CHILD FIND, REFERRALS, CASE CLOSURES, AND INTAKE

Comprehensive Child Find

The Iowa Department of Education, in collaboration with Iowa Department of Health and Human Services and Child Health Specialty Clinics, ensures all infants and toddlers with disabilities in the state who are eligible for early intervention services are identified, located and evaluated year-round.

The AEAs are responsible for implementing Iowa’s Comprehensive Child Find System to identify children under the age of three who are in need of early intervention services. The Child Find process includes a public awareness program, central directory of services and comprehensive referral and identification procedures.

Additionally, the AEAs must coordinate with other major efforts responsible for providing various education, health, social service programs and tribes/tribal organizations as part of the Child Find process. This includes the following:

• Child Find authorized under Part B of IDEA (Special Education)  
• Maternal and Child Health agencies (MCHB or Title V)  
• Early and Periodic, Screening, Diagnosis and Treatment Program (EPSDT) 
• Developmental Disabilities Assistance and Bill of Rights Act, administered by the Department of Health and Human Services  
• Early Head Start, Head Start  
• Supplemental Security Income (SSI) Program  
• Medicaid  
• Child protection and child welfare programs, including programs administered by the Department of Health and Human Services (CAPTA)  
• Child care programs  
• Programs that provide services under the Family Violence Prevention and Services Act
• Early Hearing Detection and Intervention (EHDI) systems  
• Children’s Health Insurance Program (CHIP)/Healthy and Well Kids in Iowa (Hawki)

Referrals

Referrals for early intervention services can come from anyone who has any concern about the child’s growth and/or development.  An infant or toddler may be referred to Early ACCESS with parent knowledge and approval, however, written parental consent is not required.  Referrals are made by phone, email, or online referral form. 

The Iowa Family Support Network is Iowa’s public awareness program which provides information about Early ACCESS services and assists families, community members and other referral sources with information about how to make a referral.

The following information is gathered at referral:

• Referral source information.
  • If the referral source is the parent, how they learned about Early ACCESS.
• Reason for referral. 
• Child demographic information: name, age, email, family’s address. 
• Prior pre-referral screenings, if available. 
• Language spoken in the home. 
• Other important information (e.g., date of discharge from Neonatal Intensive Care Unit).
• Supporting Documentation - referral sources may share releases, pre-referral screening results, copies of medical reports or information supporting the reason for referral to Early ACCESS.

After the child’s referral has been received, the AEA must assign a service coordinator to the family.

If a child moves into Iowa from another state and has an IFSP, the referral source is Out of State Part C. The Early ACCESS team must determine eligibility based on Iowa’s definition of eligibility.

If the date of referral is fewer than 45-days prior to the child’s third birthday, the child is referred to the Area Education Agency’s Special Education Child Find (IDEA Part B) rather than Early ACCESS.

Intake

The Early ACCESS intake process begins with the assignment of a service coordinator. The date the referring source contacts Early ACCESS is the start date of the 45-day timeline for completion of post-referral screening (if applicable), evaluation and assessment, eligibility determination and the initial IFSP meeting.  During the intake process, the service coordinator will make contact with and visit the family.  The family is provided with information on early intervention services and decides if they would like to proceed with the post-referral screening and/or evaluation and assessment process.

The IFSP meeting is to be held within 45 days of the referral; however, families may need time to process and respond, due to various circumstances.  It is acceptable for them to remain in the intake process for more than 45 days with proper documentation of family contacts.

First Visit with the Child and Family

Once the service coordinator (SC) makes contact with the family, they will set up a time to visit the child and family. Typically, the first visit will happen in the family’s home. During the first visit, the SC will:

1. Provide an overview of Early ACCESS services. This includes the purpose, a family’s right to a service coordinator, eligibility criteria and information on the post-referral screening and evaluation/assessment process, the different types of services available, and that there are no costs to families for service coordination, screening, evaluation/assessment and if eligible, early intervention services.
2. Discuss and listen to the family to begin to identify child and family strengths, interests, concerns, and needs; begin anticipating evaluation needs, and learn of potential needs and priorities of the child and family.
3. Determine if any post-referral screenings are necessary to gather additional data to help the family and team decide if the child should have a comprehensive, multidisciplinary evaluation and assessment. If no pre-referral developmental screening is completed prior to the referral and there is no known condition, a post-referral screening may help the IFSP team decide whether they want to proceed to a full evaluation.
4. Seek consent for evaluation and assessment. If the parent requests only one or two developmental areas to be evaluated, the SC must explain to the family that all areas are required to be evaluated.

