Early Childhood Intervention
Natalia Mufel, Education Specialist,
UNICEF, New Delhi
Developmental delays
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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.
A delay is measured by using validated developmental
assessments. Delays may be mild, moderate or severe.
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.
Disabilities
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Child has a physical, health, sensory, psychological,
intellectual or mental health condition or impairment that
restricts functioning in one or more areas, such as
physical movement, cognitive and sensory functions,
self-care, memory, self-control, learning, or relating to
others.
Many national and international typologies
(classifications) of disabilities exist that list impairments
by type.
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
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.
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.
Legal Framework/Operational Guidelines in India
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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 Rashtriya Bal Swasthya Karyakram
(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).
UNICEF Guidance
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In the 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.
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Early Childhood Intervention
(ECI)
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ECI programmes provide a system of early childhood
services and support for:
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Vulnerable children at high risk for developmental delays or
with confirmed developmental delays or disabilities, and
Their parents and families.
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.
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.
ECI Programmes usually include:
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Home visits and centre-based services
Parent education
Balanced early stimulation and developmental services
Physical, language and occupational therapies
Special education and inclusive services
Medical, nursing and nutritional services
Support services, including social work services,
referrals and protective services, if required
ECI services
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Serve infants and children, from birth to 3, and up to 5
Receive referrals from Health service
Identify children early through home outreach, and
referrals from parents, polyclinics, and child care centres
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
Provide transition to inclusive/regular pre-schools and
primary schools or, if necessary, special facilities
Collaborate closely with rehabilitation
hospitals for health/medical interventions, when needed
ECI personnel include:
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Early Interventionists
Special Pedagogues/Special Educators
Physical Therapists
Language/Speech Therapists
Audiologists
Occupational Therapists
Parent Educators
Psychologists and Family Therapists
Nurses
Social Workers and Protective Services Personnel
Evaluators
Continuum of early childhood
services
Service
intensity
Most
intensive
Types
ECI + parent ECI/ECD +
education
parent educ
ECD +
parent educ
Child status Level of risk
High risk of
delay
Moderate
risk
Low or no
risk
Degree of
delay/disab.
Delayed or
disabled
Mild delay or No delay or
disability
disability
Malnutrition
Moderate to
severe
Mild, making Normal
gains
nutrition
Health
status
Severely or Improved,
chronically ill but at risk
Services
Moderately
intensive
Least
intensive
Preventive &
basic care
Continuum of early childhood
services (continued)
Service
aspects
Most
intensive
Moderately
intensive
Least
intensive
Assessment
Intensive,
frequent
Regular,
Annual
less frequent
Locations
Home visits
& centre
Centre,
fewer visits
Centre only,
Groups only
Frequency
Frequent,
daily-weekly
Bi-weekly,
monthly
Upon
request only
Duration
Continuous
Depends on
child status
Upon
request only
Service
providers
Specialists,
Early Interventionists
Supervised
home
visitors
Supervised
parent
educators
Guidelines for establishing ECI
Systems
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ECI services represent far more than a new
organisational framework.
They require profound changes in ways of thinking
about:
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Children and how to maximise their potential;
Parental rights and empowerment; and
Professional competencies and roles in supporting parents and
children.
Guidelines then present: main
activities, guidance and comments
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Strategic planning
Initial design activities
Programme organisation and inter-institutional
relationships
Training activities
Programme implementation
Programme evaluation and monitoring
Preparing a Plan of Action
NIMH PROJECT TEAM 2001
Mrs. V.R.P. Sheilaja Rao
Principal Investigator
Dr. Jayanthi Narayan
Co-Investigator
Mrs. Lakshmi RavindraResearch 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
ECSE Curriculum Transaction
1.
2.
3.
4.
5.
6.
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 preschool
Adaptations in core and non – academic curricular tasks
Package Contents
1. CALENDAR
 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)
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 preschools.
Adapted ECSE Time Table
Day
10.30
11.00
(A.M.)
11.00
11.30
(A.M.)
11.30
12.00
(NOON)
12.00
12..30
(NOON)
12.30
01.00
(P.M.)
01.30
02.00
(P.M)
02.00
02.30
(P.M.)
02.30
03.00
(P.M.)
03.00
03.30
(P.M.)
MON
Music
My Family
Creativity
Out door
Games
TUE
Music
Story
Indoor
Games
Fine motor
CAI
Creativity
WED
Vegetables
Gardening
THU
Body parts
Indoor
Games
Creativity
Color concept
Creativity
Gardening
Picture
Reading
L
U
N
C
H
Rhyme
Vegetables
Body parts
Creativity
Color concept
Fine motor
Fine motor
Music
Out door
Games
Sand play
Fine motor
Picture
Reading
Out door
Games
Rhyme
Vegetables
Water play
Music
Out door
Games
FRI
Out door
Games
10.00 A.M. to 10.30 A.M. Prayer, Yoga and Physical Exercises
CAI
Fine motor
Saturday and Sunday Holidays
Thank you!