Other qualified personnel and local providers of services to young children and their families.
If the primary referral source suspects that an infant or toddler has a developmental delay, the primary referral source shall conduct or request a formal screening to determine if there is reason to refer the child for an evaluation.
If the primary referral source has reasonable cause to believe that a child has a diagnosed physical or mental condition which has a high probability of resulting in a developmental delay or has a developmental delay, the primary referral source shall refer the child for an evaluation. The primary referral source shall ensure that referral for evaluation is made no more than 2 working days after a child has been identified.
DHS 90.07 Note
Note: Referral sources should differentiate between a request or need for a formal screening and referral for an evaluation. For example, a child diagnosed as having Down syndrome, which has a high probability of resulting in a developmental delay, should be referred for an evaluation rather than a formal screening, whereas a child who seems slow in speech or motor development may first be formally screened to determine if there is need for an evaluation.
A service provider may do informal or formal screening of a child as part of the service provider's routine observations or intake procedures.
Following either a formal or informal screening, the primary referral source or the service provider shall inform the parent of the reason, procedures and results of the screening.
DHS 90.07 Note
Note: While parental consent is not required to screen a child, the service provider is encouraged to give the parent information about the screening process before conducting the screening.
DHS 90.07 History
Cr. Register, June, 1992, No. 438
, eff. 7-1-92;
am. (1), (3) (b) 2., Register, April, 1997, No. 496
, eff. 5-1-97; am (1), r. and recr. (3), Register, September, 1999, No. 525
, eff. 10-1-99.
Designation of service coordinator.
When a child is referred to the birth to 3 program for evaluation and possible early intervention services, the county administrative agency shall as soon as possible designate a service coordinator for that child and the child's family.
(2) Determination of eligibility.
A referred child shall be evaluated in accordance with the criteria under sub. (4)
to determine the child's eligibility for early intervention services under the program.
In consultation with the parent and based on the child's suspected needs, the service coordinator shall select at least 2 qualified personnel from those under par. (b)
who, with the parent and service coordinator, will make up the EI team to perform the evaluation and make the determination of eligibility. Qualified personnel may be from different agencies and shall be from at least 2 different disciplines in areas of suspected need. The service coordinator may be one of the qualified personnel if the service coordinator is qualified as required under par. (b)
. At least one of the qualified personnel shall have expertise in the assessment of both typical and atypical development and expertise in child development and program planning.
Qualified personnel who are qualified to serve on the EI team are the following:
Audiologists with at least a master's degree in audiology from an accredited institution of higher education who are registered or licensed under ch. 459, Stats.
Nutritionists registered as dietitians by or eligible for registration as dietitians by the American dietetic association;
Rehabilitation counselors employed by the department's division of vocational rehabilitation as coordinators of hearing impaired services who have at least a master's degree in rehabilitation counseling or a related field;
Registered nurses with at least a bachelor's degree in nursing from an accredited institution of higher education and licensed under s. 441.06
Special education teachers, including early childhood special education needs teachers, vision teachers and hearing teachers, licensed through the department of public instruction;
Speech and language pathologists with at least a master's degree in speech and language pathology from an accredited institution of higher education and who are registered under ch. 459, Stats.
, or licensed under ch. 115, Stats.
, and ch. PI 34
Other persons qualified by professional training and experience to perform the evaluation and determine eligibility.
A child is eligible for early intervention services under the birth to 3 program if the EI team determines under sub. (5)
that the child is developmentally delayed or under sub. (6)
that the child has a diagnosed physical or mental condition which will likely result in developmental delay.
A determination of developmental delay shall be based upon the EI team's clinical opinion supported by:
A developmental history of the child and other pertinent information about the child obtained from parents and other caregivers;
Observations made of the child in his or her daily settings identified by the parent, including how the child interacts with people and familiar toys and other objects in the child's environment; and
Except as provided under par. (b)
, a determination of at least 25% delay in one or more areas of development as measured by a criterion referenced instrument, or a score of 1.3 or more standard deviation below the mean in one or more areas of development as measured by a norm-referenced instrument, and interpreted by a qualified professional based on informed clinical opinion. In this subdivision, “areas of development" mean:
If the results of the formal testing under par. (a) 3.
closely approach but do not equal the standard in par. (a) 3.
for a developmental delay but observation by qualified personnel or parents indicates that some aspect of the child's development is atypical and is adversely affecting the child's overall development, the EI team may use alternative procedures or instruments that meet acceptable professional standards to document the atypical development and to conclude, based on informed clinical opinion, that the child should be considered developmentally delayed.
DHS 90.08 Note
Note: Examples of atypical developments are asymmetrical movement, variant speech and language patterns, delay in achieving significant interactive milestones such as exhibiting a pleasurable response to a caregiver's attention, and presence of an unusual pattern of development such as a sleep disturbance or eating difficulties.
(6) Determination of diagnosed condition.
A determination of high probability that a child's diagnosed physical or mental condition will result in a developmental delay shall be based upon the EI 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.
DHS 90.08 Note
Note: Examples of these diagnosed conditions are chromosomal disorders such as Down syndrome, birth defects such as spina bifida, significant or progressive vision or hearing impairment, neuromotor disorders such as cerebral palsy, postnatal traumatic events such as severe head injuries, severe emotional disturbances, dysmorphic syndromes such as fetal alcohol syndrome, addiction at birth, a maternal infection transmitted to the fetus such as AIDS, neurological impairments of unknown etiology such as autism, untreated metabolic disorders such as PKU and certain chronic or progressive conditions.
