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

Infant Toddler Program Early Intervention Evidence-Based Practices Presentation to Developmental Screening Learning Collaborative June 21, 2018 Melaine Shephard, Infant Toddler Program Specialist

Individuals with Disabilities Education Act (IDEA), Part C Early Intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children’s learning and development through everyday learning opportunities. Mission – reflects the overarching purpose of family-centered EI services provided under IDEA Part C http://ectacenter.org/~pdfs/topics/families/Finalmissionandprinciples3_11_08.pdf

IDEA Part C in Idaho IDEA Part C is specifically designed to provide early intervention to infants and toddlers birth-3 who have developmental disabilities or delays. Infant Toddler Program is Idaho’s designated lead agency for providing IDEA Part C services. IDEA Part C mandates that early intervention services are evidence-based and provided in natural environments.

Research Shows… When parents/caregivers provide interest-based learning opportunities as part of everyday activities (diapering, 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 biweekly hourly therapy in the absence of parent involvement. (Dunst 2006) Use multiple points, if necessary.

Evidence-Based Early Intervention Must… Be based on how all children learn throughout the course of every 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 Does Early Intervention Differ from Traditional Therapy? Takes place in the home, childcare center/preschool, or community. Works with the parent or caregiver 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 routines. Traditional Therapy Takes place in clinic or hospital setting. Works primarily with child; families watch or are minimally involved. Services only occur during therapy sessions. Use multiple points, if necessary.

Evidence-Based Practices Activity Settings within Natural Environments and Routines Primary Service Provider Approach to Teaming Coaching with Families Functional Outcomes Resource-Based Practices

Evidence-Based Practices Activity Settings within Natural Environments and Routines Infants and toddlers age birth - 3 learn best in their natural environment. “Natural environments” refers to the everyday routines, experiences, and activities that occur in various social and nonsocial contexts as part of family and community life. (Raab & Dunst, 2003)

Evidence-Based Practices The Primary Service Provider (PSP) Approach to Teaming Each enrolled family is assigned to a team of individuals from multiple disciplines who have expertise in child development, family support, and coaching. One team member serves as the primary service provider. The PSP receives coaching from other team members through ongoing planned and spontaneous interactions. (Shelden & Rush, 2013)

Evidence-Based Practices Coaching Style of Interaction with Families Supports parents and caregivers in recognizing what they are already doing that promotes learning for a child, and Assists parents and caregivers in creating ongoing learning opportunities for the child when the coach is not present (Hanft, Rush & Shelden, 2004 & 2014)

Evidence-Based Practices Functional Outcomes… …Are necessary and functional for child’s and family’s life. Reflect family’s priorities. …Reflect real-life contextualized settings. Based on family routines and activities. …Cross developmental domains. …Emphasize the positive, not the negative.

Evidence-Based Practices Resource-Based Practices Identify Resources Select Resource Access Resources Evaluate Resources

Research Supports Resource-Based Practices …family-systems intervention practices, and especially capacity-building help-giving practices, are how other kinds of practices are implemented and are therefore complimentary to parent-child and child-focused intervention when parents and other caregivers are part of implementing the interventions. Trivette, C., Dunst, C., and Hamby, D. Influences of Family-Systems Intervention Practices on Parent-Child Interactions and Child Development (Topics in Early Childhood Special Education) 2010

Medicaid Reimbursable Part C Services EPSDT Early Intervention

Infant Toddler Program Funding Federal Grant Funds Private Insurance Medicaid State General Funds

Early Intervention in Idaho The Divisions of Medicaid and Family and Community Services partnered to update Medicaid rules so that Idaho’s infants, toddlers and their families have improved access to early intervention services. Developed a project team with Medicaid and FACS staff in March 2017 Made IDAPA rule changes and State Plan Amendment Moved services provided by ITP out of Medicaid Rehab and Developmental Disabilities rules Added Early Intervention Services as a defined benefit under the ESPDT authority

Idaho’s EPSDT Services

Idaho’s EPSDT Services Early and Periodic Screening, Diagnostic and Treatment Services are preventive and comprehensive health benefits for individuals under the age of 21 who are on Medicaid Request for Additional Services Medically necessary services that exceed service limits 1905(a) services not covered in the State Plan Defined EPSDT Benefits Hearing Aids Eyeglasses Early Intervention Services

Medicaid Coverage of IDEA Part C Services New EPSDT Early Intervention Benefits Screening Evaluation and Assessment Intervention Services Multi-Disciplinary Team Services

Screening Pre-Eligibility Screening - Used to determine the appropriateness of a child’s participation in the Infant Toddler Program. Developmental Screening - The utilization of specific screeners to determine the appropriateness of a child’s participation in the Infant Toddler Program or to determine if additional ongoing assessment is needed for enrolled children.

