Ask the Doctor: Early Interventionby Deborah Borchers, M.D.
Q: The child we’re adopting is at risk for developmental delays. Our family doctor mentioned Early Intervention. What is it and how does it work?
A: Early Intervention services are designed to identify and treat developmental problems in children through 35 months of age. These programs were put into place in the United States through the Individuals with Disabilities Education Act (IDEA), guaranteeing certain rights to children with special needs. Because these federal programs are administered on a state level, specific services vary across the country.
Who should be assessed?
No matter where you live, the first step in Early Intervention is to determine whether your child is at risk for a disability. A child’s physician is usually the one who makes the referral, but parents, social workers, and child-care providers can recommend that a child be assessed. A child who joins her family through adoption often qualifies for assessment based on multiple risk factors in her past. These may include (but are not limited to) previous abuse or neglect, exposure to drugs and/or alcohol prior to birth, premature birth, cleft lip/palate, vision or hearing deficits, or a previous history of living in an orphanage. Even children with subtle developmental delays qualify for screening for Early Intervention programs.
Parents should consider initiating a referral if their child has any risk factors for developmental delays, even if there is not yet a specific concern. Research has shown that a routine office visit to a physician will identify fewer than 30 percent of the children who have developmental problems.
What’s the next step?
Once a referral is made, the state is obligated to conduct an initial evaluation and assessment within 45 days. During the initial screening assessment, a developmental specialist determines whether further evaluations are needed. If the specialist believes there is reason to be concerned about the child’s development, a comprehensive, multidisciplinary evaluation is undertaken to determine the child’s specific needs. Referrals may be made to evaluate delays in the child’s overall intelligence, physical development, communication skills, social or emotional development, or daily living skills.
If specialists identify a disability or developmental delay in an eligible child younger than 3 years old, the state is mandated to provide therapeutic services. Some states also provide services to children identified as being “at risk” for delays.
What services will we receive?
Once the determination is made that a child qualifies for services, the next step is to write an Individualized Family Service Plan (IFSP). This written plan is similar to the Individualized Education Program (IEP) that provides assistance to school-age children with special needs. The IFSP has a dual focus, providing care to the child as well as to the family. Parents should be involved in the writing of the IFSP, to ensure that their child’s developmental needs will be met. Review of the IFSP by the developmental team (including the child’s physician, teachers, and other friends or professionals whom the parents choose) and the child’s family should take place at least every six to 12 months to make certain that the child’s needs are still being met through the provided services.
Developmental services provided through Early Intervention programs will vary, depending upon state law, the specific needs of the child and family, and the availability of services where the family lives. The IFSP may include recommendations for home-based services, classroom services (with or without the parent present), or medical-based services (in a hospital or outpatient setting). [For descriptions of common interventions, see box below.]
What should families expect?
Because Early Intervention is a federal program, the initial evaluation is provided at no cost to families. If a child is deemed eligible for ongoing services, these are frequently provided at no cost to the family. In some states, services are provided on a sliding fee scale or are billed to private health insurance or government medical assistance. Treatment sessions, as well as the initial evaluation, may be provided in the child’s home, a child care center, a clinic or hospital’s outpatient facility, or even in a public agency office.
As you begin navigating the Early Intervention system, remember that a key component of the evaluation process is determining the needs of your family as a whole, as well as the needs of your child as an individual. In the medical field we recognize that, by assisting the family, we also provide assistance to the child.
DEBORAH BORCHERS, M.D., is a founding member of the American Academy of Pediatrics Section on Adoption and Foster Care, and the mother of three children adopted internationally.
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