Early Intervention Process for infants, toddlers and their families

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1 Guidance Dcument Early Interventin Prcess fr infants, tddlers and their families Eligibility Determinatin IFSP Develpment Interventin Planning Maine Department f Educatin January 2007

2 TABLE OF CONTENTS Intrductin Maine s Part C Prgram Missin and Mdel Maine s Part C Prgram Guiding Principles Maine s Part C Prgram Prcess Parent/Caregiver Rles in Part C Prgramming Referral and Initial Cntact Service Crdinatin Assignment and Respnsibilities First Visit Screening Family Assessment Preparatin f Family fr Evaluatin and Assessment Interim IFSP Evaluatin and Assessment f the Child Evaluatin/Assessment Team Selectin and Preparatin Cnducting the Evaluatin and Assessment and Determining Eligibility 25 IFSP Meeting Preparing the Parent/Caregiver fr the IFSP Meeting Preparing the Team fr the IFSP Meeting Cnducting the IFSP Meeting and Develping Initial IFSP Natural Envirnments Appendices A. Fundatin and Philsphy f Early Interventin B. Parent/Caregiver Assessment Resurces Rutines Based Interview (RBI) Rbin McWilliam Activities Based Interventin - Mary Beth Bruder ECO Mapping C. Visin and Hearing Checklists D. Resurces n Natural Envirnments ITCA Psitin Paper n Services in Natural Envirnments ME Q and A Dcument n Natural Envirnments E. Frms Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 2

3 Declining EI Services INTRODUCTION The purpse f this dcument is t prvide early interventin persnnel in Maine s Part C prgram, including service crdinatrs and service prviders, with guidelines n the prcess and the necessary steps that must be cmpleted while wrking with children and families, beginning with referral t Part C (children birth t age three) thrugh evaluatin and assessment, Individualized Family Service Plan (IFSP) develpment, IFSP implementatin/review, and transitin. The guidelines are designed t streamline prcedures, prvide a framewrk fr cnsistent and quality practices, while ensuring cmpliance and supprting efficient use f existing resurces. (NOTE: When child is 45 days r less frm 3 rd birthday, prcedures fr the 3-5 year lds will be fllwed.) Infrmatin cntained in the guidelines attempts t assist Part C service crdinatrs and service prviders in understanding the intercnnectedness f the varius steps f the prcess with the statewide frms (and instructins fr filling them ut) that were develped in cnjunctin with this guide. Infrmatin is prvided regarding which frms are used and cmpleted during the specific steps f the prcess. The guidelines als emphasize steps and practices that supprt psitive relatinships with the parent/caregiver and the use f the family s interests, cncerns, and pririties fr their child as the fundatin fr service prvisin. As a result, guidance is embedded thrugh the dcument n hw best t gather and use infrmatin frm families when cnducting the Initial Cntact, First Visit, evaluatin and assessment, develping a meaningful IFSP, and implementing IFSP services and supprts that are fluid, meet the needs f children and families, and ensure psitive results. A separate sectin n the rles f families in Maine s Part C Prgram is als prvided. The guidelines are based n evidence-based practices that are reflected in current early interventin literature. The infrmatin included reflects a paradigm shift frm the prfessinal addressing the child s develpment, t the prfessinal enhancing the family s capacity t supprt their child s learning and develpment thrugh everyday rutines and activities. A summary f the current early interventin literature regarding evidenced-based practices in wrking with infants and tddlers with disabilities and their families is included in the Appendices. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 3

4 MISSION AND MODEL OF MAINE S PART C PROGRAM The missin f Maine s Part C Prgram fr infant and tddler services is t identify yung children (birth thrugh tw years f age) with disabilities and wh have a diagnsed physical r mental cnditin that has a high prbability f resulting in develpmental delays; t prvide supprts t families that meet the individualized develpmental needs f their child; and t facilitate the child s learning and participatin in family and cmmunity life thrugh the partnerships f families, caregivers, and service prviders. The purpse f Maine s Part C Prgram is t prvide services that prmte the child s learning thrugh participatin in everyday rutines and activities while supprting the parent/caregiver in enhancing their child s develpment, learning and participatin in family and cmmunity life. T accmplish its missin, Maine s Part C Prgram prmtes the fllwing appraches as its service mdel: Use f a cllabrative partnership with regular cmmunicatin amng team members as prfessinals and families wrk tgether; Use f a multi-disciplinary, family-centered apprach in the evaluatin and assessment prcess; Use f functinal utcmes n the Individualized Family Service Plan t address family cncerns and pririties; Use f a primary service prvider in the team apprach fr service delivery; Use f caching, mdeling and infrmatin sharing t supprt families and caregivers cnfidence and cmpetence; Use f a relatinship-based apprach that increases psitive interactins between Parent and child as the fundatin upn which new develpmental skills can be built; Use f naturally ccurring rutines in which instructin is embedded as selected and preferred by the child s family. Current literature identifies sme key cncepts that supprt the implementatin f these purpses thrugh effective quality practices. These key cncepts are critical t keep in mind. Children learn best: when participating in natural learning pprtunities that ccur in everyday rutines and activities as part f family and cmmunity life; and when interested and engaged in an activity, which in turn strengthens and prmtes cmpetency and mastery f skills. The parent/caregiver has the greatest impact n their child s learning since parents knw their child best and already intervene in their child s develpment everyday thrugh planned r naturally ccurring learning pprtunities. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 4

