Nycearlyinterventionprogram Instructionsforcompletion

NYCEARLYINTERVENTIONPROGRAM INSTRUCTIONSFORCOMPLETION

ABA-SESSIONNOTES-Important Steps, Inc.

GENERALDIRECTIONS for
The interventionist must complete this formfor each session completed and document whenever asession is cancelled and thereasonfor thecancellationon theform. The family shouldreceivea copy ofthe session note asclose aspossible to thecompleted session(upon written request to the agency). The session notes mustbe submitted totheinterventionist’sproviderEI agencyforbilling purposes.
All SessionNote fieldsare mandatory. Refer totheSessionNotePolicy
DEMOGRAPHIC/AUTHORIZATION INFORMATION
Child’s Name: / Informationmustbethesameasin NYEIS (do notusenickname).
DOB: / Enter child’sdate ofbirth.
Sex: / Enter thesex ofthechild(M,F).
EI #: / The EI # appears at thetopofthe “Child Homepage” inNYEIS(i.e. assignment)
Interventionist Name: / Print thenameoftheinterventionistwhoiscompleting thisform/conducting session.
Credentials: / Interventionist’s discipline/credentials, e.g. speechtherapist(Speech/Language
Pathologist, MS, CCC/SLP, special educator (MS Ed.), etc.
National ProviderID (NPI): / WritetheNationalProviderID(NPI).Check w/Important Steps’ HR under which NPI your are subcontracting w/Important Steps, Inc. or entered in NYEIS (i.e. corp’s or ind)
Service Type: / IFSP authorizedservicedelivered by the interventionist,SI-ABA.
SessionDate / Date session was held.
IFSP ServiceLocation: / This is the location the IFSP indicates the serviceis to beprovided (i.e.,home, community (i.e. daycare, library, park) or facility,etc.).
Datenotewritten: / Date that the interventionist completes the note.It is expected thatnotes are written contemporaneouslyor ascloseas possibletothesession(i.e. soon after and before end of the day session was conducted).
Time: / Exact durationofsession.Frombegin timetoend time.AM/PM mustbe indicated in
ordertosupport billing(i.e. check time against IFSP mandate)
ICD-9 code / Therelevant ICD-9codeasindicated onthechild’sevaluation(i.e. check assignment or NYEIS. ICD-9 can be pre-typed).
HCPCSCode(ifapplicable) / EntertheLevel II HCPCScodefortheserviceor product provided by a non-healthcare
interventionist(for example, Special Educator, TSHH or Family Training) (e.g. H2014)
CPTCode(s) / Enter the CPTcode(s) as indicated by the interventionist’sprofessional association.
Dependingonthe CPT code,a sessionmay require that more than one. For example, if thesame service wasprovided fora30 minutesession and theCPT
code isfor15minutesofservice,the CPTcode wouldbe listedtwice.(See
EarlyIntervention Memorandum2003-1).CPT code is assigned during the session; therefore it has to hand-written.CPT codes must correlate w/clinician’s scope of practice.
SessionCancelled: / Whenasession is cancelled:
1. Indicate that the session was cancelled anddocument thefamily driven reason under question#1.
2.The missed session must bemadeupbefore:Write the date that is 2 weeks fromthemissed session.Themake-up sessionshould occurprior to thisdate.
3.This is a make-upsession for:If this session is amake-upsession, checkthis boxandindicate thedate ofthemissedsession.Family vacations cannot be made up. Make ups cannot be done in advance.Be mindful of the amount of make ups allowed per IFSP (i.e. usually there are 6sessions only allowed per IFSP for each authorization).
Note:Refer tothe NYC Make – Up Policy
SessionParticipants / Check the boxthat indicates the sessionparticipants.Specify others not listed(e.g.,
siblings).
Parent/ Caregiver unableto participate / Indicate thereason theparent/caregiver was not able to participate.(Parent or caregiver should be always present for home and community based services)
Questions #1 to #5supporttheinterventionistintheirworkwith theparent/caregiver andthechild.Belowisa diagram
tovisuallyshowwhatkind ofinformation isto becovered -(RefertotheAppendix for definitions ofterms.)

