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PubMed2000

Early intervention and school nursing practice.

The most vital and critical period for early intervention is in the first 3 years of life. The school nurse working in an early childhood program plays a pivotal role in assessing and meeting the health and developmental needs of very young children and their families. This article discusses early intervention, as defined by federal law, as an age-related service delivered within a family-focused, multidisciplinary, interagency, and collaborative model. An assessment framework for school nurses working with this population is described, which includes physical, social, and emotional domains. Identifying children early and then providing needed interventions and services will assist at-risk children in realizing their developmental potential.

Child, Preschool↗

PubMed1993

Identifying at-risk children for early intervention services: lessons from the Infant Health and Development Program.

A U.S. law mandates early intervention services for infants and young children who have, or are at risk for, developmental problems. Participating states must develop definitions for identifying infants and young children at risk for developmental problems. To assess the sensitivity, specificity, and positive predictive value of some commonly identified risk factors, we examined the definitions proposed by five states. Data on risk factors and 36-month developmental outcomes were obtained from follow-up participants in the Infant Health and Development Program, a multisite, collaborative prospective intervention program involving 985 low birth weight preterm infants. Few individual risk factors proposed by these states were associated with poor developmental outcomes. Characteristics with positive predictive values greater than 30% were highly specific but tended to involve few cases. Risk factors with positive predictive values greater than 50%, such as hypothyroidism, occurred infrequently (< 6%) in this sample. When state definitions for at-risk children were examined in composite, each definition yielded a positive predictive value of 25% to 35%, with poor specificities ranging from 12% to 40%. These data on low birth weight infants have implications for the design and funding of population-based early intervention programs, and suggest that more careful clinical and longitudinal research is necessary before appropriate definitions can be promulgated for identifying children in need of early intervention services.

Child, Preschool↗

PubMed1998

Early intervention and prevention in schizophrenia--experiences from a study in Stavanger, Norway.

The paper gives an overview of current literature and research that makes the foundation and rationale for early intervention in functional psychosis, i.e. schizophrenia. The duration of untreated psychosis (DUP) and its practical implications are demonstrated. An outline of the prerequisites of the psychiatric services and the societal preconditions for effective early intervention strategies is given. The development of working clinical treatment programmes within the county of Rogaland, Norway, is described, as well as strategies towards enhancing the knowledge of serious psychiatric disorders among the population and thus making the foundation for effective and early help-seeking. The different resistance factors in relation to early intervention are introduced. Preliminary results of an early intervention is presented, indicating that it is possible to shorten DUP (from 114 to 20 weeks), and showing that DUP is the single most important predictor for poor prognosis.

Humans↗

PubMed2003

Cost-effectiveness analysis of early intervention with budesonide in mild persistent asthma.

BACKGROUND: The Inhaled Steroid as Regular Therapy in Early Asthma (START) study reported that early intervention with budesonide in mild persistent asthma reduces severe asthmatic events and improves symptom outcomes and lung function in adults and children. OBJECTIVE: We sought to estimate the incremental cost-effectiveness of early intervention with budesonide, as observed within the START study. METHODS: START was a randomized, 3-year controlled trial of budesonide in early onset mild asthma among 7165 subjects ages 5 to 66 years. Three age groups (5-10, 11-17, and >or=18 years) were studied separately and overall. Differences in the probability of emergency treatments, symptom-free days (SFDs), and costs of health care were determined. Incremental cost-effectiveness ratios were estimated from the health care payer and societal perspectives. RESULTS: Compared with usual therapy, patients receiving budesonide experienced an average of 14.1 (SE, 1.3) more SFDs per year (P <.001), fewer hospital days (69%, P <.001), and fewer emergency department visits (67%, P <.05). From the health care payer perspective, the net cost of early use of budesonide was an additional US dollars 0.42 (SE, dollars 0.04) per day, and the resultant cost-effectiveness ratio was US dollars 11.30 (95% CI, US dollars 8.60-US dollars 14.90) per SFD gained. From the societal perspective, the cost offsets of lower absence from school or work reduced the net cost of early budesonide to US dollars 0.14 (SE, US dollars 0.07) per day and decreased the cost-effectiveness ratio to US dollars 3.70 (95% CI, US dollars 0.10-US dollars 8.00). Early intervention was more effective and cost saving in the youngest age group. CONCLUSION: Long-term treatment with budesonide appears to be cost-effective in patients with mild persistent asthma of recent onset.

Adolescent↗

PubMed2005

First-episode psychosis, early intervention, and outcome: what have we learned?

