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Promoting Social-emotional Wellbeing in Early Intervention Services
A Fifty-state View

Authors: Janice L. Cooper and Jessica Vick
Publication Date: September 2009

Executive Summary

Introduction

In 2007 approximately 322,000 young children received services through the Individuals with Disabilities Act (IDEA) Part C, the Early Intervention Program for Infant and Toddlers with Disabilities. Yet research shows that only a fraction of children eligible for the program received services. Against the backdrop of this gap between need for services and service use, special concerns for young children with or at risk for social-emotional developmental delays stand in relief. Even fewer of these children received services to address their social-emotional developmental needs through Part C. In part, this state of affairs reflects the significant flexibility states have in the eligibility criteria used to identify children who will receive services under Part C. However, this flexibility results in significant differences in the number of children identified in specific states. Eligibility criteria are categorized into three groups: restricted, which includes in the determination neither clinical input nor children at-risk for developmental delay; narrow, which does include a clinical option but not at risk children; and liberal, which can include both the clinical option and at-risk children.

Purpose

The aim of the study reported in this brief was to determine how states leveraged different policy choices to support integration of social-emotional developmental strategies into early intervention services. Forty-eight states’ Part C coordinators participated in the study. They reported on their states’ efforts to support screening, referral and evaluation; strategies that are part of the array of early intervention service continuum covered by the Part C program; services and supports to children who are at risk and who are not eligible for Part C; and coordination and leadership.

Key Findings

In order to address the mismatch between service needs and availability for children with social-emotional developmental needs effective collaboration between Part C and other federal programs and initiatives is needed. States’ policy choices yield mixed results regarding their potential to support better integration of strategies designed to address social-emotional developmental delays into early intervention services. A number of strategies are being used by states to foster better integration. One of the study’s most promising findings is that most states (70%) recommend the use of validated screening tools to detect social-emotional developmental delays. The Ages and Stages Questionnaire (ASQ) and the Ages and Stages Questionnaire: Social-Emotional (ASQ:SE) were the most frequently mentioned recommended tools. In addition, nearly 90% of states are involved in efforts to promote early identification by primary care physicians. Nearly all states (96%) have statewide data to measure child performance regarding improved social-emotional skills. Some states have also developed a solid platform for measuring and monitoring progress.

The study reveals several policy challenges which impede states’ abilities to support young children who have, or are at risk of developing, social-emotional developmental delays. In particular, fewer than two-fifths of states require that a professional with expertise in social-emotional development sit on the multi-disciplinary evaluation team required to determine eligibility for early intervention services. Among services available through Part C, only half of states support infant-toddler relationship-based training (a core component of a range of research-informed services) and only one-third of states include respite care. States were most likely to pay for group or individual parenting training (73%). While research indicates that group training for parents is not effective for this age group, the survey did not ask respondents to distinguish between group and individual parent training.

No questions related to the quality of the parenting interventions were asked. Finally, while not required by legislation, only 17 states had written agreements in place to guide referral and services for young children. This is significant given both recent federal mandates that require coordination between Part C and child welfare, and data that show poor access to mental health services for young children in child welfare.

Recommendations

Screening and Assessments

  • For clinicians and others who make eligibility determinations and provide services at the child and family level, states should support the use of, and the federal government should encourage and fiscally incentivize where possible, valid instruments for screening and assessment of infants and toddlers at risk for social-emotional developmental delay.
  • When screening infants and toddlers for developmental delay, valid, multi-domain screening tools that are also designed to identify problems in the social-emotional domain should be used, such as the Infant-Toddler Development Assessment (IDA ). Alternatively, a general screening tool should be supplemented by using a screening tool designed specifically for the social-emotional domain, such as the ASQ:SE.
  • States and the federal government should support – through funding if necessary – high quality training and technical assistance to ensure implementation fidelity of the existing valid screening and assessment tools for clinicians and others involved in eligibility determinations and who provide treatment and supports at the child and family level.

Empirically Supported and Family Responsive Services

  • States, the federal government, and tribal jurisdictions should, through funding and by ensuring them as part of benefit sets, support the availability of empirically supported and family responsive services to meet the needs of young children with social-emotional developmental delays or at risk for such delays. Minimally, all states should be required to provide, where clinicians indicate the need, access to a range of evidence-based interventions and support for young children. In particular, relationship-focused dyadic infant and toddler interventions should be available in the service array of state Part C programs.
  • States, the federal government, and tribal jurisdictions should undertake training and technical assistance to support the widespread adoption of evidence-based or empirically supported interventions to address the social-emotional developmental needs of young children eligible for Part C programs and for clinicians to whom young children at risk for developmental delays are referred.

Outcomes and Accountability

  • The United States Education Department, Office of Special Education Programs (OSEP) should publicly and annually report on indicators for social-emotional wellbeing for children with social-emotional developmental delays who receive services through the Part C program.
  • O SEP should develop targets for increasing the availability of services to address the social-emotional developmental needs of young children served in the Part C program.
  • O SEP should report on indicators for social-emotional wellbeing for children who receive services through the Part C program by race and ethnicity, in light of the evidence of the disparities in access to needed services previously documented.

Promotion of Wellbeing, Prevention of Ill Health and Early Identification

  • States, OSEP, and tribal jurisdictions should report on those children deemed at risk of a social-emotional developmental delay who do not meet the eligibility criteria for Part C.
  • O SEP, working in concert with states, should develop guidelines for how and where to refer children who are at risk and do not meet eligibility criteria.
  • States, tribal jurisdictions, and OSEP should track and report referrals for children deemed at risk for social-emotional developmental delay who do not meet the eligibility criteria for Part C.

Support for Service Enhancement and Service Coordination Especially for the Most Vulnerable Children

  • Policies and financial resources at the federal, state, and tribal jurisdictional level should be better coordinated and aligned to support cross-agency planning, implementation, and evaluation of resources and supports to adequately address the needs of infants and toddlers and their families. The federal government and states should place a moratorium on the creation of additional coordinating bodies and improve and work through existing efforts to meet the need for services integration and coordination.
  • Federal policy and resource allocation should be designed to ensure that all young children receive the resources and supports that they need.

The Need for More Information

  • The federal government should underwrite a study to identify all potentially available federal, state, public, and private resources to support screening, evaluation and service delivery for young children with or at risk for social-emotional developmental delay.
  • The federal government, in partnership with private groups, should support research and dissemination of valid and reliable instruments for screening and assessment and ensure that these are culturally competent and appropriate to infants and toddlers.