ECI: Making It Work Section 2: Referral and Initial Contact

ECI: Making It Work Section 2: Referral and Initial Contact

2.1 Getting started

Notes:

MIW Service Coordinator (SC):

Let's get started with the pre-enrollment process for the three children in your MIW caseload. Pre-enrollment begins when a child is referred and we make initial contact with the family … Evaluation and Assessment is the next phase of pre-enrollment; we will discuss that later.

2.2 Who referred Andre to ECI?

Notes:

MIW SC:

I just received a referral for Andre. Look at the handout-Andre’s referral form.

Question: Who referred Andre to ECI based on the referral form?

1. His parents
2. His physician
3. His daycare

Answer: Andre’s physician

Notes:

Anyone who has a concern about a child’s development can make a referral to ECI, and Texas ECI programs must accept referrals for children less than 36 months.

2.3 Referral form

Notes:

MIW SC:

The referral forms you receive at your program, may look somewhat different from other programs’ forms, but they will include the same key elements. To act on a referral we need:

·  The date of referral

·  Who made the referral

·  The parent’s name and contact information

·  The family’s address

·  The child’s name and date of birth

·  And the reason for referral.

A referral may also contain information about the parent’s concerns regarding the child’s development, and the child’s most recent physical exam or other medical record. Sometimes a referral may include a medical diagnosis. Information gathered during the referral process can also assist ECI programs to assign the most appropriate team for the child’s evaluation and assessment.

An ECI program can act on a referral only with the correct information. If a referral source does not provide correct contact information for the family, then the referral is incomplete. When this occurs, programs should contact the referral source to see if there are alternate ways to reach the family.

As you can see, there is significant and sensitive information that can be gathered during the referral process. Keep in mind that families have the right to expect the rules around confidentiality begin immediately at the point of referral. You will learn more about confidentiality and other procedural safeguards shortly ...

2.4 Reason for referral

Notes:

MIW SC:

First of all, what is the reason for the referral? Again, look at the physician referral form.

Answer: Suspected developmental delay in the cognitive and communication areas. Also, CPS recommended Andre be evaluated by a physician.

I noticed on the physician's referral form that Andre is in a foster home. CPS referred him to the doctor, who then referred Andre to ECI.

I'm going to make my initial contact with Andre's foster family today. When we make that first phone call to a family, it's important to explain that we are with "Early Childhood Intervention" or you may know our agency as “ECI.” We want families to become familiar with both terms as they are likely to hear it said both ways. Remember, families may not be familiar with the many acronyms we use routinely when we talk with one another.

Why don't you take some time now to learn more about the referral process and I'll check back with you in a bit. In the meantime, your MIW Coach is here to help ...

2.5 Referral in TAC and CFR

Notes:

MIW Coach:

ECI programs and services are governed by a variety of federal and state laws, including the Individuals with Disabilities Education Act (IDEA), the Code of Federal Regulations (CFR) and the Texas Administrative Code (TAC, often referred to as Rule).

These laws spell out what services must be provided, to whom, and how they should be provided. As you go through Making It Work, you’ll learn some of the specific information contained in these laws, and you’ll have an opportunity to practice finding information in these documents.

Let's take a closer look now at requirements around referral ...

The Texas Administrative Code that outlines requirements for referral can be found in Chapter 108, Subchapter G, listed here: http://info.sos.state.tx.us/pls/pub/readtac$ext.ViewTAC?tac_view=5&ti=40&pt=2&ch=108&sch=G&rl=Y .

The federal regulations that outline information about referral can be found in the CFR 34, 303 Early Intervention Programs for Infant and Toddlers, Subpart D, Sections 303.301, 303.302, and 303.303., listed here: http://www.ecfr.gov/cgi-bin/text-idx?c=ecfr&SID=6b266fffdc7890f6646b0e34961691ca&rgn=div5&view=text&node=34:2.1.1.1.2&idno=34#34:2.1.1.1.2.4.

