Procedural Safeguards Forms

and Guidance Sharon Walsh and Ross Taylor, Systems Improvement Project, University of North Carolina-

Chapel Hill

December 8, 2010

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WA System Improvement WA System Improvement ProjectProject

Over Arching Project Goals: Over Arching Project Goals: A more consistent approach to the A more consistent approach to the

provision of early intervention services provision of early intervention services statewidestatewide

Increase practitioner use of evidence-Increase practitioner use of evidence-based early intervention practices to based early intervention practices to better meet child and family outcomesbetter meet child and family outcomes

Infuse an infant mental health perspective Infuse an infant mental health perspective into early intervention servicesinto early intervention services

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System Improvement System Improvement ActivitiesActivities

Revise and develop new forms (e.g., Revise and develop new forms (e.g., IFSP, procedural safeguards)IFSP, procedural safeguards)

Develop guidance (e.g., IFSP, procedural Develop guidance (e.g., IFSP, procedural safeguards, fiscal, and other ) safeguards, fiscal, and other )

• Revise policies and proceduresRevise policies and procedures• Develop competencies Develop competencies • Develop on-line training modulesDevelop on-line training modules• Develop long-term implementation planDevelop long-term implementation plan

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Procedural SafeguardsProcedural Safeguards

• Webinar will focus on procedural Webinar will focus on procedural safeguards forms:safeguards forms:– Some required and some optional Some required and some optional – When each form is used When each form is used – Forms will be effective around March 2011Forms will be effective around March 2011

• Will not cover:Will not cover:– Dispute resolutionDispute resolution– Confidentiality of informationConfidentiality of information

• Webinar is being recorded and additional Webinar is being recorded and additional procedural safeguard training providedprocedural safeguard training provided

• Questions/answers will be captured today Questions/answers will be captured today

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AgendaAgenda

• Review of Key DocumentsReview of Key Documents– ESIT Parent RightsESIT Parent Rights– Procedural Safeguards TA GuideProcedural Safeguards TA Guide

• ESIT Procedural Safeguard FormsESIT Procedural Safeguard Forms• Discussion of Important ConceptsDiscussion of Important Concepts

– Written prior noticeWritten prior notice– Parental Consent Parental Consent

• Procedural Safeguards within the Procedural Safeguards within the Components of the ESIT ProcessComponents of the ESIT Process

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Key DocumentsKey Documents

• ““Individuals with Disabilities Education Individuals with Disabilities Education Act Act

(IDEA) Part C Procedural Safeguards(IDEA) Part C Procedural Safeguards(Parent Rights)”(Parent Rights)”

• ““Individuals with Disabilities Education Individuals with Disabilities Education Act Act

(IDEA) Part C Procedural Safeguards(IDEA) Part C Procedural Safeguards(Parent Rights)” - Condensed version(Parent Rights)” - Condensed version

• ““Procedural Safeguards Requirements Procedural Safeguards Requirements Technical Technical

Assistance and Training Guide” Assistance and Training Guide”

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Required Procedural Required Procedural Safeguard Forms Safeguard Forms

• IFSP AgreementIFSP Agreement – To provide written – To provide written prior notice and obtain consent from prior notice and obtain consent from the parent(s) prior to initiating or the parent(s) prior to initiating or refusing to initiate IFSP services.refusing to initiate IFSP services.

• IFSP Review AgreementIFSP Review Agreement – To – To provide written prior notice and obtain provide written prior notice and obtain consent from the parent(s) prior to consent from the parent(s) prior to initiating or refusing to initiate IFSP initiating or refusing to initiate IFSP services after an IFSP review.services after an IFSP review.

