Be respectful of families’ time and commitments.

1. We have reviewed lots of information about evaluation and assessment in early intervention. Now let’s take a closer, more integrated look at gathering information to make informed decisions in EarlySteps…. First, children are referred to the System Point of Entry (SPOE). The intake coordinator takes the referral and within 3 days, she/he must contact families. The telephone is probably the most likely way to reach them. Think back to information related to working with families… Name at least 3 things the intake coordinator should consider during the initial conversation with families.

2. Did you remember these things? Be respectful of families’ time and commitments. Be aware that families may be totally unaware of what EarlySteps can offer. Fully explain what families may be committing to, including cost participation, when discussing EarlySteps. Maintain a conversational tone. Value and honor families’ responses to the referral. Obtain as much information from the referral form as possible; limit the amount of information families have to repeat. Actively listen to what families have to say about their concerns and priorities.

3. In EarlySteps, there are a number of decision points that require accurate information or data for optimal decision making. Let’s use the flow chart as a reference, as we follow a family through those key moments, illustrating the implementation of the overall evaluation and assessment process in EarlySteps. Click on the link below for more information about Child Find & Referral in chapter 3 and the intake process in Chapter 4 of the practice manual. Click on information for provider s to the left of the screen. www.earlysteps.dhh.louisiana.gov

4. Referral received at the SPOE Day 1 Intake Activities By Day 20 Eligibility Activities By Day 35 IFSP Preparation IFSP Development By Day 45 Meet with Family, share information about EarlySteps in writing and verbally, obtain written consent to proceed by day 10. If family refuses consent, review parent’s rights. Evaluation completed. results from CDA and other information gathered reviewed, and eligibility determined by team. Intake coordinator makes Initial contact with family by Day 3 Intake Coordinator prepares family for IFSP meeting by introducing forms, identifying concerns, priorities and resources. IFSP developed at team meeting Obtain written consent for EI services identified on IFSP Schedule meeting for an interview at the family’s convenience . Family selects early intervention providers from matrix Obtain signature for releases of information that will aid with eligibility determination. If child is not eligible, provide Parent’s rights Family chooses FSC Acknowledge referral in writing by Day 5 Intake Coordinator works with family to identify members of the IFSP team, schedules IFSP team meeting. Assist with completing application forms, appropriate screenings, and interest in other programs including Medicaid Waiver Authorizations are processed for EI services including FSC Begin Electronic Record Begin EI hard copy record FSC monitors implementation of the IFSP. Services begin within 30 days of parent consent of the IFSP. Intake coordinator notifies all team members in writing. Conduct ASQ If family is not interested, provide contact information Schedule Eligibility Evaluation Notify LEA for children referred after age 2 years, 2 months.

5. Using the referral information, the intake coordinator contacts the family by phone. The coordinator introduces them to EarlySteps and talks about how the family could proceed , if they were interested in participating in the program. If they are interested in participation, the coordinator arranges a time to meet with the family at a place and time that is convenient for them. Before the meeting the coordinator asks the family to gather any information about the child’s growth and development(e.g., medical records, reports, results of tests) that they think might be useful at the initial meeting. The first encounter between an EarlySteps professional and a family sets the stage for successful collaboration throughout the early intervention program.

6. The coordinator must be sensitive to the amount of information shared at this meeting. Much of this information may be new to families, requiring repetition of the information in various ways (e.g., verbal discussion, written information). Additionally, some of the information that the intake coordinator asks from families might have been previously provided to other medical and/or developmental professionals. As it is frustrating for families to have to repeat themselves, the intake coordinator can ask families to send them any relevant information in writing before the initial meeting or bring it to the meeting. If families are frustrated at the meeting, it is important for the intake coordinator to acknowledge their feelings and apologize for any pain or unpleasantness caused by repeating the same information multiple times!

7. During the intake meeting, the intake coordinator has a LOT of business to transact! The 2nd column under the Flow Chart lists the paperwork that needs to be completed before proceeding with the eligibility determination process. The coordinator will use the data gathering tools of observation, interviewing and screening to collect information about the child and family.

