Idaho Infant Toddler Program (ITP) Anna Smith, ITP Program Specialist Christy Cronheim, ITP Program Manager

Disclosure We have no actual or potential conflict of interest in relation to this program/presentation

Idaho Infant Toddler Program The Infant Toddler Program (ITP) is housed in the Department of Health & Welfare, Division of Family & Community Services. ITP is the lead agency for the Individuals with Disabilities Education Act (IDEA), Part C. Just as Part B of IDEA requires states to provide special education services to eligible school-age children, Part C of IDEA requires states to provide early intervention services to eligible children from birth to age 3. These early intervention services help families learn ways to use everyday activities to support the growth and development of their child.

ITP’s Landscape North Hub: Regions 1 and 2 West Hub: Regions 3 and 4 East Hub: Region 5, 6, and 7 1 2 7 4 5 6 3

Infant Toddler Program ~ It Takes 2 Parts To Make One Child Find Direct Intervention Idaho Infant Toddler Program

Developmental Screenings In Idaho Typically completed by: Physicians (Thank you!) Idaho Infant Toddler Child Find Program Parents as Teachers Programs Child Care Providers Head Start Programs

ITP Child Find – Developmental Milestones Program

Who We Are and How We Came To Be Developmental Milestones is a program for parents to track the development of their child. IDEA, Part C requires ITP to have an active Child Find component. Developmental Milestones is one element of Child Find for ITP.

Where Are We Now? Idaho “Child Find” has been centralized to ITP Central Office location Named “Developmental Milestones” New Developmental Milestones brochure & checklist

Who Do We Serve? Misconception: Only at-risk children are served. Not true! Participation Criteria: 1) Live in Idaho 2) Have a child under 3 years old 3) Provide parental consent

How Do We Find Children? Conduct extensive outreach to physician offices, hospitals, and clinics Collaborate with Sound Beginnings (Idaho’s Early Hearing Detection and Intervention Program) Coordinate with Idaho STARS Program Conduct regional Child Find activities

How Do We Provide the Screenings? Online access to Ages & Stages Questionnaires in English & Spanish since August 2010 www.infanttoddler.idaho.gov Developmental Milestones enrollees – 6,010 as of Jan 1, 2018 1,052 of those enrollees use the ASQ online

Developmental Milestones Screening Instruments Ages & Stages Questionnaires, 3rd Edition. ASQ-3: Overall development in communication, gross motor, fine motor, problem solving & personal-social areas. (English/Spanish) Ages & Stages Questionnaires, Social-Emotional, 2nd Edition. ASQ:SE-2: Development of communication, social and emotional skills. (English/Spanish)

Developmental Milestones Screening Instruments Modified Checklist for Autism in Toddlers, Revised (M-CHAT R) Recommended by the AAP, the M-CHAT R screens children ages 16 -30 months for risk factors related to Autism Spectrum Disorders (ASD). Focuses on communication and social-emotional development. Provides valuable insight into how children see and respond to their world.

How Often Do We Screen? ASQ-3 is offered by mail and online at these intervals: 2, 4, 8, 12, 16, 20, 24, 30 & 36 months Intermediate intervals are added for children at risk or those who fall in the monitoring range: 6, 10, 14, 18, 22, 27 & 33 months

How Often Do We Screen? ASQ:SE-2 is offered at 12 & 30 months M-CHAT R is offered by mail at 18 & 24 months

Scoring and Next Steps All screeners are scored by qualified staff who work for ITP Screening results are typically communicated to parents within 48 hours of receipt Notifications include: Developing as Expected Monitoring Range (Specific developmental activities for area(s) of concern are included with letter) Referral Range (Phone Call to family to discuss referral to ITP. Specific developmental activities for area(s) of concern are included with letter)

Coordination of Screening Results Authorization for disclosure to physicians, child care providers Copy of score sheet sent to physicians Copy of score sheet sent to child care providers

