Evaluation page 1

Title: / EVALUATION TO DETERMINE ELIGIBILITY
Purpose: / Details the steps to be taken in conducting the initial evaluation of a child to determine eligibility for Birth to Three services.

Overview

Children under the age of three who live in Connecticut are eligible for the Connecticut Birth to Three System because they are either experiencing a significant developmental delay, or they have a diagnosed physical or mental condition with a high probability of resulting in a developmental delay. The Connecticut Birth to Three System does not serve infants and toddlers who are at risk of delay due to environmental causes but who are not actually experiencing a significant developmental delay. All children referred to the Connecticut Birth to Three System without a diagnosed condition, will receive a multidisciplinary evaluation of all five areas of development, using a standardized instrument. This eligibility evaluation will be conducted by the program receiving the referral to determine eligibility.

Who is Eligible for the Connecticut Birth to Three System?

Use of Diagnosed Conditions

A child with a confirmed diagnosed condition that has a high probability of resulting in developmental delay is automatically eligible for the Birth to Three System. The Connecticut Birth to Three System maintains a list of such conditions and modifies the list when appropriate in consultation with the Connecticut Birth to Three Medical Advisor.

The most up to date list can be found on the Connecticut Birth to Three System website “Referrals – Eligibility”

Documentation of a Diagnosed Condition

In most casesthe parent or referral source, if the referral comes from the child’s medical provider will provide documentation of the diagnosis via the referral form sent to Child Development Infoline. Here is what is required for the following diagnosed conditions:

  • For a child who is hearing impaired, an audiology report will be sufficient to document the status of the child’s hearing.
  • In the case of a child diagnosed with childhood apraxia of speech, stuttering-like disfluency, or a speech sound disorder, only a report by a speech languagepathologist showing that it meets Birth to Three eligibility criteria will be accepted.Please refer to Service Guideline 3 Children Referred for Speech Delays for specific eligibility criteria.
  • For children who received a diagnosis of an autism spectrum disorder (ASD), the diagnostic report must include information on how the most recent edition of the Diagnostic and Statistical Manual Diagnosis (DSM-5) of ASD was made and how the child performed in the core deficit areas of ASD.This diagnosis can be made by a physician, licensed social worker or licensed clinical psychologist.

Developmental Delay Definition

The eligibility criteria for a developmental delay is defined in Connecticut as being 2 SD (standard deviations) below the mean in one of the following developmental areas or 1.5 SD below the mean in two or more of the following areas:

A.cognitive development

B.physical development including vision, hearing, motor and health development

C.communication development

D.social or emotional development

E.adaptive skills development (also known as self-help or daily living skills)

Developmental Delay can be substantiated by:

  • Standard deviation scores meeting eligibility criteria following evaluation by two professionals who meet the Connecticut Birth to Three Personnel Standards to complete evaluations, or
  • One professional who holds two certifications or licenses that meet the Connecticut Birth to Three Personnel Standards to complete evaluations, or
  • Documentation of standard deviation scores meeting eligibility criteria from current (within 3 months) medical or other report, or
  • Clinical opinion substantiated by two professionals, or one professional who is qualified in more than one discipline/profession, using objective criteria to determine that the child’s delays meet the eligibility criteria.

Use of Medical Records in Eligibility Determination

Section 303.321(a)(3)(i) of the Part C regulations state that “a child’s medical and other records may be used to establish eligibility (without conducting an evaluation of the child)”. Therefore, if an program obtains written results of an existing evaluation(s), this may be used to determine the child’s eligibility if the following conditions are met (1) they were completed within the past three months,(2) they were conducted by qualified personnel (i.e. they meet the requirements of the Connecticut Birth to Three Personnel Standards), and (3) provide information from a normed standardized instrument that confirms the child is eligible due to a significant developmental delay of minus 2 standard deviations in one area or minus 1.5 standard deviations in two areas. If the program receives a report that meets these conditions then a standardized instrument is not required to determine eligibility and the multidisciplinary team can move forward to complete the initial assessment in all five areas of development (see assessment procedure).

Use of Informed Clinical Opinion to Determine Eligibility

Infrequently, standardized instruments cannot be completed because they:

  • are not applicable due to an infant’s age or significant illness
  • would require significant adaptation for a child to perform the items, thereby invalidating the results

When this is the case, the informed clinical opinion of at least two qualified professionals from different disciplines or one professional who is qualified in more than one discipline/profession may be used tosubstantiate the equivalent delay of 2 SD below the mean in one area of development or 1.5 SD below the mean in two areas of development. Record the reason in the Notes section in the Birth to Three Data System.

