D eve lo p ing A n I nte rs e c to ra l , I nte rd is c ip l inar y A nd M ult i -pro fe s s io na l A ppro a c h I n The Ea r ly

I nte r ve nt io n S e r v ic e s I n A nda lus ia : L e s s o ns L e a r ne d A nd F ut ure P ro s pe c t s

S A R A M I G U E L B A R R E N A

C L I N I C A L P S Y C H O L O G I S T

E A R L Y I N T E R V E N T I O N U N I T

H O S P I T A L P U E R T A D E L M A R ( C Á D I Z , S P A I N )

P R E S E N T A T I O N O U T L I N E

1 . I N T R O D U C T I O N

2 . T H E A N D A L U S I A N E A R L Y I N T E R V E N T I O N M O D E L

3 . C H R O N O L O G Y A N D L A N D M A R K S O F T H E A N D A L U S I A N E A R L Y I N T E R V E N T I O N S E R V I C E S

4 . S O M E R E S U L T S O F O U R I N T E R V E N T I O N S

5 . F U T U R E P R O S P E C T S

2

1 . I N T R O D U C T I O N

3

4

A N D A L U S I A N P O P U L A T I O N : 8 , 3 9 7 , 8 2 0 I N H A B I T A N T S ( I N E , 2 0 1 7 )

5

0

2.000

4.000

6.000

8.000

10.000

12.000

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

A N D A L U S I A N P E R C A P I T A I N C O M E : € 9 , 1 1 6 ( I N E , 2 0 1 7 )

SPANISH STATE

ANDALUSIA

6

0

2

4

6

8

10

12

14

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

A N D A L U S I A N B I R T H R A T E : 8 , 8 5 ( I N E , 2 0 1 7 )

SPANISH STATE

ANDALUSIA

2 . T H E A N D A L U S I A N E A R L Y I N T E R V E N T I O N M O D E L

7

8

T H E E A R L Y I N T E R V E N T I O N W H I T E B O O K ( G A T, 2 0 0 0 )

▪ Defines Early Intervention as “the set of interventions aimed at children between the ages of 0 to 6, their family and environment, which aim to respond as soon as possible to the temporary or permanent needs of children with developmental disorders or at risk of suffering from them”.

Tra n sve rs a l a c t i o n t h a t i nvo l ve s n o t o n l y t h e t ra d i t i o n a l c o n t r i b u t i o n o f s u p p o r t , t o o l s o r c a re fo r t h e c h i l d

9

i n t e r v e n t i o n l e v e l s

10

c o o r d i n a t i o n

V a l u e s a n d p r i n c i p l e s o fa c t i o n

11

▪ B E S T I N T E R E S T S O F T H E C H I L D

▪ U N I V E R S A L I T Y

▪ P U B L I C R E S P O N S I B I L I T Y

▪ F R E E H E A LT H S E R V I C E S

▪ E Q U I T Y

▪ C O M P R E H E N S I V E I N T E R V E N T I O N

▪ D E C E N T R A L I Z AT I O N , P R O X I M I T Y A N D C L O S E N E S S

▪ PA R T I C I PAT I O N

▪ Q U A L I T Y

▪ S U S TA I N A B I L I T Y

▪ I N T E R - A G E N C Y C O O R D I N AT I O N

▪ G E N D E R P E R S P E C T I V E

3 . C H R O N O L O G Y A N D L A N D M A R K S O F T H E A N D A L U S I A N E A R L Y I N T E R V E N T I O N S E R V I C E S

12

13

Families of children with

developmental needs

Groups & Associations

Professionals

Child Development

Centres

(CDC)

W H E R E

D O W E

C O M E

F R O M ?

14

U n i v e r s a l F R E E A C C E S S

15

▪ The Early Intervention White Book (GAT, 2000) is configured as a fundamental tool for the understanding and development of the Early Intervention in a uniform way in Spain.

ODAT DiagnosticClassification System

CHILDREN FAMILY ENVIRONMENT

RISK A x i s I A x i s I I A x i s I I I

DISORDER/DISEASE A x i s I V A x i s V A x i s V I

SUPPORTS/RESOURCES A x i s V I I A x i s V I I I A x i s I X

▪ The ODAT (GAT, 2000) is an Early Intervention Diagnostic Classification System that is aimed at making a functionaldiagnosis.

