Early Intervention 101

WHAT SHOULD YOU TAKE FROM THIS PRESENTATION?

TRAINING OVERVIEW• Theory of early intervention• Effects of prenatal drug exposure• How to identify developmental delays• Who has authority to refer and consent for regional center

services• Referring children for early intervention services• Evaluations and assessments• Important timelines• The IFSP• The importance of preschool• Transition from regional center to school district services

• All children develop and learn in different ways. • Being eligible for early intervention services does not mean

that the child is “dumb” or cannot learn. • Just means they need specialized services to assist with their

learning and development.

Alliance for Children’s Rights Education Manual Page 2, Handout #1

THE TRUTH ABOUT CHILDREN WHO NEEDEARLY INTERVENTION SERVICES

IMPORTANT FACTS ABOUT CHILDREN IN FOSTER CARE

• Incidence of disability in general population is 15%, in foster care it is 50%.

• Kids in foster care are more likely to have delays/disabilities because of:• Prenatal drug exposure• Poor nutrition• Effects of abuse and neglect

• Kids with delays/disabilities are more likely to end up in foster care because they are difficult to care for.

• Only 40% of foster youth graduate from high school.• Only 3% of foster youth earn a college degree.• Early Intervention can change the direction of a child’s life!

THEORY OF EARLY INTERVENTIONWhat Are We Trying to Accomplish?

PURPOSE OF EARLY INTERVENTION

• Theory: serving kids earlier reduces delays, prepares children for school either without the need for special education or less special education services

• Congress enacted part C of the Individuals with Disabilities Education Improvement Act to:• Enhance the development of infants and toddlers with disabilities• Invest resources in our youngest children now to reduce the costs of

special education later• Maximize these children’s potential for independent living in the

future• Support families caring for children with disabilities

EFFECTS OF PRENATAL DRUG EXPOSURE

OVERVIEW OF SUBSTANCES THAT ADVERSELY AFFECT INFANTS

• Nicotine: causes a host of problems including low birth weight - a significant risk factor for developmental delay. It can also affect cognition and is associated with behavioral problems

• Cocaine, Marijuana, and Other Illicit drugs: • Cocaine and Marijuana: impaired attention, language, learning skills, and behavioral

problems.• Methamphetamine: low birth weight, decreased arousal, and poor quality of movement

in infants• Heroin: low birth weight

• Alcohol: most widely used substance during pregnancy

Information from the National Institute on Drug Abuse www.drugabuse.gov

FETAL ALCOHOL SPECTRUM DISORDER “FASD”• FASD is a catchall term to describe various effects of prenatal alcohol exposure.• Fetal Alcohol Syndrome (FAS)• Partial Fetal Alcohol Syndrome• Alcohol-Related Neurodevelopmental Disorder (ARND)• Alcohol-Related Birth Defects (ARBD)

• Babies and children with fetal alcohol syndrome may have:• Low birth weight• Problems eating and sleeping• Impaired hearing and vision• Difficulty following directions and learning how to do simple things• Trouble paying attention and learning in school• Difficulty getting along with others and controlling their behavior• Need for medical care all their lives

See Handout #2 “FASD: One Woman’s Story”Information obtained from the National Institute on Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov/ & CDC.gov

HOW TO IDENTIFY DEVELOPMENTAL DELAYS: DEVELOPMENTAL SCREENINGS

WHAT IS A DEVELOPMENTAL SCREENING?• It is a broad term used to describe something that done to tell

if the child is learning basic skills typical for that child’s age • It can be any tool used to spot delays in a child’s development:• A short test• A series of questions• A checklist• A formal screening administered by a professional such as a pediatrician

DEVELOPMENTAL SCREENINGS

• Great resource for high quality milestones: http://www.cdc.gov/ncbddd/actearly/milestones/index.html

See Handout #3

COMMON DEVELOPMENTAL SCREENING TOOLSAges and Stages Questionnaire (ASQ)• A series of developmental screening tools designed to identify children with

delays from one month to 5 ½ years old exhibiting delays• Questions are answered by parent or caregiver• Takes 10-15 minutes to complete• Can be completed by anyone who has been trained-does not have to be

completed by a professional (i.e., speech and language pathologist) • A score below the test’s threshold indicates the child should be referred to a

professional for further assessment

• Parents’ Evaluation of Developmetal Status (PEDS)• A developmental-behavioral screening tool used to identify children from birth

to 8 years exhibiting delays, in need of referral for more intensive diagnosis or evaluation

• Can be done through 211; can be completed by anyone who has been trained; does not have to be completed by a professional

EDUCATION RIGHTS

WHO HAS THE LEGAL RIGHT TO MAKE DECISIONS FOR EARLY INTERVENTION

SERVICES?• The Education Rights Holder (ERH) has the legal right to make

education-related decisions for a child, including: requesting records, early intervention evaluations and assessments, and consenting to early intervention services and placements in the Individualized Family Service Plan (IFSP). • The IFSP is the contract between the ERH and the regional

center for early intervention services.

