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EVALuation

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					Effective Date: July 1, 1996                                        CT Birth to Three System
Date Revised: July 1, 2012


Title:        EVALUATION TO DETERMINE ELIGIBILITY

Purpose: Details the steps to be taken in conducting the initial evaluation of a child to
         determine eligibility for Birth to Three services.

                                        Overview

Children under the age of three who live in Connecticut are eligible for the Connecticut
Birth to Three System because they are either experiencing a significant developmental
delay, or they have a diagnosed physical or mental condition with a high probability of
resulting in a developmental delay. The Connecticut Birth to Three System does not
serve infants and toddlers who are at risk of delay due to environmental causes but who
are not actually experiencing a significant developmental delay. All children referred to
the Connecticut Birth to Three System without a diagnosed condition, will receive a
multidisciplinary evaluation of all five areas of development, using a standardized
instrument. This evaluation will be conducted by the program receiving the referral to
determine eligibility.

               Who is Eligible for the Connecticut Birth to Three System?

Use of Diagnosed Conditions

A child with a confirmed diagnosed condition that has a high probability of resulting in
developmental delay is automatically eligible for the Birth to Three System. The Connecticut
Birth to Three System maintains a list of such conditions and modifies the list when
appropriate in consultation with the Connecticut Birth to Three Medical Advisor.

The list of diagnosed conditions is divided into the following seven general categories:
1. Genetic Disorders
2. Sensory Impairments
3. Motor Impairments
4. Neurologic Disorders
5. Significant Neurodevelopmental Disorders
6. Medically Related Disorders
7. Acquired Trauma Related Disorders

The most up to date list can be found on the Connecticut Birth to Three System website
www.Birth23.org under “Making a Referral”.

Documentation of a Diagnosed Condition

In most cases the parent or referral source, if the referral comes from the child’s
medical provider will provide documentation of the diagnosis via the referral form sent
to Child Development Infoline. For a child who is hearing impaired, an audiology report
will be sufficient to document the status of the child’s hearing and in the case of a child
diagnosed with childhood apraxia of speech, only a report by a speech pathology will be
accepted.
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For children who received a diagnosis of an autism spectrum disorder (ASD), the
diagnostic report must include information on how the Diagnostic and Statistical
Manual, Fourth Edition, Text Revision (DSM IV-TR) diagnosis of ASD was made and
how the child performed in the core deficit areas of ASD.

NOTE: All Birth to Three programs must ensure that all children identified as having
ASD receive a DSM IV-TR diagnosis of autism spectrum disorder. This diagnosis can
be made by a physician, licensed social worker or licensed clinical psychologist.

Developmental Delay Definition

The eligibility criteria for a developmental delay is defined in Connecticut as being 2 SD
(standard deviations) below the mean in one of the following developmental areas or
1.5 SD below the mean in two or more of the following areas:

       A.     cognitive development
       B.     physical development including vision, hearing, motor and health
              development
       C.     communication development
       D.     social or emotional development
       E.     adaptive skills development (also known as self-help or daily living skills)

Evaluating Hearing and Vision

Parent report can provide vision and hearing screening information (also see Form 3-17
Birth to Three Vision Screening) but for eligibility purposes, documentation of visual
impairment or hearing loss must be by doctor or audiologist report.

Programs must assure that children’s hearing and vision are within normal limits prior to
completing the initial eligibility determination. It is critical that the child’s hearing be
screened or evaluated by an audiologist before beginning early intervention services
when speech or language is delayed. Any previous audiological testing or screening
results, including newborn hearing screening, are only valid for one year. If current
testing indicates a hearing loss, the program must address that in the child’s IFSP. For
vision, unless the child’s physician has specifically evaluated the child’s vision, the
assessor should use Form 3-17 “Birth to Three Vision Screening”. If any items on the
screen are answered “yes”, a copy of the results with a cover letter should be sent to
the child’s physician, with parent consent for follow-up.

