All information contained in this Handbook will be located on the website: www.developmentalpathways.org
and click on Vendor Resources to get to our Early
Childhood contract providers section
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SECTION ONE: Introduction
Introduction to Pathways
Arapahoe/Douglas County Child Find Crosswalk
Transition Process Information
DP Administration and Staff
Child Find Contact Information
SECTION TWO: Providing Service
Pathways Service Delivery Model
Purpose of Early Intervention
Working with Service Coordinators: Role and Responsibilities
Interpreters
SECTION THREE: Processes and Procedures
Referral Process and Home Visits
Early Intervention Provider Visits and Provider Role
Consult Visits and Expectations
Make-up and No-show Visits
Shadow Visits
Provider Family Visit Agreement (English and Spanish)
Maternity Policy
Student policy and process
Daycare and community settings
Extended Leave
Exit Summary
SECTION FOUR:COSF
COSF Overview
SECTION FIVE: Incident Reporting and Limits of Confidentiality
HIPAA Policies
Crisis Information and Guidelines
How to Complete an Incident Report and Abuse Information
Early Intervention Guidelines for Matters Involving the Legal System
SECTION SIX: Billing Procedures
Letter from Grant Hampe to new EI providers regarding billing procedures
Billing Procedures
Guidelines for Service Provision
FAQ on the Billing Template
APPENDIX I
Sample Referral
Sample IFSP
Sample Consent to Share
Sample Contact Visit Note
Sample Billing
Sample Provider Transition Report
Sample COSF
SIGNATURE PAGE
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Developmental Pathways is the Community Centered Board serving Douglas and
Arapahoe Counties and the city of Aurora. We are dedicated to serving individuals with disabilities. In the Early Childhood Department, we work collaboratively with our community partners: Tri County Health Department, Human Services, The ARC, and the local school distri cts’ Child Find, and many others who serve young children with developmental delays. We provide early intervention services for eligible children within our service area.
We are committed to providing high quality services for children by consulting with family members and caregivers around developmental learning opportunities during a child’s everyday routines and activities.
We use the Primary Service Provider model when possible so that one provider will interact with the family and bring strategies consistent with the goals for the child. Other team members will be called upon as needed to consult with the primary provider and the family together.
Contracted service providers with Pathways are expected to attend regular professional development opportunities and incorporate preferred practices into their work with children. We support trans-disciplinary practice and have several teams in operation.
You may attend a team meeting to observe the process and ask questions of the team members or team facilitators.
This packet will provide you with details on getting referrals, invoicing and other billing procedures, submitting contact notes, attending IFSP meetings, and assisting families with transition planning. You will receive information on collecting ongoing assessment information on child and family outcomes for the Results Matter initiative in our state.
Additionally, we are providing you with information on HIPAA which governs our confidentiality regulations, incident reports, mandatory reporting guidelines and consent forms. Again, WELCOME and happy reading!
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Child Find and Developmental Pathways Early Intervention Process:
Process Steps: Requirements:
Referral:
Families are contacted within 1 to 2 days of initial phone call
Anyone can make a referral to the early intervention system. An infant or toddler may receive early intervention services if: the family lives in Colorado, the child is birth thru 2 yrs, & the child meets the eligibility criteria for Colorado’s early intervention system.
Process Steps: Requirements:
Determining
Eligibility for
Part C:
All families are entitled to a multidisciplinary evaluation
Developmental Delay:
Children who are demonstrating a 25% or greater delay in one or more of the following areas of development:
Cognitive, Physical,
Communication, Social-
Emotional, & or Adaptive development
Infants or Toddlers with a Diagnosed Physical or
Mental Condition with a
High Probability of
Resulting In Significant
Developmental Delay:
EI Colorado maintains a database of physical and mental conditions that establish a child's eligibility: www.
eicolorado.org
Process Steps: Requirements:
DP’s Role &
Responsibilities:
Collect intake information
Obtain permission to share information (family and community partners)
If DHS/CAPTA referral:
Determine appropriate parental consent, permission to evaluate & use CAPTA intake form.
Shares information with Child
Find within 1 to 2 days
Assigns a Service Coordinator
DP’s Role &
Responsibilities:
DP determines and documents both developmental (from multi-disciplinary evaluation) and categorical eligibility (from review of records).
DP schedules home visit with the family whenever possible.
Reviews rights and procedural safeguards, has Consent to
Share & funding paperwork signed.
Collects family / child information and connects the family with other community resources
Explores funding options, per
Colorado Part C Funding
Hierarchy
Service Coordinator will send start of IFSP draft to Child Find and any additional or supporting information
DP’s Role &
Responsibilities:
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Child Find’s Role &
Responsibilities:
Collect intake information
Obtain permission to share
If DHS/CAPTA referral: Determine appropriate parental consent, permission to evaluate & use CAPTA intake form.
Share information with DP within 1 to
2 days
Schedules evaluation with the family and informs DP of scheduled appointment date
Child Find’s Role &
Responsibilities:
Child Find identifies areas of concern and parent concerns from reviewing the first few pages of the IFSP and intake form and plans for play-based evaluation.
Child Find’s Role &
Responsibilities:

Multidisciplinary
Evaluation:
A multidisciplinary evaluation needs to occur within 45 days from referral.
Evaluation is a multidisciplinary process by a team comprised of the parents and a minimum of two appropriately licensed/qualified professionals. Using multiple methods, the team establishes the child’s current levels of functioning in all 5 developmental domains.
Using information from the evaluation and assessment procedures, a determination is made as to whether the delay is significant enough (25% delay) to make the child eligible for early intervention services, and if eligible, to develop an individualized plan.
Decisions about eligibility for infants and toddlers are documented in writing and based on the informed clinical opinion of the multidisciplinary team that may consider results of diagnostic instruments, review of records, observation of child, parent report, play-basedassessment, and/or developmental checklists.
Process Steps: Requirements:
Developing the
IFSP:
Assures written 10-day notification of IFSP meeting is given to family
Assures documentation of meeting outcome is completed.
Provides information from the home visit (if possible) and assists the parent in sharing and advocating concerns and questions about their child’s development
Child Find will give the family an overview of the evaluation process and begin by discussing a family’s concerns
Conducts multi-disciplinary evaluation.
Child Find will report in family friendly (IFSP) language each developmental domain which will include next steps in development in each area as well as percentage delayed or current age range for each area.
Child Find will need to identify tools used in the evaluation: for example: play-based evaluation, review of records, observations, developmental checklists.
If child is not eligible for Part C, an
IFSP still needs to be developed and
Child Find will need to share information about each developmental domain.
Child Find may request that a child return for a follow-up evaluation if not eligible at this time.
The Individualized Family
Services Plan (IFSP) is the process and document that guides and directs the provision of early intervention services. The
IFSP is based on the individualized, functional needs of the infant or toddler and the concerns and priorities of the parents. The IFSP is routinely reviewed and changed as needs, concerns and priorities change. In order to develop a meaningful
DP’s Role &
Responsibilities:
Service Coordinators facilitate the IFSP meeting which includes:
Addressing concerns and priorities of the family
Developing goals based on the identified concerns
Determining strategies within the context of the families’ home and everyday life.
Identifying services that will match the priorities and
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Child Find’s Role &
Responsibilities:
Service Coordinators will facilitate writing goals and CF will assist in developing strategies and determining services based on the
Primary Service Provider model whenever appropriate.
After the evaluation the CF team will email the IFSP to the service coordinator within 7 days from the date of the evaluation.

IFSP for a child the IFSP team assists the family through a process of gathering information about the child’s development and the concerns and priorities of the family. The team then identifies desired outcomes for the child in the context of daily routines and places and then determining the supports and services necessary to assist in achieving those outcomes.
Process Steps: Requirements: concerns and fit within the early intervention model
Early
Intervention
Services:
Services identified on the
IFSP need to be in place within 28 days.
There are multiple early intervention services that an infant or toddler may receive based on that child's identified needs and the concerns and priorities of the family:
Assistive Technology,
Audiology Services,
Developmental
Intervention, Health
Services, Nutrition
Services, Occupational
Therapy, Physical
Therapy, Psychological
Services, Sign Language
Services, Speech
Therapy, Social and
Emotional Services,
Transportation Services, and Vision services.
Process Steps: Requirements:
DP’s Role &
Responsibilities:
Service Coordinators complete the referral for services electronic packet to begin the matching process of family to provider.
Service Coordinators ensure, through regular ongoing communication, IFSP reviews, and IFSP annual meetings that progress is being made in addition to following, documenting and assisting with any changes in service frequency and discipline as needed.
Child Find’s Role &
Responsibilities:
Transition from
Part C to Part B:
When children turn three years of age they transition out of early intervention services. Part
C of the Individuals with
Disabilities Education Act has specific procedures and timelines that early intervention systems must follow to assist families through the transition process. A transition plan
DP’s Role &
Responsibilities:
At 2 years 3 months a formal notification to the appropriate
Child Find will be made via a monthly report. This report will identify the children turning 2 years 3 months in the next 30 days. The Transition
Notification report will also identify the Transition Referral due dates.
At 2 years 6 months the
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Child Find’s Role &
Responsibilities:
Child Find will schedule Part B evaluation 3 months prior to a child’s third birthday and will determine Part
B eligibility and services.
Child Find will schedule and invite
Service Coordinator to Part B evaluation.
If eligible, Child Find will discuss Part
B services and supports appropriate for the child during the IEP eligibility

and conference must be held to determine and document necessary steps in transition into either Part
B services or home/community.
The transition plan/conference needs to be held 90 days prior to a child’s third birthday.
Members of the child’s current service (IFSP) team and a future service provider (school district) play a role in the planning process.
If determined eligible, a child may receive services from their local school district starting at age three. The early intervention team plans with the family for a smooth transition into the future service. If the child is not eligible for Part B services, the early intervention team assists in planning a transition to other appropriate community programs and services. service coordinator will send a referral using the transition referral form to Child Find for all children in need of a Part B evaluation. This referral form is provided after parent consent to share has been obtained.
*Prior to 2 years 3 months families have the option to not share transition information with the school district. If a family opts out of referral for Part B no transition information will be shared.
DP creates and send monthly transition reports which are reviewed at monthly liaisons meetings.
Service Coordinators will schedule a transition conference to develop a
Transition Plan with the family,
Child Find and will notify APS of the scheduled appointment. meeting.
Child Find will participate in the
Transition Conference and Plan development scheduled by DP whenever possible.
* If Child Find is unable to schedule
Part B evaluation 3 months before a child’s 3 rd birthday they will notify
Service Coordinator/DP team and participate as possible in the transition planning
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The transition from Part C Early Intervention services is a time of change for children with developmental disabilities and their families. Transition in early intervention services means moving out of Part C services into the next setting for your child. Service Coordinators and
Providers will support a family as they plan for this next step. At the age of three, children may enter into any one of a number of community situations. Some children will attend private preschools, faith-based programs, recreation center programs, or child-care settings. Others will be eligible for Part B services through their local school district. If a child qualified for Part C programming it doesn’t necessarily mean he/she will qualify for Part B programming as the criteria for eligibility differs.
The way a child qualifies for Part B and the services that are offered, differ from Part C. In order to determine if a child is eligible for supports and services through the school district, they must have a multidisciplinary evaluation by the Child Find team. While the guidelines for eligibility are consistent across districts the process by which they evaluate may differ. Service Coordinators will help families enter into and follow through the process that has been established within each school district.
Transition planning is a team process incorporating the entire family, Early Intervention providers, Service Coordinator, and the Child Find team.
It is important for our community to work together to create a successful Transition Plan for each child and family. The Transition Plan outlines steps for your family in planning and preparing for the next setting. It is imperative for families and service providers to realize that:

Transitions are processes
 Transitions should be centered around the child‘s educational needs

Families with their individual needs and goals play an important role in transition planning
The planning for a child’s transition out of Part C Services must occur no later than 3month’s prior to a child’s 3 rd birthday. Parents or guardians have the right to the following:

A Child Find evaluation to determine eligibility for Part B services.

