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Infants & Young Children:
doi: 10.1097/IYC.0b013e3182736cd3
Original Study

Early Intervention Practices in China: Present Situation and Future Directions

Hu, Xiaoyi PhD; Yang, Xijie MEd

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Author Information

Institute of Special Education, Beijing Normal University, Beijing, China (Dr Hu); and Research Center of Psychology and Special Education, National Institute of Education Sciences, Beijing, China (Ms Yang).

Correspondence: Xiaoyi Hu, PhD, Institute of Special Education, Faculty of Education, Beijing Normal University, Xin Jie Kou Wai Da Jie #19, HaiDian District, Beijing, 100875, China (huxiaoyi@bnu.edu.cn).

The authors acknowledge the support and assistance of Professors Ann Turnbull and Rud Turnbull in the completion of this study. In addition, the authors thank Yan Pang, Sichuan Normal University.

The authors declare no conflict of interest.

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Abstract

Early intervention services to young children with developmental delays in China have experienced significant growth since 1978, the beginning of the period of Reform and Opening. This article described the present situation of early intervention practices in mainland China, framed around the key components and guiding principles of Guralnick's Developmental Systems Approach (DSA). The overarching purpose of this to overview is to develop a nationwide, integrated, and coordinated early intervention system, one that will develop in spite of the diversity inherent in the current practices and the dominant tradition of professionals as authority around the country. Extensive evidence demonstrates that early intervention practices in China have addressed some of the guiding principles of DSA and made significant progress in developing some components of DSA. Nevertheless, there still remains a great deal of work to be done to bring China's practices for the care and intervention of families and children up to the quality standards of the DSA for early intervention. Implications within the Chinese context for incorporating the key elements of DSA with strong connections between research, policy, and practices to further develop and strengthen early intervention system are discussed.

CHINA has the largest population around the world, exceeding 1.33 billion according to the national census in 2010 (China Population Development and Research Center, 2011). The Second China National Sample Survey on Disability in 2006 revealed that the number of children with established disabilities aged 0–6 years is 1.68 millions (China Disabled Persons' Federation, 2006). Every year, the rate of young children at risk or with developmental delays increases by 0.8 million to 1.2 million, in which 0.19 million young children are with established disabilities (China Disabled Persons' Federation, 2011a). Special education in China began on the small scale in the early 20th century. Since the period of Reform and Opening in the late 1970s, more children with disabilities have had opportunities to enroll in special schools. In the 1990s, young children with developmental delays aged 0–6 years had access to early intervention services, and parents have been partially relieved of the burden of caretaking. However, in a country that covers 3.7 million square miles, developing and implementing a nationwide early intervention system is daunting. Various impediments stand in the way of improved intervention quality for young children. One is that children aged 0–6 years are severed under different providers. To further complicate matters, early intervention resources and providers are substantially varied (Zhang & Yang, 2011) because of the large disparities in the ethnic, economic, and geographic conditions between rural and urban areas and between western and eastern regions of the country.

Service providers and related professionals generally acknowledge that early intervention services are critically important to child's development and family functioning (Liu, 2007). Researchers and policy makers also have recognized the necessity for establishing a nationwide, well-integrated early intervention system with common fundamental components, criteria, and corresponding practices principles (Liu, 2007). In this regard, Guralnick's Developmental System Approach (DSA) (Guralnick, 2001, 2011) provides Chinese researchers, policy makers, practitioners, and professionals a systematic perspective to examine the current situation and design a structural framework of early intervention services in China.

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HISTORY OF EARLY INTERVENTION

The 1950s saw the advent of preschool program for young blind children in Shanghai School for Blind Students. However, the services for young children with disabilities were provided only in some social welfare houses, orphanages, and special schools scattered around China in the middle of 20th century. Since the 1980s, there has been significant progress in the development of early intervention services for young children with developmental delays and their families. The primary factor contributing to this trend is the recognition that introducing intervention at the earliest point possible may reduce the negative impacts of disabilities on the children's development (Yang, 2003). In this regard, China Disabled Persons' Federation (CDPF), the government body in charge of all disability affairs, acts as a driving force to develop and advance early intervention practices to young children with developmental delays. Established in 1988 as a unified organization for the 83 million persons with disabilities in China, CDPF has a nationwide network system to reach Local Association of Persons with Disabilities (LAPDs) in each community throughout the country.

