What You Need to Know About Early Intervention
If you’re concerned about your child’s general development skills, you have several options depending on your child’s age. Understanding these options isn’t always easy, so I’m going to do my best to explain each and describe the factors you need to consider before making a decision.
In general, your options are:
Early Intervention Services
School-Based Services
Private Therapy
This post will be all about early intervention, but keep an eye out for posts on school services and private therapy. Early intervention is provided by the state to children from birth to their 3rd birthday. Services include speech therapy, occupational therapy, physical therapy, and special instruction (someone who is trained to provide cognitive, social, and emotional support). I’ll explain some facts and history on early intervention, then walk you through the process as best I can.
1) You and your child have rights.
Back in 1975, the Individuals with Disabilities Education Act (IDEA) was put into action. Originally, it required that all children receive a free and appropriate education regardless of their disability or delay. In 2011, IDEA required that children from birth to 3-years-old receive early intervention (EI) services. (FYI: This is through Part C of IDEA 2011). In layman’s terms, this means that your child is eligible for early intervention services anywhere in the US—as long as they qualify (more on that later).
2) Early intervention (EI) varies from state to state.
The federal government places certain regulations on states such as requiring that they provide services for every eligible child, but many of the logistics are up to the state. Visit http://ectacenter.org/contact/ptccoord.asp to get the contact information for your state’s EI department.
A note for Alabama Residents:
Alabama will provide services for any child who has a medical diagnosis that can delay normal development or who has a developmental delay that causes the child not to meet developmental milestones (info taken from http://www.rehab.alabama.gov/individuals-and-families/early-intervention). You can call the state wide EI Child Find number at 1-800-543-3098.
3) Someone has to start the process.
And that someone will probably be you. Let’s say you notice that your son is 18 months old and hasn’t begun using words yet. Or maybe your niece has trouble making eye contact or playing with other kids. Your first step is to contact your pediatrician or get in touch with your state’s EI department (see #2). Pediatricians are sometimes the first to notice a problem and mention EI services. Parents—I want to make sure you hear this. You do not have to wait for an outside source (i.e. doctor, hospital staff) to refer your child for EI services! You have every right to request an EI evaluation yourself.
4) It may go without saying, but you need to know what is and isn’t expected developmentally.
I’ve worked with parents who haven’t been around many kids besides their own. It’s often hard for these parents to know what their 1-2 year old should be doing. Other parents have a “first child” who meets and exceeds all their developmental milestones and are confused when their second or third child is way behind. Sometimes we have too high or too low expectations for our kids and don’t realize that they are behind. My free PDF gives you a comprehensive guide to what your child should be doing. You can download that here.
A few things you can expect once the process gets started:
Your child will be assigned to a service coordinator.
At least, that’s is what’s done in Alabama. Here in AL, service coordinators (SC) are assigned kids as they are referred into the system. Some coordinators have certain areas of town where they provide services, while others may work in a county wide area. The coordinator is responsible for making sure parents understand Early Intervention and that their rights are protected. SC’s also either do the evaluation or bring in other therapists to complete the evaluation. They are then in charge of creating the Individualized Family Service Plan (IFSP) if your child qualifies for services (again, more on that in a sec). Other duties of a service coordinator include writing new goals, making changes to the IFSP, keeping up with when your child needs to be re-evaluated (each year), and other similar duties.
Your child is evaluated and either qualifies or doesn’t.
So, here’s the meat and potatoes of it. As I’ve said before, different states do this differently, but hopefully this will give you an idea of what to expect. In Alabama, the evaluation process is as follows:
1) There will be some paperwork for you to sign. When is there not paperwork involved? Look for forms where you give permission for your child to be evaluated and possible a case history. You should be given a written copy of your rights as a parent.
2) If your child has a medical diagnosis (i.e. cerebral palsy, Down syndrome, etc.), you will need to provide a written report for the pediatrician.
3) A vision and hearing screening will be completed to make sure neither are delaying development. If a problem is detected during the screening, you will be referred to another health professional for a more in-depth evaluation.
