Handbook I Text

Connecticut Birth to Three System
A Family Handbook Guide 1: Referral and Eligibility Evaluation

Table of Contents

Welcome to the Connecticut Birth to Three System!. .2
An introduction to the Birth to Three System. .3
The evaluation visit. .4
Parent participation in the evaluation. .4
How is my child’s eligibility decided?. .6
What if my child is not eligible for Birth to Three?. .7
What if my child is eligible for Birth to Three?. .8
How much will I have to pay?. .9
What can my Birth To Three program offer?. .10
Services in the Birth to Three System. .11
What are my rights?. .12
Who can I call if I have a question?. .15
Glossary. .16

Welcome to the Connecticut Birth to Three System!

For families worried that their child’s development is lagging behind other children
his age, the infant, toddler and preschool years can be spent anxiously waiting for
developmental milestones to be met. Early intervention and the Birth to Three System
can help you put your concerns to rest. You have taken a very important first step by
talking with the Child Development Infoline and scheduling an eligibility
evaluation visit for your child.

This handbook introduces you to the Connecticut Birth to Three System and lets you know what to expect during your child’s evaluation and beyond. A welcome video is available for viewing at our website: www.birth23.org, under videos for families. If you do not have access to a computer and would like a DVD copy of our welcome video please contact Child Development Info Line at 800-505-7000.

This handbook lets you know what to expect during your child’s evaluation.

An introduction to the Birth to Three System

Birth to Three is a system of supports for families to help them meet the needs of their infants and toddlers who have disabilities or delays in their development. Birth to Three is different from outpatient rehabilitation services where professionals work with your child while you watch. You are a very important part of your child’s team. The professionals working with your child will be including you in every session. They will coach you in ways to implement their therapies into your daily routines with your child.

The Birth to Three System was created under Part C of a federal law called the Individuals with Disabilities Education Act (IDEA), and by state law 17a-248. In Connecticut, the Department of Developmental Services is the lead agency that administers the Birth to Three System. The lead agency operates a central office for outreach, training and fiscal operations. In addition a family liaison is on staff to work directly with families who have questions or concerns about the Connecticut Birth to Three System or their individual Birth to Three program.

Staff members from each program work directly with families and eligible children. Each program serves a specific set of towns. The programs serving your hometown appear on the list included with this book. Since Birth to Three visits usually take place in the homes of eligible families, do not be concerned if your program’s office address is not in your hometown. Most towns have more than one program serving their town which gives families the option of choosing a specific program. This can be done before or after the eligibility evaluation and right up until the time you leave Birth to Three.

Information that can help you learn more about each program is available on our website at www.birth23.org by clicking on “About Our Programs”. If you would like to know how a particular program compares to other state programs click on “How Are We Doing?” then click on “Public Reporting of APR (Annual Performance Review Data).” You can also click on “State Performance Plan” to learn how well the State of Connecticut is doing. If you don’t have access to the internet you can contact the Birth to Three Accountability and Monitoring office at 860-496-3073.

The evaluation visit

The evaluation visit usually takes place in your home if that is where you and your child feel most comfortable. When scheduling this visit, think of the best time of day for you and your child. When is your child awake and alert? Can your spouse, partner, or other caregiver also be home to participate? At least one parent must be present for the evaluation. The evaluators will work with you to find a good time for the visit that also fits into their schedules.
The team will ask you to sign several forms at the start of the visit including consent to:
• Evaluate your child,
• Bill your health insurance company for the evaluation (with no co-pay or deductible for you)
• Get information from your doctor or others you identify.
The evaluators will explain each form to you before you sign. Your consent is voluntary and may be cancelled at any time. Information about your child and family is confidential and cannot be shared without your permission. See page 12 for more details about your rights in Birth to Three.

Please participate in the evaluation by:
• Helping your child feel comfortable during the evaluation visit.
• Helping with activities that explore your child’s abilities.
• Telling the team whether or not what they are seeing is typical for your child.
• Providing truthful and accurate responses to questions about your child’s development no matter how painful those answers may be.
• Helping the team see your child’s unique strengths and needs.
• Asking questions and offering your opinions about how your child’s evaluation is going.

The Birth to Three team will ask you about your concerns and priorities for your child and family and will assess your child’s strengths and areas of need. They will ask you to share information from other developmental assessments or evaluations your child might have had outside of Birth to Three. These outside evaluations may be very important for determining eligibility.

