Infants and toddlers with disabilities: relationship-based approaches.

The passage of the Education of the Handicapped Act Amendments of 1986 (P.L. 99-457) heralded a new era for early intervention for children with disabilities (De Gangi, Royeen, & Wietlisbach, 1992; Hepp, 1991; Roberts, 1991; Rossetti, 1990; Shonkoff & Meisels, 1990; Trivette, Dunst, Deal, Hamer, & Propst, 1990). This act, renamed the Individuals with Disabilities Education Act (IDEA) (P.L. 101-476) in 1990, was amended again in 1997. The section in the legislation that addresses programs and services offered to infants and toddlers (Part C in the newest reauthorization, P. L. 105-17), emphasizes the importance of the family in the intervention process and requires the involvement and collaboration of multiple disciplines and agencies in meeting the needs of families with young children. The way in which services are delivered and the philosophical and theoretical approaches that underlie service delivery have continued to evolve during the past 15 years. This article discusses current and emerging early inter vention practice in the light of its evolution during the past decade. For many of the disciplines, a change to a radically new approach to service delivery challenges the training that they received. Understanding the evolution of the approach to services to young children will help as social workers collaborate with professionals whose training may have emphasized a different understanding of service delivery. For the past 15 years, the majority of the intervention approaches used by programs serving young children focused on provision of developmental activities and therapies and services requested by the parents. Traditional approaches to early intervention used a discipline-based, normative perspective in assessment and intervention with a heavy focus on developmental milestones. Special education and therapeutic approaches grew from a medical model that was prescriptive, focusing on "deficits" and disability of the child. The desired outcome of these approaches was an increase in the number of developmental skills and milestones represented on norm-referenced and criterion-referenced instruments. Service providers each focused on their own discipline, acting as experts who assessed, developed, and prescribed interventions for children. Parents and families functioned as recipients of expert information and services. They might be involved in carrying out some recommendations--and indeed would be considered "non compliant" if they did not follow through on recommendations--but theirs was a more passive role in the traditional model. With the advent of family-centered care, the role of the family in children's development received more attention. Family goals and needs are solicited more actively in assessment and in the development of the individual family service plan mandated for infants and toddlers. The developmental perspective continues to be organized around developmental milestones with more emphasis on social--emotional development and the addition of consideration of cultural influences on development. Child deficits with some consideration for child and family strengths continue to be a central focus of many professional recommendations. Often, provision of services has been cross-disciplinary, meaning that there has been some sharing of perspectives across disciplines. Although parental involvement in the assessment and intervention process is mandated by IDEA, parental input on assessment continues to be viewed skeptically by many professionals (Sexton, Thompson, Perez, & Rheams, 1990), and as yet parents are not widely acce pted as the experts on their child and collaborators in the development of programs. Outcomes for service have expanded to include parental satisfaction, decreases in family stressors, and increases in family resources and supports. The parental role involves more participation in problem solving and in program development within controlled choices (that is, parents may choose from among the options offered by the agencies involved). …