Pre-referral, Referral, and Post-Referral Procedures Presented by: Jill Harris and Rhonda Spence NOVEMBER 16, 2011

New Organizational Structure Comments were received regarding confusion in the field about the implementation of child find, screening, evaluation, assessment and IFSP provisions. Reorganized based on structure of statutory requirements and chronological processes once a child is referred to Part C. 2

New Organizational Structure Added § to define the framework for identifying, locating, and providing EI services to infants and toddlers with disabilities; – Pre-referral Public awareness and child find – Referral – Post-referral Screening, Evaluation, & Initial IFSP Meeting 3

Pre-referral, Referral, Post- referral Procedures This morning’s presentation will focus on some of the major changes in Subpart D-Pre- referral, Referral, and Post-referral procedures including: – New partners and procedures related to the State child find efforts – Referral timeline – Clarifying exception to the 45-day timeline requirement – Screening – New definitions and their application 4

Pre-referral, Referral, Post- Referral Procedures During our presentation: – Think about the regulations and their implementation. – Write your questions down on the cards on the table. – We will collect the cards and they will inform questions for future guidance. 5

Pre-referral Procedures We have added specific requirements regarding the dissemination of child find information at § – Information is to be given especially to parents with premature infants. – Infants with risk factors associated with learning or developmental complications. – Lead agencies must develop procedures to assist primary referral sources to disseminate child find information. 6

Pre-referral Procedures Central Directory - § – The lead agency must make the central directory available “through other appropriate means” than the lead agencies website. – States may determine the methods it will use to provide access to the general public. – Requires accurate and up-to-date information about: Public and private EI services, resources and experts in the State Demonstration projects in the State relating to EI Professional and other groups (e.g. Parent Centers) 7

Pre-referral Procedures Each lead agency must inform parents of toddlers about the State Part B program for 3-5 year old children no fewer than 90 days prior to the toddler’s third birthday. – Applies to ALL children transitioning from Part C. – Can be included as part of the transition plan required for toddlers at § (d) and § (h). 8

Pre-referral Procedures The lead agency must coordinate its child find efforts with the: Programs that serve infants and toddlers who are homeless, and wards* of the State – Children’s Health Insurance Program (CHIP) – State Early Hearing Detection and Intervention System (EHDI) – Child Care Programs (§ ) 9

Pre-referral Procedures – Child Welfare/Child Protection (CAPTA and foster care) – Family Violence Prevention and Services – The Home Visiting Program under MCH *Note: “Ward” of the State is defined at §

Referral Procedures Primary referral sources are required to refer a child to the Part C program “as soon as possible but in no case later than seven days” after identification at § (a)(2)(i). – Prior requirement was “two working days after identification”. – Recommending earlier referral may be reasonable. – Maximum timeline of seven days provide more flexibility to primary referral sources. 11

Post-referral Procedures Within 45 days after the lead agency or EIS provider receives a referral, the screening (if applicable), initial evaluation, initial assessments, and the initial IFSP for that child must be completed unless: – The child is not available due to family circumstances, or – The parent has not provided consent for screening (if applicable), or the child’s evaluation or assessment. (§§ (a) and (b)) 12

Post-referral Procedures 45-day Timeline Exception: The child or parent is unavailable to complete the screening (if applicable), the initial evaluation, the initial assessment, or the initial IFSP meeting due to exceptional family circumstances that are documented in the child’s EI records. (§ (b)(1)) 13

Post-referral Procedures 45-day Timeline Exception- Parent has not provided consent. – Parent has not provided consent for the screening (if applicable), the initial evaluation, or the initial assessments of the child, despite documented, repeated attempts by the lead agency or EIS provider to obtain parental consent. (§ (b)(2)) 14

Post-referral Procedures The lead agency must develop procedures to ensure that if an exception applies, the lead agency or EIS provider: – Documents the family exception in the child’s EI record, or – Documents the repeated attempts by the lead agency or EIS provider to obtain the parental consent. – Completes the screening (if applicable), the initial evaluation, the initial assessment and conducts the IFSP meeting as soon as possible after consent is obtained or family circumstances no longer exist. (§ (c)) 15

Post-referral Procedures Using screening procedures is an option that a lead agency may choose to include as part of the State’s child find system. (§ ) The lead agency must provide the parent with prior written notice of its intent to screen the child. The notice must explain the parent’s right to request an evaluation at any time during the screening process. (§ (1)(i)) 16

Post-referral Procedures The lead agency must obtain parental consent prior to administering any screening procedures. (§ (a)(1)(ii)) The State must provide notice of the screening results to the parent and, if the screening results indicate the child is suspected of having a disability, an evaluation of the child must be conducted. (§ (a)(2)(ii)) 17

Post-referral Procedures If the child is not suspected of having a disability, parents must be provided notice of that determination, and that notice must describe the parent’s right to request an evaluation. A parent may request an evaluation at any time during the screening process even if the screening suggests that the child is not suspected of having a disability. ( § § (a)(2)(ii) and (a)(3)) 18