OBJECTIVE: There has been increased interest in the potential of early intervention to positively influence outcome in first-episode psychosis (FEP) and, consequently, to influence mental health policy and practice. This study's objective was to examine the concept of early intervention and the evidence that currently exists to support such a shift in the delivery of care. METHOD: We examined the evidence for phase-specific treatment of FEP, looking for interventions that attempt to arrest the transition from a putative prodromal state to full psychosis, as well as for interventions that attempt to reduce delay in treatment. RESULTS: Some evidence supports specialized FEP interventions for short-term outcome in terms of symptom reduction, relapse rates, and greater adherence to and retention in treatment. As well, there is modest support for benefits to aspects of social and community functioning and satisfaction with life. Limited evidence supports a positive effect of community-wide case detection in terms of reduced delays in treatment and pharmacologic and psychological interventions in the prodromal phase. CONCLUSIONS: The field of early intervention in psychosis is young, with encouraging preliminary results, especially for improving outcome in established FEP. It requires further study, especially of longer-term outcome. Further studies need to examine the effects of a specialized approach on longer-term outcome and to explore cost-effective methods to reduce delays in treatment and provide interventions in the prodromal phase.

Cognitive Behavioral Therapy↗

PubMed1997

Prevention and early intervention for anxiety disorders: a controlled trial.

The Queensland Early Intervention and Prevention of Anxiety Project evaluated the effectiveness of a cognitive-behavioral and family-based group intervention for preventing the onset and development of anxiety problems in children. A total of 1,786 7- to 14-year-olds were screened for anxiety problems using teacher nominations and children's self-report. After recruitment and diagnostic interviews, 128 children were selected and assigned to a 10-week school-based child- and parent-focused psychosocial intervention or to a monitoring group. Both groups showed improvements immediately postintervention. At 6 months follow-up, the improvement maintained in the intervention group only, reducing the rate of existing anxiety disorder and preventing the onset of new anxiety disorders. Overall, the results showed that anxiety problems and disorders identified using child and teacher reports can be successfully targeted through an early intervention school-based program.

Adolescent↗

PubMed1987

Early intervention for disabled infants and their families: a quantitative analysis.

In an evaluation of 31 selected studies, statistical procedures for synthesizing data (meta-analysis) were used to assess the effects of early intervention services on disabled children younger than 3 years of age and on their families. Results indicate that early intervention is effective in promoting developmental progress in infants and toddlers with biologically based disabilities. Programs that served a heterogeneous group of children, provided a structured curriculum, and targeted their efforts on parents and children together appeared to be the most effective. Definitive evaluation of the efficacy of early intervention programs is tempered by the restricted range of outcomes measured and by a paucity of information about the children and families enrolled in such programs, as well as about the specific nature of the services received. Despite their limitations, available data provide the basis for a rational pediatric approach to early intervention programs, while highlighting specific directions for further investigation.

Age Factors↗

PubMed1992

Child psychiatry and early intervention: III. The developmental disorders.

This paper is the third in a series of four using the concepts introduced in the paper Child Psychiatry and Early Intervention: I. The Aggregate Burden of Suffering. This paper reviews the developmental disorders of childhood to set priorities for early intervention programs. This review discusses the prevalence, course, risk, early indicators, associated impairments, and responses to intervention. The specific developmental disorders, especially learning disabilities, have a significant impact on community resources. Since the developmental disorders are easily recognized among preschool children, early intervention is feasible. However, successful interventions have yet to be demonstrated. Priority should be given to the development of effective interventions. There is a great need for research studies on the effects and effectiveness of early intervention with these individuals.

Adolescent↗

PubMed1999

Israeli mothers' expectations from early intervention with their preschool deaf children.

Family-oriented early intervention programs have become a common practice in deaf education and intervention. This trend requires the extensive investigation of parents' expectations about programs and professionals in order to enhance the efficacy of parent-professional collaboration. The goal of this study was to closely examine the expectations of mothers whose children were already enrolled i a comprehensive early intervention program for deaf children and their families. Three means of data collection were utilized: two open-ended written questions, an individual oral interview with the mother, and a set of formal questionnaires on various maternal, family, and child characteristics. A heterogeneous sample of 50 mothers of 2- to 5-year-old deaf children in Israel participated in the study. A wealth of maternal expectations emerged from this qualitative methodology, underscoring mothers' impressive knowledge and awareness, as well as individual differences. Through cluster analysis, the mothers were sorted into four distinct groups, yielding interesting patterns of expectations for programs and processionals.

Journal Article↗

PubMed1992

The case for early intervention in rheumatoid arthritis.

