INTERVENTION

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INTERVENTION
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MODELS OF CAUSATION

• LINEAR CAUSE-AND-EFFECT MODEL
• THE LINEAR CAUSE-AND-EFFECT MODEL HOLDS THAT
  THERE IS A DIRECT ONE-TO ONE RELATIONSHIP BETWEEN
  A CAUSE AND EFFECT. IN ESSENCE, EACH EFFECT HAS
  A SPECIFIC CAUSE.

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MODELS OF CAUSATION

• INTERACTION CAUSE-AND-EFFECT MODEL
• IN THIS VIEW THE CHILDS DEVELOPMENT IS SEEN AS
  THE RESULT OF THE INTERACTION BETWEEN THE CHILDS
  CONSTITUTION AND ENVIRONMENT.

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MODELS OF CAUSATION

• TRANSACTIONAL CAUSE-AND-EFFECT MODEL
• THE TRANSACTIONAL MODEL INCLUDES THE PROBABILITY
  OF CHANGE OVER TIME AND EMPHASIZES RECIPROCAL
  INFLUENCES BETWEEN THE CHILD AND THE ENVIRONMENT.

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BASIC PREMISE

• ANTHING THAT INTERFERES WITH A CHILDS ABILITY TO
  INTERACT WITH THE ENVIRONMENT IN A NORMAL MANNER
  IS A POTENTIAL SOURCE OF OR CONTRIBUTING FACTOR
  TO THE PRESENCE OF DEVELOPMENTAL DELAY.

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ENVIRONMENT OF THE NICU

• LIGHT FLUORESCENT LIGHTING 24 HOURS EACH DAY
• NOISE GREATER INTENSITY, DIFFERENT QUALITY
• TOUCH 1930- 1940 MINIMAL HANDLING 1960- 1980
  AGGRESSIVE INTERVENTION 1980- 2000 TYPE AND
  QUALITY OF TOUCH

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1941 HANDLING GUIDELINES

• 1. DONT HANDLE UNNECESSARILY
• 2. DONT ALLOW ANYONE, EXCEPT NURSE DOCTOR, IN
  THE INFANTS ROOM
• 3. DONT FEED TOO OFTEN
• 4. KEEP AWAY FROM OTHER INFANTS/CHILDREN

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CAREGIVER BEHAVIORS

• TIME PRESENT 30 ACUTE OBSERVATIONS AND 20
  CONVALESCENT OBSERVATIONS
• INTERVAL BEFORE LEAVING 85 SECONDS FOR ACUTE AND
  64 SECONDS FOR CONVALESCENT GROUPS
• AMOUNT/TYPE OF HANDLING
• TOUCHED 13 OF TIME ACUTE INFANTS 71 OF
  TOUCH IS MEDICAL

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NICU INTERVENTION

• VERBAL STIMULATION
• TACTILE STIMULATION
• SOOTHING RESPONSES TO INFANTS STRESS
• SENSORY INTEGRATED SOCIAL EXPERIENCES

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• It is time that nurseries develop this type of
  care for ventilated VLBW infants The NICUs
  choosing not to implement this form therapy
  should have clear reasons and should consider
  their own randomized trial to attempt to disprove
  this work
• VandenBerg, K.A. (1996). Developmental Care Is
  It Working?. Neonatal Network The Journal of
  Neonatal Nursing. 15.1.

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NICU DEVELOPMENTAL ENHANCEMENT

• PRIMARY GOALS
• MODIFY THE ENVIRONMENT
• INCREASE STAFF KNOWLEDGE
• INDIVIDUALIZED APPROACH
• CHANGE ROUTINE
• ENHANCE PARENT-INFANT RELATIONSHIPS

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• They collectively have demonstrated not only
  improved developmental outcome, but dramatically
  improved medical benefits and impressive cost
  savings.
• VandenBerg, K.A. (1996). Developmental Care Is
  It Working?. Neonatal Network The Journal of
  Neonatal Nursing. 15. 1.

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• Researchers have shifted their attention from
  improving survival rates of high-risk infants in
  intensive care nurseries to studying ways to
  improve developmental outcome.
• VandenBerg, K.A. (1996). Developmental Care Is
  It Working?. Neonatal Network The Journal of
  Neonatal Nursing. 15.1.

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• Infants are often receiving many varied levels
  of stimuli at once, which can be confusing and
  which cannot be integrated into meaningful
  learning experiences.
• VandenBerg, K.A. (1996). Developmental Care Is
  It Working?. Neonatal Network The Journal of
  Neonatal Nursing. 15. 1.

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• Developmental care is no longer optional it is
  mandatory if we are to provide optimal care for
  low birth weight infants
• VandenBerg, K.A. (1996). Developmental Care Is
  It Working?. Neonatal Network The Journal of
  Neonatal Nursing. 15. 1.

