Early Intervention Monitoring Tool

CHILD RECORD REVIEW

Reviewer______Child ID# ______Date of Record Review______

Program Being Reviewed ______Child’s Initials ______

The Child Record Review form is to be used in reviewing individual child records as a part of the Early Intervention Service Coordination monitoring process. A separate document should be used for each child’s record/file that is reviewed.

All questions must be answered Yes, No, or Does Not Apply (DNA).

Please note that the term “intervention plan” is used to describe the IFSP. Similarly, “evaluation report” is used to describe the document resulting from the multidisciplinary evaluation or assessment. In case of questions, the reviewer should consult with the Early Intervention Coordinator of the program.

# / Indicator in EI Management Monitoring Tool / YES / NO / DNA / Comments
(IT) / GS-3General Supervision
Is there evidence in the child’s file that the family has received the Parents’ Rights Agreement (PRA)?
(IT) / For a child eligible for services under the ITF Waiver, form 457A was given and SC note is present, documenting that the family was informed of the fair hearing appeal process for the ITF waiver
(IT) / For a child eligible for services under the ITF Waiver, service coordination notes document that the family was offered a choice of waiver provider(s) from the statewide waiver providers’ list.
4.
(IT) / GS-4 General Supervision
Were all instances of abuse, neglect and exploitation reported by the ServiceCoordinator as per training procedures, and managed in accordance with Child Protective Services Law and Department policy?
5.
(IT) / FS-1 Use of Federal Funds
Did the Service Coordinator demonstrate proficiencies regarding the appropriate use of ITF Waiver for this child?
6.
(IT) / QEIF-1 Quality Early Intervention Framework
Did the Service Coordinator, in facilitating the completion of theevaluation report ensure that the evaluation team members addressed the strengths, needs and level of functioning of the child in the developmental domains of cognitive, physical (including vision and hearing), communication, social and emotional, and adaptive? (If any one area is missing, mark No).
7.
(IT) / QEIF-2 Quality Early Intervention Framework
Did the Service Coordinatorensure that all evaluation activities were completed within the required time frames?
8.
(IT) / QEIF-3 Quality Early Intervention Framework
Did the Service Coordinator ensure that all ITFWaiver evaluation activities were completed within the required time frames?
9.
(IT) / QEIF-4 Quality Early Intervention Framework
Was a written invitation to all IFSP meetings provided by the Service Coordinator to the family and other participants early enough to ensure that they were able to attend, and within the applicable timelines?
10.
(IT) / QEIF-5 Quality Early Intervention Framework
Did the Service Coordinator ensure thatthis child has a current IFSP on the required format that documents all EI services and supports within the required timeframes? (If any part is No, then mark No)
11.
(IT) / QEIF-6 Quality Early Intervention Framework
Did the Service Coordinatorensure that services started no later than 14 days after the completion of the IFSP?
12.
(IT) / QEIF-7 Quality Early Intervention Framework
Didthe Service Coordinator include family information, as well as the assistance and services provided to support the family on this IFSP?
13.
(IT) / QEISD-1 Quality Early Intervention Service Delivery
Is there evidence that service coordination activities were provided as described in state regulations such as:
14.
(IT) / (a) the Service Coordinator coordinated the initial and ongoing evaluations and assessments
15.
(IT) / (b) the at-risk child was referred to tracking and the activities of tracking
16.
(IT) / (c) the Service Coordinator facilitated and participated in the development, implementation, review and evaluation of the IFSP
17.
(IT) / (d) the Service Coordinator assisted the family in gaining access to EI and other services identified on the IFSP?
18.
(IT) / (e) the Service Coordinator facilitated the timely delivery of EI services?
19.
(IT) / (f) the Service Coordinator assisted the family in identifying available service providers and facilitated communication with and between the family and the service provider?
20.
(IT) / (g) the Service Coordinator coordinated and monitored the delivery of EI services?
21.
(IT) / (h) the Service Coordinator informed the family of the availability of advocacy services?
22.
(IT) / (i) the Service Coordinator assisted the family in arranging for their child to receive medical and health services as needed and coordinated the provision of EI services with other services that the child needed or was being provided?
23.
(IT) / (j) the Service Coordinator offered the family opportunities and support for their child to participate in community activities with other children?
24.
(IT) / (k) the Service Coordinator informed the family of appropriate community resources?
25.
(IT) / (l) the Service Coordinator facilitated the development of a transition plan as part of the IFSP?
26.
(IT) / QEISD-2 Quality Early Intervention Service Delivery
Did the Service Coordinator include all of the required participants for the initial evaluation and/or annual evaluations?
Initial Evaluation:
Parent, Service Coordinator, personnel independent of service provision
27.
(IT) / Annual Evaluation:
Parent, Service Coordinator, at least one qualified professional and anyone the parent wants to invite
28.
(IT) / QEISD-3 Quality Early Intervention Service Delivery
Did the Service Coordinator, using an approved tool, develop and update the tracking plan for this infant or toddler eligible for tracking?
29.
(IT) / Is there evidence in the file that the family has been contacted at least once every three months (unless the family agrees to a different schedule of tracking)?
30.
(IT) / QEISD-4 Quality Early Intervention Service Delivery
Did the Service Coordinatorensure that the required personnel participated in the IFSP meeting?
*parent
* Service Coordinator
*other family members as requested by parents
