Early Intervention Programs for Infants and Toddlers at Risk

What are the characteristics of programs that have the greatest likelihood of success in promoting the development of very
young children at risk? This brief review of research offers insights for policy makers and early childhood educators alike.
This article was accepted for the fall 2007 theme issue on Gateway to Lifelong Learning.
The Earlier, the Better:
Early Intervention Programs for
Infants and Toddlers at Risk
In the United States, more than
one-third of children live in lowincome
families in which the parents
earn less than 200% of the federal
poverty line, which is $18,850 a year
(National Center for Children in
Poverty, 2004). The degree of poverty becomes deeper with
younger children:
• 42% of infants and toddlers from birth to 2 years
old in the U.S. live in low-income families, whereas
• 38% of school-age children, and
• 32% of adolescents live in low-income families
(National Center for Children in Poverty, 2004).
In general, poverty is detrimental to children’s development
because it is linked to malnutrition, disease,
and/or inadequate education. In addition, poverty is
highly correlated to other risk factors. Parents in lowincome
families are likely to be less educated, have
part-time unskilled jobs, enter parenthood earlier, and
more often become single parents as a result of unmarried
birth, divorce, separation, death, or imprisonment
(Lu & Koball, 2003). These factors can all negatively
affect children’s cognitive, physical, and socioemotional
development. Thus, children in low-income families
are exposed to more developmental risks than their
counterparts who live in affluent families.
The first 3 years of life are critical because children
develop many of the basic learning patterns and abilities
that they will build upon for the rest of their lives.
A large proportion of human brain development is
accomplished during this early period. Research indicates
that brain development can be facilitated by highquality
early experiences (Carnegie Corporation of
Boyoung Park
Poverty is highly
correlated to other
risk factors.
New York, 1994). Ironically, almost
all low-income families’ infants and
toddlers have limited access to highquality
experiences and early childhood
education programs because of
the costs involved. This amplifies
the children’s risks.
Characteristics of Successful Early
Intervention Programs
The United States is fortunate to have well-designed early
educational intervention programs that may buffer the
effects of poverty and facilitate healthy development of children.
The impact studies on those programs show that several
conditions are necessary for early intervention to be successful.
• When interventions begin before children reach
school age, and are intensive and direct, children
who are at risk may demonstrate better cognitive,
behavior, and socioemotional outcomes than those
who receive intervention after preschool (Ramey &
Ramey, 2003).
• Programs that enroll children during infancy and
provide education for their families produce greater
benefits than programs that enroll children who are
Boyoung Park, Ph.D., is Assistant Professor, Early Childhood/Special
Education Program, School of Teacher Education
and Leadership, Radford University, Radford, Virginia.
She was a preschool teacher for 5 years in Korea and conducted
early screening and developmental tests with a local
Early Head Start program in Georgia.
Winter 2008 DIMENSIONS OF EARLY CHILDHOOD Volume 36, Number 1 3

school age (Campbell, Pungello, &
Miller-Johnson, 2001; Ramey,
Campbell, & Burchinal, 2000).
• Programs that are intensive and
multi-generational are thought
to produce better outcomes
than do less intensive interventions
(Ramey, Ramey, & Lanzi,
2002). Intensive programs
include participation of parents
along with their children and
frequent intervention for longer
than one year.
• Intensive full-day programs
produce better developmental
outcomes for children at risk
Direct intervention
provides more benefits.
than do half-day programs or
frequent home visit programs
(Ramey & Ramey, 2003).
For example, infants who participated
in the Abecedarian Project received
full-time educational intervention in a
high-quality child care setting for more
than 3 years (Ramey & Campbell,
1972). Within the high-quality environment,
each child was engaged in
play-centered educational activities to
enhance physical, social, emotional,
cognitive, and language development.
Parents of children in the Perry
Preschool Project were provided with
parent education sessions via weekly
home visits (High/Scope Educational
Research Foundation, 2007).
Direct intervention provides more
benefits than intervention provided
through intermediary routes. With
placement in high-quality educational
settings and through interaction with
well-trained staff, the development of
children at risk may be enhanced more
efficiently than those children who
might only have the benefit of indirect
Subjects & Predicates
The first 3 years of life are critical because children develop many of the basic learning
patterns and abilities that they will build upon for the rest of their lives. A large proportion
of human brain development is accomplished during this early period. Research
indicates that brain development can be facilitated by high-quality early experiences.
interventions such as those provided
through parent education programs
(Blok, Fukkink, & Gebhardt, 2005).
Despite the differences in intervention
programs, continuity of intervention
approaches including parent involvement
is important (Neuharth-Pritchett
& Mantzicopoulos, 1998).
