Let First Connections be your guide in seeking help for a child.
Infants and toddlers with confirmed or suspected developmental delay are referred to First Connections as soon as possible but no later than seven (7) days after detection, according to IDEA Part C legislation.* Family and community members may also refer. *IDEA 34 CFR §303.303(a)(2)(i)
How do I make a referral?
To make a referral please visit our referral page today.
Referrals should be accompanied by an Rx for a developmental evaluation to determine eligibility along with an Rx for any specialized evaluations the physician deems necessary.
First Connections maintains a Toll Free information line at 1-800-643-8258 which any professional, family member, or individual may access. First Connections staff is ready to assist callers to answer questions regarding referral for early intervention.
When a family is referred, a service coordinator in the area in which the family resides contacts the family to offer an overview of the program and to offer assistance. Family participation is voluntary.
Highlights of IDEA Guidelines Governing EI
34 CFR §303.303(a)(2)(i) – Once a primary referral source identifies an infant or toddler who needs evaluation or early intervention services, a referral for evaluation/assessment must be made within seven (7) days. [NOTE: Referrals can be faxed to the Central Intake Unit along with pertinent medical records / screening results and a prescription for evaluation.]
34 CFR §303.31 – Each infant/toddler referred will receive a timely, comprehensive, multidisciplinary evaluation to determine eligibility (unless child is referred with a diagnosed condition qualifying eligibility) and a family assessment of the needs of the family to appropriately assist in the development of the infant/toddler. [NOTE: “no single procedure is used as the sole criterion for determining eligibility” – child’s level of functioning is assessed in each of the five developmental areas. The process involves: two testing instruments used by qualified personnel, interpretation of test results using informed clinical opinion, and a narrative report.]
34 CFR §303.310 – For an infant/toddler referred for early intervention services and determined eligible, the meeting to develop the initial IFSP must be conducted within 45-days from the date of referral. [NOTE: sending all pertinent records and a prescription for evaluation helps the family receive services in a timely manner and enables First Connections to comply with federal timelines.]
34 CFR §303.344(d)(1) – The IFSP must include a statement of the specific early intervention services, based on peer-reviewed research (to the extent practicable), that are necessary to meet the unique needs of the infant/toddler and family to achieve the results or outcomes identified in paragraph (c – “measurable outcomes expected to be achieved for the child including: pre-literacy and language skills, as developmentally appropriate for the child”). The IFSP must include the criteria, procedures, and timelines used to determine degree to which progress is being made and whether revisions of the expected outcomes and/or EI services are necessary. The IFSP also include information about the length, duration, frequency, intensity, and method of delivering early intervention services and the location/s – including justification for services provided outside of the natural environment with a transition timeline/plan for re-integration into the natural environment.
34 CFR §303.342(e) and §303.420(a)(3) – The projected date for the initiation of each early intervention services is provided on the IFSP; services should begin as soon as possible after the parent consents to the services.
34 CFR §303.26 – “Natural environments means settings that are natural or typical for a same-aged infant or toddler without a disability, may include the home or community settings”
34 CFR §303.26 -- “. . .allows for and supports providing services within family routines and activities.” [NOTE: A family assessment gathers information about the family’s daily routines and resources to, whenever possible, to embed coaching into the family’s typical activities.]
34 CFR §303.126(a) services are provided “to the maximum extent possible” in natural environments and (b) in other settings only when early intervention services cannot be achieved satisfactorily in a natural environment (as determined by the multidisciplinary IFSP team).
34 CFR §303.12(b)(3) -- EI providers “. . .are responsible for consulting with and training parents and others concerning the provision of early intervention services described in the IFSP of the infant or toddler with a disability. . .. Additionally, this consultation and training will provide family members with the tools to facilitate a child’s development even when a teacher or therapist is not present.”
34 CFR §303.510 -- State’s “Part C” programs are the payor of last resort.
34 CFR §303.521 – Families will not be charged any more than the actual cost of service and families with public or private insurance/benefits will not be charged disproportionately more than families who do not have coverage.
34 CFR §303.520(a)(2)(ii) – Providers may not require parents to sign up for or enroll in a public benefits or insurance program as a condition for their infant/toddler to receive early intervention services.
34 CFR §303.521 – Fees will not be charged to parents for services that an infant/toddler is otherwise entitled to receive at no cost. And the inability of a parent to pay for services will not result in denial of or a delay in services.
34 CFR §303.520(a)(3) – A provider may not use public or private insurance or benefits of an infant/toddler or parent to pay for early intervention services unless prior written notification to the parent/caregiver is provided. “No Cost Protection Provision” 34 CFR §303.520(a)(2)(ii) and §303.520 (b)(1) – An EIS provider must obtain consent to use an infant’s/toddler’s or parent’s public or private insurance or benefits if that use would --
Decrease available lifetime coverage or any other insured benefit for the infant/toddler.
Result in the infant’s/toddler’s parents paying for services that would otherwise be covered by the public benefits or insurance program
Result in an increase of premiums or discontinuation of benefits or insurance for the infant/toddler or for the parent
Risk loss of eligibility for the infant/toddler or the parent for home and community-based waivers based on aggregate health-related expenditures.
CFR §303.520(a)(3)(iii) – Parents have the right to withdraw consent to disclosure of personally identifiable information to the agency responsible for administration of the state’s public benefits/insurance program at any time.
Pediatric Professionals' Role in Early Intervention
Several roles for the pediatrician exist under the Individuals with Disabilities Education Act (IDEA). All pediatricians should ensure that in their practices, every child with a disability has access to the following services.
