The finally arrived new Part C regulations have some
interesting features. I haven’t compared the old with the new; CEC is going to
do that within the month. Some of the new regulations are noteworthy for
practitioners of the model described in Routines-Based
Early Intervention, published by Brookes. Direct quotations from the
new-regs document are italicized.
The two disciplines. The
definition of multidisciplinary in §303.24 has been revised with respect
to the individualized family service plan (IFSP) Team composition to require
the parent and two or more individuals from separate disciplines or professions
with one of these
individuals being the service coordinator.
An interesting interpretation of a discipline is the
inclusion of service coordinator, which is actually a role or function. But
this will alleviate the pressure on IFSP teams who have previously thought they
had to find two people other than the service coordinator. The intent,
originally, was to have different perspectives from the field. Now, when we’re
lucky enough to have a service coordinator with content knowledge about child development,
family functioning, and disability, we’ll be fine. In states where service
coordinators are limited in their content knowledge, there will theoretically
be a loss. I can’t say, however, that I’ve noticed much of a gain by having two
additional professionals from different disciplines. Evaluations have to be
rushed anyway, and they’re just for determining eligibility—not for diagnosis,
so we might as well make the process as efficient as possible. A good change.
Scientifically based research. Scientifically based research has the meaning given the term in
section 9101(37) of the Elementary and Secondary Education Act of 1965, as
amended (ESEA).
Transition. New
§303.209(b)(1)(iii) provides that if a child is referred to the lead agency fewer than 45 days before
that toddler’s third birthday, the lead agency is not required to conduct the
initial evaluation, assessment, or IFSP meeting, and if that child may be
eligible for preschool services or other services under Part B of the Act, the
lead agency, with the parental consent required under §303.414, must refer the
toddler to the SEA and appropriate LEA.
If this was already the regulation, I didn’t know about it.
I assume it’s new. This definitely provides relief to the Part C program and
makes sense. We still can’t be sure, though, that a child with a third birthday
on June 1, for example, referred at the end of May won’t be made to wait until
August or September before anyone will provide help. A good change, nevertheless.
The 45 days. New §303.310
(proposed §303.320(e)(1)) requires that, within 45 days after the lead agency
or early intervention service (EIS) provider receives a referral of a child, the
screening (if applicable), initial evaluation, initial assessments (of the
child and family), and the initial
IFSP meeting for that child must be completed (45-day timeline).
When the clock stops has long been a contentious issue, with
states receiving conflicting messages from OSEP. Note that the regulation says
the clock ends when the initial IFSP meeting is completed. Although this could
be interpreted as the IFSP meeting for the first (i.e., initial) IFSP, it could
also be interpreted as the first meeting about the IFSP. In our model, I have
argued that this could be the Routines-Based Interview, even if the signing of
the IFSP happens later—that is, after the 45 days are over. The two problems
with my argument are, first, that, unless the RBI date is documented somewhere,
no accountability is possible about meeting the 45 days. Second, it could delay
service delivery, which is the point of the 45-day requirement. I don’t buy
this second argument, however, because many parents have told us that the RBI
itself is very beneficial. A good
regulation, as long as it doesn’t get misinterpreted by states or the feds.
Abbreviation. “EIS” is
the long-standing, commonly accepted abbreviation used in the field of early
intervention and we do not anticipate any confusion by the abbreviation’s
continued use in programs administered under Part C of the Act.
It is?
Purposes of early intervention. Two commenters recommended that, when describing the purpose of early
intervention services in general, we retain the language that these services
must be designed to serve “the needs
of the family related to enhancing the child’s development” that is in current
§303.12(a)(1). The commenter stated that
meeting family needs is a key component of an early intervention system
and should be addressed routinely in IFSP development, rather than only upon
family request.
The originally proposed regs had included “as requested by
the family, the needs of the family.” In the final version “as requested by the
family” was omitted to ensure that family needs should always be addressed,
unless the family doesn’t want this. We shouldn’t wait for them to ask for
their needs to be met. A good change.
Definition of early intervention services. One commenter
requested that we clarify in the definition of early intervention services
that EIS providers who work with infants and toddlers with disabilities and
their families should focus their services on ensuring that family members and
children have the tools needed to continue developing the skills identified in
the IFSP whenever a learning opportunity presents itself even when a teacher or
therapist is not present.
