In many countries around the world, including Australia, early childhood intervention is a growing field in the service delivery, advocacy and academic sectors. They have been, and continue to be, shaped by the characteristics of cultural and political traditions that result in an amalgam of supports for young children with disabilities and their families. This article provides a brief overview of early childhood intervention programs, followed by a description of their evolution and current service trends in Australia. I conclude with thoughts about future prospects for these programs and the role of advocacy organisations in promoting access and equity in the provision of these services young children with disabilities and their families.
Early childhood intervention (ECI) is the term commonly used to describe early and preventive services and programs for children from birth to 6 years with developmental delays and disabilities. In some countries, ECI only covers the birth-to-3 year old range, while others include services for children birth-5 years of age. More recently, the birth-8 year old range has been highlighted as the most appropriate developmental period during which to address child and family concerns (Division for Early Childhood 2005). The level and type of developmental delay (i.e., at-risk versus established and more severe developmental disabilities) is another variant to be considered within the scope of ECI services eligibility. In The United States, for example, some states consider children at risk of developmental problems as qualifying for ECI programs; others only include those children with established developmental disabilities.
Specifically, ECI programs are designed to support family patterns of interaction that best promote children’s development. The focus is thus on both children and families, with intervention efforts offering a blend of specialised therapeutic and educational programs for children, and advocacy and support programs for the family as a whole. ECI programs were not always offered in this way. The medical model was prevalent through the 1980s, until a more family-centred philosophy underpinning ECI service delivery was proposed (Dunst, Trivette`and Deal 1988) and embraced by the field.
Indeed, at the beginning of this century, a series of journal articles were published highlighting both the strength of ECI as a field, and the view that ‘family-centredness’ was central to ECI practice (Bruder 2000; Dunst 2000; Simeonsson 2000). While the family-centred philosophy has somewhat evolved over the years, Bruder (2000) suggested that three values strongly remain at its core: (1) emphasis on family’s strengths rather than deficits; (2) promotion of family choice and control over desired resources; and (3) the development of a collaborative relationship between professionals and parents. The family-centred model of service delivery is now widely accepted, and has been complemented by various other principles underpinning the practice of ECI. These principles include family support, education and advocacy, inclusion in natural (educational and community) environments, and transdisciplinary team work.
Against this backdrop, ECI services in Australia have been guided by contemporary discourses that have been widely adopted by policy makers and practitioners alike. The characteristics and structures of various jurisdictions (i.e., local, state, and federal), as well as legal arrangements and funding imperatives, have considerably influenced the extent to which ECI principles and practices have been enabled in our communities. From a legal standpoint, in particular, while Australia has Commonwealth and State Disability Acts which prohibit discrimination against all people with disabilities, there are no specific laws that mandate ECI services for young children with developmental disabilities or delays. In this context, the eligibility criteria to access ECI programs are somewhat broad, whereby young children need to have a substantial delay in more than one area of development. Thus, children do not necessarily have to have an ‘established’ developmental disability, but a range of developmental delays, in order to qualify for services. Young children with less substantial developmental concerns can be identified by either the health system through a network of community health centres, or the preschool system that provides educational experiences to children for 12 months prior to school entry. While the flexibility of this approach can be useful, and to a certain extent less stigmatising, it has also developed into a ‘maze’ of uncoordinated services and programs that families find difficult to navigate. Families usually do not know where to seek help, and are confused by conflicting advice by professionals in the mainstream system. Thus, barriers to effective access to relevant and timely supports have been a great concern among families and service providers. This state of affairs, it could be argued, is consistent across Australia.
Funding is another important factor for consideration when discussing how ECI services are delivered in Australia. The federal government distributes grants to states and territories, which in turn (through their departments of education, health and community services) allocate funding to government and non-government community-based ECI agencies. ECI programs are generally delivered by community-based organisations, particularly in the states of Victoria and New South Wales, which make up 57% of a population of 22 million across the country. With some variations, in the other four states and two territories, both government and some community-based organisations have the responsibility for providing such services. Because of this diversity of funding sources and arrangements, and the make-up of the various disability service delivery systems, it is challenging to discuss ECI as a fully developed service sector in Australia. Furthermore, a national framework that systematically guides the development of policies and services in ECI is sorely lacking (Kemp and Hayes 2005).
Compounding this situation, the last 10 years have seen an increasing demand for ECI services that has inevitably led to extensive waiting lists for services for children and families who have been identified in need of service. In addition, with increasing costs and pressures on an already underfunded and fragmented system, those families who do receive ECI support do not experience high-quality programs that can effectively make a positive difference to their young child’s development and family well-being. In the state of Victoria, for example, a number of contributing factors to this situation have been identified in various reviews of the ECI system, including a lack of policy coordination among government levels; unclear policy directions at state level; an overstretched, although well-qualified workforce; and the lack of a quality framework in service provision.
Nevertheless, governments have begun to partially address these issues. The state of Victoria is currently leading the Early Childhood agenda for the Coalition of Australian Governments (COAG), which is the peak intergovernmental forum in Australia, comprising the Prime Minister, State Premiers, Territory Chief Ministers and the President of the Australian Local Government Association. In line with this development, Victoria, in particular, has commenced a process of reform with the 2008 release of the Blueprint for education and early childhood development (Department of Education and Early Childhood Development, 2008). In this document, ECI services feature in need of attention and reform, focussing on the development of a whole-of-government strategy for children and their families, and government commitment to additional funding to relieve waiting lists.
While these and other developments invite hope and enthusiasm from the sector, progress has been slow and somewhat hampered by the global financial crisis. In particular, it is alarming that the ECI reform has not been adequately integrated within the overall early childhood agenda. This is a ‘missed opportunity’, especially considering that many of the problems afflicting ECI are a reflection of the difficulties in the broader early childhood system. For instance, regular ‘natural’ preschool experiences for children with developmental delays and disabilities, which are central to their development, are heavily restricted given current funding arrangements. That is, specialised support that ECI practitioners can provide to a relatively unskilled, regular early childhood workforce whose classrooms contain children with developmental delays and disabilities, is quite limited.
Advocacy efforts on behalf of children with developmental disabilities and their families have therefore been challenged and energised into action at a state and national level. Early Childhood Intervention Australia (ECIA), which is a professional organisation representing non-government ECI services across the country, in conjunction with its various state branches, is involved in a number of activities designed to draw attention to the needs of young children with disabilities and their families, and gain government and community support for the development of quality family-centred, inclusive services. To this end, collaborative efforts among families, practitioners, and academics are beginning to emerge with the view of supporting the development of a cohesive and responsive service system for young children with disabilities that uphold the ECI principles outlined earlier.
In summary, the development of ECI programs across Australia has been uneven, and has depended more on the willingness of governments to implement services for this population, than on systematic efforts to implement policies and practices across the service system. As a result, the sector’s ability to introduce recommended practices that effectively support child and family well-being as outlined in the literature (Sandall, Hemmeter, Smith and McLean 2005) has varied greatly across the country. Currently, government reforms are being considered to establish clear directions for ECI within the overall early childhood and disability sectors. The collective strengths and actions of families, and all of those acting on their behalf, are key in the implementation of these efforts. It is with hope that those concerned with the needs of young children with disabilities and their families anticipate much needed change so the development of a quality ECI service system becomes a reality.