· Web viewMultidisciplinary Evaluation: May be performed, if warranted, to determine the child’s initial and ongoing eligibility for Early Intervention Services.

Revised June 3, 2014Reviewed August 2, 2016

EVALUATIONS

POLICY: Evaluations

PURPOSE: An infant or toddler from birth to age three who is suspected of having a developmental disability, which includes a developmental delay and/or a diagnosed physical or mental condition that has a high probability of resulting in developmental delay, is entitled to an assessment to determine eligibility for Early Intervention Services.

REFERENCES:

Public Health Law Article 25 Title II-A Subpart 69-4.8 Evaluators/screening, evaluation and assessment responsibilitiesPublic Health Law Article 25 Title II-A Subpart 69-4.23 Initial and Continuing Eligibility Criteria

GENERAL INFORMATION:

The parent/guardian has the right to select an Evaluator from the County’s list of NYS DOH approved Evaluators. Once chosen, the Evaluator must obtain written informed parental consent to perform the evaluation prior to initiating the evaluation procedures. To ensure accurate results, this process, including clinical observation, should be conducted in an environment appropriate to the unique needs of the child, with consideration given to the preferences of the parent. Such settings may include structured (e.g., clinic or office), unstructured (e.g., play room), and natural settings (e.g., the child’s home). The child’s parents or designee must have the opportunity to be present and be given the opportunity to be an active participant in the screening/evaluation process and should have the option of including the other family members.

Eligibility for Early Intervention Services shall be based on a diagnosed condition with a high probability for developmental delay or the determination of developmental delay in one or more of the five developmental domains: cognitive development; physical development, including vision and hearing; social/emotional development; communication development; and adaptive development.

Developmental delay means that a child has not attained developmental milestones expected for the child’s chronological age adjusted for prematurity, as measured by qualified professionals using appropriate diagnostic instruments and/or procedures and informed clinical opinion.

PROCEDURE:

With written parental permission, the following assessments may be conducted to determine Early Intervention eligibility.

I. Screening : Is performed by an approved evaluator to determine what type of evaluation, if any, is necessary. A screening shall not be performed if the child is known to have a diagnosed condition with a high probability of developmental delay.

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Revised June 3, 2014Reviewed August 2, 2016

II. Multidisciplinary Evaluation : May be performed, if warranted, to determine the child’s initial and ongoing eligibility for Early Intervention Services. It should employ appropriate instruments and procedures, or be based on informed clinical opinion, and should be written in a parent-friendly language, and must include:

A. Two or more qualified personnel from different disciplines who are trained to utilize appropriate methods and procedures, have sufficient expertise in child development, and at least one of whom shall be a specialist in the area of the child’s suspected delay or disability. The team shall have sufficient expertise in child development to evaluate each of the following developmental domains: cognitive development; physical development, including vision and hearing; communication development; social-emotional development; and adaptive development. [NYS Regs. Section 69-4.8a.4[I];

B. With parental consent, a review of pertinent records related to the child’s current health status and medical history;

C. An assessment of the unique needs of the child in each developmental domain, including the identification of services appropriate to meet those needs.

D. The option of participating in the family assessment process with the evaluation team. As stated in the NYS REGULATIONS Sec. 69-4.8a.8, it should be an “interactive process by which the parent and professionals share and gather information about the resources, priorities, and concerns of the family related to enhancing the development of the child.” Thus, the focus of the family assessment is different from that of a social history. The Evaluation will document family participation in the assessment process. If the family declines participation it will be documented on the Core Evaluation Summary Form.