In sum, successful early intervention
programs:
• Begin as early as infancy, or at
latest preschool age
• Provide full-day, year-round
child care and regular frequent
home visits
• Train staff who directly interact
with children so that they can
plan and implement developmentally
appropriate educational
practices as well as provide
a physically and emotionally
secure environment
• Consider meaningful family
involvement to be as important
as educating and supporting the
parents and the siblings
Programs That Make a
Difference
The Abecedarian Project (Ramey &
Campbell, 1972) and the Perry
Preschool Program (Weikart, 1959) are
excellent examples of early intervention
programs for children at risk, especially
with regard to infants and toddlers as
well as preschoolers. Both programs are
examples of intensive and direct intervention
with high-risk young children
who are from families with limited economic
resources. In both of these projects,
participants’ development was
physically or mentally delayed. Children
in both projects received highquality
child care and frequent home
visits.
These intervention programs had
short- and long-term effects on the cognitive
and socioemotional development
of children. Participants displayed a significant
advantage in gains in intelligence
scores and outperformed nonparticipants
during the preschool period.
The intelligence and academic
achievement gains were maintained
4 Volume 36, Number 1 DIMENSIONS OF EARLY CHILDHOOD Winter 2008

through the children’s seventh year in
school. Additionally as young adults,
the participants attained higher scores
on cognitive tasks and academic
achievement, were more likely to
attend a 4-year college or university,
and were less likely to become teen
parents than were individuals in the
control group (Campbell et al., 2002).
The United States government’s
largest effort to promote healthy child
and family development is Early Head
Start (EHS), which builds on the experiences
of these two early programs.
Begun in 1994, Early Head Start is a
federally funded, community-based
program for low-income pregnant
Subjects & Predicates
Effective programs for infants and toddlers at risk
provide comprehensive services such as nutrition, health
care, and family support, as well as developmentally
appropriate educational practices. These early
experiences help curb children’s risk factors and enhance
their resilience.
women and families with infants and
toddlers. Goals of the program are to
promote healthy prenatal outcomes
for pregnant women, to enhance the
development of infants and toddlers,
and to promote healthy family functioning.
All of the participating children
are from low-income families or
have disabilities. The infants and toddlers
enrolled in the program receive
high-quality intensive educational services
through center-based or homebased
programs, all at no cost (Irish,
Schumacher, & Lombardi, 2003).
According to EHS evaluation studies
(Early Head Start, 2001; 2002),
EHS children significantly outperformed
the control group
of children in cognitive
and socioemotional development
at ages 2 and 3
years. Another study that
investigated correlation
between risk factors of
children in a local EHS
program and their
developmental outcomes
showed that the participants’
risk factors were
successfully addressed with
the services provided by
the program (Park, 2005).
Recommended
Program
Practices
Start early. Early
intervention programs
that are provided before
or right after birth have
the greatest likelihood
of helping infants and
toddlers at risk. For
children born to low
socioeconomic status
families in which the
children’s pre-, peri-,
and/or postnatal care are inadequate
(making children vulnerable to diseases
or disabilities), it is best to
enroll them in intensive, high-quality
early intervention programs as
early as possible. Effective programs
for infants and toddlers at risk provide
comprehensive services such as
nutrition, health care, and family
support, as well as developmentally
appropriate educational practices.
Parent involvement
is important.
These early experiences help curb
children’s risk factors and enhance
their resilience.
Intervene immediately after
screening. Early screening to identify
the infants and toddlers at risk
must be followed by immediate
intervention. According to Park’s
study (2005), the more risks to
which children are exposed, the more
likely they are to be identified with a
disability or categorized as delayed in
development. However, much of this
delay was diminished after immediate
intervention by speech therapy, a
doctor’s exam and medical treatment,
and/or placement in a high-quality
educational environment. Thus, the
best early intervention programs
diagnose and intervene as early as
possible as well as enhance the quality
and extent of their other services.
Involve parents. Finally, parents
who are involved in the intervention
process make better progress in facilitating
their children’s development
than do parents of children not
involved in such programs. As parents
participate, they learn about
general child development, as well as
their own child’s growth. Parents
who have a better understanding of
child development typically are
Winter 2008 DIMENSIONS OF EARLY CHILDHOOD Volume 36, Number 1 5

more proactive to seek and support
services for their children. Consequently,
parent involvement opportunities
are essential for infants and
toddlers at risk.
References
Blok, H., Fukkink, R.G., & Gebhardt, E.C.
(2005). The relevance of delivery mode
and other program characteristics for the
effectiveness of early childhood intervention.
International Journal of Behavior
Development, 29(1), 35-47.
Campbell, F.A., Pungello, E.P., & Miller-
Johnson, S. (2001). Development of
cognitive and academic abilities: Growth
curves from an early childhood educational
experiment. Developmental Psychology,
37(2), 231-242.
Campbell, F.A., Ramey, C.T., Pungello, E.,
Sparling, J., & Miller-Johnson, S.
