Program Operations:
Tasks and Responsibilities
Implementation
of Early Intervention Process
Referral:
- Intake information
- Share referrals
with B-3 staff
- Initial contact
with family
- Determine action/screening
or evaluation/referral to other resources
Screening:
- Screen, share information,
determine next step in process
Evaluation:
- Contact family
- Determine team,
schedule evaluation times
- Evaluate, write
evaluation report
- Meet with family
- Determine eligibility
- Next Steps
IFSP:
- Determine participants
in IFSP with family
- Schedule and conduct
meeting
- Develop IFSP
Service:
- Determine service
coordinator
- Implement IFSP
- Periodic review
of IFSP
- Ongoing assessment
of service/child and family needs and progress
Collaboration with
other agencies serving the family
Transition from birth
to three
Service Coordination
Activities:
- List from Rosin
Whitehead
Team Development
and Support
- Attend and actively
participate in monthly 4 hr meetings
- Participate in
learning opportunities offered
- Schedule and contribute
knowledge to cross disciplinary consultation
- Visits
- Practice open communication,
active listening, interpersonal respect for team
Supervision
- Supervisors from
multiple agencies have planned monthly contact
- Staff will participate
in planned individual supervision time
- Staff will bring
issues from their work to supervision sessions
- Establish clear
lines of supervision for dual agency staff
- Implement at least
1 x year individual written performance review
Administrative
Function
- Contract development
- Hiring
- Record keeping/documentation
review and storage
- Fiscal Management
Documentation
- Legal documents
of child and family
- Ongoing program
documentation
- Program evaluation
- Records of program
costs
Permission to
share this document provided by CESA 5.
Marinette County
Birth to Three Checklist
Child’s Name
Date of Birth
Referral Date/Source
Initial Contact Date
Initial Paperwork
- ___ Birth to Three
Referral form
- ___ HSRS CORE form
(yellow)
- ___ Parent and
Child Rights
- ___ Permission
to Screen
- ___ Consent to
Evaluate
- ___ Service Consent/Refusal
Statement
- ___ Ability to
Pay
- ___ Consent to
Access Insurance
- ___ Family Needs
Assessment
- ___ Release of
Information
Evaluation/Assessment/Plan
___ Denver II Screening
___ Battelle Developmental
Inventory
___ Other Evaluation
Tool(s) (list them here)
___ IFSP
___ Child History
___ Eligibility Status
Form
___ Abilities/Strength
___ Goals/Outcomes
___ El Services Summary
___ Add’l Services
Additional Paperwork
- ___ HSRS Birth
to 3 Module form (purple)
- ___ Copy of form
sent for Client #
- ___ Authorization
for services
- ___ Information
Data Sheet
- ___ File Access
Log
Additional forms,
if applicable
___ Financial Information
(MA Case Management)
___ Copy of form
sent to clerical staff
___ COP Functional
Screen
___ COP Referral
form
___ Family Support
Referral form
___ Children’s Case
Manger Referral form
Permission to
share this document provided by Marinette County Birth to 3.
Waushara County
Birth to 3 Program Procedures
New Referrals:
- Record on new
referral form
- Record on referral
tally sheet
- Make a folder
for office
- Make a folder
for the family
- Open a CORE HSRS
(yellow) form
- Send referral
to CESA 5
- Send family a
brochure with Cost Share/Insurance billing information
- Add child’s name
to closed B-3 Master list for future disposal
- Add child to
roster under referrals
If child qualifies:
- Send Cost Share
form out to determine family share
- Send letter to
family recording their cost share/procedure
- Open on Birth
to 3 HSRS (purple) according to IFSP date
- Attend IFSP updates
- Have family fill
out records disposal form
- Add child to
roster
If child doesn’t
qualify
- Close on CORE
HSRS
- Put file in closed
Birth to 3
- Make sure child’s
name is on Master List for disposal
When a child
is discharged from the program
- Take their name
off the roster
- Make sure their
name is on the closed Master List for disposal
- Determine when
disposal can take place, depending on parents preference
- Close on both
CORE HSRS and Birth to 3 HSRS
- Combine county
file and CESA 5 file
- Make appropriate
referrals
- File case in
closed Birth to 3 files