Children are found eligible for Wisconsin’s Birth to 3 Program because of:
The following information was prepared by the Birth to 3 Eligibility Work Group to give clarity to an evaluation team in determining a child’s eligibility for the Birth to 3 Program in Wisconsin.
A. Diagnosed Conditions:
Some children served by Wisconsin’s Birth to 3 Program are found eligible based
on a diagnosed condition that has a high probability of resulting in a developmental
delay. High probability implies that a clearly established case has been made
for a developmental delay. In Wisconsin, “high probability” is defined as 50%
or greater likelihood of delay.
Information regarding diagnosed conditions changes as medical advances and new
information becomes available. For example, it was once believed that all children
born with HIV or cocaine exposure would have a high probability of having developmental
delays. Recent research and experience has described different outcomes for
these children.
Research is a dynamic process and reflects medical and intervention advancements.
As a result the eligibility work group has developed a list of diagnosed conditions
that is based on the best thinking and research in 2003. The list is based on
a) a review of other states’ lists of diagnosed conditions, b) input from physicians
with expertise in genetics, neonatology, and development and c) a review of
published literature.
See Chart 1 for a listing of the current conditions that conform to the 50%
or greater probability guideline. A diagnosis of one of these conditions would
mean a child is eligible for Birth to 3 regardless of their current development
functioning. Information about the child’s developmental status, however, is
needed to develop an Individualized Family Service Plan. This list is definitive
in that the conditions listed in Chart 1 have a 50% or greater probability of
resulting in delay, but it is not inclusive as there may be other conditions
that will be added.
B. Developmental
Delay:
It is not necessary to have a diagnosed condition to be eligible for the
Birth to 3 Program. In fact, the majority of children served in Wisconsin’s
Birth to 3 Program are eligible because of developmental delays (25% or –1.3
standard deviation below the mean) in at least one of the following five areas
of development: cognitive, communication, motor, self-help/adaptive, and social
emotional.
Research suggests that there are numerous diagnosed conditions that do not have
a high probability of resulting in developmental delay. Clearly, there are some
diagnosed conditions such as neurofibromatosis and torticollis, for which there
is not evidence that a developmental delay will result. This means that these
conditions in and of themselves do not point toward eligibility for early intervention;
however, there may be other circumstances in the child’s life (e.g., health
status, family situations) that may influence the course of the child’s development.
When developmental concerns exist concurrent with these diagnosed conditions,
the child’s evaluation team would determine eligibility based on whether there
is delayed or atypical development. (See Chart 2-I & II.)
C. Atypical Development:
In some instances a 25 % delay or a -1.3 SD below the mean may not exist, but
in the opinion of the early intervention team, some aspect of the child’s development
is atypical. The development may be unusual in its pattern and adversely affects
the child’s overall development. Under these circumstances, the team substantiates
their clinical opinion with observations, interpretations of test results, review
of records, and parent reports to determine eligibility based on atypical development.
Under these circumstances, it is the child’s atypical development, not a condition
that leads to eligibility. (See Chart 2-III.)
Chart 1: Diagnosed
Conditions
Examples of diagnosed conditions with a high probability (50% or more) of resulting
in developmental delay are listed below. Please note that this is a definitive,
but not an inclusive list.
1. Genetic
2. Perinatal
3. Neurological
4. Sensory
6. Social-emotional
Chart 2: Evaluate
for Developmental Delay, including Atypical Development
This chart describes the five areas of development considered for determining
a developmental delay and lists examples of diagnosed conditions and atypical
behaviors that may bring a child to the Birth to 3 Program for consideration
of eligibility. Children with these conditions or characteristics should
be screened and/or evaluated for Birth to 3 eligibility based on concerns
regarding their current developmental circumstances.
I. Developmental
Delays
To conclude that a child is eligible, the early intervention team must document
a 25% delay or development that is 1.3 standard deviation below the mean in
one or more of the five developmental areas below.
II. Diagnosed
Conditions
The following diagnosed conditions do not have documented evidence
of having a high probability of resulting in developmental delay. However, children
with these conditions may have developmental delays or atypical
behaviors that would result in their eligibility for the Birth to 3 Program.
If the child has a condition not listed below in Chart 2 or previously in Chart
1, the early intervention team should investigate the probability of the condition
resulting in delay.
1. Genetic
(with increased risk for developmental delay)
2. Perinatal
3. Neurologic
4. Sensory
5. Physical
6. Social Emotional
III. Atypical Behavior The following examples describe circumstances under which a child may demonstrate atypical development that should be considered a developmental delay. When parents and others identify concerns in these areas, and test results approach, but do not demonstrate a delay (25% or -1.3 S.D.), alternative measures including observations and parent reports should be used to make an informed opinion about whether a child should be considered developmentally delayed.
1. Growth and
Feeding
(e.g. severe growth delay, failure to thrive, feeding problems, gastrostomy
for feeding)
2 Sensory and
Regulatory
(chronic problems with sleep, attention, and/or eating; sensory processing disorders)
3. Chronic Illness/Medically
Fragile
(differences in a child’s development that may result from an illness or treatment
for an illness such as chronic heart disease, cystic fibrosis, technology dependent,
hypothyroidism, cancer)
4. Social Emotional
(atypical social interaction with caregivers and peers, delays or differences
in ability to communicate emotional needs or achieve expected emotional milestones
such as pleasurable interest in adults and peers)
References: Information from these states’ early intervention program guidelines was used to assist in developing guidance for Wisconsin’s Birth to 3 Program: Georgia, New Mexico, New York, Rhode Island, Utah, and Virginia.
The process for determining eligibility for early intervention is the basis for determining eligibility for children with hearing loss. A child is eligible for early intervention services under the Birth to 3 Program if the evaluation conducted by the early intervention team determines that the child is developmentally delayed or that the child has a diagnosed physical or mental condition which will likely result in developmental delay. A determination of high probability that a child’s diagnosed condition will result in a developmental delay must be based upon the team’s informed clinical opinion supported by a physician’s report documenting the condition. High probability implies that a clearly established case has been made for a developmental delay.
Early intervention
team members. Any early intervention team performing an evaluation must
include a service coordinator and at least one member who has expertise in the
assessment of both typical and atypical development and expertise in child development
and program planning. Parents should be involved throughout the evaluation process.
Members of the early intervention team must be from two different disciplines
in the areas of the child’s suspected needs.
Therefore, for a child with a diagnosed hearing loss, one or more members of
the early intervention team must be able to interpret audiological reports and
understand the developmental impact of hearing loss.
Eligibility for
a child with diagnosed hearing loss. The regulations for the Birth to 3
Program do not base eligibility on specific types or degree of hearing loss.
There is no required decibel loss nor are children with unilateral hearing loss
excluded.
Once a child with a diagnosed hearing loss is referred, the early intervention
team needs to determine whether the child’s hearing loss is likely to result
in a developmental delay. The team needs to consider factors such as the type
and degree of the hearing loss, the presence of other conditions, and the potential
effects of the hearing loss on the development of the child. The team should
make use of the scientific evidence about the long-term developmental consequences
of hearing loss in infants and toddlers. A child with a hearing loss does not
need to demonstrate a developmental delay to be eligible for the Birth to 3
Program.
If the early intervention team determines that the child’s hearing loss is not
predicted to result in developmental delay, they must offer to reconsider the
child’s eligibility within 6 months. The early intervention team should also
provide information about, and offer to refer the family to, community services
that may benefit the child and family.
Wisconsin Department of Health and Family Services, Birth to 3 Program (2001)
Developed by the Wisconsin Birth to 3 Program Eligibility Work Group, July 2003.
Committee Members
Medical Consultants