The birth of a child is an exciting, life-changing event. A beautiful new baby comes to your house, family, and neighborhood. It is a time for celebration. Family members look at the new child and wonder: Will he be a football star, will she be a famous musician, will he discover the cure for cancer, will she become President of the United States? But what happens when this new child has a disability? What if there are health problems? What if, as time goes by, it seems as if the child isn’t learning and progressing as quickly or easily as other children? What do you do?
Early intervention is an effective way to help very young children (birth to the third birthday) catch up or address specific developmental concerns as soon as possible in their lives. Early intervention services are authorized under Part C of the Individuals with Disabilities Education Act.
This part of our site can help you find answers and people who can help–specifically, through the early intervention system that’s available in every state. Use the tabs to the left to learn more about early intervention services.
Overview of Early Intervention
Early intervention is a system of services that helps babies and toddlers with developmental delays or disabilities. Early intervention focuses on helping eligible babies and toddlers learn the basic and brand-new skills that typically develop during the first three years of life, such as:
- physical (reaching, rolling, crawling, and walking);
- cognitive (thinking, learning, solving problems);
- communication (talking, listening, understanding);
- social/emotional (playing, feeling secure and happy); and
- self-help (eating, dressing).
Examples of early intervention services | If an infant or toddler has a disability or a developmental delay in one or more of these developmental areas, that child will likely be eligible for early intervention services. Those services will be tailored to meet the child’s individual needs and may include:
- Assistive technology (devices a child might need)
- Audiology or hearing services
- Speech and language services
- Counseling and training for a family
- Medical services
- Nursing services
- Nutrition services
- Occupational therapy
- Physical therapy
- Psychological services
Services may also be provided to address the needs and priorities of the child’s family. Family-directed services are meant to help family members understand the special needs of their child and how to enhance his or her development.
Authorized by Law – IDEA
Early intervention is available in every state and territory of the United States. The Individuals with Disabilities Education Act (IDEA) requires it – Part C of IDEA, to be precise. That’s why you’ll sometimes hear early intervention referred to as Part C.
Who’s eligible for early intervention?
Early intervention is intended for infants and toddlers who have a developmental delay or disability. Eligibility is determined by evaluating the child (with parents’ consent) to see if the little one does, in fact, have a delay in development or a disability. Eligible children can receive early intervention services from birth through the third birthday (and sometimes beyond).
From birth
Sometimes it is known from the moment a child is born that early intervention services will be essential in helping the child grow and develop. Often this is so for children who are diagnosed at birth with a specific condition or who experience significant prematurity, very low birth weight, illness, or surgery soon after being born. Even before heading home from the hospital, this child’s parents may be given a referral to their local early intervention office.
Developmental delay
Some children have a relatively routine entry into the world, but may develop more slowly than others, experience set backs, or develop in ways that seem very different from other children. For these children, a visit with a developmental pediatrician and a thorough evaluation may lead to an early intervention referral.
Parents don’t have to wait for a referral to early intervention, however. If you’re concerned about your child’s development, you may contact your local program directly and ask to have your child evaluated. That evaluation is provided free of charge. If you’re not sure how to locate the early intervention program in your community—keep reading. We give that information a bit further down the page.
However a child comes to be referred, evaluated, and determined eligible, early intervention services provide vital support so that children with developmental needs can thrive and grow.
What’s a developmental delay?
The term “developmental delay” is an important one in early intervention. Broadly speaking, it means that a child is delayed in some area of development. There are five areas in which development may be affected:
- Cognitive development
- Physical development, including vision and hearing
- Communication development
- Social or emotional development
- Adaptive development
Developmental milestones | Think of all the baby skills that can fall under any one of those developmental areas! Babies and toddlers have a lot of new skills to learn, so it’s always of concern when a child’s development seems slow or more difficult than would normally be expected.
Definition of “developmental delay” | Part C of IDEA broadly defines the term “developmental delay.” But the exact meaning of the term varies from state to state, because each state defines the term for itself, including:
- describing the evaluation and assessment procedures that will be used to measure a child’s development in each of the five developmental areas; and
- specifying the level of delay in functioning (or other comparable criteria) that constitutes a
- developmental delay in each of the five developmental areas.
What’s your state’s definition? | Clearly, it’s important to know how your state defines “developmental delay.” Find out more about that definition by visiting the Texas Health and Human Services webpage on Early Childhood Intervention Services at https://hhs.texas.gov/services/disability/early-childhood-intervention-services
If you’re concerned about a baby or toddler’s development
It’s not uncommon for parents and family members to become concerned when their beautiful baby or growing toddler doesn’t seem to be developing according to the normal schedule of “baby” milestones.
- “He hasn’t rolled over yet.”
- “The little girl next door is already sitting up on her own!”
- “She should be saying a few words by now.”
Sound familiar? While it’s true that children develop differently, at their own pace, and that the range of what’s “normal” development is quite broad, it’s hard not to worry and wonder.
What to do | If you think that your child is not developing at the same pace or in the same way as most children his or her age, it is often a good idea to talk first to your child’s pediatrician. Explain your concerns. Tell the doctor what you have observed with your child. Your child may have a disability or a developmental delay, or he or she may be at risk of having a disability or delay.
You can also get in touch with your community’s early intervention program, and ask to have your little one evaluated to see if he or she has a developmental delay or disability. This evaluation is free of charge, won’t hurt your child, and looks at his or her basic skills. Based on that evaluation, your child may be eligible for early intervention services, which will be designed to address your child’s special needs or delays.
There are several ways to connect with the ECI program in your community:
- Ask your pediatrician for a referral to the local early intervention system.
- Visit the ECI Program Search page at https://citysearch.hhsc.state.tx.us/
Referral | Write down any information the contact person gives you. It’s also a good idea to write down the names and phone numbers of everyone you talk to as you move through the early intervention process.
The evaluation and assessment process
Once connected with your community’s early intervention program, you’ll be assigned a service coordinator who will explain the early intervention process and help you through the next steps in that process. The service coordinator will serve as your single point of contact with the early intervention system.
One of the first things that will happen is that your child will be evaluated to see if, indeed, he or she has a developmental delay or disability. (In some states, there may be a preliminary step called screening to see if there’s cause to suspect that a baby or toddler has a disability or developmental delay.) The family’s service coordinator will explain what’s involved in the screening and/or evaluation and ask for your permission to proceed. You must provide your written consent before screening and/or evaluation may take place.
The evaluation group will be made up of qualified people who have different areas of training and experience. Together, they know about children’s speech and language skills, physical abilities, hearing and vision, and other important areas of development. They know how to work with children, even very young ones, to discover if a child has a problem or is developing within normal ranges. Group members may evaluate your child together or individually. As part of the evaluation, the team will observe your child, ask your child to do things, talk to you and your child, and use other methods to gather information. These procedures will help the team find out how your child functions in the five areas of development.
Writing the IFSP
Having collected a great deal of information about your child and family, it’s now possible for the team (including you as parents) to sit down and write an individualized plan of action for your child and family. This plan is called the Individualized Family Service Plan, or IFSP. It is a very important document, and you, as parents, are important members of the team that develops it. Each state has specific guidelines for the IFSP. Your service coordinator can explain what the IFSP guidelines are in your state.
The IFSP is a written document that, among other things, outlines the early intervention services that your child and family will receive. One guiding principle of the IFSP is that the family is a child’s greatest resource, that a young child’s needs are closely tied to the needs of his or her family. The best way to support children and meet their needs is to support and build upon the individual strengths of their family. So, the IFSP is a whole family plan with the parents as major contributors in its development. Involvement of other team members will depend on what the child needs. These other team members could come from several agencies and may include medical people, therapists, child development specialists, social workers, and others.
What info is included in an IFSP? | Your child’s IFSP must include the following:
- Your child’s present physical, cognitive, communication, social/emotional, and adaptive development levels and needs
- Family information (with your agreement), including the resources, priorities, and concerns of you, as parents, and other family members closely involved with the child
- The major results or outcomes expected to be achieved for your child and family
- The specific services your child will be receiving
- Where in the natural environment (e.g., home, community) the services will be provided (if the services will not be provided in the natural environment, the IFSP must include a statement justifying why not)
- When and where your son or daughter will receive services
- The number of days or sessions he or she will receive each service and how long each session will last
- Who will pay for the services
- The name of the service coordinator overseeing the implementation of the IFSP
- The steps to be taken to support your child’s transition out of early intervention and into another program when the time comes.
The IFSP may also identify services your family may be interested in, such as financial information or information about raising a child with a disability.
Informed parental consent | The IFSP must be fully explained to you, the parents, and your suggestions must be considered. You must give written consent for each service to be provided. If you do not give your consent in writing, your child will not receive that service.
Reviewing and updating the IFSP | The IFSP is reviewed every six months and is updated at least once a year. This takes into account that children can learn, grow, and change quickly in just a short period of time.
Timeframes
When the early intervention system receives a referral about a child with a suspected disability or developmental delay, a time clock starts running. Within 45 days, the early intervention system must complete the critical steps discussed thus far:
- screening (if used in the state),
- initial evaluation of the child,
- initial assessments of the child and family, and
- writing the IFSP (if the child has been found eligible).
That’s a tall order, but important, given how quickly children grow and change. When a baby or toddler has developmental issues, they need to be addressed as soon as possible. So—45 days, that’s the timeframe from referral to completion of the IFSP for an eligible child.
Who pays for the services?
Whether or not you, as parents, will have to pay for any services for your child depends on the policies of your state. Check with your service coordinator. Your state’s system of payments must be available in writing and given to you, so there are no surprises or unexpected bills later.
What’s free to families | Under Part C of IDEA, the following services must be provided at no cost to families:
- Child Find services;
- evaluations and assessments;
- the development and review of the IFSP; and
- service coordination.
When services are not free | Depending on your state’s policies, you may have to pay for certain other services. You may be charged a “sliding-scale” fee, meaning the fees are based on what you earn. Some services may be covered by your health insurance, by Medicaid, or by Indian Health Services. The Part C system may ask for your permission to access your public or private insurance in order to pay for the early intervention services your child receives. In most cases, the early intervention system may not use your health care insurance (private or public) without your express, written consent. If you do not give such consent, the system may not limit or deny you or your child services.
Every effort is made to provide services to all infants and toddlers who need help, regardless of family income. Services cannot be denied to a child just because his or her family is not able to pay for them.
Key Terms to Know in Early Intervention
It’s extremely important to understand that many of the terms you’re likely to hear in early intervention come from our nation’s law authorizing this program for infants and toddlers with disabilities, Part C of IDEA (Individuals with Disabilities Education Act). We frequently refer to this law on our website and in our publications, because IDEA guides how early intervention (Part C) and special education and related services (Part B) are provided to children with disabilities in the United States, birth to age 21.
States develop their own policies and procedures based on what IDEA requires. States are allowed to go beyond what IDEA requires–and frequently do, because the law leaves a great many things to State and local discretion. However, States are not permitted to have policies or procedures that are not consistent with IDEA’s provisions.
This being the case, the starting point of early intervention terms and what they mean is always how Part C of IDEA defines the terms. Your State’s definition of a term is then important to consider, because it will influence how the term is being used in your area, especially if the State definition isn’t exactly the same as IDEA’s.
Consent
The Part C regulations define consent at §303.7, as follows:
§303.7 Consent.
Consent means that—
(a) The parent has been fully informed of all information relevant to the activity for which consent is sought, in the parent’s native language, as defined in §303.25;
(b) The parent understands and agrees in writing to the carrying out of the activity for which the parent’s consent is sought, and the consent form describes that activity and lists the early intervention records (if any) that will be released and to whom they will be released; and
(c)(1) The parent understands that the granting of consent is voluntary on the part of the parent and may be revoked at any time.
(2) If a parent revokes consent, that revocation is not retroactive (i.e., it does not apply to an action that occurred before the consent was revoked).
Additional provisions of import | The following provisions are also important with respect to parental consent.
