Creating family-centered services in early intervention: perceptions of professionals in four states.

Creating family-centered services in early intervention: perceptions of professionals in four states. Early intervention ear��ly interventionn. Abbr. EIA process of assessment and therapy provided to children, especially those younger than age 6, to facilitate normal cognitive and emotional development and to prevent developmental disability or delay. programs for young children with disabilitiesare rapidly expanding as states and local communities prepare to meetrequirements for services established by Public Law 99-457. Thisexpansion is significant and should result in greater access to programsfor previously unserved children and an increasingly broad array ofservice options. In the midst Adv. 1. in the midst - the middle or central part or point; "in the midst of the forest"; "could he walk out in the midst of his piece?"midmost of this expansion phase, however,professionals working in early intervention programs are alsoexperiencing a substantial shift in fundamental assumptions about bestpractice. In short, professionals are being told that earlyintervention must be family centered. The purpose of this article is todiscuss issues that arise when significant changes are expected inprofessional practice, and to present data in which current practices infamily involvement are compared with practices embedded Inserted into. See embedded system. in afamily-focused approach to services. Barriers to change are identified,and implications for fostering change are discussed. WHAT IS A FAMILY-CENTERED APPROACH TO SERVICES? The impetus Impetus is a stimulus or impulse, a moving force that sparks momentum.Impetus may also refer to: Theory of impetus, an obsolete scientific theory on projectile motion, superseded by the modern theory of inertia for a family-centered approach to early interventioncomes from two primary sources: The law and current conceptualizationsof "best practice." Perhaps the most obvious statement of afamily focus in P.L. 99-457 is the requirement for an Individualized in��di��vid��u��al��ize?tr.v. in��di��vid��u��al��ized, in��di��vid��u��al��iz��ing, in��di��vid��u��al��iz��es1. To give individuality to.2. To consider or treat individually; particularize.3. Family Service Plan (IFSP IFSP Individualized Family Service PlanIFSP ITA Fluid Service Pallet ) for programs serving infants and toddlers upto 36 months of age. The IFSP must include, in addition to thechild-related components required in the individualized educationprogram In the United States an Individualized Education Program, commonly referred to as an IEP, is mandated by the Individuals with Disabilities Education Act (IDEA). In Canada an equivalent document is called an Individual Education Plan. (IEP IEPIn currencies, this is the abbreviation for the Irish Punt.Notes:The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. ), a documentation of family strengths and needs, aspecification of major family outcomes, a description of services to beprovided for the family, and the name of a case manager who is to assistthe family in implementing the plan and coordinating service with otheragencies and persons. The IFSP is reflective Refers to light hitting an opaque surface such as a printed page or mirror and bouncing back. See reflective media and reflective LCD. of shifting views about what constitutesbest practice in early intervention for infants and toddlers as well asfor pre-school-age children. Traditionally early intervention has beenviewed as a child-focused endeavor, the major purpose of which was toenhance the development outcomes for young children with disabilities.Over the past 5 years, however, it has been argued that a primarymission for early intervention is family support. According to according toprep.1. As stated or indicated by; on the authority of: according to historians.2. In keeping with: according to instructions.3. Ziglerand Black (1989), the ultimate goal of family support programs is"to enable families to be independent by developing their owninformal support networks" (p. 11). In early intervention,numerous labels have been applied to the family support movement,including parent empowerment em��pow��er?tr.v. em��pow��ered, em��pow��er��ing, em��pow��ers1. To invest with power, especially legal power or official authority. See Synonyms at authorize.2. (Dunst, 1985; Dunst, Trivette, & Deal,1988), family-focused intervention A procedure used in a lawsuit by which the court allows a third person who was not originally a party to the suit to become a party, by joining with either the plaintiff or the defendant. (Bailey et al., 