Complex Medical Needs and Homelessness: A Case Study of the Natural Environment

Abstract

Infants and toddlers with complex medical needs are likely to receive early intervention (EI) services, which take place in children’s natural environments (NEs). Little is known about the NE of children with complex medical needs or how their EI services are implemented in consideration of their intersectional identities. In this case study, we explored the NE of one child with complex medical needs who was experiencing homelessness and how his EI services were embedded in his NE. We used multiple qualitative methods, including observations, interviews, document review, auto-photography, and photo-elicitation. Using thematic analysis, we developed five themes from the data: (a) description of the child’s NE, (b) the family’s planning and intentionality, (c) positivity and acceptance, (d) family expertise versus provider expertise, and (e) a continuum of practices. Implications relate to practices that align with a family’s unique circumstances and the need for research that addresses a family’s intersectional experiences navigating disability.

Keywords

family-centered low-incidence disabilities disability populations partnerships with professionals families home visiting poverty case studies

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References

Annamma

S. A.

Connor

Ferri

(2013). Dis/ability critical race studies (DisCrit): Theorizing at the intersections of race and dis/ability. Race Ethnicity and Education, 16(1), 1–31. https://doi.org/10.1080/13613324.2012.730511

Bayer

N. D.

Wang

J. A.

Kuo

D. Z.

Halterman

J. S.

Yue

(2021). A national mental health profile of parents of children with medical complexity. Pediatrics, 148(2), 1–10. https://doi.org/10.1542/peds.2020-023358

Bedell

Coster

Law

Liljenquist

Kao

Teplicky

Anaby

Khetani

M. A.

(2013). Community participation, supports and barriers of school-age children with and without disabilities. Archives of Physical Medicine and Rehabilitation, 94(2), 315–323. https://doi.org/10.1016/j.apmr.2012.09.024

Blanchard

S. B.

Newton

J. R.

Didericksen

K. W.

Daniels

Glosson

(2021). Confronting racism and bias within early intervention: The responsibility of systems and individuals to influence change and advance equity. Topics in Early Childhood Special Education, 41(1), 6–17. https://doi.org/10.1177/0271121421992470

Brantlinger

Jimenez

Klingner

Pugach

Richardson

(2005). Qualitative studies in special education. Exceptional Children, 71(2), 195–207. https://doi.org/10.1177/001440290507100205

Braun

Clarke

(2019). Reflecting on reflexive thematic analysis. Qualitative Research in Sport, Exercise and Health, 11(4), 589–597. https://doi.org/10.1080/2159676X.2019.1628806

Bronfenbrenner

(1977). Toward an experimental ecology of human development. American Psychologist, 32, 513–531. https://doi.org/10.1037/0003-066X.32.7.513

Brown

S. M.

Bender

Orsi

McCrae

J. S.

Phillips

J. D.

Rienks

(2019). Adverse childhood experiences and their relationship to complex health profiles among child welfare-involved children: A classification and regression tree analysis. Health Services Research, 54(4), 902–911. https://doi.org/10.1111/1475-6773.13166

Ciupe

Salisbury

(2020). Examining caregivers’ independence in early intervention home visit sessions. Journal of Early Intervention, 42(4), 338–358. https://doi.org/10.1177/1053815120902727

10.

Dale

(2023). 20 disability activists using TikTok to break down stigmas. The Influence Agency. https://theinfluenceagency.com/blog/tiktok-disability-activists-to-follow/

11.

Decker

K. D.

Meldrum

Vaterlaus

J. M.

Foster

T. D.

(2021). Parents’ Part C experiences in rural areas: Alignment with recommended practices. Journal of Early Intervention, 43(2), 155–175. https://doi.org/10.1177/1053815120953484

12.

Division for Early Childhood of the Council for Exceptional Children. (2022). Position statement on ethical practice. https://www.decdocs.org/position-statement-ethical-practice

13.

Dunst

C. J.

Hamby

Trivette

C. M.

Raab

Bruder

M. B.

(2000). Everyday family and community life and children’s naturally occurring learning opportunities. Journal of Early Intervention, 23(3), 151–164. https://doi.org/10.1177/10538151000230030501

14.

Fleming

Sawyer

L. B. E.

Campbell

P. H.

(2011). Early intervention providers’ perceptions about providing participation-based services. Topics in Early Childhood, 30(4), 233–244. https://doi.org/10.1177/0271121410371986

15.