A Transition Conference to develop the Transition Plan, which is a required component of the Individualized Family Service Plan.

Participants at the Transition Meeting should include family, Service Coordinator,
Early Intervention provider(s), personnel from the future delivery system, and medical personnel, as indicated.
For more information please contact your Service Coordinator or log on to the website at: www.eicolorado.org
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Early Intervention Service Coordinator Contact List
(Referrals/Intake: 303-858-2073; Fax: 303-858-2200)
Abigail Collins
Alex Phares
Amie Patel
Andrea Jessen
Anne Buchanan
Brittney Redding
Brooke Cooney
Clara De La Garza
Giovana Nurena
Craig Hinojosa
Geraldine Monterroso
Heather Haubenschild
Holly Koch
Jeannette McMahan
Jessica Fox-Hernandez
Juli Clay
Karen Stone
Katie von Stein
Laura Miller
Mandi Bennett
Marianne Zbylski
Maria Esguerra
Melissa Sharpe
Meredith O’Keeffe
303-858-2149
303-858-2350
303-858-2108
303-858-2088
303-858-2162
303-858-2354
303-858-2104
303-858-2105
303-858-2097
303-858-2337
303-858-2135
303-858-2101
303-858-2042
303-858-2030
303-858-2143
303-858-2145
303-858-2046
303-858-2345
303-858-2146
303-858-2356
303-858-2120
303-858-2332
303-858-2369
303-858-2380
Paula McIntire
Paz Moya
Rachel Zalatan
Rebecca Foote
Reina Retana-Ramirez
Shannon Gibbons
Somer Lundborg
Sonya Riffel
Tristan Shipman
Victoria Meyer
Director: Judi Persoff: 303-858-2348
303-858-2365
303-858-2119
303-858-2077
303-858-2144
303-858-2016
303-858-2352
303-858-2320
303-858-2393
303-858-2142
303-858-2358
Associate Director: Michele Coates: 303-858-2319
EI Managers: Malcolm Jobe: 303-858-2090
Beth Little: 303-858-2349
Leslie Hendrickson: 303-858-2370
Grant Hampe: 303-858-2347
Sheryl Foreman: 303-858-2165
Nicole Walter: 303-858-2333
Amanda Benson 303-858-2072
(Cherry Creek, Englewood, Sheridan, BOCES)
(Aurora, Team Spanish)
(Douglas, Littleton)
(Billing)
(Senior SC/Training)
(Therapists)
(Pathways In-house Team)
SC Fax: 303-858-2084
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DOUGLAS CHILD FIND:
Phone: 720-433-0020 fax: 720-433-0021
Intake: Katie:
Kathleen.Sloggett@dcsdk12.org
Katie direct: 720-433-1186
Babies: jennifer.ice@dcsdk12.org
Jen: 720-433-1206
Address: 8204 E. Park Meadows Dr.
Lone Tree 80124
3950 Trail Boss Lane, Castle Rock
80104
CHERRY CREEK CHILD FIND:
Phone: 720-554-4001
Fax: 720-554-4044
Intake: Debbie Burham dburham@cherrycreekschools.org
CF: lmarsh@cherrycreekschools.org
Address: 16251 E. Geddes Ave. Cent
80016
AURORA CHILD FIND:
Phone: 303-340-0859 X28344
Fax: 303-326-1960
Intake: MJIMENEZ@aps.k12.co.us
CF: JLDOUGHERTY@aps.k12.co.us
Address: 1420 N. Laredo St.
Aurora.80011
LITTLETON CHILD FIND:
Phone: 303-347-6980
Fax: 303-347-6920
Intake: Kelly Smith-303-347-6928
KMSmith@lps.k12.co.us
Address: 5776 S. Crocker St. Ltn.80120
ENGLEWOOD CHILD FIND:
Phone: 303-806-2527
Fax: 303-806-2535
Intake/CF:
Marcia_Blum@englewood.k12.co.us
Address: 700 W. Mansfield Ave. Eng.
80110
SHERIDAN CHILD FIND:
Phone: 720-833-6636
Fax: 720-833-6649: Shelley Tilton stilton@ssd2.org
Address: 4000 S. Lowell Blvd. Sheridan.
80236
BOCES CHILD FIND:
Main Intake Phone: 719-775-2342
Fax: 719-775-9714
Intake/CF: Jenn Wallace
Jenn office: 719-775-2342 ext. 166
Jenn Cell: 719-740-0214 jennw@ecboces.org
Address: PO BOX 910. 820 2nd St.
Limon 80828
PART C NICU PROJECT:
Intake: Maria.Marin@ucdenver.edu
Maria: 303-724-7641
Fax: 303-724-7663
Address: Part C/NICU Liaison Project
JFK Partners, C234---L28-5110
13121 E. 17 th AVE. PO BOX 6511.
Aurora.80045
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Questions to guide Early Intervention…
1. What are the families’ goals/priorities?
2. What is required to meet this goal?
3. Is the child making progress?
A Primary Service Provider is usually backed by a team consisting of a variety of disciplines that provide direct support to a family and child to carry out strategies and interventions in a child’s natural environment.
Developmental Pathways believes this to be the model of best practice for Early Intervention when possible.
Next Steps for a Family and Child who needs additional services and supports:
Utilizing a provider of a different discipline to help provide strategies and recommendations around a specific goal or priority of the family. A consult should occur with the primary provider.
Should occur after requesting a consult and reviewing family goals and priorities with a coordinator and if it is necessary to meet the identified goals of the IFSP.
o A Multi-disciplinary Provider model consists of a team of 2 or more of professionals from different disciplines who draw upon their areas of expertise to provide assessment and intervention to children and families. o Care Conferences are used to provide opportunities for multiple providers to share interventions and strategies with each other and the family.
odel
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 To enhance the capacity of caregivers to meet the special needs of their child’s well-being, development, and learning.
 The service provider works with and supports family members/caregivers in the context of everyday routines within a child’s life.
 Early intervention should be focused around goals on the IFSP, and a family’s goals and priorities.
 A Primary Service Provider functions as part of an active team with parents/caregivers and other professional team members who provide direct support to a family and child to carry out strategies and in terventions in a child’s natural environment.
 A primary service provider is a teaching model that views the family as the expert utilizing parent education and coaching.
 Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts
 These are teams of two or more disciplines that are working with a child and family. This approach identifies discipline specific interventions. A care conference to develop a cohesive model of service may be used.
 A care conference is a meeting with all providers, service coordinator, and family to discuss approaches and current strategies in the home. This meeting could also include medical professionals as well.
Consider these questions:
1. What are the family’s goals and priorities (6 months at a time)?
2. What is required to meet this goal?
3. Is the child making progress?
 Consults
 Increasing frequency of services
 Adding another provider
 Multi-Disciplinary Team
 Care Conferences
 The team (family, service coordinator, provider, and/or Child Find) gathers together and discusses what is needed to meet the goals.
 This can happen at the development of the IFSP, periodic reviews, and annual reviews.
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When you first pick up a child , let the service coordinator know that you will be the provider
• If you have any questions regarding the family, IFSP, or evaluation
• Once you have scheduled the initial visit , give the service coordinator the start date
•
When you and the family would like to write new goals (child has met written goals, family priorities, or child needs have changed)
•When you will be talking about the child at a team meeting
•When a consult or a provider switch is needed
•When a family does not show up for an appointment , or if you have difficulty contacting the family
•With any updates regarding the child and family : medical updates, address or phone changes, etc.
To set up reviews and annuals
• To let you know when transitions are coming up and transition reports are due
1. The job of a service coordinator is to facilitate and implement the IFSP process while respecting the laws and guidelines of Part C law and State guidelines. Their main role is to teach, advocate for, and empower families.
2. Coordinators must follow protocol when requesting additional services, changes in frequency of service and/or discipline, and/or consultations from alternative disciplines.
3. Funding constraints are a reality and we are required to follow the funding hierarchy.
4. Coordinators provide resources and supports to families.
15

At the Time of Referral, Service Coordinators:

Set up file

Call family to schedule an initial home visit

Prepare for initial visit by collecting the Welcome Packet booklets and the required forms

Complete initial home visit: Explain Part C, the evaluation/eligibility process, funding

hierarchy, rights/safeguards, first 3 pages of IFSP and parental concerns & priorities

Obtain and provide any and all requests and/or needed resources
At the Part C evaluation, Service Coordinators:

Attend evaluation/IFSP meeting

Gather information to complete IFSP

Type IFSP and mail to family, Child Find, all related referral sources

Complete a referral packet to obtain a provider

Establish reminder system for monthly family contacts, provider contacts, and reviews

Attend monthly provider meetings as needed for child case discussion

Maintain file, data system, and make any needed changes and/or complete requests by family and provider
 As applicable until the child’s 3 rd birthday
At the Three/Six month IFSP Review, Service Coordinators:

Schedule 6 month review with family and provider/3 month review if the child is on an infant IFSP

Review and update present levels of development and outcomes; create new plans of action with provider input

Complete and sign Periodic Review IFSP Periodic Review

Obtain all State, Part C Law, and DP required forms/documents that need to be updated every 6 months

Type IFSP and mail to family, provider, and Child Find
At the Annual IFSP Review, Service Coordinators:

Schedule annual review with family and provider

Review and update entire IFSP

Obtain all State, Part C Law, and DP required forms/documents as originally obtained at the initial IFSP mtg. and as required annually

Type IFSP and mail to family, provider, and Child Find
During the Transition to Part B/Preparation for Leaving Part C Services, Service
Coordinators:

Begin to plan with Child Find, provider & family 12 -
9 months before child’s 3 rd b-day
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
Make sure that Child Find and district social workers (as applicable) have current IFSP

Obtain provider transition report from all providers 4 weeks prior to Part B evaluation and/or Transition Conference Mtg.

Attend and participate in the Transition Conference Mtg., Part B eval., and IEP
Mtg. if able and requested by the family

Inform provider & send a copy of the transition plan page of the IFSP and services stop date
Throughout Each Step of the Process, Service Coordinators:

Establish reminder system for monthly family contacts, provider contacts as needed, and reviews

Attend monthly provider meetings as needed for child case discussion

Maintain file and data management systems

Make any needed changes and/or complete requests by family and provider as applicable until the child’s 3 rd birthday

Maintain monthly contact with the family

Maintain regular contact with providers, community based services, and human service agencies as needed

Assist families with crisis management
Provider is responsible for calling and arranging the interpreter
Call Tracey 303-858-2141 for list of interpreters
Prior to meeting with Therapist and Family - Setting up Visits
DO:

Discuss interpretation styles with the
Therapist prior to the initial meeting with the family (i.e. simultaneous vs. consecutive).