1986), andfamily-centered care (Shelton, Jeppson, & Johnson, 1987). Althoughthese models differ in some respects, each incorporates the followingbasic assumptions: * Children and families are inextricably in��ex��tri��ca��ble?adj.1. a. So intricate or entangled as to make escape impossible: an inextricable maze; an inextricable web of deceit.b. intertwined. Intentional in��ten��tion��al?adj.1. Done deliberately; intended: an intentional slight.See Synonyms at voluntary.2. Having to do with intention. or not, intervention with children almost invariably in��var��i��a��ble?adj.Not changing or subject to change; constant.in��vari��a��bil influencesfamilies; likewise, intervention with and support of families almostinvariably influence children. * Involving and supporting families is likely to be a more powerfulintervention than one that focuses exclusively on the child. * Family members should be able to choose their level ofinvolvement in program planning, decision making, and service delivery. * Professionals should attend to family priorities for goals andservices, even when those priorities differ substantially fromprofessional priorities. IMPLICATIONS OF A FAMILY-CENTERED APPROACH FOR PROFESSIONALS A consistent theme underlying the family support movement is that areconceptualization of early intervention is needed (Dunst, 1985). Thisreconceptualization will require professionals to take on new roles andlearn new skills. More fundamentally, moving toward a family-centeredapproach in early intervention will require a basic change in the waymost early intervention services are now provided. This change is not aminor shift in practice that can be implemented with a small amount oftraining and support; rather, professionals are being asked to make achange of such magnitude that its implementation will likely be adifficult and sometimes arduous ar��du��ous?adj.1. Demanding great effort or labor; difficult: "the arduous work of preparing a Dictionary of the English Language"Thomas Macaulay.2. process. Recent studies by Mahoney,O'Sullivan, and Fors (1989) and Mahoney and O'Sullivan (1990)suggest that early intervention programs still are very child focused intheir work. What is it about becoming family centered that is such a difficultchange? First, it is a large rather than small change. Although mostadults can accommodate to occasional changes in work demands,accommodation in more difficult and is likely to be resisted if thechange differs substantially from current practice. Second, providinggoals and services for families is different from the role expectationsand training of many professionals, who would define themselves asexperts in child development and the treatment of delays or disorders inyoung children. Most therapists and teachers enter their respectivefields out of a desire to work with children, and they receive trainingthat is almost exclusively child focused (Baily, Simeonsson, Yoder,& Huntington, 1990). Third, a family-centered philosophy challengesthe long-held view of the professional as the primary decision maker inthe management of young children with disabilities, because afundamental tenet TENET. Which he holds. There are two ways of stating the tenure in an action of waste. The averment is either in the tenet and the tenuit; it has a reference to the time of the waste done, and not to the time of bringing the action. 2. of the family support movement is family choice and aresponsiveness to family priorities (Bailey, 1987). Relinquishing re��lin��quish?tr.v. re��lin��quished, re��lin��quish��ing, re��lin��quish��es1. To retire from; give up or abandon.2. To put aside or desist from (something practiced, professed, or intended).3. control of decisions about the nature and extent of early interventionservices is likely to be viewed as threatening by many professionals.Fourth, professionals work in service=delivery systems designed toprovide child-based services. Changing certain practices may not be anoption for individual professionals working in systems that areresistant to change. Finally, each of these factors is exacerbated bythe uncertainty surrounding sur��round?tr.v. sur��round��ed, sur��round��ing, sur��rounds1. To extend on all sides of simultaneously; encircle.2. To enclose or confine on all sides so as to bar escape or outside communication.n. the actual implementation of afamily-centered approach and the specific requirements for practicingprofessionals. Many states have yet to develop guidelines guidelines,n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. for the IFSPor to provide comprehensive training for professionals with regard toeither the guidelines or skills and proceduces needed to implement