A great comment. It might even have been mine. If not, I’m
claiming it anyway. The feds weren’t swayed for the following reason:
However, in addition to the
reasons stated, adding language to §303.13 as requested is not necessary
because the definition of EIS provider in §303.12(b)(3) specifies that such
providers are responsible for consulting with and training parents and others
concerning the provision of early intervention services described in the IFSP
of the infant or toddler with a disability. Additionally, this consultation and training
will provide family members with the tools to facilitate a child’s development
even when a teacher or therapist is not present.
They missed a golden
opportunity to discuss preparation for what happens between visits.
Types of early
intervention services—family training, counseling, and home visits. One commenter recommended deleting the reference to “home visits” in
the title of this paragraph because the commenter considered home visits to be
a method of providing a service rather than a service in and of itself… Section
632(4)(E)(i) of the Act expressly states that early intervention services include family
training, counseling, and home visits.
Thus, removing the reference to home visits from §303.13(b)(3) would be
inconsistent with the Act. .
No change was made. The discussion, however, shows that OSEP
still is unclear about how children learn and how services work. The paragraph
following the above discussion is as follows:
The language in
§303.13(b)(3) does not mean that family training must occur in the home or
include counseling. Section 303.13(b)(3)
merely defines three separate early intervention services –- family training,
counseling, and home visits -- that may be provided to assist the family of an
infant or toddler with a disability in understanding the special needs of the
child and enhancing the child’s development.
This suggests the other services, such as special instruction,
OT, PT, and speech-language are not also services that may be provided to
assist the family of an infant or toddler with a disability in understanding
the special needs of the child and enhancing the child’s development. It
implies that the some services are for direct application to the child and
others are for helping the family. Not how I see it!
Furthermore, I always thought home-based was a setting but
not a service. You can’t like home visits in the service section of an IFSP,
can you? I hope someone can straighten me out in a comment following this post.
Unclear.
Sign language and cued sign services. The phrase “as
used with respect to infants and toddlers with disabilities who are hearing
impaired” has not been included in the definition of sign language and cued
language services in new §303.13(b)(12).
The discussion includes the point that it isn’t only
children who are hearing impaired who might benefit from signing. Well done.
Speech-language pathology services. Several commenters recommended adding such services as auditory
habilitation and rehabilitation, dysphagia, auditory-verbal therapy, oropharyngeal, or feeding
and swallowing services to the definition of speech-language pathology
services in new §303.13(b)(15) (proposed §303.13(b)(12)).
No change was made because the definition in this section is
not intended to be exhaustive. Good! We already have too much
overspecialization in early intervention, leading to fragmentation of services
and professionals whose focus is too narrow. We also have certain subspecialty groups
trying to capture the market for certain types of children. Good nonchange.
Other services. Another commenter requested that
the Department revise the language in this paragraph to indicate that any other
services identified in the IFSP of an infant or toddler with a disability be
based on proven methods or evidence-based practices…. Discussion: Mirroring this standard,
§303.344(d)(1) requires that each IFSP include a statement of the specific
early intervention services based on peer-reviewed research (to the extent
practicable) that are necessary to meet the unique needs for the child and the
family to achieve the measurable results or outcomes identified in the IFSP.
This whole idea of services, either those identified as the
regular ones in Part C or “other services,” being based on peer-reviewed
research is laughable. As much as I’d like to advocate for this regulation, the
services used in Part C and the way they are implemented do not have a
sufficient research base anyway. But we’re not going to do away with them. So,
to apply a higher standard to other services would be ridiculous. Furthermore,
in the past 7 years or so, when the field started acting serious about
evidence-based practices, we have become bogged down in debates about which
studies are good enough to be included in analyses of EBPs and how many studies
from how many research groups need to be conducted to determine a practice is
evidence based. And then we have the issue of gradations of evidence-based, because
we’re loath to say a practice is or isn’t evidence based. And this discussion
in the regs is about services, not even practices, and everything is hugely
more complicated when we have such a broad scope as a “specific early
intervention service.” Correct nonchange
but the regs still don’t help us get rid of bogus treatments.
Services neither required nor funded under Part C. Section 303.344(e) provides for the IFSP Team to identify in the IFSP
medical and other services that the child or family needs or is receiving
through other sources, but that are neither required nor funded under Part C of
the Act.
This discussion about a rather pointless comment serves as a
good reminder that these other services can be listed in the IFSP and they don’t
commit the Part C program to pay for them. Many states, especially where
education is the lead agency, shy away from (i.e., tell service coordinators
not to) list these services, in case the family thinks the program is going to
pay for them, as would happen on an IEP. Good
reminder.
Infant or toddler with a disability. : We have revised §303.21(a)(2)(ii) to
add “severe attachment disorders” to the
list of diagnosed conditions that have a high probability of resulting in
developmental delay.
