(Draft)

To speak about Early Intervention in Portugal is not an easy task. Early Intervention history is very, very recent!

Before the 1980s, we can not speak about early intervention programs in Portugal. There was a general lack of attention of the government regarding this problem. However since the 1980s, specially in the 1990s, there has been an increase of local initiatives to provide services with some organization and consistency to the special needs of young children.

Now we have a relatively high number of different E. I. local programs around the country and, finally, in the last years the Portuguese government began to pay attention to early childhood intervention.

Obviously, this "new-born" condition of E. I. has important implications on the present situation at different levels:

 1. Low number of children with disabilities identified and attended in the first years of life;

 2. Quality: practices with different quality standards based on different conceptions of E.I.;

 3. Non existence of a legislation to give a framework and to rule the early intervention service delivery;

 4. Inappropriate training provided to professionals in its various forms:

• Initial training - the most part of professionals working in E.I. have no specific training besides their initial training in different areas (education, psychology, different therapies, health, etc.). Generally, the different courses do not include any specific subject matters about early intervention.
• Specialized Training - In 1995, Porto University created the first early intervention master's degree. Later, two other universities included early intervention modules in their master in Special Education.
• Non academic in service training - since 1985 an important number of professionals have been making Portage courses (basic and advanced). In service training has also been organized by some E. I. Projects during the last years.

5. And the last point to be emphasized is the scarce research and also scarce systematic studies in this field.

We can, however, identify some relevant landmarks and trends of E.I. movement in order to reflect the development of a service delivery system for young children with special needs.

Early childhood issues are connected with the development of health, education, childcare and economic policies. Thus, to a better understanding of the development of E.I. in Portugal, it is important to give a comprehensive overview of social and policy climate.

How have these sectors policies and practices concerning Health, Education and Social Security) been moving in order to increase the development of childhood care, pre-school services and provisions for children with disabilities?

After the April Revolution in 1974, crucial changes were introduced in our country. Portugal was an isolated and underdevelopped country, a closed society with a political repressive regime, facing a colonial war implying human and financial high cost.

Before the seventies, there was a very limited knowledge of the country reality. However, the coverage rate of early care and education services, of pre-school education and special education services was extremely low.

Even the compulsory schooling was of 6 years in 1964. High rates of school drop out and grade retention were the main features of our primary and secondary education system and the illiteracy rate was very high too.

Teacher training was not included in Higher Education or University. The Welfare Ministry provided special teacher training in a non-academic context.

With the Revolution, there was a "cut" with the former regime, and Portugal tried to encompass Europe, building the bases of a modern and democratic country.

The April Revolution in 1974 and Portugal joining to the European Community in 1986 are two important landmarks to our reaching the European levels. However Portugal yet remained a country with important asymmetries and underdeveloped zones.

Let's try point out a chronological review.

From 1970s to 1980s

During this period, there were some important steps toward an improvment of the resources and services in the field of Health, Education and Welfare, mainly in the 80s.

We must stress that in the first years after the 1974 Revolution a special attention was paid regarding the health system for young children and social protection system for families. The maternity allowance became of 3 months, and some other familiar allowances were introduced namely for families with handicapped children.

In what concerns the public health system the changes were on the improvement of local Health Centers and the care for pregnant and new-borne children under a preventive view.

Early childhood care and provision was from the exclusive responsibility of the Ministry, of Welfare while the pre-school education responsibility was divided by both Ministry, of Welfare and Education.

In the late 70s, these two Ministries increased their concerns about this field and tried to reorganize their delivery services.

Though, the two policies in the field of early childhood care and pre-school education, one more oriented toward educational concerns and the other, more oriented to social problems, didn't bring a great improvement to the youngest children provision.

In the 70s, we have no figures for coverage under 3, but the estimate was of a very low coverage. During the 80s, only 6% of children under 3 attended formal settings.                                                                                          

The pre-school coverage rate increased in a more significant way. In the 70s, it was estimated a pre-school coverage about 21 %, and in the beginning of the 80s, about 35% of children from 3 to 5 attended pre-school settings, according to the following taxonomy: official, non-profit, and private for profit institutions.

The IEA/PPP studies (International Educational Achievement / Pre-Primary Project) started in 1986 gave an important contribution to the policy makers providing a diagnosis of pre-school situation in 1988.

A National Survey in 1988 about contexts for children aged from 4 to 5 in a sample of 581 gave the following results:

• Children at kindergarten - 31%
• Children exclusively at home (mostly with their mothers) - 29.4%
• Children in informal contexts mainly with grandmothers - 38%
• Children with unknown contexts - 1.6%

In the same period the coverage rate from 3 to 5 was 35%.

