Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

Activity #1: Facilitate at Least Three Part C Eligibility Meetings Carlena Lowell SEI 513 Spring 2014

Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

*All names have been changed or covered in order to maintain confidentiality. Introduction Something I have struggled with since assuming the role of service coordinator is the eligibility meetings. I do understand how they are supposed to be facilitated, what I need to get signed, what I need to discuss, etc., and I am comfortable with those things. The thing I do sometimes struggle with, though, is creating the outcomes. Outcomes are parent or caregiver driven, and some of them know exactly how they want their child to participate in what routine and with who, but there are many who do not. This is where I need to really facilitate, and I find that difficult. I am often uncertain, or trip over my words when trying to elicit this specific information from parents or caregivers. Sometimes the evaluators will jump in, and that is helpful, although I cannot always count on that. I need to be able to encourage parents and caregivers to create meaningful, yet developmentally appropriate, outcomes for their family. One of my difficulties is the phrasing of my questions. If I am writing outcomes with a family who does not know about child development and might have unrealistic expectations, I am often unsure of what questions to ask or statements to say to let them know their idea is unrealistic. For example, a family might have an infant who is not yet able to roll over, but wants to write an outcome about taking steps. I do explain to families that we like to write outcomes that will be attainable in the next three to six months, as that is when our reviews will take place, but other than that I often struggle to say the right things that lead the families to creating the outcomes. Part of the issue for me is that I am concerned about writing the outcomes for the families. I want to

Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

provide statement and ask questions to elicit outcomes without putting words in the mouths of the parents or caregivers. This is something I plan to address in this activity throughout the semester. The first activity outlined in my IPP was to facilitate at least three Part C eligibility meetings. I reflected on these meetings throughout the practicum, which I found helpful. I so often run through my daily list of to dos, which includes the meetings outlined in my IPP, without reflecting on them because I do not feel I have the time. I debrief with co-workers when I can, but carving out time to reflect on my own is powerful. Eligibility Meeting #1 I facilitated an eligibility meeting with a family this morning. This was one of the more knowledgeable families I have worked with because their older child was in EI for nearly three years, and that ended only one year ago. They are familiar with how outcomes are developed and what they need to entail, so they already had ideas as to the outcomes they wanted before I even walked through their door. This is a unique family; not many are experienced with EI like they are. I did go through most of my spiel anyway. I discuss the idea that we like to write outcomes around certain parts of the day, such as meal time and play time, and we think of them in terms of who does what when, and why, and then how we will know it is met. While debriefing with the evaluator who was there, she was complimentary toward the way I facilitated the meeting with the parent and grandparents. She said I did a nice job explaining the outcomes, and other parts of the IFSP.

Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

We ended up writing three outcomes for the family; many around the childs gross motor abilities. After developing the outcomes, we discussed the services grid and PSP, determining the PSP will be another SLP on our team. I also explained that the whole grid would be filled out as each team member is listed. I explained the teaming approach to EI and about the quarterly reviews at our weekly team meeting. We also talked about other services the family receives, and signed the signature page and financial resources page. After finishing the IFSP, I explained the Child Outcome Summary Form (COSF), to the mother. This is a form that describes the childs strengths and needs in all five developmental domains, and then provides a 1-7 rating of the age-appropriateness of their skills. This is a non-identifying form that is completed at the start of services and the end of services if the child is in services more than six months. It is sent to the state, and eventually the government in order to track the progress children make, which is a reflection on our abilities as early interventionists. We discussed the parental rights as well, and I offered her more copies. I gave her the Maine Care/CDS letter which describes how to contact Maine Care if they want to dispute the amounts of services, among a few other things. I then let her know I would send a written notice, and then within a few weeks I would send her complete IFSP in a red, three-hole punched folder. All in all, I felt pretty good about this eligibility meeting, and must give thanks to the mother for being a great meeting participant! Eligibility Meeting #2

Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

Late Friday afternoon I completed an eligibility meeting for a child who qualifies for CDS services based on his scores in the communication and cognitive sections of the BDI-II, which were 3 and 2.27 standard deviations below the mean, respectively. I completed the evaluation the week prior with an SLP. Both parents were able to attend the meeting, which was really nice. We had to have a hard conversation with the parents that both of the SLP and I were dreading before the meeting. These parents are concerned their child is exhibiting some behaviors consistent with those of a child with autism; however, they are unsure if these behaviors are learned from his older brother who has autism, or if they are organic. The behaviors raised red flags for us as early interventionists, and we decided to discuss further evaluations with them as it is not for us to decide if his behaviors are learned or are his own. Initiating a conversation with any parent about autism is not easy, but in debriefing after, we both felt very good about the way in which it went. This was one of the longer eligibility meeting I have facilitated, but worth it given the conversations, and the amount of solid outcomes that were written. I started off having them sign the AWN, as we scheduled the meeting for less than seven days away. We then went into discussing the evaluation. I discussed my parts evaluation, which were the personal-social, motor, and adaptive sections; the SLP then discussed her sections, the two in which he qualified for services. I look forward to gaining more experience in discussing evaluations in order to gain skills related to verbal articulation of points I need to make. After discussing the evaluation, we developed the outcomes. I feel I am gaining momentum in my ability to discuss and explain why and how we develop outcomes, including natural learning environments, parents as teachers, and

Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

children learning throughout their daily activities. These parents were great at developing relevant and appropriate outcomes. We ended up with six outcomes! This was a nice experience for me as I generally struggle to develop four outcomes with parents. After the outcomes, I discussed the rest of the IFSP with the family, similarly to the way in which I did during the aforementioned eligibility meeting. Something we always recommend for children at risk for autism is an audiological evaluation to rule out potential hearing loss, particularly if the child is prone to ear infections, which this child is. After completing the components of the IFSP, I initiated the conversation regarding further evaluation. I was reluctant to do so, as I am with most difficult conversations given my lack of self-confidence in articulating things well. However, it was a conversation that needed to be had. We addressed the audiological first, and then moved into discussing further evaluation regarding the concerns we have with the childs behaviors related to autism. We brought up the M CHAT and the failed items, and that we agree with the parents and were unsure if the behaviors were learned or natural. Now that I have some experience with referring families to the DEC, have actually participated in a feedback session at the DEC in which a child received an autism diagnosis, and have elicited feedback from parents regarding the DEC, I was able to explain the process to the parents with poise. The parents asked good questions throughout this conversation. Ultimately, we decided to proceed with the audiological evaluation and once the results from that are in, go from there regarding further evaluations. This is the course of events that generally happen in situations similar to this one. Although it was a difficult conversation, I was happy to have had it,
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Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

and was pleased with the outcome. I feel I made it as comfortable as possible for the parents, and was able to explain things fairly well. I received positive feedback from the SLP while debriefing after the meeting as well. I finished up the meeting by obtaining Parental Consent for Evaluation and the Financial Resources Form for the audiological evaluation. Finally, I let the parents know about the COSF. I told them I would write a Written Notice regarding the meeting and mail it to them, and that within a few weeks would complete the IFSP and mail that to them as well. Once back at the office, I wrote the Written Notice, made the Referral for Early Intervention Services to the PSP and the EI team, made the Referral for Evaluation to the place conducting the audiological evaluation, completed the welcome to EI Individual Family Teaming Report for the upcoming EI team meeting, completed and emailed the COSF to the appropriate person, and eventually completed the IFSP. This is a process I have become comfortable completing and can now do so in a timely manner. Eligibility Meeting #3 I facilitated an eligibility meeting for a little girl who qualifies based on her score in the communication section of the BDI-II, which was 2.47 standard deviations below the mean. This was a difficult meeting for me because the mother has learning and processing difficulties, so I had to modify the way in which I typically pose questions to elicit information and outcomes. Although it was difficult, I appreciated it because it is not uncommon for the parents of the children we work with to have learning difficulties. We were able to develop five outcomes, four child level outcomes, and one parent level

Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

outcome. The mother currently has temporary full custody of the child and a PFA against the father, both to expire in September. Two of the child level outcomes are about encouraging the child to say, sign, or gesture words to get her wants and needs met, and two are about reducing her physically aggressive behaviors. Upon talking about the PSP, we decided the best PSP at this point would be the LCSW on our team. Although communication is a need for the child, given the family circumstances social work is also a high need. As a team we determined that 24, 60 minute visits semi-annually with the LCSW as the PSP and 2, 60 minute consultation visits from an SLP semi-annually would be the best choice to fit the familys current needs. Although there was some difficulty with this meeting, I felt it went fairly well overall.

Carlena Lowell SEI 513 Activity #1 Eligibility Meetings

Documentation Advance Written Notice

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Written Notice

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Individual Family Teaming Report with Early Intervention Meeting Attendance Sheet

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Referral for Early Intervention Services

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Child Outcome Summary Form

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