EI) is the process of providing services and supports to infants, toddlers, and their families when a child has, or is at risk for, a developmental delay, disability, or health condition that may affect typical development and learning. The goal of EI is to lessen the effects of a disability or delay by addressing identified needs of young children across five developmental areas (Individuals with Disabilities Education Act [IDEA], 2004):

cognitive development
communication development
physical development, including vision and hearing
social or emotional development
adaptive development

A child’s developmental needs can be best addressed when they are identified early and services can begin (Guralnick, 2011; Parlakian, 2018). The Early Intervention Program for Infants and Toddlers with Disabilities, also called Part C of IDEA, is a federal grant program that helps individual states operate comprehensive systems of multidisciplinary EI services for children ages birth to 3 years with disabilities and their families/primary caregivers. EI providers must follow both the IDEA (2004) statute and subsequent regulations, such as the IDEA Part C Final Regulations (IDEA, 2011). See also ASHA’s Analysis of the 2011 IDEA Part C Final Regulations [PDF].

Audiologists and speech-language pathologists may serve as the primary referral source to Part C programs; however, referrals may also be made by parents/caregivers, family members, physicians, child care providers, or anyone concerned about a child’s development. Eligibility for EI services or special education services once a child turns 3 years of age is based on specific state criteria. EI services can also be provided outside of Part C programs in settings such as neonatal intensive care units, pediatric rehabilitation hospitals or clinics, preschools, and private practices. Services in these settings may not be covered by federal or state dollars but may be billed to public or private insurance or to the family.

Populations

Early intervention (EI) services may include infants and toddlers with a disability or a diagnosed condition that has a high probability of resulting in developmental delay, including those with

acquired conditions (e.g., traumatic or other acquired brain injuries, illnesses or postoperative complications, abuse or neglect, hearing loss) and
neurodevelopmental conditions (e.g., autism spectrum disorder, genetic syndromes, cerebral palsy, Down syndrome, fetal alcohol syndrome, hearing loss).

Early exposure to multiple languages does not cause language delay or disability. Young children who are exposed to languages other than or in addition to English (i.e., multilingual learners) without a disability or diagnosed medical condition do not qualify for EI services under Part C based solely on limited English proficiency (Individuals with Disabilities Education Act [IDEA], 2004). However, multilingual learners with a language delay or disability may be eligible for services. See ASHA’s Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology .

Receipt of Services

Nationally, 6.8% of children from birth to 3 years receive IDEA Part C services (State of Babies Yearbook, 2023). A national survey of parents of children participating in EI determined that the vast majority had concerns about their children’s communication. Findings showed 41% of children were eligible for EI based on a speech or communication delay (Hebbeler et al., 2007).

Demographics

Research has found differences in access to EI services by child and family characteristics, including race, ethnicity, home language, age, sex, diagnosis, condition, and other household factors.

Race, Ethnicity, and Home Language

Nationally, 34.2% of children aged 9–35 months received a developmental screening. The percentage of Asian children (27.4%), Black children (28.6%), and Hispanic children (31.1%) who received a developmental screening was below the national average. The percentage of White children (36.7%) who received a developmental screening was above the national average (State of Babies Yearbook, 2023).

Studies from Colorado, Massachusetts, and Oregon showed differing EI referral rates for Black children, Asian children, Latino/a children, and children from varied language backgrounds (Clements et al., 2008; Cycyk et al., 2022; McManus et al., 2020). Similarly, studies from Massachusetts, Connecticut, and Oregon suggest differing evaluation rates in EI for Black or African American children, Latino/a Spanish-speaking children, and children from varied language backgrounds (Chan et al., 2022; Clements et al., 2008; Cycyk et al., 2022).

The 44th Annual Report to Congress on the Implementation of the Individuals with Disabilities Education Act reported that, nationally, Asian, Black or African American, or American Indian or Alaska Native infants and toddlers—and infants and toddlers with multiple racial/ethnic groups—were less likely to receive services under IDEA Part C than were Native Hawaiian or Other Pacific Islander, Hispanic/Latino, or White infants and toddlers (Office of Special Education and Rehabilitative Services, 2022).

In one national study, Black and White children who were eligible for EI services received them at the same (albeit low) rate of 9% at 9 months of age, but at 24 months of age, Black children were 5 times less likely to receive EI services than White children (Feinberg et al., 2011). In another nationally representative study, children from homes where the primary language is not English were less likely to be enrolled in EI (Morgan et al., 2012).

“Children of color who are eligible for services are less likely to receive them and more likely to face challenges while receiving them. This is due to a variety of factors, including insufficient outreach and a lack of culturally competent services” (The Education Trust, 2021, p. 11).

Age and Sex

The National Early Intervention Longitudinal Study showed that 61% of children entering EI were male (Hebbeler et al., 2007).

Nationally, in 2019, the percentage of infants and toddlers under 1 year of age served under IDEA Part C increased to 1.4% and then, in 2020, decreased to 1.1%. The percentage of 1-year-olds served increased to 3.4% in 2019 and decreased to 3% in 2020. In 2019, the percentage of 2-year-olds served under IDEA Part C increased to 6.2%. The percentage then decreased to 5.3% in 2020 (Office of Special Education and Rehabilitative Services, 2022).

According to the U.S. Department of Education, in 2021, approximately 45,000 children ages birth to 1 year received services under IDEA Part C. Approximately 120,000 children ages 1–2 years and around 241,000 children ages 2–3 years receive services under IDEA Part C (U.S. Department of Education, 2023).

Diagnoses and Conditions

A national survey showed that most children are eligible for EI based on developmental delay (64%), followed by a medical condition (20%) and then a risk condition (16%; Hebbeler et al., 2007). Only six states serve children considered “at risk” for disabilities under IDEA (State of Babies Yearbook, 2023). Children with diagnosed and risk conditions typically began EI before 1 year of age, whereas those with a developmental delay typically entered EI around the age of 2 years (Hebbeler et al., 2007).

One national study found that significantly more Black children than White children qualified for EI services based on established medical conditions at 9 months of age. At age 24 months, Black children who qualified for services based on developmental delay alone were more than 8 times less likely than White children to receive services (Feinberg et al., 2011). “This racial disparity was particularly pronounced among children qualifying for services based on developmental delays that were difficult to detect and required observational assessment, indicating that there are racial inequities in timely access to screening, attention to potential developmental concerns, and resources within health and education systems” (The Education Trust, 2021, p. 8).

A nationally representative data set revealed that birth conditions such as very low birth weight predicted a sevenfold increase in the odds of receiving speech-language services at 24 months of age, whereas moderately low birth weight doubled the chances (Morgan et al., 2016).

Household Characteristics

More than half of children in EI had two or more risk factors for negative developmental outcomes (e.g., living in a household with one adult, being in foster care, having a primary caregiver with less than a high school education, living below the poverty level, living in a single-parent household; Hebbeler et al., 2007).

The percentage of children from low-income families who received a developmental screening was below the national average, at 29.5% as compared to 34.2% (State of Babies Yearbook, 2023).

Nationally, 28% of families participating in EI were at or below the federal poverty level (Hebbeler et al., 2007). Compared to White children, Black children eligible for EI services at age 24 months were significantly more likely to live in households with income below the federal poverty level (Feinberg et al., 2011).

Of children eligible for EI services, 69% were privately insured and 31% either were publicly insured or had no insurance. Compared to White children, eligible Black children were significantly more likely to have public insurance (Feinberg et al., 2011).

Children entering EI were more likely to have mothers who had no college education (Hebbeler et al., 2007). Compared to White children, Black children eligible for EI services at 24 months of age were significantly more likely to have mothers with lower educational attainment (Feinberg et al., 2011).

Children raised by a mother who was socially isolated were 44% less likely to receive services at 24 months of age. Children with a family member with mental illness or a learning disability were twice as likely to receive speech-language services at 24 months of age; it is unknown whether this is due to heritability or due to household connection to the health care system (Morgan et al., 2016).

See ASHA’s resource on social determinants of health .

Navigating the Part C EI Process

Under IDEA (2004), EI begins when a child is referred to the Part C system and ends when a child transitions out of EI—typically at 36 months of age. Having knowledge of federal/state laws and regulations, key terms, acronyms, and definitions used in EI will assist in navigating the Part C process. EI providers must follow both the IDEA (2004) statute and subsequent regulations, such as the IDEA Part C Final Regulations (IDEA, 2011). See also the ASHA Analysis of the 2011 IDEA Part C Final Regulations [PDF].

See The Early Intervention/IFSP Process [PDF] chart from the Early Childhood Technical Assistance Center (ECTA Center).

Federal/State Laws and Regulations

Under Part C of IDEA (2004), states receive federal grants to provide comprehensive, coordinated EI services to all eligible infants and toddlers with disabilities, from birth to 3 years, and their families.

The IDEA Part C Final Regulations (IDEA, 2011) give states the discretion to extend eligibility for Part C services through the age of 5 years to children with disabilities who are eligible for services under Part B, Section 619 (Preschool Grants) and who previously received services under Part C.

States may differ in terms of which agency they designate to lead the Part C program (e.g., Department of Health, Department of Education, or Department of Rehabilitation Services) and what they choose to name their EI system (e.g., Infants and Toddlers, Early Steps, Strong Start).

Requirements for audiologists and speech-language pathologists (SLPs) who work in Part C EI programs also vary by state (see ASHA State-by-State for state EI requirements for practice).

Point of Entry and Referral

Each EI system has a point of entry or local/regional contact point designated to accept referrals from sources who suspect a developmental delay or disability in an infant or toddler. Referral sources can include parents, caregivers, health care providers, teachers, child care workers, and social service personnel, among others. The IDEA (2004) requires providers, not including caregivers who self-refer, to make referrals “as soon as possible but in no case more than seven days” after the infant or toddler is identified as having a possible delay or disability.

After receiving a referral, the lead agency or local EI service provider has 45 calendar days to complete the screening (if applicable), initial evaluation, initial assessments, and initial team meeting to develop an initial individualized family service plan (IFSP) for the child and family (IDEA, 2004). Informed written consent must be obtained prior to initiation of services. Informed written consent and all interactions should be in the preferred language(s) of the family and/or caregivers. All attempts to obtain consent should be documented, along with contact method and/or language(s) used. Families do have a right to refuse EI services.

The 45-day timeline may be extended under limited circumstances, such as when a parent has not provided written informed consent. See ASHA’s resource on IDEA Part C: referral timelines and requirements .

Once the lead agency receives a referral, a service coordinator is assigned to children and families to explain the EI process and help navigate next steps. The service coordinator typically serves as a family’s case manager and single point of contact with the EI system. In some programs, professionals have dual roles, serving as both service coordinator and intervention provider. In other programs, there is a dedicated service coordinator. The service coordinator informs families of their rights and responsibilities and when they need to provide informed consent (e.g., for evaluation).

