How to intervene at a young age?

The Ministry of Health & Family Welfare (MoHFW) has been striving to provide services with universal coverage and equitable distribution for all Indian citizens regardless of income level, social status, gender, caste or religion. With this view in mind, one of the priority areas for action is EARLY DETECTION, EARLY INTERVENTION & EARLY EDUCATION. One way of providing these accessible services will be to utilize already existing infrastructure of community service provisions to cater to the needs of very young children (0-6 years) requiring early intervention services through District Early Intervention Centers (DEIC). We believe that with this provision across the country, India truly has an opportunity to learn and successfully build DEIC models which would impact a greater population. It is then imperative that we look at flourishing models built by other countries and find the components which would be a suitable fit for the Indian society.

A maiden effort was taken by SHARP NGO to analyze the early intervention programmes of five different countries, namely, the United States, New Zealand, UK, Singapore and Sweden. With this data, SHARP was able to infer some primary differences between the models abroad and those in India. Alternatively, we also assessed the gaps in the operation of DEICs in India by visiting centers in and around the Delhi NCR region.

Why is this important? It needs to be noted that in spite of 266 DEIC’s approved in the country only 92 have been established catering to the growing needs of the children requiring early intervention services hence becoming a distant possibility. A major hurdle in the development of these services is lack of trained professionals. To reach out to those un-reached, the vital step is human resource development and the need to develop a cadre of professionals who can provide services even in the rural areas through a single window service delivery system. As in the case of the United Kingdom, the qualifications of trainers are a key factor in their recruitment as a specialist. Moreover, parents can choose from a range of different types of provisions including private, voluntary and independent settings. (Blackburn, C. (2016 https://www.researchgate.net/publication/303777321_Early_Childhood_Inclusion_in_the_United_Kingdom Accessed July 17, 2019). Parents get to decide what is best for their child, depending upon their funding options and their requirements. In India, there is a need to train school teachers & parents in providing primary support and care as they have more frequent contact with the child.

Talking about another major fail is the approach of service delivery with multidisciplinary model, where professionals work independently not fostering integrating and interactive services to the child as a whole, hence, leading to fragmented services for children and confusing or conflicting reports to parents. There is a need to shift this approach to a more Interdisciplinary or trans disciplinary approach, an answer to which can come from the US model. The Centers for Disease Control and Prevention in the United States (https://www.cdc.gov/ncbddd/actearly/milestones/index.html Accessed, July 16 2019) has developed its own Milestones App, which can be used to track the child’s diagnosis, development and next appointment. It provides a summary of a child’s milestones to view, and share it with an email to the child’s doctor and other important care providers. In India, similarly, digital platforms can be used to implement digital early interventions (App based) for health systems strengthening and Universal Health Coverage.

Environmental influences and learning are some of the factors that influence intelligence and human capacities. Handicapping conditions, both physical and environmental, can lead to serious secondary complications. Therefore, there is a need to create awareness and give special assistance to the parents and caregivers (through counselling and family interventions) in providing adequate care, stimulation and learning for their child. As parents have more frequent contact with the child at home, their contribution in eliciting developmental information about their child is essential. The ABC Center in Singapore takes this into consideration and so, parents too are given plenty of guidance by way of a free eight week training program that also includes one home-based session. (https://honeykidsasia.com/early-intervention-centres-singapore-for-children-with-special-needs/ Accessed, July 17, 2019). This model of including parents is also followed in country like New Zealand, where the program is offered in a centre-based model of service, in partnership with parents, and in accordance with international best practice. Parents are as much part of child’s development as the professional trainers. (http://www.championcentre.org.nz/ Accessed July 17, 2019)

There are other interesting models exclusive to countries such as Singapore, Sweden and the US. Singapore, for instance believes in a low therapist-student ratio. There are only over three students per trainer which leads to increased care and attention provided to each child. ((Karnes and Lee, 1978) https://bit.ly/2YRFPrg Accessed, July 17, 2019) This is unlike India, where the care providers are outnumbered by the care receivers.

As in the case of US, all schools in New York City are legally mandated under “Child Find” to find all children who have disabilities and may be entitled to special education services. (https://www.understood.org/en/school-learning/your-childs-rights/basics-about-childs-rights/child-find-what-it-is-and-how-it-works Accessed July 17, 2019) The culmination of education and care of having intervention centers in schools is also common in Sweden. (https://theconversation.com/why-swedish-early-learning-is-so-much-better-than-australias-35033 Accessed July 17, 2019) Sweden’s EDUCARE program imbibes that education and care is build into the system. Early intervention model hence is necessary to be built into the education system in India for better strengthening.

The need for inculcating foreign models is not just based on their success stories. We believe that the functionality of the center would be a mutual, two-way street. Inclusion of parents in their child’s development whether through apps or through formal training would increase the former’s interest in the intervention services provided by the government. Inversely, a greater footfall and balanced ratio of students would help the center in allocation of funds and motivate the working professionals towards skill building. Along with that, following an interdisciplinary model will aid in overcoming the limitations of individual disciplines and will maximize communication, interaction and cooperation among the team members improving on better delivery of services.

The provision has been provided already; it is about time that we ask the questions right, and start accessing our true right!