Coordination of Screening Results Cross check with Infant Toddler Program and communicate with Service Coordinator if child is enrolled or in the process of being determined eligible Copy of score sheet given to Child and Family Services Caseworker if child is in foster care

Infant Toddler Program - DIRECT INTERVENTION

Who Refers to the Infant Toddler Program? State Fiscal Year 2017, ITP received a statewide total of 3,691 referrals: 61% Medical Community 17% Parents/Legal Guardians 15% Child Find Activities 7% Child and Family Services (CFS)

Who Does the Infant Toddler Program Serve? ITP serves eligible children from birth to 3 years of age who have a developmental delay or who have conditions (such as prematurity, Down Syndrome, hearing loss) that may result in a developmental delay.

What is the Eligibility Criteria? Developmental Delay 30% below age norm, or exhibits a six-month delay, whichever is less, in 1 or more functional areas (adjusted for prematurity up to 24 months) OR Demonstrates at least 2 SD below the mean in 1 of the functional areas. Demonstrates at least 1.5 SD below the mean in two or more of the functional areas

Eligibility Criteria Established Medical Condition Confirmed sensory impairment must document at least one of these conditions: Deaf-Blind Hearing Impaired: otitis media, chronic allergies, and/or eardrum perforations Visually Impaired Physical Impairment (Orthopedic) Neurological/Physiological Impairments/ Developmental Disabilities Interactive Disorders Medically Fragile Prematurity Plus Significant Environmental Risk Other Health Impairments

No Cost for Families The Infant Toddler Program is a voluntary program provided at no cost to families. Funding for the program comes from the IDEA, Part C federal grant, State general funds, Medicaid, and private insurance.

What Services Does ITP Provide? Idaho ITP links children with services that promote their physical, cognitive, and social-emotional development, and supports the needs of their families. Infant Toddler therapeutic, educational, and support services include, but are not limited to: Family education Speech therapy Occupational therapy Physical therapy Service coordination Family training, counseling, and home visits Vision services

Who are the Infant Toddler Program Service Providers? Infant Toddler Program Service Providers include, but are not limited to: Speech Language Pathologists Physical Therapists Occupational Therapists Developmental Specialists (Family Educators) Vision Specialists Hearing Specialists Service Coordinators Clinicians

Where Are Services Provided? Early Intervention Services are provided in the child’s natural environment with parent/caregiver participation Examples of Natural Environment include: Home Childcare facility Grocery store Play group Grandparents’ home Library

How Are Services Provided? Eligibility Evaluation(s) are completed in the child’s natural environment with parent/primary caregiver participation. Once Eligibility is determined, an Individual Family Service Plan (IFSP) is developed with the family. The IFSP identifies the outcomes, services, and service providers working the family. The IFSP also identifies the type, frequency, duration, and location of the service(s). Services are provided utilizing evidence-based practices.

How Many Children Does ITP Serve?

Early Intervention Evidence-Based Practices

Evidence-Based Practice Requirements IDEA, Part C Regulations Section §303.32 – Defines Scientifically-Based Research Section §303.112 – Availability of Early Intervention Services “Each system must include a State policy that is in effect and that ensures services are based on scientifically-based research, to the extent practicable, and are available to all infants and toddlers and their families.”

Definition of Evidence-Based Practices “Practices that are informed by research, in which the characteristics and consequences of environmental variables are empirically established and the relationship directly informs what a practitioner can do to produce a desired outcome” (Dunst, Trivette, & Cutspec, 2002)

Research Shows… When parents and other caregivers provide interest-based child learning opportunities as a part of every-day activities (diaper changing, games, bathing, riding in the car, neighborhood walks, climbing stairs to go to bed, etc.) within the family routines, under the coaching of a skilled interventionist, a child could have 500,000 opportunities in a typical year to practice new skills compared to the 2% of total waking time offered by twice a week hourly therapy in the absence of parent involvement. (Dunst 2006)

As a Result of the Research, Early Intervention Must… Be based on how all children learn throughout the course of everyday life – at home and in the community. Focus on naturally occurring learning opportunities, rather than contrived specialized instruction. Support primary caregivers to provide children learning experiences and opportunities that strengthen and promote their competence and development. Support learning that occurs in contexts that have high levels of interest and engagement for the child and family. Incorporate opportunities to reflect with the family on what is working and where additional problem solving may be needed as a means of enhancing the family’s capacity and competence.

