Intervention in the Early Years
Spurred by research suggesting that early intervention can make a dramatic difference in the educational progress of "at-risk" preschool children, experts in the field of special education are moving to improve both the availability and the quality of programs for preschoolers with handicapping conditions.
So far, their labors have produced not only progress but also an agenda of complex issues still to be resolved.
Over the past 10 years, for example, 19 states have made the delivery of educational services to all 3- to 5-year-old handicapped children a legal requirement. Another 23 states have mandated services for some portion of that population. And the federal funding that helps support such state programs has also been increasing.
It is, says Pascal Trohanis, project director of the University of North Carolina's Frank Porter Graham Child Development Center, "an exciting time" for parents, care givers, researchers, and all who work with handicapped children. "There's a sense," he says, "of participating in a renewed national initiative."
But their optimism, Mr. Trohanis and other experts concede, is tempered by concern that unmet needs, unanswered questions, and undetermined priorities may stall the fulfillment of that renewed commitment.
They worry, for example, that more than half of the nation's handicapped children between the ages of 3 and 5 remain underserved; that where preschool programs do exist, funding levels are often too low; and that the wide variance from state to state in the screening devices used to evaluate children for handicapping conditions has produced great geographical disparities in the number of children identified and the kinds of services provided.
They are concerned, too, about the "critical need" to expand preschool services to include children from birth through age 2; about ensuring that staff-development and training programs keep pace with the field's rapid growth; and about the interagency jurisdictional questions that have plagued these programs at the state level.
Questions About Effectiveness
At the same time, however, experts acknowledge that the more fundamental question of the degree to which such efforts are effective has not been resolved satisfactorily.
To date, little research offering answers exists, and specialists remain divided over the applicability of other early-childhood-education findings to handicapped children.
The U.S. Education Department, in its "Seventh Annual Report to Congress on the Implementation of The Education of the Handicapped Act," affirmed that "studies on the effectiveness of preschool programs have shown that handicapped infants and preschool-aged children who receive early intervention show significant improvement in development and learning."
Among the data cited by the department's office of special education and rehabilitative services were findings from the "Perry Preschool Project," a longitudinal study by the High/Scope Educational Research Foundation on the effect of early intervention on disadvantaged children.
Results of Perry project indicate that, among such "at-risk" children, those who take part in preschool programs are less likely to require special-education placements and more likely to complete high school and succeed in work than those who do not.
"A cost-benefit analysis concluded that the return on the initial investment was three and one-half times the cost if two years of preschool were provided," the federal report noted.
Research Still Inadequate
But Karl R. White, an assistant professor of special education and psychology at Utah State University and the author of a recent study assessing more than 2,000 research projects on the efficacy of early intervention for at-risk children, cautions that such findings are not definitive.
"We can't ignore existing research, but we must put it in its proper perspective, realize its strengths and weaknesses," he said at a national meeting last month.
At a symposium at the U.S. Capitol convened by the National Center for Clinical Infant Programs, Dr. White said that the scarcity of research specifically focused on handicapped children makes it difficult to prove whether or not early intervention affects their later development. What research there is, he noted, usually contains serious methodological flaws.
And while saying he favors early-intervention programs for handicapped children, Dr. White added that those who attempt to use existing research to convince legislators to fund programs often misinterpret or misrepresent the data.
"The research is often used as a political weapon, not a scientific tool," he said.
Lawrence J. Schweinhart, director of High/Scope's Voices for Children Project, says that the results of the Perry study can be translated to apply to 85 or 90 percent of the handicapped children educated in public schools, but may not be applicable to children with severe handicaps.
"The overlap is substantial," he said in a recent interview, suggesting that "the best way to talk about it" is in categorical terms, the largest one being children who--either because of physical handicaps or socioeconomic handicaps--are "at risk for school failure."
For children with severe physical handicaps, he said, there is insufficient research to determine the effects of early intervention. Reasons for the lack of data, he said, include the logistical difficulties of conducting such research, in particular the problem of canvassing a large enough sample of severely handiel10lcapped students to complete random-assignment studies.
