Transcript Document

NASSAU COUNTY
DEPARTMENT OF
HEALTH
Early Intervention
Program
7/17/2015
1
and the Local
Early Intervention
Coordinating Council
(LEICC)
Present
7/17/2015
2
BEST PRACTICE IN
THE EARLY
INTERVENTION
PROGRAM
7/17/2015
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Professional
Boundaries
in Early
Intervention
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What do families in early
intervention need?
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Qualified personnel
Provider information
Complete written information
Transition information
Providers
Families
Awareness of boundaries
Child
Recognition of child abuse
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DOH
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• Any incident regarding suspicion of sexual and/or
physical abuse must be documented and immediately
reported to the New York State Child Abuse and
Maltreatment Register (Phone #1-800-635-1522), the
Nassau County Police Dept Special Victims Unit (in
cases of sexual or physical abuse when the allegation
involves non-familial abuse).
•EI Director, OSC/EIOD (DOH Phone #227-8648)
8:30 am to 4:45 pm
• For incidents on buses call Penauille Servisair at 4334500
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Individual Provider and
Agency Standards
• What do individual providers and agencies
need to do?
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Confidentiality
*Federal Educational Rights and Privacy Act
(FERPA)
*Confidentiality procedures
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Eligibility Requirements
Under the EI Program
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Evaluations
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Early Intervention eligibility criteria for:
• Developmental delay
• Diagnosed physical or mental condition
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To determine eligibility
use:
• Standardized tests
• Developmental checklists to support
standardized tests
• Clinical judgement
• Two or more qualified professionals
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• No single procedure or instrument may be used
as the sole criteria or indicator of eligibility
(Section 69-4.8 NYS EI Regulations)
• Schedule evaluation within 10 working days
after receipt of written request for evaluation
from NCDOH
• Keep the ISC informed of any reasons for delay
in meeting time lines
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Conducting the Evaluation
• A family assessment must be offered as an
option
• Evaluators must not make written or verbal
recommendations during the evaluation
regarding specific services, frequency, duration
or specific providers
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Written Reports
and Content
Each evaluation submitted to the DOH must
include:
• NCDOH Evaluation Summary Eligibility
Determination Packet (3pages)
• Multidisciplinary evaluation report
• Summary narrative written in collaboration with all
evaluators
• Family Assessment
• Health Status Report
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• Description and statement of eligibility must be written
in Summary Narrative, not in multi-disciplinary
evaluation report
• No written recommendations regarding specific
services, frequency or duration in the evaluation report
• Specific services must be discussed at the IFSP
meeting
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• Reconcile any differences in assessment findings
• Analyze delays in cognitive domains
• When describing a child’s inability or lack of a
particular skill, make sure it is age expected
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IFSP
Meetings
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Prior to initial IFSP
• 45 day time limit from date of referral
• Written evaluation reports to Health
Department and family within 10 days of
completion
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Initial IFSP Meetings
• Participants
• Conducting the Meeting
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review reports / findings
family concerns, priorities and resources (CPR)
develop meaningful goals
choose Ongoing Service Coordinator
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IFSP Review Meetings
 Participants
 Conducting the meeting
 minimally every 6 months
 telephone / in person
 Progress reports
 Amending the IFSP
 discuss with EIOD/OSC BEFORE family
 required paperwork
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Annual Review
Face to face mandatory
Required paperwork
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Working in Home,
Office/Facility,
Child Care Centers
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Natural Environment
• Settings that are natural or normal for young
children without disabilities
• May include:
the home, a child care setting or other
community settings in which children participate
• IFSP must contain statement of the natural
environments in which EI services shall be
appropriately provided
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Home
• Boundaries are of utmost importance
• Services in the home have a purpose, they are
not just “provided” at the home for
convenience
• This needs to be explained to parent; form a
partnership in training
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Child Care Setting
• Use letter of introduction
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Office/Facility
• Boundaries are more clearly delineated and
defined
• Supervisor is usually on-site
• Rules/procedures are usually posted
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Center-Based
• Need to work collaboratively
• Ongoing communication is essential
• Know who to contact if suspicions of child
abuse or maltreatment exist (i.e. incidences on
bus, etc)
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Delivery of
Services
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Delivery of Services
Collaboration Between Professionals and
On-going Service Coordinators
• Ongoing communication between family and team
members
• Team members should establish cohesive method of
communication through notebooks, telephone contact,
meetings and/or co-treatments
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Co-Treatment
Co-treatment is a collaborative session in which
providers from different disciplines treat a
child simultaneously
• Co-treatment should be used to problem solve, address
family issues and develop a cohesive treatment plan
• Co-treatment must be documented on Daily Notes
/Attendance Sheet
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Speech-Language Pathology
Clinical Fellowship Year (CFY)
An individual completing their Clinical Fellowship Year (CFY)
may provide speech pathology services or audiology services
and/or evaluations:
•Individuals must be employed and supervised
•Agency employing CFY candidate must maintain copy of Form 6 issued
by the State Board for Speech Pathology
•Maintain policy and procedure manual
•All Daily Notes/Attendance Sheets and evaluations must be co-signed by
supervising therapist
•Individuals completing their CFY cannot be hired as independent
contractors
•CFY and supervision must be in IFSP
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OT and PT Assistants
• OT assistants must be supervised on site by a
licensed occupational therapist
• PT assistants must be supervised on site by a
licensed physical therapist
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Student Therapists
• Noted on IFSP and approved by EIOD
• Must meet health and safety requirements
• Under direct on site supervision of a licensed
professional
• Licensed professional always has the legal
responsibility and liability for the treatment of
the child
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Rx/Therapy Orders to Start
• Who needs?
