SPECIALNEEDSPARENTING

Kasey Teixeira Ababy's first year milestones are what most parents consider groundbreaking news. From first tooth, to first step, and perhaps most memorable, first word, parents celebrate every new triumph. But, as young Kasey Teixeira of Millbury approached her first birthday without so much as a babble, Sue Teixeira, Kasey's mother, began to worry.

She shared her concerns with Kasey's pediatrician, who first suggested ruling out a possible hearing loss. Due to Kasey's age, the audiologist's screening proved inconclusive.

Finding herself back at square one, Teixeira could not help but compare Kasey's speech development to that of her son. "Ethan spoke full sentences at 18 months, and I did the same reading of books and verbal cues with both of them," she said. Family and friends advised her not to worry.

When Kasey "still had a definite lapse in her speech" as she neared her second birthday, her mother decided to delve further. A second hearing test proved, "Kasey's hearing was within normal range," Teixeira said.

Kasey's pediatrician referred the family to the Criterion Valley Early Intervention Program in Milford. There, Kasey received speech therapy until her third birthday.

"I'm glad I looked into Early Intervention," Teixeira said. ""I can't help but think that

without EI) Kasey might not be where she is today in terms of her speech and language development. She doesn't stop talking now!"

Kasey is one of countless children who benefit each year from the Massachusetts Early Intervention Program. The program, funded through tax dollars, works with families of children, from newborn through age 3, who either have developmental delays or are atrisk for delays.

Key Developmental Years

"Do not wait," advises Stacey Lavely of Shrewsbury, "if you think there is anything amiss" with your child's development. Lavely, whose son was diagnosed with Autism Spectrum Disorder at age 2, urges families to contact a local Early Intervention Program and to secure an appointment with a medical specialist, sooner rather than later.

The first three years of a child's life are critical for overall development. Profound intellectual, physical, and emotional advances are made in these key years. If an infant or toddler is not developing along with typically developing peers, "the more time that lapses without intervention the further behind the child is likely to fall," said Bill Ahearn, Director of Research for The New England Center for Children in Southborough.

Although developmental milestones such as babbling, pulling to stand, walking, and talking are often mastered at different ages, "there is a range considered the time in which that skill should emerge."

Early skills are building blocks for further development. Children "must pull to stand before they walk or babble before they talk," Ahearn said. If "delayed in reaching a developmental milestone, they will not be able to achieve the next step in development until it is reached."

Family Eligibility

With more than 60 Early Intervention (EI) programs throughout the Commonwealth, many families find a program office close to home. Depending on need and eligibility, some families will enter a program immediately following a child's birth, while others enter the program as a child develops and concerns are noted.

"We see everything from what appears to be a minor delay in speech or motor ... to complex medical needs," said Sharon Goldstein, Program Director for Boston Early Intervention for Children and Families through the Home for Little Wanderers in Brighton. Early Intervention eligibility criteria include "a 25 percent delay in one or more area of development, a medical diagnosis, or four environmental risk factors," Goldstein said. The Department of Public Health lists specific eligibility requirements at www.mass.gov/dph/fch/ei.htm.

Kirsten Hurd sought out the program after her son's fourth surgery for a cleft lip and palate. "Mason had his palate repaired at 9 months and at the follow-up appointment the surgeon asked about his speech and if we had contacted Early Intervention about an evaluation. I didn't know what EI was, but was able to track down the number through the Shrewsbury school system," Hurd said. "Three people came to do the evaluation ... Mason qualified for the program and a speech therapist (who specializes in working with cleft-affected children) was assigned to us."

Staff & Services

The services offered by local early intervention programs are tailored to the needs of individual families.

"EI staff provide services, which promote the development of motor, communication, and cognitive skills, and support social and emotional health," said Jimmilee Prouty, Program Director at the UMASS Early Intervention and Family Support Program in Worcester. "All EI programs must be able to access consultation by physical and occupational therapists, speech pathologists, social workers, and nurses," she said.

