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Completing EI Eligibility Process during State of Emergency

During the coronavirus (COVID-19) state of emergency, the Ohio Department of Developmental Disabilities’s (DODD) primary goal is to protect families and Early Intervention (EI) providers. Health and safety restrictions and best practices make it difficult or impossible to have face-to-face contact with families, so this guidance provides step-by-step guidance for local EI providers about how to complete the EI eligibility process using technology.

To create these guidelines, DODD sought guidance from evaluation tool trainers for the Bayley and Battelle (BDI-2), reviewed Office of Special Education Programs (OSEP) guidance and federal regulations, conferred with EI evaluators, and obtained guidance for how to most effectively administer evaluations via technology. Providers should ensure all activities are well-documented in case notes.

Two appendices, attached to the right of this page, provide visual representations of the steps. The contents of this page are also attached in PDF form. If you have additional questions, please contact your county’s EI program consultant.

Screening Option

Screenings can be offered to families referred to EI who do not have a diagnosis likely to result in a developmental delay. Screenings are one way to help determine which children need an evaluation.

  • The Ages and Stages Questionnaire (ASQ) and the Ages and Stages Questionnaire: Social Emotional (ASQ:SE) may be completed either by phone or virtual visit.
  • As with any screening, complete “Prior Written Notice and Consent for Developmental Screening” (EI-01) prior to administering the ASQ and ASQ:SE. Consent can be obtained via electronic signature, email consent from parent, or text from parent. The Early Intervention service coordinator (EISC) must thoroughly document all steps and activities in case notes.
  • EISC should review screening results with the family, and the family may choose to exit or move on to evaluation.
  • If the family chooses to exit, they are provided information about how to make a referral if a concern should arise in the future.

When determining a child eligible for EI using an evaluation, Ohio Rule 5123-10-02(G) requires the following:

  1. administering a department-approved evaluation tool (Bayley or BDI-2) where at least one of the qualified personnel administering the tool has received department-approved training in administration of the tool;
  2. reviewing the child's history through parent interview and medical, educational, or other records;
  3. identifying the child's level of functioning in adaptive, cognitive, communication, physical (including fine and gross motor, vision, and hearing), and social and emotional developmental domains;
  4. and gathering information from other sources, such as family members, other caregivers, medical providers, social workers, and educators, as necessary, to understand the full scope of the child's unique strengths and needs.

When administering the Bayley and BDI-2 via parent completion of the questionnaire/parent report and virtual observation, it is known that

  • the social-emotional and adaptive domains score at a high confidence level,
  • and the cognition, communication, and motor domains score at a low confidence level.

Based on these factors, DODD has developed the following guidance for conducting evaluations and determining eligibility via technology.

Step 1: Determine if the parent wants to complete the eligibility process or wait

If the parent chooses to wait:

  • Do not exit the family; determine the frequency with which the Early Intervention service coordinator (EISC) will follow up with family (at least every 14 days unless the parent requests otherwise).
  • Determine if the family has any needs and make the necessary referrals.
  • Ask how the family would like to receive their parent’s rights brochure.
  • If the child is within 90 days of their third birthday, provide the local education agency (LEA) contact information.
  • Create a reminder to follow up with the parent as agreed upon.
  • If the family chooses to wait and the individualized family service plan (IFSP) is not completed within 45 days, a family non-compliance reason (NCR) may be used.
  • Thoroughly document all conversations in case notes.

If the parent chooses to proceed:

  • Move to Step 2.

Step 2: Determine if the child has a diagnosed condition.

If the child has a diagnosed physical or mental condition with a high probability of resulting in a developmental delay:

    • Obtain “Consent for Release of Records/Exchange of Information” (EI-06) and/or hospital release of information from parent. EISC may need to reach out to the physician to see what method of signature they will accept (e.g., electronic).
    • Obtain documentation of diagnosed condition or a completed EI-12.
      • Move to Step 3.

If the child does not have a diagnosed condition, but the parent has a concern about development:

  • Move to Step 3.

Step 3: Determine if the family has access to technology with visual capability (phone, tablet, webcam, etc.).

If the child has a documented diagnosis (on list or EI-12) AND

If the child has a diagnosed condition and the family has access to visual technology:

  • Proceed to the assessment process using, at a minimum, the following:
    • personal observation of the child (such as live visual observation, pre-recorded videos, etc.),
    • parent interview,
    • review of medical records,
    • gathering of any additional information from other sources,
    • and identification of the child’s level of functioning in all five domains.

