Monday, September 9, 2013

Early intervention...or how the heck do you give special education to an eight month old?

In my non-mommy life, I am a speech-language pathologist.  I graduated with my Masters in 2003 and began work with a pediatric center.  While in school, I always thought I wanted to work with older children in elementary or middle school, or even high school.  But I started working with preschoolers in my clinical fellowship year and suddenly became involved in early intervention.  For the next ten years or so, I worked primarily with 2-5 year olds, with some of my beloved elementary school aged children sprinkled in.  I became well versed in local early intervention and the services it provides.  In our state, Early Intervention is from birth to five years old (entering kindergarten).  In the past five years, they have divided these services into Part B and Part C so that the 0-3 set is under one set of criteria and 3-5 is under another.  Most states have 0-3 in Early Intervention and then their school systems get involved at age 3.

When we got F's diagnosis and knew he would have his eye removed, I immediately started the process for an evaluation. I did not want to "wait and see" if he developed issues following surgery.  He is high risk for motor development issues because he has monocular vision.  I wanted to meet with a team and get ideas of what I could do to help him with his gross and fine motor skills and get a baseline for his skills.  I emailed the Birth to Two Team Leader while he was in surgery. Sometimes it is good to have connections.

We waited for F to heal and recover and to complete some of our appointments. In the meantime, I forced F to use his left side as much as possible.  I sat his carseat in the backseat where he would have to turn his head to look out the window.  I sat on his left side when he was in his highchair and would place food on that side of his tray.  Within a few weeks of surgery, he was crawling and seemed to have no issues with left neglect, but I still wanted someone to look at him.

 A few weeks out, I contacted CDS to schedule to evaluation.  The intake case manager did not connect my name to who I was.  However, the OT that was sent out as part of the team remembered me from when we worked together.  They came at the beginning of May.  All of F's skills were well within the normal range, including his fine and gross motor skills.  He was compensating well with his functional eye and developing at a similar rate to his twin brother.  However, given that he was "at risk" for developing motor issues, they wrote an Individual Family Service Plan for us to have an Early Childhood Educator come to the house, watch his skill development, and give me ideas to help him every month.  They also recommended a Functional Vision Assessment by a Teacher of the Blind and Visually Impaired.  Assessments from the TBVIs run on a school year calendar, even for children under three, and our referral was a bit hung up, so we are still waiting on that assessment as I write.

Our ECE is someone I worked with a bit in my job.  She was very helpful in giving me things to watch for and activities to introduce to continue strengthening F's skills.  She had me play games with flashlights and changing lighting in the hallway to increase his visual awareness.  She showed me how to teach him to check walls and doorways to his left.  She helped me help him navigate stairs.  She and I know she is "front loading" me with information for the future.

F is pretty fearless.  He is our climber and has had no trouble navigating stairs, steps, or different types of flooring.  He has learned quickly how to compensate for his eye by turning his head or using his hands.

If I weren't a practitioner in the field and didn't have connections, I don't know that we would have gotten Early Intervention services.  But my advice to parents is to be proactive, learn the ins and outs of the system, and fight for what you believe you need.

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