Abstract
This Research and Development (R&D) research aims to develop and evaluate the efficacy of the prototype of an online early intervention program for children aged 0 to 5 years with intellectual and developmental disabilities, using Rajanukul Institute during the COVID-19 pandemic as the case study setting. The study process was divided into three phases. The 1st phase was situation and needs analysis via descriptive research. Sixteen sample size were the director of Rajanukul Institute, multidisciplinary team, registered nurses, caregivers of child aged 0 to 5 years with intellectual and developmental disorders recruited by purposive sampling. Collected data using individual in-depth interview and focus group with in-depth interview form and focus group interview form, which both had a content validity score of 0.93. Analyzed data using content analysis and systematic synthesis. For the 2nd phase, the development of the prototype of early intervention program for child age 0 to 5 years with intellectual and developmental for both online (TEDA4I Online Program) and onsite (TEDA4I Onsite Program) service settings through Participatory Research. Twelve sample size were multidisciplinary team, registered nurses, caregivers of child aged 0 to 5 years with intellectual and developmental disorders recruited by purposive sampling. Content analysis and reliability were analyzed then tried out. For the last phase, the efficacy evaluation and comparison of between program prototypes using Quasi-Experimental Research with two groups pretest and posttest design. The sample size in phase 3, estimated with Bernard’s formulas, was 41 children with intellectual and developmental disabilities aged 0 to 5 years at Rajanukul Institute. Twenty participants (5 children in each age range: 0 to 2 years, 2 to 3 years, 3 to 4 years, and 4 to 5 years) were randomly assigned to an experimental group receiving TEDA4I Online Program at their homes while other twenty-one (5 children in each age range except 4 to 5 years which have six children) participants were allocated to a control group receiving TEDA4I Onsite Program. The tools in 1) TEDA4I Online Program 2) TEDA4I Onsite Program, which both had content validity score of 0.99, 3) parent’s screening skill assessment and 4) parent’s intervention skill assessment which both had content validity score of 1 and reliability score of 0.94 and 5) Developmental Surveillance and Promotion Manual (DSPM) for assessing child development which had Sensitivity of 96.04 percentage and Specificity of 64.67 percentage. Six data collectors provided Inter-rater Reliability index scores in each performance as follows: 1) 0.84 score for DSPM usage, 2) 0.79 score for assessing parent’s screening skill. 3) 0.84 score for parent version of enhancing parenting skills, and 4) 0.83 score for intervention with TEDA4I Online Program and TEDA4I Onsite Program. Quantitative data were analyzed with descriptive statistics (percentage, mean, frequency, standardization) and inference statistics (Pair t-test, independent t-test, and Chi-square). Results According from Phase 1, clients needed to continue receiving child development stimulation services under every condition and social circumstance. Their parents preferred to acquire more flexible service appointment times, at least once a month, which are compatible with their personal life and daily routines. The stimulation service should also be able to provide both in weekdays and weekend. The online program should have the similar quality as the usual program. Furthermore, the service provider should support the children and parents with stimulation tools and online program-related devices. Based from phase 2, the program prototypes both TEDA4I Online Program and TEDA4I Onsite Program consisted of 15 sessions during 14 weeks long including teaching how to assess development and to enhance development for 1 session, coaching how to enhance development for 3 sessions and self-enhancing development at home with VDO clip recoding to send back to coach for 9 sessions. Apart from all these sessions which are the first and the last sessions were preparing session before attended the program, assessed child development using Developmental Surveillance and Promotion Manual (DSPM) and assessed parenting skills. Furthermore, both programs were the program that focused on parenting skills. Both programs had content validity of 0.8-1 and the assessments of parent’s development screening skill intervention skill had content validity score of 1 and reliability score of 0.94, respectively. In case of phase 3, The mean posttest scores of development screening skill and development stimulating skill in parents, both in experimental and control groups, were significantly greater than those in pretest at the .05 level regardless age range but the between-group differences were not significant at the .05 level in any age group. The mean posttest scores of child development, both in experimental and control groups, were significantly greater than those in the pretest time point at the .05 level with the post scores in the experimental group were higher than those in the control condition. In case of the experimental group, the post development scores were significantly higher than the pre ones at the .05 level in 2-3 years and 4-5-years subgroups. In case of the control group, the post development scores were significantly higher than the pre ones at the .05 level in 0-2, 2-3, and 4-5 years. However, the levels of child development were not significantly improvement after program participating both in experimental group (developmental Improved: 60%, developmental Improved until usual: 20%, not improved: 20%) and control group (developmental Improved: 57.10%, developmental Improved until usual: 14.30%, not improved: 28.60%). Overall, the levels of improved child development between the experimental group and control group were not significantly different in every age range (in total, developmental Improved: 58.50%, developmental Improved until usual: 24.40%, not improved: 17.10%). the higher mean scores of child development, which has five areas (Gross motor, GM, Fine Motor, FM, Receptive Language, RL, Expressive Language, EL, and Personal and Social, PS), after receiving TEDA4I programs between online or on-site versions were not significantly different at the .05 level in any sub score except the EL score which significantly higher at the .05 level in the experimental group than the control group. Considering within each age group, among participants aged 0 to 2 years, the RL score of the experimental group was significantly improved than the control group at the .05 level. Conversely, in case of children aged 4 to 5 years, the PS score of the control group was significantly improved than the experimental group at the .05 level. Furthermore, no between-group differences in 2 to 3 and 3 to 4 age ranges were reach at the .05 level of significance. Conclusion The TEDA4I Online Program and TEDA4I Onsite Program which developed in this study were qualify. They could enhance caregivers to assess and train their child which their child age 0 to 5 years has a better development.
