developmental & behavioral resource guidehowkidsdevelop.com/pdf/physicianmanual.pdf · 2010. 1....

Developmental & Behavioral

Resource Guide for

Primary Care Providers

Developmental & Behavioral Resource Guide/ 7/15/2005/ page 2 of 88

June, 2005 Dear Colleagues: As primary care providers, we are in a unique position to ensure optimal physical and mental health for our patients. Every day, we are given the opportunity to make a difference in the lives of children we serve. However, in spite of our best intentions and efforts, many barriers, such as time restraints and financial limitations, exist which hinder our ability to provide the ideal well child care. Although there are no simple answers to these barriers, Children’s Care Connection, or C3, has been developed to be part of a solution. Specifically, C3 helps to provide developmental/behavioral screenings and parenting education that are nearly impossible to accomplish in 15- to 20-minute well care visits. This resource guide is designed to provide detailed information about the C3 program as well as developmental and behavioral resources in the community for providers and parents. We hope that you will find this guide useful in your practice. Sincerely, Ingrid Lin, M.D., F.A.A.P. Physician Consultant, C3


Table of Contents Part 1: C3 Program Overview

What is C3? ...............................................................................................................6 Who is eligible for C3? .............................................................................................6 Who pays for C3? .....................................................................................................7 How can children and their families be referred to C3? ...........................................7 Which screening tests are used by C3? .....................................................................7 What types of classes are offered by C3? .................................................................8 How has C3 made a difference for children and their families? ...............................8 Who developed C3? ..................................................................................................9 Does C3 provide services in languages other than English? ....................................9 What do others say about C3? ................................................................................10 Who works for C3? .................................................................................................11 Where are C3 services offered? ..............................................................................11 How can I find out more about C3? ........................................................................11 Examples of different levels of interventions provided by C3 ...............................12 Frequently asked questions by health care clinicians .............................................14 References ...............................................................................................................18

Part 2: Community Resources Referral Information

California Early Start ..............................................................................................20 Infant Education Programs .....................................................................................23 Special education services through school districts ................................................24 Exceptional Family Resource Center ......................................................................27 Head Start and Early Head Start .............................................................................28 San Diego Regional Center .....................................................................................30 Children’s Hospital and Health Center ...................................................................32 San Diego State University Communications Clinic ..............................................38 San Diego Scottish Rite Childhood Language Center ............................................39 California-Hawaii Elks Association therapy services .............................................40

Part 3: Appendix

Appendix A: Map of C3 service area ................................................................42 Appendix B: C3 referral process schematic ......................................................44

C3 referral form ...........................................................................45 Appendix C: Screening tests used by C3

Parents’ Evaluation of Developmental Status (PEDS) ................47 Denver II ......................................................................................48 Modified Checklist for Autism in Toddlers (M-CHAT) .............49


MacArthur Communicative Development Inventories (CDIs) ....50 Child Behavior Checklist (CBCL) ...............................................51

Appendix D: List of C3 classes .........................................................................53 Appendix E: Overview of C3 progress .............................................................62 Appendix F: Individualized Family Service Plan (IFSP) .................................64 Appendix G: Parent handout on Early Start/Regional Center (English) ...........66

Parent handout on Early Start/Regional Center (Spanish) ...........68

Appendix H: Individualized Education Program (IEP) .....................................71 Sample request letter for IEP .......................................................72 IEP timeline .................................................................................73

Appendix I: Parent handout on San Diego Regional Center (English) ............75

Parent handout on San Diego Regional Center (Spanish) ...........77 Appendix J: Redirecting Children’s Behavior during well/acute care visits ...80

Parent handout on Redirecting Children’s Behavior ...................82 Appendix K: Perinatal depression screening .....................................................85 Appendix L: Helpful websites ...........................................................................87


Children�s Care Connection

"Photos provided by the First 5 Commission of San Diego"


C3 Program Overview What is C3? C3, Children’s Care Connection, is a program offered by Children’s Hospital and Health Center (CHHC) designed to identify and address developmental and behavioral concerns in children birth to 5 years 11 months (or up to Kindergarten entry). C3 was created to provide evaluation and enrichment services to children with mild to moderate developmental delays and/or behavioral problems. Parents with typically developing children can also participate in parenting education and child enrichment classes. The ultimate goal of C3 is to enhance development, improve school readiness, strengthen parent-child relationships, and serve as an integrated system for the identification and treatment of developmental and behavioral problems in children. Specifically, C3:

• Establishes early identification of developmental and behavioral problems in children birth to 5 years 11 months (or up to Kindergarten entry) through free developmental and behavioral screening assessments conducted at C3 sites and community locations.

• Provides connections to in-depth evaluations and intervention for eligible at-risk

children.

• Enhances school readiness in children identified with mild delays and behavior concerns through intervention groups at the C3 site located in Solana Beach.

• Provides a variety of parenting education and child enhancement classes at C3

sites and in the community. Who is eligible for C3? The following families are eligible for C3 services:

•••• Families with children ages birth to 5 years 11 months (or up to Kindergarten

entry)

AND

•••• Families living in or served by primary care providers practicing in North San Diego County, La Jolla, or Mira Mesa (see below for eligible zip codes).

C3 Service Area Zip Codes (North San Diego County): 92007 92056 92008 92057


92009 92059 92014 92067 92024 92069 92025 92075 92026 92078 92029 92083 92054 92084 92055 92130 Expanded Service Area since 10/01/04 (La Jolla, Mira Mesa): 92037 92121 92111 92122 92117 92126

(See Appendix A for map.) Who pays for C3? C3 is funded by the First 5 Commission of San Diego, and C3 services are free to eligible families. One of the C3 sites (Solana Beach) also received one year of supplemental operational-cost funding from the Wayne and Gladys Valley Foundation. How can children and their families be referred to C3? There are three ways parents and children can be referred to C3:

• Primary care providers – C3 collaborates with many medical offices to implement a screening and referral procedure for children during health visits. (See Appendix B for C3 referral process schematic and referral form.)

• Childcare centers and preschools – C3 collaborates with several childcare

centers and preschools in North San Diego County to screen children in childcare and/or preschool settings.

• Self-referrals – parents can call C3 directly if they have any questions or

concerns about their child’s development and/or behavior. Which screening tests are used by C3? C3 utilizes a two-stage screening process:

• The “first-stage” or Stage I Screening includes the Parents’ Evaluation of Developmental Status (PEDS) Response Form - a short questionnaire completed either in pediatric offices, clinics, childcare centers, or over the phone with a C3 staff member. If concerns are raised on the first-stage screening, the child is


referred for a “second-stage” screening at a C3 site or at sites in the community (e.g. primary care provider offices, shelters, or preschools). C3 clinical staff can also travel to parents’ homes to conduct “second-stage” screening if the family does not have transportation.

• The “second-stage” or Stage II Screening includes age-appropriate assessments

performed by developmental specialists. The screening tools used by C3 are:

o Denver II for ages birth to 6 years – a developmental screening tool which assesses for personal-social, fine motor-adaptive, language, and gross motor skills.

o Child Behavior Checklist (CBCL) for ages 1 ½ to 5 years – a

questionnaire that screens for behavior and mental health problems.

o MacArthur Communicative Development Inventory (CDI) Version I, II, III, and IV (version used depends on the child’s age) – an instrument to assess language development.

o Modified Checklist for Autism in Toddler (M-CHAT) for ages 18-24

months – a screening tool for autistic spectrum disorders. Both Stage I and II Screenings are available in English and Spanish. (See Appendix C for more information about the screening tests used by C3.) Depending upon the outcome of the “second-stage” screening, C3 may refer the child for C3 parenting education and child enhancement classes, community resources/agencies, and/or further evaluations. All “second-stage” screening results are communicated with primary care providers via fax. What types of classes are offered by C3? C3 offers early intervention through a variety of child enhancement and parenting education classes. Currently, 67 different class titles are offered, and 22 of those classes are offered in Spanish. The selection of classes includes Feeding Finesse, Gesturing with Babies, Infant Massage, Infant Play, Learning and Growing Together, Talking with Toddlers, Music and Movement, Redirecting Children’s Behavior, Pushing the Limits, and Yoga Games for Preschoolers. (See Appendix D for complete listing.) The classes are taught by CHHC specialists including occupational therapists, physical therapists, speech and language pathologists, and behavior specialists. How has C3 made a difference for children and their families? Since C3’s inception in July, 2001 to March, 2005, C3 has served more than 30,000 children and families. In the same period, C3 has served over 6,700 families via 1,300


C3 classes and attained a mean class satisfaction rating of 99%. C3 has also provided approximately 300 one-on-one parenting coaching and/or behavior consultations during this time period. From July, 2001 to January, 2005, approximately 15,000 children have received a Stage I Screening, and approximately 4,000 children have received a Stage II Screening. Of those children who received Stage II Screening, most of the children (91%) were referred to C3 parenting education and/or child enhancement classes. Other referrals included: 7% for full developmental evaluation, 15% for speech evaluation, 9% for hearing evaluation, 4% for occupational therapy evaluation, 2% for physical therapy evaluation, 2% for mental health provider/counseling, 12% to California Early Start, 1% to Regional Center, 3% to Early Head Start or Head Start, and 4% to school districts. In the same period, C3 has collaborated with 72 medical offices and over 260 physicians. In addition, C3 developed and maintains the website www.howkidsdevelop.com which provides information for providers and families on development, behavior, community agencies, and resources. From August, 2001 to January, 2005, the website has logged over 2 million hits. In an independent survey of 130 C3 families conducted by Harder +Company, an outside evaluation company subcontracted by the First 5 Commission of San Diego, 49% of the families observed progress in their child’s language development, 56% of the families observed progress in the social-emotional domain, and 46% of the families observed progress in self-help skills. Moreover, 85% of the parents report that they play with their children more often as a result of C3. (See Appendix E for overview of C3 progress.) Who developed C3? C3 was developed through a collaborative effort between Developmental Services Division of CHHC, Child & Adolescent Services Research Center (CASRC), physician consultants, parent consultants, and community agency members. Does C3 provide services in languages other than English? C3 currently offers developmental and behavioral screenings that are conducted by Spanish-speaking developmental screening coordinators. In addition, 22 of the parenting education and child enhancement classes are offered in Spanish.


What do others say about C3? Pediatricians and Community Members: “Sarah loves the Creativity class and still talks about it. She calls it ‘my ‘tivity class’! We are looking forward to taking more classes through C3 in the future.” Diane Bedrosian, M.D., referring pediatrician and participating parent, Cassidy Medical Group “It's nice to have a place like C3 where parents can easily take their child for a developmental assessment. It's a great community resource!” Martin Gilboa, M.D., referring pediatrician, Kaiser Permanente “C3 has successfully filled a need for physicians who have patients with behavior concerns, and for parents who want some “coaching” or help with parenting challenges. Their services have been accessible for all kids in all areas – which has been a great help to the many lower income and underserved families that I care for in a community clinic. As a pediatrician, I have especially appreciated the practical tools that they can give parents and the excellent, personal communication that is part of their working with my office. It is great to have a resource like C3 close in the community – not a distant referral – and to be able to refer patients, friends, and colleagues to their programs with confidence.” Donald Miller, M.D., referring pediatrician, North County Health Services “We are lucky to have C3 for our families. The program has a true understanding of early childhood development and the staff makes appropriate and reliable referrals for families with young children. C3 has become a much-needed entity in the North County community for families and professionals alike.” Dr. Mark Whitney, Professor of Child Development, Mira Costa College “North County Health Services Parent-Child Resource Center and C3 have been collaborating for 2 ½ years now and the relationship continues to grow in depth and mutual understanding. It is a true collaboration between agencies and staff members, which greatly benefits the families. It has been fantastic for Spanish-speaking families to have such high-level instructors and linguistically-appropriate services on site.” Cindy Dickinson, North County Health Services, Director of Special Programs “The HOPE Infant Family Support Program staff has greatly appreciated the partnership we have with C3. We have referred many families to the excellent classes they provide. We have also relied on C3 to make referrals to HOPE and California Early Start. It’s been wonderful having such a committed partner in the community. Thanks for all of your hard work!” Staff Member, HOPE Infant Family Support Program “C3 is an invaluable resource for the community. We don’t know what we would do without it!! Families find classes really helpful. Parents also receive so much information at the assessment and they know that there is help out there for them.” Verna Sundquist, Behavioral Health Specialist, YMCA Childcare Resource Service Parents: “[C3] program has been invaluable to my relationship with my son. I have learned how capable he is. I’ve grown in my own abilities with discipline, guidance, and teaching. I am so glad to have found this place and feel it offers amazing resources to parents and their children.” “Highly recommend [C3] and the pediatrician should recommend [C3] for 1st and 2nd check-ups.” “I’ve learned: 1) a lot about temperament and how to deal with it, 2) how to discipline my child rather than [using] punishment, 3) [how to] set limits firmly and stand by them, [and] 4) I am not the only mom [whose] kids misbehave sometimes!” “I have been given a lot of ideas on how to help my toddlers learn to talk (very practical tips on things I can do at home). Thank you!”


