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Esta información en español | This information in Spanish
Current as of July 2021

If you're concerned about the development of an infant or toddler, or you suspect that a little one has a disability, this page will summarize one terrific source of help-the early intervention system in your state. Early intervention services can help infants and toddlers with disabilities or delays to learn many key skills and catch up in their development. There's a lot to know about early intervention. We present the "basics" here to get you started.

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What is early intervention?

Early intervention is a system of services that helps babies and toddlers with developmental delays or disabilities. Early intervention focuses on helping eligible babies and toddlers learn the basic and brand-new skills that typically develop during the first three years of life, such as:

physical (reaching, rolling, crawling, and walking);

cognitive (thinking, learning, solving problems);

communication (talking, listening, understanding);

social/emotional (playing, feeling secure and happy); and

self-help (eating, dressing).

Examples of early intervention services | If an infant or toddler has a disability or a developmental delay in one or more of these developmental areas, that child will likely be eligible for early intervention services. Those services will be tailored to meet the child's individual needs and may include:

Assistive technology (devices a child might need)

Audiology or hearing services

Speech and language services

Counseling and training for a family

Medical services

Nursing services

Nutrition services

Occupational therapy

Physical therapy

Psychological services

Services may also be provided to address the needs and priorities of the child's family. Family-directed services are meant to help family members understand the special needs of their child and how to enhance his or her development.

Authorized by law | Early intervention is available in every state and territory of the United States. The Individuals with Disabilities Education Act (IDEA) requires it-Part C of IDEA, to be precise. That's why you'll sometimes hear early intervention referred to as Part C.

Who's eligible for early intervention?

Early intervention is intended for infants and toddlers who have a developmental delay or disability. Eligibility is determined by evaluating the child (with parents' consent) to see if the little one does, in fact, have a delay in development or a disability. Eligible children can receive early intervention services from birth through the third birthday (and sometimes beyond).

For some children, from birth | Sometimes it is known from the moment a child is born that early intervention services will be essential in helping the child grow and develop. Often this is so for children who are diagnosed at birth with a specific condition or who experience significant prematurity, very low birth weight, illness, or surgery soon after being born. Even before heading home from the hospital, this child's parents may be given a to their local early intervention office.

For others, because of delays in development | Some children have a relatively routine entry into the world, but may develop more slowly than others, experience set backs, or develop in ways that seem very different from other children. For these children, a visit with a developmental pediatrician and a thorough evaluation may lead to an early intervention referral.

Parents don't have to wait for a referral to early intervention, however. If you're concerned about your child's development, you may contact your local program directly and ask to have your child evaluated. That evaluation is provided free of charge. If you're not sure how to locate the early intervention program in your community-keep reading. We give that information a bit further down the page.

However a child comes to be referred, evaluated, and determined eligible, early intervention services provide vital support so that children with developmental needs can thrive and grow.

What's a developmental delay?

The term "developmental delay" is an important one in early intervention. Broadly speaking, it means that a child is delayed in some area of development. There are five areas in which development may be affected:

Cognitive development

Physical development, including vision and hearing

Communication development

Social or emotional development

Adaptive development

Developmental milestones | Think of all the baby skills that can fall under any one of those developmental areas! Babies and toddlers have a lot of new skills to learn, so it's always of concern when a child's development seems slow or more difficult than would normally be expected. Our developmental milestones page outlines some of the typical skills that babies and toddlers learn by certain ages. It's a good resource to consult if you're concerned that a child may have a developmental delay.

Definition of "developmental delay" | Part C of IDEA defines the term "developmental delay." But the meaning of the term varies from state to state, because each state defines the term for itself, including:

describing the evaluation and assessment procedures that will be used to measure a child's development in each of the five developmental areas; and

specifying the level of delay in functioning (or other comparable criteria) that constitutes a developmental delay in each of the five developmental areas.

What's your state's definition? | To find out how your state defines the term "developmental delay," you can ask your child's pediatrician or the local health department. Most likely, the definition is also online, so you can also "search" for it, making sure to include the name of your state in the search.

Read more about developmental delay | We also offer a fact sheet on developmental delay that you may find helpful in understanding the developing child, what to do if you're concerned about your own child's development, and where to turn for more information.

If you're concerned about a baby or toddler's development

It's not uncommon for parents and family members to become concerned when their beautiful baby or growing toddler doesn't seem to be developing according to the normal schedule of "baby" milestones.

"He hasn't rolled over yet."

"The little girl next door is already sitting up on her own!"

"She should be saying a few words by now."

Sound familiar? While it's true that children develop differently, at their own pace, and that the range of what's "normal" development is quite broad, it's hard not to worry and wonder.

What to do | If you think that your child is not developing at the same pace or in the same way as most children his or her age, it is often a good idea to talk first to your child's pediatrician. Explain your concerns. Tell the doctor what you have observed with your child. Your child may have a disability or a developmental delay, or he or she may be at risk of having a disability or delay.

You can also get in touch with your community's early intervention program, and ask to have your little one evaluated to see if he or she has a developmental delay or disability. This evaluation is free of charge, won't hurt your child, and looks at his or her basic skills. Based on that evaluation, your child may be eligible for early intervention services, which will be designed to address your child's special needs or delays.

How to get in touch with your community's early intervention program | There are several ways to connect with the EI program in your community. Try any of these suggestions:

Contact the Pediatrics branch in a local hospital and ask where you should call to find out about early intervention services in your area.

Ask your pediatrician for a referral to the local early intervention system.

Visit the ECTA Center's early intervention "contacts" page, at:
http://ectacenter.org/contact/ptccoord.asp

What to say to the early intervention contact person | Explain that you are concerned about your child's development. Say that you think your child may need early intervention services. Explain that you would like to have your child evaluated under Part C of IDEA.

Referral | Write down any information the contact person gives you. You will probably be referred to either your community's early intervention program or to what is known as Child Find. Child Find operates in every state to identify babies and toddlers who need early intervention services because of developmental delays or disability. You can use the Parent's Record-Keeping Worksheet to keep track of this important information. In fact, in general, it's a good idea to write down the names and phone numbers of everyone you talk to as you move through the early intervention process.

The evaluation and assessment process

Service coordinator | Once connected with either Child Find or your community's early intervention program, you'll be assigned a service coordinator who will explain the early intervention process and help you through the next steps in that process. The service coordinator will serve as your single point of contact with the early intervention system.

Screening and/or evaluation| One of the first things that will happen is that your child will be evaluated to see if, indeed, he or she has a developmental delay or disability. (In some states, there may be a preliminary step called to see if there's cause to suspect that a baby or toddler has a disability or developmental delay.) The family's service coordinator will explain what's involved in the screening and/or evaluation and ask for your permission to proceed. You must provide your written consent before screening and/or evaluation may take place.

