Early intervention in Portugal: family support and

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EARLY

INTERVENTION

Early intervention in Portugal: family support and benefits CARINA SOFIA CORREIA LEITE and ANA PAULA DA SILVA PEREIRA This study investigated the support and benefits of early intervention (EI) in families with children with special needs. Data were gathered through a written questionnaire, ‘Family Benefits Inventory’, completed by 126 families with children with special needs supported by EI teams, with ages from six months to six years in Portugal. The global results obtained in this study allowed us to conclude that families considered that they obtained benefit from EI and received support most of the time in the different dimensions of the questionnaire. Furthermore, support given by an EI professional had a positive influence on families’ perceptions regarding the benefits of EI. Key words: early intervention, children with special needs, families, benefits, support.

Introduction In Portugal there has been a change in the organisation and functioning of early intervention (EI) programmes as a result of the publication of a law (No. 281/2009, 6 October 2009), which has as its principle objective the creation of a national system of early intervention. This law defends the perspectives of Harbin and Salisbury (2000), which highlight the diverse necessities of children with special needs and their families, who should be supported not only by one isolated service but by a conjunction of articulated and co-ordinated services. This law, also advocated by Gallagher and Serrano (2002), states that, in order for the existence of a collaboration of early intervention services to occur, it is necessary to include different services within the health care, education and social services. The practices suggested by research in the area of early intervention constantly challenge professionals to develop ecological, trans-disciplinary and family-centred support. In this way it is necessary to question whether early intervention services apply a family-centred approach and also if they result in benefits to families (Aytch et al., 1999; Espe-Sherwindt, 2008).

© 2013 NASEN DOI: 10.1111/1467-9604.12034

Literature in the area of early intervention considers and presents numerous studies regarding the different benefits that families obtain from EI services. Today, studies refer to three important areas of impact on families: knowledge and information; the development of competencies; well-being and the quality of life (Krauss, 1997; Turnbull et al., 2000; Park et al., 2002). Dunst et al. (2007) continue to affirm that if the professionals include the choices and decisions of families in their practices this will result in greater benefits to the families. As a result, the benefits for families can vary due to the various aspects of involvement in their social and cultural networks, including the individuals and organisations that provide these services (Neal, 2007). The individualisation of support as a response to the necessities and priorities of the family is focused in a familycentred approach as families do not share the same objectives, desires or results; this can create difficulties in finding a uniform method of evaluation of the benefits and results for families in early intervention (Bailey and Bruder, 2005). An analysis of the benefits for families, applying an instrument of measurement based on results, is a method that can be applied to address these complex questions and also to facilitate an understanding of the process and efficacy of early intervention (Neal, 2007). Campbell et al. (1998) recommend that an evaluation of the results of early intervention should include knowledge, empowerment and interaction between parents and children, together with the experience of parents in the transition and support process. Krauss (1997) emphasised that all services need to demonstrate and prove the efficacy of their work. Therefore, this study aims to contribute to the knowledge regarding the benefits of early intervention for families supported by EI programmes in the north of Portugal. We have thus attempted to define the purpose of this study by evaluating the support and benefits of early intervention for families supported by these programmes. The following objectives are defined in this study: 1.

2.

the translation and adaptation of the data collection instrument, ‘Family Benefits Inventory’ (Harbin and Neal, 2003); the identification of the type of support that families with children with special needs take advantage of when supported by early intervention teams in Portugal;

3.

the analysis of the influence of the support mechanisms provided based on the perceptions of families regarding the benefits of early intervention.

Method Participants The study sample of this research constituted 125 families of children with special needs between the ages of six months and six years, supported by early intervention teams in the north of Portugal; 83% of the participants (n = 104) were female and 17% (n = 21) male. One of the participants did not respond to the questionnaire. Of the 126 subjects constituting this study sample, and relative to the level of kinship, 99 were mothers (78.6%), 21 were fathers (16.7%) and six corresponded to other degrees of kinship (4.8%). With regard to the educational level of the participants in the sample, it was found that 13 were at a level up to the fourth year of basic education (10.3%), 63 were between the fifth and ninth years (50.0%), 27 between the tenth and 12th years (21.4%) and 22 had a university degree or a degree in some other form of higher education (17.5%). One of the participants did not respond (0.8%). Regarding the support time provided by the early intervention teams, 47 families were given support for more than six months and up to one year (37.3%), 32 between one and two years (25.4%), 29 between two and three years (23.0%) and 16 more than four years.