NYCEarlyIntervention SessionNoteInstructions1/2013

Coach parent onstrategies
Observation thatfitthe childand
familybest. Feedback parentin fromparent routine
activities
LearningAgreeand review
Functional Activitiesto strategies
Outcomes dountilthe withinthe
nextvisit routine
activities
1. Describe the progress/responses that
the child has made toward the IFSP outcomes since the last session. Incorporate parent/caregiver feedback. / The information in this section guideswhatwill beworked on during thecurrent session.
Inthissection,theinterventionistmustdocument:
1.Theprogress thechild hasmade sincethelastvisit(i.e.,generalizationto other routines, easeof doing, obstaclesencountered, etc.)afterobserving thechild & parent/caregiverintheroutineand talking with theparent/caregiver.
2.Document feedback fromtheparent/caregiver as towhat strategies workedand didnot work.
Theinterventionistmayalso updateinformation about thechild/familyifthereare changesin medical or developmental statusor incommunity services.
2. IFSP Functional
Outcome(s)and Objective(s) addressed duringthissession: / DocumenttheIFSPfunctionaloutcome(s)andobjective(s)thatwasworked oninthis
session withthe child andparent/caregiver.(i.e. chose one or more of the IFSP outcomes
from the child’s current IFSP)
Note: Ongoing discussion withtheparent/caregiversabout what their concerns, prioritiesand resourcescurrentlyarewillhelp guidethefunctionaloutcomeorobjective thatwillbeworked on.
ABA-DTT- Numbers listed correspond to individualized programs.Place percentage (%) student earned for current program step on line. Every program must be run daily.
3. RoutineActivitiesworked
on duringthe session:
Strategiesused within the
RoutineActivities: / The sessionnotemust includedocumentationthat services are being deliveredwithin
thecontextof thefamily’snaturalroutinesandarefunctionalforthechild.
1.The routinesmust be specific tothe family’s cultural and social environment and areof a concern andpriority for them.
2.Theroutineactivities should includebutare notlimited tothose listedin the functionaloutcomesintheIFSP.
3. It is expectedthat a rangeof familyroutines be documented when appropriate.
Routines should not be limited to“play routines”.
Checkoffallthosethatwereused during thesession orwriteinthedailyroutineifitis notlisted.Routineactivitiesmayinclude(please note that some of these activities are not listed on the session note and can be added in the “Other” section):
 ActivitiesofDailyLiving (ADL)Routineswhichcoverhygiene routines, food routines,dressingroutines;
 Play/Socialization routines,
 Community/Familyroutines;
 Song/RhymeRoutines;
 Book Routines; and
For ABA: please mark all that were conducted during the session:
DTT, MAND, NET, PLAY, ADL, FBA, and/or ANECD.
Indicate thestrategiesusedto help the families/caregivers successfully support thechild’sparticipation in dailyactivities.

NYCEarlyIntervention SessionNoteInstructions1/2013

Thefollowing are examples of strategies (please note that some of these strategies are not listed on the session note and can be added in the “Other” section):

• Verbal cuesonly;
• Gesture with verbal cues;
• Positivereinforcement at all levels;
• Parentmodels -child imitates;
• Physical prompts;
• Hand-over-hand;
• Increased opportunities to practice;
• Modification ofsocial or physical environment;
• Positioning;
• Adaptationof materials;
• Useof Assistive Technology; and
• Discrete trial instruction