However, initiatives of the 1990s emphasize benefits for only children who have a specific disability (e.g., children with hearing impairment, children with visual impairment). For instance, the Beijing Xingyun School is one of the earliest and best-known early intervention programs, but it serves only children with intellectual disabilities (Mao & Wang, 1994). Similarly, Beijing Rain and Star Center is disability-specific; it was the first agency run by parents to provide early intervention services to children with autism. The disability-specific nature of early intervention in the 1990s reflects China's well-established segregated special education system, which is established to serve only those children who have specific types of disability.

The first decade of the 21st century has witnessed a rapid growth of early intervention programs. Because of the high increase of young children with autism and the limited government-sponsored early intervention services and programs from LAPDs, a large number of non–governmental organizations (NGOs) have been created throughout the whole country to serve children and their families affected by autism (McCabe, 2008a). Most agencies are run by parents. Not surprisingly, therefore, families receive comprehensive services on knowledge of autism and parenting skills at home settings. In addition, some LAPDs provide financial support to families to assist them to be involved in interventions with their children. This approach of designating families to be one of the targets for LAPD services has been adopted gradually in the 2000s. It should be noted that targeted families also included those with children with autism, brain injuries, and physical disabilities. Further, some demonstration projects have been created to provide family-based rehabilitation services in home settings (Liu, 2007). In these in-home projects, professionals act as the experts and families as service receivers to carry out professionals' guidance and instructions on their child. Meanwhile, western early intervention research and programs such as the Portage Project have influenced early intervention practices in China (Liu, 2007). In the last decade, education agencies have begun to offer early intervention practices in (Zhang & Yang, 2011). Two main types of early intervention programs are special preschool/kindergarten programs in special education schools and inclusive preschool programs in some demonstration projects. In 2007, Beijing first initiated inclusive preschool classes in 18 kindergartens (Beijing Municipal Commission of Education, 2007).

The last decade is also a decade in which there has been considerable parent advocacy for early intervention for their children with developmental delays. Although the Chinese traditional perspective of disability as a stigma or shame made many families unwilling to accept assessment and intervention for their children, more and more parents have advocated for their children's rights to have a comprehensive assessment and intervention program (McCabe, 2008a). Furthermore, individuals with disability play a significant role in promoting social awareness of early intervention practices. Through public media, adults with disabilities advocate the importance of early intervention and actively engaged in developing parent to parents groups and parent training programs.

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POLICES AND LEGISLATIONS

China is one country that upholds the culture value that families' primary responsibility is to provide their children with best education. This value is clearly stated in a series of Chinese policies that emphasized on providing high-quality early childhood education since the foundation of China in 1949 (Liu, 2007). However, these national laws do not directly acknowledge the significance of early intervention services and early childhood special education. Nevertheless, since the period of Reform and Opening, children with intellectual disabilities, hearing impairments, and visual impairments have had opportunities to enroll in special schools. Official policy beginning in the mid-1980s has formalized early efforts for establishing a segregated special education system in China and demonstrated the national government's commitment to developing special education and related disability services. The Law of the People's Republic of China on Protection of Persons with Disabilities is the first law to call for early childhood special educational opportunities (National People's Congress, 1990). The State Council 1991–1995 Eighth Five-Year National Developmental Plan first declared early intervention services for deaf children (State Council, 1991). Under these two policies, demonstration projects in early intervention in public medical facilities or rehabilitation centers have been transformed into a widespread national program. In 1994, the only education law for children with disabilities in China, the Regulations on Education for Persons With Disabilities, declared to encourage providing early childhood special education to children with disabilities. However, early intervention special education or early intervention services is not required, although they are “encouraged” by laws and policies. Therefore, families lack the right to protest preschool educators' actions to exclude their children with disabilities (Liu, 2007).

