Developmental & Behavioral Resource Guide for Primary Care Providers

Transcription

1 Developmental & Behavioral Resource Guide for Primary Care Providers

2 June, 2005 Dear Colleagues: As primary care providers, we are in a unique position to ensure optimal physical and mental health for our patients. Every day, we are given the opportunity to make a difference in the lives of children we serve. However, in spite of our best intentions and efforts, many barriers, such as time restraints and financial limitations, exist which hinder our ability to provide the ideal well child care. Although there are no simple answers to these barriers, Children s Care Connection, or C3, has been developed to be part of a solution. Specifically, C3 helps to provide developmental/behavioral screenings and parenting education that are nearly impossible to accomplish in 15- to 20-minute well care visits. This resource guide is designed to provide detailed information about the C3 program as well as developmental and behavioral resources in the community for providers and parents. We hope that you will find this guide useful in your practice. Sincerely, Ingrid Lin, M.D., F.A.A.P. Physician Consultant, C3 Developmental & Behavioral Resource Guide/ 7/15/2005/ page 2 of 88

3 Part 1: C3 Program Overview Table of Contents What is C3?...6 Who is eligible for C3?...6 Who pays for C3?...7 How can children and their families be referred to C3?...7 Which screening tests are used by C3?...7 What types of classes are offered by C3?...8 How has C3 made a difference for children and their families?...8 Who developed C3?...9 Does C3 provide services in languages other than English?...9 What do others say about C3?...10 Who works for C3?...11 Where are C3 services offered?...11 How can I find out more about C3?...11 Examples of different levels of interventions provided by C Frequently asked questions by health care clinicians...14 References...18 Part 2: Community Resources Referral Information California Early Start...20 Infant Education Programs...23 Special education services through school districts...24 Exceptional Family Resource Center...27 Head Start and Early Head Start...28 San Diego Regional Center...30 Children s Hospital and Health Center...32 San Diego State University Communications Clinic...38 San Diego Scottish Rite Childhood Language Center...39 California-Hawaii Elks Association therapy services...40 Part 3: Appendix Appendix A: Map of C3 service area...42 Appendix B: C3 referral process schematic...44 C3 referral form...45 Appendix C: Screening tests used by C3 Parents Evaluation of Developmental Status (PEDS)...47 Denver II...48 Modified Checklist for Autism in Toddlers (M-CHAT)...49 Developmental & Behavioral Resource Guide/ 7/15/2005/ page 3 of 88

4 MacArthur Communicative Development Inventories (CDIs)...50 Child Behavior Checklist (CBCL)...51 Appendix D: List of C3 classes...53 Appendix E: Overview of C3 progress...62 Appendix F: Individualized Family Service Plan (IFSP)...64 Appendix G: Parent handout on Early Start/Regional Center (English)...66 Parent handout on Early Start/Regional Center (Spanish)...68 Appendix H: Individualized Education Program (IEP)...71 Sample request letter for IEP...72 IEP timeline...73 Appendix I: Parent handout on San Diego Regional Center (English)...75 Parent handout on San Diego Regional Center (Spanish)...77 Appendix J: Redirecting Children s Behavior during well/acute care visits...80 Parent handout on Redirecting Children s Behavior...82 Appendix K: Perinatal depression screening...85 Appendix L: Helpful websites...87 Developmental & Behavioral Resource Guide/ 7/15/2005/ page 4 of 88

5 Children s Care Connection "Photos provided by the First 5 Commission of San Diego" Developmental & Behavioral Resource Guide/ 7/15/2005/ page 5 of 88

6 C3 Program Overview What is C3? C3, Children s Care Connection, is a program offered by Children s Hospital and Health Center (CHHC) designed to identify and address developmental and behavioral concerns in children birth to 5 years 11 months (or up to Kindergarten entry). C3 was created to provide evaluation and enrichment services to children with mild to moderate developmental delays and/or behavioral problems. Parents with typically developing children can also participate in parenting education and child enrichment classes. The ultimate goal of C3 is to enhance development, improve school readiness, strengthen parent-child relationships, and serve as an integrated system for the identification and treatment of developmental and behavioral problems in children. Specifically, C3: Establishes early identification of developmental and behavioral problems in children birth to 5 years 11 months (or up to Kindergarten entry) through free developmental and behavioral screening assessments conducted at C3 sites and community locations. Provides connections to in-depth evaluations and intervention for eligible at-risk children. Enhances school readiness in children identified with mild delays and behavior concerns through intervention groups at the C3 site located in Solana Beach. Provides a variety of parenting education and child enhancement classes at C3 sites and in the community. Who is eligible for C3? The following families are eligible for C3 services: Families with children ages birth to 5 years 11 months (or up to Kindergarten entry) AND Families living in or served by primary care providers practicing in North San Diego County, La Jolla, or Mira Mesa (see below for eligible zip codes). C3 Service Area Zip Codes (North San Diego County): Developmental & Behavioral Resource Guide/ 7/15/2005/ page 6 of 88

