ECI: Making It Work Section 2: Referral and Initial...

ECI: Making It Work Section 2: Referral and Initial Contact

2.1 Getting startedNotes:

MIW Service Coordinator (SC):

Let's get started with the pre-enrollment process for the three children in your MIW caseload. Pre-enrollment begins when a child is referred and we make initial contact with the family … Evaluation and Assessment is the next phase of pre-enrollment; we will discuss that later.

2.2 Who referred Andre to ECI?Notes:

MIW SC:

I just received a referral for Andre. Look at the handout-Andre’s referral form.

Question: Who referred Andre to ECI based on the referral form?

1. His parents2. His physician3. His daycare

Answer: Andre’s physician

Notes:

Anyone who has a concern about a child’s development can make a referral to ECI, and Texas ECI programs must accept referrals for children less than 36 months.

2.3 Referral formNotes:

MIW SC:

The referral forms you receive at your program, may look somewhat different from other programs’ forms, but they will include the same key

1 Making It Work: Section 2: Referral and Initial ContactPrint (accessible) version

elements. To act on a referral we need:

The date of referral Who made the referral The parent’s name and contact information The family’s address The child’s name and date of birth And the reason for referral.

A referral may also contain information about the parent’s concerns regarding the child’s development, and the child’s most recent physical exam or other medical record. Sometimes a referral may include a medical diagnosis. Information gathered during the referral process can also assist ECI programs to assign the most appropriate team for the child’s evaluation and assessment.

An ECI program can act on a referral only with the correct information. If a referral source does not provide correct contact information for the family, then the referral is incomplete. When this occurs, programs should contact the referral source to see if there are alternate ways to reach the family.

As you can see, there is significant and sensitive information that can be gathered during the referral process. Keep in mind that families have the right to expect the rules around confidentiality begin immediately at the point of referral. You will learn more about confidentiality and other procedural safeguards shortly ...

2.4 Reason for referralNotes:

MIW SC:

First of all, what is the reason for the referral? Again, look at the physician referral form.

Answer: Suspected developmental delay in the cognitive and communication areas. Also, CPS recommended Andre be evaluated by a physician.

I noticed on the physician's referral form that Andre is in a foster home. 2 Making It Work: Section 2: Referral and Initial Contact

Print (accessible) version

CPS referred him to the doctor, who then referred Andre to ECI.

I'm going to make my initial contact with Andre's foster family today. When we make that first phone call to a family, it's important to explain that we are with "Early Childhood Intervention" or you may know our agency as “ECI.” We want families to become familiar with both terms as they are likely to hear it said both ways. Remember, families may not be familiar with the many acronyms we use routinely when we talk with one another.

Why don't you take some time now to learn more about the referral process and I'll check back with you in a bit. In the meantime, your MIW Coach is here to help ...

2.5 Referral in TAC and CFRNotes:

MIW Coach:

ECI programs and services are governed by a variety of federal and state laws, including the Individuals with Disabilities Education Act (IDEA), the Code of Federal Regulations (CFR) and the Texas Administrative Code (TAC, often referred to as Rule).

These laws spell out what services must be provided, to whom, and how they should be provided. As you go through Making It Work, you’ll learn some of the specific information contained in these laws, and you’ll have an opportunity to practice finding information in these documents.

Let's take a closer look now at requirements around referral ...

The Texas Administrative Code that outlines requirements for referral can be found in Chapter 108, Subchapter G, listed here: http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=2&ch=108&sch=G&rl=Y .

The federal regulations that outline information about referral can be found in the CFR 34, 303 Early Intervention Programs for Infant and Toddlers, Subpart D, Sections 303.301, 303.302, and 303.303., listed here:


http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=2&ch=108&sch=G&rl=Y

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=2&ch=108&sch=G&rl=Y

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=6b266fffdc7890f6646b0e34961691ca&rgn=div5&view=text&node=34:2.1.1.1.2&idno=34#34:2.1.1.1.2.4.

Can you find this in rule: In what section does Rule address how to handle the referral of a baby to your program with an out-of-state IFSP? Answer: Section 108.706.

