1. Pediatricians, Medical Students and the Early Intervention System in Hawaii Marge Wada CCC-SLP State of Hawaii Early Intervention Programs Jeffrey Okamoto M.D. John A. Burns School of Medicine University of Hawaii At Manoa

2. Required Statement We [and/or an immediate family member including our spouses/partners] DO NOT have a financial interest, arrangement or affiliation with a commercial organization (currently or within the past 12 months) that may have a direct or indirect interest in the subject matter of my presentation. Our presentation or participation will not involve comments or discussion concerning unapproved or off-label uses of a medical device or pharmaceuticals.

3. Objectives Explore collaborations between Pediatricians and Early Intervention Programs Discuss a training program for medical students to be oriented to early intervention activities and physician roles

4. IDEA Individuals with Disabilities Education Act (Federal Law)  Guarantees children with learning, physical, and behavioral disabilities a free and appropriate education  Special education and zero-to-three programs are included under this law

5. IFSP Federal legislation requires each child identified as having a disability to have a written plan of service  Individual Family Service Plan (IFSP) for children from birth to age three years

6. Eligibility for EI Physicians should be aware that each State determines their own eligibility criteria Hawaii has a biological at-risk category and an environmental at-risk category

7. Referral Who should be referred? How should physicians do this with their families when they refer children? Once referral is made, then what happens?

8. Materials Providing Guidance  School Health: Policy and Practice –(Committee on School Health, American Academy of Pediatrics)  Pediatrician’s Role in the Development and Implementation of an IEP and/or an IFSP –(Committee on Children with Disabilities, American Academy of Pediatrics)  The Pediatrician’s Role in School and Child Care Settings –(Ambulatory Pediatrics Association)

9. Current JABSOM Medical Student Training Third Year Medical Students  1/2 day experience for each medical student in an early intervention(EI) program, each student concentrating on a different discipline at the program but all around the same child at the program  End of block colloquium with early intervention staff, family and child observed, and medical students all sharing perspectives of the various disciplines at the EI program

10. Benefits to Early Intervention Training Physicians are trained to be more responsive to early intervention program needs Programs received inservices and information about health related topics

11. The Medical Students Study These Roles: Family Physician Physician subspecialist Program Consultant Primary Service Provider Care Coordinator

12. Scenario #1 Infant just delivered, diagnosed with Down Syndrome. He has several medical problems, including an endocardial cushion defect, and feeding issues. How is the infant referred to an early intervention program? How does the primary care physician and the subspecialists work with the early intervention program?

13. Scenario #2 A 2 1/2 year old has significant language delay. The child is not talking but rather grunting and pointing. Receptive language and motor skills appear to be normal. How would you talk to the family about referral to early intervention services? What services would you expect to be provided?

14. You’ve been invited to an IFSP meeting.  Will you attend?  What do you see as your role whether or not you attend?  How do you propose how the communication lines be kept open to work optimally?

15. How has early intervention been working in your situation? If there has been barriers, how do you propose problem solving them?

16. Challenges to Training Going from the OT/PT/SLP/Audiology clinical model to a community based transdisciplinary model How sophisticated should the discussion be for medical students?

17. Important Discussion Points Transdisciplinary versus Traditional Provision of Services (Multidisciplinary) Natural Environments versus Center-based programs Coaching versus direct treatment Provision of care to children with profound retardation that show minimal response Specific skill development versus routine based intervention