Through the UMASS Early Intervention program, "we also got some good suggestions on developing Mason's fine motor skills, which were a little lagging because of his having to be in arm restraints after his first three surgeries," Hurd said. "There is a real sense that the EI people truly care about kids and their development. They are always more than available to help with any issues that come up."

Referral & Screening

Many times, parents are unaware they can refer their own child to Eary Intervention, said Pat Hackett, Licensed Clinical Social Worker. To make a referral, parents can simply call a local office or contact the Central Directory for Early Intervention (1-800-905TIES or www.massfamilyties.org) for the list of certified programs. Parents should also be aware that participation in a program is strictly voluntary.

Following the referral, a screening visit is scheduled. Typically, several specialists meet parents in their home to obtain information, describe the program, answer questions, and observe the child at play. Evaluations, which resemble age-appropriate play sessions, are conducted with parents or caregivers present.

In the case of the Teixeira family, a Developmental Educator, Speech and Language Pathologist, and Occupational Therapist were present at the screening and evaluation. "One (specialist) would be asking my husband questions about Kasey while another would be testing her," Teixeira said.

Therapy Visits

Together, family, and EI staff decide upon goals, services, and strategies necessary to best help the child with his or her delay. A schedule outlining where, when, and with whom therapy visits will take place is also developed. Early Intervention therapies are conducted at homes, daycares, and other natural settings for children. Parents or caregivers are "present for every session so that they can learn what we are doing and carry it over with the child when we are not there," Goldstein said.

During weekly visits, the Speech and Language Pathologist "would play with Mason, using directed play in order to get him to imitate sounds," Hurd said. "This was helpful to me to see the methods that she used to illicit sounds from him. I was able to do the same thing when I played with Mason."

According to Prouty, infants and toddlers need repeated trials to acquire new skills. "EI is most effective when EI workers show families and caretakers how to present a new skill and then encourage its repetition periodically throughout the day," she said.

"I would stand nearby and learn the sign language," said Teixeira. "She (the Developmental Educator) would give me suggestions on what to do with Kasey during the week ... one that I remember was to make a picture book using photos of family members holding everyday objects to reinforce common object's names." The Teixeiras often shared the book with Kasey asking, "What is Mommy holding? What does Daddy have?" to prompt her speech.

Playgroups & Parent Groups

Local playgroups, where children participate in preschool activities, including Free Play, Art, and Circle Time are available.

Attending a weekly playgroup in Sutton helped reinforce Kasey's use of sign language and provided an opportunity for her to learn verbal skills from peers, Teixeira said. Parents may be given the opportunity to attend an onsite support group, while their children remain in the supervised classroom.

"I love both the home visits and the playgroups," Hurd said.

Finances

No family is denied program services based on lack of insurance coverage or ability to pay. EI costs that rise above a predetermined health insurance amount are covered by the Department of Public Health. According to Massachusetts Early Intervention, a nominal user fee is charged annually based on family income level.

Although professionals assist families with transitions as children approach their third birthdays, many parents express sadness when their experience is over. "I will be so sad when Mason stops getting home visits," Hurd said. "I am sure he will be, too. Whenever he hears the doorbell, his face lights up and he says

Patty's here.' I feel so bad when I have to tell him sometimes that it is just the UPS guy."

Sue Lovejoy is a freelance writer from Holden, where she lives with her husband and three children.

Parent Resources & Contacts

- Early Intervention Parent Leadership Project:

877-35-EI-PLP or www.eiplp.org

- Early Intervention Training Center: 617-618-2335 or

eitrainingcenter.org

- Massachusetts Department of Education: 781-338-3000 or

doe.mass.edu/sped

- Massachusetts Department of Public Health: 617-624-5070

or mass.gov/dph/fch/ei.htm

- Massachusetts Family TIES:

800-905-TIES or massfamilyties.org