A medical home.5,6 A medical home provides care that is accessible, continuous, comprehensive, family-centered, coordinated, and compassionate. For children with special health care needs, many of whom have an IEP or an IFSP, the pediatrician's central role as the provider of primary care means that he or she would participate in the plan development. In addition, the pediatrician should collaborate with community resources in treatment planning and in promoting early intervention programs that work.
Screening, surveillance, and diagnosis 7,8 The pediatrician should screen all children from the first encounter, checking for risk or existence of a disability or developmental delay. Pediatricians are in key positions to identify at the earliest possible age those children who may benefit from services under IDEA. Pediatricians should provide screening and surveillance using a combination of methods best designed to take advantage of multiple sources of information.
Referral. The pediatrician should be knowledgeable about the referral process to early intervention programs in his or her community and knowledgeable about the parents' right for multidisciplinary team evaluation by the school- or state-designated agency if a disabling condition may be present. In addition, some of the best support of parents comes from other parents who are able to offer emotional and social support and practical advice. Many communities have programs in which parents support each other and help parents new to the system better navigate the system.9Family Voices, a nationwide grassroots network of families and friends speaking on behalf of children with special health care needs, is a creditable organization that can assist parents and pediatricians and is accessible by telephone and the Internet (1–888-835–5669;www.familyvoices. org).
Diagnosis and eligibility. For early intervention, the pediatrician has an important role in the identification of children with established delays and in the diagnosis of conditions with a high probability of developmental delay, which will qualify a child for this program. Each state has developed a definition of these conditions, which should be obtained from the state's lead agency for this infant and toddler program. In addition, some states include “at risk” conditions as defined by the state as eligible for services. Further information about these issues can be obtained from the single point of entry into Part C locally or the state's lead agency. A list of lead agencies for state early intervention services can be obtained from the National Childhood Technical Assistance System (919/962-2001;www.nectas.unc.edu/).
Participation in assessment. A child identified through screening or observation as meeting the definition for developmental delay should receive a comprehensive multidisciplinary assessment. The pediatrician has an important role as a referral source or, if more extensive participation is elected, as a member of the multidisciplinary team. Few pediatricians have the flexibility in their schedules to participate in person in lengthy team meetings. Usually, these meetings are scheduled with a short lead time and at the convenience of the educators arranging them. However, all pediatricians should offer to be available by written communication or participate by conference call or other means to offer input to and receive feedback from the assessment team. Ideally, the pediatrician should be a member of the team and attend the IFSP meeting.
Counsel and advice. During the assessment process, families will need a knowledgeable person for medical advice and counsel. Pediatricians can alert parents to the benefits of a pre-IFSP or pre-IEP conference; of their right to sign the IFSP or IEP (for children over three) only when they are comfortable with the recommendations; and their right to have a friend or other advocate at the IFSP and IEP conference. Although a parent may bring their personal attorney to the conference, most parents do not. If an attorney is going to attend on behalf of the family, the family should notify the school agency of that fact before the meeting to give the school an opportunity to have their legal counsel or top administrator scheduled for the conference. The appeal process begins at the district school board where the child resides. The president of the school board and superintendent of schools should receive the written appeal document. If appeal at the district level fails to satisfy the family's concerns, their next appeal is to the State Board of Education. Rarely does an appeal by either the school district or family go to state or federal supreme courts. Each district school board has a published document that advises parents of procedural safeguards, which can be obtained at no cost to the family. Most assessment teams nominate a member as service coordinator to work with the families. A strong link should be developed between the assessment team and the primary care pediatrician, as well as an open sharing of concerns between parents, the pediatrician, and the assessment team.
Creation of the IEP and IFSP. Pediatricians who participate in the assessment process should be consulted by the assessment team when these documents are created. Such consultation is vital to preparing an appropriate and effective plan. The pediatrician should review the plan developed, counsel the family, and comment on health-related issues as needed. The pediatrician should determine if the health-related services proposed are appropriate and sufficiently comprehensive and assist parents in performing their advocacy tasks when there is evidence of inappropriate planning. Ideally, when schools or educational agencies are developing the IEP or IFSP, a pediatrician should serve as a member of the assessment team.
Coordinated medical services. When medical services are part of the IEP or IFSP, they should be conducted by the primary care pediatrician or an appropriate pediatric subspecialist. Medical services and communication should be coordinated by the primary care pediatrician or his or her designee in those cases in which the children have complex medical needs involving several physicians or centers. Special education personnel should be made aware of the restrictions of health care insurance including limited referral options and the role of the primary physician as “the gatekeeper” in some programs.
Advocacy. Pediatricians have many local and state opportunities to serve as knowledgeable, thoughtful advocates for improved community and educational services for children with disabilities. Pediatricians who select this role need to be aware of the structure of services in the community and the key persons who implement them. Examples of advocacy roles for pediatricians include participation in the local (LICC) or state early intervention interagency council (AICC), consulting with the Part C program and/or local school system or state department of education, or becoming a school board member.
Palfrey JS. Community Child Health. Westport, CT: Praeger Publishers; 1994:93–131
The National Information Center for Children and Youth With Disabilities. Transition Summary. New York, NY: NICHCY; 1993
Individuals With Disabilities Education Act (PL 102–119)
Education of the Handicapped Act Amendments of 1986 (PL 99–457)
American Academy of Pediatrics, Ad Hoc Task Force on Definition of the Medical Home (1992) The medical home. Pediatrics. 90:774.
American Academy of Pediatrics. The Medical Home and Early Intervention: Linking Services for Children With Special Needs. Elk Grove Village, IL: American Academy of Pediatrics; 1995
American Academy of Pediatrics, Committee on Children With Disabilities (1993) Pediatric services for infants and children with special health care needs. Pediatrics. 92:163–165.
(1) Levy SE, (2) Hyman SL