Grant

(1991). The special needs of homeless children: Early intervention at a welfare hotel. Topics in Early Childhood Special Education, 10(4), 76–91. https://doi.org/10.1177/027112149101000407

16.

Hurley

J. J.

Looby

Goodrum

A. R.

Campbell

E. M.

Bonti

G. K.

Raymon

B. A.

Condon

Schwaeber

S. E.

Mauceri

M. E.

Bourne

E. M.

Callahan

E. D.

Hardy

D. L.

Mathews

(2018). Early intervention for families and children experiencing homelessness. Infants and Young Children, 31(1), 20–36. https://doi.org/10.1097/IYC.0000000000000107

17.

Individuals with Disabilities Education Act, 20 U.S.C. § 1400 et seq. (2004).

18.

Ishimaru

A. M.

(2019). From family engagement to equitable collaboration. Educational Policy, 33(2), 350–385. https://doi.org/10.1177/0895904817691841

19.

Mazzotti

V. L.

Rowe

D. A.

Sinclair

Poppen

Woods

W. E.

Shearer

M. L.

(2016). Predictors of post-school success: A systematic review of NLTS2 secondary analyses. Career Development & Transition for Exceptional Individuals, 39(4), 196–215. https://doi.org/10.1177/2165143415588047

20.

McWilliam

R. A.

(2010). Routines-based early intervention: Supporting young children and their families. Brookes.

21.

Nwokah

Hsu

H. C.

Gulker

(2013). The use of play materials in early intervention: The dilemma of poverty. American Journal of Play, 5(2), 187–218. https://doi.org/10.1044/1058-0360(2012/12-0013)

22.

QR Collective. (2023). Reflexive quality criteria: Questions and indicators for purpose-driven special education qualitative research. Exceptional Children, 89(4), 449–466. https://doi.org/10.1177/00144029231168106

23.

Shaw

(2013). A new look at an old research method: Photo-elicitation. TESOL Journal, 4, 785–799. https://doi.org/10.1002/tesj.108

24.

Spence

C. M.

Rooks-Ellis

D. L.

Ruiz

A. B.

Fish

L. A.

Jones

O’Grady

C. E.

Sulinski

(2022). The language we use: Providers’ perceptions about families. Early Childhood Education Journal, 50, 1291–1302. https://doi.org/10.1007/s10643-021-01258-2

25.

Spence

C. M.

Rooks-Ellis

D. L.

Ruiz

A. B.

Fish

L. A.

Jones-Banahan

O’Grady

C. E.

Sulinski

(2023). How early interventionists support families experiencing vulnerable circumstances: A closer look at family-centered practice. Children and Youth Services Review, 144, 1–9. https://doi.org/10.1016/j.childyouth.2022.106752

26.

Stake

(1995). The art of case study research. SAGE.

27.

Stewart

S. L.

Applequist

(2019). Diverse families in early intervention: Professionals’ views of coaching. Journal of Research in Childhood Education, 33(2), 242–256. https://doi.org/10.1080/02568543.2019.1577777

28.

Thomas

M. E.

(2009). Auto-photography. In Kitchin

Thrift

(Eds.), International encyclopedia of human geography (pp. 244–251). Elsevier.

29.

Williams

C. S.

Ostrosky

M. M.

(2019). What about MY TOYS? Common questions about using a bagless approach in early intervention. Young Exceptional Children, 23(2), 76–86. https://doi.org/10.1177/1096250619829739

30.

Williams

C. S.

Sawyer

G. E.

Alexander

J. R.

Ostrosky

M. M.

(2023). Inclusion of infants and toddlers with significant support needs across natural environments: What can early interventionists do? Inclusive Practices, 2(2–3), 39–49. https://doi.org/10.1177/27324745231171663

31.

Williams

C. S.

Sawyer

G. E.

Ostrosky

M. M.

(2024). A close look at intersectionality in an early intervention case study. [Manuscript submitted for publication].

32.

Windsor

K. S.

Woods

Kaiser

A. P.

Snyder

Salisbury

(2019). Caregiver-implemented intervention for communication and motor outcomes for infants and toddlers. Topics in Early Childhood Special Education, 39(2), 73–87. https://doi.org/10.1177/0271121418815250

33.

Workgroup on Principles and Practices in Natural Environments, OSEP TA Community of Practice: Part C Settings. (2008). Seven key principles: Looks like/doesn’t look like. https://ectacenter.org/topics/eiservices/keyprinckeyprac.asp

34.

Yin

(2018). Case study research and applications: Design and methods (6th ed.). SAGE.

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