If the child has a diagnosed condition and the family does not have access to visual technology:

  • Develop an interim IFSP by phone.
    • Provide family, potential providers, and any other participants with IFSP Meeting Notice (EI-13) via email or mail.
    • Provide family a copy of “Prior Written Notice” (EI-11) because you are proposing to begin a new service.
    • Complete Determination of “Parent Ability to Pay” (EI-15).
    • Service coordinator coordinates services and funding (including POLR).
    • Complete sections 1, 2, 3A, 3C, 4, and 5 of IFSP.
    • Provide family and provider(s) via mail/email copy of IFSP (EI-04) within 10 days of IFSP meeting.
    • Services must start within 30 days of IFSP (document any noncompliance reasons).
    • Interim IFSPs cannot be entered in the Early Intervention Data System (EIDS); keep a copy in the physical record.
    • As soon as possible, complete child assessment and initial IFSP (updating interim IFSP) and enter in EIDS. During the state of emergency, assessments may be conducted virtually.

If the child needs an evaluation, or the parent requests an evaluation, and the family has access to visual technology:

  • Coordinate the evaluation.
    • Determine who the team will be.
    • Identify potential days/times. The virtual evaluation may need to be done over more than one session.
    • The evaluation team will need to discuss what materials are needed for each child and have a conversation with the family to plan the evaluation. The family is not going to be able to replicate the test kit, so ask questions such as:
      • What are your child’s favorite toys?
      • What does your child like to write with?
      • Does your child have a favorite doll or stuffed animal?
      • Do they have a favorite picture book?
      • Can you have a couple of cups, bowls, and spoons available?
      • What is your child’s favorite snack? 
      • Does your child have something that they like to stack?
  • Move to Step 4.

If the child needs an evaluation or the parent requests an evaluation and the family does not have access to visual technology or chooses not to have a virtual evaluation:

    • Explain to the parent that an accurate evaluation requires observation and discuss potential options (e.g., submitting video).
    • Identify family priorities and needs through conversation.
    • Offer to provide service coordination to assist the family in accessing resources until completion of an evaluation is possible.
    • Determine the frequency with which the EISC will follow-up with family (at least every 14 days unless the parent requests otherwise).
    • No IFSP is completed at this time, but all activities need to be thoroughly documented.
    • Ask how the family would like to receive their parent rights brochure.
    • Select “System Reason - COVID-19” as the NCR if the IFSP is not completed within 45 days of referral.

Step 4: Complete evaluation in all five domains using the Bayley or BDI-2 using a qualified evaluation team. Evaluators should document any adaptations made when conducting evaluation using tele-format. The evaluation team can support the parent in acting as a guided facilitator for some of the evaluation test items.

If the child is eligible by 1.5 Standard Deviation (SD) delay in either the Social-Emotional or Adaptive domains: 

  • Proceed to assessment process for program planning using, at a minimum:
      • personal observation of the child (such as live visual observation, pre-recorded videos, etc.),
      • parent interview,
      • review of medical records,
      • gathering of any additional information from other sources,
      • and identification of the child’s level of functioning in all five domains.
    • In EIDS, select the actual range for S-E and Adaptive; enter the highest range for other domains.
    • Child is eligible until age 3.

If child is not eligible by 1.5 SD delay in either the Social-Emotional (S-E) or Adaptive domains:

  • Move to Step 5.
    • In EIDS, select actual range for S-E and Adaptive; enter highest range for other domains. Enter whether informed clinical opinion (ICO) was used to confirm a delay in a particular domain.

Step 5: Determine eligibility using informed clinical opinion (ICO): Complete further evaluation using parent report, observation, and, as needed, an additional assessment tool in communication, cognition, and motor domains to support ICO.

If the child is eligible via ICO:

  • Proceed to the assessment process for program planning using, at a minimum:
      • personal observation of the child (such as live visual observation, pre-recorded videos, etc.),
      • parent interview,
      • review of medical records,
      • gathering of any additional information from other sources,
      • and identification of the child’s level of functioning in all five domains.
    • Eligibility will need to be redetermined prior to the annual IFSP.
    • Move onto IFSP coordination and development.

If the child is NOT eligible via ICO:

    • Have a conversation with the family to discuss any additional information that could result in eligibility.
    • Offer to follow up with the family for an in-person evaluation when it is possible to complete an in-person evaluation. Determine when and how parents want follow-up to occur.
    • Determine current family needs and make any appropriate referrals.
    • Complete EI-9 and EI-10, as per rule, thoroughly document all activities and conversations in detail, and exit the child after the 10 days prior written notice.
    • Ask how the family would like to receive their parent rights brochure and provide a copy.

Reminders

  • Procedural safeguards and confidentiality must be maintained regardless of the delivery of the evaluation, assessments, and services.
  • Thoroughly document every conversation and step of this process.
  • When entering child assessments in EIDS, observation can be selected as the drop-down choice if no tool is used. Similarly, if a tool is used to assess some of the domains, that tool can be entered, with the applicable domains marked as “Yes” in regard to whether that tool was used to assess each domain, and then observation also would need to be entered to indicate that the remaining domains were assessed via observation only.

References and Resources

For other DODD Early Intervention communications, visit DODD's COVID-19 page.

Individualized Family Service Plan Guidance

Informed Clinical Opinion (ICO) Guidance

OAC 5123-10-02 EI program-eligibility and services rule