guese translation was carried out by a professional bilingual translator in order to verify the authenticity of the content regarding the original instrument (Hill and Hill, 2009). After a revision of the translation was made, a pre-test on three families who were subsequently not part of the study sample was carried out, by three professionals with extensive experience in early intervention, in order to identify those items that were difficult to understand. Furthermore, and in relation to the identification and characterisation of the families who participated in this study, a sociodemographic questionnaire was constructed consisting of personal data such as sex, marital status, the municipalities in which families resided, level of education, profession, age of child, kinship with the child, length of support time provided by early intervention programmes and problems relating to the child. In order to register accurately the perception of benefits, a Likert scale with six response options was applied, namely: (l) totally disagree; (2) often disagree; (3) rarely disagree; (4) sometimes agree; (5) often agree; (6) completely agree. Each item included a measure that assessed whether the family had received support in this area by any early intervention professional, given that these items were obtained by way of a dichotomous response: Yes/No. Internal consistency reliability (Cronbach’s alpha) for this sample was .89. This value is approximate to the value .92 of the Cronbach’s alpha value defined in the study by Neal (2007).

Results Procedures and measures After contacting and receiving the respective authorisations from all the co-ordinators of the early intervention teams, sealed envelopes containing the questionnaires and a covering letter for those parents who had been supported for at least six months by the respective teams were given out. The participants were asked to have the questionnaire filled out by only two elements (of their own choice) of the family. Three hundred and eight questionnaires were delivered to participants, of which 127 were returned, thus providing a return rate of 41.5%. However, one case was eliminated as only the socio-demographic data were completed while all other questions in the questionnaire were ignored. The research instrument applied in this investigation was the questionnaire ‘Family Benefits Inventory’ with 36 items, by Harbin and Neal (2003), which evaluated the perceptions of families regarding the support provided by early intervention and its benefits. The ‘Family Benefits Inventory’ is a validated research instrument and is intended for the American population. Therefore, it was also necessary to obtain permission from the authors to have it translated into Portuguese while ensuring the authenticity of the original document. Later, a retroversion translation of the Portu-

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The results obtained in this study will be presented according to the aims defined in this research, namely: (a) translation and adaptation of the data collection instrument ‘Family Benefits Inventory’ (Harbin and Neal, 2003); (b) identification of the type of support that families with children with special needs take advantage of when supported by early intervention teams in Portugal; and (c) analysis of the influence of the support mechanisms provided based on the perceptions of families regarding the benefits of early intervention.

Translation and adaptation of the data collection instrument ‘Family Benefits Inventory’ (Harbin and Neal, 2003) The psychometric qualities of the data collection instrument were assessed by way of exploratory analyses of their reliability, validity and sensitivity. In order to determine the reliability of the data collection instrument, Cronbach’s alpha was used. The Cronbach’s alpha obtained for the ‘Family Benefits Inventory’ (36 items) presents approximate values of very good (alpha = 0.89), which are indicative of a research instrument with a marginally internal consistency

