Early Intervention: Welcome to Baby Watch

In addition to developing the Key Principles, this work group also developed an overall mission statement for all Part C early intervention programs which states,

"Part C early intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children's learning and development through everyday learning opportunities." The "mission statement" reflects the broad over-arching purpose of family- centered early intervention services provided under Part C of IDEA.

Predictable routines answer questions for children, such as

"What am I doing?" "Where am I doing it?" "How long will I do it for?" and "What will I do next?" Young children like predictability. They need to know what is expected of them and what they can expect throughout the day. Predictable routines provide this information clearly and consistently.

Book sharing is not just

"reading a book" to children. Rather, by sharing time together while looking at and talking about books, children and adults have fun and children learn. Children like books. Books have fun pictures. The pictures, and the related words and events, can help children learn new words and cause-effect relationships.

Instructional practices are a subset of intervention activities conducted by practitioners and parents. We use the term "instructional practices" rather than the terms

"teaching practices" or "intervention" because instruction is the predominant term used in the research literature to refer to intentional and systematic strategies to maximize learning.

Family practices refer to ongoing activities that

(1) promote the active participation of families in decision-making related to their child (e.g., assessment, planning, intervention); (2) lead to the development of a service plan (e.g., a set of goals for the family and child and the services and supports to achieve those goals); (3) support families in achieving the goals they hold for their child and the other family members.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Assistive technology device and service are defined as follows -

* Assistive technology device - means any item,piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of an infant or toddler with a disability. The term does not include a medical device that is surgically implanted, including a cochlear implant, or the optimization (e.g., mapping),maintenance, or replacement of that device. *Assistive technology service - means any service that directly assists an infant or toddler with a disability in the selection, acquisition, or use of an assistive technology device. The term includes— The evaluation of the needs of an infant or toddler with a disability,including a functional evaluation of the infant or toddler with a disability in the child's customary environment; Purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by infants or toddlers with disabilities; Selecting, designing, fitting, customizing,adapting, applying, maintaining, repairing, or replacing assistive technology devices; Coordinating and using other therapies,interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs; Training or technical assistance for an infant or toddler with a disability or, if appropriate, that child's family; Training or technical assistance for professionals (including individuals providing education or rehabilitation services) or other individuals who provide services to, or are otherwise substantially involved in the major life functions of, infants and toddlers with disabilities.

Our Process:

*Referral - A parent/guardian or professional is concerned about an infant or toddler's development, and contacts Baby Watch or a local EI program to request a FREE evaluation. *Evaluation& Assessment - The local EI program conducts a comprehensive evaluation and assessment of the child's development and the family's needs and concerns. *Eligibility Decision - The child may be eligible for services based on medical diagnosis, test scores, or clinical opinion. Children who are not found eligible may be evaluated again in 6 months. *IFSP Meeting - The family of an eligible child meets with the EI team to create an Individualized Family Service Plan (IFSP) that contains the goals for that child and family for the next year. *Service Visits - The EI team provides services as outlined in the IFSP, typically in the family's home or in a community setting. *Periodic & Annual IFSP Reviews - The team reviews the child's IFSP as needed throughout the year, at least every 6 months. The IFSP is updated each year at the annual review meeting. *Transition - As the child approaches their third birthday, the family and local EI program prepare for special education preschool and/or other community-based services.

States' methods for determining eligibility vary widely, and even those who serve children at risk define "risk" differently. Consequently, the proportion of infants and toddlers served varies widely, from

.72 percent in Mississippi to 9.05 percent in Massachusetts.In the last decade, 20 percent of states narrowed their eligibility criteria in response to budgetary pressures,22 which has resulted in lower enrollment rates.

Steps 1-2 look at how an infant or toddler is identified as having a disability and in need of early intervention services, including the evaluation process and the determination of the child's eligibility.

1. Hospital staff, physicians, healthcare providers, childcare providers,and parents are the people most likely to interact with and observe newborn children, infants, and toddlers on a regular basis. Any of these individuals may notice that an infant or toddler possibly has a developmental delay or a diagnosed condition that may result in developmental delays such that early intervention services can help.It's important to act and connect the child and family with the early intervention system. But how?Each State has a referral system to ensure that infants and toddlers suspected of having a developmental delay or disability can easily be referred to the early intervention (EI) system. There are two main ways that children are connected with EI: •Primary referral sources such as physicians and hospitals and other programs refer the child to the EI program through the State's referral system. •Parents can contact the EI program directly (which is sometimes called child find in the State) and ask that their infant or toddler be evaluated. 2. Parental consent is needed before the child may be evaluated.Once the parents give their consent, the child is evaluated in five major developmental areas to see: (a) if he or she meets the State's definition of delay or disability, and (b) to determine the child's eligibility for EI services. The five developmental areas are: • cognitive development • physical development, including vision and hearing • communication development • social or emotional development • adaptive development in depth assessments are conducted to determine the child's unique needs and the EI services appropriate to address those needs. With approval of the family members involved, assessments of family members are also conducted to identify the resources,concerns, and priorities of the family related to the development of the child.The evaluation and assessment process must be completed within 45days of the child being referred to the EI program. The initial meeting to write an Individualized Family Service Plan (IFSP) for an eligible child and family (see Step 3) must also be held within those 45 days. Based on the results of administering all evaluation procedures, the qualified personnel who conduct the evaluation determine if the infant or toddler is eligible for EI services. • If yes (the child is eligible), a meeting is scheduled to develop an IFSP. • If no (the child is found not eligible), parents are informed in writing of that determination and their right to dispute it (called prior written notice).

General. Early intervention services means developmental services that—

1. Are provided under public supervision; 2. Are selected in collaboration with the parents; 3. re provided at no cost, except, subject to §§ 303.520 and 303.521, where Federal or State law provides for a system of payments by families, including a schedule of sliding fees; 4. Are designed to meet the developmental needs of an infant or toddler with a disability and the needs of the family to assist appropriately in the infant's or toddler's development, as identified by the IFSP Team, in any one or more of the following areas, including— Physical development; Cognitive development; Communication development; Social or emotional development; Adaptive development; 5. Meet the standards of the State in which the early intervention services are provided, including the requirements of Part C of the Act; 6. Include services identified under paragraph (b) of this section; 7. Are provided by qualified personnel (as that term is defined in §303.31), including the types of personnel listed in paragraph (c) of this section; 8. To the maximum extent appropriate, are provided in natural environments, as defined in§303.26 and consistent with §§303.126 and 303.344 (d); and 9. Are provided in conformity with an IFSP adopted in accordance with section 636 of the Act and §303.20.

Think about the teams on which you participate and the mission to which you adhere.Then reflect on the following statements:

1. Do you know the purpose and mission of your early intervention program guiding your team? 2. Is it something that is readily available and accessible for early interventionists and families working together on a team to find and reference? 3. Is it something you visit and review with families and team members as you begin new relationships in early intervention?

Despite the importance of early identification and intervention, many infants and toddlers with disabilities or developmental delays are not being identified and receiving early intervention. In federal fiscal year 2016, roughly

3 percent of children under age 3 received services through Part C, yet experts estimate that as many as 13 percent of infants and toddlers could benefit from early intervention.

Overall, the rate of developmental screenings in the United States is low—just

31 percent of parents reported that their child aged 10 months to 5 years received a standardized developmental screening in the last 12 months. Proper screening is an important first step in ensuring that problems with development are identified and further evaluated, and that children are referred for services.

Sharing common tasks but also understanding the unique skills and roles team members play is the

4th quality teaming behavior. Some team activities will involve several team members, such as evaluation or IFSP development. Yet other activities may require the unique skills of just one team member working with the family.For example, a provider skilled in hearing aid fitting may be called in to assist a family with ensuring the right fit for their son's hearing aid.

Leaders promote adherence to and model the DEC Code of Ethics, DEC Position Statements and Papers, and the DEC Recommended Practices.

A Head Start director strives to achieve an excellent reputation in the community for his ethical standards, knowledge and adherence to practice standards. A state early intervention coordinator shares information on ethical and practice standards and creates settings, structures and policies that support implementation of those standards. A director of a pre-k program rewards performance that demonstrates adherence to ethical and practice standards.

Practitioners use functional assessment and related prevention, promotion, and intervention strategies across environments to prevent and address challenging behavior.

A behavior specialist helps an early childhood teacher, classroom teaching assistants, and a child's parents collect data on antecedents or triggers (A), behaviors (B), and consequences (C) to develop hypotheses about what functions the child's challenging behavior might be serving. For example, following an ABC analysis, the team determines that activities such as circle that involve a lot of watching (A) result in a tantrum (B), which results in the child being removed from the activity (C). The team hypothesizes that the child's challenging behavior (tantrum) serves an "escape" function (i.e., the child escapes the watching activity). The team develops a plan to make the child's escape behavior (tantrum) irrelevant by planning fun circle times that do not involve too much watching and are not longer than 10 minutes. After determining that the function of a child's hair pulling is to obtain her sister's attention, a parent makes the hair pulling inefficient by teaching the child a replacement behavior (to gently touch her sister's arm) to gain her attention. Touching her sister's arm to gain attention is easier than hair pulling. Classroom teams in an inclusive program meet regularly to discuss their instructional and interactional practices to ensure that they are not promoting or maintaining children's challenging behaviors. Staff and parents "catch children being good" and comment on their appropriate behavior as frequently as possible. Adults tailor the positive feedback by making it descriptive and individualized. Staff members use praise and other reinforcers in varied, genuine, enthusiastic, individualized, and contingent ways.

Practitioners build trusting and respectful partnerships with the family through interactions that are sensitive and responsive to cultural, linguistic, and socio-economic diversity.

A classroom teacher uses a communication journal to share information with the family about how their child is progressing and, in turn, for the family to share information about how their child is doing at home. A special instructor offers to meet with the church nursery staff to share strategies that will enable a child to successfully participate in Sunday School. An occupational therapist brings along an interpreter on her visits so that the family who does not speak English understands the strategies she's suggesting. A home visitor greets the family in their primary language and removes her shoes at the door to demonstrate her respect for the family's culture and circumstances. A service coordinator shares information about the family's rights in the format and language with which the family is most comfortable.

Practitioners use assessment tools with sufficient sensitivity to detect child progress, especially for the child with significant support needs.

A curriculum-based instrument has too few items to demonstrate progress of a child over time, so the team breaks down items on the instrument into smaller steps to detect changes. A team leader is careful to choose instruments for each child with sufficient sensitivity to measure that particular child's progress in communication, motor, or cognitive development rather than always using the same instruments for every child.

Practitioners support family functioning, promote family confidence and competence, and strengthen family-child relationships by acting in ways that recognize and build on family strengths and capacities.

A developmental specialist focuses on sharing information and providing support so that the family feels confident they can assist their child in-between visits. A family educator helps the family identify ways to share their parenting accomplishments and successes with other parents experiencing similar challenges. A physical therapist asks the family what types of activities they currently use to support their child's efforts to walk and then provides the family with strategies they can use to increase the child's participation in those activities. An early interventionist acknowledges a family's strengths and expertise in addressing the child's challenging behaviors and supports the family in using these skills to address the child's sleeping difficulties.

Leaders work across levels and sectors to secure fiscal and human resources and maximize the use of these resources to successfully implement the DEC Recommended Practices.

A director of a family support program advocates with state legislatures, advocacy organizations, and other state and national groups to obtain the resources to implement services and practices that promote better outcomes for children and families. The chair of an Interagency Coordinating Council promotes cross-sector funding for professional development aligned with the DEC Recommended Practices. A Head Start program director obtains a professional development grant and organizes schedules to provide a training on how staff can use the DEC Recommended Practices within their program.

Leaders collaborate with stakeholders to collect and use data for program management and continuous program improvement and to examine the effectiveness of services and supports in improving child and family outcomes.

A director of a local preschool program prepares a report with aggregated data that shows children's progress from program entry to program exit to share with the program's Steering Committee. A state early intervention coordinator shares data on family outcomes with the interagency coordinating council to examine how well the program is serving families' needs across the state. A director of an early intervention program talks with staff regularly about the importance of collecting valid data on children's functioning.

Leaders develop, refine, and implement policies and procedures that create the conditions for practitioners to implement the DEC Recommended Practices.

A director of a technical assistance program develops an orientation packet for new TA practitioners that includes the DEC Recommended Practices as a central focus for the TA support provided to practitioners. A preschool director develops a policy statement that includes a reference to the DEC Recommended Practices as being an integral component of the program services and activities. An early intervention program director aligns program procedures for conducting child and family assessments with the DEC recommended practices.

Practitioners obtain information about the child's skills in daily activities, routines, and environments such as home, center, and community.

A family member reports that the child has some challenging behaviors in the early evening. An early interventionist schedules a home visit at that time to try to understand the issues and find potential solutions with the family. A family reports that their child, who is very quiet in his preschool setting, talks a lot at home. An early childhood teacher asks the family to capture some examples of his communication on a video to share with her.

Practitioners promote the child's social-emotional development by observing, interpreting, and responding contingently to the range of the child's emotional expressions.

A home visitor models positive interactions for the parents by commenting on what a great helper the child is when he joins her in gathering up the toys they have been using. An early interventionist is responsive to the child's initiations by "reading" and interpreting her nonverbal cues, anticipating her desires and waiting for her to give a clear signal of that desire, and then following her lead in play. An early childhood teacher smiles frequently at children, shows genuine pleasure to be in the company of children, and shows authentic approval of each child's accomplishments.

Practitioners are responsive to the family's concerns, priorities, and changing life circumstances.

A home visitor uses open-ended questions to gather information from the family to understand their concerns and priorities A preschool teacher talks with each family member who is involved in the child's care, to gather information concerning their needs and priorities. A service coordinator assists the family in identifying and connecting to both formal and informal supports and resources, such as babysitting or respite care with family, friends, and neighbors. An early interventionist provides the family with the opportunity to discuss and prioritize Individualized Family Service Plan (IFSP) goals, so that she can update other team members on what is important to the family.

Practitioners work as a team with the family and other professionals to gather assessment information.