16

C O N C O R D A N C E TA B L E B E T W E E N O D AT A N D I C D - 1 0 ( P o n s e t a l , 2 0 0 2 )

17

I N T E G R A T E D H E A L T H C A R E P R O C E S S O F E A R L Y I N T E R V E N T I O N

▪ To assure the continuity of care, defining with clarity and withcriteria of scientific evidence:

✓what interventions are necessary to carry out on a child withregard to a certain process

✓who the suitable professional is that will realize them

✓where the place or the most suitable center is

✓when the intervention is best delivered

Monitoring the high-risk

new-born

Intellectual disabilities

Sensory disorder

Autism spectrum disorders

Motor disabilities

I N T E G R AT E D H E A LT H C A R E S U B - P R O C E S S E S

18

W H A T A B O U T T H E C H I L D D E V E L O P M E N T C E N T E R S ?

▪ Program of quality and accreditation of the CDC (2008)

▪ Standards manual of the CDC (2012)

• Decree 2016

• Framework Agreement

✓Psyc h o l o g i s t✓P hy s i o t h e ra p i s t✓ S p e e c h t h e ra p i s t

T R A N S D I S C I P L I N A RY T E A M

19

Alborada

INFORMATION

SYSTEM

C O O R D I N A T I O N I N F O R M A T I O N A N A L Y S I S

(Pons et al, 2010)

20

▪ E a r l y I n t e r v e n t i o n P r o v i n c i a l C o n s u l t a n t▪ C o o r d i n a t o r o f E a r l y I n t e r v e n t i o n U n i t s

P R O V I N C I A L E A R L Y I N T E R V E N T I O N T E A M S ( E P A T )

intersectora l coordinat ion

Social Services

professional

Educational Services

Professional

Health Services

professional

✓ E PAT S TA R T S I N 2 0 0 7

✓ I T I S R E G U L AT E D B Y D E C R E E S I N C E

2 0 1 6

21

E A R L Y I N T E R V E N T I O N U N I T S ( U A I T )

✓Pa e d i a t r i c i a n✓C l i n i c a l Psyc h o l o g i s t

T R A N S D I S C I P L I N A RY T E A M

reception

evaluation

taking decisions

22

A N D A L U S I A N E C I N E T W O R K O F R E S O U R C E S

▪ The resources existing in the Public Health System of Andalusia▪ Early Intervention Units (UAIT)▪ Child Development Centers (CDC)▪ Provincial Early Intervention Teams (EPAT)

C h i l d D e ve l o p m e n t C e n t e rs ( C D C )

REFERRALP r i m a r y C a re Pa e d i a t r i c i a n

REFERRAL

Ea r l y I n t e r ve nt i o n U n i t s ( UA I T )

▪ Educational Services▪ Social Services

E S T A B L I S H I N GC O O R D I N A T I O N

B E T W E E N

Maximum 30 days

4 . S O M E R E S U L T S O F O U R I N T E R V E N T I O N

23

24

A n n u a l a n d p r o g r e s s i v e b u d g e t i n c r e a s e

U n i v e r s a l F R E E A C C E S S

*2018: figure up to currentmonth

*2019: estimatedfigure

25

26

C A S E S A T T E N D E D I N 2 0 1 7 : 2 0 , 4 6 0 ( 4 , 1 4 % o f A n d a l u s i a n p o p u l a t i o n u n d e r 6 y e a rs o l d )

27

C A S E S A T T E N D E D I N 2 0 1 7 : 2 0 . 4 6 0 ( 4 , 1 4 % o f A n d a l u s i a n p o p u l a t i o n u n d e r 6 y e a rs o l d )

10.625

22.978

36.229

494.167

Estimated population with developmental disorders and disabilities

Estimated population with developmental disorders

Estimated population with a biological or social risk of suffering from a disorder

Andalusian population under 6 year-olds

28

R E F E R R A L A G E ( A l b o ra d a 2 0 1 7 )

29

O D A T D I A G N O S I S ( A l b o ra d a 2 0 1 7 )