– OT’s and PT’s need an MD order to treat
– ST’s need a recommendation for an evaluation and services
• IT IS ILLEGAL TO TREAT
WITHOUT Rx / Therapy Orders
• Who keeps?
– Original- provider specified on IFSP
– Copy- Contractor and DOH
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Medical Clearance/
Change of Health Status
• Medical clearance should be obtained before
any treatment occurs if
– A child’s health status poses possible risk in
treatment
– After a significant change in health status
• Should clearly state that PT and OT can resume
without any restrictions
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Required
Paperwork
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Daily Notes/
Attendance Sheets
• Accurately record information
• Never falsify information
• Never have Daily Notes/ Attendance Sheets
signed in advance or for any time other than the
specific date and time of the session
• REMEMBER - THIS IS A LEGAL
DOCUMENT !!!
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• Daily Notes/Attendance Sheets must be kept for
– All sessions
– All contacts with other professionals who are involved in the
ongoing delivery of services
– All recommendations of support, guidance & education given
to parent/caregiver.
• Fill in blanks completely
– ICD-9 Codes must be included on each Daily
Note/Attendance Sheet & CPT codes
(if applicable) for every session
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• Daily Notes/Attendance Sheets must be related
to outcomes on IFSP
• Should include
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Progress towards IFSP outcomes
Activities
Strategies
Child’s response
Pertinent information
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• Parent or caregiver must sign after each session
– Must be person over 18 years of age
– Signature reflects attendance at session
– Written parental permission is required before a
childcare provider can sign the Daily
Notes/Attendance Sheets
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NYS Regulations state:
• No more than three individual sessions in any
one location
• No more than one session of any discipline in
one location
• THIS IS THE RESPONSIBILITY OF THE
PROVIDER
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Make-Up Policy
• Session(s) should be made up whenever
possible
• One session more per week in each of next two
calendar weeks
• Only during current IFSP
• Are not cumulative
• Cannot be added onto another session
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Provider Progress Report
–Documentation
–Guide for Parent/Caregiver
–Identify Strengths/Challenges
–Quality Assurance
–Justification of Services
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What Should Be Included In the
3 Month Progress Report
A brief overview of the child’s progress
including:
•Child’s reaction
•Strategies/treatments
•Progress towards IFSP outcomes
•Current functioning level of child
•Suggestions to parents/caregivers
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6 Month Progress Reports
Child’s progress towards achieving IFSP
outcomes including:
•Reaction to therapy
•Strategies & treatments
•Who/What/Where
•Communication with team members
•Formal assessment of child’s current level of functioning
•Outcomes/Long-term goals/Short-term goals
•Family/Caregiver Plan
•Reminders
•Decrease services/discontinue services
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Progress Reports should:
• Be written professionally and typed
• Include any relevant information pertaining to
the child’s developmental level and/or
functioning (medical, equipment, etc)
• Be accurately and completely filled out
• Be submitted to DOH and family 3 weeks prior
to the end of the IFSP period
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IFSP Review Request/
Amendment
Increasing services
•Discuss with EIOD, OSC and provider team
•Discuss with family
•Fill out IFSP review with essential information and
justification for increase
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Supplemental Evaluations
• Discuss with EIOD, OSC and provider team
• Discuss with family
• Service provider must identify their specific
concern and on IFSP Review Request document
developmental tasks the child is unable to do
using developmental norms
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Decreasing Services
If significant progress has been made towards
IFSP goals, but still requires intervention, the
level of service may be decreased.
