The ABC’s of Early Intervention for Pediatricians

Families can be referred to individual or specific EI agencies that provide direct services:
            Pediatricians should be aware of the EI agencies available to them in their community.  Traditionally all referrals are processed through the Borough or County Office but referrals can also be made through the EI agencies themselves. It can be much more convenient to work through an agency with whom you are familiar and have an established working relationship.  Networking makes your life easier. You can find agencies by contacting your Early Childhood Direction Center (ECDC) (See resources below) or through the NYC Department of Health (http://www.nyc.gov/html/doh/downloads/excel/earlyint/earlydirectory-sites.xls).  It should be noted that some agencies provide service coordination only, some provide direct services only and others offer both. Having an ongoing, working relationship with two or three agencies in your area can make your job easier by giving you a specific contact person when an EI evaluation is needed.  That contact person can also personally assist the family with the process.  Representatives from specific agencies are usually happy to make appointments and visit you in your office.
 
 

Pediatricians should order a hearing evaluation.
            Pediatricians should be aware that hearing evaluations are not mandated through EI. Pediatricians should therefore ensure that an audiological evaluation has been scheduled before referring children with speech and/or language delay.  A vision evaluation may be helpful as well.
 
 

Emergency EI services are available.
            By regulations, the initial EI process should be concluded within 45 days. In certain circumstances the child may be referred for an emergency evaluation.  An interim IFSP can be requested on emergency basis in children who meet certain criteria (i.e. feeding difficulties, severe delays in a premature baby, etc). This should be requested at the time of referral.  You may still need to allow at least 45 days for a full IFSP.

Pediatricians can stay involved in the EI process and can utilize their special relationship with families to help: 
            EI is parent friendly and cannot be instituted if the parents do not want the services. Furthermore, parents can go to any approved EI agency that they choose. The PCP may be in the best position to explain the importance of the services to the family.  Therefore it is crucial that pediatricians are familiar with the rules and laws of EI in order to help parents (see references below). There are certain rights and due process to which parents are entitled.  For example, while re-evaluations occur every 6 months or annually, they can be done earlier if a parent requests, based on new concerns or a change in status.  In addition, services cannot be decreased without parental agreement.  As pediatricians become better educated about EI, they can help families to become better advocates.

Parents can give consent for the EI evaluation and IFSP results to be shared with the pediatrician.  Parents themselves can provide the reports to the pediatrician.  Have parents prepare a release or include it when submitting the medical evaluation.  Be sure to let parents and EI personnel know that you want to be kept involved. 

A recent medical evaluation is needed for all children in the EI program.  This is an opportunity to include the pediatrician’s impression and findings, as well as thoughts on treatment and need for further evaluation.  Further referrals to specialists may be necessary and should be made in conjunction with the EI process.

Pediatricians can be actively involved in every aspect of the EI evaluation, therapy and service provision, reevaluation and transition.  Physician input can be provided at any point including evaluation of eligibility, the core evaluation, IFSP meeting, reevaluation and transition planning.   (See AAP policy on IEP and IFSP). The ISC or OSC can be contacted with parental permission. 

Prescriptions for physical, occupational and feeding therapy need to be written by the pediatrician:
            Referrals are often needed for audiological evaluations, as well.  Pediatricians are in the best position to advise on certain services such as home or day care and parent support.  In complicated cases where multidisciplinary medical care is needed, the PCP plays a pivotal role in ensuring appropriate therapy.   Since pediatricians are the only team members who can order occupational, physical and feeding therapy, it is critical that PCPs understand the EI team evaluations before recommending therapy.  (See AAP policy on prescriptions for therapy).
 
            EI services can get bogged down if therapy orders are not written in a timely fashion.   If you have any questions, contact the Service Coordinator.  Make sure that you have asked parents to sign a release so that you can review the evaluation and speak to the ISC or OSC.  
 

Children with a confirmed or suspected disability OR children at risk of a disability are all eligible for services.  Medical input can be critical in this determination.  Refer anyone about whom you are concerned.  Children with behavioral issues as the primary concern can be referred as well:

EI is on your side:  
            When parents express concern, take it seriously and refer to EI. Use the EI evaluation to supplement your own screening, surveillance or discussions in the office.  This is the first step to determining whether a problem truly exists. EI can mean providing support and hope to the family.  Provision of services can reduce parental anxiety and provide hope for restoring a child to his/her expected developmental path or, at least, maximizing that path. For all its ups and downs, EI does help children.

Glossary:

Helpful phone numbers and websites: