EARLY INTERVENTION
Advocating for Those Who Can’t Speak
WHAT IS EI?
 EI is a comprehensive interagency program that supports children up
to age 3 with developmental delays in their efforts to realize their full
potential.
 It reduces the likelihood of delays among at-risk children
 It assists and empowers families to meet their child’s and their own
needs
 It entitles children regardless of race, ethnicity, or income to services
HISTORY OF EI
 Brown v. Board of Education 1954: established universal right
of all children to a decent education
 Project Head Start 1964: public policy effort to improve school
readiness and social development of disadvantaged children
 The Education for All Handicapped Children Act 1975:
ensured all children should receive a free and appropriate education
HISTORY OF EI
 Individuals with Disabilities Education Act (IDEA) 1986: reauthorization
of The Education for All Handicapped Children Act that now mandated public
schools to serve children with disabilities starting at age 3
 Part H (1987-96), Part C (1997 on): created services and supports in all 50
states and US territories creating the early intervention system. This also allowed
states to extend early intervention to at risk children (VLBW, children born to
mothers with MR, etc)
 In NY state, Early Intervention Program was established under Article 25 of
the Public Health Law in July of 1993
HOW DO YOU REFER TO
EI?
 Children under age 2 can be referred by their doctors, child care
agencies, social service workers, community –based agencies, and by
their parents
 Referral form with instructions:
 www.nyc.gov/html/doh/downloads/pdf/earlyint/ei-referral-form.pdf
 Contact your EI official: 1-800-522-5006; in New York City–311
 Sample letter for parents to refer their own child:
http://www.health.state.ny.us/publications/0532/sample1.htm
WHAT HAPPENS AFTER A
REFERRAL?
1.
Early Intervention Official will assign an initial service coordinator
2.
If the child is found to be eligible, an Individualized Family Service Plan (IFSP) will
be created
3.
If not eligible the service coordinator should explain to the parent how to access
other services and/or how to appeal the decision
4.
Reevaluate the IFSP every 6 months
5.
Preparation for transition: coordinating service providers, if necessary contacting
Committee on Preschool Education (CPSE) in the child’s school district
WHAT SERVICES ARE
AVAILABE?
 Special Instruction
 Occupational Therapy
 Speech Therapy
 Physical Therapy
 Psychological Services
 Family Training
 Counseling
 AssistiveTechonology
 Respite Services
IS EI EFFECTIVE?
 EI increases the developmental and educational gains for the child
and improves the functioning of the family
 Children in EI need fewer special education services later
 They are held back less
RESEARCH SUPPORTING EI
 Longitudinal study of Ypsilanti Perry Preschool Project: at 19 years more finished
high school, went on to postsecondary program, had employment, scored higher on
reading, math, and language tests at all grade levels vs. children who did not attend
program (Berruta-Clement, et al. 1984)
 Meta-analysis 31 studies in children <3 found EI effective in promoting
developmental progress in infants and toddlers with biologically based disabilities
(Shonkoff JP, Hauser-Cram P 1987)
 EI minimizes declines in development (Guralnick, MJ 1991)
 Longitudinal Study 25 years later for adults who had participated in Brookline Early
Education Project found in urban group completion of program associated with >1 year
additional schooling completed, fewer low income (<20,000) earners, more positive
health behaviors, and less depression than matched controls (Rosenberg, et al. 2008)
E A R LY I N T E R V E N T I O N M U N I C I PA L I T Y
P E R F O R M A N C E DATA - N E W YO R K C I T Y
Federal Fiscal Year
Evaluation Criteria
2008
2007
2006 2005
1: Percent of children receiving services 30 days or less from the date of the authorizing
Individualized Family Service Plan 1
78.0%
79.2%
85.5% 92.7%
2: Percent of children receiving services in natural environments
93.2%
92.6%
92.5% 90.2%
69.3%
(n=293;
95% C.I. =
(63.65%,
74.52%))
N/A
70.6%
4A: Percent of families participating in Part C who report that early intervention services
have helped the family know their rights2,3
72.16%
(n=176;
95% C.I. =
(64.92%,
78.64%))
63.1%
(n=293;
95% C.I. =
(57.33%,
68.68%))
N/A
65.2%
4B: Percent of families participating in Part C who report that early intervention services
have helped the family effectively communicate their children's needs2,3
68.18%
(n=176;
95% C.I. =
(60.75%,
74.99%))
78.8%
(n=293;
95% C.I. =
(73.71%,
83.37%))
N/A
82.6%
4C: Percent of families participating in Part C who report that early intervention services
have helped the family help their children develop and learn2,3
79.55%
(n=176;
95% C.I. =
(72.82%,
85.24%))
WHY MAKE CHANGES?
Exploding costs to the state for EI:
-previously, state paid for all services regardless of parents’ income
level
-75,000 children participating in EI, each costing the state 9,000$
annually
-other states pay 4,000$ per child
EXPLOSION IN EI COSTS
BUDGET CUTS AND WHAT THEY MEAN
SPECIFICALLY FOR ELIGIBILITY
 2010-2011 Budget Cuts and regulation changes (finalized June 3):
 1. Parent fees-previously all covered by the state regardless of income
level
 2. Decreasing reimbursement rate to providers by 10% for homebased services
 4.. Providers/Agencies to bill Medicaid or private insurers directly
 5.. New eligibility criteria
 6.Use of ABA aides
 7. New standards for provider approval
HOW ARE OUR PATIENTS
AFFECTED?
 Parent fees:
 State proposes a “Medicare-like” funding structure where 80% of
funding would come from the state and counties and 20% would be
from parents and health insurers
 Families earning less than 250% of the Federal Poverty Level are
exempt (= 46,000$ a year for a family of 3)
 Health insurers would need to cover the first 5,000$ in EI costs
HOW IS THIS A PROBLEM?
 Payments would need to be made quarterly
 If a parent missed one payment the child will lose EI services and
become ineligible
 Families must now provide proof of income, otherwise they have
to pay at the highest fee level which could impede the children of
homeless families, children in foster care, and particularly the children
of undocumented immigrants from access to services
DEFINING
DEVELOPMENTAL DELAY
 State definition: a child who has not attained developmental milestones
expected for the child’s chronological age, adjusted for prematurity in one
of the following areas
 1. cognitive
 2. physical
 3. communication
 4. social or emotional development
 5. adaptive development
At three months