5 Learning pprtunities facilitated within the cntext f family and cmmunity life have greater impact n child prgress than interventin sessins. The parent/caregiver prefers interventins that are easy t d, fit int their daily lives, and supprt their child in learning skills that help them be a part f family and cmmunity life. Embedding instructin in rutines selected and preferred by families will greatly increase the likelihd that the family will repeat therapeutic activities independently. There is a direct crrelatin between families perceptins f themselves as cmpetent and empwered t the families level f fllw-thrugh in facilitating learning pprtunities thrughut daily activities and rutines. Frequency and intensity f services need t be based n the amunt f supprt the family needs in using natural learning pprtunities thrughut everyday rutines and activities f family and cmmunity life. Visits prvided t frequently can be disempwering r send the message that the parent/caregiver is nt cmpetent. Prviding early interventin thrugh a primary prvider apprach des nt preclude ther team members frm cnsulting r interacting with the family r caregivers. Team cnsultatin and cllabratin are critical t supprt family and caregiver cmpetence and cnfidence related t child learning. Supprts and services need t be tailred t meet the unique needs and characteristics f every child and family. Mre is better. This means mre learning pprtunities, nt mre services. Learning is what happens between interventin visits. Learning ccurs fr all children thrugh daily child-initiated play, multiple repetitins and lts f practice with family and friends in their cmmunity. These cncepts are nt necessarily new t thse wh have been practicing early interventin. What has changed, hwever, is hw these cncepts are translated int practice. Effective early interventin services are nt achieved by taking clinical practice int the child s hme. The practitiner is n lnger viewed as the expert with the ty bag, but as a resurce and partner fr families and caregivers wh are enhancing their child s develpment and learning. In this new rle, the practitiner shares his/her knwledge and resurces with the child s key caregivers and prvides supprt t them in their day-t-day respnsibilities f caring fr their child and in ding the things that are imprtant t them. The primary fcus f each individual interventin sessin is n enhancing family capacity and cmpetence in facilitating their child s learning and participatin in family and cmmunity life. Interventin sessins fcus n what s wrking and what s challenging fr the child s and family s functinal participatin in their everyday rutines and activities f cmmunity life. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 5

6 GUIDING PRINCIPLES OF MAINE S PART C PROGRAM Children are special and unique: All children are unique, with their individual strengths and talents. The presence f a disability r special need is nt the defining characteristic f a child. Children grw, develp, and learn within the cntext f relatinships with their families and ther caregivers in the activities f everyday rutines in their caring envirnments as well as activities within their cmmunity settings. Early interventin services enhance and supprt the capacity f cmmunity partners in serving and including yung children with disabilities and their families. All children have the right t belng, t be welcmed, and t participate fully in their cmmunity. Families are central t decisin making: Each family s pririties, values, hpes and diversity are hnred thrughut the service delivery prcess. Families are partners and decisin-makers in all aspects f services; they are the experts abut their child s and family s needs. The early interventin rle: Service prviders acrss all disciplines value and encurage family participatin and cllabratin thrughut delivery f interventin services. The family-prvider relatinship builds n family strengths and is characterized by mutual trust, respect, hnesty and pen cmmunicatin. Services and supprts: Supprts, services and resurces need t be timely, flexible, individualized and respnsive t the changing needs f each child and the child s family. Supprts and services must be in cmpliance with federal and state laws and regulatins, fiscally respnsible, and crdinated with ther agencies. PROCESS FOR MAINE S PART C PROGRAM The fllwing flw chart illustrates Maine s Part C prgram s prcess f Part C prgramming, beginning with referral t Maine s Part C Prgram, intake (Initial Cntact and First Visit), evaluatin and assessment, IFSP develpment, fllwed by interventin/services, nging assessment, and IFSP mdificatins and reviews. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 6

7 Maine s Early Interventin System Primary Referral Surces Child Find & Screening Activities Referral t Part C & Initial Cntact Referral t Cmmunity Resurces and Services FIRST VISIT Descriptin f CDS & Prcedural Safeguards 45 d a y s Assessment f Family Rutines and Pririties Interim IFSP (nly if needed) Preparatin fr Evaluatin/Assessment Frmal Screening (nly if apprpriate) Evaluatin fr Eligibility and Assessment fr Interventin Planning if eligible if nt eligible 30 IFSP Meeting, Develpment f Initial IFSP, and Summary f current functinal abilities d a y s Implementatin f IFSP Onging Assessment Review f functinal abilities and IFSP (include any necessary mdificatins) Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 7

8 FAMILY ROLES IN MAINE S PART C PROGRAM Families play a key rle in the successful implementatin f Maine s Part C prgram. Beginning with the first cntact, families are prvided with infrmatin abut the purpse f early interventin t enhance the capacity f families t meet their children s develpmental needs. Families are als prvided with infrmatin n what they can expect frm Maine s Part C Prgram as well as the imprtant rle families play as a member f the team thrughut the prcess. Once families have this infrmatin, they can make infrmed decisins t define their particular rle and invlvement in their child s Part C prgramming. Essential rles f families/caregivers in Maine s Part C Prgram are as fllws: Initial Cntact and First Visit, including Family Assessment Families share their cncerns related t their child s develpment, prvide the multi-disciplinary team with infrmatin regarding their current family rutines and schedule, and identify what interactins are wrking well at hme. Families are invited t answer questins (thse which they are cmfrtable answering) and share any additinal infrmatin they feel the team needs t gain a hlistic, eclgical view f their family. During this time, families als receive infrmatin abut Maine s Part C prgram, including rights and prcedural safeguards, and they cmplete required paperwrk. Evaluatin and Assessment Prcess Families participate with their child during the evaluatin and assessment prcess; cmmunicating whether their child s functining during the evaluatin and assessment prcess is typical. They als begin sharing their pririties fr the fcus f early interventin supprts and services. IFSP Develpment Families are active participants in the IFSP meeting. They add pertinent infrmatin regarding their child s skills t cmplement the infrmatin gained thrugh the evaluatin and assessment. They als identify their pririties fr utcmes fr their child and their family as well as cllabrate with the ther team members n strategies fr embedding skill develpment. This will include ways t develp their child s skills within the cntext f everyday rutines and activities as well as thrugh relatinships with the peple wh are imprtant t their child. Part C Prgramming Families wrk with service prviders t identify and learn a variety f strategies t enhance their child's learning and develpment within their typical, everyday, hme and cmmunity rutines. Review and Evaluatin f IFSP Outcmes, Strategies, Supprts and services Families talk with service prviders cntinually abut what is making a difference in their child s and family s life. Families and service prviders discuss which strategies are wrking, hw much supprt the family needs in rder t incrprate the strategies int their everyday rutines and activities, whether utcmes have been achieved, and what changes, if any, need t be made. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 8

9 REFERRAL AND INITIAL CONTACT Demgraphics, Descriptin f Maine s Part C Prgram, And Child Medical/Develpmental Histry Families find ut abut Maine s Part C Prgram in a wide variety f ways, including thrugh public awareness materials (e.g., brchures, psters), cmmunicatin with their child s caregivers, physicians r ther health prfessinals, and/r infrmatin shared by relatives, friends r acquaintances. Regardless f hw families are cnnected with the prgram, the Initial Cntact with families made by the designated CDS staff member serves as the fundatin fr building a trusting partnership between families and service prviders. Prfessinal staff (e.g., service crdinatr, referral crdinatr, case manager) are usually designated the respnsibility fr carrying ut the steps and prcedures included in the Initial Cntact. The Initial Cntact is usually cmpleted by phne with the family. Since phne cntact is nt pssible fr all families, sme Initial Cntact steps may ccur thrugh written cmmunicatin while ther steps are cmpleted during the first face-t-face visit. Part C prgram sites have prcedures that specify hw steps and activities assciated with the Initial Cntact may be carried ut in such situatins. During the Initial Cntact, cnversatins are used by designated CDS staff members t gather relevant infrmatin in rder t plan fr next steps and t share infrmatin abut the prgram/cmmunity resurces that may be available t the family. Open-ended questins and prmpts are used t supprt families in sharing their stry and ther imprtant infrmatin abut their child in a way that suits the family s cmmunicatin style. When referral cncerns abut the child are uncertain/unclear, questins abut the child s develpment are asked t determine whether the parent/caregiver wishes t prceed t the next step. Prcedures: Referral and Initial Cntact (NOTE: When child is 45 days frm 3 rd birthday, fllw prcedures fr 3-5 year lds) 1. Designated CDS staff member assigned t take referral infrmatin cmpletes Referral Infrmatin (Frm 1) that cvers demgraphic infrmatin abut the child and family, infrmatin abut the referral surce and the reasn fr referral. If the referral surce has any infrmatin abut the child s medical and develpmental status, designated CDS staff members shuld dcument this infrmatin in the relevant sectins f Child Medical and Develpmental Infrmatin (Frm 2). 2. Designated CDS staff member assigned t take referral infrmatin determines the family s primary language and means f cmmunicatin and, if necessary, arranges fr an interpreter in accrdance with Maine s Part C prgramming prcedures t be available during the Initial Cntact and subsequent steps. 3. Designated CDS staff member cntacts the child s parent/caregiver by phne. If phne cntact is nt pssible, they use alternative means f cnnecting with families in accrdance with Maine s Part C prgram site prcedures. 4. If the referral surce was anyne else besides the family, designated CDS staff members shuld review develpmental and medical infrmatin with the family that was shared by the referral surce. Designated CDS staff members shuld ask the family t supply any additinal relevant infrmatin and dcument it in the apprpriate prtins f Child Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 9

