Improving Early Childhood Intervention

Note: May is Better Hearing and Speech Month.

The Early Childhood Personnel Center (ECPC) logo

Infancy and early childhood are important times of life for all children, but more so for those who have delays in development. These delays may be from genetic conditions, disabilities, various risk conditions, or unknown reasons. While families may be the first to recognize a difference in their child’s developmental progress, professionals trained and licensed in early childhood intervention have the skills and knowledge to detect a developmental delay and to then provide intervention to remediate and/or minimize its impact on a child’s development.

Traditionally, professionals train in a single discipline that usually corresponds to an area of development. For example, speech-language pathologists are experts in the development of communication. Likewise, physical therapists are experts in a child’s physical or motor development. Additionally, most disciplines are trained to offer services and intervene across a broad age range—the lifespan of an individual. When a person completes a program of study in a discipline, the individual is then licensed in that discipline to provide services to persons across the lifespan.

These training and licensing practices create two challenges to providing effective early childhood intervention to infants and young children and their families:

  • Interventions may be focused to specific areas of development by discipline specific interventionists (e.g. an occupational therapist provides specific motor intervention and does not incorporate any other areas of development into her therapy/intervention); and
  • Interventions may be provided by a person who does not have any specific experience or competence in infancy or early childhood.

To address these challenges, the Early Childhood Personnel Center (ECPC), which is funded by the Office of Special Education Programs (OSEP) at the U.S. Department of Education, joined representatives from seven national organizations to examine the professional knowledge, skills and competencies that all disciplines should have when providing intervention to infants and young children.*

First, ECPC identified personnel standards (i.e., knowledge and skill statements) for each of the disciplines represented by the organizations. This yielded 752 individual standards. The organizations and ECPC aligned and reduced these standards until four thematic areas emerged that encompassed all disciplinary standards. Representatives of the seven organizations endorsed these as equally important to all disciplines providing early childhood intervention services. These representatives also operationally defined each area, which are contained in the following table:

Operationalized Definitions of the Four Core Competency Areas

CORE COMPETENCY AREA DEFINITION
Family Centered Practice Family-Centered Practice is culturally competent practice in natural settings that involves and actively engages the family in decision-making and the provision of services/therapy.
Interventions Informed by Evidence Evidenced Based intervention requires the use of scientifically based evidence to inform all screening, assessment, intervention/instruction and evaluation delivered to an individual child and family. Databased intervention and instruction refers to the process of collecting data about a child’s level of performance and designing and implementing a plan (e.g. IEP, IFSP) of instruction/ intervention that is evidence-based and focused on remediating a child’s and family’s needs.
Coordination and Collaboration Coordination and collaboration refers to working across professionals from other disciplines and community organizations in every facet of intervention/instruction.
Professionalism Professionalism requires all who provide early childhood intervention to have knowledge and skills in the laws, policies, practices that govern their professional discipline. It also requires that all in early childhood intervention demonstrate professional ethics and advocacy with each infant, young child and family they work with. Professionals in early childhood intervention will also take responsibility to improve their knowledge and skills through professional development and self-reflection.

The organizations’ boards endorsed these areas and definitions, and the organizations are now working with the ECPC to identify and validate indicators for each competency area. Training and materials will then be developed for both preservice and in-service audiences to teach and support early intervention professionals from multiple disciplines to provide interventions for the infants and young children across developmental areas.

It should be noted that these competencies will not replace the need for therapists and teachers to retain expertise and be licensed in their own discipline to address the needs of the infant or child. Rather, it will help ensure the effectiveness of integrating all developmental areas into a child’s interventions.


* The seven organizations included: The Council of Exceptional Children (CEC), the Division of Early Childhood (DEC), the American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), the American Speech-Language-Hearing Association (ASHA), the National Association for the Education of Young Children (NAEYC) and Zero to Three.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

Mary Beth Bruder,
Posted by
Mary Beth Bruder, Project Director, ECPC, University of Connecticut

“Voices from the Field” Interview with Will Eiserman, ECHO Initiative

Will Eiserman with a back pack in the woods

Will Eiserman, Director, Early Childhood Hearing Outreach (ECHO) Initiative at Utah State University.