The service coordinator shall ensure that the parents of the child are involved and consulted throughout the entire evaluation process.
The EI team shall examine all relevant available data concerning the child, including the following:
Medical records and other health records concerning the child's medical history and health status, including physical examination reports, results of vision and hearing screenings, hospital discharge records and specialty clinic reports;
Any records and screening results of the child's developmental functioning in the following areas:
Records of any previous interventions provided to the child, including therapy reports, treatment records and service plans.
The EI team shall use additional observation, screening results and other testing instruments and procedures as needed, to determine the child's level of functioning in each of the following areas of development:
Cognitive development, as evidenced by play skills, manipulation of toys, sensorimotor schemes, attention, perceptual skills, memory, problem solving and reasoning;
Physical development, including hearing and vision, as evidenced by gross motor and fine motor coordination, tactility, health and growth. If there has not been a physical examination of the child in the past 2 months, one shall be requested if appropriate;
Communication development, as evidenced by understanding, expression, quantity and quality of speech sounds or words, and communicative intent through gestures. Communication development includes the acquisition of communications skills during pre-verbal and verbal phases of development; receptive and expressive language, including spoken, non-spoken and sign language means of expression; oral-motor development; auditory awareness skills and processing; the use of augmentative communication devices; and speech production and awareness.
Social and emotional development, as evidenced by temperament, mood attachment, self-soothing behaviors, adaptability, activity level, awareness of others and interpersonal relationships; and
Adaptive development which includes self-help skills, to include drinking, eating, eliminating, dressing and bathing.
Testing instruments and other materials and procedures employed by the EI team shall meet the following requirements:
They shall be administered or provided in the child's or family's primary language or other mode of communication. When this is clearly not possible, the circumstances preventing it shall be documented in the child's early intervention record;
They shall be validated for the specific purpose and age group for which they are used;
They shall be administered by trained personnel in accordance with instructions of the developer;
They shall be tailored to assess the specific area of development and not simply provide a single general intelligence quotient; and
In regard to tests, they shall be selected to ensure that when they are administered to a child with impaired sensory, manual or speaking skills, the test results accurately reflect what the tests purport to measure.
No single procedure may be used as the sole criterion for determining eligibility.
With the parent's consent, members of the EI team may consult with persons not on the EI team to help the EI team members determine if the child needs early intervention services.
Following the evaluation, all members of the EI team shall jointly discuss their findings and conclusions and determine if there is documentation, data or other evidence that the child is developmentally delayed or has a condition which has a high probability of resulting in delayed development. If a member cannot be present, that member shall be involved through other means, such as participating in a conference call, or be represented by someone who is knowledgeable about the child and about the member's findings and conclusions.
At the conclusion of the joint discussion under par. (g)
, the EI team shall prepare a report which shall include each member's findings and conclusions and be signed by all members of the team. If a member participated through a conference call, the signature may be by proxy. The report shall include:
A determination of either eligibility or non-eligibility, with a determination of eligibility accompanied by documentation of the child's developmental delay or diagnosed condition.
The service coordinator shall provide the child's parent with a copy of the EI team's report.
If the EI team finds that the child is not eligible, the EI team report shall in addition include:
Information about community services that may benefit the child and family, such as day care, parent support groups or parenting classes; and
A statement that, if the parent requests it and consents to it, referral will be made to other programs from which the child and family may benefit and that the service coordinator will assist the parent in locating and gaining access to other services.
If the parent chooses not to take part in the evaluation process or development of the report, the service coordinator shall meet with the parent upon completion of the evaluation to discuss the findings and conclusions of the EI team. The service coordinator shall document in the child's early intervention record why the parent was not involved and the steps taken to share the findings and conclusions of the EI team with the parent.
(8) Effect of relocation of eligible child.
When the family of a child who has been determined eligible for early intervention services based on an EI team evaluation moves to another county, the child shall remain eligible for services in the new county of residence on the basis of the original determination of eligibility. The services identified in the IFSP in effect on the date that the family moves to the new county shall be provided until a new IFSP is developed.
DHS 90.08 History
Cr. Register, June, 1992, No. 438
, eff. 7-1-92; emerg. am. (3) (b) 11., 12. and (8), cr. (3) (b) 13., r. (7) (h) 2., eff. 1-1-93; am. (3) (b) 11., 12. and (8), cr. (3) (b) 13., renum. (7) (h) 1. (intro.) to be (7) (h) (intro.), r. (7) (h) 2., Register, June, 1993, No. 450
, eff. 7-1-93; am. (1), (3) (a), (b) 10., (5) (a) 3., (7) (b) 1., (g), (h) (intro.), Register, April, 1997, No. 496
, eff. 5-1-97;
am. (7) (k), Register, September, 1999, No. 525
, eff. 10-1-99; CR 03-033
: am. (3) (b) 3. and 11. Register December 2003 No. 576
, eff. 1-1-04; corrections in (3) (b) 9. and 12. made under s. 13.93 (2m) (b) 7., Stats., Register December 2004 No. 588
Once a child is determined under s. DHS 90.08
to be eligible for early intervention services, the EI team shall, as needed, carry out additional observations, procedures and testing to assess and determine the child's unique developmental needs. All assessment tests and other materials and procedures shall comply with s. DHS 90.08 (7) (d)
Following the assessment under subd. 1.
, the EI team shall prepare a report. This report need not be a separate document but may be made part of the EI team's report under s. DHS 90.08 (7) (h)
or the IFSP under s. DHS 90.10
. The report shall include:
A summary of the assessment, including the child's strengths and needs; and