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HomeMy WebLinkAboutEI-107 Evaluation for Eligibility1 FRANKLIN/FULTON COUNTY MENTAL HEALTH/INTELLECTUAL & DEVELOPMENTAL DISABILITIES/EARLY INTERVENTION 425 Franklin Farm Lane Chambersburg, PA 17202 (717) 264-5387 MH/IDD/EI PROCEDURE STATEMENT PROCEDURE SUBJECT: Evaluation for Eligibility PROCEDURE NUMBER: EI-107 Effective Date: September 22, 2008 Date Revised: October 26, 2022 References: - IDEA 34 CFR §303.321-322, §303.421 - Title 55 PA Code §4226.61, §4226.62 and §4226.95 - Announcement: EI-12 #01 Screening, Evaluation and Assessment in Early Intervention - Announcement: EI-13 #08 Eligibility for Infant/Toddlers and Preschool Early Intervention POLICY: The Franklin/Fulton Early Intervention Program evaluation and assessment policy includes the process of gathering data to determine initial eligibility (Attachment) for services and supports in Early Intervention (EI) that include the following: Procedures are conducted in a non-discriminatory manner, and administered so as not to be racially or culturally discriminatory. All evaluations and assessments of an infant or toddler shall be conducted in the native language. Native language, when used with respect to an individual who is deaf or hard of hearing, blind or visually impaired, or for an individual with no written language, means the mode of communication that is normally used by the individual (such as sign language, Braille, or oral communication). As stated in Early Intervention Policy, 4226.61, the initial evaluation/Multi-Disciplinary Evaluation (MDE) is conducted by personnel independent of service provision. Each infant/toddler referred for an evaluation for EI services and is suspected of having a developmental delay, receives a timely, comprehensive, multidisciplinary evaluation with parental consent. 2 The Franklin/Fulton Early Intervention program provides use of diagnostic instruments and standard tests for the purpose and population for which they are valid and reliable. The instruments and tests shall also be administered in accordance with the recommendations provided by the instrument or test developer, including the guidelines on user qualifications and documented evidence that the user has been trained to administer the instrument or test. For an infant/toddler to be determined eligible, a child assessment shall:  address the unique strengths and needs of the infant/toddler and recommendations for consideration by the team regarding Early Intervention and related services needed to enable the infant or toddler to be involved and make progress in typical routines, community or educational activities  be conducted by qualified personnel who are trained to utilize evaluation and assessment methods The infant/toddler’s medical and other records may be used to establish eligibility (without conducting an evaluation of the child) if those records indicate that the infant/toddler’s level of functioning in one (1) or more of the developmental areas constitutes a developmental delay or that the infant/toddler otherwise meets the criteria for an infant/toddler with a disability and if the parent agrees and the qualified professionals in exercising their judgment conclude that the infant/toddler’s eligibility can be determined through such review and analysis. The Franklin/Fulton Early Intervention program shall ensure a child assessment is conducted to obtain information about the child in all five (5) areas of development and be based on information obtained through an assessment tool and also through an interview with those family members who elect to participate in the assessment; and include the family’s description of its resources, priorities, and concerns related to enhancing the infant/toddler’s development. The screening, initial evaluation and initial assessment of the infant/toddler and family and initial IFSP meeting are required to be completed within forty-five (45) days from the date of the referral for the infant/toddler. There may be exceptional family circumstances and the program may not be able to meet the forty-five (45) day timeline. These circumstances include:  the infant/toddler or parent is unavailable to complete the screening, the initial evaluation, the initial assessments of the infant/toddler and family, or the initial IFSP meeting due to exceptional family circumstances that are documented in the infant/toddler’s EI records; or  the parent has not provided consent for the screening, the initial evaluation, or the initial assessment of the infant/toddler, despite documented, repeated attempts to obtain parental consent. If an exceptional family circumstance exists, documents will note the exceptional family circumstances and/or the repeated attempts to obtain parental consent; complete the screening, the initial evaluation, the initial assessments (of the child and family), and the initial IFSP meeting as soon as possible after the documented exceptional family circumstances no longer exist or parental consent is obtained. 3 The following procedures ensure appropriate eligibility determinations for the Early Intervention program:  identifying an infant/toddler’s unique strengths and needs and the services appropriate to meet those needs throughout the period of the infant/toddler’s eligibility  includes the assessment of the infant/toddler, and the assessment of the infant/toddler’s family The following procedures ensure that an evaluation report includes all required components including the involvement of two (2) or more separate disciplines or professions and with respect to: a) evaluation and assessments of the child and family, which may include one (1) individual who is qualified in more than one (1) discipline or profession; and b) the IFSP Team, must include the involvement of the parent and two (2) or more individuals from separate disciplines or professions and one (1) of these individuals must be the service coordinator Meetings are conducted at least annually to evaluate the IFSP for an infant/toddler with a disability and the infant/toddler’s family and, as appropriate, to revise its provisions. The results of current evaluations conducted under § 4226.61 (relating to MDE), and other information available from the ongoing assessment of the infant/toddler