The ABC’s of Early Intervention for
Pediatricians
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INDEX
Referrals
Agencies
Hearing
Emergencies
Families
Prescriptions
Criteria
Glossary
Phone Numbers
Websites
AAP Policies
Centers
Introduction
Over 30,000 children from birth to three years are receiving Early Intervention
(EI) services in New York State. We hope this handout will help pediatricians to integrate
the EI process and the resulting services that their patients and their families receive into
their medical practices. We hope to make it easier for the primary care practitioner (PCP)
to refer patients with suspected or confirmed developmental delay to EI, as well as to
follow up in their care throughout the course of the intervention.
Overview
Pediatricians may refer their patients to the EI program or parents may refer their own
children. Referrals can be made to the Nassau or Suffolk County or New York City
Early Intervention Program (see phone numbers below). It should be noted that referrals
may also be made directly to service providers through their individual programs
(http://www.nyc.gov/html/doh/downloads/excel/earlyint/earlydirectory-sites.xls)
The initial service coordinator (ISC) arranges a multidisciplinary evaluation with
two qualified testers. In addition to this Core assessment, other supplemental evaluations
may be requested. The ISC should review a list of evaluation options with the family.
The ISC should also provide general information about the EI program, as well as the
family’s legal rights. With this evaluation and a recent medical examination, a summary
is written and a report submitted. The plan does not include a diagnosis; it addresses
functional status and needs, as well as strengths and weaknesses. Eligibility for services
is dependent on the extent of delay (cognitive, physical including vision and hearing,
communication, social/emotional and adaptive development) or a clear diagnosis of
developmental disability (e.g. Trisomy 21).
If a child presents with qualifying delays as determined by EI, the next step is an
Individualized Family Service Plan (IFSP) meeting where a written IFSP is developed
and an ongoing service coordinator (OSC) is chosen. The OSC may be a representative of
the program that will be providing services but will certainly ensure that mandated
services are provided. This plan, which outlines appropriate EI services, must be written
with the family’s input and agreement. Most services (especially for younger children)
are provided in the home. Older children may receive services in a center-based program.
Services can include:
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Assistive technology devices and services
Audiology
Family training, counseling, home visits and parent support groups
Nursing services which might be required for developmental services
Nutrition services
Occupational therapy
Physical therapy
Psychological services
Services Coordination
Social Work Services
Special Education
Speech-Language Pathology
Transportation costs necessary to enable a child/family to receive services
Vision Services
It should be noted that medical services may be provided for diagnostic or evaluation
purposes only.
The EI services are reevaluated on an ongoing basis as often as every three
months, but usually at six months and annually thereafter. Transition planning prior to a
child turning three years of age is a part of the care plan.
Tips for Pediatricians
1. There are a number of ways to refer children with confirmed or suspected
delays directly into the EI program. Children who are at risk for
developmental delay can be referred to Child Find (formerly Infant Child
Health Assessment Program (ICHAP)) in the same way. The pediatrician or
parent can call:
NYC – As of October 2006 Referrals should be made either by
dialing 311, or faxing the New York City Early Intervention Program Referral
Form to the Regional Office
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Bronx Fax 718-410-4504
Brooklyn Fax 718-722-2998
Manhattan Fax 212-487-7071
Queens Fax 718-271-6114
Staten Island 718-351-2858
For all other Areas Call :
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Westchester 914-813-5094 Fax 914-813-5093
Rockland 845-364-2620 Fax 845-364-2093
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Putnam 845-228-2847 ext 1031 Fax 845225-1580
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Orange 845-291-2333 Fax 845-291-2418
Dutchess 845-486-3518 Fax 845-486-3554
Certain information is needed for all referrals and includes:
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Name of child, sex, and date of birth
Name, address, phone number of parents
Reason for referral (suspected or confirmed disability or delay) or
child at-risk
See NYC EI referral form: http://www.nyc.gov/html/doh/downloads/pdf/earlyint/eireferral-form.pdf
2. Families can be referred to individual or specific EI agencies that provide
direct services:
Pediatricians should be aware of the EI agencies available to them in their
community. Traditionally all referrals are processed through the Borough or
County Office but referrals can also be made through the EI agencies themselves.
