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Carlena Lowell SEI 513 Activity #3 Intake Visits

Activity #3: Complete at Least Three Part C Intake Visits Carlena Lowell SEI 513 Spring 2014

Carlena Lowell SEI 513 Activity #3 Intake Visits

*All names have been changed or covered in order to maintain confidentiality. Introduction When I do a complete intake visit, it typically takes 1 to 2 hours. This is the way in which my intake visits happen: 1. Introductions 2. Parents sign the Authorization to Screen and Share results after I explain that I will write a one page Screening Summary after we are through with the visit 3. Part C Vision Screening is completed 4. Part C Hearing Screening is completed 5. Modified Checklist for Autism in Toddlers (M-CHAT) is complete for children 16-30 months old 6. Denver Developmental Screening-II is completed for some children (generally not for referrals from doctors, unless the caregivers are in disagreement) 7. Decide with the parents if an evaluation is warranted (if not, discuss rights, explain next stepsWN and Screening Summaryand finish visit) 8. Discuss rights, parents sign Notice of Receipt of Procedural Safeguards 9. Discuss the evaluation and how billing works, parents sign Parent Consent for Evaluation and Financial Resources Form 10. Discuss the Authorizations to Share and/or Request Information and have them sign them as neededif they want, generally always for doctors 11. Complete the routines worksheet and the childs likes and dislikes worksheet 12. Schedule the evaluation After the intake visit happens, I write the Written Notice and complete the Screening Summary, which get mailed to the parents or caregivers, given to the evaluators, and faxed to the doctor. In addition to those two things, I also fax the Authorization to Screen and Share Results and the Authorization to Request and/or Share Information (with the doctor). I also send, and request back the prescription for
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Carlena Lowell SEI 513 Activity #3 Intake Visits

the evaluation, and the medical history form. I make referrals to the evaluators, containing the referral, the update form, and all the information I have gathered thus far. I also enter all the information I can into CASE-E, our electronic file system. Going to someones house Ive never met before is something I thought I would be incredibly uncomfortable with; however, I find now it is quite the opposite. It took me a long time as a teacher (Head Start teacher do home visits to each family twice a year) to be comfortable with home visiting at all, even if I knew the family. I am pleased with the way in which I have acclimated to completing home visits, particularly the intake visits as they are with complete strangers. One of my better qualities as a person, and specifically as a professional in this field, is my ability to be non-judgmental. This is a crucial characteristic to employ when doing what I do, particularly during intake visits. For each family I do intake visits with, the only previous knowledge I have of the family is whatever information is on the referral intake sheet, and a roughly fifteen minute phone call. Intake visits are one of my stronger abilities in this position as I have completed many of them from the start of this position. I was also able to attend multiple with the previous service coordinator in the month I trained. Intake Visit #1 This child was referred to CDS on January 28, 2014 by his day care provider due to concerns with his communication, aggressive behaviors, and fine motor development; the parents share the day care providers concerns. He is approximately 28 months old, and lives with his mother, father, maternal grandparents, and four month

Carlena Lowell SEI 513 Activity #3 Intake Visits

old brother, who recently underwent a major surgery. He attends a day care five days a week from 7:30 am to 4:30 pm. Given the age and referral parameters, after getting the Authorization to Screen and Share Results signed, I did all four screenings. During the Part C Hearing Screening, I learned the child failed his newborn hearing screening, but when he went back at three months old, he passed. He was also referred for a hearing evaluation last summer; the results of that indicated a small amount of fluid, but that his hearing was within typical limits. This Part C Hearing Screening did not indicate a need for follow up. The Part C Vision Screening did not indicate a need for follow-up, and the parents are not concerned with his vision. He passed every question on the Modified Checklist for Autism in Toddlers-Revised (M-CHAT-R), indicating no need for follow-up. He also passed each item on the Denver Developmental Screening-II, which included items such as uses a spoon/fork, removes garments, uses 6 words, combines words, kicks a ball forward, and walks up steps. At this particular home visit, the screenings did not indicate a need for follow-up and I did not think he would qualify based on the BDI-II; however, there are serious behavior concerns with the child. This is when I let the parents decide to pursue an evaluation, as that is one of their rights. I let them know he passed all the screenings, and that I did not think he will qualify based on the developmental evaluation, but they do have the right to proceed with it; they chose to proceed. Because they chose to proceed with the evaluation, we did the full intake visit. Following this conversation, we discussed their parental rights. I gave them a one page

Carlena Lowell SEI 513 Activity #3 Intake Visits

summary of their procedural safeguards, and had them sign the Notice of Receipt of Procedural Safeguards. Discussion of parental rights is an area I feel I could improve upon; I feel I need to spend more time discussing them. I would like to work on developing a better script for this part of the visit. After the parental rights were briefly discussed, the mother signed the Parental Consent for Evaluation and the Financial Resources Form, followed by Authorizations to Request and/or Share Information and Records for the day care and the childs pediatrician. From there we discuss the child and familys daily activities, and the childs likes, dislikes, strengths, needs, and the familys concerns and priorities. I have two sheets that I use for this part of the intake visit. These were created by the previous service coordinator, and I feel I could tweak them to better suit the information I would like to obtain, and the way in which I ask to obtain it. Once CDS finalizes the use of the RBI with all families, which will happen eventually but not for quite some time, these two papers will be obsolete. Once we completed these two sheets, which typically take about 30 minutes, and the evaluation was scheduled, the visit was complete. I am always sure to thank the family for their time and for having me in their home. I let them know I would send a Written Notice of the visit and the Screening Summary in a few days, and that I would see them the following week at the evaluation. Intake Visit #2 This child was referred by his pediatrician due to concerns with prematurity; the infant is now six months old and was two months premature. Considering the child spent six weeks in the hospital after birth, I was a bit confused as to why the referral due