Will Eiserman is the Director of the Early Childhood Hearing Outreach (ECHO) Initiative, at the National Center for Hearing Assessment and Management, Utah State University. As Director of the ECHO Initiative, he has led a national effort to assist Early, Migrant, and American Indian/Alaska Native Head Start programs in updating their hearing screening and follow-up practices. Working in close collaboration with a team of pediatric audiologists and other Early Hearing and Detection Initiative (EHDI) experts, Eiserman has been responsible for the design of training systems, mechanisms for tracking and follow-up, and evaluation strategies associated with early and continuous hearing screening activities. His career has focused on a variety of efforts to improve early intervention systems for children with special needs, and on meeting the psycho-social needs of children with craniofacial disfigurements and their families. Eiserman’s perspective is influenced by his extensive international and cross-cultural experiences that include work in Ecuador, Vietnam, Costa Rica, Russia, and Indonesia.


ED: How did you begin your career in early learning and development?

WE: I first earned my doctorate in educational research and development, and then had an opportunity to do post-doctoral work in early intervention research that was funded by the U.S. Department of Education’s Office of Special Education Programs (OSEP). The project, based at Utah State University, looked at a common set of assumptions about early intervention for young children with disabilities and developmental delays. This was back in the late 1980s, and we were exploring questions such as, “Is early really better in terms of when we intervene with children with disabilities? Is more intervention better than less? What types of interventions are more effective with children experiencing different types of developmental delays?” It was really exciting. Ours was part of the research that set the stage for developing the early intervention (EI) and early childhood special education (ECSE) programs that are now under the Individuals with Disabilities Education Act (IDEA).

I continued my work on EI/ECSE when I moved to the University of West Florida, where we focused on inclusion and family engagement. We provided a lot of training and technical assistance (TA) for local programs on supporting the role of families in EI, and helped programs think of ways to provide interventions for young children with disabilities in more inclusive environments. I then had an international opportunity through a Fulbright fellowship in Indonesia, where I taught research and development methods in social sciences.

A common thread across these experiences is the social integration and empowerment of individuals with special needs or disabilities. They allowed me to see how often there is a constellation of variables that impact the social placement of individuals with disabilities, and how that can be addressed through policies and support.

ED: What are periodic hearing screenings and why are they so important for healthy early learning and development?

WE: When you ask early childhood educators what is important for young children, one of the things they discuss is language development. Language is at the heart of social-emotional development, cognitive development, and school readiness. As conscientious as most early childhood professionals are about promoting language, there is less awareness about the importance of monitoring the status of hearing throughout the early years of development. We tend to think about language primarily as expressive, but we are not as attentive to receptive abilities. Monitoring children’s hearing status is an important investment in healthy language development. If there are concerns, we can intervene and ensure there is minimal impact on language development.

I direct the Early Childhood Hearing Outreach (ECHO) Initiative, which is part of the National Center for Hearing Assessment and Management (NCHAM). NCHAM has been funded for over 25 years by the U.S. Department of Health and Human Services (HHS) Health Resources and Services Administration’s Maternal and Child Health Bureau (HRSA/MCHB) as a national resource center. It has been instrumental in expanding

  1. hearing screenings, and
  2. the follow-up that may be necessary based on the results of the hearing screening for young children.

Over the last two decades, significant advancements have been made through the provision of newborn hearing screenings. These screenings are now available to more than 95 percent of the children born in the U.S. This is transformative and has dramatically changed the life landscape for individuals who are born hard-of-hearing or deaf.

The work of the ECHO Initiative arose from the observed success of newborn hearing screening efforts across the nation. Recognizing the significant changes newborn hearing screening represented for children and families, the HHS Head Start Bureau (now Office of Head Start) raised an important question about the technology that was making newborn hearing screening possible: whether any of it could be used to continually monitor the status of hearing for the children ages birth–3 years old who were being served in Early Head Start (EHS) programs. Head Start and EHS programs are required to ensure that all children in their programs receive evidence-based hearing screenings. We couldn’t think of any reason why the newly available technology wouldn’t work with this population, but it had never been done. This would require EHS program staff to be trained to screen young children with the Otoacoustic Emissions (OAE) screening method. While research suggested increased likelihood that continuous screening would result in additional identification of children with hearing loss as a result of late-onset or progressive loss, we weren’t sure what we would actually find.