It can be much more convenient to work through an agency with whom you are
familiar and have an established working relationship. Networking makes your
life easier. You can find agencies by contacting your Early Childhood Direction
Center (ECDC) (See resources below) or through the NYC Department of Health
(http://www.nyc.gov/html/doh/downloads/excel/earlyint/earlydirectory-sites.xls).
It should be noted that some agencies provide service coordination only, some
provide direct services only and others offer both. Having an ongoing, working
relationship with two or three agencies in your area can make your job easier by
giving you a specific contact person when an EI evaluation is needed. That
contact person can also personally assist the family with the process.
Representatives from specific agencies are usually happy to make appointments
and visit you in your office.
3. Pediatricians should order a hearing evaluation.
Pediatricians should be aware that hearing evaluations are not mandated
through EI. Pediatricians should therefore ensure that an audiological evaluation
has been scheduled before referring children with speech and/or language delay.
A vision evaluation may be helpful as well.
4. Emergency EI services are available.
By regulations, the initial EI process should be concluded within 45 days.
In certain circumstances the child may be referred for an emergency evaluation.
An interim IFSP can be requested on emergency basis in children who meet
certain criteria (i.e. feeding difficulties, severe delays in a premature baby, etc).
This should be requested at the time of referral. You may still need to allow at
least 45 days for a full IFSP.
5. Pediatricians can stay involved in the EI process and can utilize their special
relationship with families to help:
EI is parent friendly and cannot be instituted if the parents do not want the
services. Furthermore, parents can go to any approved EI agency that they choose.
The PCP may be in the best position to explain the importance of the services to
the family. Therefore it is crucial that pediatricians are familiar with the rules and
laws of EI in order to help parents (see references below). There are certain rights
and due process to which parents are entitled. For example, while re-evaluations
occur every 6 months or annually, they can be done earlier if a parent requests,
based on new concerns or a change in status. In addition, services cannot be
decreased without parental agreement. As pediatricians become better educated
about EI, they can help families to become better advocates.
Parents can give consent for the EI evaluation and IFSP results to be shared with
the pediatrician. Parents themselves can provide the reports to the pediatrician.
Have parents prepare a release or include it when submitting the medical
evaluation. Be sure to let parents and EI personnel know that you want to be kept
involved.
A recent medical evaluation is needed for all children in the EI program.
This is an opportunity to include the pediatrician’s impression and findings, as
well as thoughts on treatment and need for further evaluation. Further referrals to
specialists may be necessary and should be made in conjunction with the EI
process.
Pediatricians can be actively involved in every aspect of the EI evaluation,
therapy and service provision, reevaluation and transition. Physician input can be
provided at any point including evaluation of eligibility, the core evaluation, IFSP
meeting, reevaluation and transition planning. (See AAP policy on IEP and
IFSP). The ISC or OSC can be contacted with parental permission.
BE SURE TO ASK PARENTS TO SIGN A RELEASE SO THAT YOU
CAN BE KEPT INFORMED!!
6. Prescriptions for physical, occupational and feeding therapy need to be
written by the pediatrician:
Referrals are often needed for audiological evaluations, as well.
Pediatricians are in the best position to advise on certain services such as home or
day care and parent support. In complicated cases where multidisciplinary
medical care is needed, the PCP plays a pivotal role in ensuring
appropriate therapy. Since pediatricians are the only team members who can
order occupational, physical and feeding therapy, it is critical that PCPs
understand the EI team evaluations before recommending therapy. (See AAP
policy on prescriptions for therapy).
EI services can get bogged down if therapy orders are not written in a timely
fashion. If you have any questions, contact the Service Coordinator. Make sure
that you have asked parents to sign a release so that you can review the evaluation
and speak to the ISC or OSC.