Who works for C3? C3 staff consists of:

• Kristin Gist, M.S. – Director of Developmental Services Division, CHHC • Laurel Leslie, M.D. – Developmental/Behavioral Pediatrician and Research

Scientist, Child & Adolescent Services Research Center (CASRC) • Nancy Cohen, M.A. – C3 Program Coordinator • Helen Hayden-Wade, Ph.D. – C3 Outcomes Coordinator • Ingrid Lin, M.D. – C3 Physician Consultant • CHHC Specialists

o Developmental Screening Coordinators o Occupational and Physical Therapists o Speech and Language Pathologists o Developmental Specialists o Behavior Specialists o Licensed Clinical Psychologists

• CASRC Outcomes Evaluation Team Where are C3 services offered? Solana Beach 667 San Rodolfo Drive, Suite 126 Solana Beach, CA 92075 858-966-8931 San Marcos 380 Mulberry Drive, Suite C San Marcos, CA 92069 760-591-0179 Oceanside 2231 El Camino Real, Suite B Oceanside, CA 92054 760-754-6110 In addition, developmental and behavioral screenings as well as C3 classes are offered on selected Saturdays at: Children’s Hospital & Health Center 8010 Frost Street, Suite 100 San Diego, CA 92123 How can I find out more about C3? For more information, please call 1-877-8C3Kids or visit www.howkidsdevelop.com.


Examples of Different Levels of Intervention Provided by C3 Case #1 � a child with typical development

Ethan started participating in C3 classes when he was four months old. His mother had learned about C3 from her colleagues and was interested in the Infant Massage class. Ethan was a happy and interactive infant when he was awake but woke up every two to three hours crying as if in pain during sleep times. His parents were exhausted from lack of continuous sleep. His mother wanted to learn relaxation techniques to share with Ethan at his bedtime. She enjoyed and appreciated the Infant Massage class and later participated in the Infant Play and Gesturing with Babies classes. At one year of age, his mother brought him back to C3 for a developmental and behavioral screening because of a family history of autistic spectrum disorder. The result of his screening was fortunately normal. Case #2 � a child with typical development A mother brought her 11-month-old son to C3 as a self-referral for a developmental and behavioral screening. She had recently adopted the child from Guatemala and wanted to


determine whether he was developing normally. Her main concern was his English language development because he had not been exposed to English before. She had scheduled a well-child visit with a pediatrician, but the appointment was one month away. The Developmental Screening Coordinator (DSC) from C3 administered the Denver II, and the result was normal. The mother was given explanation regarding the screening result and description of developmental milestones. The DSC also recommended two classes from C3, Gesturing with Babies and Talking with Toddlers, to provide the mother with strategies she could use at home to encourage his language development. No other referrals were necessary for this child. Case #3 � a child with borderline gross motor delay A pediatrician referred a 16-month-old girl to C3 for a developmental and behavioral screening to assess if a physical therapy evaluation was needed. The main concern was the child’s gross motor development because she was not walking yet. The family’s primary language was Spanish, so the family scheduled an appointment with C3’s Spanish-speaking DSC. The DSC administered the Denver II and the MacArthur Communicative Development Inventory (CDI) and found that the child’s development was age appropriate in all domains except the gross motor domain. The child could stand alone, stoop and recover but could not walk. The child’s muscle tone was assessed and found to be normal. The C3 staff recommended the parents bring their child to C3’s Infant Play class which is taught by a physical therapist so that the therapist could observe the child and refer for a physical therapy evaluation if needed. It was also recommended that the parents continue to monitor the child’s development and bring the child back to C3 in three months for re-screening. After the visit, the DSC faxed the information from the visit to the pediatrician. The parents elected to participate in the class. With interventions provided by the physical therapist at C3, the child’s gross motor skills improved, and no further interventions were needed. Case #4 � a child with autistic features A pediatrician referred a 22-month-old boy to C3 because the child exhibited some characteristics of Autism Spectrum Disorder. The main concerns were the child’s language development and his difficulty with transitions and new places. The DSC from C3 administered the Denver II, MacArthur CDI, Child Behavior Checklist (CBCL), and Modified Checklist for Autism in Toddlers (M-CHAT). The child was found to be delayed in the language and personal-social domain on the Denver II, and the result from the MacArthur CDI indicated language delay. He also failed the M-CHAT. The DSC recommended a full developmental evaluation for the child and referred the child to California Early Start for eligibility assessment. In addition, the child was referred to C3 classes to monitor his development. A summary of the findings and recommendations was faxed to the pediatrician. Through a developmental evaluation, the child was diagnosed with Autism Spectrum Disorder. The family followed up with California Early Start. In addition, the parents chose to have their child participate in C3 classes while waiting for an Individual Family Service Plan (IFSP) to be developed and services to be implemented by California Early Start.


Frequently Asked Questions by Health Care Clinicians 1. I am so busy in my office and constantly behind. Why would I want to elicit more concerns? Conservative estimates suggest that 15-18% of children in the U.S. have developmental and/or behavioral disabilities.1,2 According to data from the 1988 National Health Interview Survey, these conditions taken together had a substantial impact on the health and educational functioning of affected children: 1.5 times more doctor visits, 3.5 times more hospital-days, twice the number of school-days lost, and a 2.5-fold increase in the likelihood of repeating a grade in school compared with children without these conditions.1 There is growing evidence that early intervention services have had a positive influence on the developmental outcome of children with established disabilities or those considered "at risk" for disabilities and their families.3 Children who participate in early intervention programs prior to kindergarten are more likely to graduate from high school, hold jobs, live independently, and avoid teen pregnancy, delinquency, and violent crimes.4,5 These positive outcomes save society between $30,000 and $100,000 per child.4,6 In addition, developmental screening and surveillance fulfill the guidelines set forth by the American Academy of Pediatrics Committee on Children with Disabilities and the Individuals with Disabilities Education Act (IDEA).7 In practice, parents’ concerns about their child’s developmental and behavioral problems have ways of showing up at inopportune times, such as during 10-minute sick child visits or through frequent phone calls. If not addressed, some of the seemingly minor concerns can turn into serious problems requiring even more time commitment and resources. Addressing developmental and behavioral issues preemptively will usually save time and money in the long run. 2. I am an experienced clinician and notice developmental and behavioral problems all the time. Why do I need C3 to provide developmental and behavioral screenings? Unfortunately, research shows that clinical judgment detects fewer than 30% of children who have mental retardation, learning disabilities, language impairment, and other developmental disabilities, and clinical judgment also detects fewer than 50% of children who have serious emotional and behavioral disturbances.2 In addition, most primary care providers do not have the time during a 15- to 20-minute well-child visit to conduct standardized developmental and behavioral screenings. C3 can help primary care providers save time and resources by facilitating and conducting developmental and behavioral screenings and communicating the results back to the providers. Providers can 1) choose to administer a simple first-stage screening tool


provided by C3 in their offices, 2) use a screening tool of their choice, or 3) ask C3 staff to administer a “first-stage” screening. C3 tailors its approach to best meet the needs of individual providers and offices. 3. I worry about over-referrals with these standardized screening tests. Am I going to be flooded with requests for referrals from C3? Developmental screening tests, even those meeting standards for screening test accuracy, produce false-positive results for 15% to 30% of children. This is often thought to produce unnecessary referrals for diagnostic testing or special services and increase the cost of screening programs. However, in a study involving a national sample of 512 parents and their children, children “over-referred” for diagnostic testing by developmental screens were found to perform substantially lower than children with true-negative scores on measures of intelligence, language, and academic achievement - the three best predictors of school success. These children also carried more psychosocial risk factors, such as limited parental education and minority status. Thus, children with false-positive screening results are an at-risk group for whom diagnostic testing may not be an unnecessary expense but rather a beneficial and needed service that can help focus intervention efforts. Although such testing will not indicate a need for special education placement, it can be useful in identifying children's needs for other programs known to improve language, cognitive, and academic skills, such as Head Start, tutoring, private speech-language therapy, and quality day care.8 4. Is C3 just a way to channel patients to CHHC? No. Although C3 is administered by CHHC, C3 does not recommend any specific therapists and/or clinics to families. C3 refers families back to their primary care providers to discuss referral options as available through the child’s insurance coverage. If a child who needs further diagnostic evaluation has no health insurance coverage or if a diagnostic evaluation is denied by the child’s health insurance plan, C3 will provide the diagnostic evaluation by a licensed clinical psychologist free of charge. In addition, C3 collaborates with many public agencies, such as California Early Start, Regional Center, and area school districts. C3 is able to provide these services through a generous grant from the First 5 Commission of San Diego County. 5. What happens if C3 makes a diagnosis or recommendation that I don�t agree with or don�t think is needed? At C3, the Developmental Screening Coordinators (DSCs) will discuss the results of the screening with the families but will not make a diagnosis. If the screening results are borderline, the DSCs will refer the families to C3 classes first so that the children can be observed by occupational therapists, physical therapists, speech-language pathologists, and/or behavior specialists to see if further intervention is needed. C3 also will ask the families to come back in three months for re-screening.


If an intervention other than C3 classes or referral to free public resources such as California Early Start is needed, C3 staff will always refer families back to their primary care providers. The primary care providers and the families have the ultimate decision in the referral process. 6. I already utilize Regional Center and California Early Start as a resource for patients with developmental problems. How would C3 be helpful for me? Both Regional Center and California Early Start have eligibility criteria that children must meet to receive services. C3 bridges the gap for children with mild to moderate developmental problems who may not be eligible for services through the Regional Center or California Early Start. In addition, C3 classes may be useful for children who qualify for Regional Center or California Early Start while they are waiting for eligibility determination and implementation of services. 7. What is Proposition 10? Proposition 10 (“Prop 10”), passed by California voters in November 1998, established the California Children and Families Act. It increased the tax on tobacco products to fund services for improving the health and development of California’s children from the prenatal period to age five. In San Diego County, Prop 10 dollars are administered by the First 5 Commission of San Diego County. 8. What is the First 5 Commission of San Diego County? The First 5 Commission of San Diego County oversees Prop 10 activities in San Diego County. Its vision is to ensure children enter school physically, emotionally, socially, and developmentally ready to learn. The First 5 Commission provides leadership to achieve this vision by funding services, advocating for policy change, coordinating existing resources, and building community capacity to support families. For more information, visit www.first5sandiego.org. 9. What if I practice outside of C3�s defined region and have families whom I would like to refer for C3 services? To be eligible for C3 services, families need to fulfill the following criteria as defined by the grant from the First 5 Commission of San Diego County:

• Have children ages birth to 5 years 11 months (or up to Kindergarten entry)

AND

• Live in or be served by primary care providers practicing in North San Diego

County, La Jolla, or Mira Mesa (see below for eligible zip codes).

