1. Connecticut Birth to Three System How Birth to Three Can Be A Busy Pediatrician’s Best Partner November 7, 2018
Presenters:
Ann Milanese, MD; Associate Professor of Pediatrics at UCONN School of Medicine
Division Chief of Development and Rehabilitation Medicine at CCMC
Medical Advisor to the Connecticut Birth to Three System
Thyde Dumont-Mathieu, MD, MPH; Associate Professor of Pediatrics at UCONN
School of Medicine; Developmental-Behavioral Pediatrician
Staff Physician, Development and Rehabilitation Medicine at CCMC

2. The Connecticut Birth to Three System
Today we will discuss:
Broad range of supports available through Birth to Three
Tips on streamlining your Birth to Three referral
Update on eligibility criteria for Early Intervention (EI)
Update on Birth to Three’s approach to evidence based practices
How Pediatricians and Birth to Three can work together to support families

3. Learning Objectives
Participant will understand the range of supports available through the Birth to Three System.
Participant will understand eligibility and process necessary for making referrals to Birth to Three.
Participant will gain knowledge of Birth to Three’s approach to evidence based practices.
Participant will understand the importance of collaboration between Pediatrician and Birth to Three in order to best support families.

4. Birth to Three System Overview
Federal Dept. of Education, Office of Special Education Programs (OSEP)
CT Lead Agency: Office of Early Childhood (OEC)
Annual Budget: $55,602,882 million (FY17)
Personnel: 10 central office staff
42 programs statewide
approx. 1,200 direct care providers
Children and Families Referred: 9,462 in FY17
Served: 8,798 in FY17; may have been referred in a
previous fiscal year
Service Locations: Child’s Home or Child Care 99%

5. All Birth to Three Programs are Comprehensive This means that every program has the staff and expertise to deliver all services as required under Part C of IDEA to enrolled children
Three types:
23 General Programs - work with any eligible child and family
3 Programs for children who are Deaf or Hard of Hearing
6 Programs for children with Autism Spectrum Disorders

6. Types of Early Intervention Services
*Every family is given service coordination.
Additional services may include:
assistive technology devices and services
audiology services
family training and “counseling”
nutrition services
occupational therapy (OT)
physical therapy (PT)
sign language and cued language
social work services
specialized instruction
speech and language services
transportation or mileage reimbursement when necessary to receive other IFSP services
vision and mobility services

7. Broad Range of Supports available through Birth to Three
Early Interventionists connect families with community resources and supports
For Example:
Parenting support
Supporting family with basic needs
Assist family with seeking childcare options
Assist family to connect with playgroup in community

8. Broad Range of Supports available through Birth to Three
Attend religious services at synagogues and churches with families.
Outcome: Joey will play with his friends at church
playgroup, taking turns with toys and using words
instead of hitting

9. Broad Range of Supports available through Birth to Three
Supports provided to address the needs and priorities of the child’s family
Working on a child outcome that can be addressed
through increasing the child's participation during
grocery shopping.
For example: increasing the child's ability to follow direction, make choices, increase verbalizations during grocery shopping

10. Streamline your referral directly to www.birth23.org
Pediatricians are primary referral source for families that are unaware of Birth to Three supports

11. Tip: Medical office staff can complete online referral form anytime through the Birth to Three website in less than two minutes.

12. Eligibility Criteria
Children under age three are eligible for Birth to Three System supports because they either:
Show a significant developmental delay of -2 standard deviations in one developmental domain OR
-1.5 standard deviations in two or more developmental domains,
Have a diagnosed medical condition that has a high probability of resulting in developmental delay.
Two multidisciplinary professionals evaluate the child in their home and use one or more standardized tests to evaluate the child's strength and needs in all areas of development, regardless of the reason for referral.

13. Smooth Pediatrician Referral = Smoother Family Experience
On Birth to Three referral form, please have office staff:
Provide best phone number to reach parent.
Provide parent name in case we need to leave phone message or send a letter.
Parent’s preferred language so that we can contact families in that language.
Include documentation of completed M-CHAT-R, including scores if concerns are for autism spectrum disorder (ASD).
**Please be sure to discuss results of M-CHAT-R and ASD concerns with family.

14. Little Known Fact: When a family contacts Birth to Three for a referral they reach Child Development Infoline (CDI) – a single point of entry via toll free number. They are then triaged across all of their programs, services and supports including Help Me Grow, Early Childhood Special Education, Birth to Three and Children & Youth with Special Healthcare Needs.
Tip: Referring Pediatrician receives confirmation of scheduled evaluation date.

15. When families are referred to or Child Development Infoline they can access Birth to Three among other resources…
Help Me Grow: For families with questions about their child’s development or behavior. Offers free developmental screening program to monitor a child’s development from birth to age 5, via online or mailed questionnaire (ASQ).
In-Home Family Support Services: For pregnant women and families of young children who could benefit from in-home support services that promote positive parenting and healthy development
Connecticut Birth to Three System: For families of infants and toddlers with significant developmental delays or disabilities
Early Childhood Special Education: For children who need special education services
Children and Youth with Special Health Care Needs: For children and youth with chronic physical, developmental, behavioral, or emotional conditions who require more health and related services than other children the same age

16. Update on Eligibility for Early Intervention
The evaluation is FREE and if a family is eligible they can choose some services at no cost.
Little Known Fact: If you have referred a child that is ineligible they may be re-referred in three months for another evaluation if developmental concerns still exist.

17. If found eligible, all families can choose some services at no cost
No Cost services include:
Referral to the Birth to Three System
Evaluation and assessment of the child to determine eligibility and needs
Development and review of the child’s plan (IFSP)
One face to face visit every three months
Service coordination (which includes assisting the family with locating services from community providers)

18. Little Known Fact: Children who are ineligible for Birth to Three supports are offered developmental monitoring
If the child is found ineligible for Birth to Three, the family is offered the option of enrolling their child in the Ages & Stages (ASQ) developmental monitoring program. ASQ will help monitor a child's development over time and can trigger a re-referral if concerns are identified.

19. Family Fee
Any family whose adjusted annual income is above $45,000 a year pays a monthly fee.
Range of family fee monthly amount:$8 -$272* based on sliding scale and family size
Any child that is Medicaid eligible does not pay a family fee
* If family does not consent to bill their insurance they incur an additional fee

20. Life after Birth to Three
Birth to Three supports must end by the child’s 3rd birthday.
Transition activities and supports are offered as a part of service coordination, which is provided to every enrolled family whether or not the child received direct services from the Birth to Three System.
Families of all children leaving Birth to Three will take part in a transition conference to discuss possible future supports and services.

21. Unchanged: old and new practices
Best Practices have not changed:
- Building parents competence in addressing their child's priorities through coaching
Learning happens during natural activities
One team member is primary liaison and support to family.
What has changed:
Building capacity of Birth to Three providers to implement these best practices with fidelity.
- How to engage families using strategies with their child during and between visits.
- Expanded focus on activities of the family-where skill development and behavior
change can be addressed with child.
- Primary provider and family are supported by secondary providers, as needed, during
visits and teaming.

22. Strategies for Collaboration
We need each other to best support the family.
Birth to Three programs share the child's evaluation and assessment reports, and initial and annual Individualized Family Service Plans (IFSP) with referring Pediatricians for review and consultation.
Pediatrician is a member of the child’s IFSP team and input is valued as the team makes decisions.

23. Strategies for Collaboration
Birth to Three can attend Pediatrician and Specialty visits with families.

24. Strategies for Collaboration
Opportunities for increased communication
Pediatrician hears families concerns regarding progress with Birth to Three at well child visit these can be shared back due to open communication.
Specific point person in Birth to Three connects with point person at pediatric office who handles Birth to Three contact and concerns. Example: Birth to Three coordinator reaching office staff and leaving message with secretary when child is having dehydration issues on G- tube.
Medical Home provider practices have ideal set-up. They each offer a dedicated contact for Birth to Three providers.

25. At the 12 month well child care visit family is concerned about their child's delay in speech.
Pediatrician refers family to Birth to Three who finds child ineligible for supports.
At the 18 month well child care visit family is again concerned about their child's delay in speech. Should the Pediatrician refer family to Birth to Three again?

26. Closing Thoughts
“When parents, community programs and professionals who provide early childhood services – including the pediatrician in the medical home – promote supportive relationships and rich learning experiences for infants and young children, a stronger foundation is created for higher achievement in school and, eventually, the community.”
- Adams, et al., Pediatrics, 2013;132;31073

27. Dr. Milanese or Dr. Dumont-Mathieu:
Questions?
Dr. Milanese or Dr. Dumont-Mathieu:
Birth to Three: