Early Support for Infants and Toddlers (ESIT)

A. Regulatory Guidance

The health and safety of staff providing services, and the infants, toddlers and families receiving them, must always be prioritized. The Office of Special Education Programs (OSEP) offers flexibility in their Disaster Response Guidance which includes guidance regarding health-related disasters.

The importance of maintaining connections with families is paramount. During this time of crisis, families will likely experience a greater need for the support provided through family resources coordination. Things like accessing food, medical care and navigating especially tenuous resources may override more tangible developmental goals. Compliance requirements are secondary to maintaining strong communication with families.

Yes. The U.S. Department of Health and Human Services has notified states of enforcement discretion for telehealth remote communications during the COVID-19 Public Health Emergency.

OSEP’s Disaster Response Guidance includes health related disasters.

“For children who did not receive early intervention services for an extended period of time, once services resume, the service coordinator and EIS providers must determine if the child’s service needs have changed, determine whether the IFSP Team should review the child’s IFSP to identify whether any changes are needed, and consider whether compensatory services are needed. (20 U.S.C. 1436; 34 CFR § 303.342(b)).”

Yes. Early Intervention Providers are encouraged to find creative ways to provide continuity of services. It is important for staff providing virtual home visits to have experience with this method of service delivery or receive appropriate training. If this option is offered to one family, it must be offered consistently to all families.

There is no regulatory requirement regarding tele-practice. The ESIT state office will waive the monthly face-to-face guidance during this state of emergency.

Questions about contracts with Local Lead Agencies or School District will need to be addressed directly with the contracting agency.

If feasible, providers should first attempt to obtain parent signatures electronically. If this is not possible, to provide equal access to services during this state of emergency, service providers may obtain verbal consent. Documentation must include service provider initials and date consent was obtained. Parents can then sign and date the IFSP when face-to-face services resume.

There are two possible options. The first is to enroll the child with an interim IFSP, which allows services to begin immediately, but does not stop the 45-day timeline. The second option is to use evaluation tools that allow for parent reporting and conduct the evaluation using telephone or videoconference.

It is important to offer different options. Does the family have the ability to secure videoconferencing via either computer or cell phone? If so, virtual home visits can be offered. If this is not possible, can the family meet via telephone? If so, a phone check in and mail out printed materials can be offered. Ultimately, these decisions are up to the family.

B. Continuity of Operations

Early Intervention Provider Agencies are encouraged to follow recommendations from their respective County Health Departments in relation to continuity of operations and potential closure, in accordance with their existing governance structures. ESIT will continue to post updated guidance through the DCYF COVID-19 website.

It is important during this state of emergency to take the most expansive approach to eligibility. While CFR 303.321(4)(b) states “… no single procedure may be used as the sole criterion for determining a child’s eligibility…” there may be additional information that can be used to assist in establishing eligibility. Examples of ‘criterion’ might include:

  • Both informal and formal parent interviews
  • screening or assessments administered in a hospital or clinic settings
  • medical records from a referring physician or hospital

The use of informed clinical opinion is also encouraged to the greatest extent possible to support eligibility where a tool is not definitive.

C. Fiscal and Contract Requirements

DCYF will continue to reimburse for expenses incurred and billed on an A-19 invoice. DCYF is working in collaboration with HCA and the Insurance Commission to clarify flexibility in service provision and payment protocols during this state of emergency.

DCYF is working with OSPI leadership to verify that state special education funding for contracted early intervention services will not be impacted by closures or temporarily suspended services due to COVID-19 infection of exposure.

Options can be provided to the family that include virtual visits or tele-practice that are billable. Family Resources Coordination without additional other services can be billed for up to three months.

Excerpt from DCYF Communications
Friday, March 20, 2020
Sent by Stephen Cotter, DCYF Office Chief - Contracts & Procurement

DCYF Providers,

As you know, we have all been working to ensure the continuation of services during this unprecedented public health crisis. We have been working to develop guidance to providers during the COVID-19 pandemic. Soon, you will be asked to visit a DCYF website, where you will be shown how the services you deliver may be impacted/modified during this crisis. You will be asked to agree to these changes, as a condition of continued service delivery. These changes will largely relax provisions in your contracts and provide direction about what services you should continue to provide and how to prioritize cases.

DCYF is committed to continuing financial support to your organizations that is similar to payment you have received in the months before the Coronavirus. This website will also ask you to verify your willingness to be available for some level of service or emergency services in exchange for retainer payment. We are working out the exact methodology for this retainer payment and it may vary slightly by service area.

