Purpose
The purpose of this announcement is to clarify practices, provide guidance and ensure consistency in the process of determining when an infant, toddler, or preschool age child is eligible for the early intervention (EI) program.
Background
Results of early intervention program verifications, analysis of statewide data and discussions with early intervention leadership have shown that there is a need to clarify when an infant, toddler, or preschool age child is eligible for early intervention services.
Discussion
1) Identifying an Infant or Toddler as Having a Developmental Delay
Pursuant to 55 Pa. Code § 4226.22(a)(1) an infant or toddler is eligible for early intervention services if the infant’s or child’s score on an appropriate diagnostic instrument indicates that the infant or toddler is demonstrating a delay of 25% of the infant’s or toddler’s chronological age in one or more of the developmental areas of cognitive development; physical development, including vision and hearing; communication development; social or emotional development; and adaptive development. Section 4226.22(a)(2) provides that an infant or toddler is eligible for early intervention services if a developmental delay in one of the developmental areas specified above is documented by test performance of 1.5 standard deviations below the mean on an accepted or recognized standard test for infants or toddlers.
Diagnostic instruments and standard tests shall be used for the purpose and population for which they are valid and reliable. The instruments and tests shall also be administered in accordance with the recommendations provided by the instrument or test developer, including the guidelines on user qualifications and documented evidence that the user has been trained to administer the instrument or test.
Eligibility for early intervention services is established as a result of the overall score in one or more of the developmental areas identified above. Subset scores shall not be used to determine if an infant or toddler is eligible for the early intervention program under either Section 4226.22(a)(1) or (2).
2) Additional Methods for Determining Eligibility for the Infant/Toddler Early Intervention Program
Section 4226.22(a)(3) provides that an infant or toddler is eligible for early intervention services if the infant or toddler has a diagnosed physical or mental condition which has a high probability of resulting in a developmental delay, that is not accompanied by delays in one of the developmental areas specified above at the time of diagnosis.
Section 4226.22(b) and 34 CFR § 303.321(a)(3)(ii) provide that qualified personnel may use informed clinical opinion to establish an infant’s or toddler’s eligibility for early intervention services, especially when there are no standardized measures or the standardized measures are not appropriate for an infant’s or toddler’s chronological age or developmental area. In addition, Section 303.321(a)(3)(ii) provides that informed clinical opinion may be used as an independent basis for determining an infant’s or toddler’s eligibility for early intervention services.
Informed clinical opinion makes use of qualitative and quantitative information to assist in forming a determination regarding difficult-to-measure aspects of current developmental status and the potential need for early intervention services. Informed clinical opinion “is neither an objective criterion nor a separate assessment strategy. Rather, informed clinical opinion is the way in which qualified personnel utilize their cumulative knowledge and experience in evaluating and assessing a child and in interpreting the results of evaluation and assessment instruments.” 76 FR 60199.
When informed clinical opinion is used to establish eligibility for early intervention services, the multidisciplinary evaluation team shall fully document the evaluation process, including a description of any instruments used, a systematic analysis of information from multiple sources and an explanation of the finding that the infant or toddler is eligible for early intervention services even though the instruments used did not establish eligibility for early intervention services and the infant or toddler does not have a diagnosed physical or mental condition.
Finally 34 CFR § 303.321(a)(3)(i) provides that an infant’s or toddler’s medical and other records may be used to establish eligibility for early intervention services if those records indicate that an infant’s or toddler’s level of functioning in one or more of the developmental areas identified above constitutes a developmental delay or that the infant or toddler otherwise meets the criteria for an infant or toddler with a disability under 34 CFR § 303.21.
3) Determining Eligibility for the Preschool Early Intervention Program
Pursuant to 22 Pa. Code § 14.101 a child who is less than the age of beginners and at least 3 years of age may be determined eligible for preschool early intervention services if the child’s score on an appropriate diagnostic instrument indicates that the child is demonstrating a delay of 25% of the child’s chronological age or 1.5 standard deviations below the mean in one or more of the developmental areas discussed in Section 1 of this Announcement or by being identified as a child with a disability, as defined in 34 CFR § 300.8. In addition to being identified as having a disability or developmental delay, a preschool age child must also be in need of special education and related services in order to be eligible for early intervention services.
Diagnostic instruments and standard tests shall be used for the purpose and population for which they are valid and reliable. The instruments and tests shall also be administered in accordance with the recommendations provided by the instrument or test developer, including the guidelines on user qualifications and documented evidence that the user has been trained to administer the instrument or test.
