Source: http://www.health.ny.gov/community/infants_children/early_intervention/memoranda/2005-02/faq.htm
Timestamp: 2015-03-01 12:36:20
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Early Intervention Program - Memorandum 2005-02
> VIII. Frequently Asked Questions
What is the difference between screenings conducted for children at risk and screenings that may be conducted by a multidisciplinary evaluation team?
How many screenings are permitted?
May a parent choose one approved evaluator to conduct a developmental screening and a different approved evaluator to conduct the evaluation?
Is it permissible to use older versions of standardized test instruments when revised editions have been published?
Is it always necessary to have both a physical therapist and an occupational therapist participate in the multidisciplinary evaluation to assess physical development (particularly motor development)?
Is a delay in either fine motor development or gross motor development sufficient to establish the child's eligibility for the EIP?
Is a feeding problem sufficient to establish a child's eligibility for the EIP?
What is the difference between the parent interview and the family assessment?
Can tests of sensory integration functioning be used to establish eligibility for the EIP?
Are problems with articulation or phonology sufficient to establish eligibility for the EIP?
Is it permissible to schedule an IFSP meeting directly following completion of a child's multidisciplinary evaluation (e.g., on the same day and consecutive to the evaluation)?
How should the evaluation team document their multidisciplinary evaluation results/eligibility determination?
How should conductive hearing loss be addressed relative to eligibility for the EIP?
Why does hearing appear in both the physical and communication development domains? How is eligibility established when the child has a hearing loss?
What professional qualifications are necessary to be an evaluator under the EIP?
Reimbursement regulations at 10 NYCRR §69-4.30(c)(2)(iii)(a) allow for reimbursement of one core evaluation and up to four supplemental evaluations in a twelve-month period without prior approval from the EIO. When does the twelve-month period begin?
If the evaluator completes a core evaluation, but a supplemental evaluation is recommended in an area of concern that was not the expertise of one of the core evaluators, should the determination of eligibility wait until the supplemental evaluation is completed?
If a child is referred to the EIP and is determined not eligible for the EIP with a core evaluation, and the child is re-referred three or six months later, is it	appropriate to repeat the core evaluation, or if there is a single area of concern, such as communication development, can a supplemental be done and used in combination with the previous core to determine eligibility?
How should municipalities handle referrals of children who are adopted from foreign countries to the Early Intervention Program?
If a child's and family's dominant language is a language other than English, and the child is referred due to a concern about communication development in his/her native language, and there is no professional available to evaluate the child in his/her native language, what is the responsibility of the EIP?
If a child's dominant language is not English, can the parent insist that the evaluation be conducted in English and refuse to have the evaluation conducted in the child's dominant language?
How does the determination of eligibility based on a diagnosed condition with a high probability of resulting in developmental delay apply for a child with a history of	extreme prematurity when a child is referred when s/he is no longer an infant, i.e., when the child is one year of age or older?
Are evaluators required to adjust for chronological age, when conducting an evaluation of a child with a history of prematurity, to determine initial or ongoing	eligibility?
What professional disciplines can diagnose apraxia?
Are children diagnosed with torticollis automatically eligible for the EIP?
1. What is the difference between screenings conducted for children at risk and screenings that may be conducted by a multidisciplinary evaluation team?
When children are referred to the EIP as at risk for developmental delay or disability, the EIO is responsible for using available resources in the community, including children's primary health care provider, to ensure that children are tracked and screened for potential developmental problems. Under these circumstances, developmental screening and developmental surveillance may include a variety of techniques and strategies, including standardized screening tools such as the Ages & Stages Questionnaires. Municipalities receive administrative funding from the Department for child find activities, including arranging for screening and tracking of at-risk children. Developmental screening for at-risk children is not separately reimbursable under the EIP, since these children are not eligible for the EIP and are not entitled to a multidisciplinary evaluation.