The ECHO Initiative began as a pilot project with a handful of EHS programs in three states: Oregon, Washington, and Utah. From this pilot we discovered that yes, we can train early childhood program staff to conduct the OAE screenings and, in fact, staff often already had the set of skills most needed for conducting the screenings—getting young children to cooperate! Additionally, we found that when you screen 0–3-year-olds with the OAE, you do in fact find children with hearing loss that have not been previously identified. Newborn hearing screening programs have been shown to identify approximately three babies in 1,000 with permanent hearing loss. We found that in the 0–3-years-old range, subsequent to newborn screening, we typically identify another one to three children in 1,000 who have permanent hearing loss. This finding was consistent with research that had suggested the incidence of permanent hearing loss doubles between birth and the time children enter school; from about three in 1,000 at birth, to about six in 1,000 when children reach school-age. This finding was very compelling and led to what has been a multi-decade commitment from the Office of Head Start, in collaboration with HRSA/MCHB, to support the provision of evidence-based hearing screening and follow-up practices for all children in EHS and Head Start across the nation. This has occurred through the availability of online resources, training, and TA. Our website includes a broad array of resources and information about training and TA opportunities that help promote evidence-based hearing screening for young children.

ED: What are some of the challenges you have experienced in promoting regular hearing screenings, and what strategies have you tried to overcome them?

WE: Obviously, the use of technology nearly always involves some costs. Hearing screening equipment has associated costs, whether you’re using OAE, the recommended hearing screening method for children 0–3 years of age, or Pure Tone screening (historically used with 3–5-year-olds). Training is critical and needs to be provided in a timely fashion. It should also respond to high staff turnover, which is a reality in nearly all early care and education environments. To address these needs, the ECHO Initiative offers online trainings. We also partner with audiologists in locations across the country who can assist individual programs to conduct evidence-based hearing screening and follow-up practices.

Another challenge inherent in implementing any health or educational screening program has to do with ensuring the necessary follow-up occurs when children do not pass. There are multiple reasons why a child might not pass a hearing screening. Our data show that about 25 percent of children in the birth-to-age-3 range don’t pass the initial OAE hearing screening on one or both ears. We don’t recommend, however, that all of those children be referred for further evaluation. Instead, our protocol recommends screening these children again in 2 weeks, at which point we consistently see the “not pass” rate decline to about 8 percent. This may be due to screener error during the first screening; a transient condition that caused fluid in the middle ear and prevented an ear to pass the screening; or even a temporary wax blockage that worked its way out during the transpiring 2 weeks. For children who don’t pass the second screening, we recommend families go to a health care provider for a middle ear evaluation and treatment, if necessary. It is not uncommon that these children are found to have had an ear infection that wasn’t noted. This is not the completion of the screening process, however. Once any middle ear disorder is addressed, we screen the child again to see if they pass. If they still do not pass, then the child is referred to a pediatric audiologist for a complete audiological evaluation. You can see that there are potential challenges in supporting families to complete these many follow-up steps. Additionally, the availability of pediatric audiologists can present as a challenge. We have found that EHS and Head Start staff are often very skilled and innovative in supporting families through the completion of all follow-up, and recognizing that monitoring hearing is a critical part of promoting language development during the early years.

Spreading the message about the importance of hearing screenings is an ongoing challenge. We want to increase the awareness of this for parents, caregivers, and providers of health and educational services throughout early childhood. Given that the status of hearing can change at any time in a child’s life, we cannot rely on any single screening, but must screen periodically. We’ve developed several short videos about the importance of monitoring hearing throughout early childhood, and we invite viewers to share them and help us spread the word:

ED: What suggestions do you have for others interested in expanding regular hearing screenings as part of high-quality early learning programs?