Alliance for Children’s Rights Education Manual Page 4

WHAT YOU SHOULD KNOW ABOUT ERH• Who is the Education Rights Holder (ERH)?

• Biological Parents• Adoptive Parent • Legal Guardian• Judge’s Order – Judges can limit education rights of biological parents and appoint a new ERH via a JV-535 or

minute order*Foster Parent *Person acting as parent *CASA*Prospective Adoptive Parent *Court trained volunteer

• How and why the ERH may change?• Biological parents who previously held education rights had their rights limited or terminated by the

court• Child is reunified with biological parents after living with someone else• Child is removed from caregiver who previously served as ERH• ERH is not cooperating with advocacy efforts

• What if there is no ERH?• Ask the minor’s attorney to appoint one • The regional center must appoint a surrogate parent within 30 days of determining that one is needed• Surrogate parents cannot have a conflict of interest with the child, such as working for the regional

center or being a social worker

Alliance for Children’s Rights Education Manual Page 4

REFERRING CHILDREN FOR EARLY INTERVENTION SERVICES

WHO PROVIDES EARLY INTERVENTION SERVICES IN CALIFORNIA?

• Local regional centers contract with the state to provide services to children ages 0-3 under a program called Early Start. Local education agencies serve children with low incidence disabilities.

• Regardless of whether you think your child has a developmental delay or a low incidence disability, the initial referral should be sent to your local regional center.

REFERRAL PROCESS • Step 1: Find the child’s local regional center: http://

www.dds.ca.gov/RC/RCZIPLookup.cfm

• Step 2: Send the regional center a referral letter requesting a developmental evaluation and comprehensive assessments.

See Handout 4 for a sample referral letter• Child’s name and address• Referring for early start• Include name and contact information of educational rights holder• Describe delays and include examples or milestones that child has not met• Request developmental evaluation and specific assessments (e.g., speech and language

assessment if speech delays, occupational therapy assessment if fine motor, feeding, or sensory processing delays)

• Step 3: Contact the child’s social worker and request that the social worker also submit a referral on Form 5004.

EVALUATIONS & ASSESSMENTS

THE EVALUATION AND ASSESSMENT

• Intake Call • The regional center will call the ERH to explore their developmental concerns. The ERH

can review developmental milestones to prepare. If the call has not happened within 1 week of the referral, call the intake department to ensure they received the referral.

• Evaluation and Assessment• The regional center will meet with the ERH in the home or at the regional center to

evaluate and observe the child. The regional center must obtain written permission from the child’s ERH before this assessment takes place.

• The evaluation: will fully review all of the child’s developmental areas to determine if child is early start eligible. The evaluation must include age equivalents to calculate the percentage of delay.

• The assessment: if a child has a communication, fine/oral motor/feeding/sensory processing or gross motor delay, the regional center must also complete a speech and language, occupational therapy and/or physical therapy assessment prior to the completion of the 45 day timeline. The assessment will determine the services the child needs.

Alliance for Children’s Rights Education Manual page 9

TIMELINES

DATES AND TIMELINES TO MONITOR• Initial Referral – this is the date that either you or the social worker first

contacted the regional center to make the referral• Make sure to keep proof of when referral was sent; one way to do this is by keeping the fax

transmittal sheet.• 45-day timeline – the regional center has 45 days from the date of the referral

to evaluate and assess the child in all necessary areas and develop the IFSP. • Calculate and keep track of when the IFSP is due!

• Day 35 – if you have not heard from the regional center by day 35 to schedule the IFSP meeting, call the regional immediately to schedule the meeting

• If the IFSP is held late, the child may be entitled to compensatory or “make up” services dating back to the date when the IFSP should have been held.

Alliance for Children’s Rights Education Manual Page 4

THE INDIVIDUALIZED FAMILY SERVICE PLAN “IFSP”

• Developmental Delay• Cognitive Development• Adaptive Development• Social-Emotional Development• Communication Development• Physical & Motor Development, Including Vision and Hearing• *Must be a significant delay, if the child is less than 24 months old, the child must be 33%

delayed in 1 of the 5 areas above. If the child is 24-35 months old, the child must be 50% delayed in 1 area or 33% delayed in 2 or more areas

• Established Risk Condition• Infant or toddler has a condition that has a high probability of resulting in a

developmental delay

vs.• Prevention Resource and Referral Services (PRRS)• Only offers information, resources and referrals. They provide no direct services to

the child.