Use of Informed Clinical Opinion to Determine Eligibility

Infrequently, standardized instruments cannot be completed because they:
      are not applicable due to an infant’s age or significant illness
      would require significant adaptation for a child to perform the items, thereby
       invalidating the results
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When this is the case, the informed clinical opinion of at least two qualified
professionals from different disciplines may be used to substantiate the equivalent
delay of 2 SD below the mean in one area of development or 1.5 SD below the mean in
two areas of development.

Some standardized tests have large age intervals (six months, for example), a child
whose age is just short of the next age interval may have standard scores indicating
that he or she is not eligible. Rather than using informed clinical opinion in this
instance, it would be advisable to use an instrument with shorter age intervals. The
Battelle Developmental Inventory 2nd edition (BDI 2), for example, uses one month
intervals for scoring.

A child who is initially determined eligible for the Birth to Three System by informed
clinical opinion of developmental delay must be re-evaluated within six months using a
standardized instrument to document that the child is exhibiting a developmental delay
of 2 SD below the mean in one area of development or 1.5 SD below the mean in two
areas of development. If the child is not eligible based on the results of the re-
evaluation, the child should be exited from the system within the month or sooner with
parent agreement.

Providers who have any questions about a child’s eligibility may contact the Birth to
Three System Child Find Coordinator. The Child Find Coordinator will offer guidance
on the evaluation process or consult with the Birth to Three System’s medical advisor
for consideration of a specific diagnosis which may result in automatic eligibility.

                                 Special Circumstances

Eligibility for Children with Delays in Speech Only

A child whose delay in the area of expressive communication is at least 2 SD below the
mean, but whose combined score in the communication domain is not at least 2 SD
below the mean, is eligible if one of the following risk factors (as determined by a
speech pathologist) is also present:
1.     Oral motor disorders
2.     Moderate to severe phonological impairment (fewer than 65% of consonants
       correct in a 5 minute continuous speech sample)
3.     Chronic otitis media for more than six months
4.     Family (parents or sibling) history of language impairment or developmental
       delay
5.     Significant birth history including: congenital infection; craniofacial anomalies
       including cleft lip; birth weight less than 1500 grams; hyperbilirubinemia at a level
       requiring exchange transfusion; ototoxic medications; bacterial meningitis; Apgar
       scores of 0-4 at one minute and 0-6 at five minutes; mechanical ventilation
       lasting more than five days; head trauma associated with loss of consciousness
       or skull fracture. The presence of any one of these should be verified through
       medical records.
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The presence of one of the above biological factors must be documented either through
medical records, additional assessment, or through behavioral observations. In the case
of family history of language impairment or developmental delay, family report is
acceptable. In order to adequately weigh these factors, one of the evaluators must be a
speech and language pathologist.

When a child’s speech or language is delayed, it is critical that the child’s hearing be
screened or evaluated by an audiologist as soon as possible upon beginning early
intervention services.

Standardized instruments used to determine a child’s level of development for eligibility
typically include very few items in expressive communication. If the child’s delay is in
expressive communication only and the child was not found to be eligible based on the
developmental evaluation, then the program must also use a standardized speech and
language instrument such as the most current version of the Preschool Language Scales
(PLS). It is possible that a child showing a mild delay in speech on a multi-domain test
that does not have many items in the expressive communication area (for example the
Battelle 2) may show a significant delay when tested on the PLS. The information from
the PLS is a more accurate measure of eligibility in the area of speech than a
standardized multi-domain test of development.

For children who live in homes in which English is not the primary language, the evaluator
must be able to demonstrate that the child has a significant delay in communication in his
or her primary or dominant language. This often involves using an interpreter to obtain an
accurate evaluation. Caution is advised when determining eligibility for such children
using evaluation tools designed for English-speaking children. Such scores should not be
reported, but should only be used to help the evaluator form a clinical opinion of the child’s
degree of delay. Some language evaluations such as the Preschool Language Scale
Spanish are normed for young Spanish-speaking children and even adjusted for different
dialects.