Screening, Evaluation, and Assessment

The IDEA Part C defines screening, evaluation, and assessment as distinct processes with different purposes. As stated in IDEA Part C (2004), these services must be provided to families in their native language . In the case of a child, native language means the language and mode of communication that the caregiver normally uses with the child. However, when conducting an evaluation and assessment, it may be developmentally appropriate to use the language(s) typically used by the child (which may be different from that of the parents). Screening, evaluation, and assessment are conducted in the language(s) most likely to yield an accurate picture of the child’s skills (Division for Early Childhood [DEC], 2014; IDEA, 2004).

Screening refers to the process of identifying children who may need further evaluation to determine the presence of a developmental delay or disability. Under Part C, screening is not mandatory but is done at a state’s discretion. If included in the state’s post-referral procedures, screening is conducted using selected instruments administered by trained personnel in the lead agency or in an EI program.

At any time during the screening, a parent can request that the EI program conduct an initial evaluation, even if the results of the screening do not indicate the need for further evaluation.

Evaluation refers to the procedures used to determine a child’s initial and continuing eligibility for EI services. No single procedure may be used as the sole criterion for determining a child’s eligibility under Part C.

Evaluation considers data gathered from the following procedures (IDEA, 2004):

administering an evaluation instrument
taking the child’s developmental and medical history (including a caregiver/family interview)
identifying the child’s level of functioning in each of the five developmental areas (cognitive, communication, physical, social or emotional, and adaptive)
gathering information, such as questionnaires, from other caregivers, health care providers, and educators to get a holistic view of the child’s strengths and needs
reviewing medical, educational, or other records

Assessment refers to the formal and informal comprehensive procedures used to (a) identify a child’s strengths and needs and (b) determine the appropriate EI services to meet those needs throughout the period of eligibility. The developmental assessment tool used in services varies by state. Assessment in EI is an ongoing process. Culturally sensitive and linguistically appropriate assessments of both the child and family occur to identify resources, priorities and concerns, and the supports and services necessary to enhance the family’s capacity to meet the child’s developmental needs (IDEA, 2011).

For more information, see the Clinical Components of Screening, Evaluation, and Assessment section below and ASHA’s resource on IDEA Part C: Cultural and linguistic diversity .

Eligibility

IDEA (2004) designates that children with established risk (i.e., a diagnosed medical condition or disorder that has a known effect on developmental outcomes) are universally eligible for services under Part C. Otherwise, states have some discretion in setting eligibility criteria for Part C services, including how to define “developmental delay.” As a result, definitions of eligibility for Part C services can differ significantly from state to state. The list of categorically eligible medical diagnoses will be available at the state-level EI agency or at the local EI service provider or program. States with more restrictive eligibility criteria have lower rates of EI use (McManus et al., 2014).

States also have the option of serving children who show no delay but who are considered “at risk” for developmental challenges because of biological or environmental factors (e.g., repeated infections, prenatal drug exposure, history of abuse or neglect). IDEA Part C defines an at-risk infant or toddler as “an individual under 3 years of age who would be at risk of experiencing a substantial developmental delay if EI services were not provided to the individual” (IDEA, 2004).

When diagnostic assessment tools alone do not establish eligibility, the state lead agency must ensure that informed clinical opinion also be independently considered in the dynamic process of determining eligibility. However, once evaluation instruments have established eligibility, informed clinical opinion cannot negate these results (IDEA, 2004).

For children not found eligible for Part C services, families may choose to pursue EI through private or community resources and other federal or state-funded early childhood programs, such as home visiting or Early Head Start. If concerns about the need for EI services persist, families can request a reevaluation through their Part C program at a later time.

See States’ and Territories’ Definitions of/Criteria for IDEA Part C Eligibility [PDF] from the ECTA Center.

Once a child is found eligible, an IFSP is developed by an interprofessional team, including the family and service coordinator. The IFSP is a document detailing the EI services and supports provided to the child and family and the outcomes to be achieved. EI services and supports are family-centered, culturally and linguistically responsive, and provided in the most natural environment. Language(s) used in all assessment and intervention services, which may involve interpreters, should also be reflected in the documentation.

IDEA requires that the IFSP include the following (IDEA, 2004):

the child’s strengths, needs, and current levels of functioning
the family’s concerns and priorities
services that the child and family will receive
the frequency, intensity, and method of delivering the services, including who will provide them and where they will occur
outcomes that the family desires, timelines for achieving results, and methods of outcome measurement
a notation of the transition plan date
a statement that EI services are based on peer-reviewed research

The required timeline for IFSP development and review is as follows (IDEA, 2004):

The IFSP must be developed 45 calendar days from the date of referral.
EI services must begin within 30 calendar days of the IFSP being written and agreed upon.
The IFSP must be reviewed at least every 6 months—or whenever the child has achieved a documented outcome or a new area of need is identified.

Families can invite providers and others (e.g., family members, friends, and advocates) to attend IFSP meetings to provide support and advocacy. Families and other team members may also request review of the IFSP at any time for any reason.

Section 619 of IDEA gives states the discretion to extend an IFSP beyond the child’s third birthday through age 5 years, when the child remains eligible for preschool special education and related services as a child with a disability. An extended IFSP must contain an educational component that promotes school readiness and incorporates preliteracy, language, and numeracy skills (IDEA, 2004).

Funding and Reimbursement

Each state’s Part C system is distinct in its funding structure. Part C programs coordinate EI funding from federal, state, local, and private sources.

Annual federal funding to each state Part C EI program varies, based on the census figures for the number of children in the general population aged birth through 2 years in each state. The majority of Part C funding tends to come from the state. Based on each state’s census numbers of children birth through 2 years of age, the Secretary of Education allocates financial grants to the lead agency to help each state provide EI services through a statewide comprehensive interagency system (ECTA Center, 2023). Typically, Part C federal funds cover EI administrative costs, whereas services are funded through the state, third-party payers, and families who pay fees for services (Searcy, 2018; Vail et al., 2018).

Evaluations, assessments, IFSP development, and service coordination must be provided at no cost to families (IDEA, 2004). Some programs also offer additional EI services free of charge or on a sliding scale; however, specific policies vary from state to state. In some states, EI programs fund the cost of speech-generating devices when they are necessary for children to benefit from EI services, are listed on the IFSP, and are related to an IFSP outcome (Banajee, 2017). Some private insurance and Medicaid plans cover EI services.

When a child is not eligible for EI services, or transitions out of a Part C program, families may choose to self-pay or use their medical insurance to seek private services beyond what a school district offers.

Transitioning to Part B (Special Education) or Other Services

There are various transitions in EI. A family may experience one or more of these, including

from provider to provider (e.g., developmental specialist to SLP),
from hospital or home-based programs to community-based programs (e.g., preschool special education, community-based preschool, Head Start, outpatient clinic, or private agency), and
from one state to another state.

The most significant transition generally occurs when a child moves at age 3 years from Part C to Part B school-based services (IDEA, 2004). As a child approaches their third birthday, the IFSP team begins a formal transition process and develops a plan to ease the shift from EI to preschool special education (if eligible) or to another community-based service option (if not eligible).

Federal law mandates that there be a systematic plan for transition from a Part C EI program to the child’s next program or other appropriate services, including programs for children who are no longer eligible for EI or special education but who still have ongoing needs. Representatives of the programs involved in the transition are required to take part in the planning, and families play an active role in the process.

The IDEA (2004) requires that the transition plan be established within 90 days of the child’s third birthday but not before 9 months of their third birthday. Often, IFSP teams choose to begin the transition planning process when the child turns 2½ years. A notation of the transition plan date must be included in the original IFSP document.

EI professionals work to ensure a smooth transition for families from one program to another, as well as timely access to appropriate services (IDEA, 2004). Teams must consider the language(s) most linguistically relevant to the child at the time of transition to develop an effective plan for Part B services and educational access.

Team members, including audiologists and SLPs, need to be aware of all notification, documentation, and timeline requirements. They also must adhere to any policies regarding the extension of Part C services if their state allows children beyond the age of 3 years to remain in Part C programs as eligible or until they enter kindergarten.

The roles and responsibilities of audiologists and SLPs acting as service coordinators are as follows:

direct responsibility for oversight of transition activities
be knowledgeable about a wide range of resources in the community
ensure that families have available information on transition
ensure that families know their state’s opt-out rights, which allow parents a specified time period to object to disclosure of their child’s information to state or local education agencies when the child is potentially eligible for preschool special education services

Alternatively, as members of the IFSP team, audiologists and SLPs assist the child, family, and other professionals during the transition planning process (Searcy, 2018). In some cases, they may visit the new classroom or service provider with the family and/or take part in the initial individualized education program meeting. The members of the IFSP team also consider the language needs of multidialectal and multilingual populations.

See ASHA’s resource on IDEA Part C: Transitions (including Part C to Part B/exiting Part C) for more information. See also ASHA’s Practice Portal pages on Cultural Responsiveness and Multilingual Service Delivery in Audiology and Speech-Language Pathology .

Roles and Responsibilities of SLPs

SLPs in EI are qualified to provide services to families and their young children who demonstrate, or are at risk for developing, delays or disabilities in communication, speech, language, cognition, emergent literacy, and/or feeding and swallowing. See ASHA’s Scope of Practice in Speech-Language Pathology (ASHA, 2016).

The following roles fall into the scope of practice for SLPs:

Demonstrate knowledge of typical developmental norms from birth to age 5 years across domains.
Engage in prevention and early identification activities to promote healthy development and reduce risk factors that can impact a child’s development.
Understand federal, state, agency, and professional policies and procedures related to screening, evaluating, and assessing infants and toddlers with, or at risk for, disabilities.
Conduct culturally responsive screening, evaluation, and assessment to identify young children with, or at risk for, a delay or disorder.
Determine eligibility for services, ensuring that eligibility is based on true delay or disorder rather than linguistic or cultural differences.
Guide the development of a family-centered intervention program.
Make referrals to other professionals and inform the referral source of the outcome of the eligibility process, with the family’s consent.
Develop a plan for implementing culturally and linguistically responsive services and supports (i.e., the IFSP or an equivalent) that includes speech-language pathology interventions, methods, and settings.
Gather and report treatment outcomes and document progress.
Revise intervention plans and determine discharge criteria.
Collaborate with families, caregivers, agencies, and other IFSP team members to implement intervention strategies in everyday routines. (See ASHA’s resources on collaboration and teaming and interprofessional education/interprofessional practice [IPE/IPP] .)
Support family interactions that reflect the family’s cultural beliefs, values, practices, and priorities.
Coordinate services depending on the state’s model of service coordination (including evaluation and assessment, development of an IFSP, and access to resources) and ensure they are implemented as agreed upon by the team. See ASHA’s resource on IDEA Part C: Service coordination .
Participate in seamless transition planning to ensure timely access to services for families moving from one program to another (e.g., from hospital to community-based intervention; from IDEA Part C EI services to Part B school-based services).
Advocate at the local, state, and national levels regarding public policy, funding, and infrastructure (e.g., workload parameters) for EI services.
Raise awareness about the importance of EI by working with families and other professionals and develop and disseminate resources.
Remain informed of current evidence-based practice in EI.
Help advance the knowledge base related to the nature and treatment of speech, language, cognitive communication, and swallowing development and disorders in infants and young children.

As indicated in the ASHA Code of Ethics (ASHA, 2023) , SLPs shall engage in only those aspects of the profession that are within the scope of their professional practice and competence, considering their levels of education, discipline-specific training, and experience.

The roles of the SLP will also be guided by state licensure regulations and the service delivery models implemented by EI agencies. The SLP should be considered a primary provider when the child’s needs are communication, emergent literacy, and/or feeding and swallowing. SLPs may also consult other team members to support communication and emergent literacy development.

Roles and Responsibilities of Audiologists

Infants and young children are a unique population that requires the special knowledge, skills, and experience of audiologists specifically educated to provide services to pediatric populations ages birth to 3 years.

Provision of audiologic service in EI requires (a) the establishment of an accurate diagnosis of auditory and vestibular function, (b) effective family counseling conducted in parallel with the diagnostic process, and (c) timely service coordination.

Appropriate roles for audiologists include the following:

Oversee early identification (newborn and early childhood screening) programs (Joint Committee on Infant Hearing [JCIH], 2019) and ensure that appropriate procedures are followed.
Report results of newborn hearing screenings to state newborn hearing screening and follow-up programs (some states also have regulations requiring audiologists to report results of hearing evaluations).
Establish an accurate diagnosis of hearing status.
Provide information about the child’s hearing status and eligibility for Part C services to the referral source, with the family’s consent.
Coordinate timely audiologic services.
Coordinate and conduct a comprehensive, culturally and linguistically appropriate assessment for the determination of candidacy for hearing aids, acoustic implants, cochlear implants, and/or other hearing assistive technology.
Fit and maintain any hearing technology used by the child and ensure optimal performance and frequently validate that the technology is providing the intended benefit.
Validate hearing technology use in a variety of communicative settings.
Provide effective family support and counseling regarding the nature of auditory and vestibular conditions and implications for language development, modes/methods of communication, communication access strategies/accommodations, and acoustic modifications.
Advocate for a continuous process of family-focused service delivery (see ASHA’s resource on person-centered care in audiology ).
Refer families to parent-to-parent support and other consumer-based organizations.
Educate other professionals about the needs of infants and young children with hearing and vestibular/balance deficits and the role of audiologists in diagnosing and managing them.
Coordinate services depending on the state’s model of service coordination (including evaluation and assessment, development of an IFSP, and access to resources) as agreed upon by the team. See ASHA’s resource on IDEA Part C: Service coordination .
Advocate for the rights to and funding of services for infants and young children with reduced hearing, auditory disorders, and/or vestibular disorders.
Remain informed of research in the area of EI and help advance the knowledge base related to the nature, identification, and treatment of hearing and vestibular deficits in infants and young children.

For additional information about the roles and responsibilities of audiologists in early hearing detection and intervention, see the following two resources from JCIH and ASHA:

Joint Committee on Infant Hearing Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs [PDF] (JCIH, 2019)
Supplement to the JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention Following Confirmation That a Child Is Deaf or Hard of Hearing (ASHA, 2013)

See also ASHA’s Practice Portal pages on newborn hearing screening , childhood hearing screening , and hearing loss in children .

As indicated in the ASHA Code of Ethics (ASHA, 2023) , audiologists shall engage in only those aspects of the profession that are within the scope of their professional practice and competence, considering their levels of education, discipline-specific training, and experience. The roles of the audiologist will also be guided by state licensure regulations.

Guiding Principles of EI

Five principles guide the implementation of speech-language pathology and audiology services in EI.

Services Are Family-Centered

The term family-centered refers to a set of beliefs, values, principles, and practices that strengthen a family’s capacity to enhance their child’s development and learning (IDEA, 2004). Family-centered practices are responsive to each family’s unique circumstances and provide families with complete and unbiased information to make informed decisions (DEC, 2014).

IDEA Part C requires that EI providers involve families in all aspects of a child’s services to the extent that the family chooses. The family, not just the individual child, receives EI services that build upon their strengths (DEC, 2014; McCarthy & Guerin, 2022).

Families collaborate with professionals to design and implement individualized services that align with family preferences, resources, concerns, and priorities to foster engagement, independence, and competence (IDEA, 2011). This partnership creates a learning environment to support both the child’s and family’s needs, achieve mutually agreed-upon outcomes, and promote family capacities (DEC, 2014; Roberts et al., 2016).

Preferred practice indicates that families need to be involved and responsive to their child to effectively implement intervention strategies. Clinicians consider family members’ individual needs, learning styles, values, beliefs, and expectations when providing services (McCarthy & Guerin, 2022; Raver & Childress, 2015). Services that include opportunities for families and caregivers to directly participate in intervention strengthen existing knowledge and skills and promote the development of new abilities that enhance child and family outcomes (DEC, 2014). A variety of factors, such as social determinants and cultural presumptions, impact a family’s engagement in EI, but EI providers can facilitate collaboration when providers trust parents as experts; provide information to navigate EI and to access other community resources; and were supportive, encouraging, flexible, genuine, respectful, compassionate, collaborative, and knowledgeable (Batz & Yadav, 2023).

See also ASHA’s resources on family-centered practice and person- and family-centered care .

Services Are Culturally and Linguistically Responsive

The IDEA Part C Final Regulations state that families of infants and toddlers with a disability must have access to culturally competent services (IDEA, 2004). Different cultural dimensions can influence a family’s decisions about EI services and supports (see ASHA’s resource on examples of cultural dimensions ). For example, perceptions or views of disability may inhibit decisions to seek services or may affect how a family approaches intervention. In family-centered EI, providers assist families to engage in services that support beliefs, customs, or rituals (Cycyk et al., 2021; Peredo, 2016). The clinician considers the following processes to make any cultural and linguistic adaptations to interventions (Cycyk et al., 2021):

assess community needs and existing evidence-based interventions
select the intervention that meets community needs
consult with stakeholders (e.g., family, caregiver)
develop adaptations systematically and collaboratively
train staff on the adapted intervention
pilot-test adapted intervention to prompt additional modifications
evaluate the fully adapted intervention

The spoken native language may not be the same as the caregivers’ preferred written language. Therefore, prior written notice regarding EI services must be provided to families in their preferred language, unless it is clearly not feasible to do so. The regulations define native language as the language typically used by an individual. In the case of a child, native language is the language and mode of communication that the caregiver normally uses with the child.

EI services and supports are provided in the language(s) that the family is most comfortable using (DEC, 2014; IDEA, 2004). For children who are acquiring more than one language, multilingual EI providers or monolingual service providers collaborate with interpreters to support the home language(s). It is essential that EI providers teach families and caregivers how to implement strategies in their home language to maximize understanding and carryover (Peredo, 2016).

See ASHA’s resource on IDEA Part C: Cultural and linguistic diversity and the Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology ; Collaborating With Interpreters, Transliterators, and Translators ; Cultural Responsiveness ; and Language and Communication of Deaf and Hard of Hearing Children .

Services Are Developmentally Supportive and Promote Children’s Participation in Their Natural Environments

Developmentally supportive EI practices address family routines, concerns, and priorities through active exploration, authentic experiences, and interactions consistent with the child’s age, cognitive communication skills, strengths, and interests (DEC, 2014).

IDEA Part C requires that EI services be provided, to the maximum extent appropriate, in natural environments . These are settings that are considered typical for same-aged infants or toddlers without disabilities and may include home, child care, classroom, community, or other settings in which young children without disabilities participate (IDEA, 2004). Most often, children received EI services in their homes (Office of Special Education and Rehabilitative Services, 2022).

Familiar everyday experiences, routines, events, and places are used as opportunities to promote natural learning and incidental teaching throughout each day (Center for Parent Information & Resources, 2021; Swanson et al., 2011; Woods et al., 2011).

If the IFSP team decides the natural environment is not the optimal setting for a child, justification must be included in the documentation of services.

See ASHA’s resource on IDEA Part C: Natural environments .

Services Are Comprehensive, Coordinated, and Team-Based

A comprehensive, coordinated, and team-based approach to EI is preferred practice to prevent fragmented service delivery and to maximize child and family outcomes.

IDEA Part C (IDEA, 2004) requires that members of the IFSP team coordinate their approaches, consult with one another, and recognize that child and family outcomes are a shared responsibility. Communication among team members and with the family is also mandated and must be supported by the administering agency.

Service coordinators—who can include audiologists and SLPs—monitor family needs, child progress, team dynamics, and implementation of the IFSP. Between IFSP meetings, team members can communicate by sharing notes, discussing strategies, and collaborating to solve challenges that arise. The service coordinator maintains regular communication with all team members and documents exchanges in the child’s intervention record (ECTA Center, 2023; Raver & Childress, 2015; Searcy, 2011).

Children who receive comprehensive EI services under Part C are often seen by multiple professionals (e.g., physicians, SLPs, audiologists, physical and occupational therapists, behavioral specialists, special educators), some of whom may be from different agencies with different team models. Collaboration will vary depending on the model used, the lead agency’s policies and program guidelines, and the knowledge and skills of team members. When multiple professionals are working with the child and family, the service coordinator and other team members need to promote collaboration to facilitate communication, avoid redundancy, and promote successful achievement of outcomes.

Collaborative coordinated teams work to develop interventions that complement one another rather than contradict or duplicate services. They also benefit from joint professional development and consultation to enhance each other’s knowledge and skills for role extension (i.e., taking on responsibilities typically within the domain of other disciplines) and role release (i.e., sharing expertise, scope of practice, and intervention strategies with others; Boyer & Thompson, 2014; Coufal & Woods, 2018). Audiologists and SLPs in EI are encouraged to recognize shared competencies across disciplines in coordination and collaboration, family-centered practice, interventions informed by evidence, and professionalism to better support young children and their families (Early Childhood Personnel Center, 2017).

See ASHA’s resources on collaboration and teaming and interprofessional education/interprofessional practice (IPE/IPP) .

Services Are Based on the Highest Quality Internal and External Evidence Available

EI practices are based on an integration of the highest quality and most recent research, informed professional judgment and expertise, and family preferences and values. Internal evidence is drawn from clinical data and observations. External evidence is based on empirical research published in peer-reviewed journals. Clinical expertise comes from a variety of sources, including policy, informed clinical opinion, and professional consensus. Client perspectives can come directly from family values and perspectives or may be found in qualitative research studies. Evidence-based practice in EI evaluates all of these considerations to deliver services shown to achieve positive outcomes for young children and their families.

See ASHA’s Evidence Maps and ASHA’s resource on evidence-based practice for guidance on evidence-based decision making.

See also ECTA’s Evidence-Based Practice resources and DEC Recommended Practices for information specific to evidence-based service provision in EI.

Clinical Components of Screening, Evaluation, and Assessment

See the Assessment sections of relevant Evidence Maps for pertinent scientific evidence, expert opinion, and client/caregiver perspective on specific clinical disorders and topics.

See the Screening, Evaluation, and Assessment section for detailed definitions of each procedure.

Screening, evaluation, and assessment protocols typically consider the following.

