Over 30,000 children from birth to
three years are receiving Early Intervention (EI) services in New York State. We
hope this handout will help pediatricians to integrate the EI process and the
resulting services that their patients and their families receive into their
medical practices. We hope to make it easier for the primary care practitioner
(PCP) to refer patients with suspected
or confirmed developmental delay to EI, as well as to follow up in their care
throughout the course of the intervention.
Pediatricians may refer their patients to the EI program or parents may refer their own children. Referrals can be made to the Nassau or Suffolk County or New York City Early Intervention Program (see phone numbers below). It should be noted that referrals may also be made directly to service providers through their individual programs (http://www.nyc.gov/html/doh/downloads/excel/earlyint/earlydirectory-sites.xls)
The initial service coordinator (ISC) arranges a multidisciplinary evaluation with two qualified testers. In addition to this Core assessment, other supplemental evaluations may be requested. The ISC should review a list of evaluation options with the family. The ISC should also provide general information about the EI program, as well as the family’s legal rights. With this evaluation and a recent medical examination, a summary is written and a report submitted. The plan does not include a diagnosis; it addresses functional status and needs, as well as strengths and weaknesses. Eligibility for services is dependent on the extent of delay (cognitive, physical including vision and hearing, communication, social/emotional and adaptive development) or a clear diagnosis of developmental disability (e.g. Trisomy 21).
If a child presents with qualifying delays as determined by EI, the next step is an Individualized Family Service Plan (IFSP) meeting where a written IFSP is developed and an ongoing service coordinator (OSC) is chosen. The OSC may be a representative of the program that will be providing services but will certainly ensure that mandated services are provided. This plan, which outlines appropriate EI services, must be written with the family’s input and agreement. Most services (especially for younger children) are provided in the home. Older children may receive services in a center-based program. Services can include:
Assistive technology devices and services
Family training, counseling, home visits and parent support groups
Nursing services which might be required for developmental services
Social Work Services
Transportation costs necessary to enable a child/family to receive services
It should be
noted that medical services may be provided for diagnostic or evaluation
The EI services are reevaluated on an ongoing basis as often as every three months, but usually at six months and annually thereafter. Transition planning prior to a child turning three years of age is a part of the care plan.
There are a number of ways to refer children with confirmed or suspected delays directly into the EI program. Children who are at risk for developmental delay can be referred to Child Find (formerly Infant Child Health Assessment Program (ICHAP)) in the same way. The pediatrician or parent can call:
NYC - Totline 1-800-577-baby (2229) Fax
Nassau County – 516-227-8661 Fax 516-227-8662
Suffolk County -
Suffolk County -(631) 853-3100 Fax (631) 853-2310
Certain information is needed for all referrals and includes:
Name of child, sex, and date of birth
Name, address, phone number of parents
Reason for referral (suspected or confirmed disability or delay) or child at-risk
See NYC EI referral form: http://www.nyc.gov/html/doh/downloads/pdf/earlyint/ei-referral-form.pdf
Families can be referred to individual or specific EI
agencies that provide direct services:
Pediatricians should be aware of the EI agencies available to them in their community. Traditionally all referrals are processed through the Borough or County Office but referrals can also be made through the EI agencies themselves. It can be much more convenient to work through an agency with whom you are familiar and have an established working relationship. Networking makes your life easier. You can find agencies by contacting your Early Childhood Direction Center (ECDC) (See resources below) or through the NYC Department of Health (http://www.nyc.gov/html/doh/downloads/excel/earlyint/earlydirectory-sites.xls). It should be noted that some agencies provide service coordination only, some provide direct services only and others offer both. Having an ongoing, working relationship with two or three agencies in your area can make your job easier by giving you a specific contact person when an EI evaluation is needed. That contact person can also personally assist the family with the process. Representatives from specific agencies are usually happy to make appointments and visit you in your office.
Pediatricians should be aware that hearing evaluations are not mandated
through EI. Pediatricians should therefore ensure that an audiological
evaluation has been scheduled before referring children with speech and/or
language delay. A vision
evaluation may be helpful as well.
services are available.
By regulations, the initial EI process should be concluded within 45 days. In certain circumstances the child may be referred for an emergency evaluation. An interim IFSP can be requested on emergency basis in children who meet certain criteria (i.e. feeding difficulties, severe delays in a premature baby, etc). This should be requested at the time of referral. You may still need to allow at least 45 days for a full IFSP.
Pediatricians can stay involved in the EI process and can utilize their
special relationship with families to help:
EI is parent friendly and cannot be instituted if the parents do not want the services. Furthermore, parents can go to any approved EI agency that they choose. The PCP may be in the best position to explain the importance of the services to the family. Therefore it is crucial that pediatricians are familiar with the rules and laws of EI in order to help parents (see references below). There are certain rights and due process to which parents are entitled. For example, while re-evaluations occur every 6 months or annually, they can be done earlier if a parent requests, based on new concerns or a change in status. In addition, services cannot be decreased without parental agreement. As pediatricians become better educated about EI, they can help families to become better advocates.
can give consent for the EI evaluation and IFSP results to be shared with the
pediatrician. Parents themselves
can provide the reports to the pediatrician.
Have parents prepare a release or include it when submitting the
medical evaluation. Be sure to
let parents and EI personnel know that you want to be kept involved.
recent medical evaluation is needed for all children in the EI program.
This is an opportunity to include the pediatrician’s impression and
findings, as well as thoughts on treatment and need for further evaluation.