Team members are interested in hearing about things your child can already do and the things that are hard for your child. They will watch your child playing with you and with toys to see what he or she can do. You know more about your child than anyone else. Your input is extremely valuable.
You can best prepare for the evaluation by taking some time beforehand to think about the following:
• Your child’s prenatal history.
• Your child’s birth.
• Your child’s health and developmental history.
• Any significant changes in your life or your child’s life that may contribute to behavior changes in your child.
• When you were first concerned that something might not be quite right.
• What you may have done to learn more about the suspected problem.
• Your concerns now.

The team will review results from this testing, the information you provide about your child’s history and development, and any reports received from medical providers to arrive at an eligibility decision. If at all possible, you will be given a written draft copy of the results and eligibility decision in your native language. The evaluation report is not final until you have had a chance to read it and make sure that it is correct.

How is my child’s eligibility decided?

Your child may be found eligible for early intervention in one of two ways:
1. Your child has a confirmed medical condition that is expected to lead to a developmental delay and therefore is automatically eligible. or 2. Evaluation by staff from two different professions (for example, speech therapy and physical therapy) confirms that there is a significant developmental delay. If a Birth to Three professional holds two certificates or licenses from different disciplines (for example social work and speech therapy), then he or she can complete the eligibility evaluation without a second person from a different discipline.
The information you gave to the Child Development Infoline (CDI) about your child and family over the phone was recorded in our confidential electronic database and transferred to the Birth to Three program that will evaluate your child. If you gave consent for CDI to follow-up with you two months after the referral, your information was also recorded in a separate confidential electronic database for that purpose.
The Birth to Three program will send two staff (or one professional with two certificates or licenses) to your home to complete an evaluation visit with you and your child. If your child is not automatically eligible by having a confirmed medical condition from our diagnosed condition list, an evaluation of your child’s abilities and possible delays will be used to determine eligibility.

You will be an important part of the Birth to Three team that will assess five areas of your child’s development.
Five Areas of Development
• Physical development, such as vision, hearing, movement and health
• Communication skills, such as pointing, understanding your words, expressing thoughts
• Adaptive or self-help skills, such as feeding and dressing
• Cognitive skills, such as thinking, learning, and reasoning
• Social-emotional development, such as getting along with others, expressing feelings, developing relationships

If your child was referred to Birth to Three because of concerns about his or her speech or language abilities it is very important to have your child’s hearing tested. Hearing problems often result in speech and language delays. Your child may even exhibit tantrums and behavioral concerns that may result from the frustration of not being able to communicate. It is very important for your Birth to Three team to know your child’s level of hearing when they complete the initial assessment. Talk to your pediatrician about the possibility of being referred to a pediatric audiologist for an in depth hearing evaluation. Many health insurance plans cover this, so check your health plan to see if yours does.

What if my child is not eligible for Birth to Three?

If you disagree with the results of the Birth to Three eligibility evaluation and this cannot be resolved by talking with the program or the Family Liaison there are other ways of resolving disputes. You may file a written complaint, request mediation or request a due process hearing. For more information on your rights, see page 12.

Children who have mild delays are not eligible for Birth to Three services. If your child is not eligible your evaluation team will link you with other programs that will help you understand your child’s development. “Ages and Stages” is a free program that helps you keep track of your child’s development. If you enroll, the Child Development Infoline (CDI) will mail you a questionnaire about your child’s development every four to six months. You will mail your answers back to CDI for scoring. If your child’s development continues on schedule, CDI will send you a note telling you so along with some activities you can enjoy with your child. If your child’s development shows that he or she might need some help from Birth to Three, CDI will phone you to discuss scheduling another evaluation. All evaluations are free.

What if my child is eligible for Birth to Three?

In order to be considered eligible your child’s development must be two standard deviations below average in one developmental area or one and a half standard deviation below average in two or more developmental areas. While this may seem complicated, in simple terms it means that according to the evaluation tools used, your child’s development was considerably behind all other children his age in one or more areas. Early intervention through Birth to Three will work to close these gaps and assist you as you help your child reach age appropriate developmental milestones.
After eligibility is determined, you will be assigned a service coordinator. Your service coordinator will help bring together all the people, information and resources that are an important part of your life. Your service coordinator is your guide as you make connections to community resources including those outside of Birth to Three. These may include a wide variety of developmental, health, economic and quality of life issues.

Your service coordinator will guide you in developing a plan called the Individual- ized Family Service Plan (IFSP). The IFSP will describe the real-life outcomes you want for your child and family. The IFSP lists how, where and when your family will work with the program staff to reach those outcomes. Your service coordinator will offer you more details about the IFSP and many other topics throughout your work together.