4) Two standardized/formal evaluations that assess all five areas of development are completed. These areas include language, physical development, social/emotional, adaptive skills, and cognition.
At least 2 disciplines will be involved in the evaluation. That could include a speech therapist, occupational therapist, physical therapist, or special instructor (which you could think of as a preschool teacher).
5) There will most likely be an informal interview so the evaluators can get an idea of your concerns. This is voluntary in Alabama, but it’s obviously the best way to provide important information about your child.
6) Once all the evaluations are complete, the service coordinator will determine if there is a 25% or greater delay in any of the five developmental areas on the standardized tests. This is how it works:
Example: Your child is 22 months old. After your child was asked to do all the silly things on the evaluation (seriously, one test asks if a kid can walk backwards for 10 feet—can’t remember the last time I needed to do that), we get her developmental age for each section. Her scores read something like this:
Language: 13 months
Physical Development: 21 months
Cognition: 14 months
Adaptive: 17 months
Social/Emotional: 20 months
In this example, the child would qualify in the areas of Language and Cognition because there is a 25% delay in those areas. She’s still within “normal” limits in the other areas, so she doesn’t qualify for those services.
Got it? Yeah, I know it’s a lot. Don’t worry if it makes no sense. The folks who evaluate your little one will explain it all.
Does my child get services or not? Well, borrowing from the previously used example:
This little girl would most likely receive services from a speech therapist only. Depending on the state and the individual needs of your child, a special instructor may also be involved.
If she had qualified in physical development and not in language, a physical or occupational therapist would be seeing her instead of the speech therapist.
Once it’s been decided what your child qualifies for, the IFSP will be created. This is a legal document that states what your concerns are, what developmental needs your child has, and what goals the therapist(s) will be working on to address those needs.
The IFSP is good for one year. This means that your child will be re-evaluated each year and will either qualify for another year or have made such great progress that she no longer qualifies!
NOTE: Re-evaluations are only completed until your child turns 3-years-old. Once she turns 3, Early Intervention no longer provides services (more on that later).
At this point, the therapist(s) who will be seeing your child should be contacting you to set up your first therapy session. They will come to your house or go to the preschool/daycare depending on what your state allows and what you prefer. I always recommend most visits being in the home, but it’s also a good idea for a therapist to visit a preschool/daycare to provide strategies and tips to the staff.
You may be wondering what to expect once services start.
Early intervention services are typically focused on provided strategies and suggestions to the family and caregivers. That means a family member or caregiver needs to be in the room with the therapist or special instructor while she is seeing your child. You may be familiar with school-based or private therapy services where the therapist takes the child into a therapy room and provides services in a one-on-one or small group setting. That’s not how early intervention services are intended to be delivered. The purpose of EI services is to help the family and caregivers feel equipped and prepared to work with children to develop necessary skills. After all, you’re with your child way more than a therapist will be and have many more changes to provide learning opportunities.
Also know that EI services are usually not offered weekly. In my experience, most children are seen once or twice a month by each provider. The service coordinator will make suggestions on how often your child needs to be seen, but you also have a say! Just remember the purpose of early intervention—family education, not one-on-one therapy. You need time to try the strategies you’ve been taught and come up with questions. Sometimes twice a month is perfect for that. If your child has more profound needs, you may see a higher frequency of monthly visits suggested.
A year from the date an IFSP was created, your child will be up for their annual re-eval—if they don’t turn three first. Someone will come back out and do the same or similar evaluations as were just done for the initial evaluation (it’s often the therapists who have been working with your family).
When your child turns 3, a whole other set of circumstances will take place. My next post will describe that further.
If you’re in Alabama, this website may answer some questions. http://www.rehab.alabama.gov/individuals-and-families/early-intervention/ei-general-information
And there we have it!
That was a lot of information. I would recommend saving this post so you can look back to answer any questions you may have. If your questions aren’t answered here, I would love to take a crack at them. Comment below, if you please.
Sources: Parent Center Hub, Alabama Rehabilitative Services
