NECTAC Webinar Series on Early Identification and Part C Eligibility

1
NECTAC Webinar Series on Early Identification
and Part C Eligibility

• Session 2 A Rigorous Definition of Developmental
  Delay
• March 10, 2010

Steven Rosenberg, Ph.D.
University of Colorado Denver
Duan Zhang, Ph.D.
University of Denver
2
Issues

• Nationally only a small proportion of the
  children who are likely to be eligible for Part C
  services receive early intervention.
• Eligibility definitions, used by states and
  jurisdictions, make many more children likely to
  be Part C eligible than the system serves.

3
More Children are Likely to be Part C Eligible
than are Served

• Eligibility More than 12 percent of the nations
  children who are under 3 years of age are likely
  to be Part C eligible.
• Underenrollment Only about 10 percent of these
  presumptively Part C eligible children received
  early intervention services.
• Rosenberg, S., Zhang, D. Robinson, C.
  (2008). Prevalence of developmental delays and
  participation in early intervention services for
  young children. Pediatrics, 121, e1503e1509.

4
Problems with Making Far More Children Eligible
than are Served

• States may meet their targeted percentage of
  children served without having to create
  effective child find procedures.
• States may miss children who may have a greater
  need for early intervention than those who are
  enrolled.

5
Racial Disparity
African-American children are half as likely to
receive early intervention as white
peers. (Rosenberg, Zhang Robinson, 2008).
6
Task

• Understanding the causes for the large numbers
  of presumptively eligible infants and toddlers
  who do not receive Part C services should begin
  with an examination of how Part C eligibility is
  defined.

7
Definitional Problems

• State Part C eligibility definitions are part of
  the problem
• Many eligibility definitions make more children
  likely to be Part C eligible than the system
  intends to serve.
• Inaccuracies and contradictions are often built
  into eligibility definitions.

8
How Do State Definitions Make Children Part C
Eligible?
Standard deviations are used to establish
eligibility.
Standard deviations used in eligibility
definitions assume a normal curve.
http//www.comfsm.fm/dleeling/statistics/notes06.
html
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Standard Deviations are Used in Part C
Eligibility Definitions

• Standard deviations are directly related to the
  number of eligible children ---
• 2 standard deviations expect about 2 of children
  for each developmental domain
• 1.5 standard deviations expect about 7 of
  children for each domain

10
Assessing for Delays in Multiple Areas Increases
Rates of Eligibility

• For an eligibility criterion of 2.0 SD below the
  mean in one domain assessing with
• Mental subscale gt 2.1 eligible.
• Motor subscale gt 2.4 eligible.
• Mental or Motor subscales gt 3.6 eligible.
• Bayley Research Short Form used for ECLS-B 9
  month assessments

11
How Do State Definitions Make Children Part C
Eligible?Developmental Age (DA) Scores

• Developmental age scores are also used to
  establish eligibility.
• Developmental age is an estimate of the average
  age that children can accomplish certain tasks.

12
Developmental Age Scores Norm or Criterion
Referenced Tests

• DA scores obtained on norm referenced tests
  represent the average chronological age of the
  children who obtained a specific raw score.
• DA scores obtained from criterion referenced
  tests reflect the ages at which the behaviors
  assessed emerge in typically developing children
  based on information from the literature on child
  development or from older normed tests.

13
Developmental Age Scores

• There are a number of problems with developmental
  age scores
• DA scores are not well related to the number of
  eligible children.
• DA scores are less precise estimates of
  children's abilities than scores based on
  standard deviations.

14
Percent or Months Delay are Problematic in
Eligibility Definitions

• In general developmental age scores should not
  be subtracted or divided by childrens
  chronological ages.
• Consequently its not a good idea to use months
  delay or percent delay to establish eligibility.

15
Contradictions in Eligibility Definitions

• Definitions that use percent or months delay and
  standard deviations have built-in contradictions.
  