A case for early intervention in rheumatoid arthritis is presented on the basis of the following observations: (1) established rheumatoid arthritis of 5 years duration or more is a progressive disease in most patients; (2) most patients with rheumatoid arthritis already have evidence of permanent radiographic damage within the first 2 years of disease; (3) the morbidity and mortality of rheumatoid arthritis are predicted by baseline data indicating more severe clinical status, rather than drug toxicity or causes 'unrelated' to rheumatoid arthritis; (4) currently used therapies, even those documented to be effective in randomized controlled trials, are not effective in most patients over periods of 2 years or longer. It is not known whether earlier intervention will result in better outcomes. However, these phenomena suggest a need for studies to evaluate early aggressive intervention in rheumatoid arthritis.

Antimalarials↗

PubMedDate not supplied

Professional skills, concerns, and perceived importance of work with families in early intervention.

Innovations brought about by Public Law 99-457 require early intervention personnel to expand their work practices to involve and support families in the provision of early intervention services. To support training needs in this area, and to understand possible barriers to change, this study examined the extent to which 142 early interventionists from two states felt competent in working with families, valued family roles, and were concerned about changing to family-centered practices. Relationships among these characteristics and experience, discipline, and job category were explored. In general, nurses and social workers scored higher than did educators and other health-care professionals on several dimensions of family-centered care. Many professionals expressed concerns about collaboration.

Persons with Disabilities↗

PubMed1993

Early intervention services in selected Florida counties: the provider perspective.

Early intervention providers in five Florida counties were interviewed to obtain their perspective on the current service system in preparation for the implementation of programs under Public Law 99-457. Recommendations from the providers' perspective that have implications for policy development include (a) increase public awareness of disability, handicap, and at risk conditions as well as awareness of services; (b) increase funding for early intervention services with particular attention to the needs of families for support and other services; (c) drastically improve the transportation system; and (d) focus on helping parents and the public to learn how to negotiate the system as it exists.

Child Health Services↗

PubMedDate not supplied

Implementation and effectiveness of a home-based early intervention program for blind infants and preschoolers.

This article presents results from a comprehensive evaluation of a home-based early intervention project for congenitally blind young children. Five full-term and five preterm blind children, who had a mean age of 12 months at the beginning of the project, were visited at home with their families every 2 weeks over a 2-year period. Results showed that an individualized, handicap-specific early intervention using different types of parent involvement (cotherapist, parent counseling) could be implemented successfully. Compared with controls, developmental test data from the ages of 12 to 36 months showed an accelerating impact on the full-term children. However, no intervention effects could be found in the preterm children. This finding was mainly due to methodological limitations (e.g., selection bias). The best results among full-term children were found on blindness-specific scales (e.g., orientation and mobility). It is concluded that the outcomes in full-term children confirm the success of this type of early intervention.

Activities of Daily Living↗

PubMed1989

Occupational therapy in early intervention: a family-centered approach.

This article describes a framework for occupational therapy service provision in early intervention settings and presents pilot data aimed at examining the framework's effectiveness. The Family-Centered Framework for Early Intervention is a synthesis of concepts from the Model of Human Occupation (Kielhofner & Burke, 1980) and from the literature on play. It encompasses a systematic, holistic approach that considers the child and the family within the context of their life environments. In this framework, play is used both as an evaluative tool and as an intervention modality that addresses the volition, habituation, and performance of the child and family as well as the strengths and weaknesses of the environment. Play is also used as a primary measure of competence and change. This framework may be useful in defining occupational therapy roles for the early intervention population.

Child, Preschool↗

PubMed2003

A Canadian programme for early intervention in non-affective psychotic disorders.

OBJECTIVES: To provide a brief overview of the development of clinical services and research for early intervention in psychotic disorders in Canada; to describe components of a comprehensive clinical/research programme for nonaffective psychotic disorders; and to present a summary of results of clinical and social outcomes achieved. METHOD: This is a descriptive paper providing some details of how clinical services are being developed in Canada and concentrating on one particular early intervention programme, Prevention and Early intervention Programme for Psychoses (PEPP) London, Ontario, which is using a historical control design to evaluate the impact of an assertive approach to community case detection. Components of a phase-specific treatment programme and early case detection are described followed by results based on clinical and psychosocial data collected according to a defined protocol. RESULTS: One year outcome for patients treated in PEPP shows use of low dose, pre-dominantly novel antipsychotics and high (81.5%) retention and remission (75%) rates. Highly significant improvements were also reported for self-rated quality of life and cognition. Duration of untreated psychosis (DUP) and premorbid adjustment were associated with improvement in positive and negative symptoms, respectively. Systemic changes to improve access to the service resulted in substantial increases in number of cases treated and a> 50% decline in DUP. CONCLUSIONS: Phase-specific treatment approach and case identification strategies to reduce delay in treatment are likely to substantially improve outcome in nonaffective psychotic disorders compared with what has been reported with traditional approaches.