On the other hand, concluded Dr. White: "There is no evidence that suggests early intervention for handicapped children is detrimental or ineffective." Little will be gained, the Utah State professor said, by waiting for additional research to come in. "The consequences of not intervening are too great," he said.
Meanwhile, the progress in establishing programs--though unevenly distributed throughout the 50 states--continues.
Operating funds for preschool programs that serve handicapped 3- to 5-year-olds come from both the states and the federal government. In 1983-84, the federal share was $96 million--or $395 per child--according to Education Department statistics. (See related story on the next page.)
But since preschool education is not specifically mandated in the major federal legislation affecting handicapped children--P.L. 94-142, the Education for All Handicapped Children Act--most of the existing programs fall under the purview of the states. According to a 1981 study by the Rand Corporation, 89 percent of all funding for such programs comes from the state level.
State mandates vary widely--4from requirements that local school districts provide services to all handicapped children to mandates that narrow the delivery of preschool services to a specific age range or to types of handicapping conditions.
In Delaware, for example, the state mandates services for all handicapped 4-year-olds, but requires services beginning at age 3 for the mentally retarded and physically handicapped children. Services for children who are visually impaired, hearing-impaired, deaf-blind, or autistic are mandated from birth.
Responsibility for planning, developing, and implementing early-intervention programs usually rests with legislatures and state agencies. The process may include the development of program standards and guidelines, completion of statewide effectiveness studies, and collaboration among a number of agencies.
Nonetheless, program quality and effectiveness may vary from district to district within a state, according to Janet W. Lerner, chairman of the department of special education at Northeastern Illinois University and the author of a forthcoming book on preschool special-education programs. Many districts, she adds, may fail to provide adequate programs even when the state mandate is clear.
In its report to the Congress, the Education Department also noted a "great deal of variability ... in the availability and quality of services." The report said federal efforts would continue to focus on communicating the need for and benefits of preschool services, and on the development of models for coordinated, high-quality assessment and service.
If the availability and quality of services is to improve, the report concluded, the government must provide more technical assistance to states.
But until the research questions are answered, say experts, the states will continue to face uncertainties about the types of services handicapped preschoolers need.
They also cite other considerations, many of which were noted last year in a survey of state directors of special education:
The shortage of qualified teachers and the need for staff development and training. In testimony before the U.S. House Education and Labor Committee's subcommittee on select education this fall, Brian McNulty, executive director of special education for the Colorado Department of Education, said that a critical difference between effective and ineffective intervention programs is "the quality of the staff."
In addition to a stable funding base, he said, such programs' most pressing need is for better staff development and training, an often costly budget item. Today, he concluded, "these programs have neither the resources nor the skills to offer this much needed training."
And according to the Education Department, the shortage of special-education professionals is compounded in early-intervention programs by the fact that many related-services personnel are not trained to work with preschool-age children.
But, as Northeastern Illinois University's Ms. Lerner notes, a new kind of professional may be coming into the field as federal and state efforts expand. Her institution's training program for personnel to work with handicapped infants, which is supported by a federal grant, has drawn not only special-education teachers with public-school experience, but nurses, psychology majors, and others with nonteaching backgrounds, she says.
The need to expand services to include children from birth through age 2. The Education Department's special-education office has called the expansion of preschool services for children from birth through age 2 a "most critical need," but only five states had mandated such programs in 1984-85.
One of the states, New Jersey, allocated $10 million this year for birth-through-age-2 services, operated through the state departments of education, health, and human services. The program serves 3,000 children in 38 projects.
In testimony before the House Subcommittee on Select Education, Carl J. Dunst, director of the Family, Infant, and Preschool Program at the Western Carolina Center in North Carolina, argued that both the children served and society at large benefit from early-intervention programs for handicapped children, provided that they are begun before age 2 and use a comprehensive approach.
And in testimony before the House Select Committee on Children, Youth, and Families, Lisbeth J. Vincent, a professor in the University of Wisconsin's department of behavioral studies, noted that "P.L. 94-142 made a major difference for children 5 to 18 years old, [but] it had limited impact on children from birth to 5 years old."