E. The Evaluator will provide a copy of the following to the County Early Intervention Program:1. The Written Evaluation Report of the Multidisciplinary Evaluation (see attached

suggested format and suggested best practices document). The Evaluator will provide a copy of the report to the parent/guardian. The Written Evaluation Report must include the following:a. The completed Multidisciplinary Evaluation Summary Form, Core Evaluation

Summary Form and Supplemental Evaluation Summary Form, if applicable (See attached forms that are provided by NYS DOH and suggested Supplemental Evaluation Report Format with suggested best practices);

b. State pertinent identifying information regarding the child;c. State if report is a screening or Multidisciplinary Evaluation (Core Evaluation

plus any Supplementals done prior to IFSP meeting);d. Indicate whether child is determined eligible or not eligible for Early

Intervention Services;e. Include date of referral to evaluator and dates of evaluations and evaluation

site;f. Indicate names and specialties of qualified professionals performing the

evaluations;g. Name assessment tools used and scores/results;

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Revised June 3, 2014Reviewed August 2, 2016

h. Describe child’s current levels of functioning in cognitive, communication, physical, social/emotional, and adaptive domains;

i. State the child’s medical status. List primary and/or secondary diagnoses, if known;

j. Summarize family assessment (i.e., resources, concerns, and priorities related to child’s development);

k. Describe assessment process, conditions, the child’s responses and whether the family believes the responses were optimal;

l. Explain the scores or measures reported;m. State developmental status. A developmental delay for purposes of the Early

Intervention Program is a delay that has been documented as follows:i. no delay (development within acceptable ranges);ii. 2.0+ Standard Deviation below the mean (sufficient alone for

eligibility);iii. 1.5+ Standard Deviation below the mean (in each of two functional

areas);iv. 12 month delay (sufficient alone for eligibility);v. 33% or more delay (sufficient alone for eligibility);vi. 25% or more delay (in each of two functional areas);vii. Notwithstanding the above, for children who have been found to have

a delay only in the communication domain, delay shall be defined as a score of 2.0 standard deviations below the mean in the area of communication; or, if no standardized test is available or appropriate for the child, or the tests are inadequate to accurately represent the child’s developmental level in the informed clinical opinion of the evaluator, a delay in the area of communication shall be a severe delay or marked regression in communication development as determined by specific qualitative evidence-based criteria articulated in clinical practice guidelines (see attached copy of pertinent regulations 69.4.23 (2) following the Evaluation Forms included in this policy).

n. State method of determination, either Standardized Test or Clinical Opinion.If the clinical opinion of the multidisciplinary team is that the child is eligible for Early Intervention Services but a standardized score is inappropriate, inconsistent with clinical opinion, or cannot be determined because of a child’s age, condition, or the type of diagnostic instruments available in specific domains, state Clinical Opinion for Method of Determination and estimate the approximate functional status, rate of change in development and prognosis.

o. Identify services appropriate to meet the needs of the child and family determined eligible for Early Intervention or state recommendations for future evaluation or reason for determination of non-eligibility.

2. The Evaluator must enter the Multidisciplinary Evaluation into NYEIS within sufficient timeframe to enable convening of the IFSP meeting within 45 days of the date that the EIO received referral.

3. A complete Evaluation Checklist signed by the Evaluator.

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Revised June 3, 2014Reviewed August 2, 2016

The results of the child’s evaluation should be fully shared with the parent/guardian and Initial Service Coordinator as soon as possible and prior to the Initial IFSP meeting, including a written report of the evaluation and, if requested, the full evaluation report.

III. Supplemental Evaluation : A supplemental evaluation may be completed as part of the initial multidisciplinary evaluation, and will be included with the written summary. A supplemental evaluation may also be completed after the initial multidisciplinary evaluation and must be written into the child’s IFSP prior to performing the evaluation. A summary of the supplemental evaluation is to be written in the same manner as the multidisciplinary evaluation summary except:

A. Include the Supplemental Evaluation Summary Form (See attached forms);

B. State that this is a “Supplemental Evaluation per the (date) IFSP”;

C. It is not necessary to state medical status or summarize family assessment unless applicable.

D. The Evaluator must enter the Supplemental Evaluation into NYEIS within sufficient timeframe.

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PUT ON LETTERHEAD

Early Intervention Multidisciplinary Evaluation Summary Report

I. Family Information

Name: DOB: CA:

Parent/Guardian: Parent/Guardian:

Address: Address:

Telephone: Telephone:

Dominant Language: County:

Primary Care Provider: School District:

Date of Referral to EIP: Date of Evaluation:

II. Evaluation Team Members:

III. Summary of Assessment Process:In addition to standardized tests used, as indicated below, observations of the child, parent, interviews and informed clinical opinion were used to assess the five developmental domains.