§303.420 Parental consent and ability to decline services.
(a) The lead agency must ensure parental consent is obtained before—
(1) Administering screening procedures under §303.320 that are used to determine whether a child is suspected of having a disability;
(2) All evaluations and assessments of a child are conducted under §303.321;
(3) Early intervention services are provided to the child under this part;
(4) Public benefits or insurance or private insurance is used if such consent is required under §303.520; and
(5) Disclosure of personally identifiable information consistent with §303.414.
(b) If a parent does not give consent under paragraph (a)(1), (a)(2), or (a)(3) of this section, the lead agency must make reasonable efforts to ensure that the parent—
(1) Is fully aware of the nature of the evaluation and assessment of the child or early intervention services that would be available; and
(2) Understands that the child will not be able to receive the evaluation, assessment, or early intervention service unless consent is given.
(c) The lead agency may not use the due process hearing procedures under this part or Part B of the Act to challenge a parent’s refusal to provide any consent that is required under paragraph (a) of this section.
(d) The parents of an infant or toddler with a disability—
(1) Determine whether they, their infant or toddler with a disability, or other family members will accept or decline any early intervention service under this part at any time, in accordance with State law; and
(2) May decline a service after first accepting it, without jeopardizing other early intervention services under this part.
Developmental Delay
The definition of developmental delay in the Part C regulations of IDEA is actually very tiny. Here it is:
§ 303.10 Developmental delay.
Developmental delay, when used with respect to a child residing in a State, has the meaning given that term by the State under §303.111.
As can be seen, the entirety of the term is defined by each State, for use with children residing in that State. This gives enormous flexibility to each State—within the parameters of what specific other provisions in the Part C regulations require–especially the following:
§303.111 State definition of developmental delay.
Each system must include the State’s rigorous definition of developmental delay, consistent with §§303.10 and 303.203(c), that will be used by the State in carrying out programs under Part C of the Act in order to appropriately identify infants and toddlers with disabilities who are in need of services under Part C of the Act. The definition must—
(a) Describe, for each of the areas listed in §303.21(a)(1), the evaluation and assessment procedures, consistent with §303.321, that will be used to measure a child’s development; and
(b) Specify the level of developmental delay in functioning or other comparable criteria that constitute a developmental delay in one or more of the developmental areas identified in §303.21(a)(1).
Editor’s note | The developmental areas mentioned in the above definition are:
- Cognitive development
- Physical development, including vision and hearing
- Communication development
- Social or emotional development
- Adaptive development
Early Intervention Services
Do you really want to know how the Part C regulations define the term early intervention services? Of course you do. Brace yourself, though, because it’s a long one. Here goes…
§303.13 Early intervention services.
(a) General. Early intervention services means developmental services that—
(1) Are provided under public supervision;
(2) Are selected in collaboration with the parents;
(3) Are provided at no cost, except, subject to §§303.520 and 303.521, where Federal or State law provides for a system of payments by families, including a schedule of sliding fees;
(4) Are designed to meet the developmental needs of an infant or toddler with a disability and the needs of the family to assist appropriately in the infant’s or toddler’s development, as identified by the IFSP Team, in any one or more of the following areas, including—
(i) Physical development;
(ii) Cognitive development;
(iii) Communication development;
(iv) Social or emotional development; or
(v) Adaptive development;
(5) Meet the standards of the State in which the early intervention services are provided, including the requirements of Part C of the Act;
(6) Include services identified under paragraph (b) of this section;
(7) Are provided by qualified personnel (as that term is defined in §303.31), including the types of personnel listed in paragraph (c) of this section;
(8) To the maximum extent appropriate, are provided in natural environments, as defined in §303.26 and consistent with §§303.126 and 303.344(d); and
(9) Are provided in conformity with an IFSP adopted in accordance with section 636 of the Act and §303.20.
(b) Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph:
(1) Assistive technology device and service are defined as follows:
(i) Assistive technology device means any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of an infant or toddler with a disability. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization (e.g., mapping), maintenance, or replacement of that device.
(ii) Assistive technology service means any service that directly assists an infant or toddler with a disability in the selection, acquisition, or use of an assistive technology device. The term includes—
(A) The evaluation of the needs of an infant or toddler with a disability, including a functional evaluation of the infant or toddler with a disability in the child’s customary environment;
(B) Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by infants or toddlers with disabilities;
(C) Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing assistive technology devices;
(D) Coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs;
(E) Training or technical assistance for an infant or toddler with a disability or, if appropriate, that child’s family; and
(F) Training or technical assistance for professionals (including individuals providing education or rehabilitation services) or other individuals who provide services to, or are otherwise substantially involved in the major life functions of, infants and toddlers with disabilities.
(2) Audiology services include—
(i) Identification of children with auditory impairments, using at-risk criteria and appropriate audiologic screening techniques;
(ii) Determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures;
(iii) Referral for medical and other services necessary for the habilitation or rehabilitation of an infant or toddler with a disability who has an auditory impairment;
(iv) Provision of auditory training, aural rehabilitation, speech reading and listening devices, orientation and training, and other services;
(v) Provision of services for prevention of hearing loss; and
(vi) Determination of the child’s individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.
(3) Family training, counseling, and home visits means services provided, as appropriate, by social workers, psychologists, and other qualified personnel to assist the family of an infant or toddler with a disability in understanding the special needs of the child and enhancing the child’s development.
(4) Health services has the meaning given the term in §303.16.
(5) Medical services means services provided by a licensed physician for diagnostic or evaluation purposes to determine a child’s developmental status and need for early intervention services.
(6) Nursing services include—
(i) The assessment of health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems;
(ii) The provision of nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; and
(iii) The administration of medications, treatments, and regimens prescribed by a licensed physician.
(7) Nutrition services include—
(i) Conducting individual assessments in—
(A) Nutritional history and dietary intake;
(B) Anthropometric, biochemical, and clinical variables;
(C) Feeding skills and feeding problems; and
(D) Food habits and food preferences;
(ii) Developing and monitoring appropriate plans to address the nutritional needs of children eligible under this part, based on the findings in paragraph (b)(7)(i) of this section; and
(iii) Making referrals to appropriate community resources to carry out nutrition goals.