7. Children with a confirmed or suspected disability OR children at risk of a
disability are all eligible for services. Medical input can be critical in this
determination. Refer anyone about whom you are concerned. Children with
behavioral issues as the primary concern can be referred as well:
There are two sets of criteria to receive services:
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Confirmed or suspected disability
Children must have at least 33% delay in one area or 25% delay in two
areas to qualify for EI services. Areas tested include Cognitive,
Adaptive, Communication (expressive and receptive), Physical (motor,
vision, hearing) and Social-Emotional.
Certain medical conditions such as Trisomy 21, fetal alcohol syndrome,
cerebral palsy and sensory impairments have a high probability of
resulting in developmental delay. These children are also eligible for EI
services. Pediatricians can make these diagnoses and should send
information about the medical condition.
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Risk of a disability
If children don’t qualify by the above criteria, EI can still provide
periodic monitoring for the future through Child Find (previously known
as ICHAP). There are many risk criteria including birth weight under
1501 grams, gestational age less than 33 weeks, hyperbilirubinemia, HIV
infection, congenital malformations, elevated lead, parental illness, etc.
All these diagnoses warrant a referral to Child Find.
(http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/200502/appendix_a.htm).
Referrals are made in the same way.
8. EI is on your side:
When parents express concern, take it seriously and refer to EI. Use the EI
evaluation to supplement your own screening, surveillance or discussions in the
office. This is the first step to determining whether a problem truly exists. EI can
mean providing support and hope to the family. Provision of services can reduce
parental anxiety and provide hope for restoring a child to his/her expected
developmental path or, at least, maximizing that path. For all its ups and downs,
EI does help children.
9. Glossary:
Child Find – Formerly known as ICHAP (Infant Child Health
Assessment Program), serves 0-3 years old who are at-risk for delay by
providing ongoing developmental monitoring and services needed for
optimal development.
Early Childhood Direction Center (ECDC) - Provides
information about programs and services for young children, ages birth
through five, who have disabilities and helps to obtain services.
Early Intervention Official Designee (EIOD): Works in EI
Regional Office and signs/approves services as described in the IFSP
and annual reviews.
IFSP (Individualized Family Service Plan) – This is the written
plan of services developed for the child that guides the OSC and
agency, including frequency as well as expected outcomes.
ISC (Initial Service Coordinator) – As either an employee of an
agency or EI, the ISC oversees the initial EI evaluations and IFSP
meeting.
OSC (Ongoing Service Coordinator) – The OSC is
usually employed by an agency or by EI. They coordinate
care during the entire time child is on EI assuring that all services are
provided as mandated by the IFSP.
10. Helpful phone numbers and websites:
Early Intervention Regional Offices
Manhattan: 42 Broadway Suite 1623 New York, New York 10004 tel. 212-487-3920
Bronx: 1932 Arthur Ave. Suite 20313 Bronx, New York 10457 tel. 718-579-6800
Staten Island: 2971 Hylan Blvd. Staten Island 10306 tel. 718-351-6413
Other Resources:
Advocates for Children: 212-947-9779
Resources for Children with special health care needs: 212-677-4650
www.resourcesnyc.org
Sinergia: 212-643-2840 www.siergiany.org
Internet Resources:
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Advocates for Children - The Steps to Early Intervention: A Guide for New York City
Parents - http://www.advocatesforchildren.org/pubs/ei2.html
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Child Find/ICHAP - http://www.cpphealth.org/pdfs//Section2.pdf
