|Clinical Practice Guideline: Report of the Recommendations, Communication Disorders, Assessment and Intervention for Young Children (Age 0-3 years)|
Return to Early Intervention Index
Click on the EIP policy statement number (below) to link to the related guideline recommendation.
Children experiencing communication delays consistent with the State definition of developmental delay are eligible for the Early Intervention Program. Children with diagnosed communication disorders, including specific language impairment, hearing loss, develop-mental language disorder, receptive expressive language disorder, and dyspraxia syndrome are eligible for the Early Intervention Program by having a "diagnosed condition with a high probability of a developmental delay."
|EIP 2||The terms assessment, parents, and screening are also defined in regulations that apply to the Early Intervention Program in New York State. These definitions are included in Appendix E-2.|
|EIP 3||In New York State, the term used for professionals who are qualified to deliver early intervention services is "qualified personnel." Qualified personnel are those individuals who are approved to deliver services to the extent authorized by their licensure, certification or registration, to eligible children and have appropriate licensure, certification, or registration in the area in which they are providing services. See Appendix E-3 for the list of qualified personnel included in program regulations.|
|EIP 4||[See EIP 1]|
|EIP 5||Under the NYS Early Intervention Program, the multidisciplinary evaluation team may use a combination of standardized instruments and procedures and informed clinical opinion to determine a child's eligibility for early intervention services.|
|EIP 6||Under the EIP, the multidisciplinary evaluation team is responsible for informing the
|EIP 7||Parents can refer their children directly to the Early Intervention Official in their county of residence if they suspect possible communication disorders or a developmental delay.|
|EIP 8||Under the NYS Early Intervention Program, physicians and other professionals are considered "primary referral sources." When primary referral sources suspect a possible communication disorder or a developmental delay in cognitive, communication, physical, social-emotional, or adaptive development, they must:
|EIP 9||[See EIP 8]|
|EIP 10||The child's multidisciplinary evaluation for the EIP must be conducted in the child's dominant language, whenever feasible.|
Under the NYS Early Intervention Program, primary referral sources include a wide range of professionals who provide services to young children and their families (see information in Appendices E-2 and E-3). Primary referral sources must refer children at risk or suspected of having a communication delay or disorder, or other developmental problem, to the Early Intervention Official in the child's county of residence.
When there are heightened concerns about communication development, and these concerns are not yet to the level of a suspected communication delay or disorder, a child may be considered "at-risk." In these cases, professional judgment and parent concerns must be weighed in determining if a child should be referred to the Early Intervention Official as an "at-risk child." If it is determined that the child is at-risk for a communication delay or disorder, the child should be referred unless the parent objects.
The Early Intervention Official is responsible for ensuring that children at-risk for developmental problems are screened, tracked and referred for a multi-disciplinary evaluation if a developmental delay or disorder is suspected. If it is determined that a child is not yet "at-risk" for a communication delay, it is still important to monitor the child's progress through developmental surveillance.
|EIP 12||Under the early intervention program, a multi-disciplinary evaluation must assess all five areas of development (cognitive, communication, physical, social-emotional, and adaptive development). The multidisciplinary evaluation team can use a combination of standardized instruments and procedures and informed clinical opinion to determine a child's eligibility for services. The multidisciplinary evaluation is provided at no cost to parents.|
|EIP 13||[See EIP 7 and EIP 8]|
|EIP 14||Under the NYS EIP, the multidisciplinary evaluation should include a parent interview. The interview may be a formal interview schedule or an informal discussion with the parent.|
|EIP 15||[See EIP 8 and EIP 11]|
|EIP 16||Children with hearing impairments are eligible for the Early Intervention Program. Professionals who suspect a child may have a hearing problem, due to parent concerns or results of developmental surveillance, must refer the child to the New York State Early Intervention Program, unless the parent objects to a referral.|
|EIP 17||[See EIP 8, EIP 11 and EIP 16]|
|EIP 18||If a child has not made progress, or shows signs of regression, after three months of developmental surveillance, the child should be referred to the Early Intervention Program as suspected of having a delay in communication development or a communication disorder.|
|EIP 19||[See EIP 18]|
Under the Early Intervention Program, the multidisciplinary evaluation team may decide, with the consent of the child's parent, to first perform a screening to determine whether to proceed with an evaluation or what type of evaluation is needed.
