1. Eligibility Determination IFSP Meetings IFSP Service Implementation
Embedding Prior Written Notice and Consent for Evaluation/assessment in the IFSP Process
Eligibility Determination IFSP Meetings IFSP Service Implementation
This training is intended to address question related to obtaining parental consent for an evaluation/assess to determine a child’s initial and continuing eligibility and how prior written notice is utilized throughout the IFSP process.
MA Department of Public Health Division for Early Intervention January, 2018

2. MA Department of Public Health Division for Early Intervention
Learning Objectives
Through this training, participants will be able to:
Understand the importance of Prior Written Notice (PWN)
Understand how and when parents need to be provided PWN
Understand when to provide PWN and obtain consent throughout the IFSP process
(Read slide)
MA Department of Public Health Division for Early Intervention
January, 2018

3. The “why” of prior written notice
Providing information to parents in written prior to the implementation of the activity provides an additional means to ensure that parents understand what is being proposed, have the ability to ask questions,
and allows them to
make fully informed
decisions.
So why do EI providers need to provide “prior written notice”? And why so often?
The easy response would be that providing prior written notice is one of the procedural safeguards afforded to parents under the Individuals with Disabilities Education Act – so it is required. Procedural safeguards are a set of requirements under the IDEA designed to protect the rights of infants and toddlers with disabilities eligible, or potentially eligible for EI services and including, but not limited to prior written notice, the right to accept some EI services and not others, the right to access their child’s record and options to resolve disagreements and complaints about IFSP services.
Providing information to parents in writing prior to the implementation of the activity is an additional way to ensure that parents understand what is being proposed, have the ability to ask questions, and allow parents to make fully informed decisions.
The intent of prior written notice is to clearly provide information in writing so parent have the opportunity to process and understand what a program is proposing and to determine if they will allow the activity or action to be implemented or if they will take action to prevent it. Providing prior written notice is an opportunity to pause as if you were coming up to a yellow light at an intersection, to give importance to the event that will happen next.
MA Department of Public Health Division for Early Intervention January, 2018

4. Federally Speaking: Prior Written Notice —
Prior written notice must be provided to parents a reasonable time before the Lead Agency or Early Intervention Service provider proposes, or refuses, to initiate or change the identification, evaluation or placement of child or the provision of EI services
Content of notice must inform parents of the action being proposed or refused, the reasons for the action, and all procedural safeguards available
Prior notice must be written in language understandable to general public and be provided in native language of parent or other mode of communication used by parent unless clearly not feasible to do so. 34 CFR §
The IDEA tells us: (READ SLIDE)
Prior written notice must be provided to parents a reasonable time before the Lead Agency or Early Intervention Service provider proposes, or refuses, to initiate or change the identification, evaluation or placement of child or the provision of EI services
Content of notice must inform parents of the action being proposed or refused, the reasons for the action, and all procedural safeguards available
Prior notice must be written in language understandable to general public and be provided in native language of parent or other mode of communication used by parent unless clearly not feasible to do so.
MA Department of Public Health Division for Early Intervention January, 2018

5. The “What” of Prior Written Notice form
Changes to the form:
Adds proposal to complete an evaluation/assessment to determine eligibility
Adds entry to identify when a child is/is not eligible
Consolidates different types of IFSP meetings
Eliminates entry for an assessment
Eliminates 3 day timeline
Changes to Practice:
Separates the activities of providing PWN and obtaining consent.
Programs will use this PWN form when the multidisciplinary team makes a determination of a child’s eligibility
Programs will use this form when a parent proposes a change in service
Copy to be filed in child’s record
PWN gives notice to the events of an evaluation to determine eligibility, what the outcome of the evaluation is (eligible or ineligible), an IFSP meeting, a change in IFSP services (approved or declined) and a TPC meeting. In addition, when using for any ongoing IFSP meeting, the form can be used to provide a summary of the IFSP Team’s discussion and information used to make decisions.
What are the changes to the PWN form and the changes in practice.
The form:
Adds proposal to complete an evaluation/assessment to determine eligibility . Prior written notice must be provided to parents a reasonable time before the program completes an evaluation to determine eligibility.
Adds entry to identify when a child is/is not eligible. It is a requirement of IDEA that parents are informed of the multidisciplinary team’s determination of whether or not a child is eligible (IDEA refers to it as “identification”)
Consolidates different types of IFSP meetings – there are no longer the different entries of initial, annual or 6-month – an IFSP meeting, is an IFSP meeting.
Eliminates entry for an assessment – Prior written notice needs to be provided if you are evaluating a child to determine eligibility, but not to assess ongoing strengths and needs.
Eliminates 3 day timeline. The IDEA Part C regulations and the federal Office of Special Education Programs (known as “OSEP”) do not provide guidance on what would be considered “reasonable” notice. What might be considered “reasonable notice” for one activity might not be considered “reasonable notice” for another. An example would be providing 1 or 2 day notice to complete an evaluation to determine eligibility with a parent who has had his/her second child referred for EI services and is completely familiar with the process. That parent would very likely consider 1 or two days “reasonable notice”. Conversely, providing 1-2 days notice before making a dramatic change to a child’s IFSP services may not seem like reasonable notice.
In addition to the changes in the form, they will likely be changes to the way you provide prior written notice:
We received feedback from OSEP that we should separate out the activities of providing prior written notice and obtaining consent. OSEP views providing PWN and obtaining consent as two separate activities and advise DPH to have forms which reflected this.
Programs must provide a copy of this form to parents when their child has been determined eligible - this is a change in practice. Before, our system would move right into IFSP meeting.
While programs are not required to provide prior written notice for assessment, they could certainly do so by checking the “Other box” and writing this in.
Programs must provide a copy of this form to parents when they propose a change in service regardless if the program agrees to the change or not.
A copy of the form must now be filed in the child’s record. Previously, the service coordinator was responsible for documenting in the child’s record PWN had been provided.
MA Department of Public Health Division for Early Intervention January, 2018

6. Consent for Evaluation/Assessment
Changes to the form:
Eliminates the 3-day period
Eliminates the box with date and staff
Includes a check off for family-directed assessment
Use this form: To obtain consent for:
an evaluation/assessment to determine eligibility
a family-directed assessment
a child assessment completed by a staff/discipline not currently listed as a service provider on the child’s IFSP .
The next form to review is the Consent for Evaluation/assessment form.
The changes to the form include:
The elimination of the 3-day “reasonable notice period” because providing reasonable notice is associated with providing PWN notice of an activity being proposed or declined by the program and not obtaining consent – this is part of breaking out the two activities of providing prior written notice and obtaining consent.
Eliminates the box with date and staff – Consent is provided for the activity of an evaluation/assessment, family-directed assessment or child assessment. The parent’s consent is not limited to a particular date or particular disciplines – consent is provided for the activity – an evaluation/assessment to determine eligibility. Completing an evaluation/assessment to determine eligibility may take more than one visit.
Includes a check off for family-directed assessment. “The family–directed assessment” is not a new requirement and is used to identify the families’ resources, priorities and concerns as well as the supports and services necessary to enhance the family’s capacity to meet the developmental needs of their infant or toddler and identify eligibility criteria. It is available to all family members, but is also voluntary on the part of family members. Programs have flexibility in administering an assessment tool or interview in meeting the requirement of a family-directed assessment as long as the information gathered identifies the family’s resources, priorities and concerns in the development of the IFSP. Taking into consideration the variation in EIPs intake procedures and information gathering tools the Department has not made a recommendation for a specific tool.
While “assessment” is defined as the ongoing determination of strength and needs, we have been advised by OSEP that if the discipline to provide the assessment is not currently listed as an ongoing provider of service on the IFSP, then consent should be obtained. If the staff person completing the assessment is currently listed on the IFSP, then consent does not need to be obtained. So as an example, if a child has ongoing services by a speech/language pathologist, but would like to have a PT come out to assess motor development and provide consultation, consent for that service should be obtained.
MA Department of Public Health Division for Early Intervention January 2018

