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PubMed1999

Early intervention in schizophrenia patients--rationale for its implementation and practice.

This review examines the clinical and theoretical evidence justifying early intervention in individuals with schizophrenia. Potential reasons for the previous lack of emphasis on early intervention are discussed. Interventions that target psychosis are distinguished from those that work on prodromal symptoms. It is suggested that early intervention programmes should try to reduce the duration of untreated psychosis. The relationship between this and outcome is discussed. Improving service accessibility alone may not be sufficient, and education and destigmatisation input may be required. Once a patient is identified, vigorous pharmacological and psychosocial interventions are important to improve the long-term clinical outcome. An effective early intervention programme for psychosis provides a basis for the future development of a prodrome intervention programme.

Journal Article↗

PubMed2000

Community-based early intervention: the Coimbra project (Portugal).

The Coimbra Early Intervention Project was undertaken to develop the first co-ordinated, multidisciplinary, interagency programme involving health care, education and social services, using existing resources in the community. The programme operates region wide and supports annually about 160 families and children with disabilities or at risk. Thirty-three per cent of the 601 children served so far had developmental delay, 22% belonged to high-risk families and 45% had risk factors and disabilities. In spite of difficulties, the programme success has increased awareness of the need to integrate and co-ordinate multiple community services and to develop legislation for the provision of early intervention services.

Child↗

PubMed2001

HIT, hallucination focused integrative treatment as early intervention in psychotic adolescents with auditory hallucinations: a pilot study.

OBJECTIVE: Early intervention in psychosis is considered important in relapse prevention. Limited results of monotherapies prompt to development of multimodular programmes. The present study tests feasibility and effectiveness of HIT, an integrative early intervention treatment for auditory hallucinations, in community psychiatry. METHOD: Adolescents with auditory hallucinations consecutively referred to Groningen Voices Outpatient Department. Independent research staff collected diagnosis, sociodemographics, psychiatric history, former treatment and current treatment status from medical files. The auditory Hallucinations Rating Scale, Groningen Social Disabilities Scale and five-point rating scales on characteristics and subjective burden of voices, and satisfaction with therapy were scored with semi-structured interview. RESULTS: Good compliance and high satisfaction with HIT treatment in most cases; 65% free of voices; majority demonstrates substantial improvement on mastery, anxiety, interference with thinking and social functioning; none worsened. CONCLUSION: Integrative treatment as composed in the HIT-programme is feasible in community psychiatry and appears to be an effective early intervention in adolescents with schizophrenia both in reducing psychotic symptoms as improving quality of life.

Adaptation, Psychological↗

PubMed1993

A longitudinal study of children with Down syndrome who experienced early intervention programming.

BACKGROUND AND PURPOSE: The long-term motor, cognitive, and adaptive functioning of a sample of adolescents with Down syndrome who experienced an early intervention program was examined in this descriptive study. SUBJECTS: Ten children with Down syndrome (7 girls, 3 boys) who had participated in an early intervention program constituted the early intervention (EI) group. An age-matched group of children with Down syndrome (6 girls, 4 boys) who had not experienced an early intervention program served as a comparison group. METHODS: The EI group's motor functioning was compared with that of a normative sample used in the development of the Bruininks-Oseretsky Test of Motor Proficiency. The cognitive and adaptive skills of the EI group were compared with those of the comparison group. The children were assessed using the Stanford-Binet Intelligence Scale, the Vineland Social Maturity Scale, and the Bruininks-Oseretsky Test of Motor Proficiency. RESULTS: The EI group subjects fell below their chronological age levels in gross and fine motor skills; however, their mean gross motor skill levels exceeded their mean fine motor skill levels. The specific deficits in gross motor and fine motor skills, which were documented in a previous follow-up study on the same sample, continued to be areas of deficits (visual motor coordination, running speed, balance, and reaction time). The EI group subjects had significantly higher scores on measures of intellectual and adaptive functioning than did the children in the comparison group. The EI group subjects did not show the decline typically seen with age in adaptive functioning in individuals with Down syndrome. CONCLUSION AND DISCUSSION: Because of the design limitations, the differences between the groups should be interpreted with caution.

Adaptation, Physiological↗

PubMedDate not supplied

Early intervention for children and families: with special needs.

The purpose of this article is to provide a general overview of early intervention and how nurses can interface with this important program for children. "Early intervention" in this context refers to services for young children (birth to age 3) who have developmental delays or are at risk for delays, as well as for their families. These programs are administered by each state but are federally funded under Part C of the Individuals with Disabilities Act. The primary objective of early intervention is to maintain or maximize a child's development; a wide range of services may be provided including nursing, physical therapy, occupational therapy, and family counseling. Overall, early intervention programs have been shown to improve developmental outcomes, strengthen parent-child interactions, and provide a supportive family environment. There is a continued need for research, however, in many areas, including assessing the long-term effects of services for specific groups, determining the most effective means of providing services, and evaluating outcomes of family functioning.

