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Promoting the Social-emotional Wellbeing of Infants and Toddlers in Early Intervention Programs
Promising Strategies in Four Communities

Authors: Taniesha A. Woods, Sheila Smith, and Janice L. Cooper
Publication Date: June 2010

This is an excerpt from the full report

Project Overview

This brief presents promising approaches to support the social-emotional wellbeing of infants and toddlers through the Part C Program. The strategies discussed in this brief were identified through case studies carried out in four communities: Boston, Massachusetts; Los Angeles County, California; Doña Ana County, New Mexico; and Southeast Kansas. These case studies were part of a larger project designed to show different policy options that states use to support strategies that target social-emotional development as part of a comprehensive approach to early intervention services. The project included a 50-state survey of Part C Program coordinators, the individuals who are responsible for administering the Part C Program in compliance with federal and state requirements. Findings from this survey are reported in Promoting Social-Emotional Wellbeing in Early Intervention Services: A Fifty State View. As a companion to the survey report, this brief examines exemplary policies and practices that highlight the potential of the Part C Early Intervention Program to play a major role in reducing the risk of long-term social-emotional and behavioral difficulties of vulnerable children.

This brief is organized into three sections:

  1. A review of the Part C Program and the case-study methodology;
  2. Promising Strategies:
    • approaches to screening, eligibility, and support of at-risk children;
    • methods for enhancing the skills of professionals who provide Early Intervention services;
    • interagency collaborations that strengthen supports for young children’s social-emotional wellbeing;
    • funding strategies that support promising programs; and
  3. A summary of key findings and related recommendations for expanding states’ and communities’ use of promising early intervention strategies that support the social-emotional wellbeing of infants and toddlers.

Summary of Key Findings

Screening, Evaluation, and Eligibility

Across the case study sites, The Ages and Stages Questionnaire (ASQ) and Ages and Stages Questionnaire-Social Emotional (ASQ-SE) were the most commonly used screening instruments. These sites exemplify the use of screening tools that are valid, reliable, appropriate for use with diverse populations, and capable of identifying lags in young children’s social-emotional development.

Southeast Kansas is the one case study site that requires the participation of a mental health professional in the child’s evaluation for eligibility when a social-emotional delay is suspected.

Massachusetts and New Mexico have developed standardized tools for assessing the presence of child, parent, and family risk factors that place young children at risk of social-emotional and other developmental problems. These risk assessment tools are used in the process of determining children’s eligibility for Part C Early Intervention services.

Enhancing the Skills of the Early Intervention Workforce

New Mexico and Kansas have adopted the Michigan-AIMH competencies and endorsement system to specify skills needed by different Early Intervention professionals working with infants and toddlers and to inform their state’s design of training opportunities for these professionals.

Massachusetts and California sites are using state-developed guidelines for Early Intervention professionals that emphasize the need for competency in helping parents and other caregivers support infants’ and toddlers’ social-emotional development. Both states are aligning these guidelines with training for EI professionals.

Interagency Collaborations

In Boston, Early Intervention and Child Welfare professionals meet throughout the year to discuss families involved in both systems and to identify systems-level practices that can improve services and family engagement in supports for high risk infants and toddlers. Joint trainings that help providers understand policies and resources in each system also support effective referrals from the Child Welfare agency to Early Intervention and efforts to complete EI evaluations and engage families in services.

In Doña Anna County, providers in the community-based Healthy Start, Early Head Start, and Early Intervention programs meet regularly in order to identify families in need of rapid assessments and referrals across programs. This process has also reduced duplication of services within the “system” comprised of these three programs, and allows regular evaluation of the system’s performance.

Funding

The case study communities are using a variety of funding streams to integrate supports for infants’ and toddlers’ social-emotional wellbeing into Early Intervention services. These include third-party reimbursement, state appropriations, federal funding sources that reflect the engagement of different agencies in program collaborations (such as, Title V, Medicaid, Part C), and private funding. In addition, program partners in Los Angeles and Kansas are contributing in-kind resources and taking advantage of one-time ARRA funding to support program and workforce development efforts.