If a screening test is used before a child is referred to the program (such as during developmental surveillance included as part of a routine health care visit) and the results suggest a possible communication disorder, the child should be referred to the Early Intervention Program for a multidisciplinary evaluation, unless the parent objects. With parent consent, the results of the screening should also be provided to the multi-disciplinary evaluation team selected by the parent to conduct the child's evaluation.
|EIP 21||Under the New York State Early Intervention Program, the evaluator is responsible for sharing the results of the evaluation with the child's family and ensuring the family understands the results and implications of the evaluation for intervention.|
|EIP 22||Under the New York State Early Intervention Program, parents may request a second evaluation at public expense from their Early Intervention Official. If the Early Intervention Official agrees that a second evaluation is necessary and appropriate, he or she may authorize payment for the evaluation under the Early Intervention Program.|
|EIP 23||Under the New York State Early Intervention Program, parents may exercise their rights to a mediation or impartial hearing if the multidisciplinary evaluation findings show that the child is not eligible for early intervention services.|
|EIP 24||[See EIP 12]|
Although assessment of physical development, including a health assessment, is a required component of the multidisciplinary evaluation, medical tests (such as MRIs, metabolic tests, and genetic tests) are not reimbursable under the NYS Early Intervention Program. The service coordinator can and should assist the family in accessing these and other health care services through their primary health care providers. Supplemental physician evaluations may be accessed if appropriate and necessary to establish a child's eligibility for the Early Intervention Program.
Whenever possible, the health assessment should be completed by the child's primary health care provider.
|EIP 26||A family assessment, including an assessment of family factors related to communication development, is an optional part of the multidisciplinary evaluation for the Early Intervention Program. Parents must consent to a family assessment.|
|EIP 27||Under the NYS Early Intervention Program, the multidisciplinary evaluation team may use a combination of standardized instruments and procedures and informed clinical opinion to determine a child's eligibility for early intervention services.|
|EIP 28||An assessment of cognitive development is a required component of the multidisciplinary evaluation.|
|EIP 29||Audiological services are covered under the NYS Early Intervention Program.|
|EIP 30||Children with hearing impairments are eligible for the New York State Early Intervention Program by having a diagnosed condition with a high probability of developmental delay.|
|EIP 31||Under the New York State Early Intervention Program, augmentative communication systems are considered "assistive technology devices." The potential need for an augmentative communication system could be identified through the child's initial multidisciplinary evaluation, or later through a supplemental evaluation or ongoing assessment. The need for assistive technology devices must be agreed upon by the parent and the Early Intervention Official and included in the IFSP.|
Under the New York State Early Intervention Program, speech-language therapy is considered an early intervention service. Early intervention services must be included in a child and family's Individualized Family Service Plan (IFSP) and provided at no cost to parents, under the public supervision of Early Intervention Officials and the State Department of Health, and by qualified personnel as defined in State regulation (See Appendices E-3 and E-4 for a list of Early Intervention Officials and definition of qualified personnel).
Under the NYS EIP, an IFSP must be in place for children within 45 days of referral to the Early Intervention Official. The IFSP must include a statement of the major outcomes expected for the child and family and the services needed by the child and family. The IFSP must be reviewed every six months, and evaluated annually. Information from ongoing assessments should be used in IFSP reviews and annual evaluations. An IFSP may be amended any time the parent(s) and the Early Intervention Official agree that a change is needed to better meet the needs of the child and family.