Children recently adopted from a non-English speaking country will not be eligible due
to a significant delay in spoken English communication until at least six months post-
adoption. They should be given a complete multidisciplinary developmental evaluation
using their native language, if possible, which may identify significant delays in areas
other than communication.

For further information about intervention and eligibility for children with speech delays,
including use of an interpreter, refer to Service Guideline #3: Children Referred with
Speech Delays (2007 Revision).

Eligibility for Children with Motor Delays

While neither gross nor fine motor is actually listed separately as part of the
developmental area of physical development in the IDEA Part C regulations (34 CFR
303.21(a)(1), for purposes of eligibility, the Connecticut Birth to Three System considers
them to be separate developmental areas. Therefore, a child with a delay of 2 or more
standard deviations below the mean in either gross or fine motor is eligible.
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Consequently, a child with a delay of 1.5 SD below the mean in both gross and fine
motor is also eligible. As is the case for a child with delays in speech, children with a
referral concern in a motor area should also have a motor specific instrument (such as
the Peabody Motor Scales) completed before the result of the eligibility evaluation is
determined.

Additionally, it is recommended that the medical history of these children be considered
along with other early signs of motor dysfunction in the areas of their reflexes, tone,
posturing, decreased motor activity, decreased movement variability. This information
along with objective information from the evaluation tools could result in determining that a
child with undiagnosed neurological disorder is eligible due to clinical opinion. In order to
adequately weigh these factors, one of the evaluators must be an Occupational or
Physical therapist.

Eligibility for Children Moving to New Families

Ideally the initial evaluation of a child who has moved to a new family, either through
foster placement or international adoption, should be postponed for at least a month
until the child is able to acclimate to the new people, surroundings, food, and schedule
(unless the child has a diagnosed condition or a very obvious disability). Children in
foster care have experienced some kind of significant family disturbance and are at risk
for social/emotional delays. Please check the Infant Mental Health guidelines for more
information on examples of behaviors that signal concerns and specific social/emotional
assessment tools to assist in determining eligibility.

Eligibility for Children Who Move to Connecticut

Children who move to Connecticut from another state where they were eligible due to
being “at risk” for a developmental delay, will not be eligible for Connecticut Birth to
Three services unless the child is currently demonstrating a significant developmental
delay. Children who move to Connecticut from another state where they were deemed
eligible because of a diagnosed condition or because they were significantly delayed at
the time of their referral to the other state’s program (e.g. 2 SD or 30% delay in one
area or 1.5 SD or 25% delay in two areas) are eligible for services in Connecticut
unless they are functioning within normal limits in all five areas of development (see Exit
procedure). Current information (if not older than three months) sent from the child’s
previous early intervention program can be used to determine eligibility. If this
information is not available, the program will need to conduct an eligibility evaluation to
determine whether there is still some delay. If eligible, the child needs to have a
multidisciplinary assessment completed for program planning purposes and an initial
IFSP needs to be developed.

The Connecticut Birth to Three System is not required to provide Part C early
intervention services to a child who is also receiving Part C early intervention services in
another state if that child and their family are only temporarily visiting in Connecticut.
This does not apply to children who are homeless or whose family is highly mobile (e.g.
migrant workers) or displaced by a catastrophic event such as a hurricane or flood, who
are wards of the state, or who reside on an Indian reservation.
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                        Beginning the Initial Evaluation Process

Initial Contact,

A program will contact the family within one working day of receiving a referral and
provide the name of the person who will be acting as service coordinator to facilitate the
evaluation, and or the assessment. If the family does not have a phone they will be
contacted by mail.