A physical therapist and an early childhood special educator make a home visit together to assess the child in a familiar setting and within familiar activities. An occupational therapist, speech language pathologist, early childhood special educator and family member agree to work together using a play-based model of assessment.

Practitioners representing multiple disciplines and families work together as a team to plan and implement supports and services to meet the unique needs of each child and family.

A physical therapist and special instructor meet to talk with the family about the child's current abilities and progress and modify current strategies to align with the child's current level of performance. An early childhood teacher discusses her ideas and concerns about a child's progress with the consulting speech language pathologist and they develop additional teaching strategies.

Practitioners work with families and other adults to identify each child's needs for assistive technology to promote access to and participation in learning experiences.

A physical therapist, when developing goals or objectives with family members and other members of the child's team, discusses assistive technology as a strategy to help meet the child's goals. A speech language pathologist works with family members to incorporate the use of a child's voice output device across the family's daily routines (e.g., using the device during the child's morning routine so he can communicate what he wants to eat for breakfast).

Leaders advocate for policies and resources that promote the implementation of the DEC Position Statements and Papers and the DEC Recommended Practices.

A preschool coordinator creates opportunities for staff to learn about and share the DEC Recommended Practices. A director of a state agency advocates for and aligns state and program policies and procedures with the DEC Recommended Practices. An executive director of a state chapter of a national professional organization secures and aligns resources with the intention of implementing the DEC position statements, papers and Recommended Practices.

Leaders develop and implement policies, structures, and practices that promote shared decision making with practitioners and families.

A preschool program director encourages practitioners to provide feedback on policies and practices that impact their work and takes constructive action based on this feedback. A Head Start director provides opportunities for active and meaningful participation of family members in advisory capacities and takes constructive action based on the advice of families. A chair of a local interagency coordinating council demonstrates that diverse perspectives are valued by encouraging each team member to share information during team meetings.

Practitioners in sending and receiving programs exchange information before, during, and after transition about practices most likely to support the child's successful adjustment and positive outcomes.

A preschool teacher organizes a transition portfolio for each child who is moving to kindergarten. A director of the preschool electronically submits the academic records for each child who is moving to kindergarten and for whom the parent has given permission, to ensure that each child's prior information is included in the district's data base. A service coordinator calls the family and the preschool the week after the child's transition to preschool and again a month after transition, to make sure that all paperwork and other aspects of the transition are proceeding as planned.

The 6th key principle states, "The family's priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support."

A primary provider is the consistent person who understands and keeps abreast of the changing circumstances, needs, interests, strengths, and demands in a family's life. By having one main provider, the family does not have to tell their story over and over to multiple team members. The family works closely with one person and he or she brings in services and supports for the child and family as needed from the rest of the team. The team can include friends, relatives, and community support people, as well as specialized service providers.

Leaders promote efficient and coordinated service delivery for children and families by creating the conditions for practitioners from multiple disciplines and the family to work together as a team.

A principal of an elementary school schedules a weekly meeting time for the early childhood teacher, the early childhood special education teacher, and the therapists to meet together and with families to plan for and discuss the children they serve. A director of an early intervention program arranges schedules so that all staff working directly with families are in the office on certain afternoons to ensure time and a structure for collaboration. A director of a local child care center arranges staffing so the lead teacher in each classroom can meet weekly with the early childhood special education teacher from the school district to discuss strategies and the progress of the children with special needs attending the center.

Practitioners use communication and group facilitation strategies to enhance team functioning and interpersonal relationships with and among team members.

A program director acknowledges gaps in communication among teachers and teacher aides and develops a plan to remedy the problems. A team leader uses a round robin technique in a group meeting to ensure that all team members, including those who typically are quiet, have a chance to express their perspectives and ideas on an issue.

Leaders ensure practitioners know and follow professional standards and all applicable laws and regulations governing service provision.

A program director devotes part of each staff meeting to discussing the laws and regulations, including the rights to privacy, and the ethical and professional responsibilities involved in providing services to young children and their families. A supervisor regularly reviews program files and documentation to ensure that paraprofessionals and related service providers consistently document their work adhering to applicable rules and regulations.

Leaders establish partnerships across levels (state to local) and with their counterparts in other systems and agencies to create coordinated and inclusive systems of services and supports.

A program director is involved in state and local activities such as local interagency teams and professional affiliates that have a mission to create coordinated and inclusive systems of services and supports. A technical assistance specialist helps educate colleagues in other systems about best practices for young children with or who are at risk for disabilities and/or delays and their families and how those practices can be implemented in inclusive and typical settings. A regional preschool disability coordinator supports her staff in attending meetings with counterparts in other educational settings to create coordinated and inclusive systems of services and supports.

Practitioners inform families about leadership and advocacy skill-building opportunities and encourage those who are interested to participate.

A program director recruits a committee of family and staff members to assess the educational interests of families and to develop opportunities to engage and support families in developing those interests. A parent educator works with families to design a variety of methods to provide resources and supports to all families, including written and electronic newsletters, bulletin board displays, verbal exchanges, and informational meetings. An early childhood teacher brainstorms with a group of families to identify the types of information they would like to receive to help them learn to advocate for their children and then arranges opportunities for families to receive that information. A program director organizes a task force of family and staff members to develop policies related to holidays. An early interventionist provides the family with information about serving on the state's inter-agency coordinating council.

Practitioners work with the family to identify, access, and use formal and informal resources and supports to achieve family-identified outcomes or goals.

A service coordinator helps a family to identify childcare options in their community that meet their needs so that the child's mother can return to work. An occupational therapist helps the family find ways to answer their specific parenting questions. A social worker asks about state and federal assistance programs as well as other community programs the family uses or would like to use.

Team members assist each other to discover and access community-based services and other informal and formal resources to meet family-identified child or family needs.

A service coordinator learns about reimbursement policies and helps families, as needed, to understand the impact of using non-public funds to pay for services. A social worker compiles a resource book on programs, funding options and policies to be used by families and other team members. A case manager invites contributions and perspectives of each team member about placement options to meet a child and family's needs.

Practitioners help families know and understand their rights

A service coordinator provides the family with information about state regulations in written form prior to the eligibility evaluation and discusses the implications with the family. An early childhood program director talks with the family about the policies and procedures related to dispute resolution and answers the questions they have.

Practitioners engage the family in opportunities that support and strengthen parenting knowledge and skills and parenting competence and confidence in ways that are flexible, individualized, and tailored to the family's preferences.

A speech language pathologist tailors the information that she provides to the family's level of understanding using the best evidence available. An early childhood teacher answers the family's questions honestly and to the best of her knowledge and seeks more information for the family when necessary. A service coordinator gathers information about available parent education and training activities in their community and helps the family access desired activities. A preschool teacher works with a family who has recently moved to the United States to help them understand the American school system and to develop a plan for addressing possible differences in school and family expectations so that their child can be successful in both environments.

Leaders belong to professional association(s) and engage in ongoing evidence-based professional development.

A state early childhood special education coordinator actively participates in professional organizations, workgroups, and professional committees at community, state and national levels. A program director continually learns and grows professionally by engaging in a variety of learning experiences that are designed to support the acquisition and application of new knowledge (e.g., action research, coaching)

Leaders collaborate with higher education, state licensing and certification agencies, practitioners, professional associations, and other stakeholders to develop or revise state competencies that align with DEC, Council for Exceptional Children (CEC), and other national professional standards.

A state early intervention training director serves on advisory bodies to ensure that personnel preparation programs are aware of desired professional competencies. A task force director solicits input from cross-system stakeholders when developing state competencies.

Practitioners and the family work together to create outcomes or goals, develop individualized plans, and implement practices that address the family's priorities and concerns and the child's strengths and needs.

A teacher provides many opportunities for parents to ask questions and discuss their child's activities and progress. An Individualized Education Program (IEP) team leader works with the family and other professionals to develop IEP documents that address the needs expressed by the family. A service coordinator helps the family to understand the importance of developing IFSP outcomes that will address their concerns and help them facilitate their child's development. A speech language pathologist works with family members to identify the family routines during which IFSP goals can be implemented.

Practitioners conduct assessments that include all areas of development and behavior to learn about the child's strengths, needs, preferences, and interests.

A team assesses a child across all developmental domains and all behavioral dimensions even though the child is only being considered for eligibility in the area of speech and language disorders. A speech language pathologist talks with the family about what the child enjoys doing and what kinds of toys the child finds especially interesting at home.

Practitioners use clinical reasoning in addition to assessment results to identify the child's current levels of functioning and to determine the child's eligibility and plan for instruction.

A team completes the administration of all instruments for determining eligibility for a child and then meets together to consider the assessment results as well as their clinical opinions relative to eligibility for the child. In making a decision about eligibility, team members consider whether the scores from a standardized assessment are an accurate reflection of the child's skill level, and then seeks additional information as questions arise in order to inform their decision.

Practitioners work with the family to identify family preferences for assessment processes.

A team of practitioners and the family jointly plan the specifics of the upcoming assessment including the location, time of day, and strategies for assessment. A team leader with input from other team members plans which assessments to use after obtaining information from the family about what the child typically does and what the child likes to do. In advance of the assessment, a team leader asks families whether they prefer to watch the assessment, to serve as an informant, to participate by interacting with the child, or to provide support to the child by staying nearby.

Practitioners gather and use data to inform decisions about individualized instruction.

A team working with a preschool-aged child makes a plan to collect, summarize, and analyze data with sufficient frequency to determine if the instructional strategies being implemented with the child are resulting in progress on priority skills or if modifications to the strategies are needed. An early interventionist works with a family to develop data sheets and other data collection strategies for the family and other caregivers to use at home and in the community. An early childhood teacher and early childhood special education itinerant teacher work together to develop a plan for using multiple methods to document a child's progress on Individualized Education Program (IEP) goals. The plan includes frequency counts, work samples, checklists, videotapes, and photographs. A preschool classroom team gathers data before and after they begin a skill-building intervention on a target behavior. They graph the data to determine if there are changes in the child's behavior after the intervention is introduced relative to the child's behavior before implementing the skill-building intervention.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Psychological Services

Administering psychological and developmental tests and other assessment procedures; Interpreting assessment results; Obtaining,integrating, and interpreting information about child behavior and child and family conditions related to learning, mental health, and development; Planning and managing a program of psychological services, including psychological counseling for children and parents, family counseling, consultation on child development,parent training, and education programs.

Practitioners promote the child's communication development by observing, interpreting, responding contingently, and providing natural consequences for the child's verbal and non-verbal communication and by using language to label and expand on the child's requests, needs, preferences, or interests.

An assistant teacher uses children's preferences to increase engagement and to promote interaction with peers on the playground. A speech language pathologist who is trying to teach the child to request using the sign for "apple" in the classroom places the desired apple within sight but deliberately out of reach, in order to prompt the child to request it. A Head Start teacher teaches developmentally sophisticated peers to recognize, interpret and respond to nonverbal children's communicative attempts.

Leaders collaborate with other agencies and programs to develop and implement ongoing community-wide screening procedures to identify and refer children who may need additional evaluation and services.

An early childhood coordinator for the school district coordinates with local pediatricians to support screening procedures and referrals. A director of an early intervention program works with public health staff and the local hospital to plan and implement developmental screening in the mall. A regional early childhood coordinator reaches out to the community child care centers to implement developmental screening in each of the centers.

Leaders develop and implement an evidence-based professional development system or approach that provides practitioners a variety of supports to ensure they have the knowledge and skills needed to implement the DEC Recommended Practices.

An early childhood program director engages staff in action research with researchers, students, and community practitioners. An early childhood chair at a community college selects field experience sites for students because they provide exemplars or positive models of the DEC Recommended Practices. A principal works with staff members to develop individualized professional development plans to ensure continued professional growth, especially related to the DEC Recommended Practices.

Practitioners implement the frequency, intensity, and duration of instruction needed to address the child's phase and pace of learning or the level of support needed by the family to achieve the child's outcomes or goals.

An early childhood special education itinerant teacher works with a speech therapist, occupational therapist, and an early childhood educator to ensure learning opportunities are sufficient for a child who is acquiring a new communication skill, recognizing the child needs repeated and frequent opportunities in this phase of learning (i.e., acquisition). An early interventionist helps a parent problem-solve about how to support a child to maintain a learned skill by identifying routines and activities in which the skill can be used. A speech therapist and early childhood teacher consider similarities between the activity in which a child learned a communicative behavior and other routines and activities where the child needs to use the behavior (i.e., generalize the behavior across routines and activities). They decide on the planned frequency of embedded learning opportunities to use the communicative behavior in these other routines and activities. An early childhood special education teacher decides to modify the instructional pacing she is using with a child for learning trials focused on the child labeling pictures in a book following a teacher-delivered prompt (e.g., What's this?). She shortens the time interval between each instructional trial to 3 seconds.

Practitioners use and adapt specific instructional strategies that are effective for dual language learners when teaching English to children with disabilities.

An early childhood special education teacher and a bilingual early childhood educator who speaks the child's home language work together to develop a "what we know, what we want to know, and what we learned" table in the child's home language and in English to support instruction in both languages as part of a thematic unit in the inclusive classroom. During whole-group or reading aloud time in the preschool classroom, home language supporters who are parents of a bilingual child or volunteers from the community, read aloud in the child's home language right after reading the text in English. An early childhood classroom team labels both verbally and with pictures common classroom items or toys preferred by the child in the child's home language and in English.

Practitioners plan for and provide the level of support, accommodations, and adaptations needed for the child to access, participate, and learn within and across activities and routines.

An early childhood special education teacher and early childhood teacher work together to identify an effective prompting strategy that includes reinforcement for correct responding and error correction for incorrect responding for a child who needs additional instruction on a target skill. An occupational therapist and a family identify fun and interesting learning opportunities for an infant within daily activities and routines that provide contingent feedback as a result of the child's actions (e.g., motion-activated mobiles, rattles, musical games). A speech therapist, early interventionist, and the child's family design a choice board for the family to use during mealtimes to help the child request preferred food or drink. A physical therapist and early childhood special education teacher work together to analyze a preschool classroom environment to ensure that a child who is using a wheelchair can easily maneuver between centers and access toys and other materials. An early intervention provider and a child's parents monitor their own behavior to ensure that they are providing the appropriate level of support to enable the child to do a skill, and fading prompts when appropriate.