If a decrease is indicated, DO NOT WAIT
until the end of the IFSP period to request
this change
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Discontinuing Services
• When a child has reached age appropriate level
of development and IFSP outcomes have been
attained, a recommendation to discontinue
services should be made
• Discuss with OSC and EIOD
• Discuss with family
• If discharge is indicated, DO NOT WAIT
until end of IFSP period to request this
change
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Assistive Technology
• An Assistive Technology Device (ATD) is any
item, piece of equipment or product system
– Increases
– Maintains
– Improves
functional quality
• Call TRAID first - (516) 378-5089
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Ordering ATDs
• Contact must be made with the EIOD first
– An appropriate device
– Not a medical device
• EIOD will send request form with top
section completed
– Do not fill out copy of blank request form
• Complete and return form to NCDOH
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Do not fax
Include justification form
Include Rx if needed for particular device/service
Include written estimate
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• All necessary documentation must be
submitted before request can be processed
• Justification must be developmental, not
medical
– “to meet, maintain, increase, enhance
…developmentally appropriate skill”
– Must relate to an IFSP outcome/goal
• Approved vendors
– Any instate Medicaid vendor
– If none, contact Shannon Jauck at NCDOH
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Required
Record Keeping
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Personnel Files
The following information should be in each
individual provider’s personnel file, whether an
employee, agent or subcontractor:
• Current state licensure, certification or registration in
appropriate discipline
• Health Status Form
• Documentation of face to face interview
• Reference letters/contact indicating character and
competence of the individual
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• NYSDOH individual approval letter when applicable
• Record of in-service attendance and mandated
NYSDOH and NCDOH trainings
• Performance appraisals
• Central State Register (CSR) on Child Abuse and
Maltreatment clearance
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Children’s Files
Every child receiving EIP services must have
a complete file. The following information is
to be included:
• Child information (name, date of birth, sex, address,
parent/guardian, etc.)
• A copy of child’s evaluation(s)
• A copy of the child’s IFSP
• Record of each date of service, length of session,
description of the services provided and the child’s response
to the services, and the profession and signature of the
practitioner providing the Early Intervention Services.
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• Parental consent(s)
• Periodic Provider Progress Reports- 6 months,
annual, etc.
• Order(s) by physician(s) or other health care
professional(s) as required. Originals kept by provider
• NOTE: ALL RECORDS MUST BE RETAINED
UNTIL 3 YEARS AFTER THE CHILD REACHES
THE AGE OF 18
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Record Access
•Files must be available for review by
representatives of the NYSDOH and NCDOH
•Parents must be afforded the opportunity to
inspect and review records relating to
evaluations and assessments, eligibility,
determinations, IFSP. When the record is
accessed there must be documentation.
•Any requests for information for a child in
foster care should immediately be referred to the
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EIOD
Monitoring
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Agencies
• Designate persons responsible for supervision
– Licensed supervisor and discipline specific
– Hold providers to the highest standards
• Maintain periodic contact with families
– Phone calls
– Parent surveys
– Intermittent visits
• Consistently review paperwork and provide
feedback to the provider
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Independent Providers
• Develop system for peer mentoring and review
for professional practice
• Attend mandated NCDOH trainings,
conferences and other professional meetings
All contracted providers should oversee
services provided to children and families in EI
–Appropriateness
–Quality
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Transition
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The most important goal of
transition is to have parents:
• Register their child at school district
• Sign consent to refer child for evaluation
• Choose an evaluator of their choice
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EI Aging Out:
• A child’s eligibility for EI services ends at their
third birthday unless that child has been
determined by a school district CPSE to be a
child with a disability
• Any child turning 3 between January 1 and
August 31 ages out August 31
• Any child turning 3 between September 1 and
December 31 ages out December 31
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CPSE Eligibility
• Any child turning 3 between January 1 and June
30 is eligible to receive CPSE services as of
January 2
• Any child turning 3 between July 1 and
December 31 is eligible to receive CPSE
services as of July 1
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Service Coordinators and
Providers need to
consider the needs of a
child when assisting
parents as to when to
transition
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What is the DOH EIP Transition
Notification to parents?
