Integrated Care 4 Kids

What do Physical Therapists Do?

2009-11-08T09:09:00.006-05:00

What do Physical Therapists do with children from birth to 3 years of age?

Integrated Care works with families to provide support to children in the following areas: Gross Motor Development, Fine Motor Development, Motor Planning and Visual Motor Skills. We work on improving and working with muscle tone, strength and development, range of movement, quality of movement, eye-hand coordination, attention to task and sensory integration. Adult caregivers can also benefit from assisting physical therapists.

We look at the quality of a child’s movements such as their pace and gait when they learn to walk, their grasp of toys and crayons, or the pressure they are able to use during play dough play. Our Physical Therapists are concerned with helping children reach their full developmental potential and realizing their full range of motion to improve their quality of life.

Tips for parents from PT:
The following suggestions help to facilitate your child’s development. Children and babies learn through play and interaction with other people such as their caregivers, siblings and peers. They are follow the lead of others around them and repeat those behaviors. They explore their world through touch, sight and sound and learn about the physical properties of the objects that they come in touch with. They use their own abilities through their intrinsic curiosity and exploratory play. They develop all of their senses and their muscles while playing.

Developmental Sequences 1-7 MONTHS:
Change the position of toys and/or mobiles in the baby’s crib so the child will turn their head to see them. Changing the child’s position in the crib also assists with this and gives him/her a different perspective every day. Babies should be given opportunities to lie on their stomach to help develop their trunk muscles and assist them in learning to lift their head.

One way to encourage baby to raise their head is to lay them on your chest and talk/sing to them or, while baby is laying on his/her stomach, shake a rattle above their head to get them to look up. Alternating holding the baby on one shoulder and then the other shoulder will help them learn to turn their necks in different directions to accept visual and auditory stimulation.

As baby develops, it is important for them to begin to place weight on their forearms while lying on their stomach. To help with this, place a rolled towel under his/her arms when he/she is lying on the floor (on his/her stomach). Also, a soft wedge can be used in the same manner with a toy in front of the baby.

You can assist baby with learning to roll from their back to their side or stomach by holding a toy to one side and taking one leg and placing it across the body with the foot flat and the hip and knee bent. Gently rock baby back and forth to help develop the feeling of rolling.

Developmental Sequences 7-10 MONTHS:
It is important to encourage baby to move his/her body. You can help him/her by placing a toy slightly beyond his/her reach so he/she has to pivot and reach to get it. He/She may begin an intentional movement by dragging himself/herself across the floor or by pushing with his/her legs.

Developing trunk muscles are necessary for sitting and we must offer baby many opportunities to sit up. An easy opportunity is when baby is in a high chair. Simply arrange toys on the tray and allow baby to reach for them and manipulate them. If baby is not yet able to support himself/herself, consider using rolled towels placed on either side to make him/her more secure. When you are holding holding baby in your lap in a sit-up position, encourage him to look up, down and around by shaking a toy above and below as well as to the side.

Help your baby keep his/her back straight by tapping or rubbing his/her spine, or bouncing him/her up and down in the sitting position or stroking the center of his/her back gently and rapidly. After your baby becomes stronger and is able to sit-up independently, help him/her learn how to go from sitting to lying by positioning his/her body correctly.

When your baby begins to creep and begins to crawl, encourage him to assume the hand-knee position. Place a rolled blanket below his/her abdomen when lying on the stomach. Once comfortable with this position and baby is able to maintain it himself/herself, rock back him/her and forth. This encourages baby to shift the weight from one arm to the other. This can also be accomplished by placing a toy in front of baby so he/she will pick up one hand to get the toy.

When baby starts to pull to stand on furniture or with assistance, make sure baby’s feet are flat on the floor and knees are apart and slightly bent. Also, always stay close to baby as he/she experiments with standing independently, even if baby is holding on to something. The child cannot sit down from this position without assistance. Spend some time with baby standing in your lap, holding on to his/her hands and bouncing him/her up and down.

Developmental Sequences 11-15 MONTHS:
Around one year of age, baby may start to experiment with standing, without holding an object or a person. This is the first step towards walking. Encourage this type of activity. Hold on to baby’s back and briefly let go while he/she is standing. Also, have baby stand and lean in a corner and hold on to a large toy or provide him/her a ball to throw.

Once baby is standing and holding on to furniture, encourage walking along the furniture. This helps develop the rhythm of walking and along with the muscles needed for walking. Try placing two chairs next to one other and encourage baby to walk between them. Baby will soon begin to gain confidence in his/her abilities. Begin to move the chairs further apart. Baby will let go of one, take a step and grab hold of the next one.

During this time, baby can be encouraged to throw balls overhand, which assists in developing balance while standing. As baby becomes more comfortable with independent standing and taking steps, provide baby with opportunities to stand barefoot on different textures - grass, gravel, sand, etc. Initially, baby will walk between two adults. Encouragement should be provided to walk longer and longer distances in this way. After that accomplishment, provide opportunities to walk up and down small inclines or hills.