thelaw (Harbin, Gallagher, & Lillie, 1989). The presdent study was designed to answer three broad questions: * What is the current status of a family-centered approach ininfant intervention programs? To answer this question, professionals inearly intervention programs in four states were asked to rate currentprogram practices in four areas of family support. * Do professionals perceive a discrepancy DISCREPANCY. A difference between one thing and another, between one writing and another; a variance. (q.v.) 2. Discrepancies are material and immaterial. between current and idealpractices in working with families? To answer this question,professionals were asked to rate how they felt families should beinvolved in each of four areas of family support. * What do professionals perceive to be the barriers that make itdifficult to achieve ideal levels of family involvement? METHOD Subjects The initial pool of subjects consisted of 237 professionals workingin early intervention programs or agencies responsible for providingearly intervention programs for infants and toddlers in four states: twosouthern states (A and B), a midwestern state (C), and a northeasternstate (D). In each state, the subjects were voluntary participants in aworkshop on family assessment and the IFSP. A number of participantsfailed to respond to one or more items on the survey (n = 57) andsubsequently were dropped from the current analysis. This resulted in afinal pools of 180 professionals distributed across the four states asfollows: A (n = 30), B (n = 30), C (n = 40), D (n = 80). Demographicdata were collected in three states at the time of the study, and hadpreviously been collected in the fourth state as part of an earlierstudy. The subjects were predominantly pre��dom��i��nant?adj.1. Having greatest ascendancy, importance, influence, authority, or force. See Synonyms at dominant.2. female (95%) and Caucasian(94%). The average professional had worked for 9.5 year s with youngchildren with disabilities. Approvimately 75% were direct serviceproviders or consultants (teachers, therapists, psychologists This list includes notable psychologists and contributors to psychology, some of whom may not have thought of themselves primarily as psychologists but are included here because of their important contributions to the discipline. , andsocial workers), and 25% were program or agency administrators. Instrumentation instrumentation,in music: see orchestra and orchestration. instrumentationIn technology, the development and use of precise measuring, analysis, and control equipment. To assess typical and ideal practices, rating scales were developedto assess four dimensions of family involvement: (a) parentparticipation in decisions about the child assessment process, (b)parent involvement in child assessment, (c) parent participation in theteam meeting and decision making, and (d) provision of family services.Each scale represents a 10-point continuum Continuum (pl. -tinua or -tinuums) can refer to: Continuum (theory), anything that goes through a gradual transition from one condition, to a different condition, without any abrupt changes or "discontinuities" , with descriptive anchors forratings of 1, 3, 5, 7, and 9. A rating of 1 reflects an approach toservices that is predominantly controlled by professionals (e.g.,parents receive information presented by professionals and sign theIEP/IFSP), whereas a rating of 9 reflects an approach to services inwhich parents are allowed choices and responsibility (e.g., parents manychoose to lead the team meeting and write the IEP/IFSP). Each of thefour rating sales is shown in Figure 1. Procedure In three states (A, B, and C), the four scales were distributed atthe beginning of the workshop, whereas in the fourth state they weredistributed before the workshop and mailed back to the authors. In eachcase, the scales were described as a mechanism for helping participantsprepare for the training by considering current practices andidentifying ways in which their programs might change. Generalinstructions were first read; then participants were asked to read theanchors on the scales and complete four steps. First, they drew acircle on the scale to indicate the range within which their programcurrently involved families in the particular dimension assessed. Forexample, a participant may have indicated a range from 1 to 5 on thescale related to parent participation in decisions about the childassessment process, showing that for some families in their programprofessionals make all decisions about who is to assess and what is tobe assessed (a rating of 1), but for other families professionalspresent an assessment plan and ask parents for