7 Expanded Service Area since 10/01/04 (La Jolla, Mira Mesa): (See Appendix A for map.) Who pays for C3? C3 is funded by the First 5 Commission of San Diego, and C3 services are free to eligible families. One of the C3 sites (Solana Beach) also received one year of supplemental operational-cost funding from the Wayne and Gladys Valley Foundation. How can children and their families be referred to C3? There are three ways parents and children can be referred to C3: Primary care providers C3 collaborates with many medical offices to implement a screening and referral procedure for children during health visits. (See Appendix B for C3 referral process schematic and referral form.) Childcare centers and preschools C3 collaborates with several childcare centers and preschools in North San Diego County to screen children in childcare and/or preschool settings. Self-referrals parents can call C3 directly if they have any questions or concerns about their child s development and/or behavior. Which screening tests are used by C3? C3 utilizes a two-stage screening process: The first-stage or Stage I Screening includes the Parents Evaluation of Developmental Status (PEDS) Response Form - a short questionnaire completed either in pediatric offices, clinics, childcare centers, or over the phone with a C3 staff member. If concerns are raised on the first-stage screening, the child is Developmental & Behavioral Resource Guide/ 7/15/2005/ page 7 of 88

8 referred for a second-stage screening at a C3 site or at sites in the community (e.g. primary care provider offices, shelters, or preschools). C3 clinical staff can also travel to parents homes to conduct second-stage screening if the family does not have transportation. The second-stage or Stage II Screening includes age-appropriate assessments performed by developmental specialists. The screening tools used by C3 are: o Denver II for ages birth to 6 years a developmental screening tool which assesses for personal-social, fine motor-adaptive, language, and gross motor skills. o Child Behavior Checklist (CBCL) for ages 1 ½ to 5 years a questionnaire that screens for behavior and mental health problems. o MacArthur Communicative Development Inventory (CDI) Version I, II, III, and IV (version used depends on the child s age) an instrument to assess language development. o Modified Checklist for Autism in Toddler (M-CHAT) for ages months a screening tool for autistic spectrum disorders. Both Stage I and II Screenings are available in English and Spanish. (See Appendix C for more information about the screening tests used by C3.) Depending upon the outcome of the second-stage screening, C3 may refer the child for C3 parenting education and child enhancement classes, community resources/agencies, and/or further evaluations. All second-stage screening results are communicated with primary care providers via fax. What types of classes are offered by C3? C3 offers early intervention through a variety of child enhancement and parenting education classes. Currently, 67 different class titles are offered, and 22 of those classes are offered in Spanish. The selection of classes includes Feeding Finesse, Gesturing with Babies, Infant Massage, Infant Play, Learning and Growing Together, Talking with Toddlers, Music and Movement, Redirecting Children s Behavior, Pushing the Limits, and Yoga Games for Preschoolers. (See Appendix D for complete listing.) The classes are taught by CHHC specialists including occupational therapists, physical therapists, speech and language pathologists, and behavior specialists. How has C3 made a difference for children and their families? Since C3 s inception in July, 2001 to March, 2005, C3 has served more than 30,000 children and families. In the same period, C3 has served over 6,700 families via 1,300 Developmental & Behavioral Resource Guide/ 7/15/2005/ page 8 of 88

9 C3 classes and attained a mean class satisfaction rating of 99%. C3 has also provided approximately 300 one-on-one parenting coaching and/or behavior consultations during this time period. From July, 2001 to January, 2005, approximately 15,000 children have received a Stage I Screening, and approximately 4,000 children have received a Stage II Screening. Of those children who received Stage II Screening, most of the children (91%) were referred to C3 parenting education and/or child enhancement classes. Other referrals included: 7% for full developmental evaluation, 15% for speech evaluation, 9% for hearing evaluation, 4% for occupational therapy evaluation, 2% for physical therapy evaluation, 2% for mental health provider/counseling, 12% to California Early Start, 1% to Regional Center, 3% to Early Head Start or Head Start, and 4% to school districts. In the same period, C3 has collaborated with 72 medical offices and over 260 physicians. In addition, C3 developed and maintains the website which provides information for providers and families on development, behavior, community agencies, and resources. From August, 2001 to January, 2005, the website has logged over 2 million hits. In an independent survey of 130 C3 families conducted by Harder +Company, an outside evaluation company subcontracted by the First 5 Commission of San Diego, 49% of the families observed progress in their child s language development, 56% of the families observed progress in the social-emotional domain, and 46% of the families observed progress in self-help skills. Moreover, 85% of the parents report that they play with their children more often as a result of C3. (See Appendix E for overview of C3 progress.) Who developed C3? C3 was developed through a collaborative effort between Developmental Services Division of CHHC, Child & Adolescent Services Research Center (CASRC), physician consultants, parent consultants, and community agency members. Does C3 provide services in languages other than English? C3 currently offers developmental and behavioral screenings that are conducted by Spanish-speaking developmental screening coordinators. In addition, 22 of the parenting education and child enhancement classes are offered in Spanish. Developmental & Behavioral Resource Guide/ 7/15/2005/ page 9 of 88