When Should a Parent Refer a child to Physical Therapy?
Birth to 2 months:
-Doesn’t lift head in prone position (while lying on their stomach)
-Does not turn head to one side in prone position
-Does not turn head to both sides in supine position (lying on back)
3 Months:
-Does not hold head up 90 degrees in prone (lying on stomach)
-Does not extend both legs or kick reciprocally
-Does not roll to back when placed on their side
4 Months:
-Does not place weight on forearms in prone position
-Does not rotate or extend head
-Is unable to grasp a rattle
-Cannot bring both hands together
5 Months:
-Does not roll over one way
-Does not hold head up when pulled to sitting
-Is unable to hold head steady in supported sitting position
-Does not bear weight on legs
6 Months:
-Is unable to keep head level with body when pulled to a sitting position
-Does not demonstrate balance reactions
-Cannot bear weight on hands in prone position
-Does not move head actively in supported sitting position
7 Months:
-Does not roll over either way
-Does not bear weight on legs
-Cannot lift head or assist when pulled to sitting position
-Demonstrates little balance reactions or protective extension of arms
8 Months:
-Does not roll over both ways
-Cannot sit with little or no support
-Does not hold weight on one hand while in the prone position
-Cannot bear weight on legs and bounce
10 Months:
-Cannot get to sitting position without assistance
-Does not assume crawling position (hand-knee position)
-Does not show interest/motivation to crawl
-Cannot sit on own without hand support
1 year:
-Does not pull to stand using furniture
-Cannot switch positions from sitting to prone
-Does not creep on hands and knees
-Cannot pivot while in sit position to retrieve toy
-Cannot pass an object from one hand to the other
-Cannot stand holding on to someone or something
-Cannot pick up small object
15 Months:
-Does not walk with one hand held
-Cannot stand alone well
-Does not demonstrate balance reaction while in the kneeling position
-Does not walk alone one to two steps
-Does not demonstrate motor planning by climbing on furniture
-Has a hard time picking up small objects
18 Months:
-Does not attempt to creep upstairs
-Does not walk without support
-Cannot throw ball
-Does not bend down to retrieve objects
-Does not demonstrate balance reaction in standing
24 Months:
-Does not run
-Cannot walk upstairs with one hand held
-Cannot carry large toy while walking
-Does not squat in play
-Cannot retrieve toy off of floor from standing position
-Does not climb onto furniture, turn and sit
-Cannot build tower of 6 blocks
-Does not use utensils well
30 Months:
-Does not jump in place with both feet
-Does not stand from sitting by rolling on side
-Cannot catch large ball
-Has difficulty with gait and balance
-Does not walk downstairs using rail for support
-Does not have wide range of movement
-Does not run and stop without holding
-Does not avoid objects when running
36 Months:
-Cannot kick stationary ball
-Is not able to stand on one foot for 2 seconds
-Cannot build tower of 9 blocks
-Cannot complete 5-6 piece puzzle
-Is not using utensils properly
-Does not attempt to ride tricycle
-Does not demonstrate grasp of crayon

Developmental Sequences 16-24 MONTHS:
Adults should always supervise when children are walking, climbing, running, jumping and balancing at this age. Keep in mind that balancing skills are very important to the success of walking, running and climbing. So practice them on a regular basis and challenge your child. Sharpen your child’s skills by gently rocking him/her from side to side while he/she is standing, using an exercise ball during play and/or allowing baby to balance/walk on a wide board or curb. Also, placing things on the floor for the child to step over helps to bear weight on one leg at a time. Assist your child in learning to run by holding hands while running, have baby chase a ball and/or playing chase together.

To help develop muscles, give the child an opportunity to push or pull large toys or boxes around the house. Ride-on toys to pedal and things to climb, including stairs are excellent opportunities to develop muscles, as well. Put on some music for dancing, which is a good activity for children to learn balance, coordination and develop muscles. Play new games asking the child to such as stand on tiptoe, stand on one foot and jump.

Developmental Sequences 24-36 MONTHS:
The child at this age is able to participate in many activities very well. These skills include climbing stairs to slides, peddling on a tricycle, catching large balls, running and standing on tiptoes.
*Caution: Some of these activities are not recommended for babies with Cerebral Palsy. Please check with a physical therapist for appropriate exercises.

The items which help children develop muscles can be found below. Click on the objects for more information.

Baby:

9 months to 3 years

18 months to 5 years

24 months to 36 months

Choosing the Right Medical Care for Baby

2009-11-07T08:29:00.001-05:00

Choosing the medical care for your baby is one of the most important decisions you will ever make. This provider will provide you with important advice and monitor your child growth for many years. She will listen to your concerns, guide you through the trials and tribulations of childhood and answer questions that others will not be able to. She will be your best friend when your child is sick. Her advice is invaluable.

Parents have several choices when it comes to quality medical care for baby.

Pediatricians
A pediatrician is a medical specialty which focuses on the physical, emotional, and social health of children from birth through adolescence. The primary focus of pediatrics is on preventive health care, but this professional will also help you when problems arise. These specialized doctors complete 4 years of medical school and then must complete 3 years of pediatric residency. A pediatrician must pass a written examination given by the American Board of Pediatrics to become board certified. Pediatricians must re certify by taking examinations every 7 years. Therefore, pediatricians must keep up-to-date on changes in children's health care. They must also take a certain number of medical education courses each year to be eligible for license renewal in the state where he or she practices.
Some pediatricians become specialists in particular areas, which may be, cardiology, critical care or emergency medicine, or hematology. Thus, they usually have between 1 to 3 years of additional training after their residency to be board-certified in their subspecialty.
Family Physicians
Some families choose to maintain their family physician for the care of baby. Family physicians must complete their medical school, just as pediatricians. They also must complete 3 years of residency. While residents they train in pediatrics and several other areas, which may include internal medicine, orthopedics, and obstetrics and gynecology. They usually spend several months training in each area. They are required to take a certifying examination of the American Board of Family Medicine. They are also required to earn continuing medical education credits and take periodic re-certification examinations.
Family physicians are qualified to care for patients of all ages. The family physician would treat all members of the family. Your child would be able to see the same doctor from birth through adulthood.. A family physician will know the medical histories of all family members and may also be more aware of the family situations including, emotional and social issues within your family that can affect not only baby’s health, but all other members of the family.
Be sure to ask about age policies because some family physicians see only a few children or don't see children younger than a certain age.
Pediatric Nurse Practitioner
Another choice is the pediatric nurse practitioner (PNP). These professionals generally have a master's degree in nursing and have special training in obtaining medical histories, performing physical examinations making medical diagnoses, and providing counseling and treatment. They may specialize in a particular area, such as neurology or endocrinology. They always work closely with doctors in hospitals, clinics, and private practices. The numbers of PNP's is growing each year and are excellent alternative choices.
There are advantages of using a pediatric nurse practitioner. PNP's spend more time with them than doctors discussing health and child care issues. They are knowledgeable, work under the supervision of doctors. If a parent wants to see only the doctor or feel the doctor should be consulted after the PNP has seen your child, most practices will honor the request.