feedback (a rating of 5). Second, participants were asked to write the number that bestreflected how their program typically operated. Third, they wrote thenumber that reflected how they felt families ideally should be involved.Finally, if there was a discrepancy between typical and ideal ratings,respondents In the context of marketing research, a representative sample drawn from a larger population of people from whom information is collected and used to develop or confirm marketing strategy. were asked to identify barriers that made it difficult toimplement idea practices. Participants were assured anonymity ofresults and given 30 minutes to respond to the scales. Their responseswere then used to facilitate a discussion of issues and considerationsin becoming family centered. RESULTS Analyses were conducted to answer five questions. * How do professionals rate the current status of familyinvolvement across the four states? * How do professionals rate ideal roles of families? * Do professionals' ratings indicate a discrepancy betweencurrent and best practices? * What barriers do professionals identify as contributing to anyperceived discrepancies between typical and ideal practices? * Do ratings of typical and ideal practices vary across states?[TABULAR DATA OMMITED] Current Status of Family Involvement The current status of family involvement in each of the fourdimensions is shown in Table 1. The table presents the average rangereported by professionals across the four states as well as the meanratings of typical involvement in each dimension. Across the fourscales, professionals rated typical family involvement in the 4-5 range,reflecting a moderate degree of family involvement. Ideal Roles of Families The idea family roles in each of the four dimensions are also shownin Table 1. Across the four scales, professionals rated ideal familyinvolvement in the 7-8 range, reflecting a high degree of familyinvolvement. Discrepancies Between Typical and Ideal Roles The discrepancies between typical and ideal roles are shown inFigure 2. Substantial differences between typical and ideal levels offamily involvement are evident in each dimension. Not only is there asubstantial difference between the typical and ideal means in each, butalso there is virtually no overlap in the range of responses for each. To test the magnitude of differences between typical and idealroles, four sets of paired t-test comparisons, one for each item, wereconducted. Each comparison was highly significant, with t valuesranging from 14.3 to 16.3 (p<.0001). Barriers to Family Involvement Coding Procedure. Four major barriers to implementing idealpractices in early intervention programs were identified and defined onthe basis of a small sample of responses to the survey questions. Thefour categories--family, system, professional, and testing--representedthe array of barriers identified in the preliminary sample and wereassumed to reflect the potential range anticipated in the complete dataset. Subcategories within three of the four broad categories werespecified and defined in the same manner, and are shown in Table 2. Three coders, doctoral students in special education and schoolpsychology, independently read each response and assigned as��sign?tr.v. as��signed, as��sign��ing, as��signs1. To set apart for a particular purpose; designate: assigned a day for the inspection.2. a code basedon the definitions of barriers. The coders used multiple codes whenappropriate. For example, when a respondent In Equity practice, the party who answers a bill or other proceeding in equity. The party against whom an appeal or motion, an application for a court order, is instituted and who is required to answer in order to protect his or her interests. identified two separatebarriers, a separate code was assigned to each one. However, if arespondent mentioned the same barrier twice within a single response, itwas coded only once. When the response lacked clarity or did not fallclearly into any category, coders used "no code." After each response was independently coded, the coders met toreach consensus for all items on which there was at least onedisagreement. First, the coders reached an agreement about the numberof responses labeled "no code." Second, the coders reachedagreement about the number of distinct barriers within each response.Finally, the coders reached agreement about the most appropriate codefor each barrier identified (consensus code). Reliability. Consensus codes were used as the standard againstwhich the reliability of the original data could be evaluated. Percentof agreement with the consensus code was calculated by dividing thenumber of agreements by 3 (the number of