and family, shall be used in determining what services are needed and will be provided. The caregiver will be notified in writing of the results of the evaluation and assessment of the infant/toddler. Information will also be provided on other community supports and services that may be available to the infant/toddler and family. Contact information for the Franklin/Fulton Early Intervention program and Preschool Programs will be provided in the event that the family should have concerns regarding their child’s development in the future. The Franklin/Fulton Early Intervention program has the following procedure in place to review the level of care evaluation or re-evaluation determination for infants/toddlers who are eligible for the ITF waiver:  the Service Coordinator is responsible to request the family's permission to complete a formal level of care assessment for the infant/toddler  if the family gives this permission, the Service Coordinator is responsible to assure that the appropriate assessment and evaluation information is forwarded to the independent Qualified Professional (QP) and to the Infant/Toddler EI Program for completion of this process The level of care assessment shall be based on current social, psychological, and medical information presented to the QP. Generally, no additional assessments or evaluations apart from those records provided through the IFSP development process should be required by the QP. The QP certifies whether the infant/toddler meets the eligibility requirements for the ITF Waiver by signing the level of care form, PW 123, titled: Certification of Need for Infants, Toddlers and Families Waiver. 4 The QP then forwards the level of care form to the Infant/Toddler EI Program for completion of the eligibility determination. The Infant/Toddler EI Program Administrator or designee completes and signs the level of care forms (PW 123). Each infant/toddler's level of care eligibility must be recertified within 365 days of the initial level of care determination and at least once annually thereafter for the infant/toddler to continue to be eligible for waiver-funded IFSP services. This recertification process occurs in conjunction with the infant/toddler's annual IFSP review. The QP bases the recertification on whether the infant/toddler continues to meet the level of care criteria as evidenced by the infant/toddler's most current MDE and IFSP and an evaluation of the infant/toddler's current condition. A review to determine that an infant/toddler continues to qualify for waiver-funded services can be authorized by the Infant/Toddler EI Program at any time, based on information warranting such a review, including a recommendation from the family, the service coordinator or the IFSP team. The QP completes the applicable portions of PW 123-A, titled: Recertification of Need for Infants, Toddlers and Families Waiver, and forwards the form to the Infant/Toddler EI Program. The QP and the Infant/Toddler EI Program Administrator, or designee, completes PW 123-A to signify that the infant/toddler continues to meet the waiver eligibility requirements. A copy of the recertification form shall be maintained on record for a minimum of four (4) years. The Franklin/Fulton Early Intervention program has the following procedure in place to help explain the evaluation process and results to families in a way that they can understand. 1. If there are concerns about the child’s development, a multidisciplinary evaluation will be conducted to determine the child’s eligibility for Early Intervention supports and services. 2. The evaluation will only occur with written permission. Families will be given a consent form to indicate that they understand and agree to the evaluation. Planning for an evaluation begins with a team; the caregiver, Service Coordinator or representative from the Early Intervention Program and other team members may participate as appropriate for the child and family’s needs. The family, parent, caregiver is the expert on their child and their participation as a member of the team is very important. The evaluation will look at all areas of a child’s development. During the evaluation, members of the team will discuss positive things the child is doing, as well as identify any concerns. The evaluation will also determine the strengths and needs of the child and family. Children develop in five (5) primary areas:  Ability to move, see, and hear—physical development  Ability to talk, understand, and express needs—language and speech development  Ability to relate to others—social and emotional development  Ability to eat, dress, and take care of oneself—self-help (or adaptive development)  Ability to think and learn—cognitive development The team explains that while all children grow and change at their own rate, some children can experience delays in their development sometimes this can be cause for concern. 5 The Franklin/ Fulton Early Intervention program will ensure that all staff be trained on new or updated evaluation procedures and that all policies involving evaluations and procedure statements will be reviewed annually or sooner when changes or updates are released. Trainings for new releases or updates will occur for all staff including administrative, independent evaluation team members, therapists and, service coordination staff as needed. Any change or update to the evaluation policy or procedure statement will be sent immediately upon receipt to provider agencies and all policy or procedure changes will be reviewed and discussed at the next scheduled EI provider meeting. ATTACHMENT: Guidance on Eligibility Evaluation Practices Early Intervention Technical Assistance Revised July 2020 1 Guidance on Eligibility Evaluation Practices Early Intervention Technical Assistance Access to Pennsylvania’s Early Intervention program starts with the determination of eligibility during the initial evaluation process. The evaluation team, including the family, works together to implement appropriate, individualized assessment activities that provide documentation to establish eligibility and address the concerns of the family about their child’s development. A variety of assessment activities are used to gather comprehensive evaluation information to assist in identifying the