Post-Referral Screenings

Post-referral screening may be used to gather information to help a family decide if an evaluation is appropriate. Post-referral screening may be used if:

• No pre-referral developmental screening completed by the referral source.
• No diagnosed condition which makes the child eligible for Early ACCESS.
• Referred for a hearing concern.
• Referred by the Department of Health & Human Services.
• Parents have questions about their child’s development.

Post-referral Screenings may include:

• Developmental Screenings (e.g., Ages and Stages Questionnaire (ASQ); ASQ:Social Emotional
• Hearing screens

At any point in the post-referral screening, a parent may request a full evaluation, regardless of post-referral screening results.

Completing a post-referral screening does not alter the 45-day timeline for completing the evaluation, determining eligibility and holding the initial IFSP meeting.

If the team offers the parents a post-referral screening:  

1. Provide and review current Early ACCESS Procedural Safeguards Manual with parent(s). 
2. Obtain parent signature on Consent for Early ACCESS Post Referral Screening with Prior Written Notice form.
3. Complete screening

• • If post-referral screening information indicates the child is not suspected of having a developmental delay or disability, then the service coordinator will ensure the post-referral screening summary is completed, share results and inform parents they may request an evaluation and provide a Prior Written Notice.
  • If post-referral screening information indicates the child is suspected of having a developmental delay or disability, the service coordinator will ensure the post-referral screening summary is complete, share results and seek consent for evaluation and assessment.

Preparing for Evaluation and Assessment

If the parent consents to evaluation and assessment, the SC will:

1. Provide and review current Early ACCESS Procedural Safeguards Manual with parent(s). 
2. Obtain parent signature on Consent for Early ACCESS Evaluation & Assessment with Prior Written Notice form.
3. Discuss sources of existing records and evaluation/assessment information needed for Early ACCESS processes that have already been obtained and/or obtain Consent to Release & Exchange Information.
   • If needed, a Consent to Release and Exchange Information form should be completed at the meeting (or prior to) to allow information to be exchanged with providers from outside the network of Early ACCESS service providers. Getting a signed consent to release and exchange for the referral source is strongly encouraged so that Early ACCESS can share evaluation results with the referral source.
4. Discuss child’s medical insurance. If the child is insured by Medicaid, seek parental consent to release information for Medicaid reimbursement to include evaluation and the IFSP services.
5. Make arrangements to complete the evaluation/assessment.
   • Establish how the family and team members will communicate in the future (e.g. provide contact information; establish preferences for when and how to communicate). 
   • Schedule future times the family can meet with the service coordinator and evaluators. 
   • Complete the evaluation/assessment and document the results in the IFSP system.
6. If the parent declines or refuses evaluation/assessment for their child, the service coordinator will provide the family with Prior Written Notice (PWN) that indicates an evaluation will not be conducted due to lack of parent consent, and follow case closure procedures
7. If the parent withdraws consent for the evaluation after written consent has been provided, all evaluation activities stop. In addition, a parent can complete the evaluation process then decide they do not want to move forward with an initial IFSP meeting. In both of these cases, the service coordinator will: provide the family with a Prior Written Notice (PWN) that indicates either (1) an evaluation will not continue and eligibility will not be determined or (2) eligibility will not be determined due to parent declining to hold an initial IFSP meeting.  Follow case closure procedures. 

NOTE:  If parents have signed consent for evaluation and assessment and cannot be found after (to schedule or complete the evaluation), the SC must follow procedures for “unable to make contact with the family” and sends a Prior Written Notice (PWN) with a letter documenting that the agency will not be conducting an evaluation.  If the PWN comes back undeliverable, file the actual or electronic copy of the returned envelope and PWN in the child’s record.

Case Closures

There are a variety of reasons a child’s referral is ended. The service coordinator will document contacts and contact attempts for each referral they are assigned. 

End codes in the state IFSP system are used for children who do not develop an initial IFSP. When a referral to Early ACCESS is ended, a reason is documented – these reasons are described below.  Codes & Definitions Used in the ACHIEVE System – Early Intervention is a resource that will assist teams in documenting referral end codes in Iowa’s IFSP system.