(8) Occupational therapy includes services to address the functional needs of an infant or toddler with a disability related to adaptive development, adaptive behavior, and play, and sensory, motor, and postural development. These services are designed to improve the child’s functional ability to perform tasks in home, school, and community settings, and include—
(i) Identification, assessment, and intervention;
(ii) Adaptation of the environment, and selection, design, and fabrication of assistive and orthotic devices to facilitate development and promote the acquisition of functional skills; and
(iii) Prevention or minimization of the impact of initial or future impairment, delay in development, or loss of functional ability.
(9) Physical therapy includes services to address the promotion of sensorimotor function through enhancement of musculoskeletal status, neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation. These services include—
(i) Screening, evaluation, and assessment of children to identify movement dysfunction;
(ii) Obtaining, interpreting, and integrating information appropriate to program planning to prevent, alleviate, or compensate for movement dysfunction and related functional problems; and
(iii) Providing individual and group services or treatment to prevent, alleviate, or compensate for, movement dysfunction and related functional problems.
(10) Psychological services include—
(i) Administering psychological and developmental tests and other assessment procedures;
(ii) Interpreting assessment results;
(iii) Obtaining, integrating, and interpreting information about child behavior and child and family conditions related to learning, mental health, and development; and
(iv) Planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development, parent training, and education programs.
(11) Service coordination services has the meaning given the term in §303.34.
(12) Sign language and cued language services include teaching sign language, cued language, and auditory/oral language, providing oral transliteration services (such as amplification), and providing sign and cued language interpretation.
(13) Social work services include—
(i) Making home visits to evaluate a child’s living conditions and patterns of parent-child interaction;
(ii) Preparing a social or emotional developmental assessment of the infant or toddler within the family context;
(iii) Providing individual and family-group counseling with parents and other family members, and appropriate social skill-building activities with the infant or toddler and parents;
(iv) Working with those problems in the living situation (home, community, and any center where early intervention services are provided) of an infant or toddler with a disability and the family of that child that affect the child’s maximum utilization of early intervention services; and
(v) Identifying, mobilizing, and coordinating community resources and services to enable the infant or toddler with a disability and the family to receive maximum benefit from early intervention services.
(14) Special instruction includes—
(i) The design of learning environments and activities that promote the infant’s or toddler’s acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction;
(ii) Curriculum planning, including the planned interaction of personnel, materials, and time and space, that leads to achieving the outcomes in the IFSP for the infant or toddler with a disability;
(iii) Providing families with information, skills, and support related to enhancing the skill development of the child; and
(iv) Working with the infant or toddler with a disability to enhance the child’s development.
(15) Speech-language pathology services include—
(i) Identification of children with communication or language disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills;
(ii) Referral for medical or other professional services necessary for the habilitation or rehabilitation of children with communication or language disorders and delays in development of communication skills; and
(iii) Provision of services for the habilitation, rehabilitation, or prevention of communication or language disorders and delays in development of communication skills.
(16) Transportation and related costs include the cost of travel and other costs that are necessary to enable an infant or toddler with a disability and the child’s family to receive early intervention services.
(17) Vision services mean—
(i) Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities that affect early childhood development;
(ii) Referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; and
(iii) Communication skills training, orientation and mobility training for all environments, visual training, and additional training necessary to activate visual motor abilities.
(c) Qualified personnel. The following are the types of qualified personnel who provide early intervention services under this part:
(1) Audiologists.
(2) Family therapists.
(3) Nurses.
(4) Occupational therapists.
(5) Orientation and mobility specialists.
(6) Pediatricians and other physicians for diagnostic and evaluation purposes.
(7) Physical therapists.
(8) Psychologists.
(9) Registered dieticians.
(10) Social workers.
(11) Special educators, including teachers of children with hearing impairments (including deafness) and teachers of children with visual impairments (including blindness).
(12) Speech and language pathologists.
(13) Vision specialists, including ophthalmologists and optometrists.
(d) Other services. The services and personnel identified and defined in paragraphs (b) and (c) of this section do not comprise exhaustive lists of the types of services that may constitute early intervention services or the types of qualified personnel that may provide early intervention services. Nothing in this section prohibits the identification in the IFSP of another type of service as an early intervention service provided that the service meets the criteria identified in paragraph (a) of this section or of another type of personnel that may provide early intervention services in accordance with this part, provided such personnel meet the requirements in §303.31.
Definition of health services | You’ve reached the end of the definition of early intervention services in the Part C regulations. Now, here are the additional regulations that define “health services” (at §303.16), which were mentioned in the above definition.
§303.16 Health services.
(a) Health services mean services necessary to enable an otherwise eligible child to benefit from the other early intervention services under this part during the time that the child is eligible to receive early intervention services.
(b) The term includes—
(1) Such services as clean intermittent catheterization, tracheostomy care, tube feeding, the changing of dressings or colostomy collection bags, and other health services; and
(2) Consultation by physicians with other service providers concerning the special health care needs of infants and toddlers with disabilities that will need to be addressed in the course of providing other early intervention services.
(c) The term does not include—
(1) Services that are—
(i) Surgical in nature (such as cleft palate surgery, surgery for club foot, or the shunting of hydrocephalus);
(ii) Purely medical in nature (such as hospitalization for management of congenital heart ailments, or the prescribing of medicine or drugs for any purpose); or
(iii) Related to the implementation, optimization (e.g., mapping), maintenance, or replacement of a medical device that is surgically implanted, including a cochlear implant.
(A) Nothing in this part limits the right of an infant or toddler with a disability with a surgically implanted device (e.g., cochlear implant) to receive the early intervention services that are identified in the child’s IFSP as being needed to meet the child’s developmental outcomes.
(B) Nothing in this part prevents the EIS provider from routinely checking that either the hearing aid or the external components of a surgically implanted device (e.g., cochlear implant) of an infant or toddler with a disability are functioning properly;
(2) Devices (such as heart monitors, respirators and oxygen, and gastrointestinal feeding tubes and pumps) necessary to control or treat a medical condition; and
(3) Medical-health services (such as immunizations and regular “well-baby” care) that are routinely recommended for all children.
