Since 1990, TLG has had a large prevention-oriented project providing services locally to families in which one or both parents have a cognitive disability. Most of these families receive services funded through the Regional Center (part of the California State Department of Developmental Services). Families receive intensive, home-based and individualized services from our multidisciplinary staff during pregnancy and parenthood. These services include developmental, clinical, parenting education and support, and family therapy intervention which are adapted to the individual needs, including cognitive and learning needs, of each parent and family. Childbirth education and birthing support adapted to the needs of women with cognitive disabilities as well as OT (occupational therapist) intervention providing babycare adaptation for parents who also have a physical or visual disability are available as well.

Our intervention is aimed toward supporting good developmental outcomes for the children, good parent-child relationships, safe and appropriate parenting, and stable family situations. Services are provided by our clinicians (family-child counselors, clinical social workers, psychologists) and by our developmental specialists (infancy special educators, occupational and physical therapists, speech pathologists). During pregnancy each family receives home visits from a clinician with possible visits by a childbirth educator; the work focuses on enhancing understanding of the birthing process, self-care, preparation for newborn care and parenthood, and stabilization of the home environment. After the baby is born, each family has a developmental specialist as well as the same clinician. For the next three years, our workers provide ongoing assessment and facilitation of the baby's development, teach parenting skills, support parent-infant relationships and interactions, and address couple/family issues. After the child is three, the developmental services end, while the other services continue. Many of our families begin our services during pregnancy or at the birth of a child, but we also get referrals for families when the children are older. Many of our families have more than one child; and many now have school-age children, including adolescent children. Since our model is family-focused, we address the needs of all children in the family units. Our services are provided in the home, with families receiving one to three visits per week. We have been serving over forty families a year in this project.

In keeping with TLG's mission of providing early intervention services which are non-pathological and empowering, the emphasis of our intervention is to build on strengths and what works in families and in the relationship between parent and child. Our project has been innovative in that it was apparently the first large-scale program for parents with cognitive disabilities to have grown out of an infant mental health model, focusing on supporting good relationships and interactions between parents and their babies. In contrast to curriculum-based educational approaches, our individualized, hands-on approach to teaching parenting skills and child development enables us to search for creative ways to adapt our teaching methods to each parent and family situation.

Based on program evaluations done in 1997 and 1999, we are getting good outcomes in our work with parents with cognitive disabilities and their families, especially considering that 94% of families in this project have multiple stressors in addition to the cognitive disabilities of the parents. Most families have low income (87%), and significant numbers of these parents have personal histories of trauma or abuse (77%) and/or are considered to have emotional/psychiatric issues in addition to their cognitive disability (66%). One important outcome measure used to evaluate the effectiveness of our intervention is the number of out-of-home placements. Research literature on parents with developmental disabilities reports out-of-home placements occurring in from 40 to 60% of these families. The 2-7% out-of-home placement results during these evaluation periods strongly suggest that our intervention has been effective in preventing abuse and neglect of children in families served. Analyses of progress on individualized client goals as well as on clinicians' ratings suggest positive impact in the areas of our intervention: practical caregiving, parent-child relationship, family context, and child development. These results strongly support the value of preventive early intervention services.