Title: NECTAC Webinar Series on Early Identification and Part C Eligibility
1NECTAC 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
2Issues
- 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. -
3More 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.
4Problems 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.
5Racial Disparity
African-American children are half as likely to
receive early intervention as white
peers. (Rosenberg, Zhang Robinson, 2008).
6Task
- 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.
7Definitional 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.
8How 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
9Standard 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
10Assessing 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
11How 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.
12Developmental 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.
13Developmental 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.
14Percent 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.
15Contradictions 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
16Comparison 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.
17Inaccuracies 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.
18Avoid 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.
19Establish 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.
20What 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.
21Informed 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.
22Design 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. -
23Design 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
24A 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.
25Recommendations
- 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
26Recommendations
- 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.
28NECTAC 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