The team of this study pointed out the need of making pre-school education available to all children in Portugal. This also involved developing programs for ethnic minorities, children at risk and children with special needs.

In what concerns children from 0 to 3, we have no data concerning the settings they attended.

As for the special education, the figures are also very low. The OCDE/CERI Report of 1984, based in the Warnock Report rates, assumes that Portugal in the 70s and 80s had a coverage rate about 21 %; of these children about 80% were attended in segregated private structures; and 20% were integrated in regular public schools services of the Ministry of Education.

In 1973, the Ministry of Education assumed a new policy to the needs of children and students with handicaps, with the organization of a Special Education Department.

Nevertheless, it was only after 1974 that special education Itinerant teams spread all over the country mainly focussed on the attendance of children of compulsory education in public schools. Pre-school children were seldom attended in these programs and for them the scarce resources were mainly the private one.

On the one hand there was a step forward in order to integration; on the other hand, there was an increase of segregated initiatives and other incongruent legislative measures, such as, the decree law of 1979 exempting handicapped children from the compulsory school. This decree established:

"The children certified as handicapped may be exempt from enrolment or attendance of classes until the school-leaving age, provided that the parents or guardians make a  formal request for exemption at the School Medical Services " (OCDE/CERI, 1984).

The new Educational System Law of 1986 mentions the importance of integration and early intervention. However, practical measures are not explicit and remained a tacit acceptance of the segregated system for the children that the general system can not integrate!

During the 1990s

The 90s policies, mainly the second half, permit certain optimism concerning the basis for emerging the early intervention programs in Portugal.

In 1997, Portugal reached health indicators as the majority of developed countries of EU:

• Infant mortality - 6.4 ‰
• Neonatal mortality - 4 ‰
• Perinatal mortality - 7.2 ‰
• Delivery without assistance - 4 ‰

Nevertheless social and economical family conditions are still very low. Eurostat recent data inform us that Portugal is the country of EU with highest number os families in poverty (29%). An important set of measures had been released, and we hope that the situation is changing.

In the field of care and education under 3, the coverage rate had only a slight improvement. In 1998, it was about 14.5% in formal settings.

A study made in 1998 in Lisbon region of concerning the children care situation from 0 to 11 years old came to the following results:

• For children under 3, whose mothers were employed (69% of the studied population) around 33% attended day-care centers; 29% stayed with careminders, and 16% stayed with grandparents.

It is important to say that the Portuguese woman force labor is about 80%, which means the crucial needs of attendance for children under 5.

In 1998, the pre-school education coverage rate was about 60.5%. This means an important step towards the goals established by the government for 2000:

• Total coverage for children 4-5 years of age,
• Coverage rate of 70% for the group of 3 years.

In 1997, a new Law for Pre-school Education and other related legal dispositions sets a very positive framework to the development of pre-school education in Portugal. Than, pre-school education is defined as the first step in basic education and is intended for children from 3 to compulsory school age entry (6 years).

In what concerns special needs education, important steps have been done too.

A decree from 1990 (35/90) finally established that the requirement of nine years' compulsory education should be extended to all children, without exception, which means including students with disabilities, or those having multiple impairments.

Another new law (Decree Nº 319/91) trying to regulate the attendance of children with special needs in public regular schools, emerged in 1991 which includes many features of the English and American laws. Though recognizing its importance today we can see some limitations on it. It is clearly children-oriented and not school-oriented and nothing was referred to about early intervention.

Early intervention was first referred to in a decree from 1997 (Decree Nº 105/97), which reorganizes the Special Education Teams promoting the development both of support teacher as part of school staff and creates the Local Support Services, at a district level.

Local Support Services have as fundamental function to collaborate with ordinary schools in their efforts to provide inclusive education and to coordinate all support services for children with special needs from birth to the transition phase leading to working life.

According to the official data, in the last years we find an increase integration pattern for school-age children. In 95/96, the attendance rate of children with special needs was about 80% in regular public schools against 20% in private special structures. In 1998 this rate changes to 89% in regular public schools against 11 % in private special structures.

However, in what concerns national coverage rate from 0 to 15 years, it was estimated about 50%. This figure was obteined through an indirect calculation process.

Concerning handicapped children attended in pre-school settings in 1002 only 40% of settings enrolled these children (ICCE, 1992).

EARLY INTERVENTION

How does EI emerge from this context?

