EARLY INTERVENTION IN PORTUGAL

Transcription

1 Chisinau, 20th of April 2016 EARLY INTERVENTION IN PORTUGAL A FAMILY-CENTRED, COMMUNITY-BASED AND CROSS- SECTORAL SYSTEM José Boavida, M.D.

2 Early Childhood Intervention (ECI) is a composite of services for very young children and their families, provided at their request at a certain time in a child s life, covering any action undertaken when a child needs special support to: ensure and enhance her/his personal development, strengthen the family s own competences, and promote social inclusion of the family and the child. for Special Needs and Inclusive Education

3 BY THE END OF 1980S AND EARLY 1990S, A NEW STAGE IN EARLY C HILDHOOD INTERVENTION (ECI) BEGAN IN PORTUGAL. THE COIMBRA EARLY INTERVENTION PROJECT BASED ON INTER-SERVICE COLL ABORATION AMONG SOCIAL POLICY, HEALTH AND EDUCATION SECTORS, WAS CONSIDERED AS FAVORABLY INFLUENCING THE DEVELOPMENT OF ECI THROUGHOUT THE COUNTRY European Agency for Development in Special Needs Education, 2005

4 RELEVANT ELEMENTS TO ECI PROGRAMS Availability: reach all children and families in need of support as early as possible. Proximity: ensuring that support services reach all members of the target population, as close as possible to families. Affordability: Services are provided through public funds from health, social or education authorities, or by NGO s including non-profit associations. Interdisciplinary working: professionals belong to different disciplines. It facilitates the exchange of information among team members. Diversity of services: closely connected to the diversity of sectors in ECI. for Special Needs and Inclusive Education

5 COIMBRA REGION ECI PROJECT (1989) THE DEVELOPMENT OF AN INTER-SECTORAL EXPERIENCE LOCAL ECI TEAM COORDINATING TEAM Health Education Social Policy Private Institutions Physician 17 Nurse Educator Social Worker Psychologist Therapists

6 COIMBRA REGION ECI PROJECT THE DEVELOPMENT OF AN INTER-SECTORAL EXPERIENCE Development of a formal cross-sectoral system of ECI; Promote collaboration and articulation among different services (public and private); Provision of family centered individualized services to children at risk and with disabilities, in natural contexts; Evolve to transdisciplinary team work and integrated services; Contribute to the development of legislation.

7 OBJECTIVES OF SNIPI (ARTICLE 4 OF DL 281/2009) Ensure children the protection of their rights and the development of their capabilities, through the action of ECI throughout the country; Detect and signal all children with changes in the structure or body functions, as well as those at high risk for developmental problems; Intervene after detection, based on family context needs of each eligible child, for the purpose of preventing or reducing delays in his/her development; Support access by families to appropriate services and resources; Involve the community by creating articulated mechanisms of social support.

8 SNIPI STRUCTURE DL 281/2009 NATIONAL COORDINATING COMMITTEE REGIONAL TECHNICAL SUPERVISION TEAMS SUB-COMMITTEES LOCAL EARLY INTERVENTION TEAMS

9 COORDINATING COMMITTEES (NATIONAL / REGIONAL) Coordinate actions of the 3 ministries; Ensure the establishement of the network of ECI services; Monitor, regulate and evaluate SNIPI functioning; Create regulatory instruments, elegibility criteria, coorporative image, technical assistance tools, national database...; Promote training and research; Annual plan and activity report.

10 LOCAL EARLY INTERVENTION TEAMS (ELI) CROSS-SECTORAL WORK Reference School for ECI Physician Nurse Educator Social Worker Psychologist Therapists PRIVATE INSTITUTE Social Policy Local Health Center

11 LOCAL EARLY INTERVENTION TEAMS (ELI) Identification of eligible children (eligibility criteria); Development and implementation of the Individualized Early Intervention Plan; Identification of resources and needs in their geographical area; Articulation with other community entities; Transition to the school setting.