2.6 Primary referral sourcesNotes:

MIW Coach:

Referrals can come from a variety of sources:

Physicians and other healthcare professionals Child care providers Parents, caregivers, other family members Social Service agencies Child Protective Services (CPS) Other Texas Health and Human Services programs

Note these are the most common primary sources but there are others, such as the local school district.

Question: Which one of these primary referral sources listed above is responsible for the most referrals to ECI? Answer: Physicians and other health professionals

2.7 Referrals of MIW childrenNotes:

MIW Coach:

You saw on Andre's referral form that he was referred by his doctor. What about the other children in your caseload?

Elizabeth was referred to us at discharge from the hospital, due to her diagnosis of Down Syndrome.

Let's look at Riley's referral form to see who referred him ...


http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=6b266fffdc7890f6646b0e34961691ca&rgn=div5&view=text&node=34:2.1.1.1.2&idno=34#34:2.1.1.1.2.4



2.8 Riley's referral formLook at this sample portion of Riley’s Referral Fax Form:

REFERRAL FAX FORM Date: 8/20/2014

To: Baby Legend ECI From: Wonder Years Pre-School

Attn: __________________ Phone: 512-555-8888

Email: [email protected] Fax: __________________

Phone: 512-555-6754

Fax: 512-555-6799

2.9: Quiz: Riley’s ReferralBased on the sample fax referral form 2.8, who referred Riley to ECI?

1. Pediatrician2. DBS (Division for Blind Services)3. Parents4. Child Care Teacher

Answer: His child care teacher referred him. If you chose another option, look at the referral form again.

2.10 Pre-enrollment processNotes:

MIW Coach:

Pre Enrollment begins when you receive a referral and start gathering information about the child and family. Pre-enrollment ends when the family signs the IFSP or after evaluation has determined the child is not eligible for ECI. While the Service Coordinator is the team member responsible for facilitating pre-enrollment activities, other team members participate in the evaluation and assessment process and IFSP development. In addition, all team members should review the child and family’s information collected by 5 Making It Work: Section 2: Referral and Initial Contact


mailto:[email protected]

the Service Coordinator to prepare for the evaluation and assessment, and if the child is eligible, the IFSP meeting.

Pre-Enrollment is the time to gather information from families

In the first contacts with families, you will not just learn about needs and concerns of the family, but will begin to understand how those needs impact the family. A positive relationship with the family is critical to successful services. The strength of the relationship established during the pre-enrollment process lays the foundation for what happens throughout the family’s involvement with ECI. As rapport builds, the family will feel more confident in sharing and exploring with you what they need to support their child’s development. This is an ongoing process and is the responsibility of everyone on the team.

Pre Enrollment is the Time to Share Information

Much like the referral process, during pre-enrollment we continue to share information with the family about ECI services, family rights, and important timelines. It’s important that pre-enrollment activities are conducted in the family’s native language unless it is clearly not feasible to do so.

Check your understanding:

Question: When does pre-enrollment begin and end?

Begin: When you receive a referral and start gathering information about the family

End: When the family signs the IFSP, or when the child is determined to be ineligible for services.

2.11 Activity 2.2: Referral at your programNotes:

MIW Coach:

There are three goals for the referral and pre-enrollment process. The first goal is for the program to begin understanding the concerns regarding the child. The second is to begin delivering information to the family about the purpose and philosophy of ECI and the activities that will be completed.


The third is to provide information to referral sources that will allow them to have an accurate and complete understanding of ECI services, including who is likely to be eligible for services.

Investigate what happens at your program by completing Part A of the Worksheet 2.2, Know your Program.

2.12 Gathering informationNotes:

MIW SC:

Looks like you've learned a lot about the referral process. Good job!

I just got a call from CPS about Andre. The CPS worker assigned to his case would like to speak with us. Her name is Kerry, and she's worked with other children enrolled in ECI, so she is familiar with our evaluation process and services.

Question: What do you do since you got a call from CPS about Andre. Answer either A or B

A. Contact Kerry immediately to get more information about Andre. You already have a referral form, so it's okay to find out more about this child.