C3 Service Area Zip Codes (North San Diego County):


92007 92056 92008 92057 92009 92059 92014 92067 92024 92069 92025 92075 92026 92078 92029 92083 92054 92084 92055 92130

Expanded Service Area since 10/01/04 (La Jolla, Mira Mesa):

92037 92121 92111 92122 92117 92126

However, C3 would like to accommodate as many children and families as possible. Please have families who are ineligible based on geographic location call C3 as exceptions have been made. In addition, there are other programs sponsored by the First 5 Commission with similar aims as C3 in San Diego County. Please check with the website www.first5sandiego.org for additional resources. 10. Does C3 provide any training for primary care providers? Yes! C3 held a CME course on Redirecting Children’s Behavior for primary care providers in October, 2004 and received a very positive response. According to a survey conducted after the course, 94% of the participants thought the course increased their ability to counsel families regarding behavioral issues either by very much or a great deal. When asked what is the likelihood that changes will be made in the work setting as a result of this course, 88% responded very much or a great deal. In the future, C3 is planning to offer more CME courses on behavior management training as well as developmental and behavioral screening.


References

1 Boyle CA, Decoufle P, Yeargin-Allsoop MY. Prevalence and health impact of developmental disabilities in US Children. Pediatrics 1994; 93: 863-865.

2 Glascoe FP. Early detection of developmental and behavioral problems. Pediatrics in

Review 2000; 21: 272-280. 3 American Academy of Pediatrics, Committee on Children with Disabilities. Role of the

pediatric clinician in family-centered early intervention services. Pediatrics 2001; 107: 1155-1157.

4 Glascoe FP, Shapiro H. Developmental and Behavioral Screening. Available:

www.dbpeds.org/articles. 5 Reynolds AJ, et al. Long-term effects of an early childhood intervention on educational

achievement and juvenile arrest: A 15-year follow-up of low-income children in public schools. JAMA 2001; 285: 2339-2346.

6 Meisels SJ, Shonkoff JP, eds. Handbook of Early Childhood Intervention. Cambridge,

England.: Cambridge University Press, 1990. 7 American Academy of Pediatrics. Developmental surveillance and screening of infants

and young children. Pediatrics 2001; 108(1): 192-196. 8 Glascoe FP. Are overreferrals on developmental screening tests really a problem? Arch

Pediatr Adolesc Med 2001; 155(1): 54-59.


Community Resources

Referral Information


California Early Start California Early Start is a federally funded program mandated by Part C of the Individuals with Disabilities Education Act (IDEA) and in California by S.B. 1085, the California Early Intervention Services Act. Its goal is to ensure infants and toddlers with, or at risk for, developmental delay and their families receive coordinated intervention services in a timely manner to improve their child's developmental outcomes. Its mission is to establish a statewide, coordinated, inter-agency system for infants and toddlers and their families, based on existing resources and innovative approaches to comprehensive, family-focused early intervention services. ELIGIBILITY Infants and toddlers from birth to 36 months may be eligible for early intervention services if through documented evaluation and assessment they meet one of the criteria listed below:

1. Significant developmental delay in one or more of the following areas: • Cognitive development, e.g., limited interest in environment, limited interest

in play and learning • Physical and motor development, including vision and hearing, e.g.,

hypertonia, dystonia, asymmetry • Communication development, e.g., limited sound repertoire, limited responses

to communication with others • Emotional-social development, e.g., unusual responses to interactions,

impaired attachment, self-injurious behavior • Adaptive development, e.g., feeding difficulties

2. Established risk conditions of known etiology, with a high probability of resulting

in delayed development, such as: • Chromosomal disorders • Neurological disorders • Inborn errors of metabolism • Visual and hearing impairments

3. High risk of having a substantial developmental disability due to a combination of risk factors, such as: • Prematurity (less than 32 weeks gestation and/or low birth weight of less than

1,500 grams) • Asphyxia or need for ventilator assistance • Central nervous system infection or abnormality • Biomedical insult (including but not limited to injury, accident, or illness

which may seriously or permanently affect developmental outcome) • Parent with a developmental disability


SERVICES Early intervention services are individually determined for each eligible infant or toddler and are provided, purchased or arranged by a regional center or local education agency. Local education agencies are primarily responsible for infants and toddlers with solely low incidence disabilities (vision, hearing, and severe orthopedic impairments, including any combination of these low incidence disabilities). Regional Centers are responsible for all other children eligible for Early Start. Family resource centers/networks provide parent-to-parent support, information, and referral for all families. Within 45 days of referral,

• A service coordinator is assigned • An evaluation for eligibility is completed • An assessment is conducted for program planning • A peer parent contact may be available • A meeting will be held to develop an Individualized Family Service Plan

(IFSP) to initiate child and family services. (See Appendix F for more information on IFSP.)

There is a wide range of early intervention services available. These services may be provided by a number of agencies in the San Diego area and may include:

• Assistive technology devices/services • Audiology services • Family training, counseling, home visits • Medical services • Nursing services • Nutrition services • Occupational therapy • Physical therapy • Psychological services • Respite services • Service coordination (case management) • Social work services • Speech-language pathology • Transportation • Vision services

Additional services that the California Early Start program may help a family access if needed include:

• Supplemental Security Income (SSI) • In-home Support Services (IHSS) • Medi-Cal • Temporary Assistance to Needy Families (TANF) • Women, Infants and Children (WIC) • California Children's Services (CCS) • Child Health and Disability Prevention (CHDP)


• Healthy Families • Early Head Start/Head Start • Parenting classes

FOR MORE INFORMATION Call (800) 515-BABY or contact San Diego Regional Center, school districts, or family resource center (see pages 24-27 and 30-31 for information on these agencies). More information can also be found online at www.dds.ca.gov/EarlyStart. (See Appendix G for parent handout on Early Start/Regional Center available in both English and Spanish.)


Infant Education Programs The Infant Education Programs are public special education programs that offer services to infants and toddlers with special needs and their families as part of California Early Start. Services are offered at no cost to the families. There are five Infant Education Programs in the San Diego area. Each program serves different regions in the San Diego area and also offers different types of school-based and/or home-based interventions. FOR MORE INFORMATION Contact the Infant Education Program in your region: Alcott Infant Program 4680 Hidalgo Avenue San Diego, CA 92117 Ph: 858-272-9641 Fx: 858-581-2269 Website: www2.sandi.net/infant Region served: San Diego City Schools HOPE Infant Program 910 W. San Marcos Blvd. #101 San Marcos, 92078 Ph: 760-736-6344 Fx: 760-471-8273 Website: www.sdcoe.k12.ca.us/student/hope Regions served: North Costal, North Inland, South Bay, and Poway La Mesa/Spring Valley 3845 Spring Drive Spring Valley, CA 91977 Ph: 619-668-5747 Fx: 619-668-8304 Regions served: La Mesa, Spring Valley, and Lemon Grove Santee-Lakeside 12335 Woodside Ave. Lakeside, CA 92040 Ph: 619-390-2620 Fx: 619-390-2597 Regions served: Lakeside and Santee Sevick Center 1609 E. Madison Avenue El Cajon, CA 92019-1046 Ph: 619-593-4597 Fx: 619-588-3695 Regions served: Cajon Valley and Mountain Empire


Special Education Services through School Districts The principles of the IDEA legislation guarantee that:

• A child receives a free and appropriate public education. • A child receives an appropriate evaluation or assessment. • An Individualized Education Program (IEP) is developed according to specific

guidelines in a timely manner that defines a child's disabilities, states a child's current levels of educational performance, describes a child's educational needs, and specifies a child's annual educational goals and objectives. (See Appendix H for more information on IEP.)

• A child receives instruction in the least restrictive environment. • Both child and parent(s) have an opportunity to participate in educational decision

making. Corresponding State Law regarding special education can be found in California Education Code, Part 30, Sections 56000 to 59300. In 1977, all school districts and county offices of education were required to join to form geographical regions of sufficient size and scope to provide for all of the special education service needs of children residing within the region boundaries. Each region developed a local plan describing how it would provide special education services. Single district Special Education Local Plan Areas (SELPAs) are of such significant size to provide all services within their boundaries while smaller districts joined consortia to provide the full range of services. There are six SELPAs in San Diego County:

• North Coastal Consortium for Special Education SELPA is composed of 14 school districts in the north coastal area of San Diego County. The districts include: Bonsall Union, Cardiff, Carlsbad Unified, Del Mar Union, Encinitas Union, Fallbrook Union Elementary, Fallbrook Union High, Oceanside Unified, Rancho Santa Fe, San Dieguito Union High, San Marcos Unified, Solana Beach, Vallecitos and Vista Unified.

• North Inland Special Education Region SELPA is composed of 10 school districts

in the northeast quadrant of San Diego County. The districts include: Borrego Springs Unified, Escondido Union Elementary, Escondido Union High, Julian Union Elementary, Julian Union High, Ramona Unified, San Pasqual Union, Spencer Valley, Valley Center-Pauma Unified, and Warner Unified.

• East County SELPA is composed of eleven school districts located in the

southeast quarter of San Diego County, going east to the Imperial County line and south to the border with Mexico. The districts are: Alpine Union, Dehesa, Cajon Valley Union, Grossmont Union High, Jamul-Dulzura Union, Lakeside Union, La Mesa-Spring Valley, Lemon Grove, Mountain Empire Unified, Santee, and Barona Indian Charter.


• South County SELPA is composed of 6 school districts located in the southern region of San Diego County. The districts are: Chula Vista Elementary, National, South Bay Union, San Ysidro Elementary, Sweetwater Union High, and Coronado Unified.