10 Medical and Develpmental Infrmatin (Frm 2). Sme families may be able t readily share infrmatin abut their child ver the phne while thers may prefer t cmplete the discussin during the First Visit. 5. The designated CDS staff member explains the fllwing t the parent/caregiver: The purpse f Maine s Part C prgramming is designed t assist and supprt the family in enhancing their child s develpment thrugh participatin and learning in everyday rutines and activities; Maine s Part C prgramming and supprts may nt necessarily take the place f medical services prescribed by their child s physician r existing service prvider; Maine has a family cst participatin prvisin. Fr children cvered by Maine s Medicaid insurance prgram (MaineCare), the insurance will be accessed. Fr families with private insurance cverage, parents will be asked t chse between cntributing tward the cst f their child s Part C prgramming n the basis f a sliding fee scale r authrizing access fr their private insurance t be billed fr sme services. If a service is nt cvered by the insurance plicy, the family will be expected t cntribute the calculated fee; and Maine s Part C prgramming and supprts are prvided in the child s natural envirnment. Natural envirnment is each child s existing daily rutines and activities and can include the family s hme, the cmmunity, child-care lcatins, etc. See Natural Envirnments sectin, Federal Part C Regulatins. 6. Designated CDS staff member cnfirms with the family whether they wish t access Maine s Part C prgramming at this time. The fllwing decisins are made: Family decides t prceed t the next step in the prcess: In accrdance with each CDS site s prcedures, the designated CDS staff member creates a file that at minimum includes the fllwing frms in preparatin fr the First Visit: Referral Infrmatin (Frm 1) and Child Medical/Develpmental Infrmatin (Frm 2). These will have already been filled ut. The rest f the frms will be blank at this pint; Relevant IFSP pages (i.e., Cver Page, IFSP Pages 2-2a: Family Rutines and Pririties, IFSP Pages 3-3d: Present Abilities, Strengths and Needs) needed fr the First Visit; and Cnsent Frms (i.e., Authrizatin t Share Infrmatin, Cnsent fr Evaluatin and Assessment, Cnsent fr Screening, Prir Ntice Frm and Ntice f Child and Family Safeguards); Designated CDS staff member determines whether frmal screening is needed prir t making a decisin that an evaluatin and assessment is needed. Frmal screening may be apprpriate if the designated CDS staff member has questins abut whether the child s develpmental needs warrant an evaluatin and assessment. Guidance abut making this decisin is lcated in the First Visit sectin that fllws. Frmal screening is usually cnducted during the First Visit. A designated CDS staff member schedules a time with the family t cnduct the frmal screening and t cmplete all necessary prcedures related t the First Visit. When frmal screening is cmpleted, results are dcumented with the child s medical/develpmental infrmatin (Frm 2); OR If the designated CDS staff member determines that evaluatin and assessment is apprpriate and that a frmal screening is nt needed, the designated CDS staff member schedules the First Visit with the family t further explain the Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 10

11 prgram, prcedural safeguards, and cmplete the family assessment. Designated CDS staff members determine whether an interpreter is needed r if there are any ther cmmunicatin needs; Designated CDS staff members determine if a surrgate parent needs t be appinted; and Designated CDS staff members cmpile infrmatin fr entry int Maine s Part C Prgram data systems. Family decides nt t prceed t next step in the prcess: Designated CDS staff members must cmplete the fllwing: Infrm the family f the right t cntact Maine s Part C Prgram at any time in the future; Share infrmatin with the family abut ther apprpriate cmmunity resurces they may access and cnnect them t these resurce if the family requests; and Send Written Prir Ntice and Declining EI frm t the family dcumenting their desire t nt access early interventin services at this time and their right t cntact Maine s Part C Prgram at any time in the future. Service Crdinatin Assignment and Respnsibilities Federal Part C Regulatins: Service Crdinatin Requirements 34 CFR Part : Service crdinatin (case management). (a) General. (1) As used in this part, except in Sec (d)(11), service crdinatin means the activities carried ut by a service crdinatr t assist and enable a child eligible under this part and the child's family t receive the rights, prcedural safeguards, and services that are authrized t be prvided under the State's early interventin prgram. (2) Each child eligible under this part and the child's family must be prvided with ne service crdinatr wh is respnsible fr-- (i) Crdinating all services acrss agency lines; and (ii) Serving as the single pint f cntact in helping parents t btain the services and assistance they need. (3) Service crdinatin is an active, nging prcess that invlves-- (i) Assisting parents f eligible children in gaining access t the early interventin services and ther services identified in the individualized family service plan; (ii) Crdinating the prvisin f early interventin services and ther services (such as medical services fr ther than diagnstic and evaluatin purpses) that the child needs r is being prvided; (iii) Facilitating the timely delivery f available services; and (iv) Cntinuusly seeking the apprpriate services and situatins necessary t benefit the develpment f each child being served fr the duratin f the child's eligibility. (b) Specific service crdinatin activities. Service crdinatin activities include-- (1) Crdinating the perfrmance f evaluatins and assessments; Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 11

