Effective Date: July 1, 1996
Date Revised: July 1, 2013
Title:
CT Birth to Three System
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
www.Birth23.org under “Referrals – Eligibility”
Documentation of a Diagnosed Condition
In most cases the 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 language
pathologist 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
Evaluation page 2
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.
B.
C.
D.
E.
cognitive development
physical development including vision, hearing, motor and health
development
communication development
social or emotional development
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:
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

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 to substantiate 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
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2.
3.
4.
5.
6.
Moderate to severe phonological impairment (fewer than 65% of consonants
correct in a 5 minute continuous speech sample)
Chronic otitis media for duration of six months or longer
Family (parents or sibling) history of language impairment or developmental
delay
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.
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 speechlanguage 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 PLS is 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
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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 postadoption. 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 only when 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 disorder is eligible due to clinical opinion.
Evaluation page 6
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
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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 the team 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:

demonstrating

validating

interpreting

informing

observing
the parent, at the assessor’s request, has the child
demonstrate various skills
the parent validates for the assessor that the child’s behavior on a
test item is or is not typical
the parent can interpret for the assessor, “oh, when he does that it
means… or “saying ‘ba’ means he wants his baby doll”
the parent provides information about what the child can and
cannot do
the parent watches as the assessor administers test items
This information is also explained to parents in the Family Handbook: Guide I as
various ways that the evaluation team may ask them to participate.
The service coordinator will ask the parent if previous evaluations of the child have
been completed that may help for documentation of a diagnosed condition that affects
Evaluation page 8
eligibility or assessments that may help in determining the child’s present abilities. A
signed release, Form 3-2, to obtain written information and to speak with the child’s
primary health care provider will be obtained at this first meeting.
The service coordinator will ask the parent for authorization to share the result of the
evaluation with the child’s primary health care provider using Form 3-3 to support
ongoing care coordination by the medical home.
Written Prior Notice
Section 303. 21 of the IDEA Part C regulations states that, prior written notice must be
provided to parents a reasonable time before the lead agency or a provider proposes,
or refuses, to initiate or change:
 the identification
 evaluation
 placement of their infant or toddler
 the provision of early intervention services to the infant or toddler with a disability
and that infant’s or toddler’s family
For this reason, parents must receive prior written notice (Form 1-6) before a program
conducts an initial evaluation (see Procedural Safeguards procedure) and after the
completion of the evaluation, whether the child is found eligible or not eligible.
Obtaining Consent for Evaluation
Written consent for the evaluation must be obtained from a parent, surrogate parent, or
legal guardian prior to beginning the evaluation using Consent for
Evaluation/Assessment Form 1-4. Written consent is specific to the evaluation
instrument(s) listed. The program should only list those instruments that will be used at
the initial evaluation or can list all possible instruments and only check those to which
the parent is actually consenting. Listing all possible evaluation instruments on every
consent form is not appropriate. If the parent has consented to the use of certain
instruments and once on-site, the evaluators decide that a different instrument would
also be useful, they should obtain consent for that additional instrument on an
additional Form 1-4. The names of instruments should be spelled out on the form and
not abbreviated.
If the parent or legal guardian refuses to give their consent for the initial evaluation, the
service coordinator will make a reasonable effort to ensure that the parent is fully aware
of the nature of the evaluation and understands that the child will not be able to receive
an evaluation, or services, unless consent is given. If a parent refuses to consent to
evaluation in circumstances where lack of services constitutes child abuse or neglect,
the service coordinator is required to make the necessary report to the Department of
Children and Families, using DCF Form -136 (see Abuse and Neglect procedure).
There are some cases where there may be divorce or separation issues or questions
about which parent is legally able to give consent for an initial evaluation. Typically
either parent can give written consent for an evaluation. The exceptions are:
Evaluation page 9