DETERMINING ELIGIBILITY

Alliance for Children’s Rights Education Manual Page 10

WHAT IS THE IFSP AND WHO SHOULD BE PART OF THE TEAM?• The IFSP is the plan to improve the child’s development

• Required members of the IFSP team are:• Education Rights Holder• Regional Center Service Coordinator• Early Intervention service providers/evaluators/assessors

• Optional members• CASA• Social worker• Other family members (if appropriate)• Others who know about the child’s needs

Alliance for Children’s Rights Education Manual page 11

WHAT IS INCLUDED IN THE IFSP? • An IFSP includes:• Present Level of Development: child’s strengths and weaknesses/needs in

each developmental area

• Developmental Outcomes: goals for the next 6 months in each area of identified need• Outcomes must include how and when progress will be measured• Ex: Sally will learn 10 new words in the next 6 months.

• Specific Early Intervention Services

Alliance for Children’s Rights Education Manual page 11

WHAT ARE EARLY INTERVENTION SERVICES? • Services are designed to meet the child’s needs in 5

developmental domains.• The most common services are:• Infant Stimulation or a Center-Based Program• Speech and Language Therapy• Physical Therapy• Occupational Therapy (feeding, fine motor, adaptive, sensory processing)

• The type and amount of service should be clearly written into the IFSP document.

Alliance for Children’s Rights Education Manual page 11

IFSP CONT.• Duty to Use Generic Resources• Insurance/Medi-Cal must be used to access services before regional center funding is

used• This requirement does not apply to evaluations/assessments• Many services may be covered by insurance/Medi-Cal but this is a slow process, so

start as early as possible• In order to prevent delay, request that the regional center provide “gap funding” for

all services required in the child’s IFSP

• Accessing Services through Insurance/Medi-Cal• Describe delays to child’s pediatrician and request prescription for specific service• Contact the Alliance’s Health Care Program for providers that accept Medi-Cal, make

the earliest possible appointment, keep regional center service coordinator informed, ask service coordinator to follow up

Alliance for Children’s Rights Education Manual page 12

IFSP CONT.• Signing the IFSP• Before signing, review all outcomes, services and notes to ensure they

clearly outline what the child will receive• Do not sign a blank document• Services cannot begin until IFSP is signed• If there are parts of the IFSP that the ERH agrees with, but others she

does not, the ERH can sign for implementation of only the portions agreed to, as long as that is clearly written on signature page

• Don’t leave the meeting without a copy of the service page, including ERH signature

• Request a copy of the IFSP document be sent to you within 5 business days

THE IMPORTANCE OF PRESCHOOL FOR CHILDREN 3-5

BENEFITS OF PRESCHOOLAll children benefit from enrolling in a high-quality early care and education program to develop skills that contribute to school success, regardless of whether or not they have a developmental delay. Preschool also helps children prepare for kindergarten both academically and socially.

PRESCHOOL

• How to find an early care and education program• Early Head Start and Head Start: Visit PreKKid.org or call 1.877.773.5543• Los Angeles Care Alliance Resource and Referral Line at: 1.888.922.4453• Los Angeles Universal Preschool (LAUP): laup.net or call 213.416.1200• California State Preschool Program (CSPP): Contact Los Angeles Care

Alliance Resource and Referral Line at: 1.888.922.4453• Child Care and Development Centers: Contact Los Angeles Care Alliance

Resource and Referral Line at: 1.888.922.4453

Alliance for Children’s Rights Education Manual Page 14

TRANSITIONING & PRE-SCHOOL

TRANSITION FROM REGIONAL CENTER TO SCHOOL DISTRICT SERVICES• Why do Early Start services through the regional centers stop at age 3?• Eligibility for regional center services changes at age 3.• Children over age 3 must have a developmental disability to qualify for ongoing regional

center services, such as Mental Retardation (Intellectual Disability), Epilepsy, Autism, Cerebral Palsy or a condition similar to Mental Retardation that requires the same treatment, and this condition must constitute a substantial disability.

• What is a transition IFSP?• The transition IFSP is a meeting with the family, regional center, and school district to

discuss and plan for the transition.• All Early Start eligible children will be referred to and assessed by the school district 3-6

months before their 3rd birthday to determine if they qualify for special education services.

• What is the difference between early intervention services for children ages 0-3 and children 3-5?• For children 0-3, Early Start services are provided mainly through the regional center. For

children 3-5, services are provided by their local school district.

Alliance for Children’s Rights Education Manual Page 14

CHRISTOPHER’S STORY

• Christopher is 18 months old. He is making some sounds but he is not babbling and has not said any words. Christopher is able to pull himself up to standing but is not yet walking. Christopher’s caregiver reports that he is very “jumpy” and gets easily startled by sounds. Caregiver also mentioned that Christopher was waving bye-bye but has stopped and doesn’t give her hugs or kisses. Christopher is able to feed himself crackers and fruit and can hold a sippy cup.• What can you do to help Christopher?

How can the Alliance for Children’s Rights help?

• If you feel that the child would benefit from representation by an attorney you can request that the child’s attorney send a “0-3 Referral for Regional Center Advocacy” to our office. See Handout #5• The caregiver or ERH can also contact our intake line at

213.368.6010.

For more information contact us at 213.368.6010www.kids-alliance.org