Therapy: Developmental vs Medical vs Educational

With all the changes that have happened with regards to funding for therapies and services for kids with special needs there has been a lot of questions in terms of therapy services about the difference between medical-based therapy, developmental-based therapy and school/educational-based therapy.  I will do my best to shed some light on the matter!

Early intervention or early start services cover kids ages 0-3 who demonstrate a delay in development in specific areas.  Early start services work under a developmental model.  If your child is not reaching milestones and is delayed ‘enough’ then the goal of services is to progress your child through the developmental sequence providing them with an opportunity to catch up to their peers.  During this time parents and caregivers should be receiving training from the therapist to assist in the progression and carryover of their child’s developing skills.

Because of the requirements, in the state of California, that children now must utilize their insurance first before the state will fund therapy services many kids are getting referred to hospital outpatient facilities because that is where their insurance is contracted with.  Many of these centers (and yes, I am making a blanket statement) are used to following a more medical based model.  Oftentimes they will see a child who has a specific injury or change in status and they require services to get them back to their prior level of function.  They are helping the child and the family come back from whatever medical set back or injury they had.  This is different than the developmental model that works to progress children through the developmental sequence.

Both of these are different than school based services.  School based or educational based therapies are provided by the educational system when a child turns 3.  The child has an IEP which involves various team members and evaluations in all suspected areas of delay.  The role of the school system in providing therapy is to provide your child with access to their education.  So, even though your child may still be delayed, this does not automatically ensure that they will receive school based services because the school system may decide that it is not affecting their access to education.

I will write more later on the topic of educational based services but I wanted to give a brief description of the various delivery models that are out there for therapy to help clarify any questions families have.  The developmental vs medical based approaches are starting to cross lines due to the requirement of children using insurance but they are still different approaches.

Hopefully this answered some questions, I’m sure it raised some more – please feel free to let me know if you need anything clarified!

Top 10 Blog Posts of 2009

I always loved David Letterman’s Top 10 lists so I decided to create my own for the Top 10 Blog Posts in 2009. This is based on the number of times they were viewed.

10. Early Intervention and Budget Cuts in California

9.  Bike Riding

8.  Having a Ball with Core Muscle Strength

7.  Fun Ideas For Sensory Exploration

6.  Why is W-sitting a Four Letter Word?

5.  How Resilient is Your Child?

4.  Buns of Steel

3.  Why is w-sitting Being Promoted in Advertising?

2.  Do Video Games Promote or Hinder Child Development?

1.  Sensory Exploration in Today’s Society

I’m looking forward to see what posts will be top for 2010!  Wishing everyone a happy, healthy and prosperous New Year!

Early Intervention and Budget Cuts in California

This is a topic that is near and dear to me at the moment because it is affecting a significant number of the families that we work with here in California.  I am not sure if early intervention has been affected in other states but I know that here in California state funding has forced budget cuts in early intervention.

In California the state funded agencies for early intervention are the regional centers.  One regional center may cover several counties.  Early Start is the program run by the regional centers to cover kids who are aged 0-3 that have developmental delay.  Early intervention is mandated by the Federal Government under IDEA Part C.  You can also look up Wright’s Law for more information.   Early Intervention can vary from state to state in terms of eligibility however they must at a minimum meet the requirements of IDEA Part C.

As of July/August 2009 the California criteria for Early Start eligibility changed.  The changes still fall within the requirements for IDEA Part C however they are impacting the children and families who were and are receiving services through the Early Start program.

Some of the changes that affect children with delayed motor skills are:

• kids who are considered high risk for developmental disability are no longer eligible for Early Start services
• significant delay for children 0-23 months is considered 33% delay in one or more areas, and for children 24-36 months it is 50% in one area or 33% in two areas (gross and fine motor are considered one area) – this means that for a child turning 2 they have to be functioning at a one year old level to qualify for services
• parents must utilize private insurance for all medical services other than evaluation and assessment – once they exhaust their coverage they will receive funding through the regional center

The long term impact that these changes will have is unkown at this time however some of the concerns myself and my colleagues have are:

• Many of the current providers for Early Start do not accept private insurance so the child is having to switch providers and lose continuity of care.  The flip side is also true that a lot of larger facilities that do accept private insurance are not vendored with the regional centers so a child will have to bounce back and forth between providers as their funding source changes.
• The children who are no longer eligible for services based on the new criteria are the children who are almost where they are supposed to be and have generally been making steady progress toward closing the gap between them and their peers in terms of motor development with the help of skilled services.  By eliminating the skilled service these children are at risk for falling further behind their peers.
• These same kids who are inbetween, meaning they don’t meet eligibility criteria but they aren’t age appropriate in their motor skills are the ones who may fall in the cracks and stay just a little behind their peers or who may slow their progress and increase the gap between them and their peers.  This may increase the financial strain on the school system because now they may require skilled services once they turn 3.

All of these are speculation on my part but they are concerns.  This article discusses the benefits of early intervention and the potential to financial benefits later if the children are helped early.  By putting the time and money in early there is the potential to save resources later as the children get older.

I don’t know what the answer is but there has to be another solution that doesn’t involve eliminating services for the kids who just need that extra push to catch up with their peers.  I wanted to write this post to bring awareness to families in California and elsewhere.  I do know that by spending time with your child developing their motor skills as they grow (for example tummy time, crawling, climbing, etc.) you will decrease the chances of your child having delayed motor skills.

Please share if you have information that may help families who are affected by the changes.