B. Ensure that the family has provided consent for CPS and ECI to talk to each other about Andre.

The answer is: B, ensure the family has provided consent. The family must provide consent for you to speak with the CPS worker about Andre.

2.13 Info from CPSNotes:

Talking with a referral source

Kerry obtained consent from Andre's family to speak with ECI. She faxes you a copy. The following are the answers to possible questions you may have about Andre’s referral from CPS.

Question 1: How did CPS become involved with Andre?


Kerry: Andre was removed from his home due to neglect. An emergency room physician felt that Andre’s mother waited too long to get him care when he had a very bad ear infection. CPS investigators found the home to be unsanitary, and also felt that Andre’s mother did not seem to know a lot about providing a safe environment for an active toddler. We worked with Andre’s mother to clean up the home and take some toddler parenting classes. She made some progress but then stopped attending classes. A neighbor later called to report that Andre had been left home alone. At that time, the decision was made to place him in foster care.

Question 2: Can you tell me anything else about Andre that might be helpful to the ECI team?

Kerry: I've been involved in the case for a few months. Although Andre is not shy or timid, he doesn’t show a lot of emotion. Andre has not been around a lot of other children. I feel he is more quiet and subdued than most other kids approaching two years old. We noticed there were no books or toys in the home except Happy Meal toys appropriate for older children.

Question 3: Have any decisions been made about a permanent placement?

Kerry: At this point, the plan is to return Andre to his mother if she complies with the plan CPS has developed for her.

2.14 Needed at a meeting ...Notes:

MIW SC:

We have a team meeting now. Let's share this information about Andre with the team.

What should you do with Andre’s file? Choose A or B

A. Leave the record on your desk as long as it is covered or closed so the information contained in it is not easy to see.

B. Put the file in a secure location. You should not leave a child’srecord unattended.


The answer is B. You should not leave a child’s record unattended.

2.15 Activity: Confidentiality scenariosNotes:

Try these other scenarios about preserving confidentiality ... Answer either A or B for each question.

Question 1: A family you are working with shares personal and highly sensitive information with you. What would you do?

A. Remind the family that all information shared is confidential. If the information is not directly relevant to services, explain that it will not be kept in the child’s record or shared with other team members.

B. Explain to the family that all information is confidential; however, it can be shared with other team members.

The correct answer is A. Sometimes families will share personal information with ECI staff. It is always good to remind families about what kinds of information will remain between you and the family and what will be shared.

If you answered B, remember, Sharing information with team members or documenting it in the record should only occur if the information directly impacts providing ECI services to the child. Families need to have a clear understanding about the kinds of information you'll share with other ECI staff.

Question 2: A health clinic nurse contacts the social worker at your local program asking for information about the health status of a child their clinic physician referred and who was later enrolled in your program. What would you do?

A. Go ahead and exchange information with the child’s physician, as it is important to coordinate with the medical provider.

B. Explain confidentiality requirements to the clinic staff.

The correct answer is B. Check the child’s record to determine if consent to the clinic/physician was already in the file to determine if consent was already given. If not, talk with the family about the request and if they 9 Making It Work: Section 2: Referral and Initial Contact


agree to the release of information, obtain written consent prior to sharing any information. You must obtain consent from the family to get information from the physician and to release information to them. Talk with the family about the request and if they agree to the release of information, obtain written consent.

Question 3: A co-worker not involved with a child and family on your caseload asks questions about the services being provided.

A. Go ahead and share the information with this co-worker because the information is more about the services than the child or family.

B. Politely decline. You should not share information with anyone, including co-workers, unless they are directly providing services to the child.

The correct answer is B. Sometimes a co-worker can learn information about a child in services from relationships outside the workplace. You should not share information with anyone, including co-workers unless they are part of the child’s team. Even when the information shared is primarily about services, you cannot share any information that relates to a specific child or family, or that conveys personally identifiable information.

2.16 Role of Service CoordinatorNotes:

After the meeting, Christy tells you more about her role with ECI ...

