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EARLY INTERVENTION
Advocating for Those Who Can’t Speak
WHAT IS EI?
EI is a comprehensive interagency program that supports
children up to age 3 with developmental delays in their
efforts to realize their full potential.
It reduces the likelihood of delays among at-risk children
It assists and empowers families to meet their child’s and
their own needs
It entitles children regardless of race, ethnicity, or income
to services
HISTORY OF EI
Brown v. Board of Education 1954: established
universal right of all children to a decent education
Project Head Start 1964: public policy effort to
improve school readiness and social development of
disadvantaged children
The Education for All Handicapped Children
Act 1975: ensured all children should receive a free
and appropriate education
HISTORY OF EI
Individuals with Disabilities Education Act (IDEA) 1986:
reauthorization of The Education for All Handicapped Children Act that
now mandated public schools to serve children with disabilities starting at
age 3
Part H (1987-96), Part C (1997 on): created services and supports in
all 50 states and US territories creating the early intervention system.
This also allowed states to extend early intervention to at risk children
(VLBW, children born to mothers with MR, etc)
In NY state, Early Intervention Program was established under Article
25 of the Public Health Law in July of 1993
HOW DO YOU REFER TO EI?
Children under age 2 can be referred by their doctors, child care
agencies, social service workers, community –based agencies, and
by their parents
Referral form with instructions:
www.nyc.gov/html/doh/downloads/pdf/earlyint/ei-referral-
form.pdf
Contact your EI official: 1-800-522-5006; in New York City–311
Sample letter for parents to refer their own child:
http://www.health.state.ny.us/publications/0532/sample1.htm
WHAT HAPPENS AFTER A REFERRAL?
1. Early Intervention Official will assign an initial service coordinator
2. If the child is found to be eligible, an Individualized Family Service Plan
(IFSP) will be created
3. If not eligible the service coordinator should explain to the parent how
to access other services and/or how to appeal the decision
4. Reevaluate the IFSP every 6 months
5. Preparation for transition: coordinating service providers, if necessary
contacting Committee on Preschool Education (CPSE) in the child’s
school district
WHAT SERVICES ARE AVAILABE?
Special Instruction
Occupational Therapy
Speech Therapy
Physical Therapy
Psychological Services
Family Training
Counseling
AssistiveTechonology
Respite Services
IS EI EFFECTIVE?
EI increases the developmental and educational
gains for the child and improves the functioning of
the family
Children in EI need fewer special education
services later
They are held back less
RESEARCH SUPPORTING EI
Longitudinal study of Ypsilanti Perry Preschool Project: at 19 years more
finished high school, went on to postsecondary program, had employment,
scored higher on reading, math, and language tests at all grade levels vs.
children who did not attend program (Berruta-Clement, et al. 1984)
Meta-analysis 31 studies in children <3 found EI effective in promoting
developmental progress in infants and toddlers with biologically based
disabilities (Shonkoff JP, Hauser-Cram P 1987)
EI minimizes declines in development (Guralnick, MJ 1991)
Longitudinal Study 25 years later for adults who had participated in
Brookline Early Education Project found in urban group completion of
program associated with >1 year additional schooling completed, fewer
low income (<20,000) earners, more positive health behaviors, and less
depression than matched controls (Rosenberg, et al. 2008)
E A R LY I N T E RV E N T I O N M U N I C I PA L I T Y P E R F O R M A N C E D ATA - N E W Y O R K C I T Y
Evaluation Criteria
Federal Fiscal Year
2008 2007 2006 2005
1: Percent of children receiving services 30 days or less from the date of the authorizing Individualized Family Service Plan 1
78.0% 79.2% 85.5% 92.7%
2: Percent of children receiving services in natural environments 93.2% 92.6% 92.5% 90.2%
4A: Percent of families participating in Part C who report that early intervention services have helped the family know their rights2,3
72.16% (n=176;
95% C.I . = (64.92%, 78.64%))
69.3% (n=293;
95% C.I . = (63.65%, 74.52%))
N/A 70.6%
4B: Percent of families participating in Part C who report that early intervention services have helped the family effectively communicate their children's needs2,3
68.18% (n=176;
95% C.I . = (60.75%, 74.99%))
63.1% (n=293;
95% C.I . = (57.33%, 68.68%))
N/A 65.2%
4C: Percent of families participating in Part C who report that early intervention services have helped the family help their children develop and learn2,3
79.55% (n=176;
95% C.I . = (72.82%, 85.24%))
78.8% (n=293;
95% C.I . = (73.71%, 83.37%))
N/A 82.6%
WHY MAKE CHANGES?
