Early Childhood Intervention

1. Early Childhood Intervention Natalia Mufel, Education Specialist, UNICEF, New Delhi

2. Developmental delays z Child is assessed to have atypical behaviour or does not meet expected normal development for actual or adjusted age in one or more of the following areas of development: perceptual, fine or gross motor, social and emotional, adaptive, language and communication, or cognitive. z A delay is measured by using validated developmental assessments. Delays may be mild, moderate or severe. z Caused by: poor birth outcomes, inadequate stimulation and nurturing care from birth onward, malnutrition, chronic ill health and other organic problems, psychological and familial situations, or other environmental factors.

3. Disabilities z Child has a physical, health, sensory, psychological, intellectual or mental health condition or impairment thatrestricts functioning in one or more areas, such asphysical movement, cognitive and sensory functions,self-care, memory, self-control, learning, or relating toothers. z Many national and international typologies (classifications) of disabilities exist that list impairmentsby type.

5. On the numbers • By one widely used estimate, some 93 million children – or 1 in 20 of those aged 14 or younger – live with a moderate or severe disability of some kind. • From 21% to 31% of young children in OECD countries are affected by developmental delays and disabilities. • They are derived from data of quality too varied and methods too inconsistent to be reliable. Definitions of disability differ by place and over time, as do study design, methodology and analysis. • No one really knows how many children have disabilities

6. Children with disability are invisible affecting resources and services available for them: • In comparison with high-income countries, fewer premature or very low birth weight infants survive in LAMI countries, and a larger proportion have significant developmental difficulties. • Children with disabilities and their families are too often invisible—in statistics, in policies, in societies. According to the World Disability Report, there are 25 percent people disabled in India . However, according to the data of Census 2001, India has only 2.1% i.e., about 20 million or 2 crore disabled people.

7. One of the critical ways of ensuring children with disabilities can develop to their full potential is through health screening and early intervention. • Nearly, 6 percent of children in India are born with birth defects and 10 percent children are affected with developmental delays leading to disabilities. However, many children with developmental delays are not identified until the age of three or even primary school age, and by then their delays and learning disabilities have become permanent or are very difficult to reverse. • Child Health Screening and Early Intervention Services can reduce the extent of disability, improve quality of life and enable all children to achieve their full potential. • Inclusive health and education services have a critical role to play in building a solid foundation on which children with disabilities can build fulfilling lives.

8. Legal Framework/Operational Guidelines in India • India became seventh country to ratify the UN Convention on the Rights of Persons with Disabilities. • Government enacted the Persons with Disabilities (Equal Opportunities, Protection of Rights and Full Participation) Act in 1995 providing equal opportunities for people with disabilities and their full participation in the nation building. The Government has also set up National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities in 2001 and a National Handicapped Finance and Development Corporation in 1997 to promote economic development activities, including self-employment programmes, for the benefit of persons with disabilities. • Right to Education mandates schools to become child-friendly, inclusive spaces where children from diverse backgrounds can actively participate in learning through child-centered activities. • In 2013, Government of India has launched the RashtriyaBalSwasthyaKaryakram (RBSK) aimed at screening over 270 million children from 0 to 18 years for 4 Ds - Defects at birth, Diseases, Deficiencies and Development Delays including Disabilities. Children diagnosed with illnesses shall receive follow up including surgeries at tertiary level, free of cost under NRHM. ECI should be established in collaboration with WCD and MHRD (School Health).

9. UNICEF Guidance zInthe early years, early detection and intervention, as well as family support come to the fore. Early intervention is critical and holds tremendous potential for success. It requires high awareness among health professionals, parents, teachers as well as other professionals working with children. Family- and community-based early intervention services should be linked with early learning programmes and pre-schools, which meet the needs of children with disabilities and facilitate their smooth transition to school. z

10. Early Childhood Intervention(ECI) z ECI programmes provide a system of early childhood services and support for: z Vulnerable children at high risk for developmental delays or with confirmed developmental delays or disabilities, and z Their parents and families. z The primary goal of ECI programmes is to support parents in helping their children use their competencies to achieve their full developmental potential and attain expected levels of development, to the extent possible.

11. ECI Approach • Child-centred services build on each child’s strengths and abilities, strive to meet the current and emerging needs of each child, provide individualised services. • Family-focused services help parents advocate for their child and family, ensure that parents are partners in assessments, service planning, and evaluating programme services, involve them in all services related to their child, are friendly, are sensitive to family cultural values and traditions.

