Professionals, governmental agencies, and countries around the world are searching for ways to plan, develop or improve Early Childhood Intervention (ECI) services. In Portugal, this was a bottom-up process which stemmed from proof that it was possible to build a successful regional ECI programme using existing resources. Legislation followed to support the process of extending ECI services and programmes to the whole country.
By sharing the Portuguese experience with the introduction of an ECI system, I do not intend to present a “one size fits all” model, but simply provide some ideas and thoughts.
The inception of ECI programmes in Portugal
In the late 1980s a wide array of programmes and services were developed across Portugal. However, conceptual framework, delivery models, target populations, goals, outcome measures, level of parental involvement, type, intensity, and duration of services were extremely variable from programme to programme — and even within the same programmes.
The Coimbra Project
In 1989, the district of Coimbra, Portugal’s third city, located in the central region of the country, successfully implemented a community-based ECI programme. Within a decade, this triggered the evolution of ECI from an emerging service provided within a child-centred perspective, to a rapidly growing field with a totally different conceptual framework.
The Coimbra Project developed a system to provide individualised comprehensive services to children and families by using formal and informal resources already available in the community and by creating a collaborative effort involving health, education, and social services. This constituted the beginning of a process of no return in the development of ECI in Portugal.
Five main goals have guided the development of the Coimbra Project:
- To be district-wide and community-based, with an ECI community team in each of the 17 councils of the district.
- To develop a cross-sectoral, multidisciplinary system of ECI, using resources that already exist in the community (both human and material) and involving health, education, and social public services, as well as other private formal and informal resources.
- To provide individualised comprehensive services to children under six at high risk or with disabilities, and their families.
- To develop and provide training to all of the professionals involved in the project.
- To contribute to the development of legislation on ECI in Portugal.
All five of these goals have been achieved.
Coimbra Project structure and development
Over a period of four years, a local ECI team was created in each of the 17 councils of the Coimbra District. Team members were professionals from different agencies operating in the community. All of the teams included a core set of professionals: primary care physicians and nurses from the local health centre; special educators from the public school system; social workers, a psychologist, and therapists, either from private institutions, health centres or other local agencies. The diagnostic and therapeutic services of Coimbra Children’s Hospital and its Child Development Centre were also available to all community teams. The teams used a transdisciplinary approach, and services were provided in natural contexts.
At the district level there was a coordination team with one representative from each of the signing agencies: regional public departments of health, education and social policy as well as the National Association of Early intervention — a recently created private institution. The coordination team provided organisational support to the project, including planning, supervision, training, regular meetings with community teams, project development and implementation, and liaising between the different services. At an intermediate level between the coordination and local teams, there was a supervision team to support professionals in the field and ensure respect for the adopted conceptual framework.
Legislation approved in late 2009
Following the positive results achieved by the Coimbra Project and after an ineffective joint executive regulation published in 1999, the Decree-Law 281/2009, approved in parliament created the Portuguese System of ECI (SNIPI), allowing for the national implementation of ECI services.
The law is far from perfect, but it includes some positive key elements, based on the same philosophical principles as the Coimbra Project:
- ECI as a cross-sectoral and interdisciplinary service. This includes the involvement of the three ministers of education, health, and social policy at all four levels (national coordination, regional coordination, technical supervision teams and local ECI teams).
- Support to children from birth to six — not only children with special needs but also those at risk.
- The family as the target for planning and delivering support.
- The need to promote and enhance both childrens’ and parents' confidence and competence.
- Individualised early intervention plans developed and implemented according to a family-centred philosophy.
- Services provided in natural environments during everyday activities.
- A transition plan for every child leaving ECI.
In a moment in which SNIPI is struggling with a shortage of human resources, the major priorities in Portugal for the coming years will be to develop ways to increase the involvement of families, to redefine professional training according to desired outcomes and to maintain good quality ECI services.
Dr. José Boavida is a neurodevelopmental paediatrician with a 42-year career in Coimbra Children’s Hospital, encompassing clinical work, research, teaching as well as public policy. He was part of the team that started the Coimbra Project, which was the origin of the Portuguese ECI legislation. He was a member of the coordinating team of the National System of Early Childhood Intervention (SNIPI), as a representative of the Ministry of Health and Eurlyaid consultant and trainer. His interests include early intervention, family centred services, cross sectoral service delivery, ADHD and neurodevelopmental clinical practice.