|EIP 33||In New York State, children with speech language delays and general developmental delays are eligible for the Early Intervention Program if their delays are consistent with the State's definition of developmental delay (see Appendix E-3).|
|EIP 34||In New York State, children with hearing impairments (loss) are eligible for the Early Intervention Program by having a condition with a high probability of developmental delay.|
|EIP 35||In New York State, children with speech language delays are eligible for the Early Intervention Program if their delays are consistent with the State's definition of developmental delay (see Appendix E-3). Most children with mild expressive language delays only will not meet the eligibility criteria established in the State's definition of developmental delay. These children may be considered "at-risk" for communication delay. In determining whether to make a referral to the Early Intervention Program, professionals and parents should carefully judge the extent of their concerns and the need for formal screening and tracking.|
|EIP 36||Under the New York State Early Intervention Program, the multidisciplinary evaluation team may use a combination of standardized instruments and informed clinical opinion in determining whether a child meets the eligibility criteria for the program. If a child has expressive language delays and exhibits a preponderance of prognostic factors as included in Table III-7, and the multidisciplinary evaluation team views the combination of expressive language delays and prognostic factors as combining to show if a child meets eligibility requirements, these findings should be thoroughly documented in the child's evaluation.|
|EIP 37||Under the NYS EIP, early intervention services must be included in a child and family's Individualized Family Service Plan (IFSP) and provided at no cost to parents, under the public supervision of Early Intervention Officials and State Department of Health, and by qualified personnel as defined in State regulation (see Appendices E-2 and E-3).|
|EIP 38||Under the NYS Early Intervention Program, early intervention services can be delivered in a wide variety of home- and community-based settings. Early intervention services can be provided to an individual child, to a child and parent or other family member or caregiver, to parents and children in groups, and to groups of eligible children (these groups can also include typically developing peers). Family support groups are also available.|
|EIP 39||The type, intensity, frequency, and duration of early intervention services provided to a child and family under the NYS EIP are determined through the Individualized Family Service Planning process. All services in the IFSP must be agreed to by the parent and the Early Intervention Official. When disagreements about what should be included in the IFSP occur, parents can seek due process through mediation and/or an impartial hearing.|
|EIP 40||Under the NYS EIP, an IFSP must be in place for children within 45 days of referral to the Early Intervention Official. The IFSP must include a statement of the major outcomes expected for the child and family and the services needed by the child and family. The IFSP must be reviewed every six months, and evaluated annually.|
|EIP 41||An IFSP may be amended any time the parent(s) and the Early Intervention Official agree that a change is needed to better meet the needs of the child and family.|
|EIP 42||Under the New York State Early Intervention Program, a child and family's IFSP must be evaluated on an annual basis. This may include an evaluation of the child's developmental status if needed. After the child's initial multidisciplinary evaluation, supplemental evaluations may also be conducted when recommended by the IFSP team, agreed upon by the parent and early intervention official, and included in the child's IFSP.|
|EIP 43||For a list of qualified personnel under the New York State Early Intervention Program, see Appendix E-3.|
|EIP 44||Under the NYS Early Intervention Program, providers of early intervention services are responsible for consulting with parents and other service providers to ensure the effective provision of services and providing support, education, and guidance to parents and other caretakers regarding the provision of early intervention services|
|EIP 45||[See EIP 38]|
|EIP 46||Under the Individuals with Disabilities Education Act and New York State Public Health Law, early intervention services must be provided in natural environments to the maximum extent appropriate to the needs of the child. Natural environments means settings that are natural or normal for the child's age peers who have no disabilities.|
|EIP 47||Children with diagnosed conditions with a high probability of developmental delay are eligible to receive early intervention services under the New York State Early Intervention Program.|
|EIP 48||Personal amplification devices are considered assistive technology devices under the NYS Early Intervention Program.|
|EIP 49||Audiology services, including monitoring of the child's hearing loss, amplification fitting, and assessing the effectiveness of amplification devices are included as early intervention services under the NYS Early Intervention Program.|
|EIP 50||Medical tests or treatments, surgery, and other health services of this nature are not considered early intervention services under the NYS Early Intervention Program. However, the child's service coordinator is responsible for coordinating the provision of early intervention services and other services needed by the child and family. This includes providing appropriate referrals and facilitating access to other services needed by the child and family that are not provided under the Early Intervention Program.|
|EIP 51||[See EIP 50]|
|EIP 52||Augmentative communication systems are considered assistive technology devices under the NYS Early Intervention Program.|
The Early Intervention Program is a statewide program that provides many different types of early intervention services to infants and toddlers with disabilities and their families. In New York State, the Department of Health is the lead state agency responsible for the Early Intervention Program.
Early Intervention services can help families:
Early Intervention services can be provided anywhere in the community, including:
Parents help decide:
Early Intervention Officials (EIO)
In New York State, all counties and the City of New York are required by public health law to appoint a public official as their Early Intervention Official.
