C3.2 Child Development, Attachment, and Early Intervention

Early childhood, from birth to age five (5), is the most critical time of development and growth for children. The brain is rapidly developing during this time, resulting in the young child’s physical, cognitive, social, and emotional development and the acquisition of communication skills. Physical milestones include mastering both large and fine motor skills; cognitive milestones include the ability to learn and solve problems; social and emotional milestones include learning to interact with others and understanding facial expressions and emotions; and communication milestones include developing speech and language skills.  

The caregiver/child relationship quality sets the foundation for healthy development. Positive experiences such as nurturing interactions with caregivers and promptly meeting needs support physical, cognitive, and social-emotional development. These positive experiences and nurturing interactions help a young child to form attachments, which then provide a foundation for future mental and physical health and the ability to have healthy relationships. Conversely, early adverse experiences, trauma, and maltreatment, including chronic neglect, can impair healthy development. Removal from the home and instability in caregiving arrangements can also negatively impact development and the ability to form healthy attachments. Young children need at least one reliable, consistent, and nurturing caregiver. It is not enough to have basic needs met by constantly changing caregivers. Helping young children develop a secure attachment with a consistent caregiver and meeting developmental needs is critical to both short- and long-term well-being. Issues such as post-partum depression or anxiety, parental mental health, or substance use may interfere with the development of a healthy attachment with a consistent caregiver. Similarly, when young children have undiagnosed conditions, such as hearing loss or autism spectrum disorder, attachment may also be negatively impacted. (See Child Development and Attachment Tip Sheet for more detailed information on assessing and promoting attachment.) 

A developmental delay occurs when a child does not meet developmental milestones within comparable timeframes as peers of the same age. Many factors can contribute to developmental delays, including prematurity, congenital disorders, medical issues, early trauma, exposure to substances in utero, or lack of a consistent caregiver or attachment figure. Sometimes, the cause is unknown. Many of the same factors that can contribute to developmental delays also make a young child more likely to come to the attention of the Department for Community Based Services (DCBS). Children in out-of-home care (OOHC) are much more likely to experience developmental delays than their counterparts. Research indicates more than fifty (50) percent will have some type of developmental delay. Developmental delays, in turn, make the child more vulnerable to future maltreatment. Therefore, professionals working with young children and their families must be knowledgeable about child development and attachment and promptly make the necessary referrals for early intervention services.

The Individuals with Disabilities Education Act (IDEA) is a federal law that ensures services to children with disabilities. IDEA governs how states and public agencies provide early intervention, special education, and related services to eligible infants, toddlers, children, and youth with disabilities, and their families. Infants and toddlers, birth through age two (2), with disabilities and their families receive early intervention services under IDEA Part C. Children and youth ages three (3) through age twenty-one (21) receive special education and related services under IDEA Part B.

The Early Intervention Program, created by IDEA, is a program for children from birth to their third (3rd) birthday who are experiencing developmental delays or have a physical or mental condition with a high probability the condition will result in a delay. The Department for Public Health (DPH) administers Kentucky's IDEA early intervention program​​ . It is known as the Kentucky Early Intervention System (KEIS, formerly First Steps), a statewide program that provides services to children with developmental disabilities and significant developmental delays. This program offers comprehensive services through a variety of community agencies.

IDEA Part C requires that all children birth to age three (3) involved in a substantiated case of abuse or neglect and all children exposed to illegal substances in utero be referred to Part C early intervention services (KEIS). Following the referral, the KEIS providers will evaluate and assess for developmental delays or other needs for services. The initial evaluation is performed using evaluation instruments that address the five (5) developmental domains of cognition, communication (receptive and expressive), physical development (gross and fine motor), social and emotional development, and adaptive (self-help) skills development. To meet Kentucky’s definition of a significant developmental delay and qualify for services through KEIS, the child must obtain a score that indicates a delay of two (2) standard deviations or more in at least one (1) developmental domain or one and a half (1.5) standard deviations in at least two (2) developmental domains. Therefore, a child may have a developmental delay but not a significant delay that qualifies for KEIS services. In those situations, a child may benefit from other services.  

If a child is eligible for services through KEIS based on the assessment, an individualized family service plan (IFSP) is developed collaboratively by the family, evaluator, and early intervention professionals. An IFSP is a written plan for providing early intervention services to eligible children. A meeting to develop the initial IFSP is conducted within forty-five (45) working days of the referral to KEIS. IFSPs are reviewed at least every six (6) months but may be held more frequently as needed or at the family’s request. IFSP services are also administered through KEIS.