7. First Contact with Parents
What Typically Occurs
Why and What’s important
Program provides overview of EI including mission, approach to service delivery, eligibility, family rights, etc.
Parent indicates a desire to move forward with an eligibility/assessment evaluation.
You are informing parents of the voluntary nature of EI
Including the option to provide or decline consent for evaluations, access insurance, obtain information to potentially support eligibility or identify resources, collaborate with community providers.
Forms Used
Family Rights Notice
Prior Written Notice form
Consent for Evaluation/
assessment form
The next several slides reflects a process of referral-through-IFSP implementation. These slides and steps may not mirror your program’s practice, but they are the key points where some of the procedural safeguards forms fall in the process. The following slides do not include consents related other requirements where consent is required (such as to access a parent’s insurance or to obtain/disclose information from outside resources).
What Typically Occurs: Program provides an overview of EI including mission, approach to service delivery, eligibility, family rights, etc. And if the parent indicates a desire to move forward with an eligibility evaluation/assessment, the program would provide a copy of the Prior Written Notice form of the program’s intention to complete the evaluation/assessment to determine eligibility and obtain consent.
Depending on program practice, the first contact with parents where an overview of EI is provided may be either face-to-face or over the phone. If it’s done over the phone, the Family Rights form, prior written notice form and consent for the evaluation/assessment can be sent to the parents and then reviewed on the first face-to-face meeting.
The forms that reviewed with parents at the beginning of the process are the Family Rights Notice, the prior written notice form and consent for evaluation/assessment.
The important points to highlight for parents is to explain that parents have rights throughout the process, that EI services are voluntary and that consent is needed for various reasons. Parent always have the right to determine if they will provide or decline consent. This right extends to consent for the program to access insurance or for the disclosure of information.
MA Department of Public Health Division for Early Intervention January, 2018

8. Eligibility Evaluation
Why and What’s Important
Eligibility is determined through the gathering of information from the administration of the BDI-II, review of child and family eligibility criteria, and as needed, records/reports. Assessment (both functional and family) may occur concurrently
What Occurs
Forms Used
(If not already completed)
Consent for an Evaluation/
Assessment form
Consent is provided for the activity of an EI evaluation which determines eligibility for services and evaluates a child’s functioning in all domains, not a specific domain. Parents are informed that they may choose to provide or decline consent to obtain information which may support a determination of eligibility.
Likely at this point, you have already obtained consent for the evaluation/assessment, but if not, remind parents of the voluntary nature of EI.
The eligibility evaluation is intended to gather information related to our state’s eligibility criteria.
Eligibility is determined through the gathering of information, from the administration of the BDI-II, review of child and family eligibility criteria, and as needed, records/reports. Assessment (both functional and family) may occur concurrently.
The consent that a parent provides is for the activity of an EI evaluation which determines eligibility for services and evaluates a child’s functioning in all domains. EI does not evaluate in selected areas or domains (such as a child’s communication skills or a “PT eval”).
You may need to obtain information from outside sources in order to verify that criteria related to child or family eligibility factors exist (such as birth records, ability to communicate with DCF or the child’s medical providers). It’s important to identify to parents that they may choose to provide or decline to provide information related to the child and family eligibility factors or to consent to obtain information which may support a determination of eligibility. But parents should also be informed that the program may not be able to substantiate a child’s eligibility without the information that supports these eligibility criteria.
MA Department of Public Health Division for Early Intervention January, 2018

9. Eligibility Determination – When the Child is Eligible
Why and What’s Important
The multidisciplinary team after completing the BDI II, reviewing all available information, determines the child is eligible (note: determination of a child’s eligibility may require waiting to receive information from outside sources or over multiple visits)
Prior Written Notice form
Identifies child is eligible
May also propose moving onto IFSP meeting
Prior written notice informs the parent of the outcome/finding (“identification”) of the evaluation. Parent informed of their option to move forward with IFSP development
What Occurs
Forms Used
The multidisciplinary team after completing the BDI II, reviewing all available information, determines the child is eligible (note: determination of a child’s eligibility may require waiting to receive information from outside sources or over multiple visits)
Written notice must be provided to parents to inform them of the multidisciplinary team’s decision about whether or not a child is eligible. This is one of those instances where there is no “prior” in the prior written notice, but that this form is provided “after” the activity (specifically, the evaluation/assessment) and once the team reaches a conclusion about the child’s eligibility. It is required to be provided and relates back to the regulatory language that the program must provide notice related to the child being “identified” (or “not identified”) as an infant or toddler with a disability.
The Prior Written Notice form will replace the Written Notice of Eligibility form(s).
If the child is eligible, the program may also propose (check off) on the Prior Written Notice form moving forward with an IFSP Meeting. As stated in the September 26, 2017 IFSP Implementation Policy memo, “The IFSP Meeting invitation is no longer required. However, programs are still required to notify all IFSP team members including SSP (vision, hearing and autism) early enough to allow for their participation. Programs may determine how they notify and document how other teams members were notified.
MA Department of Public Health Division for Early Intervention January, 2018

10. Eligibility Determination – When the Child is Not Eligible
Forms Used
Why and What’s Important
The multidisciplinary team after completing the BDI II, reviewing all available information, determines the child is not eligible
Prior Written Notice form (identifies the child is not eligible)
Family Rights Notice
Health and Eligibility Summary and Developmental Summary sent to parent within 45 days of referral
PWN informs the parents of the outcome/finding of the evaluation (“identification”)
Parent informed of their right to dispute the outcome/ finding the child is ineligible
Parent provided with the same information as a parent with an eligible child.
What Occurs
The multidisciplinary team after completing the BDI II and reviewing all available information, determines the child is not eligible:
When the outcome of the evaluation is that the child is not eligible for service:
The parent is informed of the multidisciplinary team’s finding using the Prior Written Notice form.
The parent’s is informed of their right to dispute this finding by reviewing the sections of the Family Right’s notice that outline dispute resolution options,
And that the parent is informed that a copy of the narrative of the Health and Eligibility Summary and the Developmental Summary will be provided within 45 days of the referral.
DPH believes strongly that a parent of a child who is not eligible for service is entitled to the same information as an eligible child and that it is provided within the same 45 day timeline.
The program has the option to either review this written narrative in person or send the report by mail. If provided by mail, the program is encouraged to consider making another copy of the PWN form that was provided and include another Family Rights notice. The program should document in the file when the information was sent to the family.
The Prior Written Notice form replaces the Written Notice of Eligibility forms. The Health and Eligibility Summary and Developmental Summary provide the reasons for the multidisciplinary team’s finding.
MA Department of Public Health Division for Early Intervention January, 2018

11. Why and What’s Important but can also occur whenever deemed necessary
Initial IFSP Meeting
A multidisciplinary team* completes an initial IFSP
What Occurs
Why and What’s Important
* Prior Written Notice form (provided before the IFSP meeting)
*Family Rights Notice
*Program completes the Health and Eligibility Summary and Developmental Summary pages of the IFSP. The completed pages are available at the time the IFSP meeting is convened
This is a time to bring together all the information collected so far, conveying to parents and family members that they are equal members of the team and the importance of the IFSP process.
Forms Used
The initial IFSP meeting is a time to bring together all the information collected from the evaluation and functional assessment and write the IFSP.
Parents should have already received a copy of the Prior Written Notice form (provided before the IFSP meeting) and Family Rights Notice.
This is the EI team’s opportunity to again review with parents and other family members the collaborative approach of EI providers and family members working as a team to provide developmentally appropriate activities within daily routines to meet child and family identified outcomes.
The EI team will have the Health and Eligibility Summary and Developmental Summary pages of the IFSP completed in advance of the IFSP meeting to review and discuss with parents.
*A multidisciplinary team is required at Initial & Annual IFSP and anytime a full review of the plan takes place
but can also occur whenever deemed necessary
MA Department of Public Health Division for Early Intervention January, 2018