"We're putting families through five years of crisis," she said.
Programs that serve children from birth through age 2 differ from those serving 3- to 5-year-olds in that they frequently involve interagency cooperation, draw in the entire family, and are operated by entities other than school districts.
The need for interagency cooperation. A by-product of the increased focus on early-childhood programs for handicapped children, says Mr. Trohanis of the Frank Porter Graham Center, has been the recognition that "not one agency can do it all alone because of the complex needs of this population."
For this reason, he says, a systematic examination of which state agencies are best suited to perform which functions is imperative.
Ms. Lerner, citing the need for a number of agencies to work together to provide services, suggests that such entities as departments of mental health, hospital organizations, and health agencies should be involved, as well as the medical, teaching, and social-work professions and family-service providers.
The Education Department, in its report to the Congress, said "disagreement over which state agencies should assume the responsibility for serving preschool handicapped children" was a primary constraint cited by local and state education agencies trying to develop such programs.
The uneven quality of screening mechanisms. Most states have no way to identify children's developmental problems between the time they leave the hospital after birth and the time they start school.
A newborn is usually tested at the hospital within hours of birth to determine its physical condition and response to stimuli, according to Ms. Lerner. An infant having an obvious physical handicap or thought to be at risk for handicapping conditions is usually placed in a neonatal nursery; tests are conducted and the parents are informed of available services.
If a child is not determined to be at risk upon birth, the next opportunity for assessment usually comes when a school district conducts what is sometimes termed a "roundup." Through this service--often part of kindergarten registration--districts fulfill their responsibility, as set forth under P.L. 94-142, to identify and serve all handicapped children.
But though states are required to identify children who are handicapped, they are not given the funds to carry out that identification, says Samuel J. Meisels, associate professor of education at the University of Michigan, and very few states mandate developmental screening.
In addition, the screening devices school districts use vary widely from locality to locality--there are hundreds, says Ms. Lerner--and may test for a variety of problems, including those related to communication, motor, cognitive, and social skills.
If the tests do spot potential problems, the child may be placed in a special class for further observation, according to Ms. Lerner. Officials may then recommend that the child go on to a regular kindergarten program, a special preschool program, or some other placement.
To some, the process seems too haphazard. The Foundation for Children with Learning Disabilities--the nation's only charitable group giving grants solely in the area of learning disabilities--plans to examine the question of whether a uniform national screening mechanism should be established.
Avoiding stigmatization. "The most frequently cited concerns about categorical identification of very young children," according to Barbara J. Smith, director of Alaska's state-planning effort, "relate to the inaccuracies and inefficiencies in the assessment and decisionmaking process."
Misdiagnosis at an early age, she notes, may have a long-lasting negative impact not only on the child's self-image, but also on his or her capacity to learn. But it is difficult to be precise, she and others say, because evaluating the problems of4preschoolers is not an exact science.
With these difficulties in mind, the executive board of the Council for Exceptional Children's early-childhood division has asked the Education Department to provide an alternative to categorizing young children before they receive services, asking instead that they be identified as "children who have special needs."
In some states, policymakers have turned from specific labeling procedures to "deferred diagnosis."
Under New Jersey's early-intervention law, for example, children evaluated for preschool are not categorized by their handicaps. Parents are simply told that their child has developmental difficulties in language, motor, or behavioral skills and that the problem is either mild or moderate. Children entering the under-3 program are identified as "eligible for early intervention."
But perhaps most important, says Mr. Meisels, a co-author of the "Early Screening Inventory" used to identify and assess handicapped children ages 4 to 6, is the recognition that screening differs from diagnosis.
"Screening is indicative, diagnosis is meant to be definitive," he says. "Labeling is inappropriate on the basis of screening."
Mr. Meisels opposes the establishment of a national assessment procedure that would require districts to use one test to screen children. But he, like many other professionals in the field, supports mandatory developmental screening and the establishment of standards for the tests used.
The federal government, he said, should take the lead in providing such standards.