Céu Carvalho - Special educator; 
Isabel Fidalgo - Special educator;
Leonor Carvalho - Psychologist;
Supervisors and Trainers from the Coimbra Early Intervention project
 

 While Early Intervention is well established in the United States and other countries, it has only recently emerged in Portugal. The region of Coimbra developed in this country the first coordinated, multidisciplinary, interagency early intervention program, using existing resources in the community. Coimbra is Portugal's third largest city and its region has an area of 1,600 square miles and a population of about 400,000.

 The Coimbra Early Intervention Project (PIIP) was born in October 1989 as the result of a cooperative agreement between five regional agencies representing Health, Education and Social Services. The purpose of this agreement was to create a framework capable of responding to the needs for early intervention services for children and their families in the region of Coimbra. 

 Until then, there had been a well-known gap in support services for children under 3, and the services that did exist used the same methods as the special education programs for older children, which were still very child-centered. Thus, the arrival of PIIP offered an innovative approach in the region of Coimbra, outlining support services for children from birth to the age of 3 with disabilities or at risk.

 This new way of coordinating agencies, involving the active participation of each without merging them together, has proven particularly relevant for this age group, since it facilitates an articulated response to the diverse needs of the children and families in question. Agency collaboration has taken place not only on the regional level but also at a community level, with the creation of 17 local teams consisting of professionals of varying backgrounds recruited from the existing local services.  At present, approximately 120 part-time interventionists are involved, and the program supports around 200 children.

 One of the main concerns of this project has been to define a philosophic framework and to train professionals, an indispensable move for the development of a common language able to encourage the active participation of families in the resolution of their problems.  Since the beginning, PIIP has believed in:
 

• the need to develop and implement a truly family-centered type of intervention;
• the importance of teamwork for the new Early Intervention practice, within a framework that is more ecological and transactional;
• the need for an trandisciplinary approach to teamwork;
• the need for basic training and supervision for professionals, essential to support the development of a common philosophic framework  and language.

 In order to achieve these objectives, and given that training in Early Intervention is rare in Portugal, PIIP has maintained contacts with the USA throughout the 10 years of its existence, enabling it to plan a training program for all professionals involved:
 

Portage Project, Wisconsin;

Altamira Project, Albuquerque, New Mexico;

Parents Infants Nurturing Group from Cincinnati, Ohio;

Frank Porter Graham Child Development Center in Chapel Hill, North Carolina;

Child and Family Learning Center, Akron, Ohio.

This collaboration has contributed to a growing awareness of the importance of family involvement in the process of intervention, and to a change of attitude on the part of professionals working in early intervention.  The expectation of great transformations has given way to an increased tendency to value the small changes, to understand the importance of waiting and listening, and to give families time to organize themselves autonomously around their own needs and concerns.  There is recognition of the strengths, skills and competencies that families bring to bear, and as such, they have begun to constitute an independent force that knows how to make use of professional services.

 We must also make mention of another important contribution that has come from the USA, namely the use of tools such as the Individualized Family Support Plan (IFSP), which have allowed us to achieve a better understanding of the needs of children and families, and encourage their participation.  The PIIP has created its own version of the IFSP, adapting it to the Portuguese context and culture: "PIAF - Plano Individualizado de Apoio à Família". This tool is an essential for the recognition and recording of family/child history, which is the starting-point for any truly family-centered intervention.

From its first year of functioning, the concept of Family-Centered Intervention has been a central concern for PIIP. This concern resulted in a redefinition of the roles of professionals and family.  However, it became apparent that the existing early intervention materials and approaches were still very child-centered and did not consider the broader life impacts on children and families. Consequently, the PIIP has once more opted to collaborate with partners in the US, including the Portage Project at CESA 5 in Portage, Wisconsin.

In October 1993, PIIP staff attended a training that presented the new, 'Growing: Birth to Three', and was given permission to translate and adapt the materials to the Portuguese situation.  Convinced that the Core Values contained the keys to successful intervention, PIIP decided to apply the new model. The core values encourage intervention approaches that are: family centered, strengths-based, ecological, reflective, and relationship focused.

 In June 1995, staff from CESA5 came to give the first Relationship Based Intervention training to all PIIP professionals.  Many obstacles were raised during this first stage, some of which were difficult to overcome given the lack of translated and adapted material.

 Therefore, the process of material translation got under way, and in June 1997, we began to plan to develop a team of training professionals whose role would be to provide basic training and support for the professionals throughout Portugal.  In October 1998, the Portage Project staff presented a second course of basic training for the PIIP interventionists and to support the constitution of this team of trainers.  In April 1999, Portage Project staff organized a training course for trainers involved in support and training in Relationship Based Intervention approaches including the use of the Growing Birth to Three materials.  This was designed to equip this team with the necessary skills to provide training in 'Growing', extending it to all professionals involved in early intervention, not only at the level of PIIP, but also at a national level.
 Since then, the group of trainers has been supported by CESA 5, and in October and November 1999, the first steps were taken to share and publicize the message of 'Growing': Birth to Three courses for all PIIP interventionists.  Subsequently, the new model has been extended to the 17 teams of local intervention programs in the region of Coimbra.

 Although PIIP has been trying to implement family-centered intervention for ten years, 'Growing' brought a 'breath of fresh air' to the minds of the interventionists, challenging their established ideas and highlighting the real nature of concepts which were largely dormant.  'Growing' has stimulated reflection on the importance of focusing our observation and intervention on the parent-child interaction, as this is one of the most important developmental factors in the first years of a child's life.

 Intervention is scaled-down, in a perspective in which the family and relational context gains a new significance.  The "laboratory moments" (those involving child-centered intervention, and the alteration of space and time in order to undertake activities developed by the interventionist in accordance with his/her notions about what is necessary for the child's development), have given way to a valuing of the rituals and routines that a family uses to organize itself and function on a day-to-day basis, enabling parents and children to interact and construct their relationships.  The "magical moments" of intervention are taking place more and more often within the bosom of the family, and solutions tend to be increasingly family-oriented, based around the family's notion of what it is and what it aspires to be.

 The Relationship Based training and materials of 'Growing' have proven to be an efficient intervention tool. They help interventionists to focus their observation on aspects related to the parent-child interaction within the environment, and on the child and family's strengths; that is to say, they help the professionals to systematically plan the intervention in accordance with the core values of training reflected in the 'Growing: Birth to Three' materials.

 Although there is still a long way to go, we hope that application of the principles of Relationship Based Intervention will lead to a happy ending.  For it is a practice that is full of sparks and magic moments with the family and the children.  As they are our priority, we also hope that our practice will be consolidated by legislation in early intervention that has recently appeared in Portugal...