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Results for “Early intervention”

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PubMed1992

Effective early intervention.

Recent positive findings from three early educational intervention programs designed to prevent mental retardation as well as to improve school readiness and educational progress were summarized. Evidence was presented to show that without early intervention, children of low-IQ mothers are particularly at-risk for poor intellectual outcomes and that such children respond very favorably to intensive, systematic early intervention. In addition, new findings indicate a strong relation between the intensity of the early educational intervention and the amount of benefits realized by individual children. Further, there is new evidence that the benefits of continuous educational intervention over the first 5 years of life last at least until early adolescence. We identified six essential types of experiences that we think account for the positive outcomes and that need to be systematically included to the maximum feasible level in future early intervention programs.

Child↗

PubMed2002

[Child development and early intervention centers].

INTRODUCTION: Child development and early intervention centres (CDIAT) are centres with interdisciplinary characteristics whose objective is the care of children under 6 years of age with developmental disorders or at risk of developing them. DEVELOPMENT: The main goal of these centers is the detection and diagnosis of developmental disorders (TD) in order to begin treatment and support and to counsel the family when the first signs of developmental disorders appear or situations of risk are suspected. The concept of CDIAT is based on a broad concept of 'developmental disorders' which includes not only conditions such as Cerebral Palsy or Learning Discapacity but also difficulties of differing degrees in all developmental fields, be they motor, communication, language, cognitive, behavioural or emotional. The most specific characteristics of a CDIAT are its interdisciplinarity, coordination with the resources within the area and community involvement. CONCLUSIONS: A CDIAT, with its interdisciplinary and highly specialised team, becomes a referral centre for professionals in the area when they suspect the presence of developmental disorders, giving better opportunity for more integrated attention, permitting the onset of family advice and intervention at a very early age, when definite diagnosis is often difficult.

Child↗

PubMed2004

The effectiveness of standard care, early intervention, and occupational management in Workers' Compensation claims: part 2.

STUDY DESIGN: A prospective cohort. OBJECTIVES: To compare the effectiveness of standard care, early intervention treatment, and occupational management in the management of Workers' Compensation injury claims. SUMMARY OF BACKGROUND DATA: The current management of occupational back pain and work-related upper extremity disorders with either standard care or early intervention treatment appears to be ineffective. METHODS: A prospective cohort looked at the effect of one company with access to standard care (primary care) changing to occupational management (worksite encouragement to resume activity and work as soon as safely possible) and then to early intervention treatment (offsite work hardening). This information was then compared with the control company with access to early intervention treatment, which later changed to a combined occupational management/early intervention treatment approach. Survival analysis was used to attempt to explain differences in time to injury claim closure. RESULTS: Occupational management resulted in lower injury claim incidence, duration, and costs than early intervention treatment. Only the covariate of enhanced physical therapist (work hardening) involvement (2001 hazard rate ratio 17.41, 95% confidence interval 3.72-41.51 and 2002 hazard rate ratio 6.22, 95% confidence interval 2.51-15.40) was associated with delayed time to injury claim closure when the company had access to early intervention treatment. Only the covariate of serious injury was associated with delayed time to injury claim closure in the company when it had access to occupational management (hazard rate ratio 1.67, 95% confidence interval 1.05-27.20). CONCLUSIONS: It is recommended that an occupational management approach, in comparison to early intervention treatment and standard care, be considered for management of occupational injuries.

Absenteeism↗

PubMed2004

Country-specific cost-effectiveness of early intervention with budesonide in mild asthma.

Early intervention with budesonide is an effective strategy for mild persistent asthma, which has been shown to provide additional clinical benefits at a low incremental cost using USA cost data. The present authors analysed whether this strategy would be cost-effective using cost data for other countries. Based on the 3-yr prospective, randomised, double-blind inhaled Steroid Treatment As Regular Therapy (START) in early asthma study (comparing budesonide and placebo combined with usual asthma therapy), the cost-effectiveness was estimated separately for eight different countries, from both healthcare payer and societal perspectives, of adding budesonide to usual asthma therapy. Local unit costs were applied to data for the total trial population. Incremental cost-effectiveness ratios (ICER) were estimated as cost per symptom-free day (SFD) gained. Budesonide increased SFDs by an average of 14.1 days annually. From a healthcare payer perspective, budesonide would reduce the total cost of asthma care in Australia. In Sweden, Canada, France, Spain, UK, China and the USA, the ICER ranged from US$2.4-11.3 per SFD. From a societal perspective, budesonide would be cost-saving in Australia, Canada and Sweden. In conclusion, for countries where costs with budesonide are higher, the policy implication has to be determined by that health system's willingness to pay for an additional symptom-free day. However, where budesonide therapy increases symptom-free days and reduces total costs, the policy conclusion clearly favours early intervention.

