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EI 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.
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