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INITIAL EVALUATIONS

Initial Evaluation and Assessment

The Iowa Department of Education, as the Lead Agency, ensures that each infant and toddler who is referred for evaluation to determine the need for early intervention services receives a timely, comprehensive, multidisciplinary evaluation unless determined eligible through a review of medical and other records. The evaluation team, which includes the family and is led by the service coordinator, works collaboratively to complete the evaluations/assessment. Area education agencies and Child Health Specialty Clinics complete all evaluation/assessment procedures in order to establish eligibility and address the concerns of the family about the child’s development.

Multidisciplinary evaluation/assessment is defined as the involvement of two or more separate disciplines or professions, which may include one individual who is qualified in more than one discipline or profession. 

Evaluation means the procedures used by qualified personnel to determine a child’s initial and continuing eligibility. 

Assessment means the ongoing procedures used by qualified personnel to identify the child’s unique strengths and needs. In addition, appropriate services to meet the child and family needs are identified.

Components of Comprehensive Evaluations

Area Education Agencies or Child Health Speciality Clinics are responsible for completing the comprehensive, multidisciplinary evaluation. The purpose of the evaluation is to determine eligibility. The Initial Eligibility Determination Decision Flowchart provides decision-making processes to support the team in determining eligibility. It is important to note that the initial child and family assessments may occur simultaneously with the evaluation process.

To complete a comprehensive evaluation, the team seeks information to determine the child’s level of functioning in each of the following areas of development:

  • Adaptive/Self-Help (e.g. feeding, dressing, bathing, toileting);
  • Cognitive (e.g. exploring own hands/toys, figuring out simple problems);
  • Communication (e.g. making sounds, babbling, talking, listening, responding to others, and expressing wants or needs);
  • Physical including vision and hearing (e.g. grabbing things with fingers and hands, reaching, moving, crawling, walking, seeing, hearing); and
  • Social/Emotional (e.g. interacting with family and familiar adults, playing with others, following simple rules).

Multiple instruments and procedures should be used to assist with the comprehensive evaluation of infants and toddlers, including health and nutrition, such as behavior checklists, structured interviews, play-based assessments, adaptive and developmental scales, and norm-referenced, curriculum-based and criterion-based instruments.

All evaluations must ensure, at a minimum: 

  • No single source of data may be used as the sole criterion for determining a child’s eligibility for Early ACCESS.
  • Procedures include the Review Records, Interview, Observations, Test (RIOT) framework.
  • All areas of development are evaluated. 
  • All evaluations are conducted in the native language of the child unless it is clearly not feasible to do so.  
  • All evaluation procedures and materials are selected and administered so as not to be racially or culturally discriminatory.  
  • Evaluations are conducted by qualified personnel in a nondiscriminatory manner. 
  • Timelines for completing the evaluation and initial IFSP meeting are within 45 calendar days of referral. 
  • There is no cost to parents.

In order to determine the appropriate initial evaluation and assessment procedures, the team must begin the process with this question: “What conditions and information are available about the child to make an evaluation and assessment decisions?” 

Diagnosed Condition:  If the child has a physical or mental condition known to cause later delays AND the documentation of the condition in medical or other records are available for review, the child is eligible for Early ACCESS.

  • No additional evaluation is necessary. 
  • The team must conduct child and family assessments using the RIOT process. 

Established Delay and Available Records:  If the child has an established delay of 25% or more and is documented in medical or other records, the child is eligible for Early ACCESS. 

  • No additional evaluation is necessary. 
  • The team must conduct child and family assessments using the RIOT process. 

No Diagnosed Condition or Established Delay and Parent Consent: If the child does not have a diagnosed condition or an established delay AND parent consents to a full evaluation, then the team completes an evaluation and assessment using the RIOT process to collect multiple data sources. 

Note: No single source of data may be used as the sole criterion for determining a child’s eligibility for Early ACCESS.

 

Assessments

Once the team has adequate data to indicate the child may be eligible, assessments of the unique strengths and needs of the infant or toddler are conducted. Often, these assessments occur simultaneously with the evaluation. Child assessments are used to identify unique strengths and needs in all required areas of development.  Teams must use the RIOT processes to gather assessment data on the child. 

Additionally, family-directed assessments are used to identify the family’s resources, routines, priorities, concerns, and the supports and services necessary to enhance the family’s capacity to meet the developmental needs of the child. Possible family assessment tools may include:  

  • ECO-mapping (to get a good picture of family informal and formal support networks);
  • Robin McWilliam’s Routine Based Interview (RBI) which is both a tool and a process; 
  • Juliann Woods’ tools for assistance with interviews of the family for discovering child strengths and family routines and resources (http://fgrbi.fsu.edu);
  • The FACS (Family Assessment Conversation Statements) adapted from Family Statements page of the Iowa IFSP; and 
  • The Puckett Institute tools, such as the ABC Matrix. 

This use of an assessment tool is not to be a standardized measure of family risk factors for abuse, neglect, poverty, or lacking parenting skills.

The Framework for Gathering-Giving Family Info document organizes a variety of family assessments to aid teams in selecting the most appropriate tools for the family. The Family-Directed Assessment Guidance provides guidance to Early ACCESS stakeholders on family-directed assessment practices.

Using the RIOT Process 

In Iowa, teams use a process referred to as RIOT to gather and collect data during evaluation and assessment. Because no single procedure is used for determining a child’s eligibility in Early ACCESS and procedures must include using an evaluation instrument, taking the child’s history, identifying child’s level of functioning, gathering information from other sources such as family members and other caregivers, Iowa uses a process called RIOT as a systematic way of making sure requirements are met. The RIOT process ensures multiple sources of information are used to make key decisions.  This process may vary with the needs of the child and family, and the process is unique for each child.

