4
Early Intervention Programs

Interdisciplinary programs have been designed to address many of the threats to early development we have discussed. Most of these programs have had an impact, although in some areas gains are more modest (e.g., outcomes for children with very low birthweight) and harder to achieve (e.g., changes in parenting behavior) than in others (e.g., reduction in iron deficiency).

A number of early intervention demonstration programs were designed and implemented to test the effect of more comprehensive early intervention for children born into circumstances with a great many risk factors. These demonstration programs are of two types: one targets psychological development and mental health, emphasizing parenting interventions. The other targets cognitive and behavioral development as its primary purpose and usually includes direct provision of services to children in addition to family services. While the primary focus of those designing the programs is somewhat different and the research traditions tend to be separate, supporting the child in either domain is likely to have substantial spillover effects in the other domain. Early intervention policy for at-risk children can be best informed by looking at outcomes for both types of interventions, considering them as part of a single picture.



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Minority Students in Special and Gifted Education 4 Early Intervention Programs Interdisciplinary programs have been designed to address many of the threats to early development we have discussed. Most of these programs have had an impact, although in some areas gains are more modest (e.g., outcomes for children with very low birthweight) and harder to achieve (e.g., changes in parenting behavior) than in others (e.g., reduction in iron deficiency). A number of early intervention demonstration programs were designed and implemented to test the effect of more comprehensive early intervention for children born into circumstances with a great many risk factors. These demonstration programs are of two types: one targets psychological development and mental health, emphasizing parenting interventions. The other targets cognitive and behavioral development as its primary purpose and usually includes direct provision of services to children in addition to family services. While the primary focus of those designing the programs is somewhat different and the research traditions tend to be separate, supporting the child in either domain is likely to have substantial spillover effects in the other domain. Early intervention policy for at-risk children can be best informed by looking at outcomes for both types of interventions, considering them as part of a single picture.

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Minority Students in Special and Gifted Education PARENTING PROGRAMS Powerful risk and protective factors implicated in early emotional and behavioral development can be found in the relationship between parent and child (see Chapter 3). The parent plays a central role, for example, in teaching the child the critical social and emotional regulation skills that are essential for adjustment to the demands of elementary school and peer relationships. Parents also have an indirect effect on emotional development by the extent to which they buffer the child from the effects of poverty or neighborhood violence. The quality of parenting practices specifically implicated in the development of emotional and behavioral problems is affected in turn by a myriad of contextual factors associated with poverty and, in many cases, with minority status (see Chapter 3). The effects on parenting and child emotional development of interventions to increase the incomes of poor families have not been evaluated in well-designed, randomized trials. Even among the numerous promising early intervention programs targeted directly at specific aspects of parenting, only about 1 in 20 has been evaluated, and many of these have methodological weaknesses (U.S. Department of Health and Human Services, 2001b). In the findings summarized below, we emphasize randomized studies with objective or multiagent assessment. Trials without postintervention follow-up are cited for their value in establishing the causal status of antecedents to emotional disturbance. Pregnancy Through the First Two Years Early interventions directed at improving the parenting of young mothers appear highly promising for the prevention of emotional problems in children before they emerge at school entry. Importantly, the antecedents identified in developmental studies have been shown to be malleable in these intervention studies. Early Home Visitation Programs The most promising and carefully evaluated set of early interventions and randomized trials has been the nurse home visitation program developed by Olds and his colleagues (Olds et al., 1986, 1997, 1998). Beginning in the third trimester of pregnancy, women living in poverty with no previous live births were identified for a public health nurse visitation program that was targeted at specific and well-established early risk factors. Program targets included prenatal care, maternal diet, and reductions in cigarette smoking. The program provided mentoring and strong emotional support for the mother.