OK, but I think states still have the right to determine for
themselves who’s on their special list for diagnosed conditions. Severe attachment
disorders was the only addition, among a number suggested. The list is of
examples only, however, so I don’t think it really matters.
Multidisciplinary. Multidisciplinary
was defined in proposed §303.24, with respect to evaluation and assessment of a child, an IFSP Team, and
IFSP development under subpart D of this part, as the involvement of two
or more individuals from separate disciplines or professions or one individual
who is qualified in more than one discipline or profession.
Back to this issue, but now focusing on how many people should
be there. Apparently, the transdisciplinary-approach haters rallied to comment
on the regs, because a number of comments wanted to ensure the regs didn’t
allow just one person who might be qualified in two areas (service coordination
and special instruction, for example?) to replace a group, which the commenter
says is explicitly defined in Part B. Commenters requested that the
definition be modified to ensure that multiple perspectives are included on
each IFSP Team and adequate representation is not hampered or constrained on
any given IFSP Team by an individual who is qualified in more than one discipline
or profession. It’s a
toss-up whether representation is more hampered in this situation or in one
where two people have blinkers on, with respect to attending only to areas of
their narrow training.
The discussion about evaluation and assessment includes the
following: With respect to IFSP Team
meetings, we believe it is important for the parent to be able to meet not only
with the service coordinator (who may have conducted the evaluation and
assessments), but also with another individual (whether that person is the
service provider or another evaluator) to obtain input from two or more
individuals representing at least two disciplines and have revised §303.24
accordingly.
They want two people there. For those states using medical
as one of the professions, this is not the intent of this regulation, unless
the child has a chronic illness or something similar. This regulation doesn’t
address how a provider could meet with the family on an initial IFSP, before services
have been determined. I suppose the feds would say that then an evaluator would
serve as the second person. In our model, I want states and teams to consider a
most likely primary service provider (MLPSP).
Some commenters, including possibly me, wanted a reference
to transdisciplinary or interdisciplinary, but OSEP said, referencing specific team models in the regulatory definition of multidisciplinary
is not necessary.
Natural environments. Two other commenters recommended
the definition indicate that a clinical setting could be the natural
environment, particularly when the service requires the use of specialized
equipment that cannot be transported to the child’s home. One commenter expressed concern that
mandating services to be provided in settings where non-disabled children are
present may suggest that the alternative is less than acceptable. Another commenter recommended that the definition of natural
environments require that services be provided within family routines and
activities and opposed identifying specific settings….
We expected clinic-based professionals to challenge the
natural-environments provision. Fortunately, the OSEP response was We do not believe that a clinic, hospital or service provider’s office
is a natural environment for an infant or toddler without a disability;
therefore, such a setting would not be natural for an infant or toddler with a
disability. Good nonchange.
Section 632(4)(G) of
the Act provides that natural environments may include home and community
settings. However, the reference to community settings was not
included in the proposed regulations. “Community settings” was added back in. Good change.
Qualified personnel. Additionally, §303.344(g), which
provides that an IFSP contain information about the service coordinator,
requires that the service coordinator be selected from the profession most
immediately relevant to the child’s or family’s needs or be a person who is
otherwise qualified to carry out all applicable responsibilities under Part C
of the Act.
I don’t know that this is a change, but most service
coordinators in dedicated-service-coordination states are not from the
profession most immediately relevant to the child’s or family’s needs, so let’s
hope they’re otherwise qualified to carry out all applicable responsibilities….
The feds might have been thinking about service coordinators who are also
providers to the family (the blended model). But the second half of the
definition of the qualification is a complete cop-out, just when we probably
needed to raise the qualifications. That responsibility is probably correctly
with the states, but that means we’ll have to be vigilant about which states
actually make it possible for families to have properly qualified (not as
defined in the regs) service coordinators. Confusion
and cop-out.
Paraprofessionals. The feds
continue to allow paraprofessionals to “assist in the provision of early
intervention services to infants and toddlers with disabilities.” They mention
certification and supervision. It’s unclear to me whether a state could allow
paraprofessionals to be the primary service providers or weekly home visitors
to a family. I have serious reservations about the suitability of paraprofessionals
serving in that role. Missed
opportunity.
I have been through all 932 pages of the regs, and the items
above were the only ones worthy of mention. I might have missed other notables,
so I hope readers will post comments below if they have other changes to point
out. Until someone points out something different to me, the most notable
change I notice is counting the service coordinator as one of the two
professionals.