Exploding costs to the state for EI:
-previously, state paid for all services regardless of
parents’ income level
-75,000 children participating in EI, each costing the
state 9,000$ annually
-other states pay 4,000$ per child
EXPLOSION IN EI COSTS
B U D G E T C U T S A N D W H AT T H E Y M E A N S P E C I F I C A L LY F O R E L I G I B I L I T Y
2010-2011 Budget Cuts and regulation changes (finalized
June 3):
1. Parent fees-previously all covered by the state regardless of
income level
2. Decreasing reimbursement rate to providers by 10% for home-
based services
4.. Providers/Agencies to bill Medicaid or private insurers directly
5.. New eligibility criteria
6.Use of ABA aides
7. New standards for provider approval
HOW ARE OUR PATIENTS AFFECTED?
Parent fees:
State proposes a “Medicare-like” funding structure where
80% of funding would come from the state and counties and
20% would be from parents and health insurers
Families earning less than 250% of the Federal Poverty
Level are exempt (= 46,000$ a year for a family of 3)
Health insurers would need to cover the first 5,000$ in EI
costs
HOW IS THIS A PROBLEM?
Payments would need to be made quarterly
If a parent missed one payment the child will lose EI
services and become ineligible
Families must now provide proof of income, otherwise
they have to pay at the highest fee level which could
impede the children of homeless families, children in foster
care, and particularly the children of undocumented
immigrants from access to services
DEFINING DEVELOPMENTAL DELAY
State definition: a child who has not attained developmental
milestones expected for the child’s chronological age, adjusted
for prematurity in one of the following areas
1. cognitive
2. physical
3. communication
4. social or emotional development
5. adaptive development
At three months At six months At twelve months:
• turn their heads toward bright colors and lights
• move both eyes in the same direction together
• recognize bottle or breast
• react to sudden sounds or voices
• make cooing sounds
• make fists with both hands
• grasp toys or hair
• wiggle and kick with arms and legs
• lift head and chest when on stomach
• smile
• follow moving objects with their eye
• turn toward the source of normal sound
• reach for objects and pick them up
• switch toys from one hand to the other
• play with their toes
• help hold the bottle during feeding
• recognize familiar faces
• babble
• sit without support
• pull to a standing position
• crawl
• drink from a cup
• play peek-a-boo and patty cake
• wave bye-bye
• hold out their arms and legs while being dressed
• put objects in a container know five or six words
• stack two blocks
At one and 1/2 years At two years At three years
• like to pull, push and dump things
• follow simple directions ("Bring the ball")
• pull off shoes, socks and mittens
• like to look at pictures
• make marks on paper with crayons
• feed themselves
• walk without help
• step off a low object and keep balance
• use two-to-three-word sentences
• say names of toys
• recognize familiar pictures
• carry something while walking
• feed themselves with a spoon
• play independently
• turn 2-3 pages at a time
• like to imitate their parent
• identify hair, eyes, ears and nose by pointing
• build a tower of four blocks
• show affection
• walk up steps (alternating feet)
• ride a tricycle
• put on their shoes
• open door
• turn one page at a time
• play with other children for a few minutes
• repeat common rhymes
• use three-to-five-word sentences
• name at least one color correctly
• are toilet trained
ELIGIBILITY
Previously: 33% delay in one functional area or 25% delay
in two functional areas
Now: 2 standard deviations below the mean in one
domain or 1.5 standard deviations below the mean in two
separate domains
For language specifically, must show delays in both
expressive and receptive language or in one with the
presence of specific predictors of continued language delay
PREDICTORS OF CONTINUED DELAYS
Language Production
Particularly small vocabulary for age Less diverse vocabulary particularly in regard to verbs Preponderance of general all-purpose verbs (such as "do,"
"make," "want," "go") More transitive and fewer intransitive verbs (such as "give ball")
Language Comprehension
Presence of 6-month comprehension delay Large comprehension-production gap with comprehension
deficit
PREDICTORS OF CONTINUED DELAY
Phonology
Few prelinguistic vocalizations
Limited number of consonants
Limited variety in babbling structure