Practitioners work with families and other adults to acquire or create appropriate assistive technology to promote each child's access to and participation in learning experiences.

An early childhood special education teacher lends families assistive technology devices (e.g., switches, voice-output systems, adapted electronics) from the school's assistive technology library, so they can evaluate these devices before purchasing them. A speech language pathologist supports family members as they try a communication device that has four prerecorded messages prior to deciding on a more complex device with computer-generated voice output and additional messages.

Practitioners use systematic instructional strategies with fidelity to teach skills and to promote child engagement and learning.

An early childhood special educator, early care and education provider, and the child's parents work together to develop a checklist of the steps involved in using the most-to-least prompting procedure to help the child learn to feed herself with a spoon and to monitor correct implementation of the procedure during snack and meal times in the classroom and at home. A speech-language therapist demonstrates using naturalistic time delay to support a toddler to request "more" during play and feeding routines and provides opportunities for the parent to practice implementing the strategy and receive feedback about implementation. An early childhood special educator, occupational therapist, and early care and education provider task analyze the steps involved in washing hands in a preschool classroom and use backward chaining to teach the last step first. Once the child masters the last step, the previous step is taught. The team creates a checklist based on the task analysis to monitor implementation of the backward chaining procedure and reviews it weekly to monitor the child's progress. During snack time, a parent displays the food choices and waits for the child to make a request (e.g., by pointing, speaking, signing, or using their alternative communication system). If the child makes an appropriate request, descriptive feedback and access to the requested items are provided to the child. If not, a planned correction is used to help the child learn to request (e.g., "You want juice. Say juice").

Leaders create a culture and a climate in which practitioners feel a sense of belonging and want to support the organization's mission and goals.

An early childhood state program administrator communicates the mission and goals of the agency in ways that motivate practitioners to implement them. A child care director creates a climate of mutual respect among all practitioners and staff, regardless of role and individual differences. An executive director of a non-profit program is open and honest in her communications with staff and solicits input prior to making programmatic changes.

Practitioners promote the child's cognitive development by observing, interpreting, and responding intentionally to the child's exploration, play, and social activity by joining in and expanding on the child's focus, actions, and intent.

An early childhood teacher extends and expands on children's play behavior by imitating the children's behavior and then adds steps by showing how things work, other actions they can perform with objects, or ways that they can pretend with toys. A Head Start teacher encourages children to verbally describe what they are doing when they are playing in order to share their ideas with adults and peers. An early interventionist joins in on the child's exploration in the sand box following the child's lead and showing how the truck disappears under the sand and then reappears.

Practitioners promote the child's social development by encouraging the child to initiate or sustain positive interactions with other children and adults during routines and activities through modeling, teaching, feedback, or other types of guided support.

An early childhood teacher in a Head Start classroom helps peers respond to a child who uses gestures to communicate. An early interventionist works with the parents in the home to encourage and reinforce a child for initiations and engagement with materials by providing choices; making suggestions; giving the child time to make choices; and providing positive, descriptive feedback.

Practitioners create environments that provide opportunities for movement and regular physical activity to maintain or improve fitness, wellness, and development across domains.

An early childhood teacher incorporates movement and physical activities into his preschool classroom's daily routines. For example, each day children choose a movement or stretch (e.g., hopping, marching, touching their toes) and the number of the month determines how many movements the children complete together during circle time. A physical therapist works with families and other adults to identify strategies in the environment to encourage children to walk, crawl, wiggle, scoot, reach, roll, kick, or move in any other way they can. For example, she shows family members how to place desired toys in sight but out-of-reach to encourage locomotion.

Practitioners promote the child's problem-solving behavior by observing, interpreting, and scaffolding in response to the child's growing level of autonomy and self-regulation.

An early childhood teacher observes a group of children beginning to interact with pretend play materials and helps them plan their activity and identify what their roles will be as they interact with one another. When children engage in aggressive behavior, an assistant teacher models strategies using words to work out problems.

Practitioners and families work together as a team to systematically and regularly exchange expertise, knowledge, and information to build team capacity and jointly solve problems, plan, and implement interventions.

An early childhood teacher participates in the child's monthly team meetings convened by the service coordinator to discuss progress and share ideas for supporting goals in the classroom setting. A family childcare teacher spends a few minutes at pick-up and drop-off to exchange information about the child's performance with the family. An itinerant teacher works with the classroom teacher to model and demonstrate a strategy to support a child's development and learning during outdoor play.

Practitioners use peer-mediated intervention to teach skills and to promote child engagement and learning.

An early childhood teacher uses peer tutoring to promote a child's communication skills. The teacher demonstrates to two peers in the classroom how to use descriptive talk to comment on the child's behavior during play in order to provide a model of the child's specific expressive language learning targets. An early childhood special education teacher uses peers to help a child learn social interaction skills. The teacher teaches peers the skills (e.g., asking another child to play, taking turns). When the peers and the child play together, the teacher carefully monitors and reinforces their interactive play without disrupting the interactions. An occupational therapist uses peer modeling to increase a child's imitative play. During a play activity in the classroom, the therapist has peers perform a desired skill for the child and encourages the child's attention to the behavior (e.g., Wow, look what Tommy is doing with blocks. You can do that, too!). An early childhood classroom team teaches developmentally sophisticated peers how to initiate play and social interactions with target children, how to have positive exchanges with those children, and how to persist in playing with those children, even if they are not responsive to initial attempts to engage. An early childhood special education itinerant teacher helps an early childhood teacher learn to implement group contingencies for the performance of a target child's social behavior. For example, all of the children in the class receive "high fives" when the target child shares toys with peers during free choice time.

Practitioners provide the family with up-to-date, comprehensive and unbiased information in a way that the family can understand and use to make informed choices and decisions.

An early childhood teacher videotapes sessions of children in center-based programs for parents to view if they cannot accompany their child. In preparation for transition, a service coordinator supports the family's interests in exploring programming options by helping the family gather and evaluate information about the effectiveness of each option. A Head Start program director makes the parent newsletter available in several formats and in the major languages of families in the program.

Practitioners use explicit feedback and consequences to increase child engagement, play, and skills.

An early intervention provider works with a child's family to identify natural consequences associated with the child's behavior that are part of the everyday activities or routines. An early care and education provider observes a child's actions during circle time and comments positively and descriptively about the child's actions in order to sustain or elaborate on the child's engagement An early childhood special educator provides access to a preferred toy after a child uses a gesture and vocal approximation to request the toy while playing at the sensory table. An occupational therapist demonstrates to a parent how to shape a child's engagement behaviors with developmentally appropriate toys by reinforcing each increasingly complex approximation of the desired behavior. An early childhood special educator asks a child how he is going to play, secures a verbal response from the child, observes the child play, and provides reinforcement after the play session when there is a correspondence between what the child says and what the child does.

Practitioners embed instruction within and across routines, activities, and environments to provide contextually relevant learning opportunities.

An early interventionist and family identify skills a child needs to learn to be more engaged, independent, and interactive in child and family routines and activities. They use this information to identify priority child learning outcomes for the IFSP and to break down each outcome into smaller and more immediate learning targets. They then discuss when, where, and how learning opportunities will occur. They identify how they will know if the child is making progress and if engagement, independence, or interactions improve in the priority routines and activities. A preschool classroom team, including the child's family, reviews the classroom schedule and the child's IEP goals along with the smaller and more immediate priority learning targets connected to these goals. Team members identify logical and appropriate opportunities for the child to practice and learn targeted skills during routine, planned, and child-initiated activities that occur in the classroom. They then develop activity matrices to specify how many embedded learning opportunities on which learning targets are planned within and across classroom activities or routines. They indicate when, where, and with whom embedded learning opportunities will be provided and which systematic and intentional teaching strategies will be used. They identify how they will collect, summarize, and analyze data about the number of embedded learning opportunities planned versus the number provided and about child progress. They use these data to help make decisions about whether the embedded instruction plan is working or if changes are needed.

Practitioners implement systematic ongoing assessment to identify learning targets, plan activities, and monitor the child's progress to revise instruction as needed.

An early interventionist collects data on a child's fine motor learning targets during each home visit and then reviews the data to inform any changes in the targets or in the instructional strategies for the next visit. An early childhood teacher develops lesson plans for the following week based on data collected throughout the current week's activities.

Practitioners use a variety of planned and timely strategies with the child and family before, during, and after the transition to support successful adjustment and positive outcomes for both the child and family.

An infant-toddler teacher organizes the play group schedule for the older toddlers so that they practice some of the routines of preschool before they transition. A service coordinator provides families with lists of preschools and visiting schedules. She offers to accompany families on their visits to the preschools. A preschool and kindergarten teacher arrange a school visit for the preschool children. The preschool children get to explore the kindergarten classroom, talk with the kindergarten children, see the bathrooms, and sit on the school bus.

Practitioners, with the family, identify each child's strengths, preferences, and interests to engage the child in active learning.

An early interventionist conducts a structured interview to gather information from a family about what they know and recognize about the child's interests and what they have observed the child doing during everyday routines and activities. An early childhood teacher observes a child's preference for trains and turns the dramatic play area into a train station. She then provides learning opportunities for the child to "purchase" train tickets, to take turns blowing the train whistle, and to help build a pretend train station. A team composed of the early interventionist, the speech therapist, the child's family, and the service coordinator plans for and conducts observations to gather information about which toys a toddler prefers and to identify potential reinforcers. The team collects data about which toys the toddler plays with and how long the toddler plays with each toy. An early intervention provider works with the family of a toddler to identify opportunities for the child to make choices during everyday activities and routines at home and in the community.

Practitioners use assessment materials and strategies that are appropriate for the child's age and level of development and accommodate the child's sensory, physical, communication, cultural, linguistic, social, and emotional characteristics.

An early interventionist incorporates the child's use of an alternative communication system into all interactions and observations for the purpose of administering an assessment. The early intervention team agrees to do individual assessments across a few days and times based on the family's feedback that their child becomes overwhelmed by groups of people. A physical therapist observes a child with a physical disability using his mobility device and adaptive equipment while being assessed in the area of physical development.

Practitioners provide the family of a young child who has or is at risk for developmental delay/disability, and who is a dual language learner, with information about the benefits of learning in multiple languages for the child's growth and development.

An early interventionist learns some basic vocabulary words in the child's and family's primary language and uses them throughout the intervention visit to acknowledge the importance of multiple languages. A speech language pathologist working with a family who is concerned about their child's language development provides them with materials on the benefits of learning in multiple languages. The materials are written in the family's home language and in a comfortable format for the family.

Practitioners use a variety of methods, including observation and interviews, to gather assessment information from multiple sources, including the child's family and other significant individuals in the child's life.

An early interventionist observes the child in his Head Start setting and talks with the early childhood teacher about the motor skills the child demonstrates in that environment. An early childhood teacher regularly communicates with the family through a "traveling notebook" about any new skills they have seen at home so that the information they share can be incorporated into the periodic assessments of child progress. The early childhood teacher has help from other personnel at the program so that all messages are written in the family's home language and the family's messages back can be translated into English.

Practitioners, with the family, identify skills to target for instruction that help a child become adaptive, competent, socially connected, and engaged and that promote learning in natural and inclusive environments.

An early interventionist uses a routines-based interview to gather information from a family about routines that are difficult for the child and family and about the skills the child might need in order to engage in those routines more independently. A team in an inclusive early childhood program, including the child's family, uses functional behavioral assessment to identify new skills the child might need to learn as a replacement for A speech-language therapist works with the child's family to select an augmentative communication system that would be a good fit for the child and family and to identify skills the child needs in order to use the system across different activities and routines. An early childhood teacher, speech therapist, occupational therapist, and the child's family observe the child in the settings in which he regularly spends time (e.g., home, car, church, school, grocery store) to identify the skills he needs to participate actively in the activities and routines in those settings. A team of early intervention providers, the child's family, and the service coordinator collaboratively identify priority child-focused outcomes, and skills related to these outcomes, during the Individualized Family Service Plan (IFSP) process.

Practitioners use coaching or consultation strategies with primary caregivers or other adults to facilitate positive adult-child interactions and instruction intentionally designed to promote child learning and development.

An early interventionist uses coaching strategies during a home visit to support a parent who wants to learn how to embed learning opportunities for a child in everyday routines or activities. The coaching strategies involve setting the stage for the visit, observing the parent and child during the activities or routines in which embedded learning opportunities occur and providing supportive feedback, problem-solving and reflecting about the embedded learning opportunities, and discussing how the parent will implement embedded learning opportunities between visits and collect information about child responses and progress to share with the coach at the next visit. An itinerant early childhood educator uses a practice-based coaching framework to support an early childhood teacher's implementation of naturalistic instructional strategies with a child enrolled in her classroom. The itinerant teacher shares information about the naturalistic instructional strategies and video examples with the early childhood teacher. She gathers the teacher's perspectives about her confidence and competence in implementing the naturalistic instructional strategies and observes the teacher's implementation of the strategies. Based on these two sources of information, they jointly develop an action plan to support the teachers' implementation of the naturalistic instructional strategies. The itinerant teacher visits the classroom once a week for several weeks to observe the teacher's implementation of the strategies. After the observations, the teacher and itinerate teacher debrief for 10-15 minutes. They reflect on the teacher's implementation, and the itinerant teacher provides supportive and constructive feedback. They discuss next steps and determine if their action plan needs to be modified.

Practitioners provide instructional support for young children with disabilities who are dual language learners to assist them in learning English and in continuing to develop skills through the use of their home language.

An early interventionist works with the family to select a book that family members can read with their child in their home language and in English. An early childhood special education teacher and speech therapist develop a list of commonly used words in the classroom (e.g., snack, coat, all done, etc.) in the child's home language that they can use to communicate with the child and teach the corresponding English words and phrases.

Practitioners provide services and supports in natural and inclusive environments during daily routines and activities to promote the child's access to and participation in learning experiences.