Can you find this in rule: In what section does Rule address how to handle the referral of a baby to your program with an out-of-state IFSP? Answer: Section 108.706.

2.6 Primary referral sources

Notes:

MIW Coach:

Referrals can come from a variety of sources:

· Physicians and other healthcare professionals

· Child care providers

· Parents, caregivers, other family members

· Social Service agencies

· Child Protective Services (CPS)

· Other Texas Health and Human Services programs

Note these are the most common primary sources but there are others, such as the local school district.

Question: Which one of these primary referral sources listed above is responsible for the most referrals to ECI? Answer: Physicians and other health professionals

2.7 Referrals of MIW children

Notes:

MIW Coach:

You saw on Andre's referral form that he was referred by his doctor. What about the other children in your caseload?

Elizabeth was referred to us at discharge from the hospital, due to her diagnosis of Down Syndrome.

Let's look at Riley's referral form to see who referred him ...

2.8 Riley's referral form

Look at this sample portion of Riley’s Referral Fax Form:

REFERRAL FAX FORM Date: 8/20/2014

To: Baby Legend ECI From: Wonder Years Pre-School

Attn: ______Phone: 512-555-8888

Email: Fax: ______

Phone: 512-555-6754

Fax: 512-555-6799

2.9: Quiz: Riley’s Referral

Based on the sample fax referral form 2.8, who referred Riley to ECI?

1. Pediatrician
2. DBS (Division for Blind Services)
3. Parents
4. Child Care Teacher

Answer: His child care teacher referred him. If you chose another option, look at the referral form again.

2.10 Pre-enrollment process

Notes:

MIW Coach:

Pre Enrollment begins when you receive a referral and start gathering information about the child and family. Pre-enrollment ends when the family signs the IFSP or after evaluation has determined the child is not eligible for ECI. While the Service Coordinator is the team member responsible for facilitating pre-enrollment activities, other team members participate in the evaluation and assessment process and IFSP development. In addition, all team members should review the child and family’s information collected by the Service Coordinator to prepare for the evaluation and assessment, and if the child is eligible, the IFSP meeting.

Pre-Enrollment is the time to gather information from families

In the first contacts with families, you will not just learn about needs and concerns of the family, but will begin to understand how those needs impact the family. A positive relationship with the family is critical to successful services. The strength of the relationship established during the pre-enrollment process lays the foundation for what happens throughout the family’s involvement with ECI. As rapport builds, the family will feel more confident in sharing and exploring with you what they need to support their child’s development. This is an ongoing process and is the responsibility of everyone on the team.

Pre Enrollment is the Time to Share Information

Much like the referral process, during pre-enrollment we continue to share information with the family about ECI services, family rights, and important timelines. It’s important that pre-enrollment activities are conducted in the family’s native language unless it is clearly not feasible to do so.

Check your understanding:

Question: When does pre-enrollment begin and end?

Begin: When you receive a referral and start gathering information about the family

End: When the family signs the IFSP, or when the child is determined to be ineligible for services.

2.11 Activity 2.2: Referral at your program

Notes:

MIW Coach:

There are three goals for the referral and pre-enrollment process. The first goal is for the program to begin understanding the concerns regarding the child. The second is to begin delivering information to the family about the purpose and philosophy of ECI and the activities that will be completed. The third is to provide information to referral sources that will allow them to have an accurate and complete understanding of ECI services, including who is likely to be eligible for services.

Investigate what happens at your program by completing Part A of the Worksheet 2.2, Know your Program.

2.12 Gathering information

Notes:

MIW SC:

Looks like you've learned a lot about the referral process. Good job!

I just got a call from CPS about Andre. The CPS worker assigned to his case would like to speak with us. Her name is Kerry, and she's worked with other children enrolled in ECI, so she is familiar with our evaluation process and services.