At six months
• turn their heads

toward bright colors and
lights

• move both eyes in the
same direction together

• recognize bottle or
breast

• react to sudden sounds
or voices

• make cooing sounds

• make fists with both
hands

• grasp toys or hair

• wiggle and kick with
arms and legs

• lift head and chest
when on stomach

• smile
At twelve months:
• follow moving objects 
with their eye


• turn toward the
source of normal sound 

• reach for objects and 
pick them up

• switch toys from one
hand to the other

• sit without support
• pull to a standing position
• crawl
• drink from a cup

• play peek-a-boo and patty cake

• wave bye-bye
• play with their toes


• help hold the bottle
during feeding
• hold out their arms and legs while
being dressed


• recognize familiar
faces
• put objects in a container know five
or six words

• stack two blocks

• babble
At one and 1/2 years
At two years

• like to pull, push and
dump things

• use two-tothree-word
sentences

• follow simple directions
("Bring the ball")

• say names of
toys

• pull off shoes, socks and
mittens


• like to look at pictures

• make marks on paper
with crayons

• feed themselves

• walk without help

• step off a low object and
keep balance

• recognize
familiar pictures
At three years

• walk up steps (alternating
feet)

• ride a tricycle

• put on their shoes

• open door

• turn one page at a time

• carry something

while walking

• feed themselves

with a spoon

• play
independently

• use three-to-five-word
sentences
• turn 2-3 pages
at a time

• name at least one color
correctly

• like to imitate
their parent

• are toilet trained

• identify hair,
eyes, ears and
nose by pointing

• build a tower of
four blocks

• show affection
• play with other children
for a few minutes
• repeat common rhymes
ELIGIBILITY
 Previously: 33% delay in one functional area or 25% delay in two
functional areas
 Now: 2 standard deviations below the mean in one domain or 1.5
standard deviations below the mean in two separate domains
 For language specifically, must show delays in both expressive and
receptive language or in one with the presence of specific predictors
of continued language delay
PREDICTORS OF
CONTINUED DELAYS
 Language Production

