Wednesday, April 1, 2009

Getting Started...

In the time that I've spent working in the 0-3 system, I've realized that it can be very confusing for parents. As an early interventionist, I'm often the first therapist that the parents see on a regular basis, and I generally spend a fair amount of time outlining the different parts of the DDD process. Here is a basic outline of the DDD process, when it works the way it is supposed to. Although the process isn't always linear, for the sake of clarity I'm going to try and describe it that way.
Initial Referral: Anyone can make an initial referral for a child younger than 6. Some people who might make an initial referral are a parent, babysitter, or a pediatrician. A young child does not need a diagnosis. The DDD page for a referral is here.
Initial Planning Process (IPP): Once a referral has been made, this activates an IPP (Initial Planning Process) team. This is the information gathering portion of the process. It generally includes a developmental evaluation, family assessment, and a discussion of concerns.
Initial Evaluation: The initial evaluation is part of the initial planning process. It is typically done by a developmental pediatrician, a developmental psychologist, or an early interventionist who is specifically trained in evaluation. The results of the evaluation will determine whether or not the child qualifies for services. In general a child who is more than 50% delayed in more than 2 areas of development will get services through the DDD. A child who is delayed in only 1 area of development will receive services through AZEIP. A child who has low vision will receive services through FBC (Foundation for the Blind), generally in addition to other services.
IFSP: If a child qualifies for services, the next step is an IFSP meeting. IFSP stands for Individualized Family Service Plan. The family writes this plan, in conjunction with a Service Coordinator. The IFSP outlines the current strengths and needs of the family and child, the goals that the family has for their child, and the type and frequency of services that will be most beneficial to the family and child. Often during an IFSP, there is a lot of information thrown around very quickly. What is most important is that the goals and wishes of the family are reflected in the IFSP.
Therapies: This is often the part that families have been waiting for from the beginning. After the IFSP has been written to reflect the services that the family wants, the Support Coordinator begins trying to find therapists for that family. The most common therapies are speech therapy, physical therapy, occupational therapy, and early intervention (DSI). This is the part where people often get confused, because it seems like new people are in and out all of the time- therapists, support coordinators, evaluators, etc.
Evaluation: Yes, again. Each type of therapy (other than early intervention), requires a separate evaluation to determine if the child qualifies, and how that child could benefit from therapy. The therapists completing an evaluation might not be the same ones who eventually provide ongoing therapy. Once the evaluation has determined that a child qualifies for ongoing therapy, then that service can begin.
Ongoing Therapy: Once an evaluation has determined that the child qualifies for therapy, then ongoing therapy can begin. For kids ages 0-3, the preference is for therapy to be in the child's natural environment- home, day care, grandma's, etc. In some cases, therapy will take place in a center, and the parents will be expected to transfer the skills learned there to the natural environment.
IFSP Updates: These should happen every 6 months, starting from the date of the initial IFSP. The support coordinator meets with the family, the therapists, and anyone else involved with the child (doctor, nurses, grandma, etc). They discuss the progress made in the past 6 months, and write new goals for the next 6 months. The IFSP team will re-examine the existing supports and services and determine if any changes need to be made.

This therapy/IFSP update cycle continues until the child no longer needs services, or until he or she turns 3 years old. At this point, the child may transition into a developmental preschool, but that transition could (and probably will) be a whole separate post.
Since this is probably still a bit confusing, my next post will be an attempt to show what this process could look like with an actual family.

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