MIW SC: As the Service Coordinator, I make sure that all pre-enrollment activities are conducted as outlined in the Texas Rule and federal regulations. When we receive a referral, we must contact the family within a timely manner. At my program, we are required to contact the family in three days, but different programs may have different timelines. Federal regulations require that the IFSP be written within 45 days after referral.

One of the most important things I'll do at my first meeting with a family is to explain their rights, or the procedural safeguards in the ECI program.

Check your understanding: According to TAC, how long do you have after referral to write the IFSP?


Answer: 45 days.

Now, why don't you take a look at the information about procedural safeguards with your coach while I make my first visit with Andre's foster family ...

2.17 Procedural safeguards in TACNotes:

MIW Coach:

The requirements for Procedural Safeguards and Due Process Procedures is found in Chapter 108, Subchapter B of the Texas Administrative Code. Other procedural safeguards you should be familiar with are in TAC related to Family Cost Share.

Answer the following question: What notice must be given to parents regarding confidentiality and procedural safeguards?

Use the TAC to assist you with the answer: http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=2&ch=108&sch=B&rl=Y

The answer is: The ECI family rights publication (See TAC section 108.219). Currently, this is the ECI Parent Handbook.

2.18 Procedural safeguards in CFR, FERPA and HIPAANotes:

MIW Coach:

In addition to the TAC, there are several sections of the CFR that describe procedural safeguards. You should also be aware of the Family Educational Rights and Privacy ACT (FERPA) and the Health Insurance Portability and Accountability Act (HIPAA). The links are provided for you here as reference.

ECI programs must comply with all federal and state requirements related to procedural safeguards and due process. In cases of conflict between TAC and CFR, the interpretation must be in favor of the more rigorous


http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=2&ch=108&sch=B&rl=Y

http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=2&ch=108&sch=B&rl=Y

safeguards for children and families.

Click here to read about IDEA Part C: http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=6b266fffdc7890f6646b0e34961691ca&rgn=div5&view=text&node=34:2.1.1.1.2&idno=34

Click here to read about FERPA and HIPPA: http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf

2.19 Importance of family rightsNotes:

MIW Coach:

Why do IDEA, FERPA, federal regulations and state rule place such emphasis on safeguarding a family's rights?

As stated in rule, the purpose of procedural safeguards is to preserve the legal rights of children with developmental delays or disabilities and their families pertaining to early childhood intervention services. Procedural safeguards are integrated through every stage of a family’s early childhood intervention services experience. These procedures are a part of, not separate from, the required programmatic process. Early intervention personnel are legally obligated to understand and explain procedural safeguards to families and ensure they are followed throughout the course of early intervention services.

2.20 Philosophy & IntentNotes:

MIW Coach:

Procedural safeguards provide a foundation for services that result in quality and equity across programs.

The intent of IDEA is that services are family centered and the family is valued as a team member. Family rights and safeguards support the intent of IDEA.


http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/hipaaferpajointguide.pdf

http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=6b266fffdc7890f6646b0e34961691ca&rgn=div5&view=text&node=34:2.1.1.1.2&idno=34



Families bring valuable information to every step of the ECI process, and family participation is critical to the success of ECI services. When fully implemented, procedural safeguards help ensure the Individualized Family Service Plan reflects what is important to the family.

When families know and understand their rights, they are able to ask for what their child needs and to express concern or dissatisfaction with services. Procedural safeguards remind families they have the right to direct services and to speak out when services do not match the needs of their child and family.

Also, remember families are in ECI for only a short time. Their children may continue to need specialized services long after they turn three, and they may interact with a lot of different service systems, such as public schools, the health care system, and social service agencies. Knowing about their rights and how to exercise them are skills that will benefit families in the years after they leave ECI.

2.21 Family Rights VideoNotes:

MIW Coach:

Take some time now and watch the video produced by Texas ECI, “Parent to Parent: Knowing Your Rights.” This video explains procedural safeguards and describes actions all ECI programs must follow to safeguard, or protect, the families’ rights. The video is approximately 11 minutes, and afterwards there will be a quiz on what you learned.