Evaluation and Assessment Developmental Evaluation - Standardized evaluation used to determine child’s initial and continuing eligibility for the Infant Toddler Program. This evaluation looks at child’s level of functioning in 5 developmental areas and identifies services necessary to address identified needs. Early Intervention Assessment - Activities, observation and administration of standardized or non-standardized instruments and tools to identify child’s current needs and functioning within their natural environment. PT, OT, SLP Evaluation - Evaluations completed by a licensed professional to identify child’s functioning specific to their physical, occupational, or speech development.

Intervention Services Early Intervention - Individualized education, training and consultation provided to child and caregiver to promote the child’s age-appropriate growth and development. Joint Visiting - Home visit when 2 early interventionists meet with caregiver and child to identify and integrate strategies that support the child’s progress toward established outcomes.

Multi-Disciplinary Team Services Teaming: Coordination of 2 or more early intervention providers for the purpose of reviewing, integrating, and planning for a child's effective early intervention.

Physician Recommendation A recommendation from a physician or other practitioner of the healing arts must be on file for each Medicaid-eligible child receiving early intervention services. ITP may not seek reimbursement for services provided more than 30 days prior to the recommendation. The recommendation is valid for the duration indicated, not to exceed 365 days. Recommendation may be provided on a separate form or provider may sign the family’s service plan (IFSP).

Early Intervention Services for children birth to 3 years of age

Program Information Transdisciplinary Teams Region-Wide Each team consists of Service Coordinator, OT, PT, SLP, Developmental Specialist, Hearing/Vision Consultant Evidence-Based Practices Use of natural learning environment. Services provided in home or childcare facility. Use of coaching method with families Therapists interact with parents/care providers to recognize what they are already doing to support child’s learning and development as well as building upon existing and/or new ideas. Parent-identified goals

Program Information Primary coach assigned based on need of child Use of Primary Coach approach to teaming Primary coach assigned based on need of child If additional supports are recognized, primary coach staffs with transdisciplinary team for collaboration and team decides and approves additional support. Referrals Refer patients via Website, Fax, or Phone Providing medical records speeds the process

Eligibility and Services Developmental Delay Exhibits a 30% or 6-month delay in one or more areas, based on a standard evaluation Demonstates a standard deviation of -2.00 in at least one area or -1.5 in at least two areas Test in 5 domains: Cognitive, Physical, Communication, Social/Emotional, & Adaptive Established Medical Condition A condition with a high risk of developmental disability or delay (Down syndrome, hearing loss, prematurity, reoccurring ear infections) Evaluation results staffed at transdisciplinary team, and primary coach assigned based on child’s need

Regional Contacts North Hub Region 1: Boundary, Bonner, Kootenai, Benewah, Shoshone Counties Referrals: Supervisor Heather Freeman (208) 769-2707 Region 2: Clearwater, Idaho, Latah, Lewis, Nez Perce Counties Referrals: (208) 798-4119; Supervisors Mandy Maxcer (208) 882-6913 or Leah Hill (208) 882-6904 West Hub Brande Gonzalez (208) 475-5068 Region 3: Adams, Canyon, Gem, Owyhee, Payette, Washington Counties Referrals: (208) 475-5066 Region 4: Ada, Boise, Elmore, Valley Counties Referrals: (208) 334-0929

Regional Contacts East Hub Region 5: Blaine, Camas, Cassia, Gooding, Jerome, Lincoln, Minidoka, Twin Falls Counties Referrals: (208) 732-1549; Supervisor Christina Hansen (208) 732-1545 Region 6: Bannock, Bear Lake, Bingham, Caribou, Franklin, Oneida, Power Counties Referrals: (208) 234-7949; Supervisor Bonnie Jones (208) 234-7944 Region 7: Bonneville, Butte, Clark, Custer, Fremont, Jefferson, Lemhi, Madison, Teton Counties Referrals: (208) 528-4060; Supervisor Sandra Cummings (208) 528-4070

Pilot for Early Identification of Autism Two years ago, Regions 3 & 4 of the Infant Toddler Program and the St. Luke’s Children’s Center for Autism and Neurodevelopmental Disabilities formed a pilot program committed to early identification and referral of children with risk factors for Autism.

Pilot Goals Rule out Autism or provide a diagnosis that so services and treatment begin early.   When appropriate, and with parent consent, refer to the St. Luke’s Children’s Rehab clinic for specialized, intensive Autism instruction. Children under age 3 with a diagnosis are served on a high-priority basis.

Pilot Outcomes St. Luke’s Rehab therapists provided Infant Toddler therapists with an in-service on early signs of Autism and the DENVER model of therapy. ITP’s supervision team provided education to their therapists on how to hold candid conversations with primary caregivers regarding red flags for Autism and how to make this a standard practice. ITP Regions 3 & 4 referred 98 children with early signs of Autism for further evaluation and testing.