The evaluation group will be made up of qualified people who have different areas of training and experience. Together, they know about children's speech and language skills, physical abilities, hearing and vision, and other important areas of development. They know how to work with children, even very young ones, to discover if a child has a problem or is developing within normal ranges. Group members may evaluate your child together or individually. As part of the evaluation, the team will observe your child, ask your child to do things, talk to you and your child, and use other methods to gather information. These procedures will help the team find out how your child functions in the five areas of development.

Exceptions for diagnosed physical or mental conditions | It's important to note that an evaluation of your child won't be necessary if he or she is automatically eligible due to a diagnosed physical or mental condition that has a high probability of resulting in a developmental delay. Such conditions include but aren't limited to chromosomal abnormalities; genetic or congenital disorders; sensory impairments; inborn errors of metabolism; disorders reflecting disturbance of the development of the nervous system; congenital infections; severe attachment disorders; and disorders secondary to exposure to toxic substances, including fetal alcohol syndrome. Many states have policies that further specify what conditions automatically qualify an infant or toddler for early intervention (e.g., Down syndrome, Fragile X syndrome).

Determining eligibility | The results of the evaluation will be used to determine your child's eligibility for early intervention services. You and a team of professionals will meet and review all of the data, results, and reports. The people on the team will talk with you about whether your child meets the criteria under IDEA and state policy for having a developmental delay, a diagnosed physical or mental condition, or being at risk for having a substantial delay. If so, your child is generally found to be eligible for services.

Initial assessment of the child | With parental consent, indepth assessment must now be conducted to determine your child's unique needs and the early intervention services appropriate to address those needs. Initial assessment will include reviewing the results of the evaluation, personal observation of your child, and identifying his or her needs in each developmental area.

Initial assessment of the family | With approval of the family members involved, assessments of family members are also conducted to identify the resources, concerns, and priorities of the family related to enhancing the development of your child. The family-directed assessment is voluntary on the part of each family member participating in the assessment and is based on information gathered through an assessment tool and also through an interview with those family members who elect to participate.

Who pays for all this? | Under IDEA, evaluations and assessments are provided at no cost to parents. They are funded by state and federal monies.

Writing the IFSP

Having collected a great deal of information about your child and family, it's now possible for the team (including you as parents) to sit down and write anindividualized plan of action for your child and family. This plan is called the Individualized Family Service Plan, or IFSP. It is a very important document, and you, as parents, are important members of the team that develops it. Each state has specific guidelines for the IFSP. Your service coordinator can explain what the IFSP guidelines are in your state.

Guiding principles | The IFSP is a written document that, among other things, outlines the early intervention services that your child and family will receive. One guiding principal of the IFSP is that the family is a child's greatest resource, that a young child's needs are closely tied to the needs of his or her family. The best way to support children and meet their needs is to support and build upon the individual strengths of their family. So, the IFSP is a whole family plan with the parents as major contributors in its development. Involvement of other team members will depend on what the child needs. These other team members could come from several agencies and may include medical people, therapists, child development specialists, social workers, and others.

What info is included in an IFSP? | Your child's IFSP must include the following:

Your child's present physical, cognitive, communication, social/emotional, and adaptive development levels and needs

Family information (with your agreement), including the resources, priorities, and concerns of you, as parents, and other family members closely involved with the child

The major results or outcomes expected to be achieved for your child and family

The specific services your child will be receiving

Where in the natural environment (e.g., home, community) the services will be provided (if the services will not be provided in the natural environment, the IFSP must include a statement justifying why not)

When and where your son or daughter will receive services

The number of days or sessions he or she will receive each service and how long each session will last

Who will pay for the services

The name of the service coordinator overseeing the implementation of the IFSP

The steps to be taken to support your child's transition out of early intervention and into another program when the time comes.

The IFSP may also identify services your family may be interested in, such as financial information or information about raising a child with a disability.

Informed parental consent | The IFSP must be fully explained to you, the parents, and your suggestions must be considered. You must give written consent for each service to be provided. If you do not give your consent in writing, your child will not receive that service.

Reviewing and updating the IFSP | The IFSP is reviewed every six months and is updated at least once a year. This takes into account that children can learn, grow, and change quickly in just a short period of time.

Timeframes for all this

When the early intervention system receives a referral about a child with a suspected disability or developmental delay, a time clock starts running. Within 45 days, the early intervention system must complete the critical steps discussed thus far:

screening (if used in the state),

initial evaluation of the child,

initial assessments of the child and family, and

writing the IFSP (if the child has been found eligible).

That's a tall order, but important, given how quickly children grow and change. When a baby or toddler has developmental issues, they need to be addressed as soon as possible. So-45 days, that's the timeframe from referral to completion of the IFSP for an eligible child.

Who pays for the services?

Whether or not you, as parents, will have to pay for any services for your child depends on the policies of your state. Check with your service coordinator. Your state's system of payments must be available in writing and given to you, so there are no surprises or unexpected bills later.

What's free to families | Under Part C of IDEA, the following services must be provided at no cost to families:

Child Find services;

evaluations and assessments;

the development and review of the IFSP; and

service coordination.

When services are not free | Depending on your state's policies, you may have to pay for certain other services. You may be charged a "sliding-scale" fee, meaning the fees are based on what you earn. Some services may be covered by your health insurance, by Medicaid, or by Indian Health Services. The Part C system may ask for your permission to access your public or private insurance in order to pay for the early intervention services your child receives. In most cases, the early intervention system may not use your health care insurance (private or public) without your express, written consent. If you do not give such consent, the system may not limit or deny you or your child services.

Every effort is made to provide services to all infants and toddlers who need help, regardless of family income. Services cannot be denied to a child just because his or her family is not able to pay for them.

**Highly Rated Resource! This resource was reviewed by 3-member panels of Parent Center staff working independently from one another to rate the quality, relevance, and usefulness of CPIR resources. This resource was found to be of "High Quality, High Relevance, High Usefulness" to Parent Centers.
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Esta información en español | This information in Spanish Current as of July 2021 If you're concerned about the development of an infant or toddler, or you suspect that a little one has a disability, this page will summarize one terrific source of help-the early intervention system in your state.

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Centers for Disease Control and Prevention

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Early Intervention...

Is the term used to describe the services and supports that are available to babies and young children with developmental delays and disabilities and their families.

May include speech therapy, physical therapy, and other types of services based on the needs of the child and family.

Can have a significant impact on a child's ability to learn new skills and overcome challenges and can increase success in school and life.