Canada↗

PubMed1999

Changes of tibia bone properties after spinal cord injury: effects of early intervention.

OBJECTIVE: To evaluate the effectiveness of an early intervention program for attenuating bone mineral density loss after acute spinal cord injury (SCI) and to estimate the usefulness of a multimodality approach in diagnosing osteoporosis in SCI. DESIGN: A single-case, experimental, multiple-baseline design. SETTING: An SCI center in a university hospital. METHODS: Early loading intervention with weight-bearing by standing and treadmill walking. PATIENTS: Nineteen patients with acute SCI. OUTCOME MEASURES: (1) Bone density by peripheral computed tomography and (2) flexural wave propagation velocity with a biomechanical testing method. RESULTS: Analysis of the bone density data revealed a marked decrease of trabecular bone in the nonintervention subjects, whereas early mobilized subjects showed no or insignificant loss of trabecular bone. A significant change was observed in 3 of 10 subjects for maximal and minimal area moment of inertia. Measurements in 19 subjects 5 weeks postinjury revealed a significant correlation between the calculated bending stiffness of the tibia and the maximal and minimal area moment of inertia, respectively. CONCLUSION: A controlled, single-case, experimental design can contribute to an efficient tracing of the natural history of bone mineral density and can provide relevant information concerning the efficacy of early loading intervention in SCI. The combination of bone density and structural analysis could, in the long term, provide improved fracture risk prediction in patients with SCI and a refined understanding of the bone remodeling processes during initial immobilization after injury.

Adult↗

PubMedDate not supplied

The effectiveness of early intervention: examining risk factors and pathways to enhanced development.

In this paper we examine the effectiveness of early intervention, especially vis-à-vis (a) child and family risk factors and (b) the pathways to enhanced child and family development. To address these issues we draw on findings from the Infant Health and Development Program (IHDP) for low-birth-weight premature infants. The data we present reveal the considerable effectiveness of the IHDP intervention in enhancing several aspects of early and later child and family development. The findings also illustrate the importance of looking beyond intervention group differences to examine the extent to which early intervention effects are more pronounced for some children and families than others and to examine the processes underlying intervention effects (e.g., exactly how do early interventions change children and families?). For example, both initial and longer-term IHDP intervention effects varied by both characteristics of the children and characteristics of their families. Our data also provide some insight into the processes by which intervention effects may have occurred. We conclude our consideration of these many complexities with suggestions for practice, social policy, and future research.

Adolescent↗

PubMed2006

Myocardial viability testing and the effect of early intervention in patients with advanced left ventricular systolic dysfunction.

BACKGROUND: The clinical value of revascularization and other procedures in patients with severe systolic heart failure is unclear. It has been suggested that assessing ischemia and viability by positron emission tomography (PET) with fluorodeoxyglucose (FDG) imaging may identify patients for whom revascularization may lead to improved survival. We performed a propensity analysis to determine whether there might be a survival advantage from revascularization. METHODS AND RESULTS: We analyzed the survival of 765 consecutive patients (age 64+/-11 years, 80% men) with advanced left ventricular systolic dysfunction (ejection fraction < or =35%) and without significant valvular heart disease who underwent PET/FDG study at the Cleveland Clinic between 1997 and 2002. Early intervention was defined as any cardiac intervention (surgical or percutaneous) within the first 6 months of the PET/FDG study. In the entire cohort, 230 patients (30%) underwent early intervention (188 [25%] had open heart surgery, most commonly coronary artery bypass grafting, and 42 [5%] had percutaneous revascularization); 535 (70%) were treated medically. Using 39 demographic, clinical and PET/FDG variables, we were able to propensity-match 153 of the 230 patients with 153 patients who did not undergo early intervention. Among the propensity-matched group, there were 84 deaths during a median of 3 years follow-up. Early intervention was associated with a markedly lower risk of death (3-year mortality rate of 15% versus 35%, propensity adjusted hazard ratio 0.52, 95% CI 0.33 to 0.81, P=0.0004). CONCLUSIONS: Among systolic heart failure patients referred for PET/FDG, early intervention may be associated with improved survival irrespective of the degree of viability.

Aged↗