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Early Steps Operations Guide
7/1/2010

This document does not include guidance/procedures for each policy in the Early Steps Policy Handbook.  Guidance is included only as necessary to explain how to implement a policy, outline steps, or recommend actions to support implementation.

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Component:   3.0       First Contacts/Evaluation/Assessment

Related Policy Component

Guidance/Procedures

Reference/Related Documents

3.1.0 IDEA, Part C Eligibility

3.1.1

Early Steps does not prohibit services due to alien or citizenship status and there is no state residency or financial eligibility requirement.  All children who are in the state and meet Florida’s eligibility criteria may be served by Early Steps.

11/4/05 letter to J. Kane from OSEP

 

3.1.2.

  1. The attached criteria are to be used to determine infants and toddlers who would be appropriate to refer to Early Steps due to vision and/or hearing impairment.
  2. All children who weighed less than 1,200 grams at birth are eligible for IDEA, Part C due to established condition, even if they are not determined eligible until months after their birth.

IDEA, Part C Criteria for Determining Significant Visual Sensory Impairment

IDEA, Part C Criteria for Determining Significant Hearing Loss

3.1.3

  1. Conditions that are shown on the Established Conditions list will make a child eligible for IDEA, Part C; however, this is not an exhaustive list. 
  2. If an established condition is suspected but a child does not have a written confirmation from a physician or appropriate healthcare practitioner, then the LES will identify for the family at least one accessible local diagnostic resource, either within the LES or in the local community.

Established Conditions List

3.1.4

Eligibility will be based on criteria on the date eligibility is determined for Early Steps. Children made eligible under previous, broader criteria who do not meet current eligibility criteria will not be terminated from services.

 

3.1.6

Verification of eligibility is determined using an appropriate standardized instrument and one or more of the following:

  1. Observational assessments
  2. Developmental inventories
  3. Behavioral checklists
  4. Adaptive behavior scales
  5. Family Report

 

3.1.7

When a family moves to Florida and wishes to refer their child from an IDEA, Part C program in another state, the following should be done to assist with the process.

  1. The LES should work with the program the family is moving from to ensure a release is obtained and necessary information is appropriately transferred. This contact will help facilitate the process and alleviate misunderstandings.  Examples of necessary information include information related to eligibility determination, evaluation, assessment, and the IFSP.
  2. The LES office should contact the family and make arrangements for first contacts and a new evaluation (if necessary) once the family moves.
  3. If the family brings a current IFSP with them, the child will still need to be evaluated unless the child has met the criteria set forth in Policy Handbook 3.5.1.

 

3.1.8

 

 

 

 

 

Informed clinical opinion is always the consensus of the evaluation and assessment team and not the judgment of only one member of the team.

 

Instructions for Completing the Early Steps IFSP, Form D,

Refer also to Shackelford, J. (2002) “Informed Clinical Opinion” (NECTAC Notes No. 10). Chapel Hill: The University of North Carolina.

3.1.9

Information related to eligibility is documented on Form D of the IFSP.

Instructions for Completing the Early Steps IFSP, Form D

3.1.10

  1. The family of a child determined ineligible is given a copy of the results as documented on the IFSP (forms A, B, C, and D).
  2. The service coordinator should also determine if referrals to other appropriate programs can be provided.  For example, a child showing a mild delay that results primarily from economic disadvantage, but not meeting IDEA, Part C eligibility criteria, should be referred to Early Head Start. 
  3. The family should also be given information about how to refer to Early Steps if additional concerns arise.
  4. After being provided prior notice, the child’s record can then be closed. 
  5. When a parent requests another evaluation on a previously referred child who has already been evaluated and determined ineligible, the evaluation and assessment team should decide on the course of action to be taken.
    1. The team may decide that a re-evaluation is warranted, giving consideration to any extenuating circumstances or existing conditions at the time of the evaluation that have made the evaluation results questionable.
    2. The team may determine that the results are valid and no extenuating circumstances existed to make the decision of ineligibility questionable.  If the team makes this decision and refuses to re-evaluate the child, it must inform the family of the reason and their procedural safeguard rights (in writing).
    3. A re-evaluation requested by the family after an extended period of time (i.e. 6 months or more), even if the same concerns are expressed, may be warranted since a young child’s development changes rapidly.
    4. If there is not a new concern, Medicaid cannot be billed for a new evaluation.

