Early Intervention

My girls qualified for Early Intervention because of their low birth weight. I'm a teacher, so I was pretty sure I could tell if they were meeting milestones on time and if there were concerns, but I figured that it never hurts to have another pair of eyes watching. Basically, they've been getting 45 minutes of physical therapy/Early Childhood Special Ed once a month. We just needed to do a big evaluation to see if the girls would qualify for services after they turn 3. I thought Annelise might possibly qualify for speech, but was pretty convinced neither would qualify for anything else. Annelise tested right at age level for speech last week, so I was expecting to hear in the meeting today that there were no concerns and they don't qualify for services. I did hear that about Karina, which is what I expected. They told me they have huge concerns about Annelise's gross motor skills though. She tested at a 23-month-old level (she is 31 months). That's a standard deviation of -1.2 and you need a standard deviation of -1.5 to qualify for services. That means she needs a lot of help, but doesn't qualify for it. She falls through the cracks.

I'm really confused. If she is this far behind, why wasn't she getting more than 45 minutes a month of physical therapy? Even now, I had to request more sessions for her for the 4 months she is still in the program.

So now I'm scrambling to see if there are any other options to get help for her.

 

I would think if she doesn't qualify for EI, once she turns 3, maybe she would qualify through the school system. At least that's how it works here.

 

EI is the school system here. She might possibly qualify through a different program (adaptive phy. ed.), but the problem is that we attend daycare in a different school district.

 

My DDs were in Early Intervention since birth to age 3 and had PT & OT. We had bi weekly OT for a few months. Our insurance also covered OT & PT for 40 session a year (we used that for 2 years).

Then at 2.75 one DD was evaled by school district and had delays but did not qualify. I waited 8 or so months and had her reevaled. Then she qualified- she got PT & OT. It was the same thing---she was delayed, but not enough the first time. Even working with her at home- we did not make up enough 'ground'. PT & OT was done in her preschool classroom, it was great. She will get PT & OT per her IEP this year as well.

She had gross motor and social delays. Now, I dont think she would qualify per new evaluation since she has made great progress!! She is still a bit behind gross motor-wise, but not nearly as noticable. Most of all, she feels good about herself (before she used to get upset that her peers could ride a trike, run fast, etc).


Can you request a re-eval in a few months? Can you get insurance to cover any privately? We have seen a neurologist for months so we had a script from him that she needed PT & OT.

 

Definitely check your insurance benefits. There may be a pediatric home care provider that could come to your house or to daycare. Usually there are separate home care and outpatient rehab benefits so check both. A call to the PT department at a local hospital may give you some resources as well.

 

Do you know what areas she needs work in? Is it something you could work on with her at home through certain play activities? I would be a little ticked off too that she is already seeing a PT once a month and they haven't noted any concerns or wanted to do more regular therapy. PT is also often covered by private insurance. I know our speech therapy was never covered, but our OT was (which was coded to insurance for fine motor delays).

 

I just went through her IFSP (like an IEP for early childhood kids) with a fine-toothed comb and made a list of things we can work on at home. Someone on facebook made a comment about how someone she knows took her child's disability upon herself and he functions "normally" now. Well, of course I'm going to help her all I can at home, but I'm not a physical therapist. We need someone who is educated in this area to guide us. I was a little irked by that comment (not by Jessie's above because I know she meant to try to get a jump on things and not that I should do it without help) because she sort of implied that I'm depending on other people to help her and I'm not working with her myself. Anyway, I contacted the school and asked them to give me a copy of the results of the PT evaluation (all I have is a summary) so that I can take it to our pediatrician if we need to go that route. I also sent an email to the lead special ed teacher in the school in which I work to see if she has suggestions and if she thinks we can open enroll Annelise to the school to get her some adaptive phy. ed. help.

My DH seems to remember going to an adaptive phy. ed. class in 3rd or 4th grade himself. I found that interesting. So this may be somewhat genetic and not just related to her prematurity. He also reminded me that one of the girls had hip x-rays early on and we wonder if the problems might be related to that hip issue. The sad thing is that I can't remember which child there were concerns about. There weren't significant findings on the x-ray, so we never pursued anything in that area. I guess I need to call the pediatrician and find out which kid had the x-ray.