child’s developmental strengths and needs. This can include a review of the child’s medical and other records, administration of a norm-referenced tool, a family/caregiver interview, and observation of the child in typical routines and activities. Diagnostic tools and norm-referenced tests should be used for the purpose and population for which they are valid and reliable. These tests should be administered, and the scores should be interpreted in accordance with the directions in the manual. Evaluators utilizing these tests should meet specified user qualifications and have appropriate training to administer the test. Eligibility is based on a synthesis of the information gathered from all assessment activities and an analysis of that data in relation to Pennsylvania’s eligibility criteria. It is especially important that all data be considered when there is inconclusive or conflicting information with regards to eligibility. When there are questions about eligibility, the evaluation team should review all available information prior to making a decision. In addition, when evaluating the eligibility of infants and toddlers for Early Intervention services, federal and state law allow for the use of informed clinical opinion to establish eligibility. Informed clinical opinion can be used as the determining criteria for eligibility when norm- referenced tools cannot be used to adequately identify the presence or absence of a developmental delay. Possible reasons for using informed clinical opinion to establish eligibility for Early Interventions services include: • using a norm-referenced tool would require significant adaptations for the child to perform the required items, which would invalidate the results. • the child has a significant health concern or illness that makes testing difficult • the child has a limited arousal level or inability to participate at the time of the assessment • cultural/family differences that vary from the norming sample might invalidate the results Revised July 2020 2 The Bureau of Early Intervention Services and Family Supports does not endorse or recommend specific publisher’s tests. Qualified professionals participating in the evaluation process should: 1. Understand the specific eligibility criteria (Infant/Toddler or Preschool) applicable to the child being evaluated and keep up with any new regulations and OCDEL announcements. 2. Have a solid understanding of child development. 3. Be able to explain to families all procedural safeguards. 4. Use individualized assessment activities for each child that provide for an appropriate determination of eligibility and address family concerns and child strengths and needs 5. Provide the family/caregiver with opportunities for participation throughout the process. 6. Thoroughly understand test protocol and scores so that evaluation results and test scores can be accurately and sensitively communicated to the family. 7. Administer and interpret diagnostic and/or norm-referenced tools in accordance with instructions provided in the tool or test manual. 8. Recognize that a child’s test behavior is not always representative of a child’s typical behavior in other settings, and, as a result, families or caregivers need to be asked whether the child’s behavior during the administration of a test was representative of his or her typical behavior. 9. Be able to appropriately document the results of the evaluation and assessment of a child, as well as be able to explain the evaluation and assessment process and results to families. 10. Consider all information gathered during the evaluation process when making an eligibility determination. 11. Understand that eligibility for Early Intervention services can be established by an overall score in one or more of the developmental areas of cognitive, physical (including vision and hearing), communication, social/emotional, and adaptive development. If not established by the overall score alone, with sufficient documentation, eligibility for Early Intervention may be established based on other eligibility categories. Oversight of qualified professionals participating in the evaluation should be conducted by the Early Intervention program (Infant/Toddler and Preschool). In addition, a providers’ direct supervisor may also provide oversight. Oversight and supervision should include: 1. Ensuring that professionals performing evaluations demonstrate appropriate competency in evaluation practices including test administration and interpretation, observation of the child, and the ability to synthesize multiple sources of information prior to participating in eligibility determination activities. 2. Closely monitoring evaluation activities and documentation of those activities to ensure that children are being appropriately identified as eligible for Early Intervention, assessment tools and other activities are being used correctly, and regulations are being followed. Revised July 2020 3 3. Ensuring that the evaluation team receives supervisory guidance or oversight when challenging assessment situations are present, including when there is conflicting information around eligibility. 4. Informing evaluation teams how to get additional support or guidance if they are unable to reach consensus about a child’s eligibility for Early Intervention. 5. Examining evaluation practices to ensure that they are sensitive to individual family backgrounds; including but not limited to linguistic and cultural considerations and being aware that diversity among families is often greater than among evaluators. Revised July 2020 4 Appendix A The table below compares the eligibility criteria for Infant/Toddler Early Intervention services and for Preschool Early Intervention services. Note that both programs use the same definition of developmental delay when determining Early Intervention eligibility. Eligibility Criteria for Infant/Toddler Early Intervention Eligibility Criteria for Preschool Early Intervention Early Intervention services are provided to infants or toddlers who meet one or more of the following eligibility criteria: 1. A developmental delay, as measured by appropriate diagnostic instruments and procedures, of 25% of the child’s chronological age in one or more of the developmental areas of cognitive development; physical development, including vision and hearing; communication development; social or emotional development; and adaptive development. 