Are dietitians prepared to work with handicapped infants? PL 99-457 offers new opportunities. (public law)

In 1986, Congress passed Public Law 99-457, an amendment to PL 94-142, the Education of All Handicapped Children Act which had been enacted in 1975 to assure that school-age children with disabilities receive an education appropriate to their needs. PL 99-457 extended mandatory public school services to 3- and 4-year-olds with handicaps and offered incentives to states providing services to handicapped and at-risk infants, toddlers, and their families.

Part H of PL 99-457 requires that services designed for children from birth through 36 months meet their developmental needs. It mandates psychological services, parent and family training and counseling, transition services, diagnostic medical services, and health services that will enable the child to benefit from other early interventions. Each child must have a written Individualized Family Service Plan (IFSP) developed by a multidisciplinary team in collaboration with the parents. Case management services must be provided.

PL 99-457 specifies the disciplines to provide early intervention: special education, nursing, nutrition, psychology, physical therapy, occupational therapy, speech-language pathology, and social work (1,2). This law creates expanded opportunities for registered dietitians to provide nutrition care to a larger number of preschool children with handicapping conditions and their families.

The law stipulates a comprehensive system of pre-service and in-service personnel development (2). To study issues specific to PL 99-457, the Carolina Institute for Research on Infant Personnel Preparation (CIRIPP) was funded at the Frank Porter Graham Child Development Center, School of Education, University of North Carolina, with a grant from the U.S. Department of Education. Its purposes are to (a) examine pre-service and in-service education to determine how well the specified professionals are prepared to serve handicapped infants and their families and (b) develop curriculums and materials that. will meet the training needs generated by this legislation.

The CIRIPP's interdisciplinary team represents the professionals named in the law. These researchers believe that the several disciplines must collaborate to meet the varied educational, medical, psychological, and therapeutic needs of the handicapped infant in the context of the family To provide coordinated and integrated services, these professionals must have the knowledge and skills to practice their own disciplines and be able to work effectively with the other team members and the families (3,4).

Survey of pre-service dietetic education programs

In spring 1988, CIRIPP researchers conducted a nationwide survey of pre-service education programs in the eight designated disciplines. The surveys were to document how well the core curriculum prepared typical entry-level students to apply the knowledge and skills of their discipline to work with handicapped infants, their families, and the interdisciplinary team (5).

A telephone survey instrument was developed by the faculty research team assisted by graduate students. Survey content was selected by identifying areas of competence in infant intervention that are important to all of the disciplines. Selected items specific to dietetics were added to the generic cross-disciplinary questionnaire …