SCIE on how early years interventions can benefit disabled children

The Social Care Institute for Excellence looks at how early years interventions can benefit disabled under-eights and their families

In the past, large numbers of children with impairments have remained undetected before attending school. This was disproportionately the case for children from families with higher levels of social disadvantage. In recent years, improved neonatal care and diagnostics practice have led to earlier identification of disability in children.

Currently 6% of under-fives have a ­disability or long-term health need. About half a million staff work in early years ­settings and effective, integrated care requires them to respond to impairments diagnosed early.

Early intervention comprises the services provided for children from birth to age eight which promote health and well-being, encourage their competences and support parenting while seeking to limit developmental delays and functional deterioration. It can mean either action taken early in life or early in the onset or at the diagnosis of impairments.

Effective intervention

Effective early years interventions should be defined by structure, intensity, duration and simplicity of design. They should support the whole family and they should not make unrealistic demands, particularly on mothers.

Although children from the most ­disadvantaged families can benefit the most from early years services, service use is disproportionately greater among more educated and advantaged families. This should be addressed with improved targeting of disadvantaged families.

Other characteristics of effective interventions include:

● They are individualised.

● They are carried out in “natural” surroundings: at home rather than in a clinical environment.

● They address the family context.

● The are a seamless, integrated inter-agency service that are easy for families to access and navigate, improve parental responsiveness to children and help parents feel part of the strategy for improving their children’s care.

● They help children with communication problems relate to their peers.

Needs of the family

A key element of successful early years interventions is targeting the interventions to the specific needs of the family. Interventions should relate to the child as part of a family and take into account the needs of this broader unit. Two factors inform this approach:

● That children’s development is context-specific and must accommodate and utilise the home environment – working with the child in a “natural” rather than clinical setting and taking into account routine of the family.

● The inter-dependent relationship between different services, their co-ordination and integration and transitional arrangements.

Additionally, interventions that improve child-parent relationships may be more ­successful than those focused on narrow child development goals. Effective services will improve parental responsiveness to children. The success of interventions should evaluate the outcomes for children alongside parent satisfaction.

Strategic level

Managers working at a strategic level can support the effectiveness of early interventions for disabled children by focusing on these areas:

● Ensure interventions take place in a “natural setting”.

● Develop services that are characterised by structure, intensity and duration to ensure gains made by children are sustained.

● Favour programmes whose success is ­supported by evidence.

● Prioritise high-quality pre-school provision.

● Deliver interventions that are sensitive to the family environment with special focus on the needs of mothers.

● Show caution about large-scale investment in new approaches unless evidence shows the gains will justify the resources.

● Use electronic communications media to deliver teaching and information to parents.

● Establish comprehensive key worker ­services to support family relationships, quicker access to financial benefits and reduced stress.

● Shape services to address child-parent relationships as well as child development goals.

● Integrate early years intervention for disabled children into the overall strategy for improving children’s services.

Practitioners’ messages

● Improved diagnostic tools and screening have led to earlier identification of disability among children.

● More children with complex needs survive early childhood thanks to better neonatal care.

● The early years interventions should aim to enhance the parent-child relationship as well as support the child’s development.

● Research on early years interventions for disabled children has found that they are generally having a positive effect.

● Services that are easier to navigate are more effective.

● Key worker systems are an essential part of provision.

● The best educated and wealthiest families are likeliest to access early intervention services.

● More intensive and targeted early interventions can compensate the challenges faced by the most disadvantaged families.

Further reading

C4EO: Disability Research Review: Improving the well-being of disabled children (up to age 8) and their families through increasing the quality and range of early years interventions

Centre for Excellence and Outcomes in Children and Young People’s Services

Social Care Institute for Excellence

Research abstracts

Author: WALDMAN Julia et al

Title: Ensuring all disabled children and young people and their families receive services that are sufficiently differentiated to meet their diverse needs

Reference: Centre for Excellence and Outcomes in Children and Young People’s Services, 2009, 58p

Abstract This report presents a high-level overview of the findings and messages from a scoping study, which set out to establish whether services are sufficiently differentiated to meet the needs of disabled children (up to 19 years) and their families.

Author: MARTIN Kerry et al

Title: Improving the well-being of disabled children through early years interventions (age 0-8)

Reference: Centre for Excellence and Outcomes in Children and Young People’s Services, 2009, 61p

Abstract This scoping study focuses on improving the well-being of disabled children up to age eight and their families by increasing the quality and range of early years interventions. The review team considered two questions. What is the evidence that early years interventions for disabled children and their families actually leads to improvements in outcomes? Which early years interventions are most valued by parents?

Author: RIX Jonathan, SMITH-PAIGE Alice

Title: A different head? Parental agency and early intervention

Reference: Disability and Society, 23(3), May 2008, p211-221

Abstract This paper considers the agency and identity of parents of children with Down’s syndrome within early intervention. It draws on semi-structured, conversational interviews with nine parents and the reflections of one of the authors upon their experiences in early intervention programmes. It considers how representations of the deficit model permeate the participation of the parent in this process. It explores the multiple identities of the parents and links these to notions of parental participation within the current policy context of early intervention in England. The notion of parental agency is an implicit driver in early intervention programmes, yet it appears to be compromised by the nature of those programmes.

Author: MITCHELL David and BROWN Roy I

Title: Early intervention studies for young children with special needs

Reference: Chapman and Hall, 1991, 355p

Abstract Describes the need to identify children with special needs, and facilities that are being developed for this. Discusses the role of the parent in facilitating early learning, and the needs of parents when a child is diagnosed as having a disability. Also looks at advocacy and staff training.

Author: RUSSELL Philippa

Title: Access and achievement or social exclusion? Are the government’s policies working for disabled children and their families?

Reference: Children and Society, 17(3), June 2003, pp215-225

Abstract There is an increasing awareness of the need to see disabled children and families as active partners in policy development and implementation. There is also more awareness of the implications of disability discrimination legislation across children’s services and of the importance of improving arrangements for early identification and intervention to maximise disabled children’s participation in mainstream services. The challenge for the government is to ensure that disabled children are mainstreamed across all policy initiatives and to recognise the talents and ambitions of disabled children and their families in service design and implementation.