The video is linked here: https://www. youtube .com/watch?v=MVpf70j_eto .

2.22 Informed consentNotes:

You will need to make sure that parents are giving “informed consent” when they sign your forms. Informed consent is a process that includes the presentation of information, adequate opportunity for the “consenter” to ask questions and have those questions answered, and documentation of the


https://www.youtube.com/watch?v=MVpf70j_eto

voluntary decision to participate. It is a fundamental mechanism to ensure respect for persons through provision of thoughtful consent for a voluntary act. The procedures used in obtaining informed consent should be designed to educate the “consenter” in terms that they can understand. Therefore, informed consent language and its documentation must be written in "lay language", (i.e. understandable to the people being asked to participate). You will need to ask your supervisor how your program addresses informed consent for people who have limited proficiency in the English language or are cognitively impaired.

2.23 Activity: Procedural safeguards QuizWhich procedural safeguard is this? Pick the right answer from the three choices for each question. Each question has one right answer.

Question 1: Begins when the family is referred to ECI and continues throughout the family’s participation in ECI services

A. Informed Written ConsentB. Prior Written NoticeC. Confidentiality

The correct answer is C. A family has the right to confidentiality as soon as they are referred to ECI. Information in the child’s ECI record is protected, even after the child exits from ECI. Families have the right to prior written notice. However, the right to prior written notice is specific to each activity. A “blanket” notice for all activities in ECI is not given at referral. Families have the right to informed written consent. However, the right to consent is specific to each activity. A “blanket” consent for all activities in ECI is not gathered at referral.

Question 2: Must occur before the initiation of any IFSP service.


The correct answer is A. A family must give their informed written consent for any IFSP service to begin. Prior written notice is not needed to initiate


services. Prior written notice is given before the IFSP meeting to plan services. The right to confidentiality does not affect the initiation of IFSP services.

Question 3: Occurs when ECI wants to meet with the family to plan or change services or when ECI wants to change or reschedule a meeting.


The correct answer is B. Prior written notice is given to the parent when ECI proposes a meeting to plan or change services or to change or reschedule a previously scheduled meeting. Remember, when rescheduling a meeting, the new day and time must be convenient for the parent. Informed written consent is not needed to schedule, change or reschedule a meeting. Confidentiality does not directly affect scheduling, changing or rescheduling a meeting.

Question 4: Occurs prior to billing the family’s insurance/CHIP/Medicaid.


The correct answer is A. Informed written consent is needed before ECI can bill the family’s insurance/CHIP/Medicaid. Prior written notice does not apply in this situation. The right to confidentiality protects the family’s information, but this situation extends beyond just releasing personal information. There is a better answer than confidentiality

Question 5: Occurs when ECI does not agree to something the family has requested.


The correct answer is B. Prior written notice is given to the parent when ECI does not agree to something the family has requested. The Prior


Written Notice should provide information about steps a family can take if they do not agree with ECI’s decision. Informed written consent does not apply to this situation. Confidentiality does not affect this situation.

Question 6: Gives permission to conduct the evaluation and assessment.


The correct answer is A. A family must give their informed written consent for ECI to conduct any type of evaluation or assessment. Prior written notice is given before the evaluation and assessment, but it does not give ECI permission to perform these activities. The right to confidentiality does not give ECI permission to perform these activities.

Question 7: Document that informs the family the names of the assessments and evaluations that will be used for planning and who will attend the IFSP meeting.


The correct answer is B. Prior written notice is given to the family to provide information about their upcoming IFSP meeting. Informed written consent is not needed to develop the IFSP. Confidentiality does not affect this situation.

Question 8: Occurs when ECI determines a child is no longer eligible for services.


The correct answer is B. Prior Written Notice is given to the parent when ECI determines that their child is no longer eligible for services. The Prior written notice should provide information about steps the family can take if they do not agree with ECI’s decision. The family does not give informed


written consent when their child is no longer eligible for services. Confidentiality does not affect a child’s eligibility for ECI.

How did you do on the Procedural Safeguards Quiz?

2.24 Helping the family prepareNotes:

The Service Coordinator provides the family with information about:

Family rights ECI eligibility determination process

o Evaluation of all areaso Team approacho BDI-2

MIW SC:

I just got back from visiting with Andre's foster family. To help them prepare for the evaluation process, I provided them information about their rights and we discussed important features of the ECI eligibility determination process. I let them know that:

ECI will evaluate all areas of Andre’s development ECI will use a team approach. The team includes the family, and information that the family provides is vitally important to make sure the evaluation and assessment results are accurate. ECI uses the Battelle Developmental Inventory, which is a standardized tool. You'll learn more about the BDI soon …

I'll share information I learned from the family with the rest of the team to help them prepare for the evaluation. We have a meeting set-up later today.

For now, take some time to learn some details about your own program. Find out how information from pre-enrollment is shared with the team by completing Part B of Worksheet 2.2. When you've completed both Parts A and B, discuss what you've learned with your supervisor.


2.25 Appropriate teamNotes:

MIW SC:

It is important that every child and family be assigned an appropriate team during pre-enrollment. By completing Worksheet 2.2, you learned how teams are assigned at your program. So what constitutes an appropriate team? The right team for a child will consist of professionals with knowledge of infant and toddler development who also have expertise in the area of concern. The interdisciplinary team for a child should be fluid throughout enrollment, with members added or removed as the needs of the child and family change.

Stress for the family may be greatly reduced when the appropriate team is assigned from the beginning, based on the concerns expressed at referral. This allows the concerns about the child to be addressed promptly without the need to schedule discipline specific assessments at a later date.

It is recommended that all evaluation teams have a Licensed Practitioner of the Healing Arts (LPHA).

2.26 LPHAsNotes:

MIW SC:

ECI rule §108.103 defines the professions considered to be LPHAs. Take a look at the list ...

LPHAs according to rule:

registered nurse advanced practice nurse licensed physician assistant licensed physical therapist licensed occupational therapist licensed speech language pathologist licensed intern in speech language pathology


licensed professional counselor licensed clinical social worker licensed psychologist licensed dietitian licensed audiologist licensed specialist in school psychology licensed marriage and family therapist

I have another home visit now. Try this next activity about the composition of evaluation teams. Your coach is ready to provide assistance if you need it ...

2.27 Activity: Composition of the Evaluation teamsIn each of the following scenarios, choose the most appropriate answer.

Question 1: A 20-month old child is referred by her doctor. The child has a suspected delay in speech. Who is the most appropriate LPHA to complete the initial evaluation with an EIS?

A. Speech Language Pathologist (SLP)B. Licensed Professional Counselor (LPC)C. Physical Therapist (PT)D. Occupational Therapist (OT)

The correct answer is A, Speech Language Pathologist. Since the main referral concern is speech, the SLP is the most appropriate team member for this evaluation. An LPC, PT or OT might be a valid team member because they are an LPHA, but not the most appropriate.

Question 2: An 18-month old child is referred with a suspected gross motor delay. What is the best team to evaluate this child?

A. EIS and Licensed Professional CounselorB. EIS and Physical TherapistC. EIS and Speech Language PathologistD. EIS and Service Coordinator

The correct answer is B, EIS and Physical Therapist. A PT can evaluate the gross motor skills. The LPC or SLP could be a member of the team


because they are an LPHA, but there is a better choice. The Service Coordinator is not an LPHA.

Question 3: A 9-month old child is referred with feeding issues. What is the best team to evaluate the child?

A. EIS and Physical TherapistB. EIS and Licensed Professional CounselorC. EIS and Licensed Dietician (LD)D. EIS and Occupational Therapist

The correct answer is D: EIS and Occupational Therapist. Of the choices here, the OT can best evaluate suspected feeding issues. Remember that Speech Pathologists evaluate feeding, too. A LD is an LPHA and has knowledge regarding feeding and diet, but there is a better choice. A PT and LPC are licensed LPHAs, but not the best choices.

Question 4: A two-month old baby is referred with Down Syndrome. Which two team members would you choose to complete the Comprehensive Needs Assessment?