 

This is the list I've compiled from the info I found in her IFSP:


1. Jump with both feet together 3 times consecutively.
2. Walk on tiptoes and balance for 3 steps.
3. Jump forward 4 inches.
4. Jump off a 8 inch step with one foot leading.
5. Throw a playground ball 5 feet 3 times in a row.
6. Walk up and down steps consistently without assistance.
7. Stand on one foot for two seconds.
8. Throw a tennis ball moving arm up and back so ball travels 5 feet forward.
9. Run in a mature fashion with arms down and reciprocal swing for 45 feet in less than 6 seconds.
10. Attempt to hop on one foot.

The one part that really seems difficult is #6. She is really very small. Normal steps come almost all the way to her knee. She also usually cannot reach a handrail if there is even one available. If steps were that tall to me, I would also have a hard time getting up and down them without using my hands on the steps and I probably wouldn't alternate feet either.

The rest of the stuff seems reasonable and like things we can work on at home. DH jokingly said it's too bad he can't help since he can't do most of those things himself. He has never been an athletic guy.

 

Wow-- they wanted her to do all that at 2.5??

Neither of my DDs could at 2.5 and only one qualified for an ISFP/IEP. At age 3.5 her gross motor skill goals (things she could not do) included throw a ball 'forward', hop on one foot, go up stairs reciprically, walk a 6 foot balance beam,stand on one foot for 4 seconds, ride a bike w/ training wheels, and run appropriately--and she only has mild delays. IF your ISFP was written for the next year, it would make sense for her to master those 'by age 3.5', but not neccasarily.

Now at 4.75 she can do all those things except the stairs (she CAN but does not do it if you dont make her) and seh still can not ride a bike up an inclined plane (only flat surfaces).


One of the best purchases we got to help 'jump' skills (and for sensory) was a small personal trampoline w/ handle bar. The PT suggested what one and we have it in our living room (it is REALLY small- kid sized) and it made huge strides in improving her leg muscle tone and endurance.

I would also look into some gross motor play 'groups', we got involved in a gross motor play group that was free through EI adn it was great!

Good luck adn hoep all goes well. Both my DDs has gross motor delays and one is fully caught up and the other is sooooo close! It is amazing the growth in a year.

 

Well, these are goals that were just set at her IFSP review for the next 6 months (really only 4 months since she'll turn three and will not be eligible for services after that). But about half of the goals are carry-over from the past IFSP since she did not meet them. Thanks for the trampoline suggestion. That's a good idea.

 

You're probably going to have to find something else. I don't have the best experience with EI either, before we moved my DD who couldn't put her feet flat at all had therapy every other week... totally useless. Then even at 2.5, they need huge delays to qualify... my kids are almost 30 months and barely have 40 words, and we had to cheat a little to keep them with EI... so a lot of kids who should get help falls through the crack because they are delayed but not enough... it's sad!

 

They are trying to change the delay to 50% from 30% here.

 

:hug: Beth! It sounds like EI really dropped the ball on not getting her help sooner for her gm skills.
We just went through our re-assessment for my two that are in therapy through EI and they told me that they won't do the big assessment for 3y until they are under a month away from turning 3. Can you talk to the therapist? My son's therapist has been working with him for over a year and she mentioned that she didn't think he would technically qualify for therapy once he turns 3 and goes to the Public School system but that she felt she could underscore him a tad to help that. He's going to be very very close like your dd. It might be worth pushing a little. Just a thought. ardon:

For now I would get as much info from her therapist as possible and maybe some training or books that you can look at to help her if she ends up not going on.

Good luck!

 

Jumping boards here. My experience with EI has been pretty positive. Michael was initially declined for PT but approved for OT services. I pushed to have him re-evaluated and they told me I was entitled to another evaluation in 3 months. He was seen by another PT who approved him for services. My suggestion would be to ask for another evaluation, by another PT, to get another opinion and to see what process she's making with her current therapy program.

 

The problem is that there are only 4 months before she no longer qualifies for EI at all because she turns three. The other problem is that there is only one PT, so there is no way to get another opinion within EI. Right now I'm trying to get a copy of the evaluation (not just the summary I have) so that I can take her to our pediatrician to see what he recommends.

ETA: The PT was also supposed to call me regarding setting a time for therapy this week (I was told this last Wed.) and I have yet to hear from her. I'm going to call this morning and see what I can find out.