It is very rare for a child to be diagnosed with bipolar disorder as a preschooler. However, if your child falls into this category, or if she has another disabling condition that emerges in early childhood, she should be eligible for Early Intervention (EI) services.

EI service offerings vary widely according to where you live. They should, however, be determined by the child's needs, not just what happens to be available or customary in your area. Evaluation is the first, and sometimes the most important, service provided through EI programs. Once an evaluation has been carried out, if your child is found to have bipolar disorder or another disability an Individual Family Service Plan (IFSP) is developed. The IFSP spells out the needs of the child and the family, and the services that will be provided to meet those needs.

The Individual Family Service Plan

This document should be created at an IFSP meeting, which you will be invited to attend and contribute to. Although it's a good idea for both parents and practitioners to write down their ideas for goals and interventions in advance, the IFSP itself should not be written in advance and simply handed to the parents to sign.

The cover page of the IFSP summarizes what's known about the child and his diagnosis, and lists the team members present at the IFSP meeting. It also lists the services to be provided, who will provide them, how often they will be provided, and where they will be delivered. Further details about these services are entered on goals and objectives pages, later in the IFSP. Accordingly, the cover page should be mostly blank until the goals and objectives pages have been filled out.

Goals and objectives will be developed by the team at the IFSP meeting. They can be written to cover any area where your child has a deficit, including cognition, behavior, coping strategies, fine and gross motor development, communication, social skills, and self-help skills. Goals should be finite, observable items rather than general concepts. For example, "Kim will learn to use counting to ten and breathing deeply as a response to frustration," is a workable goal, while "Kim will learn to deal with frustration," is not.

One or more pages of the IFSP describe your child's evaluation. These pages should cover medical information, psychiatric diagnosis, and the results of hearing, vision, and developmental screening, if any.

The IFSP can also include services needed by the whole family to help you care for your child. For example, these services might include parent education classes, the services of a behavior expert who can help you with home discipline problems, psychiatric consultation, and assistance in finding and accessing community resources.

The goals set in your child's IFSP will dictate what kind of setting services should be delivered in. Typical EI settings include:

• Home-based services. For very young children, home-based services often make the most sense. Home-based programs may include direct therapeutic and educational services, training and supervision for parents and volunteers working with the child, and assistance with medical procedures and care needed to allow education to take place.
• Direct services. This category includes all types of professional services, such as psychological therapy, that are delivered in a school setting (but not as part of the preschool program itself), clinic, or other setting outside the home. For example, the IFSP might specify that your child is to receive 45 minutes of play therapy twice a week at a nearby university's clinic. These services may be delivered by professionals or facilities under contract with Early Intervention, or by practitioners working directly for the EI program.
• School-based services. This category includes all services delivered as part of a public or private preschool program, at the school site. Therapeutic services may be integrated into a special or typical preschool program, or may be delivered as pull-out services for which your child leaves the class for one-on-one or small-group work.

A primarily home-based program goes the furthest to build a strong relationship between the child and his parents. It takes place in a familiar, non-distracting environment that has probably already been made appropriate for the child's sensory and safety needs. It eliminates lost time and problems related to transporting a preschool child to school (many EI programs actually bus infants and toddlers across town). It also provides the best stage for intensive, one-on-one intervention, such as floor-time play therapy.

It can also be extraordinarily difficult to get approval for. One tool that may help you win this battle is a thorough and accurate financial appraisal that compares the cost of an intensive home-based program in the early years to twelve years of residential or private placement. If your child has been diagnosed with a bipolar disorder at this early an age, it is likely that his symptoms are already very severe. That makes early, intensive intervention the most cost-effective solution, no matter how you cut it.

Early Intervention classrooms

A preschool setting with other children is often considered the best placement for a young child with a psychiatric condition, because it provides the child with the greatest number of opportunities to relate to others, play, and learn. Spending time with other children in a structured setting can be very beneficial for developing social skills. However, attention must be paid to your child's special needs, deficits, strengths, and so on--just any preschool class won't do.

Early Intervention preschools come in four basic flavors:

• Regular preschool classroom, with or without special support. Also called a full integration setting or mainstreaming, this might be a Head Start or similar preschool classroom. Your child would attend preschool with therapeutic services, classroom adaptations, and personal support, such as an aide, as needed. These services, adaptations, and supports must be written into the IFSP.
• Supported integrated preschool classroom. Also called a reverse integration setting, because it's the nondisabled students who are integrated into a special program rather than the other way around. This is a specially created preschool setting that brings together a small group of children with disabilities and children without disabilities. Therapeutic services, classroom adaptations, and personal support are provided to each child with a disability as per his IFSP. Children in a supported integrated classroom may have a variety of different disabilities, such as autism, Down syndrome, or mental illness.
• Special preschool classroom. This is a specially created preschool setting for children with disabilities only. The children may have a mix of various physical or emotional disabilities, or a mix of different behavior disorders only. The classroom may be part of a larger school with other types of classrooms.
• Special preschool. This is an entire preschool program created specifically to work with children who have disabilities. It may be within a larger school program that also educates school-age children. It may be owned and run by a public school district, or it may be a private school that contracts with the Early Intervention program to provide services. If it is private, EI and/or the school district should pay the full cost of tuition if it is judged to be the most appropriate setting for your child.

There are positive aspects to each of these typical settings. For children who can handle full, supported inclusion in a regular preschool classroom, there are ample opportunities to model the behavior of less-challenged peers.

Supported integrated classrooms offer similar benefits, with a daily program and structure that's more geared toward the child with special needs.

Special classrooms and schools generally have the most services, but provide few opportunities to interact with nondisabled peers. Your child's needs, abilities, and difficulties will dictate the right placement, as there is no workable one-size-fits-all approach.