Programs are available in every state and territory (see each program's contact information below). These publicly funded programs provide services for free or at reduced cost for any child who is eligible.

How do I find out if my child is eligible for services?

Eligibility for early intervention services is based on an evaluation of your child's skills and abilities.

If you, your child's doctor, or other care provider is concerned about your child's development, ask to be connected with your state or territory's early intervention program to find out if your child can get services to help. If your doctor is not able to connect you, you can reach out yourself. A doctor's referral is not necessary.

If your child is under age 3: Call your state or territory's early intervention program (see contacts below) and say: "I have concerns about my child's development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services."

If your child is age 3 or older: Click here.

U.S. State, Commonwealth & Territory Early Intervention Contacts

Commonwealths & Territories

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is my child eligible for early intervention

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how to get early intervention for my child

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What is "Early Intervention" and is my child eligible?

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Early intervention helps children improve their abilities and learn new skills. If you are concerned about your child's development, ask to be connected with your state or territory's early intervention program

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Handout for Professionals SE 12-24_Zeroto3

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Developmental Screening Assessment and Evaluation_ Key Elements for Individualizing Curricula in Early Head Start Programs

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Handout for Professionals SE 24-36_Zeroto3

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Upon completion of this module, child care consultants will be able to:

Describe factors that affect infant/toddler development and identify resources for reference on developmental milestones.

Discuss how the integrated nature of infant/toddler development affects overall growth and development.

Describe their state's professional development system supports for infant/toddler caregivers and how they can be accessed.

Define the difference between observation, screening, and ongoing assessment and the key components of each process.

Discuss the importance of coordinating referrals with the family and other care providers, such as medical and dental homes, therapists, and additional child care providers.

Identify key aspects of the state Part C/Early Intervention system for infants and toddlers with disabilities.

Discuss the importance of involving families in the process of observation, screening, and assessment.

Infant/Toddler Development, Screening, and Assessment is one of three infant/toddler modules created to support consultants working in child care settings, especially those who have not had education or training specific to infants and toddlers in group care. These modules were designed to complement training offered to early childhood consultants through the National Training Institute at the Department of Maternal and Child Health, University of North Carolina at Chapel Hill.

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Infant and Toddler Development, Screening, and Assessment

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Upon completion of this module, child care consultants will be able to: Describe factors that affect infant/toddler development and identify resources for reference on developmental milestones. Discuss how the integrated nature of infant/toddler development affects overall growth and development. Describe their state's professional development system supports for infant/toddler caregivers and how they can be accessed.

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The birth of a new baby is a time of great hope and opportunity. This sense of hope is reinforced by science, which has significantly enhanced our knowledge about how infants and toddlers develop and the ways we can support them. We know that the early years establish the foundation upon which later learning and development take place. Although babies grow and develop at different rates, most follow a predictable path and learn to walk, talk, and gain new skills in expected ways. For some young children, however, development unfolds according to a slower timetable or in an atypical fashion. For those infants and toddlers with a disability or developmental delay, intervening early can make all the difference in the world. Early intervention provides services and supports to promote the best possible developmental outcomes, and it enhances the capacity of families to meet their child's needs. For children at significant risk, early intervention can serve as a protective buffer against the multiple adverse influences that may hinder their developmental progress. If the promise of a bright future is to be realized for all young children, policymakers should permanently authorize and adequately fund services of the Early Intervention Program of the Individuals With Disabilities Education Act (IDEA Part C) to ensure the optimal development of infants and toddlers with or at risk of developmental delays.

What is Part C of the Early Intervention Program for Infants and Toddlers With Disabilities (IDEA)?

The Early Intervention Program for Infants and Toddlers With Disabilities, or Part C of the Individuals With Disabilities Education Act (IDEA), is a federal grant program that assists states in operating a comprehensive statewide program of services and supports for children birth through 2 years old with developmental delays, including (at state option) children who are "at risk" of developing a delay or special need that may affect their development or impede their education.

Congress established the Early Intervention program (generally referred to as "Part C") in 1986, and most recently reauthorized the statute in 2004, in recognition of "an urgent and substantial need" to

enhance the development of infants and toddlers with disabilities;

reduce educational costs by minimizing the need for special education through early intervention;

minimize the likelihood of institutionalization and maximize independent living; and

enhance the capacity of families to meet their child's needs.

States vary widely in the type of quantitative criteria they use to describe a developmental delay, as well as in the level of delay required for eligibility for Part C services. In addition to identifying children who are experiencing developmental delays or who have a diagnosed physical or mental condition that has a high probability of resulting in development delay, states can choose to provide services to infants and toddlers who would be at risk of experiencing a substantial developmental delay if early intervention services were not provided.

Approximately 16% to 18% of children have disabilities or developmental delays.

In order for a state to participate in the program, it must ensure that early intervention will be available to every eligible child and his or her family. The governor must designate a lead agency to receive the grant and administer the program and must appoint an Interagency Coordinating Council (ICC) to advise and assist the lead agency. Annual funding to each state is based upon census figures of the number of children, birth through 2 years old, in the general population.

The current IDEA 2004 Statute (P.L. 108-446) for Part C contains many requirements states must meet, and it specifies the minimum components of a comprehensive statewide early intervention system. New proposed regulations for Part C were issued on May 9, 2007 by the Office of Special Education and Rehabilitative Services at the U.S. Department of Education. These regulations, when issued in their final form, will reflect the changes resulting from IDEA 2004 and provide guidance to states on how Part C is to be implemented.

Policy Recommendations

1. Expand and enhance early identification of infants and toddlers to include greater coordination and collaboration among early childhood providers.

Expand and enhance early identification of infants and toddlers to include greater coordination and collaboration among early childhood providers. The earlier children are identified and provided with carefully designed intervention and family supports, the more they benefit by gains in cognitive, language, and social development, and later in higher academic and life achievement. These services and supports best serve children when they are coordinated and collaborative. For example, early screening and identification should include:

developmental screenings for low-income infants and toddlers under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program;

the use of standardized screening tools by primary care physicians to monitor child development;

coordination of screening efforts through a medical home;

improved information and referral networks;

health and mental health consultation to child care; and

collaboration between public health, child welfare and early intervention services to ensure children in the child welfare system are screened. Additional funding should be provided to support increased screening and referral efforts

Infants and toddlers who have been maltreated are six times more likely than the general population to have a developmental delay. Children entering early intervention are far more likely than the general population to be in foster care.