coders) and multiplying by 100.Percent of agreement was computed for each of the 730 barriers coded.The mean percent agreement was calculated for each coding category andsubcategory sub��cat��e��go��ry?n. pl. sub��cat��e��go��riesA subdivision that has common differentiating characteristics within a larger category. . The overall mean percent among coders was 94.5%. The meanpercent agreements for each of the coding categories and subcategoriesare shown in Table 3. Results. The percentage of barriers to family involvementmentioned most frequently in three of the four states (data were notavailable for State A) are shown in Table 4. A visual analysisindicated that the states did not differ markedly in the distribution oftheir ratings. Generally, family and system barriers were mentionedmost frequently, followed by professional barriers. Testing barriersaccounted for a relatively small proportion of the total barriersmentioned. Figure 3 shows the percentage of barriers mentioned most frequentlyacross the four dimensions of family involvement. Family and systembarriers were mentioned most frequently in three of the dimensions. Inthe fourth area, provision of family services, system barriers werementioned most frequently by all states. Cross-State Variability The mean ratings of typical and ideal practices are displayed bystate in Figures 4 and 5. To determine the extent to which the fourstates varied, eight separate analyses of variance The discrepancy between what a party to a lawsuit alleges will be proved in pleadings and what the party actually proves at trial.In Zoning law, an official permit to use property in a manner that departs from the way in which other property in the same locality were conducted(typical and ideal ratings on each of the[TABULAR DATA OMITTED] TABLE 3 Mean Percentages of Interior AgreementBarrier Category MeanFamily Knowledge or skill 97.83 Attitude 97.51 Resources and 95.17 function Other 97.88System Institutional 87.31 Resource 95.08 Status quo 95.05Professional Knowledge or skill 89.25 Attitude 91.05Testing 95.14 TABLE 4 Barriers to Change No. of %Barrier Type Statements of TotalFamily (total) 261 35.8 Knowledge/skill 94 12.9 Attitude 122 16.7 Resources and 29 4.0 function Other 16 2.2System (total) 256 35.1 Institutional 16 2.2 Resource 110 15.1 Status quo 130 17.8Professional (total) 108 14.8 Knowledge/skill 44 6.0 Attitude 64 8.8Testing 7 .9Not codable 97 13.4four scales). Two comparisons of typical practices were significant:parent participation in child assessment (F = 4.42, df = 3,176,p<.01) and provision of family goals and services (F = 4.78, df =3,176,p<.01). In both comparisons the difference was accounted forprimarily by the discrepancy between states B and C. Two comparisons ofideal practices were significant: parent participation in decisionsabout child assessment (F = 8.73, df= 3,176, p<.001) and parentparticipation in team meeting and decision making (F = 3.21, df =3,176,p<.05). The difference on the first scale was accounted forprimarily by the discrepancy between states A and D, whereas thedifference on the second scale was accounted for primarily by thediscrepancy between states B and D. A visual analysis of the distribution across states shown inFigures 4 and 5 suggests that the statistical differences found actuallyrepresent relatively small variations in ratings across the four states.The greatest differences observed in comparing any two states was 1.5points on the scale, reflecting a relatively small difference in whatactually occurs. DISCUSSION This study documents the perceptions of early interventionprofessionals in four states regarding typical and ideal practices infour areas of family involvement. The study is limited due to severalfactors: (a) it is unknown how representative the professionals in thestudy are of all early intervention professionals within each state; (b)the generalizability to other states is uncertain; and (c) theself-report nature of the data means that it only describes perceptionsof practices, rather than documenting actual practices. Nonetheless,three consistent findings of importance emerged from the study. First,professionals perceive a substantial discrepancy between how theycurrently involve families in early intervention programs and howfamilies ideally should be involved. The magnitude of the discrepancyis statistically significant, and an inspection of the mean values foreach scale indicates that the discrepancy represents a clinicallyrelevant difference in approaches to service delivery. Furthermore, thediscrepancies are consistent across each of the four domains of parentinvolvement. Second, professionals readily identified reasons for