GETTING A FORMAL EVALUATION

What if my health care provider indicates I need a follow-up visit with a specialist?

Your health care provider is simply telling you that your child needs a more formal evaluation to learn more about how he or she is learning to talk, interact, act, play, learn and move. This will be a much longer visit. It is typically done by a specialist in the area of child development, but may involve several different specialists.

What sort of specialist?

There are many routes to a formal evaluation:

You can obtain an evaluation by public Early Intervention and public education offices. The contact information for these offices changes depending on where you live and can be found on the Autism Speaks website.
You can obtain a developmental health assessment by a pediatrician, psychologist, neurologist or other specialist. This may or may not be covered by insurance, so be sure to check with your insurance provider. Get a referral from your primary care provider to be safe.
You may also be referred to a private health specialist like a speech therapist, occupational therapist or physical therapist who can evaluate your child.

Many parents choose to follow multiple routes at the same time. For the most part, information in this tool kit pertains to evaluations that are provided by the public health and education systems.

What are my rights?

Unfortunately, it is common for families to have to wait weeks or months before seeing a specialist. While you are waiting for an appointment with a specialist, there are some things that you may want to know.

The following piece is “time critical” as Early Intervention services through the public education or health system are only available until age three in most states.

If your child is under the age of 36 months:

He or she is entitled to an evaluation through your state’s office of Early Intervention, also referred to as “Birth to Three” or “Part C.”
The local Early Intervention agency must perform a free assessment to determine if any child has a disability.
The agency is required to complete an initial evaluation no later than 45 days after receiving written consent from you to assess your child.

If your child is 36 months or older:

He or she can receive an evaluation through the school district.
Local education agency must perform a free assessment to determine if any child between 36 months and 21 years of age has a disability.
The initial evaluation must be completed no later than 60 days after receiving written consent from you to assess your child.

What are the costs?

Evaluations and assessments by the state Early Intervention or public education department are provided at no cost to parents. They are funded by the state and federal government. In terms of services for your child, whether or not you will have to pay for certain services depends on the policies of your state. Services that must be provided at no cost to families include: Child Find services, evaluations and assessments, development and review of the Individualized Family Service Plan (IFSP), as well as service coordination.

Depending on your state’s policies, you may have to pay for certain other services. You may be charged a “sliding-scale” fee, meaning the fees are based on what you earn. Check with the Early Intervention representative in your area or state. Some services may be covered by your health insurance or by Medicaid. Every effort is made to provide services to all infants and toddlers who need help, regardless of family income. Services cannot be denied to a child just because his or her family is not able to pay for them

What sort of assessments will my child receive?

Your health care provider may also provide referrals for an evaluation or additional testing, which may or may not be covered by insurance. Here are some important points to remember:

An audiological assessment (hearing test) referral should be made for all concerns regarding speech, language or hearing difficulties. This is usually done by an audiologist.
A cognitive evaluation (or developmental assessment) using standardized tests that measure both verbal and nonverbal abilities should be performed by a psychologist or other professional experienced in testing children.
A medical and neurological evaluation may need to be conducted to assess such issues as acquired brain injury, seizure disorder, self- injury and sleep or eating disturbances.
A speech-language-communication evaluation should be performed on all children who have communication difficulties. This is done by a speech-language pathologist or psychologist.
An evaluation of sensorimotor skills by a physical or occupational therapist should be onsidered when a child demonstrates difficulties in how he or she moves or in sensory responses, as part of the diagnostic, cognitive, medical or speech evaluation.

If your health care provider sends you to a specialist for a diagnostic assessment of autism, you will receive a written report of the results of your child’s evaluation. This should also include information on your child’s strengths and weaknesses, as well as general level of developmental functioning.

What does a typical evaluation through the Early Intervention system look like?

Once your child is referred, your Early Intervention office will assign an initial service coordinator to work with you and your family. He or she will talk with you regarding your concerns about your child’s development.

The coordinator will also review your family’s rights, make sure you understand them and help you arrange for your child’s evaluation. If your child’s evaluation shows that he or she is eligible for the state’s Early Intervention program, your initial service coordinator will set up a meeting to work on your Individualized Family Service Plan (IFSP), a written plan for providing Early Intervention services to your child. The job of your initial service coordinator is to help you with all the steps leading up to your first IFSP meeting.