12. IFSP meetings – Result in no changes in a child’s IFSP service
Why and What’s Important
A multidisciplinary team (service coordinator and one other member of the team) meets to review and update the IFSP
6 month and periodic IFSP reviews are an opportunity to review the IFSP, progress, evolving priorities , and making adjustments as needed.
PWN form(provided before the meeting)
Family Rights Notice
Review any updated information and incorporate in the relevant sections of IFSP
What Occurs
Forms Used
6-month and periodic IFSP reviews are an opportunity to review the IFSP, progress, evolving priorities and make adjustments as needed.
The process for 6 month and periodic IFSP review pretty much remains unchanged. What has changed, is where the information is documented.
We are still using the Prior Written Notice form to inform the parent of the intent to convene an IFSP meeting, but will be using relevant pages of the IFSP to provide any updated information. This may include adding information related to any subsequent assessments completed, reviewing or commenting on progress toward attaining outcomes or reviewing daily routines.
Programs may choose how to notify other members of the child’s team, including Specialty Service Providers and others the family wishes to have participate. As a reminder, notification must be provided early enough to allow participation.
*A multidisciplinary team is required at Initial & Annual IFSP and anytime a full review of the plan takes place
but can also occur whenever deemed necessary
MA Department of Public Health Division for Early Intervention January, 2018

13. IFSP meetings – Program Initiated IFSP Change in Service
Why and What’s Important
Service Coordinator* meets to review and update the IFSP as a result of a program initiated change in IFSP service
PWN (provided before the meeting)
Family Rights Notice
PWN is provided to document the discussion of the team’s decision.
IFSP “Change in Service Delivery” page
Parents are informed of their right to decline/refuse consent for the program proposed change in IFSP service.
Parents are informed of their options for dispute resolution.
What Occurs
Forms Used
For a program initiated change in service, the program would provide the parent with prior written notice to convene an IFSP meeting. At the conclusion of the IFSP meeting, a second Prior Written Notice form is provided to document the discussion of the team’s decision.
The program would also complete a Change in IFSP Service Delivery page. The PWN form and the Change in IFSP Service Delivery page replace the former IFSP Review page. And again, this is an example of how OSEP would like to see the activities of prior written notice and consent as separate activities.
We encourage programs to be thoughtful and transparent when completing the sections of the Prior Written Notice form that relate to the explanation for why the change is being proposed and basis for the program’s decision.
If as part of an ongoing IFSP review, the team proposes or determines the need for an assessment by a discipline who is not a current ongoing IFSP service provider, the program would need to complete a Prior Written Notice form and may write in “Assessment” in the Other box. Because there will be an additional service provided that is not currently on the child’s IFSP, the program would need to obtain consent on a “Consent in Service Delivery” page. The same process would apply if a co-treatment were to be proposed by either the program or the parent.
Programs should continue to be thoughtful about a service that is being proposed and how that service is addressing outcomes.
Again, just like in the previous slide, any changes must be reflected on the appropriate IFSP pages. Changes in services must have consent provided on the Change in IFSP Service Delivery page.
The Family Rights Notice is provided and parents are informed of their right to provide or decline their consent of an IFSP Change in Service Delivery plan page.
*A multidisciplinary team is required at Initial & Annual IFSP and anytime a full review of the plan takes place
but can also occur whenever deemed necessary
MA Department of Public Health Division for Early Intervention January, 2018