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of very good. This value is approximate to the value of α encountered by Neal (2007), with an excellent value of .92. Analysis of the sensibility of the research instrument shows that it is considered to represent good values given that the average value (4.83) is approximate to the median (4.85) and the mode (4.83), and the asymmetric values (0.56) and kurtosis (0.46) do not deviate from zero and do not exceed the unit (George and Mallery, 2006; Almeida and Freire, 2008). To determine the validity of the research instrument, its adequacy was analysed in relation to a factorial analysis according to Barlett’s test, and considering a minor or equal probability of .05. Simultaneously, a Kaiser Mayer Olkin (KMO) test was carried out to verify whether the distribution of data was ideal for the realisation of the factorial analyses. The KMO test in this case obtained a value of 0.8 which, according to George and Mallery (2006), is an average value, almost good, regarding the adequacy of the measurement of the sample. To proceed with the calculation of validity, an exploratory factorial analysis was made of the items, followed by a varimax rotation as it attempted to identify, by way of interrelationships, factors or dimensions that could be significant, and to understand the importance of each of the factors or dimensions in the final result. The factorial analyses identified ten factors in accordance with the Keiser rule (eigenvalue > 1) which explains approximately 72% of the total variance. In the original study by Neal (2007), a factorial analysis identified eight factors which explain 60% of the total variance. However, since the items are distributed in a dispersed form and not supported by research, we conducted a new (factor) analysis, opting for a solution of forced extraction of four factors as in the original study by Neal (2007). In this way, a factorial structure of the benefits explains 51.0% of the total variance of the results, given that the remainder were justified by chance, or by any other variable not addressed or identified in this study. Factor I explains approximately 18.9% of the total variance of the scale and is saturated in items 29, 27, 16, 28, 23, 10, 11, 18, 26, 25, 21, 22, 1, 30, 14, 17 and 15. It is this factor that we have designated as well-being. Factor II explains approximately 12.9% of the total variance of the scale and is saturated in items 1, 20, 13, 12, 14, 17, 15, 3, 31, 2 and 9. It is this factor that we have designated as control/ empowerment. Factor III explains approximately 10.7% of the total variance of the scale and is saturated in items 3, 2, 8, 6, 7, 4, 5 and 24. It is this factor that we have designated as knowledge. Factor IV explains approximately 8.6% of the total variance of the scale and is saturated in items 33, 34, 19, 35, 32 and 36. It is this factor that we have designated as involvement.

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We suggest the elimination of item 36, ‘Members of my family have taken part in a programme to gain job skills or get further education (completing courses, getting a GED, getting a diploma or degree)’ in the future application of this questionnaire since it presents a level of saturation of less than 0.3. In the first factor, well-being, we can refer to the fact that there exist key characteristics of all the definitions, namely: (a) global feelings of well-being; (b) positive social involvement feelings; and (c) opportunities to enhance their skills (Turnbull et al., 2003). With reference to point (a), global feelings of well-being, it can be found, for example, in items like ‘My family feels hopeful and optimistic about our child’s future’ (item 16), ‘My family feels comfortable and accepted taking our child with special needs to places in the community, such as the grocery store, the shopping mall, places of worship, and restaurants’ (item 28) and ‘My family copes with the stresses of having a child with special needs’ (item 23). Items like ‘My family has friends, family, and neighbors who we can count on to provide care and support us’ (item 18) and ‘My family enjoys activities available in the community with our child who has special needs, such as parks, library, and swimming pool’ (item 27), reflect item (b), positive social involvement feelings. Finally, item (c), opportunities to enhance their skills, can be found in items like ‘Members of my family have a job if they need or want to be employed’ (item 30) and ‘My family goes to bat for our child in order to get things done’ (item 15). The second factor, control/empowerment, is composed of items that represent the family’s perceptions about the control they have over their own lives. Cruz et al. (2003) report that control and empowerment exist when families feel confident in their own competencies to solve future challenges. These aspects are well represented in items like ‘My family makes the primary decisions about the services for our child and family and where services are provided’ (item 13), ‘My family knows about a variety of community resources, such as child care, and transportation options, to meet our family and child’s broader needs’ (item 3) and ‘My family knows about all of the special services and resources that are available to meet our child’s special needs’ (item 2). In accordance with Neal (2007), terms like knowledge, information and perceptions regarding the resources are applied to describe what the family learns and understands regarding their rights, services and resources. In this way, we designated factor III as knowledge since all of the items reflect aspects of learning and understanding as mentioned by the respondent. In relation to factor IV, involvement, Neal (2007) observes that this reflects involvement and participation in relationships out of the family. Involvement is related to the help of other families with children with special needs, helping services for children with special needs, participating in activities that promote services, or in community


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Table 1. Differences in family perceptions about the kind of support they are provided by EI professionals according to length of time

Variable

Between 6 months and 1 year

Support in EI

Between 1 and 2 years

Between 2 and 3 years

More than 3 years

M

SD

M

SD

M

SD

M

SD

19.20

10.44

19.53

9.14

24.07

9.51

25.33

6.80

F

p

2.822

.04

More than 3 years > between 6 months and 1 year

LSD

organisations/associations, among others. These aspects are evident in items 19, 33, 34 and 32, respectively.