Factors Related to the Child and Family

background—developmental and medical history
language(s) used and age(s) of exposure
family concerns, priorities, and available resources/supports
family/caregiver–child interaction
environmental stressors

Factors Related to the Child’s Abilities

hearing status
functional listening skills
sensory, motor, and cognitive skills (including play and problem solving)
speech, language, and emergent literacy skills
feeding/swallowing
emotional and social functioning

Screening is an important component of prevention, family education, and support that is particularly relevant for young children and their families. Screening may result in recommendations for rescreening, comprehensive assessments, or referral for other examinations or services.

Audiologic Screening

Audiologists screen hearing and vestibular function. Hearing screening is within an SLP’s scope of practice, as well.

Hearing Screening

Newborn hearing screening has been the standard of care in U.S. hospitals since 1999. Babies who do not pass their newborn hearing screening are referred for medical and audiologic follow-up. Screening and hearing evaluation data are reported to the state Early Hearing Detection and Intervention (EHDI) program. The overarching goals of state EHDI programs are to ensure that

all infants have access to hearing screening using a physiologic measure at no later than 1 month of age;
all infants who do not pass the initial hearing screening and any subsequent rescreening have appropriate audiologic and medical evaluations to identify hearing status at no later than 3 months of age; and
all infants with confirmed permanent hearing conditions receive EI services as soon as possible after diagnosis but no later than 6 months of age (ASHA, 2013; Centers for Disease Control and Prevention, 2017; JCIH, 2019; Yoshinaga-Itano et al., 2017).

Hearing screenings after the newborn period (0–6 months) are important for early identification and management of the hearing status that may have been either missed during newborn hearing screening or acquired after the newborn period. Children who are evaluated for EI services should receive a hearing screen as part of their comprehensive speech-language evaluation. Children under age 3 years who have been diagnosed with reduced hearing should be referred to both the state EHDI system and the Early Intervention Program for Infants and Toddlers with Disabilities (Part C).

See ASHA’s Practice Portal pages on newborn hearing screening , childhood hearing screening , and hearing loss in children .

See also the following two resources from JCIH and ASHA:

Screening for Vestibular Dysfunction

Young children often are unable to verbally describe vestibular symptoms (Janky, 2021; McCaslin et al., 2011; Wiener-Vacher, 2008). Instead, they may use actions, gestures, or emotions (e.g., covering ears with hands, crying).

Vestibular system impairments in young children may present as developmental delays in activities such as walking. Children who have autism, brain injuries, reduced hearing, otitis media, and certain syndromes (e.g., enlarged vestibular aqueduct syndrome, Usher syndrome, Waardenburg syndrome, Pendred syndrome, Alport syndrome) may be at increased risk of vestibular disorders.

Audiologists and SLPs should consider case history, gross motor milestones, balance, coordination, and parental concerns and refer for further evaluation and assessment when suspicions arise (Doettl & McCaslin, 2017).

See ASHA’s Practice Portal page on Balance System Disorders .

Speech, Language, Cognitive Communication, and Swallowing Screening

SLPs screen for risk or the presence of speech, language, cognitive communication, and feeding/swallowing difficulties using a variety of tools. They select age-appropriate, culturally and linguistically sensitive screening procedures that are conducted in the language(s) used by the child and family.

Screening typically includes

direct interaction with the child,
observation of interactions between child and caregiver(s) in natural contexts,
interviews with family members or early childhood teachers regarding concerns about the child’s skills, and/or
professional-administered and parent-completed measures.

When evaluating screening results, clinicians should consider whether responses may distinguish a disorder within the dialect(s) and language(s) (Oetting et al., 2016). This is critical when screening any child whose cultural or linguistic background, including dialects or language varieties of English, is different from that of the normative sample used in the screening tool. If a screening measure does not have a normative sample that is representative of the child’s background or lacks appropriate psychometric properties (e.g., reliability, validity), then the clinician cannot report the measure’s standard scores. However, the clinician can adapt the screening measure with dynamic assessment procedures. All screenings and assessments heavily consider the family’s routines-based interview. See ASHA’s Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology ; Cultural Responsiveness ; and Collaborating With Interpreters, Transliterators, and Translators .

Recommendations and referrals for further evaluation and assessment of infants and toddlers are often based on developmental expectations. To evaluate whether or not a child is meeting these expectations, the SLP needs to determine if results of the screening are a valid reflection of the child’s typical behavior.

See ASHA’s Clinical Topics Practice Portal pages for further information relevant to speech, language, cognitive communication, and swallowing screening for specific clinical diagnoses and disorders in young children.

Pre-Assessment and Evaluation Planning Processes

Prior to evaluation and assessment, IDEA Part C requires that EI team members meet with the child and family to

identify what the family wants and/or needs from the assessment process;
identify the language(s) to be used in the evaluation;
identify areas and activities of strength and need for the child;
determine roles/responsibilities that family members and caregivers will take in assessment; and
determine times, locations, and activities that will facilitate the assessment process.

Evaluation and Comprehensive Assessment

IDEA (2004) identifies communication as one of the developmental domains required in a comprehensive evaluation. The legislation also specifies that both evaluation and comprehensive assessment be based on a variety of measures that include informed clinical opinion.

In some states, evaluation and assessment are separate processes in which one team of professionals evaluates the child to determine eligibility and then refers the child to another team for service coordination, assessment, and/or other intervention services. In other states, a single team may provide a combined evaluation/assessment and then provide service coordination and intervention planning services.

Although there may be overlap in the methods and teams that make up evaluation and assessment practices in EI, assessment usually encompasses more in-depth observations and information gathering than eligibility evaluations. The evaluation process is used to determine a child’s eligibility for Part C services, whereas assessment results are typically an integral part of intervention planning. If a child has a categorically eligible diagnosis, the EI entity may complete the evaluation as a baseline of present levels and not for eligibility purposes. In addition, a larger group of professionals may participate in the assessment process. Ongoing assessment by various team members also helps determine response to treatment (ECTA Center, 2023).

Evaluation and Assessment Methods

Evaluation and assessment of infants and toddlers include more than testing. These processes involve a comprehensive set of activities to identify a child’s strengths and challenges, address the family’s concerns and priorities, and develop a plan for the next steps for the child and family (Crais, 2011; Raver & Childress, 2015).

IDEA (2004) requires that evaluation or assessment be completed using a range of tools in a variety of contexts. The law also states that eligibility decisions cannot be based on standardized measures alone. Such decisions must be supported by informed clinical opinion that is derived from various methods using data triangulation methods or the converging evidence framework. See Castilla-Earls et al. (2020) for an example. See ASHA’s resources on assessment tools, techniques, and data sources and on dynamic assessment .

Information gathered through the interview and assessment serves as the context for development of the culturally and linguistically responsive IFSP, collaborative intervention, plans for caregiver education, and attainment of desired outcomes (Center for Parent Information & Resources, 2021; Hwang et al., 2013; Westby, 2009; Woods & Lindeman, 2008).

Interviews and Questionnaires

Ethnographic or routines-based interviews are useful for gathering information about the family’s environment; the child’s participation in family-identified routines and activities (e.g., grooming, mealtimes, child care); the family’s culturally informed beliefs, values, and practices; and prior experience with health care and educational settings. Families have the opportunity to talk about their concerns, priorities, and current supports, including the child’s level of engagement, independence, and participation in familiar contexts, as well as their preferences for service provision. Such interviews can also enhance the relationship between the clinician and the family and support collaborative partnerships (Hampton et al., 2023). Caregivers’ report of concerns about communication development, including in diverse populations with lower educational attainment, is also a valid indicator of delay or disorder (Restrepo, 1998). See ASHA’s Practice Portal page on Cultural Responsiveness for more information about ethnographic interviewing.

Language background surveys or questionnaires are important to collect information on the child’s home language(s) and language dialects/varieties. Such tools capture relative amount of input provided to the child in each language by their caregivers. Clinicians can use this information to guide decisions about the language(s) of evaluation/assessment and to interpret evaluation/assessment findings to discern difference from difference within delay or disorder.

Direct Observation

Direct observation of the child’s interaction with caregivers within typical routines provides information on the child’s functional communication abilities and how caregivers support child communication. Assessment of child functional communication can involve examining frequency and diversity of child gesture use, rate of intentional communication acts (gestures, vocalizations, verbalizations), range of communication functions, average length of utterances, sentence diversity, lexical diversity, and phonological inventory, among others. In addition, direct observation of caregiver–child interactions can support the assessment of the quality and quantity of caregiver input. Input quantity and quality influence many aspects of early child communication development (Zauche et al., 2016).

Dynamic Assessment

Dynamic assessment approaches may also be useful to evaluate a child’s learning potential, particularly when appropriate standardized measures are not available. Dynamic assessment offers an opportunity to determine how quickly or easily a child learns a particular skill with varied levels of support. Evidence of the utility of dynamic assessment in evaluating infants and toddlers is emerging (Spicer-Cain et al., 2023).

See also the Assessment sections of relevant Clinical Topics Practice Portal pages for information related to specific clinical diagnoses and disorders in young children.

Considerations for Assessing Young Children

There are a limited number of standardized cognitive communication assessments specifically for infants and toddlers; even fewer standardized tests exist for young children with acquired communication disorders from causes such as brain injury.
There are few non-English or bilingual standardized assessments. Interpreting an English measure for administration in another language is not appropriate, and reporting standardized scores when the child’s background does not match the normative sample is not recommended.
Test bias may occur. Test items may not be culturally or linguistically relevant or may not be relevant to the child’s context and experiences. In addition, there is situational bias to the question-and-answer assessment process. This process may be unfamiliar for children who are learning by observation.
Cognitive and communication skills are still developing during this period; many children will be preverbal, impacting the selection of assessment methods.
Overall development is rapid, uneven, episodic, and highly influenced by the environment, with great variability within and among children; therefore, ongoing assessment is necessary to identify changes and/or emerging deficits, particularly as cognitive communication demands increase (Ross, 2018).
Young children often have limited attention and feel stressed or anxious in unfamiliar settings with unfamiliar people; using families/caregivers and the information they provide during assessment within typical daily routines in familiar environments (e.g., home, child care, community) is essential.

Sharing Information With Families

Consider how cultural beliefs, values, and practices affect information sharing with families. Each family will perceive their child’s disability or condition differently. The family’s goals and expectations may vary for each child. Families may have differing levels of comfort asking questions and expressing disagreement.
Before discussing assessment results, audiologists and SLPs ask families to share their impressions of assessment activities, their concerns, and what they see as their child’s strengths and needs (Center for Parent Information & Resources, 2021; Woods & Lindeman, 2008).
Families may feel uneasy giving input about the assessment or stressed if they are given more information than they are ready to receive. Providers need to meet families where they are, follow their lead, and provide information more than once, as needed (Caicedo, 2014; ECTA Center, 2023; Raver & Childress, 2015).
The type and amount of information shared and the way it is shared may have an impact on how families and professionals feel about the assessment process and on follow-up decisions (Crais, 2011; ECTA Center, 2023).
Families need complete and unbiased information in plain language terms in the language that they prefer so they can make informed decisions and actively participate in conversations about next steps. Consider the literacy levels of caregivers and whether written documents are the most appropriate method of sharing information.
When collaborating with an interpreter, consider the interpreter’s background knowledge. Sharing EI-specific terminology and diagnostic/eligibility labels with interpreters ahead of meeting with the family can help to ensure accurate interpretation.
Evaluation or assessment findings may sometimes be unexpected or difficult for families to hear. They may be overwhelmed, grieving, or in denial. It is important to address family emotions within the assessment and intervention process, as emotions can be a barrier to action (Bhat, 2017; Caicedo, 2014; ECTA Center, 2023; Raver & Childress, 2015; Searcy, 2011; Searcy & Hughes, 2015). See ASHA’s Practice Portal page on Counseling for Professional Service Delivery .