Always choose the doctor before the baby is born.

Make a list of questions to ask the doctor before the baby is born. Fill out the necessary forms and provide the necessary insurance papers. Be sure the doctor knows as much as she can about your family and your pregnancy. You might do this in a conversation with the doctor or simply submit a letter to the doctor with the filled out forms.

Consider some of these questions, but add your own personal questions before placing your call to the doctor.

Interview Questions
1. What are the office hours? Flexibility of the doctor's schedule may be a concern, especially if you work outside the home; you may prefer a doctor who offers weekend and evening hours.
2. Is this a solo or group practice? If it's a solo practice and your doctor is not available on weekends or evenings, what are his or her coverage arrangements? If it's a group practice, ask about the qualifications of the other doctors in the office. Who will see your child if your doctor is on vacation or otherwise unavailable?
3. Does a PNP work in the office? How does he or she fit into the practice arrangement?
4. With which hospitals is your doctor affiliated? It is important to know the reputation of the hospital and the nearness to your home.
5. Will your doctor come to the hospital when you deliver to examine the baby once he or she is born? If your baby needs to be hospitalized, who will care for him there?
6. How does the office handle phone inquiries during and after hours? Is it an answering service and will they give immediate information to the doctor regarding your needs. Does the doctor give you his/her cell phone number?
7. Are special times set aside for parents to call in with questions or is there an open advice line (usually staffed by a "phone nurse") during working hours? How are after-hours calls handled? How quickly can you expect a call back from the doctor on call after you have contacted the answering service?
8. Are after-hours calls routed to a "nurse-on-call" system? This is a service that employs a staff of nurses to give parents advice about how to handle most common childhood illnesses. If your child's illness is thought to be serious, the nurse will transfer the call to your child's doctor or a covering physician, or advise you to go directly to the emergency room. Otherwise, a record of the call will be relayed to your child's doctor the next day.

Building Your Child's Self-Esteem

2009-11-03T05:11:00.004-05:00

Self-esteem—a person's sense of worth—is important for success. When children feel confident and secure, they're more likely to succeed in school and achieve personal goals. As they get older, they learn to confront problems and resist peer pressure. More important, having a positive self-image helps a child feel happy and capable of maintaining personal relationships.

Building children's self-esteem is an ongoing part of parenting. Letting children do things for themselves helps them acquire needed skills. When parents respect their children, the children learn to respect themselves. And when parents show affection, kids learn how to share their feelings with others.

Parents' actions influence the way children feel about themselves. When a parent holds a child, the child can feel how important he or she is. Parents who can't be with their kids on a daily basis can call them, write them notes or send e-mails. Parents should talk to their kids, listen to what they have to say and show them that their opinions count.

Children need their parents' unconditional love and support. The love of a parent should not depend on the good behavior of a child. Even as they set limits and enforce discipline, parents should reassure their kids that they love them. Withholding love from kids when they misbehave will make them feel bad about themselves. Parents sometimes tell a misbehaving child, “You're a bad boy (or girl)!” This tells the child that he or she is bad, not the behavior. Instead, parents should explain to the child what he or she did was wrong and then impose a consequence. For example, if the child hit someone, explain that hitting hurts and remove the child from the room.

Praising children when they behave well makes them feel good and motivates them to continue the good behavior—a win-win situation for parents and children! Parents should praise kids' efforts and their successes. If a child's team loses a game, for example, a parent could say, “You tried hard. You should feel proud of yourself!”
Some people worry that praising kids too much will spoil them. Yet as a child's self-esteem grows, so does his or her sense of responsibility and competence. Assigning chores and praising accomplishments makes children feel valued. Their self-confidence and independence grow, and their increasing sense of security helps them confront the many challenges that are a natural part of growing up.
Studies show that children who feel confident are better able to stand up to bullies.

Parents should give kids the tools they need to stand up for themselves and help them learn to solve problems. As they get older, they will be able to handle difficult situations on their own.

The way parents interact with their children influences the type of people they become. Nurturing parents who share their love help increase their children's sense of self-worth. Kids learn to feel good about themselves and to care about others. When parents build their Children’s self-esteem, a foundation for a strong, loving relationship is laid.

The following books will provide excellent advice in helping your child develop a good self concept.

Obtained from Children’s Hospital, Pittsburgh, Pa.