Parent receives DOH EIP Transition Notification
at least 120-180 days prior to CPSE eligibility
date
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Make sure parents understand
that they still must register their
child at the school district and
sign a referral consent to begin
the evaluation process even if
they sign “yes” to the Transition
Notification form
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Cultural
Competence
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What is Cultural
Competence?
-Being aware of one’s
own culture
-Being aware of
different cultures
-Being aware of the
family’s culture
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How can this information
be used?
• To better understand the
family’s need
• To understand the
culture’s view of a child
with special needs
• To help families become
more involved and
participate in Early
Intervention services.
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Resources
-Community services
-Agency or independent
provider
-Family that is receiving
services
-Attendance at Cultural
Competence workshops
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Autism
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Evaluations
Diagnostic psychological evaluations may
be performed by:
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•
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Clinical psychologists
Developmental pediatricians
Licensed clinical social workers
Pediatric psychologists
who are qualified and trained in the approved
test measures to rule in or rule out Autism
Spectrum Disorders (ASD)
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Evaluations
The supplemental evaluation may be part of
the initial core evaluation or it may be
suggested at a later date by the therapists
treating the child to the Nassau County
EIOD/Service Coordinator if behaviors
symptomatic of ASD are observed
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Evaluations
If a service provider or parent observes at
least two or more behaviors characteristic
of ASD, an IFSP Review Request may be
suggested to the Nassau County
EIOD/Service Coordinator for the
supplemental evaluation
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Services
Family training is an integral part of the child’s
schedule of therapy:
• Incorporates the child’s home and natural environment into their
educational plan
• Offers a forum for parents to review their child’s progress and
discuss concerns
• Offers parents the opportunity to receive training to help
incorporate behavioral and communication techniques into the
daily routines of the child and family
• Provides team leader access to be able to observe other team
members in order to ensure consistency of services as well as the
child in alternate settings
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Level of Service
In accordance with the level and frequency of
authorized services by the EIOD/SC as per the
IFSP, a service plan schedule is formulated with
attention to the child’s and family’s schedule and
needs
• Schedule must first be approved by Nassau County
EIP before services are implemented
• Any changes to the schedule of services must first be
approved by the agency and DOH before being
implemented
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Level of Service
Family training services are scheduled
as part of the weekly service plan schedule
as well as a monthly team meeting for all
service providers to attend.
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Team Meetings
Team meetings are typically held in the
family/caregiver home. If an alternative site
is requested by the family, confidentiality
and professional boundaries must be
maintained.
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Team Meetings
Purpose of the team meeting:
• Members can communicate
• Members can share concerns and recognize achievements
• Strategies should be expanded, explored to ensure the child is
making optimum progress
• Parents have opportunity to share any concerns
• Related service providers should report on their methods, goals,
and any reinforces they are using
• If child is attending a center based program, a representative
from that program should attend
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Team Meeting
At the conclusion of the team meeting the
team leader should:
• Collect the attendance sheets
• Summarize the main points of the meeting
• Set the schedule for the next meeting
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Paperwork: Record Keeping
and Documentation
Team Leaders:
3 Month ABA Report - form EI5284
3 Month Family Training Report - form EI5285
6 Month ABA Report- form EI5287.A and B
6 Month Family Training Report – form EI5285
Team Members:
3 and 6 month ABA report form EI5284
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Paperwork: Record keeping and
Documentation
ABA Team Meeting Notes
and Attendance Sheet
• Signed by all in attendances including the
parent/caregiver
• Submitted to the EIOD/SC by the end of the month in
which the meeting is held
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Data Collection
• Data based decision making is a key
component of Applied Behavior Analysis
and data is essential to evaluating the
effectiveness of the teaching
• Each child should have an individualized
curriculum represented in their program
book
(refer to specific agency guidelines for forms and record keeping)
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Health
and
Safety
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Facility-Based Services
The facility should provide a safe physical
environment for children, persons delivering
services, and other individuals that access the
premises, including employing a policy for
adequate emergency procedures.
– use Universal Precautions
– Supervise children at all times
– Document health/safety incidents
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Home and CommunityBased Services
The provider delivers services that in a way
protect the health and safety of children and other
persons involved in the delivery of services,
including a policy for emergencies. The provider
must be in compliance with other applicable local
and state standards.
Refers to NYS Department of Health Early Intervention Program Health &
Safety Guidance Document
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QUESTIONS
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NEXT STEPS
• E-mail request to DOH
for Best Practice manuals
•Review your
policies/procedures
• Train your staff
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REMEMBER
Best Practice is
Everyone’s Job!
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