12 (2) Facilitating and participating in the develpment, review, and evaluatin f individualized family service plans; (3) Assisting families in identifying available service prviders; (4) Crdinating and mnitring the delivery f available services; (5) Infrming families f the availability f advcacy services; (6) Crdinating with medical and health prviders; and (7) Facilitating the develpment f a transitin plan t preschl services, if apprpriate. (c) Emplyment and assignment f service crdinatrs. (1) Service crdinatrs may be emplyed r assigned in any way that is permitted under State law, s lng as it is cnsistent with the requirements f this part. (2) A State's plicies and prcedures fr implementing the statewide system f early interventin services must be designed and implemented t ensure that service crdinatrs are able t effectively carry ut n an interagency basis the functins and services listed under paragraphs (a) and (b) f this sectin. (d) Qualificatins f service crdinatrs. Service crdinatrs must be persns wh, cnsistent with Sec (g), have demnstrated knwledge and understanding abut-- (1) Infants and tddlers wh are eligible under this part; (2) Part C f the Act and the regulatins in this part; and (3) The nature and scpe f services available under the State's early interventin prgram, the system f payments fr services in the State, and ther pertinent infrmatin. Nte 1: If States have existing service crdinatin systems, the States may use r adapt thse systems, s lng as they are cnsistent with the requirements f this part. Nte 2: The legislative histry f the 1991 amendments t the Act indicates that the use f the term ``service crdinatin'' was nt intended t affect the authrity t seek reimbursement fr services prvided under Medicaid r any ther legislatin that makes reference t ``case management'' services. See H.R. Rep. N. 198, 102d Cng., 1st Sess. 12 (1991); S. Rep. N. 84, 102d Cng., 1st Sess. 20 (1991). [58 FR 40959, July 30, Redesignated at 63 FR 18294, Apr. 14, 1998]. Federal Part C regulatins require that every child in a Part C Prgram be assigned a service crdinatr t; crdinate services acrss agency lines; t serve as the pint f cntact; t supprt the family thrugh the multiple steps f the prcess and ensure receipt f the rights, prcedural safeguards, and necessary services and supprts. The service crdinatr is assigned fr each child and family fllwing referral in accrdance with each Maine Part C Prgram site s prcedures. The intent f service crdinatin is t guide families tward greater cnfidence and independence in enhancing their child s learning and develpment thrugh everyday rutines and activities. The service crdinatr has a rle f great respnsibility, ne that is equally as imprtant as the rle f service prvider. The service crdinatr assists the family in understanding the early interventin prcess and the family s rles thrughut the prcess. They als ensure that the family receives sufficient infrmatin t make infrmed decisins and t participate as an equal partner in decisin making. T ensure this, the service crdinatr must assist the family t fully understand what is happening at each juncture, why, and what the impact is fr their child and family. In additin, the service crdinatr is respnsible t ensure that the child and family are receiving all f the services and supprts needed t meet their unique needs. This requires crdinatin within the early interventin prgram as well as knwledge f ther cmmunity services and resurces. It is als hped that service Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 12

13 crdinatrs can assist families t effectively cmmunicate their children s needs in rder t prepare them fr the future as they transitin frm Maine Part C Prgram supprts and services. Prcedures: Service Crdinatin Assignment and Respnsibilities 1. Each CDS site assigns a service crdinatr fllwing referral t early interventin services in accrdance with state requirements and lcal prcedures. 2. Each CDS site can designate the title f the psitin that is respnsible fr carrying ut service crdinatin respnsibilities (e.g. case manager, intake crdinatr, service crdinatr, etc.) 3. Each CDS site ensures that persnnel assigned t carry ut service crdinatin respnsibilities have cmpetencies t carry ut these functins. 4. Each CDS site has prcedures t ensure that service crdinatin activities are carried ut as required. Nte: Specific service crdinatr (e.g., case manager, intake crdinatr, etc.) respnsibilities are embedded in subsequent steps f the early interventin prcess. FIRST VISIT Screening, Prcedural Safeguards, Family Assessment, Interim IFSP, and Preparatin f Family fr Evaluatin and assessment A designated CDS staff member cnducts this part f the prcess with the child s parent and/r caregiver face-t-face in the child s hme r a natural envirnment apprpriate t the child and family. The infrmatin btained during the First Visit builds upn the results f the Initial Cntact t achieve several different utcmes. The cmbined infrmatin is the infrmed screening prcess used t determine next steps fr the family. If the next steps include evaluatin and assessment by Maine s Part C Prgram, the screening infrmatin will be used in the fllwing ways: T determine the cmpsitin f the evaluatin and assessment team; T prepare the team fr the evaluatin and assessment f the child; and T determine the next steps f the prcess fr children with diagnsed physical r mental cnditins. Prcedures: General Steps and Respnsibilities 1. The First Visit is cnducted face-t-face with a child s family in a natural envirnment. 2. Designated CDS staff members will be assigned the respnsibility fr carrying ut the steps and prcedures included in the First Visit. 3. The child will need t be present fr at least part f the First Visit. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 13

14 4. These steps are t be cmpleted within 15 calendar days frm referral in rder t ensure that the 45 day timeline frm referral t IFSP meeting is met. 5. If any f the demgraphic infrmatin n Referral Infrmatin (Frm 1) r any infrmatin n Child Medical and Develpmental Infrmatin (Frm 2) was nt cmpleted during the Initial Cntact, this infrmatin shuld be cmpleted at this pint. In additin, apprpriate infrmatin shuld be entered nt the IFSP Cver Page. 6. Designated CDS staff members prvide infrmatin abut the family-centered fcus f Maine s Part C Prgram and eligibility criteria t the parent/caregiver during this visit. Designated CDS staff members prvide clarificatin abut the prgram, including a detailed review f the family cst participatin prvisin. 7. Designated CDS staff members infrm the parent/caregiver that participatin in Maine s Part C Prgram is vluntary and that the family can decide what infrmatin they chse t share with the prgram abut their child and family. They are, hwever, encuraged t share infrmatin that will be helpful in meeting the needs f their child and family. They are infrmed that all infrmatin shared is cnfidential. 8. Designated CDS staff members are respnsible fr prviding the family with a cpy f and explaining the Ntice f Child and Family Safeguards and cmpleting the fllwing with the parent/caregiver: Authrizatin t Share Infrmatin, when apprpriate Cnsent fr Screening, when apprpriate Cnsent fr Evaluatin and Assessment, when needed Written Prir Ntice Family Cst Participatin Frm Screening One f the bjectives f the First Visit is cmpleting a screening f the child. The First Visit and the infrmatin and bservatins prvided by the parent/caregiver serve as the screening prcess fr the child. In mst instances, frmal screening (e.g. administering a screening tl) will nt be necessary, especially when sufficient develpmental infrmatin is available t determine that an evaluatin and assessment is apprpriate. Nte: Part C regulatins require that infrmatin prvided by hspitals, physicians and thers invlved with the child be reviewed as part f the child s evaluatin and assessment; therefre, develpmental assessments, including screening results, cnducted prir t referral t CDS will be cnsidered in determining whether an evaluatin and assessment f the child is apprpriate. Frmal screening is nt required under Part C f IDEA (34 CFR Part 303). Hwever, frmal screening can be very helpful when insufficient develpmental infrmatin is available t determine whether cnducting an evaluatin and assessment is apprpriate. Gathering develpmental infrmatin frm the referral surce and parent/caregiver during the referral and Initial Cntact is an apprpriate step prir t determining if a frmal screening is needed. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 14