All eligible families receive service coordination. In addition, most families receive one or more direct services for their child. Birth to Three can include up to seventeen different services, but typical services for most families include working with a developmental specialist, (teacher), physical or occupational therapist, speech pathologist, or other professional. There are 17 different services listed under Part C, but typical service for most families include working with a developmental specialist (teacher) physical or occupational therapist, speech pathologist or other professional. These professionals will demonstrate for your family how to teach your child new skills. They will coach you as you practice these skills with your child throughout your daily activities so they become a part of your routine. Again, Birth to Three is different from outpatient rehabilitation services where professionals work with your child for a fixed amount of time while you watch. Research shows infants and toddlers learn best when skills are incorporated into their daily routines by their caregivers. You and your child’s other caregivers are an essential part of the Birth to Three team.

How much will I have to pay?

Your child’s eligibility evaluation is completed at no cost to your family. You will be asked for permission to bill your health insurance to help offset the cost, but this is voluntary and will not affect your child’s evaluation in any way. If your child is found eligible, you will be asked again for permission to bill your health insurance plan for reimbursement of some of the services. This is also voluntary and will not affect any of your child’s or family’s services but does affect monthly fees.

IMPORTANT: If you receive an insurance reimbursement check at any time for Birth to Three evaluation or services at any time you must endorse it and send it to the Birth to Three program that completed the evaluation or provided the service.
If your child is found eligible and your income is under $45,000 you will NOT be asked to pay. If your income is over $45,000 and you wish to receive direct services, you will be asked to begin making monthly payments after your first full month of services.

Parent payments are on a sliding fee scale according to your income, family size and whether or not you have consented to have your insurance billed. Some monthly payments can be as low as $24 per month or as high as $544 depending on a combination of the above factors. There is also the possibility of reducing your income if you have extraordinary expenses that are documented and approved by the Birth to Three Fiscal office. This will reduce the amount of your monthly fee. For more about a family’s ability to pay please see the glossary.

Be sure to ask your service coordinator for a copy of Parent Fees: A Guide for Families; and A Family Handbook II: Orientation to Services for more detailed information about parent payments and the supports and services provided by Birth to Three.

If you and your family decide you would like to obtain services from a private provider in your community at your own cost or through your own health insurance, there are still certain things Birth to Three can offer you at no cost to your family. They are: service coordination, development and review of a Individualized Family Service Plan (IFSP), assessment and due process rights.
If your child is enrolled in the Medicaid program (HUSKY A) there is no fee.

What can my Birth to Three program offer?

Your service coordinator is employed by an agency that earned approval to provide Birth to Three services and supports. Each approved agency employs staff who are licensed or certified in different specialties. These specialties include: education, physical therapy, social work, audiology, behavior analysis, occupational therapy, speech therapy and other areas of expertise. The staff will work with you and your family to help you and your child reach the outcomes you choose for your child and family.
Each Birth to Three program offers:
• Free eligibility evaluation by trained professionals, typically in your home.
• A Service coordinator who will also be providing direct services (such as speech) and who is responsible for identifying resources in your community to assist your family, coordinating all the different people, information and resources, that support your family and assisting your family as you plan for your childs transition out of Birth to Three.
• Trained staff all of whom will help you to work on goals related to your child’s and your family’s needs.
• Services that will help you practice new skills with your child during activities that are a part of your family’s regular routine. Practicing these skills with your child in your home and in the places where you both spend time in your community (for example your child’s daycare or grandma’s house) is the best way for your child to most successfully learn new skills.
• Due process rights under part C guarantees families certain rights, called procedural safeguards. Please refer to pages 12 and 14 of this handbook to learn more about your rights in Birth to Three.

All programs and their staff meet the standards for excellence set by the Birth to Three System.

Services in the Birth to Three System

Services are designed around your family’s needs, concerns, and priorities. Natural learning opportunities happen throughout your day and are used for practicing new skills with your child. Here is a quick look at supports and services:
• FOCUS: Your whole family, not just your eligible child will be supported in Birth to Three.
• OUTCOMES: You choose which skills you want to work on with your child so that he may become successful in family and community activities.
• PROVIDERS: work with you and your family in a close partnership using a transdisciplinary model demonstrating and coaching you on incorporating skills into your child’s daily routine.
• LENGTH OF SERVICE: Services are voluntary. You may leave whenever you choose, when services are no longer needed at or by your child’s third birthday, whichever comes first. The service coordinator assists the family in transitioning to community programs upon exit from Birth to Three. Examples of community programs may include child care, preschool special education or Head Start.
• WHERE: Your home and community, wherever your child spends time during the day.
• INTENSITY: The frequency of visits is designed to match your outcomes for your child and family. The intensity reflects the early intervention practice of demonstration by providers and coaching of parents during daily routines. More frequent visits do not guarantee faster development. The intensity of Birth to Three services may look very different than what your doctor or medical team is prescribing. Birth to Three is not like an outpatient rehabilitation service where you sit and watch a professional work with your child. You are an essential part of your child’s team.
• MEASURES OF SUCCESS: your child learns new skills; your family gains confidence in meeting your child’s needs and connects with community resources and activities.