See the Treatment sections of relevant Evidence Maps for pertinent scientific evidence, expert opinion, and client/caregiver perspective on specific clinical disorders and topics.

Various approaches and treatment strategies are available for audiologists and SLPs in EI. Selection depends on several factors, including the child’s hearing, communication, and swallowing or feeding needs; the presence and severity of co-occurring conditions; and the family’s cultural–linguistic background, values, and preferences.

Families and caregivers have a direct impact on their child’s development and play a pivotal role in treatment outcomes. They need clear descriptions of what intervention involves and their roles. Audiologists and SLPs adapt to the learning styles of families to effectively teach the skills they need to promote the child’s participation in everyday natural settings (Center for Parent Information & Resources, 2021; Friedman et al., 2012; Swanson et al., 2011; Trivette et al., 2009).

General Treatment Approaches

Treatment approaches to family-centered EI that promote functional outcomes include routines-based intervention (RBI) and coaching (McWilliam et al., 2020; Salisbury et al., 2018).

RBI is an approach that builds caregiver capacity using everyday activities as a context for embedded instruction (McWilliam, 2010b; McWilliam & Younggren, 2019). The primary objective is to increase child and caregiver participation within their natural environment (McWilliam, 2010a, 2010b, 2016; Raver & Childress, 2015).

EI providers, families, caregivers, and/or teachers collaborate to develop child-specific strategies that are practiced during daily routines. Audiologists and SLPs who participate in RBI

identify regular learning opportunities in family, preschool, and/or community life;
work with parents, caregivers, and teachers to create communication and participation goals during learning opportunities;
determine the child’s interests, strengths, and motivators within daily routines; and
establish techniques (e.g., naturalistic language facilitation and/or swallowing strategies) that will be used to maximize development and learning within these routines (McWilliam et al., 2020).

RBI emphasizes caregiver-implemented intervention using toys and objects from the home to encourage practice and facilitate generalization of strategies used during treatment sessions (Crawford & Weber, 2014; McWilliam et al., 2020). The Family Guided Routines-Based Intervention model is one RBI program that incorporates IDEA Part C mandates, caregiver coaching, embedded interventions, and evidence-based practices based on adult learning principles (ECTA Center, 2023; McWilliam et al., 2020; Woods et al., 2011).

Coaching is an approach that guides families, caregivers, and other professionals on how to build the capacity of all care providers to implement communication and swallowing strategies in natural environments. It is a complex process that involves consideration of adult learning methods (Dunst & Trivette, 2012; Pellecchia et al., 2020; Roberts et al., 2016; Salisbury et al., 2018). Coaching uses clearly defined, observable, and measurable procedures to support others in their efforts to promote child learning and development. It is an interactive process that includes the following components, not always in this order (Akamoglu & Dinnebeil, 2017; Brown, 2016; Friedman et al., 2012):

joint planning
observation
action/practice

Coaching also involves more specific strategies such as the following (Woods et al., 2011):

direct teaching
questioning
guided practice
problem solving

The coaching process supports continuous engagement and ongoing self-assessment of learning to improve existing abilities, develop new skills or plans, and gain an understanding of EI practices (Brown, 2016; ECTA Center, 2023; McWilliam et al., 2020; Trivette et al., 2009; Woods & Brown, 2011; Woods et al., 2011). Coaching families is a common practice in caregiver-implemented interventions such as RBI and Family Guided Routines-Based Intervention.

Coaching colleagues is also an integral part of EI practice in general (Brown, 2016; Woods et al., 2011). Audiologists and SLPs work with colleagues in the context of everyday routines and activities to identify the most beneficial strategies for the child (Roberts et al., 2016; Salisbury et al., 2018).

Speech-Language Pathology Interventions

SLPs provide treatment to maximize a child’s ability to communicate and/or swallow effectively and to enhance the family’s capacity to support their child’s development in everyday routines. SLPs treat children who use a variety of communication methods, including spoken language, sign language, cued speech, simultaneous communication (a combination of sign and spoken language), and/or augmentative and alternative communication (AAC). They may provide audiologic (re)habilitation services to children with hearing loss.

For prelinguistic infants and toddlers, treatment often focuses on engagement, meaningful play, and gestures (Roberts et al., 2016; Tait et al., 2021). For young children with complex communication needs, implementation of some form of AAC may be indicated (Light et al., 2021; Smith et al., 2016; Wright & Quinn, 2016). Family-centered AAC interventions empower families to promote their child’s communication growth (Wright & Quinn, 2016). A child does not need to meet certain prerequisites, such as cognitive skills, language skills, or age, to use AAC (Romski & Sevcik, 2005). AAC does not limit spoken language abilities (Kasari et al., 2014; Leonet et al., 2022; Walters et al., 2021). See ASHA’s Practice Portal page on Augmentative and Alternative Communication for more information, including the different types of AAC, assessment and treatment approaches, and vocabulary selection.

Under Part C of IDEA, there has been a shift toward family-implemented interventions and collaborative consultation, instead of direct one-on-one intervention with the child only.

SLPs often coach families, caregivers, and other team members in how to implement functional, language-enhancing strategies during daily activities (Brown, 2016; Brown & Woods, 2015, 2016; Roberts et al., 2014; Salisbury et al., 2018). Such interventions support child communication development and caregiver use of language facilitation strategies (Heidlage et al., 2020).

Language-enhancing strategies taught within the context of family-centered EI include the following (Madigan et al., 2019; Paavola-Ruotsalainen et al., 2018; Rantalainen et al., 2022; Roberts et al., 2016):

quantity-based strategies —focus on varying the amount and complexity of language directed toward the child, regardless of the child’s communication skills
responsive strategies —focus on self-talk (adult narrates what they are doing); parallel talk (adult narrates what the child is doing); and imitation, expansion, or recasting of what the child says
directive strategies —focus on directing language production using open-ended questions, choice questions, or prompts (e.g., “Tell me about . . .”)
multimodal strategies —focus on providing tactile support (e.g., touch to initiate interaction) or visual support (e.g., combining gestures with words)
engagement-based strategies —focus on providing encouragement to engage in communication (e.g., shared reading and child-directed play)

See ASHA’s Clinical Topics Practice Portal pages and Evidence Maps for in-depth descriptions of these strategies and other evidence-based speech-language pathology interventions relevant to specific clinical diagnoses and disorders in young children.

Audiology Interventions

Most audiologists working in EI provide aural (re)habilitation services for children who are deaf and hard of hearing (DHH). In addition, audiologists treat some young children for vestibular disorders. Family-centered EI services for children who are DHH begin as soon as possible following identification but no later than 6 months of age, per EHDI’s 1–3–6 guidelines and the JCIH (ASHA, 2013; Centers for Disease Control and Prevention, 2017; JCIH, 2019).

Audiologists are responsible for providing families with unbiased information, recommendations, and the range of available educational and communication options to facilitate informed decision making. When choosing treatment approaches, the audiologist incorporates the family’s goals, priorities, values, beliefs, culture, and linguistic background. Treatment decisions are fluid; ongoing; and responsive to the changing needs, preferences, and learning styles of the family.

EI audiologists work collaboratively with clinical audiologists, teachers of the deaf, and other members of the IFSP team (including SLPs) to provide services that foster communication and language development (ASHA, 2004, 2008). They work with children who use a variety of communication methods, including spoken language, sign language, cued speech, simultaneous communication, and/or AAC.

EI audiologists may be involved in the following interventions for DHH children between the ages of birth and 5 years (ASHA, 2004, 2008, 2013; Casoojee et al., 2021; English et al., 2017; Moeller et al., 2013):

Collaborating with a child’s clinical audiologist to select, fit, and evaluate personal hearing instruments (e.g., hearing aids, cochlear implants, bone-anchored hearing aids), hearing assistance technologies (e.g., frequency-modulated/digitally modulated systems), and visual technologies (e.g., home alerting devices) in the child’s natural environment
Training families and other team members in the use and management of technologies to troubleshoot barriers and support consistent, effective use
Helping to determine and make appropriate acoustic modifications for the home, learning environments, and other natural settings
Helping families learn and use the most effective modes and methods of communication, communication access strategies, and accommodations
Conducting auditory skills training, including activities to improve sound awareness, discrimination, recognition, and comprehension

See ASHA’s Practice Portal pages on Newborn Hearing Screening , Childhood Hearing Screening , Hearing Loss in Children , Balance System Disorders , and Language and Communication of Deaf and Hard of Hearing Children . See also ASHA’s resource on person- and family-centered care .

Monitoring Interventions and Outcomes

Young children can change rapidly, and families respond differently to them at various stages of development. Therefore, systematic plans for periodic assessment of progress are needed.

Beyond the federally required IFSP review every 6 months, audiologists and SLPs need to regularly monitor changes in language, communication, and/or feeding and swallowing, as well as the effects of interventions and progress toward outcomes.

They also monitor priorities and needs, strategies and approaches, and models and locations of service delivery, so that plans can be modified if needed to meet the desired outcomes and changing needs of the child and family (Kuhn & Marvin, 2016).

Qualitative and quantitative data collection, including use of participation-based outcome measures to describe the child’s involvement in activities with others, assist in monitoring interventions by doing the following (Searcy, 2011, 2018; Shelden & Rush, 2014; Wolery, 2004):

validate the conclusions from the initial evaluation/assessment
develop a record of progress over time
identify facilitators or barriers
attend to levels of engagement (e.g., at home, at school, or with peers)
determine whether and how to revise intervention plans
ensure fidelity of the intervention plan (i.e., degree to which an intervention is delivered as intended)

Monitoring interventions by measuring participation-based outcomes is meaningful to families because it facilitates conversations related to real-world expectations and functioning (Cunningham et al., 2017; Shelden & Rush, 2014; Wolery, 2004; World Health Organization [WHO], 2007).

The WHO’s International Classification of Functioning, Disability and Health–Children and Youth Version provides a framework to assist audiologists and SLPs in evaluating interventions and outcomes in infants, toddlers, and preschoolers, including their ability to communicate, perform activities, and participate in everyday routines, play, and social interactions (WHO, 2007).

Factors Affecting Service Provision in EI

There are many factors affecting service provision in EI, including point of entry, access to EI services, and the service delivery approach used. Some examples follow.

