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Early Intervention: What to Expect

By Jeffrey Hartman - @jhartman1276

 

For many children and their parents, special education services begin long before kindergarten. Depending on the nature of the disability, the journey might begin before or just after a child is born. The news of a child having a delay or disability is jarring enough. Learning to navigate the system of available services can be confounding. Becoming acquainted with this system sometimes starts mere hours after delivery.

An attending physician may note the possibility of a delay upon examination of a newborn. Characteristics of a specific disabling condition might be clearly evident. Apgar assessments of breathing and reflexes and such might aid identification, but visual inspection alone could be enough to note an anomaly. The team assisting in the delivery might immediately begin what could be considered proto-special education as they prepare a referral for early intervention services.

The purpose of early intervention services (often abbreviated as EI) is to address a possible developmental delay. These are delays in what would be considered average functioning for a child at a given developmental level. Eye gaze, grasping, or sitting are examples of milestones that could be delayed. Such delays might be the result of surgery, prematurity, or low birth weight. They also could be caused by a congenital condition. If an obstetrician or pediatrician notes a possible delay at birth or in the days, weeks, or months afterwards, he or she will recommend EI. Parents also might initiate a referral if they note something atypical and bring this to a pediatrician’s attention.

EI is meant to promote the physical, cognitive, and even social development of a child experiencing some kind of developmental delay. The services are provided via Part C of the Individuals with Disabilities Education Act (IDEA) and consequently are considered special education. They are free to parents. Protocols and protections akin to those afforded to older students with special needs are in place.  Access to EI is a right and the IDEA mandates provision.

A child must first qualify for EI. The referral doesn’t automatically qualify the child. Parents must take the referral to a center that provides EI. If a physician hasn’t made (or won’t make) a referral, parents might be able to obtain one directly from the EI provider. Typically, this provider will be a county Intermediate Unit (IU) or a county office of intellectual disabilities (whether or not an intellectual disability is suspected). Sometimes the provider will be an entity solely dealing with EI. Whichever the case, an intake and evaluation will proceed at the direction of an assigned service coordinator. This will be the point person throughout the evaluation. The point of the evaluation will be to determine the presence of a delay and the need for EI.

The IU, county office, or EI center staff will conduct the evaluation. Even if the parent initiates the referral, the service coordinator will obtain parental permission before proceeding. To the greatest extent possible, the evaluation will take place in the most comfortable environment for the child, which usually is the home. The evaluating team might consist of a nurse, a teacher, and a psychologist. Various therapists might participate, depending on what is noted in the referral. Parents will answer a set of screening questions. The team will use various scales to determine readiness. The evaluation will resemble a conversation mixed with playtime for the child.

The team completes the evaluation after meeting with the child. They review results with the parents. To qualify for EI, the completed evaluation must note that the child shows delays of approximately 25% or 1.5 standard deviations below what would be considered average functioning in at least one of the assessed areas. The actual cutoffs and assessed areas vary per state. If the child qualifies, the team must create an Individualized Family Service Plan (IFSP) within forty-five calendar days of the completed evaluation. Should the parents disagree with the findings of the evaluation (which might be the case if a child is found ineligible), they can request an independent evaluation and use the findings of this to challenge what the initial evaluation finds.

The IFSP determines what EI will be. Per the IDEA, services should take place in the most natural setting possible, such as a typical daycare center for children without disabilities. They might take place in the home per a qualified instructor. This is in the same spirit of least restrictive environment that applies for older children with special needs. For children with severe disabilities, services might need to happen at a center for EI. Wherever they happen, they will resemble a more sophisticated and deliberate version of common daycare activities. Unlike most available daycare, services might include specialized transportation or specific therapies. Crucially, all services will be based on the needs of each child. Six months following the start of the IFSP, the team will review its effectiveness and revise as needed. Such adjustments can be made earlier per teacher, therapist, or parental request. In rare instances, teams might determine services can cease—a decision parents can challenge. If a child qualifies initially, the likelihood of services no longer being needed by the time of a review is fairly low.

Part C of the IDEA covers services from birth to three. From three forward, Part B of the IDEA begins. Services for children from three to school age are considered early childhood services, although in some states and districts it is still called EI. Prior to the child turning three (ideally, at least four months prior to this), parents must contact the local school district about enrollment. The EI service coordinator can assist with this. A written request for a new evaluation should accompany the contact, though schools are obligated to honor oral requests.

The school district will send the parents a specific request form for an evaluation followed by a formal permission form. It might seem redundant, but most districts will insist on both—the first to verify the request and the second to obtain indisputable permission. The district must send the permission form within ten calendar days of the written or oral request. Upon receipt of the parent’s permission, the district must complete the new evaluation within sixty calendar days. A team including a teacher, a psychologist, and various therapists will create the evaluation. Parents will supply input. Testing might happen in the home or other daycare setting, but more likely will happen at a district early childhood center. The evaluation once again will determine eligibility, this time according to one of the thirteen disability categories under the IDEA.

If the child is eligible, the team (including the parents) will have thirty calendar days to create and implement an Individualized Education Program (IEP). This document will guide the child’s educational program through the district-run early childhood center. A certified special education teacher specifically licensed to work with young children will oversee the IEP. Parents get the opportunity to review and approve or disapprove the program before its implementation. If they disagree with some aspect of it, they can refuse the placement notice and request either mediation or due process. Some cases don’t even get this far without a dispute. Like with the EI evaluation, parents of a child found ineligible can dispute the findings and request an independent evaluation.

The child will be evaluated every two or three years, depending on the disability. At regular school age, a placement determination will be made per which school or program will best meet the child’s needs. Admission to a regular school could be delayed by the team should members feel the child isn’t ready for that transition. Services do transfer to private and charter schools, although these entities might not be able to actually accommodate some needs. Public schools have to either accept students or pay for them to be educated at an appropriate private school.

The path from EI to school admission can seem complicated. It does involve many steps. Parents must know that county IU and intellectual disability offices are in place to assist them. A massive network of support exists. Although it might appear overwhelming, it is there to help.

 

References:

http://www.drnpa.org/wp-content/uploads/2012/10/early-intervention-questions-and-answers.pdf

http://www.parentcenterhub.org/repository/ei-overview/

http://www.wrightslaw.com/info/ei.index.htm

Posted in : Early Intervention, New Parent
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