The EIO is the person in the county responsible for:
The EIO is the "single point of entry" for children into the Program. This means that all children under three years of age who may need early intervention services must be referred to the EIO. In practice, Early Intervention Officials have staff who are assigned to take child referrals.
Parents are usually the first to notice a problem. Parents can refer their own children to the Early Intervention Official (see Step 1 of Early Intervention Steps). Sometimes, someone else will be the first to raise a concern about a child's development. New York State public health law requires certain professionals, primary referral sources, to refer infants and toddlers to the Early Intervention Official if a problem with development is suspected. However, no professional can refer a child to the EIO if the child's parent says no to the referral.
There are two types of service coordinators in New York State - an initial service coordinator and an ongoing service coordinator. The initial service coordinator is appointed by the Early Intervention Official. The initial service coordinator helps with all the steps necessary to get services - from the child's multidisciplinary evaluation to the first Individualized Family Service Plan (IFSP).
Parents are asked to choose an ongoing service coordinator as part of the first IFSP. The main job of the ongoing service coordinator is to make sure the child and family get the services in the IFSP. The ongoing service coordinator will also help change the IFSP when necessary and make sure the IFSP is reviewed on a regular basis. Parents may choose to keep the initial service coordinator - or can choose a new person to be the ongoing service coordinator.
Children are eligible for the Early Intervention Program if they are under three years old AND have a disability OR developmental delay. A disability means that a child has a diagnosed physical or mental condition that often leads to problems in development (such as Down syndrome, autism, cerebral palsy, vision impairment, hearing impairment).
A developmental delay means that a child is behind in at least one area of development, including:
A child does not need to be a U.S. citizen to be eligible for services. And, there are no income requirements for the Program. The child and family do have to be residents of New York State to participate in the Early Intervention Program.
How is eligibility decided?
All children referred to the Early Intervention Official have the right to a free multidisciplinary evaluation to determine if they are eligible for services. The multidisciplinary evaluation also helps parents to better understand their child's strengths and needs and how early intervention can help.
A child who is referred because of a diagnosed condition that often leads to developmental delay - like Down syndrome - will be eligible for early intervention services.
If a child has a diagnosed condition, he or she will still need a multidisciplinary evaluation to help plan for services. If a child has a delay in development - and no diagnosed condition - the multidisciplinary evaluation is needed to find out if the child is eligible for the Program. A child's development will be measured according to the "definition of developmental delay" set by New York State.
The Early Intervention Program offers many types of services. Early intervention services are:
Early Intervention services include:
Provision of services
Only qualified professionals-individuals who are licensed, certified, or registered in their discipline and approved by New York State-can deliver early intervention services. All services can be provided using any of the following service models:
Home- and community-based visits. In this model, services are given to a child and/or parent or other family member or caregiver at home or in the community (such as a relative's home, child care center, family day care home, play group, library story hour, or other places parents go with their children).
Facility- or center-based visits. In this model, services are given to a child and/or parent or other family member or caregiver where the service provider works (such as an office, a hospital, a clinic, or early intervention center).
Parent-child groups. In this model, parents and children get services together in a group led by a service provider. A parent-child group can happen anywhere in the community.
Family support groups. In this model, parents, grandparents, siblings, or other relatives of the child get together in a group led by a service provider for help and support and to share concerns and information.
Group developmental intervention. In this model, children receive services in a group setting led by a service provider or providers without parents or caregivers. A group means two or more children who are eligible for early intervention services. The group can include children without disabilities and can happen anywhere in the community.
All services are at no cost to families. Funding sources to cover the cost of services include Medicaid and private health insurance, supplemented by county and state funds.
For more information about the New York State laws and regulations that apply to Early Intervention services, contact the state Early Intervention Program.
New York State Department of Health
Early Intervention Program
Corning Tower Building, Room 208
Albany, NY 12237-0618
These definitions are from 10 New York Code of Rules and Regulations, § 69-4.1 and § 69-4.10. For a complete set of the regulations governing the Early Intervention Program, contact the New York State Department of Health's Early Intervention Program at (518) 473-7016 or visit the Department's website: Final Regulations - Subpart 69-4 (PDF file size approximately 123 KB) Available as Adobe's Portable Document Format (help for PDFs).