Infants, toddlers, and preschoolers do not have a single point of entry into a system for treatment. Eligible families can receive treatment through their state Part C agencies in the family’s natural environments (i.e., locations where the child would be found if they did not have a diagnosed disability or delay). Children who are found to be ineligible for Part C may still receive supports in their natural environments, in clinics, or in inpatient or outpatient programs. However, families would need to access private funding or insurance to cover treatment when their child is determined to be ineligible for Part C EI services.
Access to EI may be affected by logistical factors such as geographic location, transportation, family responsibilities (e.g., work, child care), or financial resources. However, if a child is eligible for Part C services, access to EI must be provided regardless of these factors.
Family values; beliefs; perspectives on disability; and understanding of the child’s needs, levels of acceptance, grieving, and/or stress can also impact access. See, for example, Núñez and Hughes (2018) and Peredo (2016).
A mismatch between the cultural and/or linguistic background of the provider and the family can impact trust, understanding, and rapport-building (Ng et al., 2022). Providers are encouraged to examine their implicit biases and continually develop skills in culturally and linguistically responsive care (Hyter & Salas-Provance, 2019).
Some families and providers may need to develop a new understanding about their roles when EI service delivery approaches are more consultative and collaborative rather than traditional, child-centered treatment methods (Brown, 2016; Ross, 2018; Searcy, 2011; Searcy & Hughes, 2015).

Other factors that EI service providers report as challenges include the following:

change in eligibility criteria that exclude children who may be perceived (e.g., by families and providers) as needing services
restrictive eligibility criteria or state/agency policies
insufficient reimbursement or funding for services
lack of communication among service agencies
limited time and large caseloads
difficulty accessing necessary resources (e.g., personnel shortages, lack of transportation, appropriate measures, interpreters)
limited number of qualified providers to deliver services
limited knowledge, training, and professional development for audiologists and SLPs in EI, especially for serving culturally and linguistically diverse populations
varying levels of buy-in, support, engagement, and follow-through (e.g., from families, child care, or educational teams)
inconsistent implementation of strategies across child care, preschool, and home settings
family uneasiness with home visitors
loss to follow-up or poor attendance
limited collaboration among professionals working with the child and family
lack of research

See ASHA’s Schools Survey and SLP Health Care Survey for detailed summaries.

Service Delivery

See the Service Delivery sections of relevant Evidence Maps for pertinent scientific evidence, expert opinion, and client/caregiver perspective on specific clinical disorders and topics.

In addition to determining the optimal EI approach and treatment for the child and family, audiologists and SLPs consider other service delivery variables—including format, provider, dosage, and setting—that might affect treatment outcomes.

Format refers to the structure of the treatment session.

The shift from direct intervention toward consultative and collaborative approaches aligns with the federal mandate to provide family-centered services in natural environments (Coufal & Woods, 2018). Consultative and collaborative formats support inclusive practices and focus on the child’s participation and functional communication during daily activities and routines.

Because Part C EI services are structured within the context of the child’s home, community, and group care settings, the format regularly includes key people in those settings (e.g., parents, teachers, care providers, siblings, and peers).

For EI services outside of Part C programs, format selection depends on factors such as treatment setting (e.g., acute care, rehabilitation hospitals, home, preschool, and community), stage of intervention, impact of the disorder, and the primary goals of the team at different points in the EI process. It is important to implement formats that are flexible and dynamic to allow for developmental growth and changing family priorities and concerns.

Telepractice can also be used to remotely deliver synchronous EI services. This format fosters interdisciplinary collaboration, consultation, coaching, and coordinated care within naturalistic contexts (see, e.g., Hamren & Quigley, 2012; Houston, 2013; Larson et al., 2022; Olsen et al., 2012; Stredler-Brown, 2017). See ASHA’s Practice Portal page on Telepractice and resource on reimbursement of telepractice services .

Provider refers to the person providing the treatment (e.g., SLP, audiologist, or other professional; trained volunteer).

Although many children and families receiving EI services have multiple service providers from different disciplines, state Part C programs are increasingly using a primary service provider (PSP) approach to service delivery (Lineberger, 2022; Marturana et al., 2011).

Interprofessional practice (IPP) through transdisciplinary teaming supports primary service delivery. Primary service provision emphasizes an IPP approach to EI service delivery that involves a team of professionals and a PSP, who serves as the primary point of contact for the family. Although there may be more than one service listed on the IFSP, the PSP is the professional—other than the service coordinator—who sees the family most often (Raver & Childress, 2015; Shelden & Rush, 2013). Audiologists and SLPs may serve as PSPs, which sometimes requires role release and role extension (see, e.g., Boyer & Thompson, 2014; Crais & Woods, 2016; Lineberger, 2022; Marturana et al., 2011). See ASHA’s resource on interprofessional education/interprofessional practice (IPE/IPP ) .

Members of the IPP team support the PSP, child, and family through joint visits, consultations, team meetings, and coaching or formal training (Shelden & Rush, 2013). The PSP stays in regular contact with all team members to keep everyone updated on progress and family questions. Primary service provision often strengthens the knowledge and skills of audiologists and SLPs through teamwork with other professionals (Lineberger, 2022; Marturana et al., 2011).

The primary service provision model is not meant to limit a family’s access to EI professionals and services. The intent is to address the child’s development from a holistic perspective in the context of the family, rather than viewing the child from a discipline- or domain-specific perspective. The PSP helps the family and other team members consider how all aspects of development (e.g., communication, motor skills, play) overlap in the child’s everyday life (Raver & Childress, 2015; Shelden & Rush, 2013).

This approach may be less intrusive because there are fewer professionals in the home or classroom, and it may help to reduce fragmented services, conflicting information, and caregiver stress (Boyer & Thompson, 2014; Crawford & Weber, 2014; King et al., 2009; Lineberger, 2022). The decision to use a PSP approach may be based on team input, on the child’s and family’s priorities and concerns, and on state and local policies for service delivery (Lineberger, 2022; Marturana et al., 2011).

Dosage refers to the frequency, intensity, and duration of service.

Some families and caregivers require more frequent contact and more concrete support, whereas others prefer more freedom to foster their own learning (Bagnato et al., 2011). Some individuals may prefer or benefit from extra support implementing interventions, or they may need new approaches to try. Others prefer longer intervals between visits, as this provides more time to use strategies, practice new skills in daily routines, and gain confidence in their own abilities (Dunst et al., 2014; James, 2022; Keilty, 2010; Roberts et al., 2016).

Intervention characteristics (e.g., unfamiliarity, complexity) often guide decisions about dosage needs more than the severity of a disorder. Matching the strengths of providers to the needs of individual families and children is also essential to determine effective dosage (James, 2022; Kuhn & Marvin, 2016).

Setting refers to the location of treatment (e.g., home, community-based).

Federal legislation supports IFSP teams in determining the most appropriate location(s) for EI services and supports. Factors such as the family’s geographical location, child and family needs and resources, and family preferences will help determine where services and supports occur (Dunst et al., 2014; Searcy, 2018).

IDEA Part C (IDEA, 2011) requires that intervention services and supports be provided to the maximum extent appropriate in natural environments, including home and community settings in which children without disabilities participate. For infants, toddlers, and families receiving services through Part C programs, the delivery of services in traditional clinical or medical locations may not be eligible for reimbursement by Part C because these are not the child’s and family’s natural environment. In some cases, IDEA allows for justification of service delivery in settings other than the natural environment. The IFSP team must document the necessary justification in order for Part C to consider payment for these services.

The natural environments for EI services and supports may change over time as family and child needs change. In addition, some children may receive EI services in more than one setting and/or outside of a Part C program altogether. Audiologists and SLPs deliver EI services outside of Part C programs in settings such as neonatal intensive care units, pediatric acute care and rehabilitation hospitals, community clinics, child care programs, and private schools (Kellar-Guenther et al., 2014; Weglarz-Ward et al., 2020).

See the section above titled Services Are Developmentally Supportive and Promote Children’s Participation in Their Natural Environments.

ASHA Resources

ASHA State-by-State
Assessment Tools, Techniques, and Data Sources
Birth-to-Six Program: What IDEA Says
Collaboration and Teaming
Consumer Information: Early Intervention
COVID-19: ASHA Web Event Series on Service Delivery Considerations in Early Intervention
COVID-19: ASHA Web Event Series on Service Delivery Considerations for Private Practice in Speech-Language Pathology
Current IDEA Part C Final Regulations (2011): Analysis and Issue Briefs
Early Hearing Detection and Intervention (EHDI)
Family-Centered Practice
Identify the Signs
Interprofessional Education/Interprofessional Practice (IPE/IPP)
Payment and Coverage of Audiology and Speech-Language Pathology Telepractice Services
Person-Centered Care in Audiology
Person- and Family-Centered Care
Practice Policy
Guidelines for Audiologists Providing Informational and Adjustment Counseling to Families of Infants and Young Children With Hearing Loss Birth to 5 Years of Age
Knowledge and Skills Needed by Speech-Language Pathologists Providing Services to Infants and Families in the NICU Environment
Learning Disabilities and Young Children: Identification and Intervention
Loss to Follow-Up in Early Hearing Detection and Intervention
Supplement to the JCIH 2007 Position Statement: Principles and Guidelines for Early Intervention Following Confirmation That a Child Is Deaf or Hard of Hearing
The Use of FM Amplification Instruments for Infants and Preschool Children With Hearing Impairment
Social Determinants of Health

Other Resources

This list of resources is not exhaustive, and the inclusion of any specific resource does not imply endorsement from ASHA.

Autism Navigator
Birth to 5: Watch Me Thrive!
Center for Parent Information & Resources
Centers for Disease Control and Prevention: Learn the Signs. Act Early.
Division for Early Childhood
Early Hearing Detection & Intervention – Pediatric Audiology Links to Services (EHDI-PALS) Directory
Early Childhood Hearing Outreach (ECHO) Initiative
Early Childhood Personnel Center (ECPC)
Early Childhood Technical Assistance Center (ECTA Center)
Early Intervention Services
Part C of IDEA
Part C State Systems and Coordinators
Practice Improvement Tools: Using the DEC Recommended Practices
Research and Reference Portal
EI Excellence
Family Guided Routines-Based Intervention (FGRBI)
Yes you can! Routines-Based Intervention and Telepractice [Video]
Routines-Based Telepractice Visit Checklist [PDF] (Evidence-based International Early Intervention Office)
FIRST WORDS Project: The Florida State University College of Medicine: Autism Institute
Head Start: Early Childhood Learning & Knowledge Center
Hear to Learn
IDEA Infant & Toddler Coordinators Association
Illinois Early Intervention Clearinghouse
Key Principles of Early Intervention and Effective Practices: A Crosswalk With Statements From Discipline Specific Literature [PDF]
National Association for the Education of Young Children
National Association of Neonatal Therapists
States’ and Territories’ Definitions of / Criteria for IDEA Part C Eligibility [PDF]
Virginia Early Intervention Professional Development Center: Tools of the Trade
Zero to Three
200 by Two: An Early Intervention Guide on Communication and Language Development [Video]

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Coufal, K. L., & Woods, J. J. (2018). Interprofessional collaborative practice in early intervention. Pediatric Clinics, 65 (1), 143–155. https://doi.org/10.1016/j.pcl.2017.08.027

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Crais, E. R., & Woods, J. (2016). The role of speech-language pathologists in providing early childhood special education. In B. Reichow, B. Boyd, E. Barton, & S. Odom (Eds.), Handbook of early childhood special education (pp. 363–384). Springer.

