Early Intervention Evaluation and Eligibility Determination Training

1. New York State Department of HealthDivision of Family HealthBureau of Early Intervention Advanced Training: Early Intervention Evaluation, Assessment, andEligibility Determination December 2011 Updated August 2012

2. Unit #1 Welcome Introductions Course Overview

3. Training Agenda • Welcome, Introductions and Course Overview • Review of MDE Requirements • Components of an Evaluation • Determining Eligibility Break • Reporting Results • Ongoing Assessment and Continuing Eligibility • Review Activity and Course Evaluation

4. Learning Outcomes Increase understanding of the required regulatory elements and best practices for conducting a Multidisciplinary Evaluation Enhanced knowledge of eligibility criteria and determinations Understand and implement best practice procedures for reporting evaluation results Increase understanding of assessing a child’s progress and ongoing eligibility

5. Activity Evaluation Essentials 5

6. Unit #2 Review of MDE Requirements

7. Regulation Changes as of June, 2010 69-4.1(h): Clarifies that the physical domain includes oral motor feeding and swallowing disorders 69-4.8(a)(6)(i): Use of standardized instruments approved by the Department 69-4.8(a)(9)(i): Submission of written summary and report 69-4.8(a)(9)(iii): Eligibility statements must provide sufficient detail to demonstrate child’s eligibility 69-4.23: New section of regulation for initial and continuing eligibility, including communication only criteria 7

8. Requirements for Conducting the MDE Must be conducted in a professional, objective manner by personnel trained to use appropriate methods and procedures Must use age-appropriate, approved, standardized instruments and procedures that are valid, reliable, and contain appropriate levels of sensitivity and specificity Must be conducted in a setting appropriate to the needs of the child Must consider the unique characteristics of the child EI Regulation 69-4.8 8

9. Requirements for Conducting the MDE (cont’d.) Include informed clinical opinion and observations Include several sources of information about the child Include parent involvement in the evaluation Use of non-discriminatory procedures; responsive to cultural/linguistic background Must assess all five developmental domains EI Regulation 69-4.8 9

10. Requirements for Conducting the MDE (cont’d.) Must include a health assessment of the child Review of other pertinent records or external evaluations, with parent consent Must include assessment of transportation needs Must include the Parent Interview May include the optional Family Assessment Completed with sufficient time to develop the IFSP within 45 days of referral EI Regulation 69-4.8 10

11. Assessment Tools No single procedure or instrument can be used as sole criterion or indicator of eligibility This does not mean two tests must be conducted, unless the child’s developmental status clearly indicates the need for more than one test 11

12. Assessment Tools and Results Evaluators should: choose from a variety of assessment tools use DOH-approved standardized assessment tools normed for the child who will be assessed utilize appropriate assessment materials specific to the child’s needs be familiar with the assessment tool: scoring and interpreting 12

13. Assessment Tools and Results (cont’d.) If modifying the assessment tool, use the findings for descriptive purposes only Use clinical opinion in interpreting test results Incorporate clinical expertise when assessing very young children (less than a year old) Adjust for prematurity as needed 13

14. The “Team” Approach The evaluation is conducted as a “team” collaboration among the evaluators, not as individual evaluations Evaluation agencies must develop evaluation procedures to ensure the integration and coordination of evaluation services 14

15. Integrating and Coordinating Evaluation Results All sources of information obtained during the MDE must be synthesized and interpreted together to determine eligibility, including: Standardized assessment results Informed Clinical Opinion, including clinical clues and predictors of a continued delay Child’s Health Assessment Parent Interview (and optional Family Assessment) Other assessment tools (non-standardized) Additional sources of information (direct observation, day care providers, external evaluations) 15

16. Unit #3 Components of an Evaluation 16

17. Described in EI Regulation 69-4.8(a)(4) A required component of the MDE Used to determine the family’s concerns, priorities, and resources related to the child’s development Others can be interviewed, with parent consent Must be fully documented in the evaluation report and summary Parent Interview 17

18. Examples of Parent Interview Questions • Describe your child’s typical daily routine. • Describe your child’s favorite activity or toy? How does he/she play with it? • What new things has your child recently learned? • How does your child play with you and others? 18

19. Family Assessment Assists the family in assessing their own concerns, priorities, and resources related to enhancing their child’s development. It may include how the family views: their knowledge and need for information about a child’s delay or disability the family’s composition (including siblings and extended family) the family’s demographics and specific circumstances 19

20. Family Assessment family values and culture the family’s current support systems and resources (including extended family) the family’s stressors, tolerance for stress, and coping mechanisms and style family interaction and patterns of parenting style caregiving skills and sharing of caregiving responsibilities 20

21. Examples of Family Assessment Questions • Are you currently using any supports in the community? • What activities in the community would you and your family like to become involved in? • Do you think you need more information about your child’s development or disability? • Do you need help in accessing child care or day care for your child? • Do you have adequate time for yourself? 21

22. Parent Interview vs. Family Assessment

23. Cultural and Linguistic Considerations “Responsiveness to the cultural background of the family shall be a primary consideration in all aspects of evaluation and assessment.” EIP Regulations 69-4.8(a)(14)(i) 23

24. Cultural and Linguistic Considerations The evaluator should: Assess the family’s culture, parent priorities, parenting styles, and support system Ascertain the dominant language of the child and the language preference of the parent Assess the need for a bilingual evaluation or use of an interpreter/translator Consider use of cultural/community advocate where available