Instructions for Completing the Early Steps IFSP, Form A

Instructions for Completing the Early Steps IFSP, Form B

Instructions for Completing the Early Steps IFSP, Form C

Instructions for Completing the Early Steps IFSP, Form D

 

 

 

 

 

 

Florida Medicaid Early Intervention Services Coverage and Limitations Handbook  (Evaluations)

3.2.0 First Contacts

3.2.1

  1. The purpose of first contacts is to:
    1. Establish a relationship with the child and family and to gather information about them in preparation for the evaluation and assessment.
    2. Orient the family to Early Steps.
    3. Conduct child screening if needed. 
  2. During first contacts, families receive information about Early Steps and complete required paperwork.

Diagram – Entering the Early Steps System

3.2.2

  1. In the case of a family that self-refers, the initial contact is made at the time of this first telephone contact with the family.
  2. A phone call is preferred for the initial contact with the family.
  3. At the time of initial contact, next steps in the first contacts process should be explained to the family.
  4. Initial contact attempts should also include attempts by mail if unable to reach the family by phone.  If the family still cannot be contacted, updated contact information should be obtained from the referral source or a county health department, if possible.  If updated contact information is obtained, attempts to contact the family should be repeated prior to closure of the child’s Early Steps record.   

 

3.2.3

  1. While a face-to-face meeting is not required as part of the first contacts process, it is still preferable and considered best practice.
  2. The appointment for First Contacts should be scheduled in enough time to allow the IFSP to be developed within 45 days from the referral date.

 

3.2.4

  1. If the first contacts activities include a face-to-face meeting, the meeting must be in a location convenient to the family.
  2. It is best practice for a face-to-face meeting to take place in the natural environment if the family’s circumstances allow.

 

3.2.5

Information regarding the family’s concerns, priorities, resources and everyday routines, activities and places is recorded on Form C.

Instructions for Completing the Early Steps IFSP, Form C

3.2.7

First contacts information is used to determine the formation of the evaluation and assessment team and the focus of the evaluation and assessment.  First contact information is recorded on forms A, B, and C.

Instructions for Completing the Early Steps IFSP, Form A

Instructions for Completing the Early Steps IFSP, Form B

Instructions for Completing the Early Steps IFSP, Form C

3.3.0 Developmental Screening

3.3.1

  1. If a developmental screening is conducted, the screening tools that are recommended for use as general developmental screeners and should be considered first are: the Ages and Stages Questionnaire (ASQ), Birth to Three Screener, the Battelle Screening Tool or the Early Learning Accomplishment Profile (ELAP) Screener. Screening may occur by:
    1. Conducting a developmental questionnaire or other appropriate parent report tool face-to-face or by telephone; or
    2. Mailing a developmental questionnaire to families with instructions on how to check their child’s development; or
    3. A combination of a face-to-face visit using an approved tool, telephone contact and mailed questionnaire.
  2. For children who appear to have a specific area of developmental concern, the LES may choose a screening instrument developed for that specific area.
  3. For children suspected of having Autism Spectrum Disorder, Local Early Steps will obtain screening results from the child’s medical home or other local community screening initiatives.  When no community resources are available or the child does not have a medical home, the Local Early Steps may provide at any time a screening for those children who are identified with communication or social/emotional concerns that may indicate Autism Spectrum Disorder.  The Modified Checklist for Autism in Toddlers (M-CHAT) or the Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP) should be considered first.
  4. If  a child suspected of having Autism Spectrum Disorder fails the first screening, Early Steps may conduct another screening to confirm the results of the first screening.  The Modified Checklist for Autism in Toddlers (M-CHAT) Interview should be considered first.   
  5. When screening is completed, the results are documented on Form B of the IFSP document.
  6. Screening records from other agencies, (e.g., Early Head Start, Healthy Start, the county health department, etc.), should be considered if they were conducted no earlier than thirty days prior to the time of referral and the screening tool addressed each of the five developmental domains.