Question: What do you do since you got a call from CPS about Andre. Answer either A or B

1. Contact Kerry immediately to get more information about Andre. You already have a referral form, so it's okay to find out more about this child.
2. Ensure that the family has provided consent for CPS and ECI to talk to each other about Andre.

The answer is: B, ensure the family has provided consent. The family must provide consent for you to speak with the CPS worker about Andre.

2.13 Info from CPS

Notes:

Talking with a referral source

Kerry obtained consent from Andre's family to speak with ECI. She faxes you a copy. The following are the answers to possible questions you may have about Andre’s referral from CPS.

Question 1: How did CPS become involved with Andre?

Kerry: Andre was removed from his home due to neglect. An emergency room physician felt that Andre’s mother waited too long to get him care when he had a very bad ear infection. CPS investigators found the home to be unsanitary, and also felt that Andre’s mother did not seem to know a lot about providing a safe environment for an active toddler. We worked with Andre’s mother to clean up the home and take some toddler parenting classes. She made some progress but then stopped attending classes. A neighbor later called to report that Andre had been left home alone. At that time, the decision was made to place him in foster care.

Question 2: Can you tell me anything else about Andre that might be helpful to the ECI team?

Kerry: I've been involved in the case for a few months. Although Andre is not shy or timid, he doesn’t show a lot of emotion. Andre has not been around a lot of other children. I feel he is more quiet and subdued than most other kids approaching two years old. We noticed there were no books or toys in the home except Happy Meal toys appropriate for older children.

Question 3: Have any decisions been made about a permanent placement?

Kerry: At this point, the plan is to return Andre to his mother if she complies with the plan CPS has developed for her.

2.14 Needed at a meeting ...

Notes:

MIW SC:

We have a team meeting now. Let's share this information about Andre with the team.

What should you do with Andre’s file? Choose A or B

1. Leave the record on your desk as long as it is covered or closed so the information contained in it is not easy to see.
2. Put the file in a secure location. You should not leave a child’s

record unattended.

The answer is B. You should not leave a child’s record unattended.

2.15 Activity: Confidentiality scenarios

Notes:

Try these other scenarios about preserving confidentiality ... Answer either A or B for each question.

Question 1: A family you are working with shares personal and highly sensitive information with you. What would you do?

1. Remind the family that all information shared is confidential. If the information is not directly relevant to services, explain that it will not be kept in the child’s record or shared with other team members.
2. Explain to the family that all information is confidential; however, it can be shared with other team members.

The correct answer is A. Sometimes families will share personal information with ECI staff. It is always good to remind families about what kinds of information will remain between you and the family and what will be shared.

If you answered B, remember, Sharing information with team members or documenting it in the record should only occur if the information directly impacts providing ECI services to the child. Families need to have a clear understanding about the kinds of information you'll share with other ECI staff.

Question 2: A health clinic nurse contacts the social worker at your local program asking for information about the health status of a child their clinic physician referred and who was later enrolled in your program. What would you do?

1. Go ahead and exchange information with the child’s physician, as it is important to coordinate with the medical provider.
2. Explain confidentiality requirements to the clinic staff.

The correct answer is B. Check the child’s record to determine if consent to the clinic/physician was already in the file to determine if consent was already given. If not, talk with the family about the request and if they agree to the release of information, obtain written consent prior to sharing any information. You must obtain consent from the family to get information from the physician and to release information to them. Talk with the family about the request and if they agree to the release of information, obtain written consent.

Question 3: A co-worker not involved with a child and family on your caseload asks questions about the services being provided.

1. Go ahead and share the information with this co-worker because the information is more about the services than the child or family.
2. Politely decline. You should not share information with anyone, including co-workers, unless they are directly providing services to the child.

The correct answer is B. Sometimes a co-worker can learn information about a child in services from relationships outside the workplace. You should not share information with anyone, including co-workers unless they are part of the child’s team. Even when the information shared is primarily about services, you cannot share any information that relates to a specific child or family, or that conveys personally identifiable information.