10 What do others say about C3? Pediatricians and Community Members: Sarah loves the Creativity class and still talks about it. She calls it my tivity class! We are looking forward to taking more classes through C3 in the future. Diane Bedrosian, M.D., referring pediatrician and participating parent, Cassidy Medical Group It's nice to have a place like C3 where parents can easily take their child for a developmental assessment. It's a great community resource! Martin Gilboa, M.D., referring pediatrician, Kaiser Permanente C3 has successfully filled a need for physicians who have patients with behavior concerns, and for parents who want some coaching or help with parenting challenges. Their services have been accessible for all kids in all areas which has been a great help to the many lower income and underserved families that I care for in a community clinic. As a pediatrician, I have especially appreciated the practical tools that they can give parents and the excellent, personal communication that is part of their working with my office. It is great to have a resource like C3 close in the community not a distant referral and to be able to refer patients, friends, and colleagues to their programs with confidence. Donald Miller, M.D., referring pediatrician, North County Health Services We are lucky to have C3 for our families. The program has a true understanding of early childhood development and the staff makes appropriate and reliable referrals for families with young children. C3 has become a much-needed entity in the North County community for families and professionals alike. Dr. Mark Whitney, Professor of Child Development, Mira Costa College North County Health Services Parent-Child Resource Center and C3 have been collaborating for 2 ½ years now and the relationship continues to grow in depth and mutual understanding. It is a true collaboration between agencies and staff members, which greatly benefits the families. It has been fantastic for Spanish-speaking families to have such high-level instructors and linguistically-appropriate services on site. Cindy Dickinson, North County Health Services, Director of Special Programs The HOPE Infant Family Support Program staff has greatly appreciated the partnership we have with C3. We have referred many families to the excellent classes they provide. We have also relied on C3 to make referrals to HOPE and California Early Start. It s been wonderful having such a committed partner in the community. Thanks for all of your hard work! Staff Member, HOPE Infant Family Support Program C3 is an invaluable resource for the community. We don t know what we would do without it!! Families find classes really helpful. Parents also receive so much information at the assessment and they know that there is help out there for them. Verna Sundquist, Behavioral Health Specialist, YMCA Childcare Resource Service Parents: [C3] program has been invaluable to my relationship with my son. I have learned how capable he is. I ve grown in my own abilities with discipline, guidance, and teaching. I am so glad to have found this place and feel it offers amazing resources to parents and their children. Highly recommend [C3] and the pediatrician should recommend [C3] for 1 st and 2 nd check-ups. I ve learned: 1) a lot about temperament and how to deal with it, 2) how to discipline my child rather than [using] punishment, 3) [how to] set limits firmly and stand by them, [and] 4) I am not the only mom [whose] kids misbehave sometimes! I have been given a lot of ideas on how to help my toddlers learn to talk (very practical tips on things I can do at home). Thank you! Developmental & Behavioral Resource Guide/ 7/15/2005/ page 10 of 88

11 Who works for C3? C3 staff consists of: Kristin Gist, M.S. Director of Developmental Services Division, CHHC Laurel Leslie, M.D. Developmental/Behavioral Pediatrician and Research Scientist, Child & Adolescent Services Research Center (CASRC) Nancy Cohen, M.A. C3 Program Coordinator Helen Hayden-Wade, Ph.D. C3 Outcomes Coordinator Ingrid Lin, M.D. C3 Physician Consultant CHHC Specialists o Developmental Screening Coordinators o Occupational and Physical Therapists o Speech and Language Pathologists o Developmental Specialists o Behavior Specialists o Licensed Clinical Psychologists CASRC Outcomes Evaluation Team Where are C3 services offered? Solana Beach 667 San Rodolfo Drive, Suite 126 Solana Beach, CA San Marcos 380 Mulberry Drive, Suite C San Marcos, CA Oceanside 2231 El Camino Real, Suite B Oceanside, CA In addition, developmental and behavioral screenings as well as C3 classes are offered on selected Saturdays at: Children s Hospital & Health Center 8010 Frost Street, Suite 100 San Diego, CA How can I find out more about C3? For more information, please call C3Kids or visit Developmental & Behavioral Resource Guide/ 7/15/2005/ page 11 of 88

12 Examples of Different Levels of Intervention Provided by C3 Case #1 a child with typical development Ethan started participating in C3 classes when he was four months old. His mother had learned about C3 from her colleagues and was interested in the Infant Massage class. Ethan was a happy and interactive infant when he was awake but woke up every two to three hours crying as if in pain during sleep times. His parents were exhausted from lack of continuous sleep. His mother wanted to learn relaxation techniques to share with Ethan at his bedtime. She enjoyed and appreciated the Infant Massage class and later participated in the Infant Play and Gesturing with Babies classes. At one year of age, his mother brought him back to C3 for a developmental and behavioral screening because of a family history of autistic spectrum disorder. The result of his screening was fortunately normal. Case #2 a child with typical development A mother brought her 11-month-old son to C3 as a self-referral for a developmental and behavioral screening. She had recently adopted the child from Guatemala and wanted to Developmental & Behavioral Resource Guide/ 7/15/2005/ page 12 of 88

13 determine whether he was developing normally. Her main concern was his English language development because he had not been exposed to English before. She had scheduled a well-child visit with a pediatrician, but the appointment was one month away. The Developmental Screening Coordinator (DSC) from C3 administered the Denver II, and the result was normal. The mother was given explanation regarding the screening result and description of developmental milestones. The DSC also recommended two classes from C3, Gesturing with Babies and Talking with Toddlers, to provide the mother with strategies she could use at home to encourage his language development. No other referrals were necessary for this child. Case #3 a child with borderline gross motor delay A pediatrician referred a 16-month-old girl to C3 for a developmental and behavioral screening to assess if a physical therapy evaluation was needed. The main concern was the child s gross motor development because she was not walking yet. The family s primary language was Spanish, so the family scheduled an appointment with C3 s Spanish-speaking DSC. The DSC administered the Denver II and the MacArthur Communicative Development Inventory (CDI) and found that the child s development was age appropriate in all domains except the gross motor domain. The child could stand alone, stoop and recover but could not walk. The child s muscle tone was assessed and found to be normal. The C3 staff recommended the parents bring their child to C3 s Infant Play class which is taught by a physical therapist so that the therapist could observe the child and refer for a physical therapy evaluation if needed. It was also recommended that the parents continue to monitor the child s development and bring the child back to C3 in three months for re-screening. After the visit, the DSC faxed the information from the visit to the pediatrician. The parents elected to participate in the class. With interventions provided by the physical therapist at C3, the child s gross motor skills improved, and no further interventions were needed. Case #4 a child with autistic features A pediatrician referred a 22-month-old boy to C3 because the child exhibited some characteristics of Autism Spectrum Disorder. The main concerns were the child s language development and his difficulty with transitions and new places. The DSC from C3 administered the Denver II, MacArthur CDI, Child Behavior Checklist (CBCL), and Modified Checklist for Autism in Toddlers (M-CHAT). The child was found to be delayed in the language and personal-social domain on the Denver II, and the result from the MacArthur CDI indicated language delay. He also failed the M-CHAT. The DSC recommended a full developmental evaluation for the child and referred the child to California Early Start for eligibility assessment. In addition, the child was referred to C3 classes to monitor his development. A summary of the findings and recommendations was faxed to the pediatrician. Through a developmental evaluation, the child was diagnosed with Autism Spectrum Disorder. The family followed up with California Early Start. In addition, the parents chose to have their child participate in C3 classes while waiting for an Individual Family Service Plan (IFSP) to be developed and services to be implemented by California Early Start. Developmental & Behavioral Resource Guide/ 7/15/2005/ page 13 of 88

14 Frequently Asked Questions by Health Care Clinicians 1. I am so busy in my office and constantly behind. Why would I want to elicit more concerns? Conservative estimates suggest that 15-18% of children in the U.S. have developmental and/or behavioral disabilities. 1,2 According to data from the 1988 National Health Interview Survey, these conditions taken together had a substantial impact on the health and educational functioning of affected children: 1.5 times more doctor visits, 3.5 times more hospital-days, twice the number of school-days lost, and a 2.5-fold increase in the likelihood of repeating a grade in school compared with children without these conditions. 1 There is growing evidence that early intervention services have had a positive influence on the developmental outcome of children with established disabilities or those considered "at risk" for disabilities and their families. 3 Children who participate in early intervention programs prior to kindergarten are more likely to graduate from high school, hold jobs, live independently, and avoid teen pregnancy, delinquency, and violent crimes. 4,5 These positive outcomes save society between $30,000 and $100,000 per child. 4,6 In addition, developmental screening and surveillance fulfill the guidelines set forth by the American Academy of Pediatrics Committee on Children with Disabilities and the Individuals with Disabilities Education Act (IDEA). 7 In practice, parents concerns about their child s developmental and behavioral problems have ways of showing up at inopportune times, such as during 10-minute sick child visits or through frequent phone calls. If not addressed, some of the seemingly minor concerns can turn into serious problems requiring even more time commitment and resources. Addressing developmental and behavioral issues preemptively will usually save time and money in the long run. 2. I am an experienced clinician and notice developmental and behavioral problems all the time. Why do I need C3 to provide developmental and behavioral screenings? Unfortunately, research shows that clinical judgment detects fewer than 30% of children who have mental retardation, learning disabilities, language impairment, and other developmental disabilities, and clinical judgment also detects fewer than 50% of children who have serious emotional and behavioral disturbances. 2 In addition, most primary care providers do not have the time during a 15- to 20-minute well-child visit to conduct standardized developmental and behavioral screenings. C3 can help primary care providers save time and resources by facilitating and conducting developmental and behavioral screenings and communicating the results back to the providers. Providers can 1) choose to administer a simple first-stage screening tool Developmental & Behavioral Resource Guide/ 7/15/2005/ page 14 of 88

15 provided by C3 in their offices, 2) use a screening tool of their choice, or 3) ask C3 staff to administer a first-stage screening. C3 tailors its approach to best meet the needs of individual providers and offices. 3. I worry about over-referrals with these standardized screening tests. Am I going to be flooded with requests for referrals from C3? Developmental screening tests, even those meeting standards for screening test accuracy, produce false-positive results for 15% to 30% of children. This is often thought to produce unnecessary referrals for diagnostic testing or special services and increase the cost of screening programs. However, in a study involving a national sample of 512 parents and their children, children over-referred for diagnostic testing by developmental screens were found to perform substantially lower than children with truenegative scores on measures of intelligence, language, and academic achievement - the three best predictors of school success. These children also carried more psychosocial risk factors, such as limited parental education and minority status. Thus, children with false-positive screening results are an at-risk group for whom diagnostic testing may not be an unnecessary expense but rather a beneficial and needed service that can help focus intervention efforts. Although such testing will not indicate a need for special education placement, it can be useful in identifying children's needs for other programs known to improve language, cognitive, and academic skills, such as Head Start, tutoring, private speech-language therapy, and quality day care Is C3 just a way to channel patients to CHHC? No. Although C3 is administered by CHHC, C3 does not recommend any specific therapists and/or clinics to families. C3 refers families back to their primary care providers to discuss referral options as available through the child s insurance coverage. If a child who needs further diagnostic evaluation has no health insurance coverage or if a diagnostic evaluation is denied by the child s health insurance plan, C3 will provide the diagnostic evaluation by a licensed clinical psychologist free of charge. In addition, C3 collaborates with many public agencies, such as California Early Start, Regional Center, and area school districts. C3 is able to provide these services through a generous grant from the First 5 Commission of San Diego County. 5. What happens if C3 makes a diagnosis or recommendation that I don t agree with or don t think is needed? At C3, the Developmental Screening Coordinators (DSCs) will discuss the results of the screening with the families but will not make a diagnosis. If the screening results are borderline, the DSCs will refer the families to C3 classes first so that the children can be observed by occupational therapists, physical therapists, speech-language pathologists, and/or behavior specialists to see if further intervention is needed. C3 also will ask the families to come back in three months for re-screening. Developmental & Behavioral Resource Guide/ 7/15/2005/ page 15 of 88

16 If an intervention other than C3 classes or referral to free public resources such as California Early Start is needed, C3 staff will always refer families back to their primary care providers. The primary care providers and the families have the ultimate decision in the referral process. 6. I already utilize Regional Center and California Early Start as a resource for patients with developmental problems. How would C3 be helpful for me? Both Regional Center and California Early Start have eligibility criteria that children must meet to receive services. C3 bridges the gap for children with mild to moderate developmental problems who may not be eligible for services through the Regional Center or California Early Start. In addition, C3 classes may be useful for children who qualify for Regional Center or California Early Start while they are waiting for eligibility determination and implementation of services. 7. What is Proposition 10? Proposition 10 ( Prop 10 ), passed by California voters in November 1998, established the California Children and Families Act. It increased the tax on tobacco products to fund services for improving the health and development of California s children from the prenatal period to age five. In San Diego County, Prop 10 dollars are administered by the First 5 Commission of San Diego County. 8. What is the First 5 Commission of San Diego County? The First 5 Commission of San Diego County oversees Prop 10 activities in San Diego County. Its vision is to ensure children enter school physically, emotionally, socially, and developmentally ready to learn. The First 5 Commission provides leadership to achieve this vision by funding services, advocating for policy change, coordinating existing resources, and building community capacity to support families. For more information, visit 9. What if I practice outside of C3 s defined region and have families whom I would like to refer for C3 services? To be eligible for C3 services, families need to fulfill the following criteria as defined by the grant from the First 5 Commission of San Diego County: Have children ages birth to 5 years 11 months (or up to Kindergarten entry) AND Live in or be served by primary care providers practicing in North San Diego County, La Jolla, or Mira Mesa (see below for eligible zip codes). C3 Service Area Zip Codes (North San Diego County): Developmental & Behavioral Resource Guide/ 7/15/2005/ page 16 of 88

17 Expanded Service Area since 10/01/04 (La Jolla, Mira Mesa): However, C3 would like to accommodate as many children and families as possible. Please have families who are ineligible based on geographic location call C3 as exceptions have been made. In addition, there are other programs sponsored by the First 5 Commission with similar aims as C3 in San Diego County. Please check with the website for additional resources. 10. Does C3 provide any training for primary care providers? Yes! C3 held a CME course on Redirecting Children s Behavior for primary care providers in October, 2004 and received a very positive response. According to a survey conducted after the course, 94% of the participants thought the course increased their ability to counsel families regarding behavioral issues either by very much or a great deal. When asked what is the likelihood that changes will be made in the work setting as a result of this course, 88% responded very much or a great deal. In the future, C3 is planning to offer more CME courses on behavior management training as well as developmental and behavioral screening. Developmental & Behavioral Resource Guide/ 7/15/2005/ page 17 of 88

