Chapter 8 - Early Intervention Intake

8.1 Intake Policy

• 8.1.1 Intake is the process of meeting face to face with the family to explain what EI is and to complete all initial steps required prior to beginning the Evaluation/Assessment process. Service Coordinators are required to fully complete all intake activities prior to scheduling Evaluation/Assessment activities.
• 8.1.2 All contact with the family must be in the family's chosen language and/or method of communication. If the parent is deaf or hard of hearing, blind or visually impaired, or for the parent with no written language, the mode of communication that is usually used by the parent should be used (sign language, Braille or oral interpretation/translation). The Service Coordinator should always be aware of and sensitive to the family's culture, ethnicity and language.
• 8.1.3 A family's right to confidentiality must be ensured at all times and the CFC Notice of Confidentiality Practices and a signed CFC Consent to Use Personally Identifying Information (PII)& Bill Public Benefits form must be provided and received at intake. Families should be invited and encouraged to include other family members, friends or other sources of support during initial intake activities. Families should be made aware that protected health information and other personal information will be discussed during intake activities.
• 8.1.4 Once the family has been located, information about the referral may not be given to the referral source without appropriate consent. If the referral source wants to know the outcome of its referral, the referral source should seek consent from the family and provide a copy of a signed consent form to the CFC at the time of referral. Information about referrals may also be given to the referral source if the CFC obtains consent from families using the CFC Consent for Release of Information form.
• 8.1.5 If the child has a Primary Care Physician (PCP), always request that the family sign the CFC Consent for Release of Information form to the physician if you did not receive a signed consent from the physician with the referral. It is important that the PCP be aware that the child was referred to EI, is provided information on the status of the referral and receives a copy of the IFSP if the child is deemed eligible.
• 8.1.6 Upon receipt of signed CFC Parental Consent and Ability to Decline Services and CFC Consent to Use Personally Identifying Information (PII) & Bill Public Benefits forms from the child's parent, the Service Coordinator shall proceed with initial intake activities identified in Procedures found below.
• NOTE: The purpose of the consents is to allow the Service Coordinator to legally gather additional information about the child/family, to document that you have provided and explained family rights and procedural safeguards and the CFC Notice of Confidentiality Practices and to get consent to complete evaluations and assessments, to transfer a case to another CFC if the need arises, to complete a voluntary family assessment and to move forward to complete the full intake process.
• 8.1.7 With appropriate consent from the family, using the CFC Consent for Release of Information form, the CFC may obtain and/or release information to the individual/entity identified on the form, including medical information, evaluation reports completed prior to referral to EI, diagnosis, prescriptions, referral, and other information as specifically described on the consent form. A separate form containing an original parent signature must be completed to obtain and/or release information for each entity that information will be obtained from and/or released to. The Service Coordinator is required to complete the form prior to requesting that a parent sign the form. Never ask a parent to sign a blank form.
• 8.1.8 With written parental consent Service Coordinators will complete a voluntary family directed assessment using the "Routines Based Interview" assessment tool. This assessment must be completed within 45 days of the referral. You can download the Routines Based Interview Report at https://blogs.illinois.edu/files/6150/364271/88801.pdf. 
• 8.1.9 Ensure the family-directed Assessment is completed within the required 45-day time line.
• 8.1.10 The purpose of the family directed assessment is to determine the supports and services necessary to enhance the family's capacity to meet the developmental needs of the child based upon their functional outcomes. This requires full family participation throughout the process to ensure that the Service Coordinators observations are a meaningful reflection of the family's perspective.
• 8.1.11 With parental permission administer the appropriate ASQ: SE-2.
• 8.1.12 Upon completion of intake the Service Coordinator will fully complete the Intake/Social History Summary Sheet and distribute the completed sheet to the members of the initial Evaluation/Assessment team, including the parents.
• 8.1.13 Families have the right to decline services at any time. Steps to follow when a family declines services are described in procedure below.

8.2 Intake Procedures

• 8.2.1 Contact the family within two business days after the date of referral to verify that general eligibility requirements such as age, etc., are met and if so;
  • Discuss the EI intake process and time lines;
  • Answer any initial questions that the family may have about EI such as family participation fees, use of private insurance, transition, etc.;
  • Discuss family rights, procedure safeguards and EI privacy practices;

• 8.2.2 If it is more than 45 days but less than 90 days before the child will turn 3 years old, discuss EI age requirements, transition to 3 to 5 services and continue with the Intake procedures.
  • If the child is determined eligible for Part C based upon completion of evaluations/assessments and the child may be eligible for 3 to 5 services, with parental consent notify the school district/LEA and begin the transition process immediately.See the Chapter 13-Transition for EI to EC Transition Tracking policy/procedures.