How is Early Intervention Different From Traditional Therapy? Takes place in the home, child care center/preschool, or community Works with the parent or care giver to teach them how to help their child during activities of interest to the child and family Services are based upon the child and family's daily routine Traditional Therapy Takes place in clinic or hospital setting Works primarily with the child, families watch or are minimally involved Services only occur during therapy sessions

Early Intervention Evidence-Based Practices Teaming An identified team of practitioners from multiple disciplines having expertise in child development, family support, and coaching. Supports/coaches the primary coach in building the capacity of the parent or care provider to support the child’s participation in natural everyday occurring routines. Coaching as an Interaction Style An adult learning strategy in which the coach promotes the learner’s ability to reflect on his or her actions as means to determine the effectiveness of an action or practice and develop a plan for refinement and use of the action in immediate and future situations. (Rush & Sheldon, 2014) Coaching characteristics: Joint planning, observation, action, reflection, and feedback. Research shows that parent interaction/responsiveness is the #1 predictor in a child achieving their developmental outcomes. Joint Visits Other members of the team go with the primary coach to a home visit to teach, support, etc. PSP and family. Primary Coach Approach to Teaming The primary coach approach to teaming is a family-centered process for supporting families of young children with disabilities in which one member of an identified multidisciplinary team is selected as the primary coach who received coaching from other team members, and uses coaching as the key intervention strategy to build the capacity of parents and other care providers to use everyday learning opportunities to promote child development. (Rush & Sheldon, 2012) Everyday Natural Learning Opportunities Everyday family and community activities are used as sources of natural learning opportunities, and child interests are used as the basis for encouraging participation in those activities. Research shows that everyday family and community activities, settings, experiences, and opportunities are important contexts for young children’s acquisition of a variety of behavioral and developmental competencies. (Dunst, Bruder, Trivette, Raab, & McLean, 1998; Dunst, Hamby, et al., 2000; Gallimore et al., 1993; Göncü, 1999; Hart & Risley, 1995; Odom, Favazza, Brown, & Horn, 2000) Research and practice show that learning and development occurs more rapidly in young children when they are engaged in activities of interest to them, thus creating opportunities for them to practice existing skills, explore the environment, and learn new skills. (Dunst, Herter, & Shields, 2000) Functional Outcomes Participation-based IFSP outcomes vs. discipline-specific, skill-based outcomes. Necessary and functional for child’s and family’s life – reflects family’s priorities Reflect real-life contextualized settings – based off of family routines and activities Crosses developmental domains and is discipline-free Jargon-free, clear and simple Emphasize the positive, not the negative Ex: Maxwell will play with his toys happily during mealtime with his family by sitting without much support Vs. Maxwell will improve muscle tone for sitting. Parent Responsiveness Parent interaction/responsiveness is the #1 predictor in a child achieving developmental outcomes.

References The Family, Infant and Preschool Program (FIPP) Publications http://fipp.org/publications/ U.S. Department of Education, The Individuals with Disabilities (IDEA), Part C Regulations https://www2.ed.gov/policy/speced/reg/idea/part-c/index.html Infant Toddler Program Website http://www.infanttoddler.idaho.gov  

Questions?

Contact Information Anna Smith (208) 334-6530 Anna.Smith@dhw.idaho.gov Christy Cronheim (209) 334-5590 Christy.Cronheim@dhw.idaho.gov