A. EIS and Physical TherapistB. EIS and Speech Language PathologistC. EIS and Licensed DieticianD. EIS and Occupational Therapist

The correct answer is D. An OT can evaluate the quality of skills related to muscle tone and oral motor/feeding issues. A PT can evaluate the quality of skills related to muscle tone, but not related to oral/motor feeding issues. A Speech Therapist can evaluate the quality of skills related to oral motor/feeding issues, but not issues related to muscle tone.

Although a Dietician is an LPHA, there is a better option.

Question 5: A 27-month old child is referred with speech intelligibility issues. Who would be the most appropriate team?

A. EIS and Physical TherapistB. EIS and Speech Language PathologistC. EIS and Registered Nurse


D. EIS and Occupational Therapist

The correct answer is B, EIS and Speech Language Pathologist. Since the area of concern is speech intelligibility, the SLP could make a qualitative determination of delay in communication, even if the child did not qualify on the BDI. If there was a need for QDD, the PT, RN or OT would not be the best LPHA to be on the team.

2.28 Results Notes:

MIW Coach:

You've learned a lot about the pre-enrollment process so far. Before we look at ECI eligibility, let's see how you're doing. Answer the following four questions about pre-enrollment, your role, and the role of the Service Coordinator.

2.29 Activity: Pre-enrollment Quiz: Review of the Pre-Enrollment Process (True or False)Question 1: The Service Coordinator is responsible for facilitating pre-enrollment, including the evaluation and assessment and IFSP development.

A. TrueB. False

The correct answer is True. The Service Coordinator is responsible for facilitating the pre-enrollment process, however all team members participate through evaluation, assessment and the development of the IFSP.

Question 2: All team members are responsible for learning what information has been gathered about the child and family prior to the evaluation, assessment and IFSP process.

A. TrueB. False


The correct answer is True. The information gathered from the family, medical providers and other sources informs the team about what the child and family may need as well as, the strengths they have to support their child’s development. The entire team is responsible for bringing this information forward and incorporating it into the planning process.

Question 3: The Service Coordinator is the team member who is responsible for establishing rapport and building trust with the family during the pre-enrollment process.

A. TrueB. False

The answer is False. Building rapport is an ongoing process. Everyone on the team has the responsibility to develop rapport and establish trust during the evaluation and assessment process.

Question 4: It is the role of all team members to explain ECI’s approach to services during the evaluation and assessment process and as they develop the IFSP.

A. TrueB. False

The correct answer is False. Your ECI program and the Service Coordinator will explain ECI’s approach to services during the referral process. However, all team members have a role in how families experience services beginning with evaluation, assessment and IFSP development. As a team member, you should continually reflect on how well you adhere to ECI’s approach to services.

2.30 Determining eligibilityNotes:

MIW SC:

You need to determine if the children are eligible for ECI services ...

2.31 Eligibility in TAC and CFRNotes:22 Making It Work: Section 2: Referral and Initial Contact


MIW Coach:

Let's take a closer look at requirements around eligibility ...

Federal regulations related to eligibility determination can be found in the CFR, Title 34, Part 303.21(a) and 303.321. Federal regulations are linked here: http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=6b266fffdc7890f6646b0e34961691ca&rgn=div5&view=text&node=34:2.1.1.1.2&idno=34

State rules about eligibility determination can be found in the Texas Administrative Code, Title 40, Part 2, Chapter 108, Subchapter H Eligibility.

TAC is linked here: http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=4&ti=40&pt=2&ch=108

Can you find this in the CFR, or federal rule: The federal regulations list five areas of developmental delay. What are they?

Answer:

1. Cognitive 2. Physical (including vision and hearing)3. Communication 4. Social or emotional5. Adaptive

2.32 Three ways to qualifyNotes:

There are three ways children can qualify for ECI services. Let’s explore all three ...

2.33 Developmental delayNotes:

A child can qualify for ECI services by exhibiting a delay of at least 25% in one developmental domain (gross motor, fine motor, communication, cognitive, adaptive, and personal-social), or a delay of at least 33% in


expressive language only. You'll learn more about how to determine whether a child has a developmental delay in the next section.