Post-referral Procedures Screening Procedures are defined in § (b) as: – Activities carried out by to identify infants and toddlers suspected of having a disability and in need of EI services. – Includes the administration of appropriate instruments and personnel trained to administer those instruments. 19

Post-referral Procedures For every child referred for screening, the lead agency must provide an evaluation if the child is suspected of having a disability OR the parent requests an evaluation. The lead agency does not have to make available EI services to the child and family unless a determination is made that the child meets the definition of an infant or toddler with a disability under § (§ (c)) 20

Review This morning we discussed: – Pre-referral Procedures Public Awareness Child Find – Referral Procedures – Post=referral Procedures 45-day timeline and Exceptions Screening – We will continue discussing Post-referral Procedures after the break 21

Post-referral Procedures Parental consent is required before evaluation. Definitions have been added at § (a)(2)(i) to clarify the current requirements: – Evaluation means the procedures used by qualified personnel to determine initial and continuing eligibility. – Initial Evaluation refers to the child’s evaluation to determine eligibility. 22

Post-referral Procedures The lead agency must ensure, after obtaining parent consent, a timely, comprehensive multidisciplinary evaluation to establish eligibility, unless eligibility is established through a child’s medical records. (§ (a)(1)(i)) 23

Post-referral Procedures A child’s medical records and other records may be used to establish eligibility (without conducting an evaluation of the child), if the records indicate that functioning in one or more of the developmental areas: – Constitutes a developmental delay (as defined by the State), or – The child meets the criteria of an infant or toddler with a disability. (§ (a)(3)(i)) 24

Post-referral Procedures A condition that has a high probability of resulting in developmental delay as listed at §303.21(a)(2), and includes as examples: – Chromosomal abnormalities – Congenital infections – Sensory impairments – Severe attachment disorders – Secondary exposure to toxic substances (fetal alcohol syndrome) 25

Post-referral Procedures If eligibility is established using medical or other records, the lead agency or EIS provider must still conduct the assessment of the child and family. (§ (a)(3)(i)) 26

Post-referral Procedures Informed clinical opinion must: – Be used when conducting an evaluation and assessment of the child. – May be used as an independent basis to establish eligibility even when other instruments do not establish eligibility. – May not be used to negate the results of evaluation instruments used to establish eligibility (§ (a)(3)(ii)) 27

Post-referral Procedures The evaluation must be conducted in the native language of the child. – Native language is defined at § The language normally used by that individual, or, in the case of a child, the language normally used by the parents of the child, except: – For purposes of evaluation and assessment, the language normally used by the child, if determined developmentally appropriate for the child by qualified personnel conducting the evaluation or assessment. 28

Post-referral Procedures The required evaluation procedures must include: – Administering the evaluation procedure; – Taking the child’s history (including interviewing the parent); – Identifying the child’s level of functioning in each of the developmental areas; – Reviewing medical, educational and other records; and – Gathering information from other sources. (§ (b)) 29

Post-referral Procedures If a child is determined eligible as an infant or toddler with disability as defined in §303.21, the LA must: – Complete a multidisciplinary assessment of the unique strengths and needs of the infant or toddler and the identification of appropriate services to meet those needs. – Complete a family-directed assessment of the resources, priorities, and concerns of the family. – The evaluation and assessment of the child may be simultaneous. (§ (a)(1)(ii)) 30

Post-referral Procedures Assessment means the ongoing procedures used by qualified personnel to identify a child’s unique strengths and needs and the appropriate EI services. – Initial Assessment refers to the assessment of the child and the family conducted prior to the child’s first IFSP meeting. (§ (a)(2)(ii) and (iii)) 31

Post-referral Procedures If the child is not eligible, the lead agency must: – Provide the parent with prior written notice and include the parent’s right to dispute the eligibility determination through the dispute resolution mechanisms (due process hearing, mediation or filing a State complaint). (§ ) 32

Post-referral Procedures The lead agency must ensure the development of an IFSP developed by a multidisciplinary team. – The multidisciplinary team with respect to the IFSP team in §303.24(b) means the parent and two or more individuals from separate disciplines or professions and one of these individuals must be the service coordinator. 33

Post-referral Procedures Multidisciplinary, with respect to evaluation and assessment, may include one person who is qualified in more than one discipline or profession (e.g. special education teacher who is also a speech pathologist). Multidisciplinary, with respect to the IFSP meeting, must involve two or more individuals or professions and one of these must be the service coordinator. (§303.24) 34

Post-referral Procedures The specific service coordination services under § include: – Making referrals to providers for needed services and scheduling appointments for infants and toddlers with disabilities. (§303.34(b)(1)). – Conducting follow-up activities to determine that appropriate Part C services are being provided. (§303.34(b)(7)). – Coordinating funding sources for Part C services ONLY. (§303.34(b)(9)). 35

And…. At-risk is defined at §303.5 Early intervention service (EIS) program is defined at § EIS provider is defined at § and includes a list of EIS provider responsibilities. The types of early intervention services now includes: – Sign language and cued language services (§303.13(b)(12)). 36

Model IFSP Form Statute under IDEA section 617 requires modes to be published. Includes all of the regulatory content- related requirements. Distributed in your packets and can be found on line at 37