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Minority Students in Special and Gifted Education For two years after birth, maternal engagement with the child, maternal validation, and problem solving were central targets, as were parenting skills more generally. Parents were encouraged to utilize agencies and programs for financial, social, and educational support. Importantly, mothers were encouraged and assisted to develop job skills. The program has been replicated in rigorous randomized studies, and follow-up studies have been conducted for up to 15 years. A wide variety of immediate impacts on early child behavior and cognitive development have been reported, as well as important long-term effects on behavioral adjustment. In addition to direct effects on child development and parenting, the mothers in the intervention groups had fewer and more widely spaced pregnancies and were significantly more likely to get paying jobs and to leave welfare. Beyond demonstrating the potential of early intervention with parents, the program also demonstrates the wide range of serious risk factors that are malleable in high-risk families with young children. A variant of this model, called Healthy Start, originated in Hawaii and now operates in 37 or 38 states; it appears effective and feasible for largescale prevention efforts. To date there have been no randomized trials of Healthy Start. Improving Mother-Infant Attachment The basis for early and secure emotional attachment between mother and child has long been considered the foundation on which the psychological, emotional, and social development of the child is built. Insecure attachment has been implicated in both ineffective, harsh, and neglectful parenting and in the development of externalizing behavior by young children. A large number of studies of the efficacy of interventions designed to improve attachment has been carried out with mixed results. A classic study by van den Boom (1994) showed dramatic effects of early intervention both on the mother (contingent responsiveness, sensitivity) and on the infant (secure attachment, sociability, self-soothing, exploration). These findings were partially replicated by Toth et al. (2000) and by Wendland-Carro (1999). Although the long-term effects of attachment-focused interventions are not yet clear, they reliably increase maternal sensitivity and engagement, which are key factors in the prevention of emotional-behavioral problems. For a review and meta-analysis of relevant studies, see van Ijzendoorn et al. (1995). Children Ages 3 to 5 The key developmental challenges during the preschool period expand to include demands for increased impulse control and compliance to social

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Minority Students in Special and Gifted Education norms and parental expectations. Key risk factors during this period include parental reports of difficult child temperament, noncompliance, aggression, parental irritability and harshness, lack of discipline skills— particularly limit setting—and low parental warmth and playfulness. A substantial number of randomized trials of parent training and support interventions have targeted this constellation of risk factors. The most programmatic and successful work to date has been reported by Carolyn Webster-Stratton and her colleagues (Webster-Stratton, 1989, 1998; Webster-Stratton et al., 1988). Targeted at parents of children demonstrating severe conduct problems, these interventions focused on discipline, supervision, problem solving, praising, and positive interactions. Using both parent reports and direct observation data, they consistently report strong improvements in these skills, as well as improvements in children’s social behavior, lower rates of problems and aggression, and better social skills. The parent training interventions are highly replicable and can be enhanced with videotapes and parenting manuals. Follow-up studies show persistence for up to two years. An intriguing study by McNeil et al. (1991) demonstrated that improving parenting skills has direct and positive effects on young children’s behavior in preschool classrooms (also see Sheeber and Johnson, 1994). As the next chapter discusses, these strategies can be integrated with school-based programs to produce truly integrated interventions for elementary school students. CHILD DEVELOPMENT PROGRAMS Demonstration programs that provide services directly to children to promote their cognitive and behavioral development have a history that stretches back 30 years. The effects of these programs have been reviewed thoroughly, frequently, and recently (Karoly et al., 1998; National Research Council [NRC], 2000a, 2000b; Ramey and Ramey, 1999; Guralnick, 1997; White and Boyce, 1993; Farran, 1990; Haskins, 1989; Karweit, 1989; Carnegie Task Force on Meeting the Needs of Young Children, 1994; Bryant and Maxwell, 1997; Currie, 2000). We do not undertake another review here. Rather, we summarize some of the major lessons from the programs characterized both by the provision of high-quality, intensive services and by the use of rigorous research designs to analyze outcomes (Ramey and Ramey, 1998). High quality refers to the nature of the transactions between caretakers and children, and is supported by the education and training of the caretakers, smaller child/adult ratios, and smaller group size. The findings synthesized below draw from prospective randomized trials targeted to children at risk for developmental delay, mental retardation, poor school achievement, or a combination of the three. A list of

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Minority Students in Special and Gifted Education programs for which longitudinal studies were conducted to determine program effect appears in Table 4-1, along with program features. We can conclude with confidence that early intervention programs can produce modest to large effects (effect sizes of 0.2 to over 1.0 standard deviation) on children’s cognitive and social development. Larger effect sizes are associated with better subsequent performance in school, particularly when the schools are of good quality (Campbell and Ramey, 1994, 1995; Lazar et al., 1982). Variation in effect size and duration is associated with the particular program features reviewed below (Ramey and Ramey, 1992). Developmental Timing Interventions that begin early and continue for a longer duration result in greater benefits to participants. The five major studies that demonstrated some of the largest effects of early intervention on cognitive and social development all enrolled children during infancy (the Abecedarian Project, the Brookline Early Education Project, the Milwaukee Project, Project CARE, and the Infant Health and Development Program). Data on early cognitive development for program and control children in the Abecedarian Project displayed in Figure 4-1 suggest that, without intervention, high-risk children fall substantially behind as early as the second year of life. Since no experimental design has tested for a critical period or threshold effect, however, no precise timing for intervention can be supported empirically. Program Intensity Programs that provide more hours of service delivery produce larger positive effects than do less intensive interventions. Within programs, children and parents who participate the most actively and regularly are the ones who show the largest developmental gains. All of the programs mentioned as effective with regard to timing also provided intensive intervention services. In addition to these, the Perry Preschool Project (Weikart et al., 1978) and the Early Training Project (Gray et al., 1982), both of which began when children were 3 or 4 years old, also provided intensive services and registered substantial program impact. Numerous examples of early intervention programs that had little or no effect on cognitive, social, or later academic performance were less intensive.1 1   The Utah State Early Intervention Research Institute (White, 1991), for example, found no significant effects in the 16 randomized trails of early interventions for children with developmental disabilities. None of these interventions provided full-day programs or multiple home visits per week. Similarly, a brief prenatal and postnatal program for urban teen mothers failed to affect their children’s cognitive performance or social development (Brooks-Gunn and Furstenberg, 1987). For other examples, see Ramey and Ramey (1998).

