Easing the Transition from Early
Intervention to Preschool-Based
Services
PDSA Project
Washington Heights Family
Health Center
2005-2006
Why did we choose this
PDSA project?
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Many kids seemed to “fall through the
cracks” after Early Intervention expired at the
age of three
Familiarize providers about the transition
process between early intervention and
school-based services
Further allow this transition to be as
uninterrupted as possible
Background: Early Intervention
Program (EIP)

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Age eligibility: 0-3 years
EIP must provide a service coordinator to ensure
that services are provided year-round and an Early
Intervention Official (EIO) to help ease the transition
to pre-school
An Individualized Family Service Plan (IFSP) details
all of the services to be provided for each referral
Children eligible for pre-school special education can
stay enrolled in EIP until their third birthday
Background: Preschool-aged
Special Education
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
Age eligibility: >3 years
Patients are deemed eligible by the
Committee on Preschool Education (CPSE)
and must have documented disability within
an Individualized Education Plan (IEP)
Background: Transition Process
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Begin EARLY! At 2 ½ years of age!
A transition plan should be incorporated
into the IFSP by the service coordinator
Obtaining written parental consent is an
integral step in the transition process
–
Parent must report to regional CPSE
office with EI exit evaluation and MDendorsed health form
PDSA Cycle 1: Pre-intervention chart
review
• 12 total well-child visits of children 3 years
old with a diagnosis of developmental,
speech, or language delay were reviewed
 50% had documentation of transition to
school-based services
–
–
Documentation was non-uniform
Attendings and third year residents were most
likely to document school transition
Project Goals
1.
2.
3.
To improve MD discussion of transition process to
80% of eligible children
To educate at least 75% of parents of eligible
children about the transition process
To document the transition to a school-based
service (or at least document the completion of an
intermediate step for at least 50% of eligible
children)
Develop lecture series of
background information


Meetings held with Evelyn Batista, MSW and
Dr. Harriet McGurk to gather information
Lectures given (during block 4) to all
providers during afternoon resident didactic
session
Develop EI folder to be placed in all
provider rooms
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Contents determined from
prior research
EI folder holds the following
useful tools:
–
–
–

“MD Information Sheet”
highlighting critical steps in
transition process
Map of educational districts with
contact information
List of organizations who
provide direct advocacy
assistance for individual
students with school problems
District map also displayed in
resident room
PDSA Cycle 2: Develop EI sticker
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EI sticker to be used in the
charts of patients between
ages two and three who are
EI participants and will be
transitioning
Prompts the provider to
collect information about
the officials responsible for
the transition process
Prompts the provider to ask
about parent-participation
Reminds the provider of
their role in the transition
process
First Draft of EI Sticker
EI Service Coordinator
EI Srvcs Continue Thru
[ ]8/31 (turning 3 between 1/1-8/31)
[ ]12/31 (turning 3 between 9/1-12/31)
CPSE Region & District
(see map)
Region _____ District_____
Phone Number _____________
CPSE Referral Status
[ ] EI has referred child to CPSE for evaluation
[ ] Parent has signed consent for CPSE evaluation
[ ] Evaluation has been scheduled
[ ] Parent attended meeting about their child’s IEP
and/or signed a consent agreeing with the IEP
[ ] Placement will be at ____________________
Provider Action
[ ] Completed health forms for CPSE eval
[ ] Asked parent to bring a copy of the IEP
[ ] Other:
Abbrevs: EI= Early Intervention, CPSE= Committee on Preschool Education,
IEP= Individualized Education Program
PDSA Cycle 2, cont’d: EI Sticker
Critique/Feedback from Providers
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Add place for signature of provider
Delete line with abbreviations and format to
fit sticker size
Sign-up list placed in resident room with
medical record number and provider for each
new sticker placement (to track progress)
Second Draft of EI sticker
EI Service Coordinator
EI Srvcs Continue Thru
[ ]8/31 (turning 3 between 1/1-8/31)
[ ]12/31 (turning 3 between 9/1-12/31)
CPSE Region & District
Region ____ District_____ Phone #
____________
CPSE Referral Status
[ ] EI has referred child to CPSE for evaluation
[ ] Parent has signed consent for CPSE evaluation
[ ] Evaluation has been scheduled
[ ] Parent attended meeting about their child’s IEP
and/or signed a consent agreeing with the IEP
[ ] Placement will be at ____________________
Provider Action
[ ] Completed health forms for CPSE eval
[ ] Asked parent to bring a copy of the IEP
[ ] Other:
Signature:
Date:
PDSA Cycle 3: Formal EI sticker
evaluation