When children are referred to the EIP with a suspected or confirmed developmental delay or disability, the EIO must designate a service coordinator who is responsible for assisting the family in arranging for a multidisciplinary evaluation by an evaluator selected by the parent. The purpose of the screening conducted by the evaluation team is to assist in determining what type of evaluation, if any, is necessary (10 NYCRR §69-4.8(a)(2)(i)). If a screening is conducted, the evaluation team must discuss the results of the screening with the parent. If the child passes the screening (e.g., no problems are identified with the child's development), the evaluator and parent may agree to conclude the evaluation process at that point. If the screening results indicate that a multidisciplinary evaluation is warranted, the evaluator(s) must discuss the implications of this result and the composition of the evaluation team with the parent (10 NYCRR §69-4.8(a)(2)(iv)).
See section on Intake and Screening Procedures for a full discussion about this issue.
2. How is developmental screening conducted as part of the multidisciplinary evaluation for a child suspected of having a developmental delay reimbursed under the EIP?
If only a screening is performed, and further evaluation is not needed, the evaluator will be reimbursed for the screening at the established rate. An approved evaluator may bill for both a screening and an evaluation for the same child only when the screening is performed at home or off-site at a location different from the evaluator's business site. When a screening and evaluation are performed at an approved evaluator's site, the evaluator may only bill for the evaluation.
3. How many screenings are permitted?
Reimbursement may be provided for up to two screenings for a child suspected of having a developmental delay in any twelve-month period, without the prior approval of the Early Intervention Official. Screenings are not reimbursable for children who have already been found eligible for the EIP. For example, if an evaluator decides a screening should be performed, and the parent consents, and the screening suggests that an in-depth assessment is not yet warranted, but there are sufficient clinical clues or concerns about the child's development, the evaluator may recommend to the parent that the child be re-screened at some specified time period and be reimbursed for the second screening. See Appendix F for recommendations on enhanced developmental surveillance from the Department of Health clinical practice guidelines on communication disorders.
4. May a parent choose one approved evaluator to conduct a developmental screening and a different approved evaluator to conduct the evaluation?
No. The parent selects an evaluator to conduct the multidisciplinary evaluation for the child. The evaluator may, with parent consent, screen a child to determine what type of evaluation, if any, is necessary unless the child is known to have a condition with a high probability of resulting in developmental delay. If the evaluator conducts a screening, with parental consent, the evaluator is responsible for conducting the full multidisciplinary evaluation if the screening indicates an evaluation is needed.
5. Is it permissible to use older versions of standardized test instruments when revised editions have been published?
Consistent with regulatory requirements about the reliability and validity of test instruments and procedures, the most recent edition of a standardized test instrument should be used as soon as practicable (e.g., when the standardized instrument has become widely available, including the availability of training, if required by test developers) when conducting evaluations for the purpose of determining a child's initial or ongoing eligibility for the EIP.
6. Is it always necessary to have both a physical therapist and an occupational therapist participate in the multidisciplinary evaluation to assess physical development (particularly motor development)?
No. The multidisciplinary team does not necessarily have to include either a physical therapist or an occupational therapist to assess physical development. However, it may be appropriate to include either a physical therapist, or an occupational therapist, or both, on the multidisciplinary evaluation if there are specific concerns about the child's motor development that indicate that an evaluation by one or both of these professionals is needed.
7. Is a delay in either fine motor development or gross motor development sufficient to establish the child's eligibility for the EIP?
A delay of 2 SD below the mean or 33% in either gross motor or fine motor can be sufficient to establish a child's eligibility for the EIP. Motor development delays are often indicative of more serious underlying problems. The multidisciplinary evaluation should include a thorough assessment of the child's motor and physical functioning, including a health and diagnostic assessment (which can be completed through a review of recent and current examinations, if available and with parental consent). The multidisciplinary evaluation team should document the extent of the motor delay, including any clinical clues and indicators of motor problems. The Department's clinical practice guideline on motor disorders includes clinical clues and indicators of motor disorders, as well as comprehensive assessment and evaluation information. The multidisciplinary evaluation team is responsible for documenting the impact of the delay in motor development on the child's physical development and functioning to establish the child's eligibility for the EIP.
8. Is a feeding problem sufficient to establish a child's eligibility for the EIP?
An isolated feeding problem in and of itself may not be sufficient to establish a child's eligibility for the EIP. Feeding and swallowing problems often co-occur in children who have motor disorders, and may be an early indicator of a motor or other developmental or health problem. Feeding and swallowing problems are signs and symptoms, and it is important to determine the underlying cause.