 

3.3.2

  1. A child who has an established condition or obvious developmental delay does not need a screening.  However, a screening may be conducted for such a child if it is determined that developmental screening information would be helpful to the IFSP team.
  2. A screening also may be helpful when other less formal information gathering does not reveal specific domain deficits, when no specific developmental concerns are identified, or to determine those children who are functioning at an age appropriate level.

 

3.3.3

…if parents continue to refer their infant or toddler who is suspected of having a disability to IDEA, Part C, the State must conduct an evaluation and assessment that meets the requirements of 34 CFR §§303.322 and 303.323.  If the State refuses to conduct an evaluation of the child despite the referral, then the State must provide the parent with the information required under prior written notice requirements at 34 CFR §303.403(b).  The notice must include the fact that an evaluation is being refused, the reasons for refusing to provide an evaluation and the procedural safeguards available under IDEA, Part C including the due process and mediation procedures adopted by the State under 34 CFR §303.401 through 303.460 and the State complaint procedures adopted under 34 CFR §303.510 through 303.512. [Excerpt from OSEP letter to Connecticut, October 24, 2003

 

3.3.4

 

Families should be given the Informed Notice and Consent form to indicate if they wish to provide or decline consent for their child to receive an evaluation and assessment.  If the form is not used and the family declines services, the decision of the family must be documented in case notes.

  1. If the family does not provide consent for their child to have an evaluation and assessment, the LES must explain to the family:
    1. The child will not be able to receive an evaluation or assessment unless consent is given.
    2. The nature of the evaluation, assessment, and other services that would be available if the child were to meet eligibility criteria.
  2. If the results of the screening indicate the child is at age level, and the family chooses not to proceed with an evaluation/assessment, the family is provided with developmental materials and referrals to community agencies, as indicated.  The family should also be provided with contact information for Early Steps and offered a re-screening in three to six months, as appropriate. 

Informed Notice and Consent - English

Informed Notice and Consent - Spanish

Informed Notice and Consent - Creole

 

3.4.0 Evaluation/Assessment

3.4.1

The LES may initiate procedures to challenge parental refusal to consent to an evaluation, and if successful, obtain the evaluation.

 

3.4.2

  1. The evaluation and assessment should take place at a time and location convenient to the family.
  2. The family should be involved in planning and con-ducting the evaluation/assessment.  Examples of planning activities include providing input on the child’s likes and dislikes, favorite toys, and times when most alert.  The family may either play the role of observer, or may choose a more active role during the actual evaluation/assessment.  Examples of an active role include playing and engaging with the child as part of the evaluation/assessment; recording observations, or providing clarification when questions arise.

 

3.4.3

  1. A consistent, collaborative team that conducts the evaluation and assessment concurrently, in one encounter is strongly encouraged.  Conducting the evaluation/assessment in this way:
    1. Is more convenient to the family.
    2. Allows for sufficient time to complete all activities within the 45 day timeframe between referral and development of the IFSP.
  2. If the evaluation and assessment cannot be conducted concurrently, it is still preferable that the team conducting the assessment be the same as the evaluation team.

 

3.4.4

  1. The child’s presenting concerns should drive the make-up of the evaluation and assessment team.
  2. The evaluators/assessors’ signatures on Form D and Form E verify the evaluation and assessment information as the formal report(s).

Operations Guide 3.4.3

Instructions for Completing the Early Steps IFSP, Form D

Instructions for Completing the Early Steps IFSP, Form E

3.4.6

  1. The family members or caregivers may need interpretation/translation services even though the child’s native language is English.
  2. LES should make a substantial good faith effort to find a translator professional, extended family member, or community resource person to assist with translation when English is not the family’s primary language.
  3. Professional sign language interpreters should be used to provide accessibility to caregivers who are deaf.