Discuss exactly what the Therapist wants interpreted to the family .

Make sure that your schedules correlate and you can be on time to the visits – will you meet outside prior to the visit?

Agree how to confirm visits.

BE ON TIME – call the Therapist if late.

Assume that all Therapists want or expect the same thing out of your interpretation services.
DO NOT:

Assume that the services will always remain the same during the course of the
IFSP. Family and provider priorities may change.

Be offended if a Therapist requests to change Interpreters. The relationship of the Therapist with the family and progress of the child is a priority here.
17

Home Visits with a Therapist (OT, PT, ECSE and SLP)
DO:

Facilitate communication between the parent, family and Therapist to allow active family participation and lessen language barrier.
 Help provide clarity to parents’ understanding of the therapy to make sure family understands what the
Therapist is trying to communicate.

Remember that you are a voice. You are a device used to communicate for the Therapist.

Remember that while you may develop a relationship with the family, you are not the Therapist, the Service
Coordinator or a friend.

Keep in mind that you are both guests in this home.

Help facilitate necessary phone calls to doctors during visits with the Therapist as requested.
DO NOT:

Have side conversations with the parent and/or other family members. The
Therapist MUST know what you are saying.

Argue with the Therapist in front of the family.

Give your own opinion on how to administer therapy or how the parents should work with their child.
 Show “favoritism” to families. If you choose to help families outside of contracted hours
- you are NOT acting as a representative of
DP.

Bring up the name of any of any other child or family
– follow confidentiality rules.

Bring food, eat, chew gum, etc. while on home visits.
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How do I get referrals?
Referrals are distributed via our electronic referral process.
Team members balance the number of ongoing children seen with a regular availability for consults as needed. If you are willing to become a Medicaid provider, you will increase your ability to get referrals. We also need providers who go to several different locations across our community, Douglas, Arapahoe Counties and the city of Aurora. Additionally, if you are bilingual or have special skills and training you may increase your referrals.
How do I begin work with families?
The Service Coordinators are the key to working with families. They develop a relationship with the family and have the responsibility of connecting the appropriate supports and services to enhance the child’s development. Please contact them to let them know you have accepted a referral. The Service Coordinator also assists with any changes to the IFSP using the “review” process. Any changes in frequency or provider are the “child’s team” decision with all parties in agreement with the changes before the services are provided. You will receive a copy of the signed S&S page by email. Do not go on an actual visit until you receive this and bill only for the listed services. (See samples of signed S&S pages under the billing section.) Providers contact and set up their own interpreters.
What is the best approach to use with new families?
We support the use of
Trans-disciplinary Teams and the Primary Service Provider Model. We encourage you to use the Provider Family Visit Agreement to outline successful visits with families. Interventions are to be provided in the natural environment of the child and should focus on techniques to enhance development during daily routines such as dressing, feeding, playtime, and transitions. You will also be doing ongoing assessment of the child’s progress and are required to provide regular reports through the Results Matter initiative using the COSF tool and associated Progress
Reports. You must write a contact note (3 part forms are provided to you) at the end of each session with strategies that you have discussed with the family. Keep a copy for your records, leave a copy with the family and turn in a copy from each visit on a monthly basis.
Are visits always to be done in the family home?
Babies are typically seen in the home, however providers may do a session to help with the transition from home to car, at a grocery store, park or some other place in which the family routinely travels.
The key is the outcome on the IFSP that you are trying to achieve. Sometimes visits must be done in a day-care setting. Extra communication with the family by phone or email is required in these instances. Reviews and Transition Plan meetings are counted as one of your monthly visits. The Service Coordinator plans and is always present at these meetings. Please be prepared to update goals and present levels across all developmental areas
.
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Initial/1 st Home Visit
Review of IFSP
Visit to accompany a family to an appointment
Care Conference
Part B evaluation/Transition

Contact family and set up visit schedule.

Email/call Tracey to confirm that you are taking the referral.

Call service coordinator to let them know you will be the provider and when your first visit is scheduled. If date of 1 st visit changes, please let service coordinator know as they need this information for data purposes.

We are required to have all providers recommended by the evaluation/IFSP team placed within 28 days of the IFSP date! If you are unable to visit the family by that date, call the service coordinator with explanation of the delay.

The IFSP process requires a review of the IFSP at 3 and/or 6 months or anytime change needs to happen to the IFSP including a change in discipline.

A review is used to update all present levels of development, current goals, supports and services, and priorities of the family.

A “3-month” review is utilized for infants 6 months old and younger, as well as, families requiring more frequent updates.

A “6-month” or periodic review is an IFSP requirement to review and update goals.
Provider must be prepared to update all present levels of development and next steps for each area.

An annual review is an IFSP requirement with the same function as a periodic review

You can use one of your approved monthly visits to accompany a family to a doctor appointment, special evaluation (vision, hearing, developmental evaluation, etc.)

Please let SC know what you are doing and a contact note providing the same information.

This may be used as an additional paid visit to provide the opportunity for multiple providers to share interventions and strategies with each other and the family.

The service coordinator must be present for these meetings and a review can be conducted at this time but is not a requirement. Please contact the SC to discuss this option.

These visits are usually for providers not on DP district teams and/or not on the same team.

This is optional and occurs when both provider
21

Meeting
Shadow Visit
Co-Visits
Twins
No-show and family would prefer the provider accompany them for support and/or to give additional information to the Child Find evaluation team concerning child’s progress.

The Provider Transition Report should be submitted to Child Find at least 2 weeks prior to the evaluation.

This visit takes the place of a regularly scheduled visit in order to be paid.

This is a paid visit used for professional development.

A provider may arrange to “shadow” another provider with the goal of learning about specific interventions.

Please call 303-858-2333 for more information.

Two providers may choose to do a visit together based on the needs of the child and preference of the family. Each provider bills separately and each does a contact note.

Often times twins have similar needs and therefore can receive therapy simultaneously.

When this happens you will usually see an approval to see each child 3 hours/mo (12 units).
This does not mean that you need to schedule six separate visits each month, rather you will schedule four visits that last 1.5 hours. Four visits at 1.5 hours (6 units) each equals the 6 hours (24 units) total you are approved to see the twins each month.

You will divide your time between each child and bill accordingly. Remember that you bill in units
(15 minute increments). So in the case of twins that you saw for 1.5 hours total for the visit, your invoice would show 3 units (45 minutes) for each child.

If the twins have different needs, the s/s will reflect this. You can still see the children on the same visit, but the amount of time you spend educating the parents on strategies for each child will be different. Your invoice should reflect the amount of time spent on each child.

If a family cancels with no prior notice, with less than 2 hours notice, or is not home for a scheduled, confirmed appointment, it is considered a No-Show visit. The contractor may bill $20 for the No-Show if there is not a make-up visit scheduled and the service coordinator must be notified of the No-Show status. You may bill for either a No-show or you may provide and bill for a make-up visit, but not both. If there are 2 consecutive No-Show visits, STOP GOING. - the
IFSP team must be reconvened to reevaluate
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Make-up frequency of service provision prior to the contractor scheduling a 3 rd visit.

Both families and providers sometimes need to cancel visits. Based upon your schedule, you do not have to do make-up visits. Explain to the family whether or not you will be able to make-up a visit and if at all possible, sessions should be made up within the same month missed. Try to re-schedule with the family and work it in later in the same billing cycle, indicating “make-up” on the invoice. If the make-up occurs the following month, indicate “make-up visit from mo/day” on the invoice.
Months with five weeks:
You are generally authorized for (4 to 16 units) per month on the S & S page. Please plan ahead with the family to address any months with five weeks, so there are no misunderstandings. As an independent contractor, it is up to you to balance your schedule to meet the contracted number of hours/units without going over.
Team Meetings:
Team members may bill the two monthly meetings at $40 per meeting. Designate “XX
Team Meeting and date” on your invoice and in parenthesis, put the names of two children you may want to discuss, or who are on your caseload.
Child Record Management :
Best practice is to save a child’s records which may include contact notes, transition reports and IFSP documents for six years before shredding personal information.
Primary Provider: Before requesting a Consult Visit –
Do’s

Try your own repertoire of strategies for the concerns for the “whole child”.

If there are more providers in the home – please talk to them about your concerns.

If you are on a team – try to videotape.

If you discuss at a team meeting – implement the ideas/strategies generated by your team.

If you still require more input – talk to the SC to have them do a referral for a specific provider or discipline for 1 or 2 consult visits in a specific month or wait to discuss at the next review .
Consult Provider: Do’s

Tracey will email you with the referral page request.

Contact the primary provider to set up a day/time to do a home visit with them.
Do Not –

Expect that asking for a consult means automatically adding that discipline/provider to services.

Ask another provider to do a consult without talking to the SC.

Tell the family the child needs the service so many times per month.

Assume that a child with Medicaid funding “automatically” gets more visits/services.
Do Not –

Go without a signed S&S from
Grant.

Go without talking to the primary provider about the concerns.
23


Inquire as to the issues involved to be prepared with possible strategies, handouts, etc.

Present possible strategies to the provider and family around routines in the child’s life.

Share your cell number in case they have questions.

If more than 1 visit is necessary – check with the primary provider to schedule the next consult visit.

If you feel that the child requires additional services-please talk to the primary and SC.

Follow the lead of the Primary Provider and defer to their concerns.
Primary Provider – During Consult Visit: Do’s

Write suggested strategies on a contact note for the “consult” provider (both of you can initial note).

Implement/reinforce these strategies in future visits.

If another consult visit is necessary – contact the provider to set up the next consult co-visit.

If you believe the consult’s services need to be part of the IFSP – please talk to the SC to do a
“review”.

Go out alone – go with the primary.

Expect that you will necessarily be added as an on-going provider.
 Tell the family they “MUST” have xy-z.

Assume that a child with Medicaid funding automatically “gets” more services.