The service coordinator who contacts the family will review the referral information that
was received, explain the evaluation and assessment process and discuss the
importance and requirement of the involvement of the family, caregivers and primary
health care provider in this process. Parents are required to be present for the initial
evaluation and will be asked where and when the evaluation should take place. The
evaluation should be scheduled in the home or in another location familiar to the child in
order to elicit the best responses from the child. However, if an evaluation is scheduled
using this information and the family is not there when the team arrives, all subsequent
attempts to evaluate the child will be scheduled at a location convenient to the
evaluators. If either of the parents who will be present at the evaluation is of limited
English proficiency, the service coordinator must ensure that an interpreter will be
present.

The service coordinator will ask the parent if previous evaluations of the child have
been completed that may help in determining the child’s present abilities. A signed
release, Form 3-2, to obtain written information and to speak with the child’s primary
health care provider will be obtained at this first meeting.

Written Prior Notice

Section 303. 21 of the IDEA Part C regulations states that, prior written notice must be
provided to parents a reasonable time before the lead agency or a 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. For this reason, parents must receive
prior written notice (Form 1-6) before a program conducts an initial evaluation (see
Procedural Safeguards procedure) and after the completion of the evaluation, whether
the child is found eligible or not eligible.

Obtaining Consent for Evaluation

Written consent for the evaluation must be obtained from a parent, surrogate parent, or
legal guardian prior to beginning the evaluation using Consent for
Evaluation/Assessment Form 1-4. Written consent is specific to the evaluation
instrument(s) listed. The program should only list those instruments that will be used at
the initial evaluation or can list all possible instruments and only check those to which
the parent is actually consenting. Listing all possible evaluation instruments on every
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consent form is not appropriate. If the parent has consented to the use of certain
instruments and once on-site, the evaluators decide that a different instrument would
also be useful, they should obtain consent for that additional instrument on an
additional Form 1-4. The names of instruments should be spelled out on the form and
not abbreviated.

If the parent or legal guardian refuses to give their consent for the initial evaluation, the
service coordinator will make a reasonable effort to ensure that the parent is fully aware
of the nature of the evaluation and understands that the child will not be able to receive
an evaluation, or services, unless consent is given. If a parent refuses to consent to
evaluation in circumstances where lack of services constitutes child abuse or neglect,
the service coordinator is required to make the necessary report to the Department of
Children and Families, using DCF Form -136 (see Abuse and Neglect procedure).

There are some cases where there may be divorce or separation issues or questions
about which parent is legally able to give consent for an initial evaluation. Typically
either parent can give written consent for an evaluation. The exceptions are:
 When one parent’s parental rights have been terminated OR
 If there is a State Court custody order that either requires that decisions be made
    jointly OR
 The custody order gives sole decision-making authority to one of the parents

Regardless of who has decision-making authority, the program must send written prior
notice and a copy of the evaluation report to both parents unless one parent’s rights
have been terminated.

Child Development Infoline (CDI) will ask all parents upon referral whether there are
any custody issues regarding decision making that the program needs to know about.
If the parent says “yes”, CDI will ask whether they have sole or joint custody, and if
there is a parent at another address who should receive the evaluation report. CDI will
list this information, including the second parent’s address, in the notes section on the
referral screen of the data system. If CDI has flagged the issue, the person who
schedules the evaluation should confirm the information when they call to schedule. If
the referring parent has indicated that joint decision-making is required, the program
should send the evaluation consent form out ahead of time so that both signatures can
be obtained. If there is another parent listed at a separate address, both the written
prior notice of the evaluation and the evaluation report must be sent to that second
parent.