• 8.2.3 Determine whether an educational surrogate parent is required. If a surrogate parent is required, request the appointment of a surrogate parent upon referral and prior to evaluation of a child who would not otherwise have foster or relative care representation.
• NOTE: Please review the guidelines found at the end of this Chapter, "Surrogate Parents".
• 8.2.4 Discuss the requirement that a Legally Responsible Adult (LRA) or surrogate parent who has the right to sign consent forms on behalf of the child must attend the meeting. An LRA is a biological or adoptive parent of the child, a foster parent, a guardian authorized to act as the child's parent, a relative caregiver with whom the child lives, an individual who is legally responsible for the child's welfare or a surrogate parent. Surrogate parents have the same rights as parents;
• 8.2.5 Schedule a date, time and location for the intake meeting that is convenient for the family. This may include locations such as home, school, business or other community setting.
• 8.2.6 Explain to the family that they have the right and are encouraged to invite other family members, friends or other sources of support to attend the intake meeting.
• 8.2.7 Explain to the family that protected health information and other personally identifying information (PII) will be discussed and shared during the intake meeting.
• 8.2.8 If appropriate, immediately send Sample Letter 3: Intake Appointment Confirmation.
• 8.2.9 If the family does not have a telephone or if you are unable to contact the family by phone:
  • Send Sample Letter 4: Initial Contact - Unable To Contact by Phone
  • Include necessary enclosures to inform the family of the EI referral and ask them to schedule a meeting.
  • If no response after ten (10) days, send Sample Letter 5: Second Contact - Unable to Contact by Phone and copy the referral source. Parent liaison may assist in attempting contact.
  • If no response to the second letter within another 10 days, close the case.

8.2.10 Meet with the family face to face to complete the following intake activities:

• • Provide the family with a copy of the State of Illinois Infant/Toddler and Family Rights booklet, A Guide for Families Parent Handbook, and the CFC Notice of Confidentiality Practices.
  • Review these documents with the family and explain family rights, procedure safeguards and Confidentiality Practices to the family.
  • Obtain parent signature(s) on the CFC Parental Consent and Ability to Decline Services form and the CFC Consent to Use Personally Identifying Information (PII) & Bill Public Benefits forms. Document receipt of notices provided on the CFC Acknowledgement of Receipt of Notices form.
  • Review all initial referral information entered into Cornerstone to determine if initial information gathered is accurate and complete.
• NOTE: If information is inaccurate or is not complete; do not create a duplicate record in Cornerstone. Go back to the original record and make the appropriate changes.
  • Familiarize the family to EI services and other related services.
  • Discuss with the family their option for having evaluation, assessment and IFSP development on the same day or on different days.
  • Describe "natural environments" and the federal requirement that EI services be provided in a child's natural environments.
• NOTE: §303.126(b) of Part C of IDEA states that "Natural environments means settings that are natural or typical for a same aged infant or toddler without a disability, may include the home or community settings".
  • If the family consented to the voluntary family assessment when signing the CFC Parental Consent and Ability to Decline Services by checking the Yes box, administer the Routines Based Interview (RBI) assessment. After the intake meeting, record the results of the assessment on the Intake/ Social History Summary Sheet.
  • Discuss the child's likes and dislikes as well as other information that may facilitate the evaluation process.
  • Discuss the family's developmental priorities and concerns.
  • Discuss the family's resources. This means determination of what the family already has available to help support the child's development in home and community based settings (i.e., extended family, park programs, church, playgroup, respite care, WIC or other).

• 8.2.11 With parental permission, administer the appropriate ASQ: SE-2 based upon the child's chronological age and record the results or pertinent information on the Intake/Social History Summary Sheet after the intake meeting.