Administration, Inhalation↗

PubMed2001

Prognostic value of duration of illness and early intervention in bulimia nervosa: a systematic review of the outcome literature.

OBJECTIVE: Early intervention is often regarded as an important step for the prevention of a chronic eating disorder. The primary aim of this review was to systematically evaluate the outcome literature and to better describe the effects of early intervention on the course of bulimia nervosa. METHOD: Twenty-four follow-up studies were subjected to nine "best-evidence" criteria for methodological soundness. Of these 24 studies, 5 met all methodological criteria and were considered in more detail. RESULTS: Only one of these five studies found a significant association between duration of illness and outcome. These studies were re-examined to exclude studies that included patients who were not first admissions in order to distinguish between the effect of duration of illness versus early intervention. This re-examination excluded four of the five studies, and the remaining study provided no data regarding prior treatment. DISCUSSION: Based on this selection of studies, it was concluded that there is no consistent evidence to support that early intervention necessarily implies a better long-term outcome. Due to the multiple methodological problems that plague follow-up studies, future research would be improved by employing designs that directly test the impact of early versus late intervention.

Adolescent↗

PubMed1994

Which children benefit the most from early intervention?

Recent findings from three separate studies support and extend a large and growing body of early-intervention research literature spanning 30 years. The literature is consistent in demonstrating positive developmental outcomes as a result of intensive early intervention for children of low-income and undereducated families. New analyses confirm that maternal intelligence is a key factor in children's intellectual development, especially when these children are not provided with intensive early intervention. Fortunately, children whose mothers have low IQs respond positively to intensive, high-quality early intervention, which leads to a dramatic reduction in their rates of mental retardation during the intervention program. Unresolved issues include how best routinely to identify children and families who will benefit from such programs, how early to begin programs and for how long to continue them to produce desirable developmental outcomes, and whether sufficient public and political will exists to scale-up early intervention efforts to match the magnitude of the problem in our society.

Child↗

PubMed1989

Economic and policy implications of early intervention in HIV disease.

Early medical intervention in human immunodeficiency virus disease has far-reaching implications for the health care system of the United States. Several factors are enabling the medical community to begin intervention prior to a patient's diagnosis of acquired immunodeficiency syndrome. These factors include an understanding of the biologic markers of disease progression; advances in antiviral therapeutics; and an improved ability to control the most common presenting opportunistic infection, Pneumocystis carinii pneumonia. Providing adequate ambulatory care for large numbers of asymptomatic human immunodeficiency virus-infected individuals and coordinating inner-city health care facilities will become critical. Important questions regarding service provision need to be adequately addressed. The cost of yearly treatment, estimated to be $5 billion per year, will require a major financial commitment at all levels of government and the private sector. Effective early intervention in human immunodeficiency virus disease may alter the course of one of the most devastating epidemics in modern history. Planning for its implementation should begin immediately.

Federal Government↗

PubMed2003

Cognitive rehabilitation as a component of early intervention in Alzheimer's disease: a single case study.

Early intervention in Alzheimer's disease (AD) should focus on psychological and social needs as well as the provision of medication. One possible component of early intervention programmes for people with early-stage AD is cognitive rehabilitation aimed at fostering the development of strategies for coping with memory problems. The likely relevance of cognitive rehabilitation in early-stage AD is supported by neuropsychological and experimental learning studies, but further work is required to develop clinically relevant interventions, which can be applied in the real-life setting. This paper presents a single case intervention study in which a 66-year-old man with early-stage AD learned the names of 13 members of his support group using a mnemonic strategy coupled with either expanding rehearsal or repeated presentation, or both, within an errorless learning paradigm. Recall scores improved from a mean of 2.31% at initial baseline to 91.46% following intervention, and gains were largely maintained at follow-up. There was no evidence of any increase in depression, anxiety or caregiver strain during the intervention. The results support the view that cognitive rehabilitation interventions may form a valuable component of comprehensive early intervention programmes for people with AD.

