The Early Intervention Program

Mary H. Belkin, Ph.D.
Mary Belkin, Ph.D. is with the Jacksonville Early Intervention Program.

Early Intervention In A Nutshell
  • EIP provides access to individualized interventions at no cost to the family.
  • EI saves money. It is estimated that for every $1 spent on early intervention $7 can be saved in subsequent intervention and educational costs.
  • EIP performs multidisciplinary evaluation of the child to assess cognitive, motor, social, language, and adaptive functioning.
  • EIP develops plan for intervention (FSP) and coordinates services to address child's needs.
  • To receive services through EIP, children from birth to 3 years must meet eligibility requirements by either having a documented established condition, physical disability, or a developmental delay in one or more areas.
  • Primary Care Providers should refer upon the first suspicion of a delay or impairment to ensure that children receive the greatest benefit from specialized services.
The purpose of this article is to provide an overview of early intervention services available for children from birth to three years of age. Information will be provided regarding the legislation that mandates early intervention services and how these services are structured. Eligibility criteria will be discussed, as will the major components of the multidisciplinary evaluations conducted through the Early Intervention Program. The role of the Primary Care Providers (PCPs) in early identification will be addressed in conjunction with a summary of various screening procedures. Finally, the importance of the PCP as an advocate (coordinating services and providing support) will be discussed.

Where Did Early Intervention Originate?

In 1975, Congress passed the Education for All Handicapped Children Act (Public Law 94-142) to ensure that all children with disabilities receive a free education appropriate to their needs. Additional legislation in 1986 called for "statewide, comprehensive, coordinated, multidisciplinary, interagency program(s) of early intervention services for all infants and their families." As outlined by Congress, developmental services were designated to enhance children's functioning in one or more of the following areas: physical, cognitive, speech/language, psychosocial, and self-help skills. It was hoped that offering these services would enable families of all socioeconomic levels to more effectively meet the needs of their children. Over the long term, it was believed that early intervention would reduce educational costs by decreasing the need for special educational services once these youngsters reached school age, minimizing the need for institutionalization, and increasing the likelihood of independent living.

What Is Early Intervention?

Early intervention programs provide an array of therapeutic and social services to families of young children with developmental concerns. These programs are based on the assumption that therapies and enriching experiences provided at an early age can help lessen the impact of developmental problems. According to a recent report by the FSU Center for Prevention and Early Intervention Policy, children not involved in an early educational program were more likely to be placed in special education, drop out of high school, participate in welfare programs, and have a greater number of incarcerations. Furthermore, this report estimated that every dollar spent on quality early intervention can save up to $7 in subsequent educational and service-related expenses.

The Jacksonville Early Intervention Program (EIP) serves children from birth to three years of age in Duval, Clay, Baker, St. Johns, and Nassau counties. The EIP falls under the umbrella of the State of Florida Children's Medical Services and is operated by the University of Florida/Jacksonville Department of Pediatrics. An estimated 3000 children were evaluated this past year through the Jacksonville EIP, with approximately 800 of these infants/toddlers receiving ongoing services. Services include, but are not limited to, developmental assessments, services coordination, funding for recommended intervention (not reimbursed by Medicaid or other third party payors), and family education/support. Community agencies (e.g., Cerebral Palsy of Northeast Florida, Easter Seals, and Nemours Children's Clinic) provide the recommended therapeutic interventions under fee for service agreements with the program. It is estimated that an additional 10,917 newborns were screened for a possible hearing impairment through the Infant Hearing Program (another component of early intervention).

Who Can Receive Early Intervention Services?

In the state of Florida, children birth to 36 months of age may be entitled to receive early intervention services if they meet one or more of the following conditions:

  • Physical disability (visual, hearing impairment);
  • Established medical condition (Down Syndrome, Spina Bifida, Cerebral Palsy);
  • Developmental delay (deficits in cognitive, motor); or
  • Communication, social/emotional, and/or adaptive/self-help skills).

What Is The Assessment Process?

Referrals are typically made by PCPs and other professionals providing care to a child with an established condition or a suspected developmental delay. Parents may also request an evaluation if they have developmental concerns. Assessments are performed by a multidisciplinary team that consists of a child psychologist/developmentalist, physician or ARNP, speech/language pathologist, physical therapist, occupational therapist, service coordinator, and/or family resource specialist. Based on the multidisciplinary evaluation, a determination is made regarding the child's eligibility for services. If services are recommended, the service coordinator facilitates the initiation of the proposed interventions. At the conclusion of the evaluation, a Family Support Plan (FSP) is written outlining the needs of the child/family and the specific plan to address these needs (e.g., recommended services, frequency/duration/location of services, method of payment). Preliminary treatment goals are also delineated on the FSP. Federal regulations mandate that the entire process (from referral to the initial FSP) be completed within 45 days. Furthermore, the FSP is reviewed every 6 months, and the child is re-evaluated on an annual basis. Written feedback is provided to the PCP after each formal evaluation in order to communicate the assessment team's clinical impressions and recommendations. Typically, referrals are needed from the child's PCP in order to initiate the recommended services. All evaluations conducted through the Early Intervention Program are optional and free of charge.

How Can The PCP Detect Developmental Delays?

The Primary Care Provider is of paramount importance in the early detection of children who are eligible to receive services through the EIP. Referrals for children with established conditions (e.g., Down Syndrome, Spina Bifida, cerebral palsy) and physical disabilities (e.g., visual/hearing impairment, orthopedic handicap) are straightforward. However, identifying children with potential developmental delays is somewhat more complicated. A variety of approaches are available to assess a child's developmental functioning and a brief summary of these methods is provided in Table 1.

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A combination of parental prescreening and physician surveillance likely represents the optimal pragmatic approach to timely identification of the child at risk for a developmental disorder. "The problem with surveillance (alone) is that studies have shown that, probably for fear of worrying families, physicians tend to underidentify children. They often take a `wait and watch' approach. Then, when it's obvious that the child has a delay, they refer. Parents, though they may suspect a problem, will usually go along with their trusted physician's suggestion. The result is that precious time is lost for an earlier intervention" (Solomon, p. 43). Conservative patient management would suggest that referral for a more complete evaluation should be made upon the suspicion of a delay.

Developmental Checklist

Summary

The Primary Care Provider is usually the first professional with the opportunity to assess the needs of infants/toddlers and their families. Therefore, it is imperative that the PCPs enhance their knowledge about child development and acquaint themselves with services available to all children who may benefit from specialized interventions. The Early Intervention Program is designed to assist physicians and families to ensure that special needs of children zero to three do not go unmet.

REFERENCES

  1. American Academy of Pediatrics, Committee on Children with Disabilities. Statement on early intervention. Pediatrics. 1992; 89(2).
  2. American Academy of Pediatrics, Committee on Children with Disabilities. Statement on early intervention. Pediatrics. 1999; 104(1).
  3. Dworkin, P. Developmental screening: Expecting the impossible? Pediatrics. March 1992; 1,253-1,255.
  4. Florida Department of Education, Division of Public Schools and Community Education. Early Intervention services for your young child with special needs. 1998 (rev. ed.).
  5. Florida State University Center for Prevention and Early Intervention Policy. Florida's children: Their future is in our hands. 1997.
  6. Solomon R. Pediatricians and early intervention: Everything you need to know but are too busy to ask. Infants and Young Children. 1995; 7(3):38-50.
Jacksonville Medicine / March, 2000

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