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Minority Students in Special and Gifted Education TABLE 4-1 Longitudinal Studies of Child Development Programs Researcher Age Group Ratio Group size Duration Abecedarian Project (Campbell and Ramey, 1994) Infants, preschool 1:3 1:6 14 12 5 years Brookline Early Education Project (Hauser-Cram et al.,1991) Infants, preschool 1:1 16 18 5 years Early Childhood Education Project (Sigel et al., 1973; Cataldo, 1978) 2-3 years 1:7 22 3 years Early Training Project (Gray et al., 1982) Preschool 1:5 20 2 or 3 years Family Development Research Program (Honig and Lally, 1982) 1-2 years Infants, preschool 1:4 8 5 years Harlem Training Project (Palmer, 1983) Preschool 1:1 NA 1-2 years Infant Health and Development 1-2 years 1:3 6 8 3 years Program (Ramey et al., 1992; Infant Health and Development Program Consortium, 1990) 2-3 years 1:4     Milwaukee Project (Garber, 1988) 2 years 3 years preschool 1:2 1:3 1:7 ? 6 years Perry Preschool Project (Schweinhart and Weikart, 1993) Preschool 1:5 20-25 2 years Project CARE (Wasik et al., 1990) Infants, preschool 1:3 1:6 14 12 5 years   SOURCES: Data from Frede (1998); Lazar et al. (1977); and NRC (2001b:134-135). The principle that intensity matters applies to two-generation programs that work with parents as well. One home visit program (Powell and Grantham-McGregor, 1989) produced significant cognitive benefits with three visits per week but not with less frequent visits. Similarly, the Brookline Early Education Project (Hauser-Cram et al., 1991) reported significant cognitive and social benefits only from its most intensive two-generation interventions.

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Minority Students in Special and Gifted Education Intensity Curriculum Teacher Qualifications Activities for Parents Full-day Interactive Experienced paraprofessionals to certified teachers Group meetings, home visits Part- or full-day Interactive Certified teachers Home visits, guided observation in classroom Half-day Interactive Certified teachers and 2 paraprofessionals None Part-day 10 weeks summer Structured Interactive Certified teacher Weekly home visits during academic year Full-day Interactive but less structured Paraprofessional-home visitors/professional teachers Weekly home visits, informal class visits, and daily notes home 2 weeks 2 tutoring approaches: concept training or discovery Tutors change every 6 weeks high school to Ph.D. candidate None Full-day Interactive Bachelor’s degree with early childhood education specialty Home visits Full-day Cognitive curriculum Paraprofessional/certified teacher at 4 years Job training, social services, home visits Half-day Interactive Certified teachers Weekly home visits Full-day Interactive Experienced paraprofessionals to certified teachers Group meetings, home visits To date, only one study has looked at program intensity at the level of the individual child: the Infant Health and Development Program. As indicated in the discussion of low birthweight in Chapter 3, the amount of intervention each child and family received, monitored daily over the first three years of life, had a strong, positive effect on the child’s intellectual and social development at 36 months. Blair et al. (1995) found that children’s yearly intellectual development was strongly linked to variations in yearly participation rates.

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Minority Students in Special and Gifted Education FIGURE 4-1 Intellectual performance of children in the Abecedarian Project during the preschool years. SOURCE: Ramey and Ramey (1999). Reprinted with permission. Direct Provision of Learning Experiences Children who receive direct educational experiences show larger and more enduring benefits than do children in programs that rely only on the training of parents to change children’s competencies. Variation in the delivery of services across programs between those that provide educational experiences to children directly and those that train caregivers (usually parents) to do so are clear: direct techniques are more powerful in enhancing children’s intellectual and social experiences (e.g., Casto and Lewis, 1984; Madden et al., 1976; Scarr and McCartney, 1988; Wasik et al., 1990). Even when weekly home visits were sustained from birth to age 5 in a randomized, controlled trial with economically disadvantaged, high-risk children (Wasik et al., 1990), no measurable benefits on children’s cognitive or social performance, parent attitudes or behavior, or the quality of the home environment were found. For the group that received both the weekly home visit and daily center-based intervention, there were significant cognitive gains for the children.

