The Long-Term Effectiveness of Implementing a Community Habilitation Program for Early Childhood Intervention: a Cluster-Randomized Controlled Trial of the Routines-Based Engagement Classroom Model

Ministry of Health and Welfare has proposed related policies of early childhood intervention based on the launch of the Implementation Act of the Convention on the Rights of the Child (Social and Family Affairs Administration, 2014) to promote “participation” and inclusion for children as the human right in clinical and community settings. According to Special Education Law (2013) in Taiwan, the age for inclusion education has been extended down to age 2 years, many young children with special needs now receive both clinical rehabilitation and school-based therapies. The Nobel Prize winning economist James Heckman (2000) and UK Forsight project (2010) forecasted that early intervention and early education program predict later nation wealth and economy. International rehabilitation program for children have taken the advantages of preschools and day-care institutes as a connection between families and community to develop an integrated, sustained and life-long community habilitation program for children. This continuously evolved program was the following project of the pilot study previously funded by the Ministry of Science and Technology [project No.: 105-2314-B-182 -012]). The pilot study consolidated the conceptual framework of the participation-based therapy and routines-based model into a practical model named “The routines-based engagement classroom model (RECM)” which is designed to be applicable to preschool/day-care settings. In contrast to traditional early intervention which focused on body functions and developmental milestones, RECM expands the focus and scope of early intervention to engage family in planning and implementing learning opportunities for the child through participation in developmental activities at home, school, and community. The RECM is now a culturally appropriate model and stresses on the same core concepts with participation-based therapy and routines-based model. The core concepts are “participation”, “family-centered”, “child/family-professional collaboration” and “professional development” . The pilot study indicates that the on-site professional support system can promote the mind set shifting in early intervention. The preliminary data showed the significantly positive relationship between children’ community participation and their family quality of life. Therefore, the purposes of this continuous project are to:(1) Apply implementation science to conduct a randomized controlled trial of the RECM versus traditional intervention in day-care settings (institutes/preschools) ; (2) Investigate the intervention outcomes of the RECM approach compared to a traditional approach; (3) Investigate the implementation outcomes (processes of professional development and family empowerment) of the RECM approach compared to a traditional approach; and (4) Investigate the cost-effectiveness of the RECM approach compared to a traditional approach by economic evaluation. This research is a four-year longitudinal follow-up project with a 2-wave (70 families for each) cluster randomaized control trial. According to the pilot study, we found that all the children benifited from early intervention in the inclusion preschool/institutes. Therefore, the participants are young children with or at risk for developemtal delay and typically developed children aged 2-6 years who experience transition from home to preschool, the professionals (primary service providers), and classroom teachers. The primary outcomes are children’s participation/Engagement in home, community, and school routines, families’ participation in decision making of intervention goal setting and planning, and professionals’ participation in responding to the needs and respecting the choices and actions of families/caregivers. Growth curves trajectories will be plotted across the 7 time points to analyze and compare growth trajectories. Data will be analyzed using two-way ANOVA with group-time interaction. The changes of growth curve are analyzed by hierarchial linear modeling with clusters of preschool and prefession types. The project will form an evidence-based and contextual-appropriate practical model of “Routines-based Engagement Classroom Model” in Taiwan. The multiple outcome indices, process of parent-professional collaboration, and cost-effectiveness analysis will provide the framework of implementing community-based early childhood habilitation services, and the blueprint for professional development.

Project ID:PC10608-1475
External Project ID:MOST106-2314-B182-047