2. Permanently authorize and fully fund Part C of the IDEA.

The 2004 reauthorization of IDEA continued Part C as a discretionary grant program without permanent authorization. In addition, Part C funding is unusually designated as payor of last resort, requiring that all federal, state, local and private resources be exhausted prior to using Part C funds. As states continually struggle with the need to adjust or expand the array of resources to support an integrated early intervention system, they are faced with financing systems that are unstable, inadequate, and complex. It is important to permanently authorize the Part C program with a sufficient and stable base of funding. Doing so will ensure responsive and effective services and supports for infants and toddlers with or at risk of developmental delays or disabilities and their families-significantly boosting the promise of a bright future for children, families, and communities.

3. Include at-risk infants and toddlers in the state's definition of eligibility for Part C services.

Part C allows states to provide services to infants and toddlers who are at risk of developmental delay. States may include children with a history of significant biological or medical conditions (e.g., low birth weight or failure to thrive) and/or children who are at risk due to environmental factors such as poverty, homelessness, substantiated child abuse or neglect, parental age, parental illegal substance abuse, and parental mental illness. As of February 2008, only five out of 56 states and territories serve at-risk children, even though it is well documented that young children with multiple risk factors are the most vulnerable to poor health and development. States should expand their definitions to include these at-risk infants.

4. Fully implement the Part C and the Child Abuse Prevention and Treatment Act (CAPTA) mandates requiring states to refer to Part C all children under the age of 3 with substantiated cases of abuse, neglect, and drug exposure.

Both the IDEA 2004 and CAPTA 2003 reauthorizations require state early intervention and child welfare systems to establish coordinated procedures for the referral of substantiated cases of abused, neglected, or illegal drug-exposed infants and toddlers to Part C services. Infants and toddlers who have been maltreated are far more likely than the general population to have a developmental delay. States should take steps to fully implement these mandates by structuring collaboration between Part C and child welfare agencies and by increasing staff training.

More than 50% of children in early intervention had two or more risk factors; one in five children had four or more. Research suggests that the potential for negative developmental outcomes increases substantially when a child has multiple risk factors.

5. Expand access to inclusive early care and education experiences for infants and toddlers across diverse settings.

Infants, toddlers, and their families thrive when they are able to live, learn, and play in the "natural environments" in their own communities-including the settings in which children without disabilities participate. To ensure inclusive experiences, children with disabilities and developmental delays should have full access to early care and to education, health, social, and recreational services. Successful inclusion requires collaboration at all levels, appropriately trained personnel, cultural responsiveness, and a framework that emphasizes parent-child and peer interactions in typical routines and natural environments.

6. Invest in the professional development of the early intervention workforce.

Research clearly links well-trained and qualified providers to better child outcomes. Expert consultation and training for providers is necessary to effectively support infants, toddlers, and their families who confront significant child developmental disabilities, experience special health care and mental health needs, or face the stresses of poverty, substance abuse, and child maltreatment. Training should be targeted to:

building expertise in early social-emotional development and mental health;

training providers from different cultural, ethnic, and racial backgrounds and preparing them to meet the needs of diverse populations; and

developing and implementing a set of standards for early intervention practice.

Research

Earlier identification and intervention is more effective and less costly. The science of early development highlights the remarkable opportunities to optimize child development. During the earliest months and years of life, the architecture of the brain is being built at an unparalleled rate in response to nurturing early experiences. Early identification and intervention for children with developmental delays or disabilities can improve cognitive and social skills, lead to higher achievement and greater independence, and promote family competence and well-being.

1 in 3 infants and toddlers who received early intervention services did not later present with a disability or require special education in preschool.

Supporting a family's capacity to understand and enhance their baby's unique development positively influences both parents and children. Supportive and caring relationships between babies and caregivers have a significant and enduring influence on young children's growth and development. Many studies have documented the link between early loving, secure relationships and a child's self-esteem, confidence, and ability to communicate, deal with stress, develop positive relationships, develop a conscience, and learn. We know that families are central to their children's development. It is through relationships that babies discover who they are and how to interact with others. Families of young children with developmental disabilities can be confronted with many challenges and stressors that can compromise their ability to foster their child's health and development. Child development, as well as parental well-being, is enhanced when parents and other caregivers are encouraged to understand each child's unique characteristics and respond with sensitivity and warmth.

Child development, as well as parental well-being, is enhanced when parents and other caregivers are encouraged to understand each child's unique characteristics and respond with sensitivity and warmth.

Programs that combine support for families with carefully designed services for young children appear to have the greatest impact. Intervention is most effective when approached from a whole-child perspective. multigenerational programs that focus on relationship-building and parent-child interactions, while providing carefully and individually designed programs for young children, can positively impact both children and parents. Comprehensive services in home and community settings provided by highly qualified staff, tailored to individual child and family needs and interests, embedded in typical family routines, and coordinated across agencies and systems have the most promise for the best developmental and societal outcomes.
Download the PDF for a full list of citations.

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Making Hope A Reality: Early Intervention for Infants and Toddlers With Disabilities

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For children at significant risk, early intervention can serve as a protective buffer against the multiple adverse influences that may hinder their developmental progress. Policymakers should permanently authorize and adequately fund services of the Early Intervention Program of the Individuals With Disabilities Education Act (IDEA Part C) to ensure the optimal development of infants and toddlers with or at risk [...]

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EI Infant Toddler Eligiblity Process Flow Chart

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What is Early Intervention (EI) in Pennsylvania?
Early intervention in Pennsylvania consists of services and supports designed to help families with children who have developmental delays or disabilities. Early intervention builds upon the natural learning occurring in those first few years. It is a process that promotes collaboration among parents, service providers, and others significantly involved with your child.

Early intervention:
* Helps children with disabilities develop and learn to their fullest potential
* Enhances each family's capacity to meet the developmental needs of their child in the settings where children would be if they did not have a disability
* Respects the family's strengths, values, diversity and competencies and answers families' questions about their child's development
* Supports communities to become more aware of the gifts and abilities of all its children
* Helps prevent the need for more and costly intervention in the future

What are Early Intervention supports and services?
Early intervention supports and services are provided at no cost to families. Early intervention services can include: information about how children develop, parent or caregiver education, family supports, and developmental and instructional therapies that assist in child development.

Early intervention is individualized and provides supports to the child and family in the home and community. Early intervention can also assist families to link to a variety of community services and supports.

You are the expert about your child. The recommendations or suggestions that you have for your child and family are uniquely yours. Sharing them with other members on your early intervention team allows others to know what is important to your family. This information will help your early intervention team to create meaningful individualized services and supports.

Who is eligible for Early Intervention services?
If your child is:
Birth to 3 Years Old:
Infants and Toddlers who have:
* A 25 percent delay in one or more areas of development
OR
* A specialist's determination that there is a delay even though it doesn't show up on the assessments (called informed clinical opinion)
OR
* A known physical or mental condition that has a high probability for developmental delays (such as Down syndrome)
AGE 3 to age of entrance to first grade:
* A 25 percent delay in one or more areas of development
OR
* Any of the following physical or mental disabilities: autism/pervasive developmental disorder: serious emotional disturbance: neurological impairment; deafness/hearing loss; specific learning disability; intellectual disability; multiple disabilities; other health impairment; physical disability; speech impairment or blindness/visual impairment;
AND
* Are in need of special education services.

Through a unique collaboration between the Pennsylvania Departments of Education (PDE) and the Department of Human Services, the Office of Child Development and Early Learning (OCDEL) administers the commonwealth's early intervention program for eligible infants, toddlers, and preschoolers.

At a local level, the infant/toddler early intervention programs administer the services for children from birth to three years of age.

OCDEL contracts services through intermediate units (IUs), school districts, and private agencies for local services to preschoolers from three years of age to the age of beginners (age of entrance into first grade).

Where do I start?
Screening
A screening is a quick and way process, usually just a few questions about your child's development. The screening helps to determine if an evaluation is needed. You may request a multidisciplinary evaluation at any point during the screening process.

Planning for an evaluation begins with a team; you and your service coordinator or representative from the early intervention program. Other team members may participate as appropriate for your child's and family's needs. You are the expert on your child and your participation as a member of the team is very important.

How do I prepare for the evaluation?
* Inform the service coordinator or your early intervention contact person if you need an interpreter or other assistance.
* Be ready to share information that you think is important: current health appraisal, medical records, a baby book, growth chart, or other evaluations or reports.
* Think about your child and any questions or concerns you might have related to his or her development.
* Be prepared to share information about activities that are challenging for your child and family to participate in at home, in the community, and at child care or preschool, as well as what your child and family enjoy doing together.
* Think about where your current support comes from, for example, your extended family, a faith community, your neighborhood, a parent group, etc.

The evaluation will look at all areas of your child's development. During the evaluation, you and members of the team will talk about the good things your child is doing as well as identify any concerns. The evaluation will also determine the strengths and needs of your child and family.
If your child is determined eligible, the information from the evaluation will help the team know what is important to your family and will help create meaningful individualized services.

Your IFSP/IEP team will meet together and discuss the information gathered from the evaluation about your child's strengths and needs. The plan meeting is your opportunity to share ideas for your child and family with other members of the team. It is also your opportunity to share information about your daily routines, preferred activities, and activities that are challenging for your family. This information will provide your team with ideas about how to target early intervention supports and services to meet your child's and family's needs.

An IFSP or IEP must include:
* A statement of your child's level of development
* With your consent, a statement of the family's strengths, priorities, and concerns as they relate to your child's development
* Information or assistance to help you access community resources
* Special considerations that relate to vision, hearing, challenging behaviors, communication, and needs related to assistive technology or transitions
* The measurable goals or outcomes expected for your child and family, as well as how and when it is hoped they will be achieved
* A description of early intervention services that are to be provided, as well as in what setting they will occur
* A statement of when services are expected to begin and how long they will continue
* The name of your service coordinator or early intervention contact person
* A written plan for transitions as your child's needs change
* The date when the IFSP or IEP will be reviewed

You may request an IFSP or IEP meeting to discuss the potential need for changes at any time by getting in touch with your service coordinator or contact person.

How to prepare for the IFSP or IEP:
* Identify your child's unique qualities and strengths.
* Think about what you and your family want for your child now, and in one, two, or five years from now or even as an adult.
* Identify the questions you have regarding your child. All questions are important. For example: Why is she so fussy? Why is he so quiet? Is that ok? Is that a concern?
* List what you and your child really enjoy doing such as: playing with water or sand, watching TV, or going for walks. This will help you and the teams identify how you can use these routines to help your child develop and grow.
* Consider the special needs your child has. Think about what your child might need to reach his or her full potential: adaptive equipment, feeding or self-help skills, help to move around, or help to communicate.
* Consider issues for which you would like help in finding the solution. For example, do you as a family like to go to the beach, but you're concerned about how to take your child?

What does it mean when I am told we must transition?
Transition in early intervention services means movement from one program to another, such as:
* From the hospital to your home
* From an infant/toddler early intervention service to a preschool early intervention service
* From early intervention services to other early care and education settings such as
* Head Start or child care programs
* From preschool early intervention services to kindergarten or first grade

How does my family/team plan for a successful transition?
As a very important part of the team, you need to know all the options-ask questions:
* What is needed for my child?
* What is available?
* Who is involved?
* Where are they?
* When is this transition going to occur?
* How will the transition occur?
* What activities will help my child adjust to the transition?
* How can my family and child be supported through this change?

If your child is in the preschool early intervention program, during the year before your child is eligible for kindergarten or first grade, the early intervention program will invite you to a transition meeting to discuss options for your child. This transition meeting must occur before the end of February. If your child is kindergarten/school age, the funding for services is the responsibility of the local school district.

What does individualized supports and services mean?
Early Intervention supports and services are individualized for each child and family.
* This means that: The plan developed for each child and family will reflect their unique activities, values, and community participation. Services and supports should match the family's priorities and concerns, and will vary from family to family, and should change as priorities and concerns change. There are many ways for families to receive services and supports. Location, frequency, or type of service or support is not based on the child's age or type of disability. The outcomes identified by the family and the child's team will guide the choices of services and supports necessary to accomplish them. Friends, neighbors, early education practitioners, playgroups, churches, libraries, and other community supports enhance the quality of every family's life. Services using natural routines and activities support and encourage families to find and strengthen natural supports outside the Early Intervention system. These supports, established when the child is young, are likely to remain throughout the child's school years and into adulthood.
* Early Intervention can be provided at home, in childcare, in private or public preschools, Early Head Start and Head Start, or combinations of these that the family and the team determine are the most appropriate for the child's progress. Services and supports also change as needed.

What protections does the Individuals with Disabilities Education Improvement Act of 2004 (IDEA) provide for Early Intervention?

In Pennsylvania, the Office of Child Development and Early Learning, Bureau of Early Intervention
Services, administers both Part C and Part B of the federal law IDEA.

Part B
(Section 619 is the Preschool Section) Provides services for eligible young children and their families from age three to the age of beginners (start of first grade). Services are developed by a team and written into an Individualized Education Program (IEP). Services are delivered in the least restrictive environment.

Part C
Provides services for eligible infants and toddlers and their families from birth until the child's third birthday. Services are developed by a team and written into an Individualized Family Service Plan (IFSP).Services are delivered in a natural environment for the child and family.