15 Prcedures: Screening 1. Based n infrmatin gathered during Referral and Initial Cntact, CDS staff decides if frmal screening is needed t determine if evaluatin and assessment is necessary. The fllwing infrmatin guides decisin-making abut whether screening needs t be cmpleted and hw best t cnduct the screening. A child may nt be determined eligible based n the results f a screening tl alne. (NOTE: When child is 45 days frm 3 rd birthday, fllw prcedures fr 3-5 year lds) NO FORMAL SCREEN NECESSARY Infrmatin Received Child has a diagnsed physical r mental cnditin (an established cnditin)* that has a high prbability f resulting in develpment delay * see Appendix fr list f established cnditins that have a high prbability f resulting in develpmental delay Child is referred t a Maine Part C Prgram with an existing evaluatin and assessment Child is referred t a Maine Part C Prgram with existing frmal screening. Actin Needed a. Frmal screen is nt necessary. b. A Part C evaluatin and assessment is scheduled. c. Designated CDS staff members btain infrmatin frm the physician that dcuments the established cnditin. a. A Part C evaluatin and assessment is scheduled. b. Designated CDS staff members infrm the evaluatin and assessment team that ne r mre areas have already been evaluated/assessed. This infrmatin is cnsidered as part f the assessment prcess and if the child is fund eligible can be used t develp the IFSP. a. Determine if existing frmal screening infrmatin is reliable. Prceed t next apprpriate step. b. If previus screening results seem unreliable and it is questinable that the child needs an evaluatin and assessment, then anther frmal screening may be administered. REASONS FOR CONDUCTING A FORMAL SCREENING (IN PERSON OR BY PARENT/CAREGIVER RESPONSE) The referral surce r initial family phne call reveals that the parent has sme difficulty when asked t verbally share accurate r sensitive infrmatin abut their child s develpment t determine if the child is in need f an evaluatin and assessment. There may be qualitative develpmental cncerns that cannt be easily cnveyed thrugh verbal reprt. N ther prfessinal has seen the child and it is highly likely that it wuld be difficult t get clear infrmatin frm the parent. During cnversatins with the family, the child s develpmental skills and behavirs fall within a typical develpmental range (i.e., screens ut) but the family requests a develpmental screening. In the case f a child with an internatinal adptin histry r a family in which English is a secnd language, special care will need t be taken t determine whether the child and family (due t language r ther cultural issues) may require a different evaluatin/assessment prcedure. 2. If a decisin is made t cnduct a frmal develpmental screening, designated CDS staff members explain and prvide the parent/caregiver with the Ntice f Child and Family Safeguards, explain the Cnsent t Screen frm, and btain the signature f the Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 15

16 parent/caregiver. Written Prir Ntice is als prvided and explained. Cpies f the signed Cnsent t Screen and Written Prir Ntice frms are maintained and placed in the child s recrd. 3. When frmal screening is cnducted, a natinally nrmed and standardized tl will be used. A child may nt be determined eligible based n the results f a screening tl alne. 4. If frmal develpmental screening is cnducted, screening results are dcumented in Frm 2: Child Medical and Develpmental Infrmatin. NEXT STEP DECISIONS AND ACTIONS NEEDED The fllwing steps summarize the necessary actins related t whether an evaluatin and assessment is apprpriate r desired by the family based upn frmal screening results and/r infrmatin gathered frm Referral and Initial Cntact: Decisin Actins Needed Family chses nt t prceed t evaluatin and assessment at this time. Family chses t prceed t evaluatin and assessment. Child screens at age level in all develpmental areas and family requests a develpment evaluatin and assessment a. Declining Early Interventin Services is explained and signed and Ntice f Rights is explained and prvided t the parent/caregiver. A cpy f the Declining Early Interventin Services is maintained and filed in the child s recrd. b. Parent/caregiver is prvided with Maine Part C Prgram cntact infrmatin and is infrmed that they may cntact a Maine Part C Prgram at any pint in the future if they have cncerns abut their child s develpment. [Maine Part C Prgram sites may als chse t ffer re-screening at intervals determined with the family. Offers t re-screen are nt required by federal r state law, and d nt initiate timelines fr cmpliance r imply entitlement t the same parental rights as thse f an eligible child with a disability.] c. Parent/caregiver is prvided with infrmatin abut child develpment. d. Available cmmunity resurces are discussed with the parent/caregiver and assistance in accessing these services is prvided if requested by the family. a. Cnsent fr Evaluatin and Assessment is explained and signature f the parent/caregiver is btained fr the child s recrd. b. Written Prir Ntice is cmpleted, a cpy is prvided t the family, and a cpy is placed in the child s recrd. Ntice f Child and Family Safeguards is explained and a cpy is prvided t the Parent/caregiver. a. Cmpliance timeline ends; designated CDS staff members schedule an evaluatin and assessment. All applicable ntices must be cmpleted, prvided, and placed in the child s recrd (see bx abve). Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 16

