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First Steps Eligibility


First Steps Eligibility
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Each state is responsible for defining their eligible population within the

parameters set forth by the law. Eligible children must be between birth through

two years of age who are in need of early intervention services. Indiana has a

very broad definition in which children are deemed eligible if they exhibit a

developmental delay, have a diagnosed physical or mental condition likely to

result in a delay or have any one of eight identified biological risk factors likely to

result in a delay. Eligibility must be determined by a multidisciplinary team using

multiple sources of information and be redetermined annually. A multidisciplinary

team must include the Service Coordinator, the family, and representatives from

at least two early intervention disciplines.

In Indiana eligibility may be determined using informed clinical opinion when

standardized assessment instruments are not appropriate. If there is enough

existing information to determine eligibility, no additional assessments are

necessary. The categories of eligibility are defined as follows:

Developmental Delay - In order to be eligible under the category of

developmental delay a child must have a:

  • 20% delay in function below the chronological age or a score of 1.5

standard deviation below the mean in one area of development

- or -

  • 15% delay in function below the chronological age or a score of 1

standard deviation below the mean in two areas of development

A developmental delay can be determined through the use of appropriate

norm referenced instruments or through informed clinical opinion.

Developmental delay according to the informed clinical opinion of the early

intervention team, including the parents may be supported by:

  • Developmental history
  • Observation of child in daily settings
  • Review of medical and health records
  • Assessment instrument (i.e., checklist)

Diagnosed Physical or Mental Condition which will likely result in

developmental delay. There are specific diagnoses and conditions as defined in

the Indiana law that lead to eligibility. These conditions must be supported by a

statement/report signed by physician or psychologist indicating condition, and a

multidisciplinary evaluation report that Early Intervention services would be

appropriate. The categories include:

  • Chromosomal abnormalities/genetic disorder
  • Neurological disorder
  • Congenital disorder
  • Sensory impairment including vision and hearing
  • Severe toxic exposure
  • Severe infectious disease
  • Atypical development disorder

(Note: Eligibility in this category must be supported by a physician statement that verifies the

condition identified as likely to result in a delay.)

At Risk of a Developmental Delay - The eligibility definition includes a final

category defined as at risk based on biological conditions. Children birth through

two years of age shall be considered eligible to receive early intervention

services if they have any one of the following eight biological factors.

  • Limited prenatal care – refers to pregnant mothers who have had four or

fewer obstetrical visits prior to the 34th week of pregnancy or whose

prenatal care was initiated in the third trimester.

  • Maternal prenatal substance abuse – the risk factor refers to regular

maternal use of tobacco, alcohol (more than one drink per day), or illicit

and prescription drugs known to affect the developing fetus during


  • Severe prenatal complications – refers to complications during pregnancy

known to potentially compromise neonatal outcomes. Examples include

moderate to severe toxemia, placenta previa, abruptio placentae, lead

exposure, or such maternal illness as diabetes or rubella.

  • Severe perinatal complications – this risk factor refers to severe

complications in the birth and postpartum period, such as prematurity (32

weeks gestation) or respiratory distress syndrome. This risk factor would

not be used in conjunction with another risk factor, low birth weight (less

than 1500 grams), unless there are severe perinatal complications other

than prematurity or respiratory distress which describe the infant.

  • Asphyxia – this risk factor refers to a particular cluster of clinical signs,

which indicate that a reduction in the oxygen level below the physiological

requirements of the neonate has occurred (Amiel-Tison & Ellison 1986;

Blackman, 1989; Brann, 1986; Broman, 1979). The clinical signs of

asphyxia include fetal distress (i.e. fetal heart rate during the first stage of

labor is lower than 120 or above 160, abnormal heartbeat patterns, and/or

the passage of meconium) and neonatal distress (e.g. poor color, poor

muscle tone, failure to breathe spontaneously, as typically assessed by

the Apgar scores used to designate the occurrence of asphyxia). To

interpret a low Apgar (i.e. at least 5 as indicative of asphyxia) other signs

known to occur during intrapartum asphyxia must also be present (i.e.

fetal distress or passage of meconium). Symptoms in the neonate that

indicate that asphyxia occurred are: lethargy (abnormal state of

consciousness), seizures, abnormal muscle tone, poor feeding and

abnormal reflexes. Thus, the most accurate assessment that an infant

has been asphyxiated is based on an indication of fetal distress in

conjunction with evidence of immediate neonatal distress and signs of

CNS abnormality.

  • Very low birth weight – This risk factor refers to a premature infant whose

birth weight is less than 1500 grams or 3.3 lbs.

  • Small for gestational age – small for gestational age (SGA) refers to

infants whose birth weights are abnormally small for their gestational age.

Researchers have been very consistent in defining abnormally small as

having a birth weight below the 10th percentile for gestational age on one

of several sets of sex-specific norms for that population (Klebanoff, Meirik

and Berenedes, 1989; Neligan, Kolvin, Scott & Gardside, 1976; Parkinson,

Scrivener, Graves, Bunton & Harvey, 1986). This term can refer to

premature or full-term infants.

  • Severe postnatal complications – Includes catastrophic infections, growth

deficiencies/nutritional problems.

Note: Eligibility in this category must be supported by a physician statement that verifies the identified risk as likely to result in a delay.)

Eligibility must be clearly documented so each child is identified as having a

medical condition, a developmental delay, or is at risk of a delay. Indiana uses a

common Eligibility Determination Form.

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