*advocate or person outside the family as requested by parent
*person directly involved in conducting the evaluations
*person who will be providing services as appropriate.
31.
(IT) / If anyone listed above was unable to attend, is there documentation that arrangements were made for their involvement which may have included a telephone conference call, sending a knowledgeable representative, or making pertinent records available?
32.
(IT) / QEISD-5 Quality Early Intervention Service Delivery
Did the Service Coordinator ensure that the team addressed how the needs identified under Special Considerations of the IFSPwill be met? (All Special Considerations must be marked. If not, mark N.)
33.
(IT) / Transition
If the toddler is between 2 years 3 months and 2years nine months,did the IFSP include activities on the transition page to meet the child and family needs related to transition to Preschool EIPart B or the community?
34.
(IT) / Transition
If the child is moving from an early intervention program because of changes in the life of the family or child such as attainment of all goals, new family situations, is the appropriate transition planning shown? (May be in IFSP or in other notes in file.)
35.
(IT) / QEISD-6 Quality Early Intervention Service Delivery
If the IFSP was developed prior to July 1, 2008 and/or no restraints were used, mark DNA for this and #36.
36.
(IT) / For the IFSP developed on or after July 1, 2008, if behavior is checked as a special consideration, a Functional Behavior Assessment (FBA)was conductedand the child’s behavioral needs are addressed byoutcomes/goals in the IFSP or a Positive Behavior Intervention Plan, as an additional document.
37.
(IT) / QEISD-7 Quality Early Intervention Service Delivery
Does the IFSP include outcomes/goals that are related to the recommendations from the evaluation report?
38.
(IT) / Are all outcomes/goals on the IFSP measurable and specific enough that the team and/or reviewer can tell what is to be accomplished and the outcome/goal can be used to determine that progress is being made?
(If some are measurable and some are not, look for patterns. If most are good but a few need a little work, mark yes but add comments. If most are weak, mark no and add comments, even if a few are measurable.)
39.
(IT) / QEISD-8 Quality Early Intervention Service Delivery
Does the file show evidence that family resources, concerns and priorities are current and included on the evaluation report?(Concerns may be related to the developmental needs of their child and other areas of family concerns.)
40.
(IT) / Does the intervention plan include outcomes/goals, strategies, and/or modifications, that reflect the family’s priorities and, as appropriate, enhance their ability to support their child?
41.
(IT) / QEISD-9 Quality Early Intervention Service Delivery
Does the file contain evidence that services are being delivered within the context of the family’s routines?
42.
(IT) / Does the file contain evidence that EI services positively impact the caregiver’s ability to successfully support their child’s participation in daily activities?
43.
(IT) / Does the file contain evidence that services are provided in a manner that recognizes and supports the family’s cultural preferences?
44.
(IT) / QEISD-10 Quality Early Intervention Service Delivery
If a service or services is/are not in a natural environment, does the file contain (a) a justification of the extent to which each service will not be provided in a natural environment, and (b) the location in which it will be provided?
(If any part is missing, mark No).
45.
(IT) / QEISD-11 Quality Early Intervention Service Delivery
Are records/notes available to show evidence that the hours of services being delivered match the hours of services listed on the IFSP?
46.
(IT) / Are services being provided in the environments listed on the IFSP document?
47.
(IT) / Is the IFSP accessible to all service providers responsible for implementation?
48.
(IT) / Have appropriate adaptations been made to environments or materials to support the child/family?
49.
(IT) / Are outcomes/goals on IFSP being addressed by the services provided?
50.
(IT) / Services are delivered with no interruptions or there is documentation that existing gaps were due to family reasons.
51.
(IT) / Are the supports and services being provided effective in meeting the identified needs of the child and family? If answer is no, IFSP team must reconvene.
52.
(IT) / QEISD-12 Quality Early Intervention Service Delivery
Did the child move into the area served by the EI program (from within or outside of PA) with a current IFSP?
53.
(IT) / Did this child receive services comparable to those on the existing document until the EI program adopted the IFSP, developed a new IFSP, or determined that the child was not in need of services?
54.
(IT) / QEISD-13 Quality Early Intervention Service Delivery
Did the IFSP team document how to measure progress on each goal?
55.
(IT) / Did the IFSP team document how much progress was made?
56.
(IT) / Did the IFSP team revise the strategies as needed to maintain or increase the rate of attainment or level of skills?
57.
(IT) / Did the IFSP team document revisions or modifications to the outcomes as necessary?
58.
(IT) / When revising the IFSP, did the team address any lack of expected progress toward the goals?
59.
(IT) / Was a written (words, graphs, other visual representation) report of progress on outcomes/goals provided to parents on the schedule agreed upon in the IFSP?
60.
(IT) / T-1 Transition
For children transitioning out of Infant/Toddler EI, was the invitation letter received at least 30 days prior to the transition meeting, as described in OCDEL letter issued 6/30/05?
61.
(IT) / T-2 Transition
Was the transition conference held not less than 90 days (but not more than 9 months) prior to the child’s third birthday, at the discretion of all parties?
62.
(IT) / Item T-3: Does the IFSP include steps to support the transition of the child with a disability who is over the age of two into preschool EI services, if eligible, or to other services that may be available, if appropriate?

4/2/09 Monitoring Record 1