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Objectives
• To understand the process of referral through exit within the AzEIP system– Flow Chart– Forms Handout
Initial Visit
Activities• Explanation of Early
Intervention: 7 Key Principles
• Discuss Eligibility • Conduct Vision and Hearing
Screening• Discuss family rights
Forms• Key Principles and Mission
Card
• PWN of eligibility• Vision Screen Checklist • Hearing Screening Tracking
form • Child and Family Rights in
AzEIP
SC visits within 10 days ; AzEIP SC or ASDB SC
Initial Visit (cont)
Activities• Discussion of all funding
sources • Explanation of consents, as
appropriate • Explanation of Child and
Family Assessment
Forms• Family Guide for Funding • Consent for Insurance • Financial Information Form • Percent to Pay Table • Hardship • Rate Sheet • Consent to Obtain Information • Consent to Share Information • Authorization to Disclose
Protected Health Information • Consent for Child Assessment • Child and Family Assessment
Guide for Families
Child potentially eligible based on % delay• Family concerns• No records• Records indicate child is not eligible
Initial Visit
Activities• Explanation of Early
Intervention: 7 Key Principles • Conduct Developmental
Screening, if appropriate• Conduct Vision and Hearing
Screening• Discuss Eligibility, need for
evaluation• Provide and explain child and
family rights
Forms• Key Principles and Mission
Card• Consent for Screening/PWN• Screening tool• Vision Screen Checklist • Hearing Screening Tracking
form • Consent to evaluate -PWN• PWN Refuse to Evaluate• Child and Family Rights
AzEIP SC visits within 10 days
Initial Visit (cont)Activities• Discuss all funding sources • Explain consents, as
appropriate
Forms• Family Guide for Funding • Financial Information Form • Percent to Pay Table • Hardship • Rate Sheet • Consent for Insurance • Consent to Obtain Information • Consent to Share Information • Authorization to Disclose
Information
Evaluation
Activities• 2 team members conduct the
evaluation using AzEIP approved test instruments
• DDD and/or ASDB eligibility simultaneously addressed
• All evaluations include the use of Informed Clinical Opinion
• Team members come to consensus regarding eligibility
• Evaluation cannot be combined with Assessment
Forms• AzEIP approved evaluation
instrument • AzEIP Developmental
Evaluation Report
Conducted by 2 (PT, OT, SLP, VI, HI, SW, Psych, DSI)
Evaluation (cont.)Activities
If eligible: •Explain Child and Family Assessment•Address financial matters•Discuss PWN, eligible•Offer copy of family rights
If not eligible: •Discuss community resources •Process for re-referral •Discuss PWN, not eligible•Offer copy of family rights.
Forms
•Consent for Child Assessment •Child and Family Assessment Guide for Families •Financial Information Form •Child and Family Rights in AzEIP •PWN Eligible•PWN Not Eligible
Initial Assessment• SC from AzEIP (or in some cases ASDB) schedules and
participates in the Child and Family Assessment with the family and: – If eligible based on record review: 2 core team members
( PT, OT, SLP, VI, HI, SW, Psych, DSI)– If eligible based on evaluation: 1 team member (PT, OT,
SLP, VI, HI, SW, Psych, DSI)
• If ASDB is conducting the assessment, 2 team members, one of whom may be certified vision or hearing professional with ASDB
• The Initial Assessment must be completed prior to the Initial IFSP Meeting
Initial Assessment
Activities• Explain Early Intervention: 7
principles • Explain Assessment process • Obtain Consent for
Assessment • SC and team members
facilitate Assessment discussion
• Complete Child Indicators
Forms• Consent for Child Assessment • Child and Family Assessment
Guide for Families• IFSP Child and Family
Assessment pages • Child Entry Indicator
Summary• Rating Definitions • Decision Making Tree
AzEIP SC (or in some cases ASDB SC)
Initial IFSP
Activities• Review Family Priorities
from Assessment
• Complete IFSP - Discuss all funding sources - Discuss family rights and complete needed Consents and PWN
Forms• IFSP • Consent for Insurance • Consent to Share • Consent to Obtain
Information • Financial Information Form • Rate Sheet • Percent to Pay Table • Hardship Request• Child and Family Rights • AzEIP Child Data Forms
Ongoing SC and at least one team member from eval/assessment
6 month or other review IFSP
Activities• Update IFSP pages, as
appropriate• Consents, as needed • Address upcoming
transition, if appropriate • Update data form• Update data base
Forms• Child’s current IFSP • IFSP Addendum pages• AzEIP Child Data Forms
If needed, • Consent to Share
information • Consent to Obtain
Information
SC and all IFSP team members
Annual Assessment
Activities• Prior to, provide family a copy
of Assessment Guide for Families ; ensure they have a copy at assessment.
• Review 7 Key Principles• Obtain Consent for Child
Assessment• Document Assessment
discussion on NEW IFSP pages • Conduct vision and hearing
screening
Forms• 7 Key Principles card• Child and Family Assessment
Guide for Families• Consent for Child
Assessment • IFSP Child and Family
Assessment pages • Vision Screening Checklist • Hearing Screening Tracking
form
SC and at least one IFSP team member
Annual IFSP
Activities• Complete new IFSP
– Transition Activities, as appropriate
• Annual consents as appropriate
• Explain and provide Family Survey
• Update data
Forms• New IFSP form
– Child and Family Assessment pages
– Transition IFSP pages – PEA Notification/Referral
• Consent to Share Information• Consent to Obtain Information• Consent for Insurance • AzEIP Family Survey • AzEIP Child Data Form
SC and all IFSP team members
Transition
Activities• Transition planning at IFSP
closest to child’s 2nd Birthday• Document transition steps on
IFSP• IFSP Transition Planning
Meeting• Coordinate, schedule and
facilitate Transition Conference prior to age 2.9
• Send PEA Notification/Referral Form
• Attend IEP, if requested by the family
Forms• IFSP Transition Plan Page • IFSP Transition Timeline Page • Invitation to the Transition
Conference• Transition Conference
Summary • PEA Notification/Referral Form • Consent to Share Information
SC, all IFSP service providers, and all persons involved in evaluation or assessment (depending on the child’s age)
Exit
Activities• Coordinate with ASDB and
DDD, as appropriate• Complete Child Indicators
Exit Summary • Provide family with Family
Survey • Offer family copy of record • Update AzEIP Child Data
Form • Update I-TEAMS
Forms• Child Indicators Exit
Summary • Family Survey • Postage-paid AzEIP
envelope • AzEIP Child Data Form
SC coordinates and documents the child’s exit from AzEIP
ResourcesAzEIP SC Video Team Based EI Overview video PWN TableEligibility video7 Key principles of Early InterventionScreening videoProcedural Safeguards videoFamily Guide to Funding Data Form Guidance AzEIP List of Approved ToolsExplanation of funding/FCP forms sent to familiesHearing Screen Resources Child and Family Rights Eligibility VideoAssessment videoIFSP videoGuidelines for Requesting EPSDT ServicesTransition videoTransition Activities Table