• 8.2.12 Complete the CFC Consent for Release of Information to:

• NOTE: If information is received concerning HIV/AIDS, do not sha1. this information with any other entity without a consent that is specific to HIV/AIDS that has been signed by the parent or guardian only. It is a violation of Public Health laws to share HIV/AIDS information without specific consent.
  • If consent is given to obtain/release information, describe the information that will be obtained/released in the description area of the CFC Consent for Release of Information before asking the family to sign the form(s).
  • Obtain a separate CFC Consent for Release of Information form, with an original signature, for every entity that you will obtain from and/or release information to.
• 8.2.13 Explain parents' role and responsibilities related to their participation in the development of the IFSP and the EI Services System.
• 8.2.14 Complete the process identified below to determine the family's enrollment status in All Kids and DSCC using the Screening Device for Determining Family Fees and Eligibility for All Kids and DSCC and complete appropriate follow-up as indicated. Provide every family with the CFC Notice of System of Payments and Fees as well as the Illinois Family Participation Fees Program Fact Sheet. Explain the content and answer any questions the family may have. Document receipt of the notices on the CFC Acknowledgement of Receipt of Notices form.
• The All Kids program encompasses a population that extends beyond the scope of the annual gross income identified on the DSCC Screening Device form. Families whose income exceeds the annual gross income identified on the DSCC Screening Device may be eligible for All Kids or other programs. Families who do not have insurance are strongly encouraged to complete the All Kids application.
  • If a family's gross income falls within the stated guidelines identified on the DSCC Screening Device, explain the benefits of enrolling in the All Kids program. If the parent agrees to enroll in the All Kids program, the Service Coordinator should refer the parent to an All Kids agent or help the parent complete the application and submit the All Kids application to HFS.
  • If a family's gross income exceeds the stated guidelines identified on the DSCC Screening Device, and the family has insurance, ALWAYS ask if the family has high medical bills. If the family's medical bills exceed $2,000 per month, do not take an All Kids application. Refer the family to their local DHS Office to apply for medical assistance. (In this situation, the family is being referred to their local DHS office to determine if they are eligible for spend-down.)
  • If a family's gross income exceeds the stated guidelines identified on the DSCC Screening Device and the family does not have medical bills over $2,000 per month or any type of private insurance coverage, ALWAYS ask the family if they would like to file an All Kids application. Never refuse to take or discourage a family from filing an All Kids application.
  • If the child may be eligible for All Kids based upon the stated income guidelines identified on the DSCC Screening Device, but the family has chosen not to file an All Kids application, the eligible child/family still has the right to receive all EI services identified in the IFSP.
  • If referral to DSCC is indicated and a CFC Consent for Release of Information has been completed and signed by the parent/guardian, send a copy of the consent form, the completed DSCC Screening Device and copies of the following Cornerstone screens/reports to your local DSCC office, Including:
  • Participant Enrollment Information (HSPR0770) and
  • Assessment History (HSPR0207).
• NOTE: When completing the consent form to make a referral to DSCC, under "Type of Information, Other" write "DSCC Referral". File the DSCC Screening Device in the child's CFC permanent record.
• * Place a signed copy of the DSCC Screening Device in the child's permanent case record and document in case notes whether or not the family was referred to an All Kids agent or an All Kids application was completed and submitted for eligibility determination if the family consented and their gross income falls within the stated guidelines identified on the DSCC Screening Device.
• 8.2.15 Discuss the Family Fee determination process and information regarding the use of private insurance, if the family has private insurance, and/or is in the income range requiring fees.
• NOTE: See Chapter 10-Public and Private Insurance Use Determination and Chapter 11- Family Participation Fees for process details. Hand the Financially Responsible Adult (FRA) the CFC Acknowledgement and CFC Notice of Social Security Disclosure to explain the use of collected Social Security Numbers for EI. The FRA must sign agreeing or declining to provide their Social Security Number.
• 8.2.16 If the child has private insurance and/or public benefits, follow the procedures as outlined in the Chapter 10-Public and Private Insurance Use Determination.
• 8.2.17 If potentially eligible for an exemption, outlined in Chapter 10-Public and Private Insurance Use Determination, for private insurance use based on the type of private health plan they own, the CFC must follow the process to submit the request to exempt the use of the private health insurance plan. Inform the family of the various types of exemptions and refer to Chapter 10-Public and Private Insurance Use Determination for actions to take to obtain the private insurance exemption.
  • The following is a list of exemption types for Private Insurance.
  • The private health insurance plan is a privately purchased/non-group plan.
  • The private health insurance plan has a lifetime cap on some or all IFSP services that could endanger the future use by the family for non-EI services.
  • The private health insurance plan is part of enrollment in the Illinois Comprehensive Health Insurance Program (ICHIP).
  • The private health insurance plan has a tax-savings account attached that automatically withdraws based on billing by providers of EI services.
  • Inform the families that exemptions from private health insurance plans may result in the family paying a Family Participation Fee based on household size and income.
• NOTE: It is very important to begin the private insurance exemption request process as early in the Intake process as possible in order to prevent possible service delays.
• 8.2.18 If the family appears eligible for an exemption from Family Participation Fees (as outlined in Chapter 11-Family Participation Fees under 11.8), discuss the Family Fee Exemption process with the family.
  • Inform the family that proof of income will be required in order to apply for the exemption at the initial IFSP development, an annual IFSP development or at any time during the IFSP.
  • If the family declines to provide proof of income and is not eligible for All Kids, inform the family that failure to provide the requisite income information and documentation will result in a family fee charge that is equal to the maximum allowable family fee monthly installment charged per month.
  • If the family provided proof of income, complete the appropriate sections and provide the family with the CFC Family Participation Fee Exemption Request to sign and follow the procedures in outlined in Chapter 11-Family Participation Fees.
  • Provide assistance to facilitate form completion and required documentation gathering as necessary.
  • Inform the family that a CFC Family Fee Exemption Request can be completed prior to the initial IFSP (or anytime during the IFSP but it is not retroactive) to submit to the Bureau of EI for approval. If a family chooses to request the exemption prior to IFSP, send family size and gross income in place of the Family Fee Report because a family fee report cannot be generated from the Cornerstone system prior to the IFSP.
• 8.2.19 Provide a general overview of the IFSP process.
• NOTE: Refer to Chapter 12-Individualized Family Service Plan (IFSP) area for the process.
• 8.2.20 Provide a general overview of the transition process.
• 8.2.21 Complete intake/social history activities on your laptop in Cornerstone and questionnaire screens PA11, PA16, AS01 and EI20.
• NOTE: Refer to the Cornerstone Reference Manual, Section 17.2.2 - Home Visit for information on the use of laptops for intake activities.
• 8.2.22 If the family declines services during any part of the intake process:
  • Explain right to decline services.
  • Ensure that family understands consequences of refusal.
  • Explain complaint procedures.
  • Explain how to access future services.
  • Refer to community resources.
  • Document the date and the reason for case discontinuation in Cornerstone Case Notes.
  • Complete case closure.
• NOTE: Refer to Chapter 14 - Transfer and Case Closure.
• 8.2.23 Send a follow-up letter to the referral source if the referral source or the CFC has obtained a signed consent from the family.
• 8.2.24 Fully complete the Intake/Social History Summary Sheet and place a copy in the child's CFC permanent case record. Send copies to the parents and to each provider who will complete initial evaluations/assessments with the authorizations to provide those services. If the child is eligible and an IFSP is written, share a copy with the ongoing service providers if different from Evaluation/Assessment team.
• 8.2.25 For any ICD Diagnosis Code other than developmental delay, enter the ICD code into Cornerstone only if a copy of a medical record from a physician that documents that the child truly has that medical diagnosis (such as Autism, Cerebral Palsy, etc.) has been provided.