In the 2000s, as education agencies and NGOs begun to provide early intervention and early childhood special education, several national polices have been established. For example, in Suggestions on Further Promote Special Education issued by the Ministry of Education and other seven Ministries (State Council, 2009), Chinese government stated the policy to develop early childhood special education around the whole country in line with local conditions. Specifically, this policy articulated that urban sites and rural areas with certain conditions should basically meet the educational needs of young child with disabilities. However, there is no explanation on the meaning of “certain conditions” and “basically.” In 2010, in the National Education Reform and Development of Medium and Long-term Plans (2010–2020), the government first articulated its goal to encourage early intervention programs in inclusive settings (State Council, 2010). Again, there are no mandates for this implementation. Meanwhile, the government found itself “unable to meet all of the early childhood special education and other welfare needs of its population....”; government “encouraged non-government sectors to provide services” to children as well as their parents (Zhang, Chen, Wang, & Li, 2009, p. 36). The Ministry of Civil Affairs has issued several less restrictive regulations to release private initiatives in area of education, including early intervention services and early childhood special education. By 2010, more than 2300 private nonprofit nonenterprise units had been created to provide either training and guidance to parents or early childhood special education and therapies to young children with developmental delays (Zhang et al., 2009).

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CURRENT STATUS OF EARLY INTERVENTION SERVICES

With the development of early intervention and early childhood special education in China, more and more service providers have entered into this field. Currently, families and children can obtain early intervention services from four primary resources: medical and health care centers, CDPF, NGOs, and education agencies.

As the earliest early intervention services provider, medical and health care sectors have made tremendous efforts to promote social awareness of early detection and identification to parents and the public. More and more families have abandoned the traditional perspective of disability as stigma and have accepted medical screening and assessment for their children. According to the National Preventive Plan to Children With Disabilities, a nationwide preventive system for three primary and largest disabilities populations (i.e., visual impairment, hearing impairment, and intellectual disabilities) will be established in medical and health care sectors by 2015 (China Disabled Persons' Federation, 2011b). Meanwhile, clinical assessment is carried out in hospitals of urban and suburban areas (China Disabled Persons' Federation, 2011a). In addition to provide screening and clinical assessment, children can have rehabilitation or therapy services in some hospitals or health care centers in urban cities but not in rural areas where medical professionals and resources are in a serious shortage.

The second early intervention services provider is CDPF. As the key national government body, CDPF has expanded early intervention targets from children with the traditional three types of disabilities to all children with developmental delays, including brain injuries, autism, and physical disabilities. Children can get access to early intervention programs provided by LAPDs until they reach the age of 6 years. For children aged from 3 to 6 years, they have another choice to go to individualized inclusive programs in kindergartens or special preschool programs in special education schools. Both are public programs offered from education system. In both settings, service providers emphasize on parent training to promote parenting skills and disability-related knowledge.

Last but not least, with parents and grassroots efforts, a large amount of young children with developmental delays enter into private intervention services. More importantly, parents benefit substantially from these programs and actively engaged in the development and delivery of intervention to their children. The Chinese government allows the existence of three types of NGOs in serving young children with developmental delays: (a) international foundations or charity organizations (e.g., Handicap International; Save the Children Fund UK; Right to Play; UNICEF), (b) government organized non–governmental organizations with various levels of government sponsorship (e.g., China National Committee for the Wellbeing of the Youth), and (c) fully independent organizations (e.g., Beijing Stars and Rain Center). Normally, NGOs design programs for providing screening or developmental evaluations, early care, education, treatment, and services for young children with developmental delays. Large NGOs have been operating in both urban and rural areas around the whole country. An outstanding private agency is Half the Sky, which aims to train qualified caregivers to offer loving, family-like care to orphaned children of all ages, especially young orphaned children with disabilities and developmental delays. During the past 14 years, Half the Sky has trained 8758 caregivers in welfare centers that serve 63,959 young children nationwide (Half the Sky, 2011). Undoubtedly, all these three types of NGOs in the area of social welfare are providing necessary services that support or supplement state-run activities (e.g., LAPDs), They have worked as one critically important effort to develop early intervention services in China in the last two decades. Nevertheless, it has to be admitted that these three types of NGOs represent diverse voices and communities and are not coordinated with each together (Yang, 2003).