18 References 1 Boyle CA, Decoufle P, Yeargin-Allsoop MY. Prevalence and health impact of developmental disabilities in US Children. Pediatrics 1994; 93: Glascoe FP. Early detection of developmental and behavioral problems. Pediatrics in Review 2000; 21: American Academy of Pediatrics, Committee on Children with Disabilities. Role of the pediatric clinician in family-centered early intervention services. Pediatrics 2001; 107: Glascoe FP, Shapiro H. Developmental and Behavioral Screening. Available: 5 Reynolds AJ, et al. Long-term effects of an early childhood intervention on educational achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools. JAMA 2001; 285: Meisels SJ, Shonkoff JP, eds. Handbook of Early Childhood Intervention. Cambridge, England.: Cambridge University Press, American Academy of Pediatrics. Developmental surveillance and screening of infants and young children. Pediatrics 2001; 108(1): Glascoe FP. Are overreferrals on developmental screening tests really a problem? Arch Pediatr Adolesc Med 2001; 155(1): Developmental & Behavioral Resource Guide/ 7/15/2005/ page 18 of 88

19 Community Resources Referral Information Developmental & Behavioral Resource Guide/ 7/15/2005/ page 19 of 88

20 California Early Start California Early Start is a federally funded program mandated by Part C of the Individuals with Disabilities Education Act (IDEA) and in California by S.B. 1085, the California Early Intervention Services Act. Its goal is to ensure infants and toddlers with, or at risk for, developmental delay and their families receive coordinated intervention services in a timely manner to improve their child's developmental outcomes. Its mission is to establish a statewide, coordinated, inter-agency system for infants and toddlers and their families, based on existing resources and innovative approaches to comprehensive, family-focused early intervention services. ELIGIBILITY Infants and toddlers from birth to 36 months may be eligible for early intervention services if through documented evaluation and assessment they meet one of the criteria listed below: 1. Significant developmental delay in one or more of the following areas: Cognitive development, e.g., limited interest in environment, limited interest in play and learning Physical and motor development, including vision and hearing, e.g., hypertonia, dystonia, asymmetry Communication development, e.g., limited sound repertoire, limited responses to communication with others Emotional-social development, e.g., unusual responses to interactions, impaired attachment, self-injurious behavior Adaptive development, e.g., feeding difficulties 2. Established risk conditions of known etiology, with a high probability of resulting in delayed development, such as: Chromosomal disorders Neurological disorders Inborn errors of metabolism Visual and hearing impairments 3. High risk of having a substantial developmental disability due to a combination of risk factors, such as: Prematurity (less than 32 weeks gestation and/or low birth weight of less than 1,500 grams) Asphyxia or need for ventilator assistance Central nervous system infection or abnormality Biomedical insult (including but not limited to injury, accident, or illness which may seriously or permanently affect developmental outcome) Parent with a developmental disability Developmental & Behavioral Resource Guide/ 7/15/2005/ page 20 of 88

21 SERVICES Early intervention services are individually determined for each eligible infant or toddler and are provided, purchased or arranged by a regional center or local education agency. Local education agencies are primarily responsible for infants and toddlers with solely low incidence disabilities (vision, hearing, and severe orthopedic impairments, including any combination of these low incidence disabilities). Regional Centers are responsible for all other children eligible for Early Start. Family resource centers/networks provide parent-to-parent support, information, and referral for all families. Within 45 days of referral, A service coordinator is assigned An evaluation for eligibility is completed An assessment is conducted for program planning A peer parent contact may be available A meeting will be held to develop an Individualized Family Service Plan (IFSP) to initiate child and family services. (See Appendix F for more information on IFSP.) There is a wide range of early intervention services available. These services may be provided by a number of agencies in the San Diego area and may include: Assistive technology devices/services Audiology services Family training, counseling, home visits Medical services Nursing services Nutrition services Occupational therapy Physical therapy Psychological services Respite services Service coordination (case management) Social work services Speech-language pathology Transportation Vision services Additional services that the California Early Start program may help a family access if needed include: Supplemental Security Income (SSI) In-home Support Services (IHSS) Medi-Cal Temporary Assistance to Needy Families (TANF) Women, Infants and Children (WIC) California Children's Services (CCS) Child Health and Disability Prevention (CHDP) Developmental & Behavioral Resource Guide/ 7/15/2005/ page 21 of 88

22 Healthy Families Early Head Start/Head Start Parenting classes FOR MORE INFORMATION Call (800) 515-BABY or contact San Diego Regional Center, school districts, or family resource center (see pages and for information on these agencies). More information can also be found online at (See Appendix G for parent handout on Early Start/Regional Center available in both English and Spanish.) Developmental & Behavioral Resource Guide/ 7/15/2005/ page 22 of 88

23 Infant Education Programs The Infant Education Programs are public special education programs that offer services to infants and toddlers with special needs and their families as part of California Early Start. Services are offered at no cost to the families. There are five Infant Education Programs in the San Diego area. Each program serves different regions in the San Diego area and also offers different types of school-based and/or home-based interventions. FOR MORE INFORMATION Contact the Infant Education Program in your region: Alcott Infant Program 4680 Hidalgo Avenue San Diego, CA Ph: Fx: Website: www2.sandi.net/infant Region served: San Diego City Schools HOPE Infant Program 910 W. San Marcos Blvd. #101 San Marcos, Ph: Fx: Website: Regions served: North Costal, North Inland, South Bay, and Poway La Mesa/Spring Valley 3845 Spring Drive Spring Valley, CA Ph: Fx: Regions served: La Mesa, Spring Valley, and Lemon Grove Santee-Lakeside Woodside Ave. Lakeside, CA Ph: Fx: Regions served: Lakeside and Santee Sevick Center 1609 E. Madison Avenue El Cajon, CA Ph: Fx: Regions served: Cajon Valley and Mountain Empire Developmental & Behavioral Resource Guide/ 7/15/2005/ page 23 of 88