A child demonstrating serious feeding dysfunction may experience physical, social, cognitive, and emotional problems related to the feeding dysfunction that significantly impact on their development and functioning. A serious feeding dysfunction, impacting on the child's physical development and functioning and adaptive development, can be sufficient to establish a child's eligibility for the EIP under the physical and adaptive domains. See Appendix I, Table IV-5, IV-6, and IV-7, from the Department's clinical practice guideline on motor development, for clinical clues of a possible serious feeding problem; questions that should be considered when taking a feeding history; and, recommended components of an initial oral-motor assessment for children with significant feeding problems. If the central concern for a child is feeding dysfunction, the multidisciplinary evaluation must provide sufficient evidence the feeding problem is significantly impacting on the child's developmental status. The nature of the feeding dysfunction (e.g., oral-motor and self-regulatory substrates, etc.) and its impact on the child's development must be documented in the multidisciplinary evaluation report, including the statement of the child's eligibility for the EIP. A child who is a "picky eater" or whose family needs guidance in food selection and introduction, would not be eligible for the EIP
9. What is the difference between the parent interview and the family assessment?
The parent interview is a required part of the child's multidisciplinary evaluation, which focuses on the child's developmental status. The parent interview assists the multidisciplinary evaluation team in assessing the unique needs of the child in each developmental domain, and the family's resources, priorities, and concerns related to the child's development. The multidisciplinary evaluation team is required to offer families the opportunity to participate in a family assessment; however, participation in this assessment process is voluntary on the part of the family. The family assessment process is defined in EIP regulations as "the process of information gathering and identification of family priorities, resources, and concerns, which the family decides are relevant to their ability to enhance their child's development."
10. Can tests of sensory integration functioning be used to establish eligibility for the EIP?
No. Tests and assessment tools on sensory integration functioning cannot be used to establish eligibility for the EIP. To be eligible for the EIP, a child must have a developmental delay in one of the following five areas: communication, physical, cognitive, social-emotional, and adaptive development. Problems with sensory integration, sensory processing, hypersensitivity, or other sensory issues must be affecting the child's overall development in one or more of these areas to establish the child's eligibility for the EIP, and this must be documented by the multidisciplinary evaluation team.
11. Are problems with articulation or phonology sufficient to establish eligibility for the EIP?
No. However, problems with articulation or phonology may be among a constellation of clinical clues and indicators that establish the child's eligibility for the EIP, based on a delay in communication development.
12. Is it permissible to schedule an IFSP meeting directly following completion of a child's multidisciplinary evaluation (e.g., on the same day and consecutive to the evaluation)?
EIP regulations at 10 NYCRR §69-4.11(a) require that IFSP meetings must be conducted within 45 days of the child's referral to the Early Intervention Official, except under exceptional circumstances, including illness of the child or parent. EIP regulations at 10 NYCRR §69-4.11(a)(4) require the meeting to be conducted in times and settings that are convenient to the parent. The evaluator is required to participate in the meeting, and if the evaluator is unable to attend the meeting, arrangements must be made for the evaluator's involvement in the meeting by telephone conference call or having a knowledgeable representative directly involved in the child's evaluation attend the meeting. Federal regulations specifically require that a person or persons directly involved in conducting the child's multidisciplinary evaluation must participate in the IFSP meeting.76
It is permissible, but not required, to schedule the IFSP meeting directly following completion of the multidisciplinary evaluation, if the parent agrees to schedule the meeting at that time. In addition, the municipality cannot require that the IFSP meeting be routinely scheduled for all families on the same day and immediately following the multidisciplinary evaluation. Considerations as to whether or not to schedule the IFSP meeting immediately following the multidisciplinary evaluation include: the nature of the child's condition; the extent to which the evaluation team requires an opportunity to review, score, discuss, and integrate the results of the evaluation prior to explaining the evaluation results to the parent(s); whether the parents are comfortable with a verbal explanation of the evaluation results or prefer to receive a written evaluation report and/or summary before the IFSP meeting; the extent to which parents and the EIO may require additional time to understand the results of the evaluation prior to convening the IFSP meeting; and, the availability of other participants the parents may wish to have present at the meeting; and, other circumstances that may impact on the quality of the IFSP meeting.