IV. Child and Parental Response to Evaluation:

V. Summary of Test Results:DOMAIN TEST USED SCORES OBTAINED DOCUMENTED DELAY

1. Adaptive2. Cognitive

3. CommunicationReceptive –Expressive –Total Language -

4. Social/Emotional

5. Physical Gross Motor -Fine Motor -

VI. Statement of Eligibility:

Signature Date Signature Date

PUT ON LETTERHEAD

Early Intervention Multidisciplinary Evaluation Report

I. Family Information

Name: DOB: CA:

Parent/Guardian: Parent/Guardian:

Address: Address:

Telephone: Telephone:

Dominant Language: County:

Primary Care Provider: School District:

Date of Referral to EIP: Date of Evaluation:

Evaluators: Licensure/Certification: on file with County

Licensure/Certification: on file with County

II. Reason for Referral:

III. Medical and Background Information:

IV. Family Assessment:Opportunity to engage in family assessment process offered. Document results and/or refusal below.

V. Child and Parental Response to Evaluation:

VI. Evaluation Procedure and Assessment Tools:In addition to standardized test used, as indicated below, observations of the child, parent, interviews and informed clinical opinion were used to assess the five developmental domains.

It should be noted that abilities in young children vary greatly over a short period of time. The current scores obtained are only an indication of current functional levels and should not be interpreted as an indication of a child’s potential development.

VIII. Explanation of Measures/Scores of the 5 Developmental Domains:

ADAPTIVE

COGNITIVE

COMMUNICATION

SOCIAL/EMOTIONAL

PHYSICAL

VIII. Statement of Eligibility:

IX. Recommendations:

The parent/guardian has been given the opportunity to discuss the evaluation results including any concerns they may have with the evaluation process.

Signature Date Signature Date

Sent to: Parent Early Intervention Official Initial Service Coordinator

Date Evaluation Report Completed:

Suggested Best Practices for Evaluation ReportingPUT ON LETTERHEAD

ITEMS IN RED ARE SUGGESTED BEST PRACTICES FOR EVALUATION REPORTING

Complete all sections/fields of this report.

Use in conjunction with NYS DOH Bureau of Early Intervention Memorandum 2005-02Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility

Requirements and Determinations Under the Early Intervention Program at: www.health.state.ny.us/community/infants_children/early_intervention/index.htm

Early Intervention Multidisciplinary Evaluation Report

I. Family Information

Name: DOB: CA:

Parent/Guardian: Parent/Guardian:

Address: Address:

Telephone: Telephone:

Dominant Language: County:

Primary Care Provider: School District:

Date of Referral to EIP: Date of Evaluation:

Evaluators: Licensure/Certification: on file with County

Licensure/Certification: on file with County

II. Reason for Referral:Include parent perception of concern, diagnosis if applicable and who made referral.

III. Medical and Background Information:Should include:

1. Parent interview to obtain information from the perspective of the child’s parents and, with parental consent, from other individuals familiar with the child’s development regarding concerns about the child’s developmental status and progress.

2. Birth history3. Family composition4. Hearing and vision status5. Immunization status and date of most recent physical exam (evaluator must attach a copy

of most recent physical exam and immunization record)6. Child care, if applicable7. Per Section 69-4.8(a)(4)(v)a, b, & c, an evaluation of the transportation needs of the

child, which shall include:a) parental ability or inability to provide transportation;

b) the child’s special needs related to transportation; andc) safety issues/parental concerns related to transportation.

IV. Family Assessment:Opportunity to engage in family assessment process offered. Document results and/or refusal below.

All parents must be given the opportunity to participate in a voluntary family-directed assessment to determine resources, priorities and concerns of the family related to enhancement of the child’s development, conducted by appropriately qualified personnel on the multidisciplinary evaluation team.

V. Child and Parental Response to Evaluation:The child’s responses to the procedures and instruments used as part of the evaluation process, and the family’s belief about whether the responses were optimal.

VI. Evaluation Procedure and Assessment Tools:In addition to standardized test used, as indicated below, observations of the child, parent, interviews and informed clinical opinion were used to assess the five developmental domains.

