Evan is 2 years old. He has been referred by his pediatrician to the early intervention program in his small town due to signs of global developmental delay. Evan says two words—ma (for mom, dad, or grandma) and ba (for bottle). He is still on a bottle and rejects many table foods. Evan began walking 4 months ago, and still falls down quite a bit. Although his parents report that Evan is generally a happy toddler, when he becomes upset, he is prone to intense temper tantrums that include screaming and kicking. His parents handle these episodes in a calm, consistent manner, and Evan typically regains his composure within 2 or 3 minutes. His mother and father teach in the local school district, and Evan is cared for by his grandmother during the school day. Evan’s parents are quite engaged in seeking support for Evan; they vow to do everything in their power to promote his development.
Bryce is also 2 years old. He was referred to the early intervention program in the same small town by a caseworker with the Department of Health and Human Services (DHHS) as required by law under CAPTA (the Child Abuse Prevention and Treatment Act). Bryce was found one rainy day wandering alone outside the ground-level apartment where he lives with his mother and baby sister. He had succeeded in opening the screen door and walked out unnoticed. A passer-by spotted him and called the police. A DHHS caseworker was assigned to investigate the circumstances. During her visits, the caseworker observed that Bryce communicated by grunting and pointing to things, but she did not hear him using understandable words. Bryce’s mother reported that he was usually good-natured, but the caseworker noticed that when he became upset, he was prone to intense temper tantrums that included screaming and kicking. Bryce’s mother did not seem to know what to do with him at that point, and she told the caseworker she usually gave him what he wanted because he “was so upset.” Bryce was not removed from his home because his mother voluntarily agreed to services offered by the caseworker. The caseworker also explained that she was required by the CAPTA provision to refer Bryce and his family to the early intervention program for assessment of Bryce’s development; Bryce’s mother expressed interest in the program.
The local community’s Early Intervention multidisciplinary team completed assessments of both children. The assessments included observations and standardized instruments completed with the boys and their parents to determine the children’s eligibility for services. Although results of the observations and standardized assessments revealed that both Evan and Bryce qualified for early intervention services as children with developmental delays in cognitive and language development, many questions remained for their early intervention teams. What were the families’ priorities for their children? What supports would be optimal to effect positive outcomes for these children? What dosage of service from the early intervention team would be needed—How often and how intensive