Sometimes one parent may request the evaluation without telling the other parent.
Only one parent’s consent is needed to proceed with an evaluation unless there is legal
documentation indicating that joint decision-making is required. If both parents decide
to decline the evaluation when contacted by the program to schedule the eligibility
evaluation or when the evaluation team arrives to complete the evaluation, the program
will indicate that the parent declined the evaluation in the Birth to Three data system.
The program will inform the parents of their right to re-refer their child at any time.
                                                                           Evaluation page 8


                                  Evaluation Process

Part C regulations under IDEA require that the initial eligibility evaluation be completed
by a multi- disciplinary team unless the child is already known to be eligible due to a
diagnosed condition or previous evaluation. The program will compose an evaluation
team of at least two professionals from two different disciplines trained to use
appropriate methods and procedures to determine eligibility. The team members
should be selected based on the child’s needs (e.g. a speech pathologist should be part
of the team evaluating a child referred for communication concerns). Personnel who
are qualified to evaluate for eligibility are those professionals identified in the
Connecticut Birth to Three Personnel Standards who have current certification,
licensure, or comparable requirements of their profession. It does not include COTAs,
Early Intervention Associates, Early Intervention Assistants or other paraprofessional
personnel. Early Intervention Specialists and Teachers cannot be paired to meet the
multidisciplinary requirement just as a Social Worker and Marriage and Family
Therapist do not constitute a multidisciplinary team.

A parent must be present and should actively participate in the evaluation of their child.
If parents are not active participants valuable information may be missed, families may
not assume ownership of decisions made or interventions planned and families may not
feel like part of the team. Parent participation may take many forms, based on the
family’s perceptions of what is appropriate and important. These perceptions will be
shaped by their cultural backgrounds, economic status, and value system as well as the
assessor’s attitude and communication skills. Part of the evaluation process must be
the consideration of the parent’s preference for their role in the evaluation. Those roles,
as described on a continuum from most involved to least involved are:

   demonstrating    the parent, at the assessor’s request, has the child
                     demonstrate various skills
   validating       the parent validates for the assessor that the child’s behavior on a
                     test item is or is not typical
   interpreting     the parent can interpret for the assessor, “oh, when he does that it
                     means… or “saying ‘ba’ means he wants his baby doll”
   informing        the parent provides information about what the child can and
                     cannot do
   observing        the parent watches as the assessor administers test items

This information is also explained to parents in the Family Handbook: Guide I as
various ways that the evaluation team may ask them to participate.

The team will evaluate all five developmental areas including cognition; physical
(including fine and gross motor, vision, and hearing); communication (including
receptive and expressive); social/emotional; and adaptive using a multi-domain
standardized instrument. The instrument should be used in its entirety. Other
instruments targeting specific domains should also be used when appropriate. No
single procedure (standardized testing, observation, parent interview, review of medical
information, others) may be used as the sole criterion to determine eligibility. For
children born prematurely, an adjusted age should be used only when directed by the
                                                                            Evaluation page 9


administration/scoring directions of the chosen instrument(s). For children with delays
in speech only, a standardized speech and language instrument must be used (see
section: Children with Delays in Speech Only).

Section 303.321(a)(3)(i) of the Part C regulations state that “a child’s medical and othe
records may be used to establish eligibility (without conducting an evaluation of the
child)”. Therefore, if an program obtains written results of an existing evaluation(s) may
be used to determine the child’s eligibility if the following conditions are met (1) they
were completed within the past three months,(2) they were conducted by qualified
personnel (i.e. they meet the requirements of the Connecticut Birth to Three Personnel
Standards), and (3) provide information from a normed standardized instrument that
confirms the child is eligible due to a significant developmental delay of minus 2
standard deviations in one area or minus 1.5 standard deviations in two areas. If the
program receives a report that meets these conditions then a standardized instrument
is not required to determine eligibility and the multidisciplinary team can move forward
to complete the initial assessment in all five areas of development (see assessment
procedure).

If an eligibility evaluation and assessment cannot be completed in sufficient time to
ensure that the IFSP meeting is held within 45 days of referral, the service coordinator
will document the reasons in the child’s early intervention record and the data system.
Providers who have any questions about a child’s eligibility may contact the Birth to
Three Child Find Coordinator to request a review by the Birth to Three System’s
medical advisor.
Choice of Program

Each Birth to Three program is responsible, after determining that a child is eligible, to
give the family objective information on all available programs in their geographic area.
They must allow the family to decide if they wish to receive services from their program
or select another. If another program is selected, the service coordinator will contact
either the program director or Child Development Infoline to determine whether that
program is accepting referrals. If not, the program should help the family select a
program that is accepting referrals. After obtaining a written release from the parent
using Form 3-3, the original program should send all records to the new program and
complete the electronic transfer operations in the Birth to Three data system.

