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CT Birth to Three System and You:
Working Together to Meet Patients’ Needs
September 16, 2014
Presenters:
Ann Milanese, MD,
Associate Professor of Pediatrics at UCONN School of Medicine, the Medical Director
of Education Rehabilitation Services and Division Chief of Development and Rehabilitation Medicine at CCMC and
Medical Advisor to the Connecticut Birth to Three System
Cliff O'Callahan, MD, PhD, Pediatric Faculty and Director of Nurseries, Middlesex Hospital.
He serves
as Chair of the Multidisciplinary Action Group of the AAP Section Forum Management Committee, former President of
CTAAP and is the Immediate past Chair of the AAP Section on International Child Health.
Eileen McMurrer, M.Ed., CT Birth to Three System Public Awareness Coordinator and University of CT
Health Center medical school faculty
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Today we will talk about:
1. How and when to make a referral to CT Birth to Three
2. Eligibility criteria for early intervention (EI)
3. Core components of early intervention
4. The range of services available through Birth to Three
5. Strategies for successfully meeting patients’ needs in
collaboration with Birth to Three
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What is Birth to Three?
• A system of supports for families to help them meet the needs of their
infants and toddlers who have developmental delays
• Part C of a federal law called the Individuals with Disabilities
Education Act (IDEA), and state law 17a-248. Part B of IDEA is
special education for children ages 3 – 21 years.
• In Connecticut, the Department Developmental Services is the lead
agency that administers the Birth to Three System.
• Contracted Birth to Three programs provide supports and services.
Each program serves a specific set of towns. Three specialty
programs serve children with hearing loss statewide. Autism-specific
programs work with children on the Autism Spectrum.
• Medical Advisor liaises with health care professionals and
provides guidance to Birth to Three
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System Overview
Federal Dept. of Education, Office of Special Education Programs
CT Lead Agency: Department of Developmental Services (DDS)
Annual Budget: $49.55 million (FY14)
Personnel: 14 DDS central office staff
45 programs
approx. 1,200 direct care providers
Children and Families Referred: 8,720 in FY14
Served: 9,686 in FY14; may have been referred in a
previous fiscal year
Service Locations: Child’s Home or Child Care 97%
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Required System Components - Federal
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Comprehensive Child Find and referral system
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Public Awareness program including information for
parents
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Rigorous definition of “developmental delay”
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Appropriate EI services available for all eligible children
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Timely, comprehensive, multidisciplinary evaluations
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IFSP and service coordination for each eligible child
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Policies and procedures to ensure that early intervention
services are provided in natural environments
•
…plus nine others…
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Screening and Early Identification
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PHCPs:
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developmental surveillance
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Autism screening
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Mental health screening
Improved screening using valid instruments leads to earlier referral and
identification.
Earlier identification and service provision leads to better child and
family outcomes and significant cost savings.
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Referral for Evaluation
Anyone can refer a child
•
Only the Parent can give consent to proceed
Most parents refer their own child (61%)
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Parents who did not previously know about Birth to
Three learned about it from:
•

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PHCP (66%)
Relative, friend (17%)
2-1-1 or ASQ (3%)
Other health care provider (6%)
Child care or preschool (6%)
Media (2%)
No need to wait for a diagnosis to refer
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Child Development Infoline (CDI)
CDI is the intake office for all Birth to Three referrals by
phone, fax or online
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1-800-505-7000
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•
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TTY and Language Line phone interpreter service available
fax referral form to 860-571-6853
www.birth23.org -- “Referrals – Eligibility” tab at top
CDI staff are available M-F, 8am - 6pm
Voicemail at all times
Children who are within 45 calendar days of their 3rd birthday
are redirected to their local school district.
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Billing Medicaid for completed
Screenings
Effective August 1, 2014, providers who bill for completion of
developmental and behavioral health screening tools using CPT
code 96110 must add a modifier that indicates the outcome of that
screen as Positive (U3), or Negative (U4).
When a child has a positive screen, the provider should:
• Provide age appropriate anticipatory guidance
• Refer for evaluation/assessment
Birth to Three provider agencies are all Medicaid-enrolled providers.
Children under three years old with a positive screen should be
referred to Birth to Three for a developmental evaluation.
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Referral from PHCP
CDI confirms parent choice to obtain an evaluation for their
child, then sends a letter to referral source with:
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Name of B-3 program that will determine eligibility, if the
parent agreed (this is where you send medical records with
parent consent)
•OR,
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Notice that:
•
•
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the family could not be reached, or
the family declined services, or
the child was previously referred
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Supporting Parent Understanding
When you talk with the parent about making a
referral for their child, please tell them
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Why you are concerned about their child’s development
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how important early brain development is for later success
in school and in life
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the evaluation is FREE
•
Birth to Three is just as important as following up with any
other specialist, e.g., neurologist
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Eligibility
Children are eligible in Connecticut when they
1. have a significant developmental delay
2 Standard Deviations below the mean in one area of
development, or
1.5 Standard Deviations below the mean in two or more areas
of development
(89% in FY14)
OR
2. have a diagnosed physical or mental condition
with a high probability of resulting in a developmental
delay
(11% in FY14)
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Using Medical Records for Eligibility
Section 303.321(a)(3)(i) of IDEA 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 a program obtains written results of an
existing evaluation(s), these may be used to
determine the child’s eligibility when:
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Testing was completed within the past 3 months, and
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Report provides information from a standardized, norm
referenced instrument that confirms scores meeting
Connecticut eligibility criteria, and
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The determination is made by an appropriately composed
Birth to Three team
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Children who are Not Eligible
Not eligible == No developmental delay
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Continue developmental surveillance
Provide parent with anticipatory guidance
Refer to Help Me Grow 1-800-505-7000 for other
community supports
Encourage parent to enroll their child in Ages and
Stages Questionnaires (ASQ)
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Request parent consent to have screening results sent to your office
If you are still concerned 90 days later,
Re-Refer to Birth to Three
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Supporting Parent Enrollment
Most families of eligible children choose to enroll
•Some do not…
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“State system”…..DCF?
