NASSAU COUNTY DEPARTMENT OF HEALTH Early Intervention Program

1. NASSAU COUNTY DEPARTMENT OF HEALTHEarly Intervention Program

2. and the Local Early Intervention Coordinating Council (LEICC)Present

3. BEST PRACTICE IN THE EARLY INTERVENTION PROGRAM

4. Professional Boundariesin Early Intervention

5. What do families in early intervention need? • Qualified personnel • Provider information • Complete written information • Transition information • Awareness of boundaries • Recognition of child abuse Providers Families Child DOH

6. Any incident regarding suspicion of sexual and/or physical abuse must be documented and immediately reported to the New York State Child Abuse and Maltreatment Register (Phone #1-800-635-1522), the Nassau County Police Dept Special Victims Unit (in cases of sexual or physical abuse when the allegation involves non-familial abuse). • EI Director, OSC/EIOD (DOH Phone #227-8648) 8:30 am to 4:45 pm • For incidents on buses call Penauille Servisair at 433-4500

7. Individual Provider and Agency Standards • What do individual providers and agencies need to do?

8. Confidentiality *Federal Educational Rights and Privacy Act (FERPA) *Confidentiality procedures

9. Eligibility Requirements Under the EI Program

10. Evaluations

11. Early Intervention - eligibility criteria for: • Developmental delay • Diagnosed physical or mental condition

12. To determine eligibility use: • Standardized tests • Developmental checklists to support standardized tests • Clinical judgement • Two or more qualified professionals

13. No single procedure or instrument may be used as the sole criteria or indicator of eligibility (Section 69-4.8 NYS EI Regulations) • Schedule evaluation within 10 working days after receipt of written request for evaluation from NCDOH • Keep the ISC informed of any reasons for delay in meeting time lines

14. Conducting the Evaluation • A family assessment must be offered as an option • Evaluators must not make written or verbal recommendations during the evaluation regarding specific services, frequency, duration or specific providers

15. Written Reports and Content Each evaluation submitted to the DOH must include: • NCDOH Evaluation Summary Eligibility Determination Packet (3pages) • Multidisciplinary evaluation report • Summary narrative written in collaboration with all evaluators • Family Assessment • Health Status Report

16. Description and statement of eligibility must be written in Summary Narrative, not in multi-disciplinary evaluation report • No written recommendations regarding specific services, frequency or duration in the evaluation report • Specific services must be discussed at the IFSP meeting

17. Reconcile any differences in assessment findings • Analyze delays in cognitive domains • When describing a child’s inability or lack of a particular skill, make sure it is age expected

18. IFSP Meetings

19. Prior to initial IFSP • 45 day time limit from date of referral • Written evaluation reports to Health Department and family within 10 days of completion

20. Initial IFSP Meetings • Participants • Conducting the Meeting • review reports / findings • family concerns, priorities and resources (CPR) • develop meaningful goals • choose Ongoing Service Coordinator

21. IFSP Review Meetings • Participants • Conducting the meeting • minimally every 6 months • telephone / in person • Progress reports • Amending the IFSP • discuss with EIOD/OSC BEFORE family • required paperwork

22. Annual Review Face to face mandatory Required paperwork

23. Working in Home, Office/Facility, Child Care Centers

24. Natural Environment Settings that are natural or normal for young children without disabilities May include: the home, a child care setting or other community settings in which children participate IFSP must contain statement of the natural environments in which EI services shall be appropriately provided

25. Home • Boundaries are of utmost importance • Services in the home have a purpose, they are not just “provided” at the home for convenience • This needs to be explained to parent; form a partnership in training

26. Child Care Setting • Use letter of introduction

27. Office/Facility • Boundaries are more clearly delineated and defined • Supervisor is usually on-site • Rules/procedures are usually posted

28. Center-Based • Need to work collaboratively • Ongoing communication is essential • Know who to contact if suspicions of child abuse or maltreatment exist (i.e. incidences on bus, etc)

29. Delivery of Services

30. Delivery of Services Collaboration Between Professionals and On-going Service Coordinators • Ongoing communication between family and team members • Team members should establish cohesive method of communication through notebooks, telephone contact, meetings and/or co-treatments

31. Co-Treatment Co-treatment is a collaborative session in which providers from different disciplines treat a child simultaneously • Co-treatment should be used to problem solve, address family issues and develop a cohesive treatment plan • Co-treatment must be documented on Daily Notes /Attendance Sheet

