AI VI ECI Notes for Feb. 27, 2017

AI VI ECI Notes for Feb. 27, 2017

ERCOD/Statewide updates:

Mari Hubig shared via Zoom for her and Susie Tiggs that they have piloted the Online Ski-Hi sessions. They are currently planning to train new SKI-HI trainers in TX- currently there are only two. The hope is to roll this out in summer or fall, but there is not a date yet. Also this summer, they will be offering on-line “best practice training” for Parent Advisors.They also plan to have PA support meetings on-line every 2-3 months. This can be open to audiologists and SLPS and anyone working with these families. They plan to create a video to help LEA’s understand the importance of classes for 3 year old students who are hearing impaired. Also, the DHH mentor program to expand to include listening and spoken language, not just ASL support. She noted as well the, “Visual Communication and Sign Language Checklist for Signing Children” – Susie is encouraging people to use this as a tool for children using any form of sign communication – ASL, SEE, etc.

ECI:

Can we do co-visits?

Yes, Co-visits must be listed on IFSP with justification. Co-visits are possible and even encouraged in some cases. This is a team decision but must be addressed in the IFSP if the team does plan to provide co-visits.

Examples of wording for the justification: “to coordinate strategies between ECI and AI/VI staff,” “for AI/VI staff to support the implementation of sensory-specific strategies.” There really are no magic words to use, but just know that if co-visits are to happen, they must be indicated on the IFSP services page. I attached those pages for you to reference.

What are the referral timelines?

In general, the timeline is 5 working days and can only happen with parental consent.
HEARING: If a need for further hearing evaluation is identified at ECI screening/needs assessment AND the child has not had a hearing eval in the past 6 months, ECI has 5 working days to refer the child to an audiologist (or pediatrician if they have to go through pedi to access a specialist). If ECI receives audiological records that document a hearing impairment, ECI has 5 working days to refer the child to get an otological exam and to the LEA for part C.
VISION: If a need for further vision evaluation is identified at ECI screening/needs assessment AND the child has not had a vision eval in the past 9 months, ECI has 5 working days to refer to an eye doctor (or pediatrician if they have to go through pedi to access a specialist). If ECI receives an eye exam report that documents vision impairment, ECI has 5 working days to refer the child to the LEA and to HHSC Blind Services.
Please see these policy references from the Texas Administrative Code: Referral to AI RequirementsReferral to VI Requirements.

What if we have a child with AI who we suspect may have an eye condition?

If ECI expresses that there is a concern, they can, with parental consent, provide info to TVI and to Doctor, and TVI might be able come to the home and explain their services with general suggestions…but not do an “evaluation”.If you suspect an eye condition for a child who is already enrolled, let the ECI service coordinator know so that she can make the appropriate referral. If you see no movement on the issue, please follow up with that ECI program’s Director.
If the baby is not yet enrolled and concerns come up as part of the initial ECI evaluation and IFSP process, Vision Assessment can be written as an IFSP service on the IFSP services grid (where you would write VI services, Speech therapy, etc). This obligates the ECI program to address this within 28 days of the date that IFSP is signed. This does not account for delays due to obtaining needed medical records, etc, but it does ensure that the ball gets rolling.Some ECI programs do not like to do it this way because it does obligate them to take action quickly and instead choose to write an IFSP outcome/goal to address the need. That is also acceptable, but does not come with the time limited obligation for action.

If the ECI program does not have any documentation of a vision impairment but they suspect it, the service coordinator can obtain written consent from the family to share information with the LEA or HHSC Blind Services staff and ask the TVI to come meet the family and provide ‘general’ relevant developmental information (since a vision evaluation has not been done).

What if the eye report did not note any VI issues?

If the team still has a concern after the eye exam, then TVI can do a consult and perhaps ensure that the child saw a pediatric ophthalmologist as opposed to a generic optometrist or try to help the team “frame” the issues.

Do you want to know how to write “ECI appropriate outcomes”?