12. ECI Programmes usually include: z Home visits and centre-based servicesz Parent education z Balanced early stimulation and developmental servicesz Physical, language and occupational therapiesz Special education and inclusive servicesz Medical, nursing and nutritional servicesz Support services, including social work services, referrals and protective services, if required

13. ECI services z Serve infants and children, from birth to 3, and up to 5z Receive referrals from Health service z Identify children early through home outreach, and referrals from parents, polyclinics, and child care centresz Continuous referral and tracking systems are required: identification, screening and/or assessment, individualised family service plans (IFSP), services, case management, referrals, tracking and follow-up z Provide transition to inclusive/regular pre-schools and primary schools or, if necessary, special facilities z Collaborate closely with rehabilitation hospitals for health/medical interventions, when needed

14. ECI personnel include: z Early Interventionists z Special Pedagogues/Special Educatorsz Physical Therapists z Language/Speech Therapistsz Audiologists z Occupational Therapistsz Parent Educators z Psychologists and Family Therapistsz Nurses z Social Workers and Protective Services Personnelz Evaluators

15. Continuum of early childhoodservices Service Most Moderately Least intensity intensive intensive intensive Services Types ECI + parent ECI/ECD + ECD + education parent educ parent educ Child status Level of risk High risk of Moderate Low or no delay risk risk Degree of Delayed or Mild delay or No delay or delay/disab. disabled disability disability Malnutrition Moderate to Mild, making Normal severe gains nutrition Health Severely or Improved, Preventive & status chronically ill but at risk basic care

16. Continuum of early childhoodservices (continued) Most Moderately Least intensive intensive intensive Intensive,frequent Service Assessment Regular, Annualless frequent aspects Centre only,Groups only Locations Home visits Centre, & centre fewer visits Frequency Frequent, Bi-weekly, Upon daily-weekly monthly request only Duration Continuous Depends on Upon child status request only Specialists,Early Inter-ventionists Service Supervised Supervised providers home parent visitors educators

17. Guidelines for establishing ECISystems z ECI services represent far more than a new organisational framework. z They require profound changes in ways of thinking about: z Children and how to maximise their potential;z Parental rights and empowerment; and z Professional competencies and roles in supporting parents and children.

18. Guidelines then present: main activities, guidance and comments z Strategic planning z Initial design activities z Programme organisation and inter-institutional relationships z Training activities z Programme implementation z Programme evaluation and monitoringz Preparing a Plan of Action

25. NIMH PROJECT TEAM 2001 Mrs. V.R.P. Sheilaja Rao Principal Investigator  Dr. Jayanthi Narayan Co-Investigator Mrs. Lakshmi Ravindra Research Officer Ms. Rama Cousik Research Assistant NATIONAL INSTITUTE FOR THE MENTALLY HANDICAPPED (Government of India, Ministry of Social Justice & Empowerment) Manovikas Nagar P.O.Secunderabad 500 009, A.P,India

27. ECSE Curriculum Transaction Shift from Medical to Educational Model by engaging Multidisciplinary Team approach for Assessment, Programming & Evaluation Initiate Parent Training Programs for parents of students attending ECSE prior to placement in Regular Pre Schools Develop IEP & IFSP for School Readiness To develop School Readiness schedule for individualised and group learning by selecting customised placement in regular and special school settings Develop Transition Curriculum for shift from home to pre-school Adaptations in core and non – academic curricular tasks

28. Package Contents • 10 months curriculum, month - wise objectives and activities list with representative pictures. • Activities are divided into 5 teaching strategies with headings: - CONVERSATION (Green) - GAMES (Brown) - SONGS (Pink) - STORY (Blue) - CREATIVE ACTIVITY (Yellow) 1. CALENDAR

30. 2. ACTIVITY CARDS Representative pictures, sequenced in steps to teach activities from the calendar. Each step is adapted to suite any disability condition with iconic representation in order to make cards more teacher friendly. 3. TEACHER’S MANUAL Background details of various disability guidelines to use the training package and impart tips to be used in teaching strategies for the disabled in regular pre-schools.

33. Adapted ECSE Time Table Out door Games Out door Games My Family Rhyme Vegetables Fine motor Creativity Music Indoor Games Story Body parts Creativity Sand play Creativity Music Music Out door Games Picture Reading Vegetables Fine motor Gardening Fine motor Color concept CAI Indoor Games Picture Reading Body parts Vegetables Creativity Fine motor Rhyme Water play Out door Games Out door Games Color concept Gardening Fine motor Music Creativity CAI 10.00 A.M. to 10.30 A.M. Prayer, Yoga and Physical Exercises Saturday and Sunday Holidays

34. Thank you!