Portugal is a culture grounded in strong traditions and family. Yet, social changes like women returning to the workforce and a decreased national birth rate are impacting the traditional family structure and caregiving environments of children. Female employment has been increasing steadily in Portugal over the last three decades (Galego & Pereira, 2006) and the total fertility rate decreasing from 4.1 to 2.8 (INE, 2006). Furthermore, extended family members, like grandparents, no longer reside close by to their children and grandchildren as in the past, because of a changing labor market. Many of the younger generation are leaving their rural communities to flock to urban areas because of job opportunities, leaving behind older relatives who would have otherwise participated in the daily care of children. Given these social and economic changes, children are spending more time in out-of-home care with non-familial caregivers. Yet, government regulations and guidelines in early care and education (ECCE) and early intervention (EI) are only just emerging; it continues to be a work in progress.

Since 2000, it has been reported in the European Agency Final Report (June, 2005) that there is low coverage of children from 0-2 years, children are at environmental and biological risk (25-30%) and only a quarter of children with identified special needs are enrolled in EI services under 3 years.

In an effort to address the need for better quality care for children and families, Dr. Marina Fuertes (Post-doctoral fellow, in the Child Development Unit, Children's Hospital Boston) and other professionals at the Gabineto de Apoio ao Desenvolvimento Infantil e à Familia (GADIF), School of Education, the Instituto Superior de Educacao e Ciencias in Lisbon, a Portuguese center focused on child development, research, and family support, have developed a home-based program (The Integrative Intervention Home Visiting Program) to promote the healthy development of young children by empowering families and reinforcing positive caregiving of their children.

The essence of the Integrative Intervention Program is best represented by the comments of one parent: "These activities performed in our own home enable us [parents] to use and practice important skills with our child, with appropriate tools. Most of the activities are something we normally wouldn't think about doing at home, amidst our routines. We would probably think that these strategies were not something we could do, but only professionals. We can see benefits for the child growth and development. Our child is a very good example of this! There is a strong psychological effect. So, once you start doing that, then it really makes our family feel a whole lot better about ourselves."

As an institution, GADIF offers quality, affordable child development services that support child and family functioning. The organization provides a range of individualized services regarding child development, parent-child attachment, and family functioning. Specific services include, but are not limited to Psychology, Family education, Counseling, Home visiting, Special education for children with special needs, Physical therapy, Speech/Language services, and occupational therapy.

Unlike the traditional, proscriptive approach of the medical model, GADIF is unique because of its collaborative approach with families and focus on child behavior and family support. Programs at GADIF are embedded in three major theoretical underpinnings:

• Mother-infant attachment and the impact on child physical, cognitive and social-emotional development (Bowlby, 1980, Ainsworth, et al., 1978; Bradley, et al., 1989; Brazelton & Cramer, 1990; Crittenden, 1999; Crittenden & Claussen, 2000; Spangler, et al., 1994)
• The important role of the family and social experiences in a child's development (Bowlby, 1980; Brazelton & Cramer, 1990; Tronick, 2003)
• Child development exists in context (Sameroff & Chandler, 1975; Sameroff & Fiese, 2000; Bronfrenbrenner, 1986) and social interaction (Bandura, 1977, Lerner & Kaufman, 1985; Moen, Elder & Luscher, 1995; Vygotsky, 1978)

GADIF is also a research organization. Current research activities focus on the impact of mother-infant attachment and emotional outcomes of children. Research activities are always informing clinical practice within the various programs.