By Ashley Opp
A child's earliest years are filled with new stimulations and novel experiences that drive his or her cognitive, social, and physical growth. The first 3 years of life are a critical time for brain development, especially if a child is delayed or restricted in development. If a child needs support to develop optimally, occupational therapy can help.
There are programs called early intervention across the country that are funded by federal, state, and local dollars. Early intervention is a collection of therapy and support services that provide children from birth to 3 years old who have disabilities, or who are at risk for developing them, the help they need to succeed later in life. Occupational therapy is one of several services that may be provided as part of early intervention. It benefits children with many specific conditions (e.g., Down syndrome, autism), in addition to children with no clear diagnosis.
For children with developmental delays or a known physical or mental condition associated with a high probability of delays, occupational therapy can help improve their motor, cognitive, sensory processing, communication, and play skills. The goal is to enhance development, minimize the potential for developmental delay, and help families to meet the special needs of their infants and toddlers.
The Individuals with Disabilities Education Act (IDEA) mandates that early intervention programs provide services in the natural environment and within naturally occurring routines and activities of the family’s day. According IDEA regulations, natural environments are those that are typical for the child’s peers who have no disabilities. Occupational therapy practitioners have always worked within the child and family situation. "Services are provided in the setting that your child needs to learn and practice a skill," says Debra Rhodes, an early intervention occupational therapist with Baltimore County Infants and Toddlers program. These settings could be at home, at day care, or at the playground.
Access to publicly funded early intervention depends on state law, and some states might require a family co-pay or health insurance subsidy. Some states provide services with absolutely no cost, and others depend on a family's ability to pay or their insurance coverage. States also use different definitions of developmental delay and have different eligibility criteria. To access services, parents need to call a 'single point of entry' number determined by their state or local jurisdiction. This is based on the county in which they live, and the individual county will give directions on how to obtain a local referral. Hospitals also offer early intervention services, although families would need to fund them privately.
Once referred, an evaluation takes place, unless the child already has a diagnosis. If the child is found to be eligible for early intervention service, a service coordinator develops an Individualized Family Service Plan (IFSP) with the parent. The IFSP is a written plan that details the services or supports that the child will receive. Based on the family's values and priorities, it outlines what parents want their child to learn to do. Next, the coordinator and parents determine what kind of expertise might be most useful to achieve the outcomes on the IFSP. Occupational therapy may be the only service or one of several services identified through the IFSP process as best able to help the child reach his or her goals.
What occupational therapy practitioners actually do in early intervention settings depends on the goals the family has for the child. The practitioner evaluates the child and then identifies things that parents and caregivers can do throughout the day to reinforce a skill and improve sensory processing or enable new learning. "Very young children learn skills within the context that they will be used on a daily or frequent basis. [They] do not generalize a skill from one setting to another well," says Rhodes. Rather, "they need to learn and practice a skill in the routine that they will use it in." For example, parents might be concerned that their child cannot pick up her food to finger feed. An occupational therapy practitioner can work with her family to identify times during the day that the child can practice isolating her index finger and grasping small things. Together, the practitioner and parents might develop strategies to adapt meal times with larger bits of food for easier grasping, opportunities to press buttons on the TV remote, and work on pointing to pictures during the bedtime story routine at night. Incorporating therapy into regular occupations is a central tenet of occupational therapy.
Occupational therapy practitioners support and encourage parents' relationship with their child. "The desire to learn in very young children is very much tied to a foundational caring relationship with their family and childcare provider," says Rhodes. She points to research that shows that clear, dependable, rewarding responses from caregivers motivates a child to learn, be happy about his or her accomplishments, and take pleasure in play. The time a family spends working with a child in between an occupational therapy practitioner's visits is vital.
In an early intervention context, occupational therapy centers on the family, and the occupational therapy practitioner is there to support the family. “Families have a right to be included in all aspects of their child’s early intervention services, and to decide what supports their own family’s needs,” says Rhodes. “Your family is unique and services are provided with a deep respect for your family’s desires, values, and culture.”
Occupational therapy services are tailored to the child’s family, including siblings and other family members, and services alter and adapt as the family’s needs change. “Families are key,” says Rhodes. “It’s the hours between therapy visits that you and your child-care providers spend with your child that matter the most. You are your child’s first and best teacher.”
Ashley Opp is AOTA’s production editor.
Find an Occupational Therapy Practitioner
Your pediatrician or other health professional can refer you to occupational therapy practitioners in your area.
Access Early Intervention Services in Your Area
Each state has an agency that is responsible for coordinating early intervention services (look under “Programs for Infants and Toddlers with Disabilities”). The National Early Childhood Technical Assistance Center (www.nectac.org) maintains a list of these agencies online. The National Dissemination Center for Children with Disabilities also offers State Resource Sheets (www.nichcy.org), which provide contact information for organizations and agencies in each state that serve children with disabilities and their families.