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 >.