Eligibility for early intervention services is established as a result of the overall score in one or more of the developmental areas identified in Section 1 of this Announcement. Subset scores shall not be used to determine if a preschool age child is eligible for the early intervention program under 22 Pa. Code § 14.101.
Next Steps
Infant/toddler and preschool early intervention programs shall review existing procedures to assure they are consistent with this Announcement.
Infant/toddler and preschool early intervention programs shall ensure that all staff and providers, including independent evaluation teams, review the information included in this Announcement and revise local procedures.
Comments and questions should be directed to the Office of Child Development and Early Learning, Bureau of Early Intervention Services at 717-346-9320 or ra-ocdintervention@pa.gov.
Attachment
Access to Pennsylvania’s Early Intervention program starts with the determination of eligibility during the initial evaluation process. The evaluation team, including the family, works together to implement appropriate, individualized assessment activities that provide documentation to establish eligibility and address the concerns of the family about their child’s development. A variety of assessment activities are used to gather comprehensive evaluation information to assist in identifying the child’s developmental strengths and needs. This can include a review of the child’s medical and other records, administration of a norm-referenced tool, a family/caregiver interview, and observation of the child in typical routines and activities.
Diagnostic tools and norm-referenced tests should be used for the purpose and population for which they are valid and reliable. These tests should be administered, and the scores should be interpreted in accordance with the directions in the manual. Evaluators utilizing these tests should meet specified user qualifications and have appropriate training to administer the test.
Eligibility is based on a synthesis of the information gathered from all assessment activities and an analysis of that data in relation to Pennsylvania’s eligibility criteria. It is especially important that all data be considered when there is inconclusive or conflicting information with regards to eligibility. When there are questions about eligibility, the evaluation team should review all available information prior to making a decision.
In addition, when evaluating the eligibility of infants and toddlers for Early Intervention services, federal and state law allow for the use of informed clinical opinion to establish eligibility. Informed clinical opinion can be used as the determining criteria for eligibility when norm-referenced tools cannot be used to adequately identify the presence or absence of a developmental delay. Possible reasons for using informed clinical opinion to establish eligibility for Early Interventions services include:
- using a norm-referenced tool would require significant adaptations for the child to perform the required items, which would invalidate the results.
- the child has a significant health concern or illness that makes testing difficult
- the child has a limited arousal level or inability to participate at the time of the assessment
- cultural/family differences that vary from the norming sample might invalidate the results
The Bureau of Early Intervention Services and Family Supports does not endorse or recommend specific publisher’s tests.
Qualified professionals participating in the evaluation process should:
- Understand the specific eligibility criteria (Infant/Toddler or Preschool) applicable to the child being evaluated and keep up with any new regulations and OCDEL announcements.
- Have a solid understanding of child development.
- Be able to explain to families all procedural safeguards.
- Use individualized assessment activities for each child that provide for an appropriate determination of eligibility and address family concerns and child strengths and needs
- Provide the family/caregiver with opportunities for participation throughout the process.
- Thoroughly understand test protocol and scores so that evaluation results and test scores can be accurately and sensitively communicated to the family.
- Administer and interpret diagnostic and/or norm-referenced tools in accordance with instructions provided in the tool or test manual.
- Recognize that a child’s test behavior is not always representative of a child’s typical behavior in other settings, and, as a result, families or caregivers need to be asked whether the child’s behavior during the administration of a test was representative of his or her typical behavior.
- Be able to appropriately document the results of the evaluation and assessment of a child, as well as be able to explain the evaluation and assessment process and results to families.
- Consider all information gathered during the evaluation process when making an eligibility determination.
- Understand that eligibility for Early Intervention services can be established by an overall score in one or more of the developmental areas of cognitive, physical (including vision and hearing), communication, social/emotional, and adaptive development. If not established by the overall score alone, with sufficient documentation, eligibility for Early Intervention may be established based on other eligibility categories.
Oversight of qualified professionals participating in the evaluation should be conducted by the Early Intervention program (Infant/Toddler and Preschool). In addition, a providers’ direct supervisor may also provide oversight. Oversight and supervision should include:
- Ensuring that professionals performing evaluations demonstrate appropriate competency in evaluation practices including test administration and interpretation, observation of the child, and the ability to synthesize multiple sources of information prior to participating in eligibility determination activities.