Infant or Toddler with a Disability
Key terms don’t get more key than this one! The Part C regulations define infant or toddler with a disability at §303.21, as follows:
§303.21 Infant or toddler with a disability.
(a) Infant or toddler with a disability means an individual under three years of age who needs early intervention services because the individual—
(1) Is experiencing a developmental delay, as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas:
(i) Cognitive development.
(ii) Physical development, including vision and hearing.
(iii) Communication development.
(iv) Social or emotional development.
(v) Adaptive development; or
(2) Has a diagnosed physical or mental condition that—
(i) Has a high probability of resulting in developmental delay; and
(ii) Includes conditions such as chromosomal abnormalities; genetic or congenital disorders; sensory impairments; inborn errors of metabolism; disorders reflecting disturbance of the development of the nervous system; congenital infections; severe attachment disorders; and disorders secondary to exposure to toxic substances, including fetal alcohol syndrome.
(b) Infant or toddler with a disability may include, at a State’s discretion, an at-risk infant or toddler (as defined in §303.5).
(c) Infant or toddler with a disability may include, at a State’s discretion, a child with a disability who is eligible for services under section 619 of the Act and who previously received services under this part until the child enters, or is eligible under State law to enter, kindergarten or elementary school, as appropriate, provided that any programs under this part must include—
(1) An educational component that promotes school readiness and incorporates pre-literacy, language, and numeracy skills for children ages three and older who receive Part C services pursuant to §303.211; and
(2) A written notification to parents of a child with a disability who is eligible for services under section 619 of the Act and who previously received services under this part of their rights and responsibilities in determining whether their child will continue to receive services under this part or participate in preschool programs under section 619 of the Act.
Multidisciplinary
Not a very long definition this time. Multidisciplinary is defined as follows:
§ 303.24 Multidisciplinary.
Multidisciplinary means the involvement of two or more separate disciplines or professions and with respect to—
(a) Evaluation of the child in §§303.113 and 303.321(a)(1)(i) and assessments of the child and family in §303.321(a)(1)(ii), may include one individual who is qualified in more than one discipline or profession; and
(b) The IFSP Team in §303.340 must include the involvement of the parent and two or more individuals from separate disciplines or professions and one of these individuals must be the service coordinator (consistent with §303.343(a)(1)(iv)).
Native Language
Here’s another short-ish but important definition from the Part C regulations.
§ 303.25 Native language.
(a) Native language, when used with respect to an individual who is limited English proficient or LEP (as that term is defined in section 602(18) of the Act), means—
(1) The language normally used by that individual, or, in the case of a child, the language normally used by the parents of the child, except as provided in paragraph (a)(2) of this section; and
(2) For evaluations and assessments conducted pursuant to §303.321(a)(5) and (a)(6), the language normally used by the child, if determined developmentally appropriate for the child by qualified personnel conducting the evaluation or assessment.
(b) Native language, when used with respect to an individual who is deaf or hard of hearing, blind or visually impaired, or for an individual with no written language, means the mode of communication that is normally used by the individual (such as sign language, braille, or oral communication).
Natural Environments
Early intervention services are to be provided in natural environments to the maximum extent appropriate for the child and for the service being provided. Here’s Part C’s definition of the term.
§303.26 Natural environments.
Natural environments means settings that are natural or typical for a same-aged infant or toddler without a disability, may include the home or community settings, and must be consistent with the provisions of §303.126.
And what might the provisions of §303.126 have to say?
§303.126 Early intervention services in natural environments.
Each system must include policies and procedures to ensure, consistent with §§303.13(a)(8) (early intervention services), 303.26 (natural environments), and 303.344(d)(1)(ii) (content of an IFSP), that early intervention services for infants and toddlers with disabilities are provided—
(a) To the maximum extent appropriate, in natural environments; and
(b) In settings other than the natural environment that are most appropriate, as determined by the parent and the IFSP Team, only when early intervention services cannot be achieved satisfactorily in a natural environment.
Prior Written Notice
The purpose of prior written notice is to inform the parents fully of a proposed (or refused) activity or action on the part of the early intervention system.
§303.421 Prior written notice and procedural safeguards notice.
(a) General. Prior written notice must be provided to parents a reasonable time before the lead agency or an EIS provider proposes, or refuses, to initiate or change the identification, evaluation, or placement of their infant or toddler, or the provision of early intervention services to the infant or toddler with a disability and that infant’s or toddler’s family.
(b) Content of notice. The notice must be in sufficient detail to inform parents about—
(1) The action that is being proposed or refused;
(2) The reasons for taking the action; and
(3) All procedural safeguards that are available under this subpart, including a description of mediation in §303.431, how to file a State complaint in §§303.432 through 303.434 and a due process complaint in the provisions adopted under §303.430(d), and any timelines under those procedures.
(c) Native language. (1) The notice must be—
(i) Written in language understandable to the general public; and
(ii) Provided in the native language, as defined in §303.25, of the parent or other mode of communication used by the parent, unless it is clearly not feasible to do so.
(2) If the native language or other mode of communication of the parent is not a written language, the public agency or designated EIS provider must take steps to ensure that—
(i) The notice is translated orally or by other means to the parent in the parent’s native language or other mode of communication;
(ii) The parent understands the notice; and
(iii) There is written evidence that the requirements of this paragraph have been met.
Service Coordination Services
And last but not least, here’s how the Part C regulations define the term service coordination services, which is referenced in the definition of early intervention services above.
§303.34 Service coordination services (case management).
(a) General. (1) As used in this part, service coordination services mean services provided by a service coordinator to assist and enable an infant or toddler with a disability and the child’s family to receive the services and rights, including procedural safeguards, required under this part.
(2) Each infant or toddler with a disability and the child’s family must be provided with one service coordinator who is responsible for—
(i) Coordinating all services required under this part across agency lines; and
(ii) Serving as the single point of contact for carrying out the activities described in paragraphs (a)(3) and (b) of this section.