Whether the evaluation and the IFSP meeting will occur on the same day, or on different days, requirements to notify the family and required participants of the initial IFSP meeting date, in writing, remain in effect.77
13. How should the evaluation team document their multidisciplinary evaluation results/eligibility determination?
Reports of multidisciplinary evaluation results must include a statement of the child's eligibility, including a diagnosed condition with a high probability of resulting in developmental delay, if any, or developmental delay in accordance with the definition of developmental delay. When the child has a diagnosed condition with a high probability of resulting in developmental delay, the eligibility determination should include confirmation that a diagnosis has been made by a physician or other qualified personnel, and the relevant ICD-9 code(s). When a child is eligible based on a developmental delay consistent with the State definition of developmental delay, the evaluation team should document the specific findings that establish the child's eligibility, including the results of any standardized instruments or clinical procedures used to evaluate the child that substantiate the child has a delay in one or more areas of development consistent with eligibility criteria.
It is insufficient for an evaluator to indicate that a child is eligible based on a percent delay and informed clinical opinion, without providing findings to support this statement. Relevant ICD-9 codes should also be incorporated in the evaluation findings.
14. How should conductive hearing loss be addressed relative to eligibility for the EIP?
EIP regulations (10 NYCRR §69-4.3(e)(5)) specify that a hearing impairment qualifying as a diagnosed condition with a high probability of resulting in developmental delay is a diagnosed hearing loss that cannot be corrected with treatment or surgery. Thus, for the purposes of this diagnostic category, only conductive hearing losses that are not amenable to resolution through medical or surgical means, are chronic in nature, and/or have an impact on other areas of development, particularly communication development (including speech/language development), constitute diagnosed conditions with a high probability of resulting in developmental delay for the purposes of eligibility in the EIP. Consistent with the regulatory language, an occasional or transient conductive hearing loss occurring in isolation, i.e., without concomitant delays in other developmental domains, would typically be managed through the child's primary medical care provider, and would not be sufficient to establish a child's eligibility for services under the EIP.
See Early Intervention Guidance Memorandum 1999-2 for further information on other types of hearing loss and other diagnosed conditions with a high probability of resulting in developmental delay.
15. Why does hearing appear in both the physical and communication development domains? How is eligibility established when the child has a hearing loss?
The EIP regulations include hearing and vision in the physical domain in the definition of developmental delay at 10 NYCRR §69-4.1(g). EIP regulations specify that the multidisciplinary evaluation conducted to determine eligibility for EIP services must include an evaluation of the child's physical development, including a health assessment, which consists of a physical examination and routine vision and hearing screening, and, where appropriate, a neurological assessment (10 NYCRR §69-4.8(a)(4)(i)). In addition to determining the child's developmental status with respect to physical development (and in particular motor development and functioning), the health assessment is important to ensure that children are physically able to tolerate intervention services, identify any health issues to which providers of early intervention services should be alerted and informed about, and to ensure that any physical health issues that may impact on the extent to which children may benefit from early intervention services are identified.
Because hearing is fundamental to oral language development, it is also discussed in the context of the communication development domain. Hearing loss (impairment) is a diagnosed condition with a high probability of resulting in developmental delay if the hearing loss cannot be corrected with treatment or surgery (10 NYCRR §69-4.3 (e)(5). If children are diagnosed with a hearing loss meeting this definition (e.g., a sensorineural hearing loss or a conductive hearing loss that is not amenable to medical treatment or surgery), their eligibility for the EIP is established by this diagnosis.
For the purposes of establishing EIP eligibility, the diagnosis of a permanent hearing loss as described above would constitute the reason for the child's eligibility. Children with hearing loss would not be eligible due to a delay in "physical development" and in "communication development" – they are eligible due to a condition with a high probability of resulting in developmental delay.
