Service Delivery Models for Educating Young Children with Special Needs
Services for infants, toddlers, and preschoolers may be provided in home-based, center-based, or home-center programs. Although these programs must be administered by a state agency, services from other agencies may be contracted to meet the requirement that programs provide a full range of services. Local education agencies may use a variety of service delivery options, and the length of intervention time for infants and toddlers and the length of the school day for preschoolers may vary. Each model has certain advantages and disadvantages for children, and their families.
Home-Based Program Model
In home-based programs, an ECSE professional travels to a family’s home to work directly with the child and the child’s family. The child and the family are both the focus of intervention (D’Amato & Yoshida, 1991). While in the home, the ECSE professional may work directly with the child (e.g., playing with the child on the floor) or may work indirectly with the child (e.g., guiding a caretaker as he or she plays with the child on the floor). The pace of interactions, teaching, and discussion is dictated by the parents’ preferences and needs and by the child’s ability to profit from what is being offered. The following are considered recommended practices for home-based programs (Sandall et al., 2005):
- Interventions should be embedded into activities of daily living, such as bathing, mealtimes, play, family recreation, and bedtime at home and in natural environments.
- Interventions should include all family members who wish to be involved.
- The level of intensity and range of services provided should match the level of need identified by the family.
Generally during a home visit, the ECSE professional participates in the following activities: (1) modeling ways to facilitate the child’s play and learning for family members present, (2) providing feedback on family members’ interactions with the child, (3) observing the child’s ability to use a skill in different ways and in different situations, and (4) brainstorming with parents/caretakers about ways to promote the child’s skills and learning.
Home visits may be arranged in the family’s home or occur at other locations, such as the neighborhood park or the child’s daycare center, if the family prefers or requests it. Environments that are typical for the family, such as the family’s home, the grocery store, and Sunday dinners at Grandmother’s house, are considered natural environments. With parents’ input, the professional attempts to find ways to logically embed teaching the child skills within family activities. For example, if a child’s outcome is to raise his head and hold it up for three seconds while engaged in an activity, it is natural to have the child hold his head up while his shirt is being put on in the morning, while he is playing with Dad on the sofa after work, and while he is reaching for toys in the bathtub. Although intervention in natural environments is based on brainstorming with parents and a good deal of common sense, research has found that experienced practitioners are better able to describe natural environments in terms of their learning opportunities than are less-experienced professionals (Raab & Dunst, 2004). Many families find that embedding the teaching of outcomes into their routines feels comfortable and saves them time. However, a child’s entire intervention program need not be embedded into existing family routines unless that is the family’s choice (FACETS, 2000).
Interactions during a home visit should be relaxed, structured, supportive, and professional. A professional’s presence in the family’s home can arouse strong feelings in parents regarding their attitudes toward their child’s disability, their living circumstances, and their competence as parents (Peterson, Luze, Eshbaugh, Jeon, & Kantz, 2007). Family members’ reactions to home visits can range from feelings of gratitude to feelings of resentfulness. There is no one way to handle the range of emotions family members may express during home visits. Usually by finding a balance between empathy and objectivity, the professional can find a way to address most of the family’s more significant needs.
Home-based programs offer several advantages for children, families, and professionals: (1) continuous contact with the child and his or her family in their own environment, (2) time flexibility, (3) increased contact with all family members, (4) flexibility in the intensity of services, and (5) the relatively low cost of the services. Disadvantages of this model include: (1) inconsistency in training and experience among service providers in infant-toddler programs, (2) limited opportunities to coordinate additional services such as therapies, and (3) limited contact with other children the same age with and without disabilities.
The best home teaching activities are those that are simple and enjoyable to the child and family members (Dunst, Hamby, Trivette, Raab, & Bruder, 2000). Home-based programs are the most common model for providing services to infants and toddlers, and to their families, but they may also be offered to preschoolers.
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