Part B
(Section 619 is the Preschool Section) Provides services for eligible young children and their families from age three to the age of beginners (start of first grade). Services are developed by a team and written into an Individualized Education Program (IEP).Services are delivered in the least restrictive environment.

What is the Pennsylvania Act 212: Early Intervention Services System Act of 1990?
PA-Act 212, the state statute for early intervention services, requires the Departments of Education and Public Welfare to ensure that:
* Eligible young children (birth until the age of beginners) and their families receive early intervention services and programs
* Appropriate services under public supervision that are designed to meet the developmental needs of eligible children are available
* Services specifically designed to address the needs of the family to enhance their child's development are provided

What is the Family Educational Rights and Privacy Act (FERPA)? What are my rights and privileges?
The following information summarizes your rights and privileges under the Family Educational Rights and Privacy Act of 1974(FERPA). This is a federal law which protects the confidentiality of a child's educational records by limiting their disclosure. FERPA guarantees parents certain rights which are described below.
* Access to records: You have the right to inspect and review your child's records and to receive a copy of the records.
* Amend information in records: You have the right to request that your child's early intervention records be changed if they are inaccurate or misleading and to have a hearing if that request is refused.
* Disclosure of personally identifiable information: Generally, the early intervention program must have written permission from the parent in order to release any information from a child's educational record. However, FERPA allows early intervention programs to disclose those records, without consent, to the following parties or under the following conditions:
o Early intervention officials with legitimate educational interest
o Dissemination of directory information (e.g., child's name, DOB, and parent contact information)
o Other early intervention programs to which a child is transferring
o Specified officials for audit or evaluation purposes
o Organizations conducting certain studies for or on behalf of the early intervention program
o To the courts to comply with a judicial order or lawfully issued subpoena
o Appropriate officials in cases of health and safety emergencies
* Complaints: If you believe that the early intervention program is not complying with FERPA or not guaranteeing you your rights outlined above, you may file a letter of complaint with the federal office in charge of enforcing the Act at the address below:
Family Policy Compliance Office U.S. Department of Education
400 Maryland Avenue
Washington, DC 20202-8520 202-260-3887
* Policy: A complete copy of the FERPA legislation is available at your request. You may receive a copy by contacting your early intervention program or http://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html

What is Parental Consent and Notice (PCN)? What does it meant to me?
* Prior written notice: You have the right to prior written notice before the early intervention program proposes, or refuses, to initiate or change the identification, evaluation, or placement of your child or the provision of early intervention services.
* Parental consent: You must provide consent before any screening, evaluation or assessment; before early intervention services are provided; before public benefits or insurance or private insurance is accessed; and prior to the disclosure of personal identification information.

Who has access to a child's information?
Child information contained in the information management system is kept confidential and only persons authorized by federal and state confidentiality, privacy, and security laws have access to the records. Data in PELICAN ((Pennsylvania's Enterprise to Link Information for Children Across Networks; the name of OCDEL's information management system) is protected by security protocols, which require secure and encrypted servers, unique usernames with strong passwords and user roles that are assigned specific security roles and access. This means that:
* Only the staff directly involved with specific child has access to that child's information.
* State personnel have limited access to child information for the purposes of monitoring the delivery of early intervention services.
* Information about a child will not be shared outside a program, except as permitted by law with parental consent.

What are Pennsylvania's Parent Centers? How do I contact them?

These are federally-funded Parent Centers that are available to provide information, resources, and training opportunities to educate families about all aspects of Early Intervention and Special Education (from birth to age 21).

* Parent Education and Advocacy Leadership Center (PEAL) The PEAL Center helps parents with early intervention and education issues in western and central Pennsylvania. PEAL also helps families statewide with access to health care, health insurance, and access to services at home and in the community through the PEAL Family to Family Health Information Center (F2F). The PEAL Center provides individual information, technical assistance and training, including leadership training for families for children with disabilities and special health care needs (CSHCN). http://www.pealcenter.org/ 1-866-950-1040
* Hispanos Unidos para Niños Excepcionales (HUNE) HUNE serves, but is not limited to, Spanish-speaking families across the state. http://huneinc.org/ 215-425-6203

What is a Parent Guide?
GBYS Parent Guides are parents of children who are deaf, hard of hearing or deaf-blind who have received special training that prepares them to function in this important capacity. This training provides a strong foundation in supporting families without a bias towards communication modes or methods, as well as a functional understanding of formal systems and services available to families and their children. Parent Guides are able to bring their direct experience, specialized knowledge, and personal compassion to their role while making the family's needs their primary focus. They have been where you are and are willing to listen and share their experiences.

Who is eligible for the program?
Families of Pennsylvania infants and toddlers (ages birth to 3) who have a hearing loss.

What is Hands and Voices Guide by your Side™ of Pennsylvania? What can the GBYS program do for my family?
GBYS Parent Guides located throughout the state provide:
* Timely emotional support at the point of diagnosis of hearing loss
* Direct parent/peer support and networking
* Unbiased information and resource sharing specific to hearing loss, including insights on navigating the systems from a parent perspective
* Support to families throughout the Infant/
Toddler Early Intervention years by combining an experienced parent's insight with knowledge of Early Intervention and educational systems
* Information about other parent support opportunities

How much does the GBYS program cost?
The GBYS program is provided to families at no cost.

How do I request a GBYS Parent Guide?
* Complete the GBYS Referral Form on the families page onwww.paearlyhearing.org
* Or call the Hands & Voices Guide By Your Side™of PA Program Coordinator at 800-360-7282 x3908(in PA only) or 717-541-4960 x3908

Hands & Voices Guide By Your Side™ of PA is supported by the Pennsylvania Department of Health. Guide By Your Side has an office at the Pennsylvania Training and Technical Assistance Network (PaTTAN) and shares resources with Early Intervention Technical Assistance (EITA).

What is the Early Learning Network (ELN)?
The Early Learning Network (ELN) is an initiative of the Office of Child Development and Early Learning (OCDEL). ELN is a comprehensive unified data system that allows authorized users to assess individual-level child outcomes across multiple programs. It links existing data systems by child identifier and will collect additional information on child and family services across program areas. When fully implemented, the data will be used to inform state policy decisions, investments and improvement efforts for early education programs from birth to third grade.

What is the Early Intervention Technical Assistance System (EITA)?
Early Intervention Technical Assistance system (EITA) provides statewide training and technical assistance on behalf of the Office of Child Development and Early Learning, Pennsylvania Departments of Public Welfare and Education. The primary recipients of EITA training and technical assistance are the local Infant/Toddler and Preschool Early Intervention agencies that provide supports and services to children birth to school age with developmental disabilities and their families. EITA is part of the Pennsylvania Training and Technical Assistance Network (PaTTAN). EITA is administered through the Tuscarora Intermediate Unit.