16. What professional qualifications are necessary to be an evaluator under the EIP?
Section 635(9) of IDEA requires states to establish and maintain qualifications for early intervention personnel that are consistent with any State-approved or recognized certification, licensing, registration, or other comparable requirements that apply to the area in which such personnel are providing early intervention services. Federal regulations at 34 CFR §303.361(a)(2) require states to adopt policies to ensure that personnel who provide early intervention services meet the highest entry level academic degree needed for any State-approved or recognized certification, licensure, registration, or comparable requirements that apply to a specific profession/discipline in which the individual is providing services. In New York State, the State Education Department (SED) is responsible for the certification and licensing of professionals. Persons who provide services in the EIP are subject to the SED's regulation of professional practice. In addition to their certification or licensure, professionals must be approved by the Department of Health to provide early intervention evaluations. Qualifications established in the Department's provider approval process include educational requirements consistent with the SED requirements for each profession, experience working with the children age birth to five years with special needs, and a satisfactory character and competency review.
Consistent with the applicable credentials for their professional certification and/or licensure, individuals who provide evaluations under the EIP should possess knowledge of early childhood development and developmental disabilities in young children, competence in their discipline, be experienced in the evaluation of young children, and have expertise in working with young children and their families. The Department's clinical practice guidelines provide specific recommendations for the training and experience of professionals involved in the evaluation and assessment of children with communication disorders, motor disorders, autism/pervasive developmental disorders, Down syndrome, vision impairment, and hearing loss.
17. Reimbursement regulations at 10 NYCRR §69-4.30(c)(2)(iii)(a) allow for reimbursement of one core evaluation and up to four supplemental evaluations in a twelve-month period without prior approval from the EIO. When does the twelve-month period begin?
Reimbursement regulations allow for reimbursement of one core evaluation and up to four supplemental evaluations in a twelve-month period to develop and implement initial IFSPs, and subsequent annual IFSPs, without prior approval of the Early Intervention Official. Supplemental evaluations conducted after the initial IFSP must be agreed to by the EIO and included in the child's IFSP. The "start date" for the 12-month-period is the date of the child's referral to the EIP.
18. If the evaluator completes a core evaluation, but a supplemental evaluation is recommended in an area of concern that was not the expertise of one of the core evaluators, should the determination of eligibility wait until the supplemental evaluation is completed?
Eligibility is established through a multidisciplinary evaluation. The evaluator is responsible for conducting an evaluation that is sufficient to establish the child's eligibility. If a core evaluation is completed, and the child is found to be within normal developmental range in all five areas of development, the child can be found ineligible for services. If a core evaluation is completed and a concern is identified that requires an in-depth assessment by an individual with specific expertise, a supplemental evaluation may be recommended by the evaluation team and completed with the consent of the parent. Eligibility cannot be established until the full multidisciplinary evaluation is completed, including the supplemental evaluation.
19. If a child is referred to the EIP and is determined not eligible for the EIP with a core evaluation, and the child is re-referred three or six months later, is it appropriate to repeat the core evaluation, or if there is a single area of concern, such as communication development, can a supplemental be done and used in combination with the previous core to determine eligibility?
If a child is re-referred to the EIP, an initial service coordinator must be assigned and the parent must select an evaluator to evaluate the child. The evaluator is responsible for determining the type of evaluation needed to assess the child's development in all five areas and determine whether the child is eligible for the EIP. As discussed in Section III of this document, the evaluator should review records from previous evaluations, including evaluations conducted under the EIP, with parent consent. If the evaluator believes, based on a review of the child's records, parent interview, and the length of time between the previous evaluation and the child's re-referral, that a re-evaluation is necessary; the evaluator may recommend that the core evaluation be repeated. Since the first core would have been conducted within a twelve-month period, the EIO must provide prior approval for another core evaluation to be conducted.
20. How should municipalities handle referrals of children who are adopted from foreign countries to the Early Intervention Program?
The purpose of the EIP is to provide early intervention services to children with developmental delays and/or disabilities. The EIP is not intended to be a source of English as a second language education, or to provide assistance to these children in adapting to a new culture or family. Primary referral sources are responsible for ensuring that only those children who are at risk for developmental delays or disabilities, or suspected of having a developmental delay or disability, are referred to the EIP.
However, some children involved in foreign adoption will be experiencing developmental delays or diagnosed conditions with a high probability of resulting in developmental delay. When EIOs receive referrals of children who are adopted from foreign countries from a primary referral source, the EIO should ascertain the reason for the referral and substantiate that the presenting problem involves a suspected developmental delay and/or disability.
