Intervention Services for a Child With Multiple Disabilities

This chapter will focus on providing intervention services for an eight-year-old African-American female, Dawn, with multiple disabilities. Dawn has been diagnosed with Down syndrome, a comorbid diagnosis of an intellectual disability, and exhibits behavior problems at home and school. In this scenario, she has been evaluated within the school system to determine eligibility for services, and the speech-language pathologist needs to develop intervention goals and select therapy strategies to provide appropriate services. While both parents are involved in the child's care, the family does not have permanent housing and moves frequently. Information from actual cases has been incorporated into this chapter.

A Rapid Learning Health System to Support Implementation of Early Intervention Services for Psychosis in Quebec, Canada: Study Protocol

Background: Given the strong evidence for their effectiveness, early intervention services for psychosis (EIS) are being widely implemented. However, heterogeneity in the implementation of essential components, remains an ongoing challenge. Rapid learning health systems (RLHS), that embed data collection in clinical settings for real-time learning and continual quality improvement, can address this challenge. We therefore implemented a RLHS in 11 EIS in Quebec, Canada. This project aims to determine the feasibility and acceptability of implementing a RLHS in EIS, and to assess its impact on compliance with standards for essential EIS components. Methods: Following literature recommendations, the implementation of this RLHS involves six iterative phases: external and internal scan, design, implementation, evaluation, adjustment, and dissemination. Multiple stakeholder groups (service users, families, clinicians, researchers, decision makers, provincial EIS association) are involved in all phases. Meaningful indicators of EIS quality (e.g., satisfaction, timeliness of response to referrals) were selected based on literature review, provincial guidelines, and stakeholder consensus on indicators prioritisation. A digital infrastructure was designed and deployed that comprises (a) a user-friendly interface for routinely collecting data from programs (b) a digital terminal and mobile app to collect feedback from service users and families regarding care received, health, and quality of life (c) data analytic, visualization and reporting functionalities to provide participating programs with real-time feedback on their performance over time, and in relation to standards and to other programs, along with tailored recommendations. Community of practice activities are being conducted that leverage insights from data to build capacity among programs to continually progress towards aligning their practice with standards/best practices. Guided by the RE-AIM framework, we are collecting quantitative and qualitative data on the Reach, Effectiveness Adoption, Implementation and Maintenance of our RLHS. These RE-AIM data will be analyzed to evaluate our RLHS’s impacts. Discussion: This project will yield valuable insights about how a RLHS can be implemented by EIS, along with preliminary evidence for its acceptability, feasibility and impacts on program-level outcomes. Its findings will refine our RLHS further and advance approaches that bring data, stakeholder voices and collaborative learning to improve outcomes and service quality in psychosis. Trial registration: NA

Ka puāwai ngā kōhungahunga turi: a study of the nature and impacts of early intervention for Māori deaf children and their whānau

<p>This research investigates the early experiences of Māori deaf children, documenting whānau (family) perspectives on interactions with early intervention professionals and environmental sources of information, the effects of these on whānau perceptions of deafness, how decisions around communication and language use are arrived at, and how these affect a sense of parental competence. The features of a whānau-centred model of intervention are explored by whānau participants and the researcher in order to provide an understanding of how early intervention services could be more effective from Māori perspectives. Developing age appropriate language, communication skills and social acculturation is a synchronous process which typically occurs within the context of families. The majority of deaf children, however, are born to hearing parents and families with little experience of deaf people from which to develop a subconscious repertoire of skills with which to engage, facilitate and teach language to a deaf child. Early intervention services seek to support deaf children and their families in this process. In New Zealand a family-centred model of early intervention is accepted practice. Māori children are over-represented in deafness diagnostic statistics and their early language and social development takes place within a social context that is configured differently to the prototypical non-Māori family, that is, the whānau. Little is known or documented about the characteristics and efficacy of a family-centred model in relation to Māori deaf children and their whānau. The Māori metaphor of transformative praxis was used to frame a kaupapa Māori approach to case study research. Kete mātauranga (woven baskets of knowledge) were co-constructed between whānau participants, early intervention professionals, and the researcher, using Māori methods of qualitative data collection: kōrero-a-tinana (observations of action and behaviour), kōrero-a-waha (spoken language), kōrero-a-ringaringa (signed language), kōrero-a-tuhituhi (written language). Analysis of the data suggests that whānau perceptions of their deaf child evolve as the child moves through developmental stages and as the whānau encounters different sources of information and experiences relating to deafness. The study shows how the relevance of information, spoken, written, and signed, from early intervention professionals and observational knowledge gained from others with lived experience of deafness, deaf people and their whānau, was interpreted and weighed by participants as they interacted with their own deaf child in everyday social contexts. Participants' aspirations for their deaf children centred on a holistic perspective of wellbeing and development, the whānau providing the foundational context from which this developed. Recognising that their deaf child was situated at the borders of multiple cultural and linguistic groups, through either familial or social connection, whānau aspirations centred on the child’s active social and linguistic participation within these groups. Initial encounters with professionals focused on medical perspectives of hearing loss, positing deafness as a medical concern remedied through routine technical and medical interventions. However, as the child entered developmental stages, whereby language acquisition and the social acculturation process began, whānau started to relate to their deaf child in more social terms, and required more social and linguistic support to ensure participation in various home and educational contexts. Early intervention services were seen by some participants to constrain, or conflict with, their social-cultural aspirations for the child, through a focus on acquisition of spoken English and facilitating participation in mainstream educational contexts. Whānau expressed frustration at the compromise they endured as a consequence and wished for a model of support that engaged with whānau aspirations and relational styles more effectively. Potential features of a whānau-centred model of early intervention were composed by the researcher and whānau participants during a wānanga (forum) held as a part of the research. The features identified utilised the tradition of raranga (weaving) as a metaphor with which to frame relational and participatory components of a whānau-centred early intervention model for Māori deaf children.</p>