Identification of the type of support that families with children with special needs take advantage of when supported by early intervention teams in Portugal In the analysis of the different items in the questionnaire that assessed the type of support provided in EI, it can be seen that there is a variance of averages between 3.00 and 6.00 and that the average total is 4.8 (4 = sometimes agree, 5 = often agree). This value is very close to the study by Neal (2007), whose sample included 296 families which had an average total of 4.4. It should also be noted that only two families had an average of less than 3.5. The items with the highest value were, respectively, and in descending order, item 17, ‘My family has a loving and enjoyable relationship with our child’ (5.82), item 15, ‘My family “goes to bat” for our child in order to get things done’ (5.72) and item 1, ‘My family knows about our child’s condition, delays, or disability’ (5.50). According to Neal (2007), the items with the highest average were, respectively, and in descending order, item 17, ‘My family has a loving and enjoyable relationship with our child’ (5.77); item 11, ‘Answer to the basic necessities of our child’ (5.46) and item 16, ‘My family feels hopeful and optimistic about our child’s future’ (5.34). The results also showed that the variables of support time in EI and the education levels of the family influence the perceptions of the family in relation to the type of support that is provided by the professional in EI. Analysis of variance techniques (F one way) was used to analyse these two variables. There existed relationships between EI support time and the type of support provided by the professional in EI, F = 2.82, p = .004. To analyse the differences, a post hoc, least significant difference (LSD) test was used which demonstrated that there are statistically significant differences (p < .05) among families supported for more than three

years and those for between six months and one year. Those families supported for more than three years had higher values regarding the perception of support received in comparison with families that were supported for between six months and one year, as shown in Table 1. We also noted significant differences among families supported for between two and three years over those supported for between six months and one year. In other words, families supported for between two and three years had higher perception values of the support they received in comparison with those families receiving support for between six months and one year. Differences in the perceptions of families regarding the type of support provided by the EI professional were found, taking into consideration differences in education levels, namely up to the fourth year, from the fifth to the ninth year, the tenth to the 12th year and a university or higher education course, F = 5.279, p = .02. In the Scheffé test, we found that there existed significant differences (p < .05) among families with an education level of up to the fourth year, between the fifth and ninth year, between the tenth and 12th year and those families with a university or higher education course. The families with an education level of up to the fourth year had higher values regarding the support they perceived having received from professionals in comparison with families with university or higher education courses, as shown in Table 2.

Analysis of the influence of the support mechanisms provided based on the perceptions of families regarding the benefits of early intervention Regarding the perceptions that families have about the type of support provided by EI professionals, it appears that the items that correspond to a higher percentage of families receiving support at that level are, respectively, in descending order, item 1, ‘My family knows about our child’s

Table 2. The differences in the perceptions of families regarding the kind of support that is provided by EI professionals in the different items according to level of education Variable

Up to the 4th year M

Support in EI Scheffé

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24.77

SD

5th to 9th year M

SD

10th to 12th year M

SD

University or higher education course M

F

SDP

9.16 21.9 9.68 23.52 9.37 14.23 8.38 5.279 4th year > to university or higher education course, 5th year to 9th > university or higher education course, 10th to 12th year > 12 year > university or higher education course


p

.002

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condition, delays, or disability’ (93,7%), item 20, ‘My family feels supported by the people who provide services to our child and to us’ (85.7%), item 2, ‘My family knows about all of the special services and resources that are available to meet our child’s special needs’ (84.1%), item 9, ‘My family helps our child develop new skills and learn new things’ (80.2%), item 3, ‘My family knows about a variety of community resources, such as child care, and transportation options, to meet our child and family’s broader needs’ (77%) and item 16, ‘My family feels hopeful and optimistic about our child’s future’ (74.6%). Neal (2007) reports that the items with a higher percentage are, respectively, and in descending order, item 31, ‘In general, my family has benefited and made gains as a result of participating in Early Intervention’ (84.7%), item 2, ‘My family knows about all of the special services and resources that are available to meet our child’s special needs’ (83.9%), item 1, ‘My family knows about our child’s condition, delays, or disability’ (83.3%) and item 7, ‘My family knew what was supposed to happen when it was time for our child to leave Early Intervention’ (80.4%). The items with a percentage below 50%, that is, which are less than half of the respondent families who had some professional support from an EI professional in the resolution and the promotion of these aspects, are, respectively, in descending order, item 26, ‘Members of my family are healthy’ (44.4%), item 24, ‘My family is able to get someone to care for or “babysit” with our child when needed’ (43.7%), item 33, ‘My family tries to help other families who have a child with special needs or tries to help the programmes in some way’ (42.9%), item 8, ‘My family knows about the kinds of services our child might need when he or she gets older’ (38.9%), item 30, ‘Members of my family have a job if they need or want to be employed’ (35.7%), item 32, ‘My family takes part in neighborhood, community, or civic organizations’ (34.1%), item 34, ‘My family takes part in activities that help to improve services for children, such as serving on councils, making presentations, or helping to train professionals’ (31.0%), item 19, ‘My family has a helpful connection with another family who has a child with special needs’ (31.0%) and item 36, ‘Members of my family have taken part in a programme to gain job skills or get further education (completing courses, getting a diploma or degree’ (28.6%). Neal (2007) encountered substantially different values to our study where 20 of the questionnaire items obtained a percentage of less than 50% while in our study only ten items obtained percentages of less than 50%. Only in item 8 of the study by Neal (2007) was a percentage higher than 50% (53.5%) obtained, while in our study this item obtained a percentage of 38.9%. The rest of the items (26, 24, 33, 30, 32, 35, 34, 19 and 36) have a percentage of less than 50% in the study by Neal (2007). To determine the influence of the support provided regarding the perceptions of families about the benefits of EI, the

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statistical test, Pearson’s correlation coefficient RH was applied. Regarding the analysis of the obtained results, it can be verified that there is moderate positive correlation (r = .254) between the support given and the perceptions of the families regarding the benefits of EI and that this correlation is highly significant (p < .01).

Discussion The purpose of this study was to evaluate the support and benefits of early intervention for families supported by these programmes. The results showed that the amount of support time for families in EI influences the perceptions of families regarding the type of support that is provided by the EI professional. Those families who were supported longer by EI programmes believed that they had received greater support. These findings are corroborated by those obtained by Neal (2007), where the researcher found, as we did, that families supported for more than a year obtained higher scores in comparison with families supported for less than one year in the area of knowledge. Contrary to our results, McWilliam et al. (1995) found no statistically significant differences when analysing the influence of EI support time in the perception of families regarding EI services. In contrast, McWilliam et al. (2000) carried out a study whose objective was to determine the extension of the perceptions of the professionals and the families regarding family-centred practices and to what extent the characteristics of the participants explain the variations in these practices. A positive correlation was found in analysis of the variable time of support; that is, the longer the family received EI services, the more frequently they referred to family-centred practices. Pimentel (2005) verified that the longer the EI support time lasted, the less importance and frequency were noted for services focused on the child. Another aspect relevant to understanding the results obtained regarding the time of support variable is the influence of intensity of services on the quality of life of families in EI. At this level, we focused on the research by Dunst et al. (2007) where the influence of intensity of services on the welfare of the family was studied and which concluded that this was negatively related to the welfare of the family. Furthermore, it was found that the contact time between parents and professionals did not influence the feeling of control by parents, but familycentred practices and feeling of control were significantly related. The intensity of services was also the subject of a study by Warfield et al. (2000), which in contrast to the previous study found that a higher intensity of services was significantly and positively correlated with increased family cohesion and further increase in support. Judge (1997), in his study conducted with 69 parents of children with special needs or at risk of developmental delays participating in


