Organization of the Manual

Collage of early intervention in India
 
The plasticity of the brain and body in the first few years of life, gives us an unmatched opportunity to promote development and reduce the impact of disease or damage to the developing system. Effective early intervention services recognize the role of excellent health care and rich early experiences in supporting best outcomes for children. Early experiences are fostered by supporting the family to understand and respond to their child’s special needs and by modifying and enriching the child’s environment and routines. 
 
Early intervention services may be organized in different ways depending on the needs of the family and child and the resources of the organization. While it may not always be possible to do, meaningful and lasting benefits can be achieved by seeing and serving children and families in their own environments, especially in the very early years. Services may also be offered through support provided to other service providers such as the local Balwadi or Anganwadi. Early intervention services should be available within hospital settings so that all the needs of the child can be met in one place. 
 
Especially in the early years, both children and families benefit from having access to one consistent professional as they try to learn many new skills and negotiate situations that are emotionally challenging. The early intervention professional should have competence in identifying and responding to a range of support needs and knowing when and to whom referrals should be made for detailed assessment and guidance. The manual will help the user identify referral points and direct families to appropriate resources. 
 
When a family walks into the early intervention services center, the interventionist should be able to use the manual as a ready reference to remind themselves of what is important to observe during this period, identify what may be delayed and locate resources and suggestions. 
 

Planning & Progress Documentation

An intervention plan should take into consideration the strengths and needs of the child and family, the resources available at home and in the community and the resources of the organization providing the services. The frequency of contact with the professional providing early intervention services is also a key factor in determining the actual goals and intervention plan created. 
 
Within this section you will find guidance for the first meeting with caregivers and the child and forms that can be used to help assess the situation, to create plans, as well as document the impact of intervention over time. This allows the interventionist to constantly monitor the effectiveness of the plan and adjust as needed. 
 
We also include quality indicators for sessions with the child and the family and for the program itself. These can be used by the interventionist or a program mentor to help determine professional needs for training and support. 
 

Child Development

We have used age as the primary way in which to divide the manual to help the interventionist view children holistically and use their typical activities to guide goals and interventions rather than focus only on the impairment and delay. Within each age group, we organize information so that the interventionist is easily able to identify issues as well as solutions for a child and family. When the use of the gender-neutral term “child” makes the sentence too complex and unwieldy, we alternate between using “he” and “she” and expect the interventionist to recognize that we mean both genders. In each age group, we have four sections described below. 
 
The importance of the age: The simplest form of intervention is to enable children to have play experiences that are similar to other children in the same age group. The first section of each age group, therefore focuses on what the child is doing and learning during this period. When a parent talks about their child’s day and activities, this section will help the interventionist compare it with other children of the same age and help them understand the areas of life and learning that could be impacted by the child’s impairments. 
 
Developmental Milestones Circle: This section guides the intervener to quickly recognize the child’s skills and capacities while identifying areas of concern. By placing the different areas of development in a circle, we hope to help interventionists and caregivers to always see the child as a complete person with all his or her strengths and weaknesses. The milestones in this section were compiled from several Indian research efforts and tools. 
 
Besides the milestones, the pictures in the circle, illustrate typical activities that encourage children to develop and gain skills that are age appropriate. A range of people, objects and environments are illustrated to remind the interventionist to look beyond the impairment and consider other limitations and resources when planning intervention. 
 
Points for concern: This section identifies some key areas of concern during early childhood, along with suggestions and resources for further assessment and intervention. Many skills selected in each age bracket are also developmental markers of possible delays or impairment. Others are to encourage us to think of changing the experiences of young children so they can experience a stimulating environment. For example, early exposure to pictures, books and opportunities to scribble and play with puzzles are not always part of typical early childhood opportunities. Delays in these areas are often due to lack of exposure and we hope to encourage adults caring for children to see value in providing these experiences. Drawing focus to how early these skills emerge will help improve areas like nutrition, language and problem solving in all children.
 
This section also encourages the interventionist to stay alert about issues that may otherwise be missed while observing children and listening to families. Problems with vision and hearing for example, are often missed in children who have other obvious impairment.  
 
Intervention through play: Intervention in early childhood can be simply thought of as enabling age appropriate play. Play is an important activity, enabling the child in a fun way to learn and to develop. Children are internally motivated during play, allowing them to relax, develop the capacity to focus their attention and retain and recall their learning more easily. Play challenges children to use their senses and their motor skills and to practice without feeling discouragement at failure. 
 
If at each stage, we think of how a baby plays – with what, with whom, where and how – we have actually the fundamentals of a good early intervention program. Once we identify the factors that limit a child’s play, the interventionist must think of how to adapt the environment, the toys, the activity and provide appropriate position and support to the child to enable active engagement in age-appropriate play. 
 

Recommended Resources 

Many resources exist to guide intervention for children with delays and disabilities. A basic set of recommended books are listed in the resource section. We draw heavily on the tremendous body of work put into the open source domain by the Hesperian Foundation and tested and used around the world. These can be accessed free online and are typically available in numerous languages. 
 
In addition to this, we have compiled a few resources in a separate Resources Folder. This comprises of resources frequently used in the field, often from the experiences and consultants of Perkins International, to serve as a quick starting point. The interventionists are encouraged to add to these resources from their own experience, needs and discovery so that this manual is personalized to the needs and resources relevant to the community they are serving.