Ka puāwai ngā kōhungahunga turi: a study of the nature and impacts of early intervention for Māori deaf children and their whānau

<p>This research investigates the early experiences of Māori deaf children, documenting whānau (family) perspectives on interactions with early intervention professionals and environmental sources of information, the effects of these on whānau perceptions of deafness, how decisions around communication and language use are arrived at, and how these affect a sense of parental competence. The features of a whānau-centred model of intervention are explored by whānau participants and the researcher in order to provide an understanding of how early intervention services could be more effective from Māori perspectives. Developing age appropriate language, communication skills and social acculturation is a synchronous process which typically occurs within the context of families. The majority of deaf children, however, are born to hearing parents and families with little experience of deaf people from which to develop a subconscious repertoire of skills with which to engage, facilitate and teach language to a deaf child. Early intervention services seek to support deaf children and their families in this process. In New Zealand a family-centred model of early intervention is accepted practice. Māori children are over-represented in deafness diagnostic statistics and their early language and social development takes place within a social context that is configured differently to the prototypical non-Māori family, that is, the whānau. Little is known or documented about the characteristics and efficacy of a family-centred model in relation to Māori deaf children and their whānau. The Māori metaphor of transformative praxis was used to frame a kaupapa Māori approach to case study research. Kete mātauranga (woven baskets of knowledge) were co-constructed between whānau participants, early intervention professionals, and the researcher, using Māori methods of qualitative data collection: kōrero-a-tinana (observations of action and behaviour), kōrero-a-waha (spoken language), kōrero-a-ringaringa (signed language), kōrero-a-tuhituhi (written language). Analysis of the data suggests that whānau perceptions of their deaf child evolve as the child moves through developmental stages and as the whānau encounters different sources of information and experiences relating to deafness. The study shows how the relevance of information, spoken, written, and signed, from early intervention professionals and observational knowledge gained from others with lived experience of deafness, deaf people and their whānau, was interpreted and weighed by participants as they interacted with their own deaf child in everyday social contexts. Participants' aspirations for their deaf children centred on a holistic perspective of wellbeing and development, the whānau providing the foundational context from which this developed. Recognising that their deaf child was situated at the borders of multiple cultural and linguistic groups, through either familial or social connection, whānau aspirations centred on the child’s active social and linguistic participation within these groups. Initial encounters with professionals focused on medical perspectives of hearing loss, positing deafness as a medical concern remedied through routine technical and medical interventions. However, as the child entered developmental stages, whereby language acquisition and the social acculturation process began, whānau started to relate to their deaf child in more social terms, and required more social and linguistic support to ensure participation in various home and educational contexts. Early intervention services were seen by some participants to constrain, or conflict with, their social-cultural aspirations for the child, through a focus on acquisition of spoken English and facilitating participation in mainstream educational contexts. Whānau expressed frustration at the compromise they endured as a consequence and wished for a model of support that engaged with whānau aspirations and relational styles more effectively. Potential features of a whānau-centred model of early intervention were composed by the researcher and whānau participants during a wānanga (forum) held as a part of the research. The features identified utilised the tradition of raranga (weaving) as a metaphor with which to frame relational and participatory components of a whānau-centred early intervention model for Māori deaf children.</p>