Although young children and their families have multiple choices to enter into early intervention services, these services in China are still a segregated practice: health care sectors are primarily responsible for screening and assessment, CDPF and education sectors are in charge of intervention programs development and delivery, and NGOs are for those who are not included into public services. There is no system perspective or a developmental framework incorporating all components of early intervention practices. It is clear that a systematic perspective is critically needed to guide and advance early intervention practices in China.

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SYSTEMATIC PERSPECTIVE OF EARLY INTERVENTION PRACTICES IN CHINA

Relying on the DSA (Guralnick, 2001), we will provide a description of the early intervention practices in China from a systemic perspective. In each component, current situations with examples of early intervention programs will be provided.

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Screening and referral

A process of screening and referral is the first step for children and families entering the early intervention system. In China, as the Four Early principle (i.e., early detection, early screening, early referral, and early treatment) has gained increasing attention and recognition in the field of social services for people with disabilities over the decade (Zhang & Yang, 2011), young children are provided with multiple options for screening. Generally speaking, children with Down syndrome are most often diagnosed during pregnancy. Children with severe cerebral palsy are identified within the first months of life. Medical professionals, such as physicians, pediatricians, and community-based child care workers, take the primary responsibility to provide universal screening, information, and referral to all children throughout the country. In 2000, China established the newborn baby hearing screening to prevent the hearing loss, which, as of 2006, affected 20,040,000 individuals (China Disabled Persons' Federation, 2006). Over the past 5 years, developmental screening for autism and other developmental delays for children up to 5 years of age has been carried out in hospitals in 31 provinces (China Disabled Persons' Association, 2011a). In most cases, however, parents initiate the screening request and seek assistance from hospitals, clearly concerned because they themselves have detected their child's atypical development. In education services, kindergarten or daycare professionals (e.g., teachers or nurses) may detect psychosocial problems (e.g., lacking social competence) or medical conditions. They will inform parents and refer the child to medical professionals for assessment. More often, then, based on clinical judgment, community-based child care workers refer children to specialized clinics or hospitals for additional screening and information.

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Monitoring and surveillance

In China, premature and low-birth-weight infants are routinely referred to community-based child care centers for ongoing monitoring. Moreover, hospitals provide monitoring and surveillance services only to newborn children at risk of cerebral palsy or other brain injuries in urban areas. (An urban is an area where the population is greater than 50,000; suburban is an area where the population is between 10,000 and 50,000; and rural is an area where the population is <10,000). In some demonstration projects, specific protocols for pediatricians' surveillance are used in children's clinics (Yang & Gao, 2002). For example, in Lanzhou project, community-based child care nurses and pediatricians work with parents to use monitoring protocols in home settings for children at risk of cerebral palsy (Liu & Fan, 2004). Up to 2009, a home–community–hospital monitoring network for children at risk of cerebral palsy has been established throughout the whole country (China Disabled Persons' Federation, 2011c). However, most Chinese medical services (i.e., hospitals or specialized clinics) do not monitor referred children who did not meet initial screening criteria for referral.

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Point of access

In China, there is no clearly defined common point of access to early intervention services, but there is a moment for families and the child to be advised to have a more official and comprehensive assessment in diagnostic centers or hospitals. In urban cities, parents easily get accessed to these services. In rural and suburban areas, where medical professional cannot provide comprehensive interdisciplinary assessment or specialized treatment, parents and the child will then go to hospital/clinics in other cities for assessment and families in communities (Wu & Chen, 2010). The fact is that the services are distant, which may impede their point of access, the subsequent assessment process, and the planning for a timely early intervention program. Research has demonstrated that families are overwhelmed by the task of locating high-quality medical professionals, traveling and keeping records for the child's information and assessment reports, telling infants' development to doctors over and over again, and conducting duplicated examinations (Zhang et al., 2009). Finally, children feel social alienation from their local peers and have to be with parents to navigate in the diagnosis and medical services.

