Week 1 OT in Early Intervention

What is the Early Intervention program

a voluntary federally mandated program

offers a collection of therapy and support services to eligible infants and toddlers

enhances child development

minimizes the potential for developmental delay

assist families to meet the specific needs of their children

Targeted demographic for EI programs

infants and toddlers (0-3yr) and their families

children w disabilities or who are at risk of developing them

All eligible children regardless of race, ethniccity, income, disability or immigration status 

What is the primary purpose of EI (Early Intervention)?

To improve a child’s development in the five major developmental domains.

Besides child development, what else does EI support?

Back: Provides families with support (training, resources, empowerment, advocacy).

Who can benefit from EI services?

Back: Children with a variety of diagnoses or with no clear diagnosis.

Front: What approach does EI use?

Back: Family-centered, individualized, team-based approach.

Front: How is EI funded for families?

Back: Provided at no cost to the family (varies by state, e.g., free in NY); covered by private insurance and Medicaid.

4 major components of EI

• family centered practice 

• natural learning environments 

• collaborative team processes 

• service integration 

Legislation: IDEA (Part C)

a federal law that covers/set the rules for early intervention (EI) services for infants and toddlers with developmental delays or disabilities.

How is IDEA (Part C) funded?

Back: Funded by federal, state, and local dollars.

Front: Who coordinates early intervention (EI) services under IDEA Part C?

Back: Each state has an agency responsible for coordinating EI services.

Front: How many services must each state include at minimum in their EI program under IDEA Part C?

Back: 16 services.

What makes a service under IDEA Part C an entitlement?

Back: If the child qualifies, they are entitled to receive the service.

Front: How are children classified under IDEA Part C compared to school-age children?

Back: Children under Part C are not classified by category (unlike school-age children).

Front: What type of approach does IDEA Part C use?

Back: Family-centered approach.

Front: Where are IDEA Part C services delivered?

Back: In natural environments (e.g., home, community settings).

Front: What are the primary areas of occupation addressed in IDEA Part C?

Back: ADLs (rest and sleep), play, and social participation.

Front: What is the IFSP in IDEA Part C?

Back: Individualized Family Service Plan – a written plan detailing the services and supports the child will receive.

Importance of Co occupations

• occupations sharded between childern, family memebers, peers and other adults (two or more people)

• ie: feeding and eating, dressing, bathing, and caregiver- child

OT services in the EI systems are…

• culturally sensitive

• evidence based

• including interdisciplinary team

• including family members and use of coaching and training models

EI requirements of engagement parents

an important part of the team

several coaching models used ( OP coaching model, PCI coaching, DIR parent coaching, embedded coaching etc) 

coaching varies throughout US

What are the elements of NYS Embedded coaching model?

• integrates evidence based, family centered best practice into EI services 

• EI providers work with families to improve a child’s development within their daily routine

• federal and state laws require EI providers to apply embedded coaching in a Childs natural enviroments

Elements of Embedding coaching

• on going observation of routines and conversations with the family

• children and family history, interest and strengths

• family goals, concerns, priorities, resources and routine activities (Ot doesn’t write goals. family creates/determines goals) 

Collaborative coaching

interventionists coach and provide feedback to families

Benefits of embedded coaching

• family centered

• adult learning styles

• done in NE

• helps caregivers gain self confidence and assume responsibility 

Using Telehealth to facilitate the coaching model

• can be used to bring all team members together 

• includes OTP observation of the caregiver and the caregivers observation of the clude as well as practice, reflection and evaulution 

What are some of the components of best practice in EI

Family centered, Natural environments, using activities and routines to become the context for intervention

What are some strategies that can be used in the natural enviroment?

• use incidental learning opportunities 

• follow child’s lead

• use natural consequences to promote the child acquisition of functional motor, social and communication skills

What is the EI procress

referral → initial service coordination → evaluation* → IFSP meeting* → service provision* → review* → transition 

*Otps participate in these areas

What is the evaluation process? 

• must have signed parental/guardian consent to conduct the evaluation

• guided by parents/guardians information about their childs current level of performance and skills 

• OT services are tailored to the childs family services 

• alter and adapt as the family needs change 

The EI Evaluation process can include:

• semi-structured interview (routine based)

• observation

• formal assessments (PDMS-3) 

• criterion references assessments (hawaii early learning profile) 

• informed clinical opinion 

What are some of the approved OT standardized evaluation tools (Norm Referenced)

• peabody developmental motor scale PDMS-3 (more often used)

• alberta infant motor scale (aims)*

• the pediatric evaluation of disability inventory (PEDI)*

• Developmental Assessment of Young Children (DAYC) *

*Usually done when additional OT services need to be added on 

How is Developmental Delay defined in EI

Child hasn’t attained development milestones expected for their chronological age or adjusted age (for prematurity) in one or more areas of development 

• cognitive 

• social emotional 

• adaptive development (ADL)

• physical (gross and fine motor, vision, hearing) 

• communication

Developmental delays must be measured by….

qualified personnel using informed clinical opinion and an appropriate testing tool

Adaptive behaviors

• addresses feeding (bringing food to mouth) and eating (chewing and swallowing)

• interventions to improve feeding mechanics 

• caregiver-infant interaction during feeding 

• sleeping and rest

What is the criteria for EI services?

1. Either 2.0 Standard deviation in one area OR 1.5 SD in 2 areas. 

2. Automatic services provided for specific diagnosis: Fragile X, Downs Syndrome, Spina Bifida, CP, severe metabolic disorders

The individualized Family service Plan IFSP

• legal contract

• meeting for this plan occurs after the completed evals and the child is eligible for EI. plan is developed during the meeting 

  • participants: Parents, and EI official Designee, Inital Service Coordinator, a representative of the evual team, and anyone parents would like to bring to meeting 

Components of an IFSP

• Goals/outcomes (written parent friendly, appropriate for child to perform in their natural setting) 

• frequency, duration, and location of determined services (OT, Speech, ABA, SW, Spec Ed, Vision, RN etc; home, dyacare, centered based, community; basic enhanced)

• Childs present level of performance (cognitive, social emotional, physical,communication, adaptive, family needs) 

• ongoing service coordination identified 

Writing goals and  objectives PFSP outcome statements are..

functional for the child and family → reflective of performance in natural setting → jargon - free → discipline free → active →> positive 

What are the modes of service provision 

• Home and community based individual visits

• family based individual visits

• parent child groups

• group development intervention

• family/caregiver support group

Required Documentation in EI

Session notes → Quarterly notes : done at 3 m and 9 m → 6m review (requires mini assessment, must have age equivalent, developmental milestones included) → annual review done at 12 m 

Payment for OT services

Through reimbursement

• only with direct time with child

• Can be Telehealth but as decreased since 2020

• done by state

• OT needs to timely submitted documentation

• Billing codes

  • (International classification of disease) ICD codes published by the WHO (World Health Organization)

• Type of employment: state, employee, private contractor, agency worker

Transitioning From EI

• starts closer to 2nd birthday but offically happen when 3

• carefully planned by the team

• can be : CPSE, daycare, headstart, UPK 3, private therapy, home

• Support systems are needed for the child/family to facilitate smooth trantion

• IDEA part C (EI) → Part B (CPSE)

• IFSP (0-3y) → IEP (3+yrs old)