Part I: What is Early Intervention?
Part II: How do I know if my child needs EI and who do I contact?
Part III: What are delays and eligible diagnoses?
The process for receiving Early Intervention services varies in each state and sometimes in each county. It is similar in many ways throughout the country, but specifically I can describe the NY state process in detail.
The EI steps are: Referral, Evaluation, Initial IFSP meeting, Implementation of services, 6 month reviews, Discharge/closing.
Referral: A parent/guardian, pediatrician, caseworker, or other person, can make the referral to EI for the child. The county of which the child lives, is called and describes the developmental concerns to the intake/referral personnel. They are then given an appointment with an Initial Service Coordinator for either a screening or an evaluation, depending on the nature and severity of concerns. If a screening indicates probably delays they are also sent to an evaluation.
Evaluation: This is called a "core evaluation". It is conducted with a special education teacher and either a physical therapists or speech therapists (depending on concerns with each individual child), or sometimes both a motor and language person in addition to the ever-present education teacher. The scores will serve as a baseline for this child. Each developmental domain (social/emotional, self-help, communication, cognitive & motor) will be tested with recognized, standardized tests. Some tests that may be used are: Battelle, Peabody, PLS4, etc. The scores of these tests will show where, if any, delays are present for the child. These are the areas that will be addressed by services. A child may also be referred at this time for other specific evaluations such as: Occupational therapy/sensory, Audiological, and Developmental evaluation with a developmental pediatrician.
Initial IFSP meeting: After the evaluation determines the areas of need, a meeting will be held to complete the Individual Family Service Plan (IFSP). The Initial Service Coordinator (ISC) along with an evaluation representative will meet with the parents to determine services, frequency, etc. If a child's scores show delays in communication then a speech therapist will be added to the plan to address that domain. Frequency is determined by the severity of delay and other circumstances affecting the child and family. Generally, a child begins services 1xweek for an hour, per service. A child may start his EI stay with one service, or 5 +, depending on his needs. This plan begins the day it is written and goes for 6 months. IFSPs are renewed every 6 months with the On-going coordinator and team members to determine if the child continues to qualify or not.
Implementation of services: Services for the child begin immediately, as allowed or able to do so. Generally, the ISC, after reviewing the evaluation, will be able to tell which services the child will need, and will begin contacting providers to start as soon as possible with the family. Occasionally, there are not openings for specific services and a child will be placed on a waiting list until space opens up. Services are usually at home or daycare, in the child's "natural environment". This is similar to the "least restrictive environment" that the 3-5 CPSE system adheres to when authorizing services.
6 month review: The IFSP plan for each child is authorized for a maximum of 6 months, at which time it will be reviewed with the family, service providers/therapists, OSC and possibly a county representative (EIO/D). At any time before this, a therapist may determine the child needs more services, less service, another service in a different area, a supplemental evaluation of a different area, or discharge.
For example: If Johnny is receiving physical therapy because he is 18 months old and not walking, the PT will work on his motor skills. However, she might notice after working with Johnny for a few months that he isn't using words, and doesn't seem to understand directions. She will ask for a supplemental speech/language evaluation to see if Johnny qualifies and would benefit from speech.
At the 6 month IFSP review the team will discuss the child's beginning level of service/where they started, the goals the family had set for the 6 months, if the child has achieved them and needs to continue services, and new goals for the next 6 months. Then another plan will be developed, describing which services and frequencies of those services, the child will receive.
Discharge/closings: If a child, after receiving services for any length of time, has made enough progress that the family is satisfied (remember this is all voluntary and they can stop at anytime-unless mandated to receive services, which does happen with CPS Involvement) they can decide to close the EI case. Typically what happens is the therapists working with the child begin to see improvement and let the team know the child is nearing age appropriate skills and will no longer need the services. If the child receives more than one service, than they can continue on until all areas are addressed and age appropriate. (It's not exactly age appropriate development, just not "severe", a child may still have a mild speech delay, but not qualify for services, etc.) If the child receives only one service and has neared age appropriate skills, then they will be discharged from EI. Sometimes we need to close EI cases for other reasons, such as: family unresponsive to services, family has moved out of the area, decides they do not want services, unable to locate family to provide services, and many others... We do make sure the family has information to contact EI again, or their school district to re-evaluate the child should they ever need services again.
That is a brief overview of the entire EI process from start to finish (very brief!) and there are always a lot more details, questions, answers, and other steps to address.
Next topics, to finish my "series" are:
Part V: Role of EI team (and my job)
Part VI: Transitioning out of EI into CPSE services
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