(3) Service coordination is an active, ongoing process that involves—
(i) Assisting parents of infants and toddlers with disabilities in gaining access to, and coordinating the provision of, the early intervention services required under this part; and
(ii) Coordinating the other services identified in the IFSP under §303.344(e) that are needed by, or are being provided to, the infant or toddler with a disability and that child’s family.
(b) Specific service coordination services. Service coordination services include—
(1) Assisting parents of infants and toddlers with disabilities in obtaining access to needed early intervention services and other services identified in the IFSP, including making referrals to providers for needed services and scheduling appointments for infants and toddlers with disabilities and their families;
(2) Coordinating the provision of early intervention services and other services (such as educational, social, and medical services that are not provided for diagnostic or evaluative purposes) that the child needs or is being provided;
(3) Coordinating evaluations and assessments;
(4) Facilitating and participating in the development, review, and evaluation of IFSPs;
(5) Conducting referral and other activities to assist families in identifying available EIS providers;
(6) Coordinating, facilitating, and monitoring the delivery of services required under this part to ensure that the services are provided in a timely manner;
(7) Conducting follow-up activities to determine that appropriate Part C services are being provided;
(8) Informing families of their rights and procedural safeguards, as set forth in subpart E of this part and related resources;
(9) Coordinating the funding sources for services required under this part; and
(10) Facilitating the development of a transition plan to preschool, school, or, if appropriate, to other services.
(c) Use of the term service coordination or service coordination services. The lead agency’s or an EIS provider’s use of the term service coordination or service coordination services does not preclude characterization of the services as case management or any other service that is covered by another payor of last resort (including Title XIX of the Social Security Act—Medicaid), for purposes of claims in compliance with the requirements of §§303.501 through 303.521 (Payor of last resort provisions).
Parent Notification and Consent
Parents are essential partners in early intervention. They have the right to be deeply involved at every step along the way, from evaluation of their child, to the writing of the individualized family service plan (IFSP), to helping to determine the early intervention services their child receives.
Not surprisingly, Part C of IDEA includes specific provisions to support the informed involvement of parents in their child’s early intervention program. Two notable requirements are:
- prior written notice, which the early intervention system must provide to parents at key points in time; and
- parental consent, which must be obtained from parents, also at key points in time.
The right to be informed and the right to give or refuse consent for pivotal activities are important procedural safeguards for parents and recognize their authority and responsibility in making decisions about their child’s involvement in early intervention, and the family’s.
Prior Written Notice: Parents’ Right to Be Fully Informed
Prior written notice refers to the notification that must be provided to parents a reasonable time before the lead agency or an early intervention services (EIS) provider proposes (or refuses) to “initiate or change the identification, evaluation, or placement of their infant or toddler, or the provision of early intervention services to the infant or toddler with a disability” and his or her family.
Purpose | The purpose of prior written notice is always the same—to ensure that parents are fully informed regarding whatever action the lead agency or EIS provider is proposing to take (or not take) with their infant or toddler or with the family. Parental consent is often needed before the lead agency or EIS provider may proceed, and that consent must be informed. Even if parental consent is not required, parents still have the right to know when something about their child’s (or family’s) involvement in early intervention is being proposed, refused, about to start, or about to change.
Content of the notice | The notice must be in sufficient detail to inform parents about—
- the action that is being proposed or refused;
- the reasons for taking (or refusing to take) the action; and
- all procedural safeguards that are available to parents, should they disagree with the early intervention system (e.g., mediation, filing a State complaint or a due process complaint, relevant timelines).
Examples | Prior written notice to parents is required in circumstances like these:
- The early intervention system wants to evaluate their infant or toddler and is seeking parental consent for the evaluation.
- The early intervention system refuses to evaluate an infant or toddler when parents have requested an evaluation.
- The early intervention system intends to change the child’s identification as an eligible “infant or toddler with a disability.”
- The early intervention system wants to begin providing early intervention services to the infant or toddler and family.
- A service provider wants to change the services being provided to an infant or toddler with a disability.
Native language | To ensure that a parent can understand the notice, it must be written in a language understandable to the general public and provided in the parent’s native language(or other mode of communication), unless it is clearly not feasible to do so. If the parent’s language is not a written one, the lead agency or EIS provider must ensure that:
- the prior written notice is translated orally to the parent,
- the parent understands the notice, and
- there is written evidence that these requirements have been met.
Parental Consent
Consent within IDEA has a very specific meaning that is closely tied to prior written notice. Consent, in IDEA, means informed written consent. The notice that is provided to parents informs them by comprehensively describing a proposed or refused action and the reasons for it. This builds the foundation of understanding upon which informed consent may then be given (or not).
The term consent is defined as follows:
IDEA Part C regulations
§303.7 Consent.
Consent means that—
(a) The parent has been fully informed of all information relevant to the activity for which consent is sought, in the parent’s native language, as defined in §303.25;
(b) The parent understands and agrees in writing to the carrying out of the activity for which the parent’s consent is sought, and the consent form describes that activity and lists the early intervention records (if any) that will be released and to whom they will be released; and
(c)(1) The parent understands that the granting of consent is voluntary on the part of the parent and may be revoked at any time.
(2) If a parent revokes consent, that revocation is not retroactive (i.e., it does not apply to an action that occurred before the consent was revoked).
This definition makes it clear that:
- The early intervention system must use the parents’ native language (or other mode of communication) when seeking their consent for an activity.
- Consent must be given by parents in writing.
- There’s a consent form and it describes the activity for which consent is sought.
- The consent form also lists the early intervention records that will be released (if any) and to whom.
- Giving consent is voluntary on the part of parents.
- Parents may revoke their consent at any time.