Early Intervention Services During the COVID-19 Pandemic in Spain: Toward a Model of Family-Centered Practices

Early intervention services (EIS) worked hard to continue serving children and their families during the COVID-19 lockdown, using online applications. This study aimed to determine families’ and professionals’ perceptions of the functioning of the early intervention (EI) model in Spain during the pandemic. The study sample comprised two subsamples: 81 families of children attended at an EIS (72 mothers and 9 fathers) and 213 professionals recruited from EIS. The survey was conducted online several weeks after the end of the strict lockdown in Spain. Descriptive statistics of the questionnaire answered by families and professionals were compiled, comparisons were made between the families’ and the professionals’ responses, and the relationships with several sociodemographic variables were analyzed. The results indicated that parents who cared for their children and were fully responsible for housework, parents who had used telematic tools before the lockdown, and younger professionals had a more positive perception of the EI model and the incorporation of family-centered practices (FCP) during the pandemic. The results also showed statistically significant differences in some items between parents and professionals: for example, professionals perceived more advantages than families during the lockdown, quoting the greater participation of families in the intervention and a greater focus on families’ needs. The data obtained from professionals suggested a more positive attitude toward FCP: however, the results show that they continued to adopt a directive role in the intervention, a position that is at odds with the tenets of FCP. There is a clear need for more training if a paradigm shift to FCP is to be achieved. Families’ and caregivers’ perceptions of telerehabilitation, and their adherence to telerehabilitation programs, are discussed. The implications of this study with regard to guiding future telematic interventions and family support are also considered.

“Prevention of opioid use disorder: the HOME (housing, opportunities, motivation and engagement) feasibility study”

Young adults experiencing homelessness are at high risk of opioid and other substance use, poor mental health outcomes, exposure to trauma, and other risks. Providing access to stable housing has the potential to act as a powerful preventive intervention, but supportive housing programs have been studied most often among chronically homeless adults or adults with serious mental illness. The Housing First model, which does not precondition supportive housing on sobriety, may reduce drug use in homeless adults. In the present study, we piloted an adapted model of Housing First plus prevention services that was tailored to the needs of young adults (18–24 years) experiencing homelessness in the USA. Preventive services were added to the Housing First model and included youth-centered advocacy services, motivational interviewing, and HIV risk prevention services. This model was piloted in a single-arm study (n = 21) to assess the feasibility, acceptability, and initial efficacy of a Housing First model over a 6-month period in preparation for a larger randomized trial. We use repeated measures ANOVA to test for changes in alcohol and drug use (percent days of use; alcohol or drug use consequences), housing stability, social network support, and cognitive distortions over 6 months of follow-up. A total of 17 youth completed the study (85% retention), and a high proportion of youth were stably housed at 6-month follow-up. Participation in intervention services was high with an average of 13.57 sessions for advocacy, 1.33 for MI, and 0.76 for HIV prevention. Alcohol use did not change significantly over time. However, drug use, drug use consequences, and cognitive distortions, and the size of youths’ social networks that were drug using individuals decreased significantly. The Housing First model appeared to be feasible to deliver, and youth engaged in the supportive intervention services. The study demonstrates the potential for an adapted Housing First model to be delivered to youth experiencing homelessness and may improve outcomes, opening the way for larger randomized trials of the intervention.

Education Of Autis Students At Islamic Boarding School Al Achsanyah

<p class="06IsiAbstrak">The purpose of the study was to find out how the educational process with autistic students intervention services at the Al-Achsaniyyah Kudus Islamic Islamic Boarding School. This research is a type of qualitative research with data analysis model of Miles and Huberman, data collection, data reduction, data presentation, and data verification. Data obtained through the process of interviews, observation, and documentation. The results of this study indicate that the educational model of Al-Achsaniyyah Kudus Islamic Islamic Boarding School is different from other Islamic boarding schools. Kyai/ Caregiver at Al-Achsaniyyah Kudus Islamic Islamic Boarding Schoolis not only a religious expert but also a doctor, Santri are children with autism syndrome. Al-Achsaniyyah Islamic Islamic Boarding School is not only a shelter but also a place of treatment and madrasa for autistic students. While the intervention service uses intervention services from an early age with the principle of Applied Behavior Analysis (ABA) on autistic students.</p>