32. Speech-Language Pathology Clinical Fellowship Year (CFY) • An individual completing their Clinical Fellowship Year (CFY) may provide speech pathology services or audiology services and/or evaluations: • Individuals must be employed and supervised • Agency employing CFY candidate must maintain copy of Form 6 issued by the State Board for Speech Pathology • Maintain policy and procedure manual • All Daily Notes/Attendance Sheets and evaluations must be co-signed by supervising therapist • Individuals completing their CFY cannot be hired as independent contractors • CFY and supervision must be in IFSP

33. OT and PT Assistants • OT assistants must be supervised on site by a licensed occupational therapist • PT assistants must be supervised on site by a licensed physical therapist

34. Student Therapists • Noted on IFSP and approved by EIOD • Must meet health and safety requirements • Under direct on site supervision of a licensed professional • Licensed professional always has the legal responsibility and liability for the treatment of the child

35. Rx/Therapy Orders to Start • Who needs? • OT’s and PT’s need an MD order to treat • ST’s need a recommendation for an evaluation and services • IT IS ILLEGAL TO TREAT WITHOUT Rx / Therapy Orders • Who keeps? • Original- provider specified on IFSP • Copy- Contractor and DOH

36. Medical Clearance/Change of Health Status • Medical clearance should be obtained before any treatment occurs if • A child’s health status poses possible risk in treatment • After a significant change in health status • Should clearly state that PT and OT can resume without any restrictions

37. Required Paperwork

38. Daily Notes/Attendance Sheets • Accurately record information • Never falsify information • Never have Daily Notes/ Attendance Sheets signed in advance or for any time other than the specific date and time of the session • REMEMBER - THIS IS A LEGAL DOCUMENT !!!

39. Daily Notes/Attendance Sheets must be kept for • All sessions • All contacts with other professionals who are involved in the ongoing delivery of services • All recommendations of support, guidance & education given to parent/caregiver. • Fill in blanks completely • ICD-9 Codes must be included on each Daily Note/Attendance Sheet & CPT codes (if applicable) for every session

40. Daily Notes/Attendance Sheets must be related to outcomes on IFSP • Should include • Progress towards IFSP outcomes • Activities • Strategies • Child’s response • Pertinent information

41. Parent or caregiver must sign after each session • Must be person over 18 years of age • Signature reflects attendance at session • Writtenparental permission is required before a childcare provider can sign the Daily Notes/Attendance Sheets

42. NYS Regulations state: No more than three individual sessions in any one location No more than one session of any discipline in one location THIS IS THE RESPONSIBILITY OF THE PROVIDER

43. Make-Up Policy • Session(s) should be made up whenever possible • One session more per week in each of next two calendar weeks • Only during current IFSP • Are not cumulative • Cannot be added onto another session

44. Provider Progress Report Documentation Guide for Parent/Caregiver Identify Strengths/Challenges Quality Assurance Justification of Services

45. What Should Be Included In the 3 Month Progress Report A brief overview of the child’s progress including: Child’s reaction Strategies/treatments Progress towards IFSP outcomes Current functioning level of child Suggestions to parents/caregivers

46. 6 Month Progress Reports Child’s progress towards achieving IFSP outcomes including: • Reaction to therapy • Strategies & treatments • Who/What/Where • Communication with team members • Formal assessment of child’s current level of functioning • Outcomes/Long-term goals/Short-term goals • Family/Caregiver Plan • Reminders • Decrease services/discontinue services

47. Progress Reports should: • Be written professionally and typed • Include any relevant information pertaining to the child’s developmental level and/or functioning (medical, equipment, etc) • Be accurately and completely filled out • Be submitted to DOH and family 3 weeks prior to the end of the IFSP period

48. IFSP Review Request/ Amendment Increasing services Discuss with EIOD, OSC and provider team Discuss with family Fill out IFSP review with essential information and justification for increase

49. Supplemental Evaluations Discuss with EIOD, OSC and provider team Discuss with family Service provider must identify their specific concern and on IFSP Review Request document developmental tasks the child is unable to do using developmental norms

50. Decreasing Services If significant progress has been made towards IFSP goals, but still requires intervention, the level of service may be decreased. If a decrease is indicated, DO NOT WAIT until the end of the IFSP period to request this change