Building Loving Relationships

2009-11-03T05:07:00.001-05:00

These tips will provide parents with a more loving and positive relationships with their children.
1. Children first learn about relationships from their parents. Kids who are loved at home are able to share love and affection with others. Be affectionate with your children. Hugging, holding and kissing them makes them feel secure and teaches them how to show love for others. It also helps you build a nurturing relationship with them.
2. As your children grow, continue to share your love with them. It is natural for parents to give babies and toddlers a lot of physical attention, but it is also important to be affectionate with your older children. Spending time with them also lets them know you care about them.
3. Tell your children that you love them. Just as adults like to hear how much they are loved, children also need affirmation that their parents cherish them.
4. Appreciate the special moments in your daily lives. Think of routine tasks as opportunities to bond with your children. Sitting together while reading books can be a time to feel close with your kids. Let them know you’re interested in them by taking time to look at their school papers or asking about their activities. Share in their excitement as they make new discoveries, explore the outdoors or play in the mud!
5. Teach your children how to maintain friendships by setting an example in your own adult relationships. Be loving and respectful with your spouse or partner, and your children will learn to act positively toward the important people in their lives.
6. Listen and talk to your children on a regular basis. Good communication helps relationships grow. Let your children know you care about their feelings, and try to give them your full attention when they talk to you. When you listen to your children, they learn how to listen and to manage their emotions.
7. Try to spend time together as a family each week. Whether you’re enjoying a Sunday dinner, bike riding, or playing board games at home, have fun together.
8. Spend some one-on-one time alone with each of your children on a regular basis. Let them know what makes them special to you. Each child is unique, and praising their distinct qualities enhances their sense of self-worth. When children feel valued, they are better able to handle problems and conflicts that come up in their lives.
9. Set a positive tone when you interact with your kids. Being part of a loving family helps children feel good about themselves and gives them the confidence they need to interact socially with others.
1o. Be affectionate with your children every day, and you’ll be rewarded by the smiles, hug, and love they’re sure to give you in return! Your relationship with your children will continue to grow, and the bonds between you will last as they mature and start new relationships of their own.

Obtained from Children’s Hospital, Pittsburgh, Pa.

Reading to Your Baby!

2009-11-03T04:48:00.003-05:00

Are there benefits of reading to your baby? Certainly an infant can't understand what you're doing or why. Think about it. You wouldn't wait until your child could understand what you were saying before you started speaking to him or her, right? And you wouldn't bypass lullabies until your baby could carry a tune or wait until he or she could shake a rattle before you offered any toys.
Reading aloud to your baby is a wonderful shared activity you can continue for years to come — and it's an important form of stimulation.
Reading aloud:
• teaches a baby about communication
• introduces concepts such as numbers, letters, colors, and shapes in a fun way
• builds listening, memory, and vocabulary skills
• gives babies information about the world around them
Believe it or not, by the time babies reach their first birthday they will have learned all the sounds needed to speak their native language. The more stories you read aloud, the more words your child will be exposed to and the better he or she will be able to talk. Hearing words helps to imprint them on a baby's brain. Kids whose parents frequently talk/read to them know more words by age 2 than children who have not been read to. And kids who are read to during their early years are more likely to learn to read at the right time.
When reading, your child hears you using many different emotions and expressive sounds, which fosters social and emotional development. Reading also invites your baby to look, point, touch, and answer questions — all of which promote social development and thinking skills. And your baby improves language skills by imitating sounds, recognizing images, and learning words.
But perhaps the most important reason to read aloud is that it makes a connection between the things your baby loves the most — your voice and closeness to you — and books. Spending time reading to your baby shows that reading is a skill worth learning.
Different Ages, Different Stages
Young babies may not know what the images in a book mean, but they can focus on them, especially faces, bright colors, and contrasting patterns. Read or sing lullabies and nursery rhymes to interest and soothe your infant.
Between 4 and 6 months, your baby may begin to show more interest in books. He or she will grab and hold books, but will mouth, chew, and drop them as well. Choose sturdy vinyl or cloth books with bright colors and repetitive or rhyming text.
Between 6 and 12 months, your child is beginning to understand that pictures represent objects, and most likely will develop preferences for certain pictures, pages, or even entire stories. Your baby will respond while you read, grabbing for the book and making sounds, and by 12 months will turn pages (with some help from you), pat or start to point to objects on a page, and repeat your sounds.
When and How to Read
Here's a great thing about reading aloud: It doesn't take special skills or equipment, just you, your baby, and some books. Read aloud for a few minutes at a time, but do it often. Don't worry about finishing entire books — focus on pages that you and your baby enjoy.
Try to set aside time to read every day — perhaps before naptime and bedtime. In addition to the pleasure that cuddling your baby before bed gives both of you, you'll also be making life easier by establishing a routine. This will help to calm your baby and set expectations about when it's time to sleep.
It's also good to read at other points in the day. Choose times when your baby is dry, fed, and alert. Books also come in handy when you're stuck waiting, so have some in the diaper bag to fill time sitting at the doctor's office or standing in line at the grocery store.
Here are some additional reading tips:
• Cuddling while you read helps your baby feel safe, warm, and connected to you.
• Read with expression, pitching your voice higher or lower where it's appropriate or using different voices for different characters.
• Don't worry about following the text exactly. Stop once in a while and ask questions or make comments on the pictures or text. ("Where's the kitty? There he is! What a cute black kitty.") Your child might not be able to respond yet, but this lays the groundwork for doing so later on.
• Sing nursery rhymes, make funny animal sounds, or bounce your baby on your knee — anything that shows that reading is fun.
• Babies love — and learn from — repetition, so don't be afraid of reading the same books over and over. When you do so, repeat the same emphasis each time as you would with a familiar song.
• As your baby gets older, encourage him or her to touch the book or hold sturdier vinyl, cloth, or board books. You don't want to encourage chewing on books, but by putting them in his or her mouth, your baby is learning about them, finding out how books feel and taste — and discovering that they're not edible! What to Read
Books for babies should have simple, repetitive text and clear images. During the first few months of life, your child just likes to hear your voice, so you can read almost anything, especially books with a sing-song or rhyming text. As your baby gets more interested in looking at things, choose books with simple pictures against solid backgrounds.
Once your baby begins to grab, read vinyl or cloth books with faces, bright colors, and shapes. When your baby begins to respond to what's inside of books, add board books with pictures of babies or familiar objects like toys. When your child begins to do things like sit up in the bathtub or eat finger foods, find simple stories about daily routines like bedtime or bathtime. When talking starts, choose books that invite babies to repeat simple words or phrases.
Books with mirrors and different textures (crinkly, soft, scratchy) are also great for this age group, as are fold-out books that can be propped up, or books with flaps that open for a surprise. Board books make page turning easier for infants and vinyl or cloth books can go everywhere — even the tub. Babies of any age like photo albums with pictures of people they know and love. And every baby should have a collection of nursery rhymes!
One of the best ways you can ensure that your little one grows up to be a reader is to have books around your house. When your baby is old enough to crawl over to a basket of toys and pick one out, make sure some books are included in the mix.
In addition to the books you own, take advantage of those you can borrow from the library. Many libraries have storytime just for babies, too. Don't forget to pick up a book for yourself while you're there. Reading for pleasure is another way you can be your baby's reading role model.

