Texas Early Childhood Intervention Program

Written by Margaret Nelson

The Texas Early Childhood Intervention Program: Overview

Every child is full of potential. However, some kids need extra help early in life to be successful. In some cases, babies and toddlers might not meet appropriate developmental milestones. Early childhood intervention might be necessary to provide them with the support they need when this happens.

If a developmental delay or disability is suspected, the child must receive ECI services as soon as possible. The earlier a child receives intervention services, the more likely they are to meet their developmental milestones.

However, the cost of services often deters families from seeking services, and local school districts and private practices often do not accept children under the age of three. Fortunately, there is an option available for families to get the services their babies and toddlers need at an affordable cost. In this article, we will discuss the Early Childhood Intervention program in the state of Texas. We will further discuss topics such as who qualifies for services, how to initiate services, and payment and insurance.

What is the Early Childhood Intervention Program

In Texas, the Early Childhood Intervention (ECI) program is a state-affiliated program that helps families with young children (0-36 months) who have disabilities or other developmental delays. While this program is specific to the state of Texas, many states have similar programs. The goal is to help children with disabilities and other developmental delays meet their developmental milestones. The program also aims to support parents/caregivers and educate families so that they can better care for their children. It also initiates any necessary treatment and, if necessary, will connect families to other resources within the community.

ECI only lasts until the child reaches the age of 36 months or until the child no longer needs services, whichever comes first. At the beginning of the process, each qualified family is assigned a service coordinator to set up services. As the child approaches their third birthday, they will work with caregivers to transition the child to the next step and provide continuity of care. Depending on the needs and diagnoses of the child, there are several options available, such as special education services through a local school district or private services.

Available Family Education and Support Services

Once a child is referred to ECI, a team of care providers will evaluate them to determine their strengths and weaknesses, as well as what services would benefit them the most. From there, the team provides family education and support services tailored to the child's needs.

Every qualified family receives support from a variety of providers. The support provided can vary depending on the age of the child, as well as their delays, diagnoses, and specific needs. For example, kids with gross motor delays might need a physical and/or occupational therapist. For kids with behavioral disabilities, a psychologist or counselor might be needed. Likewise, children might require a dietitian for any nutrition concerns or a speech-language pathologist for any speech delays.

Services are tailored to meet the family's needs, and they are often provided in settings that are familiar to the child. Providers also work with families to integrate activities into the family routine. While most services take place within the home, they can also be given in other places that are familiar to the child, such as a daycare center, a playground, or another setting.

The Benefits of Early Intervention

In recent years, there has been a growing movement to expand such services, especially since the research has shown the benefits of early intervention. These include the following:

• Up until the age of three, the brain is very flexible and can adapt to new ways of thinking and behaving. As they get older, their neural pathways become solidified, making them harder to change. In other words, intervention services often have the most significant impact when administered before age three.
• Experts have determined that chronic (or toxic) stress can negatively affect the developing brain and cause lifelong problems. These sources include extreme poverty and severe maternal mental health issues, as well as abuse, neglect, and other unmet needs. Early intervention can help combat the effects of this toxic stress.
• Having stable relationships and good experiences can help the child to see the world as a good, safe place. With early intervention, providers can help caregivers learn how to be a positive, stable influence in their child's life. Such support might be necessary to break cycles, especially if they experienced abuse or neglect as children.

The Early Childhood Technical Assistance Center has supplemented these interventions with the Three Child Outcomes guidelines, which focus on Positive Social Emotional Skills, Acquisition and Use of Knowledge and Skills, and Use of Appropriate Behaviors to Meet Needs.

Qualifications for the Early Childhood Intervention Program

To receive Early Childhood Intervention services, children and their families must meet specific qualifications. To receive help, children must be under the age of 36 months. They must also have a qualifying condition, an auditory or visual impairment, or a developmental delay.

In addition, there are other requirements a child must meet to qualify for services. For example:

• If the child qualifies through a medical diagnosis, caregivers must provide copies of their medical records.
• If the child has an auditory or visual impairment, the child must meet the Texas Education Agency (TEA) definition for such an impairment, and the local school district would need to confirm this.
• If the child is suspected to have a developmental delay, they must have a delay of at least 25% in one or more developmental areas. If there is only a delay in expressive language development, a delay of at least 33% must be present to qualify.