Particularly small vocabulary for age

Less diverse vocabulary particularly in regard to verbs

Preponderance of general all-purpose verbs (such as "do,"
"make," "want," "go")

More transitive and fewer intransitive verbs (such as "give ball")
 Language Comprehension

Presence of 6-month comprehension delay

Large comprehension-production gap with comprehension deficit
PREDICTORS OF
CONTINUED DELAY
 Phonology
 Few prelinguistic vocalizations
 Limited number of consonants
 Limited variety in babbling structure
 Fewer than 50% consonants correct (substitution of glottal consonants and back sounds for front)
 Restricted syllable structure
 Vowel errors
 Imitation
 Few spontaneous imitations
 Reliance on direct model and prompting in imitation tasks of emerging language forms
PREDICTORS OF
CONTINUED DELAY

Play

Primarily manipulating and grouping

Little combinatorial and/or symbolic play



Gestures
Few communicative gestures, symbolic sequences, or supplementary gestures
Social Skills

Behavioral problems

Few conversational initiations; interactions with adults more than peers

Difficulty gaining access to activities

Health and Family History

Recurrent otitis media

Family history of persistent problems in language learning
WHO DOES THIS AFFECT?
 Mainly affects patients with language delays
 A child with a delay of 25% or 1.5 standard deviations below the
mean in two aspects of a single domain no longer qualifies for EI
A child that qualifies because he or she meets the criteria of a delay 2
standard deviations below the mean can lose services if there is
improvement in any aspect of that domain
EXAMPLES
 A child with a delay of 1.5 standard deviations in expressive language and
1.5 standard deviations in receptive language with no other delays is not
eligible
 A child with a score of 2 standard deviations below the mean in expressive
language but no (or less significant) delay in receptive language is not eligible
 A child that starts out 2 standard deviations below the mean in expressive
and receptive language could lose services with improvement in one of those
aspects
D O H C L I N I C A L P R AC T I C E
GUIDELINES FOR
C O M M U N I C AT I O N D I S O R D E R S
 Severe language delay:
 Children < 18 months:
• Has not reached any of the normal language milestones expected for
children in the next younger age range and none of the upper limits
expected for the child’s age range
SEVERE LANGUAGE DELAY
CONTINUED
 Children 18-36 months:
•
•
•
•
No words by 18 months
Less than 30 words by 24 months
No two word combinations by 30 months
Documented presence of known predictors of developmental delay
in language production, comprehension, phonology, imitation, play
gestures, social skills, health and family history
W H AT H A P P E N S T O T H E
C H I L D R E N A L R E A DY E N RO L L E D ?
 All children enrolled prior to June 3rd do not need to meet the new
eligibility criteria until the EI official requests a new evaluation
 New evaluations cannot be done before six months into the
program OR there is an observable change that may indicate that the
child is no longer eligible
WHAT CAN WE DO?
 Email state legislators: sample letters for parents as well as others
can be found through Advocates for Children New York at
http://capwiz.com/iacny/state/main/?state=NY
 Write letters/call your state legislators: to find your State Senator
http://www.senate.state.ny.us/senatehomepage.nsf/senators?OpnForm
 To find your NY Assembly member go to:
http://www.assembly.state.ny.us/mem/
ADDITIONAL RESOURCES FOR OUR
PA T I E N T S A N D PA R E N T S
 Early Childhood Direction Centers:
www.vesid.nysed.gov/specialed/transition/whocan.htm
 Parent to Parent of New York State: www.parenttoparentnys.org
 Other sites for parent information:
 www.taalliance.org
 www.advocacycenter.com
 www.advocatesforchildren.org
 www.resourcesnyc.org
FURTHER RESOURCES
 Advocacy Services: www.cqc.state.ny.us
 Mediation: If with the new changes in eligibility a child is deemed to no longer be eligible
parents can request mediation
 Parents can send a letter to their EI official to ask for mediation , EI official then
notifies Community Dispute Resolution Center
 The mediation process must be completed within 30 days of the Community Dispute
Resolution Center receiving the request
 If an agreement is made then a written agreement is prepared detailing the services to be
provided
 If no agreement is reached then parents can request an impartial hearing
STEPS FOR MEDIATION
 Parents can send a letter to their EI official to ask for mediation
 EI official then notifies Community Dispute Resolution Center
 The mediation process must be completed within 30 days of the Community
Dispute Resolution Center receiving the request
 If an agreement is made then a written agreement is prepared detailing the
services to be provided
 If no agreement is reached then parents can request an impartial hearing
 More info at: New York State Dispute Resolution Association www.nysdra.org
 www.nyhealth.gov/publications/0532/index.htm
REFERENCES