Children Determined Not Eligible

Parents of children evaluated and found not eligible should receive a Prior Written
Notice (Form 1-6) and a written explanation of the decision within four days. See the
Dispute Resolution Regarding Eligibility section of this procedure if the parent is not in
agreement with this decision.

If there are still concerns about the child’s development, the parent may request a new
eligibility evaluation three months after the last evaluation by contacting Child
Development Infoline. The parent may request a new evaluation be completed sooner
                                                                            Evaluation page 10


than three months from the last evaluation if there is a significant change in the child’s
development or health status. When a second evaluation is requested the parent may
choose to have the original program complete the evaluation or request a different
program if one is available.

With written consent of the parents, children who are evaluated and found to be not
eligible will be offered developmental monitoring through the Ages and Stages
Questionnaires (administered by the Help Me Grow Program) and will also be referred
to other appropriate community resources and programs.

                       Dispute Resolution Regarding Eligibility

If a parent disagrees with the eligibility determination they are encouraged to:

   1. discuss with the evaluator(s) how their child’s abilities and needs compare with
      Connecticut’s eligibility criteria.
   2. offer new information to the evaluator(s), such as a recent medical diagnosis that
      might affect eligibility.
   3. contact the Child Find Coordinator and request that the eligibility decision be
      reviewed; or
   4. send a written complaint or a request for a hearing to the Birth to Three Director
      if they feel there were problems with evaluation process.

If a parent calls the Child Find Coordinator or files a written complaint, the following
process will be followed:

   1. The Child Find Coordinator will request a copy of the evaluation and any other
      available information from the program.
   2. The Child Find Coordinator and the Birth to Three medical advisor may review
      the evaluation report and supporting documentation.
   3. If, during the course of the review, it is discovered that information was
      overlooked or the evaluation process was flawed, the program will be asked to
      re-consider the eligibility determination in light of the new information or to re-
      evaluate the child.

Evaluation Report

Parents of children evaluated and determined to be eligible should receive a written
statement of eligibility within four days of the evaluation. This may be done by giving a
draft of the evaluation report or it may be just a one page summary form or a visit note.
Regardless of the format, the statement must explain clearly why the child was
determined to be eligible. Parents must also receive prior written notice (Form 1-6)
after the completion of the evaluation, whether the child is found eligible or not eligible,
(see Procedural Safeguards procedure)

Each initial evaluation and annual redetermination (whether or not the child was found
eligible) must result in a written (typed or computer-printed) report. The report should
address the child’s development in all five areas as required by IDEA but should use
                                                                           Evaluation page 11


functional descriptions of the child as a whole rather than a report limited to descriptions
of items the child passed or failed on various tests and age levels. It is appropriate to
include standard scores when available and an explanation about them when they are
used to determine eligibility. When the results of the evaluation are combined with an
assessment, the report should provide comprehensive, detailed, strength-oriented
information about the child’s abilities, areas of concern or readiness, learning style,
environmental demands, adaptations, and next steps in development. The report must
also include the following:
     1. The program name, address, child name, parent’s names, address, DOB, and
         age at the time of the evaluation
     2. The date of the evaluation.
     3. The location of the evaluation.
     4. A description of the process and instruments used to complete the evaluation.
     5. A description of the child and family’s daily routines.
     6. Language that describes the family’s input and how they participated in the
         evaluation process. This involvement should be evidenced throughout the report
         by referencing the parent(s) role using one or more of the categories provided on
         the preceding pages.
     7. Child’s strengths, areas of concern and next steps in development.
     8. Current levels of functioning across all five areas of development (cognitive,
         physical -including vision, hearing, motor and health, communication, social or
         emotional, and adaptive skills, also known as self-help or daily living skills).
     9. A clear statement of the specific reason(s) why the child was determined to be
         eligible or not.
     10. Original signatures on the same page along with the initials of the credentials of
         two qualified personnel from two different disciplines or one with a report
         confirming an acceptable diagnosed condition. The dates of the signatures
         should correspond with the date of the report not the date of the evaluation
         unless the report was written on the date of the evaluation.