25. Cultural and Linguistic Considerations(cont’d.) Understand the limitations of standardized tests for culturally and linguistically diverse populations Provide a child who is exposed to more than one language with the opportunity to respond in any of the languages Understand other modes of communication used, e.g. body language, posturing, etc. Understand the cultural and familial differences regarding eye contact, gender roles, play, and social interactions 25

26. Unit #4 Determining Eligibility

27. Points to Remember No single measure or source of information may be used to establish a child’s eligibility; eligibility is not based on test scores alone It is possible for a child to have a developmental delay and not meet the initial eligibility criteria for the EIP (e.g., “late talkers” who appear to be experiencing a normal variation in development) It is also possible that a child may have a delay, but not qualify for services under the Early Intervention Program Some children who are not eligible may continue to receive screening and tracking, if they appear to be at risk for developmental delay 27

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30. Eligibility Criteria Based on Communication Delay Only For children found to have a delay in only the communication domain, delay is defined as: Score of 2 SDs below the mean in the entire communication domain; OR If no standardized test is available or appropriate for the child, ORthe tests are inadequate to accurately represent the child’s development in the informed clinical opinion of the evaluator, a delay in communication shall be a severe or marked regression in communication development 30

31. Eligibility Criteria Based on Communication Delay Only EI Regulations Section 69-4.23(a)(2)(iv) outline specific eligibility criteria for children younger than and older than18 months of age. 31

32. What is Informed Clinical Opinion? The best use of quantitative and qualitative information by qualified personnel regarding a child and family. Such information includes: The child’s functional status Rate of change in development The child’s prognosis 10 NYCRR 69-4.1(x) 32

33. What is Informed Clinical Opinion? (cont’d.) Must always be used in combination with diagnostic instruments to determine the degree of delay and to formulate an eligibility statement Especially important when standardized instruments are unavailable or inappropriate due to child’s age, culture, language or developmental problem OR did not accurately reflect the child’s developmental level Needs to reflect specific and detailed information, and behavioral observations 33

34. What is Informed Clinical Opinion? (cont’d.) Should document a preponderance of clinical clues associated with the disorder and/or likelihood of continued delay Based on recognized clinical practice guidelines or professional standards 34

35. Preponderance of Clinical Clues • Means the greater weight or the majority of clues which are predictors of continued delay for the age of child being evaluated. • EIP regulation does not quantify that a specific number or a specific percentage of clues must be present in order to document a developmental delay or a preponderance of clinical clues. 35

36. Isolated Issue or Developmental Delay? Feeding Sensory Articulation/Phonology Receptive/Expressive Language Fine/Gross Motor 36

37. Isolated Issue or Developmental Delay? A Sample Comparison 37

38. Making an Eligibility Determination Initial Eligibility for the EIP cannot be established solely by: A delay of 2 SD below the mean or 33% in either gross or fine motor skills. A delay of 2 SD below the mean in either expressive, receptive, or articulation skills. Initial eligibility is based on a delay in the entire domain, not a selected portion. A delay of 2 SD or more below the mean in either gross motor or fine motor skills can help to establish a child’s eligibility for the EIP, but alone it is not sufficient. 38

39. Making an Eligibility Determination The evaluator must determine that there is a significant enough impact on the child’s development and functioning to meet the minimum eligibility criteria for the EIP, including initial eligibility criteria for communication delay only. The evaluator must determine whether all composite findings, considered together using informed clinical opinion, are consistent with initial eligibility criteria 39

40. The Physical Domain The evaluator is required to assess the child’s fine and gross motor skills, vision, hearing, oral motor and feeding, sensory functioning, and neurological development (if appropriate) A total physical domain score as a result of standardized testing must be determined and reported. Evaluators are not expected to work outside their professional scope of practice when assessing the physical domain. 40

41. BREAK 41

42. Unit #5 Reporting Results 42

43. The Evaluation Report and Summary Must contain enough supporting documentation to ensure all members of the IFSP team understand how the child is eligible or not eligible Must contain sufficient information/ description to assist and inform the IFSP team in planning for the appropriate services 43

44. The Evaluation Report and Summary (cont’d.) Must be submitted to the parent, early intervention official, and initial service coordinator; and with parental consent, the child's primary health care provider It should be apparent to the lay reader of the evaluation report and summary how the team formulated the determination of eligibility The MDE report and summary must contain the same required components 44

45. Meet “Anderson Lane” Multidisciplinary Evaluation Report 45

46. Required Components of the MDE Report and Summary The evaluation report should be created as one cohesive document that addresses all developmental domains and includes: identification of persons conducting the evaluation description of the assessment process and conditions under which it was conducted a clear, detailed statement of eligibility 46

47. Required Components of the MDE Report and Summary (cont’d.) family’s belief of whether the child’s responses were optimal description of the assessment tools used and full explanation of scores justification for use of non-standardized instruments an assessment of the unique needs of the child in each developmental domain, including the identification of services appropriate to meet those needs 47

48. Contents of the Report The MDE report and summary should also include: a definition of clinical terms parent’s feedback and response to their concerns regarding the evaluation description of test modifications documentation of evaluator observations and qualitative concerns 48

49. Contents of the Report (cont’d.) interpretation of child’s responses rather than only listing passes and failures documentation of child’s transportation needs description of child’s learning ability – what adaptations worked to help the child participate during the evaluation characteristics of the developmental delay, including the severity and how this impacts the child’s functioning 49

50. Contents of the Report reporting of results of parent interview and optional family assessment detailed reporting of child’s medical history documentation of vision and hearing screening reason for referral description of significant background information 50