Here are some excellent books to read to your baby.

Finding a Child Care Center

2009-11-03T04:36:00.003-05:00

The quality of child care has a direct impact on your child’s ability to learn, to build healthy relationships and become the best he or she can be. However, the important decision of where to place your child is often difficult and confusing. The Office of Child Development has developed this guide to educate and empower parents to make smart decisions when choosing child care.

As a part of resource and referral services for parents, Pennsylvania has three goals to help support your decisions about early childhood programs:
1. To educate families on the benefits of quality care.
2. To match families with care and services that meets their needs.
3. To develop a relationship with families in order to provide continuing service.

TAKING THE FIRST STEPS
• Write down what you want from your child care program. Think about what your child may also want. Ask your child, if he or she is old enough.
• Talk to the staff at your local Child Care Information Services (CCIS) agency.
• Think about what you can afford. Check into any child care financial assistance through the state or your employer.
• Interview caregivers on the phone. Ask about staff-to-child ratios, costs, certification, learning opportunities offered and if the provider is participating in Keystone STARS.
• Use the steps and checklist provided in this guide (pages 11-14) to help you make your choice.

TYPES OF CHILD CARE
You should choose the most appropriate child care program that meets your child and family needs.
Child Care Center
• Serves seven or more children unrelated to the child care operator.
• State certification required, based on health and safety.
• Voluntary participation in Keystone STARS or other types of accreditation at discretion of the program.
Group Home
• Serves between seven and 12 children unrelated to the child care operator.
• State certification required, based on health and safety.
• Voluntary participation in Keystone STARS or other types of accreditation at discretion of the program.
Family Home
• One caregiver who serves between four and six children unrelated to the caregiver.
• State registration required, based on health and safety.
• Voluntary participation in Keystone STARS or other types of accreditation at discretion of the program.
Relative/Neighbor care
• One caregiver who cares for one, two or three children who are not related to the caregiver and up to three additional children who are related to caregiver.
• No state oversight. No health and safety requirements.
• Unable to participate in accrediting programs.

ABOUT CERTIFICATION
The state Department of Public Welfare (DPW) certifies child care providers. At least once a year, DPW inspects Child Care Centers, Group Homes and on a random basis, inspects Family Homes that serve four to six children. DPW is also responsible for investigating complaints about child care facilities.
Child care is an important partnership between parents and child care providers. Both partners play a key role in achieving the well-being and healthy development of children.
For more information about requirements and who is considered to be related to the child care operator or if you have questions or concerns regarding child care, call your regional child care office (listed on page 15) or contact your local Child Care Information Services (CCIS) for more information.

DEFINING QUALITY CHILD CARE
Quality child care will offer your child a stimulating, nurturing environment which should help prepare them for school and to reach his or her full potential. Quality care environments far exceed minimum standards set by the state and provide a stimulating, loving atmosphere in which your child will mentally, socially, emotionally and physically thrive.

CHARACTERISTICS OF QUALITY
• Small group sizes and adult-to-child ratios encourage the best opportunities for a child’s development.
• Caregivers or teachers who have experience and education in early childhood development.
• Opportunities for meaningful parent involvement.
• Learning materials and teaching styles that are age-appropriate and respectful of children’s cultural and ethnic heritage.
• Learning opportunities that promote your child’s success in school.
• Participation in accrediting programs such as Keystone STARS.
10 REASONS FOR PARENTS TO CHOOSE QUALITY CHILD CARE
1. SCHOOL READINESS!

Children in a quality setting will not only gain intellectual skills, but also social sills that will prepare them for the school environment.
2. ATTENTION!
Lower staff-to-child ratios increase your child’s individual attention while in care.
3. PROFESSIONAL STAFF!
A quality care setting includes a staff trained to care for children and their needs
4. GOOD RELATIONSHIPS!
Quality care promotes a positive relationship between parents and the caregiver. Parent involvement is a priority.
5. OPPORTUNITY!
Age-appropriate learning materials and activities give children the opportunity to learn and grow.
6. RESPECT!
A quality program will be respectful of children’s and parent’s cultural, ethnic and special accommodations.
7. PROFESSIONALISM!
A quality program will have business practices and policies in place so parents know what to expect in various situations.
8. SAFETY!
The basic need of a quality child care setting is to ensure that the children in care are in the safest environment possible.
9. STABILITY!
Parents have assurance that their child is in a safe, positive environment without jumping from provider to provider.
10. PARTICIPATION!
Quality providers participate in accrediting programs (such as Keystone STARS), to continue striving for higher quality early learning experiences for children.

WHAT DOES KEYSTONE STARS MEAN?
Keystone STARS is a continuous quality improvement program. It has four STAR levels. Each STAR designation has its own research-based performance standards. These standards measure four areas that make a difference in the quality of care your child receives:
1. The educated and well-trained staff
2. The environment your child is in everyday
3. Leadership and Management
4. Family and Community Partnerships
As a program moves from STAR 1 to STAR 4, the requirements in these areas increase.

AT A KEYSTONE STARS PROGRAM YOU SHOULD FIND:
• Department of Public Welfare Certificate of Compliance for Centers or Certificate of Registration for Family Homes.
• A comfortable place where your child can explore and learn.
• Laughing, reading and talking which builds language skills.
• Teachers learning new ways to help your child succeed.
• A safe, healthy and exciting place.
• Music, art, science and play activities that increase school readiness.
• Your child feeling good about himself or herself.
• Family involvement.
• Teachers that listen to children and parents.
• Children having fun together and being respectful of each other.

KEYSTONE STARS: QUESTIONS AND ANSWERS
Q: Why should parents care about Keystone STARS?
A: Your child’s Early Education is critical to his or her development and future success in school and life. Keystone STARS sets requirements for early childhood educators to promote the best learning environment and safest setting possible for your child.
Q: What are the requirements set by Keystone STARS?
A: Quality ratings are based on four areas:
1. Staff education – early childhood educators have the training and knowledge to interact properly with children.
2. Learning environment – program has appropriate materials for a variety of ages and provides opportunities for children to learn on a daily basis.
3. Leadership and management – a well-run business has policies and plans in effect to not only optimize safety, but also for parents to know what will happen in certain situations.
4. Family and community partnerships – Parents and community stakeholders are encouraged to offer ideas and feedback regarding the learning program.
Q: How does Keystone STARS rate a program?
A: A program begins Keystone STARS with a “Start with STARS” rating and can work it’s way to a STAR 1, STAR 2, STAR 3 until it becomes a top-rated STAR 4 program.
Q: What is the difference between a STAR 1 and higher STAR ratings?
A: Programs are rated using the four quality areas, but the requirements increase in each area for each STAR level. Please speak with your local Child Care Information Services (CCIS) for details of STAR level requirements.
Q: The Pennsylvania Department of Public Welfare (DPW) certifies programs. Isn’t
that good enough?
A: A certified center does meet Pennsylvania’s minimum requirements for safety. However, certification does not address Early Education. Keystone STARS programs combine these safety requirements with Early Education standards to give children a safe and an educational environment.
Q: Does it cost more to enroll my child in a Keystone STARS program?
A: Providers enroll voluntarily in the Keystone STARS program and there are no charges for the provider to enroll. Costs to parents are set only by the provider themselves.
Q: What will my child get out of being enrolled in a Keystone STARS program?
A: Many things! Individual attention, daily learning activities, a safe, friendly and respectful environment, feeling good about himself or herself, a well educated staff, parent involvement and more.
Q: What do parents get out of enrolling their children in a Keystone STARS program?
A: Knowing that your child is safe and respected, that your child is learning something new every day, and the security of knowing what to expect from your provider in certain situations. Most of all, giving your child the best opportunity to succeed today and in the future.

INFORMATION ON CHILD DEVELOPMENT
The benefits of Early Learning programs are numerous. A child’s ability to think, form relationships, and live up to his or her full potential is directly related to the connected effect of good health, good nutrition and appropriate stimulation and interaction with others. Scientists have shown the importance of early brain development and the need for positive stimulation, good health and nutrition.
Children who participate in early learning programs tend to be more successful later in school, are more competent socially and emotionally, and show higher verbal and intellectual development during early childhood than children who do not participate in early learning programs.
Ensuring healthy child development, therefore, is an investment in your child.
According to the American Academy of Pediatrics, “the brain undergoes its most rapid development in the first three years of life, and in this development the environment plays a central role. Nerve connections that are associated with specific skills such as language are developed during this critical period.” Children need quality care and education in the first years of life to develop to their full potential.

4 STEPS TO SELECTING A CHILD CARE PROVIDER
1. Interview Caregivers
CALL FIRST
Ask:
• Is there an opening for my child?
• What hours and days are you open and where are you located?
• How much does care cost? Is financial assistance available?
• How many children are in your care? What age groups do you serve?
• Do you provide transportation?
• Do you provide meals (breakfast, lunch, dinner, snacks)?
• Do you have a certificate of compliance/
• Other accreditations?
• Do you participate in Keystone STARS?
• When can I come to visit?