8. Referral received at the SPOE Day 1 Intake Activities By Day 20 Eligibility Activities By Day 35 IFSP Preparation IFSP Development By Day 45 Meet with Family, share information about EarlySteps in writing and verbally, obtain written consent to proceed by day 10. If family refuses consent, review parent’s rights. Evaluation completed. results from CDA and other information gathered reviewed, and eligibility determined by team. Intake Coordinator makes Initial contact with family by Day 3 Intake Coordinator prepares family for IFSP meeting by introducing forms, identifying concerns, priorities and resources. IFSP developed at team meeting Obtain written consent for EI services identified on IFSP Schedule meeting for an interview at the family’s convenience . Family selects early intervention providers from matrix Obtain signature for releases of information that will aid with eligibility determination. If child is not eligible, provide Parent’s rights Family chooses FSC Acknowledge referral in writing by Day 5 Intake Coordinator works with family to identify members of the IFSP team, schedules IFSP team meeting. Assist with completing application forms, appropriate screenings, and interest in other programs including Medicaid Waiver Authorizations are processed for EI services including FSC Begin Electronic Record Begin EI hard copy record FSC monitors implementation of the IFSP. Services begin within 30 days of parent consent of the IFSP. Intake coordinator notifies all team members in writing. Conduct ASQ If family is not interested, provide contact information Schedule Eligibility Evaluation Notify LEA for children referred after age 2 years, 2 months.

9. Before continuing, let’s stop and think about the initial meeting. Even though there is a lot of information to be gathered at this meeting, it is MOST important that the intake coordinator keep the dialogue with the family as conversational and non-intrusive as possible, even though this may mean that not every piece of the child’s medical and developmental history is confirmed at this first meeting! And the meeting may take longer than 30 or 45 minutes! Flexibility is a must in this situation…

10. Eligibility….. Once the family decides that they want to participate in EarlySteps, the eligibility process begins. The first “test” in this process can be the screening questionnaire. If a recent screening is not in the child’s health records, then the Intake Coordinator is responsible for assisting the family in the completion of the developmental screening. Remember that the ASQ, is the screening tool used in our early intervention program. The screening must be completed by day 20 as shown on the flow chart on following page.

11. Referral received at the SPOE Day 1 Intake Activities By Day 20 Eligibility Activities By Day 35 IFSP Preparation IFSP Development By Day 45 Meet with Family, share information about EarlySteps in writing and verbally, obtain written consent to proceed by day 10. If family refuses consent, review parent’s rights. Evaluation completed. results from CDA and other information gathered reviewed, and eligibility determined by team. Intake Coordinator makes Initial contact with family by Day 3 Intake Coordinator prepares family for IFSP meeting by introducing forms, identifying concerns, priorities and resources. IFSP developed at team meeting Obtain written consent for EI services identified on IFSP Schedule meeting for an interview at the family’s convenience . Family selects early intervention providers from matrix Obtain signature for releases of information that will aid with eligibility determination. If child is not eligible, provide Parent’s rights Family chooses FSC Acknowledge referral in writing by Day 5 Intake Coordinator works with family to identify members of the IFSP team, schedules IFSP team meeting. Assist with completing application forms, appropriate screenings, and interest in other programs including Medicaid Waiver Authorizations are processed for EI services including FSC Begin Electronic Record Begin EI hard copy record FSC monitors implementation of the IFSP. Services begin within 30 days of parent consent of the IFSP. Conduct ASQ Intake coordinator notifies all team members in writing. If family is not interested, provide contact information Schedule Eligibility Evaluation Notify LEA for children referred after age 2 years, 2 months.

12. Let’s look at the ASQ a little more closely. This is a screening tool that uses the report of a parent (or someone else familiar with the child’s development) about what a child is doing or not doing yet across different areas of development. Here are some additional characteristics of the ASQ second edition… • Child’s behavior is recorded across the areas of communication, gross motor, fine motor, and problem solving (30 items, 6 items per area) • Typically takes about 10 to 15 minutes to complete • 19 questionnaires, validated with normative groups for the following ages: 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 27, 30, 33, 36, 42, 48, 54, and 60 months • Each item is scored: • Yes 10 points • Sometimes 5 points • Not Yet 0 points

13. The coordinator can assist with the completion of the screening; it is optimal to engage families in the administration of test items to directly observe the child’s behavior and interactions between the child and family. The ASQ focuses attention on children’s development and emerging skills and is often used as anticipatory guidance (e.g., what is coming next in development). Screening results do not confirm a developmental problem or diagnosis.

