FYI

As the NYC Early Intervention program is very dynamic and frequently evolving, providers need to be constantly re-trained regarding processes to ensure compliance.  Make sure not to toss out memos from provider agencies, and check the EI website every quarter to be informed of regulatory changes and/or new rules.  The NYC EI website is a resource trove for agencies, interventionists, EI providers, and families.  You'll find the most current EI Policy and Procedure Manual, guidance memos regarding changes in Early Intervention, updated forms, audit tools, information on Embedded Coaching, and downloadable brochures and handouts for families and providers.  

A LOT of good read

Warning: Evaluation Info Overload ☺

Check out this article and let me know what you think. It's a journal article that is being recommended by ESU (Evaluations Standards Unit).  *The Anderson article on "Appropriate and Inappropriate Interpretation and Use of Test Scores in Early Intervention," Journal of Early Intervention, 2004, Vol. 27, No.1, pp 55-68.  It offers description of informed clinical opinion on both an individual level and on a team level and the difference between the two.

Fellow evaluators, as per NYS DOH EIP Memo 2005-02, we ought to recognize and understand:
1) the necessity of documenting clearly the evidence that supports eligibility determinations under the EIP, including the use of standardized instruments and informed clinical opinion;
and 2) that such documentation is subject to monitoring (which could include clinical record reviews) by municipal and state representatives.   We need to consistently ensure that evaluations are performed appropriately, and eligibility is well documented and established for all children and families participating in the Early Intervention Program.

The use of the Department of Health (DOH) publications on Clinical Practice Guidelines on assessment  (and treatment) offer information and recommendations based on scientific evidence and expert clinical opinion on effective practices for children with or suspected of having autism/pervasive developmental disorders, communication disorders, motor disorders, hearing loss, and Down Syndrome.  As indicated in the 2005-02 Memorandum, clinicians should also refer to recognized clinical practice guidelines and standards, including the Department's clinical practice guidelines and the guideline recommendations for in-depth assessment procedures for each of these conditions should be used as part of the MDE (multidisciplinary evaluation) procedures for the guidelines that have been published and disseminated.

The DOH Clinical Practice Guidelines can be accessed via the links below or ordered from the state (free of charge).

Autism/Pervasive Developmental Disorders – Assessment and Intervention for Young Children (Age 0-3 Years): Report of the Recommendations
Communication Disorders - Assessment and Intervention for Young Children (Age 0-3 years): Report of the Recommendations.
Down Syndrome - Assessment and Intervention for Young Children (Age 0-3 Years): Report of the Recommendations (PDF, 1.43MB, 292 pg.).
Hearing Loss – Assessment and Intervention for Young Children (Age 0-3 Years): Report of the Recommendations (PDF, 1.62MB, 301 pg.).
Motor Disorders - Assessment and Intervention for Young Children (Age 0-3 Years): Report of the Recommendations (PDF, 2.03MB, 322 pg.).
Vision Impairment - Assessment and Intervention for Young Children (Age 0-3 Years): Report of the Recommendations (PDF, 1.92MB, 290pg.)

State guidelines indicate that "professionals are responsible for adhering to recognized standards of practice for their respective disciplines, and to use evidence-based practice recommendations when available, including the clinical practice guidelines issued by the Department, in the conduct of multidisciplinary evaluations and eligibility determinations under the EIP." Team collaboration need to be regularly practiced by evaluators involved in a case.  As we know, according to the state, "eligibility determinations cannot be made on the basis of isolated delays in specific skill areas. Rather, the evaluation team must, using their informed clinical opinion, decide whether composite evaluation findings, considered together, are consistent with eligibility criteria for the EIP."  In addition, no single procedure or instrument may be used as the sole criterion or indicator of eligibility.  The MDE team must rely on information from a variety of appropriate sources, which should include standardized instruments and procedures, when appropriate or possible; observations of the child; parent interviews; informed clinical opinion; and, any other sources of information about the child's developmental status available to the team conducting the child's evaluation. 

If a standardized test is used in combination with other procedures (diagnostic tests, observation, parent report, examination of medical records, etc.), any scores from the test must be used in combination with all other sources of information to determine eligibility.  For example, if the evaluation team uses a standardized language test, and the child receives a subscore of 2 standard deviations below the mean in expressive language, but shows no, or a less significant delay, in receptive language, the child would not be eligible for the EIP, unless the results of the evaluation also substantiate the existence of a preponderance of clinical clues/indicators of problems in language and communication development.  In other words, it is possible for a child to have a developmental delay and not meet the eligibility criteria for the EIP. Children who appear to be experiencing a normal variation in development (e.g., "late talkers," "late walkers") may continue to receive screening and tracking, preferably through their primary health care providers, to monitor their developmental progress.  In cases where symptoms or problems do not occur alone, but may be secondary to other problems or conditions, it is incumbent upon the evaluation team to determine whether: the presenting symptom or problem represents a normal variation in development that any child and his/her family might experience (e.g., difficulties in regulating sleep-wake cycles, feeding problems, challenging behaviors, etc.); or, the child is experiencing significant developmental delays affecting one or more domains or a physical or mental condition with a high probability of resulting in developmental delay that qualify the child for the EIP. (Memo 2005-02).

Helpful NYS DOH EIP Links

http://www.nyhealth.gov/community/infants_children/early_intervention/memoranda/2005-02/cover_memo.htm
http://www.nyhealth.gov/community/infants_children/early_intervention/memoranda.htm
http://www.nyhealth.gov/community/infants_children/early_intervention/memoranda/2005-02/index.htm
http://www.health.state.ny.us/community/infants_children/early_intervention/