WE: We encourage people to explore the resources and learning opportunities we have available on the ECHO website. In developing our various resources, we have recognized that those doing hearing screening nearly always have many other responsibilities as well. We have tried to provide a comprehensive set of resources so that programs can easily develop evidence-based practices without having to recreate the wheel. And we’ve tried to provide resources that are applicable and relevant across a variety of early childhood program contexts, including center-based or home-based programs; rural or urban program settings; and programs serving children in Head Start-funded programs, IDEA Part C, or health care settings. We also try to make our resources helpful across our stakeholder groups, which include many partners with an interest in increasing periodic hearing screenings—health care providers, IDEA Part C early intervention programs, EHS and Head Start programs, child care providers, families, and the Early Hearing and Detection Initiative (EHDI) programs within states.

My final suggestion is to be aware of the assumptions we often make in early childhood. We don’t ever want to assume a child can hear before that has been verified. For example, even if a child turns toward sound, that doesn’t give you enough information to know that the child’s hearing is in the normal range. We also don’t want to just assume a child has been assessed. Unless you have ear-specific results from an objective screening that was conducted within the last year, you really can’t be certain of the current status of a child’s hearing. Finally, we must caution that, even if a child passes an objective hearing screening, any concerns about a child’s hearing ability or language development would warrant a referral for a complete audiological evaluation.


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.

Will Eiserman
Posted by
Director, Early Childhood Hearing Outreach (ECHO) Initiative, National Center for Hearing Assessment and Management, Utah State University

“Voices from the Field” Interview with Deborah Dixon,
American Speech-Language-Hearing Association (ASHA)
Director of School Services

Deborah Dixon, ASHA Director of School Services

Deborah Dixon, ASHA Director of School Services

“True collaboration requires a lot of trust, but once you build that trust you understand that no one person can be responsible for a child’s progress”.


As part of Better Hearing and Speech Month (BHSM) ED interviewed Deborah Dixon, M.A., CCC-SLP, who is American Speech-Language-Hearing Association’s (ASHA) Director of School Services. Deborah leads ASHA’s schools team to provide resources, technical assistance and contemporary information to school-based speech-language pathologists (SLPs). She has presented to many state and national organizations and serves as ex officio to several ASHA committees. Some of her areas of expertise are integrating state standards; workload strategies; the role of the SLP in multi-tiered systems of support (MTSS) and response to intervention (RTI); dynamic service delivery for SLPs; eligibility and dismissal criteria for school SLP services; and contemporary issues in school practice.

Note to readers: Given the importance of high quality early learning opportunities for young children with disabilities, OSERS will periodically highlight voices from the broader field of early learning in our blog.


ED: Speech-language pathologists (SLP) are trained to work across the age span, why did you become interested in working specifically in schools?

Deborah: Most of my practice career [as an SLP] was in and around Pittsburgh in various school districts. I was always interested in working in a school setting since the most important things in a child’s life happen in the context of the child’s family and in their schools. In the school setting I enjoyed building relationships with teachers and other colleagues, families, and children. Working with children at an early age allows you to watch them change and grow overtime and to have an impact on many aspects of their development, including social, emotional, language, and literacy. With a preventive mindset, we can catch children early when they are struggling with language or communication, and then work with them and the adults in their lives to improve their outcomes.

ED: What is the SLP’s role in an early learning or school environment?

Deborah: When most people think about a speech-language pathologist, they think about helping children with make correct speech sounds, but an SLP’s role is much broader and includes all aspects of communication. SLPs serve an important role in assisting students to be “reading ready” by helping them hear and process differences in sounds, expand their vocabulary, use and understand grammar, build skills to summarize and sequence information, and problem solve and interpret idiomatic language. They support both oral and written language. SLPs also help students engage socially with one another; helping them learn a wide variety of verbal and nonverbal skills that support more successful interactions with peers and adults.

One of ASHA’s major strategic goals is to promote cross-discipline collaborationencouraging SLPs and their colleagues in schools (teachers, parents, physical therapists, occupational therapists, etc.) to work more collaboratively to address the needs of the whole child. We need to bring the various perspectives from different professions together to conduct child assessments, develop an intervention approach focused on improving outcomes for children holistically, and assess whether what we, the professionals, are doing is working. True collaboration requires a lot of trust, but once you build that trust you understand that no one person can be responsible for a child’s progress. A team made up of the family and professional, each with different expertise, can make all the difference.

ED: What are some of the challenges in this work, and what strategies have you tried to overcome them? 