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Optional Model ESIT Optional Model ESIT Procedural Safeguard Procedural Safeguard

Forms Forms • Authorization for Release of Authorization for Release of

RecordsRecords• Confirmation of Individualized Confirmation of Individualized

Family Service Family Service Plan (IFSP) Plan (IFSP) ScheduleSchedule

• Declining Participation in the Declining Participation in the ESIT ProgramESIT Program

• Declining One or More Early Declining One or More Early Intervention ServicesIntervention Services

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Optional Model ESIT Optional Model ESIT Procedural Safeguard Procedural Safeguard

FormsForms• Notice and Consent for Notice and Consent for

ScreeningScreening• Notice & Consent for Initial Notice & Consent for Initial

Evaluation/AssessmentEvaluation/Assessment• Notice & Consent for Notice & Consent for

Evaluation/AssessmentEvaluation/Assessment• Parent Written Prior NoticeParent Written Prior Notice• Record of AccessRecord of Access

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Written Prior NoticeWritten Prior Notice

ESIT must give written prior notice before:ESIT must give written prior notice before:

ProposingProposing •to do something new, or to do something new, or •change something in place alreadychange something in place already

Refusing Refusing •to do something new, or to do something new, or •change something the parent is requestingchange something the parent is requesting

Always provide a copy of the ESIT Always provide a copy of the ESIT Parent Rights and explain to Parent Rights and explain to parents parents

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Parental ConsentParental Consent

Written Parental Consent must be obtained Written Parental Consent must be obtained before:before:

– Conducting screeningConducting screening– Conducting any evaluation and assessmentConducting any evaluation and assessment– Initiating or changing any early Initiating or changing any early

intervention intervention services;services;– Using parent private and/or public Using parent private and/or public

insurance insurance – Releasing confidential information about a Releasing confidential information about a

child and familychild and family

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ReferralReferral• Step 1- Step 1- Referral ReceivedReferral Received

a.a. Parent ReferralParent Referralb.b. Referral by Primary Referral SourceReferral by Primary Referral Source

• Step 2- Step 2- Determination of Determination of Surrogate ParentSurrogate Parent

* * * * * * * ** * * * * * * *Declining Participation in the ESIT Declining Participation in the ESIT

ProgramProgram

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IntakeIntake

• Step 1 - Step 1 - Intake Procedure Intake Procedure • Step 2 - Step 2 - Complete Screening As Complete Screening As

NecessaryNecessary• Step 3 - Step 3 - Determining Need for Determining Need for

Evaluation/AssessmentEvaluation/Assessment

* * * * * * * * * ** * * * * * * * * *

Authorization for Release of RecordsAuthorization for Release of RecordsNotice and Consent for Screening (ESIT Parent Notice and Consent for Screening (ESIT Parent

Rights)Rights)Parent Written Prior Notice (ESIT Parent Rights)Parent Written Prior Notice (ESIT Parent Rights)Declining Participation in the ESIT ProgramDeclining Participation in the ESIT ProgramNotice & Consent for Initial Evaluation/Assessment Notice & Consent for Initial Evaluation/Assessment

(ESIT Parent Rights)(ESIT Parent Rights)

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Evaluation and Assessment Evaluation and Assessment ActivitiesActivities

• Step 1 - Establishing the MDTStep 1 - Establishing the MDT• Step 2 – Completion and Step 2 – Completion and

Documentation Documentation of MDT Activitiesof MDT Activities• Step 3 - Documentation of EligibilityStep 3 - Documentation of Eligibility

a.a. Child Is Eligible Child Is Eligible b.b. Child Is Not EligibleChild Is Not Eligible

* * * * * * * * * ** * * * * * * * * *

Parent Written Prior Notice (ESIT Parent Parent Written Prior Notice (ESIT Parent Rights)Rights)

Declining Participation in the ESIT ProgramDeclining Participation in the ESIT Program

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Individualized Family Individualized Family Service Plan ActivitiesService Plan Activities

Step 1 – Initial IFSP MeetingStep 1 – Initial IFSP Meetinga.a. Written Notice of the IFSP Meeting Written Notice of the IFSP Meeting b.b. IFSP Meeting in Native LanguageIFSP Meeting in Native Languagec.c. Family AssessmentFamily Assessmentd.d. IFSP ConsentIFSP Consent

1.1. Providing Written Prior Notice and Obtaining Providing Written Prior Notice and Obtaining Consent for All Early Intervention Services Consent for All Early Intervention Services Recommended by the IFSP TeamRecommended by the IFSP Team

2.2. Declining Participation in ESIT:Declining Participation in ESIT:3.3. Declining One or More Part C Services Recommended Declining One or More Part C Services Recommended

by the IFSP Teamby the IFSP Team* * * * * * * * * * * * * * * * * * * * * *

Confirmation of Individualized Family Service Plan (IFSP) Confirmation of Individualized Family Service Plan (IFSP) ScheduleSchedule