Home-based supports: + / Parent sliding fee scale
Not ready to accept their child’s delay
Wait and see…
Are uncertain about what they are being offered
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Key Elements of EI Services
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Family-centered
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Coordinated
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Evidence -based
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Strengthen positive parent-child relationships
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Primary provider is the service coordinator
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Community connections and supports
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e.g., Medical Home, Early Head Start, libraries, town park programs
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Birth to Three Programs
All Birth to Three Programs are comprehensive
This means that every program has the staff and expertise to deliver
all services as required under Part C of IDEA to enrolled children
Three types:
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General Programs - work with any eligible child and family
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Programs for children who are Deaf or Hard of Hearing
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Programs for children with Autism spectrum disorders
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Services and Supports
• focus is on the whole family, not just the eligible child
• designed around family’s needs, concerns, and priorities
• use natural learning opportunities that happen throughout the day
• family chooses their desired outcomes and which skills to work on
with their child
• service coordinator coaches the caregivers and works with the child
and family in a close partnership
• services are transdisciplinary and reflect input and expertise from
the entire Birth to Three team and other providers
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Types of Early Intervention Services
Every family is given service coordination.
Additional services may include:
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assistive technology devices and services
audiology services
family training, counseling, and home visits
health services
medical diagnostic or evaluation services
nursing services
nutrition services
occupational therapy (OT)
physical therapy (PT)
psychological services
Sign language and cued language
social work services
specialized instruction
speech and language services
transportation or mileage reimbursement when necessary to receive other IFSP
services
vision and mobility services
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IFSP (Individualized Family Service Plan)
Child and Family Information
• Daily Activities:
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What is/is not going well?
What Else is Important
• Child/Family Outcomes
• What’s Next for Us? including Transition
• Early Intervention Services and Supports
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*What is going to
happen
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*Delivered by:
(Discipline
responsible)
*Location
Who is Part of Our Team
*How
often
*How
long
*Start
date
*End
date
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IFSP Section Eight: Services Page
Must be signed by a physician or APRN before
services can begin
Thank you for reviewing, signing and returning the
IFSP to the Birth to Three program working with the
family as soon as possible to avoid delays in starting
services and family supports.
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Infant Mental Health
P.A. 13-178 was established to meet the behavioral health needs of all
children in Connecticut
Infants and toddlers may experience mental health issues directly
themselves, or from their caregivers, e.g., maternal depression.
Elements of support for infant mental health include:
1.
easy access for diverse families
2.
a system of early identification of concerns, screening, and referral
3.
full access to an array of supportive resources
4.
promotion of family knowledge of conditions and service delivery
systems
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ensuring family-centered care with family satisfaction as an outcome of
interventions
– Adams, et al., 2013, Pediatrics 132;e1073
ALL Birth to Three programs employ mental health professionals trained
in early identification and treatment of social-emotional issues.
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What does a home visit look like?
Providing effective supports in a family’s home
requires
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updated professional knowledge
sensitivity and respect
the ability to fold new learning strategies into the child’s
daily activities
recognizing and acting on what truly matters to the
family
To see what EI home visits look like, go to
https://www.youtube.com/watch?v=8fOJGmIdj0c&list=PLC
BE09BD900359C53
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Family Cost Participation
Sliding Fee based on income and family size
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Applies to families with adjusted gross annual incomes
greater than $45,000 and not eligible for Medicaid
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One fee charged per month regardless of:
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number of children enrolled in Birth to Three
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number of EI visits provided
Fee can be adjusted when the family has documented
extraordinary expenses
Parents are also asked for permission to bill their insurance
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EI visits do not affect annual or lifetime insurance caps under state
law
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Services at No Cost
Parents of eligible children may opt to receive:
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Service coordination
Evaluation and assessment
Service plan development and review, including transition
planning
Due Process rights
WITHOUT any parent fee
Service Coordinator may assist the parent in locating
direct services from community providers.
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Life after Three
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Birth to Three supports must end by the child’s 3rd
birthday
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The parent and service coordinator begin planning for
this up to six months prior but no later than 90 days
before
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Free Appropriate Public Education at 3 – required by
federal law
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Service coordinator can facilitate referral for preschool
special education or other community supports
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Preschool Special Education
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IDEA Part B – different requirements than Part C
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Each school district determines eligibility criteria
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No automatic eligibility due to diagnosed condition or prior Birth to Three
enrollment
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Planning and Placement Team (PPT) - which includes the
parent(s) - makes eligibility, placement, and service decisions
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Individualized Educational Program (IEP) written by PPT
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Opportunities for Collaboration
Ask the parent for consent to:
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share medical information with the B23 team
receive the B23 evaluation results
If the child is eligible, participate in development of the
IFSP service plan; communicate with the parent about
their Birth to Three visits
If the child is not eligible,
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encourage the parent to enroll in Help Me Grow, ASQ
re-refer after 90 days if concerns remain
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Closing Thought
We all have an obligation to
Do Best by Children and Families
through effective use and coordination of all
resources available
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Questions?
1-800-505-7000
www.birth23.org
eileen.mcmurrer@ct.gov