14. A sample page from the ASQ to be used with the family of a 16 month old child.

15. Lets review a sample Information Summary page from the ASQ screening tool, focusing on the scoring section. When you look in the middle of the Information Summary page, any total domain scores that fall in the shaded area, are considered below the cut off scores. Scores that fall in the area not shaded are considered above the cut off scores.

16. What happens when children PASS the ASQ? Based on the screening results, decisions are made to either move the family forward in the intake process or not. If a child scores “no concerns” in any of the ASQ developmental domains, these results are discussed with the family and the family is provided a Notice of Action: Eligibility Refused. The family is given the next two levels of the questionnaire to look for what happens next in development, as the child ages. This procedural safeguard means that the child and family are not eligible for EarlySteps since there are no developmental concerns noted on the screening tool. However, the family has the right to challenge this decision through due process. Although the case is closed, families should be encouraged to contact EarlySteps at any time, if their children’s development changes. Anticipatory guidance should also be provided to acquaint families with the next steps in their children’s motor, communication, social-emotional and cognitive development.

17. What happens when children FAIL the ASQ? Children, whose ASQ scores fall below the cut off scores in at least one domain, move to the next step in the intake process, evaluation , to determine if the child is eligible for services and supports through EarlySteps. Eligibility is determined through a multi-disciplinary process. Key elements of this process are the identification of a medical condition that will likely result in a developmental delay or confirmation of a developmental delay. At this point, the eligibility evaluation is scheduled. We are now in the 3rd column of the EarlySteps Flow Chart -Eligibility Determination Activities!

18. Referral received at the SPOE Day 1 Intake Activities By Day 20 Eligibility Activities By Day 35 IFSP Preparation IFSP Development By Day 45 Meet with Family, share information about EarlySteps in writing and verbally, obtain written consent to proceed by day 10. If family refuses consent, review parent’s rights. Evaluation completed. results from CDA and other information gathered reviewed, and eligibility determined by team. Intake Coordinator makes Initial contact with family by Day 3 Intake Coordinator prepares family for IFSP meeting by introducing forms, identifying concerns, priorities and resources. IFSP developed at team meeting Obtain written consent for EI services identified on IFSP Schedule meeting for an interview at the family’s convenience . Family selects early intervention providers from matrix Obtain signature for releases of information that will aid with eligibility determination. If child is not eligible, provide Parent’s rights Family chooses FSC Acknowledge referral in writing by Day 5 Intake Coordinator works with family to identify members of the IFSP team, schedules IFSP team meeting. Assist with completing application forms, appropriate screenings, and interest in other programs including Medicaid Waiver Authorizations are processed for EI services including FSC Begin Electronic Record Begin EI hard copy record FSC monitors implementation of the IFSP. Services begin within 30 days of parent consent of the IFSP, Intake coordinator notifies all team members in writing. Conduct ASQ If family is not interested, provide contact information Schedule Eligibility Evaluation Notify LEA for children referred after age 2 years, 2 months.

19. For the evaluation, the intake coordinator, and family choose an early interventionist enrolled as an evaluator in EarlySteps to conduct the evaluation. The evaluation should be scheduled at a time convenient to the family and should occur in the child’s natural environment (e.g., home, childcare center, community playground, church). The evaluation includes administration of the comprehensive developmental assessment (CDA) tool, the BDI-2, Autism screening for children 18 months and older, observation and family interview. Remember the CDA tool is a norm-referenced test; results can be compared to the scores of other children the same age in the normative sample.

20. Federal law requires that each state adopt nondiscriminatory evaluation and assessment procedures to ensure that: Tests and other evaluation materials and procedures are administered in the native language of the parents or other mode of communication, unless it is clearly not feasible to do so Any assessment and evaluation procedures and materials that are used are selected and administered so as not to be racially or culturally discriminatory No single procedure is used as the sole criterion for determining a child's eligibility under this part and Evaluations and assessments are conducted by qualified personnel

21. These protections mean that early intervention systems like EarlySteps must have procedures to identify infants and toddlers with disabilities that are fair and equitable and that protect children from misidentification. The evaluation process in EarlySteps is a multi-source, multi-disciplinary approach to eligibility, in which several pieces of information, not just one test score, identify a child as eligible for services. Another safeguard is that evaluations and assessments are conducted by qualified personnel who are knowledgeable about proper test administration and scoring as well. Earlier, we talked about the eligibility requirements for EarlySteps. In Louisiana, children and families qualify for early intervention services and supports using an established criteria.

22. Eligibility Determination Conceptual Methodological • How am I collecting information? • Compensating for strange experience of test? • Being as flexible as standard administration protocol allows? • Administering and scoring the test accurately? • Using a test that is normed with a sample of children similar to the child I’m testing? • Linking evaluation data with other known information about the child for congruence? • Being fair to the child or should I pursue eligibility through the Informed Clinical Opinion procedures? • Why am I collecting information? • To collect unknown facts about • child’s areas of developmental • concern in order to know whether • meets eligibility criteria for EarlySteps • Collected information to include • ASQ results • Parent concerns • Relevant medical history • Standardized, • norm-referenced instrument • Informed clinical opinion What are known facts about child & family? History indicates mother is concerned about development and child’s nutritional status ASQ screening identifies concerns and need for more assessment in areas of gross motor and communication What are unknown facts about child & family? CDA (BDI-2) results

23. Diagnosed Physical or Medical Condition or Developmental Delay The intake coordinator, examines all of the medical documents gathered from the family, then reviews the list of approved medical conditions to determine if the child has a medical diagnosis that qualifies him/her for early intervention services and supports. If the child has a condition on the list, it must be validated by acceptable documents (e.g., signed health summary, medical records, discharge report). Go to chapter 5 of the practice manual. Click on the website below and go to information for providers located on the left of the screen. www.earlysteps.dhh.louisiana.gov

24. If the child does not have a medical condition on the list, the next step is to see if he qualifies for early intervention services and supports under the developmental delay criteria. Next steps….. The family selects an evaluator to conduct the eligibility evaluation. The evaluation is scheduled at a time that is convenient for the child and family and at a location best suited to capture the child’s typical routines and behaviors. Before the appointment, the evaluator reviews the information previously collected by the intake coordinator(e.g., ASQ, parent’s concerns, medical and developmental history).

25. The evaluator uses observation, interviewing and the Battelle Developmental Inventory – II (BDI-2), the approved comprehensive developmental assessment tool, to complete the evaluation. The evaluator observes the child interact with people and objects in the his/her natural environment, talks with the family about what the child does during typical routines and activities throughout the day, and obtains information from test items on the BDI-2.

26. See next slide to review a sample BDI-2 protocol. Children who have a developmental delay of at least 1.5 standard deviations below the mean in one or more developmental areas or sub-domain areas, are eligible for EarlySteps. This information, in addition to the results of the ASQ, the family’s concerns, medical and development history and data gathered during the evaluation based on observation and interview, is used by the team to determine if the child and family qualifies to receive early intervention services and supports based on the developmental delay criteria.

28. What if this child was a young infant or exhibited abnormal sensory-motor responses . Do you think he would qualify for early intervention services under the developmental delay or medical criteria? Probably not. In Louisiana, there is an alternate path by which children may be deemed eligible for EarlySteps services. This option, informed clinical opinion, is meant to be used only rarely and in cases in which the CDA test can not be administered in a valid manner AND medical eligibility is not an option. Click on www.earlysteps.dhh.louisiana.gov and go to information for providers and click Chapter 5 of the practice manual for the criteria for informed clinical opinion.

29. Additionally, an evaluation with a standardized, norm-referenced test may not be appropriate for young infants as most tests have VERY FEW items for children younger than 3 months of age. For example, the ASQ second edition does not begin until 4 months of age. Similarly, children who exhibit atypical sensory-motor responses related to central nervous system or brain dysfunction or an affective or social disorder may not be able to participate in a typical evaluation. These children can be evaluated for developmental delay using informed clinical opinion.

30. How does the team determine eligibility…… • The child must be assessed by 2 or more qualified professionals, with competence in the area(s) of concern. • Two assessments must be conducted. The first assessment must include an attempted BDI-2 and the second assessment must include an assessment specific to the child’s area(s) of concern. • Evaluators must document that the behavior/condition is likely to worsen and interferes with normal development. • The behavior/condition must be observed by the evaluator during the evaluation and/or assessment. • The behavior/condition must be substantiated by the parent or caregiver.

31. What are the next steps in the eligibility evaluation process?

32. As stated previously, eligibility for EarlySteps can not be determined by the evaluator alone. To continue the evaluation process, following administration of the CDA, a second meeting is scheduled with the family. At this visit, other assessments might be administered to gather additional information about the child’s development. The Family Assessment of Concern, Priorities, and Resources (CPR) form is also completed. It is important for the evaluator to know more about how the child participates in typical routines and activities, his/her interests and strengths and what the family wants for the child and themselves, as a result of receiving early intervention services and supports.

33. Following this visit, an eligibility determination meeting is scheduled. A written notification of the meeting date and time, 5 days prior to the meeting, is sent to the team (i.e., family, intake coordinator, early intervention evaluator, advocate or additional persons invited by the family) to ensure their attendance and participation in the meeting. All of the information obtained in the evaluation will be shared with the family and the rest of the team in a comprehensive written report at the eligibility meeting. This information will help the team, including the family, make final decisions in determining eligibility and in developing the Individualized Family Service Plan (IFSP).

34. At the eligibility meeting, all information collected (i.e., health summary, medical and developmental history, observations, interview, developmental screening results, BDI-2, and results of any other assessments) is reviewed and eligibility to receive services is determined. If the child is eligible and the family wants to receive early intervention services and supports; the eligibility determination form is completed and planning for the individualized family service plan (IFSP) begins. The intervention plan is designed to build the family’s capacity to foster and support their child’s development, provide a basis for ongoing determination and documentation of progress. If the child is not eligible, complete eligibility determination forms and refer to other appropriate services including EPSDT services. See the forms section of the practice manual. Click website below and go to information for providers on the left of the screen www.earlysteps.dhh.louisiana.gov

35. Referral received at the SPOE Day 1 Intake Activities By Day 20 Eligibility Activities By Day 35 IFSP Preparation IFSP Development By Day 45 Meet with Family, share information about EarlySteps in writing and verbally, obtain written consent to proceed by day 10. If family refuses consent, review parent’s rights. Evaluation completed. results from CDA and other information gathered reviewed, and eligibility determined by team. Intake Coordinator makes Initial contact with family by Day 3 Intake Coordinator prepares family for IFSP meeting by introducing forms, identifying concerns, priorities and resources. IFSP developed at team meeting Obtain written consent for EI services identified on IFSP Schedule meeting for an interview at the family’s convenience . Family selects early intervention providers from matrix Obtain signature for releases of information that will aid with eligibility determination. If child is not eligible, provide Parent’s rights Family chooses FSC Acknowledge referral in writing by Day 5 Intake Coordinator works with family to identify members of the IFSP team, schedules IFSP team meeting. Assist with completing application forms, appropriate screenings, and interest in other programs including Medicaid Waiver Authorizations are processed for EI services including FSC Begin Electronic Record Begin EI hard copy record FSC monitors implementation of the IFSP. Services begin within 30 days of parent consent of the IFSP. Intake coordinator notifies all team members in writing. Conduct ASQ If family is not interested, provide contact information Schedule Eligibility Evaluation Notify LEA for children referred after age 2 years, 2 months.

36. By day 45, the IFSP is developed. Outcomes, specified by the family and written in their words, are documented on the IFSP. Additionally, the team, including the family, develop objectives for each outcome and decide what intervention strategies would work best to target each outcome (e.g., “I want my child to walk better”; “I want Riley to use more words to talk”). Next, the family chooses early interventionists from various backgrounds (e.g., special instructor, speech language pathologist, occupational therapist) to provide services and supports to families. The frequency of visits and the method of data collection to measure progress over time, is also documented on the intervention plan. Then, intervention begins and assessment data is collected and analyzed on an ongoing basis. Typically, the intervention team meets every 6 months to review the IFSP and revise it, if needed. However, a family can convene a meeting and amend the IFSP due to new developmental concerns, meeting objectives or changes in priorities and/or available resources, etc, at any time. In addition, the BDI-2 is administered each year for re-eligibility determination and when the family exits the program, to collect child outcome data. Click below and go to chapter 6 of the practice manual. IFSP forms EarlySteps Practice Manual

37. Please complete the last two exercises, the Post Test and the Evaluation. Thank you for participating in the Making Informed Decisions training module. We hope you have gained useful knowledge about evaluation and assessment that will help you support young children and families in EarlySteps!