EITA provides both statewide and regional training initiatives that are developed through the analysis of statewide data, including program monitoring results, state and federal requirements, relevant research, and planning with state department staff. Statewide professional development training is provided across the Commonwealth when it is necessary to ensure a consistent message from the Office of Child Development and Early Learning. Family members are always welcome to attend. Examples of current statewide training initiatives include supporting children with complex needs including medically fragile, positive behavior supports, inclusion, assistive technology, literacy, autism, and parent leadership.

EITA also provides an individualized Technical Assistance Plan developed annually with each Infant/Toddler and Preschool Early Intervention program. The TA plan is based on findings from EI monitoring, self-assessments, OCDEL priorities, relevant research, and locally identified needs. The TA plan is linked to the state performance plan submitted to the United States Office of Special Education. Technical assistance planning is an ongoing process that is the result of conversations, data collection and review, research and clear identification of outcomes. The TA plan focuses on specific programmatic changes or outcomes and includes information on how the change will be measured. EITA TA plans focus on providing technical assistance and building local capacity through repeated contacts with the same persons/programs to assist with program-wide change. The TA plan is a flexible document that is updated as additional information or needs arise.

Acknowledgments:
A Family's Introduction to Early Intervention in Pennsylvania; Office of Child Development and Early Learning (OCDEL)

Early Intervention Supports and Services: Facts for Families; Office of Child Development and Early Learning (OCDEL) and Pennsylvania Early Intervention

PaTTAN: http://www.pattan.net/

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Early Intervention in Pennsylvania - FAQ

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What is Early Intervention (EI) in Pennsylvania? Early intervention in Pennsylvania consists of services and supports designed to help families with children who have developmental delays or disabilities. Early intervention builds upon the natural learning occurring in those first few years. It is a process that promotes collaboration among parents, service providers, and others significantly involved with your child.

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Similarities of Early Intervention Infant Toddler and Preschool Programs

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Parental Reaction to Disability Hedderly

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A Case for Family Coaching in Early Intervention

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Implementing and Preparing for Home Visits

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While all children grow and develop in unique ways, some children experience delays in their development. Children with developmental delays and disabilities benefit from The Pennsylvania Early Intervention program, a state supported network of parents, service practitioners, and others which builds…

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EARLY INTERVENTION

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The Warren Center | Non-profit organization in Richardson, Texas

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Early Childhood Intervention - The Warren Center | Non-profit organization in Richardson, Texas

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The Warren Center Early Childhood Intervention (ECI) program serves children, age birth to three years old, with developmental delays or disabilities. The Warren Center's team of early childhood specialists, therapists, social workers, and other professionals conducts evaluations and provides services to children and their families in their natural setting (where they live, learn and play).

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My Experience with Screening and Assessment

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The official website for the Pennsylvania General Assembly.

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Eligibility A Parent's View Jevon's Story

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When an infant is born and we look into his or her eyes, we can see the promise of a bright future for that child and for all of us. For some infants and toddlers, healthy development may not be a clear path, and intervention is needed to achieve that promise of a bright future. Occasionally, there are obstacles that compromise an infant's growth-a medical condition, prenatal or birth trauma, or factors in the child's environment. Many months may elapse between the time a problem or concern first emerges and when a child is enrolled in appropriate services, which can make a difference in the child's developmental outcome.

Developmental screening programs identify children whose development may deserve closer observation or assessment and children who may be at risk of later developmental problems. Early identification of developmental issues, partnered with a system of supports to intervene, can prevent early challenges from compromising the child's development. Building ongoing developmental screening into services that routinely have contact with infants, toddlers, and their families allows professionals to monitor and support children's development. If screening raises concerns, children can be referred for in-depth evaluation and appropriate intervention to improve developmental outcomes. Policymakers can offer a bright future for infants and toddlers by ensuring that all children have access to developmental screening and that follow-up services are available for those children who need more detailed evaluation and treatment.

Approximately one of every seven children in the United States faces a developmental disability or a disabling behavioral problem before age 18. Yet fewer than 50% of these children are identified before they start school.

Policy Recommendations

1. Ensure that all infants and toddlers who are eligible for Medicaid and the Medicaid-expansion Children's Health Insurance Program (CHIP) are enrolled and receive periodic developmental screening under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program, which includes physical, mental, and dental health.

Low-income infants and toddlers are more likely to have poor birth outcomes or experience physical and social-emotional challenges that can lead to developmental delays and disabilities. More than 25% of U.S. infants and toddlers live in poverty and are eligible for health services under public health programs such as Medicaid or CHIP. Medicaid mandates health and developmental screening through the EPSDT requirements. However, not every eligible child is enrolled, and even many enrolled children do not receive the full services to which they are entitled. In 2008, 40 states met the federal benchmark that at least 80% of the infants enrolled in Medicaid receive at least one developmental screening during their first year of life, and 44 states met the benchmark of two screenings for toddlers. Only five states have implemented the American Academy of Pediatrics (AAP) recommendation that infants receive seven well-child visits, during which ongoing screening and monitoring can take place. Ongoing monitoring is important because one in five children with a disability will not be identified through a single developmental screening. Disabilities are more likely to be detected if monitoring and screening are continued in all well-child medical care visits. State Medicaid managed care agreements and publicly funded children's health plans should clearly outline required EPSDT services, screening frequency, and other screening mandates, and ensure that these important services are delivered to all eligible children. Children eligible for CHIP services should also receive EPSDT-like screening, diagnosis, and treatment services regardless of whether the state uses CHIP funds for Medicaid expansion or for a separate children's health insurance program.

2. Require the use of standardized developmental screening tools through regulation, including tools that screen for issues in social-emotional development.

Some developmental issues may pass unnoticed during the early years, and some issues, especially relating to social-emotional development and behavioral health, are not identified early or easily without the help of standardized screening tools. The AAP recommends that surveillance be conducted at all well-child checkups (at 3-5 days of age, at 2, 4, 6, 9, 12, 15, 18, 24, and 30 months, and at the 3rd birthday). Developmental screening using a standardized screening tool should be conducted at 9, 18, and 30 months. Surveillance should consider parents' concerns as well as risk and protective factors. These include family conditions, such as parental depression or alcohol or substance abuse, that impact the child's development and security. Policymakers should make funding available to provide training and technical assistance to support professionals (pediatricians, home visitors, early care and education professionals, and others) to incorporate standardized screening tools into their contacts with infants, toddlers, and families. In addition, state Medicaid and CHIP regulations and private health care plans should spell out covered screening, diagnosis, and treatment services and identify appropriate screening tools.

3. Ensure that physicians and mental health professionals are reimbursed adequately for conducting screenings.

Physician reimbursements under private insurance or Medicaid/CHIP for well-child visits may be low, and pediatric care providers may have limited time to devote to surveillance and screening activities during well-child visits. Policymakers should ensure that reimbursement for well-child visits covers the time required to complete surveillance and screening along with other visit activities. Payment should also reimburse for screening as a separate activity whenever a concern is suspected between checkups. More favorable reimbursement rates for preventive care activities have been provided through 2014 under the Affordable Care Act (ACA), but funds will be needed to maintain this increase in the long term and to support state cost-sharing under ACA.

Poverty is a strong predictor of poor developmental outcomes in children. Low-income children are more likely than children from other income groups to have poor health and special health care needs that place them at risk of developmental delays. Yet these children are less likely to receive developmental screening.

4. Promote linkages between early identification services and a network of treatment services so that children's developmental concerns are addressed.

Identifying a possible developmental concern is the first step to successful prevention or intervention. If health providers and others are linked in a network providing early identification, preventive and treatment services, and family supports, they can recognize developmental concerns early and respond to children's needs. Some valuable linkages include coordinating care through a medical home; building relationships between pediatricians and local IDEA Child Find and intake services; strengthening information and referral networks; providing health and mental health consultation to child care providers and home visitors; and building collaboration between public health, child welfare, and early intervention services to ensure that children in the child welfare system are screened and referred. Funding should be provided to support increased service coordination, to increase community screening and referral networks through collaborative efforts such as Early Head Start, and to develop data systems that support tracking of children across service sectors.

Uninsured children are less likely to receive developmental screenings and preventive health care than children enrolled in public insurance programs such as Medicaid or the Children's Health Insurance Program (CHIP).

5. Support outreach to inform parents about developmental screening and follow-up services.

Many parents seek assurance that their children are developing on a typical path, yet they may not understand the purpose of developmental screening. If they have a concern, they often do not know where to go for help. Community helpers who enter the lives of infants and toddlers (for example, child care providers, parent educators, home visitors, and health clinic staff) should understand that services are available for developmental screening, assessment, and treatment and should be able to provide information about these services. Funds should be provided to raise awareness and conduct outreach campaigns to educate community providers and increase family participation in screening activities.

Key Definitions

Surveillance or monitoring refers to the ongoing process of observing a child's development and tracking parents' concerns.

Developmental screening is the process of identifying children who may have a developmental problem or a delay in one or more domains of development, or who are at risk of developmental problems in the future. Comprehensive developmental screening should include consideration of the child's physical, cognitive, language, and social-emotional development and risk factors in the child's background.

Standardized screening tools are measures that gather evidence indicating the probability of or potential for a developmental problem, delay, or risk. Assessment is a more intensive process that evaluates the child's development in depth in order to identify a specific developmental problem and to determine whether the child could benefit from intervention.

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT): Under Medicaid, every eligible child is entitled to periodic developmental screening and treatment for diagnosed conditions to ensure that physical and mental conditions that could affect development are identified and corrected. The screening component includes keeping a health history and conducting a physical exam; laboratory tests; developmental and mental health screening; and dental, vision, and hearing screening.

Policymakers should ensure that reimbursement for well-child visits covers the time required to complete screening and other visit activities.

Child Find: The Individuals With Disabilities Education Act (IDEA) requires that states create a system to "find" children from birth to 3 years of age who may be eligible for services provided under Part C of IDEA, and children ages 3-18 years for Part B services. Child Find systems must coordinate with other state agencies and systems in efforts to identify children in need of services.

Research

Early investments have significant benefit to children and to society at large. An example of this long-term benefit is found in the test to detect congenital hearing problems in newborns. This simple test allows children to be identified beginning in the first months of life. Early treatment may prevent severe disabilities in communication and language development. Although the incidence of congenital hearing problems is low, its personal and economic cost is great. The Centers for Disease Control and Prevention estimates that the cost of providing special education services to a child with significant hearing loss is $11,006 per year. Early detection and treatment could greatly reduce this expense. Children whose hearing loss is detected in infancy and who receive treatment services have better language outcomes at 8 years of age. This in turn is linked to better educational outcomes and enhanced lifelong productivity. The newborn hearing screening test has been mandated in 43 states, and it is one of the 30 newborn screening tests recommended by the March of Dimes.

Low-income children are at greater risk of developmental delays and problems. Low-income children are more likely to face a number of risks that make them more vulnerable to health and development problems. These risks include parental depression, poor housing conditions (contributing to problems like lead poisoning or asthma), and nutrition deficiencies. In addition, the greater risk of exposure to substance abuse in the family, child abuse or neglect, or family disruption among low-income families puts children at greater risk of long-term problems in health and behavior. These risks could be detected and addressed through comprehensive screening and follow-up programs. While the number of low-income children covered by Medicaid or CHIP grew steadily in the early 2000s through CHIP expansion programs, low-income children still continue to face barriers to care such as frequent eligibility redetermination; lowered eligibility ceilings; shortages of participating pediatricians, dentists, and specialists; language barriers; and challenges due to immigration status. Their mothers are less likely to receive adequate prenatal care and screening for perinatal depression. In the current fiscal climate, states are shrinking eligibility for health services and early intervention programs or increasing families' out-of-pocket expenses, making preventive care, screening, and treatment programs even less available for vulnerable families.

Only 5 states meet the standard for frequency of well-child checkups in the first year of life as recommended by the American Academy of Pediatrics for monitoring the infant's health and development.

Training and support for pediatricians can improve screening rates and practices. The Assuring Better Child Health and Development (ABCD) project, designed to incorporate developmental monitoring and screening into pediatric practices and link pediatricians to referral networks, has significantly increased the occurrence of developmental screening and adoption of validated screening tools across the participating states. The project has also demonstrated strategies for taking these best practices to scale and made policy recommendations to improve practice statewide, such as revising Medicaid payment policies and training health providers on billing procedures so that reimbursement for screening activities was adequately covered. New voluntary benchmarks for use by Medicaid and CHIP programs to track health care quality will support states' efforts to improve screening practices.
For a list of citations, download the full PDF.

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Achieving the Promise of a Bright Future: Developmental Screening of Infants and Toddlers

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When an infant is born and we look into his or her eyes, we can see the promise of a bright future for that child and for all of us. For some infants and toddlers, healthy development may not be a clear path, and intervention is needed to achieve that promise of a bright future.