VISIT NEXT
Look for:
• Responsive, nurturing, warm interactions between caregiver and children.
• Children who are happily involved in daily activities and comfortable with their caregiver.
• A clean, safe and healthy indoor and outdoor environment, especially napping, eating and toileting areas.
• A variety of toys and learning materials, such as books, puzzles, blocks and climbing equipment, that your child will find interesting and that will contribute to your child’s growth and development.
• Children getting individual attention.
Ask:
• Can I visit anytime?
• How do you handle discipline?
• What do you do if a child is sick?
• What would you do in case of emergency?
• Do you have a substitute or back-up caregiver?
• Where do children nap? How do you ensure that babies sleep on their backs?
• What education have you (and other staff) had? What ongoing professional development is available?
• May I see a copy of your state certificate of compliance?
• May I see a copy of additional accreditations?
• May I have a list of parents (current or former) who have used your program?
• What kind of parent involvement do you have?
2. Check References
Ask Other Parents:
• Did your child learn new things while enrolled in the program?
• How did the caregiver discipline your child?
• Did your child enjoy the child care experience?
• How did the caregiver respond to you as a parent?
• Do you feel that this program has helped prepare your child for school?
• Would you recommend the caregiver without reservation?
• If your child is no longer with caregiver, why did you leave?
Ask the Local Child Care Information Services (CCIS) Agency or Certification Office:
• What regulations should child care providers meet in my area?
• Is there a record of complaints about the child care provider I am considering and how do I find out about it?
3. Make the Decision for Quality Care
From what you heard and saw, ask yourself:
• Which child care should I choose so that my child will be happy and grow?
• Which caregiver can meet any special accommodations for my child?
• Are the caregiver’s values compatible with my family’s values?
• Is the child care available and affordable according to my family’s needs and resources?
• Do I feel good about my decision?
4. Stay Involved
Ask yourself:
• How can I arrange my schedule so I can….
i. Talk to my caregiver every day?
ii. Talk to my child every day about how the day went?
iii. Visit and observe my child in care at different times of the day?
iv. Be involved in my child’s activities?
• How can I work with my caregiver to resolve issues and concerns that may arise?
• How do I keep informed about my child’s growth and development while in care?
• How can I promote good working conditions for my child care provider?
• How can I network with other parents?

QUALITY CHILD CARE CHECKLIST:
What to look for in a quality child care program
When visiting a program, ask these questions.
Your answers to these questions should be “yes.”
Facility:
____ Is the provider certified by the Department of Public Welfare and is it posted?
____ Does the provider participate in Keystone STARS?
____ Are there appropriate toys and materials for children of all age groups?
____ Does the provider encourage you to drop in and visit at any time/
Staff:
____ Does staff communicate daily with parents about their child’s progress?
____ Does staffing allow for each child to receive individual attention?
____ Does staff sit and read to the children?
____ Does staff seem patient and receptive to children’s needs?
____ Is staff respectful of children?
____ Is staff respectful of parents?
____ Does staff encourage children’s sharing, manners, and other good behaviors?
____ Does staff appear lively, smiling and interacting in a positive manner with the children?
____ Does staff involve children in daily learning activities?
Safety:
____ Does the facility appear orderly and clean?
____ Are hazardous materials locked away?
____ Is there an emergency plan and is it posted?
____ Are there security measures in place?
____ Is there a policy for sick children and other circumstances?
Children:
____ Do the children have a consistent routine that they can understand and follow?
____ Do the children seem occupied and engaged?
____ Are the children involved in activities that promote learning?
____ Is there a policy on discipline?
____ Do the children seem happy?
Feelings:
____ Is your initial reaction upon entering the site a positive one?
____ Is this a place my child would enjoy?
____ Would my child be safe here?
____ Would I/we feel comfortable using this program?
____ Would my child learn new things every day at this program?

FOR MORE INFORMATION ABOUT CHILD CARE, CALL THE CHILD CARE OFFICE IN YOUR REGION
Western Region: 1-800-222-2149
Counties:
Allegheny, Armstrong, Beaver, Butler, Cameron, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Venango, Warren, Washington, Westmoreland
Central Region: 1-800-222-2117
Counties:
Adams, Bedford, Blair, Cambria, Centre, Clinton, Columbia, Cumberland, Dauphin, Franklin, Fulton, Huntingdon, Juniata, Lancaster, Lebanon, Lycoming, Mifflin, Montour, Northumberland, Perry, Snyder, Somerset, Union, York
Northeast Region: 1-800-222-2108

Identifying Proper Language Development

2009-10-18T17:55:00.022-04:00

Identifying whether your child has a language delay can be as simple as answering several questions. After "testing" your child with these questions, you will know whether you should contact our office. (888-645-5683). If you have a concern, please feel free to phone us immediately. We will be happy to discuss your concerns and provide you with options, if necessary.

Answer the following questions:
Birth to 5 months:
1. Does your baby react to loud sounds?
2. Does your baby turn toward a sound source such as your voice?
3. Does your baby watch your face when you sing or talk?
4. Does your baby vocalize pleasure such as laughs or giggles) or displeasure (crying and fussing?)
5. Does your baby make noises when talked to?

6 to 11 months
1. Does your baby understand the words, "No, no?"
2. Does your baby babble identifiable sounds such as, "ma-ma" or "ba-ba?"
3. Dos your baby tr to communicate by gestures or actions?
4. Does your baby try to repeat your sounds when you speak to him/her?

12 to 17 months
1. Does your child show interest in a book or toy for 2 or more minutes.
2. Does your child follow very simple directions accompanied by gestures.
3. Does your child answer simple questions nonverbally.("Point to the dog.")
4. Does your child point to objects, pictures and family members when asked. (Where is daddy?")
5. Does our child say two or three words to label a person or object, though the pronunciation may not be clear. ("Grammy nice.")
6. Does your child imitate simple words? (book)

18 to 23 months
1. Does your child enjoy hearing a book being read?
2. Does your child follow simple commands without gestures. ("Bring mommy the book.)
3. Does your child point to simple body parts? ("Show me your eyes?")
4. Does your child understand simple verbs (action words?) ("jump, crawl, sleep")
5. Does your child correctly pronounce most vowels and the sounds or n,m,p,h particularly when they are the beginning syllables in short words. ("hop, man," etc.)
6. Does your child say 10 or more words, though they may be unclear?
7. Does your child ask for foods by name, though the words may be unclear?
8. Does your child make animal sounds? ("baaaaa, mooooo, ruff ruff")
9. Is your child beginning to combine words. ("want drink, more milk")
10. Is your child beginning to use the pronouns? ("I, mine.)