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programmes, also found that EI service providers who had spent more time with those families studied (number of contact hours per month, ranging from less than one hour per month to over five hours per month) had a more positive assessment with regard to their practical support. It was also found that parents who had more frequent contact with professionals demonstrated a greater degree of control and involvement. Mahoney and Filer (1996) obtained a moderate but significant correlation between the number of home visits in EI and the amount of information received by mothers regarding their children and their learning activities. Cruz et al. (2003) showed that families who had received support for a longer period of time had a lower level of satisfaction regarding their knowledge of the rights of families and regarding the turnover of EI professionals. It was also found that as frequency of support increased, so did the importance of EI in the lives of families. Contrary to our results, Dempsey and Carruthers (1997) found that there were no differences between parents who were supported by EI professionals for at least one year and those receiving such support for between one and three years. Regarding the analysis of the interaction variable, the impact of parents’ education level on perceptions of families regarding the type of support that is provided by the EI professional, there appear to be significant differences between families with only primary and secondary education levels and those parents with a university or a higher education degree. The education levels of families were also studied by Bailey et al. (2004), who found that 12% of families where the primary caregiver had less than secondary school level education reported a great deal of difficulties in obtaining services compared with 9% of those with a Bachelor’s degree or higher. The study by Dunst et al. (2007) also evaluated the influence of socio-economic status on the welfare of the family. This was determined through the family’s annual income, years of schooling and job situation, concluding that families with higher socio-economic status tend to evaluate practices as less family-centred. Therefore, the influence of socioeconomic status of the family has an effect on the sense of control and well-being of the family. Contrary to our results, McWilliam et al. (2000), found no statistically significant differences when analysing the influence of socio-economic status on the perception of families regarding family-centred support received. Satisfaction of supported families was the subject of a study by Cruz et al. (2003). Responses from 161 families supported by EI programmes were analysed with the main objective of analysing their level of satisfaction. It was also found that, overall, supported families were satisfied with the service provided by EI professionals. Some trends in the data collected were observed, particularly that of lower satisfaction among respondents with higher educational levels. It was also these families who indicated that they had

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received less information about services providing financial and administrative support. These families revealed a low level of satisfaction regarding the knowledge they had about their rights. These results are in line with those obtained by Almeida (2009), who found that mothers with a higher educational level showed lower levels of satisfaction. Regarding the interaction analysis between the support variables provided and the perceptions of families regarding the benefits of EI, there existed a significant and moderately positive correlation (p < .01). That is, the support provided influenced the perceptions that families had of the benefits of EI. Cruz et al. (2003) verified globally that supported families were satisfied with the service that was provided by EI professionals and that EI helped them feel much more confident in solving their own problems. The results obtained by Mahoney and Filer (1996) in their study of 357 mothers showed that the services that offer programmes for families in EI are highly responsive to their needs. Turnbull et al. (2000) also reported that EI programmes resulted in benefits in the levels of empowerment and knowledge. Bailey et al. (2004) studied parental satisfaction concerning initial interactions with EI professionals and found that most respondents (77%) believed that their involvement in decision making was adequate, but a substantial number of parents (22%) wanted more involvement. Respondents reported a high degree of satisfaction with EI professionals with a percentage higher than 98%, implying that these professionals respected the values and cultural backgrounds of the families, which helped them feel more optimistic about the future of their child. However, approximately 7% agreed or strongly agreed that professionals ignored their opinions, although most families disagreed with this statement. Almeida (2009) also verified in her study that as many mothers as professionals valued family-centred practices and that the more family-centred the programme was, the greater was its degree of satisfaction. She also examined the perceptions of mothers in an attempt to answer the following research questions: did the programmes introduce positive changes in the lives of children and their families? Were families satisfied with these programmes and did they help them build a positive vision of the future? Almost all mothers felt that the EI programmes introduced positive changes in the lives of their families and reported only positive aspects of relationships with professionals, and about half of the mothers were optimistic about the future, while the other half felt insecure. Bailey et al. (2004) concluded that parents were of the opinion that the positive results obtained for both the child and the family were the result of EI. Nearly three-quarters of the sample (2,586 households) reported that EI had a tremendous impact on the development of their children, and that the family became ‘better’ because of the help and information received through EI support. McWilliam et al. (1995) found that the individual behaviour of the


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professionals was often directly linked to the positive impressions that families had of the services of EI. McBride et al. (1993) found that the families were able to describe very clearly the way in which they had been strengthened by their participation in intervention programmes, and felt they had gained knowledge and parenting skills and also that the progress of their children strengthened the welfare of the family. The relationship between family-centred practices regarding the degree of satisfaction of families was also studied by Romer and Umbreit (1998). Their results clearly showed a high degree of satisfaction (76%) when professionals worked from a family-centred perspective. When the family-centred model was not implemented the families had a high degree of dissatisfaction (85%). None of the parents studied by Dempsey and Carruthers (1997) were very dissatisfied with the support received by the EI programme, and the vast majority of parents were either satisfied (26.5%) or very satisfied (70.9%). However, except for items related to concerns and well-being, there was a statistically significant difference between current practices and desired support.