Child Health Services↗

PubMed2004

Characteristics of successful early intervention programs.

A plethora of terms and titles are currently used to describe early intervention programs. The terms "Critical Incident Stress Management Team," "Rapid Response Team," "Community Crisis Response Program," "Critical Incident Stress Team," "Staff Support Team," "Critical Incident Support Team," "Critical Incident Support Services," and "Assaulted Staff Action Program" are among many titles utilized to name a variety of crisis response programs. Additionally, crisis intervention services use different tactics to aim at a wide range of populations from primary victims to community groups, military service personnel, and emergency services responders. Some program titles contain within them relatively specific descriptions of the team's main functions or areas of responsibility. Others may generate misunderstanding or confusion about the purpose of the teams. The end result may be that individuals or organizations requesting assistance from a team or program may be uncertain that they have contacted the right team to support them. Furthermore, no title, no matter how creative or descriptive it is, can indicate if the team or program has a greater or lesser potential to be of assistance by providing the right services during a crisis. This article focuses on the key characteristics of well-organized crisis intervention or, more precisely, "critical incident stress management" program. It also offers guidelines for identifying early intervention programs that have the best potential to provide efficient and effective early intervention services to those who request assistance.

Crisis Intervention↗

PubMed1976

Interdisciplinary early intervention program.

Developmental data were obtained on 40 children with Down's syndrome by an interdisciplinary team during an ongoing early intervention program. Interventive methods are described. Results are compared with available data on children with Down's syndrome who were not in early intervention programs. Comparisons of developmental progress are also made of children begun in the early intervention program before six months of age with those begun after six months of age. Conclusions from the study indicate that early intervention helps the child in earlier attainment of many developmental tasks and enhances functioning of the family unit.

Counseling↗

PubMed2005

[Lowering incidence of cerebral palsy of premature infants through early intervention].

OBJECTIVE: In recent years, the survival rate of premature infants is increased, but the incidence of cerebral palsy did not decrease, instead, there was a tendency of increase. The incidence of cerebral palsy of premature infants was 29.13 per thousand in 7 provinces in China in an investigation of over 30,000 children 1 - 6 years of age in 1997, which is 25.16 times higher than that of full term infants. Each year, about 1 million premature infants are born in China, which may include an increase of approximately 29,000 cerebral palsy infants. The rehabilitation expense of cerebral palsy infants is high, older patients cannot be cured; only improved life quality is possible. Therefore, we carried out this research from March 1, 2000 to the end of February 2003 to explore the effects of early intervention in lowering the incidence of cerebral palsy among premature infants. METHODS: A total of 1053 cases of survived premature infants, gestational age under 37 weeks, excluding those with congenital deformity and hereditary metabolic diseases, born or treated in all collaborative units were classified into 2 groups: early intervention group (551 cases) and routine care group (502 cases). Method of classification: all premature infants born within 1 year before beginning of the study and premature infants born after beginning of the study whose parents did not want to receive early intervention were included in the routine care group; all premature infants born after beginning of the study whose family intended to actively participate in early intervention were included in the intervention group. The numbers of infants in the two groups were quite close in each collaborative unit. In the intervention group, the premature infants received early intervention after discharge from hospital, in addition to routine care, once a month before corrected age of 6 months and once every two months after 6 months. The parents were instructed to cultivate the infant's cognition, language, emotion and communication ability, and the infants were given massage, subjected to exercise and received active motor training. All infants with abnormal motor manifestations were given appropriate rehabilitation training. In the routine care group, infants received similar routine care only. RESULTS: In the 2 groups, no significant differences (P > 0.05) were found in complications of pregnant mothers, average gestational age and birth weight, proportion of small for gestational age (SGA), proportion of single and multiple births, fetal stress, postnatal asphyxia, incidence of neonatal hypoxic inschemic encephalopathy (HIE) and intracranial hemorrhage, Apgar Score and Neonatal Behavioral Neurological Assessment Score at 40 weeks of gestational age. These indicate that the two groups were comparable. At 1 year of age, the incidence of cerebral palsy was 0.91% (5/551) in the intervention group and 3.19% (16/502) in the routine care group (P < 0.01). Of the 5 cases with cerebral palsy in the interventional group, 3 were mild and 2 severe. Of the 16 cases in the routine care group, 7 were moderate and 9 severe. CONCLUSION: Early intervention can reduce the incidence of cerebral palsy of premature infants. This conclusion awaits confirmation from studies with larger sample size.

Apgar Score↗

PubMed2003

Designing research to study the effects of institutionalization on brain and behavioral development: the Bucharest Early Intervention Project.