• Poway Unified School District SELPA

• San Diego Unified School District SELPA

The San Diego County Office of Education is the Administrative Unit for North Coastal, North Inland, East County, and South County SELPAS; the San Diego Unified School District is the Administrative Unit for Its SELPA as is the Poway Unified School District. FOR MORE INFORMATION North Coastal SELPA 570 Rancheros Drive #200 San Marcos, CA 92069 Ph: 760-471-8208 Fx: 760-471-2008 North Inland SELPA 398 D St. Ramona, CA 92065 Ph: 760-788-4671 Fx: 760-788-4681 East County SELPA 924 East Main Street El Cajon, CA 92121 Ph: 619-590-3920 Fx: 619-588-2495 South County SELPA 800 National City Blvd. #202 National City, CA 91950 Ph: 619-470-5224 Fx: 619-470-5266 Poway Unified School District SELPA 13626 Twin Peaks Road Poway, CA 92064-3098 Ph: 858-668-4100 Fx: 858-748-1791


San Diego Unified School District SELPA 4100 Normal Street, Annex 6 San Diego, CA 92103-2682 Ph: 619-725-7650 Fx: 619-725-7246 San Diego County Office of Education 6401 Linda Vista Road, Rm. 315 San Diego, CA 92111 Ph: 858-292-3774 Website: www.sdcoe.net/speced/selpas.asp


Exceptional Family Resource Center Implementation of Part C of the IDEA mandates states to implement a comprehensive early intervention service system for all infants and toddlers with disabilities or at risk for disabilities, and their families. Family support services are included in these systems. In California, family resource centers are part of the Early Start Program. Staffed by families of children with special needs, family resource centers offer parent-to-parent support and help parents, families, and children locate and use needed services. They offer support services and resources in many languages (English, Spanish, Mandarin, Korean, Tagalog, and Japanese), which may include newsletters, resource libraries, parent-to-parent support groups, sibling support groups, warmlines, and information and referral for parents and professionals regarding the Early Start system. FOR MORE INFORMATION Main Office 9245 Sky Park Ct., #130 San Diego, CA 92123 Ph: 619-594-7416 or 800-281-8252 Fx: 858-268-4275 North County 380 Mulberry Dr., Suite A San Marcos, CA 92069 Ph: 760-510-3994 Fx: 760-510-3995 Imperial County 512 West Aten Rd. Imperial, CA 92251 Ph: 760-355-0147 Fx: 760-355-0739 Website: www.efrconline.org


Head Start and Early Head Start Head Start is a federal program for preschool children from poverty level families. It began in 1965 as part of President Lyndon B. Johnson's 'War on Poverty' and started as an 8-week summer program designed to provide children from low-income families with a comprehensive program to meet their emotional, social, health, nutritional, and psychological needs. It now serves over 10,000,000 children nationwide. The Head Start program is operated by local non-profit organizations in almost every county in the nation. Neighborhood House Association (NHA) is the grantee for Head Start in San Diego County excluding the far northwest region which is operated by the Metropolitan Area Advisory Committee (MAAC). NHA Head Start operates programs directly in the North Coastal area, North Inland area, Central San Diego, Southeast San Diego, and Southwest San Diego. In addition, NHA contracts with two delegate agencies to provide Head Start services: Alpha Kappa Alpha Head Start provides services in the East County, and Episcopal Community Services (ECS) provides services in the South Bay area. Early Head Start (EHS) program provides services to expectant mothers and infants from birth up to three years of age. ELIGIBILITY Preschool age children, three- to five-years-old, and infants and toddlers, birth to three-years-old, qualify for Head Start and EHS respectively if their families meet income eligibility criteria. 10% of enrollment slots may be given to children from families that exceed the income guidelines. SERVICES Early Childhood Education Head Start's educational program is designed to meet each child's individual needs. Educational activities are individualized and linked to "school readiness" curricula. Health Medical and Dental: children receive a complete examination, including vision and hearing screenings, immunizations, and a dental exam. Follow-up treatment is provided for identified health problems. Nutrition: a trained nutritionist supervises the nutritional activities of each Head Start program and helps the staff identify the nutritional needs of the children. The nutritionist plans an educational program to teach parents how to select healthy foods and prepare well-balanced meals, and how to obtain food stamps and other community assistance when needed. Mental Health: a mental health professional is available for every Head Start program to provide mental health training for staff and parents and to increase awareness of the need for early attention to the special problems in children.


Parenting Through participation in classes and workshops on child development and through staff home visits, parents can learn about the needs of their children and about educational activities that can be carried out at home. Family Partnerships Social services staff assists families through community outreach, referrals, families’ needs assessments, information about available community resources, recruitment and enrollment of children, and emergency assistance and/or crisis intervention. FOR MORE INFORMATION Neighborhood House Association (NHA) 5660 Copley Drive San Diego, CA 92111 Ph: 858-715-2642 Fx: 858-715-2670 Website: www.sandiegoheadstart.org Metropolitan Area Advisory Committee (MAAC) 800 W. Los Vallecitos, Suite J San Marcos, CA 92069 Ph: 760-471-4210 Fx: 760-471-9320 Area Served: San Marcos, Oceanside, Vista, Rincon, Fallbrook, Valley Center, and Camp Pendleton


San Diego Regional Center

San Diego Regional Center (SDRC) is one of a network of 21 Regional Centers in California established by the Lanterman Mental Retardation Services Act of 1969. It is a private, non-profit corporation working under contract with the California Department of Developmental Services. Legislative changes from 1969 through the present expanded the population served by Regional Centers to include persons with mental retardation, cerebral palsy, epilepsy, autism, or other handicapping conditions similar to mental retardation. Regional Centers also administer intervention programs for children birth to 36 months with or at risk for developmental delay. (See the section on California Early Start for more information.) ELIGIBILITY Residents of San Diego or Imperial County diagnosed with a developmental disability that originates before age 18, constitutes a substantial handicap, and is expected to continue through life, may be eligible for SDRC services. These developmental disabilities include:

• Mental Retardation • Cerebral Palsy • Epilepsy • Autism • Other conditions similar to mental retardation that require treatment similar to that

required by persons with mental retardation The disability cannot include handicapping conditions that are:

• Solely psychiatric disorders where there are impaired intellect or social functioning which originated as a result of the psychiatric disorders or treatment given for such disorders

• Solely learning disabilities • Solely physical in nature (such as hearing loss, mild cerebral palsy, vision

impairment, etc.) Infants and toddlers, birth to age three are eligible for SDRC Early Start program if they meet eligibility criteria for California Early Start. SERVICES The SDRC provides a variety of services to persons with development disabilities, their families, and the community. The services include:

• Case finding and intake • Assessment, diagnosis, evaluation, and counseling • Development of an Individual Program Plan (IPP), a written plan with goals and

objectives designed to meet the needs of the consumer • Case management services


• Purchase of services, such as Early Start services, behavior modification, residential services, transportation, and respite services

• Advocacy for the protection of legal, civil, and service rights FOR MORE INFORMATION For San Diego County, contact: San Diego Regional Center 4355 Ruffin Rd., Suite 200 San Diego, CA 92123 Ph: 858-576-2996 Fx: 858-576-2873 For Imperial County, contact: San Diego Regional Center-Imperial County 512 West Aten Road Imperial, CA 92251 Ph: 760-355-8383 Fx: 760-355-0739 Website: www.sdrc.org (See Appendix I for parent handout on San Diego Regional Center available in both English and Spanish.)


Children�s Hospital & Health Center

Developmental Services Division Children's Hospital Developmental Services Division offers programs to identify, evaluate and treat individuals and families with potential delays, disabilities, and injuries, and to prevent secondary behavioral problems. The programs are designed to restore, sustain, and enhance the developmental and functional potential of children and families. ELIGIBILITY Children from birth to 18 years are eligible for services. These services are covered by many insurance plans including Medi-Cal. SERVICES Services provided include:

• Developmental evaluations for children ages 6 months to 6 years • Educational evaluations for children 6 to 17 years • Occupational therapy • Physical therapy • Speech, language, and voice screenings, evaluations, and treatment • Audiology/hearing evaluation

FOR MORE INFORMATION Developmental Evaluation Clinic, Audiology, Occupational Therapy, Physical Therapy, and Speech-Language Pathology Children's Main Center 8010 Frost Street, Suite 100 & 200 San Diego, CA 92123 Ph: 858-966-5817 Fx: 858-966-8528 Children's Solana Beach Center 667 San Rodolfo Dr., Suite 126 Solana Beach, CA 92075 Ph: 858-793-9591 Fx: 858-793-1153 Children's North County Center 4120 Waring Road Oceanside, CA 92054 Ph: 760-758-1620 Fx: 760-945-0758 Website: www.chsd.org/body.cfm?id=998


Children�s Outpatient Psychiatry Clinic Children’s Outpatient Psychiatry Clinic provides outpatient mental health services to assist children and their families with emotional, behavioral, and learning problems. ELIGIBILITY Children from birth to 18 years are eligible for services. SERVICES Mental Health Outpatient psychiatric services including diagnostic evaluation and individual, family, and group therapy are provided at multiple sites. Emergency and crisis intervention is available 24 hours a day through Children's Emergency Department. Chemical Dependency and Eating Disorders Special programs are available for adolescents in areas such as chemical dependency, eating disorders, and phobias. FOR MORE INFORMATION Children’s Outpatient Psychiatry Clinic 3665 Kearny Villa Rd., Suite 101 San Diego, CA 92123 Ph: 858-966-5832 Fx: 858-966-6733 Website: www.chsd.org/body.cfm?id=35&action=detail&ref=81. Chadwick Center for Children and Families Chadwick Center for Children and Families offers programs that provide for the prevention, identification, evaluation, treatment and rehabilitation of children and adults who have experienced abuse, neglect, violence, rape, or other traumas. ELIGIBILITY Children and adults who have experienced abuse, neglect, violence, rape, or other traumas are eligible for services. SERVICES Forensic and Medical Service The Forensic and Medical Service (FMS) is provided on the Children’s Hospital campus and includes evaluation of children who are suspected of being abused or neglected, children who have not met normal growth and developmental milestones, and children who have gynecologic problems. All children receive an assessment by a specialized


multidisciplinary team consisting of physicians, nurses, social workers, and other disciplines. The forensic services may also include a videotaped child interview that is generally requested by investigating agencies. Trauma Counseling Service The Trauma Counseling Service (TCS) provides advocacy and counseling services to children and families impacted by any type of trauma including child abuse and neglect; domestic, school, or community violence; hate crimes; and witnesses to violence, homicides, and other crimes. Included as a specialty unit within TCS is the Family Violence team that supports women to find safe housing, emotional support, financial and legal assistance, as well as counseling. Kids in Court The Kids in Court program familiarizes children and their parents with the court proceedings experienced in criminal or juvenile courts. Informal question and answer sessions with a judge and district attorney, as well as a mock trial, give children and parents reasonable expectations about the court process. Family Support Program The Family Support Program (FSP) provides a continuum of supportive and educational services whose goal is to increase a family’s coping skills, promote positive health and safety outcomes, and enhance self-sufficiency. The services include home visitation for families at risk of abuse and neglect, for pregnant and parenting teens, as adjunct to enrollment in Cal Works programs, for families of first time juvenile offenders, and for families of children who have medical and developmental issues that require increased coping skills (asthma, diabetes, failure to thrive, developmental delay); health development and risk assessment; parenting education and child development classes; and parent support groups. Most of the services provided are a collaborative effort between CHHC and other community agencies and groups, such as schools and hospitals. Child Protection Team and other collaborations The Chadwick Center for Children and Families staff also interacts with liaisons from a number of community agencies, including the San Diego Police and Sheriff's Department Child Abuse Units, the District Attorney's Office, San Diego County Health and Human Services, Family Resource Centers, San Diego Regional Center, hospitals, and physicians. FOR MORE INFORMATION Chadwick Center for Children and Families 3020 Children's Way, MC 5016 San Diego, CA 92123 Ph: 858-966-8572 or 858-576-1700 x4972 Fx: 858-966-8018 or 858-966-7434 Website: www.ChadwickCenter.org.


Children�s Autism Intervention Center Children’s Autism Intervention Center (CAIC) offers comprehensive evaluations and effective treatment plans for children with autistic spectrum disorders and their families. The program utilizes a multidisciplinary team consisting of occupational therapists, speech-language pathologists, neurologists, developmental pediatricians, specialty physicians, and psychologists. ELIGIBILITY Children from birth to 18 years are eligible for services. Children do not need to have a diagnosis of autistic spectrum disorder prior to referral. SERVICES In addition to multidisciplinary evaluations and interventions, CAIC provides the following services:

• Individual parent training programs to help parents interact with their children in ways that facilitate appropriate behaviors while reducing inappropriate behaviors. The program involves working with the child and parents in individual sessions, one time per week for a total of 12 weeks. Parents are taught to use different intervention techniques based on the needs of their child. The program primarily uses Pivotal Response Training (PRT). However, it also incorporates the Picture Exchange Communications System (PECS), Floor Time (interactive play therapy), and behavioral techniques such as functional analysis and self-management, depending on the individual child and family characteristics and specific developmental needs.

• Social skills group programs to promote social, language, and motor skills. • Parent lecture series. • Consultation services to area schools, group homes, community agencies, and

families. Consultation services are typically provided on a short-term basis to develop behavior plans, goals for treatment, determine appropriate environmental/classroom arrangement, or to assist with program development.