What are my rights?

The IDEA gives you certain rights under the Birth to Three System beginning immediately with your first contact with Birth to Three, whether you called to refer your child or someone else did. If at any time you are not sure of your rights, please talk with your service coordinator, program director, the Birth to Three Family Liaison or the Child Development Infoline. Your service coordinator will also give you a brochure called, Parent

Rights Under IDEA Part C, that describes your rights in more detail. Here is a brief summary:
• You have the right to give written permission before your child is evaluated, before services begin or change, and before any information about your child or family is shared with anyone.
• You have the right to be notified before any action takes place. You must be told in advance about any meetings, evaluations, services, or actions affecting your child under the Birth to Three System. This is called prior written notice. You will be asked to sign forms given to you by your service coordinator to show you agree. You can change your mind at any time.
• You have the right to an Individualized Family Service Plan (IFSP) delivered by a team that includes you and anyone you want to invite. Meetings to develop or review an IFSP should be at a convenient time and place for you and your family. You have the right to request an IFSP meeting to review, change, discontinue or add a different service that will help you and your family reach your outcomes. You also have the right to postpone a meeting in progress if needed.
• IFSP meetings must be held in your native language or other mode of communication you need, such as Braille or sign language, unless it is not possible to do so. You may ask for an interpreter to help you understand and actively participate in the IFSP discussion.
• You have the right to request an IFSP meeting at any time to review the supports and services of your child and family receive. However, in order to change your IFSP a multidisciplinary team including you and at least two individuals from separate disciplines must be present. One of the individuals must be the service coordinator. Please keep in mind that it may take a short time to make arrangements for the team to assemble for an IFSP meeting.
• You have the right to privacy. Information about your child or family is confidential. Only select Birth to Three staff, Lead Agency auditors, and accrediting agencies can review your child’s record without your specific written consent.
• You have the right to examine your child’s record. An electronic record is begun at the time your child is referred and is updated until you exit. Your service coordinator also maintains a folder with important papers. You may schedule an appointment to examine these records at any time. If you do not understand anything in the record, it will be explained to you. If you do not agree with something in the record, you can request to have it changed. Your program must provide your record within 10 days of your request.

You have the right to disagree with the Birth to Three System. There are five ways to do this.

1. Very often the quickest and most satisfying way to resolve a concern is to talk with your service coordinator. If you feel uncomfortable doing this you can also speak to the program director of your Birth to Three program. If you are uncomfortable doing this or you feel the problem has not been resolved you may contact the Family Liaison at Birth to Three central office. She will try to understand the problem and work with you and your Birth to Three program to make adjustments to meet the needs of the situation. In many situations a simple explanation of why something is usually done in a certain way is all that is needed to resolve the problem.

2. If this is not successful or if you choose, you may also file a written complaint. The letter should be addressed to:
Linda Goodman, Director
CT Birth to Three System
460 Capitol Avenue
Hartford, CT 06106-1308
and must signed and include your name, address, and phone number; the name and address of the program or person that you are complaining about; plus a statement of what the complaint is about. A copy of the complaint must also be mailed by you to the program with whom you have the complaint. It would be helpful to also include the best days and times that you can be reached by telephone.

The Director will then ask a Birth to Three manager or an independent person to investigate your charges. That person will contact you to see if you have any additional information that you want to submit. The Director will send you a written response within sixty calendar days that will include
• The facts and conclusions
• The reason for the decision
• The corrective actions, if needed, that will be taken

3. Another way to resolve a disagreement is to write to the Family Liaison to request mediation. Mediation allows you and your program’s staff to talk about the details of your disagreement with an impartial, trained mediator. The mediator will work with you and your program to find a solution that suits both of you, then write up the terms of your agreement. Mediation works well in many situations and you are encouraged to consider this option but you are not required to use mediation.