Limitations, implications and future directions Study limitations The first limitation relates to the sample itself; as it only analysed one district of Portugal it may be difficult to make generalisations from the findings. Another limitation of this study relates to the use of the questionnaire as a tool for data collection because, even though the study method of the questionnaire was recommended by the Early Childhood Outcomes Centre (Bailey et al., 2006), it has some disadvantages: families with low literacy skills were unable to answer or had difficulty in answering the questionnaire, which therefore limited the scope of the sample. The use of only one collection data tool to assess the support and benefits of EI for families implies another important limitation which should be highlighted. The questionnaire covered only closed answers, so it was not possible to collect other data that would allow for a more qualitative clarification of some answers. The factor analysis carried out at the level of the questionnaire items resulted in four factors, namely well-being, control/empowerment, knowledge and involvement. These dimensions of the benefits of support in EI should be a cause for reflection in future studies, since research indicates the importance of considering the additional dimensions related to the child’s development (Dunst et al., 2007). Implications and future directions We believe that while research regarding the benefits of EI for supported families in Portugal is still at an embryonic

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stage, it is nevertheless important to recognise some ideas that we will submit as recommendations, which may have implications for policy, practice and research professionals. In the area of policy, a comprehensive system of services should maintain a link with the results of the joint efforts of families and not be isolated to the provision of services. The results obtained in this study indicated a good average related to the benefits of EI for families and, in the majority of items, the families considered that they received support from professionals. In this way, our data highlight the importance of EI in the lives of families with children with special needs, which calls for the hiring of human resources for EI teams in order to ensure accessibility for all families with children with special needs. Given the current difficult economic and financial processes that Portugal is going through, it is imperative to combine efforts to ensure the rights of families to access EI services. The evaluation results from a given family are crucial in determining the effectiveness of EI services, and may also help to contribute to the vision and policy-making decisions regarding the funding of these services. Another aspect relates to the need to promote more and better training of professionals in the specific area of EI so that they can become better qualified and apply practices recommended in EI, including a family-centred approach, a trans-disciplinary model and support in natural contexts, among others, as these approaches lead to more positive outcomes for children with special needs and their families. Finally, from a revolutionary perspective, perhaps policy makers could include family members in policy-making decisions regarding EI, since they are the ones who must determine and decide how services should work in order to provide them with accrued benefits. With regard to practice, we recommend that professionals should pay special attention to the presentation of the results of this study which can be seen as ‘predictor’ results, attesting to the powerful influence of EI on family life. We must also be aware of the less common types of results reported by families as benefits of EI, since they can be targets of intervention that are being neglected for some families. These results also demonstrated which support items the family considered they did or did not receive from EI professionals, so they can serve as a starting point for the improvement of practices and appropriateness for the needs, expectations and individuality of families. Finally, in relation to research, and in light of the limitations described above, it would be interesting to include the benefits and support given to families involved in EI in the various districts of Portugal. In order to obtain more consistent and relevant information about the data collection instrument, it would be interesting to analyse the content of the items, their quality and relevance to the Portuguese reality by extending this analysis to the opinions of EI experts and professionals and families from other geographic districts.


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In order to reach an approximation to the reality of most families supported by EI in Portugal, it might also be appropriate to apply simultaneously a qualitative methodology for the selection of families who could be interviewed to clarify some answers or add some open-ended response items to the questionnaire used in this study.

Acknowledgement This work is financed by national funds by FCT – Fundação para a Ciência e a Tecnologia under the project pes-OE/ CED/UI1661/2011, cied.

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Correspondence Ana Paula da Silva Pereira Departamento de Psicologia da Educação e Educação Especial Instituto de Educação, Universidade do Minho Gualtar 4700 Braga Portugal Email: [email protected]


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