Early prevention of childhood disability in developing countries.

The concept of prevention, while implicit in most early intervention efforts, has not been comprehensively articulated as a basis for conceptualizing early intervention services. The growing recognition of the importance of early identification and intervention for infants and young children, and involvement of the family, are factors which contribute to conceptualizations of services which are preventive in nature. This recognition parallels broader concerns for family support programmes which have a preventive focus and seek to enhance the development of children and families. The purpose of this paper is to present a comprehensive framework for the provision of child and family service by conceptualizing early intervention in terms of levels of prevention. Specifically, the concept of primary, secondary, and tertiary levels of prevention will be presented as a framework suitable to encompass the preventive function of community based rehabilitation. The relevance of early prevention is based on the premise that the condition of childhood disability can be prevented at primary, secondary, and tertiary levels. Viewed in this way, the problem or condition of developmental delay or disability in children can be addressed at each of the three levels to effect a reduction of its expression, its duration or extended impact. Primary, secondary, and tertiary prevention can be implemented in the context of community based rehabilitation to address these goals: (a) enhance development and minimize the potential for delay; (b) minimize the need for special education and related services; and (c) minimize the likelihood of institutional or other restrictive care outcomes.