Some standardized tests have large age intervals (e.g. six months), a child whose age is just short of the next age interval may have standard scores indicating that he or she is not eligible. Rather than using informed clinical opinion in this instance, it would be advisable to use an instrument with shorter age intervals. The Battelle Developmental Inventory 2nd edition (BDI 2), for example, uses one month intervals for scoring for the first 24 months. Additionally use of a domain specific tool in the area of concern (for example: Alberta Infant Motor Scale for infants with motor concerns or Preschool Language Scale 5 for toddlers with language concern) may yield valid standardized information that confirms the eligibility determination, in addition to the multi-domain tool.

A child who is initially determined eligible for the Birth to Three System by informed clinical opinion of developmental delay must be re-evaluated within six months using a standardized instrument to document that the child is exhibiting a developmental delay of 2 SD below the mean in one area of development or 1.5 SD below the mean in two areas of development.Do not change the eligibility status in the data system. Instead make a note with the date of the confirmed determination. If the child is not eligible based on the results of the re-evaluation, the child should be exited from the system within the month or sooner with parent agreement noting Completion of IFSP as the reason.

Birth to Three Medical Advisor

Providers who have any questions about a child’s eligibility may contact the Birth to Three Child Find Coordinator to request a review by the Birth to Three System’s medical advisor.

Special Circumstances

Eligibility for Children with Delays in Speech Only

A child whose delay in the area of expressive communication is at least 2 SD below the mean, but whose combined score in the communication domain is not at least 2 SD below the mean,is eligible if one of the following risk factors (as determined by a speech pathologist) is also present:

  1. Oral motor disorders
  2. Moderate to severe phonological impairment (fewer than 65% of consonants correct in a 5 minute continuous speech sample)
  3. Chronic otitis media forduration of six months or longer
  4. Family (parents or sibling) history of language impairment or developmental delay
  5. Significant birth history including: congenital infection; craniofacial anomalies including cleft lip; birth weight less than 1500 grams; hyperbilirubinemia at a level requiring exchange transfusion; ototoxic medications; bacterial meningitis; Apgar scores of 0-4 at one minute and 0-6 at five minutes; mechanical ventilation lasting more than five days; head trauma associated with loss of consciousness or skull fracture.
  6. Ongoing concerns by the family or the evaluator about the child’s qualitative performance in the areas of social/emotional or interpersonal skills and/or play interest and/or sensory domains.

The presence of one of the above biological factors must be documented either through medical records, additional assessment, or through behavioral observations. In the case of family history of language impairment or developmental delay, family report is acceptable. In order to adequately weigh these factors, one of the evaluators must be a speech and language pathologist.

When a child’s speech or language is delayed, it is critical that the child’s hearing be screened or evaluated by an audiologist as soon as possible upon beginning early intervention services.

Standardized instruments used to determine a child’s level of development for eligibility typically include very few items in expressive communication. If the child’s delay is in expressive communication only and the child was not found to be eligible based on the developmental evaluation using a multi-domain instrument (e.g. BDI II), then the program must also use a standardized speech and language instrument such as the most current version of the Preschool Language Scales(PLS)or send out a speech-language pathologist before the result of the eligibility evaluation is determined. The speech specific tool must be administered by a speech language pathologist or someone who has been trained in use of the tool.

It is possible that a child showing a mild delay in speech on a multi-domain test that does not have many items in the expressive communication area (for example the Battelle 2) may show a significant delay when tested on the PLS. The information from the PLSis a more accurate measure of eligibility in the area of speech than a standardized multi-domain test of development.

For children who live in homes in which English is not the primary language, the evaluator must be able to demonstrate that the child has a significant delay in communication in his or her primary or dominant language. This often involves using an interpreter to obtain an accurate evaluation. Caution is advised when determining eligibility for such children using evaluation tools designed for English-speaking children. Such scores should not be reported, but should only be used to help the evaluator form a clinical opinion of the child’s degree of delay. Some language evaluations such as the Preschool Language Scale Spanish are normed for young Spanish-speaking children and even adjusted for different dialects.

Children recently adopted from a non-English speaking country will not be eligible due to a significant delay in spoken English communication until at least six months post-adoption. They should be given a complete multidisciplinary developmental evaluation using their native language,if possible,which may identify significant delays in areas other than communication.

For further information about intervention and eligibility for children with speech delays, including use of an interpreter, refer to Service Guideline #3: Children Referred with Speech Delays (2013 Revision).

Eligibility for Children with Motor Delays

While neither gross nor fine motor is actually listed separately as part of the developmental area of physical development in the IDEA Part C regulations (34 CFR 303.21(a)(1), for purposes of eligibility, the Connecticut Birth to Three System considers them to be separate developmental areas. Therefore, a child with a delay of 2 or more standard deviations below the mean in either gross or fine motor is eligible. Consequently, a child with a delay of 1.5 SD below the mean in both gross and fine motor is also eligible.