When one parent’s parental rights have been terminated OR
If there is a State Court custody order that either requires that decisions be made
jointly OR
The custody order gives sole decision-making authority to one of the parents
Regardless of who has decision-making authority, the program must send written prior
notice and a copy of the evaluation report to both parents unless one parent’s rights
have been terminated.
Child Development Infoline (CDI) will ask all parents upon referral whether there are
any custody issues regarding decision making that the program needs to know about.
If the parent says “yes”, CDI will ask whether they have sole or joint custody, and if
there is a parent at another address who should receive the evaluation report. CDI will
list this information, including the second parent’s address, in the notes section on the
referral screen of the data system. If CDI has flagged the issue, the person who
schedules the evaluation should confirm the information when they call to schedule. If
the referring parent has indicated that joint decision-making is required, the program
should send the evaluation consent form out ahead of time so that both signatures can
be obtained. If there is another parent listed at a separate address, both the written
prior notice of the evaluation and the evaluation report must be sent to that second
parent.
Sometimes one parent may request the evaluation without telling the other parent.
Only one parent’s consent is needed to proceed with an evaluation unless there is legal
documentation indicating that joint decision-making is required. If both parents decide
to decline the evaluation when contacted by the program to schedule the eligibility
evaluation or when the evaluation team arrives to complete the evaluation, the program
will indicate that the parent declined the evaluation in the Birth to Three data system.
The program will inform the parents of their right to re-refer their child at any time.
Completing the Evaluation
No single procedure (standardized testing, observation, parent interview, review of
medical information, others) may be used as the sole criterion to determine eligibility.
The team will evaluate all five developmental areas including cognition; physical
(including fine and gross motor, vision, and hearing); communication (including
receptive and expressive); social/emotional; and adaptive using a multi-domain
standardized instrument. The instrument should be used in its entirety. Other
instruments targeting specific domains should also be used when appropriate. Prior to
determining a child ineligible when only using a multi-domain tool, a tool more specific
to the referral concern must also be used (see Special Circumstances section of this
procedure for more information).
If an eligibility evaluation and assessment cannot be completed in sufficient time to
ensure that the IFSP meeting is held within 45 days of referral, the service coordinator
will document the reasons in the child’s early intervention record and the data system.
Evaluation page 10
Evaluating Hearing and Vision
Parent report can provide vision and hearing screening information (also see Form 3-17
Birth to Three Vision Screening) but for eligibility purposes, documentation of visual
impairment or hearing loss must be by doctor or audiologist report.
It is critical that the child’s hearing be screened or evaluated by an audiologist before
beginning early intervention services when speech or language is delayed. If the status
of the child’s hearing or vision is in question then programs must assure that this is
addressed in the IFSP. Any previous audiological testing or screening results, including
newborn hearing screening, are only valid for one year. If current testing indicates a
hearing loss, the program must address that in the child’s IFSP. For vision, unless the
child’s physician has specifically evaluated the child’s vision, the assessor should use
Form 3-17 “Birth to Three Vision Screening”. If any items on the screen are answered
“yes”, a copy of the results with a cover letter should be sent to the child’s physician,
with parent consent, for follow-up.
Choice of Program
Each Birth to Three program is responsible, after determining that a child is eligible, to
give the family objective information on all available programs in their geographic area.
They must allow the family to decide if they wish to receive services from their program
or select another. This includes children with hearing loss or deafness, or an autism
spectrum disorder, whose parents may choose a specialty program or general program
to provide their supports. If another program is selected, the service coordinator will
contact either the program director or Child Development Infoline to determine whether
that program is accepting referrals. If not, the original program should help the family
select a program that is accepting referrals. After obtaining a written release from the
parent using Form 3-3, the original program should send all records to the new program
and complete the electronic transfer operations in the Birth to Three data system.
Children Determined Not Eligible
Parents of children evaluated and found not eligible should receive Prior Written Notice
(Form 1-6) and a written explanation of the decision within four days. See the Dispute
Resolution Regarding Eligibility section of this procedure if the parent is not in
agreement with this decision.
It is important to note that a child may not meet the Birth to Three eligibility
requirements but still show some degree of delayed development, this information
should be conveyed to the parents and included in the evaluation report.
If there are still concerns about the child’s development, the parent may request a new
eligibility evaluation three months after the last evaluation by contacting Child
Development Infoline. The parent may request a new evaluation be completed sooner
than three months from the last evaluation if there is a significant change in the child’s
development or health status. When a second evaluation is requested the parent may
choose to have the original program complete the evaluation or request a different
program if one is available.
Evaluation page 11
With written consent of the parents, children who are evaluated and found to be not
eligible will be offered developmental monitoring through the Ages and Stages
Questionnaires (administered by the Help Me Grow Program) and will also be referred
to other appropriate community resources and programs.