• Developmental ages and standard deviations
  frequently dont agree

16
Comparison of Eligibility Based on Criteria of
At least 30 Percent Delay OR Two Standard
Deviations Below the Mean
Chronologic Age (Months) Developmental Age (Months) Percent Delay Standard Score (70 2 SD) Agreement on Eligibility Criteria
18 13 28 not eligible 65 eligible (under 2 SD) Disagree
19 13 32 eligible 65 eligible Agree
20 14 30 eligible 65 eligible Agree
21 15 29 not eligible 82 not eligible Agree
22 15 32 eligible 82 not eligible Disagree
23 16-18 22 30 Yes and No 87 not eligible Agree Disagree
Battelle Developmental Inventory Cognitive
Domain Subtest Adapted from Andersson (2004).
Appropriate and inappropriate interpretation and
use of test scores in early intervention. Journal
of Early Intervention, 27, 5568.
17
Inaccuracies in Eligibility Definitions

• When we use eligibility criteria that make use
  of inaccurate indicators of developmental level
  we are more likely to make mistakes about which
  children are eligible for Part C services.

18
Avoid Using Criterion Referenced Tests for
Determining Eligibility

• Criterion referenced tests do not provide an
  accurate way of knowing if a childs development
  is delayed compared to typically developing
  peers.

19
Establish a Rigorous Definition of Part C
Eligibility

• States should establish definitions of
  developmental delay that are --
• clear, reliable and which make eligible
  only those children the state intends to serve.

20
What is a Rigorous Definition?

• A rigorous definition of developmental delay is
  reliable and valid
• Reliable different evaluators can use the
  definition independently and reach high levels of
  agreement on who is Part C eligible
• Valid high content validity stakeholders
  agree that the definition is consistent with the
  level of delay that should make a child Part C
  eligible.

21
Informed Clinical Opinion Is Not a Substitute for
a Rigorous Definition

• The use of informed clinical opinion doesnt
  eliminate the need for a definition of
  developmental delay.
• Informed clinical opinion is not a definition of
  eligibility.
• Informed clinical opinion is the outcome of a
  careful process for determining a childs
  eligibility based on a review of information from
  multiple sources.

22
Design a Rigorous Definition of Part C Eligibility

• Tailor the definition to the group of children
  your state intends to serve.
• To design a rigorous definition of Part C
  eligibility first decide which children the state
  intends to serve and then create a definition
  that makes only those children eligible.

23
Design a Rigorous Definition of Part C Eligibility

• The criteria used to define children who are
  eligible for Part C should be clear, internally
  consistent and reflect state enrollment goals.
• The criteria used in a definition should make use
  of precise estimates of child development that
  can be compared to norms of typically developing
  peers

24
A Rigorous Definition is Not Enough

• How state Part C eligibility criteria are applied
  impacts enrollment
• Eligibility criteria must be applied consistently
  in each community
• Every community must have an effective child find
  process for recruiting Part C eligible children
  and their families.

25
Recommendations

• Eligibility definitions should be rigorous
• Eligibility criteria using percent delay or
  months delay should be avoided
• Informed clinical opinion should not be used as a
  substitute for a rigorous definition

26
Recommendations

• States should track the level of agreement
  between the percentage of the population expected
  under their eligibility definition and the
  percentage enrolled.
• States should monitor whether the children they
  intend to serve are in fact the ones who are
  receiving Part C services.

27

• For additional information
• Steven A. Rosenberg, Ph.D.
• University of Colorado Denver
• 4455 E. 12th Avenue, Campus Box C268-22
• Denver, CO 80220
• steven.rosenberg_at_ucdenver.edu

This work was supported by grants from the U.S.
Department of Education, Office of Special
Education Programs (OSEP) Grant No. H324T990026
(University of Colorado, Denver) and Grant No.
H324T990006 (University of Connecticut Health
Center), and Grant No. R40 MC 05473 from the
Maternal and Child Health Bureau (Title V, Social
Security Act), Health Resources and Services
Administration, Department of Health and Human
Services US Department of Health and Human
Services, Administration on Developmental
Disabilities, University Center of Excellence in
Developmental Disabilities Education, Research
and Service (UCEDD) Award 90DD0632.
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NECTAC Webinar Series on Early Identification
and Part C Eligibility

• Session 2 A Rigorous Definition of Developmental
  Delay
• March 4, 2010

Thank you for listening. Presentations from this
series and their related resources are made
available on the NECTAC Web Site
at http//www.nectac.org/calls/2010/earlypartc/
earlypartc.asp