If the child’s area of concern is in motor and the child was not found to be eligible based on use of a multi-domain evaluation tool, then the program must also complete the most current version of a standardized motor specific instrument (such as the Alberta Infant Motor Scale or Peabody Motor Scales) or send out a motor therapist before the result of the eligibility evaluation is determined. The motor specific tool must be administered by a motor therapist or someone who has been trained in use of the tool.

For a child with concerns in the motor area it is recommended that the medical history of these children be considered along with other early signs of motor dysfunction in the areas of their reflexes, tone, posturing, decreased motor activity, decreased movement variability. This information along with objective information from the evaluation tools could result in determining that a child with undiagnosed neurological disorder is eligible due to clinical opinion. In order to adequately weigh these factors, one of the evaluators must be an Occupational or Physical therapist

Children Born Prematurely

For children born prematurely, an adjusted age should be used onlywhen directed by the administration/scoring directions of the chosen instrument(s).

Additionally, it is recommended that the medical history of these children be considered along with other early signs of motor dysfunction. This information along with objective information from the evaluation tools could result in determining that a child with undiagnosed neurological disorderis eligible due to clinical opinion.

Eligibility for Children Moving to New Families

Ideally the initial evaluation of a child who has moved to a new family, either through foster placement or international adoption, should be postponed for at least a month until the child is able to acclimate to the new people, surroundings, food, and schedule (unless the child has a diagnosed condition or a very obvious disability). Children in foster care have experienced some kind of significant family disturbance and are at risk for social/emotional delays. Please check the Infant Mental Health guidelines for more information on examples of behaviors that signal concerns and specific social/emotional assessment tools to assist in determining eligibility.

Eligibility for Children Who Move to Connecticut

Children who move to Connecticut from another state where they were eligible due to being “at risk” for a developmental delay, will not be eligible for Connecticut Birth to Three services unless the child is currently demonstrating a significant developmental delay.

Children who move to Connecticut from another state where they were deemed eligible because of a diagnosed condition or because they were significantly delayed at the time of their referral to the other state’s program (e.g. 2 SD or 30% delay in one area or 1.5 SD or 25% delay in two areas) are eligible for services in Connecticut unless they are functioning within normal limits in all five areas of development (see Exit procedure). Current information (if not older than three months) sent from the child’s previous early intervention program can be used to determine eligibility. If this information is not available, the program will need to conduct an eligibility evaluation to determine whether the child is currently on age level in all areas or whether he is still demonstrating a delay. If eligible, the child will need to have a multidisciplinary assessment completed for program planning purposes and an initial IFSP developed.

The Connecticut Birth to Three System is not required to provide Part C early intervention services to a child who is also receiving Part C early intervention services in another state if that child and their family are only temporarily visiting in Connecticut. This does not apply to children who are homeless or whose family is highly mobile (e.g. migrant workers) or displaced by a catastrophic event such as a hurricane or flood,who are wards of the state, or who reside on an Indian reservation.

The Initial Evaluation Process

Initial Contact

A program will contact the family within one working day of receiving a referral and provide the name of the person who will be acting as service coordinator to facilitate the evaluation, and or the assessment. If the family does not have a phone they will be contacted by mail. The service coordinator who contacts the family will review the referral information that was received, explain the evaluation and assessment process and discuss the importance and required involvement of the family, caregivers and primary health care provider in this process.

The eligibility evaluation must be completed by:

  • at least two qualified professionals from different disciplines or
  • one professional who is qualified in more than one discipline/profession or
  • one professional who verifies the acceptability of a medical report documenting developmental delay that meets CT Birth to Three eligibility criteria.

The team members should be selected based on the child’s needs (e.g. a speech pathologist should be part of theteam evaluating a child referred for communication concerns). Personnel who are qualified to evaluate for eligibility are those professionals identified in the Connecticut Birth to Three Personnel Standards who have current certification, licensure, or comparable requirements of their profession.

Parents are required to actively participate in the initial evaluation and will be asked where and when the evaluation should take place. The evaluation should be scheduled in the home or in another location familiar to the child in order to elicit the best responses from the child. However, if an evaluation is scheduled using this information and the family is not there when the team arrives, all subsequent attempts to evaluate the child will be scheduled at a location convenient to the evaluators. If either of the parents who will participate in the evaluation is of limited English proficiency, the service coordinator must ensure that an interpreter will be present.

If parents are not active participants valuable information may be missed, families may not assume ownership of decisions made or interventions planned and families may not feel like part of the team. Parent participation may take many forms, based on the family’s perceptions of what is appropriate and important. These perceptions will be shaped by their cultural backgrounds, economic status, and value system as well as the assessor’s attitude and communication skills. Part of the evaluation process must be the consideration of the parent’s preference for their role in the evaluation. Those roles, as described on a continuum from most involved to least involved are: