Welcome to Early Intervention (EI)

Early Intervention is the process of providing services, education and support to young children who are deemed to have an established condition, those who are evaluated and deemed to have a diagnosed physical or mental condition (with a high probability of resulting in a developmental delay), an existing delay or a child who is *at-risk of developing a delay or special need that may affect their development or impede their education. The purpose of early intervention is to lessen the effects of the disability or delay. Services are designed to identify and meet a child’s needs in five developmental areas, including: physical development, cognitive development, communication, social or emotional development, and adaptive development.

(plagiarized from http://www.wrightslaw.com/info/ei.index.htm#faqs which is an excellent resource!)

 

How to Start

 

Call Montgomery County Early Intervention when your child arrives home from the hospital at 610-277-7176. Early Intervention will set up a time for your child to be evaluated in your home by a team of therapists. They will then make recommendations for the types of therapies your child needs based on their assessment. Therapists will contact you to set up a time to meet with you and your child regularly in your home. Please be aware that this process can take a few weeks to get established so be patient.  This and the therapies are no cost to you and are conducted in your home or daycare!

 

Some Important Points

• Start as early as possible.
• Apply for Medical Access.  This is a secondary insurance.  It will cover co pays, prescriptions, part of glasses, etc.  The application is long and tedious, but it is worth it.  Also, later down the road this will be helpful to your school district.

Therapy – Who Are They, How is it Evaluated, What Kind, and Purpose

• The EI companies that you may get assigned to in Montgomery County are:  Easter Seals, MARC or Ken Crest
• Your EI team is composed of your therapists and your EI coordinator.
• Continual Evaluations:  Every 3 months, the EI team goes over goals and about twice a year your child will be assessed and rated on a developmental scale.  Don’t get hung up on the age rating of the scale.  The assessments are a guideline. (example:  don’t feel that your 18 month old child is behaving as a 6 month old just because that is the number on the assessment.  Your child may be doing great on other things, but didn’t meet a certain milestone.)
• Types of therapy:  Physical Therapy (PT), Occupational Therapy (OT), Speech, Education, Vision, Floor Time, even a Social Worker (typically our children get PT, OT, education and Speech).

10% of children with DS have autism.  Early intervention will cover Applied Behavioral Analysis Behavioral therapy (ABA).  Your ABA therapist will work with your EI team to integrate as much therapy as possible.

• Sessions don’t have to be in the living room or the childcare room.  Encourage them to go outside on nice days in order to incorporate playground equipment, curbs etc.
• Therapy sessions are designed to teach you techniques to help your child reach his or her full potential in all areas of development where he or she is experiencing a delay. Being an active participant or staying abreast on the therapy sessions as well as following through on therapists’ suggestions are vital to your child’s success.
• As parents, you are the one that knows your child the best.  The therapists are a great resource and a trained second set of eyes that help you define problems and can propose solutions to them (physical and behavioral).  Sometimes an obvious root cause to an issue could elude you and sometimes your reaction or behavior can contribute to a problem.

Getting More Therapy

• Contact your EI coordinator with your concerns.
• You do not have to wait for a review meeting to increase, decrease or change therapies.  Express all concerns to your Early Intervention team as soon as you have them, so they can begin to help your child right away.
• Talk to other parents.  Find out what strategies they had to use to get the therapies they need.  Sometimes there is no fight at all, other times you need to say the right thing to get it.  It seems to depend on the service provider, the therapists’ current work load and even geographical location – none of this should be relevant to the decision.
• If you request extra therapy, have examples to validate your need for therapy.
  • Example-Josh is increasing inappropriate sensory behaviors, fine motor skills are not progressing and feeding skills are not progressing, therefore he needs OT once a week instead of once every other week.
  • Ask, “Can you achieve the objectives listed in the Individualized Family Service Plan (IFSP) in the given amount of time?”
• Express all concerns to your family pediatrician as well as to the developmental pediatrician (like Dr. Pippan of the CHOP Trisomy 21 clinic).  Ask for their recommendations in writing.  Provide your service coordinator with the written recommendations of your doctors.  Also, you might need the written recommendations or referrals for the insurance companies if you obtain extra therapy on your own.
• If you would like a second opinion about an issue being addressed in therapy, let your doctor or developmental pediatrician know and ask for a prescription for an evaluation by CHOP or your health care provider.  Take home some of the strategies from these appointments and share with your EI therapists.  This can also simply serve as reassurance that what your therapists are doing is just what your child needs.
  • We have had OT, Physical therapy and feeding evaluations done by CHOP to get a different perspective on certain issues.
• If you do need extra therapy, check into what is covered by your insurance.  Your primary insurance might cover some of this and the secondary might cover the rest for an out of pocket expense of $0 for great therapy.
• Make Informed Decisions.  Understand what the therapy is and see if there is already an overlap of service.
  • Example-Our Developmental Pediatrician recommended six hours a week of Floor Time Therapy.  We raised this concern with the Early Intervention Team.  We were given videos on Floor Time and realized his therapists were using these techniques with him already.  It also gave a sense of how we could use play time a bit more constructively.  We decided the benefit of adding six hours would not outweigh the burden of scheduling that much more therapy time into our family’s routine.