Conclusion

The strategies used by communities highlighted in this brief are illustrative of ways to promote the social-emotional wellbeing and healthy development of infants and toddlers through supports provided by the Part C Early Intervention Programs. These efforts represent both state policy choices, including funding decisions and state eligibility criteria, as well as community level innovation and cross-systems collaboration. Children’s experience of positive social-emotional health and development in the first three years is critical to their future educational success, health and life prospects. Given these high stakes, the strategies used by these communities provide valuable examples to other states and communities. The recommendations that follow suggest key opportunities for using the Part C program to support young children’s social-emotional wellbeing in every state and community.

Recommendations

Establish policies and practices that increase the participation of young children at high risk of social-emotional problems in Early Intervention services.

  • States that use narrow eligibility criteria in their Part C Early Intervention (EI) Programs should expand their eligibility criteria to include children at-risk of serious delays, including social-emotional problems. Early Intervention with at-risk children can reduce the chance of costly long-term conditions that limit children’s prospects for good educational outcomes.
  • States and community programs should consider the use of standardized risk factor assessments, such as New Mexico’s ERA tool, that help identify a range of parent and family risk factors associated with serious social-emotional problems in young children. Use of these assessments in evaluations to determine children’s eligibility for EI services can ensure that children who are at-risk for social-emotional problems receive early interventions needed to prevent later learning and adjustment problems in school.
  • Community programs should use validated screening instruments that can identify possible social-emotional delays in infants and toddlers. Available instruments include tools that assess multiple domains, including social-emotional growth, and tools that provide specific screening for problems in this area. States should require and provide information about the use of thesetools.
  • Screening instruments that can identify possible social-emotional delays should be used by trained community providers across a wide range of settings, including early childhood programs, home visiting, health care settings, and family resource centers. This practice can increase the chances that a young child with social emotional delays or risk factors for developing serious problems in this domain will be identified and provided with needed interventions.
  • Early intervention programs should strengthen their capacity to respond to young children’s mental health needs by requiring the participation of a professional with expertise in infant-toddler social-emotional development during the multidisciplinary evaluation that determines eligibility for EI services. States should set a policy requiring this practice.

Invest in efforts to promote the skills and knowledge of professionals who help identify children for participation in the Early Intervention program, and who deliver early intervention services to children and their families.

  • States should consider establishing formal guidelines for competencies related to professionals’ support of infants’ and toddlers’ social-emotional development. As demonstrated in this report, states can purchase established competency guidelines or develop their own.
  • States and communities should invest in efforts to use social-emotional competency guidelines to train all professionals who play a role in supporting infants’ and toddlers’ development, including child care providers, child welfare workers, and the many different professionals who provide EI services (such as, occupational therapists, speech-language specialists).
  • States and communities should establish special competency guidelines and related training for professionals who supervise EI service providers. This training should include guidance about helping all EI providers respond to the social-emotional needs of infants and toddlers and supervision methods that support providers in this work.

Use cross-systems collaboration and funding strategies to support effective Early Intervention practices.

  • Community programs and agencies serving Part C Early Intervention families should establish formal procedures for supporting timely, successful referrals and family engagement; these procedures should include regular, joint reviews of families served across programs to identify strategies for ensuring that children receive evaluations and interventions following referrals.
  • States and communities should assess a range of federal, state, and local funding sources for supporting the initial development or purchase of training and competency guidelines for Early Intervention professionals and for ongoing training of this workforce. Two options for using these sources should be considered: Integrating funds for workforce development across agencies and programs, or creating continuous funding by using funds from separate agencies in sequence over time.
  • State and community-level systems serving young children and their families should specify shared outcomes for the social-emotional wellbeing of infants and toddlers, and identify shared funding strategies to support the services and program coordination that can achieve these outcomes.