It should be noted that abilities in young children vary greatly over a short period of time. The current scores obtained are only an indication of current functional levels and should not be interpreted as an indication of a child’s potential development.

VIII. Explanation of Measures/Scores of the 5 Developmental Domains:

ADAPTIVEIf a child is determined to have a delay in this domain, it should be associated with delays or impairments in other areas of development.

COGNITIVEChildren who score significantly below average using a standardized test would be considered to have substantial limitations in cognitive functioning.

COMMUNICATION

Problems with articulation or phonology are not sufficient to establish eligibility for the EIP.Cannot qualify based on delay in subcategories only. Must be the total score.

For children who have been found to have a delay only in the communication domain, delay shall be defined as a score of 2.0 standard deviations below the mean in the area of communication; or, if no standardized test is available or appropriate for the child, or the tests are inadequate to accurately represent the child’s developmental level in the informed clinical opinion of the evaluator, a delay in the area of communication shall be a severe delay or marked regression in communication development as determined by specific qualitative evidence-based

criteria articulated in clinical practice guidelines (see attached copy of pertinent regulations 69.4.23 (2) following the Evaluation Forms included in this policy).

SOCIAL/EMOTIONALIf child is only experiencing delays in the social/emotional domain, then the child must exhibit behavioral patterns consistent with the diagnoses and disorders listed in Appendix B of NYS Department of Health Memorandum 2005-2. http://www.health.ny.gov/community/infants_children/early_intervention/memoranda/2005-02/docs/memorandum_2005-02.pdf

Psychological testing should be provided if this domain is being used to determine eligibility.

Tests and assessment tools on sensory integration functioning cannot be used to establish eligibility for the EIP. Problems with sensory integration, sensory processing, hypersensitivity, or other sensory issues must be affecting the child's overall development in one or more of these areas to establish the child's eligibility for the EIP, and this must be documented by the multidisciplinary evaluation team.

PHYSICAL

GROSS MOTOR:Cannot qualify based on delay in subcategories only. Must use total score in gross motor to qualify.

FINE MOTOR:Cannot qualify based on delay in subcategories only. Tests and assessment tools of sensory integration functioning cannot be used to establish eligibility for EIP.

*If the central concern for a child is feeding dysfunction, the multidisciplinary evaluation must provide sufficient evidence that the feeding problem is significantly impacting on the child’s developmental status. The nature of the feeding dysfunction (e.g., oral-motor and self regulatory substrates, etc.) and its impact on the child’s development must be documented in the multidisciplinary evaluation report, including the statement of the child’s eligibility for the EIP.

VIII. Statement of Eligibility:The eligibility statement must include either a diagnosed condition with a high probability of resulting in developmental delay and associated ICD-9 code; or a statement of developmental delay consistent with the state definition of developmental delay and associated ICD-9 code for developmental delay.

IX. Recommendations:State the specific service(s) but do not state specific service modality, frequency, duration intensity and/or specific provider(s).

I have given the parent/guardian the opportunity to discuss the evaluation results including any concerns they may have with the evaluation process.

Signature Date Signature Date

Original signature ensures that this report was written, reviewed and submitted by the signing clinicians.

Sent to: Parent Early Intervention Official Initial Service CoordinatorAdd additional individuals receiving report, if applicable

Date Evaluation Report Completed: Is the date the written report was completed. Expectation is that the report is sent within one working day.

With parent consent, the evaluation summary and report should also be shared with the child’s primary health care provider and the local social services commissioner or designee for those children in the care and custody or custody and guardianship of such commissioner.

Effective Date: 06/03/2010Title: Section 69-4.23 - Initial and continuing eligibility criteria

69-4.23 Initial and continuing eligibility criteria.