Crawford, M. J., & Weber, B. (2014). Early intervention every day! Embedding activities in daily routines for young children and their families. Brookes.

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Kasari, C., Kaiser, A., Goods, K., Nietfeld, J., Mathy, P., Landa, R., Murphy, S., & Almirall, D. (2014). Communication interventions for minimally verbal children with autism: A sequential multiple assignment randomized trial. Journal of the American Academy of Child & Adolescent Psychiatry , 53 (6), 635–646. https://doi.org/10.1016/j.jaac.2014.01.019

Keilty, B. (2010). The early intervention guidebook for families and professionals: Partnering for success. Teachers College Press.

Kellar-Guenther, Y., Rosenberg, S. A., Block, S. R., & Robinson, C. C. (2014). Parent involvement in early intervention: What role does setting play? Early Years, 34 (1), 81–93. https://doi.org/10.1080/09575146.2013.823382

King, G., Strachan, D., Tucker, M., Duwyn, B., Desserud, S., & Shillington, M. (2009). The application of a transdisciplinary model for early intervention services. Infants & Young Children, 22 (3), 211–223. https://doi.org/10.1097/IYC.0b013e3181abe1c3

Kuhn, M., & Marvin, C. A. (2016). “Dosage” decisions for early intervention services. Young Exceptional Children, 19 (4), 20–34. https://doi.org/10.1177/1096250615576807

Larson, A. L., Romano, M., Meyers, C., Eugenio, J., & Olsen, S. T. (2022). Supporting caregiver coaching in telepractice through web-based professional development. Perspectives of the ASHA Special Interest Groups , 7 (2), 616–634. https://doi.org/10.1044/2021_PERSP-21-00089

Leonet, O., Orcasitas-Vicandi, M., Langarika-Rocafort, A., Mondragon, N. I., & Etxebarrieta, G. R. (2022). A systematic review of augmentative and alternative communication interventions for children aged from 0 to 6 years. Language, Speech, and Hearing Services in Schools , 53 (3), 894–920. https://doi.org/10.1044/2022_LSHSS-21-00191

Light, J., Barwise, A., Gardner, A. M., & Flynn, M. (2021). Personalized early AAC intervention to build language and literacy skills: A case study of a 3-year-old with complex communication needs. Topics in Language Disorders , 41 (3), 209–231.

Lineberger, A. (2022). Characteristics and consequences of a primary service provider approach to teaming in early intervention. CASEmakers , 9 (1), 1–5.

Madigan, S., Prime H., Graham S. A., Rodrigues, M., Anderson, N., Khoury, J., & Jenkins, J. M. (2019). Parenting behavior and child language: A meta-analysis. American Academy of Pediatrics , 144 (4), 1–14. https://doi.org/10.1542/peds.2018-3556

Marturana, E., McComish, C., Woods, J., & Crais, E. (2011). Early intervention teaming and the primary service provider approach: Who does what, when, why, and how? Perspectives on Language Learning and Education, 18 (2), 47–52. https://doi.org/10.1044/lle18.2.47

McCarthy, E., & Guerin, S. (2022). Family-centred care in early intervention: A systematic review of the processes and outcomes of family-centred care and impacting factors. Child: care, health and development , 48 (1), 1–32. https://doi.org/10.1111/cch.12901

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McManus, B. M., Richardson, Z., Schenkman, M., Murphy, N. J., Everhart, R. M., Hambidge, S., & Morrato, E. (2020). Child characteristics and early intervention referral and receipt of services: A retrospective cohort study. BMC Pediatrics, 20 (1), Article 84. https://doi.org/10.1186/s12887-020-1965-x

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Morgan, P. L., Farkas, G., Hillemeier, M. M., & Maczuga, S. (2012). Are minority children disproportionately represented in early intervention and early childhood special education? Educational Researcher, 41 (9), 339–351. https://doi.org/10.3102/0013189X12459678

Morgan, P. L., Hammer, C. S., Farkas, G., Hillemeier, M. M., Maczuga, S., Cook, M., & Morano, S. (2016). Who receives speech/language services by 5 years of age in the United States? American Journal of Speech-Language Pathology, 25 (2), 183–199. https://doi.org/10.1044/2015_AJSLP-14-0201

Ng, Z. Y., Waite, M., Ekberg, K., & Hickson, L. (2022). Clinicians’ and managers’ views and experiences of audiology and speech-language pathology service provision for culturally and linguistically diverse families of young children with hearing loss. Journal of Speech, Language, and Hearing Research , 65 (7), 2691–2708. https://doi.org/10.1044/2022_JSLHR-21-00378

Núñez, G., & Hughes, M. T. (2018). Latina mothers’ perceptions and experiences of home-based speech and language therapy. Perspectives of the ASHA Special Interest Groups, 3 (14), 40–56. https://doi.org/10.1044/persp3.SIG14.40

Oetting, J. B., Gregory, K. D., & Rivière, A. M. (2016). Changing how speech-language pathologists think and talk about dialect variation. Perspectives of the ASHA Special Interest Groups , 1 (16), 28–37. https://doi.org/10.1044/persp1.SIG16.28

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Olsen, S., Fiechtl, B., & Rule, S. (2012). An evaluation of virtual home visits in early intervention: Feasibility of “virtual intervention” [Monograph]. The Volta Review, 112 (3), 267–281. https://www.agbell.org/Portals/26/VoltaReview/112-3.pdf [PDF]

Paavola-Ruotsalainen, L., Lehtosaari, J., Palomäki, J., & Tervo, I. (2018). Maternal verbal responsiveness and directiveness: Consistency, stability, and relations to child early linguistic development. Journal of Child Language, 45 (2), 319–339. https://doi.org/10.1017/S030500091700023X

Parlakian, R. (2018, July 12). What you need to know: Early intervention. Zero to Three. https://www.zerotothree.org/resource/what-you-need-to-know-early-intervention/

Pellecchia, M., Beidas, R. S., Mandell, D. S., Cannuscio, C. C., Dunst, C. J., & Stahmer, A. C. (2020). Parent empowerment and coaching in early intervention: Study protocol for a feasibility study. Pilot and Feasibility Studies , 6, Article 22. https://doi.org/10.1186/s40814-020-00568-3

Peredo, T. N. (2016). Supporting culturally and linguistically diverse families in early intervention. Perspectives of the ASHA Special Interest Groups, 1 (1) , 154–167. https://doi.org/10.1044/persp1.SIG1.154

Rantalainen, K., Paavola-Ruotsalainen, L., & Kunnari, S. (2022). Maternal responsiveness and directiveness in speech to 2-year-olds: Relationships with children’s concurrent and later vocabulary. First Language , 42 (1), 81–100. https://doi.org/10.1177/01427237211049585

Raver, S. A., & Childress, D. C. (2015). Family-centered early intervention: Supporting infants and toddlers in natural environments. Brookes.

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Roberts, M. Y., Hensle, T., & Brooks, M. K. (2016). More than “try this at home”—including parents in early intervention. Perspectives of the ASHA Special Interest Groups, 1 (1), 130–143. https://doi.org/10.1044/persp1.SIG1.130

Roberts, M. Y., Kaiser, A. P., Wolfe, C. E., Bryant, J. D., & Spidalieri, A. M. (2014). Effects of the teach-model-coach-review instructional approach on caregiver use of language support strategies and children’s expressive language skills. Journal of Speech, Language, and Hearing Research, 57 (5), 1851–1869. https://doi.org/10.1044/2014_JSLHR-L-13-0113

Romski, M., & Sevcik, R. A. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18 (3), 174–185. https://doi.org/10.1097/00001163-200507000-00002

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Searcy, K. L. (2011). Here’s how to do early intervention for speech and language: Empowering parents. Plural.

Searcy, K. L. (2018). Funding and documentation for early intervention (0 to 3 years). In N. Swigert (Ed.), Documentation and reimbursement for speech-language pathologists: Principles and practice (pp. 251–291). Slack Incorporated.

Searcy, K. L., & Hughes, D. M. (2015, November). A collaborative framework for early intervention services: Redefining natural environments [Paper presentation]. American Speech-Language-Hearing Association Annual Convention, Denver, CO, United States.

Shelden, M. L., & Rush, D. D. (2013). The early intervention teaming handbook: The primary service provider approach. Brookes.

Shelden, M. L., & Rush, D. D. (2014). IFSP outcome statements made simple. Young Exceptional Children , 17 (4), 15–27. https://doi.org/10.1177/1096250613499246

Smith, A. L., Barton-Hulsey, A., & Nwosu, N. (2016). AAC and families: Dispelling myths and empowering parents. Perspectives of the ASHA Special Interest Groups, 1 (12) , 10–20. https://doi.org/10.1044/persp1.SIG12.10

Spicer-Cain, H., Camilleri, B., Hasson, N., & Botting, N. (2023). Early identification of children at risk of communication disorders: Introducing a novel battery of dynamic assessments for infants. American Journal of Speech-Language Pathology, 32 (2), 523–544. https://doi.org/10.1044/2022_AJSLP-22-00040

Stredler-Brown, A. (2017). Examination of coaching behaviors used by providers when delivering early intervention via telehealth to families of children who are deaf or hard of hearing. Perspectives of the ASHA Special Interest Groups, 2 (9), 25–42. https://doi.org/10.1044/persp2.SIG9.25

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About This Content

Acknowledgments.

Content for ASHA’s Practice Portal is developed and updated through a comprehensive process that includes multiple rounds of subject matter expert input and review. ASHA extends its gratitude to the following subject matter experts who were involved in the development of the Early Intervention page:

Winnie Chung, AuD, CCC-SLP
Lauren M. Cycyk, PhD, CCC-SLP
Cheryl Deconde Johnson, EdD
Elaine McCarty, AuD, CCC-A
Karen F. Muñoz, EdD, MS, CCC-A
Patricia A. Prelock, PhD, CCC-SLP
Christina Royster, EdD, CCC-SLP, BCS-CL
Sharon S. Ringwalt, PhD
Kathleen D. Ross, MS, CCC-SLP
Dathan D. Rush, EdD, MA, CCC-SLP
Karyn Lewis Searcy, MA, CCC-SLP
Arlene Stredler-Brown, PhD, CCC-SLP
Juliann J. Woods, PhD, CCC-SLP

In addition, ASHA thanks the members of the Ad Hoc Committee on the Role of the Speech-Language Pathologist in Early Intervention, whose work was foundational to the development of this content. Members of the committee were M. Jeanne Wilcox (chair), Melissa A. Cheslock, Elizabeth R. Crais, Trudi Norman-Murch, Rhea Paul, Froma P. Roth, Juliann J. Woods, and Diane R. Paul (ex officio). ASHA Vice Presidents for Professional Practices in Speech-Language Pathology Celia Hooper (2003–2005) and Brian B. Shulman (2006–2008) served as the monitoring officers.