Second chart review conducted to determine whether
providers are using the sticker, and if not, why?
–

5 of 6 residents and 9 of 12 attendings surveyed
Of 14 surveyed, 6 use the sticker, and 8 admit to not
using it at all.
–
When asked why nonusers decline using the stickers, the
answers were:
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“The patient did not fit the criteria to benefit for special
education services”
“I did not know about it”
PDSA Cycle 4: Assess parental
knowledge of transition process
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Resident called seven parents from patients listed on
sign-up sheet
Parents are unaware of the transition process and
assume that it “just happens automatically”
Parents are surprised that we may play a role in
easing this transition
–

“¿Doctora, porque Ud quiere a ayudarme con esto?”
Parents want our help in knowing how to advocate
for their children
PDSA Cycle 5: Interview with EI
Coordinator

Spoke with an EI service coordinator to gain insight
into reasons why the transition process may fail:
–
–
–
–
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Lack of parental consent for CPSE evaluation
Not receiving the CPSE packet in the mail
Not responding to the packet
Misunderstandings about the evaluation
Social stigmata of special education
CPSE refuses to provide services
PDSA Cycle 6: Interim Review

Chart review: Patients seen between 12/1/05 and
3/1/06 with primary diagnosis of developmental
delay or speech delay
–
–
–
25 charts reviewed, 15 of these patients fit criteria for sticker
placement, but only 4 had a sticker in their chart (26.6%)
3 additional charts had written documentation but no sticker
Higher percentage of sticker usage among residents than
attendings (33% vs 22%)
PDSA Cycle 6, cont’d: Provider
Feedback on Interim Chart Review
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EI sticker should be used with each initial
referral
Sticker should be modified to include the
date of initial referral
PDSA Cycle 7: Chart review to assess
sticker usage in new referrals
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Chart review: Charts from patients seen in
2/06 were examined to see if there was
documentation of a new EI referral with a
sticker
–
–
Nine charts reviewed, three were new referrals
Of these three, only one had a sticker
documenting the date of the initial referral (33.3%)
Third and Final Draft of EI sticker
Date of Initial Referral
EI Service Coordinator
EI Services Continue
Through
[ ]8/31 (turning 3 between 1/1-8/31)
[ ]12/31 (turning 3 between 9/1-12/31)
CPSE Region & District
Region ____ District_____ Phone # ____________
CPSE Referral Status
[ ] EI has referred child to CPSE for evaluation
[ ] Parent has signed consent for CPSE evaluation
[ ] Evaluation has been scheduled
[ ] Parent attended meeting about their child’s IEP
and/or signed a consent agreeing with the IEP
[ ] Placement will be at ____________________
Provider Action
[ ] Completed health forms for CPSE eval
[ ] Asked parent to bring a copy of the IEP
[ ] Other:
PDSA Cycle 8: Final Chart review

18 charts reviewed with diagnosis of either
developmental delay or speech delay of patients
seen between 3/1/06 and 3/29/06; seven met
criteria:
–
Three new EI referrals (all resident patients)

–
Two in EI → CPSE transition (one resident, one attending)

–
–
Two with stickers, one without
Both with stickers
One EI Re-evaluation (attending patient) with sticker
One Follow-up EI (resident patient) without sticker
PDSA Cycle 8: Data from Final Chart
Review
100
90
80
70
60
50
40
30
20
10
0
Attending usage
Resident usage
Initial chart review
Final chart review
Conclusions
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Sticker usage has improved among attendings and
residents (>50% as in initial project goals)
Providers have become better informed about the
transition process
Sticker usage should continue to be encouraged
because it:
–
–
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Acts as a reminder for the provider to address these issues
during a well-child encounter
Encourages families to view us as another resource to
advocate for their child.
Format EI sticker in future Eclypsis system
References
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Dr. Harriet McGurk
Evelyn Batista, MSW
Elba Moreira, EI Assistant Director of Service
Coordination
www.insideschools.org
www.health.state.ny.us/community/infants_c
hildren/early_intervention
www.vesid.nysed.gov
Acknowledgements
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Dr. Adriana Matiz
Dr. Mariellen Lane
Dr. Daniel Hyman
Dr. Harriet McGurk
Evelyn Batista, MSW
Dr. Teresa Lee
Dr. Monique Collier
Dr. Matt Laurich
Dr. Maria Kim
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Dr. Eliza Auerbach
Dr. Sarah Shrager
Dr. Ray Liu
Dr. Paola Ayora
Dr. Dawn Wetzel
Dr. Rachel Salguero
Dr. Rachelle Gandica
Dr. Maja Castillo
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Easing the Transition from Early Intervention to Preschool