MISSOURI’S EARLY INTERVENTION PROGRAM FOR CHILDREN FROM AGES

BIRTH TO 3.

First Steps

Mission Statement

First Steps is a support and service system designed to improve family capacity to enhance their child’s development and learning as well as to increase the child’s participation in family and community life.

Missouri First Steps Philosophy

Is Family-Focused - Requires the Families Active Participation & is a Voluntary Program

An educational/coaching model of service delivery (Is Not Medically-Based)

Provides supports and services in natural environments (where the infant or toddler lives, plays and grows – home and child care)

Service - Provider to suggest strategies and activities to the family to implement which should be wrapped around the way the family and child spend time.

First Steps Belief Statements

Families are Decision Makers and the Child’s First Teacher – Family is forever, providers come and go.

Effective Services are Designed Around and Promote Family Strengths – Promoting family strengths builds confidence & competence that will further enhance the child’s development.

Effective Services are Culturally Competent

Effective Services are Provided in the Context of the Child’s and Family’s Natural Routines

First Steps Belief Statements cont.

Effective Services are Provided in Natural Environments

Services and Supports are Individualized – Services & Supports should fit into a family’s life – not be added on.

Competent Providers Focus on Family Competence – Providers should be “Consultants & Coaches” to families & other Primary Caregivers.

Early Identification and Family Engagement are Critical to Early Intervention

Who is eligible for First Steps?

A child with a diagnosed physical or mental condition associated with developmental disabilities or has a high probability of resulting in a developmental delay or disability.

A child with a half age (50% or more) developmental delay in one of the 5 developmental areas: Physical, Cognitive, Adaptive, Communication or Social Emotional

First Steps Missouri’s Early Intervention Program for Children, ages birth to 3.

Very Low Birth Weight (less than 1500 grams) with one or more of the following conditions:

Apgar of 6 or less at 5 minutes

Intracranial bleeds (Grade II, III, or IV)

Ventilator dependent for 72 hours or more

Asphyxiation

Conditions diagnosed at birth or within 30 days post birth (newborn conditions)

First Steps

Conditions DiagnosedNeonatal/Infant/Toddler Conditions

• Down Syndrome• Cri‐du‐Chat Syndrome• Klinefelter's Syndrome• Trisomy 18 (Edward's Syndrome)• Trisomy 13 (Patau's Syndrome)• Turner's Syndrome• Triple‐X Syndrome• Fragile X Syndrome• Prader‐Willi Syndrome• Pierre Robin

Genetic Conditions known to be associated with developmental disabilities including but not limited to:

Hypoxic‐Ischemic Encephalopathy (HIE) and at term (36 weeks gestation or more)

Cranio‐facial anomalies Epilepsy/Seizure Disorder Spina Bifida Blindness, including visual

impairments Macro/Microcephalus,

including Hydrocephalus Deafness, including hearing

impairments

Fetal Alcohol Syndrome Cyanotic Congenital Heart

Disease PKU (phenylketonuria) Cerebral Palsy Viruses/bacteria

(Herpes, syphilis,cytomegalovirus, toxoplasmosis, and rubella)

Acquired Immune Deficiency Syndrome (AIDS)

Autism Spectrum Disorders

Conditions DiagnosedNeonatal/Infant/Toddler Conditions

Additional conditions known to be associated with developmental disabilities including but not limited to:

Conditions DiagnosedNeonatal/Infant/Toddler Conditions

Other Conditions known to be associated with developmental disabilities to be considered for eligibility must be based upon Informed Clinical Opinion (ICO) by a Board Certified: Neonatologists, Pediatrician, Geneticist and/or Pediatric Neurologist

ICO: The Physician must indicate the specific condition & document the potential impact of the condition in any of the five developmental areas SPECIFIC TO THAT INDIVIDUAL CHILD BEING REFERRED

Who is eligible for First Steps?

Children with a half age (50% or more) developmental delay in one of the 5 developmental domains:

•Physical•Cognitive•Communication •Adaptive •Social/Emotional

Developmental Domains

Physical – Includes hearing, vision and fine and gross motor skills for large and small muscles

Cognitive – Includes thinking, reasoning & problem solving

Communication – Includes expressive language skills (spoken) as well as receptive language skills (understanding of spoken words and/or gestures)

Adaptive – Includes life skills such as eating, drinking, dressing or self independence

Social/Emotional – Includes play skills & interactions with others.

Developmental Delay: Eligibility

First Steps uses the Developmental Assessment of Young Children (DAYC) tool to help determine if a child is eligible to receive services.