An occupational therapist visits a family during meal time in their home to help the parents problem solve positioning or feeding strategies, so their child can eat and socialize with the entire family instead of eating before or after the rest of the family. A physical therapist goes on a shopping trip to assist a parent of a child who uses an assistive device for mobility, to develop a new routine to ensure the child's safety while navigating the parking lot and store.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Service Coordination and Case Management

As used in this part, service coordination services mean services provided by a service coordinator to assist and enable an infant or toddler with a disability and the child's family to receive the services and rights, including procedural safeguards, required under this part. * Each infant or toddler with a disability and the child's family must be provided with one service coordinator who is responsible for— Coordinating all services required under this part across agency lines; Serving as the single point of contact for carrying out the activities described in paragraphs (a)(3) and (b) of this section. *Service coordination is an active, ongoing process that involves— Assisting parents of infants and toddlers with disabilities in gaining access to, and coordinating the provision of, the early intervention services required under this part; Coordinating the other services identified in the IFSP under §303.344(e) that are needed by, or are being provided to, the infant or toddler with a disability and that child's family.

Transition is a process that generally involves many activities on the part of the practitioner in collaboration with the family.

As with other life transitions or changes, positive relationships—in this case positive teacher-child and practitioner-family relationships—are associated with greater satisfaction, better adjustment, and better child outcomes.

On an interdisciplinary team, multiple professionals and family members work together to

Assess the child and understand the family concerns. The IFSP is developed by providers from different disciplines, each contributing their own discipline-specific goals.Multiple providers meet regularly to coordinate and plan services. Family involvement in the activities during a home visit is encouraged. Professionals and family members work toward common goals. Professionals may evaluate children separately, but jointly discuss results and develop intervention plans.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Specific Service Coordination

Assisting parents of infants and toddlers with disabilities in obtaining access to needed early intervention services and other services identified in the IFSP, including making referrals to providers for needed services and scheduling appointments for infants and toddlers with disabilities and their families; Coordinating the provision of early intervention services and other services (such as educational, social, and medical services that are not provided for diagnostic or evaluative purposes)that the child needs or is being provided; Coordinating evaluations and assessments; Facilitating and participating in the development, review, and evaluation of IFSPs; Conducting referral and other activities to assist families in identifying available EIS providers; Coordinating, facilitating, and monitoring the delivery of services required under this part to ensure that the services are provided in a timely manner; Conducting follow-up activities to determine that appropriate Part C services are being provided; informing families of their rights and procedural safeguards, as set forth in subpart E of this part and related resources; Coordinating the funding sources for services required under this part; Facilitating the development of a transition plan to preschool, school,or, if appropriate, to other services.

Principle Two does look like:

Assuming all families have strengths and competences; appreciating the unique learning preferences of each adult and matching teaching, coaching, and problem-solving styles accordingly. Matching the kind of help or assistance with what the family desires; building on family strengths, skills and interests to address their needs. And, Building on family supports and resources; supporting them to marshal both informal and formal supports that match their needs and reduce stressors.

What is Baby Watch?

Baby Watch is the state agency responsible for Part C early intervention (EI) services in Utah.Our statewide network of EI programs serves the families of eligible infants and toddlers with developmental delays or disabilities.

As you learned from the video clip and from reviewing the 7 Key Principles documents, Principle 2 does not look like:

Basing expectations for families on characteristics, such as race, ethnicity, education, income or categorizing families as those who are likely to work with early intervention and those who won't. Viewing families as apathetic or exiting them from services because they consistently miss appointments or don't carry through on prescribed interventions, rather than refocusing interventions on family priorities. Or, Taking over and doing "everything" for the family or, conversely, telling the family what to do and doing nothing to assist them.

Steps 7-8 summarize what happens as the infant or toddler with a disability approaches his or her 3rdbirthday, when eligibility for early intervention typically ends. These steps are meant to prepare for the child's smooth transition from Part C services to Part B or other appropriate services or programs. This is step 8

By age 3, the child exits the Part C early intervention program. The child transitions either to the Part B preschool program or to another appropriate program, if one is available in the State.

The 4th principle does look like:

Collaboratively tailoring services to fit each family; providing services and supports in flexible ways that are responsive to each family's cultural, ethnic, racial, language, socioeconomic characteristics and preferences. Collaboratively deciding and adjusting the frequency and intensity of services and supports that will best meet the needs of the child and family. And, treating each family member as a unique adult learner with valuable insights, interests, and skills.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Nutrition Services

Conducting individual assessments in — Nutritional history and dietary intake; Anthropometric, biochemical, and clinical variables; Feeding skills and feeding problems; Food habits and food preferences; Developing and monitoring appropriate plans to address the nutritional needs of children eligible under this part, based on the findings in paragraph (b)(7)(i) of this section; Making referrals to appropriate community resources to carry out nutrition goals.

Practitioners and families may collaborate with each other to identify one practitioner from the team who serves as the primary liaison between the family and other team members based on child and family priorities and needs.

During a home visit, the occupational therapist shares strategies with parents that were developed in conjunction with the physical therapist. An early childhood teacher, who serves as the primary contact for the family, receives instruction, feedback, and support from the itinerant hearing specialist to provide individualized support for the child during transitions within the classroom.

Steps 4-6 summarize what happens after the initial IFSP is written and the lead agency receives parental consent to provide the EI services identified in the IFSP. This is step 4

Each EI service listed in the IFSP must be made available as soon as possible after parents give their consent for that service. The service coordinator serves as the single point of contact for the family and helps coordinate the EI services for the child and family.

What is Early Intervention?

Early intervention (EI) is a parent coaching program that teaches families how to support their infant or toddler's development. EI services are customized for every child and family, and are provided by a team of qualified personnel that may include: service coordinators registered nurses social workers child development specialists occupational therapists hearing specialists speech-language pathologists physical therapists vision specialists

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Vision Services

Evaluation and assessment of visual functioning, including the diagnosis and appraisal of specific visual disorders, delays, and abilities that affect early childhood development; Referral for medical or other professional services necessary for the habilitation or rehabilitation of visual functioning disorders, or both; Communication skills training, orientation and mobility training for all environments, visual training, and additional training necessary to activate visual motor abilities.

Now you know that the 4th Principle does not look like:

Expecting families to "fit" the services; giving families a list of available services to choose from and providing these services and supports in the same manner for every family. Providing all the services, frequency and activities the family says they want on the IFSP. Treating the family as having one learning style that does not change. Or, Expecting the IFSP document, outcomes, strategies and services not to change for a year.

How the primary service provider approach is supported by the foundational pillars -

Family Centered and Relationship Based - The PSP really knows the family and provides holistic support minimizing their need to decipher information from multiple providers Natural Environments - The PSP gets to know the family routines, activities, places, and interactions and helps find ways to use these as natural learning opportunities. Children's Learning - With the parent, the PSP learns what interests and engages the child and help parents gradually build on children's learning Adult Learning - The PSP understands the parent's learning style versus the parent having to decipher information from multiple providers.

What are the Foundational Pillars of Early Intervention?

Family-Centered Practices Children's Learning Natural Environments Adult Learning Quality Teaming

States also have the flexibility to determine how they will administer services. Year after year, states make adjustments to their programs to meet increasing demand with limited funding. Some states implement or increase

Fees for families; reduce reimbursement rates for providers; or require families to use private insurance. States are also increasingly relying on Medicaid to provide early intervention to Medicaid-eligible infants and toddlers through the program's Early and Periodic Screening, Diagnostic, and Treatment benefit. While these approaches are intended to help states better serve all eligible children, they may reduce the availability, frequency, or intensity of services available to families, particularly those who are uninsured or under-insured.

The 5th Key Principle states, "IFSP outcomes must be functional and based on children's and families' needs and priorities."

Functional outcomes address the needs of the child in a meaningful way for the family. Functional outcomes aren't based on test items or other criteria that have no significance to the family. Functional outcomes build on the child's natural motivations to learn and strengthen what is important and already happening in the family's daily life. The ultimate goal of a functional outcome is to have practical improvements in the child's and family's life.

The 6th Principle does look like:

Having a primary provider, with necessary support from the team, maintain a focus on what is necessary to achieve functional outcomes; and Supporting the family to carry out the strategies and activities; directly engaging team members when needed. Working as a team; all team members understanding each other's on-going roles. And, Making time for team members to communicate formally and informally, and recognizing that outcomes are a shared responsibility.

The 6th Principle does not look like:

Having separate providers seeing the family at separate times and addressing narrowly defined, separate outcomes or issues. Providing services outside one's scope of expertise or beyond one's license or certification. Having a disjointed IFSP process, with different service providers who do not meet and work together with the family as a team. Or Working in isolation from other team members with no regularly scheduled time to discuss how things are going.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Audiology services include—

Identification of children with auditory impairments, using at-risk criteria and appropriate audio logic screening techniques; Determination of the range, nature, and degree of hearing loss and communication functions, by use of audiological evaluation procedures; Referral for medical and other services necessary for the habilitation or rehabilitation of an infant or toddler with a disability who has an auditory impairment; Provision of auditory training, aural rehabilitation, speech reading and listening devices, orientation and training, and other services; Provision of services for prevention of hearing loss; Determination of the child's individual amplification, including selecting, fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the effectiveness of those devices.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Speech-language pathology services

Identification of children with communication or language disorders and delays in development of communication skills, including the diagnosis and appraisal of specific disorders and delays in those skills; Referral for medical or other professional services necessary for the rehabilitation or rehabilitation of children with communication or language disorders and delays in development of communication skills; and Provision of services for the habilitation,rehabilitation, or prevention of communication or language disorders and delays in development of communication skills.

At present, just five states serve children at risk for delay:

Illinois, Massachusetts, New Hampshire, New Mexico, and West Virginia.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Occupational therapy

Includes services to address the functional needs of an infant or toddler with a disability related to adaptive development, adaptive behavior, and play, and sensory, motor, and postural development. These services are designed to improve the child's functional ability to perform tasks in home,school, and community settings, and include Identification, assessment, and intervention; Adaptation of the environment, and selection, design, and fabrication of assistive orthodontic devices to facilitate development and promote the acquisition of functional skills; Prevention or minimization of the impact of initial or future impairment, delay in development, or loss of functional ability.

What does IDEA stand for?

Individuals with Disabilities Education Act

7 Key Principles & Mission of Early Intervention

Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts. All families, with the necessary supports and resources, can enhance their children's learning and development. The primary role of a service provider in early intervention is to work with and support family members and caregivers in children's lives. The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child's and family members' preferences, learning styles and cultural beliefs. IFSP outcomes must be functional and based on children's and families' needs and family-identifypriorities. The family's priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.

Teamwork in Early Intervention

It involves a process of working collaboratively with a group of people in order to achieve a shared goal. We often think of teamwork in sports, but teamwork in early intervention is fundamental for providing quality services to infants and their families.

To enable families to provide care for their child and have the resources they need to participate in their own desired family and community activities.

Know their rights; Effectively communicate their children's needs; Help their children develop and learn.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Social Work Services

Making home visits to evaluate a child's living conditions and patterns of parent-child interaction; Preparing a social or emotional developmental assessment of the infant or toddler within the family context; Providing individual and family-group counseling with parents and other family members, and appropriate social skill-building activities with the infant or toddler and parents; Working with those problems in the living situation (home, community, and any center where early intervention services are provided)of an infant or toddler with a disability and the family of that child that affect the child's maximum utilization of early intervention services; Identifying, mobilizing, and coordinating community resources and services to enable the infant or toddler with a disability and the family to receive maximum benefit from early intervention services.

It is a MAJOR assumption of early intervention that

NO ONE person, discipline, program, or agency can provide the support necessary for a family with a young child with a disability. Because children and families are complex, we know that no one person can provide everything to meet all of their needs. The federal law and regulations require that "teams" of professionals from various disciplines work together to provide services and supports to families and their children.

Step 3 looks at what happens immediately after an infant or toddler is determined eligible for EI services.

Once the infant or toddler is found eligible for EI, a meeting is held with the parent to identify appropriate services and develop an IFSP for the child. Parents receive notice of the initial IFSP meeting and other information in a document called the prior written notice. They also receive written information about their parental rights, which is called the procedural safeguards notice. The meeting to develop the IFSP must be conducted in the family's native language or other mode of communication (e.g., sign language), unless it is clearly not feasible to do so. The group that develops the IFSP is known as the IFSP Team. This team includes the child's parents, advocates or other family members as requested by the parents, the service coordinator assigned to the family, individuals involved in the child's evaluation, and, as appropriate, the individuals who will provide the EI services to the child. The IFSP must include certain information, such as: • the current levels of developmental functioning of the child; • the family's resources, priorities, and concerns about such development; • the child's measurable results or outcomes to be achieved; • the EI services identified as appropriate for the child based on his or her needs; • the settings where EI services will be provided; and • other services the child will receive. Early intervention services are to be provided in natural environments to the maximum extent appropriate. Natural environments are settings that are natural or typical for a same-aged infant or toddler without a disability. Examples may include the home or community settings (such as the child's daycare if the child is in daycare). If an EI service is to be provided in a setting that is not a natural environment, the IFSP Team must include an appropriate justification in the IFSP.The child's parent must give consent to the provision of each EI service identified in the IFSP. A parent may consent to a particular EI service without jeopardizing the child's right to receive any of the other EI services identified in the IFSP. Parents may also revoke their consent for an EI service at any time. That revocation of consent is not retroactive.

The mission of early intervention, as defined by the National Workgroup on Principles and Practices Community of Practice (CoP), is stated here.

Part C early intervention builds upon and provides supports and resources to assist family members and caregivers to enhance children's learning and development through everyday learning opportunities. It has been adopted by many states to guide their programs.Having a stated and public mission statement such as this, provides team members a specific focus for their work together.

