Service Delivery Models for Educating Young Children with Special Needs

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.

Center-Based Program Model

Children are brought to a central location to receive services in center-based programs. The services provided will vary depending on the number of staff and the resources of the sponsoring agencies. In some programs, professionals provide the majority of direct services to the children and offer regular conferences to their families. In others, parents come to a center where they are guided through intervention activities with their children while professionals act as facilitators or models. Some programs offer information, training, or social sessions for families that may involve siblings and/or extended family members on a regular schedule. Recommended practices for center-based programs include the following (Sandall et al., 2005):

• The physical setting should be safe, clean, barrier-free, and accessible to children to promote independent play and learning.
• The ratio of adult staff to children should be such that it maximizes safety, health, and the promotion of goals.
• Isolated support services, such as speech-language therapy and physical therapy, should be avoided unless identified child and/or family needs cannot be met within family routines.
• Materials and toys provided should be developmentally appropriate.
• Activities should stimulate children’s initiations, choices, and involvement/engagement with adults, peers, and materials.
• Team members should communicate regularly with other staff and families.

The services offered in center-based programs vary based on the child’s age, the needs of the child and his or her family, and the resources of the providing agency. For example, infant-toddler center-based programs tend to offer a variable attendance schedule, with few requiring daily attendance. Preschool center-based programs tend to require regular attendance.

Center-based programs provide many advantages for children, families, and professionals: (1) a consistent, prearranged program for both children and families; (2) opportunities for children to interact with other children the same age; and (3) the provision of most services, including therapies and occasionally transportation, at the center. This model also has some disadvantages: (1) the difficulty of accommodating the needs of individual children and their families in groups, (2) the prospect of limited interaction with children without disabilities, and (3) the gap in services during the summer months.

Home-Center Program Model

Some states offer a combination of home- and center-based options to families. For example, family members may choose to have services provided for their preschool-aged child in a preschool or daycare program for children with typical development and to have the child also receive home visits. When home visits are offered in conjunction with center programs, visits usually occur about once a month.

Financial considerations and geographic location often dictate whether center-home programs are available. Due to limited financial resources and restricted access to trained professionals, some localities are limited in the range of service delivery options that can be offered. Despite this, professionals still make every effort to individualize services based on each child’s characteristics, abilities, and health as well as his or her family’s preference and needs.

Itinerant Teacher Model/Inclusion

In this model, an ECSE teacher serves as an inclusion specialist, supporting infants, toddlers, preschoolers, and primary-aged students. Young children with disabilities who receive instruction in general education settings receive it from itinerant ECSE teachers (Raver, 1980). In fact, nearly 50% of school-aged students with mild disabilities are served with this model (IDEA, 2004). Despite a growing reliance on consultation as a primary support for ECE professionals, there is little agreement in the field on a particular approach or set of procedures to guide the consultation practice (Sadler, 2003).

In general, itinerant services combine direct services (e.g., work with the child in the child’s setting) and collaborative-consultative services (e.g., work with another professional in the child’s setting to support that professional in better including the child). Many early childhood special educators describe their itinerant teaching activities as involving the following:

• providing direct services to children through individualized classroom routines,
• coaching/consulting with ECE staff on how to address children’s IEP objectives during the remainder of the week,
• providing emotional support and encouragement to ECE classroom staff, and
• serving as a resource for information and other services for ECE staff and families.

To support general education staff in meeting individual children’s goals and objectives, itinerant teachers may help staff develop the organizational strategies needed to systematically build objectives for children with special needs into the curriculum and the schedule (Raver, 2003). Further, environmental adaptations to maximize a child’s engagement in all activities in the classroom might need to be discussed and arranged. Commonsense interventions such as permitting toddlers and preschoolers to participate in only one learning center at a time may help them experience more productive interactions with that center, rather than moving from one center to another without an apparent purpose. ECE staff may need guidance in how to improve the social-communicative environment for a child. For example, by requiring a preschooler to use picture cards and words to request center changes, the teacher is structuring a way for that child to increase communication and problem-solving skills. Itinerant teachers demonstrate and reinforce general education staff members’ use of specific strategies for teaching developmental skills. By encouraging staff to wait five seconds before offering assistance (called time-delay), for instance, communicative responding in some toddlers and/or preschoolers may increase (Wolery, 2001).

Models for Primary-Aged Students

Commonly in kindergarten and first-grade settings, itinerant teachers have the critical role of helping general education teachers identify appropriate preacademics for children who are not ready to begin systematic academic instruction or who require a different pace of academic instruction. Children with complex and severe needs may not benefit as much from full-group participation, and itinerant teachers can help staff identify ways to create individual or small-group settings in which to provide direct instruction to these children (Sadler, 2003).

Many children with disabilities in kindergarten through third grade are educated in three primary placements or variations of these placements (IDEA, 2004). A description of these—the general education classroom, the resource room, and the separate special education classroom—follow.

General Education Classroom

Students who receive the majority of their schooling in the general education classroom and who receive special education and related services, such as speech-language therapy, outside the general education classroom for less than 21% of the school day are said to be educated in the regular classroom. These students tend to have mild learning difficulties and display social behaviors that do not pose special discipline problems. They receive the services of a special education teacher and/or paraprofessional within the general education classroom. These professionals provide both direct and indirect, or consultative services, for varying amounts of time each day.

Resource Room

Students who receive special education and related services in a resource room and other settings outside the general education classroom for 21% to 60% of the school day are considered to be educated in the resource room. These students tend to have one or more academic need areas. That is, they may have difficulty with reading, mathematics, or both. However, their academic needs are not so significant that they do not benefit from the general education curriculum. These students leave the general education classroom for an established period of time each week (e.g., one hour a day, one hour four times a week, etc.) to receive intensive, individualized instruction from a special educator or other specialist, such as a reading specialist, with the intention of remediating their present difficulties.

Separate Special Education Classroom

Students who are outside the general education classroom 61% to 100% of the school day, receiving special education and related services, are considered to be educated in a separate classroom. These students are taught by a special educator and tend to have academic needs that are too great to be managed appropriately in a resource room or a general education classroom. Further, they may have social and/or behavioral issues that are extreme enough to reduce their chances of success in a general education classroom.