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Comprehensive interdisciplinary assessment

As the most costly, time-consuming, yet critically important component of the DSA, comprehensive interdisciplinary assessment in China is mainly carried out in hospitals by medical professionals for diagnostic/etiologic purposes. During the assessments, professionals determine the type and severity of developmental delays or disability. After families receive the results of the assessments and conclusion that that their children have disability, they are entitled to have the disability card for their children, a permission authorized from CDPF to enter the early intervention program. This card shows the disability type and severity based on the assessment result.

Generally speaking, the assessment process provides a profile of child health and development; however, it does not include patterns of family functioning within their home, neighborhood, and larger community. Instead, the assessment is focused solely on producing a diagnostic identification, often labeling the child. Without active participation of the child's family, information about the context in which the child and family live and interact is absent.

With the increase of the children with autism, specialized interdisciplinary teams focusing on autism have been established in big cities around China (Zhang et al., 2009). Families with children with autism benefit substantially from this specialized assessment. However, families usually passively receive assessment results solely from medical professionals on medical diagnosis and treatment for their child. Cooperation between physicians, early intervention professionals, and related service providers is weak. Similarly, hospitals are not able to play an active role in developing and providing individualized family service plans to families. In rural and suburban areas, there is no specialized assessment for children with autism. Generally speaking, these areas can provide assessment only for the primary three types of disabilities (i.e., visual impairment, hearing impairment, and intellectual disabilities).

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Eligibility and entrance into an early intervention program

Clinical judgment from the medical professionals determines children's eligibility for early intervention programs. Eligibility for early intervention services in China derives from the fact that a family has received a disability card issued by government body in charge of disability affairs (i.e., the CPDC). With this card, young children have been determined to have met the eligibility criteria of seven disability types in China (i.e., visual impairment, hearing impairment, speech and language disabilities, physical disability, intellectual disabilities, psychiatric disabilities, and multiple disabilities). The DSA recommends two options for children with disabilities or developmental delays: preventive and early intervention programs. Unfortunately, there is no current preventive intervention program for Chinese young children. Early intervention programs in China are provided by both public and private organizations. The public organizations are mainly special schools, LAPDs, rehabilitation centers, and daycare centers or kindergartens. As local government bodies, LAPDs in some poor rural areas provide early intervention services because the local education sectors (e.g., daycare centers) are unable to provide intervention to the large numbers of children and families that are in need of such services. However, to have admission for these public programs sponsored by government, parents will have to provide the disability card.

To enter into programs provided by NGOs, clinical judgment and an interview with the child and the parents will be enough. In most cases, these programs specialize in certain interventions for certain problems, such as children with hearing impairment, sensory disorders, or motor difficulties. Some services, especially those from international foundations/charity organizations, or government organized non–governmental organizations are provided free to parents and children. However, the number of these two types of NGOs is small and children served are few. In fact, the largest type of NGOs serving young children with developmental delays in China are fully independent private agencies. A good example is Beijing Stars and Rain Center, which aims primarily to provide both center-based services and home-based intervention to children with autism and empowers parents' efficacy by educating them to engage in meaningful parent–child interactions (McCabe, 2008a). These services are usually intensive, comprehensive, and provide one-to-one training. Therefore, the service fee or tuition is much higher than public programs. Unfortunately, the parents must pay these high fees for these private agencies, although fees are never paid with a goal of earning a profit; instead, they are set at balancing out the cost of paying teacher and staff salaries. For young children who have the disability card, they may also choose private early intervention programs but they cannot get any compensation from government. From 2010, LAPDs in Shanghai and Beijing declared new local policies to compensate some portion of tuition fees for NGOs to those who are not willing to go to public early intervention services. However, families in other areas still have to pay high fee for services from private agencies.