(2002). Early childhood education:
Young adult outcomes from the
Abecedarian Project. Applied Developmental
Science, 6(1), 42-57.
Carnegie Corporation of New York. (1994).
Starting points: Meeting the needs of our
youngest children. New York: Author.
Early Head Start. (2001). Building their
futures: How Early Head Start programs
are enhancing the lives of infants and toddlers
in low-income families. Executive
summary. Washington DC: Author.
Early Head Start. (2002). Making a difference
in the lives of infants and toddlers and
their families: The impacts of Early Head
Start. Executive summary. Washington
DC: Author.
High/Scope Educational Research Foundation.
(2007). The Perry Preschool longitudinal
study. Retrieved online January 19,
2007, from
http://www.highscope.org/Research/PerryProject/perrymain.htm
Irish, K., Schumacher, R., & Lombardi, J.
(2003). Serving America’s youngest: A
snapshot of Early Head Start children,
families, teachers, and programs in 2002.
CLASP Policy Brief, 3, 1-7.
Lu, H., & Koball, H. (2003). Living at the
edge. Research brief No. 2. The changing
demographics of low-income families and
their children. Washington DC: National
Center for Children in Poverty.
National Center for Children in Poverty.
(2004). Low-income children in the
United States. Retrieved online July 16,
2007, from
www.neep.org/pub_cpf04.html.
Neuharth-Pritchett, S., & Mantzicopoulos,
P.Y. (1998). Transitional first-grade referrals:
An analysis of school-related factors
and children’s characteristics. Journal of
Educational Psychology, 90(1), 122-133.
Park, B. (2005). Early risk factors of children
in poverty: The effectiveness of early intervention.
Doctoral dissertation at the University
of Georgia, Athens.
Ramey, C.T., & Campbell, F.A. (1972). The
Carolina Abecedarian Project. Retrieved
online January 19, 2007, from
www.fpg.unc.edu/~abc.
Ramey, C.T., Campbell, F.A., & Burchinal,
M. (2000). Persistent effects of early
childhood education on high-risk children
and their mothers. Applied Developmental
Science, 4(1), 2-14.
Ramey, C.T., Ramey, S.L., & Lanzi, R.G.
(2002). Early educational interventions
for high-risk children: How center-based
treatment can augment and improve
parenting effectiveness. In J.G. Borkowski,
S.L. Ramey, & M. Bristol-Power
(Eds.), Parenting and the child’s world:
Influences on academic, intellectual, and
social-emotional development (pp. 125-
140). Mahwah, NJ: Erlbaum.
Ramey, S.L., & Ramey, C.T. (2003).
Understanding efficacy of early educational
programs: Critical design, practice,
and policy issues. In A.J. Reynolds,
M.C. Wang, & J. Herbert (Eds.), Early
childhood programs for a new century (pp.
35-70). Washington, DC: Child Welfare
League of America.
Weikart, D.P. (1959). The High/Scope
Perry Preschool Program. Retrieved
online July 16, 2007, from
www.highscope.org/index.asp.
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Put These Ideas Into Practice!
The Earlier, the Better: Early Intervention Programs
for Infants and Toddlers at Risk
Boyoung Park
Conditions necessary for successful early intervention
• When interventions begin before children reach school age, and are intensive and direct, children who are at risk may demonstrate
better cognitive, behavior, and socioemotional outcomes.
• Programs that enroll children during infancy and provide education for their families produce greater benefits than programs that enroll
children who are school age.
• Programs that are intensive and multi-generational are thought to produce better outcomes than do less intensive interventions.
• Intensive full-day programs produce better developmental outcomes for children at risk than do half-day programs or frequent home
visit programs.
Recommended program practices
• Encourage pregnant women to get regular check ups and
prenatal care.
• Urge families at risk to look for an early intervention
program before giving birth. To learn more about Early
Head Start programs, go to http://www.ehsnrc.org/
• After children are enrolled, screen them for potential delays
or disabilities as soon as possible. Trained screeners use
reliable screening tools. Implement any indicated
interventions immediately.
• Provide full-day, year-round services including nutrition,
health care, and a high-quality educational environment
and activities.
• Support parents and other siblings as well as the child who
receives the service directly.
Ideas to share with parents of young
children at risk
• If your family income is below the poverty level, seek
appropriate prenatal care. Contact a social worker for
assistance.
• If your child has or may have a disability, contact local
early intervention programs such as Early Head Start as
soon as possible.
• After your child is enrolled in an early intervention
program:
1. Attend all meetings and workshops for parents
2. Communicate with the staff as much as possible
3. Make sure your child attends every session
• Talk, read, and play with your child at home as frequently
as possible.
Note: Dimensions of Early Childhood readers are encouraged to copy this material for early childhood students as well as teachers of young children as a professional development tool.
Winter 2008 DIMENSIONS OF EARLY CHILDHOOD Volume 36, Number 1 7