Connecticut Birth to Three System How Birth to Three Can Be A Busy Pediatrician’s Best Partner November 7, 2018 Presenters: Ann Milanese, MD; Associate Professor of Pediatrics at UCONN School of Medicine Division Chief of Development and Rehabilitation Medicine at CCMC Medical Advisor to the Connecticut Birth to Three System Thyde Dumont-Mathieu, MD, MPH; Associate Professor of Pediatrics at UCONN School of Medicine; Developmental-Behavioral Pediatrician Staff Physician, Development and Rehabilitation Medicine at CCMC

The Connecticut Birth to Three System Today we will discuss: Broad range of supports available through Birth to Three Tips on streamlining your Birth to Three referral Update on eligibility criteria for Early Intervention (EI) Update on Birth to Three’s approach to evidence based practices How Pediatricians and Birth to Three can work together to support families

Learning Objectives Participant will understand the range of supports available through the Birth to Three System. Participant will understand eligibility and process necessary for making referrals to Birth to Three. Participant will gain knowledge of Birth to Three’s approach to evidence based practices. Participant will understand the importance of collaboration between Pediatrician and Birth to Three in order to best support families.

Birth to Three System Overview Federal Dept. of Education, Office of Special Education Programs (OSEP) CT Lead Agency: Office of Early Childhood (OEC) Annual Budget: $55,602,882 million (FY17) Personnel: 10 central office staff 42 programs statewide approx. 1,200 direct care providers Children and Families Referred: 9,462 in FY17 Served: 8,798 in FY17; may have been referred in a previous fiscal year Service Locations: Child’s Home or Child Care 99%

All Birth to Three Programs are Comprehensive This means that every program has the staff and expertise to deliver all services as required under Part C of IDEA to enrolled children Three types: 23 General Programs - work with any eligible child and family 3 Programs for children who are Deaf or Hard of Hearing 6 Programs for children with Autism Spectrum Disorders

Types of Early Intervention Services *Every family is given service coordination. Additional services may include: assistive technology devices and services audiology services family training and “counseling” nutrition services occupational therapy (OT) physical therapy (PT) sign language and cued language social work services specialized instruction speech and language services transportation or mileage reimbursement when necessary to receive other IFSP services vision and mobility services

Broad Range of Supports available through Birth to Three Early Interventionists connect families with community resources and supports For Example: Parenting support Supporting family with basic needs Assist family with seeking childcare options Assist family to connect with playgroup in community

Broad Range of Supports available through Birth to Three Attend religious services at synagogues and churches with families. Outcome: Joey will play with his friends at church playgroup, taking turns with toys and using words instead of hitting

Broad Range of Supports available through Birth to Three Supports provided to address the needs and priorities of the child’s family Working on a child outcome that can be addressed through increasing the child's participation during grocery shopping. For example: increasing the child's ability to follow direction, make choices, increase verbalizations during grocery shopping

Streamline your referral directly to www.birth23.org Pediatricians are primary referral source for families that are unaware of Birth to Three supports

Tip: Medical office staff can complete online referral form anytime through the Birth to Three website in less than two minutes.

Eligibility Criteria Children under age three are eligible for Birth to Three System supports because they either: Show a significant developmental delay of -2 standard deviations in one developmental domain OR -1.5 standard deviations in two or more developmental domains, Have a diagnosed medical condition that has a high probability of resulting in developmental delay. Two multidisciplinary professionals evaluate the child in their home and use one or more standardized tests to evaluate the child's strength and needs in all areas of development, regardless of the reason for referral.

Smooth Pediatrician Referral = Smoother Family Experience On Birth to Three referral form, please have office staff: Provide best phone number to reach parent. Provide parent name in case we need to leave phone message or send a letter. Parent’s preferred language so that we can contact families in that language. Include documentation of completed M-CHAT-R, including scores if concerns are for autism spectrum disorder (ASD). **Please be sure to discuss results of M-CHAT-R and ASD concerns with family.

Little Known Fact: When a family contacts Birth to Three for a referral they reach Child Development Infoline (CDI) – a single point of entry via toll free number. They are then triaged across all of their programs, services and supports including Help Me Grow, Early Childhood Special Education, Birth to Three and Children & Youth with Special Healthcare Needs. Tip: Referring Pediatrician receives confirmation of scheduled evaluation date.