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EFFICACY OF NICU INTERVENTION (Low SES Families)

• METHODS
• 60 MOTHER INFANT PAIRS
• INVOLVEMENT OF CHILD DEVELOPMENT SPECIALIST
• INTERVENTION INCLUDED TEACHING MOTHERS ABOUT
  BABIES BEHAVIOR
• CONTROL AND EXPERIMENTAL GROUP USED
• MEASURES MADE AT 4 8 MONTHS

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EFFICACY OF NICU INTERVENTION

• RESULTS
• 85 FOLLOW-UP RATE
• SIGNIFICANT DIFFERENCE ON MENTAL AND MOTOR
  SCORES
• GREATER INTERACTION
• INFANTS BELOW 1,500 GRAMS BENEFITED MOST
• SUMMARY
• SHORT-TERM NICU INTERVENTION ENHANCED OVERALL
  PERFORMANCE.

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MOTHER-INFANT COMMUNICATION

• SHORT UTTERANCE LENGTH AND SIMPLE SYNTAX
• SMALL CORE VOCABULARY-OBJECT CENTERED
• TOPICS LIMITED TO HERE NOW
• HEIGHTENED FACIAL EXPRESSION GESTURE
• FREQUENT QUESTIONING GREETING
• MEANINGFUL RESPONSES- TURNTAKING PROLONGING
• FREQUENT VERBAL RITUALS

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COMMUNICATION INTERVENTION PRINCIPLES

• COMMUNICATION EMERGES FROM NATURAL CONVERSATIONS
• INTERVENTION MUST ENGAGE CHILD AND CAREGIVER
• TURNTAKING BECOMES A CRITICAL SKILL
• LOOK FOR NONLINGUISTIC ACTS
• ADULTS MUST BE TAUGHT HOW TO RESPOND

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COMMUNICATION INTERVENTION PRINCIPLES

• THE GOAL OF THE ACTIVITY IS NOT TO FINISH THE
  PLANNED ACTIVITY, BUT TO ELICIT COMMUNICATION
• DO NOT TRY TO FORCE VERBAL OUTPUT
• EMPLOY COMMUNICATION ELICITING TECHNIQUES SUCH AS
  IMITATION, MODELING, QUESTIONS, PARAPHRASES,
  EXPANSION, AND SENTENCE COMPLETION

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COMMUNICATION INTERVENTION PRINCIPLES

• MONITOR YOUR TALKING
• USE ACTION NOT PICTURES
• EXPAND NEW CONCEPTS
• AVOID YES/NO QUESTIONS
• EMPHASIZE FUNCTION/INTENT RATHER THAN STRUCTURE

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HANEN PROGRAM

• OBSERVE CHILDS ATTEMPTS TO COMMUNICATE
• FOLLOW THE CHILDS LEAD
• RESPOND SO CHILD WILL LEARN
• KEEP THE CONVERSATION GOING
• PROMPT FOR BETTER TURNS
• PREPLAN PLAY ACTIVITIES

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ADULT GOALS

• RESPOND TO CHILDS LEAD
• INITIATE INTERACTIONS
• SUSTAIN JOINT ACTIVITIES
• RESPOND AT CHILDS PACE
• RESPOND TO NONVERBAL CUES
• MATCH ACTIONS, SOUNDS, WORDS
• BE CHILDLIKE
• BE ANIMATED AND ENJOY

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COMMUNICATION GOALS

• CHILD GOALS
• INCREASE INTERACTION
• RESPOND WITH INTEREST
• PREFER SOCIAL CONTACT
• COMMUNICATE WITH MOVEMENTS SOUNDS
• TAKE TURNS
• SHARE THE LEAD IN PLAY
• EXPRESS EXPERIENCES/INTENTIONS

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COMMUNICATION INTERVENTION PHASES

• PHASE I GENERAL READINESS
• GAZING OR VISUAL ATTENTION
• POSITIONING
• SENSORY PROXIMITY

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COMMUNICATION INTERVENTION PHASES

• PHASE II RECIPROCAL ACTIONS
• ESTABLISH JOINT ATTENTION
• USE VARIOUS OBJECTS
• ESTABLISH RECIPROCAL RESPONDING
• EXPAND THE CHILDS REPERTOIRE
• LOOK FOR SOCIAL RITUAL GAMES

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COMMUNICATION INTERVENTION PHASES

• PHASE III SOCIAL-COMMUNICATIVE SIGNALS
• VOCALIC, MOTORIC, GESTURAL ACTIONS
• CONTINGENT RELATIONSHIPS
• LOOK FOR AND REWARD ANY VOCAL OR GESTURAL
  ATTEMPTS TO COMMUNICATE

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COMMUNICATION INTERVENTION

• PHASE IV EARLY COMPREHENSION
• TEACH APPROPRIATE RESPONSES TO CERTAIN WORDS
• EXPAND COMPREHENSION REPERTOIRE FORMAL OR
  NATURALISTIC APPROACH ATTEMPTS

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COMMUNICATION INTERVENTION

• PHASE V EARLY PRODUCTION
• ENHANCE ALL VOCALIZATIONS
• ACCEPTABLE SOUND COMBINATIONS
• WORK ON WORD PRODUCTION/REWARD LIBERALLY
• LINK ACTIVITIES/OBJECTS WITH WORDS
• ENHANCE WORD SEQUENCING
• EXPANSION/CHAINING/TURNTAKING