Address concerns with family that contradicts the Primary Provider without first discussing this.
Do Not –

Tell the family that you will be adding or changing any services without talking to the SC first.
Purpose of a shadow visit :
A shadow visit is a form of professional development which supports our philosophy of transdisciplinary intervention. A provider may choose to “shadow” another provider (same or different discipline) when they feel the need to learn more about a particular strategy or intervention.
Example: an ESCE may want to see an OT work with a sensory-seeking child to be better able to identify sensory-seeking behavior and to learn strategies to address it.
Example: an SLP may want to shadow another SLP using an Interpreter to feel more comfortable in using an interpreter themselves. The focus is on learning more about the behavior, strategies and interventions – not the actual child. Therefore, a shadow is NOT a chance to add more visits with a particular child.
Process to Request a Shadow visit: Please call 303-858-2333
You will complete the following form. All shadow visits MUST be pre-approved with this process.
Your name/Discipline: ______________________________________
Child’s name DOB SC Name/Discipline of Provider you are Requesting to
Shadow
Date of
Requested
Shadow Visit
What you hope to learn:
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We will contact the SC to confirm consent by family and to update the S&S. Grant will still email you the signed S&S. PLEASE email or call after your shadow visit is completed to discuss outcome of visit and with what other kiddo you will be using your new knowledge.
FOR SC - Example S&S wording:
Activity/
Location
Home and
Play
EI Service &
Name of
Provider
Suzy, ECSE/DI
(shadow
Betty, OT)
Supports and Services
Method Frequency & Projected Start
Intensity Date
Shadow visit (4 units) in Nov.
11-1-08
Projected end date
11-30-08
Funding
Source
DP ($40)
FOR PROVIDER - Example invoice wording :
Child’s name DOB SC
Susan Sweet 1-5-08 Sally SC
Dates of service # of units
11-10-08 shadow visit with Betty, OT 4
Cost
$40.00
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Provider Family Visit Agreement
Welcome to Early Intervention Services!
We believe in a family centered approach to deliver supports/services to children with special needs and their families. Parents and professionals focus on the child’s development with attention to increasing a family’s ability to meet their child’s needs. Early childhood providers have experience and knowledge in overall child development and many providers are part of a team of other professionals who offer coaching, ideas and consultation to support child and family.
We believe parents and early childhood professionals/providers can work together on ideas and strategies that enhance the child’s development in everyday routines. Parents partner with a provider and as a team, they look at how the child learns; at home and in the community, in relationships and during the everyday routines/activities.
Home visits are generally scheduled Monday –Friday, 8am-5pm.
Providers of early intervention services will:
protect family’s privacy by adhering to strict confidentiality practices. Limits of confidentiality include; mandated reporting practices (health, safety, and child abuse).
teach parents how to continue working on goals within activities of daily schedule and provide a written summary of recommendations to explore between visits.
confirm/cancel home visits due to illness, schedule conflicts or vacation and offer make appointments when possible.
Children and families receive the most benefit when they:
participate in activities, ask questions and communicate openly with the provider
offer their undivided attention; allow phone to ring, keep TV/radio off during visits
explore recommendations and offer feedback/comments to provider at next visit
make decisions for their child and call to cancel/reschedule visits if child is ill. A child should be alert, well rested, have clean diaper, face & hands and pacifier/bottle are used properly
participate in one monthly visit with provider and childcare provider when child is seen at childcare; flexibility when scheduling visits as some timeslots fill up quickly.
Call their service coordinator to assist with finding support groups, community resources/services and insurance/billing questions.
Appointment Guidelines
Safety is our #1 concern. Home visits may be cancelled if road conditions are poor. Caregivers must be present for the entire visit. If a caregiver is not present, provider will wait 10-15 minutes before leaving. Please call the provider to cancel appointment or leave a note on your door. Two or more noshows will result in a review of supports and services with your service coordinator.
Illness
Please cancel visit if anyone in the home is ill or has a contagious illness in past 24 hours.
Providers exposed to illness can easily catch and pass virus to others in the program. If you or your child does not appear to “feel well”, use your best judgment and consider canceling.
Service Coordinator: ____________________________________________________Phone: ___________
Early intervention Provider:_______________________________________________ Phone:____________
I have read and understand the above program policies
____________________________________
Parent Signature and date
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INTERVENCION TEMPRANA
BIENVENIDOS!
La Intervención Temprana es un programa centralizado en la familia, el cual autoriza a los Padres de familia para enfrentar el desafío de criar a un niño (a) con necesidades especiales. A través de demostraciones y consejos, los Terapeutas enseñan a los padres como aplicar técnicas específicas de intervención en las actividades de la rutina diaria. Se utiliza práctica transdisciplinaria para atender a las necesidades a medida que estas se presentan(Educación Especial para niños, terapías Ocupacional, de Lenguaje y Física).
El Terapeuta encargado trabajará con su familia de manera continua. Esta persona tiene experiencia y conocimiento sobre los niveles del desarrollo del infante y consulta periódicamente con el equipo transdisciplinario. Las visitas en casa generalmente se programan de Lunes a Viernes (8 a.m
– 5 p.m.)
Los Terapeutas de intervención temprana van a…

Entregarles un resumen escrito de recomendaciones para que usted lo lleve a cabo hasta la siguiente reunión.
 Enseñar a los padres como trabajar durante las actividades de la rutina diaria para lograr les metas establecidas.
 Cancelar citas cuando estén enfermos, participando en reuniones, o recibiendo formación adicional.

Cumplir con las precauciones de higiene y seguridad necesarias para trabajar con su familia.
 Proteger la privacidad de su familia cumpliendo las prácticas de máxima confidencialidad.
Los padres reciben el mayor beneficio cuando ellos…

Participan en actividades, hacen preguntas y se comunican abiertamente con el Terapeuta
 Dan su completa atención: no contestan al teléfono y apagan la TV y el radio durante las visitas.
 Llaman con anticipación para cancelar o reprogramar las citas.

Hacen seguimiento de las recomendaciones y ofrecen sugerencias/comentarios sobre estas.

Son flexibles al programar las visitas, ya que las horas preferidas se llenan rápidamente (ej. 9-11 a.m.)
 Participan por lo menos en una visita mensual con el Terapeuta cuando se trabaja con el niño (a) en un centro de cuidado de niños.

Se comunican con los coordinadores de servicios para pedir asistencia con los servicios, recursos en la comunidad, asuntos de pago, grupos de apoyo, etc.
Su hijo/a está listo para la visita cuando él o ella esta …
 Alerto, bien de salud y descansado; con su pañal, cara y manos limpias.
Pautas de las Citas
Los Terapeutas pueden cancelar las citas, si las condiciones de las carreteras les impide viajar con seguridad. Si los padres no están presentes cuando el Terapeuta llega, este esperará 10-15 minutos antes de irse. Por ninguna razón se puede dejar el niño (a) solo con el Terapeuta sin que los padres estén presentes. Por favor, si necesita cancelar una cita, trate de comunícarse con el Terapeuta 24 horas antes y si no logra comunicarse, deje una nota en la puerta. Si la cancela ción es inevitable, los Terapeutas harán un esfuerzo para cambiar su cita siempre y cuando su horario se los permita.
Entrenamientos, IFSP y reuniones de equipo son factores que influyen al programar citas. La frecuencia de las citas puede ser reducida du rante el tiempo de fiestas y vacaciones. Si la familia no atiende a dos o más citas seguidas, y no responde a las llamadas, se asume que no está interesada en los servicios de Intervención
Temprana , motivo por el cual se daría inicio a la cancelación de dichos servicios por parte del coordinador.
Enfermedad
Si alguien en su hogar está enfermo, ha tenido una enfermad contagiosa durante las últimas 24 horas o no puede estar presente (física o mentalmente) por favor, pida otra cita.
Si los Terapeutas son expuestos a una enfermedad, pueden contagiarse fácilmente y transmitir el virus a otros miembros del programa. Enfermedades contagiosas incluyen, pero no son limitadas a: fiebre de más de 100 grados, vómito, diarrea, tos/estornudo, secreción nasal, etc. Si su niño (a) se siente indispuesto, considere una cancelación.
Service Coordinator: _______________________________ Phone: _______________________
Early Interventionist: _______________________________ Phone: _______________________
Interpreter: _______________________________ Phone: _______________________
Parent Signature________________________________________Date: _____________________
27

Before your leave begins :
Please submit a list of your kiddos, their service coordi nator’s name, frequency of visits, and the anticipated length of your leave.
Write an exit summary for each kiddo for the new provider. This is especially important when a co-visit cannot be arranged before your leave begins.
Tracey will need this list 5 weeks before you go on leave so it allows enough time to find replacement providers. You will continue to work with your families until your requested leave date; this will just allow us time to have someone in line and may give time for a co-visit to help the family transition to the replacement provider.
If you have found coverage yourself through a known contracted provider please let Tracey know and she will offer the referral to them first.
Please stay in communication with Tracey and your SC throughout the process.
* Don’t forget to make sure notes, billing and COSF are up to date before you go.
When you plan to return :
Contact Tracey and your Service Coordinator with your anticipated date of return. Your SC will contact the family and let them know you are back. The family has the option to pick back up with you or may choose to continue with the replacement provider. This choice is up to the family. To make this a less difficult conversation for the family please allow your SC or Tracey to facilitate this process.
We are happy to facilitate the many requests we receive for you to have a student shadow you during part of their schooling. Keep in mind, Pathways is not an approved practicum site and we will not sign off on any clinical hours.
This process is currently under review and we hope to have a form to you in the near future.
For now: request permission from the family for their child to be observed by your student. The family has the option to decline this request. Once approved by the family update the consent to share to have the student’s name added under “other”. The consent will be changed again once the observation period is over.
It is your responsibility to train your student in the regulations of HIPAA and confidentiality.
Written parent consent must be obtained before audio, video or clinical presentations may be made.
If you currently work for one of our six school districts, you are only allowed to accept referrals within the boundaries of another school district. Please indicate in your provider information sheet if you are a school district employee.
28

When providing services in a daycare setting, remember the daycare provider needs to be on the consent to share. If the request to see the child in an alternate setting was made last minute – document that “verbal consent was obtained by parent to see the child in __________ setting” on a progress note. Then update the consent as soon as possible
When all services are being provided in the daycare and notes are being left with the daycare provider it is important to arrange a consistent time to discuss progress, strategies and concerns with the parents by phone. In order to protect your case management time, you may decrease your daycare visit to 45 minutes to allow for the remaining 15 minutes to be spent on the phone with the parent each week.
All attempts should be made by the therapist and service coordinator to arrange reviews and annuals at the family’s home.
In cases where you are planning an extended vacation or need to take a leave of absence please follow the maternity policy previously mentioned. As make- up visits are difficult to arrange we can attempt to arrange for a sub – provider for absences of a month or longer. Any time you are aware that sessions will be missed please inform your Service Coordinator and the family as soon as possible.
When exiting with a family, changing providers or transferring the file to another CCB or out of state when a COSF is not needed we would like you to write a brief summary about the current level of functioning and any specific strategies being used. This summary should be sent to the Service
Coordinator who will add the summary to the child’s file for transfer or will pass along to the new provider. The summary can be specific to your discipline, keeping in mind the importance of noting any difficult behaviors or specific skills required to support the development of this kiddo.
Example:
“Sally has made nice gains in her communication. She is currently using 15-20 words to label familiar objects and continues to increase in her interest and imitation. Currently, Sally is very motivated by Elmo books and working with her animal puzzle. She will attempt to imitate almost all animal sounds, but especially loves the Elephant. She is beginning to use two words together
“more please” and “help me” with prompting. Before beginning structured work swinging is used to calm her system. The family has a bucket swing in the back yard which is used. Sally is able to sustain attention for 20 minutes after 5 minutes of swinging. Session is currently taking place in her room with her mom present. Closing the door helps prevent her avoidance behaviors and escaping demands. When sessions began considerable time was spent chasing her around the house trying to get her to attend. The swinging and working in a smaller space has improved her attention. Sally’s parents are highly motivated and work on homework assigned each week.”
29

30

Child Outcome Measurements (COSF)
Each year, states report to OSEP the percent of infants and toddlers with IFSPs who demonstrate improved:
1. Positive social-emotional skills
2. Acquisition and use of knowledge and skills
3. Use of appropriate behaviors to meet their needs
Our state, Early Intervention Colorado has chosen to report information on these outcomes through the completion of the Child Outcomes Summary Form (COSF). The combination of three elements: use of one formal assessment tool, family interview, and professional observation allows the team to gather needed information to answer the three child outcome measurements to meet federal accountability requirements. We will begin using the COSF on July 1, 2011.
Timeline:
Two ratings will be conducted on each child receiving early intervention services.

The first rating will be within 16 weeks from the date of the referral.