2. A developmental delay in one or more of the developmental areas of cognitive development; physical development, including vision and hearing; communication development; social or emotional development; and adaptive development, as documented by test performance of 1.5 standard deviations below the mean on accepted or recognized standard tests for infants and toddlers. 3. A diagnosed physical or mental condition which has a high probability of resulting in a developmental delay, including a physical or mental condition that is not accompanied by delays in a developmental area at the time of diagnosis. 4. Informed clinical opinion has established a child’s eligibility when other instruments do not establish eligibility. Informed clinical opinion may be used as an independent basis for establishing eligibility. It may not be used to negate eligibility established through the use of other appropriate evaluation instruments. A child’s medical and other records may be used establish eligibility (without conducting an evaluation of the child) under this part if those records indicate that the child’s level of functioning in one or more of the developmental areas identified above constitutes a developmental delay or that the infant or toddler otherwise meets the criteria for an infant or toddler with a disability [55 Pa. Code § 4226.22] and [34 CFR § 303.321(a)(3)(ii)] Early Intervention services are provided to preschool-aged children who meet the following eligibility criteria: 1. Determined to be a child with a disability including: • Autism • Deaf-blindness • Deafness • Hearing Impairments, • Intellectual Disability • Multiple Disabilities • Orthopedic Impairment • Other Health Impairment • Serious Emotional Disturbance • Specific Learning Disability • Speech or Language Impairments • Traumatic Brain Injury • Visual impairments, including blindness [34 CFR §§ 300.8 and 300.111] or 2. Found to have a developmental delay as result of one of the following: i. The child’s score, on a developmental assessment device, on an assessment instrument which yields a score in months, indicates that the child is delayed by 25% of the child’s chronological age in one or more developmental areas. ii. The child is delayed in one or more of the developmental areas, as documented by test performance of 1.5 standard deviations below the mean on standardized tests. [55 Pa. Code § 14.101] AND In need of special education and related services. [34 CFR § 300.8] Please refer to OCDEL Announcement: EI 13-#08 Eligibility for Infant/Toddler and Preschool Early Intervention for policy directives. Revised July 2020 5 Appendix B Common Test Terminology Evaluators should be trained in interpreting test statistics in addition to being trained in the specific evaluation tools. The terms used below are not mutually exclusive. Tests Standardized Test: A standardized test is a test administered and scored in a consistent or standard manner. A standardized test is administered under standardized or controlled conditions that specify where, when, how, and for how long children have to respond to the questions. In standardized tests, the questions, conditions for administering, scoring procedures, and interpretations are consistent. Norm referenced tests: Norm referenced tests are designed to permit comparison of one child’s performance to that of a referent group by providing measures of relative standing (i.e., standard scores and percentile ranks) that correspond to locations on a normal distribution, often depicted as a bell- shaped curve. Norm referenced tests are sometimes also standardized (meaning all items are administered in a standard format). They may also use observation and interview which are not standardized approaches. Criterion referenced tests: Criterion referenced tests are instruments that are designed to describe a child’s developmental functioning in relation to specified criteria for the purpose of indicating whether the child is evidencing delay in development. The child’s performance is compared to a criteria or performance standard not to the performance of other children. Criterion referenced tests determines if specific skills are mastered, they do not make comparisons to other children’s performance. Scores Raw score: A raw score is the number of questions answered correctly on a test or subtest. For example, if a test has 59 items and the student gets 23 items correct, the raw score would be 23. Raw scores are converted to percentile ranks, standard scores, grade equivalent or age equivalent scores. Age equivalent (AE): AE scores represent the chronological age of the children in the standardization sample for whom a specific raw score was the average (median or mean) score. Standard score: The standard scores represent the degree to which a child’s score deviates from the mean. Standard scores are especially useful because they allow for comparison between children and comparisons of one child over time. Standard deviation (SD): A measure of the variability of a distribution of scores. The more the scores cluster around the mean, the smaller the standard deviation. In a normal distribution, 68% of the scores fall within one standard deviation above and one standard deviation below the mean. Revised July 2020 6 Percentiles or percentile ranks (PR): Percentage of scores that fall below a point on a score distribution; for example, a score at the 75th percentile indicates that 75% of students obtained that score or lower. Developmental age: A measure of a child's development (in body size or motor skill or psychological function) expressed in terms of age norms. Normal distribution curve: A distribution of scores used to scale a test. Normal distribution curve is a bell-shaped curve with most scores in the middle and a small number of scores at the low and high ends. Sources: Wrightslaw: From Emotions to Advocacy, 2nd Edition,Center for Research on Evaluation, Standards, and Student Testing (CRESST), Graduate School of Education & Information Studies, UCLA; American Guidance Service; Harcourt, Inc.; Office of Special Education and Rehabilitative Services, U. S. Department of Education.