As mentioned above, only in the early 80s an increasing attention was paid to the necessity of providing services to young children with special needs and their families. So, professionals of Health, Education and Welfare started being concerned about early identification and early stimulation.

Though the identification of children's problems continued being too late mostly at primary school or kindergarten entry.

The few initiatives of an approach to young children were mainly characterised by the diagnostic perspective and "some" counselling to families. The few under 5 children attended were in a traditional model: either medical or rehabilitative.

In the late 80s some significant experiences within this area appear in Portugal. Among those, we will consider two experiences that reveal a step forward on E.I. in Portugal.

"The Center of Studies and Support for Children and Family", - Lisbon (CEACF) - Early Intervention contributes

This agency was established in 1967 within Welfare Ministry after the French model of "services medico-pedagogiques" to provide assessment and other supports for children of school aged with disabilities and at risk as well as their families.

Since the beginning, this Center has had an innovator role on the field of special education related services and it was the first service in Portugal including interdisciplinary teams. Soon, it enlarged the age rank to attend pre-school children.

Later,in 1985, concerned about early intervention and recognizing their teams training needs to provide early intervention services, the Portage model was introduced, receiving support from the English Portage Association, the Institute of Education of London University and from CESA 5., U.S.A.

Thus, an action research project was initiated in 1986: "The Early Intervention - based on Portage Model for Parents". This Project had three main goals:

To provide home-visiting programs to children under 3 referred to the Center.

To develop and disseminate an early intervention model adequate to enormous needs of the country in this field thorough in-service training courses and supervision.

To evaluate project impact on children, families, professionals and local service.

These initiatives had a decisive role on the early intervention movement in Portugal and with the collaboration of PIIP of Coimbra was founded in 1992 the Portuguese Portage Association.

More than 500 professionals from all the country had received Portage training courses and other early intervention modules through in-service training.

Resulting from this project evaluation as well as from the general evolution of early intervention models and practices in the last years, a family centered approach has been progressively developed by some of the teams from CEACF. Mainly after 1993 when her director had the opportunity to stay for 2 months as a visitor scholar in FPG, Cnapel Hill.

At present in the region of lisbon CEACF has an important role in the field of E.I., providing:

• E.I. services, home-based and centered-based for families and their children under 3.
• Technical Assistance and in-service training to other agencies namely, Ministry of Education teams.
• Collaboration as a partner in a community-based E.I. Program (Odivelas);
• A home visitors training program for non-professionals.

The Early Intervention Integrated Project of Coimbra - 1989/1999(PIIP)

We can say that an integrated or comprehensive way to face the needs of disabled and at risk children under 6 and family needs through local services collaboration take place for the first time around 1976 with Agueda Project. At least, it is the first most relevant attempt known in Portugal.

In the late 70s and especially along the 80s, this Project had a great influence to other similar attempts, namely to the Early Intervention Integrated Project of Coimbra.

The Early Intervention Integrated Project being developed since 1989 in the region of Coimbra (central/littoral region) is a good example of an innovative experience based on collaborative efforts initiated by Regional state departments (health, welfare, and education ones). An effective interagency organization involving public and private institutions gave way to develop community-based delivery systems to disabled or at risk children under 3 and their families.

Ten years later, in spite of the difficulties connected with getting the needed government funding, and human resources mobility, the Project counts with 18 early intervention local nuclei. A broaden community perspective is clearly associated with early intervention provisions in the Coimbra Project.

Since the beginning, its work as been mainly home-based and family centered. The Portage model was an important reference to the Project, especially in its first years, having the first practitioners received Portage training and supervision from DSOIP and Portage Association. The staff training thorough frequent in-service activities with national and foreign specialists, visiting experiences carried out in other countries, etc. has been one of the measures adopted by the Project to enable its staff.

Although the Project has not a comprehensive evaluation of the its outcomes sofar, the PIIP really seems to be an example of good practices to bear in mind in Portugal, concerning:

• The possibility of integrating and coordinating services from multiple agencies (public and private ones);
• The developing of teamwork in a family centered approach and in a community based perspective;
• The importance of providing adequate training to professionals.

In the last years, PIIP has been providing an important support to the implementation and development of other Projects in the country and to the in-service training of many professionals.

* * *

The paradigm shift introduced by these two entities associated with the public policy funding thorough national or European community programs, led to a meaningful increase of E.I. Projects along the 90s.