(a) Initial eligibility for the early intervention program shall be established by a multidisciplinary evaluation conducted in accordance with section 69-4.8 of this subpart and shall be based on the following criteria:

(1) a diagnosed physical or mental condition with a high probability of resulting in developmental delay; or, (2) The presence of a developmental delay which affects functioning in one or more of the following domains of development: cognition, physical (including vision, hearing and oral motor feeding and swallowing disorders), communication, social-emotional, or adaptive development; and, as measured by qualified personnel using informed clinical opinion, appropriate diagnostic procedures, and/or instruments and documented as: (i) a twelve month delay in one domain; or(ii) a 33 percent delay in one domain or a 25 percent delay in each of two domains; or (iii) if appropriate standardized instruments are individually administered in the evaluation process, a score of at least 2.0 standard deviations below the mean in one domain or a score of at least 1.5 standard deviation below the mean in each of two domains; or (iv) notwithstanding subdivisions (i)-(iii) for children who have been found to have a delay only in the communication domain, delay shall be defined as a score of 2.0 standard deviations below the mean in the area of communication; or, if no standardized test is available or appropriate for the child, or the tests are inadequate to accurately represent the child's developmental level in the informed clinical opinion of the evaluator, a delay in the area of communication shall be a severe delay or marked regression in communication development as determined by specific qualitative evidence-based criteria articulated in clinical practice guidelines issued by the Department, including the following:

a) for children 18 months of age or older; (i) a severe language delay as indicated by no single words by 18 months of age, a vocabulary of fewer than 30 words by 24 months of age, or no two-word combinations by 36 months of age; or(ii) the documented presence of a clinically significant number of known predictors of continued language delay at 18-36 months of age, in each of the following areas of speech language and non-speech development:

(1) Language production;

(2) Language comprehension;

(3) Phonology;

(4) Imitation;

(5) Play;

(6) Gestures;

(7) Social Skills; and,

(8) Health and family history of language problems; or,

b) for children younger than 18 months of age, documentation that the child has attained none of the normal language milestones expected for children in the next younger age range, and none for the upper limit of the child's current chronological age range, and the presence of a preponderance of established prognostic indicators of communication delay that will not resolve without intervention, as specified in clinical practice guidelines issued by the Department. (b) If there is an observable change in the child's developmental status that indicates a potential change in eligibility, the early intervention official may require a determination to be made of whether the child continues to be eligible for early intervention program services. The early intervention official shall not, however, require that such a determination be made sooner than six months after a child and family's initial IFSP in the program.

(1) Continuing eligibility for the early intervention program shall be established by a multidisciplinary evaluation conducted in accordance with section 69-4.8 of this subpart which includes the right for the parent to select an approved evaluator, and shall be based on the following criteria: (i) a delay consistent with the criteria established for initial eligibility as set forth above; or, (ii) a delay in one or more domains, such that the child's development is not within the normal range expected for his or her chronological age, as documented using clinical procedures, observations, assessments, and informed clinical opinion; or, (iii) a score of 1.0 standard deviation or greater below the mean in one or more developmental domains; or, (iv) the continuing presence of a diagnosed physical or mental condition with a high probability of resulting in a developmental delay. (2) If pursuant to subdivision (b) herein, the early intervention official requests a determination of the child's continuing eligibility for the early intervention program, and the parent refuses to consent to a multidisciplinary evaluation to establish the child's continuing eligibility, continuing eligibility has not been established and the child shall no longer be eligible for early intervention program services. The early intervention official shall provide the parent with written notice ten working days before the early intervention official proposes to discharge the child from the early intervention program. The notice must be in sufficient detail to inform the parent about the action that is being proposed, the reasons for taking such action; and, all procedural safeguards available under the early intervention program, including the right of the parent to request mediation or an impartial hearing on the child's ongoing eligibility for the early intervention program.

PUT ON LETTERHEADITEMS IN RED ARE SUGGESTED BEST PRACTICES FOR EVALUATION REPORTING

Complete all sections/fields of this report.

Use in conjunction with NYS DOH Bureau of Early Intervention Memorandum 2005-02Standards and Procedures for Evaluations, Evaluation Reimbursement, and Eligibility

Requirements and Determinations Under the Early Intervention Program at: www.health.state.ny.us/community/infants_children/early_intervention/index.htm

Early Intervention Supplemental Evaluation Report

I. Family Information

Name: DOB: CA:

Parent/Guardian: Parent/Guardian:

Address: Address:

Telephone: Telephone:

Dominant Language: County:

Primary Care Provider: School District:

Date of Referral to EIP: Date of Evaluation:

Evaluator: Licensure/Certification: on file with County

II. Reason for Referral:Include parent perception of concern, diagnosis if applicable and who made referral.

III. Medical and Background Information:May refer back to Multidisciplinary Evaluation Report and should include:

8. Parent interview to obtain information from the perspective of the child’s parents and, with parental consent, from other individuals familiar with the child’s development regarding concerns about the child’s developmental status and progress.

9. Birth history10. Hearing and vision status

IV. Child and Parental Response to Evaluation:The child’s responses to the procedures and instruments used as part of the evaluation process, and the family’s belief about whether the responses were optimal.

V. Evaluation Procedure and Assessment Tools:In addition to standardized test used, as indicated below, observations of the child, parent, interviews and informed clinical opinion were used to assess the five developmental domains.

It should be noted that abilities in young children vary greatly over a short period of time. The current scores obtained are only an indication of current functional levels and should not be interpreted as an indication of a child’s potential development.

VIII. Explanation of Measures/Scores:Use only areas that are applicable to this Supplemental Evaluation.

ADAPTIVEIf a child is determined to have a delay in this domain, it should be associated with delays or impairments in other areas of development.

COGNITIVEChildren who score significantly below average using a standardized test would be considered to have substantial limitations in cognitive functioning.

COMMUNICATIONProblems with articulation or phonology are not sufficient to establish eligibility for the EIP.Cannot qualify based on delay in subcategories only. Must be the total score.

For children who have been found to have a delay only in the communication domain, delay shall be defined as a score of 2.0 standard deviations below the mean in the area of communication; or, if no standardized test is available or appropriate for the child, or the tests are inadequate to accurately represent the child’s developmental level in the informed clinical opinion of the evaluator, a delay in the area of communication shall be a severe delay or marked regression in communication development as determined by specific qualitative evidence-based criteria articulated in clinical practice guidelines (see attached copy of pertinent regulations 69.4.23 (2) following the Evaluation Forms included in this policy).

SOCIAL/EMOTIONALIf child is only experiencing delays in the social/emotional domain, then the child must exhibit behavioral patterns consistent with the diagnoses and disorders listed in Appendix B of NYS Department of Health Memorandum 2005-2.http://www.health.ny.gov/community/infants_children/early_intervention/memoranda/2005-02/docs/memorandum_2005-02.pdf

Psychological testing should be provided if this domain is being used to determine eligibility.

Tests and assessment tools on sensory integration functioning cannot be used to establish eligibility for the EIP. Problems with sensory integration, sensory processing, hypersensitivity,

or other sensory issues must be affecting the child's overall development in one or more of these areas to establish the child's eligibility for the EIP, and this must be documented by the multidisciplinary evaluation team.

PHYSICAL

GROSS MOTOR:Cannot qualify based on delay in subcategories only. Must use total score in gross motor to qualify.

FINE MOTOR:Cannot qualify based on delay in subcategories only. Tests and assessment tools of sensory integration functioning cannot be used to establish eligibility for EIP.

*If the central concern for a child is feeding dysfunction, the multidisciplinary evaluation must provide sufficient evidence that the feeding problem is significantly impacting on the child’s developmental status. The nature of the feeding dysfunction (e.g., oral-motor and self regulatory substrates, etc.) and its impact on the child’s development must be documented in the multidisciplinary evaluation report, including the statement of the child’s eligibility for the EIP.

VIII. Statement of Eligibility:The eligibility statement must include either a diagnosed condition with a high probability of resulting in developmental delay and associated ICD-9 code; or a statement of developmental delay consistent with the state definition of developmental delay and associated ICD-9 code for developmental delay.

IX. Recommendations:State the specific service(s) but do not state specific service modality, frequency, duration intensity and/or specific provider(s).

I have given the parent/guardian the opportunity to discuss the evaluation results including any concerns they may have with the evaluation process.

Signature Date

Original signature ensures that this report was written, reviewed and submitted by the signing clinicians.

Sent to: Parent Early Intervention Official Ongoing Service CoordinatorAdd additional individuals receiving report, if applicable

Date Evaluation Report Completed: Is the date the written report was completed. Expectation is that the report is sent within one working day.

With parent consent, the supplemental evaluation report should also be shared with the child’s primary health care provider.

Effective Date: 06/03/2010Title: Section 69-4.23 - Initial and continuing eligibility criteria

69-4.23 Initial and continuing eligibility criteria.

(a) Initial eligibility for the early intervention program shall be established by a multidisciplinary evaluation conducted in accordance with section 69-4.8 of this subpart and shall be based on the following criteria:

(1) a diagnosed physical or mental condition with a high probability of resulting in developmental delay; or, (2) The presence of a developmental delay which affects functioning in one or more of the following domains of development: cognition, physical (including vision, hearing and oral motor feeding and swallowing disorders), communication, social-emotional, or adaptive development; and, as measured by qualified personnel using informed clinical opinion, appropriate diagnostic procedures, and/or instruments and documented as: (i) a twelve month delay in one domain; or(ii) a 33 percent delay in one domain or a 25 percent delay in each of two domains; or (iii) if appropriate standardized instruments are individually administered in the evaluation process, a score of at least 2.0 standard deviations below the mean in one domain or a score of at least 1.5 standard deviation below the mean in each of two domains; or (iv) notwithstanding subdivisions (i)-(iii) for children who have been found to have a delay only in the communication domain, delay shall be defined as a score of 2.0 standard deviations below the mean in the area of communication; or, if no standardized test is available or appropriate for the child, or the tests are inadequate to accurately represent the child's developmental level in the informed clinical opinion of the evaluator, a delay in the area of communication shall be a severe delay or marked regression in communication development as determined by specific qualitative evidence-based criteria articulated in clinical practice guidelines issued by the Department, including the following:

a) for children 18 months of age or older; (i) a severe language delay as indicated by no single words by 18 months of age, a vocabulary of fewer than 30 words by 24 months of age, or no two-word combinations by 36 months of age; or(ii) the documented presence of a clinically significant number of known predictors of continued language delay at 18-36 months of age, in each of the following areas of speech language and non-speech development:

(1) Language production;

(2) Language comprehension;

(3) Phonology;

(4) Imitation;

(5) Play;

(6) Gestures;

(7) Social Skills; and,

(8) Health and family history of language problems; or,

b) for children younger than 18 months of age, documentation that the child has attained none of the normal language milestones expected for children in the next younger age range, and none for the upper limit of the child's current chronological age range, and the presence of a preponderance of established prognostic indicators of communication delay that will not resolve without intervention, as specified in clinical practice guidelines issued by the Department. (b) If there is an observable change in the child's developmental status that indicates a potential change in eligibility, the early intervention official may require a determination to be made of whether the child continues to be eligible for early intervention program services. The early intervention official shall not, however, require that such a determination be made sooner than six months after a child and family's initial IFSP in the program.

(1) Continuing eligibility for the early intervention program shall be established by a multidisciplinary evaluation conducted in accordance with section 69-4.8 of this subpart which includes the right for the parent to select an approved evaluator, and shall be based on the following criteria: (i) a delay consistent with the criteria established for initial eligibility as set forth above; or, (ii) a delay in one or more domains, such that the child's development is not within the normal range expected for his or her chronological age, as documented using clinical procedures, observations, assessments, and informed clinical opinion; or, (iii) a score of 1.0 standard deviation or greater below the mean in one or more developmental domains; or, (iv) the continuing presence of a diagnosed physical or mental condition with a high probability of resulting in a developmental delay. (2) If pursuant to subdivision (b) herein, the early intervention official requests a determination of the child's continuing eligibility for the early intervention program, and the parent refuses to consent to a multidisciplinary evaluation to establish the child's continuing eligibility, continuing eligibility has not been established and the child shall no longer be eligible for early intervention program services. The early intervention official shall provide the parent with written notice ten working days before the early intervention official proposes to discharge the child from the early intervention program. The notice must be in sufficient detail to inform the parent about the action that is being proposed, the reasons for taking such action; and, all procedural safeguards available under the early intervention program, including the right of the parent to request mediation or an impartial hearing on the child's ongoing eligibility for the early intervention program.