NECTAC Webinar Series
on Early Identification
and Part C Eligibility
Session 4: Streamlining Eligibity Determination for Part C Early
Intervention
May 10, 2010
Carl J. Dunst, Ph.D
Orelena Hawks Puckett Institute
Asheville, NC
Purposes
• Clarify the meaning of the categories of infants and
toddlers who are eligible for Part C early
intervention
• Describe the procedures for developing guidelines
for simplifying eligibility determination for
participation in Part C early intervention
Placing the Streaming Process in Perspective
(A short history of eligibility determination)
United States of America Committee on Education and Labor
Congressional Report 99-860
Education of the Handicapped Act Amendments of 1986
Definition of the term “Handicapped Infants and Toddlers”
1. Experiencing developmental delays, as measured by
appropriate diagnostic instruments and procedures…or
2. have a diagnosed physical or mental condition which has a
high probability of resulting in a developmental delay
(emphasis added) (e.g., a child with Down Syndrome is de
facto eligible)
Congressional Report 99-860
Meaning of Term “Diagnosed Physical and Mental Condition”
A condition which has a high probability of resulting in a
developmental delay [and includes] infants and toddlers who will
need early intervention services even though many will not
exhibit developmental delays at the time of diagnosis
(emphasis added)
The term [diagnosed physical and mental condition] may also
include at a State’s discretion…infants and toddlers who are “at
risk” of having substantial developmental delays if early
intervention services are not provided (emphasis added)
Individuals with Disabilities Education
Improvement Act of 2004
Public Law 108-446
An infant or toddler with a disability means an individual who:
(A)(i) is experiencing developmental delays as measured by
appropriate diagnostic instruments and procedures,
(A)(ii) has a physical or mental condition that has a high
probability of resulting in developmental delays, and
(B)(i) at risk infants and toddlers who may experience a
substantial developmental delay if early intervention were not
provided
Tracking, Referral and Assessment
Center for Excellence (TRACE)
I want to take the information about eligibility and describe
the development of an eligibility determination process that
attempts to streamline eligibility decisions.
Decision Making Algorithms
An algorithm is a step-by-step decision-making process that
results in an accurate decision in as few steps as possible
The more straightforward the decision making process, the
higher the probability that accurate decisions will be made
An Eligibility Determination Algorithm
The eligibility criteria for Part C early intervention were
used to develop a decision-making process that could
facilitate and streamline infants and toddlers enrollment in
early intervention.
Decision Rules
1. If a child has an identified condition or diagnosis that has a high
probability of resulting in a developmental delay and the condition or
diagnosis is included in the State’s eligibility definition, then the child is
eligible for early intervention.
2. If a child has one or more biological at-risk conditions and any of these
conditions are included in the State’s eligibility criteria, then the child is
eligible for Part C early intervention.
3. If a child has one or more environmental risk conditions and the number
of conditions a child is experiencing meets the State’s eligibility criteria,
then the child is eligible for early intervention.
4. If the child has no identified condition or diagnosis and no biological or
environmental risk factors but has a developmental delay and the
degree of the delay meets a State’s eligibility criteria, then the child is
eligible for early intervention.
5. If the child does not meet any of the above conditions but informed
clinical opinion indicates that the child has an obvious need, then the
child may be considered eligible for early intervention.
Eligibility Determination Decision Algorithm
Relationship Between
Federal and State Eligibility Criteria
Federal Criteria
State Criteria
Does the child
have an
identified
condition?
Is the condition
included in the
State’s Eligibility
Definition?
Step 1
Yes
No
No
to Step 2
Yes
Child is Eligible for
Early Intervention
Relationship Between
Federal and State Eligibility Criteria
Federal Criteria
State Criteria
Does the child
have a biological
risk condition?
Is the biological
risk condition
included in the
State’s Eligibility
Definition?
Step 2
Yes
No
No
to Step 3
Yes
Child is Eligible for
Early Intervention
Relationship Between
Federal and State Eligibility Criteria
Federal Criteria
State Criteria
Does the child
experiencing
environmental
risk factors?
Are the
environmental risk
factors included in
the State’s
Eligibility
Definition?
Step 3
Yes
No
No
to Step 4
Yes
Child is Eligible for
Early Intervention
Relationship Between
Federal and State Eligibility Criteria
Federal Criteria
State Criteria
Step 4
Does the child
have an
established
developmental
delay?
Yes
No
No
to Step 5
Does the degree
of delay meet the
State’s Eligibility
Definition?
Yes
Child is Eligible for
Early Intervention
Relationship Between
Federal and State Eligibility Criteria
Federal Criteria
State Criteria
Step 5
Is there a
developmental
concern that
warrants
intervention?
No
Yes
Child is not
eligible for early
intervention
Is early intervention
warranted based on
clinical opinion?
No
Yes
Child is Eligible for
Early Intervention
Field-Test of the Algorithm
As part of research at TRACE, we used the eligibility
determination algorithm on a sample of 180 infants and toddlers
to determine the usability of the decision making process.ª
Results showed that the decision-making process correctly
identified eligible children at a 95+% accuracy rate.
ª Mott, D.W., & Dunst, C.J. (2006). Use of presumptive eligibility for enrolling children in
Part C early intervention. Journal of Early Intervention, 29, 22-31.
What is Needed to Use the Algorithm?
• An operational definition of developmental delay, explicit
procedures for administering and scoring a developmental
scale or instrument, and clearly defined steps for determining
if a child’s developmental standing meets a State’s definition
of delay.
• A list of identified conditions that without exception make a
child eligible for early intervention.
• If included in a State’s eligibility definition, a list of risk factors
and the particular number or constellation of factors that make
a child eligible for early intervention.
• Clearly stated guidelines and procedures for making a child
eligible for early intervention using informed clinical opinion.
State of the States
• Most States and Jurisdictions (N= 47) do not serve at-risk
infants and toddlers
• The level of developmental delay necessary to be eligible for
early intervention has become increasingly more stringent
• The identified conditions that make a child eligible for early
intervention are in some cases not as explicit as necessary
and in other cases are not known by providers at the streetlevel
• Procedures for using informed clinical opinion are more often
than not vague and difficult to understand
Conclusion
One of the conclusions of the President’s Commission on
Special Education (2001) was that “IDEA establishes complex
requirements that are difficult to effectively implement at the
state and local level. Nowhere in IDEA is this more complex than
the eligibility determination process.” Add to this the
cumbersome and complex procedures states have in the past
and continue to develop, and the complexity is compounded.
Eligibility determination need not be a cumbersome process, and
methods like and eligibility determination algorithm could
streamline infant and toddler enrollment in early intervention and
ensure the timely provision of early intervention supports.
NECTAC Webinar Series
on Early Identification
and Part C Eligibility
Session 4: Streamlining Eligibility Determinations for Part C Early
Intervention
May 10, 2010
Thank you for listening.
Presentations from this series and their related resources
are made available on the NECTAC Web Site at:
http://www.nectac.org/~calls/2010/earlypartc/earlypartc.asp