Carlena Lowell SEI 513 Activity #3 Intake Visits

to prematurity was just now being made. When I made the initial call, the mother shared my confusion, but for a different reason: she had absolutely no concerns about her babys development. During the initial call, I like to start by asking the family if they have concerns and if so what are they, as well as how Part C of CDS works, and finally about the packet I will send them in the mail. During this initial call, the mothers tone of voice indicted she was a bit upset about the referral; she let me know she had no concerns. I made sure to let her know our service is voluntary, and if she did not want to have the intake visit that was her choice. Despite her confusion about the referral, she did say it was fine for me to come out to her house. When I arrived, the baby was sitting on the mothers knees facing her as she held his hands; his head was straight and strong. This came as a bit of a surprise to me. I completed the screenings, which for this visit included the Part C Hearing Screening, the Part C Vision Screening, and the Denver-II. I complete the Denver-II when it is a doctor referral, only if the parents are in strong disagreement with the doctor, which this mother was. The child passed all the screenings with flying colors based on the few things I administered with him, and parent report. The Denver-II corrects for prematurity and this child was two months premature; therefore, I screened for a four month old. However, in looking at the indicators to the right of the line, and he was able to do quite a few of those items as well. At six months, four corrected, he was able to work for a toy, smile both spontaneously and responsively, reach for things, hold his hands together, grasp a rattle, turn to voice, use single syllable consonant sounds as well as vowel sounds, bear weight on his legs, hold his chest up with arm support during tummy
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Carlena Lowell SEI 513 Activity #3 Intake Visits

time, and sit with his head steady. The Part C Hearing and Vision Screenings did not indicate need for further follow-up, per parent report. I let the parent know I do not see a need for an evaluation at this point, but if in the future she becomes concerned with his development she could certainly call me back. I also let her know I would send a Written Notice and a Screening Summary to her, and his pediatrician. I ended with a thank you to her for letting me come out to her house. Intake Visit #3 During a late afternoon on a Tuesday, I completed an intake visit with a family who has an 11 month old son. Their son has a seizure disorder involving his bodys ability to metabolize or not metabolize P5P, or B6, that began when he was just three days old. He spent three weeks in the NICU before coming home. After that he continued to have seizures for four more months before multiple trips to Portland and Boston finally gave way to doctors finding the right medications to control them. He has now been seizure free since last June; however, his parents estimated he had well over a hundred seizures in those first few months of life. He has been receiving PT in home since coming home from the hospital at three weeks old. I could clearly see the parents respond well to coaching from professionals as they continuously corrected his sitting and standing positions throughout the visit. I felt confident in the way the technicalities (screenings, paper work, etc.) of this intake visit went; however, even though we are going through with the evaluation, I am not so sure he will qualify for CDS services. I would love nothing more than to offer these parents early intervention services, as I know they would really like them.

Carlena Lowell SEI 513 Activity #3 Intake Visits

However, at this point, their son is developing within average limits in all areas of development, which is a wonderful thing considering his first four months of life were rattled with seizures. After the intake visit, I looked up a list of established conditions. Maine does not have its own list of established conditions for Part C; however, I sometimes refer to Colorados list just to check if certain disorders are on it. I was unable to find any seizure disorder on their list. I do believe this would fall under the atrisk category; however, Maine does not provide services to children who are at -risk for developing delays. The child recently had an evaluation, the Bayley, completed in Portland and the results indicated borderline scores in the area of cognition. The parents also have concerns regarding his speech and language development. After the January evaluation, it was recommended they contact CDS for further evaluation, which they promptly did. When I completed the screenings, I found he passed all of the items on the Part C Vision Screening and the Denver Developmental Screening-II. Since he was in the NICU for more than 48 hours and the parents have speech and language concerns, the Part C Hearing Screening indicated a need for monitoring, which in this case, will be follow-up with a Battelle Developmental Inventory-II. I did explain to them my findings in the screenings and that I was unsure if he would qualify or not. During the intake visit, they expressed an interest in learning more about young childrens development and milestones so they know what they need to look for as red flags in his development, if any were to occur. Regardless of whether or not he qualifies for services, finding resources for this is something we will help them with. Overall I felt good about this intake visit. The more I do them, the more
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Carlena Lowell SEI 513 Activity #3 Intake Visits

comfortable I feel with explaining the ins and outs of the referral process, CDS services, how third party payments work, among other things.

Carlena Lowell SEI 513 Activity #3 Intake Visits

Documentation

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Four of these were signed for the childs various doctors and therapist.

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