2.34 Auditory or visual impairmentNotes:

A child who has a documented auditory or visual impairment as defined by the Texas Education Agency (TEA) 19 TAC 89.1040 may also qualify for ECI. A child with an auditory impairment must have documentation of an examination by an otologist (or a medical doctor if an otologist is not available) that indicates an impairment. An evaluation by a licensed audiologist is also needed. Based on this information, the team, including personnel from the local education agency (LEA) would then determine if the child qualifies.

Visual impairment must be documented by an ophthalmologist or optometrist. The child must also be evaluated by a certified teacher of students with visual impairments. The team, including personnel from the LEA, uses the results of these examinations and evaluations to determine if the child qualifies. Like children who qualify with a medical diagnosis, a comprehensive evaluation is not needed to establish eligibility for children who qualify with auditory or visual impairments.

2.35 Qualifying Medical DiagnosesNotes:

A child with a qualifying medical diagnosis is eligible for ECI. A comprehensive evaluation is not needed to establish eligibility for a child with a qualifying diagnosis, but the child’s record must contain medical documentation of the diagnosis. In addition, a comprehensive needs assessment is required to determine if a child with a qualifying diagnosis demonstrates a need for ECI services. We'll talk more about how a comprehensive evaluation and assessment are different in the next section.

Here is the list of qualifying medical diagnoses. These are posted on the ECI website: https://hhs.texas.gov/services/disability/early-childhood-intervention-services/how-make-a-referral-eci.


https://hhs.texas.gov/services/disability/early-childhood-intervention-services/how-make-a-referral-eci


2.36 Activity: Test your Knowledge of Eligibility (True or False)Question 1: A child with a qualifying medical diagnosis needs to have a comprehensive evaluation

A. TrueB. False

The correct answer is False. Children with a qualifying medical diagnosis automatically qualify for ECI services, so a comprehensive evaluation is not needed. Note, however, that a comprehensive needs assessment is required.

Question 2: Auditory and/or visual impairment (as defined by TEA) automatically qualifies a child for ECI services.

A. TrueB. False

The correct answer is True. Children with AI/VI as defined by TEA automatically qualify for ECI services.

Question 3: A child who has a developmental delay of at least 10% in gross or fine motor skills would qualify for ECI services.

A. TrueB. False

The correct answer is False. It would need to be at least a 25% delay.

Question 4: A child who has a developmental delay of 30% in the adaptive/self-help domain and 18% in cognition would qualify for ECI services.

A. TrueB. False

The correct answer is True. The child would qualify because at least one delay is greater than 25%.

Question 5: Which of the following does not qualify a child for ECI services? Check the link of qualifying medical diagnoses to get the answer: https://hhs.texas.gov/services/disability/early-childhood-intervention-



services/how-make-a-referral-eci.

A. Down SyndromeB. Noonan's SyndromeC. Spina Bifida with Hydrocephalus (Arnold Chiari / Chiari II )D. Fetal Alcohol SyndromeE. Parental drug use

The correct answer is E. Parental drug use does not automatically qualify a child for ECI. A child with Down Syndrome automatically qualifies for ECI services. A child with a diagnosis of Noonan’s Syndrome is eligible for ECI services. Most forms of Spina Bifida are automatic qualifiers for ECI. Fetal Alcohol Syndrome is a qualifying medical diagnosis.

How did you do on this activity?

2.37 Who is eligible? Notes:

Based on what you've learned so far, which child on your caseload do you know is eligible for ECI services?

A. AndreB. ElizabethC. Riley

The correct answer is B, Elizabeth. We received a medical record from Elizabeth’s pediatrician documenting her qualifying medical diagnosis of Down Syndrome. We have not received documentation indicating a qualifying medical diagnosis or a hearing or vision impairment for Andre or Riley at this time. We'll need to move on to the BDI-2 to determine eligibility.

2.38 End of this sectionCongratulations! You have completed the Referral and Initial Contact section of Making It Work. You will now move on to the Evaluation and Assessment section.



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