12 ELIGIBILITY CRITERIA Children from 0 to 6 yrs, and their families, who present conditions included in the following 2 groups: «Changes in body function or structure» that limit normal 1 development and participation in typical activities, taking in consideration the developmental expectations for their age and social context; (All) «High risk of developmental delay» by the existence of 2 biological or environmental conditions, which imply a high probability of significant delay in child development; (4 or more risk factors)

13 1 CHILDREN WITH CHANGES IN BODY FUNCTION OR STRUCTURE Developmental delay of unknown etiology, 1.1 covering one or more areas of development (motor, physical, cognitive, language and comunication, emotional, social and adaptive), validated by formal appropriate professional assessment. 1.2 Developmental delay related with specific conditions.

14 2 CHILDREN AT HIGH RISK FOR DEVELOPMENTAL DELAY 2.1 Children exposed to biological risk factors 2.2 Children exposed to environmental risk factors Parental factors Contextual factors

15 INDIVIDUALIZED EARLY INTERVENTION PLAN (IEIP) The IEIP results from the evaluation of the child in his/her social and family context. It includes measures and actions to ensure an intervention adjusted to individual child and family characteristics. It also ensures an appropriate transition process or a complementarity among services and institutions needed.

16 INDIVIDUALIZED EARLY INTERVENTION PLAN (IEIP) The IEIP should include at least, the following elements: Identification of child and family resources and needs. Identification of the support to be provided. Indication of the starting date of the plan and probable duration. Define frequency of evaluations and interventions, held with the child and family, as well as developmental and adaptation progression. Procedures for monitoring child s transition to formal education setting.

17 MINISTRY OF HEALTH PRIMARY CARE Developmental screening; Detection, Identification of risk factors; LOCAL ECI TEAM Referral to development centers; CHILD DEVELOPMENT CENTERS PEDIATRIC HOSPITALS/SERVICES (SPECIALIZED EVALUATION AND INTERVENTION) Developmental Pediatricians; Psychologists; Special Educators; Therapists (OT, FT, SLT); Child neurologists; + Geneticists; Metabolic specialists; Other subspecialties;

18 SNIPI CROSS-SECTORAL SYSTEM MINISTRY OF HEALTH MINISTRY OF EDUCATION MINISTRY OF SOCIAL POLICY NATIONAL COORDINATING COMMITEE 5 REGIONAL SUBCOMMITEES 150 LOCAL EARLY INTERVENTION TEAMS (ELI)

19 ELIGIBILITY CRITERIA 2014, SNIPI ANUAL REPORT

20 RECOMENDATIONS INTER-SECTORAL WORK 1 - Reach all populations in need of ECI: ECI services should be provided for all children and families as early and quickly as possible, following identification of need; Children and families should be at the centre of all actions of the ECI process; Sharing information among professionals and providing adequate information to families. for Special Needs and Inclusive Education

21 RECOMENDATIONS INTER-SECTORAL WORK 2 - Ensure quality and equal standards of ECI: Establish opportunities to share and disseminate good practice; Develop evaluation tools and mechanisms for quality assurance; Develop a systematic approach to the dissemination of results; 3 - Respect the rights and needs of children and their families. for Special Needs and Inclusive Education

22 RECOMENDATIONS INTER-SECTORAL WORK 4 - Develop Legislation and policy measures: Efficient coordination of services with clearly defined roles and responsibilities; Equal quality of provision according to well defined ECI quality standards; An increase in legislative or policy measures in order to avoid discriminatory situations; Full involvement of families in all the ECI process; A well organized transition process among services. for Special Needs and Inclusive Education

23 RECOMENDATIONS INTER-SECTORAL WORK 5 - Improve coordination across and within sectors. 6 - Provide Professional Development. Provide team-based training; Besides bodies of knowledge and skills, include values and philosophy; Provide a shared vision and a common philosophy about service delivery; Provide a common core of content across disciplines. for Special Needs and Inclusive Education

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