The ABC’s of Early Intervention for Pediatricians

====================================================

INDEX

Referrals
Agencies
Hearing
Emergencies
Families
Prescriptions
Criteria
Glossary
Phone Numbers
Websites
AAP Policies
Centers

Introduction

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. 

Overview

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:

It should be noted that medical services may be provided for diagnostic or evaluation purposes only.

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.

Tips for Pediatricians

  1.  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:

Certain information is needed for all referrals and includes:                        

See NYC EI referral form: http://www.nyc.gov/html/doh/downloads/pdf/earlyint/ei-referral-form.pdf

 

  1. 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.
     
     

  2. Pediatricians should order a hearing evaluation.
                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.
     
     

  3. Emergency EI 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.

  4. 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.

    Parents 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. 

    A 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.

    Pediatricians 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 permission. 

    BE SURE TO ASK PARENTS TO SIGN A RELEASE SO THAT YOU CAN BE KEPT INFORMED!!  

  1. 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.  

     

  2. 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:

    • Confirmed or suspected disability

      Children must have at least 33% delay in one area or 25% delay in two areas to qualify for EI services. Areas tested include Cognitive, Adaptive, Communication (expressive and receptive), Physical (motor, vision, hearing) and Social-Emotional.

      Certain medical conditions such as Trisomy 21, fetal alcohol syndrome, cerebral palsy and sensory impairments have a high probability of resulting in developmental delay.  These children are also eligible for EI services. Pediatricians can make these diagnoses and should send information about the medical condition.

    • Risk of a disability  

      If children don’t qualify by the above criteria, EI can still provide periodic monitoring for the future through Child Find (previously known as ICHAP).   There are many risk criteria including birth weight under 1501 grams, gestational age less than 33 weeks, hyperbilirubinemia, HIV infection, congenital malformations, elevated lead, parental illness, etc. All these diagnoses warrant a referral to Child Find. (http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/2005-02/appendix_a.htm). Referrals are made in the same way.

  3. EI is on your side:  
               
    When parents express concern, take it seriously and refer to EI. Use the EI evaluation to supplement your own screening, surveillance or discussions in the office.  This is the first step to determining whether a problem truly exists. EI can mean providing support and hope to the family.  Provision of services can reduce parental anxiety and provide hope for restoring a child to his/her expected developmental path or, at least, maximizing that path. For all its ups and downs, EI does help children.

     

  4. Glossary:

            Child Find – 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.   

Early Childhood Direction Center (ECDC) - Provides information about programs and services for young children, ages birth through five, who have disabilities and helps to obtain services.

Early Intervention Official Designee  (EIOD): Works in EI Regional Office and signs/approves services as described in the IFSP and annual reviews.

            IFSP (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.

            ISC (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.

  1. Helpful phone numbers and websites:

Brooklyn EI Regional Office

Crystal Duhart, Assistant Director
16 Court St 6th fl
Brooklyn, New York 11241
718-722-4202

 

Suffolk County Early Intervention Program
Suffolk County Department of Health Services
Division of Services for Children with Special Needs
50 Laser Court
Hauppauge, NY 11788
     Referral line (631) 853-3100
     FAX: (631) 853-2310
http://www.suffolkcountyny.gov/departments/healthservices/children.aspx 
The Early Intervention Referral Form can be printed out and faxed to (631) 853-2310. http://www.suffolkcountyny.gov/upload/healthservices/csn_referral.pdf 
     Both the Suffolk County Early Intervention Program and the Suffolk County Child Find Program can be accessed by calling (631) 853-3100.

 

Nassau County Department of Health
Kathleen Walsh, PHN  
Director, Office of CSHCN  
516-227-8648

Nassau County Child Find

Eileen Connolly, PHN

Asst. Director, Early Intervention

516-227-8685

516-227-8695

 

Queens EI Regional Office

Agatha Guadagno, Acting Director
718-271-1003


 

Families and Advocates for Children’s Services (FACS)/AHRC New York City
       Geri Haggerty-718-634-0572
 

Internet Resources:

Relevant AAP policies:

 

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
 

Brooklyn
Karen Samet, Director
Early Childhood Direction Center
160 Lawrence Avenue
Brooklyn, NY 11230
Phone:(718) 437-3794
Fax:(718) 436-0071
E-mail:
ksamet@ucpnyc.org

Nassau
Tara McNally, Director
Early Childhood Direction Center
Variety Child Learning Center
47 Humphrey Drive
Syosset, NY 11791-4908
Phone:(516) 364-8580
Fax:(516) 921-2354
E-mail:
nassauecdc@VCLC.org  

Queens
Catherine Warkala, Director
Early Childhood Direction Center
Queens Center for Progress
82-25 164th Street
Jamaica, NY 11432
Phone:(718) 374-0002 Ext. 465
Fax:(718) 380-3214
E-mail: cwarkala@queenscp.org

Suffolk
Valerie Kelly. Director
Early Childhood Direction Center
99 Hollywood Drive
Smithtown, NY 11787
Phone:(631) 863-2600
Fax:(631) 863-2082
E-mail: ecdcsuffolk@ddiinfo.org   

Developed by AAP Chapter 2 Committee on Developmental-Behavioral Pediatrics/Children with Disabilities

Jack M. Levine, MD, Chairman
dpeds@optonline.net
(516) 734-2997
(718) 268-5282

Chuan Chang, MD
Chuan_chang@yahoo.com
718-283-1924

Eileen Fontanetta, MD, MPH
efontanetta@yahoo.com

Hazel Goodwin, MD
hgoodwin@brookdale.edu

Alyson Gutman, M.D.

Dorie E. Hankin, M.D.
doriehankin@yahoo.com
(516) 739-1936

David Meryash, MD

Carolyn Rehm, MD

Eddie Simpser, MD
esimpser@stmaryskids.org
(718) 281-8778

Jogesh Syalee, MD
jsyalee@pol.net
(718) 206-9888 x236

   

Special 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  

====================================================

Section 504 and the Pediatrician

     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.

====================================================


====================================================

Calendar|New York 2 Executive and Committees|Links|Members

Return to The New York Chapter 2 of the American Academy of Pediatrics