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Birth to Three

The Medical Home and Early Intervention Partnership

"Early identification of children with developmental delays is important in the primary care setting. The pediatrician is the best-informed professional with whom many families have contact during the first 5 years of a child's life. Parents look to the pediatrician to be the expert, not only on childhood illnesses, but also on development. Early Intervention services for children from birth to 3 years of age and Early Childhood Education Services for children 3 to 5 years of age are widely available for children with developmental delays or disabilities." AAP Policy (RE0062) [Committee: 2001]

Roles of the Medical Home in Transition

  • Initiate communication with the Early Intervention team. (Sample referral form: Baby Watch Referral Form (PDF Document 156 KB) .)
  • Instruct the family to start keeping their own written medical history and immunization record. (Sample medical history: Medical Summary (PDF Document 18 KB) .)
  • Begin to discuss the child's future with the family.
  • Encourage the family to make financial arrangements (including special needs trust), to write wills, and consider Guardianship/Estate Planning to document their wishes in the event they are not able to provide care for their child.
  • Begin transition planning to preschool by age 2.

Early Intervention (E.I.) - the Individuals With Disabilities Education Act (IDEA)

In 1997, an amendment to IDEA mandated early identification and intervention for children with special health care needs through the development of a community-based service system (Part C) (see IDEA97 compared to IDEA04). To meet this mandate, federal financial assistance was granted to states to develop a system to deliver interagency, multidisciplinary services for all eligible children. Local programs are responsible for finding and providing services for children from birth to three years with developmental delays or disabilities.

Who is Eligible for Early Intervention?

Eligibility is determined by one of these methods:
  • Standardized Assessment - A child is eligible if they score 1.5 standard deviations at or below the mean, or at or below the 7th percentile in one or more areas of development on the Bayley, Peabody, or other validated developmental assessment instrument. These will be administered when needed by Early Intervention program personnel.
  • Informed Clinical Opinion - Clinical opinion is used when concerns relate to aspects of development that are difficult to measure, such as poor feeding skills, or low or high muscle tone in infants. Parent concerns are considered and medical records reviewed. Two or more professionals who have knowledge and expertise in the area of concern establish an "informed clinical opinion".
  • Diagnosis - Early Intervention has a list of diagnoses that will qualify a child for services. Diagnoses may vary by state. The program must have documentation of the diagnosis. For a current list of qualifying diagnoses, contact your state or local Early Intervention provider: see all Early Intervention Programs services providers (33) in our database.

The Referral and Evaluation Process

Once a referral is received, the service coordinator schedules an appointment with the family to obtain information and describe the services, resources, and evaluation process. A multidisciplinary evaluation is then scheduled to focus on specific child development skills. Qualified personnel use a variety of tests to assess cognitive, language, motor, social, emotional, behavioral, and self-help skills. The evaluation process includes a complete assessment of the family's "concerns, priorities, and resources" (CPRs). Evaluation and assessment services are provided at no cost to the family.
During the initial evaluation, the service coordinator will request information from the Medical Home provider including well child visit records, vision, hearing, and developmental testing. Federal Regulations state the evaluation and assessment process must be completed within 45 days of the referral. Health information provided by the Medical Home is essential to help the early intervention team assess levels of functioning and eligibility of the infant/toddler.

The IFSP

Following the initial assessment and eligibility determination, an IFSP, or Individualized Family Service Plan, is developed with input from the family, early intervention program staff, and other appropriate staff or professionals.
The IFSP team uses the assessment process to determine the location, frequency, intensity, and duration of services to be provided. The child's current level of functioning is documented and outcomes are written for each identified need. The team develops strategies to meet the outcomes, and a re-evaluation date is set for a six-month review. The IFSP is reevaluated each year but can be revised at any time if the child's needs change.

Who Pays for Services?

State and Federal agencies are responsible to provide specific services with no charge to the family. These include:
  • Child Find and Referral
  • Assessment and Evaluation
  • Individualized Family Services Plan (IFSP) Development and Review
  • Procedural Safeguards (Family Rights)
  • Service Coordination
For all other services there is a sliding fee scale that determines the amount a family may have to pay. Medicaid can be a designated payer.