If the child who is not eligible for Birth to Three is suspected to need mental health
services, the parent should be referred back to Child Development Infoline/Help Me
Grow for referral to a licensed mental health professional. In all cases, the phone
number for such referrals is 1-800-505-7000.
Dispute Resolution Regarding Eligibility
If a parent disagrees with the eligibility determination they are encouraged to:
1. Discuss with the evaluator(s) how their child’s abilities and needs compare with
Connecticut’s eligibility criteria.
2. Offer new information to the evaluator(s), such as a recent medical diagnosis
that might affect eligibility.
3. Contact the Child Find Coordinator and request that the eligibility decision be
reviewed; or
4. Send a written complaint or a request for a hearing to the Birth to Three Director
if they feel there were problems with evaluation process.
If a parent calls the Child Find Coordinator or files a written complaint, the following
process will be followed:
1. The Child Find Coordinator will request a copy of the evaluation and any other
available information from the program.
2. The Child Find Coordinator and the Birth to Three medical advisor may review
the evaluation report and supporting documentation.
3. If, during the course of the review, it is discovered that information was
overlooked or the evaluation process was flawed, the program will be asked to
re-consider the eligibility determination in light of the new information or to reevaluate the child.
Evaluation Report
Parents of children evaluated and determined to be eligible should receive a written
statement of eligibility within four days of the evaluation. This may be done by giving a
draft of the evaluation report or it may be just a one page summary form or a visit note.
Regardless of the format, the statement must explain clearly why the child was
determined to be eligible or not eligible. Parents must also receive prior written notice
(Form 1-6) after the completion of the evaluation, whether the child is found eligible or
not eligible, (see Procedural Safeguards procedure)
Whether or not the child was found eligible, each eligibility evaluation and assessment
must result in one typed report. The report should address the child’s development in
Evaluation page 12
all five areas as required by IDEA but should use descriptions of the child’s functioning
within daily activities, rather than a report limited to descriptions of items the child
passed or failed on various tests. It is appropriate to include standard scores when
available with an explanation so that the parents understand the meaning of the scores.
When the results of the eligibility evaluation are combined with an assessment, the
report should provide comprehensive, detailed, strength-oriented information about the
child’s abilities, areas of concern or readiness, learning style, environmental demands,
adaptations, and next steps in development. All reports should be written in a way that
is useful to the parents, avoiding use of jargon. The report must also include the
following:
1. The program name, address, child name, parent’s names, address, DOB, and
age at the time of the evaluation
2. The date of the evaluation.
3. The location of the evaluation.
4. A description of the process and instruments used to complete the evaluation.
5. A description of the child and family’s daily routines.
6. Language that describes the family’s input and how they participated in the
evaluation process. This involvement should be evidenced throughout the report
by referencing the parent(s) role using one or more of the categories provided on
the preceding pages.
7. Child’s strengths, areas of concern and next steps in development.
8. Current levels of functioning across all five areas of development (cognitive,
physical -including vision, hearing, motor and health, communication, social or
emotional, and adaptive skills, also known as self-help or daily living skills).
9. A clear statement of the specific reason(s) why the child was determined to be
eligible or not.
10. Original signatures on the same page along with the credentials of:
 two qualified Birth to Three personnel from two different disciplines or
 one Birth to Three evaluator who is qualified in more than one
discipline/profession or
 one Birth to Three professional who confirmed an acceptable diagnosed
condition or
 one Birth to Three professional stating that an existing report confirmed a
significant developmental delay as defined by Connecticut’s Birth to Three
System
The dates of the signatures should correspond with the date of the report not the date
of the evaluation unless the report was written on the date of the evaluation.
Prior to the evaluation report being finalized, the parents should have an opportunity to
review it with one of the team members to be sure they are in agreement. If the parents
have additional information or request any changes, the report should be modified to
reflect their input. A final copy is given to the family and filed in the child’s record. To
the extent feasible, families with limited proficiency in English should receive a
summary of the written report in their native language.
The service coordinator will ask the parents for written consent to release the final
report to the child’s primary physician (Form 3-3) and the referral source if that is
different from the family or primary physician. Permission to release report should not
Evaluation page 13
be requested until the parent has had a chance to read it at least in draft form.
Evaluation information, including whether the child is eligible, may not be shared with
anyone, including the referral source, without the parent’s written consent.
Information Specific to Autism Spectrum Disorders
Screening Children for Autism Spectrum Disorders (ASD)
The American Academy of Pediatrics recommends that children be screened for an
ASD twice before their second birthday. The Connecticut Birth to Three System
requires that all children referred to the Birth to Three System who are 16 months of
age (adjusting for prematurity up to two years of age) or older and do not have a prior
positive screen or a diagnosis of autism will be screened for ASD as part of the intake
process. This will be explained to the parent and completed even if the parent and/or
referral source have no concerns about autism. All screening and evaluation done by
Birth to Three is voluntary and requires written consent. If the parent chooses not to
have their child screened, the evaluation team must document that the parent refused