 

3.5.0 Evaluation

3.5.1

 

  1. The focus of the evaluation should be consistent with the area(s) of concern as indicated by the first contact information and/or developmental screening.
  2. The purpose of evaluation is to expeditiously confirm eligibility for early intervention services by determining the child’s level of functioning.
  3. An evaluation is conducted only for the initial IFSP to establish eligibility and is not required for the annual evaluation of the IFSP.
  4. The Developmental Assessment of Young Children (DAYC) or the Battelle Developmental Inventory (BDI-2 should be considered first as the evaluation instrument, when appropriate for the child’s presenting condition(s).
  5. Neither the DAYC nor the BDI-2 may be appropriate for a child with a single area of concern. If necessary, other evaluation instruments may be administered in specific discipline areas(s) to further determine a child’s eligibility.  This may especially be helpful when a child falls in the borderline area of eligibility.
  6. For children who have communication or motor skills as their only area of concern, one of the testing instruments should produce individual scores in the sub-domains of fine and gross motor or receptive and expressive language.
  7. For a child who fails the secondary screening for Autism Spectrum Disorder, the LES may make a referral to the child’s medical home or other community resource, if available, for a diagnostic evaluation.  If no other resource is available, the Local Early Steps may evaluate the child for an Autism Spectrum Disorder (ASD) if an ASD diagnosis is necessary to ensure appropriate, quality early intervention services that meet the developmental needs of the child and the needs of the family related to enhancing the child’s development.  The Autism Diagnostic Observation Schedule (ADOS) should be considered first.

 

3.5.2

The five required developmental domains are:

  1. Communication: includes expressive and receptive communication skills, both verbal and non-verbal.
  2. Self-Help/adaptive: refers to the ability to function independently within the environment and the child’s competency with daily living activities such as sucking, eating, dressing, playing, etc., as appropriate to the child’s gestational or chronological age. 
  3. Cognitive: refers to the acquisition, organization and ability to process and use information.
  4. Physical: refers to vision and hearing as well as the abilities with tasks requiring large and small muscle coordination, strength, stamina, flexibility and motor development appropriate for the developmental age.
  5. Social/emotional: refers to interpersonal relationship abilities.  This includes interaction and relationships with parent(s) and caregivers, other family members, adults and peers, as well as behavioral characteristics, e.g. passive, active, curious, calm, anxious and irritable.

Parent Interview Protocol for Child Hearing and Vision Skills

Parent Interview Protocol for Child Hearing and Vision Skills - Creole

Parent Interview Protocol for Child Hearing and Vision Skills - Spanish

 

3.5.5

The evaluation report is on Form D of the IFSP.

Instructions for Completing the Early Steps IFSP, Form D

3.6.0 Assessment

3.6.1

  1. One of the following instruments (or any portion thereof) should be considered first to conduct the initial assessment in an arena style, provide information for intervention planning, and track the child’s progress:
    1. Battelle Developmental Inventory (BDI-2), a norm and criterion based assessment.
    2. Hawaii Early Learning Profile for Infants and Toddlers (HELP) a curriculum-based assessment.
    3. Early Learning Accomplishment Profile (ELAP), a criterion-referenced test.
    4. Assessment Evaluation and Programming System for Infants and Children (AEPS), a curriculum-based assessment.
  2. An additional specialized assessment instrument that is indicated by the child’s established condition or developmental delay (for example, visual impairment or autism spectrum disorder) may be used.  Examples of such instruments (not inclusive) are:  Language Development Scale (LDS), Auditory Skills Checklist, Preschool Language Scale(PLS-4), Vineland Adaptive Behavior Scales, Assessment of Basic Language & Learning Skills (ABLLS-R), Transactional Supports (SCERTS), Individual Growth and Developmental Indicators (IGDI). 
  3. Assessment should be conducted by those individuals who are likely to be involved in providing direct or consultative services to the child and family.
  4. If there is not sufficient information from reviewing collateral information to provide current levels of development in each of the domains for the annual evaluation of the IFSP, then the IFSP team must determine how best to obtain this information.  This may include a discipline specific assessment using one of the instruments in 3.6.1 A or B above.  
  5. When a child has previously performed within normal limits, the IFSP team may use the ASQ or other parent report method to confirm that the child is still performing within normal limits. 

 

3.6.3

 

 

 

The assessment process results in a statement on the IFSP of the child’s level of functioning in the required develop­mental domains. The child’s assessment information is documented on Form E of the IFSP.

Instructions for Completing the Early Steps IFSP, Form E


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