The RIOT process includes: 

  • a review of the child’s medical and other records (REVIEW),
  • a family assessment interview (INTERVIEW),
  • observation of the child in typical routines and activities (OBSERVATION), and 
  • administration of a norm-referenced evaluation tool or test to assist in identifying the child’s level of developmental functioning (TEST).

 

Review

A member of the multidisciplinary evaluation team reviews the relevant documents available for the infant or toddler and determines what information is important to the evaluation. 

Records that might be reviewed include records related to the child’s current health status and medical history, existing child reports related to evaluation, assessment, and prior screenings.

Interview

The interview process is used to gather information on the child’s abilities to participate in daily activities, also referred to as the child’s current level of functioning.

Members of the multidisciplinary evaluation team interview the parents and other individuals with direct knowledge and understanding of the child and family with respect to the specified areas of development within the context of the home or other community settings.

A conversational interview process is used to help the family identify and share their resources, routines, priorities, and concerns.

Observe

Team members may observe children in their natural environment and within the families’ daily routines and activities such as eating, playing, and dressing. 

Child interactions with the family, friends, and other professionals are also observed.

Test

Testing is the process of gathering direct information and providing a numeric measure of performance gathered through a variety of means.

Testing may include and is not limited to rubric assessments based on functional skills, functional behavioral assessments, curriculum-based assessments, norm or criterion-referenced assessments, or performance assessments through the completion of specific tasks.

Tests or assessments may be administered to assist with determining: functioning level in all required areas of development; the gap between the child’s current level and expected development; additional areas where more in-depth evaluation may be needed; and if additional testing is needed. 

Eligibility Determination

After the evaluation and/or assessment process is completed, the Service Coordinator schedules the initial Individualized Family Service Plan (IFSP) meeting with the family and members of the IFSP team. During the initial IFSP meeting, information and evaluation results are reviewed to discuss the eligibility of the child for Early ACCESS.   

The Initial Eligibility Determination Decision Flowchart provides decision-making processes to support the team in determining eligibility.

Preparation for eligibility based on diagnosed condition:

  • Gather and review data to support the known condition and results of assessments.
  • Complete the initial IFSP meeting.

Preparation for eligibility based on a 25% delay:

  • Gather and review data to support a 25% delay.
  • Complete the initial IFSP meeting.

Preparation for eligibility based on Informed Clinical Opinion (ICO):

  • Gather and review data to support informed clinical opinion.
  • Complete the initial IFSP meeting.

The IFSP team has four choices when making the eligibility determination decision: 

 

A child is eligible based on diagnosed condition

Infants and toddlers referred to Early ACCESS may have a diagnosed physical or mental condition that: 

  • Has a high probability of resulting in a developmental delay; and
  • Includes conditions such as chromosomal abnormalities; genetic or congenital disorders; sensory impairments; inborn errors of metabolism; disorders reflecting a disturbance of the development of the nervous system; congenital infections; severe attachment disorders; disorders secondary to exposure to toxic substances, including fetal alcohol syndrome; and preterm birth less than 32 weeks gestation or very low birth weight less than 1500 grams (3 pounds 5 ounces).

Children with certain documented diagnosed conditions are automatically eligible for Early ACCESS services without having to conduct an evaluation. The Early ACCESS “Diagnosed Conditions Eligibility List” provides names of diagnosed conditions and if the condition automatically qualifies a child for services. Children with diagnosed conditions that are not automatically eligible for Early ACCESS should still be referred, screened, and/or evaluated for developmental delays.

For additional information on the development of the Initial IFSP, click here.

A child is eligible based on a 25% delay in at least one developmental area

Infants and toddlers referred to Early ACCESS may be experiencing a developmental delay in one or more of the following areas:

  • Cognitive development;
  • Physical development including vision and hearing;
  • Communication development;
  • Social or emotional development; and
  • Adaptive development. 

The infant or toddler with a 25% or greater delay in one or more of these required areas of development is considered eligible for Early ACCESS services.

For additional information on the development of the Initial IFSP, click here.

Note: For children with a diagnosed condition AND who have a 25% delay in one or more of the previously described developmental areas, the IFSP team designates diagnosed conditions as the determination criteria for eligibility.

A child is eligible based on the team’s informed clinical opinion

The professional judgment (informed clinical opinion) of evaluators becomes a significant factor in the eligibility decision-making process especially when norm-referenced evaluation instruments cannot be used to adequately identify the presence or absence of a developmental delay. If the results of the evaluation indicate concerns in the child’s development but are not at the 25% delayed level, it may be appropriate to provide early intervention services to the child and family. An eligibility decision would be made when there is expressed parental concern and the evaluators’ clinical opinion establishes the child and family could benefit from early intervention services until the time when the parent has no more concerns and delays in development are no longer evident.  For additional guidance on determining informed clinical opinion, refer to the Informed Clinical Opinion document.

For additional information on the development of the Initial IFSP, click here.

A child is not eligible

An initial IFSP meeting is not required, however, the family must be provided Prior Written Notice stating the child is not eligible for services.  The service coordinator explores other community options with the family and makes referrals as appropriate.  With parent permission, ineligible children should be referred to the local Title V child health agency or Child Health Specialty Clinic for developmental monitoring.  Parents should be informed they may make a new referral if they have concerns about their child in the future.

Case Closures

For more information on closing Early ACCESS cases, please visit our Case Closure page.