4. You may also write to the Family Liaison to request a due process hearing, a more formal process conducted before an impartial hearing officer. The incident about which you are requesting a due process hearing must have occurred in the past 12 months unless there are extenuating circumstances. You would usually have legal counsel or another person with professional knowledge of your child represent you. The Birth to Three System would be represented by an Assistant Attorney General. The 30 day timeline for a due process hearing decision may be extended by the hearing officer at the request of either party.

5. Witnesses are called to testify and are cross-examined, evidence is presented, and shortly after the hearing ends, the hearing officer issues a written decision within 30 days of the request. The hearing is provided at no cost to you, but you must pay for any professionals that represent you. You can request a brochure on mediation or due process hearings from the Family Liaison.
While a complaint is being resolved in any of these ways, you have the right to continue receiving services not in dispute until your child turns three or unless you and Birth to Three agree that this is not in your child’s best interest.

For more information about your rights in Birth to Three click on “Videos for Families,” then click on
“Welcome videos for families.”

Who can I call if I have a question?

If you have already scheduled your child’s evaluation visit, you may call the evaluation team with questions or ask them once they arrive in your home. Refer to the insert that came with this booklet for your program’s agency name and phone number.
You may contact the Family Liaison at any time before or after your child’s evaluation for answers to your questions about all aspects of early intervention. If you do not speak English, over-the-phone interpretation services in your native language are available at no charge to you.
The Birth to Three website is also a great source of information that is updated often.

Glossary

accrediting agencies: national organizations that give an “approved” status to those programs that meet their standards for excellence.

Birth to Three program: an agency under contract with the Birth to Three System or run by the lead agency in order to provide supports and services that help you help your child and family to reach your chosen outcomes.

Birth to Three team: people who have specialized knowledge about what works to reach developmental outcomes; always includes your family, and may include one or more therapists, a teacher, and other professionals who match your goals and needs.

confidential: private; cannot be shared without your permission.

consent: the approval that you give for someone to do something; consent in Birth to Three is always voluntary and may be cancelled at any time.

delays: A developmental milestone that failed to happen at the intended or expected time.

development: the process of learning and mastering new skills over time; includes ability to move, communicate, think, see, hear, and play with toys or other people.

disabilities: conditions that limit or slow down one or more kinds of development.

early intervention: supports and services offered to an eligible child and family as soon as a developmental delay is identified in order to improve the child’s ability to live, learn, and play in their home and community

eligible: meeting the requirements to participate.

eligibility evaluation: using developmental measurements to test a child’s abilities, and then comparing these with what is expected for children the same age; a significant difference will make the child eligible for early intervention.

Individualized Family Service Plan (IFSP): a written plan describing the outcomes you want for your child and family, the Birth to Three services and supports used to reach those outcomes, as well as where and when they take place and who will work with you.

Individuals with Disabilities Education Act (IDEA): A federal law that supports the
provision of early intervention to eligible infants and toddlers (under Part C of the
law), and guarantees that all children ages 3 to 21 who need special education
receive a free appropriate public education (under Part B of the law).

lead agency: the state agency responsible for Part C of the IDEA, assures quality,
and conducts audits in order to maintain compliance with all applicable laws; the
lead agency in Connecticut is the Department of Developmental Services.

natural learning opportunities: the everyday routines and activities of life that can
be used to teach and practice new skills (for example, snack time, diaper changing,
bath time).

outcomes: the changes that a family wants to work toward achieving.

Part C: Part of the Individuals with Disabilities Education Act providing funds to state
lead agencies to assist in the provision of early intervention services to infants and
toddlers with disabilities, ages birth through two.

service coordination supports: a way to bring together the different people,
information, and resources that your child and family work with as a team; your
service coordinator is the person who will help the most to make these connections
and identify resources.

service coordinator: a person from your Birth to Three program who will help you
to communicate with the people on your team, understand the information given to
you, and will work with you to connect your family to community resources outside
of Birth to Three covering a wide variety of developmental, health, economic, and life
quality issues.

transdisciplinary: when parents and professionals from two or more different
disciplines teach, learn and work together across traditional disciplinary or
professional boundaries. For example, a developmental specialist working with
parents on their child’s problem-solving skills will include speech activities during
the visit if language development is a concern. The team may designate one
member as the primary interventionist. Team members may provide direct services,
consultative services, or both. A transdisciplinary approach to service delivery is
recommended for all early intervention and support services.

1-866-888-4188

Funding provided under Part C of the Individuals with Disabilities Education Improvement Act,
through the United States Department of Education, Office of Special Education Programs.

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