17 Family Assessment Federal Part C Regulatins Family Assessment Sec : Evaluatin and Assessment (d) Family Assessment. (1) Family assessments under this part must be family-directed and designed t determine the resurces, pririties, and cncerns f the family and the identificatin f the supprts and services necessary t enhance the family s capacity t meet the develpmental needs f the child. (2) Any assessment that is cnducted must be vluntary n the part f the family. (3) If an assessment f the family is carried ut, the assessment must (i) Be cnducted by persnnel trained t utilize apprpriate methds and prcedures; (ii) Be based n infrmatin prvided by the family thrugh a persnal interview; and (iii) Incrprate the family s descriptin f its resurces, pririties, and cncerns related t enhancing the child s develpment. Family assessment is usually cmpleted during the First Visit nce it is clear that the evaluatin and assessment is apprpriate and desired by the family. The purpse f the family assessment is t gather infrmatin frm the family abut their everyday rutines and activities, their child s and family s interests, as well as their cncerns, pririties, and resurces. In accrdance with federal Part C regulatins, the identificatin f cncerns, pririties and resurces is vluntary, with the cncurrence f the family. Designated CDS staff members will be assigned the respnsibility fr carrying ut the steps and prcedures included in the family assessment Gathering family pririties, cncerns, and resurces shuld be as cnversatinal as pssible. T d this, the persn asking fr the infrmatin shuld create a climate in which the family feels free t talk abut their child and family. This individual must have sufficient training in cnducting interviews, including rapprt-building, active listening and use f apprpriate and effective questins. Using cnversatins t learn abut the child's and family's backgrund, strengths and needs, as well as their interests and activities in which they participate is imperative. Fr sme children, it is als imprtant t learn abut the child s early care and educatin settings. During this exchange, the family is given the pprtunity t share their stry, including their experiences with their child as well as previus medical, health, r develpmental evaluatin infrmatin, and t describe their cncerns, pririties and infrmatin abut their child s develpment. It is imprtant that families be asked t prvide infrmatin abut their child s day, including what is wrking and what is challenging. Prcedures: Family Assessment 1. The family assessment is usually cnducted during the First Visit. Infrmatin gathered frm the family during the Initial Cntact shuld be used as a fundatin fr the family assessment. 2. Infrmatin gathered thrugh the family assessment prcess is dcumented n IFSP Pages 2-2a: Family Rutines and Pririties which has tw parts: (a) Everyday Rutines, Activities and Places, and (b) Family Cncerns, Pririties, and Resurces. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 17

18 3. Prir t initiating the family assessment, designated CDS staff members infrm the parent/caregiver that: the family assessment is vluntary the infrmatin that the parent/caregiver chses t share abut their child and family is cnfidential; and the family helps determine what infrmatin is recrded n the IFSP regarding their family rutines and pririties. 4. Designated CDS staff members infrm the parent/caregiver f the purpse f family assessment including identifying the fllwing: the child's and family's strengths and interests. the settings where the child and family currently live and play (hme, cmmunity, and child care r preschl settings), alng with the peple wh are invlved. The way the child has affected the activities that the family is invlved in. the family's cncerns and pririties fr the child s participatin in family, cmmunity, and early care and educatin activities and rutines. the family's need fr additinal supprts, including infrmatin, materials, and emtinal supprts. 5. Designated CDS staff members use cnversatins, rather than a structured interview, t gather this infrmatin abut the child and family. 6. Designated CDS staff members may use a number f specific family assessment tls/methds in cnjunctin with cnversatins with families based n lcal prgram prcedures. (See Appendices fr examples f family assessment tls/methds). 7. Designated CDS staff members may wish t incrprate sme f the fllwing kinds f questins when cnversing with the family t cmplete Everyday Rutines, Activities, and Places f the IFSP Pages 2-2a: Family Rutines and Pririties, especially if the parent/caregiver struggle(s) in telling their stry: Can yu tell me abut yur day? Where d yu g? What d yu d? Wh d yu spend time with? What types f things happen n mst mrnings? Afternns? Nights? Weekends? What types f things r activities d yu and yur child like t d (e.g., hiking, ging n picnics, playing games at hme)? What are yur child s interests? What things des yur child enjy and what hlds yur child s attentin (e.g., peple, places, things such as tys, dg, being utside)? What makes yur child happy, laugh and/r smile? What rutines and/r activities des yur child nt like? What makes these rutines and/r activities difficult and uncmfrtable fr yur child? What des yur child usually d during these rutines/activities? Wh are key family members, ther caregivers, r imprtant peple wh spend time with yur child, and in what settings des this ccur? Are there activities that yu used t d befre yur child was brn that yu wuld like t d again? Are there any ther activities that yu and yur child wuld like t try? 3. Designated CDS staff members summarize fr the parent/caregiver the cncerns that they heard identified during the cnversatin regarding everyday rutines, activities and places and cnfirm these cncerns with the family. Designated CDS staff members assist the family in identifying which f these cncerns are their mst imprtant pririties. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 18

19 9. Designated CDS staff members summarize fr the family any resurces including family members, friends, cmmunity grups, financial supprts, and ther cmmunity resurces etc. that were identified during their cnversatin abut everyday rutines and activities that may be helpful in addressing their pririties. The parent/caregiver is asked if this summary f resurces is accurate and if they can think f thers that were nt previusly mentined. 10. Designated CDS staff members summarize fr the family strengths that were identified during the cnversatin abut everyday rutines and activities. 11. Cncerns, pririties and resurces cnfirmed by the family are recrded n the Family Rutines and Pririties sectin f IFSP Pages 2-2a: Family Rutines and Pririties. 12. Additinal infrmatin gathered frm the family abut their interests, cncerns and pririties fllwing the evaluatin and assessment and during the IFSP meeting shuld be incrprated int the Family Assessment. Preparatin f Family fr Evaluatin and Assessment Preparing fr the evaluatin and assessment f the child is a critical step, nt nly fr the family, but als fr the designated CDS team members wh will be cnducting the evaluatin and assessment. It is imprtant that the family understand the purpse f the evaluatin and assessment, the prcess that will be used in the evaluatin and assessment, an idea f wh might be invlved in cnducting the evaluatin and assessment, when eligibility will be determined, and what happens if their child is r is nt fund eligible. Each team will cnduct a transdisciplinary evaluatin and assessment in which all members f the team are invlved in planning based n infrmatin received frm the Initial Cntact and ther available infrmatin. A transdisciplinary mdel allws fr an interactive and integrated prcess acrss dmains t get a hlistic picture f the child. Evaluatin and assessment activities are cnducted fr tw different purpses. The utcme f evaluatin is t expeditiusly cnfirm eligibility fr Maine s Part C Prgram and t determine the child s level f functining in all five required develpmental dmains. An assessment is cnducted fr interventin planning thrugh the identificatin f the child's unique strengths and needs in each develpmental area and the supprts and services apprpriate t meet thse needs. Prcedures: Preparatin fr Evaluatin and Assessment 1. Prir t cmpleting the visit with the family, designated CDS staff members infrm the family abut evaluatin and assessment and the eligibility determinatin prcesses. The fllwing pints are included in the explanatin: The purpse f the initial evaluatin and assessment is t determine eligibility and t identify the unique strengths and needs f the child; At least tw (2) prfessinals and the parent will be invlved in cnducting the initial evaluatin and assessment and determining eligibility. Designated CDS staff members wh cnduct the First Visit and family assessment shuld participate in the child s evaluatin and assessment f and be respnsible fr preparing the evaluatin and assessment team. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 19

20 During the initial evaluatin and assessment, the team will use prcedures including a standardized develpmental evaluatin tl, pertinent recrds, bservatin f child (whenever pssible invlved in their everyday rutines and activities), parent/caregiver feedback, etc. t determine the child s develpmental status and unique strengths and needs in each develpmental area; The family will have an pprtunity t identify their cncerns, prvide their bservatins, and ask questins f the team; If the child is eligible fr Maine s Part C Prgram, a meeting t develp the initial IFSP must be cnducted within 45 days f the date f referral. The prfessinals wh cmplete the evaluatin and assessment will wrk with the family t develp an IFSP that identifies supprts and services apprpriate t meet the child s and family s needs; and If the child is nt eligible fr Maine s Part C Prgram, the team will discuss ther ptins that might be apprpriate fr the child and family. 2. Designated CDS staff members discuss with the family their ptential rles in the evaluatin and assessment prcess. The parent/caregiver is encuraged t be an active team member, but they have the final decisin regarding their level f participatin. Designated CDS staff members ask the family abut the best time and place t cnduct the evaluatin and abut any suggestins the family might have t make the prcess g smthly. This infrmatin is recrded n Preparatin fr Evaluatin and Assessment and is used t prepare all individuals invlved in cnducting the prcess. 3. The family and designated CDS Staff member shuld discuss and determine whether the IFSP Meeting will be cnducted at the same time as the Evaluatin and Assessment. If hlding the Evaluatin and Assessment and IFSP Meeting n the same day, then CDS staff must als prepare the family fr their participatin in develping the IFSP. (Guidance relating t this, including apprpriate prcedural safeguards, can be fund in the sectin f this dcument n the IFSP Meeting and Develpment f Initial IFSP.) EVALUATION AND ASSESSMENT OF THE CHILD Federal Part C Regulatins: Evaluatin and Assessment, Nndiscriminatry Prcedures, and Multi-disciplinary Sec : Evaluatin and Assessment (a) General. (2) Each system must include the perfrmance f a timely, cmprehensive, transdisciplinary evaluatin f each child, birth thrugh age tw, referred fr evaluatin, and a family-directed identificatin f the needs f each child's family t apprpriately assist in the develpment f the child. (3) The lead agency shall be respnsible fr ensuring that the requirements f this sectin are implemented by all affected public agencies and service prviders in the State. Early Interventin Guidance Dcument Maine s Part C Prgram 1/16/07 Page 20

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