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Assessment of stressors

According to DSA, when a child who has developmental delays or established disability is born into a family, stressors linked to the child are created that can negatively impact the three levels of family patterns of interaction and ultimately the child development. At the heart of, and as the most complex component of DSA, the assessment of stressors is first designed to obtain information about four categories of potential stressors: parent and child needs, interpersonal and family distress, resource needs, and confidence threats. Moreover, family characteristics, including personal characteristics of parents, financial resources, social support, and child characteristics, can also influence the quality of family patterns of interaction. Assessment of these stressors generated by either child or family characteristics is conducted once families enter the early intervention program to better develop and implement a comprehensive program as well as to enhance the optimal family patterns of interaction.

In most cases, the interdisciplinary team of hospital or mental health center does oral interviews with the parents to assess family characteristics, including family financial resources, marital relationship, how the family perceives the child's developmental delays, how it affects their family life, and how the family functions in daily life (Yang, 2003). Although this information is meaningful for developing the early intervention program, it is usually not recorded in assessment files but simply used for assessment specialists to build a good rapport with the family. Indeed, assessment of stressors that may be affecting family interaction has been long ignored because intervention in China is mainly child-focused.

Recently, since the introduction of the concept of family support into China, researchers advocate for developing family-oriented early intervention services (Hu, 2011). Studies that are focused on families in early intervention programs found that families expressed several stressors that closely related the child's biologic risk and established disabilities. These stressors include information to child development (Chen, 2007), parenting skills (Huang, Zhang, & Xing, 2009), financial assistance (Lv & Gao, 2005), resource needs (e.g., respite care), and mental health (Xuan, 2007). Most of these assessed could be included into the categories of stressors associated with child and family characteristics. However, again, these stressors are explored only in research level, not included as one task for early intervention service providers.

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Developing and implementing a comprehensive program

The Developmental Systems Approach emphasizes that comprehensive intervention programs should be child-focused as well as family-focused. However, most Chinese early intervention programs target children's development needs. Yang (2003) found that 95% of intervention studies focused on children in five categories: hearing impairment, visual impairment, autism, intellectual disabilities, and cereal palsy.

As mentioned previously, intervention programs are provided from public and private organizations and these two types of programs demonstrate distinctive characteristics. Generally speaking, intervention programs from public organizations are more systematic and comprehensive in terms of curriculum design and content. Public education sectors (e.g., inclusive preschool programs, special education preschool programs) focus on preschool education curriculum by integrating social, practical, and cognitive skills training. Compared with these programs from preschools, intervention programs provided by public rehabilitation centers in medical facilities and LAPDs are more apt to emphasize intervention to address children's function development arising from a specific disability. For instance, the intervention program to the largest population of young deaf children (i.e., 1,370,000 deaf children younger than 6 years) is provided in the China Rehabilitation and Research Center for Deaf Children. The intervention program includes speech therapy, language training, and auditory training (Yang, 2003). In addition, to better serve young children with severe disabilities, some special education schools and LAPDs provide early intervention services into the home settings. Usually, these services are physical therapy, rehabilitation training, and care.

Private organizations run by parents, especially those with children with autism, are the pioneers to include families into early intervention programs (Liu, 2007). In these agencies, professionals pay attention to the parents' role as necessary active participants in the child's development in every area of the child's life. These agencies use several family-focused intervention programs (e.g., Relationship Development Intervention, floor time) to partner with parents to interact with children and develop social and communication skills of children with autism. Moreover, professionals emphasize reciprocal influences between parents and the child as one key intervention outcome. On the contrary, parents have to devote much of their time to work with professionals, and some parents have been reported to have quit employment to accompany the child the whole day in agencies' programs and continue practicing skills back to home (Hu, 2011).

In the 1990s, Chinese national policy adopted the individualized education plan as an element of a child's education, and in the 2000s, education policy makers restated the significance of individualized education and added the child's progress within the individualized education plan into school system as one key performance monitor criteria (Liu, 2007). This concept has impacted early intervention practices, especially those affecting program development and delivery. In both public and private organizations, early intervention professionals have adopted this individualizing principle to develop intervention program in accordance to child characteristics and needs (Zhang & Yang, 2011).

