United states deparment of education office of special education and rehabilitative services
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B. AREAS OF NONCOMPLIANCE1. Lack of Eligibility Criteria for Effective Referral. The Part C regulations at 34 CFR §303.321(d) require the Co-Lead Agencies to establish procedures for use by primary referral sources for referring a child to the appropriate public agency for evaluation and assessment, and as appropriate, for the provision of services. Procedures must provide an effective method of making referrals by primary referral sources that include hospitals, physicians, parents, day care programs, local education agencies, public health facilities, other social service agencies, and other health care providers. The State is also responsible for having an effective means to inform the public and primary referral sources about which children are potentially eligible for services. 34 CFR §303.320. According to 34 CFR §303.10 and §303.16, the Co-Lead Agencies must serve at least two groups of infants and toddlers: (1) those experiencing developmental delays and (2) those with diagnosed conditions that have a high probability of resulting in developmental delay. Each State may, by developing a definition of developmental delay, determine the extent of the delay that a child must exhibit in order to be eligible for Part C services. However, a State may not require that a child with a developmental delay fit the eligibility criteria for any specific disabling condition or that the etiology of the delay be identified. At the time of OSEP’s visit, early intervention services were made available to infants and toddlers who had diagnosed conditions that matched one of twelve special education categories of disabling conditions, such as autism, deaf-blindness, and behavioral disorder. Because the State did not have a separate category for infants and toddlers with developmental delays, infants and toddlers who were experiencing developmental delays of unknown origin had to fit into one of the twelve disability conditions to have access to early intervention services. OSEP finds that the Co-Lead Agencies failed to provide effective referral procedures to inform primary referral sources that infants and toddlers with suspected developmental delays of unknown etiologies should be referred to the early intervention system and that these children were potentially eligible for early intervention services. OSEP found that there was a continuing belief by referral sources that infants and toddlers who did not have a diagnosed condition and were only experiencing developmental delays of unknown cause were not eligible for early intervention; therefore, public and private agencies were not referring these children to the early intervention system and potentially eligible children did not have access to the child find system. Nebraska’s Special Education Advisory Council formed an ad hoc committee in the spring of 1998 to make recommendations to the State regarding a developmental delay category for infants and toddlers. The committee reported that “Nebraska currently remains the only state in the nation that uses the Part B, IDEA categories exclusively for verifying infants and toddlers…without the option for Developmental Delay. This option is required by IDEA, Part C.” OSEP notified the State in its conditional award of Part C grants for fiscal years 1997 and 1998 that OSEP would be gathering data on the impact of the State’s eligibility criteria during the 1998 site visits. The definition of developmental delay and its eligibility criteria were identified as the top priority issue during the public meetings and Steering Committee proceedings. Members of one planning region team reported that hospitals are not referring children with significant developmental delays because, from past experiences, the hospitals believed that these children did not fit into a special education category and are therefore not determined eligible for early intervention services. A multidisciplinary team (MDT) and service coordinators in another region stated that it was hard to fit the infants and toddlers with developmental delays into special education categories and that eligibility determination depended on the cooperation of doctors to provide a diagnosis to fit these children into a category of disability. These groups also stated that the State is not serving some children “because there is no definition for infants and toddlers with developmental delays”. An interagency collaborator told OSEP that it took four months to obtain a physician’s diagnosis of “other health impaired” for a child with motor delays of unknown etiology to qualify for early intervention services. Primary referral sources, including health providers and physicians, who “are confused about eligibility” criteria, perceive that the criteria have been narrowed, and believe that fewer children qualify for services; these sources were cited in the State Quality Improvement reviews in two areas of the State that serve approximately 50% of the birth to 3 population. One health provider in a large metropolitan was reported to be frustrated that very young infants demonstrating delays are not getting services because doctors are hesitant to provide a medical diagnosis for infants below age 1, such as cerebral palsy. They stated that they believed that infants and toddlers demonstrating delays from unknown causes would not otherwise qualify for early intervention services. Parents reported to the Parent Training and Information Center that while they did not like having their infant and toddler labeled with an established special education category, they understood that being placed in a category was necessary in order to qualify for and receive early intervention services. In the spring of 1999, after OSEP’s visit, the State legislature amended Nebraska’s statute so that infants and toddlers with developmental delays are eligible for services under Part C. R.R.S. Neb. § 79-1118.01 (1999). Although there is a new State law in place that defines “developmental delay,” outreach and education efforts will need to be aggressively pursued to inform referral sources, parents and other individuals involved in delivering services to Part C eligible children. 2. Failure to Complete a Multidisciplinary Evaluation in All Developmental Areas 34 CFR §303.322 requires the State to ensure that each referred child receive a comprehensive, multidisciplinary evaluation of the child’s level of functioning in each of the following developmental areas: cognitive development; physical development, including vision and hearing; communication development; social or emotional development; and adaptive development. As discussed below, OSEP found that the State has not effectively ensured that each child referred for early intervention services receives a multidisciplinary evaluation in all of the developmental areas. Nebraska regulations governing early intervention iterate that evaluations shall be conducted in only those areas related to the “suspected disability.” OSEP commented on the limitation of this regulation during its review of the State’s application for Part C. When OSEP raised this issue during the application process, the State assured OSEP that multidisciplinary teams were assessing infants and toddlers in all areas of development. However, in three of the four regions visited, the multidisciplinary teams, service providers, and service coordinators stated that only the area or areas identified at the time of referral are evaluated. For example, if a child is referred due to a suspected speech delay, then this is the only area of development that is evaluated. This practice was also confirmed through record review in three of the four areas visited. Given the narrower eligibility definition, this limited evaluation practice may result in the State not finding Part C eligible children and even when identified, may result in needs not being identified. |