Consent during evaluation process | It will come as no surprise that both prior written notice and parental consent are required repeatedly throughout the evaluation process. These times are:
- Before administering screening procedures to see if an infant or toddler is suspected of having a disability
- Before conducting evaluation of the infant or toddler to determine eligibility for Part C
- Before conducting all assessments of the infant or toddler
Consent before services are provided | Parental consent is also required before the early intervention services listed in the child’s IFSP may be provided. In order to ensure that parents understand what they are being asked to consent to, the Part C regulations require that the contents of the IFSP be fully explained to the parents [§303.340(e)]. The Part C regulations also make it clear that parents have the right to give or refuse consent for each service (one by one) and to revoke consent at any time for any service. Those regulations read:
(d) The parents of an infant or toddler with a disability—
(1) Determine whether they, their infant or toddler with a disability, or other family members will accept or decline any early intervention service under this part at any time, in accordance with State law; and
(2) May decline a service after first accepting it, without jeopardizing other early intervention services under this part. [§303.420]
Each early intervention service must be provided as soon as possible after the parent provides consent for that service.
Other times when consent is required | There are other times when parental consent may be required, but these depend on State policy. Two are mentioned in §303.420(a) and stipulate that parental consent must be obtained before the lead agency:
- may use the family’s public benefits or insurance or private insurance, if such consent is required under §303.520; and
- discloses personally identifiable information.
May the lead agency challenge or try to override a parent’s refusal to give consent? | No. The lead agency may not challenge a parent’s refusal to provide consent, not even through using the due process procedures that Part C and Part B provide for resolving disputes. [§303.420(c)]
Writing the IFSP for Your Child
After your young child’s evaluation is complete and he or she is found eligible for early intervention services, you, as parents, and a team will meet to develop a written plan for providing early intervention services to your child and, as necessary, to your family. This plan is called the Individualized Family Service Plan, or IFSP.
The IFSP is a very important document, and you, as parents, are important members of the team that develops it. This webpage focuses on the IFSP – both the process of writing it and what type of information it will contain.
What is an IFSP?
The IFSP is a written document that, among other things, outlines the early intervention services that your child and family will receive.
One guiding principal of the IFSP is that the family is a child’s greatest resource, that a young child’s needs are closely tied to the needs of his or her family. The best way to support children and meet their needs is to support and build upon the individual strengths of their family. So, the IFSP is a whole family plan with the parents as major contributors in its development. Involvement of other team members will depend on what the child needs. These other team members could come from several agencies and may include medical people, therapists, child development specialists, social workers, and others.
Each state has specific guidelines for the IFSP. Your service coordinator can explain what the IFSP guidelines are in your state.
What is included in the IFSP?
Your child’s IFSP must include the following:
- Your child’s present levels of functioning and need in the areas of his or her physical, cognitive, communication, social/emotional, and adaptive development
- Family information (with your agreement), including the resources, priorities, and your concerns, as parents, and other family members closely involved with the child
- The major results or outcomes expected to be achieved for your child and family
- The specific early intervention services your child will be receiving
- Where in the natural environment (e.g., home, community) the services will be provided (if the services will not be provided in the natural environment, the IFSP must include a statement justifying why not)
- When and where your son or daughter will receive services
- The number of days or sessions he or she will receive each service and how long each session will last
- Who will pay for the services
- The name of the service coordinator overseeing the implementation of the IFSP
- The steps to be taken to support your child’s transition out of early intervention and into another program when the time comes.
The IFSP may also identify services your family may be interested in, such as financial information or information about raising a child with a disability.
The IFSP must be fully explained to you, the parents, and your suggestions must be considered. You must give written consent before services can start. If you do not give your consent in writing, your child will not receive services.
Who develops the IFSP?
The meeting to develop the child’s first IFSP (and each annual meeting thereafter to review the IFSP) must include the following participants:
- the parent or parents of the child;
- other family members, as requested by the parent, if feasible to do so;
- an advocate or person outside of the family, if the parent requests that the person participate;
the service coordinator designated by the system to be responsible for implementing the IFSP;
a person or persons directly involved in conducting the evaluations and assessments of the child and family; and - persons who will be providing early intervention services under this part to the child or family (as appropriate).
What happens next?
With your written permission, the IFSP is then implemented, meaning that the services described in the IFSP are provided to your child in the manner described in the IFSP. In other words, all that information you included in the IFSP now serves as a roadmap for the early intervention system as it provides services to your child and family.
About parent consent | You, as parents, have the right to decline any early intervention service without jeopardizing your child’s eligibility for other early intervention services. Parents may also revoke their consent for one or more services at any time.
Review and update of the IFSP | The IFSP is reviewed every six months and is updated at least once a year. You, as parents, are also part of that review and revision process. Together, you and the team will look at your child’s progress and decide how (or if) the IFSP needs to be changed to reflect your child’s growth toward the goals you’ve set, the family’s current situation, and so on.
Providing Services in Natural Environments
Early intervention services are to be provided in natural environments to the maximum extent appropriate for the child and for the EI service itself. So – what’s considered a “natural environment”? What isn’t? This article focuses upon answering these questions and on connecting you with resources of additional information and best practice.
IDEA’s definition of “natural environment”
Part C of the Individuals with Disabilities Education Act (IDEA) requires that eligible infants and toddlers with disabilities receive needed early intervention services in natural environments to the maximum extent appropriate. The 2011 regulations for Part define the term as follows:
§303.26 Natural environments.
Natural environments means settings that are natural or typical for a same-aged infant or toddler without a disability, may include the home or community settings, and must be consistent with the provisions of §303.126.
That’s a straightforward, easily understood definition–with the exception of how it ends (“…must be consistent with the provisions of §303.126″). What might the provisions of §303.126 require?
Let’s have a look. Here they are:
§303.126 Early intervention services in natural environments.
Each system must include policies and procedures to ensure, consistent with §§303.13(a)(8) (early intervention services), 303.26 (natural environments), and 303.344(d)(1)(ii) (content of an IFSP), that early intervention services for infants and toddlers with disabilities are provided—
(a) To the maximum extent appropriate, in natural environments; and
(b) In settings other than the natural environment that are most appropriate, as determined by the parent and the IFSP Team, only when early intervention services cannot be achieved satisfactorily in a natural environment.
