It's a Big Environment Out There

Idea 1:
I am working on a systematic review looking at developmental assessments of cognitive and motor skills for young children born with congenital heart disease (CHD).  It is known that developmental delay is more common in this population compared with typically developing peers without CHD, but researchers are working to understand what factors are associated with variability in developmental trajectory and how to maximize development potential for this population of children.

In the reading that I am doing for this review, I have been impressed that the most prominent predictors for developmental outcome for this group of children are mostly unrelated to their heart condition.  Maternal education, overall socioeconomic status, publicly funded health insurance, growth and oral feeding skills (which are more related to the health of the child in many cases) are associated most with the cognitive, language and motor development of children with CHD.  By and large, number of surgical procedures, intraoperative strategies, birth history, and heart anatomy are not significantly correlated with developmental skills.

Idea 2:
A kiddo is 7 months old, has been hospitalized nearly 3 of those 7 months, does not take oral feeds, was born prematurely and with other risk factors, and has hypotonia.  He not only is at risk for delay, but has established global developmental delay already.  He has had a difficult time receiving support services due to social challenges, as well as repeated hospitalizations.  Health concerns continue to trump developmental concerns.

Idea 3:
I think about resource access often when I think about the children to whom we have provided foster care and have been reunified with family members.  We get to know these children.  I can't help but to set some goals for what I would like to work on while we are caring for them.  We see progress and potential, but it requires concerted effort, time, and resources.  We also recognize the desire to parent coming from biological families, but appreciate the desperate situation that they are often living in.  The limitation of resources does not afford them the luxury many times to do more than "good enough" to get by.  That is not a judgement of their person, but a reality of poverty or unsupported mental health disorders or broken family structure or whatever the case may be.  Although we have always felt confident that the children were going to a safer situation than the one they were removed from, it was always clear that the environment was a starkly different one from our home environment.

Resolution:
I was impressed by: (1) Arianna's post about knowing what children can actually do, and (2) Lin's comment about self-regulation being a trait or skill or both.  If an environment is such that children are unable to use their skills, build upon them, and continue a strong developmental trajectory, what are we supposed to assess and intervene upon?  If I evaluate the child with CHD or the child with repeated hospitalizations or the child living in a challenging social situation and they are found to have motor delays, should my intervention be aimed more directly upon that child or the environment and the parent?  Are the caregivers even able to handle having one more someone talk to them about anything because they are just so beyond their capacity to self regulate their current situation that having a PT in the mix does virtually nothing but make more chaos? Mastering a motor skill in the midst of a bigger environment is far more than the right dosing of my therapy intervention.  I have always known and respected this.  However, I am becoming more and more convinced that that bigger environment plays a bigger role than I may have ever considered in the past.