Sec. 69-4.10 Service Model Options
|(a)||The Department of Health, state early intervention service agencies, and early intervention officials shall make reasonable efforts to ensure the full range of early intervention service options are available to eligible children and their families.|
|(1)||The following models of early intervention service delivery shall be available:|
|(i)||home and community based individual/collateral visits: the provision by appropriate qualified personnel of early intervention services to the child and/or parent or other designated caregiver at the child's home or any other natural environment in which children under three years of age are typically found (including day care centers and family day care homes);|
|(ii)||facility-based individual/collateral visits: the provision by appropriate qualified personnel of early intervention services to the child and/or parent or other designated caregiver at an approved early intervention provider's site;|
|(iii)||parent-child groups: a group comprised of parents or caregivers, children, and a minimum of one appropriate qualified provider of early intervention services at an early intervention provider's site or a community-based site (e.g. day care center, family day care, or other community settings);|
|(iv)||group developmental intervention: the provision of early intervention services by appropriate qualified personnel to a group of eligible children at an approved early intervention provider's site or in a community-based setting where children under three years of age are typically found (this group may also include children without disabilities); and|
|(v)||family/caregiver support groups: the provision of early intervention services to a group of parents, caregivers (foster parents, day care staff, etc.) and/or siblings of eligible children for the purposes of:|
|(a)||enhancing their capacity to care for and/or enhance the development of the eligible child; and|
|(b)||providing support, education, and guidance to such individuals relative to the child's unique developmental needs.|
Sec. 69-4.1 Definitions
|(b)||Assessment means ongoing procedures used to identify:|
|(1)||the child's unique needs and strengths and the services appropriate to meet those needs; and|
|(2)||the resources, priorities and concerns of the family and the supports and services necessary to enhance the family's capacity to meet the developmental needs of their infant or toddler with a disability.|
|(g)||Developmental delay means that a child has not attained developmental milestones expected for the child's chronological age adjusted for prematurity in one or more of the following areas of development: cognitive, physical (including vision and hearing), communication, social/emotional, or adaptive development.|
|(1)||A developmental delay for purposes of the Early Intervention Program is a developmental delay that has been measured by qualified personnel using informed clinical opinion, appropriate diagnostic procedures and/or instruments and documented as:|
|(i)||a twelve month delay in one functional area; or|
|(ii)||a 33% delay in one functional area or a 25% delay in each of two areas; or|
|(iii)||if appropriate standardized instruments are individually administered in the evaluation process, a score of at least 2.0 standard deviations below the mean in one functional area or score of at least 1.5 standard deviation below the mean in each of two functional areas.|
|(gg)||Parent means a parent by birth or adoption, or person in parental relation to the child. With respect to a child who is a ward of the state, or a child who is not a ward of the state but whose parents by birth or adoption are unknown or unavailable and the child has no person in parental relation, the term "parent" means a person who has been appointed as a surrogate parent for the child in accordance with Section 69-4.16 of this subpart. This term does not include the state if the child is a ward of the state.|
|(jj)||Qualified personnel are those individuals who are approved as required by this subpart to deliver services to the extent authorized by their licensure, certification or registration, to eligible children and have appropriate licensure, certification, or registration in the area in which they are providing services:|
|(2)||certified occupational therapy assistants;|
|(3)||licensed practical nurses, registered nurses and nurse practitioners;|
|(4)||certified low vision specialists;|
|(6)||orientation and mobility specialists;|
|(8)||physical therapy assistants;|
|(9)||pediatricians and other physicians;|
|(15)||special education teachers;|
|(16)||speech and language pathologists and audiologists;|
|(17)||teachers of the blind and partially sighted;|
|(18)||teachers of the deaf and hearing handicapped;|
|(19)||teachers of the speech and hearing handicapped;|
|(20)||other categories of personnel as designated by the Commissioner.|
|(ll)||Screening means a process involving those instruments, procedures, family information and observations, and clinical observations used by an approved evaluator to assess a child's developmental status to indicate what type of evaluation, if any, is warranted.|
|New York City||1-800-577-BABY
|Send questions or comments to: firstname.lastname@example.org|
|Revised: June 2002|