Aged↗

PubMed2001

The therapeutic approach of early intervention for rheumatoid arthritis: what is the evidence?

OBJECTIVE: The concepts of early intervention and early arthritis clinics for the management of rheumatoid arthritis (RA) were introduced almost a decade ago. The evidence for these is diverse and the best therapeutic approach remains vehemently debated. This review addresses these issues. METHODS: The MEDLINE database was searched to identify relevant papers satisfying inclusion criteria for disease duration and no previous use of disease-modifying anti-rheumatic drugs (DMARDs). Where possible, evidence was obtained from randomized controlled trials. We selected the most relevant topics to best justify early therapeutic intervention in RA. RESULTS: The benefit of DMARDs over placebo and delayed therapy is unquestionable from the studies presented, with reduction in bone damage and preservation of function. Through prevention of disability, early treatment should be the most cost-effective approach. The evidence presented supports the use of DMARDs when the diagnosis of RA is first made. Delay in treatment may result in irreversible damage. There is insufficient evidence to recommend combination therapy for all patients at disease onset. Further research into newer therapies is required before their routine first-line use is recommended. CONCLUSIONS: Early therapeutic intervention in RA reduces long-term disability and joint damage. Optimal management appears to be the early identification of non-responders and targeted combination therapy. Biological therapies have the potential to revolutionize the treatment of early RA.

Adrenal Cortex Hormones↗

PubMed1997

Does early intervention improve the prognosis in anorexia nervosa? A systematic review of the treatment-outcome literature.

OBJECTIVE: Early intervention has been suggested to be an important positive prognostic factor in the treatment of anorexia nervosa (AN). The treatment-outcome studies conducted thus far were systematically reviewed in search of evidence to confirm this suggestion. METHOD: An extensive search was conducted for treatment outcome studies specifically addressing the prognostic value of the duration of the illness. Thirty-three follow-up studies of eating disorders and AN in particular were subjected to nine "best-evidence" criteria for methodological soundness. Six of these studies were found to meet all of the criteria and thus considered in greater detail. RESULTS: In four of these studies, the duration of illness was not found to be related to the treatment outcome. This is presumably because of the low variability in duration of illness found in these studies. In the two remaining studies, a negative relation between duration of illness and the outcome of treatment was reported. As a result of methodological shortcomings and a lack of control for potentially confounding variables, however, the prognostic value of early intervention could still not be estimated on the basis of these studies. DISCUSSION: The prognostic value of early intervention in AN cannot be estimated on the basis of the treatment-outcome literature. Unfortunately, the duration of the illness and not the occurrence of early intervention is considered in most of the outcome studies of AN. In addition, a number of methodological shortcomings make it impossible to evaluate the prognostic value of early intervention.

Anorexia Nervosa↗

PubMed2006

Updated competencies for physical therapists working in early intervention.

PURPOSE: : The purpose of this project was to revisit the 1990 American Physical Therapy Association Section on Pediatrics policy statement and competencies for physical therapists in early intervention and update their content to reflect present practice, legislation, and terminology. METHODS: : A review of the literature and competencies for early intervention professionals was completed. Surveys of six focus groups of parents of children with disabilities were conducted to ascertain their perspectives of the knowledge and skills important for therapists. This information was integrated into a listing of competencies expected of physical therapists working in early intervention. The competencies were reviewed regionally and nationally by experts in the field and therapists practicing in early intervention. RESULTS: : Nine content areas with specific competencies were identified in which early intervention physical therapists should have expertise. The primary change in the content between the 1990 and 2005 competencies is the addition of service provision in natural environments. CONCLUSION: : Physical therapists who work in early intervention require specific skills and knowledge to effectively serve infants, toddlers, and their families. Competencies are useful to guide professional development.

Child↗

PubMed1994

A competency-based training program in early intervention.

This paper describes a federally funded training program developed to prepare entry-level occupational therapists to deliver early intervention services. The program had two phases. Phase I was designed to provide occupational therapy supervisors with advanced skills for supervising and teaching the students about the provision of early intervention services. These skills were specific supervisory strategies and learning techniques designed to facilitate optimal communication between the student, the supervisor, and the academic faculty members, as well as to facilitate consistency of information between workshops and practices in the clinic. Phase II involved a 12-week clinical fieldwork experience for the students in an early intervention program combined with didactic programs at the university. Both supervisors and students provided feed-back on the program. Supervisors reported that the training strengthened their supervisory skills and techniques. Students reported that the training helped them to clarify the role of occupational therapy in early intervention and that they had developed skills critical to providing family-centered early intervention. These skills included both providing direct treatment to children and working in partnership with families and caregivers.

Adolescent↗

PubMedDate not supplied

Lessons learned in translating research evidence on early intervention programs into clinical care.

There is research evidence describing quality early intervention programs that can promote positive child health and behavior and enhance parenting behaviors and parent-child interactions. Two of the programs with persuasive research evidence are home visitation and parent training. Despite the evidence, it seems that few of these strategies have been translated to real-world clinical settings. This article reviews an evidence-based practice framework that highlights the influence of the research evidence, patient preferences, provider expertise, setting-specific contextual factors, and important role of a facilitator. Examples from one particular early intervention project that implemented a standardized parent training program via home visiting the families of 2- to 6-year-old children help explicate the facilitators and pitfalls in translating best practices into the real-world settings. Strategies that can lead to successful implementation of early intervention child health and parenting best practices in real-world clinical settings are recommended.

Benchmarking↗

PubMed1998

First-episode schizophrenia. Early intervention and medication discontinuation in the context of course and treatment.

BACKGROUND: The concept that early intervention with antipsychotic medications improves the long-term course of schizophrenia is discussed. METHOD: This report reviews the literature concerning early intervention with antipsychotic medications for people with first episodes, and how it affects long-term morbidity. It also studies the effects of discontinuing antipsychotic medications on relapse for people with first episodes. RESULTS: Early intervention with antipsychotic medications appears to decrease the long-term morbidity of schizophrenia. CONCLUSIONS: Early intervention with antipsychotic medications should be encouraged for people experiencing their first episode of schizophrenia. This report proposes that studying the various phases of subject response to treatment can be helpful in elucidating when antipsychotic medications should be tapered or withdrawn.

Antipsychotic Agents↗

PubMed2001

Relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of therapists' behaviors during early intervention.

BACKGROUND AND PURPOSE: Federal law mandates family-centered care as the service delivery model in early intervention programs for children from birth to 36 months of age. This study investigated the relationship of therapists' attitudes, children's motor ability, and parenting stress to mothers' perceptions of physical therapists' family-centered behaviors during early intervention. SUBJECTS AND METHODS: Twenty-five physical therapists and 75 mother-child dyads (3 from each therapist's caseload) participated. The mean chronological age for the children was 21.2 months (SD=7.3, range=6-35). Mothers participated in a structured interview using the Measures of Processes of Care (MPOC-56), and they completed the Parenting Stress Index-Short Form (PSI-SF) and a questionnaire. The Bayley-II Motor Scale was administered to the children. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and a questionnaire. RESULTS: Scores for mothers on the MPOC-56 and for therapists on the MPOC-SP indicated strong positive perceptions and attitudes toward family-centered behaviors. Hierarchical multiple regression analyses indicated that parenting stress explained a considerable amount of the variance in mothers' perceptions of family-centered behaviors, whereas therapists' attitudes explained a considerable amount of the variance in mothers' perceptions of respectful and supportive care. Children's motor ability was inversely related to parenting stress. DISCUSSION AND CONCLUSION: Findings suggest that mothers perceive that physical therapists are using family-centered behaviors in early intervention. Findings from the questionnaires suggest that some early intervention policies may be barriers for therapists and prevent them from actualizing attitudes toward family-centered behaviors.

Adolescent↗

PubMed2003

Treatment- and cost-effectiveness of early intervention for acute low-back pain patients: a one-year prospective study.

In an attempt to prevent acute low-back pain from becoming a chronic disability problem, an earlier study developed a statistical algorithm which accurately identified those acute low-back pain patients who were at high risk for developing such chronicity. The major goal of the present study was to evaluate the clinical effectiveness of employing an early intervention program with these high-risk patients in order to prevent the development of chronic disability at a 1-year follow-up. Approximately 700 acute low-back pain patients were screened for their high-risk versus low-risk status. On the basis of this screening, high-risk patients were then randomly assigned to one of two groups: a functional restoration early intervention group (n = 22), or a nonintervention group (n = 48). A group of low-risk subjects (n = 54) who did not receive any early intervention was also evaluated. All these subjects were prospectively tracked at 3-month intervals starting from the date of their initial evaluation, culminating in a 12-month follow-up. During these follow-up evaluations, pain disability and socioeconomic outcomes (such as return-to-work and healthcare utilization) were assessed. Results clearly indicated that the high-risk subjects who received early intervention displayed statistically significant fewer indices of chronic pain disability on a wide range of work, healthcare utilization, medication use, and self-report pain variables, relative to the high-risk subjects who do not receive such early intervention. In addition, the high-risk nonintervention group displayed significantly more symptoms of chronic pain disability on these variables relative to the initially low-risk subjects. Cost-comparison savings data were also evaluated. These data revealed that there were greater cost savings associated with the early intervention group versus the no early intervention group. The overall results of this study clearly demonstrate the treatment- and cost-effectiveness of an early intervention program for acute low-back pain patients.

Acute Disease↗

PubMed2000

Attitudes toward family-centered care and clinical decision making in early intervention among physical therapists.

Family-centered care is the mandated service delivery model in early intervention. The purpose of this study was to examine the attitudes of physical therapists toward family-centered care and to describe clinical decision making factors in determining frequency and duration of service. A convenience sample of 25 physical therapists working in early intervention participated in a mail survey. Therapists completed a modified version of the Measures of Processes of Care for Service Providers (MPOC-SP) and the Physical Therapist Questionnaire. Mean subscale scores on the modified version of the MPOC-SP varied from 6.04-6.43 on a seven-point scale with highest scores on the Respectful and Supportive Care subscale. Therapists' attitudes toward family-centered care correlated with attitudes toward direct intervention items (r = 0.43-0.66, p < 0.05). Child considerations were most important to therapists and administration considerations were least important when determining levels of service. Results suggest that therapists are sensitive to the needs of families and children and value parents as partners on the early intervention team. The relationship between therapists' family-centered care attitudes and intervention are consistent with a systems approach. Results on clinical decision making reflect the role of the physical therapist in early intervention and suggest a potential conflict with administrative policies when determining levels of service.

Journal Article↗

PubMed2006

Significance of reverse orientation of the ductus arteriosus in neonates with pulmonary outflow tract obstruction for early intervention.

Reverse orientation of the ductus arteriosus (RDA), defined as an inferior angle at the aortic junction of <90 degrees , is associated with pulmonary atresia; however, the significance of RDA in nonatretic pulmonary outflow tract obstruction (POTO) is unknown. The purpose of this study was to evaluate the relation between ductal morphology and the need for early intervention. Ductal morphology was retrospectively reviewed in 76 neonatal cases of POTO. Patients were stratified to those with conotruncal (CT) or primary pulmonary valve (PV) abnormalities. The prevalence of RDA was 40 of 68 (59%) and was higher in patients with CT defects (28 of 30, 93%) compared with PV abnormalities (12 of 38, 32%; chi-square = 26.4, p <0.0001). Early intervention was required in 29 of 40 patients with RDA (73%) compared with only 8 of 28 patients with normal ductal morphology (31%; chi-square = 12.8, p <0.001). The proportion of patients with RDA who required early intervention was greater in PV abnormalities (12 of 12, 100%) compared with CT defects (17 of 28, 61%; chi-square = 6.5, p <0.02). Importantly, after excluding patients with pulmonary atresia, these analyses were unchanged. In patients with nonatretic POTO, a threshold inferior angle of 65 degrees was predictive of the need for early intervention. RDA in patients with PV abnormalities, or CT defects and an inferior angle <65 degrees , is a specific indicator for early intervention. These findings demonstrate an association between RDA in the context of atretic and nonatretic POTO and the need for early intervention. The need for early intervention should be considered when RDA is identified in this population.

Aortic Valve↗