thediscrepancies. Family barriers and system barriers were equallymentioned overall and collectively accounted for more than 70% of thebarriers identified. This pattern was relatively stable across threedomains of parent involvement; a different pattern emerged for theprovision of family services, where systems barriers accounted for morethan 50% of the statements. Only 15% of the barriers mentionedreflected a lack of skills or knowledge on the part of professionals. Finally, the findings generally were stable and consistent acrossthe four states. Although some statistically significant differencesamong states were found in some items on ratings of typical and idealpractices, an inspection of the means indicates that these likelyrepresent relatively small differences in actual practice. All statesreported significant discrepancies between typical and ideal practices,and the pattern of barriers reported was generally stable across states. The data collected extend that reported in other studies (Mahoney& O'Sullivan, 1990; Mahoney, O'Sullivan, & Fors, 1989)and suggest that states will need to make substantial changes if theyare to fulfill ful��fillalso ful��fil ?tr.v. ful��filled, ful��fill��ing, ful��fills also ful��fils1. To bring into actuality; effect: fulfilled their promises.2. the family-focused mandate and intent of P.L. 99-457.The gap between typical and desired practices is substantial.Furthermore, practicing professionals readily admit that a discrepancyexists. The reasons mentioned for the discrepancy, however, raiseconcerns about the nature and magnitude of change required and suggestthat traditional mechanisms for achieving change in practice (e.g.,inservice training) may need to be part of the larger systemic systemic/sys��tem��ic/ (sis-tem��ik) pertaining to or affecting the body as a whole. sys��tem��icadj.1. Of or relating to a system.2. effort.For example, many professionals cited the following systems factors asmajor barriers to change: lack of administrative support, inadequateresources, the difficulty inherent in changing established patterns ofpractice, or inconsistent philosophical perspectives betweenadministrators and practitioners. The need for administrative supportin facilitating change has been documented in the research literature(e.g., Ingvarson & MacKenzie, 1988) and was cited in recent studiesas a major factor limiting the family focus of early interventionprograms in other states (Mahoney & O'Sullivan, 1990; Mahoney.O'Sullivan, & Fors, 1989). Winton (1990) has argued for aaystemic approach to inservice training, suggesting that training bedirected toward "organizational families," includingadministrators and other key decision makers. Professionals also suggested that many families may not have theknowledge or skills to participate fully in early intervention planningand decision making, or may not be interested in these roles. Theseconcerns raise a number of implications. One possibility is that someparents may need additional training or support to participate at thelevel they choose. A second possibility is that parents could beinvolved in making decisions about the change process if programs are tobe more family focused. Finally, professionals may need to examinetheir philosophy and values concerning family competence andpreferences. Why were professionals unlikely to cite personal limitations (e.g.,"I don't have the skills needed to perform this role") asbarriers to implementing a family focus? One explanation, of course, isthat they did, in fact, believe that they were skilled in working withfamilies. This is not likely, given the lack of family content in mostpreservice training programs (Bailey, Simeonson, Huntington, &Yoder, 1990). Furthermore, Bailey, Buysse, and Palsha (1990) found thatprofessionals rated themselves as low in skills and knowledge related toworking with families. An alternative expplanation is that family andsystems issues seemed so enormous that the acquisition of professionalskills was viewed as comparatively insigmificant. Clearly inservicetraining will be needed, but perhaps alternative approaches arenecessary. This study extends our knowledge about factors that facilitate orlimit change in professional practices. Ultimately, states will need todesign systems that are organized in ways likely to recognize the needfor new practices and to act accordingly to create the possibilities forchange to occur. Likewise, professionals need to view themselves assystems change agents and work toward the implementation of practicesthey and the clients they serve perceive to be important. Inservicetraining can help facilitate this process by addressing the system asthe unit of change rather