8.3 Surrogate Parents

• 8.3.1 Foster parents and relative caregivers of children who are wards of the state may serve as educational surrogate parents for the children in their care in place of the natural parent(s).
• 8.3.2 A guardian authorized to act as the child's parent, a relative caregiver with whom the child lives or an individual who is legally responsible for the child's welfare may serve as educational surrogate parents for the children in their care.
• 8.3.3 CFC staff shall notify the local DCFS Educational Advisor's Office if a foster parent or relative caregiver of a DCFS ward needs assistance in making decisions regarding the child's services.
• 8.3.4 CFC staff shall request the appointment of an educational surrogate parent from ISBE Surrogate Parent Program for all wards of the state placed in private residential facilities.
• 8.3.5 If unable to identify or locate the parent, guardian, or relative of a child who is not a ward of the state, CFC staff shall request the appointment of an educational surrogate parent from ISBE.
• 8.3.6 CFC staff shall monitor to assure that surrogate parent appointment is made by ISBE within ten days but no more than 30 days.
• 8.3.7 Surrogate parents have the same rights as a parent.

8.4 What the Foster/Surrogate Parent Signs

The Foster/Surrogate Parent, other than one for a child who is a ward of the state, signs everything that a parent would normally sign.

8.5 What the DCFS Guardian Signs

Annually, DHS obtains DCFS Guardian signature on all forms that must be co-signed by the DCFS Guardian. DHS then provides copies of these forms to CFCs for use with all DCFS wards. DCFS Guardian signed forms must be renewed annually in the child's file.

Rev. 11/01/2015