Early Intervention
An Overview of
Family Centered Early Supports and Services

Parent Information Center PO Box 2405 Concord, NH 03302-2405 Telephone: (603) 224-7005 (800) 232-0986 web:    www.parentinformationcenter.org e-mail: picinfo@parentinformationcenter.org © 4/2003

Early Intervention services for children with disabilities and their families from birth to 2 are provided for under federal law in Part C of the Individuals with Disabilities Education Act and in New Hampshire under He M510, Family Centered Early Supports and Services. Services are provided through the Department of Health and Human Services, Division of Developmental Services, and delivered to the family by their local Area Agency.

Family-centered Early Supports and Services are designed to maximize the family’s ability to understand and care for their child’s developmental, functional, medical and behavioral needs. It does this by providing the family and other caregivers with information, training, special instruction, evaluation, therapeutic interventions, financial assistance, materials and equipment and emotional support.

Those eligible for services are families with a child, birth through 2, who has a developmental delay, is at risk for substantial developmental delay, or has an established condition that is likely to result in a significant developmental delay.

Developmental delay means a child who:

demonstrates a 33% delay in one or more of the following areas: Physical development, including hearing and/or vision Cognitive development Communication Development Social or emotional development Adaptive development, or

has atypical behaviors documented by the family and qualified personnel, such as: Extreme fearfulness or other modes of distress that do not respond to comforting by caregivers Self-injurious behavior or extremely aggressive behavior Extreme apathy Unusual and persistent patterns of inconsolable crying, chronic sleep disorder, regression in functioning, absence of pleasure, interest in adults and peers and inability to communicate emotional needs Persistent failure to initiate or respond to most social situations

A child who is at risk for substantial developmental delay is a child who experiences 5 or more of the following conditions, events or circumstances affecting the child or the parent or a combination of the two:

Affecting the Child	Affecting the Parent
Birth weight less than 1500 grams (3 lbs. 5 ozs.)	Parent with a developmental disability or psychiatric disorder
Respiratory distress syndrome	Family history of lack of stable housing
Gestational age less than 27 weeks or more than 44 weeks	Parental education less than 10th grade
Asphyxia	Social isolation
Nutritional problems that interfere with growth and development	Substance addiction
Intercranial hemorrhage grade III or grade IV	Age of either parent is less than 18 years
	Parent/child interactional disturbances
	Founded child abuse or neglect

A child with an established condition refers to a child with a diagnosed physical or mental condition which has a highly probability of resulting in a developmental delay, even if no delay exists at the time of referral, including, at a minimum, conditions such as:

• Chromosomal abnormality/genetic disorder (ex. Down syndrome)
• An inborn error of metabolism (ex. PKU)
• Congenital malformation (ex. Hydrocephalic)
• A severe infections disease (ex. HIV infection)
• A neurological disorder (ex. Tourette’s syndrome)
• A sensory impairment (ex. Hearing or vision impairment)
• A severe attachment disorder
• Fetal alcohol syndrome
• Lead poisoning
• A developmental delay secondary to severe toxic exposure (ex. drugs)

Family Centered Early Supports and Services defines qualified personnel as meeting New Hampshire requirements for certification, licensing, and requirements including audiologists, dieticians, early childhood educators, family therapists, nurses, nutritionists, occupational therapists, orientation and mobility specialists, physicians, physical therapists, psychologists, social workers, and speech and language pathologists.

What do you do if you think that your child may need services?

1. Referral
If you believe that your child and family are eligible for Early Supports and Services, a referral must be made. A referral is made to your local Area Agency. A parent, doctor, childcare provider or other individual may make a referral. Once the referral has been made, the Area Agency must assign you an intake coordinator who will serve as your interim caseworker until a determination of your child’s eligibility has been made. Besides reviewing the request and talking with the family, the intake coordinator must also provide information relative to Family Centered Early Supports and Services and other community services and inform the family of the process for initiation of Family Centered Supports and Services, including their rights under these rules.

2. Evaluation
If you decide to seek eligibility for services, the Area Agency must obtain written parental consent for evaluations. A TEAM is brought together for a meeting to determine what assessment and evaluations will be conducted. You as a parent are a member of this team along with professionals from two or more different disciplines, and any other individuals you may feel are relevant. The evaluations must be based on informed clinical opinion and include an assessment of your child’s present level of performance in each of these developmental areas:

1. Cognitive development
2. Physical development (including hearing and vision)
3. Communication development
4. Social and emotional development
5. Adaptive development

Also, a family directed family assessment (to the extent that a family agrees) may be conducted to include the family’s description of its needs, concerns, priorities, and resources.

3. Determining Eligibility
Once the evaluations and assessments are completed, the team will meet to determine whether your child is eligible for services. Determination will be based on the results of the evaluation and a team consensus. Parents will be given written notice of the decision. If your child is found ineligible for services, the written notice must include:

1. Other specific supports and services the family may need
2. Family’s right to challenge the determination and the procedure to do so
3. Names, addresses and phone numbers of advocacy organizations that may be contacted for assistance.
4. Findings of the evaluation and recommendations

If your child is found eligible for services, the team will schedule a meeting to develop an Individualized Family Support Plan (IFSP), though this may happen the day you meet to determine eligibility. If not, this meeting must take place within 45 days from the initial referral.

