Joey and Joy are twins who were born at only 23 weeks gestation (17 weeks before their due date). Both had a very long and difficult stay in the Neonatal Intensive Care Unit (NICU). In the beginning, their parents, who had been married for eight years, were at their bedsides around the clock. Mom had an extremely high level of faith, as well as supportive parents of her own, and she was able to accept challenges with Joey and Joy?s fragile conditions and uncertain futures. Dad, however, didn?t share in mom?s perspective, and he left the family while the twins were still hospitalized. The twins were never placed together in a single isolette, because each was so fragile and critically ill.
Joy arrived home four months after her birth, receiving oxygen around the clock. She slept very little, and cried a lot. Joey arrived home two months later, but was rehospitalized almost immediately for a surgical revision of his shunt. By the time mom had both children at home with her, they were seven months old. Joy remained on oxygen part of the day, and Joey was unable to support his enlarged head, and only moved it to one side. Despite lack of sleep and lots of demands, mom was grateful to have her children home, and eager to support their growth and development.
Since both children had been referred to early intervention shortly after their birth, an early interventionist was assigned to contact the family once Joey and Joy were home. She chose to assess the family?s needs slowly, by spending consistent time in the home getting to know mom and the twins, who were very leery of strangers. In talking with mom and watching her daily routine with the twins, several things became clear to the early interventionist: (1) mom had many things to do with the twins throughout the day and night that related to their medical care (2) each child showed a desire to be where the other one was, doing the same thing, and (3) both Joey and Joy were very interested in exploring their environments.
While each child had a different set of developmental needs, the early interventionist realized that there needed to be a way to include each sibling in any activities that supported the other?s goals. This would meet the twins? needs to be near each other, as well as to explore their environment. It would also address mom?s expressed desire for Joey and Joy to have as much possible time together, after having been separate for so long. It was also very important that any developmental activities recommended for the twins be easily included in their daily routine, as it was already hectic enough.
The early interventionist wrote an Individualized Family Service Plan (IFSP) for each child with mom. Both IFSP?s included developmental goals and objectives, as well as suggested activities for meeting them. All of those activities were already part of mom?s daily routine with Joey and Joy. All of the suggested activities also included both twins. Mom stated that she felt like she would be able to be a successful partner in supporting Joey and Joy?s development, and that she was pleased about being able to do so without adding additional responsibilities to her plate, and without having to separate her children.
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