Steps 7-8 summarize what happens as the infant or toddler with a disability approaches his or her 3rdbirthday, when eligibility for early intervention typically ends. These steps are meant to prepare for the child's smooth transition from Part C services to Part B or other appropriate services or programs. This is step 7

Part C services end when the child reaches age 3. At least 90 days before the child's 3rd birthday, with the approval of the family, the lead agency or EI provider will hold a conference with parents to develop a transition plan. This conference may also be held up to 9months before the child turns 3, at the discretion of all parties. The program options available to the toddler upon leaving the EI program are reviewed and may include: • preschool services under Part B of IDEA; • elementary school or preschool services for children participating under a State's extended Part C option;* • early education, Head Start, or Early Head Start or child care programs; or • other appropriate services. The transition meeting also focuses on the transition steps and services the child and family need to ensure they make a smooth transition from Part C to the next program setting. This information is included in the transition plan, and the transition plan is included in the child's IFSP. (For many children who are referred to Part C after their 2nd birthday, the transition plan may be part of the initial IFSP.)Parent consent is needed before the transition plan may be implemented. Some exiting toddlers may be eligible for preschool services under Part B of IDEA. For each of these children: • The transition conference described under Step 7 must occur;and • The State educational agency (SEA) and the child's local educational agency (LEA) must be notified. About the transition conference - If the child is potentially eligible for preschool services under Part B, with family approval, participants in the conference include the lead agency, family, and the LEA, as well as other members of the IFSP Team, including the service coordinator and individuals invited by the family. About the transition notification - When a toddler is potentially eligible for preschool services under Part B of IDEA, the lead agency or EI provider must notify the SEA and the child's LEA that the toddler will soon reach the age of eligibility for services under Part B. This transition notification must take place at least 90 days before the child's 3rd birthday. The notification includes the child's name, date of birth, residence, and parent contact information. Once notified, and before the child turns 3, the LEA must: • provide the procedural safeguards notice to parents, which explainsthe procedural safeguards available to them under IDEA; • decide if the child is suspected of having a disability as that term is defined under IDEA Part B and therefore needs to be evaluated to determine his or her eligibility under Part B, and, if so,conduct that evaluation; and • make sure that an Individualized Education Program (IEP) is developed for the child, if he or she is found eligible for preschool services under Part B.

To enable young children to be active and successful participants during the early childhood years and in the future in a variety of settings- in their homes with their families, in child care, preschool or school programs, and in the community.

Positive social-emotional skills (including social relationships); Acquisition and use of knowledge and skills (including early language/communication/early literacy); Use of appropriate behaviors to meet their needs.

Family and professional collaboration:

Practices that build relationships between families and professionals who work together to achieve mutually agreed upon outcomes and goals that promote family competencies and support the development of the child.

Family capacity-building practices:

Practices that include the participatory opportunities and experiences afforded to families to strengthen existing parenting knowledge and skills and promote the development of new parenting abilities that enhance parenting self-efficacy beliefs and practices.

Family-centered practices:

Practices that treat families with dignity and respect; are individualized, flexible, and responsive to each family's unique circumstances; provide family members complete and unbiased information to make informed decisions; and involve family members in acting on choices to strengthen child, parent, and family functioning.

Practitioners consider Universal Design for Learning principles to create accessible environments.

Program directors and early childhood teachers ensure that the physical environment of the early childhood center and classrooms are accessible to all children and allow for easy traffic flow between areas and activities. Teaching and learning opportunities are embedded throughout children's daily routines and activities regardless of where children spend time. For example, the speech therapist supports family members to prompt their child to use the word "more" while eating dinner, taking a bath, and playing in the park.

The 7th and final key principle states, "Interventions with young children and family members must be based on explicit principles, validated practices, best available research and relevant laws and regulations."

Providers need to know and be able to explain why they do what they do. They must know the research and the evidence base behind their practices. Evolving brain research, research in the field of early childhood intervention and data from ongoing assessment of the individual child and family all provide rationale for decision making about services. Keeping abreast of current evidence-based practices is not only one of the Key Principles, it is also a standard in many of the early intervention service providers' codes of ethics. These are just some examples of professional organizations and journals that can provide staff with information about explicit principles, validated practices, best available research and relevant laws and regulations.

As you learned from the video clip and from reviewing the 7 Key Principles documents, the 3rd Principle does not look like:

Simply being "nice" to families and becoming their friend. Training families to be "mini" therapists or interventionists. Or, showing strategies or activities to families that the provider has planned and then asking families to fit these into their routines.

Steps 4-6 summarize what happens after the initial IFSP is written and the lead agency receives parental consent to provide the EI services identified in the IFSP. This is step 5

The IFSP is reviewed at least every six months to see if changes need to be made, given the child's growth or changes in develop-mental status, or given changes in the family's priorities and concerns. The IFSP periodic review may be held more frequently if the family requests it or if conditions warrant it. Parents receive a prior written notice if there is a proposal or refusal to conduct a reevaluation or to change EI services for the child. If there are no changes being proposed, the six-month IFSP review meeting may be a small meeting with just the service coordinator and the parent and an advocate or other family member requested by the parent.

Steps 4-6 summarize what happens after the initial IFSP is written and the lead agency receives parental consent to provide the EI services identified in the IFSP. This is step 6

The IFSP must be reviewed annually. The annual review meeting is held with the service coordinator, the parent, an advocate or other family member requested by the parent, and appropriate service providers. IFSP Team members review the progress the child is making in meeting the measurable results or outcomes listed in the IFSP. Do changes need to be made to the IFSP to reflect the child's current levels of developmental functioning or the family's re-sources, priorities, and concerns about that development? If so, the IFSP Team revises the IFSP, as needed.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Nursing Services

The assessment of health status for the purpose of providing nursing care, including the identification of patterns of human response to actual or potential health problems; The provision of nursing care to prevent health problems, restore or improve functioning, and promote optimal health and development; The administration of medications, treatments, and regimens prescribed by a licensed physician.

Practitioners conduct assessments in the child's dominant language and in additional languages if the child is learning more than one language.

The co-teacher, who is fluent in both English and Spanish, assesses the child in Spanish first using the Spanish version of the instrument. The early childhood teacher later assesses the child in English. The bilingual home-based early interventionist assesses the child first on one domain of an assessment in Spanish and then assesses the child on that domain in English. Dividing the assessment up prevents using the entire home visit for the assessment.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Special instruction

The design of learning environments and activities that promote the infant's or toddler's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction; Curriculum planning,including the planned interaction of personnel, materials, and time and space, that leads to achieving the outcomes in the IFSP for the infant or toddler with a disability; Providing families with information, skills, and support related to enhancing the skill development of the child; Working with the infant or toddler with a disability to enhance the child's development.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Qualified Personnel

The following are the types of qualified personnel who provide early intervention services under this part: 1. Audiologists. 2. Family therapists. 3. Nurses. 4. Occupational therapists. 5. Orientation and mobility specialists. 6. Pediatricians and other physicians fordiagnostic and evaluation purposes. 7. Physical therapists. 8. Psychologists. 9. Registered dieticians. 10. Social workers. 11. Special educators, including teachers of children with hearing impairments (including deafness) and teachers of children with visual impairments (including blindness). 12. Speech and language pathologists. 13. Vision specialists, including ophthalmologists and optometrists. * (d) Other services.The services and personnel identified and defined in paragraphs (b) and (c)of this section do not comprise exhaustive lists of the types of services that may constitute early intervention services or the types of qualified personnel that may provide early intervention services. Nothing in this section prohibits the identification in the IFSP of another type of service as an early intervention service provided that the service meets the criteria identified in paragraph (a) of this section or of another type of personnel that may provide early intervention services in accordance with this part, provided such personnel meet the requirements in §303.31.

Practitioners work with the family and other adults to modify and adapt the physical, social, and temporal environments to promote each child's access to and participation in learning experiences.

The itinerant early childhood special education teacher works with a childcare provider to modify transitions in the childcare setting by posting a visual schedule of the daily routine. A developmental specialist works with family members to find resources to modify their home so their child who uses a walker can move easily from place to place. An early childhood teacher modifies a popular board game (e.g., he adds an easy to grasp foam handle to game pieces) so that a child who has difficulty grasping can access and play the game with classroom peers.

The first of the 7 Key Principles is: Infants and toddlers learn best through every day experiences and interactions with familiar people in familiar contexts.

The life of an infant or toddler is filled with new experiences. Important and familiar people in the child's life like parents, siblings, child care providers, and grandparents help support and guide the child in all of these learning opportunities. The first principle highlights the importance of these relationships and these naturally occurring tasks and routines. Key concepts related to this principle include: Learning occurs through participation in a variety of enjoyable activities and learning is relationship-based. As infants and toddlers participate in a variety of enjoyable activities, they have more opportunities to practice and build upon previously mastered skills.

The third key principle is:

The primary role of the service provider in early intervention is to work with and support the family members and caregivers in a child's life. Principle three builds upon principle one. Because we understand the importance of the primary caregiver(s) in the child's overall learning and development, we know that our intervention will be most effective when we are supporting that person instead of taking over and providing direct therapy to the child. Early interventionists share their expertise and knowledge of child development and community resources while caregivers bring their expertise and knowledge about their child and their family. This collaboration enhances caregiver confidence and competence that creates a partnership between providers and families.

As you learned from reviewing the Key Principles documents, the 7th Principle does not look like:

Thinking that the same skills and strategies one has always used will always be effective. sing practices without considering the values and beliefs they reflect. Using practices that "feel good" or "sound good" or are promoted as the latest "cure-all". Or, Using practices that are contrary to relevant policies, regulations or laws.

The 4th Key Principle is: "The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child's and family members' preferences, learning styles and cultural beliefs." In order for early intervention services to be most effective, families must be active participants in all aspects of services.

This active participation supports each family member as a unique adult learner with valuable insights, interests, and skills. When early intervention is collaboratively tailored to fit each family, it encourages flexible and responsive interactions that value every family's cultural, ethnic, race, language, socioeconomic characteristics and preferences. Families are the ultimate decision makers in the amount, type of assistance and the support they receive and should be supported in their decision making.

Distracting and Redirecting Children to Engage in Appropriate Behavior

This concept means distracting and redirecting a child from one activity to another or away from challenging behavior. Sometimes distraction or redirection is all that is needed to change children's challenging behavior and make them forget about whatever was causing the behavior. When children are upset, you can show them a toy, lead them to another activity, or choose a new playmate to help focus attention away from undesirable behavior. These strategies can lead to a "reset" in behavior, for the better. This works best when the child really likes the distraction and redirection object or activity.

The 7th Principle does look like:

Updating knowledge, skills and strategies by keeping abreast of research. Refining practices based on introspection to continually clarify principles and values. Basing practice decisions for each child and family on continuous assessment data and validating program practice through continual evaluation. And, Keeping abreast of relevant regulations and laws and using evidence-based practice to amend regulations and laws.

The 3rd Principle does look like:

Using professional behaviors that build trust and rapport and establish a working "partnership" with families. Providing information, materials and emotional support to enhance families' natural role as the people who foster their child's learning and development. And, Involving families in discussions about what they want to do and enjoy doing; and continually acknowledging the many things the family is doing to support their child.

The 2nd Key Principle is: All families, with the necessary supports and resources, can enhance their children's learning and development.

We know that families are their child's best teacher. Regardless of educational level, culture, socioeconomic status or any other variable, ALL families can support their child's development. Different families, however, may need differing levels of support from the early intervention team. Thinking back to the first principle, we know that the consistent adults in a child's life have the greatest influence on learning and development-not early intervention providers. All families have strengths and capabilities that can be used to help their child. So, supports you provide need to build on strengths and reduce stressors so families are able to engage with their children in mutually enjoyable interactions and activities.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Collaboratively plan and write strategies/activities, services, and supports to address outcomes and enhance participation and learning in natural environments.

When developing strategies, activities and methods reinforce the positive, emphasize how caregivers and providers will work together, and indicate who will do what. -What is the family already doing? -What are the child's and family's interests? -What family and community routines and activities could provide learning opportunities? -What are the activities the family would like to participate in or try? -What informal supports and services are needed to enhance participation and eliminate barriers or difficulties the family is experiencing or anticipating? •Incorporate family strengths into strategies and activities that the family is comfortable implementing or put in place plans how to build those skills. •Discuss and identify the informal supports and community services which can be used to address each outcome. •Identify the primary service provider. •Determinate the involvement of other team members in addressing each outcome. •Consider the need for assistive technology or other adaptations to enhance the child's participation in targeted daily routines and activities. •Finalize and list the formal early intervention services that the team decided upon, specifying frequency, intensity, and funding sources. •List other formal services (beyond early intervention services) needed to meet outcomes. •Review the balance of services and activities to determine if, as a whole, they support the family's everyday life or overwhelm the family. •Remind the family and other team members that the family can accept or reject any service at any time and still participate in other early intervention services.

Practitioners report assessment results so that they are understandable and useful to families.

When writing reports to share assessment information with a family, the team leader is careful to use words, language and a format that will be understood by the family. In advance of the team meeting to share assessment results, information is shared with the family by at least one team member, and family members are provided the opportunity to ask questions or express concerns. During the meeting to review assessment results, all team members encourage the family to ask questions.

You know that the 5th principle does not look like:

Writing discipline-specific outcomes without full consideration of the whole child within the context of the family. Having outcomes that focus on deficits and problems to be fixed. Listing the services to be provided as an outcome for example, Johnny will get PT in order to walk. Or, Measuring a child's progress by a "therapist checklist" or re-administration of initial evaluation measures.

The 5th Principle does look like:

Writing integrated outcomes that focus on the child participating in community and family activities. Describing what the child or family will be able to do in the context of their typical routines and activities. And, Identifying how families will know a functional outcome is achieved by writing measurable criteria that anyone could use to review progress, using measures that make sense to families.

One national study of children who participated in early intervention found that roughly one-third of infants and toddlers who received services did not have

a disability at entry into kindergarten

At present, too many infants and toddlers with delays and disabilities are going unidentified and are not

accessing early intervention due to budget shortfalls. Significant federal and state investments in Part C are necessary to bolster states' Child Find efforts; improve service coordination and provision; and address provider availability, training, and oversight. Early intervention provides infants and toddlers with disabilities and delays the support they need to learn and grow, but will continue to fall short of serving all families in need until policymakers invest substantial resources.

Young children who have or are at risk for developmental delays/disabilities learn, play, and engage with adults and peers within a multitude of environments such as home, school, child care, and the neighborhood. Environmental practices refer to

aspects of the space, materials (toys, books, etc.), equipment, routines, and activities that practitioners and families can intentionally alter to support each child's learning across developmental domains.

Part C early intervention builds upon and provides supports and resources to

assist family members and caregivers to enhance children's learning and development through everyday learning opportunities.

Sensitive and responsive interactional practices are the foundation for promoting the development of a child's language and cognitive and emotional competence. These interactional practices are the

basis for fostering all children's learning. For children who have or are at risk for developmental delays/disabilities, they represent a critical set of strategies for fostering children's social-emotional competence, communication, cognitive development, problem-solving, autonomy, and persistence.

Within the legislation, IDEA sets forth a philosophical base, lists what services are to

be provided, addresses funding, and spells out mandatory requirements for Part C systems. Contributing to the philosophical base in the federal legislation are basic themes that helped to lay the foundation for early intervention as we know it today.

While each team may have different members, members should always demonstrate certain

behaviors as they work together in support of the child and family. Literature on teaming describes some specific behaviors associated with quality teaming.

In an evaluation of Early Head Start, researchers found that low-income infants and toddlers who received early intervention services were more likely to

catch up to their peers without delays or disabilities compared to children who were suspected of delay but did not receive services. Early intervention services benefit parents as well by equipping them with the skills necessary to support their children's special needs.

On a multidisplinary team information is gathered from the family about the

child and the family.Often this happens when the family meets the team members during the evaluation. The professionals conduct separate discipline-focused evaluations. (Multidisciplinary Team) - Child assessment - Diagnosis - Child Intervention The IFSP is developed by various professionals each contributing their own discipline specific goals. The professionals provide separate intervention visits to work on their discipline's goals. Professionals from two or more disciplines work independently of each other toward the same purpose. Professionals evaluate and provide services separately.

Of course, early intervention teams MUST include the

child's family. Families are always equal and vital members of their child's team. Their insight and participation is both essential and valued.

When it is time for children to move to centers or play areas in the room, offer a

choice of where to go. If a choice of location is not available to a child, offer a choice within an activity, such as "Do you want the red cup or the blue cup during lunch time?" Using pictures to inform children of their choices is a good way to help them understand.

While federal regulations require that states serve infants and toddlers with developmental delays, states have the flexibility to define Part C eligibility criteria and can

choose whether or not to serve those who are at high risk for delay

Thirdly, Quality teams engage in open and honest communication. For early intervention teams to support the family and each other, they need to communicate

clearly and frequently with one another. This communication can happen in a variety of formal and informal ways. It may include emailing, texting, communication through system databases, and of course, phone calls and face-to-face contact.

The final behavior of quality teaming is that members share

common tasks as they work together to support families and children. This might involve going on a joint visit, problem-solving with a colleague, or engaging in a mentoring or coaching relationship. Team members should feel supported in asking for help when it is needed, and members should be readily available to provide assistance to others.

Moving and exploring is allowing children to

crawl or walk around a safe space and explore objects or activities of their choice. Children learn by exploring their environment and moving the objects in it. Children's actions as they move and explore create opportunities for learning and practicing motor skills.

Transdisciplinary teams are quite different. The family and team members

cross discipline boundaries to assess the child from a holistic lens. IFSP outcomes are developed with the family sharing their priorities and concerns for what they feel is important to work on. The resulting outcomes are functional and non-domain specific. Professionals come together with the family for evaluation. A primary provider works with family members to provide ongoing services. Consultation occurs with others as needed and co-visits occur to share and teach. The transdisciplinary approach, with use of a primary provider, is recognized as one of the seven key principles for providing early intervention services.It is also supported by many of the professional organizations in the field and addressed in the DEC practices on teaming and collaboration - the family's priorities, needs, and interests are addressed most appropriately by a primary provider who represents and receives team and community support.

The term natural environment was first used in the 1986 legislation and remains in the

current Individuals with Disabilities Education Act or IDEA. The definition reads "to the maximum extent appropriate services are provided in natural environments, including the home and community settings in which children without disabilities participate."

Changes in funding levels and in how states administer programs also affect providers, who face

decreasing reimbursement rates, increasing caseloads, and high staff turnover in some states.

Sometimes children's developmental progress does not go as expected. Infants and toddlers with

developmental delays and disabilities likely need extra help in the form of early intervention to meet their developmental milestones.

Early intervention is designed to help infants and toddlers with

developmental delays or diagnosed disabilities. The EI program is available in every State and is coordinated by the State's lead agency.

Instructional practices are a cornerstone of

early intervention and early childhood special education. Teachers, other practitioners, family members, and other caregivers use instructional practices to maximize learning and improve developmental and functional outcomes for young children who have or are at risk for developmental delays/disabilities.

Early Intervention team members can come from a variety of

early intervention disciplines. Team members may also come from the families' community and include medical or child care providers, family friends or relatives and anyone else the family would like to include.

A focus for the many methods of communication among team members should be sharing information in the most

effective manner. Doing so reduces the likelihood of miscommunication. - Know your audience - Think about the message you're conveying - Choose simple clear words - Avoid judgemental statements - Encourage feedback and question - Use "I" statements and not "you" statements

we define practitioners as those who are responsible for and paid to

enhance the optimal development of young children who have or are at risk for developmental delays/disabilities. This includes providing care, education, or therapy to the child as well as support to the child's family.

We selected interactional practices to promote specific child outcomes, and these will vary depending on the child's developmental levels and cultural and linguistic background. Practitioners will plan specific ways to engage in these practices across

environments, routines, and activities. In addition, practitioners will assist others in the child's life (family members, other caregivers, siblings, and peers) in learning sensitive and responsive ways to interact with the child and promote the child's development.

While not all states use a transdisciplinary approach with a primary provider, many states see its advantage and are

exploring ways to move towards this teaming type. Included here are some of the common misconceptions about the primary provider and transdisciplinary teaming and some of the identified advantages to this approach. PSP is NOT - A new concept - only person the family gets to see - Always the EI specialist out there on their own - A watered-down way of giving services - A cheaper way of providing services - What is used due to staff shortages - The approach used only for children with mild delays. ADVANTAGES - Visits with families are more holistic and less fragmented for caregivers. - Emphasizes joint thinking through multiple perspectives about what is working and what is not. - Supports the family/caregivers to promote the child's learning in "real situations." - Less intrusive to families - Transdisciplinary focus is supported by the ASHA, AOTA, APTA, DEC

Teaming is not just something that happens during formal meetings. It is part of the

fabric of all interactions with colleagues, families, and other early intervention stakeholders.In essence all interactions between a family and team member or between one or more colleagues can be thought of as a team meeting. These interactions are the place where all five quality team behaviors come together, whether it is at a home visit or as part of a conversation with a colleague.

Becoming a quality team is an ongoing "developmental" process. It requires

frequent and regular times for teams to interact with one another so they can grow and learn together.

Notably, federal funding for Part C of IDEA is intended to support states in planning, developing, and implementing their early intervention systems, rather than to fully

fund the provision of services

Part C of the federal Individuals with Disabilities Education Act (IDEA) provides

grant funding to states to support early intervention systems. States are required to operate a Child Find program as part of this system to identify children with developmental delays and disabilities and refer them to services. States must serve all eligible children younger than age 3 who meet the state-established criteria for developmental delay, or whose diagnosed condition is associated with a high probability of develop-mental delay.

When you are planning activities, use children's interests to

guide you. When transitioning to an activity that the child does not prefer, use favorite interests to help motivate and engage the child.

it is important to remember that research shows that providing early intervention in natural environments and practicing the spirit of natural environments results in

high quality early intervention. Providers can truly address families' needs and concerns that happen throughout their day in the places and activities that are important to each family. Children benefit as using each family's "natural environments" helps to maximize all the natural learning opportunities in the many places and activities that families and children are involved in throughout their day.

Remember that providing services in natural environments and supporting families' priorities means that intervention visits may occur in places other than the

home. You may meet the family at a local restaurant, the grocery store, the playground, or any other place they go and would like early intervention support to address the functional outcomes they prioritized for their family.

Transition refers to the events, activities, and processes associated with key changes between environments or programs during the early childhood years and the practices that support the adjustment of the child and family to the new setting. These changes occur at the transition from

hospital to home, the transition into early intervention (Part C) programs, the transition out of early intervention to community early childhood programs, the transition into Part B/619, and the transition to kindergarten or school-age programs.

The lead agency must ensure that all infants and toddlers with disabilities in the State who may have a developmental delay or a diagnosed disability are

identified and evaluated. This agency conducts public awareness and child find activities throughout the State to let residents know that early intervention services are available to help eligible infants and toddlers with disabilities.

Infants and toddlers with developmental delays or disabilities should be

identified and receive early intervention services in a timely manner.

The recommended instructional practices below are written from the perspective of the practitioner. They may also be

implemented by families or others who interact with the child, often with support of the practitioner.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Sign language and cued language services

include teaching sign language, cued language,and auditory/oral language,providing oral transliteration services (such as amplification), and providing sign and cued language interpretation.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Transportation and related costs

include the cost of travel and other costs that are necessary to enable an infant or toddler with a disability and the child's family to receive early intervention services

Natural environments are an essential part of early intervention, ensuring the rights of infants and toddlers to be

included and participate in the same types of routines, activities, and places as available to all infants and toddlers.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Physical Therapy

includes services to address the promotion of sensorimotor function through enhancement of musculoskeletal status,neurobehavioral organization, perceptual and motor development, cardiopulmonary status, and effective environmental adaptation. These services include— Screening, evaluation, and assessment of children to identify movement dysfunction; Obtaining, interpreting, and integrating information appropriate to program planning to prevent, alleviate, or compensate for movement dysfunction and related functional problems; Providing individual and group services or treatment to prevent, alleviate, or compensate for,movement dysfunction and related functional problems.

The environmental practices we address in this section encompass the physical environment (e.g., space, equipment, and materials), the social environment (e.g., interactions with peers, siblings, family members), and the temporal environment (e.g., sequence and length of routines and activities). They relate not only to supporting the child's access to learning opportunities but also ensuring their safety. It is important for practitioners to remember that these environmental dimensions are inextricably

intertwined for young children who have or are at risk for developmental delays/disabilities and their families. Through implementation of the environmental practices, practitioners and families can promote nurturing and responsive caregiving and learning environments that can foster each child's overall health and development.

See here how this mom takes advantage of the opportunity to point to the bird out the window and draw her daughter's attention to it. This typical event for this family can be used to model

language, encourage joint attention, practice counting the birds and build mini conversations about the bird and what he does. Opportunities like this happen throughout the day.

Services are supported by a combination of state and other federal funds, and some states have local funding as well. Medicaid is the

largest federal funding source for early intervention services, comprising at least 20 percent of total funding. Conversely, federal Part C funds comprise just 13 percent of total funding. At present funding levels, federal support for Part C cannot even function as the "glue" for state early intervention systems as it was intended.

Sometimes a simple phone call or asking your fellow team members questions at IFSP meetings about their skills and experiences will help you

learn more about them.Remember, when you take the time to get to know your teammates, it will help you learn to trust and support one another.

The incredible importance of natural environments is that they provide young children so many

learning opportunities to practice the skills and behaviors needed for their successful participation in day-to-day activities. After all; children naturally spend more time with their parents and caregivers than they ever would spend with an early intervention provider.

A significant proportion of children with unmet needs are probably in

low-income families, as low-income children are more likely to be at risk of developmental delay or disability but less likely to receive services. Some evidence also indicates that children of color with developmental delays are less likely to receive services compared to their White peers. Accessing early intervention services is a multi-step process, and, unfortunately, families have many opportunities to fall through the cracks.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Health services

mean services necessary to enable an otherwise eligible child to benefit from the other early intervention services under this part during the time that the child is eligible to receive early intervention services. Such services as clean intermittent catheterization, tracheostomy care, tube feeding, the changing of dressings or colostomy collection bags, and other health services; Consultation by physicians with other service providers concerning the special health care needs of infants and toddlers with disabilities that will need to be addressed in the course of providing other early intervention services. *This term does not include services that are Surgical in nature (such as cleft palate surgery, surgery for club foot, or the shunting of hydrocephalus); Purely medical in nature(such as hospitalization for management of congenital heart ailments, or the prescribing of medicine or drugs for any purpose); Related to the implementation,optimization (e.g., mapping), maintenance, or replacement of a medical device that is surgically implanted, including a cochlear implant. *Nothing in this part limits the right of an infant or toddler with a disability with a surgically implanted device (e.g., cochlear implant) to receive the early intervention services that are identified in the child's IFSP as being needed to meet the child's developmental outcomes. Nothing in this part prevents the EIS provider from routinely checking that either the hearing aid or the external components of a surgically implanted device (e.g., cochlear implant)of an infant or toddler with a disability are functioning properly; Devices (such as heart monitors, respirators and oxygen, and gastrointestinal feeding tubes and pumps) necessary to control or treat a medical condition; Medical-health services (such as immunizations and regular "well-baby" care) that are routinely recommended for all children.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Medical Services

means services provided by a licensed physician for diagnostic or evaluation purposes to determine a child's developmental status and need for early intervention services.

Types of early intervention services. Subject to paragraph (d) of this section, early intervention services include the following services defined in this paragraph: Family training, counseling, and home visits

means services provided, as appropriate, by social workers, psychologists, and other qualified personnel 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.

A location for services such as the home or child care center meets the literal interpretation of

natural environment in the law. However, focusing on the location alone falls short of meeting the best practices intent of the law.

Natural environments facilitate generalization of learning throughout all the

natural learning opportunities of the day. Children are not expected to take what is learned in a clinical setting and then apply it to their home and family life. It is practiced right where it needs to happen. It also does not burden families to find ways to fit extra things into their already busy lives.

The example for taking what was done in a clinic or special education setting and doing all the same things in the home is also not an example of natural environments. Often people think that just because the intervention is in the home that it means it is in a

natural setting for the family. However, this is another example of where an interventionist is coming in with their own ideas and activities that may not be any part of the child and family's routine, or be anything that they will have an ability to follow through with in between visits. Remember, natural learning opportunities naturally facilitate the generalization of learning and there is nothing natural for children and families if they're being taught to replicate clinic-based activities.