24 Special Education Services through School Districts The principles of the IDEA legislation guarantee that: A child receives a free and appropriate public education. A child receives an appropriate evaluation or assessment. An Individualized Education Program (IEP) is developed according to specific guidelines in a timely manner that defines a child's disabilities, states a child's current levels of educational performance, describes a child's educational needs, and specifies a child's annual educational goals and objectives. (See Appendix H for more information on IEP.) A child receives instruction in the least restrictive environment. Both child and parent(s) have an opportunity to participate in educational decision making. Corresponding State Law regarding special education can be found in California Education Code, Part 30, Sections to In 1977, all school districts and county offices of education were required to join to form geographical regions of sufficient size and scope to provide for all of the special education service needs of children residing within the region boundaries. Each region developed a local plan describing how it would provide special education services. Single district Special Education Local Plan Areas (SELPAs) are of such significant size to provide all services within their boundaries while smaller districts joined consortia to provide the full range of services. There are six SELPAs in San Diego County: North Coastal Consortium for Special Education SELPA is composed of 14 school districts in the north coastal area of San Diego County. The districts include: Bonsall Union, Cardiff, Carlsbad Unified, Del Mar Union, Encinitas Union, Fallbrook Union Elementary, Fallbrook Union High, Oceanside Unified, Rancho Santa Fe, San Dieguito Union High, San Marcos Unified, Solana Beach, Vallecitos and Vista Unified. North Inland Special Education Region SELPA is composed of 10 school districts in the northeast quadrant of San Diego County. The districts include: Borrego Springs Unified, Escondido Union Elementary, Escondido Union High, Julian Union Elementary, Julian Union High, Ramona Unified, San Pasqual Union, Spencer Valley, Valley Center-Pauma Unified, and Warner Unified. East County SELPA is composed of eleven school districts located in the southeast quarter of San Diego County, going east to the Imperial County line and south to the border with Mexico. The districts are: Alpine Union, Dehesa, Cajon Valley Union, Grossmont Union High, Jamul-Dulzura Union, Lakeside Union, La Mesa-Spring Valley, Lemon Grove, Mountain Empire Unified, Santee, and Barona Indian Charter. Developmental & Behavioral Resource Guide/ 7/15/2005/ page 24 of 88

25 South County SELPA is composed of 6 school districts located in the southern region of San Diego County. The districts are: Chula Vista Elementary, National, South Bay Union, San Ysidro Elementary, Sweetwater Union High, and Coronado Unified. Poway Unified School District SELPA San Diego Unified School District SELPA The San Diego County Office of Education is the Administrative Unit for North Coastal, North Inland, East County, and South County SELPAS; the San Diego Unified School District is the Administrative Unit for Its SELPA as is the Poway Unified School District. FOR MORE INFORMATION North Coastal SELPA 570 Rancheros Drive #200 San Marcos, CA Ph: Fx: North Inland SELPA 398 D St. Ramona, CA Ph: Fx: East County SELPA 924 East Main Street El Cajon, CA Ph: Fx: South County SELPA 800 National City Blvd. #202 National City, CA Ph: Fx: Poway Unified School District SELPA Twin Peaks Road Poway, CA Ph: Fx: Developmental & Behavioral Resource Guide/ 7/15/2005/ page 25 of 88

26 San Diego Unified School District SELPA 4100 Normal Street, Annex 6 San Diego, CA Ph: Fx: San Diego County Office of Education 6401 Linda Vista Road, Rm. 315 San Diego, CA Ph: Website: Developmental & Behavioral Resource Guide/ 7/15/2005/ page 26 of 88

27 Exceptional Family Resource Center Implementation of Part C of the IDEA mandates states to implement a comprehensive early intervention service system for all infants and toddlers with disabilities or at risk for disabilities, and their families. Family support services are included in these systems. In California, family resource centers are part of the Early Start Program. Staffed by families of children with special needs, family resource centers offer parent-to-parent support and help parents, families, and children locate and use needed services. They offer support services and resources in many languages (English, Spanish, Mandarin, Korean, Tagalog, and Japanese), which may include newsletters, resource libraries, parent-to-parent support groups, sibling support groups, warmlines, and information and referral for parents and professionals regarding the Early Start system. FOR MORE INFORMATION Main Office 9245 Sky Park Ct., #130 San Diego, CA Ph: or Fx: North County 380 Mulberry Dr., Suite A San Marcos, CA Ph: Fx: Imperial County 512 West Aten Rd. Imperial, CA Ph: Fx: Website: Developmental & Behavioral Resource Guide/ 7/15/2005/ page 27 of 88