On the other hand, the criteria, the organizational and methodological conditions, required by these funding policies and programs, introduced several positive features to the development and quality of the new projects. The most important aspects are the following:

• A well detailed planning with definition of: goals, target population, methodology, needing resources, budget provision as well as evaluation process.
• Partnership, interagency collaboration and interdisciplinary team work.

Since this period, a meaningful number of privates, non-profit and public agencies, came promoting E.I. projects. At this moment, we have diversified initiatives concerning E.I. practices although some of these projects developed under the new designation adopted traditional models and strategies. In some cases persists a medical model and practices more similar to early stimulation ones.

On the other hand, we have no reliable statistics or empirical studies, which permit us to know objectively the needs of children under 3 and their families.

Yet, we know the existence of early intervention programs with irregular implantation and a very low coverage of needs. Indirect estimations point out coverage between 1.5% and 3% of children with special needs under 3.

Nevertheless, who receives any kind of early intervention, stimulation or support? Before trying to establish a very rough scheme of those receiving any kind of help we must mention that the age of the children attended in the so-called "early intervention activities" goes up to five years of age.

Distribution of children receiving any kind of support:

• Children attended by day-care or kindergarten.
• Children with medical problems and/or followed by development centers (medical structures).
• Children attended by special education teams mainly by pre-school teachers.
• Children attended in the new integrated projects of early intervention (very recent).
• Children attended in pediatric hospitals or rehabilitation centers.

Now we will try to characterize some aspects of E.I. Programs in Portugal from two studies on the evaluation of programs. consistent ones we know. They both try to make a typology of E.I. Programs through the same instrument, the "Scale for Evaluating Early Intervention Programs" (Mitchell, 1991).

Veiga Study (Veiga, 1995)

In the first study, (Veiga, 1995) did her research in the context of an E.I. master degree in Porto University. She analysis 13 E.I. Programs sponsored by the Welfare Ministry and the Ministry of Education carried out in public, profit and non-profit private institutions.

These programs were submitted to a qualitative analysis using an adapted version of the scale mentioned above. In its original version, the scale included 51 items clustered in 14 dimensions but in this study, only 12 dimensions were used.

"Scale for Evaluating Early Intervention Programs" (Mitchell, 1991)

A. Children served by program
B. Assessment
C. The Curricula
D. Counseling and support
E. Advocacy
F. Transdisciplinary approaches
G. Staff training
H. Program evaluation
I. Cultural sensitivity (not used)
J. Interagency co-ordination
K. Parent-professional relationship
L. Integration
M. Location and Physical environment
N. Administration (not used)

Owing to the low number of cases, we must be very careful when analyzing the conclusions. The more relevant conclusions are:

• A child centered approach characterizes most of the programs;
• Most of the program stress the importance of the curriculum, but its use seems to be limited to assessment tasks. There is no reference to a curriculum-approach to the goal planning and its evaluation;
• The parent's role is valued in the assessment process, although their most important role is to give information and rarely participating in the decisions;
• Regarding family concerns and resources, they are rather based on subjective impressions and value judgments made by the professionals than on a true information gathering based on family information, and the program goals are not consistent with them;
• Family supporting strategies used don't promote family autonomy but they stimulate a dependence relationship on the professionals;
• In the most of the programs, an effective interdisciplinary team work wasn't found but a group of professionals providing fragmented and non integrated facilities instead;
• None of the practitioners involved in the programs received an academic early intervention specific training. Only some of them received some in-service training and they haven't any kind of supervision;
• No program had an evaluation planning and a systematic evaluation based on family and children outcomes.

The author still found that the Welfare and Social private agencies programs revealed higher quality standards than those run by the Ministry of Education (M.E.). The main weaknesses of M.E. programs are related to the monodisciplinary practices and to the children eligibility criteria to the program: attendance of a formal pre-school setting.

Almeida Study (Cercizimbra National Meeting, 1998)

The other study occurred in 1998. It consists of a qualitative analysis over on 12 E.I. Programs description made to a presentation of Posters in a national meeting (Almeida, 1998). The taxonomy of projects was similar to the former research:

• 5 programs depending on the Welfare Ministry;
• 1 program depending on a private social initiative institution;
• 1 program depending on a private for-profit institution;
• 7 programs of integrated projects of interagency collaboration.

These integrated projects are an innovative model that was scarcely disseminated at the time of the former study. They mainly emerged from 1995 on after the government funding policies.

For the qualitative analysis the author created a greed based on the "Scale for Evaluating Early Intervention Programs" (Mitchell, 1991). According to the 13 categories used, we can find the following results on the Table 1:

Table 1- Early Intervention Programs - Content Analyses results (Cercizimbra National Meeting, 1998)

Studies Conclusions

Four years having separated these two studies, what is important now is to conclude if there was a relevant improvement between them, in spite of the different methodologies.

• In 1995, parents were rarely seen as active partners while an active parents'role or family involvement is evident in the 1998 projects. Ten of these programs stressed the importance of family involvement and 2 of them stressed the parent's partnership and their decision-making role. Although we should ask if a family-centered approach is already an effective practice or if it is still a providers' desire.
• The two studies identified team working as being something difficult, mainly owing to the monodisciplinar characteristics and tradition of the Ministry of Education support teams. Nevertheless, some progresses appeared in the 1998 projects. The 1998 study at least revealed 8 projects having multidisciplinary approaches and 4 having a transdisciplinary one. This progress is due to the interagency collaboration.
• The interagency coordination present in the most of the projects reviewed in 1998 is much more positive, although only 2 projects refer to the existence of the "case manager", which is an important condition to guarantee effective practices coordination.
• The reference to inclusion policy perspective is almost inexistent.
• Clear references to curricular aspects are omitted by the projects in both studies, some differences emerged in 1998 projects, expressing a family -centered intervention process. However, this dimension came more visible thorough some formal statements about how the practices were perceived by the providers than effective behaviors expressed. On the other hand, neither development adequate practices principles nor well-defined educational goals are used in the activities planning. The providers' interventions seem to be oriented by what we can call "hidden-curricula".
• The staff training activities are a weakness expressed in all projects, in what concerns academic and non-academic facilities. In spite of the scarce and dispersed activities of in-service training, this is the only training support to the most of the providers. Even today, a high number of program providers revealed that the Portage training courses were the only early intervention training facilities they have received. The supervision practices are also more common among the programs whose providers have received Portage training.
• The program evaluation revealed to be absents in both studies. In spite of being a crucial factor to guarantee programs quality, only 3 of the 1998 projects revealed concerns about program evaluation.

GENERAL CONCLUSIONS

1) The development of early intervention programs in Portugal can not be separated from the general situation of the country.

2) Programs are linked with the evolution of the systems of Health, Education and Welfare.

3) In the last 30 years the evolution of these systems has been slow, disconnected and irregular with very low rates of coverage. So "something" must happen in order to accelerate the implementation of EI Programs.

4) Considering that 1 in each 3 Portuguese families live in poverty, important financial investments both from Portugal and EU have been made in Health, Education and Welfare Projects, to face the situation. Among these projects we can mention "Fight against poverty" (EU), "Grow up well", "Minimum guaranteed income" (which covers 400,000 families), etc. These programs have a double aim: to give financial support and to promote social inclusion. So these efforts must be put in connection with EI Programs in the geographical regions where they are developing.

5) Because of the above-mentioned social problems, the population requiring more effective early intervention is the one of children at risk and their families. Therefore these programmes must be developed in close connection with general programmes of social development

6) Programs of EI in Portugal should give priority to children from 0 to 3 and their families. One of the reasons has already been mentioned: the great number of children at risk. The other deals with the fact that the most important care setting for those children is the family.

7) Given the fact that Portuguese EI Programs are developed in a disconnected and not planned way, a categorisation of the existing programmes must be organise in order to correct the situation.

8) Following this categorisation a typology should be established in order to adequate those programmes to different regions, populations and resources as well as to promote a good co-ordination between local services and an effective participation from famities and community.

9) The training of E.I practitioners is an important issue in Portugal. In order to solve this problem Universities, Higher Schools of Education, and others Schools should organise their resources at regional level as suggested for projects.

10) The rare existing post-graduate EI training should be enlarged. The internationalisation of E.I. programmes and the development of some "excellence poles" could be a way to dynamize training and research.

11) Some especial issues:

a) Difficulties of E.I. Portuguese professionals in a co-operative work with adults, both other professionals and parents, must be a concern of training at all levels: initial and in-service.

b) Child-centred practices of the majority of professionals are another problem to overcome, at training level and attitudes.

c) The attitudes of professionals toward families must change. A role of "expert" must give place to a role of partner.

d) The attitudes of dependence of families in relation to professionals must be object of concern in order to change.

e) It is important to adequate to the Portuguese culture: models, instruments and practices imported from other countries.

12) Key words for the improvement of EI in Portugal:

a) Decentralisation

b) Collaboration / Co-ordination

c) Implementation / Diffusion of adequate models of EI

d) Innovation at the training level

e) Research