Each professional participating on the team to develop the report will contribute
information pertaining to his or her discipline. This information will be contained in one
report that each evaluator will sign. Evaluators will work together to produce one report,
rather than individual ones. The person(s) who reviewed any outside evaluations that
were used should indicate that such a review was performed in the written report. The
report should be readable and useful to parents and members of various disciplines.
Professional jargon should be eliminated, or if essential, defined.

Prior to the evaluation report being finalized, the parents should have an opportunity to
review it with one of the team members to be sure they are in agreement. If the parents
have additional information or request any changes, the report should be modified to
reflect their input. A final copy is given to the family and filed in the child’s record. To
the extent feasible, families with limited proficiency in English should receive a
summary of the written report in their native language. The service coordinator should
ask the parents for written consent to release the final report to the child’s primary
physician (Form 3-3) and the referral source if that is different from the family or primary
physician. Permission to release report should not be requested until the parent has
had a chance to read it at least in draft form. Evaluation information, including whether
                                                                          Evaluation page 12


the child is eligible, may not be shared with anyone, including the referral source,
without the parent’s written consent.

When writing the report it is important to remember that for the child who is found to be
eligible for Birth to Three supports and services, the next step will be to develop an
IFSP, identifying with the family the outcomes that they wish to address. To make this
plan meaningful it should be based not only on the child’s skills but also on knowledge
of his or her routines, preferred activities, and the people who will be part of his daily
care and play. This, along with the family’s concerns, priorities and interests for their
child and family, can help to identify desired outcomes and formal and informal
supports to attain them.

                 Information Specific to Autism Spectrum Disorders

Screening Children for Autism Spectrum Disorders (ASD)
The American Academy of Pediatrics recommends that children be screened for an
ASD twice before their second birthday. The Connecticut Birth to Three System
requires that all children referred to the Birth to Three System who are 16 months of
age (adjusting for prematurity up to two years of age) or older and do not have a prior
positive screen or a diagnosis of autism will be screened for ASD as part of the intake
process. This will be explained to the parent and completed even if the parent and/or
referral source have no concerns about autism. All screening and evaluation done by
Birth to Three is voluntary and requires written consent. If the parent chooses not to
have their child screened, the evaluation team must document that the parent refused
consent in their evaluation report. Preferred screening instruments include the Modified
Checklist for Autism in Toddlers (M-CHAT) and the Brief Infant Toddler Social-
Emotional Assessment (BITSEA). If there are questions about the child’s overall
communication development and the program chooses to use the Communication and
Symbolic Behavior Scales Developmental Profile (CSBS DP Infant-Toddler Checklist),
the results may be used in lieu of conducting an autism screening.

Children Found Not Eligible for Birth to Three services due to developmental
delay although the screening indicates there is concern about ASD

When a child is not eligible due to developmental delay but the autism screen indicates
the presence of critical behaviors that may indicate an autism spectrum disorder, the
family will be given the opportunity to have one of the autism-specific programs conduct
further assessment to determine if the child meets the diagnosis of autism as
determined by the Diagnostic and Statistical Manual, Fourth Edition, Text Revision
(DSM IV-TR). If the autism assessment indicates the existence of an autism spectrum
disorder, then the child is eligible for the Birth to Three System. The family will then
need to choose to have their child receive services from an autism-specific program or
a general program that serves their town.
                                                                            Evaluation page 13


Determining if a Child is Eligible for Birth to Three due to a diagnosis of Autism
Spectrum Disorder