Further referrals to specialists may be necessary and should be made in
conjunction with the EI process.
can be actively involved in every aspect of the EI evaluation, therapy and
service provision, reevaluation and transition. Physician input can be provided at any point including
evaluation of eligibility, the core evaluation, IFSP meeting, reevaluation and
transition planning. (See
AAP policy on IEP and IFSP). The ISC or OSC can be contacted with parental
Prescriptions for physical, occupational and feeding therapy need to be
written by the pediatrician:
Referrals are often needed for audiological evaluations, as well. Pediatricians are in the best position to advise on certain services such as home or day care and parent support. In complicated cases where multidisciplinary medical care is needed, the PCP plays a pivotal role in ensuring appropriate therapy. Since pediatricians are the only team members who can order occupational, physical and feeding therapy, it is critical that PCPs understand the EI team evaluations before recommending therapy. (See AAP policy on prescriptions for therapy).
EI services can get bogged down if therapy orders are not written in a timely fashion. If you have any questions, contact the Service Coordinator. Make sure that you have asked parents to sign a release so that you can review the evaluation and speak to the ISC or OSC.
Children with a confirmed or suspected disability OR children at risk of a disability are all eligible for services. Medical input can be critical in this determination. Refer anyone about whom you are concerned. Children with behavioral issues as the primary concern can be referred as well:
There are two sets of criteria to receive services:
EI is on your side:
– Formerly known as ICHAP (Infant Child Health Assessment Program), serves
0-3 years old who are at-risk for delay by providing ongoing developmental
monitoring and services needed for optimal development.
Childhood Direction Center (ECDC) -
Provides information about programs and services for
young children, ages birth through five, who have disabilities and helps to
Intervention Official Designee
(EIOD): Works in EI Regional Office and signs/approves services as
described in the IFSP and annual reviews.
(Individualized Family Service Plan) – This is the written plan of
services developed for the child that guides the OSC and agency, including
frequency as well as expected outcomes.
(Initial Service Coordinator) – As either an employee of an agency or EI,
the ISC oversees the initial EI evaluations and IFSP meeting.
OSC (Ongoing Service Coordinator) – The OSC is usually employed by an agency or by EI. They coordinate care during the entire time child is on EI assuring that all services are provided as mandated by the IFSP.
Brooklyn EI Regional Office
Crystal Duhart, Assistant Director
Suffolk County Early
Nassau County Department of Health
Nassau County C hild Find
Eileen Connolly, PHN
Asst. Director, Early Intervention
Queens EI Regional Office
Agatha Guadagno, Acting Director
Early Childhood Direction Centers (ECDC) - http://www.vesid.nysed.gov/lsn/ecdc/home.html
Brooklyn - (718) 437-3794
Queens - (718) 374-0002 Ext. 465
Nassau - (516) 364-8580
Suffolk - (631) 863-2600
Developed by AAP Chapter 2 Committee on Developmental-Behavioral Pediatrics/Children with Disabilities
Jack M. Levine, MD, Chairman
Chuan Chang, MD
Eileen Fontanetta, MD, MPH
Hazel Goodwin, MD
Alyson Gutman, M.D.
Dorie E. Hankin, M.D.
David Meryash, MD
Carolyn Rehm, MD
Eddie Simpser, MD
Jogesh Syalee, MD
(718) 206-9888 x236
thanks to Vivian Babin, OTR and Dawn Oakley, OTR, St. Mary’s Healthcare System
for Children; Nancy Rybacki, Stepping Stone School; Kathleen
Walsh, PHN and Eileen Connolly, PHN, Nassau County Department of Health
Pediatricians play an integral role in helping their patients with special needs get an appropriate and meaningful education. They are often called on to provide guidance to school districts in administering medication (e.g. ADHD, asthma, anaphylaxis), providing medically prescribed treatments (e.g. clean intermittent catheterization), managing diabetes (insulin administration, glucose monitoring) and recommending accommodations for children with medical disabilities (ADHD, visual/hearing deficits).
Two federal laws guarantee the rights of children to free appropriate public education: Section 504 of the Rehabilitation Action Act of 1973 (section 504) and the Individuals with Disabilities Education Act, amended in 2004 (IDEA). Section 504 prohibits schools that receive federal funds from discrimination against children with disabilities. IDEA is a special education law. Coverage under section 504 is broader than IDEA.
While coverage under IDEA requires special education services, coverage under Section 504 may require educational services or only require accommodations. Accommodations can mean any number of special modifications tailored to the educational needs of a child such as preferential seating, un-timed tests, extra time on tests or assignments, or help from the school nurse on taking medication or medical services.
A child is considered eligible for section 504 if their medical condition significantly limits a major life activity (e.g. learning). A child not eligible for special education (under IDEA) may still receive related services and accommodations under section 504 if they meet the requirements. Any child with a medical condition which substantially limits their ability to learn (e.g. ADHD) should by eligible.
An evaluation is required and parents must be notified. Full evaluation by the Board of Education (necessary for an IEP) is not required. However, an evaluation by a medical professional is required to establish eligibility. Pediatricians are often called on to fill out the section 504 form: http://schools.nyc.gov/Offices/DYD/Health/SchoolHealthForms/default.htm. There are different forms for medication, medically prescribed treatment, diabetes management and accommodations for medial conditions, such as ADHD.
The linked examples illustrate section 504 accommodations for ADHD. Special thanks to International Dyslexia Association, New York Branch K www.nybdia.org and Advocates for Children of New York http://www.advocatesforchildren.org.
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