The second rating will be 90 days prior to the child’s exit from intervention or the child’s third birthday.

If a child is younger than 6 months at the time of referral, the first rating should occur once a child has reached 6 months of age.

No COSF is required for children receiving less than 6 months of early intervention services.
Assessment Instruments:
Developmental Pathways has chosen to utilize the Hawaii Early Learning Profile (HELP Birth-3) and will provide you with protocols and training.
Data Entry:
COSF data will be entered directly into the state’s provider database by each provider. A primary provider will be identified on the IFSP team as the individual responsible to ensure that the COSF data is collected, entered and shared with the family. After data entry, COSF forms will be collected by
Developmental Pathways, reviewed and kept as a part of the child’s file.
Activity Provider Developmental Pathways
Service
Initiation
Initial COSF
Rating
At the time that services are initiated, providers will be notified of the need for the initial COSF rating.
Developmental Pathways will review Initial COSF Ratings to ensure completion.
Exit COSF
Rating
Children who Exit
Prior to Age
3
The Initial COSF Ratings must be completed through a combination of one formal assessment tool (HELP), family interview, and professional observation within 12 weeks from the date of the child’s referral to the EI program. Team Providers will enter the COSF rating into the state’s Provider database and send the COSF Rating form to the service coordinator to be kept in the child’s file. Non-team providers will send the completed COSF
Rating to Nicole Spiering.
Prior to the transition conference, the Exit COSF Rating must be completed through a combination of one formal assessment tool (HELP), family interview, and professional observation. Team Providers will enter the
COSF rating into the state’s Provider database and send the COSF Rating form to the service coordinator to be kept in the child’s file. Non-team providers will send the completed COSF Rating to Nicole Spiering.
At the time of program completion, schedule a final review with the family and complete an Exit COSF Rating if the child has been in the program for at least 6 months.
Developmental Pathways will review Exit COSF Ratings to ensure completion.
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32

Developmental Pathways: HIPAA Policies
What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) is a federal regulation that came into effect on April 14, 2003.
Who is affected?
All health care providers who conduct electronic billing, health plan administrators, and health care clearinghouses are considered covered entities and are required to comply with HIPAA regulations.
Why does Developmental Pathways have to comply?
Developmental Pathways submits Medicaid and other billing records electronically.
We are also considered a health care provider and maintain records with Protected
Health Information (PHI) on our children and families.
The purpose of HIPAA is:
1. To allow an individual more control over their Protected Health Information (PHI)
2. To limit the use of personal medical information and individually identifiable health information
3. To ensure that covered entities provide appropriate safeguards and take reasonable steps to ensure that personal health information is protected
4. To hold health care providers accountable with civil and criminal penalties if they violate individuals’ privacy rights
5. To provide a system by which individuals may file a complaint regarding the privacy practices of a covered entity
6. To prohibit marketing
HIPPA addresses Protected Health Information (PHI) whether it is on paper, computer or communicated orally.
What is PHI?
Protected Health Information (PHI) includes any information that allows you to indentify a consumer/patient. This information can include:

Name

Dates (birth, service, admission, discharge)

Telephone numbers, contact information

email

Social security number

Medical record numbers

Photographs

Finger and voice prints

Any unique identifying information
33

As a general rule, the client or legal guardian must give explicit consent/permission to release PHI.
The only exception to client permission is as follows:

Direct release of information to the client/legal guardian

For the purpose of treatment, payment and healthcare operations in order to be able to do our jobs

Incidental use and disclosure (any information that is disclosed incidentally as part of your job must have safeguards in place and be limited to the minimum necessary information to accomplish the intended purpose.
Safeguards:

Do not share PHI in public areas (hallways, elevators, common or public areas)

Share only the minimum necessary information

Make sure you know with whom and why you are sharing information

Be prepared to ask for identification if in doubt

Do not leave documents containing PHI in areas accessed by others

Keep PHI secured in areas not accessible to others (behind 2 locks)
What happens if I inappropriately share information?
HIPAA regulations identify civil penalties of $100 per incident, with a maximum of
$25,000 per year and criminal penalties of up to $250,000 per incident and or 10 years incarceration. The Office of Civil Rights carries out enforcement.
What am I permitted to know or share?
Incidental Use and Disclosure refers to the need to share information with those who
NEED TO KNOW in order to provide appropriate treatment for an individual
What is confidential information?
Confidential information is all identifying information contained in any record pertaining to a person receiving services or a person applying for services.

Consumer records are not public records, which means that records are not open to general public review

Proper authorization for release of information is necessary (Consent to Share)

Consumer records are the property of the agency which is responsible for maintaining and safeguarding their contents

Information that is electronically collected, processed or stored is also confidential

Confidentiality also includes identifying information in subject lines of emails, email addresses, (example: email address uses actual name of family)
Developmental Pathways operates under relative confidentiality because we need to ensure that all staff is aware of client needs, concerns, and celebrations. When we share information, we need to make sure the other person is bound by confidentiality and that they need to know the information they are receiving.
34

Safeguarding Records
Staff/Contract providers shall not discuss a person receiving services with identifying information in public or with persons who are not entitled to the record. Identifying information shall not be posted in areas accessible to the general public, or left unsecured or unsupervised for extended periods of time in work areas with more limited public access.
Who has unrestricted access to a Record?

Individual receiving services
 Legal Guardian/ “Educational Parent”

Staff working directly with the individual (service coordinators, program managers)

DDD
You will need to get a release of information (consent to share) from the legal guardian/educational parent as most individuals are not automatically entitled to information in the file.
Releasing information
There must be a signed consent form to release information. The person receiving services, the individual’s legal guardian or educational parent may authorize release of information.
All consent forms must be:

Signed and dated

Valid for 1 year unless otherwise specified

Specific as to the information or photograph to be disclosed and the intended use of information or photograph

Specific as to whom it will be disclosed
Authorization may be revoked in writing or verbally at any time by the person who provided the authorization.
Medical Personnel
Physicians, psychologists, and other professional persons providing services or supports to a person in an emergency situation may have access to only that portion of the file that pertains to their profession.
An authorization for release of information must also be on file for medical personnel.
*Please refer to HIPAA guidelines in respect to health protected information.
Storage
Child and family records are maintained and stored in locked files or in a locked room
(providers should maintain a double locked system) and shall not be located in a place accessible to the general public.
35