IFSP Agreement (ESIT Parent Rights)IFSP Agreement (ESIT Parent Rights)Declining Participation in the ESIT ProgramDeclining Participation in the ESIT ProgramDeclining One or More Early Intervention ServicesDeclining One or More Early Intervention Services

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IFSP ActivitiesIFSP Activities

Step 2 – IFSP Reviews:Step 2 – IFSP Reviews:a.a. Written Notice of the IFSP Review MeetingWritten Notice of the IFSP Review Meetingb.b. IFSP Meetings in Native LanguageIFSP Meetings in Native Languagec.c. Written Prior NoticeWritten Prior Noticed.d. Ongoing EligibilityOngoing Eligibility

* * * * * * * * * ** * * * * * * * * *Confirmation of Individualized Family Service Plan Confirmation of Individualized Family Service Plan

(IFSP) Schedule(IFSP) ScheduleParent Written Prior Notice (ESIT Parent Rights)Parent Written Prior Notice (ESIT Parent Rights)IFSP Review Agreement (ESIT Parent Rights)IFSP Review Agreement (ESIT Parent Rights)Notice & Consent for Evaluation/Assessment (ESIT Notice & Consent for Evaluation/Assessment (ESIT

Parent Rights)Parent Rights)

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IFSP ActivitiesIFSP Activities

Step 3 - Annual IFSP:Step 3 - Annual IFSP:a.a. Written Notice of the Annual IFSP Written Notice of the Annual IFSP

MeetingMeetingb.b. IFSP Meetings in Native LanguageIFSP Meetings in Native Languagec.c. Written Prior NoticeWritten Prior Noticed.d. Ongoing EligibilityOngoing Eligibility

* * * * * * * * * ** * * * * * * * * *Confirmation of Individualized Family Service Plan Confirmation of Individualized Family Service Plan

(IFSP) Schedule(IFSP) ScheduleParent Written Prior Notice (ESIT Parent Rights)Parent Written Prior Notice (ESIT Parent Rights)IFSP Agreement (ESIT Parent Rights)IFSP Agreement (ESIT Parent Rights)

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Transition ActivitiesTransition ActivitiesStep 1 - Transition PlanStep 1 - Transition PlanStep 2 – LEA NotificationStep 2 – LEA Notification::

a.a. Notification of children shortly reaching the age of Notification of children shortly reaching the age of eligibility for preschool special education eligibility for preschool special education

b.b. Notification of children deemed potentially eligible for Notification of children deemed potentially eligible for preschool special education (referral to Part B)preschool special education (referral to Part B)

Step 3 - Referral to Other Community Step 3 - Referral to Other Community ProgramsPrograms

Step 4 - Transition Meeting: Step 4 - Transition Meeting: a.a. Part B Transition Meeting Part B Transition Meeting b.b. Other Transition MeetingOther Transition Meeting

* * * * * * * * * * * * * * * *

Authorization for Release of RecordsAuthorization for Release of RecordsParent Written Prior Notice Parent Written Prior Notice (ESIT Parent Rights)(ESIT Parent Rights)

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Systems Improvement Systems Improvement ProjectProject

Karen Walker, ESIT Karen Walker, ESIT Program AdministratorProgram Administrator

(360) 725-3516(360) 725-3516Karen.Walker@del.wa.goKaren.Walker@del.wa.go

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Kathy Grant-DavisKathy Grant-DavisARRA Project ConsultantARRA Project Consultant

(360) 725-3519(360) 725-3519Kathryn.Grant-Kathryn.Grant-Davis@del.wa.govDavis@del.wa.gov

Kathi Gillaspy, UNCKathi Gillaspy, UNC(919) 843-5950(919) 843-5950

Kathi.Gillaspy@unc.eduKathi.Gillaspy@unc.edu

Joicey Hurth, UNCJoicey Hurth, UNC(919) 962-7323(919) 962-7323

Joicey.Hurth@unc.eduJoicey.Hurth@unc.edu

Anne Lucas, UNCAnne Lucas, UNC(804) 379-3833(804) 379-3833

alucas3@comcast.netalucas3@comcast.net

http://www.del.wa.gov/esit