When the screening tool indicates that the child may be at risk for an ASD, the general
Birth to Three program will encourage the family to seek a determination of whether the
child meets the diagnosis of autism as determined by the Diagnostic and Statistical
Manual, Fourth Edition, Text Revision (DSM IV-TR). All of the autism-specific programs
are equipped to make this diagnosis, but in some cases they may be made by the
general program that has assessed the child. This determination process will consist
of:
    1. An in-depth review of the autism screening that was completed to confirm the
        “red flags” identified as part of the screening. This may be done as part of the
        original screening completed by the Birth to Three program.
    2. A review of the child’s health information to determine if the child’s hearing has
        recently been screened or evaluated to rule out a possible hearing loss.
    3. A review of assessments previously completed on the child to assure that the
        child demonstrates a delay greater than 1 standard deviation below the mean in
        receptive language, expressive language, social-emotional or adaptive behavior
        skills. If needed, additional developmental assessments such as a Vineland
        Adaptive Behavior Scales or the Preschool Language Scales 4th Edition (PLS 4)
        should be completed to give a full picture of the child.
    4. If it is determined that there is a need for further assessment, the administration
        of a validated assessment measure such as the Autism Diagnostic Observation
        Schedule (ADOS) (for children 12 months and older), the Autism Diagnostic
        Interview-Revised (ADI-R) (for children 24 months and older), or the Childhood
        Autism Rating Scale (CARS) (2+ years) by a professional or professionals with
        appropriate training will be completed.

Children who Receive a Diagnosis of ASD Prior to Referral or Have an Outside
Evaluation for ASD

For children who have received a diagnosis of ASD prior to a referral being is made,
Child Development Infoline will offer the family a choice of one of the autism-specific
programs or one of the general programs serving their town of residence. The program
that receives the referral will first confirm that sufficient information on the diagnosis is
available (see Documentation of a Diagnosed Condition section of this procedure).

Since the child is already known to be eligible because of a diagnosed condition,
whichever program receives the referral will perform an initial multi-disciplinary
assessment in all five developmental domains and a family assessment prior to
developing the initial IFSP.

Children referred due to a concerned that the child may have ASD, but a
diagnosis has not been made

These children will be referred directly to an autism-specific program by Child
Development Infoline. The autism-specific program must determine 1) whether the
child is eligible for Birth to Three based on developmental delay and/or 2) whether the
                                                                          Evaluation page 14


child has a DSM-IV TR diagnosis of ASD. If a child is determined to have the DSM-IV
TR diagnosis of ASD, the parent will be offered the choice of remaining with the autism-
specific program, choosing a different autism-specific program that serves their town, or
choosing one of the general Birth to Three programs that serves their town, as long as
the program they choose is accepting new referrals.

If the child is eligible due to developmental delay but is not determined to have a
diagnosis of ASD, the family will be offered a choice of one of the general Birth to Three
programs that serves their town.

If the child is neither eligible due to a developmental delay nor determined to have a
diagnosis of an autism spectrum disorder, the parents will be told that the child is not
eligible and offered resources outside of the Birth to Three System, such as Help Me
Grow (a developmental monitoring and resource referral program for children at-risk)




__________________________
References:
Form 1-4, Consent for Evaluation/Assessment
Form 1-6, Prior Written Notice
Form 3-2, Authorization for Programs to Obtain Information
Form 3-3, Authorization for Programs to Release Information
Form 3-17, Birth to Three Vision Screening
Part C of IDEA Sec. 1432 (5)
34 CFR Section 303.321
17a-248e (e) of the C.G.S.
Section 17a-248-1 (16) of the Regulations of CT State Agencies
Service Guideline #3, Children Referred with Speech Delays
Service Guideline #1, Autism Spectrum Disorder
Exit Procedure
Ages and Stages Questionnaire
Personnel Standards
Procedural Safeguards Procedure

				
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