Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation

As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed.

Early Intervention in the Structure of Children’s Rehabilitation (on the Example of the Republic of Tatarstan)

The early intervention system is currently considered as an independent activity which has a clear conceptual model. The generalmechanisms of the early intervention system facilitate the child’s social adaptation and its integration into the educational environment. This creates the conditions for the child development and the formation of the child’s skills necessary in daily life situations. At the same time, it remains unclear how the routing of a child in need of rehabilitation is carried out, taking into account the need toreceive early intervention services for the target group of patients. Aim. To determine the place of early intervention in the structure of the rehabilitation service of the Republic of Tatarstan. Results and Discussion. The early intervention system contains functional, personality-oriented and environmental approaches,which are implemented using the domains of activity and participation of the International Classification of Functioning, Disabilitiesand Health. The use of this classification implies the need for joint work of the number of specialists who make up a multidisciplinaryteam, forms a unified methodology for constructing rehabilitation plans and early assistance programs, and offers a conceptual basisfor analyzing the effectiveness of their implementation. In addition, the application of the International Classification of Functioning,Disabilities and Health makes it possible to determine the role of early intervention when planning a child’s rehabilitation route. The articlepresents a model of routing a child in need of rehabilitation measures, implemented in the Republic of Tatarstan, which providesfor early identification of children with indications and their referral accordingly to these indications to early intervention, medical orsocial rehabilitation. Conclusion. Identifying children of the target group in need of the early intervention and their timely referral to organizations that areproviders of relevant services is one of the stages in solving urgent problems of rehabilitation. Currently, the departments of early interventionsystem are opened on the basis of medical, social and educational organizations in the Republic of Tatarstan, and includedin the rehabilitation structure playing an important integrating role in the formation of interagency cooperation.

The New Zealand Police Early Intervention System: A review of implementation and impact issues

This paper examines the implementation process and impacts of an Early Intervention System (EIS) introduced into the New Zealand Police in 2013. The system was associated with large reductions in complaints of 72.5% against target employees ( N = 526), but without this clearly translating into reductions in the overall number of complaints. The New Zealand case also highlighted the issue of the different potential uses of early intervention. Should the priority be officer welfare or the more usual aim of improving officer conduct, police–citizen relations and public confidence in police? The authors argue that the traditional focus on reducing adverse incidents between police and citizens, with public complaints as a major guide and measure, should have at least equal weight in an EIS that is part of a comprehensive state-of-the-art police integrity management system. The paper also highlights the need for detailed publicly accessible data to ensure accountability of investments in integrity strategies.

Participation of Children between Three and Five Years Old at Home and in the Community Setting

The main goal of the present study was to document the participation of preschool children at home and in the community setting, describing the differences between eligible children with support of Special Education Service and/or of the Early Intervention System and noneligible children, in three main dimensions: child functioning, child participation and perceived environmental barriers. Data about child functioning was collected through preschool teachers and about participation and barriers through parents. Sociodemographic data was also collected. Forty preschool teachers and 116 children (and their parents) participated in this study. Forty-two children were eligible and had support from Special Education Service and/or of the Early Intervention System. The results showed that eligible children have lower levels of functionality, participate less frequently and are less involved in the activities at home and in the community setting and that their parents perceive more environmental barriers in both settings. The results were analysed considering the Biopsychosocial Model.

Professional Training in Early Intervention for Children and Families in Russian Federation

In accordance with the Concept for the Development of Early Care in the Russian Federation (Decree of the Government of the Russian Federation of 2016, December 17, No. 2723-r), the creation of an early intervention system for children from birth to three years old and their families is an integral part of the formation of comprehensive assistance to children with health disabilities. One of the priority tasks of the Concept implementation is the management of the quality of services, including through the creation of a system for training professionals in the field of early intervention. The article analyzes the need for professionals specializing in providing early intervention in the constituent entities of the Russian Federation, as well as the directions and content of their training. In addition, information is provided on domestic and foreign experience of professional training of such experts. The results of the analysis indicate the need to create a variable system for training professionals in the field of early intervention in the Russian Federation. Training offers include activities in the field of higher and further professional education, including retraining and advanced training. The authors emphasize the need to combine professional training in selected areas of early care — with the training of transdisciplinary professionals.

Experience of providing early intervention services in the municipal health institution

The Government of Ukraine has approved a plan of measures for the implementation of the pilot project "Creating a system of early intervention services to ensure the development of the child, preserve his health and life" for 2019-2021. The pilot regions implementing the early intervention service include ten regions of Ukraine, including the Odessa region. The main goal of piloting the project is to create and develop an early intervention system for children with disabilities or the risk of disability and their families, to improve the quality of early intervention services, to reduce the level of disability of children in Ukraine and to prevent their institutionalization at an early age. The purpose is to consider, on the example of a municipal non-profit enterprise of urban subordination, a mechanism for implementing early intervention services in Odessa. The materials of the research are the principles of financing of the health care system of the city of Odessa and the work of local medical institutions in the conditions of reforming the medical industry; methods are description, analysis, synthesis, generalization, graphic design. The article provides an example of funding services for the public at the expense of both national and local budgets, as well as mechanisms for coordinating services for children with disabilities or the risk of disability and their families.