- Closely monitoring evaluation activities and documentation of those activities to ensure that children are being appropriately identified as eligible for Early Intervention, assessment tools and other activities are being used correctly, and regulations are being followed.
- Ensuring that the evaluation team receives supervisory guidance or oversight when challenging assessment situations are present, including when there is conflicting information around eligibility.
- Informing evaluation teams how to get additional support or guidance if they are unable to reach consensus about a child’s eligibility for Early Intervention.
- Examining evaluation practices to ensure that they are sensitive to individual family backgrounds; including but not limited to linguistic and cultural considerations and being aware that diversity among families is often greater than among evaluators.
The table below compares the eligibility criteria for Infant/Toddler Early Intervention services and for Preschool Early Intervention services. Note that both programs use the same definition of developmental delay when determining Early Intervention eligibility.
| Eligibility Criteria for Infant/Toddler Early Intervention | Eligibility Criteria for Preschool Early Intervention |
|---|---|
Early Intervention services are provided to infants or toddlers who meet one or more of the following eligibility criteria:
Informed clinical opinion may be used as an independent basis for establishing eligibility. It may not be used to negate eligibility established through the use of other appropriate evaluation instruments. A child’s medical and other records may be used establish eligibility (without conducting an evaluation of the child) under this part if those records indicate that the child’s level of functioning in one or more of the developmental areas identified above constitutes a developmental delay or that the infant or toddler otherwise meets the criteria for an infant or toddler with a disability [55 Pa. Code § 4226.22] and [34 CFR § 303.321(a)(3)(ii)] | Early Intervention services are provided to preschool-aged children who meet the following eligibility criteria:
AND In need of special education and related services. [34 CFR § 300.8] |
Common Test Terminology
Evaluators should be trained in interpreting test statistics in addition to being trained in the specific evaluation tools. The terms used below are not mutually exclusive.
Tests
Standardized Test: A standardized test is a test administered and scored in a consistent or standard manner. A standardized test is administered under standardized or controlled conditions that specify where, when, how, and for how long children have to respond to the questions. In standardized tests, the questions, conditions for administering, scoring procedures, and interpretations are consistent.
Norm referenced tests: Norm referenced tests are designed to permit comparison of one child’s performance to that of a referent group by providing measures of relative standing (i.e., standard scores and percentile ranks) that correspond to locations on a normal distribution, often depicted as a bell- shaped curve. Norm referenced tests are sometimes also standardized (meaning all items are administered in a standard format). They may also use observation and interview which are not standardized approaches.
Criterion referenced tests: Criterion referenced tests are instruments that are designed to describe a child’s developmental functioning in relation to specified criteria for the purpose of indicating whether the child is evidencing delay in development. The child’s performance is compared to a criteria or performance standard not to the performance of other children. Criterion referenced tests determines if specific skills are mastered, they do not make comparisons to other children’s performance.
Scores
Raw score: A raw score is the number of questions answered correctly on a test or subtest. For example, if a test has 59 items and the student gets 23 items correct, the raw score would be 23. Raw scores are converted to percentile ranks, standard scores, grade equivalent or age equivalent scores.
Age equivalent (AE): AE scores represent the chronological age of the children in the standardization sample for whom a specific raw score was the average (median or mean) score.
Standard score: The standard scores represent the degree to which a child’s score deviates from the mean. Standard scores are especially useful because they allow for comparison between children and comparisons of one child over time.
Standard deviation (SD): A measure of the variability of a distribution of scores. The more the scores cluster around the mean, the smaller the standard deviation. In a normal distribution, 68% of the scores fall within one standard deviation above and one standard deviation below the mean.
Percentiles or percentile ranks (PR): Percentage of scores that fall below a point on a score distribution; for example, a score at the 75th percentile indicates that 75% of students obtained that score or lower.
Developmental age: A measure of a child's development (in body size or motor skill or psychological function) expressed in terms of age norms.
Normal distribution curve: A distribution of scores used to scale a test. Normal distribution curve is a bell-shaped curve with most scores in the middle and a small number of scores at the low and high ends.
Sources: Wrightslaw: From Emotions to Advocacy, 2nd Edition, Center for Research on Evaluation, Standards, and Student Testing (CRESST), Graduate School of Education & Information Studies, UCLA; American Guidance Service; Harcourt, Inc.; Office of Special Education and Rehabilitative Services, U. S. Department of Education.