What Services are Provided?

Examples of early intervention services include occupational therapy, physical therapy, speech and language therapy, special instruction, nutritional services, nursing services and family training. Early intervention therapists and home visitors may have a special early intervention training or credentials above and beyond their professional license or certification.

Where Services are Provided?

Children are served according to the outcomes and strategies documented on the IFSP. The service providers use activities in natural learning environments that meet the child's changing needs and promote functional skills, development, and learning. These environments may include the family's home, child care center, play group, or at a local community activity.

Timelines for Developmental Visits

  • Baby Watch Development Chart
    A chart of typical development from 1 month to 3 years.
  • Talaris child development Timeline
    "Dedicated to discovering how children think, feel and learn. From birth to age five, a child observes, experiments, and begins to understand the world." Click Timeline at the top of the page.

Emotional, Behavioral, and Cognitive Development

  • Bright Futures
    A national health promotion initiative dedicated to the principle that every child deserves to be healthy and that optimal health involves a trusting relationship between the health professional, the child, the family, and the community as partners in health practice. Information on healthy emotional, behavioral and cognitive development.
  • Healthy Minds, from Zero to Three
    Created by the National Center For Infants, Toddlers and Families. Developmental handouts in PDF for parents.
  • First Signs
    A national non-profit organization dedicated to educating parents and pediatric professionals about the early warning signs of autism and other developmental disorders. Includes developmental milestones, red flags, communication needs of parents and physicians.

Mental health resources in Utah

  • Utah Public Community Health Agency Locator
    A map of Utah that allows users to click on the area in which they live to see available public-funded services for Substance Abuse and Mental Health
  • Utah Association for Infant Mental Health
    A Utah State University sponsored site that has links to a power point presentation of the State Practice Model to support the mental health of children aged 0-5. This site also includes toolkits for screening, early intervention, and treatment to promote healthy social emotional development

Resources

Information & Support

For Parents and Patients

Utah Parent Center
A statewide non-profit organization, founded in 1984, to provide training, information, referral and assistance to parents of children and youth with ALL disabilities, including physical, mental, hearing, vision, learning, behavioral and emotional. Staff consists primarily of parents of children and youth with disabilities. The Center provides information on support and advocacy for families of children with special health care needs.

Transition Tips for Parents of Newborns or Newly Diagnosed Children with Disabilities (PDF Document 483 KB)
This pamphlet developed by Shriners Hospital for Children, also called A New Start, provides information for parents on coping, staying strong, building hope, utilizing resources, and using health care efficiently.

Utah State Office of Education, Special Education
Information about Utah schools including district and special education contact information.

Utah State Office of Education Special Education Rules
This policy provides detailed, technical information about Utah's Special Education services.

Baby Watch Early Intervention Program
Utah's network of service for children ages birth to three with developmental delays or disabilities.

Baby Watch Early Intervention Locations
A list of Utah Baby Watch locations throughout Utah providing early intervention programs.

Baby Watch Referral Form (PDF Document 156 KB)
Information referral and release form to exchange information between the Medical Home and early intervention programs in Utah.

List of Diagnoses/Conditions (PDF Document 85 KB)
A list of diagnoses and conditions that assure eligibility for Utah early intervention/developmental services. Diagnoses and conditions may vary in your state.

Utah School for the Deaf and the Blind
Home page for the school of the deaf and blind.

IFSP form (PDF Document 224 KB)
Sample Individual Family Service Plan.

Services

Early Intervention Programs

See all Early Intervention Programs services providers (33) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Author: Gina Pola-Money, 12/2005
Reviewing Author: Alfred Romeo RN, PhD, 7/2008
Content Last Updated: 10/2008

Page Bibliography

Committee on Children With Disabilities.
Role of the pediatrician in family-centered early intervention services.
Pediatrics. 2001;107(5):1155-7. PubMed abstract / Full Text