• Fast ForWord program, a computer-based treatment program designed for children aged 5 to 15 years who are diagnosed with an auditory processing impairment. This program targets the underlying impairment which causes many speech, language and reading problems. Computer-processed sounds, words and sentences are presented in the form of games. The consistent stimulation of the auditory system by the multiply processed input gradually increases the child’s ability to hear clearly and accurately. This also fosters the sound-letter association necessary for learning to read.

• Children’s Toddler School, an education program designed to integrate early education for toddlers with autistic spectrum disorders with typically developing children.


FOR MORE INFORMATION Children’s Autism Intervention Center 3020 Children's Way MC 5042 San Diego, CA 92123 Ph: 858-966-7453 Fx: 858-966-8011 Website: www.chsd.org/body.cfm?id=843. High Risk Infant Program The High Risk Infant (HRI) Program provides evaluation for the growth and development of infants and young children who are at risk for neurologic problems or developmental delays because of premature birth, low birth-weight, or other problems at birth. ELIGIBILITY Infants discharged from a California Children’s Services (CCS) approved NICU without a CCS eligible condition but who continue to be at-risk for developing a CCS eligible condition (usually cerebral palsy) may be followed until two years of age (corrected for prematurity) if they have any one of the following:

• Birthweight <1500 grams • Cardiorespiratory depression at birth which may include infants with Apgar

scores of 0-3 at five minutes, failure to institute spontaneous respirations by 10 minutes of age, or hypotonia persisting to two hours of age

• Prolonged perinatal hypoxemia/acidemia, neonatal hypoglycemia, or repetitive apnea

• Assisted ventilation > 48 hours in the first 28 days of life or any duration on ECMO

• Hypoxic-ischemic encephalopathy • Documented intracranial abnormality or pathology including intraventricular

hemorrhage of grade 2 or higher, or cerebral infarction • Other potential neurologic problems (e.g., history of seizure activity, CNS

infection, documented sepsis, bilirubin in excess of usual exchange transfusion level, etc.)

• Retinopathy of prematurity or sensorineural hearing abnormalities • Necrotizing enterocolitis or gastrointestinal anomaly or surgery requiring

prolonged parenteral nutrition • Severe metabolic imbalance including hypernatremia, hypoglycemia, inborn

errors of metabolism, etc.

SERVICES


The HRI Program provides screening and diagnostic assessment by a pediatric nurse practitioner or a clinical psychologist in the following areas: neuromotor function, growth and nutrition, language development, social interaction, and developmental milestones. FOR MORE INFORMATION Children’s Hospital & Health Center 8010 Frost St., Suite 200 San Diego, CA 92123 Ph: 858-966-8801 Fx: 858-966-8528 Website: www.chsd.org/body.cfm?id=2279. Developmental Screening and Enhancement Program The Developmental Screening and Enhancement Program (DSEP) addresses the developmental needs of children ages 3 months up to 6 years upon entry into the child welfare (foster care) system. ELIGIBLITY Children ages 3 months to 6 years are automatically referred to DSEP when they enter the foster care system in San Diego County. SERVICES DSEP provides children and families with the following services:

• Early identification of developmental and behavioral problems through screening and evaluation

• Advocacy to facilitate the linkage to recommended early intervention services and treatment services

• Consultation and training for care providers at Polinsky Children's Center, which is a temporary facility where children live until they are reunited with their parents or placed in a foster care home.

FOR MORE INFORMATION Jeanne Gordon, M.A. 3020 Children’s Way MC 5111 San Diego, CA 92123 Ph: 858-966-7874 Fx: 858-966-7521 Website: www.howkidsdevelop.com


San Diego State University (SDSU) Communications Clinic

The SDSU Communications Clinic provides services to individuals of all age groups with speech-language and audiological concerns. The Clinic functions as a training program for graduate students who provide all of Its services and who are directly supervised by University faculty certified by the American Speech-Language and Hearing Association (ASHA) and licensed by the state of California. Clinic sessions are held each semester: fall, spring, and summer. ELIGIBILITY All individuals with speech-language and audiological concerns are eligible for services. Fees vary for services provided, and a sliding scale fee program based on financial need is available upon request. SERVICES Assessment and intervention programs are provided for problems such as: augmentative communication, articulation and phonological disorders, specific language impairment, aphasia, dysphagia, apraxia of speech and other motor speech disorders, traumatic brain injury, cognitive-communicative disorders, language-based learning disabilities, cleft palate, voice and resonance disorders, fluency disorders, hearing loss and deafness. Programs specific to the audiologic area include hearing assessment, hearing aid evaluation and selection, assistive listening devices, earmolds, ear protectors, hearing conversation, and speech reading/aural rehabilitation. FOR MORE INFORMATION SDSU Communications Clinic Department of Communicative Disorders San Diego State University 6330 Alvarado Court, Suite 100 San Diego, CA 92120-4917 Ph: 619-594-7747 Fx: 619-594-7790 Website: http://slhs.sdsu.edu/cc.php


San Diego Scottish Rite Childhood Language Center The San Diego Scottish Rite Childhood Language Center provides speech and language screenings, evaluations, and therapy services for children ages 2 to 21. The services are free to eligible children, and funding is provided by Scottish Rite members. ELIGIBILITY Children ages 2 to 21 whose primary presenting problem is a significant speech and/or language disorder are eligible for services, with the following exclusions:

• Children with a diagnosis of mental retardation, deafness, cerebral palsy, or autism. All children with questionable cognitive skills, diagnosis of developmental delay and/or diagnosis of Pervasive Developmental Disorder (PDD) will be required to present evidence of at least low-average non-verbal intelligence. The evaluation must include at least one quantitative measure of nonverbal intelligence.

• Children already receiving services elsewhere individually twice a week for 40-60 minutes or in a group of three or fewer for at least 60 minutes.

Whenever there is a question about the appropriateness of therapy, the child’s readiness for therapy, or prognosis for success, the child will be enrolled in a three-month trial period. If significant progress is made during this period, therapy will be continued as deemed appropriate by the treating therapist.

SERVICES The Center provides speech and language screenings to individual children and preschools when requested, comprehensive speech and language evaluations, and intensive one-on-one speech and language therapy services. Services are typically rendered for a maximum of 18 months. The clinic is staffed by 3 speech-language therapists. In addition, the staff will act as a child advocate and assist the parents in finding the best school programs for their children. FOR MORE INFORMATION San Diego Scottish Rite Childhood Language Center 1895 Camino Del Rio South San Diego, California 92108-3683 Ph: 619-291-2506 Fx: 619-291-8017 Website: www.scottishritesandiego.org


California-Hawaii Elks Association Therapy Services The California-Hawaii Elks Association is a charitable organization which has been serving children with disabilities since 1950. The Association provides occupational therapy, physical therapy, and speech-language services through individual home instructions free of charge to eligible children. ELIGIBILITY Any child with a physical disability who:

1. Is under 18 years of age 2. Is currently not enrolled in other therapy program or services 3. Has no health insurance coverage 4. Cannot travel to receive therapy services due to lack of transportation or severity

of medical condition 5. Can receive services in a home setting

There is no financial eligibility requirement. SERVICES Currently, only occupational therapy services are available in the San Diego area, and a physician’s referral is needed for evaluation and treatment. Referrals considered for treatment include the child with sensory-motor and learning disabilities as well as physical conditions such as spina bifida, cerebral palsy, juvenile rheumatoid arthritis, muscular dystrophy, trauma, high risk infants, and other orthopedic and neurological conditions. FOR MORE INFORMATION Charlene Brown California-Hawaii Elks Association 5450 E. Lamona Ave. Fresno, CA 93727-2224 Ph: 951-677-2778 Fx: 951-677-3588 Website: www.chea-elks.org


APPENDIX A


APPENDIX B

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TO: Children's Care Connection

FAX: (760) 754-6110 Phone: (760) 722-3482 2231-B El Camino Real Oceanside, CA 92054

FROM: ____________________________________ ____________________________________ ____________________________________

Children's Care Connection REFERRAL INFORMATION

Referral Date: _________________ Referral Source: ________________________________________ Contact Person: _______________________________________ Phone Number: ________________ Child's Name: ________________________________________ DOB: _____________ Sex: ______ Address: ____________________________________________ Phone: _______________________ ______________________________________________ Primary Language: ______________ Mother's Name: ___________________________ Father's Name: ___________________________ Developmental Concerns: ______________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Parent Authorization for Release of Information Authorization is hereby granted for release of any information between Children's Hospital and Health Center and its affiliated entities to professionals treating my child, including other physicians, public health nurses, psychologists, counselors, school district personnel, HOPE, San Diego Regional Center, Health and Human Services Agency, California Children's Services, preschools, and child care providers. A copy of this authorization is as valid as the original. Parent Signature ______________________________________________ Date __________________ The information contained in this facsimile message is legally privileged and confidential intended only for the use of the individual or entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this facsimile is strictly prohibited. If you have received this facsimile in error, please immediately notify us by telephone and return the original message to us at the above address via the U.S. Postal Service. Thank you.


APPENDIX C


Parents� Evaluation of Developmental Status (PEDS) The PEDS is a parent-completed screening tool. It is easily administered within the context of primary care offices due to its short length and self-exploratory nature. This tool:

• Consists of ten questions targeting parent concerns regarding various aspects of development and behavior, including one question assessing global or cognitive concerns and eight questions eliciting concerns in each of the following domains: expressive language and articulation, receptive language, fine-motor, gross motor, behavior, social-emotional, self-help, and school.

• Can be used from birth to 8 years of age.

• Takes about two minutes to administer and score.

• Has high sensitivity and identifies 74% to 80% of children with developmental disabilities.

• Has high specificity; 70% to 80% of children without developmental disabilities

are identified as typically developing.

• Is written at the fourth- to fifth-grade reading level.

• Has been validated on more than 771 children across the U.S. in various settings: pediatric offices, outpatient clinics, day care centers, and schools.

• Has been standardized on 2,823 families from various backgrounds, including

varying levels of socioeconomic status and varying ethnicity.

• Is available in English and Spanish.

• Can be purchased through the website www.pedstest.com. For providers and offices participating in the C3 program, the PEDS is provided free of charge.

Adapted from the website www.pedstest.com.


DENVER II The DENVER II is a well known and widely used developmental screening tool designed to screen asymptomatic children for possible problems and to monitor children at risk for developmental problems, such as those who have experienced perinatal difficulties. This tool:

• Is the result of a major revision and restandardization of the Denver Developmental Screening Test (DDST) which was first published in 1967. The major differences between the Denver II and the DDST are: 1) an 86% increase in language items; 2) the addition of two speech intelligibility items; 3) a revised age scale that corresponds to the periodicity schedule for health maintenance visits of the American Academy of Pediatrics; 4) a new category of item interpretation to identify milder delays; 5) a behavior rating scale; and 6) new training materials.

• Consists of 125 tasks, or items, which are arranged on the test form into the

following four domains: personal-social, fine motor-adaptive, language, and gross motor.

• Takes about 20 minutes to complete by trained professionals.

• Can be used with apparently-well children between birth to six years of age.

• Has sensitivity of 83% with questionable/untestable items scored as fails but

sensitivity decreases to 56% with questionable/untestable items scored as passes.

• Has specificity of 43% with questionable/untestable items scored as fails but specificity increases to 80% with questionable/untestable items scored as passes.

• Has average inter-rater reliability of 0.99 (SD 0.01) and 7- to 10-day test-retest

reliability of 0.90 (SD 0.12).

• Standardized on 2,096 children from Colorado who were stratified by age, race, socioeconomic status, and residential area.

• Is available in English and Spanish.

• Can be purchased through the website www.denverii.com.