Balancing, Tracking and Contacting Therapists

• There are many opportunities available for your child through Early Intervention.  You need to create a schedule for your family that balances therapy with family obligations and opportunities for fun.
  • Example-Your child may be able to get PT twice a week, but if this interferes with getting your child outside for a good dose of fresh air mixed with lots of gross motor activity, you may want to have PT once a week and free your schedule for family fun outside instead of structured therapy.
  • Example-Josh qualified for weekly OT at CHOP.  This involved getting Josh up early and taking an hour and a half round trip drive with traffic to King of Prussia weekly for one hour of OT.  Although it was nice to get input from a second OT, it was not good for Josh to be confined to a car seat and expected to perform in therapy.  It was much more beneficial to spend that time playing outside, where he was getting lots of sensory input and large motor activity.
• Work with the therapist to get a schedule that works for both of you.
  • Example- When Sofia was 1-2 yrs old, I worked from home and so we were able to set up time at home with the therapist.  Now I am in the office every day and so the therapists have been able to go see her at the daycare and coordinate their time with the daycares. The children take naps in the afternoon and Sofia needs her nap.
• If you need a break from therapy, take it.  Sometimes it can be a burden and taking time off might be good for you and sometimes your child.
• When a therapist takes time off, depending on your EI company, they may not be obliged to repay the time as long as it’s not excessive.  Missing 10-30% of therapy hours is a big deal.  Request to get the therapy made up.  *note contracted therapists are eager to make up the time because they get paid per visit instead of a salary.
• Keep a calendar, whether an outlook one on the computer or a physical calendar to keep track of therapy.  This way you have a record of what you have and have not received.
• It’s helpful to have email addresses and cell phone numbers of all therapists in case you have to cancel at the last minute.  Then you’re not scrambling around trying to find that stuff at the last minute.
  • Example-We didn’t have to scramble around when Reegan had to go to the hospital.

Informing Others

• Keep all therapists informed of new developments or concerns about your child even if the issue does not fall under their area of expertise.  Your child will benefit from therapists who are well informed about all aspects of his/her development.  Problems in one area of development may be helped by skills in other areas.
  • Example- Josh did not want to walk down stairs.  He learned numbers through a fine motor activity with his OT and learned counting through a stacking activity with his teacher.  He liked counting and numbers so much that he will now walk down the stairs if we count them on the way.
  • Example- Josh has sensory issues being addressed by his OT.  All other therapists take these issues into consideration when planning their sessions and allow Joshua opportunities to meet his sensory needs while working to meet the objectives we have set for him in their areas of development.  (Speech therapist gets Josh to use the words “stop” and “go” appropriately by pushing him back and forth on a sled)
• Keep therapists informed of health issues and concerns, such as hearing or vision conditions or an injury that may affect development.
• Make therapists aware of how your child learns best.
  • Example-Josh needs to alternate between focused fine motor activities and large motor or heavy work activities.  All of his therapists now give him physical activity opportunities throughout the session and are then able to get more focused work over all.
• Let all the therapists know or understand what your child likes or dislikes.  Sometimes, you might determine certain tasks that your child is doing that the therapist are not aware of.
  • Example-By the time we got PT, Sofia was pulling herself up to stand.  However, the PT and OT were concentrating on getting her to crawl.  I really felt she was more interested in walking since she was pulling herself to stand and trying to cruise.  They finally decided to work on her standing and cruising.  She was more mobile after this.  By the way, Sofia never really crawled.