Destruction of Files
Records containing identifying information can be purged and destroyed in accordance with regulation and policy that applies to that type of record. * Early
Intervention files should be kept for 6 years and shredded after that time.
Never take it upon yourself to remove information from a file.
All information deleted from a record will be destroyed in a manner which will minimize its reconstruction.
Reference your licensing/certification requirements for specifics on storage and destruction of files.
Keep in mind Developmental Pathways can request documents from your records for 6 years after the child’s third birthday.
MAKING A CHILD ABUSE REPORT
In your professional capacity as a therapist with Developmental Pathways you are a
Mandated reporter of abuse. You must report if abuse is witnessed, suspected or you have been informed that abuse is taking place by a reasonably reliable third party.
The state currently states: “… any person specified who has reasonable cause to know or suspect that a child has been subjected to abuse or neglect or who has observed the child being subjected to circumstances or conditions which would reasonably result in abuse or neglect shall immediately upon receiving such information report or cause a report to be made of such fact to the county department o r local law enforcement agency”
A mandatory report to law enforcement and or/ the
Department of Human Services does not apply if the victim is currently 18 years or older. www.ccasa.org
.
Reference your licensing board about specific requirements.
If you are concerned, REPORT . If the child is not in imminent danger first call Nicole
Walter @ 303-858-2333 to discuss can discuss next steps. If you or the child are in imminent danger, FIRST call 911, get safe and then follow up with a call to Nicole
Walter at DP. You will additionally need to complete and incident report for documentation.
Document, Document, Document!
- Use our incident report forms and progress notes. You need a clear record of what you observed, heard or was reported to you.
Process of Making a Report:
1. Report Immediately
Within 24-36 hours of the incident a report needs to be made to the appropriate Human Services reporting line.
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Remember You do not need to prove or investigate the suspected abuse before calling. It is the responsibility of Human Services to follow up on all reported incidents and take next steps. If you think something is abuse/neglect - REPORT .
2. Gather Identifying Information
You will need the child’s name, date of alleged incident(s), address, date of birth, parent or guardian’s name and phone number. You may also be asked about other individuals living in the home and information regarding the alleged perpetrator(s).
3. What are you reporting
Be clear about what you are reporting. What did you observe? What did the child tell you? What did a third party tell you? What did you observe and how frequently? Location of reported abuse, etc. Use your notes and documentation to help inform your phone call.
4. Prepare to answer questions such as:
Are there marks on the child? Where? How big? What shape? How old are the marks?
When and where did the child say (if verbal) the abuse happened?
What did you observe that was of concern?
Has this happened to the child before?
You will need to identify yourself and what capacity you know the family. This information is kept confidential.
5. Make the Call.
Dial the Human Services Hotline number for the appropriate area:
Arapahoe County (303) 636-1750
Douglas County (303) 688-4825, (303) 663-6270
Adams County (303) 412-5212
Denver (720) 944-3000
Jefferson County (303) 271-4131
- Tell the screener that you have a “suspected abuse/neglect situation to report” and you will be guided through a series of set questions.
- Document the screener’s name and next steps on the DP Incident Report form or on a progress note. (The incident report form will be emailed to you after you have called Nicole Spiering to process the report or have contacted your SC )
6. After Reporting, complete a Developmental Pathways Incident Report.
Email the completed report to your Service Coordinator, Program
Manager or Nicole Walter.
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Definitions of Child Abuse and Neglect
Child Welfare Information Gateway – www.childwelfare.gov
Physical Abuse: Abuse or child abuse or neglect means, an act or omission that threatens the health or welfare of a child in one of the following categories: skin bruising, bleeding, failure to thrive, burns, fracture of any bone, subdural hematoma, soft tissue swelling or death and either :
- the condition or death is not justifiably explained
- the history given concerning the condition is at variance with the degree or type of such condition or death
- the circumstances indicate that the condition may not be as a result of an accidental occurrence.
Physical abuse is generally defined as “any non-accidental physical injury to the child” and can include striking, hitting, kicking, burning, or biting the child OR any action the results in a physical impairment of the child.
Neglect: The term child abuse or neglect includes any case in which a child is in need of services because the child’s parent/guardian has failed to provide adequate food, clothing, shelter, medical care or supervision that a prudent parent would take.
A child is neglected or dependent if :
- The parent/guardian has subjected the child to mistreatment or abuse
- the child lacks proper parental care through the actions or omissions or the parent/guardian.
- the child’s environment is injurious to his/her welfare.
- the parent/guardian fails or refuses to provide the child with proper or necessary subsistence, education, medical care or any other necessary care.
- the child is homeless or has run away.
Neglect is commonly defined as the failure of a parent or other person with responsibility for the child to provided needed food, clothing, shelter, medical care or supervision such that the child’s health, safety and well being are threatened with harm.
Educational Neglect: When the parent of caretaker either through action or omission fails to provide for the child’s education and/or school attendance.
Abandonment: When the child has no parental support or available alternate caretaker.
Lack of Supervision : When the child’s age and skill level would require parental supervision and could or did result in harm to the child.
Sexual Abuse Exploitation: Abuse or child abuse or neglect occurs when a child is subjected to sexual assault or molestation, sexual exploitation or prostitution.
Sexual conduct includes any of the following: sexual intercourse including genitalgenital, oral-genital, anal-genital, or oral-anal, whether between persons of the same or opposite sex or between humans and animals. Penetration of the vagina or rectum by any object. Masturbation. Sexual sadomasochistic abuse.
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Emotional Abuse: The term abuse or child abuse or neglect include any case in which a child is subjected to emotional abuse. Emotional abuse means an identifiable and substantial impairment or a substantial risk of impairment of the child’s intellectual or psychological functioning or development. Generally defined as
“injury to the psychological capacity or emotional stability of the child as evidenced by an observable or substantial change in behavior, emotional response or cognition” or as evidenced by “anxiety, depression withdrawal or aggressive behavior”.
* The reasonable exercise of parental discipline is not considered abuse.
Family Crisis Resources
Mental health issues are often co-existing conditions of the families we work with. If an adult is a danger to themselves or others while you are working with them or their child you may be mandated to take steps to ensure the safety of the adult and the child.
Reference your licensing board for specific requirements.
DOCUMENT
– document all crisis issues that arise in working with families. Contact
Nicole Walter @ (303) 858-2333 if you have questions about next steps. Complete
DP incident report/ incident of concern. Documentation helps protect families and your professional license.
Mental Health Concerns: For clients not facing immediate danger to themselves or others. Connect family/individual to community Mental Health resources or encourage them to utilize their insurance, Medicaid etc. to connect with support.
Contact your service coordinator if a Mental Health consult is needed for the child/family.
Community resources:
Arapahoe/Douglas Mental Health Network (303)730-8858
Aurora Mental Health Center (303) 617-2300
Suicide: If a family member you are working with threatens to harm themselves necessary steps are needed to ensure their safety. This can range from having another safe adult come and stay with the individual to calling 911. Along with Child
Abuse reporting, this is an area where you may break confidentiality. Even if your session time is up – DO NOT LEAVE an at risk individual without a plan of action in place.
1. If an individual threatens to harm themselves – take it seriously. Ask follow up questions- when, how, why. You are looking to determine if a client has an active plan and means to harm themselves or if they are just reaching out for help and need counseling support.
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2. What resources does the individual have for support? Are they already in counseling? If so contact the individual’s therapist immediately. The therapist will help arrange a safety plan.
3. If the therapist cannot be reached and you feel the threat is serious OR if the client does not have a therapist utilize the following resources:
-Connect with family resources. Your goal is to get the individual with a safe adult. Can the children go to daycare, grandparents etc.
Resources :
- National Suicide Hotline 1800 Suicide or 1800 273 TALK
-
Denver Lis’n Crisis Hotline (303)860-1200
- Aurora Mental Health Urgent Care Line (303) 617-2300
- Arapahoe Douglas Mental Health Network Crisis Line (303) 730-3303
- Encourage Client to go to the local emergency room.
- Non-emergency Police (Denver) (720) 913-2000
- Non –Emergency Police (Arapahoe) (303) 795-4711
- Non- Emergency Police (Douglas) (303) 660-7500
- Emergency Calls: 911 You can Also request the CIT (Crisis Intervention
Team)
4. Complete and Incident Report and follow up with Nicole Walter or your
Service Coordinator.
Domestic Violence: If domestic violence is observed by the child it may be a child abuse report scenario. If physical violence between parents is occurring during your session get yourself to a safe location and call the police. Custody issues, child services, legal and mental health issues are common.
Resources for Families:
-National Domestic Violence Hotline 1800 799-7233
- Alternatives to Family Violence (Adams County) crisis (303)289-4441 admin (303) 428-9611
- Gateway Battered Women’s Services (Arapahoe County) crisis (303) 343-1851 admin (303)343-1856
Women’s Crisis and Family Outreach Center (Douglas County) crisis (303)688-8484 admin (303)688-1094
- Safehouse Denver, Inc. (Denver County) crisis (303)318-9889 admin(303)318-9959
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Subpoena Process:
Subpoena: is a legal order commanding the person or organization named in the subpoena to give sworn testimony at a specified time and place about a matter concerned in an investigation or legal proceeding, such as a trail. A subpoena duces tecum substitutes the requirement of your appearance to testify with a requirement that you supply specific physical material in your possession. A deposition subpoena means that your sworn testimony will be taken during a phase of the trail process known as discovery, and will likely occur at a lawyer’s office.
1. As independent contractors, Developmental Pathways is not able to accept subpoenas on your behalf. You may be served by registered mail or may be contacted by a process server who will arrange a time to meet with you. Meeting to accept a subpoena does not constitute a breach in confidentiality. You do not need to disclose your home address and can arrange to be served in a public location.
Your signature may be required and you may be given a check for a nominal amount as part of the process.
2. Once you receive your subpoena you are responsible for responding.
3. Contact the Service Coordinator to make them aware of the subpoena. At this time, you will want to review who is on the Consent to Share.
4. Send a copy of the subpoena to Nicole Walter, Michele Coates or Judi Persoff at
Developmental Pathways.
5. Complete an Incident Report and send this to Nicole Walter.
6. The types of subpoenas: a. Notice to appear- this commands your appearance in court at a specified date and time. b. Notice for deposition- typically take place in an attorney’s office. c. Notice for physical material/documents- as contractors, you may provider copies of your progress notes, a notes summary or copies of assessments you have completed. Developmental Pathways holds the master file including the IFSP.
7. You cannot bill Developmental Pathways for time spent in court of preparing documents.
8. As an independent contractor you are responsible for seeking your our legal advice as is appropriate. You may also want to contact your liability provider or licensing boards for guidance on next steps.
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Restraining Order:
The court is required to enter an order restraining the person charged with a crime from
"harassing, molesting, intimidating, retaliating against, or tampering with any victims or witnesses."
In cases involving domestic violence the court may also require the following:
• That the defendant vacate the victim's home and that he or she stay away from any place where the victim is likely to be found;
• That the defendant not contact the victim either directly or indirectly;
• That the defendant be prohibited from having any guns or weapons;
• That the defendant be prohibited from keeping or consuming alcohol; and
• Any other order the court deems appropriate.
The restraining order remains in effect until the case is over which is when the defendant completes his or her sentence including probation (or if the case is dismissed or the defendant acquitted). When an officer has probable cause to believe a person has violated a restraining order the officer is required to arrest that person or to seek a warrant for an arrest
.

As independent contractors you cannot treat if you become aware of a Restraining
Order against either parent and that parent is at the home or shows up at the home during your visit.

Please call your Service Coordinator or Nicole Walter to inform them of the incident and document it on your contact/visit note. You will additionally need to complete an
Incident Report (Incident of Concern).
Confidentiality/ Consent to Share
Confidentiality a. Personally identifiable data, information, or records pertaining to a referred child shall not be disclosed by a Community Centered Board, any Early Intervention Service provider, or any personnel involved in dispute resolution to any person other than his or her parent, except as provided in the federal Health Insurance Portability and
Accountability Act (HIPAA) of 1996, 42 U.S.C. Section 1320, as amended, and the federal Family Educational Rights and Privacy Act (FERPA) of 1974, 20 U.S.C. section 1232g which is incorporated by reference as defined in Section 16.900, A, 3.
Consent to Share b. A parent may voluntarily give written parental consent for the exchange of confidential information to other parties.
www.eicolorado.org
- Procedural Safeguards.

As Independent contractors, it is your responsibility to maintain HIPAA regulations and confidentiality practices as is required by your contract and professional licensure. It is always a good idea to know who is on the consent to share and
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update it frequently. Your Service Coordinator will be able to inform you of who is on the consent to share and support you in updating this form as needed. Review
HIPAA policies if you have questions about protected breaches of confidentiality.
Scope of Practice
The range of responsibility –eg, types of patients or caseload and practice guidelines that determine the boundaries within which a physician, or other professional, practices.

As independent contractors, it is your responsibility to only work within your scope of practice and scope of competency. Reference your licensing/credentialing agency if you have questions as to what your scope of practice is.

Follow your scope of practice in making therapeutic recommendations, writing progress notes or in any other professional documentation.

Maintain scope of practice when involved in any matter regarding the legal system.
Types of Incident Reports:
 Injury for a child, provider or coordinator
 Alleged mistreatment, abuse or neglect
 Incident of concern with family or child
 Subpoena/court appearance
Some Examples include but are not limited to:
 injury to a child, parent, or provider during a therapy session or home visit
 suspected , confided or reported abuse of a child or family member

Social service investigation
 restraining order
 divorce /custody disputes
Reporting Steps :
1. Make contact with a Program Manager/Director as soon as possible.
 Whether you are a Service coordinator or a Provide, contact your program manager and they will provide guidance through the next steps in the process.
2. Complete a DP Early Intervention Incident Report:
The Incident Report is for documenting an incident and is available in both an electronic or written format.
 Indicate the type of incident
 Complete basic identifying information
 Complete an accurate and concise objective recounting of what happened, what you have observed or been told by the family directly
 Indicate who was notified
 Send to Program Manager, who will determine next steps and follow up
3. Follow-up and Next Steps:
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 Program Managers will review incident report and determine what needed follow up should take place (social services report, mental health referral, community resources, etc.) or if additional notification or reporting is needed
 Program Manager will document follow up steps on incident report and save report on Share point System
 Reports will be saved (Last Name, First Name, month, day, year) and categorized by incident type
4. Making a Social Services Report:
Discuss the following steps with a Program Manager, Associate/Director prior to making a report.
 Gather identifying information including name, address, and date of birth, parent or guardian’s name, phone number before making the report.
 Have clearly in your mind what was said to you or what you witnessed regarding the incident.
 Prepare to answer questions about what, when, where the incident took place.
 Make the phone call with your Program Manager/Associate/Director.

Arapahoe County: 303-636-1750

Douglas County: 303-688-4825 or 303-663-6270

Adams County: 303-412-5212

Denver County: 720-944-3000

Jefferson County: 303-271-4131
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(To be completed by Program Manager/Director)
i.e. Mental Health Facility, WIC,
Head Start, Parents as Teachers, etc)
45

46

Hello,
You are receiving this email because you recently became an independent contractor with the Early Childhood Department at Developmental Pathways. My name is Grant
Hampe and I am the person who authorizes the supports and services pages (s/s page) and can help you with billing questions. When you start working with families you will receive an email from me that has an s/s page attached to it. The s/s page is what authorizes how many units you are allowed to see a child and who will be paying for those units. There are three sources of funding for our program which can be identified on an s/s page. The first is Developmental Pathways. This funding comes to us from state and local governments. The second type of funding is
Medicaid. You are not required to become a Medicaid provider, but it provides access to additional children if you do. Finally, certain insurance plans are required to pay into an insurance trust fund to help cover the cost of Early Intervention for their clients. The third funding source is this trust fund. The services for a child will be approved by my circling of the funding source in the funding column on the s/s page followed by my initials and the date. If necessary, I will make a note on the s/s about any service not being approved as written. Please make sure to take note of the funding source, as children who are using the trust fund must be billed separately from the children who are funded by Developmental Pathways. Also, remember that you must list the children on you invoices alphabetically by last name and invoices are due to us by the last day of each month. Submitting your invoice to us at eibilling@developmentalpathways.org
is the best way to assure your invoices have been received. Once you receive the approved s/s page via email you are free to start services. The email you receive from me will not have any communication other than the attached s/s page and will simply have the child’s initials in the subject line.
It is important to have the approved s/s before you start seeing a child as we cannot pay for services delivered before a child has been through our entire enrollment process. If you run into a situation where you are set up to see a family before you
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have an s/s page, please contact me so that verbal authorization may be given for you to see the child prior to receiving my email. If you have questions about the specifics of an s/s page, accidentally deleted it, etc… contact the service coordinator for assistance as I do not keep copies of the s/s pages I send out to you. Please keep a copy of the s/s on your computer as this is your authorization for what services are to be delivered. Every time an s/s is updated, revised, or changed I will re-authorize all services and email a copy to each person on the s/s, even if the change does not affect them. If you ever have any questions about an invoice you submitted or are concerned that you have not received a check you can call me at
303/858-2347 and I will help you troubleshoot the situation. Pathways policy states that we have thirty days from the receipt of your invoice to issue a check. So a check is not considered late until it has gone past thirty days. Due to lengthy processes in our finance department, you can expect it to take three to four weeks for your payment to be issued. Checks are only cut on Thursdays, so after your invoice has been fully processed, you can look for a check from us over the weekend or early in the next week, depending on how quick the post office is in your area. Please check out our website for some commonly used forms that you can download and save on your computer or print out at a family’s home. Follow this link to go directly to our
Resources page or access our website at www.developmentalpathways.org
and click on Vendor Resources to get to our Early Childhood contract providers section. I have attached two billing templates to this email that you might want to use. One is for your
Pathways funded children and the other is for your trust fund funded children. You are not required to use our billing templates but you will have everything you need to have a complete invoice if you either use our template or make one similar to ours.
Lastly regarding your invoice, funding regulations require you to use your full nine digit zip code (aka zip + 4) on your invoice. You can use this link to find your zip + 4 code www.usps.com/zip4/ . Also attached are some billing procedures and an example of an invoice. Thank you for taking a moment to read this email and feel free to call me with any procedural questions you may have.
Sincerely,
Grant Hampe
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Billing policies and procedures
You will have two types of invoices that are submitted to Developmental Pathways.
The first type is for children funded by Developmental Pathways. These children access funding from State, Local and Federal governments. The second type of invoice you will have is for children funded by the trust fund. These children are funded by their insurance company through a qualifying insurance plan. In both cases, the invoices are sent to Developmental Pathways and you will receive a check from us for your services. The reason you need to invoice separately for these two different funding sources is that our process for reimbursement is different for each one and they both follow different deadlines.
When billing Developmental Pathways you are required to use units. One unit equals fifteen minutes. A typical visit lasts one hour so you would bill us four units for that visit. Units allow you flexibility in your scheduling. If a particular visit is going really well and you want to stay for an hour and a half, you can. On the other hand, if shorter more frequent visits work better for the child, you can schedule them that way. Just remember not to go over the total units you are allowed each month.
Please see below for the unit rates for each type of provider:
Therapist unit rate is $18.75
Bi-lingual therapist unit rate is $20.00
Interpreter unit rate is $10.00
Team meeting unit rate is $10.00 (max 4 units per meeting)
No-show unit rate for Therapists is $20.00 (max 1 unit per no-show)
No-show unit rate for Interpreters is $10.00 (max 1 unit per no-show)
Shadow visit unit rate is $10.00
Please be sure to make a note about make-up, no-show, and shadow visits on your invoice. See the sample invoice for a guide as how to properly bill for visits. Please note that each invoice can only have services from one month. For example if you are submitting an invoice for your April visits and realize that you forgot to invoice for a March visit. You will need to submit your April visits on one invoice and the March visit on another invoice.
How to create an invoice
Developmental Pathways provides it’s contract employees with billing templates for the two types of invoices they will need. If our invoices do not meet the needs for your company, you may make your own invoice, but it must include the following items:

Your name.

What discipline you perform.

Your address including your zip + 4 (federal regulations require this).

The best phone number to get a hold of you.
 To whom to make the check payable to (your name or your company’s name).
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
Invoice number. This number can never repeat and should contain only numbers, not letters. Your regular Pathways invoice and your trust fund invoice use the same pool of numbers so you must number them differently.

Invoice Date.

The complete given name of each child, no nicknames. Please hyphenate double last names. Children must be listed alphabetically by last name.
 Child’s date of birth.
 The child’s service coordinator’s name.

Dates of service.

Total number of units for the child. If any visit had more or less units than the rest of your visits, please indicate by putting the number of units in parenthesis next to the date.

Total amount due for the child.

Team meeting dates and the name of one child on your caseload (Please use a
Pathways funded child).

The total amount due for all children at the bottom of the invoice.
If your invoice has more than one page please make sure that each page is numbered and that your name and invoice number appears on each page.
Invoice submission procedures
The best way to submit your invoices to Developmental Pathways is via email at eibilling@developmentalpathways.org
You will receive a confirmation that your invoice has been received. If you do not receive an email back from us, we have not received your email. Please try again and if you are still having problems, please call
Lori Polacek at 303-858-2106. When submitting your invoice through email please attach your invoice to the email, do not place your invoice in the body of the email.
Also please do not ask questions or request anything with your invoice, the person who receives your invoices does not respond to messages sent in with invoices.
Please call or email Grant Hampe at 303-858-2347 with any questions or requests related to invoices.
Billing time lines
All Early Intervention invoice are due by the last day of the month. If you finish with your visits before the end of the month, you may submit your invoice early. You may not however, submit an invoice twice a month. Invoices received after the due date are subject to a penalty and invoices received more than 60 days late may not be processed. Our year-end financial procedures follow stricter guidelines and all invoices must be received on June 30 th . In addition, any visits that you may have forgotten to invoice for, including Medicaid visits which you did not receive payment from Medicaid for, must be sent in by June 30 th or payment will not be made. For those providers who can invoice Medicaid please do so primarily. If you have not received reimbursement after 30 days, then bill Pathways for your services before 60 days has elapsed. Please continue to try to invoice Medicaid. If you receive payment from Medicaid after Pathways has paid, you will need to reimburse
Pathways for the units you received double payment for. Pathways policy states that we have thirty days from the receipt of your invoice to issue a check. Due to lengthy
50

processes in our finance department, it may take three to four weeks for your payment to be issued. If it is getting close to thirty days and you have not received your payment, feel free to call or email Grant Hampe at 303-858-2347 for assistance investigating where your invoice is in our process. From time to time there may be an issue with your invoice, responding quickly to our inquiry will help get your invoice back into the process and result in quicker payment. Checks are only issued on
Thursdays. After your invoice has been fully processed, you can look for a check from us over the weekend or sometime in the next week depending on how quick the post office is in your area.
Coordinated systems of payment a.k.a. The Trust Fund
A Colorado law effective January 1, 2008 requires certain types of (qualifying) private health insurance plans to cover early intervention services. Previously, private health insurance plans may have covered some early intervention services, but many times parents had difficulties getting their insurance companies to cover needed early interventions services. Providers also encountered barriers to becoming a provider for and trouble billing insurance companies. Under the new law, a child who has a qualifying insurance plan and an IFSP is able to access their insurance via the trust fund to pay for early intervention services. The trust is funded by the insurance companies who deposit a lump sum with the state of Colorado to cover therapies for the year. We then draw down the funds as we deliver services to the families and any leftover money at the end of the year is refunded to the insurance company.
What do you have to do differently for a child who is accessing the trust fund?
Simply invoice for all of your trust fund children on a separate invoice labeled Trust
Fund. You will still deliver your service the same way you always do and bill
Developmental Pathways, Inc. for those services. We will in turn invoice the state for the services you have delivered. You will continue to receive your payments from
Developmental Pathways, Inc. as you usually do.
Make Up Visits :
Both families and providers sometimes need to cancel visits. Based upon your schedule, you do not have to do make-up visits. Talk with the family about whether or not you will be able to make-up a visit and if all possible, sessions should be made up within the same month missed or in the next month. If the make-up occurs the following month, indicate “make-up visit from mo/day” on the invoice.
No Show Visits:
If a family cancels with no prior notice, with less than 2 hours notice, or is not home for a scheduled, confirmed appointment, it is considered a No-Show visit. Contractor may bill
$20 (Interpreter $10) for the No-Show if there is not a make-up visit scheduled provided the service coordinator is informed of the No-Show status. You may bill for either a Noshow or you may schedule and bill for a make-up visit but not both. If there are 2 consecutive No-Show visits, the IFSP team must be reconvened to reevaluate frequency of service provision prior to Contractor scheduling a 3 rd visit. Complete a contact note to
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indicate a no-show, late cancellation or make-up session to coincide with billing. Also document the conversation with the Service Coordinator regarding any missed sessions on these notes.
Months with five possible visits:
You are generally authorized for one to four visits per month on the S & S page. Please plan ahead with the family to address any months with five possible visits, so there are no misunderstandings. As an independent contractor, it is up to you to balance your schedule to meet the contracted number of hours without going over. Two common solutions to the months with five possible visits is to either plan to skip one week or plan to have five shorter visits.
Team Meetings:
Team members may bill the two monthly meetings at $40 per meeting. Please be sure to list the team meetings you attended and their dates. Also list the name of one non-trust fund child on your caseload for billing purposes.
Child Record Management :
Best practice is to save a child’s records which may include contact notes, transition reports and IFSP documents for five years before shredding personal information.
Q.
In your example you have the service coordinators listed by their Last Name, First initial, do I have to list them this way?
A.
No , but please do list at least list a full name and an initial. (H. Troutman or Heidi
T.)
Q.
How do I bill for team meetings?
A.
Team meetings are billed by first selecting your discipline in the type of service column and then writing “Team Meeting” and the name of one Pathways funded (not trust fund or Medicaid) child on your caseload in the child’s name column. Our
Finance department only needs the name of one child for your meetings. You can then tab over to the dates of service column and enter the dates of the meetings.
Finally enter the number of units (4 per meeting) and the unit amount of $10 and you are good to go.
Type of
Service:
Child's
Name:
Last Name,
First
DOB: Service
Coordinator:
Dates of service:
02/03,
02/17
# of
Units:
8
Unit
Amount:
$10.00
Cost:
$80.00
Meeting
Richard
Thompson
Q.
What do all of the codes mean in the type of service column?
A.
Please see the list below for a listing of the codes and their meaning.
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AT – Assistive Technology
DI – Developmental Intervention (ECSEs use this code)
NS
– Nutritional Services
OT – Occupational Therapy
PT – Physical Therapy
PS
– Psychological Services (Behavioral services delivered by a LCSW or higher degree)
SC – Service Coordination
SE
– Social Emotional (Behavioral services delivered by someone supervised by an
LCSW or higher)
SLP – Speech Language Pathology
VS – Vision Services
Q.
If all of my visits are not the same number of units do I have to let you know?
A. Yes, please indicate the visit that is not the same length as the others by putting the number of units in parenthesis next to the date. See James Neutron on the sample invoice for an example. The rest of the visits are 4 units long but the visit on
1/1 was only 2 units long.
Q.
I typed in an amount in the totals column last month and now it won’t calculate correctly. What happened?
A.
Although the totals column shows a number, it really has a formula in it that calculates your hourly rate X the number of units. Once you type an amount into the totals column you have erased the formula in that cell and it will no longer “do the math for you”. To correct the problem you can copy one of the other cells in the totals column and paste it to the cell that is no longer working. If you are having trouble you can give Grant Hampe (303/858-2347) a call and he can walk you through the repair procedure.
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INSERT REFERRAL SAMPLE HERE
55