Frankenburg WK, et al. The Denver II: A major revision and restandardization of the

Denver Developmental Screening Test. Pediatrics 1992; 89: 91-97. Glascoe FP, et al. Accuracy of the Denver-II in developmental screening. Pediatrics

1992; 89: 1221-1225. Frankenburg WK, et al. Denver II Screening Manual. Denver, CO: Denver

Developmental Materials, Inc., 1990.


Modified Checklist for Autism in Toddlers (M-CHAT) The M-CHAT is a simple, self-administered, parental questionnaire designed to screen for autism/pervasive developmental disorder (PDD). This tool:

• Is an expanded American version of the original CHAT (Checklist for Autism in Toddlers) from the United Kingdom aimed to improve the sensitivity of the CHAT and to position it better for the American audience. The original CHAT consists of nine items asked of the parents by the physician and five items observed and scored by a home health visitor in the home.

• Consists of 23 yes/no items that rely on parents’ report of current skills and

behaviors. Six critical items were identified by discriminant functional analyses: item 2 (child takes interest in other children), item 7 (child uses index finger to point and to indicate interest in something), item 9 (child brings objects over to show the parent), item 13 (child imitates), item 14 (child responds to his or her name when called), and item 15 (child follows point across the room).

• Is designed to be used during 18- to 24-month checkups to improve the early

detection of autism/PDD and facilitate an early start on effective therapies.

• Was used to screen a population of 1,293 children for the initial study, which included children screened during well-baby checkups with primary care providers at 18- or 24-months and children screened through early intervention services providers at any age between 18-30 months.

• Has sensitivity of 0.87, specificity of 0.99, positive predictive power of 0.80, and

negative predictive power of 0.99.

• Has internal reliability of 0.85 for the entire checklist and 0.83 for the critical items.

• Has been translated into Spanish, Japanese, and Turkish, and one study has been

published which used the M-CHAT translated into Chinese.

• Can be downloaded free of charge from the website www.firstsign.org. Robins DL, et al. The Modified Checklist for Autism in Toddlers: An initial study

investigating the early detection of autism and pervasive developmental disorders. Journal of Autism and Developmental Disorders 2001; 31: 131-144.

Dumont-Mathieu T, Fein D, Kleinman J. Screening for Autism in Young Children: The Modified Checklist for Autism in Toddlers. Available: www.dbpeds.org/articles.

Wong V, et al. A modified screening tool for autism (Checklist for Autism in Toddlers [CHAT-23]) for Chinese Children. Pediatrics 2004; 114: 166-176.


MacArthur Communicative Development Inventories (CDIs) The MacArthur CDIs are widely-used parent-report instruments for assessing communicative skills. The CDI infant and toddler long forms contain 396 and 680 words, respectively. The time required to complete the long forms restricted their applicability in many research, clinical, and educational settings when a rapid assessment of a child’s language level was needed. As a result, the CDI short forms were developed to capitalize on the demonstrated effectiveness of parent input in a briefer format.

• The CDIs can be used to screen for delays in language development, identify individual patterns of strengths and weaknesses, formulate intervention strategies, and evaluate treatment outcomes.

• The infant short form (Level I, for 8- to 18-month-olds) contains an 89-word

checklist for vocabulary comprehension and production. • There are 2 parallel versions of the toddler short form (Level II, Forms A and B,

for 16- to 30-month olds), and each version contains a 100-word vocabulary production checklist and a question about word combinations. Either form may be used for a single administration. For longitudinal studies, users have the option of alternating between the two versions.

• The forms may also be useful with developmentally delayed children beyond the

specified age ranges.

• The forms take about 10-20 minutes to complete.

• The normative study was carried out on 481 infants and 898 toddlers from New Haven, Seattle, and San Diego.

• Reliability for Level I, Level IIA, Level IIB was 0.97, 0.99, 0.99 respectively.

• Validity for Level I was 0.88 for vocabulary comprehension and 0.90 for

vocabulary production. Validity for vocabulary production was 0.74 for Level IIA and 0.93 for Level IIB.

• The CDIs are available in English, Spanish, Italian, and American Sign Language.

• Can be purchased by calling (619)594-6614. Ordering information can be

obtained at the website www.sci.sdsu.edu/cdi. Fenson, L, et al. Short-form versions of the MacArthur Communicative Development

Inventories. Applied Psycholinguistics 2000; 21: 95-115. Fenson, L, et al. MacArthur Communicative Development Inventories User’s Guide and

Technical Manual. San Diego: Singular Publishing Group, Inc., 1993.


Child Behavior Checklist (CBCL) The CBCL is a standardized form that parents fill out to describe their child’s behavioral and emotional problems. This tool:

• Can be used to identify behavioral and emotional problems, facilitate the diagnostic process, and assess service delivery and outcomes.

• Is given to parents or caregivers of children ages 18-60 months.

• Consists of 100 problem items to be rated 0, 1, and 2 as well as open-ended

questions that ask the respondent to describe any illnesses or disabilities, concerns, and the “best things” about the child.

• Gives the results on a profile that compares the child with a normative sample of

peers in each of the following seven syndromes: emotionally reactive, anxious/depressed, somatic complaints, withdrawn, sleep problems, attention problems, and aggressive behavior. There is also a category for “other problems” for items that do not fit into the above syndromes. The syndromes can be further grouped into internalizing (problems that are mainly within the self) and externalizing (problems that mainly involve conflicts with other people and with their expectations for the child). The internalizing group consists of emotionally reactive, anxious/depressed, somatic complaints, and withdrawn syndromes. The externalizing group consists of sleep problems, attention problems, and aggressive behavior syndromes. Scores for the internalizing and externalizing groups are also given so a clinician can determine whether the child’s problems tend to be concentrated in either, both, or neither of the areas.

• Is designed to be self-administered by parents with fifth grade reading skills.

• Takes about 10-20 minutes to complete and about 2 minutes for computer

scoring.

• Is based on ratings of 1,728 children and is normed on a national sample of 700 children.

• Is available in English and Spanish. The Achenbach System of Empirically-

Based Assessment forms have been translated into 71 languages.

• Can be purchased through the website www.aseba.org. Achenbach TM, Rescorla LA. Manual for the ASEBA Preschool Forms & Profiles.

Burlington, VT: University of Vermont Department of Psychiatry, 2000.


APPENDIX D

* Please note: Non-registered siblings are not permitted to attend classes.

C3 Parent Enrichment Classes

INFANT Oceanside: (760) 754-6110

Solana Beach: (858) 966-8931 San Marcos: (760) 591-0179

Feeding Finesse! Understanding and Encouraging Development in the Feeding Process

This two-session parent-only class focuses on feeding development, behavior, and functional strategies to use at home. Infant, toddler, and preschool classes are available. For ages: infant- 6 yrs. or Kindergarten entry Facilitator(s): Speech Therapists, Occupational Therapists, Behavior Specialists

Gesturing with Babies! Using gestures to stimulate your child’s language development This two-session class promotes the use of baby signs for the enhancement of language development in children as young as 10 months through two years of age. This class is meant for parents of children who do not yet have a large vocabulary. The goal is to boost vocabulary, increase parent-child book-looking, and promote early language development. Parent and child classes. For ages: 5 - 18 mos. Facilitator(s): Speech Therapists

Grow and Learn with Me! Building Confidence and Esteem for Parents and Infants

This hands-on parent-infant series integrates all areas of development, with an emphasis on cognitive, emotional and social development. Using the “magic of everyday moments,” the class provides simple, effective ideas and techniques to enhance understanding, communication and attunement between parents and infants. This series meets once a week for four weeks. For ages: A. birth to just crawling B. crawling to just walking Facilitator(s): Developmental and Behavior Specialists

Infant Massage: A Sensory Experience to Enhance the Parent/Child Relationship

This two-three session class teaches you and your baby the joys of infant massage, promoting stress reduction, relaxation, and colic relief, and parent/infant interaction and communication. Parents are taught to interact with their babies through touch. For newborn babies to pre-crawlers and their parents. This is a one-hour class. For ages: pre-crawlers Facilitator(s): Physical Therapists


Infant Play! How to Encourage Development Through Movement and Play Activities

This three-session interactive parent/child class focuses on the importance of active play. The class will provide parents with activity and positioning suggestions to promote play and developmental skills. This class is available for children who are not yet walking. For ages: pre-walkers over 3 mos. Facilitator(s): Physical Therapists, Occupational Therapists

Making a Match! Choosing an Appropriate Preschool for Your Child

This one-session parent-only class is designed to give parents information and strategies for choosing an appropriate preschool for their child. Topics include: types of schools available, definitions of various methods and curriculums, state regulations, observation techniques, and tips for understanding children’s learning styles and how they can impact choices. For ages: anyone choosing a preschool at any age Facilitator(s): Developmental Specialists

Parent Coaching This private one-hour parent-only session addresses individual concerns such as parenting issues or child behavior issues. Call for an appointment. For ages: 0 – 4 yrs. 11 mos. Facilitator(s): Behavior Specialists

Talking with Toddlers! How to Stimulate Toddler’s Language Development This class provides parents with benchmarks of language development, and specific strategies they can use at home to encourage language development in their child. Early language developmental milestones are targeted to promote linguistic development, book-looking, and the precursory skills for later development of pre-literacy skills. The four-week class meets for 1-1 ½ hours, once weekly. The first three sessions are parent only, the last session is parent-child. For ages: 18 months-3 yrs. Facilitator(s): Speech Therapists

*Please note: Non-registered siblings are not permitted to attend classes.


TODDLER Oceanside: (760) 754-6110


Declaration of Independence! Understanding Young Children’s Behavior

This is a four-week, adults-only series for parents of toddlers and young preschoolers. With an emphasis on addressing individual families’ questions, the class includes discussions on how young children learn, how temperament and environment affect behavior, and how one’s own childhood experiences affect parenting styles and choices. Using first-hand examples and role plays of children’s challenging behaviors, we explore ways to use positive discipline and effective communication techniques to enhance both children’s and parents’ sense of mastery and cooperation within a loving and respectful relationship. For ages: walking well to 3 yrs. Facilitator(s): Developmental and Behavior Specialists

Feeding Finesse! Understanding and Encouraging Development in the Feeding Process

This two-session parent-only class focuses on feeding development, behavior, and functional strategies to use at home. Infant, toddler, and preschool classes are available. For ages: infant – 6 yrs. or Kindergarten entry Facilitator(s): Speech Therapists, Occupational Therapists, Behavior Specialists

Grow and Learn with Me! Building Confidence and Esteem for Parents and Toddlers

This hands-on parent-child series integrates all areas of development with an emphasis on cognitive, emotional and social development. Using the “magic of everyday moments,” the class provides practice and coaching in using simple, effective ideas and techniques to enhance understanding, communication and cooperation between parents and children. This series lasts four weeks with two 90-minute classes per week (one class for parents only, one for parents and children together). PLEASE NOTE: Classes at the C3 San Marcos site include a single class for parents only, followed by four weekly classes of parents and children together. For ages: walking well to 36 mos. Facilitator(s): Developmental and Behavior Specialists


Making a Match! Choosing an Appropriate Preschool for Your Child

This one-session parent-only class is designed to give parents information and strategies for choosing an appropriate preschool for their child. Topics include: types of schools available, definitions of various methods and curriculums, state regulations, observation techniques, and tips for understanding children’s learning styles and how they can impact choices. For ages: Anyone choosing a preschool Facilitator(s): Developmental Specialists

Music and Movement!

Music sparks children’s imagination and promotes creative movement opportunities. This class will explore ways to develop balance, equilibrium and listening skills while having fun with music. Parents will be given ideas for incorporating music into their daily family routines. There are separate classes for early toddlers (15-24 months), toddlers (2-3 years), and preschoolers (4-6 yrs. or Kindergarten entry). The class will meet once a month for 1 hour. Families are encouraged to attend monthly, as topics and crafts change each month. Facilitator(s): Physical Therapists, Behavior/Developmental Specialists

Parent Coaching

This private one-hour parent-only session addresses individual concerns such as parenting issues or child behavior issues. Call for an appointment. For ages: 0 - 6 yrs. or Kindergarten entry Facilitator(s): Behavior Specialists

Talking with Toddlers! How to Stimulate Your Toddler’s Language Development

This class provides parents with benchmarks of language development, and specific strategies they can use at home to encourage language development in their child. Early language developmental milestones are targeted to promote linguistic development, book-looking, and the precursory skills for later development of pre-literacy skills. The four-week class meets for 1-1 ½ hours, once weekly. The first three sessions are parent only, the last session is parent-child For ages: 18 mos.-3 yrs. Facilitator(s): Speech Therapists

Toddler Play! Importance of Movement in Development This 2-3-session interactive parent/child class focuses on the importance of active play. The class will provide parents with activity and positioning suggestions to promote play and developmental skills. This class is available for children who are walking, up to the age of 30 months. For ages: under 30 months and walking. Facilitator(s): Occupational Therapists or Physical Therapists



PRESCHOOL Oceanside: (760) 754-6110


Creativity! Learning Through Play

This interactive parent/child series is designed to teach parents how to utilize everyday activities with their children to enhance creativity and learning. Weekly topics include: science, art, and cooking. The series lasts four weeks, with two classes per week. For ages: 3 yrs.- 6 yrs. or Kindergarten entry

Facilitator(s): Developmental Specialists Feeding Finesse! Understanding and Encouraging Development in the Feeding Process

This two-session parent-only class focuses on feeding development, behavior, and functional strategies to use at home. Infant, toddler, and preschool classes are available. For ages: infant – 6 yrs. or Kindergarten entry Facilitator(s): Speech Therapists, Occupational Therapists, Behavior Specialists

Fun with Speech Sounds! How to Increase Exposure and Awareness of Speech Sounds

This class is designed for parents of children who are having difficulty articulating and producing sounds correctly. By focusing on sound production and phonological skills, the class will teach parents techniques, games and activities for later use at home. The class will allow the parents to practice with their child under the guidance of a speech-language pathologist. There are five classes in the series. The first class is a parent-only lecture. The lecture is a prerequisite for attending the remaining four parent-child classes. For ages: 3 yrs. - 6 yrs. or Kindergarten entry Facilitator(s): Speech Therapists

Grow and Learn with Me! Building Confidence and Esteem for Parents and Preschoolers This hands-on parent-child series integrates all areas of development with an emphasis on cognitive, emotional and social development. Using a rich sensory-motor base, the class provides practice and coaching in using simple, effective ideas and techniques to enhance understanding, communication and cooperation between parents and children. This series lasts four weeks with two 90-minute classes per week (one class for parents only, one for parents and children together). PLEASE NOTE: Classes at the C3 San Marcos site include a single class for parents only, followed by four weekly classes of parents and children together. For ages: 3 yrs.- 6 yrs. or Kindergarten entry Facilitator(s): Developmental and Behavior Specialists

* Please note: Non-registered siblings are not permitted to attend classes

Making a Match! Choosing an Appropriate Preschool for Your Child This one-session parent-only class is designed to give parents information and strategies for choosing an appropriate preschool for their child. Topics include: types of schools available, definitions of various methods and curriculums, state regulations, observation techniques, and tips for understanding children’s learning styles and how they can impact choices. For ages: anyone choosing a preschool Facilitator(s): Developmental Specialists

Music and Movement!

Music sparks children’s imagination and promotes creative movement opportunities. This class will explore ways to develop balance, equilibrium and listening skills while having fun with music. Parents will be given ideas for incorporating music into their daily family routines. There are separate classes for early toddlers (15-24 months), toddlers (2-3 years), and preschoolers (4-6 yrs. or Kindergarten entry). The class will meet once a month for 1 hour. Families are encouraged to attend monthly, as topics and crafts change each month. Facilitator(s): Physical Therapists, Behavior/Developmental Specialists

Parent Coaching

This private one-hour parent-only session addresses individual concerns such as parenting issues or child behavior issues. Call for an appointment. For ages: 0-6 yrs. or Kindergarten entry Facilitator(s): Behavior Specialists

Preschool Play! The Importance of Movement in Learning

This one-session parent/child class incorporates recreational activities and outdoor games. We will discuss ways that movement and big muscle play are important for skill development, sensory processing and learning. This class will take place in a local park. For ages: 3 yrs.- 6 yrs. or Kindergarten entry Facilitator(s): Occupational Therapists, Physical Therapist

Pushing the Limits! How to Handle Challenging Behavior

Pushing The Limits is a parent-only, five-week class for parents of preschoolers. The objectives of the class are to educate parents about child temperament and social-emotional development, to teach parents positive and effective parenting skills and discipline strategies, and to provide a safe and supportive environment for parents to share and discuss parenting concerns and behavioral-social difficulties they are encountering with their child. The emphasis in this class is on equipping parents with the information and skills that they need to help high energy, spirited children feel successful in home and preschool settings. For ages: 3 yrs. – 6 yrs. or Kindergarten entry Facilitator(s): Behavior Specialists


Redirecting Children’s Behavior! Peace Begins at Home

This parent-only course meets for 2½ hours, once a week for five weeks. It is a “hands-on” positive parenting course that focuses on ways to help your child build self-esteem and responsibility, promote positive social interactions with adults and peers, and create win-win situations with all family members. A stable and safe family environment is a key factor in your child’s early learning and literacy. The course will help parents identify different types of misbehavior and how to effectively redirect them. This is a nationally acclaimed parenting course, from the International Network for Children and Families, with plenty of role playing and parent participation! Appropriate for parents of toddlers and preschoolers. For ages: 3 yrs. – 6 yrs. or Kindergarten entry

Facilitator(s): Behavior Specialists Redirecting Children’s Behavior: For Dads Only!

This dad-only course, a compact version of RCB, meets for 2½ hours, once a week for only three weeks. It is a “hands-on” positive parenting course that focuses on ways to help your child build self-esteem and responsibility, promote positive social interactions with adults and peers, and create win-win situations with all family members. A stable and safe family environment is a key factor in your child’s early learning and literacy. The course will help parents identify different types of misbehavior and how to effectively redirect them. This is a nationally acclaimed parenting course, from the International Network for Children and Families, with plenty of role playing and parent participation! Appropriate for parents of toddlers and preschoolers. For ages: 3 yrs. – 6 yrs. or Kindergarten entry

Facilitator(s): Behavior Specialists Redirecting Children’s Behavior: The Graduate Series

This group is for graduates of the five – session Redirecting Children’s Behavior course. After completing the course, many parents find they are able to use only some of the information. As the weeks and months pass, parents find themselves forgetting what they learned in RCB and slipping back into their old patterns with their children. Now there is a way to strengthen the skills you learned in RCB. Each month we will cover a particular topic, such at power struggles or consequences, by reviewing the information from the class; discovering new aspects of the topic; and getting practical ideas on how to use the information daily in our families. There will also be time for brainstorming solutions to current challenges or situations that are happening within your family.

For Ages: Parents of toddlers and preschoolers (3 yrs. – 6 yrs. or Kindergarten entry) Facilitator(s): Behavior Specialist Sensory Motor Play! Using Play to Strengthen Body and Mind

This 3-4-session parent/child class teaches parents the importance of sensory motor play and how to incorporate it into their child’s day. The class will prepare children for learning by providing sensory activities and improving postural stability to enhance coordination, attention span and school readiness. For ages: 3 yrs. – 6 yrs. or Kindergarten entry Facilitator(s): Occupational Therapists, Physical Therapists


Talking with Preschoolers! How to Stimulate Your Preschooler’s Language Development

This class provides parents with benchmarks of language development, and specific strategies to use at home to encourage language development in their child. Parents will learn about language milestones, teaching language through play, book time activities, and facilitating higher level language skills. The class meets for four weeks, for one-hour sessions. The first two classes are parent-only lectures. The last two weeks are parent and child classes. For ages: 3 yrs. – 6 yrs. or Kindergarten entry Facilitator(s): Speech Therapists

Watch Me Learn! (for 3-year-olds)

This class focuses on the motor, social and speech-language skills needed for learning. This parent-child class meets once a week for four weeks. All sessions are parent/child-interactive and help parents learn techniques that can be used at home. Fine motor and early language activities are the primary focal points of this class. For ages: 3 yrs. – 3 yrs. 11 mos. Facilitators: Occupational Therapists, Speech Therapists

Watch Me Learn! (for 4-year-olds)

This class focuses on motor, social, and speech-language skills needed for kindergarten. This parent-child class meets once a week for four weeks. All sessions help parents learn techniques that can be used at home. Pre-writing and pre-reading/early literacy activities are the primary focal points of this class. For ages: 4 yrs. - 6 yrs. or Kindergarten entry Facilitator(s): Occupational Therapists, Speech Therapists

Yoga Games for Preschoolers

This is a three-session interactive parent/child class that focuses on exercises that promote mind-body relaxation and fitness, strength, balance, and coordination. This class incorporates deep breathing and movement games that help preschoolers learn to focus their energy and attention in a positive way, preparing them for the demands of kindergarten. For Ages: 3 yrs. 6 mos. - 6 yrs. or Kindergarten entry Facilitator(s): Physical Therapists and Occupational Therapists


APPENDIX E

OVERVIEW OF C3 PROGRESS FROM 07/01-01/05

9748 Children received Stage I Screening at pediatrician’s office (2986 referred to C3)

4281 Parents referred children directly to C3 & children received

Stage I Screening

529 parents chose to receive Stage II

Screen at home (HV)

3570 parents chose to receive Stage II

Screen at C3 site

2408 parents chose C3

classes only

3987 Stage II Screens Completed (3066 C3 Site, 470 HV, 451 Off-Site)

Recommendation to Services: • 280 (7%) Full Developmental Evaluation • 3643 (91%) C3 Enhancement Classes • 457 (12%) California Early Start • 28 (1%) Regional Center • 126 (3%) Early Head Start or Head Start • 141 (4%) School District for Evaluation

• 604 (15%) Speech Evaluation • 370 (9%) Hearing Evaluation • 155 (4%) Occupational Therapy Evaluation • 75 (2%) Physical Therapy Evaluation • 91 (2%) Mental Health Provider/Counseling • 255 (6%) C3 Parent Coaching/Consults

1360 Children referred from childcare center or other agency

& received Stage I Screening

8627 Intakes Completed

114 families were

ineligible

979 families C3 was

unable to contact

433 families refused

594 parents chose to receive Stage II Screen off-site

= total # C3 Stage I Screens

= total # C3 Stage II Screens

= total # C3 Intake Surveys & disposition


APPENDIX F


Individualized Family Service Plan (IFSP) The IFSP is a written plan that serves as the framework for meeting the developmental needs of a child and family. It consists of:

• A statement regarding the child's present level of development in the following areas: physical (including vision, hearing, and health status), cognitive, communicative (language and speech), psychosocial, and adaptive behavior.

• A statement regarding family strengths, resources, concerns, and priorities in

relationship to the child's development.

• A statement regarding the major outcomes expected to be achieved for the child and family.

• A statement regarding the early intervention services that are necessary to meet

the identified outcomes for the child and family, including the frequency, intensity, and method of delivering services.

• A statement regarding the natural environments in which the services will be

appropriately provided or a statement explaining why services will not be provided in a natural environment.

• Projected dates for the initiation of services and the anticipated duration of these

services.

• Identification of a service coordinator who will be responsible for the implementation of the IFSP and the coordination with other agencies and professionals.

• Development of a transition plan prior to three months before the child reaches

age three.

• Written consent from the parents or legal guardians (must be obtained prior to provision of services).

(Adapted from website www.dpi.state.nd.us.)


APPENDIX G


APPENDIX H


Individualized Education Program (IEP) An IEP is a written document that consists of:

• A statement regarding the child's present levels of educational performance based on information gathered from a variety of sources such as tests, observations, work samples, etc. For preschool children, as appropriate, an IEP might describe how the disability affects the child's participation in age-appropriate activities.

• A statement regarding the annual goals and related short-term objectives that

delineate what the child is expected to learn over a specific time period. Most IEP goals are annual goals that cover the entire school year. Objectives are for shorter amounts of time, and a system should be in place to update them on a regular basis. Objectives must be stated in measurable terms, and:

1. Specify what behavior(s) the child is to perform. 2. Describe the conditions under which the child is to perform the desired

behavior(s). 3. State the degree to which the child is expected to perform the desired

behavior(s).

• A statement regarding the special education and related services to be provided to help the child obtain the stated goals and objectives.

• The extent of time to which the child will participate with nondisabled children in

the general education setting, including participation in district-wide and statewide assessments.

• The projected dates the special education program and other services will begin,

and the anticipated duration that the services will be provided.

• The criteria that will be used to determine whether goals and objectives have been met.

• The date for evaluating the child's performance and the effectiveness of the

program in meeting the child's short-term instructional objectives (each child's program must be reviewed at least once a year, or at least as often as progress is reported for nondisabled children).

(Adapted from website www.dpi.state.nd.us.)


Request for Assessment for Special Education Date: _______________________________________ RE: Name _________________________________ Date of Birth ___________________________

Dear _________________________________________

I am the parent of ___________________________________. I am concerned

about my child's development for the following reasons: __________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

I wish to request an assessment for my child for possible Special Education

services. I look forward to working with you within the next 15 days to develop an

assessment plan to begin the evaluation process. Please ensure that I receive copies of

the assessment results one week prior to the IEP meeting.

Thank you so much for your assistance. I can be reached by phone at

_______________________________. The best time to reach me is at

_______________________________.

Sincerely,


IEP TIMELINE

● DAY 1 OFFICE SPECIAL EDUCATION REFERRAL

● 15 DAYS ASSESSMENT PLAN (BY DAY 16) ● 15 DAYS PARENTS REVIEW AND (BY DAY 21) SIGN ASSESSMENT PLAN ● 50 DAYS ● ASSESS STUDENT (BY DAY 81) ● IEP TEAM MEETING ● WRITTEN IEP ● 2-3 DAYS IMPLEMENT PROGRAM (BY DAY 84)


APPENDIX I


APPENDIX J


Redirecting Children�s Behavior during Well/Acute Care Visits Even though a child may have been to your office before, an office visit can still be overwhelming. Most children remember the equipment, the sounds, the smells, and especially the needles. If children are coming for an acute care visit, they are also not feeling their best! When children feel as though they have some control over the situation, they are less likely to misbehave. Here are some quick and easy ways to accomplish this in a 15-minute appointment. General strategies to try: • Ask questions instead of giving commands.

o “Can you tell me if this is too cold?” o “Are my hands warm enough for you?” o “Let me know if this feels sharp or pinches.” o “Would you like me to look in your mother’s or father’s ears too?”

• Give choices (< 4years old, 2 choices only).

o “Would you like me to look at your eyes or ears first?” o “Would you like to sit up on the table or start by sitting in the chair?” o “Would you like the medicine in your right or left arm?” (No, really it works!)

• Ask them for their help. This lets them know how important they are and that

they are needed. o “I need your help. Will you hold this tongue blade for me while I…?” o “I need your help. Will you tell me when you see the red dot?” o “Will you count to ten (sing the ABCs)? When you are done, I will be too.”

• Acknowledge the child�s feelings and your needs.

o “I know how scary this can be. What can we do to help you feel less afraid? Do you want to look at this (otoscope, ophthalmoscope, stethoscope etc.) before I use it?”

o “I need to look in your ears, and I know you don’t want me to because they have been hurting you. What can we do so I can do what I need to, which is to take a look in your ears?”

If they have no response, which is usually the case, you continue…

o “I have some ideas. We could look in your mom’s or dad’s ears first.” o “We could have you sit in your mom’s or dad’s lap while I look in your ears

or you could sit up on the table.” • Acknowledge that feelings are OK but misbehavior is not.

o “Angry is OK, biting the tongue depressor is not; hitting your mother or father is not.”

o “Crying is OK when I look in your ears, but let’s see how you can stay still. The more still you stay the less it will hurt.”


Things to avoid: • Go �head-to-head� with them.

If you find yourself trapped in a “head-to-head” situation, stop what you are doing and let go of your fixed position. Ask yourself: “How can I examine this child in a different way then I usually do?”

• Tell them to be a �big boy� or a �big girl�.

This gives the message they are not OK as they are right now. • Give threats.

o “If you don’t cooperate we will have to hold you down”. o Threats may work in the moment, but not in the long run. Threats also work

out of fear, not awareness of how to act in a doctor’s office. The child will leave the appointment remembering how mean you are and gaining cooperation will be even more difficult the next visit.

Points to remember: • Children do not understand sarcasm. • Children deserve all the respect any human deserves. • When a child states something, acknowledge it…don’t deny it. This doesn’t mean

you have to agree with them, just acknowledge that they feel the way they do. o “Oh, when I put my stethoscope on your chest it hurts you.”

• Parents are watching every move you make! Be the best role model you can be! Source: Redirecting Children’s Behavior Kathryn Kvols


Redirecting Children�s Behavior Keys to Successful Parenting

1. Use Genuine Encounter Moments (GEMS) Children’s self esteem is greatly influenced by the quality of time spent with parents. With our busy lives, we are often thinking about the next thing that we have to do, instead of focusing 100% of our attention on what our children are saying to us. We often pretend to listen or ignore our children’s attempts to communicate with us. If we don’t give our children Genuine Encounter Moments (GEMS) throughout the day, they will often start to misbehave. Negative attention to a child is better than no attention. When your child comes to you to tell or ask you something, stop what you are doing (when at all possible), and:

Get down on his/her level Give eye contact Touch him/her

Give 100% focused attention

GEMS take about 3 minutes because they are so focused and will make your child feel like he/she is the most important thing in your life. 2. Acknowledge all feelings are fine It is important to recognize that feelings are neither right nor wrong. Feelings are just what the children are feeling at a particular time. So when your child says to you, “Daddy/Mommy, you never spend time with me” (even though you had just played with him/her), he/she is expressing what he/she feels. It is best at these times to validate his/her feelings by saying, “Yeah, I bet it feels like we don’t get enough time together.” 3. Use actions not words Statistics report we give our children over 2,000 compliance statements per day: “eat your banana”, “put your socks on”, “get in the tub”, or “brush your teeth”. No wonder our children become “parent deaf”! Instead of nagging or yelling, ask yourself: “What actions can I take?” or “What questions can I ask him/her?” For example, if you have repeatedly told your child to unroll his socks when he takes them off, then only wash socks that are unrolled. Actions speak louder than words. 4. Give children appropriate ways to feel powerful If you don’t, they will find inappropriate ways to feel their power. Some ways to help children feel powerful and valuable are to ask their advice, give them choices, and ask them to help with cooking and shopping. A two-year-old can wash plastic dishes and vegetables and put napkins on a table. Often, we do the job for them because we can do it with less hassle, but the result is that they don’t feel valuable or needed.


5. Use natural consequences Ask yourself: “What would happen if I didn’t interfere in this situation?” For example, if your child forgets his/her lunch, don’t bring it to him/her. Instead, allow him/her to find a solution and learn the importance of being responsible. If we interfere when we don’t need to, we rob our children of the chance to learn from the consequences of their actions. 6. Use logical consequences Often, the natural consequences can occur too far into the future, or it may be unsafe or not practical to use natural consequences. Logical consequences are then used. Logical consequences are related, reasonable, and respectful, and teach the children about responsibility for their own actions. For example, if your child throws a toy against the wall, the toy gets put away. If he/she can’t play with the toy safely and appropriately, he/she can’t play with the toy. The toy can be brought out later with a quick reminder of the safe ways to play with it. 7. Parent with the end in mind Most of us parent in ways to get the situation under control as soon as possible. We are looking for the expedient solution. This often results in the children feeling overpowered or not disciplined. But, if we learn to parent in a way that keeps in mind how we want our children to be as adults, we will be more thoughtful in the way we parent. Think of the relationship you have with your child and not only of the immediate situation at hand. You may win this “battle”, but at what cost to the relationship? 8. Be consistent, follow through If you have an agreement with your child not to buy candy at the grocery store, do not give in to his/her pleas, tears, demands, or pouting. If you give in, you are teaching him/her that if he/she whines long enough, then he/she gets what he/she wants. Your child will learn to respect you more if you mean what you say and are consistent. These parenting techniques come from the Redirecting Children’s Behavior parenting class. The course elaborates on each one of these ideas and utilizes role plays to practice them. For more information, questions or concerns, please contact C3, Children’s Care Connection at 1-877-8C3Kids or visit www.howkidsdevelop.com. Source: Redirecting Children’s Behavior Kathryn Kvols


APPENDIX K


Perinatal Depression Screening

An estimated 10% to 20% of women struggle with major depression before, during, and after delivery of a baby. Perinatal depression has substantial consequences by interfering with quality of child-rearing and adversely affecting parent-child interactions, maternal responsiveness to infant vocalizations and gestures, and other stimulation essential for optimal child development. The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening test for postnatal depression. This tool:

• Was first described by Cox et al in 1987 in the British Journal of Psychiatry. • Was developed in England at health centers in Livingston and Edinburgh to assist

primary care health professionals to detect whether mothers are suffering from postnatal depression.

• Consists of ten items, typically self-administered, requiring about five minutes to

complete.

• Has sensitivity of 86% and specificity of 78%.

• Has a maximum score of 30; a score of 10 or more may indicate possible depression of varying severity.

• Has a screening question for suicidal thoughts (item 10).

• Should be used as an adjunct to clinical judgment.

• Can be downloaded in English and Spanish free of charge from

www.dpaillinois.com. Adapted from: Glascoe FP. Screening for Maternal Perinatal Depression. Available:

www.dbpeds.org/articles Illinois Department of Public Aid website www.dpaillinois.com.


APPENDIX L


Helpful Websites American Academy for Cerebral Palsy and Developmental Medicine www.aacpdm.org American Academy of Child and Adolescent Psychiatry www.aacap.org American Academy of Pediatrics www.aap.org AAP National Center of Medical Home Initiatives for Children with Special Needs www.medicalhomeinfo.org Centers for Disease Control and Prevention www.cdc.gov Department of Developmental Disability www.ddhealthinfo.org Developmental Behavioral Pediatrics Online Community www.dbpeds.org Learning Disabilities Association of America www.ldanatl.org MedlinePlus Health Information www.nlm.nih.gov/medlineplus/childdevelopment.html National Center for Complementary and Alternative Medicine www.nccam.nih.gov National Institute of Child Health and Development www.nichd.nih.gov National Dissemination Center for Children with Disabilities www.nichcy.org NYU Child Study Center www.aboutourkids.org San Diego ADHD Project www.sandiegoadhd.com San Diego Network of Care for Mental Health www.networkofcare.org


Society for Developmental and Behavioral Pediatrics (SDBP) www.sdbp.org Utah Collaborative Medical Home Project http://medhome.med.utah.edu

developmental & behavioral resource guidehowkidsdevelop.com/pdf/physicianmanual.pdf · 2010. 1....

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