Fewer than 50% consonants correct (substitution of glottal consonants and
back sounds for front)
Restricted syllable structure
Vowel errors
Imitation
Few spontaneous imitations
Reliance on direct model and prompting in imitation tasks of emerging
language forms
PREDICTORS OF CONTINUED DELAYPlay
Primarily manipulating and grouping
Little combinatorial and/or symbolic play
Gestures
Few communicative gestures, symbolic sequences, or supplementary gestures
Social Skills
Behavioral problems
Few conversational initiations; interactions with adults more than peers
Difficulty gaining access to activities
Health and Family History
Recurrent otitis media
Family history of persistent problems in language learning
WHO DOES THIS AFFECT?
Mainly affects patients with language delays
A child with a delay of 25% or 1.5 standard
deviations below the mean in two aspects of a single
domain no longer qualifies for EI
A child that qualifies because he or she meets the
criteria of a delay 2 standard deviations below the
mean can lose services if there is improvement in
any aspect of that domain
EXAMPLES
A child with a delay of 1.5 standard deviations in
expressive language and 1.5 standard deviations in
receptive language with no other delays is not eligible
A child with a score of 2 standard deviations below the
mean in expressive language but no (or less significant)
delay in receptive language is not eligible
A child that starts out 2 standard deviations below the
mean in expressive and receptive language could lose
services with improvement in one of those aspects
Severe language delay:
Children < 18 months:• Has not reached any of the normal language
milestones expected for children in the next younger age range and none of the upper limits expected for the child’s age range
DOH CLINICAL PRACTICE GUIDELINES FOR COMMUNICATION
DISORDERS
SEVERE LANGUAGE DELAY CONTINUED
Children 18-36 months:• No words by 18 months• Less than 30 words by 24 months• No two word combinations by 30 months• Documented presence of known predictors of
developmental delay in language production, comprehension, phonology, imitation, play gestures, social skills, health and family history
WHAT HAPPENS TO THE CHILDREN ALREADY
ENROLLED?
All children enrolled prior to June 3rd do not need
to meet the new eligibility criteria until the EI official
requests a new evaluation
New evaluations cannot be done before six months
into the program OR there is an observable change
that may indicate that the child is no longer eligible
WHAT CAN WE DO?
Email state legislators: sample letters for parents as
well as others can be found through Advocates for Children
New York at http://capwiz.com/iacny/state/main/?state=NY
Write letters/call your state legislators: to find your
State Senator http://
www.senate.state.ny.us/senatehomepage.nsf/senators?OpnF
orm
To find your NY Assembly member go to:
http://www.assembly.state.ny.us/mem/
ADDITIONAL RESOURCES FOR OUR PATIENTS AND PARENTS
Early Childhood Direction Centers:
www.vesid.nysed.gov/specialed/transition/whocan.htm
Parent to Parent of New York State:
www.parenttoparentnys.org
Other sites for parent information:
www.taalliance.org
www.advocacycenter.com
www.advocatesforchildren.org
www.resourcesnyc.org
FURTHER RESOURCES
Advocacy Services: www.cqc.state.ny.us
Mediation: If with the new changes in eligibility a child is deemed to no
longer be eligible parents can request mediation
Parents can send a letter to their EI official to ask for mediation ,
EI official then notifies Community Dispute Resolution Center
The mediation process must be completed within 30 days of the
Community Dispute Resolution Center receiving the request
If an agreement is made then a written agreement is prepared detailing
the services to be provided
If no agreement is reached then parents can request an impartial hearing
STEPS FOR MEDIATION
Parents can send a letter to their EI official to ask for mediation
EI official then notifies Community Dispute Resolution Center
The mediation process must be completed within 30 days of the
Community Dispute Resolution Center receiving the request
If an agreement is made then a written agreement is prepared detailing
the services to be provided
If no agreement is reached then parents can request an impartial hearing
More info at: New York State Dispute Resolution Association
www.nysdra.org
www.nyhealth.gov/publications/0532/index.htm
REFERENCES
Early Intervention. New York City Department of Health and Mental Hygiene. 22 February 2011 <http://nyc.gov/html/doh/html/earlyint/earlyservices.shtml>.