Early Intervention. New York City Department of Health and Mental Hygiene. 22 February 2011
<http://nyc.gov/html/doh/html/earlyint/earlyservices.shtml>.

Early Intervention. New York City Department of Health and Mental Hygiene. 22 February 2011
<http://nyc.gov/html/doh/html/earlyint/earlydif.shtml>.

Early Intervention Program. New York State Department of Health Information for a Healthy New York. 22
February 2011< http://www.health.state.ny.us/ >.

Early Intervention Program. New York State Department of Health Information for a Healthy New York. 22
February 2011< http://www.health.state.ny.us/ >.

Early Intervention Program. New York State Department of Health Information for a Healthy New York. 23
February 2011
<http://www.health.state.ny.us/community/infants_children/early_intervention/ei_revised_regulations_webinar1_overview_faqs.htm>.

Early Intervention Program. New York State Department of Health Information for a Healthy New York. 23
February 2011
<http://www.health.state.ny.us/statistics/community/infants_children/early_intervention/local_program_performance/n
ew_york_city.htm#three>.

Early Intervention Program. New York State Department of Health Information for a Healthy New York. 24
February 2011 <http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/200502/eligibility_criteria.htm>.

Early Intervention Program. New York State Department of Health Information for a Healthy New York. 25 February 2011
<http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/2005-02/appendix_f.htm>.

Early Intervention Program. New York State Department of Health Information for a Healthy New York. 25 February 2011
<http://www.health.state.ny.us/community/infants_children/early_intervention/memoranda/2005-02/appendix_g.htm>.
REFERENCES

Ramey CT, Ramey SL. “Early Intervention and Early Experience.” American Psychologist. 1998; Vol 53 (2): 109-120.

Bailey DB, Gebbeler K, Scarborough A, Spiker D, Mallik S. “First Experiences with Early Intervention: A National Perspective.”
Pediatrics. 2004 Sep; 114 (3): 896.

Palfrey JS, Hauser-Cram P, Bronson MB, Warfield ME, Sirin S, Chan E. “The Brookline Early Education Project: A 25 Year Followup Study of a Family-Centered Early Health and Development Intervention.”Pediatrics.” 2005 Jul; 116 (1): 144-52.

Early Intervention Scheduled for More Cuts in State Budget. New York State Speech-Language-Hearing Association, Inc. 24
February 2011 <http://www.nysslha.org/i4a/headlines/headlinedetails.cfm?id=52>.

Meeting the Health Care Needs of New Yorkers. Division of the Budget New York State. 25 February 2011.
<http://www.budget.state.ny.us/pubs/archive/fy0304archive/fy0304littlebook/health.html>.

Fertig, Beth. “Schools Chancellor Says Cuomo’s Budget Cuts are Unjust.” WNYC News Blog 15 February 2011: WNYC.

Weaver, Teri. “First Look at Cuomo’s Proposed Budget Shows Cuts, Consolidation.” The Post Standard 1 February 2011: The Post
Standard.

Important Action Alert: Oppose Harmful Changes to Early Intervention. Lublin, Nina. Resources for Children with Special Needs.
23 February 2011 <http://www.resourcesnyc.org/advocates039-voices-blog/important-action-alert-oppose-harmful-changes-earlyintervention>.