Early Childhood Intervention (ECI) programs are essential for providing support to children with

developmental delays, disabilities, and behavioural or mental health needs. However, the provision of
ECI services varies widely from country to country, and many children and families do not have access to
the services they need. Through an analysis of the efforts of Croatia and Serbia to develop and improve
their ECI systems, this case study highlights the importance of a coordinated and integrated approach to
providing ECI services, and the potential benefits of investing in early childhood development. By
examining the challenges faced by these countries in providing ECI services, the strategies they have
employed to address these challenges, and the outcomes of their efforts, we can gain insights into the
key factors that contribute to the success of ECI programs and the ways in which these programs can be
improved to better serve the needs of children and families. Specifically, we will focus on the situation
analysis conducted in Croatia in 2019 to identify the strengths and weaknesses of existing ECI services,
and the series of studies conducted in Serbia to identify the conditions for developing a phased process
towards building a national ECI system.

The key problems and issues identified in the case study are:

1. Lack of integration and coordination among policies and services that respond to the complex
needs of young children with developmental difficulties and their families.

2. Scarce early childhood intervention (ECI) services and lack of capacity among professionals to
provide these services based on new evidence and innovative approaches that place families at
the center of interventions.

3. Majority of developmental delays are recognized too late in Serbia, partly because
paediatricians do not use standardized tools to monitor and assess child development.

4. Prevailing medical approach aiming to correct ‘defects’ and ‘cure’ the child based on medical
protocols or treatment/rehabilitation.

5. Persisting prejudice, stigma, discrimination, child abandonment, and institutionalization due to

disability in the wider environment.

6. Need for ongoing capacity-building for professionals and advocacy and outreach services that
are led from the central level.

7. Need for a well-developed legal foundation and effective management and coordination
mechanisms.

8. Need for well-coordinated services, including planning, budgeting, supervision, normative

program guidelines, and procedures.

9. Need for promoting the use of standardized assessment tools at an early age to identify children
who have or are at risk of having developmental and behavioural delays.

The case study focuses on the development of early childhood intervention (ECI) services in Croatia and
Serbia. The situation analysis conducted in both countries revealed that the status of ECI services differs
from country to country, and services are provided by a range of ministries, municipalities, NGOs, and
organizations of people with disabilities. The lack of integration and coordination among policies and
services that respond to the complex needs of young children with developmental difficulties and their
families is a major issue in both countries. Scarce ECI services and lack of capacity among professionals
to provide these services based on new evidence and innovative approaches that place families at the
center of interventions are also significant problems. In Serbia, the majority of developmental delays are
recognized too late, partly because paediatricians do not use standardized tools to monitor and assess
child development. The prevailing medical approach aiming to correct ‘defects’ and ‘cure’ the child
based on medical protocols or treatment/rehabilitation is another issue. Persisting prejudice, stigma,
and discrimination, child abandonment, and institutionalization due to disability in the wider
environment are also significant challenges. The case study highlights the need for ongoing capacity-
building for professionals and advocacy and outreach services that are led from the central level, a well-
developed legal foundation, and effective management and coordination mechanisms.

Possible alternatives for improving ECI services in Croatia and Serbia include:

1. Developing a comprehensive and integrated ECI system that places families at the center of
interventions, promotes the use of standardized assessment tools, and provides ongoing
capacity-building for professionals.

2. Advocating for policy changes that support the development of ECI services and ensure
equitable access to these services for all children and families.

3. Strengthening the legal foundation for ECI services to ensure that they are sustainable,
accountable, and responsive to the needs of children and families.

4. Establishing effective management and coordination mechanisms to ensure that ECI services are
integrated and coordinated across different sectors and levels of government.

5. Providing outreach and advocacy services to raise awareness about the importance of ECI
services and promote the use of standardized assessment tools among pediatricians and other
professionals.

The alternatives were not rejected, but some constraints and reasons may limit their implementation.
For example, developing a comprehensive and integrated ECI system requires significant resources,
including funding, trained professionals, and infrastructure. Advocating for policy changes may face
resistance from stakeholders who are not convinced of the importance of ECI services or who have
competing priorities. Strengthening the legal foundation for ECI services may require changes to existing
laws and regulations, which can be a lengthy and complex process. Establishing effective management
and coordination mechanisms may require significant changes to existing structures and systems, which
can be challenging to implement. Providing outreach and advocacy services may require significant
resources and sustained efforts over time to achieve the desired impact.

One specific and realistic solution to improve ECI services in Croatia and Serbia is to establish a national
ECI program that provides comprehensive and integrated services to all children and families in need.
This solution was chosen because it aligns with the recommendations of UNICEF and other international
organizations, which emphasize the importance of developing a country-wide organizational structure
for program coordination, planning, and accountability.
Evidence from the case study and outside research supports the need for a national ECI program. The
situation analysis conducted in Croatia in 2019 revealed that the current ECI system is fragmented and
lacks coordination, resulting in inequitable access to services and poor outcomes for children and
families. Similarly, in Serbia, the lack of integration and coordination among policies and services that
respond to the complex needs of young children with developmental difficulties and their families is a
major issue.

A national ECI program would address these issues by providing a coordinated and integrated system of
services that is accessible to all children and families in need. This program would include a range of
services, such as early identification and assessment, family support and counselling, therapy and
intervention services, and transition planning to other services as needed. The program would also
provide ongoing capacity-building for professionals and advocacy and outreach services that are led
from the central level.

This solution aligns with the concept of a comprehensive and coordinated system of care, which is a key
principle of ECI. It also aligns with the recommendations of UNICEF and other international
organizations, which emphasize the importance of developing a country-wide organizational structure
for program coordination, planning, and accountability.

To accomplish the proposed solution of establishing a national ECI program in Croatia and Serbia, the
following strategies could be implemented:

1. Develop a national policy framework: A national policy framework should be developed to guide
the development and implementation of the ECI program. This framework should include
guidelines and procedures, service and personnel standards, and performance standards.

2. Establish a national coordinating body: A national coordinating body should be established to

oversee the development and implementation of the ECI program. This body should be
responsible for coordinating services, monitoring progress, and ensuring accountability.

3. Develop a comprehensive service delivery model: A comprehensive service delivery model

should be developed that includes a range of services, such as early identification and
assessment, family support and counselling, therapy and intervention services, and transition
planning to other services as needed.

4. Provide ongoing capacity-building for professionals: Ongoing capacity-building for professionals

should be provided to ensure that they have the knowledge and skills needed to provide high-
quality ECI services.

5. Provide advocacy and outreach services: Advocacy and outreach services should be provided to
raise awareness about the importance of ECI services and promote the use of standardized
assessment tools among paediatricians and other professionals.

The national coordinating body should be responsible for overseeing the development and
implementation of the ECI program. This body could be composed of representatives from relevant
ministries, NGOs, and organizations of people with disabilities. The development of the national policy
framework and service delivery model could be led by a team of experts in ECI, with input from
stakeholders and families. Ongoing capacity-building for professionals could be provided by universities
and training institutions, with support from the national coordinating body. Advocacy and outreach
services could be provided by NGOs and other organizations, with support from the national
coordinating body.

Further action may be needed to address some of the issues that could arise during the implementation
of the ECI program. For example, there may be resistance from stakeholders who are not convinced of
the importance of ECI services or who have competing priorities. To address this issue, advocacy and
outreach services could be provided to raise awareness about the benefits of ECI services and the
importance of investing in early childhood development. Additionally, ongoing monitoring and
evaluation of the ECI program could be conducted to ensure that it is meeting the needs of children and
families and achieving its goals.