than the individual, as well as by helpingindividuals and teams design strategies for changing existing systems.Through a dual and collaborative effort such as this, perhaps systemscan be created to respond quickly to new ideas and implement them in atimely and efficient fashion. REFERENCES Bailey, D. B. (1987). Collaborative goal getting: Resolvingdifferences in values and priorities for services. Topics in EarlyChildhood Special Education, 7(2), 59-71. Bailey, D. B., Buysse, V., & Palsha, S. A. (1990).Self-ratings of professional knowledge and skill in early intervention.Journal of Special Education, 23, 423-435. Bailey, D. B., Simeonsson, R. J., Winton, P. J., Huntington, G.S.,Comfort, M., Isbell, P., O'Donnell, K. J., & Helm, J. M.(1986). Family-focused intervention: A functional model for planning,implementing, and evaluating individualized family services in earlyintervention. Journal of the Division for Early Childhood, 10, 156-171. Bailey, D. B., Simeonsson, R. J., Yoder, D., & Huntington, G.S.(1990). Infant personnel preparation across eight disciplines: Anintegrative analysis. Exceptional Children, 57,26-35. Dunst, C. J. (1985). Rethinking early intervention. Analysis andIntervention ni Developmental Disabilities, 5, 165-201. Dunst, C. J., Trivette, C. M., & Deal, A. G. (1988). Enablingand empowering families: Principles and guidelines for practice.Cambridge, MA: Brookline Books. Harbin, G., Gallagher, J.J., & Lillie, T. (1990).States' progress related to fourteen components of P.L. 99-457,Part H. Chapel Hill: Carolina Policy Studies Program, Frank PorterGraham Frank Porter Graham (14 October 1886 - 16 February 1972) was a Democratic U.S. Senator from the U.S. state of North Carolina.Born in Fayetteville in south central North Carolina in 1886, Graham graduated from the University of North Carolina in Chapel Hill in 1909. Child Development Center, University of North Carolina at ChapelHill The University of North Carolina at Chapel Hill is a public, coeducational, research university located in Chapel Hill, North Carolina, United States. Also known as The University of North Carolina, Carolina, North Carolina, or simply UNC . Ingvarson, L., & MacKenzie, D. (1990). Factors affecting theimpact of inservice course for teacher: Implications for policy.Teaching and Teacher Education, 4, 139-155. Mahoney, G., & O'Sullivan, P. (1990). Early interventionpractices with families of children with handicaps. Mental Retardation mental retardation,below average level of intellectual functioning, usually defined by an IQ of below 70 to 75, combined with limitations in the skills necessary for daily living. .28, 169-176. Mahoney, G., O'Sullivan, P., & Fors, S. (1989). Thefamily practices of service providers of young handicapped children.Infant Mental Health Journal, 10(2), 75-83. Shelton, T. L., Jeppson, E. S., & Johnson, B. H. (1987).Family-centered care for children with special health care needs.Washington, DC: Association for the Care of Children's Health Children's HealthDefinitionChildren's health encompasses the physical, mental, emotional, and social well-being of children from infancy through adolescence. . Winton, P.J. (1990). A systemic approach for planning inservicetraining related to Public Law 99-457. Infants and Young Children, 3(1),51-60. Zigler, E., & Black, K. B. (1989). America's familysupport movement: Strength and limitations. American Journal ofOrthopsychiatry or��tho��psy��chi��a��tryn.The psychiatric study, treatment, and prevention of emotional and behavioral problems, especially of those that arise during early development. , 59, 6-19. ABOUT THE AUTHORS DONALD B. BAILEY, JR. (CEC (Central Electronic Complex) The set of hardware that defines a mainframe, which includes the CPU(s), memory, channels, controllers and power supplies included in the box. Some CECs, such as IBM's Multiprise 2000 and 3000, include data storage devices as well. NC Federation) is the Director of EarlyChildhood Research: VIRGINIA BUYSSE (CED (Capacitance Electronic Disc) An earlier videodisc technology from RCA that was released in 1981 and abandoned five years later. Like phonograph records, the analog disc contained grooves that a stylus rode over. Chapter #857) is a ResearchAssociate and doctoral Candidate in Special Education; and REBECCAEDMONDSON and TINA M. SMITH are Research Assistants and DoctoralStudents in School Psychology at the Frank Porter Graham ChildDevelopment Center at the University of North Carolina North Carolina,state in the SE United States. It is bordered by the Atlantic Ocean (E), South Carolina and Georgia (S), Tennessee (W), and Virginia (N).Facts and FiguresArea, 52,586 sq mi (136,198 sq km). Pop. , Chapel Hill.