INSERT SAMPLE IFSP
56

SAMPLE Consent to Share:
Developmental Pathways Inc.
Consent/Release for Mutual Exchange of Information
325 Inverness Drive South
Englewood, Co 80112
Child’s Name____________________________________________________ Date of
Birth________________
I understand that Early Intervention Colorado is an interagency collaboration and that information about my child and family will be shared between the partners initialed below and Developmental Pathways (Community Centered Board) for support planning and development.
This is in accordance with the 1995 Memorandum of Understanding among the Colorado Department of Education, Public Health and
Environment, Human Services, and Health Care Policy and Financing.
Initials of Parent __________________
I hereby authorize the mutual exchange of information and release of documents regarding the above named person between Developmental
Pathways. Inc. and the individuals or agencies listed below:
__ Doctor(s) _________________________
__ Tri- County Health Department
__ Developmental Pathways
__ Littleton Public School
__ Cherry Creek Public Schools
__ Englewood Public Schools
__________________________
__ Sheridan Public Schools
__ Aurora Public Schools
__ East Central BOCES
__ Douglas Public Schools
__ Arapahoe County Dept. of Human Services
__ Douglas County Dept. of Human Services
__ The Children’s Hospital
__ Swedish Medical Center
__ St. Joseph Hospital
__ Porter Hospital
__ St. Anthony Hospital
__ University of Colorado Hospital
__ Presbyterian/St. Luke’s Hospital
__ Social Security Administration
_________________________
_________________________
__ Therapist(s) _________________________
_________________________
__ Other (Specify)
_______________________
_______________________
__ SkyRidge Hospital
__ Littleton Adventist Hospital
__ Home Care Management
__ Anchor Center
__ CHIP
__ Aurora Mental Health
__ The Medical Center of Aurora
__ Rose Medical Center
__ Lutheran Medical Center
__ Denver Health
Referral Information
Admission Summary
Discharge Summary
Physical Therapy Evaluations
Occupational Therapy Evaluations
Speech Therapy Evaluations
Developmental Screening Results
Hearing Screen or Test Results
Vision Screen or Test Results
Evaluation Results
IFSP
Other:
Specifically, is there any person or agency that you do not give consent to review your child’s information?_______________________________________________________________________________________________________
____
I hereby authorize the mutual exchange of information/records regarding the above named person between Developmental Pathways and school district Child Find for Three-year-Old school age (Part B) planning.
Initials of Parent ______________________
I have been fully informed of the intended use of this information. I also understand that the agency/person receiving this information is obligated to maintain it in a confidential manner and that it is to be used only for the purpose I have authorized. I understand that this information will be kept in a database that is password protected, and for the exclusive use of the Part C service coordinators and their supervisors for the purpose of optimizing communication, resources, and supports for my child and family. I understand my consent is effective for one year from the date of signing. I also understand that I may cancel all or any part by notifying Developmental Pathways at any time.
Signature of Parent Date
HIPAA ACKNOWLEDGEMENT I have received from Developmental Pathways, Inc. information on their compliance with the Health
Insurance Portability and Accountability Act (HIPAA) of 1996 and a copy of the “Notice of Privacy Practices.” For more information, see
45 CFR (Code of Federal Regulations) Parts 160 and 164 HIPAA and 34 CFR Part 99 FERPA.
Initials of Parent ______________________ The terms of this consent shall not exceed one year from date of signature.
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Focus of Visit(Goals and Observations)/ Family Status:

Location and participants of the visit (ex: home with mom, at daycare , etc.)

Target skills presented and progress

Level of regulation/frustration and level of affect ( how calm/ mad is this kiddo)

How much support is kiddo needing to complete task (i.e. independent, moderate, mild)

Length of sustained attention to task

Behavioral supports being used (reinforces, consequence model)

Therapy strategies (ex: sensory diet, prompt, modeling, errorless training etc.)

Specific toys or therapy items being used.

Changes in family system or family stressors (ex: medical issues, family move etc. )

Any additional information of note
Strategies taught to Parent(s)/Caregiver(s)

Weekly homework in simple concrete language ( if using an interpreter – make sure homework is clearly explained to parents and written in primary language )

Model homework for parent during the current session and follow up on homework at the next scheduled visit

Be very clear- where should they do the task, with what toy/equipment/ how often and how
 to “end” the homework time.
With Speech: leave clear target words for the week vs. “prompt for increased language”
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INSERT SAMPLE CONTACT NOTE:
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Developmental Pathways Sample Invoice
VENDOR
NAME:
VENDOR
Marie Barone
SERVICE: OT
ADDRESS: 123 Main St.
CITY,
STATE,
ZIP+4: Lynbrook, CO 80123-4567
PHONE
NUMBER: 303/858-2347
INVOICE
NUMBER:
0111
INVOICE January
Mo & Yr: 2011
Make check payable to: Marie Knows Best
Type of
Service:
Child's DOB:
Name:
Last Name,
Service
Coordinator:
Dates of service:
OT
First
Cleaver,
Wallace
OT Drake, Joshua
12/07/04
12/08/05
Stassi, L
Gibbons, S
1/29, 1/30,
1/31,
1/31
OT Kent, Clark
OT Neutron,
James
OT Parker, Peter
OT Shea, Carly
OT Squarepants,
Spongebob
OT Tank-Engine,
Thomas
OT Turner,
Timothy
12/03/00
12/11/08
12/05/02
12/09/06
12/12/09
12/06/03
12/10/07
Cooney, B
Zalatan, R
1/15
1/1 (2 units),
1/2, 1/3, 1/4
Foote, R
Kooima, A
01/10
01/1
(shadow visit)
Troutman, H 01/01, 01/02,
Newton, R
01/03, 01/04
01/05
Hinojosa, C
OT Wayne, Bruce
OT Wayne, Bruce
OT Team Meeting
Wonderland,
Allison
12/04/08
12/04/08
Rich, M
Rich, M
01/01/2011,
01/02/2011,
01/03/2011,
01/04/2011
(make up for
12/12)
01/12/2011
01/19/2011
(NS)
01/04/2011,
01/18/2011
# of
Units:
6
4
4
14
4
4
16
4
16
4
1
8
Unit
Amount:
$18.75
$18.75
$18.75
$18.75
$18.75
$10.00
$18.75
$18.75
$18.75
$18.75
$20.00
$10.00
Total Amount Due
Cost:
$112.50
$75.00
$75.00
$262.50
$75.00
$40.00
$300.00
$75.00
$300.00
$75.00
$20.00
$80.00
$0.00
$0.00
$0.00
$1,490.00
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Child Outcomes Summary Form (SAMPLE)
Child’s Name : JOE SMITH CCMS ID#: 1234 Unable to complete exit rating due to:
DOB: 01/01/10
Date of Assessment: 2/7/2012
Check one:  Entry status  Exit status  Annual
(optional)
Person(s) involved in summary rating
Nicole Walter
Title
Therapist LMFT
Mom Smith
Dad Smith
Molly Speech
Mother of child
Father of Child
Speech Therapist
 Child enrolled < 6 months
 Inability to contact family
 Other, explain:
Sources of Information
XAssessment Tool(s) (required)
HELP___________
XFamily Interview (required)
XObservation (required)
 Professional Reports
 Decision Making Tree
X Other ____IFSP___________
POSITIVE SOCIAL- EMOTIONAL SKILLS (Including Social Relationships)
1a. To what extent does this child demonstrate age-appropriate functions, across a variety of settings and situations on this indicator? (Check one number)
Not Yet Nearly Somewhat Completely
1

2 3 4 5 6 7
1b. Has the child shown any new skills or behaviors related to positive social-emotional skills since the last outcome summary?  Yes  No *Answer 1b only at annual or exit summary rating.
Supporting Evidence:
1.
Using the HELP Joe is functioning in the 18 month range on the Social Scale (5.0). Displays affection to parents, imitates some symbolic play themes, needs rituals and routines.
2.
Parents report concerns regarding Joe’s limited range of interest, and difficulty “making friends”. According to mom he plays alone at daycare and when on outings and has limited interest in peers and sharing. Dad reports he is “shy”.
3.
During session, Joe is primarily utilizing foundational skills in this area. He enjoys literal plays themes, isolated play and playing on the computer. Joe has some emerging immediate foundational skills as he engages with eye contact and high affect with familiar adults in familiar settings. He does not yet identify emotions or engage in a wide range of independent symbolic play. Most symbolic play is scripted or imitated. Therapy visits are taking place at home – no exposure to peers has been observed. Making progress with reciprocal play and following non preferred tasks.
ACQUIRING AND USING KNOWLEDGE AND SKILLS
2a. To what extent does this child demonstrate age-appropriate functions, across a variety of settings and situations on this indicator? (Check one number)
Not Yet Nearly Somewhat Completely
1
2b. Has the child shown
2

3 4 5 6 7 any new skills or behaviors related to acquiring and using knowledge and skills since the last outcome summary?
 Yes  No * Answer 2b only at annual or exit summary rating.
Supporting Evidence:
1.
Using the HELP Joe is functioning in the 18-20 month range on the Cognitive Scale (1.0) and in the 18-20 month range for
Language (2.0)
2.
Parents report communication to be an area of great concern for them. Mom reports that she understands “about half” of his language and that he is consistently only using 10-15 words and some signs. Parents are not concerned about his play skills at this time and report that he “likes a variety of toys”
3.
Joe consistently uses immediate foundational play and language skills. Joe is highly imitative with familiar persons and is expanding his range of pretend and symbolic play. Joe engages appropriately with puzzles, blocks, shape sorters and his train set.
Joe is limited by his difficulty communicating using expressive language. He uses 10-15 words unprompted to indicate preference and meet his needs. Prompted language increases to 20-30 words and sounds. He will imitate animal sounds and basic vocabulary consistently. He is not yet using two words phrases. He will point and grunt to indicate his preference. Joe has a nice attention span to preferred tasks and emerging tolerance for non preferred play and transitions.
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TAKING APPROPRIATE ACTION TO MEET NEEDS
3a. To what extent does this child demonstrate age-appropriate functions, across a variety of settings and situations on this indicator? (Check one number)
Not Yet Nearly Somewhat Completely
1
3b. Has the child shown
2 any
3

4 5 6 7 new skills or behaviors related to taking action to meet needs since the last outcome summary?  Yes  No *Answer 3b only at annual or exit summary rating.
Supporting Evidence:
1.
Using the HELP Joe is around the 20-24 month range on the Self Help scale (6.0).
2.
Per parent report this is not an area of concern for them. Joe finger feeds himself, is highly mobile and able to access his environment independently. He is beginning to potty train using a schedule and reward system. He continues to be in pull ups during the day and diapers at night but will indicate when he needs to be changed by saying “uh oh”. He assists with getting dressed and likes bath time. He is not a picky eater and sleeps through the night.
3.
This outcome is heavily reliant on parent repot as most self help routines are not observed as part of therapy sessions. Joe has nice emerging skills in this area and has more age appropriate functioning than not age appropriate. Joe’s limited expressive language is an area of delay on this outcome as he is not yet able to express his needs/wants verbally and can become frustrated.
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