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Minority Students in Special and Gifted Education Planned Curriculum Successful early intervention models have used a variety of curricula. But relatively little research has been done that allows for a direct comparison of curricular effects. No single curriculum has been demonstrated to be superior to others (Bryant and Maxwell, 1997), but this may reflect the difficulty of separating out the effects of curriculum, program intensity, and teacher quality. However, research does indicate the importance for learning outcomes of having a planned, well-integrated curriculum (NRC, 2001b). Comprehensive Service Provision The intervention programs that have produced relatively large early effects, including the Abecedarian Project, the Brookline Early Education Project, Project CARE, the Milwaukee Project, the Infant Health and Development Program, and the Mobil Unit for Child Health, all provided health and social services, transportation, practical assistance with meeting pressing family needs, neurodevelopmental therapies when needed, and parent services and training in addition to quality educational programs for children. Benefits Vary with Type and Level of Risk The idea that individuals respond differently to any kind of “treatment” is pervasive in many domains, including child development, medical interventions, and education. Indeed, a key mark of progress is the extent to which differential responses (or person by treatment interaction) are understood and incorporated into the intervention. Many of the early intervention programs viewed children as either disadvantaged or not, and the treatment for the disadvantaged ones was a program or service that differed often by site, but for reasons unrelated to the characteristics of the individual children. Several studies, however, suggest relevant dimensions for distinguishing among children in the intervention required and the response anticipated. The Infant Health and Development Program (1990) found that very low birthweight babies did not benefit as much from the intervention as their heavier counterparts. In a study of educational interventions for children with disabilities, Cole et al. (1993) found that children who were higher performing at program entry benefited more from direct instruction techniques, while lower-performing students benefited more from the mediated learning treatment. Findings from the Abecedarian Project showed the

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Minority Students in Special and Gifted Education largest gains for children whose mothers had the lowest IQ scores, findings reinforced by several other programs that showed larger program impact from intensive intervention for children whose mothers had low levels of education (Ramey and Ramey, 1998). Systematic attention to the match between the child’s characteristics and the program provided holds promise for improvement in the efficiency and outcome of early intervention. Sustained Cognitive, Social, and School Achievement Benefits Long-term benefits of early intervention on school achievement, grade retention, and special education placement, as well as on behaviors outside school, have been identified (Campbell and Ramey, 1995; Lazar et al., 1982; Schweinhart and Weikart, 1993). Most studies also detect IQ benefits, but they generally diminish over time (Ramey and Ramey, 1998). Given that children in the studies live in high-risk environments and attend schools in high-risk neighborhoods, this result is not surprising. No theory of development would support an expectation of normative development in a high-risk environment without continued intervention. One randomized study tested the effects of providing continued support into the elementary school years to children who received early intervention services. At age 8, children who received services for all eight years, children who received services for the first five years, and those who received services for three years were compared with control group children (Horacek et al., 1987). A strong positive association was found between the number of years that supports were maintained and reading and math scores at age 8. A nonrandomized study of Chicago Head Start children supports this finding (Reynolds, 1994). When resources are constrained, focusing supports on the early years, when children are putting into place the basic capacities and skills required for later functioning may be efficient. But if children are to continue to develop at a normative pace, it will not be sufficient. Would Early Intervention Reduce Special Education Placement? Since well-designed early intervention programs have been shown to affect cognitive and social functioning, one would expect that those improvements would move some number of students with mild disabilities over the threshold separating those who require special supports and those who do not. Several studies measure the effect directly. Two model demonstration programs provide data on special education placements. The Perry Preschool project reports rates of special education placement of 17 percent for program participants compared with 37 percent for control children (Schweinhart et al., 1993). In the Abecedarian Project, special education placements rates differed even more dramatically