14. IFSP meetings – Parent Initiated IFSP Change in Service
Why and What’s Important
Service coordinator meets to review and update the IFSP as a result of a parent initiated change in IFSP service
What Occurs
PWN (provided before the meeting)
Family Rights Notice
PWN is provided to document the discussion of the team’s decision
IFSP “Change in Service Delivery” page
Forms Used
Parents are informed of their right to decline/refuse consent for the program proposed change in IFSP service.
Parents are informed of their options for dispute resolution.
When a parent initiates a change in IFSP services, the program needs to respond to it by providing PWN of the what the program will actually act upon. This is a change in practice and comes after discussions with OSEP.
Our system is good about discussing parent concerns related to service. But I would like programs to reflect or do further exploration with staff about how staff view a proposal from parents that may came out in a way such as “I want” or “I think he needs” and how staff document this.
These discussions now need to be documented on a PWN form. If a parent makes or proposes a specific request about a particular service or an intensity about service, the program should document what the parent’s recommendation was and the outcome of the discussion (related to what the program actually agreed to provide) and document the reasoning for what was ultimately decided based on the clinical expertise of staff.
If the program does not agree with the parent’s initial specific proposal, the program needs to document this as declining a parent initiated a proposal, check the box of what the program has proposed, and document what is ultimately decided on an IFSP “Change in Services Delivery” page.
Under the “Summary of IFSP Team’s Discussion” on the prior written notice form, this is where the program to thoughtfully think about and document how IFSP services are provided. Why is the activity being proposed or declined? And what information has the program used to come to their decision about what the program agrees to provide?
The new Prior Written Notice form in conjunction with the IFSP “Change in Service Delivery” page replaces the IFSP review page. The Prior Written Notice form documents the proposed change, the discussion that occurred related to the change and decisions that were made. It’s intended to inform the parent in advance of presenting the IFSP “Change in Service Delivery” plan page which is where consent is reflected. Parents then have the option to agree or disagree in whole or in part and if they don’t agree, access their options for dispute resolution.
PWN is a form used to impart information, not to obtain consent which was one of the reasons why the IFSP review page was eliminated; because it was being used both as a written notice and potentially to document a parent’s consent to a change in service.
*A multidisciplinary team is required at Initial & Annual IFSP and anytime a full review of the plan takes place
but can also occur whenever deemed necessary
MA Department of Public Health Division for Early Intervention January, 2018

15. Transition Planning Conference
Why and What’s Important
Parents, family members and others the parents may wish to have participate meet for a Transition Planning Conference
What Occurs
PWN (provided before the meeting)
Relevant Transition information is included on appropriate pages of IFSP
(If needed) IFSP “Change in Service Delivery” page and PWN if services are changed as part of the Transition Plan.
Forms Used
PWN identifies a Transition Planning Conference as a distinct activity.
For a Transition Planning conference, parents, family members and others the parents may wish to have participate meet for a Transition Planning Conference. If the child is potentially eligible for Part B special education or related services, a representative from the school district in which the child resides is also notified of the Transition Planning Conference.
Prior Written Notice form (is provided before the meeting)
Relevant Transition information is included on appropriate pages of IFSP
(If needed) IFSP “Change in Service Delivery” page and Prior Written Notice if services are changed as part of the Transition Plan.
MA Department of Public Health Division for Early Intervention January, 2018

16. Prior Written Notice form
Use this form:
Prior to any evaluation/assessment to determine eligibility
At the conclusion of an eligibility evaluation/assessment once the multidisciplinary team determines if a child is eligible or ineligible.
For all IFSP Meetings.
To document all proposed or declined changes in service – including parent initiated changes in service.
Transition Planning Conference
This is a mark-up “Tip Sheet” of the Prior Written Notice form that identifies not only when the form needs to be issued, but also includes hints and tips for completing the form.
It’s available as an additional resource in the “grab and go” resource section for download.
See the attachment in the “Grab-n-Go” section titled
PWN.2017.TipSheet.docx
MA Department of Public Health Division for Early Intervention October, 2017

19. Resources Resources available to support staff may be found at:
Click the “IFSP 2017 Documents” folder and then the “Procedural Safeguards” folder
PowerPoint Handout
PWN grid
FAQ
PWN Tip Sheet
MA Department of Public Health Division for Early Intervention October 2017