28 Head Start and Early Head Start Head Start is a federal program for preschool children from poverty level families. It began in 1965 as part of President Lyndon B. Johnson's 'War on Poverty' and started as an 8-week summer program designed to provide children from low-income families with a comprehensive program to meet their emotional, social, health, nutritional, and psychological needs. It now serves over 10,000,000 children nationwide. The Head Start program is operated by local non-profit organizations in almost every county in the nation. Neighborhood House Association (NHA) is the grantee for Head Start in San Diego County excluding the far northwest region which is operated by the Metropolitan Area Advisory Committee (MAAC). NHA Head Start operates programs directly in the North Coastal area, North Inland area, Central San Diego, Southeast San Diego, and Southwest San Diego. In addition, NHA contracts with two delegate agencies to provide Head Start services: Alpha Kappa Alpha Head Start provides services in the East County, and Episcopal Community Services (ECS) provides services in the South Bay area. Early Head Start (EHS) program provides services to expectant mothers and infants from birth up to three years of age. ELIGIBILITY Preschool age children, three- to five-years-old, and infants and toddlers, birth to threeyears-old, qualify for Head Start and EHS respectively if their families meet income eligibility criteria. 10% of enrollment slots may be given to children from families that exceed the income guidelines. SERVICES Early Childhood Education Head Start's educational program is designed to meet each child's individual needs. Educational activities are individualized and linked to "school readiness" curricula. Health Medical and Dental: children receive a complete examination, including vision and hearing screenings, immunizations, and a dental exam. Follow-up treatment is provided for identified health problems. Nutrition: a trained nutritionist supervises the nutritional activities of each Head Start program and helps the staff identify the nutritional needs of the children. The nutritionist plans an educational program to teach parents how to select healthy foods and prepare well-balanced meals, and how to obtain food stamps and other community assistance when needed. Mental Health: a mental health professional is available for every Head Start program to provide mental health training for staff and parents and to increase awareness of the need for early attention to the special problems in children. Developmental & Behavioral Resource Guide/ 7/15/2005/ page 28 of 88

29 Parenting Through participation in classes and workshops on child development and through staff home visits, parents can learn about the needs of their children and about educational activities that can be carried out at home. Family Partnerships Social services staff assists families through community outreach, referrals, families needs assessments, information about available community resources, recruitment and enrollment of children, and emergency assistance and/or crisis intervention. FOR MORE INFORMATION Neighborhood House Association (NHA) 5660 Copley Drive San Diego, CA Ph: Fx: Website: Metropolitan Area Advisory Committee (MAAC) 800 W. Los Vallecitos, Suite J San Marcos, CA Ph: Fx: Area Served: San Marcos, Oceanside, Vista, Rincon, Fallbrook, Valley Center, and Camp Pendleton Developmental & Behavioral Resource Guide/ 7/15/2005/ page 29 of 88

30 San Diego Regional Center San Diego Regional Center (SDRC) is one of a network of 21 Regional Centers in California established by the Lanterman Mental Retardation Services Act of It is a private, non-profit corporation working under contract with the California Department of Developmental Services. Legislative changes from 1969 through the present expanded the population served by Regional Centers to include persons with mental retardation, cerebral palsy, epilepsy, autism, or other handicapping conditions similar to mental retardation. Regional Centers also administer intervention programs for children birth to 36 months with or at risk for developmental delay. (See the section on California Early Start for more information.) ELIGIBILITY Residents of San Diego or Imperial County diagnosed with a developmental disability that originates before age 18, constitutes a substantial handicap, and is expected to continue through life, may be eligible for SDRC services. These developmental disabilities include: Mental Retardation Cerebral Palsy Epilepsy Autism Other conditions similar to mental retardation that require treatment similar to that required by persons with mental retardation The disability cannot include handicapping conditions that are: Solely psychiatric disorders where there are impaired intellect or social functioning which originated as a result of the psychiatric disorders or treatment given for such disorders Solely learning disabilities Solely physical in nature (such as hearing loss, mild cerebral palsy, vision impairment, etc.) Infants and toddlers, birth to age three are eligible for SDRC Early Start program if they meet eligibility criteria for California Early Start. SERVICES The SDRC provides a variety of services to persons with development disabilities, their families, and the community. The services include: Case finding and intake Assessment, diagnosis, evaluation, and counseling Development of an Individual Program Plan (IPP), a written plan with goals and objectives designed to meet the needs of the consumer Case management services Developmental & Behavioral Resource Guide/ 7/15/2005/ page 30 of 88

31 Purchase of services, such as Early Start services, behavior modification, residential services, transportation, and respite services Advocacy for the protection of legal, civil, and service rights FOR MORE INFORMATION For San Diego County, contact: San Diego Regional Center 4355 Ruffin Rd., Suite 200 San Diego, CA Ph: Fx: For Imperial County, contact: San Diego Regional Center-Imperial County 512 West Aten Road Imperial, CA Ph: Fx: Website: (See Appendix I for parent handout on San Diego Regional Center available in both English and Spanish.) Developmental & Behavioral Resource Guide/ 7/15/2005/ page 31 of 88