4. How did youcoach
(techniques) the parent/caregiver?
Iftheparent/caregiverwas unavailable,how didyou workwiththechild and communicatewiththe parent/caregiverabout the session? / Each familylearnsin different ways.Somefamiliesmay notchoose to participate ina
sessionwhileothers may choose to participate. Checkoff all coaching techniquesused duringthesession. If atechniqueis not listed,please check “other” anddescribe the technique(s).
Some techniques utilized to coach theparent/caregiver includebut arenotlimited tothe following items:
 Observedparent/caregiverandchild performing activities
 Discussed activity with parent/caregiver
 Assisted parent/caregiver
 Giving theparenta pictureillustrating thewaytoposition thechild after demonstratingthemethod
 Demonstrated parent/caregiver activity
 Interventionistmodeledandexplainedthestrategy and provided feedback as parent tried the activity withthe child
 Videotapedlearning activity and reviewed withparent.
 Observedparent/caregiverandchildperforming activitiesand boththe parent/caregiverand theinterventionistprovidedfeedback duringthe session
 Reviewedcommunicationtool with parent/caregiver
 Identifiedthe methodsandsequence oftheactivity for the parent
 Generalized the strategyto other routineswith theparent
Documentthestrategiesthatwereused to work with thechildwhentheparent/caregiver wasnotavailableorchosenotto participatein thesession.(i.e. please note parent or caregiver must be present during the whole session. He/she may choose to observe only. If the session was conducted at the Daycare center as per agreement w/parent, please indicate in this section your follow up communication way w/parents such as “contacted via phone on same day”, or “wrote a note and send it home in communication book”, etc). Indicatethemethodsused to communicate these strategies to the parent/caregiver.
5. Whatlearning activities did theparent/caregiver
agree todo with the child beforethe nextvisit.
(This is the “homework” you give to parents/caregiver to work on until your next scheduled session. This should address3 “W’s: / A learning activity is a combination of the strategyembedded within theroutine activity. Outline the sequence of the learningactivity (ies)for theparent/caregiver that theyhave
agreedto dountil the nextvisit. Indicatehere if theparent/caregiverdid not agree to workon alearning activitywiththereasonif givenand what efforts were madeby the
interventionistto engage the parent/caregiver.
During each visit, the interventionist andthe parent/caregiver determineand collaborate togetheron decidingwhich learningactivities:
Willbe integrated intothechild and family’snaturalroutinesbased on family’s comfortlevelandthatfitseamlesslyinto thefamily’sdailyroutines.
 Willbeused tobuild upon thechild andfamily’sstrengthsandcompetencies.
 Thefamily can use without the presenceof the interventionist.
(You must agree on some “homework” w/parent. Parentcannot refuse to do at least a simple activity as they all have agreed at the initial IFSP to participate in the IEP program)
What activity demonstrated during the session, Where (i.e .park, home, daycare, etc) and When(i.e during which family natural routine activities, example meal time, bath time, play time etc. /

• Theframeworkof the strategies and whetherthey may beusedacrossother natural routines when thechild and family feel they havebeen successful.

• Includerecommendationsof otherinterventionists working withthe parent/caregiver and child whenever possible.
• Include the following information if applicable:
• If the child is authorized an AT device, describe how the family will use the device as part of the child’s daily routine.

Parent/Caregiver Signature
andRelationship tothechild: / The parent/caregiver who participated in thesession signs the sessionnoteand indicates
his/herrelationshiptothechild attheend ofthesession.Thedateused is thedatethat theparent reviews/signsthecompletednote (soon after the session is conducted on same day during the “Indirect time” indicated on Therapy Monthly Logs).Aparent must not beasked tosign an incomplete note. *This does notapply for facilitybased or group developmental services*.
InterventionistSignature,
Date and
License/Certificationnumber / The interventionist signs the session note and addshis/her credentials. If certified, write:: “certified” and donot indicate number. Thedatethatthe session notewas signed is the one entered.
Thisfieldmayalsoinclude theName, Signature,License/Certificationnumberof asupervisor inthecaseof CFYs, or COTAs,asapplicable.Adate shouldalso be indicated.

NYCEarlyIntervention SessionNoteInstructions1/2013