21. If a child's and family's dominant language is a language other than English, and the child is referred due to a concern about communication development in his/her native language, and there is no professional available to evaluate the child in his/her native language, what is the responsibility of the EIP?
EIP regulations at 10 NYCRR §69-4.8(a)(14) require that tests and other evaluation materials and procedures must be administered in the dominant or other mode of communication of the child, unless it is clearly not feasible to do so. Dominant language is defined at 10 NYCRR §69-4.1(i) to mean the language or mode of communication used by parent or the potentially eligible child, including Braille, sign language, or other mode of communication. For purposes of the multidisciplinary evaluation, the dominant language of the potentially eligible child, and not the parent, is relevant. The EIO and initial service coordinator should assist the family in accessing a bilingual evaluation if possible. If an evaluator cannot be identified to conduct a bilingual evaluation, the EIO and initial service coordinator should arrange for the services of an interpreter to assist in the evaluation process.
22. If a child's dominant language is not English, can the parent insist that the evaluation be conducted in English and refuse to have the evaluation conducted in the child's dominant language?
No. As stated in EIP State regulations, evaluators must administer tests and other evaluation materials and procedures in the dominant language of the child, unless it is clearly not feasible to do so. Participation in the EIP is voluntary to families. If a parent does not consent to a multidisciplinary evaluation consistent with federal and State requirements, eligibility cannot be established for the EIP and the municipality is not obligated to develop an IFSP and provide services to the child.
There may be circumstances under which a child may be considered to be bilingual (e.g., have two dominant languages, one of which is English). Under these circumstances, the evaluator is responsible for determining the appropriate language in which to administer the evaluation in accordance with the requirement that non-discriminatory evaluation and assessment procedures are used.
23. How does the determination of eligibility based on a diagnosed condition with a high probability of resulting in developmental delay apply for a child with a history of extreme prematurity when a child is referred when s/he is no longer an infant, i.e., when the child is one year of age or older?
If a child is referred to the EIP when s/he is one year of age or older, with a history of extreme prematurity, the child must receive a multidisciplinary evaluation to determine his/her eligibility for the EIP. Eligibility determinations for children in this instance are based on documentation of developmental delay, and are not the same as referral of infants in the neonatal and post-neonatal period (i.e., the time period immediately after birth up to one year of age) with a diagnosed condition of extreme prematurity, when eligibility is based on the existence of a condition with a high probability of resulting in developmental delay.
24. Are evaluators required to adjust for chronological age, when conducting an evaluation of a child with a history of prematurity, to determine initial or ongoing eligibility?
Decisions regarding the use of adjusted age for children with a history of prematurity should be made by clinicians on the evaluation team, as appropriate to the clinical situation and the test/diagnostic assessment instrument being used in the evaluation process. Evaluation reports should clearly state the amount and type of adjustment that was made during developmental assessments, if any.78
25. What professional disciplines can diagnose apraxia?
Physicians, nurse practitioners, and speech-language pathologists can make a diagnosis of apraxia. Professionals are responsible for being aware of and acting within the scope of practice for the profession(s) in which they are licensed and/or certified. EIOs are responsible for ensuring that multidisciplinary evaluations to determine eligibility for the EIP are conducted by qualified personnel as defined in 10 NYCRR §69-4.1 (aj) of the EIP regulations.
26. Are children diagnosed with torticollis automatically eligible for the EIP?
Torticollis is viewed as a medical condition for which there is wide variability in clinical expression, from mild to severe. Therefore, congenital torticollis is not routinely considered a condition that has a high probability of resulting in a developmental delay, and children with this condition are not automatically eligible for the EIP. If a primary health care provider observes that an infant or toddler is not attaining expected milestones during routine developmental surveillance, or if a parent or other primary referral source has concerns about a child's development, they should refer that child to the EIP in the child's municipality of residence to determine whether the child is eligible for the EIP.
76 CFR § 303.343(b)
77 10 NYCRR Section §69-4.11(a)(5)
78 Wilson, S. and Cradock, M. (2004) Review: Accounting for prematurity in developmental assessment and the use of age-adjusted scores. Journal of Pediatric Psychology, 29 (8) pp. 641-649.