Early Intervention. New York City Department of Health and Mental Hygiene. 22 February 2011 <http://nyc.gov/html/doh/html/earlyint/earlydif.shtml>.
Early Intervention Program. New York State Department of Health Information for a Healthy New York. 22 February 2011< http://www.health.state.ny.us/ >.
Early Intervention Program. New York State Department of Health Information for a Healthy New York. 22 February 2011< http://www.health.state.ny.us/ >.
Early Intervention Program. New York State Department of Health Information for a Healthy New York. 23 February 2011 <http://www.health.state.ny.us/community/infants_children/early_intervention/ei_revised_regulations_webinar-1_overview_faqs.htm>.
Early Intervention Program. New York State Department of Health Information for a Healthy New York. 23 February 2011 <http://www.health.state.ny.us/statistics/community/infants_children/early_intervention/local_program_performance/new_york_city.htm#three>.
Early Intervention Program. New York State Department of Health Information for a Healthy New York. 24 February 2011 <http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/2005-02/eligibility_criteria.htm>.
Early Intervention Program. New York State Department of Health Information for a Healthy New York. 25 February
2011 <http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/2005-02/appendix_f.htm
>.
Early Intervention Program. New York State Department of Health Information for a Healthy New York. 25 February
2011 <
http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/2005-02/appendix_g.htm>.
REFERENCES
Ramey CT, Ramey SL. “Early Intervention and Early Experience.” American Psychologist. 1998; Vol 53 (2): 109-120.
Bailey DB, Gebbeler K, Scarborough A, Spiker D, Mallik S. “First Experiences with Early Intervention: A National Perspective.”
Pediatrics. 2004 Sep; 114 (3): 896.
Palfrey JS, Hauser-Cram P, Bronson MB, Warfield ME, Sirin S, Chan E. “The Brookline Early Education Project: A 25 Year Follow-
up Study of a Family-Centered Early Health and Development Intervention.”Pediatrics.” 2005 Jul; 116 (1): 144-52.
Early Intervention Scheduled for More Cuts in State Budget. New York State Speech-Language-Hearing Association, Inc. 24
February 2011 <http://www.nysslha.org/i4a/headlines/headlinedetails.cfm?id=52>.
Meeting the Health Care Needs of New Yorkers. Division of the Budget New York State. 25 February 2011. <
http://www.budget.state.ny.us/pubs/archive/fy0304archive/fy0304littlebook/health.html>.
Fertig, Beth. “Schools Chancellor Says Cuomo’s Budget Cuts are Unjust.” WNYC News Blog 15 February 2011: WNYC.
Weaver, Teri. “First Look at Cuomo’s Proposed Budget Shows Cuts, Consolidation.” The Post Standard 1 February 2011: The Post
Standard.
Important Action Alert: Oppose Harmful Changes to Early Intervention. Lublin, Nina. Resources for Children with Special Needs. 23
February 2011 <
http://www.resourcesnyc.org/advocates039-voices-blog/important-action-alert-oppose-harmful-changes-early-intervention >.