Medical Diagnosis or Impairments

One of the ways a child can qualify for services is through an appropriate medical diagnosis or impairment. Texas Health and Human Services categorize these into the following categories:

• Certain infectious and parasitic diseases
• Neoplasms
• Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism
• Endocrine, nutritional and metabolic diseases
• Mental, Behavioral, and Neurodevelopmental disorders
• Diseases of the nervous system
• Diseases of the eye and adnexa
• Diseases of the circulatory system
• Diseases of the skin and subcutaneous tissue
• Diseases of the musculoskeletal system and connective tissue
• Certain conditions originating in the perinatal period
• Congenital malformations, deformations and chromosomal abnormalities
• Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified
• Injury, poisoning and certain other consequences of external causes

Each category includes a varying number of disorders. Many of these disorders range from common ones, like Autism Spectrum Disorders and Cerebral Palsy, to rarer ones, like microcephaly. It even includes disorders related to injuries, such as Shaken Baby Syndrome. The Texas Health and Human Services website contains a comprehensive list of all qualifying conditions.

Developmental Delays and Early Intervention Services

As mentioned earlier, children with qualifying developmental delays are eligible to receive early intervention services. With ECI, caregivers do not need to wait for a referral from a doctor or another professional, and they do not even need to have a confirmed diagnosis of developmental delays. ECI encourages families to contact them when they suspect a developmental delay. If the child is suspected to have developmental delays as a newborn, then caregivers are encouraged to contact ECI to discuss their options, and they can also determine if the issues need to be addressed right away.

One option is to have ECI conduct an investigation. If a caregiver decides to move forward with the evaluation, they will be paired with a service coordinator who will arrange for one to be performed.

Claiming Early Intervention Services

To receive early intervention services, someone on behalf of the child must contact ECI for a referral. While families make a quarter (24 percent) of referrals and health care providers make 55 percent of referrals, anyone can make a referral, such as a grandparent or a daycare provider.

There are several ways that families can get in contact with ECI. For example:

• Often, caregivers will bring up any concerns about development with their pediatrician. If the pediatrician agrees that there is a concern, they will contact ECI on your behalf. They might also initiate a discussion about ECI with the caregiver if the child has a qualifying medical condition.
• If the pediatrician does not provide a referral, families can locate their nearest ECI program and contact them directly. There are three ways that they can do so:
  • They can use the Texas Health and Human Services search tool
  • They can call the HHS Office of the Ombudsman and receive information over the phone. There are multiple languages available, as well as an option for callers with hearing impairments.
  • They can submit an online message to the HHS Ombudsman.

For more information about these options, please visit the Texas Health and Human Services website.

After contacting the program, ECI can conduct an evaluation to determine eligibility. Once the child is eligible, they will work with a service coordinator to arrange services.

Working with a Service Coordinator

Once the child qualifies for services, the service coordinator plays an instrumental role in the child's success. In essence, they act as a case manager and a liaison between the family and ECI. They will build a team to support the child, including themselves, the caregivers, and the care providers the child needs. They are also available to answer any questions the caregivers may have about the process.

After this team is assembled, they will learn more about their routines, identify strengths and weaknesses, and determine the priorities for services. Caregivers are highly involved in this process since they know the child best.

With this information, the team creates the Individualized Family Service Plan (IFSP). This plan will outline the needs of the child and their required services, and it is reviewed frequently to ensure that it remains up-to-date.

Working with an Early Interventionist Specialist

Early Intervention Specialists (EISs) are professionals who work with ECI. They are one of the most common team members, and they are often the first person who meets with the child. As part of their job duties, they also serve on teams that determine the eligibility for services and create IFSPs. While there is no specific degree or license to become an EIS, most have a four-year degree and have taken at least 18 hours of coursework related to child development, psychology, and special education.

Once the IFSP is created, they will give this information to the service coordinator, who will then locate service providers who can best address the challenges. Depending on the child's needs, EISs also help administer the services needed to address their delays.

Family Support and Receiving Services

ECI provides a lot of family support once the child begins receiving services. Services provided are family-centered and individualized to the needs of each family. Because of this, children often receive their services at home. This provides a variety of benefits to the child and their family. For example:

• Providing services at home is more convenient for families, especially for those without reliable transportation.
• Caregivers can learn how to support the child's needs and integrate development activities during their daily routine, instead of having to dedicate separate time to do isolated activities. They can also learn how to use their environment to help support the child and their needs.
• Siblings and other relatives can get involved in the activities, which makes the process easier for the main caregiver.
• Because the services are administered in a familiar setting, it can help ease any feelings of distress in the child, making the services less invasive.

Even though most services are provided at home, families can choose any other setting that the child regularly attends, such as a daycare center, a playground, a local public library, or another community setting.

Transitioning to Special Education and Early Childhood Education Services

ECI services end at the age of 36 months. As this date approaches, the caregiver(s) and ECI team will discuss the next steps. Depending on the child, their diagnoses, and their needs, several options are available, such as special education through a local public school, enrollment in an early childhood education center, or another option in the community that can provide early education. The service coordinator will help to determine options and eligibility for programs like special education.

If the team determines that the child needs more services beyond their third birthday, they will work with the caregiver(s) to transition them to a new program without any gaps in care. This is typically done by creating a transition plan that considers the child's unique needs. Having this plan will ensure that everyone understands what is going to happen.

For those who are interested in working in early childhood education, TExES offers an exam in TExES Core Subjects EC-6. This exam measures proficiency in public elementary school teachers in English Language Arts and Reading & the Science of Teaching Reading, Mathematics, Social Studies, and Fine Arts, Health, and Physical Education. By taking this TExES exam, candidates will be qualified for various early childhood careers.

Funding and the Texas Health and Human Services Commission

For many families, finances are a barrier to obtaining the necessary intervention services for their children. However, because this program is sponsored by the Texas Health and Human Services Commission, it receives much of its funding from the state. In many cases, services are free or low-cost. Some services are always provided at no cost, such as evaluations, case management, IFSP development, and translation and interpreter services. The rest of the services might or might not have a cost.

There are some situations where families will not have to pay anything for services. For example, if the child is in foster care or in a kinship placement (i.e. living with biological grandparents or an aunt and uncle) at the time that the services are administered, the family will not be required to pay for services because the state covers these costs for the duration of their time in care. Likewise, if the child has Medicaid, the family will not have to pay for services. If either of these circumstances apply to the child, the caregivers will be asked for permission to bill Medicaid for the administered services.

There are many ways that families can pay for services, such as with private insurance, Medicaid, and/or based on an income-based sliding scale.

Sliding Scale for Payment

Even if the child is not in foster care or does not qualify for Medicaid, families can pay according to an income-based sliding scale. To determine the total out-of-pocket charge for services, the family will determine the number of household members and dependents, as well as the annual income of the family. If the family pays for things like insurance premiums, deductibles, and transportation to medical care out of pocket, then these expenses are subtracted from the total income. After that, the family will determine where their income lies on the Monthly Maximum Charge Sliding Scale. Even though this scale is subject to change, families will generally not be expected to pay for services if their adjusted family income is less than or equal to 100% of the Federal Poverty Line.

The maximum charge will be reviewed annually to ensure that the financial obligations remain up-to-date. If the caregivers do not agree with the maximum charge, they have options that include requesting a review, filing a complaint, requesting mediation, and filing for a due process hearing. In addition, if the family could pay for services but the cost now presents a financial hardship, they can ask ECI to review the maximum charge before the next review. This would be most appropriate for situations like the birth or adoption of a child, a lost job, or a significant, unexpected bill (such as home damage due to a natural disaster).

Insurance and Paying for Services

If the caregiver(s) have Medicaid, CHIP, or private insurance, this can often further reduce the cost of services. Because insurance plans vary widely, caregiver(s) will need to talk to their provider to discuss what will and will not be covered. If the family has a balance after insurance, the balance will not be more than the agreed-upon maximum monthly charge.

There are some differences between using private insurance, Medicaid, and CHIP:

• If the child has Medicaid, the services will remain free as long as the child still has coverage. If the child loses coverage, then the caregivers will have to pay for services according to the agreed-upon maximum monthly charge.
• If the child has CHIP coverage, the caregiver(s) are responsible for paying for services that are not covered.
• If the child is covered by private insurance, then the caregiver(s) might have to pay for any services that were not covered. Private insurance plans vary in terms of deductibles, copays, and annual or lifetime caps. Caregivers should familiarize themselves with their insurance plans. ECI can also help find out the specifics about a healthcare plan, explain how it will be used to pay for services, and answer any questions.

Summary

In recent years, there has been a movement to get early intervention services to the kids who need them, especially as more studies have proven the benefits of such services. However, such interventions can be cost-prohibitive for many families, especially for those without insurance or sufficient income. With programs like ECI, all children can receive the services they need, regardless of their socioeconomic status. Families are not turned away due to an inability to pay, and services are charged based on an income-based sliding scale. Insurance can often further reduce these costs, and options like Medicaid can eliminate the costs. Even though ECI only lasts until age three, their team will help them transition to a new program if more services are needed. Thanks to this program, every child can be set up for success.