Citing Practice Portal Pages

The recommended citation for the Practice Portal page is:

American Speech-Language-Hearing Association. (n.d.). Early intervention [Practice portal]. https://www.asha.org/Practice-Portal/Professional-Issues/Early-Intervention/

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Developing High-Quality, Functional IFSP Outcomes and IEP Goals Training Package

This training package was developed collaboratively with staff from the ECTA Center and the Western Regional Resource Center (WRRC) in response to the need expressed from state and local providers to have specific information and resources about developing Individualized Family Service Plan ( IFSP ) outcomes and Individualized Education Program ( IEP ) goals. First introduced in September 2012, this revised training package includes:

a set of six fully scripted PowerPoint presentations ;
handouts, activities and supplemental materials ; and
how states have used and adapted the materials

All the materials needed, including instructions for use and adaptation, are included in the training package. For questions, please contact Anne Lucas.

Training Presentations: Developing High-Quality, Functional IFSP Outcomes and IEP Goals

The training packages' presentation materials are provided in Microsoft Powerpoint format in six sections. Each presentation includes information for both Early Intervention ( EI ) and Early Childhood Special Education ( ECSE ) settings, and can be freely edited and adapted by presenters based on needs such as time allotted and audience.

Presentation Materials

Each presentation includes activities, links to additional resources and a link back to the webpage you're reading right now. The closing slide of each section has been set up for up to two presenters to add their own contact information.

Section 1: Setting the Context
Section 2: Functional Assessment
Section 3: Integrating Functional Assessment and Outcome Measurement with IFSP Outcomes/ IEP Goals
Section 4: Functional, High Quality IFSP Outcomes and IEP Goals
Section 5: IFSP Strategies to Meet Outcomes and IEP Objectives to Meet Goals
Section 6: Applying the Information: Practical Learning Experience

Handouts, Activities and Supplemental Materials

-->

Handouts, Activities and Supplemental Materials
Handout, Activity, Supplement	Title and Link	/	Section, Slide(s)	Annotation
Handout	Outcomes/ Goals Training Package: Guidance for Trainers	,	Section 1, Slide 1	This document provides the purpose and background, content organization and use and adaptation suggestions for the training. Appendices include a draft participant agenda as well as references and resources.
Handout	, 2005 ( )	,	Section 1, Slide 18	This document is referenced in the training as the source for the goals of early intervention and of early childhood special education.
Handout	, 2008 (Workgroup on Principles and Practices in Natural Environments)		Section 1, Slide 19	This document is referenced in the training as the source of the mission and principles of Part C early intervention.
Handout	, 2008 (Workgroup on Principles and Practices in Natural Environments)		Section 1, Slide 19	This document is referenced in the training as an additional source of information about the principles of Part C early intervention.
Handout	Process: Supporting Family Participation, Inclusive Practices and Positive Outcomes for Preschool Children with Disabilities, 2012 (Workgroup on Principles and Practices for the Process)		Section 1, Slide 20	This document is referenced in the training as an additional source of information about the goal and principles of early childhood special education.
Handout	, 2010 ( )	,	Section 1, Slides 25-26	This document provides a brief overview of the child and family outcomes, as well as information on the conversion of child outcome information into the federal progress categories and the summary statements reported for the .
Handout	Questions for Eliciting Family Interests, Priorities, Concerns, and Everyday Routines and Activities	,	Section 2, Slides 16-17	This handout provides the full list of questions from which the examples on slides 17 and 18 were pulled. It is a comprehensive list of questions that may be asked of families to gather information.
Handout, Activity	Table Talk: Authentic Assessment	,	Section 2, Slide 20	This handout accompanies an activity, during which participants talk at their tables about current practices in authentic assessment.
Handout			Section 3, Slide 9	This is the flow chart of the process with the steps of including child outcomes measurement highlighted in red text.
Handout			Section 3, Slide 9	This is the flow chart of the process with the steps of including child outcomes measurement highlighted in red text.
Activity	Edelman, L. (Producer) (2001). (video). Denver: Western Media Products -->. Used with permission from JFK Partners, University of Colorado School of Medicine and the Colorado Department of Education.		Section 3, Slide 11	This is the video that is shown for the activity. Scroll down to the bottom of the page to access the "Nolan's Story" video.
Activity	.		Section 3, Slide 12	This is the video that is shown for the activity.
Handout, Activity	Outcomes: A training activity for Infant and Toddler service providers		Section 4, Slide 39	This training activity is used to support participants' understanding of the criteria needed to develop and write high quality, participation-based outcomes. Outcomes Answer Key: Page 20
Handout, Activity	Goals: A training activity for Early Childhood Special Education staff		Section 4, Slide 39	This training activity is used to support participants' understanding of the criteria needed to develop and write high quality, participation-based goals. Goals Answer Key: Page 21
Handout, Activity	Worksheet: Developing Measurable and Functional Outcomes/Strategies and Goals/Objectives	,	Section 6, Slide 5	This worksheet will be completed as a part of the final activity, during which participants read a case study (Kim) and use the information to develop high quality outcomes/goals, as well as strategies, services and supports.
Handout, Activity		,	Section 6, Slide 5	Participants who work in early intervention Part C programs will use this case study to complete the final activity of the training. The case study includes medical and developmental background on Kim, information on family routines and priorities, and child developmental background that will be used to complete the worksheet above.
Handout, Activity			Section 6, Slide 5	Participants who work in early childhood special education (Section 619) programs will use this case study to complete the final activity of the training. The case study includes medical and developmental background on Kim, information on family routines and priorities, and child developmental background that will be used to complete the worksheet above.
Supplement	Outcomes			This webpage provides presentation examples and resources for developing outcomes.
Supplement				This document provides additional information on the quality practices that, when used, can lead to high quality, participation based, functional outcomes.
Supplement	Outcomes Statements, BriefCASE, Vol 2, No. 1. Dathan Rush and M'Lisa Shelden	,		This document by Rush and Shelden provides in depth information on the process of gathering information about children and families in every day routines and activities for the purpose of developing participation based outcome statements.
Handout, Supplement	Resources for Writing IFSPs and IEPs	,		This resource provides several web links with annotations to additional resources.
Supplement	Goals		Section 4, Slide 32	This document provides examples of high-quality, functional goals in the area of articulation (making speech sounds). It may be used as a supplement in the training when participants include speech –language pathologists to support their understanding of writing functional goals for children receiving services for articulation only.
Supplement	Process: Supporting Family Participation, Inclusive Practices, and Positive Outcomes for Preschool Children with Disabilities, 2012 (Workgroup on Principles and Practices for the Process)			This document provides additional information on the quality practices that, when used, can lead to high-quality, participation-based, functional goals.
Supplement	Contents			This Department of Education website provides information on the requirements for Individual Education Plans. Section 5 of this webpage provides specific information on the content requirements of the .
Supplement	Model Form			This document provides an example of an that meets the federal requirements for s.
Supplement		,		This Department of Education website provides information on the requirements for s. Section 8 of this webpage, provides information on writing goals, including the special factors that must be considered when developing goals.
s, 2009 (Wisconsin Department of Education)			This document from the Wisconsin Department of Public Instruction is an example of a state guidance document for writing quality s.

Early childhood services local case examples

17 May 2021

A series of case studies based on EIF's work with local areas looking at contemporary practice in delivering maternity and early years services through local centres or hubs.

In 2020, we engaged 14 local areas across England to see and understand different approaches to providing early childhood services through community venues. The experiences and reflections of some of these areas are captured in these case studies.

Please note that these case examples are intended to illustrate what others are doing in this field; we do not endorse any of the specific decisions, plans or actions.

Find out more

Case examples, share this page, related content.

Developmental Early Intervention Program: A Case Study

September 2018
In book: Recent Researches in Health Sciences (pp.279-297)
Publisher: Cambridge Scholars Publishing

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Using and Providing Services: Case Studies in Early Intervention

A case study approach was used to examine the complexities of service utilization in early intervention with infants, toddlers, and young children with disabilities. Seventy-two families of children (ages birth to 4) participating in nine early intervention programs in three states (Colorado, North Carolina, and Pennsylvania) and their service providers completed a self-report questionnaire and were interviewed. In addition, documents (the Individualized Family Service Plan or the Individualized Education Program and the latest assessment report) were analyzed. Results are reported in terms of families' service use and professionals' provision of services, including family characteristics, family-service provider relationships, African American mothers, support families received, families' reflections, and service providers' reflections. Overall, findings suggest that professionals' provision of services reflects: (1) a predominant child versus family orientation...

Related Papers

Vera Rentier

This article utilizes four knowledge sources to characterize a current gap in policy and practice related to serving families in early intervention (birth to 5) programs. It argues that the field of early intervention has focused primarily on implementing family-centered practices by focusing on how families and professionals should interact. The field has not sufficiently addressed what supports and services should be offered to families to enhance the likelihood of positive outcomes for families themselves and for their children with disabilities. The paper concludes with recommendations for enhancing policy, research, and professional development related to family services and supports. This paper converges four knowledge sources to distinguish and describe a current gap in policy and practice related to families: empirical, conceptual, statutory, and infor-mation obtained from a national summit. The gap is the absence of a clear conceptu-alization of what supports and services

Infants and Young Children

Kathleen Hebbeler

Carole Upshur

Journal of Early …

Pamela Epley

Relationships between parent ratings of Part C/early intervention (EI) services and family outcomes for families of young children with disabilities were examined—specifically, the early childhood outcomes (ECO)–recommended family outcomes and family quality of life (FQOL). Measures included the Early Childhood Services Survey, the ECO Center Family Outcomes Survey, and the Beach Center Family Quality of Life Scale. Findings support a logic-model relationship between parent ratings of Part C/EI services, ECO-recommended family outcomes, and FQOL. Parent ratings of Part C/EI services were found to predict immediate family outcomes as measured by ECO-recommended family outcomes, and ECO-recommended family outcomes, in turn, predicted the broader outcome of enhanced FQOL. Implications for EI practice and evaluation are discussed.

Topics in Early Childhood Special Education

Background. Families of young children with disabilities are eligible for early intervention services as mandated by Part C of the Individuals With Disabilities Education Act. Although prior research has shown that families are generally satisfied with early intervention, this research has not been based on a nationally representative sample of families, nor has it systematically examined perceptions of the initial experiences entering early intervention. Objective. This study was designed to determine families’ initial experiences in determining their child’s eligibility, interactions with medical professionals, effort required to obtain services, participation in planning for services, satisfaction with services, and interactions with professionals. Method. We interviewed a nationally representative sample of 3338 parents of young children with or at risk for disability. All the children had recently entered an early intervention program operated under the auspices of Part C of th...

Laurie Ford

Exceptional Children

Donna Spiker

Infants & Young Children

Mary Beth Bruder

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