2 to 3 years
1. Do you think your child knows between 50 words by the time s/he is two?
2. Does your child understand spatial concept words? ("in,on,under")
3. Does your child know most pronouns and begin to use them? ("I, you, me, her")
4. Does your child say about 40 words by age 2 years?
5. Is your child's speech becoming more accurate, even though "strangers" may not understand his speech sounds?
6. Does your child answer simple questions? (Where is your bear?")
7. Does your child use two or three word phrases. ("I get milk.")
8. Is your child beginning to use inflection in his/her voice when asking for something ("MY kitty.")
9. Is your child beginning to use plurals and regular past tenses? ("shoes,walked")

For additional information, please refer to these books:

These are excellent resources to use with your child:

Integrated Care - Get to Know Us!

2009-06-19T18:21:00.001-04:00

Welcome to Integrated Care – our blog!

The purpose of our blog is to help parents and child care providers succeed in helping children with delays in their physical, occupational, speech, hearing and vision as well as developmental development.

We will be answering questions, offering general advice and even providing important information and articles that will help providers and parents by supporting infants through age three. Our goal is to provide the best advice and to assist through this blog and of course, through personal contact - if need be.

We believe this is the on line support will help parents and providers by personally addressing issues regarding developmental delays. We will be happy to answer questions in a timely matter and support you.

Our company is a highly respect company that provides early intervention for infants to children three years of age. Our goal is to work with families in our designated area of Western Pennsylvania to have appositive impact on the lives of families through our early intervention services. We work with families in 13 counties in Western Pennsylvania. They are Allegheny, Armstrong, Beaver, Butler, Clarion, Fayette, Greene, Indiana, Lawrence, Mercer, Venango, Washington and Westmoreland.

We believe that every child can be successful and our experienced professionals provide expert services to help each child reach his or her highest potential. This is done through a complete assessment and analysis of the child along with a personalized program designed specifically for that child.

We work with each family to maximize the success of their child. We keep the family informed about the progress of their child, write personalized plans for the child, and work with the child on a weekly basis.

Our goal is to provide each family with an easy way to overcome difficulties in a positive atmosphere. Together, with our therapists and specialists and your family, we accomplish getting your child off to the right start. It will pay off in not only your child’s future, but the families future.

We have opened this blog to help parents and caregivers by providing them with information that will assist in understanding how best to help overcome physical, occupational, speech, hearing, vision and developmental delays in our very youngest of children.

If you have any questions or comments, please feel free to write on this blog or give us a call. All of your questions and comments will be held in the strictest of confidence. You may reach us at: 888-645- LOVE (5683) or find the block at the bottom of this information. Find us on the web at http://integratedcare.us/philosophy.html

Physical Therapy

2001-01-01T00:01:00.008-05:00

What Do Physical Therapists Do?

Service Areas

2001-01-01T00:01:00.007-05:00

Allegheny County
Birth - Three - contact The Alliance For Infants and Toddlers (412)885-6000
Three - Five - contact Project Dart (412)394-5736
request Integrated care for Birth - Three

Armstrong / Indiana Counties
Birth - Three - contact (724)545-1234
Three - Five - contact Arin IU (724)463-5300
request Integrated care for Birth - Three

Beaver County
Birth - Three - contact The Base Service Unit (800)318-8138
Three - Five - contact Beaver IU (724)774-7800
request Integrated care for Birth - Three

Butler County
Birth - Three - contact The Center For Community Resources (800)318-8138
Three - Five - contact Midwestern IU Four (724)458-6700
request Integrated care for Birth - Three

Clarion County
Birth - Three - 814 226 1080 x 7
Three - Five - I U 6 814 226 7103 x 161
request Integrated care for Birth - Three

Fayette County
Birth - Three - contact The Base Service Unit (724)430-1370
Three - Five - contact IU One (724)437-3237
request Integrated care for Birth - Three

Greene County
Birth - Three - 724 852 5276
Three - Five - contact IU One (724)437-3237
request Integrated care for Birth - Three

Lawrence County
Birth - Three - contact The Human Services Center (724)658-3578
Three - Five - contact Midwestern IU Four (724)458-6700
request Integrated care for Birth - Three

Mercer County
Birth - Three - contact Behavioral Health Commission (724)662-1550
Three - Five - contact Midwestern IU Four (724)458-6700
request Integrated care for Birth - Three

Westmoreland County
Birth - Three - contact The Westmoreland Case Management and Supports (724)837-1808
Three - Five - contact IU Seven (724)836-2460
request Integrated care for Birth – Three

Washington County
Birth - Three - contact Washington Communities (724)729-2620
Three - Five - Intermediate Unit One (724)938-3241
request Integrated care for Birth – Three

Hearing and Vision Therapy

2001-01-01T00:01:00.005-05:00

Developmental Therapy

2001-01-01T00:01:00.003-05:00

Speech Therapy

2001-01-01T00:01:00.002-05:00

Occupational Therapy

2001-01-01T00:01:00.001-05:00