Providers develop an Individualized Family Service Plan (IFSP), which identifies the child's

needs, developmental goals, and the services he or she will receive. By law, these services must be provided in children's "natural environments"—their homes, child care programs, or communities—to the maximum extent possible. States can impose fees on families but cannot deny services to families due to an inability to pay.

If one of the benefits of providing intervention in natural environments is the ability to capitalize on using the materials, activities, routines, interactions, and locations already in the family's life, then bringing in your own toys that will not be accessible to the family outside of your early intervention visits is

not going to help the child or family during the countless hours/days that pass in between early intervention visits.

Joint attention is when a child shares an

object or activity with a caregiver. A child might point to an interesting object, look back and forth between you and an object, or show interest by holding up or giving you an object. Adding words during periods of joint attention can help children pair words with objects and activities and help them learn new words.

Joint attention is a social exchange, usually between a child, caregiver, and an

object that interests the child. A child engages with an adult, usually by pointing to, sharing, or showing an object. Joint attention also can happen when a child is looking back and forth between an object and the caregiver, often sharing enjoyment, such as smiling, laughing, or showing and maintaining interest.

Following the child's lead in play means actively engaging the child in activities and with

objects that he or she chooses and/or prefers. Children are like little scientists. They learn by exploring their environment. This exploration helps them form ideas about how the world works, which they can then test through active play. To promote this type of active learning, it's important that children have the opportunity to do activities that they are interested in, while an adult follows their lead and acts as a facilitator.

Furthermore, the way early interventionists spend their time during their visits should be somewhat

organic in nature and follow the family's lead within their routines, activities and priorities. This may take some time and practice to learn how to be flexible and fluid with this process rather than focusing on your own ideas, lessons and goals for what you want to accomplish together.

Providing intervention in natural environments acknowledges the essential role

parents play as the most influential people in the child's life -the natural facilitators of children's learning in the early years and beyond.

Best practices define how natural environments include the

places children and families spend time, the things they do, the toys they use in play, and the interactions they have throughout the day with the people they spend time with and know best.

We define leaders as those in

positions of leadership or authority in providing services to all young children who have or are at risk for developmental delays/disabilities and their families. Examples of such leaders include state, regional, and local administrators; early childhood coordinators; building principals; and assistant directors and coordinators.

It is a given that the family is an essential member of the team and that the team includes

practitioners from multiple disciplines as needed. The teaming and collaboration practices we present include strategies for interacting and sharing knowledge and expertise in ways that are respectful, supportive, enhance capacity, and are culturally sensitive.

Family guided routines useful for interventions are those

predictable and meaningful activities identified by the family that match the interests and individual schedules of the child and family. Not every activity or routine is appropriate for intervention. For example, meals may be an ideal time for teaching and learning for one family. However, they may not be chosen by another family due to the child's difficulty eating or the family's busy schedule. Putting on shoes may be a perfect opportunity for one child to work on specific outcomes but may not meet another child's need at a particular time.

Considering the location alone, and not the family's routines and the people involved in the child's life, is another example that would not be consistent with intervention in a natural environment. Natural environments go beyond the location by considering how services are

provided in the context of what families naturally do, as well as where they do them and who they do them with.

Assessment is the process of gathering information to make decisions. Assessment informs intervention and, as a result, is a critical component of services for young children who have or are at risk for developmental delays/disabilities and their families. In early intervention and early childhood special education, assessment is conducted for the

purposes of screening, determining eligibility for services, individualized planning, monitoring child progress, and measuring child outcomes. Not all of the practices that follow apply to all purposes of assessment.

Appreciations is a positive exchange that begins with offering a genuine compliment and in turn,

reciprocating with a "thank you." This tip is most appropriate for preschoolers and older children. Teaching children to express and receive words of appreciation fosters social awareness and relationship skills.

Infants and toddlers learn a lot in the first three years of life: how to

roll over, sit up independently, crawl, stand, walk, and use language to communicate with caregivers and peers.

IDEA allows some flexibility for states to design their early intervention systems. In addition to IDEA and the federal regulations, each state has its own

rules, policies and procedures that their early intervention staff must follow. For more information about a specific state's rules, policies and procedures, please visit the Early Childhood Technical Assistance Center's website by clicking the link on the slide.

Predictable spaces are spaces in your setting that are used for the

same purpose on a regular basis. For example, you may have an area for snack time and another area for circle time. Predictable spaces give children information, like "What am I doing?" and "Where am I doing it?" Most children like predictability. Predictable spaces provide consistency in the child's environment and give cues about what the child is supposed to be doing.

Early intervention" refers to a system of

services—including assistive technologies; speech and language, occupational, or physical therapy; nursing or other medical services; and resources for parents to better understand and promote their child's development—that supports infants and toddlers with developmental delays or disabilities and their families

Peer-mediated support means teaching children specific

social skills to help them play with friends who have social difficulties. Social development is an important part of children's development. Research tells us that early social skills and friendships predict positive social and academic outcomes for all children. Teaching children how to initiate play with their peers encourages friendships and allows them to bond by socializing.

The first three years of children's lives set the stage for their developmental trajectories. Early intervention equips parents with the skills to support their children's

special needs and enhances children's developmental progress, reducing the need for more intensive and costly services later.

Even if all infants and toddlers were being screened, evaluated, and referred for services, early intervention systems would likely

struggle to adequately serve all eligible infants and toddlers due to significant funding challenges. Federal appropriations for Part C have been mostly flat over the last decade and have declined in real dollars since 2003

Educational programs and services for young children who have or are at risk for developmental delays and disabilities, by their nature, always involve more than one adult. The quality of the relationships and interactions among these adults affects the

success of these programs. Teaming and collaboration practices are those that promote and sustain collaborative adult partnerships, relationships, and ongoing interactions to ensure that programs and services achieve desired child and family outcomes and goals.

ll children are capable of learning. Some may need more

support from their caregivers than others. To promote learning, you can get children's attention, provide clear instructions, persist in your request, and help them respond appropriately. Many children miss out on hundreds of learning opportunities every day because they are not paying attention to what others pay attention to. Missed learning opportunities can hold children back in their development. Over time, lack of progress may lower adult expectations. This can be prevented.

Instructional practices are intentional and systematic strategies to inform what to

teach, when to teach, how to evaluate the effects of teaching, and how to support and evaluate the quality of instructional practices implemented by others.

Services are provided through a primary provider who receives needed support from other

team members. Team members meet frequently to consult and coach each other in order to assist the family during intervention visits. The focus of intervention is building the family's confidence and competence to achieve the team outcomes and help their child grow and develop.

The first behavior of quality teaming is that each member of the team knows

the mission and purpose of early intervention. Members of the team may work for different agencies or work for various programs. When they are working on early intervention, it is vital for them to understand their purpose in this specific capacity.

By providing early intervention in natural environments, we can capitalize on using

the routines, activities, and things the family already does. The role of the early intervention provider is then to assist the family to discover, use, and expand on these opportunities. Doing so enhances participation, engagement, and learning throughout the day.

In 2007 a work group of national experts, sponsored by the Early Childhood Technical Assistance Center (formally NECTAC) and the Office of Special Education Programs (OSEP), was convened to explore what was meant by natural environments in early intervention. As conversations continued, it became evident that the

the work group's task was much larger. The work group developed guiding principles for providing effective services for young children with developmental delays. The Key Principles, which are based on research and evidence-based practices, describe an approach that national experts agree is necessary to provide the best possible services and supports in early intervention.

Teaming is such an important foundational pillar that it is addressed as one of the

themes in the 2014 DEC Recommended Practices. The Practices note that the quality of relationships and interactions among all the adults on the team (family and providers) affects the success of the services and the program. Included here is the link to the DEC Recommended Practices.

Thinking questions are questions that cause children to

think and talk about what they are thinking. With opportunities to practice, children can think and learn to express the how/why of what they did, know, or feel. Asking thinking questions helps children think about their own thinking and practice how to explain it to others.

Narrate daily routines with children. Don't just do it; talk them

through it. Routine times are the perfect opportunity to incorporate more language into a child's life. Caregivers dress children every day. They feed them. They play with them. You're going to be doing these activities anyway, so why not use your words to build a child's brain along the way!

Early identification and intervention are critical for infants and toddlers who have or are at risk for delays and disabilities. When problems are identified early,

timely intervention can mitigate or even eliminate the long-term effects on children's language, cognitive, motor, and social-emotional development, while possibly reducing the need for intensive special education services later.

Social object play means playing with

toys or other objects in a way that encourages talking, looking, or engagement between a child and a caregiver and/or a peer. The child and the adult or peer play together with an object, usually taking turns that build on each other's activity to keep the play going. Social object play should be fun. The caregiver and the child share in this fun together, meaning there are mutual smiles or laughs, and the child shows interest in continuing the activity.

Each team will be

unique to the individual child and family. Pictured here is one member of the team who helped medevac Eli, back to the United States, from Germany where his family was stationed. Eli was born in Germany with a diagnosis of Spinal Muscle Atrophy (SMA). Now safely back in the United States, Eli and his family have a new team with whom they are working.

The second behavior of quality teaming is

valuing and treating each other with respect. Each team member brings their own unique personal and professional background to the team. Everyone has their own personality and style of interacting.Yet, in order to function well, each member needs to show respect for one another so that the diverse talents, skills, and backgrounds come together to form a productive whole.

Basic Themes of the Legislation:

viewing young children from a whole child perspective, working together across service systems, promoting development within the context of the family environment, and respecting and empowering families. These are fundamental and key concepts for all state's early intervention programs under IDEA Part C.

Scheduling visits may also look differently when providing services in natural environments. To address a particular issue or concern, the provider may need to be

with the family at the time of day that this occurs rather than a preset weekly time. Being there with the family allows the provider to see what is or is not working, to effectively and collaboratively identify strategies and to try those strategies in the moment to see if they are workable for the family.

There are various ways early intervention teams organize to get their

work done. While team involvement in early intervention is required and necessary, the law does not dictate a particular team structure to provide services.The 3 most commonly used team structures include multidisciplinary, interdisciplinary and transdisciplinary.Each includes families and carries out early intervention functions in different ways.

Components of a Routine

• Beginning and ending • Outcome oriented • Meaningful • Predictable • Sequential or systematic • Repetitious

Routine

• Customary or regular course of procedure. • Common place task, chore or duties done regularly or at specified intervals. • Typical or everyday activity. • Regular, unvarying, habitual rote procedure • Unvarying, constantly repeated formula, predictable response

Principle 1 does look like:

• Using toys and materials found in the home or community setting. • Identifying activities the child and family like to do which build on their strengths and interests. • Helping caregivers engage the child in enjoyable learning opportunities that allow for frequent practice and mastery of emerging skills in natural settings. And, • Focusing intervention on caregivers' ability to promote the child's participation in naturally occurring, developmentally appropriate activities with peers and family members.

As you learned from the video clip and from reviewing the 7 Key Principles documents, Principle 1 does not look like:

• Using toys, materials and other equipment the professional brings to the visit. • Designing activities for a child that focus on skill deficits or are not functional or enjoyable. • Teaching specific skills in a specific order in a specific way through "massed trials and repetition" in a contrived setting. Or, • Conducting sessions or activities that isolate the child from their peers, family members or naturally occurring activities.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Discuss with the family the formal and informal supports they use or would like to use.

•Ask open ended questions such as: "Who's important to your child and other members of your family?" "Who do you call on for help?" "Who do you see regularly? Consider friends, relatives, members of your faith community or other community activities that you engage in." •Ask the family members if they would like to be put in contact with other families in early intervention or family organizations that offer support. •Inquire about formal services and other community programs the family uses or may wish to use (e.g., medical, social services, Medicaid, recreation, place of worship).

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Begin gathering information about the family's everyday routines and activities and the child's behavior and interactions with others in those contexts.

•Ask open-ended questions such as: "What activities do you and your child do throughout the day or a typical week?" "Describe how your child participates in those activities." •Ask strengths-and interest-based questions such as "What activities go very well?" "What do you like to do together?" "What do you wish you could do together?" •Ask questions about activities the family might find challenging such as "What's a tough time of the day or activity for you? "How does your child behave and interact with others in these challenging activities?" •Use prompts and observations to encourage the family to describe their child's engagement/participation, independence, and social interaction in various routines and activities.

The other seven topic areas provide guidance for practitioners:

•Assessment •Environment •Family •Instruction •Interaction •Teaming and Collaboration •Transition

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Identify the team member who will provide ongoing service coordination.

•Assign the service coordinator, based on state and local model of service coordination. •Assure that the family has appropriate contact information and a good understanding of service coordination •Explain how the family may ask for a change in service coordinator, if state policy and procedures address this issue.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Identify transitions that the child and family may be facing and identify useful supports.

•Assure that the family understands the time frame for transition from early intervention and when transition planning should occur. •If transition is eminent, develop an outcome and the strategies, services, and supports as appropriate (transition plan).

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - Build on or establish trust and rapport.

•Before each visit, reflect on your own beliefs and values and how they might influence your suggestions and strategies with this particular family or caregiver. •Use communication styles and social behaviors that are warm and welcoming and respectful of family culture and circumstances. •Conduct yourself as a guest inthe family's home or caregiver's setting. •Respectfully provide complete and unbiased information in response to requests or questions. •Be credible and follow through on plans you made with the family. •If you don't know the answer to a question, tell the family you do not know but will find out for them. Tell them when you will get back to them with the information.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - For on-going visits, use the IFSP as a guide to plan how to spend the time together.

•Begin each visit by asking-open ended questions to identify any significant family events or activities and how well the planned routines and activities have been going. •Ask if there are any new issues and concerns the family wants to talk about. Explore if these concerns need to be addressed as new outcomes; if so, plan an IFSP review. •Decide which outcomes and activities to focus on during the visit.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Become acquainted and establish rapport.

•Use communication styles and social behaviors that are warm and welcoming and respectful of family culture and circumstances. •Ask what language the family usually speaks (mode of communication) and if any family members may want an interpreter. Explore their level of comfort with written documents. •Balance the time listening to the family with sharing information. •Let the family know that you are interested in exploring the family's concerns and working with them to find solutions.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Determine if the child is eligible and explain and provide written prior notice.