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Child Find referrals/Children at risk http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/200502/appendix_a.htm
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NYC Department of Health and Mental Hygiene – Comprehensive information about
EI including diagnoses with high probability of developmental delay:
http://www.nyc.gov/html/doh/downloads/pdf/earlyint/ei-manual-add.pdf
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NYC Department of Health and Mental Hygiene - Spreadsheet of EI providers http://www.nyc.gov/html/doh/downloads/excel/earlyint/earlydirectory-sites.xls
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NY State Department of Health - The Early Intervention Program: A Parent's Guide for
Children with Special Needs - Birth to Age Three http://www.health.state.ny.us/community/infants_children/early_intervention/parents_gui
de/index.htm
NY State Department of Health – comprehensive information
http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/200502/index.htm
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Relevant AAP policies:
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Individualized Education Plan and IFSP:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;104/1/124
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Pediatricians’ role in EI:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;107/5/1155
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Prescriptions for therapy:
http://aappolicy.aappublications.org/cgi/content/full/pediatrics;113/6/1836
Early Childhood Direction Centers (ECDC) - http://www.vesid.nysed.gov/lsn/ecdc/home.html
Bronx
Service Area: Bronx
Ana Cecilia Hernandez, Director
Early Childhood Direction Center
2488 Grand Concourse
Room 405
Bronx, NY 10458
Phone:(718) 584-0658
Fax:(718) 584-0859
E-mail: ecdcbronx@yahoo.com
Manhattan
Service Area: New York (Manhattan)
Marilyn Rubinstein, Director
Early Childhood Direction Center
New York Presbyterian Hospital
435 East 70th Street, Suite 2A
New York, NY 10021
Phone:(212) 746-6175
Fax:(212) 746-8895
E-mail: mrubinst@nyp.org
Staten Island
Service Area: Richmond (Staten Island)
Laura Kennedy, Director
Early Childhood Direction Center
Staten Island University Hospital
256 C Mason Avenue
3rd Floor
Staten Island, NY 10305
Phone:(718) 226-6670
Fax:(718) 226-6385
E-mail: Lkennedy@siuh.edu
Westchester Region
Area Served: Putnam, Rockland, Westchester Counties
Suzanne Peretz, Director
Early Childhood Direction Center
Westchester Institute for Human Development
20 Hospital Oval West, Room 300A
Vahalla, NY 10595
Phone: (914) 493-1709
Fax:(914) 493-1973
E-mail: speretz@wihd.org
Newburgh (Mid-Hudson Region)
Service Area: Dutchess, Orange, Sullivan, Ulster Counties
Suzanne Tremper, Executive Director
Early Childhood Direction Center
Independent Living, Inc.
5 Washington Terrace
Newburgh, NY 12550
Phone:(845) 565-1162 ext. 209
Fax:(845) 565-0567
E-mail: stremper@myindependentliving.org
Developed by AAP Chapter 2 Committee on Developmental-Behavioral Pediatrics/Children with
Disabilities, adapted by AAP Chapter 3 CCD co-chairs, Lynn Davidson, M.D. and Maris
Rosenberg, M.D.
Jack M. Levine, MD, Chapter 2 Chairman
dpeds@optonline.net
(516) 734-2997
(718) 268-5282
Chuan Chang, MD
Chuan_chang@yahoo.com
718-283-1924
Eileen Fontanetta, MD, MPH
efontanetta@yahoo.com
Hazel Goodwin, MD
hgoodwin@brookdale.edu
Alyson Gutman, M.D.
Dorie E. Hankin, M.D.
doriehankin@yahoo.com
(516) 739-1936
David Meryash, MD
Carolyn Rehm, MD
Eddie Simpser, MD
esimpser@stmaryskids.org
(718) 281-8778
Jogesh Syalee, MD
jsyalee@pol.net
(718) 206-9888 x236
Lynn Davidson, M.D.
ldavidso@montefiore.org
(718) 920-5271
Maris Rosenberg, M.D.
mrosenbg@aecom.yu.edu
(718)430-8504
Special thanks to Vivian Babin, OTR and Dawn Oakley, OTR, St. Mary’s Healthcare System for Children;
Nancy Rybacki, Stepping Stone School; Kathleen Walsh, PHN and Eileen Connolly, PHN, Nassau County
Department of Health
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