5

1 3

1 7 5 3 4

9

1 1 4

2 7 7 7

0 4 0 0 0 8 0 0 0 1 2 0 0 0 1 6 0 0 0 2 0 0 0 0

A x i s V I E N V I R O N M E N T

A x i s V FA M I LY

A x i s I V D E V E L O P M E N TA L D I S O R D E R S

A x i s I I I E N V I R O N M E N TA L R I S K FA C T O R S

A x i s I I FA M I L I A L R I S K FA C T O R S

A x i s I B I O L O G I C A L R I S K FA C T O R S

30

A X I S I V ( A l b o ra d a 2 0 1 7 )

1333

81422

1099

5131

256

5782

2664

381

0

1000

2000

3000

4000

5000

6000

7000

4.a 4.b 4.c 4.d 4.e 4.f 4.g 4.k 4.l

Autism Spectrum Disorders (ASD)

Developmental Delays

Communication and Language

Disorders

31

A U T I S M S P E C T R U M D I S O R D E R S ( A l b o ra d a 2 0 1 7 )

32

R E A S O N S F O R T R E A T M E N T T E R M I N A T I O N ( A l b o ra d a 2 0 1 7 )

33

756

94

1458

1529

324

0 200 400 600 800 1000 1200 1400 1600 1800

EXITUS

OTHER

VOLUNTARY DISCHARGE

REACHED 6 YEARS OF AGE

APPROPRIATE LEVEL OF DEVELOPMENT

TEAM CHANGES

5 . F U T U R E P R O S P E C T S

33

S t r e n g t h s o f t h eA n d a l u s i a n E C I

34

▪ U N I V E R S A L F R E E A C C E S S

▪ I N C R E A S E D A C C E S S I B I L I T Y I N T E R M S O F :

▪ G E O G R A P H I C A L P R O X I M I T Y

▪ S P E E D O F R E S P O N S E T I M E ( F R O M R E F E R R A L T O E VA L U AT I O N & T R E AT M E N T )

▪ T H E ALBORADA I N F O R M AT I O N S Y S T E M

35

S o m e p r o p o s a l s f o r t h e f u t u r e

O R G A N I Z AT I O N L E V E L T R A I N I N G & R E S E A R C H Q U A L I T Y

▪ To publish the Andalusian Comprehensive Childhood Intervention Plan

▪ To create the Early Childhood Council and the Technical Commission for Early Childhood Intervention

▪ To promote the homogenization of the ECI in the entire Spanish state

▪ To design a training and research policy for Early Intervention professionals

▪ To promote research that provides new data on the relationship between socio-demographic aspects of populations and incidences of developmental disorders in Andalusia

▪ Put together new evaluation tools, or re-evaluate the existing ones

▪ To replace the current quantitative criteria of intervention needs by qualitative criteria

▪ To assist the entire susceptible population by increasing the budget

36

S o m e p r o p o s a l s f o r t h e f u t u r e

O R G A N I Z AT I O N L E V E L T R A I N I N G & R E S E A R C H Q U A L I T Y

✓ P U BL I S H

✓C R EAT E

✓H O MOGEN I Z E

✓ T & R P O L I C Y

✓N E W DATA

✓ N E W E VA LUAT I O N

TO O L S

✓Q UA L I TAT I V E C R I T E R I A

✓ B U D G E T I N C R EA S E

t h a n k s f o r y o u r a t t e n t i o n

S A R A . M I G U E L . S S P A @ J U N T A D E A N D A L U C I A . E S

A S P E C T S T O D I S C U S S

38

1 . R e f l e c t i n g o n t r a n s d i s c i p l i n a r y a n d m u l t i -p r o f e s s i o n a l c o n c e p t s .

2 . R e f l e c t i n g o n t h e c e n t r a l r o l e o f t h e f a m i l y d u r i n g t h e p r o c e s s o f d e t e c t i o n , e v a l u a t i o n a n d

i n t e r v e n t i o n .

3 . H o w t h e s o c i o d e m o g r a p h i c a n d f a m i l i a l r i s k f a c t o r s c a n i n f l u e n c e t h e e x p r e s s i o n o f s o m e

e a r l y d i s o r d e r s .

4 . I m p r o v e m e n t s t r a t e g i e s ( e n v i r o n m e n t , i n t e r s e c t o r a l c o o r d i n a t i o n ) .