consent in their evaluation report. Preferred screening instruments include the Modified
Checklist for Autism in Toddlers (M-CHAT) and the Brief Infant Toddler SocialEmotional Assessment (BITSEA). If there are questions about the child’s overall
communication development and the program chooses to use the Communication and
Symbolic Behavior Scales Developmental Profile (CSBS DP Infant-Toddler Checklist),
the results may be used in lieu of conducting an autism screening.
Children Found Not Eligible for Birth to Three services due to developmental
delay although the screening indicates there is concern about ASD
When a child is not eligible due to developmental delay but the autism screen indicates
the presence of critical behaviors that may indicate an autism spectrum disorder, the
family will be given the opportunity to have one of the autism-specific programs conduct
further assessment to determine if the child meets the diagnosis of autism as
determined by the current Diagnostic and Statistical Manual, (DSM 5). If the autism
assessment indicates the existence of an autism spectrum disorder, then the child is
eligible for the Birth to Three System. The family will then need to choose to have their
child receive services from an autism-specific program or a general program that serves
their town.
Determining if a Child is Eligible for Birth to Three due to a diagnosis of Autism
Spectrum Disorder
When the autism screen indicates the presence of critical behaviors that may indicate
an autism spectrum disorder, the family will be given the opportunity to have one of the
autism-specific programs conduct further assessment to determine if the child meets
the diagnosis of autism as determined by the latest version of the Diagnostic and
Statistical Manual (DSM-5). All of the autism-specific programs are equipped to make
this diagnosis. In some cases they may be made by the general program provided that
one of the evaluators is a physician, licensed clinical social worker, or licensed clinical
psychologist. This determination process will consist of:
Evaluation page 14
1. An in-depth review of the autism screening that was completed to confirm the
“red flags” identified as part of the screening. This may be done as part of the
original screening completed by the Birth to Three program.
2. A review of the child’s health information to determine if the child’s hearing has
recently been screened or evaluated to rule out a possible hearing loss.
3. A review of assessments previously completed on the child to assure that the
child demonstrates a delay greater than 1 standard deviation below the mean in
receptive language, expressive language, social-emotional or adaptive behavior
skills. If needed, additional developmental assessments such as a Vineland
Adaptive Behavior Scales or the Preschool Language Scales 5th Edition (PLS 5)
should be completed to give a full picture of the child.
4. If it is determined that there is a need for further assessment, the administration
of a validated assessment measure such as the most recent version of the
Autism Diagnostic Observation Schedule (ADOS-2), for children 12 months and
older, the Autism Diagnostic Interview-Revised (ADI-R), for children 24 months
and older, or the Childhood Autism Rating Scale (CARS) (2+ years) by a
professional or professionals with appropriate training will be completed.
Children who Receive a Diagnosis of ASD Prior to Referral or Have an Outside
Evaluation for ASD
For children who have received a diagnosis of ASD prior to a referral being is made,
Child Development Infoline will offer the family a choice of one of the autism-specific
programs or one of the general programs serving their town of residence. The program
that receives the referral will first confirm that sufficient information on the diagnosis is
available (see Documentation of a Diagnosed Condition section of this procedure).
Since the child is already known to be eligible because of a diagnosed condition,
whichever program receives the referral will perform an initial multi-disciplinary
assessment in all five developmental domains and a family assessment prior to
developing the initial IFSP.
Children referred due to a concern that the child may have ASD, but a diagnosis
has not been made
If a child has been screened or determined by a doctor to have a high risk of having an
autism spectrum disorder, the children will be referred directly to an autism-specific
program by Child Development Infoline. The autism-specific program must determine
1) whether the child is eligible for Birth to Three based on developmental delay and/or
2) whether the child has a DSM-5 diagnosis of ASD. If a child is determined to have
the DSM-5 diagnosis of ASD, the parent will be offered the choice of remaining with the
autism-specific program, choosing a different autism-specific program that serves their
town, or choosing one of the general Birth to Three programs that serves their town, as
long as the program they choose is accepting new referrals.
If the child is eligible due to developmental delay but is not determined to have a
diagnosis of ASD, the family will be offered a choice of one of the general Birth to Three
programs that serves their town.
Evaluation page 15
If the child is neither eligible due to a developmental delay nor determined to have a
diagnosis of an autism spectrum disorder, the parents will be told that the child is not
eligible and offered resources outside of the Birth to Three System, such as Help Me
Grow’s Ages and Stages Questionnaire (a developmental monitoring and resource
referral program for children at-risk).
If the child who is not eligible for Birth to Three is suspected to need mental health
services, the parent should be referred back to Child Development Infoline/Help Me
Grow for referral to a licensed mental health professional. In all cases, the phone
number for such referrals is 1-800-505-7000.
__________________________
References:
Form 1-4, Consent for Evaluation/Assessment
Form 1-6, Prior Written Notice
Form 3-2, Authorization for Programs to Obtain Information
Form 3-3, Authorization for Programs to Release Information
Form 3-17, Birth to Three Vision Screening
Part C of IDEA Sec. 1432 (5)
34 CFR Section 303.321
17a-248e (e) of the C.G.S.
Section 17a-248-1 (16) of the Regulations of CT State Agencies
Service Guideline #3, Children Referred with Speech Delays
Service Guideline #1, Autism Spectrum Disorder
Exit Procedure
Ages and Stages Questionnaire
Personnel Standards
Procedural Safeguards Procedure