This paper provides an overview of the largest longitudinal investigation of institutionalized children less than 2 years old ever conducted. The Bucharest Early Intervention Project is an ongoing randomized controlled trial of foster placement as an alternative to institutionalization in abandoned infants and toddlers being conducted in Bucharest, Romania. In addition to describing the contexts in which this study is imbedded, we also provide an overview of the sample, the measures, and the intervention. We hope that the natural experiment of institutionalization will allow us to examine directly the effects of intervention on early deprivation. We hope it will provide answers to many of the critical questions that developmentalists have asked about the effects of early experience, the timing of deprivation, and the ameliorating effects of early intervention and provide clues to which underlying neurobiological processes are compromised by, and resilient to, dramatic changes in early experience.

Brain↗

PubMed1996

Early intervention: professional views and referral practices of Australian paediatricians.

OBJECTIVE: To gather information from paediatricians concerning their attitudes to early intervention services for young children with developmental disabilities and to study their referral practices. METHODOLOGY: Two hundred and ninety-five Australian paediatricians completed a postal questionnaire. RESULTS: Paediatricians presented a positive view of early intervention, particularly for its beneficial impact on families, and perceived the quality of services to be comprehensive or adequate. There were few differences between States, or between country or metropolitan areas. Most paediatricians make prompt referrals to early intervention services when a child has an established disability. Referral is much less likely with suspected delay. CONCLUSIONS: Paediatricians are aware of the benefits of early intervention but additional information concerning the role of these services and their significant impact on families and children should be provided.

Australia↗

PubMed2000

Early intervention and sustaining the management of vulnerability.

OBJECTIVE: The purpose of this article is to consider the issue of how long early intervention needs to be sustained to have a long-term impact on the course of psychosis. METHOD: Factors relevant to the concept of secondary prevention in psychosis are discussed. The need for sustained intervention for long-term impact on psychosis is examined. Evidence concerning the length of time required for the maximal impact of early intervention services and interventions that have been demonstrated as effective in achieving long-term change is reviewed. The article discusses individuals of low and high vulnerability to schizophrenia and the interaction between this vulnerability and the length and type of treatment they require to change the deteriorating course of psychosis. RESULTS: There is increasing evidence for the concept of a 'critical period' lasting up to 5 years after first presentation, during which the long-term level of vulnerability to relapse and disability may be determined. CONCLUSIONS: For many highly vulnerable patients, early intervention must be sustained for a minimum of 3 years to prevent or limit the potential for early decline. A core unanswered question is whether effective early intervention prevents potential long-term disability or merely delays it.

Adolescent↗

PubMed2003

[Pervasive developmental disorder: a model of early intervention centered on the family].

Early intervention with children suffering from a pervasive developmental disorder is widely recognized. However, models of services which integrate the many components are lacking. It is indeed important to support not only the child but also his family, to identify the needs at an early stage and to assess and diagnose very early on in order to respond rapidly. This article proposes a model of services divided in five phases: 1) early identification; 2) individualized family service plan; 3) preliminary assessment of the child; 4) detailed diagnostic evaluation and 5) intervention. The last two phases are concurrent while the five phases are elaborated as well as integrated within a dynamic model.

English Abstract↗

PubMed1999

Collaboration and teamwork in assessment for early intervention.

Interdisciplinary teamwork and collaboration in early intervention require that professionals adopt a common set of developmentally appropriate standards that guide the major activities of screening, diagnostic assessment, individualized curriculum planning, progress and program evaluation, and family-centered services. This article has reviewed the common roadblocks to effective teamwork, especially among educational and medical professionals. As solutions to the typical problems in collaboration, eight developmentally appropriate standards ensure best practice and adherence to the Individuals with Disabilities Education Act mandates: utility, acceptability, authenticity, equity, sensitivity, convergence, congruence, and collaboration.

Child Psychiatry↗

PubMed2002

[Investigation in early intervention].

OBJECTIVE: Point out the importance of the research in early intervention (EI), its limitations, and peculiarities. DEVELOPMENT: After defender the importance of research in this applied field, its problems in EI are analysed from different perspectives. The idiosyncrasy of the intervention goals perfectly explain the concurrence of ethical and methodological limitations, which affect to the possible research designs. The diversity of possible needs of EI in the children lead to a great variability and heterogeneousity in the attended population and a great dispersion in the research purposes in this field. Centred in the interest by to improve the quality of the offered services, the actual situation of the research on the efficacy of the intervention in EI lead to reclaim insistently the development of multidimensional approaches. Evaluation of the intervention results, for example, must not exclusively centred in child developmental acquisitions, or at least not only in the classic aspects of motor, cognitive, language, etc.; quite the contrary, it must be take into account new areas and competencies, related both to the child and to his/her family. The evaluation of results or goals of the intervention must be only one dimensions more, which must be faced simultaneously to the evaluation of the characteristics of the child and his/her family and the characteristics of the programs itself. CONCLUSIONS: The accumulated experience after eight years of service of a Research Department in a Childhood Developmental and Early Intervention Centre permit point out that this type of initiatives are valid to promote the research in the EI field.