Please stay tuned and await further communication from DCYF. We appreciate your hard work and dedication during these difficult times.

D. Practice

The U.S. Department of Health and Human Services has notified states of enforcement discretion for telehealth remote communications during the COVID-19 Public Health Emergency. “A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients.

OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.”

The state does not have the authority to waive this requirement. The federal government has temporarily waived potential HIPAA penalties for good faith use of telehealth [teleintervention] services. This waiver is an effort to allow providers to use virtual methods of service delivery more quickly to ensure continuity of services during the COVID-19 outbreak.

Although providers may not be penalized for using communication methods that do not otherwise meet the safeguard standards of the HIPAA Security Rule, FERPA and IDEA protections still apply to a child’s educational record. If a teleintervention session is recorded, it becomes part of the child’s record and must be maintained in the record and protected in compliance with FERPA and IDEA. If the session is not recorded, the notes related to the session are a part of the record and must be maintained and protected in compliance with FERPA and IDEA.

While the HIPAA waiver allows providers to use methods such as Skype or FaceTime for providing teleintervention services, records and communications must still be protected from unauthorized disclosure and accessed through secure Wi-Fi. For more information, including acceptable platforms for telehealth [teleintervention] and other communications, please read the guidance from the U.S. Department of Health and Human services

E. School District Closures

Joint Collaborative Response
DCYF and OSPI on March 24, 2020

See Question B.1. in Questions and Answers: Provision of Services to Students with Disabilities During School Closures for COVID-19

Health and safety concerns are paramount. If there is no feasible way to continue evaluations safely using distance methods or following social distancing requirements, then districts should consider delaying the evaluation until safety measures can be implemented.

State Lead Agency for the ESIT Program (DCYF): Early Intervention Provider Agencies (EIPAs) are encouraged to communicate with individual families and with their local school districts regarding the feasibility of a virtual transition conference and how best to approach required transition activities. Potential options for transition meetings may include virtual methods to include conference phone calls or videoconferencing during periods of school closures. Existing early childhood transition personnel and their respective contact information remains the same during the period of school closure. School districts have local protocols in place to respond to emails. After decisions related to early childhood transition options have been jointly determined, written communication with families should be prioritized. For assistance troubleshooting specific circumstances, please contact Val Arnold, ESIT Strategic Innovations Advisor, at valerie.arnold@dcyf.wa.gov or 360-485-7773.

State Education Agency (OSPI): Resident school district personnel responsible for planning and scheduling initial evaluations for special education preschool services are encouraged to communicate with individual families to determine the feasibility of face-to-face transition conference meetings for 3-year-olds exiting B-3 early intervention. Consideration of social distancing measures and DOH guidance to ensure safe implementation is a priority. If this is not feasible or acceptable to families’, alternative virtual options may be explored as a means of meeting transition planning and implementation requirements. After decisions related to early childhood transition options, including the timeline for completing an initial evaluation have been jointly determined, written communication with families should be prioritized. For assistance troubleshooting specific circumstances, please contact Ryan Guzman, Early Childhood Special Education/Section 619 Coordinator at ryan.guzman@k12.wa.us or (360) 764-9448. 

Joint Collaborative Response
DCYF and OSPI on March 24, 2020

See Question B.4. in Questions and Answers: Provision of Services to Students with Disabilities During School Closures for COVID-19

In collaboration with DCYF, school districts who are providing early intervention services for children ages 0–3 under IDEA Part C directly, and not contracting for those services with a community-based organization, should extend the 3–21 guidance provided in this Q&A to include Part C service delivery, where applicable. For assistance troubleshooting child/family-specific circumstances, please contact Valerie Arnold, ESIT Strategic Innovations Advisor, at valerie.arnold@dcyf.wa.gov or 360-485-7773.

If the delay is caused by provider illness, efforts must be made to offer services from another provider (these may be offered via tele-practice).If the delay is caused by family illness or family cancelation for other reasons please apply exceptional family services as an allowable reason for not meeting required timelines. In some cases, compensatory services must be considered (See below). Compensatory services are intended to compensate or make up for IFSP services that were unavailable to the child and family. The information we have received from OSEP is from their Disaster Response Guidance and includes health related disasters. “For children who did not receive early intervention services for an extended period of time, once services resume, the service coordinator and EIS providers must determine if the child’s service needs have changed, determine whether the IFSP Team should review the child’s IFSP to identify whether any changes are needed, and consider whether compensatory services are needed. (20 U.S.C. 1436; 34 CFR § 303.342(b)).”

March 13, 2020