Combining these two sets of provisions makes it clear that early intervention services:
- must be provided in settings that are natural or typical for a same-aged infant or toddler without a disability to the maximum extent appropriate;
- may be provided in other settings only when the services cannot be achieved satisfactorily in a natural environment.
Who decides where services will be provided?
The Part C regulations also make it clear that the IFSP team determines the appropriate setting for providing early intervention services to a child or toddler. The IFSP team may determine that a service will not be provided in a natural environment only “when early intervention services cannot be achieved satisfactorily in a natural environment.”
Note | IFSP team refers broadly to the group of people who write the child’s individualized family service plan (IFSP). More specifically, as described in the Part C regulations:
- The child’s parents are members of the IFSP team. They may invite other family members to participate on the team as well (if it’s feasible to do so). They may also request an advocate or person from outside the family to participate on the team.
- The IFSP team must include two or more individuals from separate disciplines or professions, one of which must be the family’s service coordinator.
- The IFSP team must also include a person or persons directly involved in conducting the evaluations and assessments of the child and family.
- As appropriate, people who will be providing early intervention services to the child may also serve on the IFSP team. (§303.343)
This, then, is the group of well-informed individuals that makes the decision as to where early intervention services will be provided to the baby or toddler.
On what basis does the team decide the setting?
The short answer | The IFSP team decides where each EI service will be provided based on the measurable results or measurable outcomes expected to be achieved by the child. Those results or outcomes have been identified by the IFSP team and listed in the IFSP.
The longer answer | Again, the Part C regulations provide the necessary guidance.
At §303.344(d)(1)(ii)(B), the regulations state:
(B) The determination of the appropriate setting for providing early intervention services to an infant or toddler with a disability, including any justification for not providing a particular early intervention service in the natural environment for that infant or toddler with a disability and service, must be—
(1) Made by the IFSP Team (which includes the parent and other team members);
(2) Consistent with the provisions in §§303.13(a)(8), 303.26, and 303.126; and
(3) Based on the child’s outcomes that are identified by the IFSP Team in paragraph (c) of this section… [emphasis added]
An example | The Department of Education provides an example of how it may not always be practicable or appropriate for an infant or toddler with a disability to receive an early intervention service in the natural environment based either on the nature of the service or the child’s specific outcomes. The Department states:
For example, the IFSP Team may determine that an eligible child needs to receive speech services in a clinical setting that serves only children with disabilities in order to meet a specific IFSP outcome. When the natural environment is not chosen with regard to an early intervention service, the IFSP Team must provide, in the IFSP, an appropriate justification for that decision. (76 Fed. Reg. at 60205)
What must be included about natural environments in the child’s IFSP?
The Part C regulations indicate that the IFSP must include:
…A statement that each early intervention service is provided in the natural environment for that child or service to the maximum extent appropriate …
or…
a justification as to why an early intervention service will not be provided in the natural environment. [§303.344(d)(1)(ii)(A)]
If the IFSP team determines that an early intervention service will not be provided in the natural environment, it must document in the IFSP the justification for why not–in other words, “why the alternative service setting is needed for the child to meet the developmental outcomes identified for the child in his or her IFSP” (76 Fed. Reg. at 60205).
Two points from the Department of Education
When the Department of Education released the 2011 Part C implementing regulations, it included the often fascinating Analysis of Comments and Changes. The Department’s discussion of “natural environments” includes two very interesting and illuminating observations we’d like to share with you.
Why not include a list of settings considered “natural environments” and those not considered “natural environments”?
The Department declined to add a fuller list of settings that may be considered (or would not be considered) “natural environments.” The current regulations only mention that natural environments “may include home and community settings.” Why did the Department decline including a fuller list? According to the Department:
“It would not be appropriate or practicable to include a list of every setting that may be the natural environment for a particular child or those settings that may not be natural environments in these regulations.
In some circumstances, a setting that is natural for one eligible child based on that child’s outcomes, family routines, or the nature of the service may not be natural for another child….
[T]he decision about whether an environment is the natural environment is an individualized decision made by an infant’s or toddler’s IFSP Team, which includes the parent…” (76 Fed. Reg. at 60157-60158)
Are clinics, hospitals, or a service provider’s office considered “natural environments”?
A very good question, you must admit! Here’s the Department’s response:
We appreciate the commenters’ requests for clarification as to whether clinics, hospitals, or a service provider’s office may be considered the natural environment in cases when specialized instrumentation or equipment that cannot be transported to the home is needed.
Natural environments mean settings that are natural or typical for an infant or toddler without a disability….We do not believe that a clinic, hospital or service provider’s office is a natural environment for an infant or toddler without a disability; therefore, such a setting would not be natural for an infant or toddler with a disability.
However, §303.344(d)(1) requires that the identification of the early intervention service needed, as well as the appropriate setting for providing each service to an infant or toddler with a disability, be individualized decisions made by the IFSP Team based on that child’s unique needs, family routines, and developmental outcomes. If a determination is made by the IFSP Team that, based on a review of all relevant information regarding the unique needs of the child, the child cannot satisfactorily achieve the identified early intervention outcomes in natural environments, then services could be provided in another environment (e.g. clinic, hospital, service provider’s office). In such cases, a justification must be included in the IFSP… (76 Fed. Reg. at 60158)
Resources for More Information
Texas Health and Human Services
Early Childhood Intervention
https://hhs.texas.gov/services/disability/early-childhood-intervention-services
Early Childhood Intervention (ECI) is a statewide program within the Texas Health and Human Services Commission for families with children birth up to age 3, with developmental delays, disabilities or certain medical diagnoses that may impact development.
National Early Childhood Technical Assistance Center (NECTAC)
919.962.2001
http://ectacenter.org/
NECTAC ‘s mission is to strengthen service systems to ensure that children with disabilities (birth through five) and their families receive and benefit from high quality, culturally appropriate, and family-centered supports and services.
National Early Childhood Transition Center
Toll Free 866.742.4015
www.hdi.uky.edu/nectc
The National Early Childhood Transition Center’s mission is to examine factors that promote successful transitions between infant/toddler programs, preschool programs, and public school programs for young children with disabilities and their families.