INFANT BEHAVIORAL ASSESSMENT AND INTERVENTION PROGRAMA PROGRAM GUIDEAn Education and Training Program for Early Intervention ProfessionalsTraining is offered in the following components:
NEUROBEHAVIORAL ASSESSMENT AND INTERVENTIONThe Infant s Behavioral StoryInfants speak to us via the expression of approach, stress, and self-regulatory behaviors emanating from the four subsystems of communication (i.e., autonomic, motoric, state, attention/interaction). The neurobehavioral approach as advocated by Als (1997), Lawhon (1997), and Hedlund and Tatarka (1991) postulates that the infant s behavior provides the best information base from which to be continuously attuned to the infant (Als & Duffy, 1982). Infants participate as active collaborators in their own developmental agenda in a continuous relationship with those caring for them and the current environment which contains or holds them. Each infant has his own unique behavioral story to tell, a story that speaks directly to his needs, wants, and developmental agenda that he is striving toward. It is only through the direct observation of the behavioral repertoire of an infant that we can infer: 1) what goals the infant seeks to accomplish; 2) what strategies are being employed by the infant to accomplish these goals; 3) how effective these strategies are; and 4) what supports might be useful to facilitate the infant s overall development and neurobehavioral organization. Through direct observation of the behavioral expression of the infant and facilitation of his neurophysiological organization, early intervention professionals may better support the infant along his individual developmental trajectory. Goals of Neurobehavioral Intervention The neurobehavioral intervention as advocated by our past and present work (Hedlund, 1998; Hedlund & Tatarka, 1988) addresses the needs of growing numbers of infants, newborn through six months developmental age, who are born with very low birth weight or at risk for poor long-term neurodevelopmental outcome. The main goals of this approach are to: 1. Support early intervention professionals to read and interpret the infant s behavioral story. This is accomplished through training in the administration of the Infant Behavioral Assessment (IBA). Through these clinical observations the infant s neurobehavioral organization and self-regulatory competence is evaluated. Based upon these observations a determination is then made with respect to the degree and quantity of neurobehavioral support that the infant is eliciting and seeking. 2. Translate the infant s behavioral story into appropriate neuobehavioral and developmental action by selecting and implementing the neurobehavioral strategies that best supports the infant along his individual developmental trajectory. The strategies assist professionals to conduct developmental assessments as well as implementing therapeutic, educational, and care giving intervention that is sensitive to, and supports the neurophysiological state and organizational system of the infant. Through this process the infant is individually supported in his efforts to engage and be engaged by the environment, thus enhancing the child s growth and development. 3. Validate and support parental perceptions of their growing developing infant. The approach offered in Holding Parents Holding Their Baby significantly differs from the current train the parent model implemented in traditional early intervention programs today. The materials included in this manual reflect a philosophy guided by the recognition of, and a respect for, what comes naturally to parents as they love and care for their baby. It serves to support parents as they continue to explore ways to adjust and adapt themselves to the neurobehavioral organization and self-regulatory competence of their infant. 4. Bring about a shift from protocol-based (i.e., curriculum bound) to process thinking (i.e., how to facilitate learning and social interaction), and from agenda oriented (i.e., mastery of developmental tasks/milestones) to relationship-based developmental intervention (Als, 1997). Training Participants Training in the Infant Behavioral Assessment and Intervention Program is offered to special educators, physical and occupational therapists, communication disorder specialists, nurses, pediatricians, psychologists, social workers, and infant developmental specialists. These professionals must receive prior instruction and certification in the administration of the Infant Behavioral Assessment (IBA) before application of the NCEI materials is granted. As selection and implementation of the neurobehavioral strategies is based upon the clinical observational skills of the adult, it is imperative that training in all neurobehavioral components of the IBA have been successfully completed. In addition, experience with neonates or young infants and knowledge of neonatal medicine, infant development, and standardized testing is required. Training in the implementation of the neurobehavioral intervention/assessment strategies and related materials is best suited for clinicians who are already skilled in their own pediatric specialty and whose current practice includes intervention with high-risk, medically fragile, or disabled infants and their families. Overview of the Training offered by the Infant Behavioral Assessment and Intervention Program As infants are discharged from hospital neonatal intensive care units (NICUs), their parents are confronting the long-term implications of their child's special needs. "Support and neurobehavioral intervention cannot end when the infant is discharged from the NICU, but must systematically link families and infants to sound models of community-based supports that build on the neurobehavioral care and intervention provided in the NICU" (Als, 1992, p. 353). Intervention offered these infants and their families must capitalize on family strengths to support parents to facilitate the neurobehavioral needs of their infants, create opportunities for parent-to-parent contact, focus intervention goals on parent-identified needs, and facilitate and support the development of mutually satisfying parent-infant interactions. Infant Behavioral Assessment (IBA) The Infant Behavioral Assessment (IBA) (Hedlund & Tatarka, 1988) sensitizes early intervention professionals to the neurophysiological organization and self-regulatory competence of the infant. The IBA provides a window upon the neurobehavioral repertoire of the infant and assists the professional to adjust his/her intervention style to more closely match the neurobehavioral and developmental needs of the infant. Drawing upon the work of Als, Lester, Tronick, & Brazelton (1982), Als (1984, 1986, 1988), Brazelton (1984a, 1984b), and Barnard (1978), Hedlund and Tatarka (1988) developed the IBA. Als (1986) theoretical conceptualization of the Synactive Model of Newborn Behavioral Organization and Development served as the foundation for the development of the IBA. Drawing upon Synactive Model, Hedlund and Tatarka (1988) have further articulated this theoretical construct. The four subsystems (i.e., autonomic, motoric, state, attention/interaction) as delineated by Als (1986), are seen as avenues of communication, from which three categories of behaviors have been identified: approach, self-regulatory, and stress. The expression of these behaviors reflect both the infant s response to sensory input and the integrity of the four subsystems. The IBA is a time sampling of 113 communicative behaviors. The behaviors are categorized according to the four subsystems: 26 autonomic/visceral cues, 44 motor responses, 9 state categories , and 34 attention/interaction cues. These are organized along a continuum of responses from approach to stress. Each of the four subsystems is further divided into a total of 14 sub-categories. This instrument is used to: 1) assess the infant's neurobehavioral organization and self-regulatory competence; 2) measure improvements in the infant s capacity to use more sophisticated levels of self-regulatory strategies as a means to stabilize his neurophysiological functioning during assessment, intervention, care giving routines, and social interactions; 3) identify specific behavioral antecedents that may be responsible for the expression of these behaviors; and 4) determine the degree and quantity of neurobehavioral strategies that would best support the infant along his individual developmental trajectory. Training in the administration of the IBA is addressed in the Trainee Responsibilities outline. The Neurobehavioral Curriculum for Early Intervention (NCEI) In view of the dearth of curricula in early childhood special education that address the neurobehavioral needs of these infants, the Neurobehavioral Curriculum for Early Intervention makes a unique and important contribution to current practice. This curriculum is based on four major theoretical perspectives: 1) the ecological model of human behavior (Bronfenbrenner, 1979, 1986; Sameroff & Fiese, 1990; Sameroff, 1993) which views the development of the infant within the broader familial and societal context as well as recognizing the importance of their inter-transactional nature across time; 2) the parent-infant interactional model (Papousek & Papousek, 1987, 1992; Trevarthen, 1980; Tronick & Cohn, 1989) which recognizes the critical role social interactions play in the infant s development; 3) the principle of dynamic assessment and intervention (Feurerstein, 1977; Lidz, 1983; Lidz, Bond, & Dissinger, 1991) based upon Vygotsky s (1934/1986, 1978) conceptualization of the zone of proximal development; and 4) the Synactive Model of Newborn Behavioral Organization and Development (Als, 1986, 1992, 1997) which focuses upon the infant s intraorganism subsystems and their continuous interaction with each other and the environment across time. These theories provide a framework for the translation of these principles into supporting the neurobehavioral and self-regulatory competence of the infant. This new intervention model translates our past and present neurobehavioral research into meaningful intervention practices that optimize the development of infants with disabilities as well as supporting their families. The NCEI provides specific neurobehavioral strategies for early intervention professionals to integrate into infant assessments/interventions and curricula that they may currently be using. The focus of the NCEI is not what to teach (content curricula), but how to teach, a process oriented approach. The capacity of the infant to learn requires an alert state, a graded presentation of stimuli, and a sensitivity to feedback signals indicating limits of tolerance (Papousek & Papousek, 1987, 1992). The NCEI assists early intervention professionals to learn and implement specific neurobehavioral strategies that will facilitate these infant learning prerequisites. In addition parents as well as paraprofessionals are assisted to recognize and support the neurobehavioral needs of these fragile infants. This is accomplished through three major components of the Neurobehavioral Curriculum for Early Intervention. These include: 1. Neurobehavioral Strategies for Early Intervention. These strategies were designed to assist early intervention professionals to support the neurobehavioral organization and self-regulatory competence of the infant during assessment, intervention, care giving routines, or while the infant is engage in social interaction. The strategies are divided into three sections and accompanying subsections: Environmental Facilitation
Handling and Positioning
Cue-Matched Facilitation
The subsections are organized beginning with a description of the neurobehavioral organizational condition of the infant within the four subsystems as well as the infant s self-regulatory competence. This is followed by neurobehavioral strategies that have been classified into five levels of support: 1) Minimal, 2) Low, 3) Moderate, 4) High, and 5) Terminate the Interaction: the infant s threshold for sensory input has been exceeded. The level of support is determined by the neurobehavioral organization and self-regulatory competence of the infant (i.e., Optimal, High, Moderate, Low, and Minimal Self-Regulatory Competence). For example, the infant may, for the most part, appear to be well organized (ie., High Self-Regulatory Competence) but may require a small amount of facilitation (i.e., Low Support) to maintain an Interactive Alert State. 2. Holding Parents Holding Their Baby. The materials developed for this manual begin with an introductory overview of the Transition to Parenthood This section includes a discussion of the past developmental history of each parent, their relationship, the evolving pregnancy, and finally the birth of the infant. Reflections upon Winnicott and Facilitations: Talking with Parents, follow as the next section of the manual. The Reflections were developed to assist the professional to integrate and apply Winnicott s philosophical approach and tone in his/her work with families and their babies. The Facilitations are a collection of writings that serve to support parents as mothers and fathers to their baby. The remaining parent materials address neurobehavioral supports for parents to consider while caring for their baby. 3. Neurobehavioral Instructional Guide for Paraprofessionals . This guide supports paraprofessionals toward a greater understanding of the communication avenues (i.e., autonomic, motoric, state, attention/interaction) available to infant and the behaviors emanating from them (i.e., approach, self-regulatory, and stress). The Neurobehavioral Instructional Guide assists paraprofessionals to better support the neurobehavioral organization of infants during their day-to-day interactions with infants and their families. This site is currently under construction. Further information on training procedures and expenses will follow in the near future. Back to WRI |