The DAYC evaluates the child’s developmental skills in all 5 developmental domains.

In addition to the DAYC; service coordinator interview, feedback from parents and primary caregivers, physician reports, etc., will be used to help determine if a child is eligible for the program.

Individualized Family Service Plan (IFSP)

An IFSP is a written “road map” or action plan for the services that a child and family will receive.

When will the IFSP meeting take place?Part C federal and state regulations require that the IFSP meeting for eligible children be held no more than 45 days after the referral to First Steps.

Who makes up the IFSP Team?The IFSP team includes: The Parents of the Child,Service Coordinator, Early Intervention Providers, Health Care Provider and anyone that the family would like to invite to the IFSP.

Individualized Family Service Plan (IFSP)

The IFSP includes: Present Levels –

Strengths & Concerns The Families CPR’s –

Concerns, Priorities & Resources

Outcomes –Strategies & Activities

Services – Frequency & Intensity

Transitions –into, within, & out of First Steps

The IFSP for each eligible child must be written within 45 days from the date of the referral and reviewed at least every six months as well as annually.

First Steps Services

Physical Therapy

Occupational Therapy

Special Instruction/Developmental Services

Speech and Language Services

Assistive Technology

Audiology

Family Training

Health Services

Medical Services(for evaluation purposes only)

Nursing Services

Nutrition Services

Psychological Services

Service Coordination

Social Work/Counseling

Transportation

Vision Services

Family Cost Participation

Some families participating in First Steps are required to pay a monthly fee.

The fee is not tied to a particular service or amount of services.

A family will pay a single fee regardless of the number of children actually receiving services.

The fee amount varies from $5 per month to $100 per month based on a family’s adjusted income and the number of family members in the household.

Who will be required to pay a Cost Participation fee?

Families eligible and enrolled in Medicaid will not be required to pay the monthly fee.

A family must have an annual adjusted gross income at or above 200% of the federally established poverty level before their obligation to pay a monthly fee is triggered.

If a family encounters “financial hardship”, the monthly fee may be affected. Financial hardship in First Steps is defined as:

• Loss of home • Loss of job (one or more income earners) • Extensive medical costs incurred/documented in the current

year and determined to be applicable by the SPOE

What if a child is found NOT eligible to receive First Steps services?

The Service Coordinator will inform the Family that their child has been found ineligible (go over all assessments & medical records received with the family thoroughly) and provide them with community resources.

The Service Coordinator will also provide the family with a copy of their parental rights, evaluations that First Steps conducted & a notice of action for their records.

If a child is found ineligible and concerns persist, he or she may be re-referred at any time before the age of 3.

First StepsMissouri’s Early Intervention Program for Children from ages

birth to 3.

MEDICAL REFERRALS DEVELOPMENTAL DELAY REFERRALS

ELIGIBILITY DETERMINATION Medical Records or DAYC

CHILD & FAMILY ASSESSMENTS (Assessments, CPRs, RBI)

DELAY SUSPECTED

ELIGIBLE NOT ELIGIBLE

NO DELAY SUSPECTED Parent Withdraw or SPOE Refusal

SCREENING Existing Information and/or Phone Interview

IFSP DEVELOPMENT

INTERVENTION

REFERRAL TO COMMUNITY PROGRAMS

NOTICE & CONSENT Initial Evaluation

NOTICE & CONSENT Initial Evaluation

RELEASE OF

INFORMATION

NOTICE & CONSENT Initiation of Service

Who may refer a child to First Steps?

Primary Referral Sources include:

Hospitals including prenatal and postnatal care facilities

Physicians

Parents or Guardians

Child-Care Programs

Local Educational Agencies (including special education, Parents As Teachers (SB658) and Early Head Start)

Public Health Facilities

Other Social Service Agencies, including DSS and DMH

Other Health Care Providers

How do I refer a family to First Steps?

A person may refer a family to First Steps by calling or faxing their local regional System Point of Entry office (SPOE).

St. Louis Area SPOE:(P) 314-453-9203; (F) 314-453-0802

A person may also refer by calling Missouri First Steps (Toll Free) at: 1-866-583-2392

Online at www.mofirststeps.com

What other resources are available for children who are NOT eligible for First Steps?

Parents as Teachers

Early Childhood Special Education 2 year old programs

Mother’s Day Out Program

Hearing Centers

Medical Services/Outpatient Therapy Services

Early Head Start/ Head Start

Child Daycare Association - CDCA