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INITIAL EVALUATIONS

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Initial Evaluation and Assessment

The Iowa Department of Education, as the Lead Agency, ensures 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 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 and appropriate early intervention services to meet the child and family needs are identified. It includes the assessment of the child and of the child’s family.

Qualified personnel means personnel who have met state-approved or state-recognized certification, licensing, registration, or other comparable requirements that apply to the areas in which the individuals are conducting evaluations or assessments or providing early intervention services.

Using the RIOT Process 

In Iowa, a comprehensive, multidisciplinary evaluation and assessment of the child and family includes information gathered from multiple sources of data using a RIOT process. The RIOT process stands for Review, Interview, Observation, and Test.  These are the different methods teams may use to assist in identifying a child’s level of developmental functioning and determining eligibility for Early ACCESS. 

No single procedure may be used for determining a child's developmental functioning and eligibility thus the RIOT process ensures multiple sources of information are used to make decisions.  The methods used by a multidisciplinary team may vary based on the child and family and is unique for each child.  

More information on the different methods is below:

Review

The multidisciplinary team reviews the relevant medical, educational, and other documents available for the infant or toddler to determine what information is important for the evaluation and assessment. A child’s medical and other records may be used to establish eligibility if the records indicate the child meets the eligibility criteria for Early ACCESS. 

Records which may be reviewed include records related to the child’s current health status and medical history (hearing, vision, and medical diagnosis), existing child reports related to evaluation, assessment, and prior developmental screenings. The reports may include information from a developmental pediatrician, another State Part C program, or private provider.

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 information about a child’s development and determining a numeric measure of performance which may include a convergence of data gathered through a variety of means.

Multidisciplinary and IFSP teams identify a child’s unique strengths and needs by completing initial and ongoing assessments throughout the period of a child’s eligibility. The assessments assist with determining the functioning level in all required areas of development; gaps between the child’s current level and expected development; changes in developmental progress; and plans for individualized early intervention services.

Components of Comprehensive Evaluations

The purpose of the evaluation is to determine a child’s initial and continuing eligibility for Early ACCESS.  Before teams begin the evaluation process, they should ask “What information is already available about the child?”  Identifying existing information will assist the team in determining the evaluation and assessment procedures which are used to determine a child’s eligibility, level of functioning, and early intervention services.

An evaluation must be able to determine whether a child is experiencing a developmental delay, which is a 25 percent delay.  Eligibility determination is made through the administration of appropriate diagnostic instruments and procedures.

The Initial Eligibility Determination Decision Flowchart provides decision-making processes to support the team in determining the appropriate evaluation and assessment procedures.

The information available about the child determines what procedures must be completed to conduct the evaluation and assessment.

Diagnosed Condition:  If the child has a diagnosed 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 the delay 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 comprehensive, multidisciplinary evaluation and assessment, then the team completes a timely evaluation and assessment using the RIOT process to collect multiple data sources. 

To complete a comprehensive, multidisciplinary 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, hearing and health (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.

All evaluations must ensure, at a minimum: 

  • No single source of data is used as the sole criterion for determining a child’s eligibility and level of functioning by following the RIOT process.
  • All areas of development are evaluated and assessed. 
  • All evaluations/assessments are conducted in the native language of the child unless it is clearly not feasible to do so.  
  • All evaluation/assessment procedures and materials are selected and administered so as not to be racially or culturally discriminatory.  
  • Evaluations/assessments are conducted by qualified personnel in a nondiscriminatory manner. 
  • Timelines for completing the evaluation, assessment, and initial IFSP meeting are within 45 calendar days of the date of referral. 
  • There is no cost to parents.

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 process 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. 

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

Eligibility Determination

After the evaluation and/or assessment process is completed, teams will review and discuss the information to determine a child’s eligibility and current level of development in the developmental areas. To be eligible for Early ACCESS children either need to have a diagnosed condition known to cause delay, a 25% delay in one or more areas of development or the child is eligible based on the team’s Informed Clinical Opinion

The 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.

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 areas of development is considered eligible for Early ACCESS services.

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

The 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’ 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.

A child is not eligible

A meeting is not required; however, the family must be provided Prior Written Notice (PWN) stating the child is not eligible for services.The PWN automatically includes information for parents about the Procedural Safeguards for Parents and dispute resolution process. The service coordinator explores other community options with the family and makes referrals as appropriate.  Ineligible children should be offered a referral to the local Child Health Program 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.

For a child not eligible the referral will be closed. For more information on ending the Early ACCESS case, please visit the Case Closure page.

For children with a diagnosed condition AND who have a 25% delay in one or more of the previously described developmental areas, the team will choose diagnosed condition as the basis for eligibility.

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

If a child is eligible for Early ACCESS, the team will schedule and hold an Initial IFSP meeting to develop the IFSP.