Libby is two years old and has recently been referred by a pediatrician for an early intervention childhood program

due to showing signs of delayed developmental skills. After viewing Libbys previous history, doctors showed signs of concern for her premature birth and the implications that might follow Libby throughout her life. Libbys doctor and parents are concerned about her delayed developmental skills. For example, most children Libbys age can walk and run (Gillen, 2014). Libby is able to stand without assistance, but displays a scissor gait when walking and is unable to run. Libby is also not attempting to mimic those around her and is unable to differentiate shapes and colors. Her parents have also discussed concerns about stiffness in Libbys muscles and joints. Libbys pediatrician has noticed slight contractures in Libbys upper limbs. Libbys parents are concerned because they want to send her to preschool, but are worried she will not be able to keep up with her peers. Libby will visit an Early Childhood Intervention clinic, Launchability, for her first evaluation. She will be evaluated by an occupational therapist, physical therapist, speech-language pathologist, psychologist, and a nutritionist (K. Barnes, personal communication, October 8, 2013). Libby must show at least a 35% developmental delay in order to receive therapy. The occupational therapist will use the Batelle Developmental Inventory for her initial evaluation. Every six months, Libby will be reevaluated by her occupational therapist. During each evaluation and session computerized notes are taken to track the patients progress. For this program to have the best outcomes for Libby teamwork is essential. Unlike most early childhood interventions that use a transdisciplinary approach, Launchability uses an interdisciplinary team because team members share goals with one

another and discuss with each other how their intervention plans will be implemented. The team members become interdependent as they improve the health outcomes for their clients. The following link will provide further information about Launchability and their program. launchability.org/index.php/services/early-childhood-intervention After the initial evaluation, Libby will be seen for therapy at her home once a week for 45 minutes to an hour. Libby will have the opportunity to attend group therapy at Launchability based on delayed developmental skills. Group therapy can vary from eating tasks, crawling, walking, and social interaction skills. Libby would be more apt to attend group sessions focusing on walking and social skills to improve performance. Libbys therapist will also work with her parents to educate them on ways they can help Libby reach her treatment goals. In discussing which models are used in ECI intervention, Libbys therapist described using a combination of many models (K. Barnes, personal communication, October 8, 2013). Libbys therapist mainly utilizes the EHP model in her practice. The occupational therapist typically uses a top-down approach by targeting the area of occupational performance first and basing her intervention upon them. Libbys therapist targets the client by providing treatment in her clients natural contexts making environmental modifications as needed. Her therapist will also educate the parents on ways to prevent falls and injuries. Launchability primarily relies on state funding and donations in order to provide their services (K. Barnes, personal communication, October 8, 2013). They do accept Medicaid and have a family share cost system based on income and family size for those who need additional help. Libbys occupational therapist works five days a week

for at least 40 hours with possible overtime. She also receives salary pay. She must provide her own transportation to visit clients homes and she receives tax-write-offs for her mileage. She will visit about six to eight patients daily. Libbys therapist has over 25 years of experience in this field (K. Barnes, personal communication, October 8, 2013). Lack of a full occupational therapy staff is a common issue within this setting. Since therapists visit clients at their homes, they must transport all their materials and equipment with them. Occupational therapists working in this setting must also be conscious of safety factors while visiting clients homes. Therapist must be aware of family issues (including possible abuse and violence) and utilize their best ethical judgment in these situations. After evaluating Libby and focusing on what she can do, the occupational therapist will use interventions providing education to the client and caregivers on range of motion to prevent Libbys contractures from worsening as well as finding ways to manage daily tasks (Slocum, 2014). To improve the slight upper limb contractures the occupational therapist takes Libby through passive range of motion to prevent shortening of the muscle and increase range of motion. The occupational therapist also addresses the scissor gait by using task oriented gait training (Lundy-Ekman, 2013). When focusing on mobility the occupational therapist will also address the cognitive aspect of Libby not being able to mimic or differentiate shapes and colors. Knowing Libby can walk and verbalize a few words, her therapist makes games having her repeat color after color of things she likes such as food or her favorite toys. The therapist also uses different shaped toys and has Libby tell her what shape it is. If Libby is correct she is rewarded and is allowed to play with the toys for a short time. With these

interventions, the occupational therapist strives to help Libby generalize her skills and help her attend preschool with the aid of assistive devices if needed (Tomchek, 2014).

References Gillen, G. (2014). Motor function and occupational performance. In Schell, B. A., Gillen, G., & Scaffa, M. E. (Eds.), Willard & Spackmans occupational therapy (12th ed.) (pp. 750-778). Philadelphia, PA: Lippincott Williams & Wilkins. Lundy-Ekman, L. (2013). Neuroscience: Fundamentals for rehabilitation (4th ed.) St. Louis, MO: Elsevier. Slocum, S. (2014). Common conditions, resources, and evidence. In Schell, B. A., Gillen, G., & Scaffa, M. E. (Eds.), Willard & Spackmans occupational therapy (12th ed.) (pp. 1127-1129). Philadelphia, PA: Lippincott Williams & Wilkins. Tomchek, S. D. (2014). Occupational therapy in a comprehensive intervention program for individuals with autism spectrum disorder: Early intervention to supported employment. In Schell, B. A., Gillen, G., & Scaffa, M. E. (Eds.), Willard & Spackmans occupational therapy (12th ed.) (pp. 911-924). Philadelphia, PA: Lippincott Williams & Wilkins.