Deborah: One of the biggest challenges is the school day. For meaningful collaboration, professionals need time to meet regularly. It is a huge struggle to find collaborative planning time because of the way schools are scheduled. One solution to this is getting buy-in from program or school leadership on how teams need to work to ultimately benefit children. Currently there isn’t a great understanding of the different roles and responsibilities of specialists (SLPs, OT, PT) in early learning programs and schools, or how they contribute to improving the developmental and educational outcomes of all children.

One successful strategy for improving collaboration is integrating SLP services into the program or classroom. If an SLP works in the general education classroom, the teacher sees their expertise in action and vice versa. The SLP also witnesses experiences the demands the teacher faces every day. Both professionals gain a new appreciation for roles and expectations, and have an opportunity to work together. Another strategy is to make staff assignments based on workload and not simply on numbers of children.

When there is concern in a school such as literacy rates or behavioral problems, bringing a team together can be really effective. Schools and early learning programs need to create a learning community that engages professionals and families to collaboratively develop solutions for such issues, including using data to inform interventions. If, as members of such a team, we all understand what we each other are trying to achieve, we can work together much more efficiently and effectively.

Families are a key partner in this collaborative work. We are getting better at figuring out how to engage working families. This is important, because most families do want to be involved. We must use technology and innovative solutions to involve families. We often tell families, “you need to work on this,” but we don’t engage with them on the other piece, how you build this into your everyday activities. This type of engagement can go a long way, and provide great support and perspective for the family and professional. For example, how do you use the grocery store to facilitate speech and language development?

ED: May is Better Hearing and Speech Month (BHSM). Why is it important to have a BHSM?

Deborah: BHSM is an annual opportunity to raise awareness about communication disorders, share strategies for building communication skills every day, and promote the important role SLPs and audiologists play in helping to build communication skills.

This year’s BHSM theme is “Communication—the Key to Connection.” This provides an opportunity to underscore that we engage with one another through communication. As adults, we are role models for children in our communication; even in terms of our problem solving, disagreeing, etc. Being very deliberate in terms of modeling positive communication skills is important. Additionally, being aware of and understanding the cultural nuance of communication gives us an opportunity to embrace and celebrate our diversity.


More information on BHSM can be found at: http://www.asha.org/public/


Blog articles provide insights on the activities of schools, programs, grantees, and other education stakeholders to promote continuing discussion of educational innovation and reform. Articles do not endorse any educational product, service, curriculum or pedagogy.


Deborah Dixon, ASHA Director of School Services
Posted by
American Speech-Language-Hearing Association’s (ASHA) Director of School Services

Better Hearing & Speech Month 2015:
Early Intervention Counts

2015 May is Better Hearing & Speech Month: Early Intervention Counts

Each May, The American Speech-Language-Hearing Association (ASHA) highlights Better Hearing & Speech Month (BHSM) to raise awareness about communication disorders. The 2015 theme is “Early Intervention Counts.” The Individuals with Disabilities Education Act (IDEA) supports states in providing early intervention services for infants and toddlers with disabilities and their families (Part C) and special education and related services for preschool children with disabilities (Part B, Section 619). Results of a recent survey of ASHA’s membership revealed that 45% of expert respondents reported a lack of awareness as the number one barrier to early detection of communication disorders. Research has shown that early detection is critical to addressing communication disorders. Delayed intervention can result in delayed development, as well as poor academic or career performance.

The importance of human communication—talking, reading, listening and interacting—is paramount to children’s overall development, including their academic and social success. The importance of human interaction is all the more true in this age of technology, in which “smart” devices occupy an ever-increasing amount of time, attention and prominence in the lives of infants to teens. For more information and resources about early detection of communication disorders, visit ASHA’s Web site (www.asha.org) and its Identify the Signs campaign (identifythesigns.org), which includes some interesting articles below:

Download the 2015 Better Hearing & Speech Month poster:

Download the 2015 Better Hearing & Speech Month poster

 

The ASHA materials contained herein are not an endorsement by the U.S. Department of Education and herein do not necessarily reflect the position or policy of the United States Department of Education.

OSERS Avatar -- OSERS: Inclusion, Equity and Opportunity
Posted by
Dawn Ellis is an Education Program Specialist in the Office of Special Education Programs at the U.S. Department of Education.