Child↗

PubMed1991

Scaling and attainment of goals in family-focused early intervention.

Evaluating the impact of early intervention as a means to prevent or ameliorate developmental disabilities has been a long standing problem and the issue of effectiveness continues to be debated. This study explored the utility of Goal Attainment Scaling as a planning and evaluation tool whereby intervention outcomes for infants and families could be documented. The 23 families in this study were participants in a larger research effort evaluating the implementation of community based, family-focused intervention. An average of 5.9 goals were written for each family, with approximately 60% of goals written for infants and 40% for families. Attainment of goals was evident in a mean T-score of 51.9 for post-test values and in documentation that approximately two-thirds of all goals were attained at least at the expected level. The practical features of Goal Attainment Scaling and the correspondence of goal attainment scores with other measures of change suggest that it may be a valuable approach to complement traditional evaluation strategies.

Child↗

PubMed2000

Parents' psychosocial problems influencing the continuity of early intervention treatment in children with developmental delay.

Developmental delay is a chronic disorder, which has a significant and continuing impact on the developmental progress of children. Whether the developmentally delayed children have continuous early intervention treatment is important for the success of early intervention. Professionals in early intervention services have been encouraged to understand parents' psychosocial problems and to further enhance their understanding of care for their delayed children. The purposes of this study were two-fold. The first was to identify the parents' psychosocial problems. The second purpose was to find parents' psychosocial variables that could be used to significantly discriminate whether the retarded children have continuously received treatment programs. A questionnaire to investigate parents' psychosocial problems was implemented. It mainly consisted of twenty descriptive items concerning parents' psychosocial conditions. Parents used a four-point Likert scale to rate the likelihood of the items. Parents also responded as to whether their child had received treatments continuously. Subjects were the parents of children who were diagnosed to have developmental delay. Factor analysis and discriminant analysis was used for statistical data examination. Analyzed data were from 207 completely finished questionnaires. Six parents' psychosocial factors were extracted via factor analysis, and they accounted for 46.9% of the variance of the twenty items. The factors were identified as family income, family members' relationships, caring skills, supporting resources, acceptance of the retarded child, and self-psychological adaptation. About half of the children had received treatment continuously. Discriminant analysis revealed that family income was crucial to parents' capacity to meet the needs for treatment.

Adult↗

PubMed2001

Early intervention after severe oxygenation index elevation improves survival following lung transplantation.

BACKGROUND: Reperfusion injury and technical problems following lung transplantation may result in life-threatening pulmonary dysfunction that requires intervention with either extracorporeal membrane oxygenation or reoperation. Early intervention in these patients could prevent complications associated with delayed or emergent intervention and may improve survival. The oxygenation index [(mean airway pressure x percent of inspired oxygen)/partial pressure of arterial oxygen] provides a rapid assessment of pulmonary function in the critical phase of reperfusion. Our hypothesis was that the oxygenation index could be used as an early predictor for severe respiratory failure requiring acute intervention. METHODS: Analysis of 136 consecutive lung transplant operations revealed 18 patients (reperfusion injury in 16 and technical complications in 2) with an oxygen index of > or = 30. Of those patients with reperfusion injury, 9 had fibrotic lung disease, 4 had obstructive lung disease, and 3 had primary pulmonary hypertension. RESULTS: Patients undergoing transplantation for fibrotic lung diseases were more likely to develop severe reperfusion injury (oxygenation index > or = 30) compared to patients with obstructive lung diseases (9 of 42 or 21% vs 4 or 80 or 5%, p = 0.005). The 5 patients with early intervention (< or = 2 hours) after an oxygenation index elevation above 30 had significantly improved survival compared to the 13 with no or late intervention (80% vs 15% survival, p = 0.02). CONCLUSION: Oxygenation index elevation > or = 30 following lung transplantation is an early predictor of severe respiratory failure requiring acute intervention. Early intervention in these patients improves survival.

Adult↗

PubMed1997

Alcohol early intervention: a nursing model for screening and intervention strategies.

This paper presents the background policy directions in Australia that are encouraging nurses to initiate alcohol early intervention strategies. The current clinical initiatives that are supporting screening and early intervention strategies are critically reviewed and presented in the form of an Alcohol Early Intervention Model to guide nursing practice. The model is compatible with current directions in nursing which encourage more independent, empowering and educationally focused strategies. This model also provides direction for undergraduate and graduate nursing curricula and offers opportunities for future research.

Alcoholism↗