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Minority Students in Special and Gifted Education for children who received the preschool program (12 percent) and the control group children (48 percent; P < .01). The Chicago Child-Parent Center Program, unlike the demonstration programs reviewed above, is a large-scale federally funded program that provides education, family, and health services to low-income, mostly black children and their families. The program includes half-day preschool at ages 3 to 4, half- or full-day kindergarten, and services to children ages 6-9 linked to the elementary school. Outcomes for program children at a 15-year follow-up were compared with groups of matched children who were in alternative early childhood programs like full-day kindergarten, a subset of whom were in the program’s kindergarten but who had not participated in the preschool program. Preschool participation was associated with significantly lower rates of special education placement (14.4 vs. 24.6 percent; P < .001), and the program group spent on average 0.7 years in special education compared with 1.4 years for comparison students. Participation in the school-age program for at least a year was associated with lower rates of special education as well (15.4 vs. 21.3 percent, P = .02). Children with 5 or 6 years of participation had the lowest remediation (Reynolds et al., 2001). Preschool program participation was also associated with higher rates of high school completion (49.7 vs. 38.5 percent; P = .01) and lower juvenile arrest rates (16.9 vs. 25.1 percent; P = .003) and violent arrests (9.0 vs. 15.3 percent; P = .002) (Reynolds et al., 2001). EXISTING FEDERAL EARLY INTERVENTION PROGRAMS Federal legislation currently provides for funding to states for early intervention services for young children in low-income families through a variety of programs. Table 4-2 lists the largest of these programs, although the General Accounting Office has identified 69 in total that provided for or supported education and care for children birth to age 5 in fiscal year 1999 (U.S. General Accounting Office, 2000). We focus here on the intervention services for children diagnosed with or at risk of disability and on the largest of the early intervention programs—Head Start. Early Intervention Under IDEA IDEA Services for Infants and Toddlers In 1986, the Individuals with Disabilities Education Act (IDEA) was expanded with the establishment of the Early Intervention Program for Infants and Toddlers with Disabilities (Part H, now Part C of IDEA). By 1994, all states and U.S. territories had programs in place. The states are

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Minority Students in Special and Gifted Education FIGURE 4-2 Race/ethnicity: National versus Part C percentages. SOURCE: U.S. Department of Education (2000). vices if they are in the $15,000-$25,000 income bracket than if they are in the lowest income bracket. With this exception, these data support the link between poverty and special needs discussed above: while children from all income groups have disabilities, the income status of the family is negatively correlated with the likelihood of disability. The NEILS data also support more specific links between biological and environmental conditions more common in low-income (disproportionately minority) families and disability identification. Low-birthweight children were represented in the early intervention group in large numbers: 31 percent of early intervention children were low birthweight, and 17 percent were very low birthweight. These percentages far exceed those in the population as a whole, in which 7.5 percent are low birthweight and 1.4 percent are very low birthweight. A total of 42 percent of black children in the early intervention program were low birthweight, and 30.9 percent were very low birthweight—substantially higher than any for other racial/ ethnic group. But the rate at which black low-birthweight children are provided with early intervention services is just below the rate for white low-birthweight children, while the rate for Hispanic low-birthweight children is just above that of whites. The NEILS data also suggest that black children who were served under Part C were substantially more likely to have been in intensive care at birth than were the white and Asian children served, and they were less likely to be rated as in good or excellent health. The risk models discussed above suggest that the challenges faced by children are compounded the greater the strain on the family and the fewer

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Minority Students in Special and Gifted Education TABLE 4-4 Household Income and Race/Ethnicity for Children Receiving Early Intervention   All EI/GP African American EI/GPa Hispanic EI/GP Asian Pacific Islander White EI/GP Other Early Intervention Percent with Income: $15,000 or less 25.7 1.46 48.1 1.37 34.6 1.14 20.1 15.5 1.36 24.4   (1.8)   (3.5)   (3.4)   (8.4) (2.0)   (2.5) $15,001 to $25,000 15.4 1.26 20.1 1.18 27.0 1.37 7.1 10.6 1.10 20.6   (.9)   (2.0)   (3.3)   (2.3) (.8)   (34.4) More than $25,000 58.9 .84 31.8 .67 38.4 .76 72.8 74.0 .94 45.0   (2.1)   (2.9)   (4.0)   (8.6) (2.6)   (4.6) General Population—Families with Children under 18 Percent with Income: $15,000 or less 17.6   35.2   29.9   11.4       $15,001 to $25,000 12.2   17.6   19.7   9.6       More than $25,000 70.3   47.2   50.4   79.0       NOTE: Standard errors are in parenthesis. N for early intervention = 2,801. General population data not available for Asian/ Pacific Islander and Other. aEI/GP is the percentage of those receiving early intervention in the income group divided by the percentage of the population in that income group. SOURCE: Hebbeler and Wagner (2000).

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Minority Students in Special and Gifted Education resources the family has available to cope with those strains. The glimpse of families served in early intervention provided by the NEILS data suggests that the strains are highest in black and Hispanic families, in which the number of children is on average greater, as is the likelihood that more than one child in the household will have special needs. The resources are fewest in the black families, in which the likelihood that only one adult lives in the household is more than double that of Hispanic families and five times greater than that for Asian and white families. In Hispanic and black families, the likelihood that the mother will have less than a high school education is 29 and 25 percent respectively, while that for whites and Asians falls below 10 percent. A final, significant risk factor is foster care. Children in foster care are substantially more likely than other children to have disabilities (Gottlieb, 1999; Blatt and Simms, 1997; Klee et al., 1996). Almost 7 percent of the children in the NEILS dataset were in foster care—10 times that for the general population (U.S. Department of Health and Human Services, 1999). Over 18 percent of the black children were in foster care, however. In the general population, 45 percent of all children under 18 who are in foster care (less than 1 percent of the population) are black. IDEA Services for Preschoolers At the same time that the Early Intervention Program was added to IDEA, the Preschool Grants Program for Children with Disabilities was changed from an incentive program to a mandated program (U.S. Department of Education, 2000). By 1991, states were required to provide a “free and appropriate public education” to all eligible 3- to 5-year-olds. As Figure 4-3 indicates, the rate of identification increases with the child’s age. The rapid increase in the number of children served in the early 1990s slowed substantially (to about 1.5 percent) by the end of the decade (U.S. Department of Education, 2000). Data on the race/ethnicity of children served in the preschool program are available only as of 1998-1999. They differ considerably from either the early intervention proportions or the later population served under IDEA. In the preschool program, white children and American Indian children are represented in disproportionately large numbers (see Figure 4-4). The representation of black children is almost identical to the proportion in the population, and Hispanic and Asian children are served in less than proportional numbers. Most of these children (92 percent) receive special education services in regular public school settings (U.S. Department of Education, 2000). Why is the racial composition of children in the preschool program different from the early intervention program and the special education

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Minority Students in Special and Gifted Education FIGURE 4-3 Number of preschool children with disabilities served under IDEA by age and year, 1992-1993 through 1998-1999. SOURCE: U.S. Department of Education (2000). program during the school years? An answer to that question is no more than speculation. One possibility is that the label serves the purpose of providing access to preschool services, and the Head Start program provides an alternate source of services for poor children. The disproportionate number of black children served in Head Start may shrink the proportion served under IDEA during those years. Head Start The Head Start program was created in 1965 to narrow the gap between disadvantaged children and their more advantaged peers by providing educational experiences, improved nutrition, parent involvement, and access to health and social services (U.S. General Accounting Office, 1998). In 1999-2000 the program served 857,664 children, primarily 3- and 4-year-olds. The program serves disproportionate numbers of black and Hispanic children, as one would expect given the targeted population of children living in poverty (see Table 4-5). About 12.7 percent of the children served were designated as disabled (see 2001 Head Start Fact Sheet: http://www2.acf.dhhs.gov/programs/hsb/about/fact2001.htm). Many of the Head Start programs provide home visitation services.

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Minority Students in Special and Gifted Education FIGURE 4-4 Race/ethnicity of preschoolers receiving special education and of the general preschool population, 1998-1999. SOURCE: U.S. Department of Education (2000). In all, 32 percent of Head Start staff are parents of children served or formerly served in the program. The program operates with a paid staff of 180,400, which is dwarfed by the volunteer staff of 1.25 million, about 0.8 million of whom are parents. The average expenditure per child in Head Start in fiscal year 1999-2000 was $5,951, but the average conceals enormous variation both within and between states. In 1996-1997 the average in Texas was $1,081, while that in New York was $17,029. Within New York, the range between the lowest and highest expenditure per child was $16,206 (U.S. General Accounting Office, 1998a). Little research using experimental design has been done to evaluate the effectiveness of Head Start in any of the services it provides (U.S. General Accounting Office, 1997). Unlike the efforts at evaluation of Early Head Start, Head Start has not yet been subject to randomized trials to determine its impact on school readiness or on health and nutrition. However, the Department of Health and Human Services recently awarded a contract for a Head Start Impact Study that will involve random assignment (see 2001 Head Start Fact Sheet: http://www2.acf.dhhs.gov/programs/hsb/about/fact2001.htm).

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Minority Students in Special and Gifted Education TABLE 4-5 Head Start: Fiscal Year 2000 Data Enrollment 857,664 Ages: Number of 5-year-olds and older 5.0% Number of 4-year-olds 56.0% Number of 3-year-olds 33.0% Number under 3 years of age 6.0% Racial/Ethnic Composition American Indian 3.3% Hispanic 28.7% Black 34.5% White 30.4% Asian 2.0% Hawaiian/Pacific Islander 1.0% Number of Grantees 1,525 Number of Classrooms 46,225 Number of Centers 18,200 Average Cost per Child $5,951 Paid Staff 180,400 Volunteers 1,252,000   SOURCE: 2001 Head Start Fact Sheet. Available: http://www2.acf.dhhs.gov/programs/hsb/about/fact2001.htm [accessed July 11, 2001]. Whether the program achieves the goal of narrowing the gap between disadvantaged children and their more advantaged peers in school readiness is difficult to say. The Family and Child Experiences Survey funded by Head Start is a nationally representative sample of families and children in the Head Start program designed to assess changes in children between the beginning and the end of the Head Start year. The analysis of the survey data shows conflicting results (Whitehurst and Massetti, in press), with possible small gains in word recognition and emergent writing. But without a control group, even these small gains cannot be attributed to the program. On measures of letter knowledge, book knowledge, and reports of the home reading environment, there were no improvements over the course of the Head Start year (Administration of Children, Youth, and Families, 2001). The survey analyses are consistent with other studies that have shown that children participating in Head Start score very low in language development and preliteracy skills (Legislative Office of Education of Ohio,

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Minority Students in Special and Gifted Education 1998; Robinson and Dixon, 1992; Snow and Paez, in press). However, two recent longitudinal studies of Head Start children in elementary school found that those children who had begun to learn about print, sounds, and writing during the preschool years were more likely to be reading successfully in elementary school (Lonigan et al., 2000; Storch and Whitehurst, 2001; Whitehurst and Fischel, 2000). One recent study examining nonexperimental data suggests that Head Start may have long-run positive effects. Garces et al. (2000) analyzed data from the Panel Study of Income Dynamics, a longitudinal dataset that has collected data on a group of individuals for over a quarter-century. Data were examined for adults at age 30 who were asked whether they had participated in Head Start. The dataset contains information that allowed the study to control for family background and environmental characteristics. The findings suggest that for whites, Head Start is associated with a higher probability of completing high school and attending college, as well as with higher earnings in later years. Black males who had participated in Head Start were more likely than their siblings to have completed high school and less likely to have been charged with or convicted of a crime. Early Head Start The two-generation Early Head Start program, launched in 1995, provides services to low-income families with infants and toddlers. Currently the program provides services to 45,000 families at over 600 sites (U.S. Department of Health and Human Services, 2001a). A national random assignment evaluation of about 3,000 children in 17 sites was also begun in 1995 but has not yet been fully analyzed. Initial results, however, suggest that, compared with control groups, children in the program at age 2 performed significantly better on measures of cognitive, language, and social-emotional development, although the gains were relatively modest in magnitude. However, parents in the program scored higher than control parents on measures of home parenting behavior, home environment, and knowledge of infant and toddler development and were more likely to attend school or job training—outcomes that bode well for continued gains. CONCLUSIONS AND RECOMMENDATIONS Our review of biological and social/contextual contributors to early development brings us to the compelling conclusion that there are several factors that have a known detrimental impact on early cognitive and behavioral development that affect some groups of minority children disproportionately. The biological factors include low birthweight, alcohol and tobacco exposure, microneutrient deficiencies, and exposure to lead.

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Minority Students in Special and Gifted Education Existing intervention programs to address early biological harms have demonstrated the potential to substantially improve developmental outcomes. For example, prenatal health and nutrition programs that reduce the incidence of low-birthweight babies, and intervention strategies to stimulate development in low-birthweight babies, have had measured positive effects. Addressing these early biological risks has the potential to reduce the number of children, particularly minority children, with achievement and behavior problems. The strategies are neither unknown nor recently discovered. It is a matter of political priority whether resources are devoted to do so. The committee calls particular attention to the recommendation of the President’s Task Force on Environmental Health Risks and Safety Risks to Children to eliminate lead from the housing stock by 2010 (U.S. President’s Task Force, 2000). The committee also looked at social and environmental influences on development with no clear biological basis that might differ by race. Low socioeconomic status—both income and education level—is centrally implicated and is highly correlated with race/ethnicity. Poverty, especially persistent poverty, is associated with maternal depression, and with less optimal home environments on such dimensions as responsiveness and sensitivity of the mother to her child, the amount and level of language stimulation, direct teaching, and parenting styles. Income is also positively correlated with educational resources both inside and outside the home (child care and preschool). For both biological and social risk factors, the effect of any single factor is compounded by the presence of other risk factors. Given the positive results of the research-based early interventions for high-risk children, the committee’s view is that there is ample theoretical and empirical support to justify launching systematic prevention efforts. Indeed, both federal and state governments have acknowledged the importance of doing so in the variety of programs that have been put in place over the last several decades and expanded in recent years. But current policy falls short in terms of systematic prevention. Existing programs cover only a fraction of those eligible and at high risk. IDEA Part C, for example, allows for services to be delivered to high-risk children, even if they have not been identified with a disability, in the at-risk category. In only eight states, however, is the at-risk category used.3 3   Of the children receiving early services nationally, 64 percent had clearly identified developmental delays, 20 percent were diagnosed with a condition with a high probability of leading to a disability, and only 16 percent were served in the at-risk category (Hebbeler and Wagner, 2000).

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Minority Students in Special and Gifted Education The benefit of the IDEA legislative vehicle is that it allows for the targeting of children with the greatest need—i.e., children with a high number of risk factors whose chance of being referred to special education will be greatest without intervention. Given limited resources, the group that will require the most intensive interventions to ensure positive outcomes can be targeted through IDEA. Similarly, Early Head Start provides an opportunity to serve high-risk children from birth, and without the connection to IDEA the services can be provided without establishing disability or risk of disability. But again, only a small number of children are currently served. A larger number of children are served in programs for 3- and 4-year-olds, including Head Start and IDEA Part B for preschoolers. Still, two-thirds of eligible children are not served, and the quality and effectiveness of the services provided to those who are served are questionable. Because the committee regards the evidence on the benefits of early provision of services to children with multiple risk factors as compelling, we make the following recommendations: Recommendation EC.1: The committee recommends that all high-risk children have access to high-quality early childhood intervention. For children at highest risk, these interventions should include family support, health services, and sustained, high-quality care and cognitive stimulation right from birth. Preschool children (ages 4 and 5) who are eligible for Head Start should have access to a Head Start or other publicly funded preschool program. These programs should provide exposure to learning opportunities that will prepare children for success in school. The committee urges attention to the well-documented early learning practices recommended in two recent National Research Council reports that focus on early childhood pedagogy: Preventing Reading Difficulties in Young Children, and Eager to Learn: Educating Our Preschoolers. We also call attention to the finding that a critical requirement of the proposed change is raising the education requirements for preschool teachers. Intervention should target services to the level of individual need, including high cognitive challenge for the child who exceeds normative performance. The proposed expansion should better coordinate existing federal programs such as Head Start and Early Head Start, and IDEA parts C (for infants and toddlers) and B (for children 3-21), as well as state-initiated programs that meet equal or higher standards.

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Minority Students in Special and Gifted Education By high-quality early intervention services, we mean that early care and education provided to children through these programs should consistently reflect the current knowledge base regarding child development. It is important for all children to have quality child care and preschool services. However, to narrow the gap in school readiness among children at high risk for poor developmental outcomes and their lower-risk peers, carefully designed programs that support the development of self-regulation, social skills, and language and reasoning skills are critical. While we know much about the types of experiences young children need for healthy development and we know that early intervention can improve outcomes, improving the quality of early childhood programs on a large scale will require that we refine our knowledge base in ways that are directly useful to early intervention efforts and bridge the chasm between what we know and what we do. This will require a sustained vision and a rigorous research and development effort that transforms knowledge about what works and what doesn’t work into field-tested program content, supporting materials, and professional development. This is not likely to happen with current funding levels. Recommendation EC.2: The committee recommends that the federal government launch a large-scale, rigorous, sustained research and development program in an institutional environment that has the capacity to bring together excellent professionals in research, program development, professional development, and child care/preschool practice. Among its efforts, the research and development program should: fund projects to incorporate usable knowledge about early childhood development into field-tested curricula, educational tools, and professional development materials for early childhood teachers and classrooms; focus on areas with high potential for providing knowledge that can lead to prevention of disabilities and special education identification and the enhancement of gifted behaviors; systematically examine the comparative benefits associated with different early early intervention models and the developmental pathways through which those results were produced; conduct comprehensive re-analyses of longitudinal data sets to obtain clues about why some programs have succeeded and others have failed. While the results of longitudinal studies are now well known, the data have not been fully probed for an understanding of the components of both success and failure; and explore whether some subgroups of participants in early intervention programs have benefited/are benefiting differentially.

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Minority Students in Special and Gifted Education The proposed expansion of early childhood services to disadvantaged children will, the committee acknowledges, require a substantial investment. Few programs collect longitudinal data that would allow for a careful cost-benefit analysis. Two programs—the Perry Preschool program and the Prenatal and Infancy Home Visitation by Nurses—have done longitudinal data collection that indicates benefits outweigh costs by several times when long run effects on crime and teenage pregnancy are considered (Karoly et al., l998). Those results should not be projected onto large-scale intervention programs for many reasons, among them the change in both costs and benefits as program size increases dramatically and the characteristics of the population changes. The results do suggest, however, that up front investment in changing a developmental trajectory produces benefits over a life course with implications for government revenues as well as for individual success.