4. Developing an Individualized Family Support Plan
An IFSP helps to ensure that both the family and child receive the services and support they need to help the child grow and develop. If the family is willing, the IFSP should include a statement of the family’s strengths, needs and concerns relating to promoting the child’s development. It must, however, include the following:

	A statement of the child’s present level of physical development, cognitive development, communication development, social or emotional development, and adaptive development
	A statement of major outcomes expected to be achieved for both the child and the family, along with the methods, procedures, criteria and timelines to determine progress
	A statement of exactly what services will be needed to meet the needs of the child and family
	The natural environments in which the supports and services will be provided (If services will not be provided in a natural setting a statement as to why, a plan for the future provision of services in a natural setting and a time line for it must be included)
	The frequency, intensity, and method of delivery, and persons responsible for implementing the services, along with projected dates and duration
	A summary of document medical services a child may need such as hospitalization, surgery or medication and to the extent possible, funding sources (even though Early Supports and Services will not be required to pay for these services)
	The name, telephone number, agency, and location of the case manager and the names of all team members
	Beginning at age 24 months, the steps that will be taken to support the transition from Early Supports and Services to the school district, Area Agency services for children three years of age or older, or community programs
	Parent signature

Supports and services are to be provided in the child’s natural setting (such as the home, childcare program or library story hour). These services may include:

1. Assistive Technology- including the evaluation for, providing for the acquisition of, and training of the child and family
2. Audiology Services- including evaluation, medical referrals, provision of various trainings or devices, as well as for prevention of hearing loss
3. Family Training and counseling (related to helping the family understand the child’s disability and ways to they may support the child’s development)
4. Health Services- including consultations with physicians and for diagnostic purposes. Also included intermittent catheterization, tracheotomy care, tube feeding, and the changing of dressings or ostomy collection bags. Does not include hospitalizations, surgeries or devices necessary to treat or control a medical condition
5. Nursing Services
6. Nutrition Services
7. Occupational therapy- including evaluation for and the provision of supports, adaptation of the environments, orthotic devices, and preventative measures
8. Physical therapy
9. Social Work services
10. Speech and language therapy
11. Vision services

Re-evaluation:
At any time a family may request a reevaluation or reassessment to determine progress, redefine services and outcomes and/or plan for future needs. At least annually, a formal reevaluation must be conducted to review eligibility and provide recommendations to be reviewed by the team for incorporation into the IFSP. The plan itself must be reviewed at least every six months. Written parental consent must be given before any changes can be made to the IFSP. If the parents do not provide consent, it will remain unchanged.

Transition
Once a child turns three, they are no longer eligible for services under Family Centered Early Supports and Services. They may, however, be eligible for special education under RSA 186-C and the New Hampshire Rules for the Education of Children with Disabilities. As with Family Centered Early Supports and Services, there is a process to determine eligibility and provide your child with needed services. A written transition plan should be a part of your child’s IFSP starting at 24 months of age. If your child began receiving Early Supports and Services after age 24 months, the transition plan would be a part of his/her initial IFSP. In preparing this transition plan, you should have discussions with your service providers about:

1. All available community program options for the child such as childcare, private preschool, special education, head start and recreation programs
2. All available community programs for the family
3. All necessary evaluations and assessments to determine eligibility for future programs that must be conducted
4. All procedural safeguards and parental rights and responsibilities

At least 90 days before the child becomes eligible for special education or a preschool program, a meeting must be held including the Family-Centered Early Supports and Services providers, the family and the Local Education Agency (LEA, also known as the school district) or pre school staff. The purpose of this meeting is to determine your child’s program options from their third birthday through the remainder of the school year and to create a transition plan into the local educational agency.

It is important to note that all children who were eligible for services under Family Centered Early Supports and Services may not be eligible for special education at age three. It is the Area Agency’s responsibility to notify (make a referral to) the LEA of your child’s possible eligibility. You should ask your child’s case manager if this has already happened. The LEA then has the responsibility to evaluate your child and determine whether or not they have an educational disability. You have the right to be involved in all meetings surrounding these decisions, and your written consent will be required before evaluations may be conducted.

To learn more about the special education process, your rights and responsibilities contact the Parent Information Center to ask for a copy of The Steps in the New Hampshire Special Education Process.

To be determined eligible for special education, your child must be evaluated and found to have a disability. In addition, the disability must mean that the child requires special education or special education and related services in order to benefit from their education. Once evaluated and found eligible, your child will be classified (coded) into one or more of these 13 categories:

1. mental retardation
2. hearing impairment, including deafness
3. speech or language impairment
4. visual impairment, including blindness
5. emotional disturbance
6. orthopedic impairment
7. autism
8. traumatic brain injury
9. other health impairment
10. specific learning disability
11. deaf-blindness
12. multiple disabilities
13. developmental delay for children ages 3 - 9

Procedural Safeguards
If at anytime a parent or Early Supports and Services provider disagrees with the services the child is receiving, they may access either formal or informal procedural safeguards. Informally you may ask for additional meetings to discuss the issue more fully, share information or take other steps to resolve your disagreement. Formal dispute resolution includes mediation, a hearing or you may file a complaint.