•Describe and discuss eligibility for the program. •In order to make the eligibility decision, review and summarize findings, sharing perspectives among the team, which includes the family. •If the team determines that the child is eligible, provide written prior notice, for both the eligibility decision and the IFSP meeting. •If the child is not eligible, explain the team decision, provide written notice for the eligibility decision, including procedural safeguards and explain the process for filinga complaint if they disagree with the decision. •If the child is not eligible, discuss and give information about available community resources, developmental milestones, and contacting the early intervention program in the future.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Explore and identify the roles that the family may want to play in their child's evaluation and assessment process.

•Describe and discuss the evaluation and assessment process. •Discuss who the family would like to include in the evaluation and assessment process. •Use screening and family information to identify the team members and assessment styles to fit the needs and interests of the child and family. •Schedule times and locations that are convenient to the family. •Help the family decide how they want to participate in their child's evaluation and assessment, e.g., assistant, facilitator, observer, assessor. Give concrete descriptions of the various ways they might participate using other families' scenarios as examples. •Make a list with the family of specific questions they would like to have answered.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - During the first visit, review the IFSP and plan together how the time can be spent.

•Describe the practical aspects of a visit and what the family or caregiver can expect. For example: the length of the typical visit, that other people are always welcome at the family's invitation, the variety of places in which visits can occur, the program's cancellation policy, etc. •Describe examples of visits in various home and community settings where the family participates. You might want to offer to share clips from commercial or videos produced by your program. •Invite the family to reflect on their experience with the IFSP process to date and share any concerns or questions. •Review the IFSP document and assessment information. •Consider each agreed upon outcome - is it wh at the family is still interested in; prioritize again, if necessary, where to begin; change wording if needed; provide any explanations to help family understand purpose, etc. •Discuss how outcomes, activities, and strategies can be a starting place for each home visit. •Clarify who will work on each outcome - family, friends, other caregivers, service providers. •Talk about community activities and events that can be used to support practice and mastery for the specific outcomes. •If not previously done, ask the family to sign the IFSP, consent forms, and any other necessary documentation. •Provide information about family-to-family support and parent groups that are available.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Describe early intervention as a system of supports and services for families to assist them in helping their children develop and learn.

•Discover family members' personal preferences for sharing and receiving information. • Offer information in multiple formats. •Explain how children learn best through everyday experiences and interactions with familiar people in familiar contexts. Explain how services work to support caregivers in making the most of the many learning opportunities. •Explain how family members are "experts" in understanding their child and family circumstances and interests. •Use the family's interests and concerns to offer concrete examples of how a service provider might work with the child and family. •Explain that the early intervention program has rules and procedures that providers must follow. •Show the family the location of the procedural safeguards written in the program materials and tell them that you'll review these at different points in the process. •Describe the kinds of information that will be important in the assessment process. Explain confidentiality. Make sure that the family knows that they should only share information they are comfortable sharing.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Collaboratively identify and write functional outcomes to be achieved for the child and the family.

•Discuss the outcomes the family wants to work on to enhance the child's development, engagement, social relationships, and independence in family and community routines and activities. •Discuss the family outcomes that they want to include, •Prioritize potential outcomes and choose which to work on first. • Discuss what can be reasonably achieved in an agreed upon time frame. •Write outcomes using active language that describe a desired and measurable end result, including what the routine/activity/behavior should look like and where/when/with whom it should occur. For example: "Abby will crawl to get toys out of her reach when playing on the floor, so she can play more independently."

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - Prepare families for transition out of Part C services.

•Early in the relationship with the family have conversations about what they want for their child's future after the early intervention program ends. •At formal 6 month/annual IFSP reviews share written information about the "transition process" and options (no services, community services, and Part B services) and describe that early intervention services end at age three. •By no later than the child's second birthday, have conversations about the types of programs, places, and activities the family would like their child to participate in at age three. •Discuss and share information about ALL options available to children and families at age three. •Provide written information about these options or assist the family as needed to explore and visit these options. •Jointly review the IFSP and revise/add outcomes and strategies based upon the above discussions. •Develop a transition plan which includes the outcomes and activities to prepare the child and family for success after early intervention.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Identify the criteria, procedures, and timelines used to determine progress toward achieving each outcome.

•Ensure inclusion of measurable, functional criteria that any team member could use to review progress toward achieving each outcome. •Use family-friendly language and verify the family understands in a supportive manner. •Emphasis the critical role that families and caregivers play in sharing information with other team members about the status of progress made in achieving outcomes.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Describe the purpose and process, of the initial IFSP meeting, including a thorough explanation of the IFSP document.

•Explain that the family is an equal member of the early intervention team. •Explain the various roles that the family might play in the meeting and explore how the family chooses to participate (e.g., facilitator). •Ask the family who they would like to invite to the meeting. •Schedule times and locations that are convenient to the family. •Describe the IFSP document asa dynamic plan, developed by the team that guides the provision of family-centered early intervention supports and services based upon the changing needs of the child and family.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Provide written prior notice along with all the procedural safeguards, and ask the family to sign consent for evaluation and assessment and release of medical or other records.

•Explain that, just as the early intervention program cannot share information about the family without permission, it also needs the family's permission to ask other programs for information about their child and the family. •Explain prior notice and review all the rights and procedural safeguards with the family, asking if they have any questions such as, "Is this clear and understandable?" "Do you have any questions about why we need to do it this way?"

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Review the purpose and process (agenda) of the IFSP meeting. Review the IFSP document as a dynamic plan that will guide the provision of supports and services.

•Explain the meeting process thoroughly. •Emphasize the family's role as an equal team member in developing the IFSP and in implementing, evaluating, and revising it over time. •Explain the pertinent rights and procedural safeguards, and explain that the team will revisit these rights and safeguards throughout the IFSP process.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - As applicable, conduct a developmental screening.

•Follow state and local procedures about providing written prior notice and obtaining consent for screening. Always explain the meaning and intent of pertinent procedural safeguards. •Ask engaging questions that invite the family to share their thoughts and concerns about their child's development. •Explain that there is an age range when children learn certain skills and abilities and that screening is a quick way to determine how a child is doing. •When implementing a screening protocol clearly describe the process with the family. •Talk with families about what the screening is showing and ask for their observations of their child's behavior or other information they want to share. •Come to agreement on the results of the screening and what the next steps should be. •If the screening shows no concerns and the family does not want their child to be evaluated,describe other available community resources, as appropriate. •Explain that the family can contact the early intervention program any time up until the child turns three years old. •Leave the family with necessary information, such as how to contact the early intervention program, resources on developmental milestones, and information about other community resources. •Follow state and local protocols about notifying the referral source about action taken on referral.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - Jointly revise, expand, or create strategies, activities or routines to continue progress toward achieving outcomes and address any new family concerns or interests.

•Having listened throughout the visit, reflect on what you have heard that may suggest new outcomes or activities; explore with the family if this is something they want to address soon. •Support and encourage family decisions. •Focus recommendations on promoting the child's participation in everyday family and community life. •Explain the "why" behind recommendations that you make so the family understands what to look for and do. •Together, plan next steps and/or revise activities and strategies to build on the child and family's interests, culture, enjoyment, strengths. •Consider any adaptations and augmentations to toys, materials, or environments that are necessary for success. •Try out new strategies or activities to be sure family members or caregivers can do them on their own. •Determine if and what type of support from other team members is needed for the next steps (consultation, information, co-visit, etc.)

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - Explain and follow the regulations, timelines, and procedures for transition plans, planning conferences, and data collection.

•Help the family prepare for any formal evaluations the child may need. •Assist in arranging the formal (transition?) meeting with the program staff who may be working with the child after age three. •Assist the family to find on-going family support if needed. •Acknowledge feelings about ending the relationship with this family and help to focus on a positive future as the child and family move on. •Celebrate with the family or caregiver the accomplishments and joys they have experienced with their child.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - Modify services and supports to reflect the changing strategies, activities, or routines.

•Identify community activities and informal supports that will assist the outcomes and activities to be achieved. •Facilitate referrals and provide any needed assistance, adaptations, or support for the family and the child to participate in desired community activities. •Plan what early intervention and other services and supports are needed to help the child succeed and make progress. •Add to or modify the IFSP as appropriate. If changes are significant (adding outcomes, or changing services, frequency, or intensity), a team review of the IFSP is necessary.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Provide justification of the extent, if any, to which services will not be provided in a natural environment.

•If the team decides that a specific child outcome cannot be met in a natural environment, write a sufficient justification. •Make sure the justification includes a plan for how to move the child from the non-natural environment back into other settings at home or in the community once the specific outcome that could not be met in the natural environment is achieved. •If services are provided in an exclusive/restricted environment, discuss plans for moving services to a natural environment.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Establish a welcoming and respectful climate for family members and caregivers as equal members of the IFSP team.

•Introduce all present as equal team members with essential input to share throughout the meeting. •Clarify roles, e.g. service coordinator, facilitator,and note-taker. •Encourage all team members to learn together, share observations, raise questions, and develop a functional plan. •Avoid the use of jargon or explain what it means, so that everyone at the meeting understands terms that are used. •Tailor interactions to the unique learning preferences and modes of communication of each adult.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - Prepare and assist with formal reviews and revisions of the IFSP.

•Minimally, at 6 months and annually, and any other time the family/provider team wants to make significant changes to the IFSP, plan the Review meeting with the family. •Review with the family questions, recommendations, or suggestions they wish to discuss with other service providers. •Decide with the family the agenda for the meeting and their preferred role(s), including who should facilitate. •Determine together who should be included in the "formal review meeting", when and where the meeting should occur. •Explain and provide written prior notice for the review meeting. •Conduct the review meeting and evaluate progress toward outcomes. Ensure all outcomes, services, and supports are still needed, current, and accurate. Make additions and revisions as needed.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Throughout the assessment process, observe and ask the family about their teaching and learning strategies with their child.

•Observe and discuss with the family how they help their child learn. •Offer compliments about how the family uses specific strategies that support the child's learning. Use concrete examples of how the family supported the child's skills during assessments.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: Ongoing Intervention Practices - Participate with the family or other caregivers and the child in the activity and/or routine as the context for promoting new skills and behaviors.

•Offer a variety of options to families for receiving new information or refining their routines and activities, such as face-to-face demonstrations, video, conversations, written information, audios, CDs, diaries, etc.. •Gather any needed toys and materials and begin the selected activity or routine. •Listen, observe, model, teach, coach, and/or join the ongoing interactions of the family and child. •Encourage the family to observe and assess the child's skills, behaviors, and interests (a continual part of on-going functional assessment). For example, ask the family if behaviors are typical, if they've seen new behaviors (suggesting emerging skills), or how much the child seems to enjoy the activity. •Use a variety of consulting or coaching strategies throughout the activity, including: observing, listening, attending, acknowledging, expanding, responding, probing, summarizing, etc. •Reflect with the family onwhat went well, what they want to continue doing, and what they would like to do differently at the next visit.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - For children proceeding to evaluation/ assessment, explain the purpose and process, including the importance of gathering information about family concerns, priorities, and resources.

•Plan with the family how to address relevant individual, cultural, and linguistic characteristics that may influence assessment. •Explain how family information can be used to know who to involve and how to conduct an appropriate evaluation/assessment.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Collaboratively review information collected during early contacts regarding family concerns, priorities, and resources.

•Review and update family concerns, priorities, and resources in the context of the families' day-to-day life. •Allow time for all of the team members to understand concerns from the family's perspective. •Determine if there are any additional family needs or interests that the IFSP should address.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Collaboratively review information gathered previously about the child's health, development, and learning.

•Review and update health information pertinent to the child and the provision of early intervention support and services. •Assure that the synthesis (report) of present levels of the child's development across all domains is functional and focused on skills, strengths, and behaviors rather than a rote recap of test scores. •Review the child's unique abilities, emerging skills, and engagement or participation in various routines and activities.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Ensure the family understands relevant procedural safeguards and next steps.

•Review procedural safeguards related to providing consent for services and obtain written consent for IFSP services. •Discuss the "timely" initiation of services. •Make sure the family understands that changes c an be made to the IFSP as needed. •Give the family reports, records, and copies of the IFSP. •Discuss confidentiality and family access to educational records. •Agree upon next steps for all team members to begin services in a timely manner.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS: The IFSP Meeting - Consider pre-literacy and language skills that are developmentally appropriate for the child.

•Talk with the family about the many ways they support language (pre-literacy) development through their daily activities. •Consider outcomes or strategies to further support pre-literacy interests.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Evaluate and assess the functional needs and strengths of the child.

•Use assessment procedures that ensure collaboration among the family and providers, including supporting the family to participate in the way they choose. •Identify the child's skills that seem to be emerging. •Observe the child's authentic behaviors in typical routines and activities. •Use assessments that capture information about the child's interests, engagement, social relationships, and independence. •Give equal weight to the family's observations and reports about their child's behaviors, learning, and development. •Throughout the assessment process, reflect with the family about observations of the child's behaviors, summarize results, clarify and confirm that the family understands the process and results, and record the findings.

AGREED UPON PRACTICES FOR PROVIDING EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTS - Engage in a conversation to find out why the family is contacting early intervention and to identify the next appropriate step in the referral process.

•Use open-ended questions and/or comments such as "Why did you contact early intervention?" "What are your questions or concerns about Michael's health and development?" "If someone suggested that you call us, what were his/her concerns?" "What kind of information would be most useful to you?" •If the childhas a diagnosis, ask questions such as: "What has your doctor/nurse told you about Michael's diagnosis?" "What questions do you have about the diagnosis? "What questions or concerns do you have about how it might affect your child and family?" •Listen for developmental "redflags" indicating an appropriate referral or a diagnosis that would make a child automatically eligible. •Consider whether a child's development sounds typical enough that a screening may be a good idea before the full evaluation and assessment. •Explain the general purpose of the early intervention program and how children and families are eligible. Provide public awareness materials. •If a decision is made that early intervention is not appropriate at this time, explain that the family can contact the early intervention program any time up until the child turns three years old. •Share with the family other appropriate community resources or services.