However, the results of a pilot study (Jiang & Huang, 2005) show that professionals devote most of their time to dealing with individualized intervention to each child and have little time to carry out family-focused services in the home or to involve families in the intervention for the child. In most cases, programs provide parent training as one part of their intervention plans. The training is in the form of one-way counseling or training: the parents are given information and guidelines by professionals on how they should deal with their children in certain circumstances.

With the increase of NGOs, more and more parents are unified and advocate that parents with young children with similar developmental delays must act to help themselves (Hu, 2011). However, as recipients of unchallenged authority, parents follow educators' or other professionals' advice about the nature of services for the child, which they must then try to act on for the benefit of their child at home (Deng & Poon-McBrayer, 2004). One way is to create parent-to-parent support among families of children with autism. Indeed, since the 2000s, several grassroots initiatives have been launched by parents to provide counseling, disseminate knowledge, share resources, and educate parents with similar situations about their children entitlements to (Hu, Wang, & Xiao, 2012). Parent-to-parent support has been included into the intervention program in such a way that professionals will provide intervention to two parents with children with similar conditions at the same time, communicate with them about their concerns, and create some communication among the parents themselves to share their stories and learning from each other (McCabe, 2008b).

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Monitoring and outcome evaluations

In order to ensure the effectiveness of early intervention services, early intervention programs began, during the last decade, to emphasize the importance of regular meetings with parents or home visits to evaluate family involvement and monitor children's development. Researchers have recognized the significance of parent and professional satisfaction and family needs or stressors changes over the life span of the families or the child (e.g., Jiang & Huang, 2005). They actively advocate to CDPF and education policy makers to establish outcome evaluation criteria to guide LAPD and special education schools. At present, several local regulations have established monitoring policy by assigning supervisors from local CDPF or rehabilitation centers to early intervention programs (China Disabled Persons' Federation, 2011c). Reports from supervisors are the primary yearly performance evaluation for these programs to ensure the financial allowance from government.

Unfortunately, outcome evaluation is still a gap—one that confronts professionals, researchers, and policy makers. Only some early intervention demonstration programs provide outcome evaluations; these, however, focus on the child's level of development in different areas (Yang, 2003) or the inclusive preschool environment (Hu, 2010). In some cases, parents themselves will bring their children to pediatric or child psychiatric clinics to conduct periodic assessment on child's mental, behavioral, and intelligence performance. In many instances, parents receive a written report of their child's assessment with specified child outcomes and use it as a critical supporting document when they apply for preschool programs for their children.

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Transition planning

Some special education schools provide transition planning for children from their early intervention programs to preschool or from preschool to elementary program if the children stay in the same schools. Usually, teachers or parents accompany children to visit the new classes and peers. School opening-day activities also provide parents an opportunity to communicate with new teachers about their child's special needs and interests. The purpose of transition planning in China is to make parents realize that they will have to shoulder more responsibility to partner with schools to better promote a child's development. However, there is no other transition planning assistance from hospitals, health care or rehabilitation centers to early intervention programs, special education schools, inclusive schools, or other early intervention agencies. In some cases, parents have to move around to locate better early intervention services to their children, which may disrupt the child's development. Accordingly, families are actively advocating for consistent and comprehensive medical, educational, and social services, starting from early intervention to adulthood assistance (Hu, 2011).

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FUTURE RECOMMENDATIONS

This article described the situation of early intervention practices in mainland China, framed around the components of DSA and designed with the overarching purpose of developing a nationwide, integrated, and coordinated early intervention system, one that will develop in spite of the diversity inherent in the current practices and the dominant tradition of professionals as authority around the country. Extensive evidence demonstrates that early intervention practices in China have addressed some of the guiding principles of DSA: early detection and identification have been incorporated explicitly into policies; surveillance and monitoring will be the next national task for the next 5 years (China Disabled Persons' Federation, 2011a); individualized plans sensitive to children's characteristics and development are central to the development and delivery of early intervention programs; program performance evaluation has been one key criterion for service providers to obtain financial allowance from the government; and partnership with families as one part has integrated to public and private intervention programs. Nevertheless, there still remains a great deal of work to be done to bring China's practices for the care and intervention of families and children up to the quality standards of the Developmental Systems Approach for early intervention. Because many of the barriers to the implementation of such a system are common to all countries, Guralnick's principles and critical components of DSA provide a useful guide for the Chinese context. In this regard, it is urgent for Chinese policy makers, researchers, and practitioners to overcome the barriers and develop a developmental framework integrating the common fundamental components of DSA and in accordance with local uniqueness and variations across the whole country.

With regard to the policy, national law is needed for developing and implementing a nationwide, comprehensive, coordinated system to provide early intervention services to all Chinese young children and families, regardless of their locations. Legislative change is required to articulate services funding, develop services available to children and families, explicitly include families as service target, and clarify service providers' roles with respect to children and families alike. Policy makers also need to articulate the responsibility of CDPF, LAPD, education sectors, and health care organizations to collaborate with families at all levels to provide resource supports, social supports, information, and services. In addition to addressing interagency coordination and families as the central foci of early intervention, political will is required to encourage grassroots NGOs to work together for great impact. Furthermore, early identification needs to be well funded to give families access to a quality health care system. In this regard, community-based efforts and financial allowances should give priority to families with young children with development delays who are in poverty (Hu, 2011). Also, support providers from LAPDs are playing a critical role to cooperate with other related social identities to solve the prioritized stressors families have.

In terms of research, the most far-reaching change for developing early intervention system in China is the conceptual paradigm shift from a child-focused model to a family-focused service model. Under that paradigm, all components of the early intervention system should center on families (Guralnick, 2001, 2011). In the 1990s, families were ignored outside of intervention. Currently, although families are engaged more in intervention, they still are treated as assistants to child development experts and as receivers of professional guidance. In this regard, Chinese researchers would need to recognize that expertise resides not only in the professionals but also in the parents themselves. Therefore, it is essential for researchers to develop family stressor instruments and protocols to examine stressors related to both child and family characteristics, family patterns of interaction, family needs at the whole-family-unit level.

With respect to practices, the DSA provides a framework for community-based early intervention services for young children with developmental delays and their families (Guralnick, 2001). In China, a community-based delivery model should be established. That model should especially consider the large disparities in the ethnic, economic, and geographic conditions across the country. Parent-to-parent groups should also be encouraged to develop community-based delivery. Local government bodies, especially LAPDs in rural and suburban areas, are playing critical role to integrate community interagency resources. Finally, one of the fields in which the need for improvement is most evident is in the transition planning and continuity of services for the child when the child leaves the early intervention program. Current practices show that China is lacking of coordinated transition planning, and segregation is in obvious existence between preschool and elementary education system and health care and education system. This is due to the fact that, in the past three decades, China has established a segregated special education, social welfare, and health care system designed for persons with disabilities. The Chinese government has realized that this segregation leads to social isolation, which is a huge social issue to adults with disabilities (Deng, & Poon-McBrayer, 2004). Coordination and continuity of early intervention services at the early stage for a person with disabilities is the first step that Chinese government would need to consider.

It is self-explanatory that every child and family, irrespective of skin color, income, educational background, or family needs, has the most basic and fundamental right to pursue better child development and family quality of life. To advance early intervention practices in China, the fundamentally critical next step is to develop a national framework, incorporating the key components and guiding principles of Developmental Systems Approach. Definitely, this huge task needs efforts from research, policy, and practice sectors and the coordinated initiatives of all related parties. Efforts must be made at policy levels to improve the situations of early intervention practices. There is much to be considered, particularly with regard to how the policy can best address developing and implementing a nationwide, comprehensive, coordinated early intervention system by articulating responsibilities and coordinating different service providers for greater impact. In the pursuit of rigorous research, an essential next step is to conduct evidence-based research to examine the long-ignored family stressors for effective family-focused early intervention and how best to design programs to meet the child and family needs. In terms of practice, community-based intervention program would be established with quality interdisciplinary professionals to serve those families especially in rural and suburban areas.

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early intervention; developmental systems approach; China

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