When families are referred to 2-1-1 or Child Development Infoline they can access Birth to Three among other resources… Help Me Grow: For families with questions about their child’s development or behavior. Offers free developmental screening program to monitor a child’s development from birth to age 5, via online or mailed questionnaire (ASQ). In-Home Family Support Services: For pregnant women and families of young children who could benefit from in-home support services that promote positive parenting and healthy development Connecticut Birth to Three System: For families of infants and toddlers with significant developmental delays or disabilities Early Childhood Special Education: For children who need special education services Children and Youth with Special Health Care Needs: For children and youth with chronic physical, developmental, behavioral, or emotional conditions who require more health and related services than other children the same age

Update on Eligibility for Early Intervention The evaluation is FREE and if a family is eligible they can choose some services at no cost. Little Known Fact: If you have referred a child that is ineligible they may be re-referred in three months for another evaluation if developmental concerns still exist.

If found eligible, all families can choose some services at no cost No Cost services include: Referral to the Birth to Three System Evaluation and assessment of the child to determine eligibility and needs Development and review of the child’s plan (IFSP) One face to face visit every three months Service coordination (which includes assisting the family with locating services from community providers)

Little Known Fact: Children who are ineligible for Birth to Three supports are offered developmental monitoring If the child is found ineligible for Birth to Three, the family is offered the option of enrolling their child in the Ages & Stages (ASQ) developmental monitoring program. ASQ will help monitor a child's development over time and can trigger a re-referral if concerns are identified.

Family Fee Any family whose adjusted annual income is above $45,000 a year pays a monthly fee. Range of family fee monthly amount:$8 -$272* based on sliding scale and family size Any child that is Medicaid eligible does not pay a family fee * If family does not consent to bill their insurance they incur an additional fee

Life after Birth to Three Birth to Three supports must end by the child’s 3rd birthday. Transition activities and supports are offered as a part of service coordination, which is provided to every enrolled family whether or not the child received direct services from the Birth to Three System. Families of all children leaving Birth to Three will take part in a transition conference to discuss possible future supports and services.

Unchanged: old and new practices Best Practices have not changed: - Building parents competence in addressing their child's priorities through coaching Learning happens during natural activities One team member is primary liaison and support to family. What has changed: Building capacity of Birth to Three providers to implement these best practices with fidelity. - How to engage families using strategies with their child during and between visits. - Expanded focus on activities of the family-where skill development and behavior change can be addressed with child. - Primary provider and family are supported by secondary providers, as needed, during visits and teaming.

Strategies for Collaboration We need each other to best support the family. Birth to Three programs share the child's evaluation and assessment reports, and initial and annual Individualized Family Service Plans (IFSP) with referring Pediatricians for review and consultation. Pediatrician is a member of the child’s IFSP team and input is valued as the team makes decisions.

Strategies for Collaboration Birth to Three can attend Pediatrician and Specialty visits with families.

Strategies for Collaboration Opportunities for increased communication Pediatrician hears families concerns regarding progress with Birth to Three at well child visit these can be shared back due to open communication. Specific point person in Birth to Three connects with point person at pediatric office who handles Birth to Three contact and concerns. Example: Birth to Three coordinator reaching office staff and leaving message with secretary when child is having dehydration issues on G- tube. Medical Home provider practices have ideal set-up. They each offer a dedicated contact for Birth to Three providers.

At the 12 month well child care visit family is concerned about their child's delay in speech. Pediatrician refers family to Birth to Three who finds child ineligible for supports. At the 18 month well child care visit family is again concerned about their child's delay in speech. Should the Pediatrician refer family to Birth to Three again?

Closing Thoughts “When parents, community programs and professionals who provide early childhood services – including the pediatrician in the medical home – promote supportive relationships and rich learning experiences for infants and young children, a stronger foundation is created for higher achievement in school and, eventually, the community.” - Adams, et al., Pediatrics, 2013;132;31073

Dr. Milanese or Dr. Dumont-Mathieu: Questions? Dr. Milanese or Dr. Dumont-Mathieu: 860-837-5758 Amilane@connecticutchildrens.org TDumont@connecticutchildrens.org Birth to Three: 1-800-505-7000 www.birth23.org