See on-line training HANDOUT attached…Also, on that flyer see “Coaching families” training link.These are two separate resources. In the Making it Work module you will find information about how to write ECI-appropriate outcomes Making It Work(you’ll need to navigate to section 4: IFSP and the subsection labelled “Outcomes”. Coaching FamiliesThe Coaching Families module addresses what an early intervention home visit should look like.

Do we need permission to do an assessment of any type?

Be sure to have signed consent before doing any type of assessment or evaluation.This means the ECI Service Coordinator needs to be advised ahead of time so that she can provide the family with prior written notice and procedural safeguards. These are legally required elements for ECI and will get the ECI program in trouble if this is missed. TVI/Parent Advisor will have at most up to 2 weeks (ASAP) at very most to turn in the evaluation. (There is no set deadline, this is a good-faith request). We can document findings briefly in the IFSP, then follow-up with detailedreport. Once a service is written into the IFSP, the child must have the 1stservice delivered within 28 daysof the date the parent signs the IFSP. For ECI purposes, evaluation equals eligibility determination(initial or annual) …anything else is assessment.

If the service plan says,”4x per month” …

When parent does a cancellation late in the month, it counts as a cancellation for whatever month the visit was scheduled in. The example that was presented was this: A child had received all 4 visits in February and was scheduled for a visit in the first week of March – which still had two days of February in it). Parent contacted the service provider in late February to reschedule that 1st March visit for a date that was actually still in February. Does that count as the March visit? The answer is no. If the service was delivered in February, it then counts as an extra February visit and there are still 4 visits required in March.

Answer from Susie Tiggs, state lead for AI: “Services need to be offered 52 weeks out of the year. Can document specific frequency of services related to parent’s needs/preferences. Include parent’s preferences in plan (ex. 48 out of 52 weeks due to parent vacation and parent holiday plans). If you have said 4x/month, it needs to be provided 4x/month. If it is going to be over 3 weeks or 2 weeks instead of all four weeks, it needs to be stated that way in the IFSP. Think about it in these terms:

• If your staff all wins the lottery and moves to Bimini without a phone, will the new staff know how to implement?
• If your staff is going over 3 weeks or doubling up over the holiday, is that because of request by the parent, or is that for staff convenience? While we all know that we do need to take staff needs into consideration, family needs come first.
• Also, if you are stating in PEIMS 45min/week for funding, it has to be provided 45 min/week, not over three weeks.

ECI states any make up sessions have to be made up w/in calendar month.”

In December, what is the policy when the teachers are not working? Parents are entitled to the 52 weeks per year (if scheduled) and school calendar is irrelevant. “Services need to be offered 52 weeks out of the year. Can document specific frequency of services related to parent’s needs/preferences. Include parent’s preferences in plan (ex. 48 out of 52 weeks due to parent vacation and parent holiday plans). ECI states any make up sessions have to be made up w/in calendar month.”

If a district is not in session, it is supplemental time and the PA needs to be compensated.

Since the IFSP does not have names of providers, a substitute provider may be used.

In the world of Deaf ed, there are critical needs for speech therapy for kids with hearing loss. Families are in need of intensive therapy more than one time per week. Are there limits on services?

These needs are individualized. ECI cannot be a medical therapy model. AI service providers contend that it is not medical, it is educational. Parents need to also practice and implement with child.

What is the most frequent that they can come to the home? They could come 4x per month.

Maybe we need some training and information sharing needs to happen b/t programs. Qulaification comes from the person who did the evaluation. Some DHH children do not qualify for Speech, often the children only get 1x per month. There is a training need in this area. Or family can access private therapy and ECI at the same time, but insurance may not cover it.There is potentially a lack of understanding as well as a lack of SLP’s to provide the service in the ECI. If a child is not being servied adequately, go up the ladder.

As for VI, some doctors are using the “delayed visual maturation” label if doctors don’t have enough information. ??TVI could do an intake with parent to see if all questions were answered. Or ECI could ask HHSC Case managers to be part of the team to help family get to the eye doctor.

Reminder about summer services, if ECI has a concern that VI or AI staff may not be able to cover summer services, please contact Debra at the ESC, r Elaine Young at