CFC Procedural Manual - Sample Letters

Sample Letters

The text within these letters should be individualized for each child and family.

Sample Letter 1: Ineligible Based On General Eligibility - Over Age Three

Dear (parent/guardian):

As we discussed, (child's name), is not eligible for Early Intervention because he/she is over the age of three. Your local school district will be able to assist you in determining whether (child's name) is eligible for developmental or educational services through the school. (LEA contact), (Title/Position) works for the school district and can assist you in the screening process. He/She can be reached at (phone number).

Sincerely,

Service Coordinator

Sample Letter 2: Ineligible Based On General Eligibility - Not an Illinois Resident

Dear (parent/guardian):

As we discussed, (child's name) is not eligible for Early Intervention because he/she does not live in Illinois. The Early Intervention system in (state of residence) will be able to assist you in determining whether (child's name) is eligible for early intervention services in (state of residence). (Early Intervention Coordinator in state of residence) is the Early Intervention system coordinator in (state of residence). He/she can be reached at (phone number).

Sincerely,

Service Coordinator

Sample Letter 3: Intake Appointment Confirmation

Dear (parent/guardian):

(Child's name) was recently referred to Child and Family Connections by (referral source) because of concerns with his/her (adaptive/cognitive/communication/motor/ social-emotional development. Child and Family Connections is the regional system point of entry for the state's EI Services System. EI provides services and supports to infants and toddlers with developmental concerns and their families. Participation is voluntary.

As discussed, we will meet on (date) at (time and place) to begin the intake and eligibility determination process. I can be reached at (Service Coordinator phone number). I look forward to meeting you and your child.

Sincerely,

Service Coordinator

Enclosure: Informational Brochure(s)

Rights Booklet

Sample Letter 4: Initial Contact - Unable To Contact by Phone

Dear (parent/guardian):

(Child's name) was recently referred to Child and Family Connections by (referral source) because of concerns with his/her (adaptive/cognitive/communication/motor/ social-emotional) development. Child and Family Connections is the regional system point of entry for the state's Early Intervention Services System. Early Intervention provides services and supports to infants and toddlers with developmental concerns and their families. Participation is voluntary.

I have not been able to contact you by phone. Please contact me in the next 10-days to let me know if you are interested in moving forward with this referral. I can be reached at (Service Coordinator phone number), or you can return this letter in the enclosed envelope. I look forward to hearing from you.

Sincerely,

Service Coordinator

Enclosure: Informational Brochure(s)

Rights Booklet

Check one and return in the enclosed envelope if unable to contact me by phone:

[ ] Please call me at this number: ________________________  at this time:  ______________to discuss this further.

[ ] I am not interested at this time.

Sample Letter 5: Second Contact - Unable To Contact by Phone

Dear (parent/guardian):

(Child's name) was recently referred to Child and Family Connections by (referral source) because of concerns with his/her (adaptive/cognitive/communication/motor/social-emotional) development. Child and Family Connections is the regional system point of entry for the state's Early Intervention Services System. Early Intervention provides services and supports to infants and toddlers with developmental concerns and their families. Participation is voluntary.

I have not been able to contact you by phone and have received no response to our first letter dated (date of first letter). Please contact me in the next two weeks to let me know if you are interested in moving forward with this referral. I can be reached at (Service Coordinator phone number), or you can return this letter in the enclosed envelope. I look forward to hearing from you.

If I do not hear from you by (10 days) I will assume you do not wish proceed with the referral at this time. If at any time before your child turns three you wish to learn more about Early Intervention, please feel free to contact us.

Sincerely,

Service Coordinator

Enclosure: Informational Brochure(s)

Rights Booklet

Check one and return in the enclosed envelope if unable to contact me by phone:

[ ] Please call me at this number: ________________________  at this time:  ______________to discuss this further.

[ ] I am not interested at this time.

Sample Letter 5: Second Contact

N/A

Sample Letter 6: Discontinuation Of One Or More Services - Child Reaches Three Years of Age (Entering Other Services)

Dear (parent/guardian):

As you know, (child's name) will be three years old on (date of child's third birthday). It is my understanding that (child's name) will be (entering the school district's special education program/enrolling in Head Start/receiving private therapy services/attending preschool/participating in child care/other) after he/she leaves Early Intervention.

(Child's Name)'s Early intervention services will end on (day before child's third birthday). Each of (child's name)'s service providers are aware/have been notified of his/her transition. OPTIONAL SENTENCE: (Child's name)'s IFSP has been forwarded to (school district/Head Start/other), as requested.

I have enjoyed working with you and your family.

Sincerely,

Service Coordinator

Sample Letter 7: Discontinuation of One or More Services - Child Reaches Three Years of Age (Not Entering Other Services)

Dear (parent/guardian):

As you know, (child's name) will be three years old on (date of child's birthday). It is my understanding that (child's name) will not be (entering the school district's special education program/enrolling in Head Start/receiving private therapy services/attending preschool/participating in child care/other) after he/she leaves Early Intervention.

(Child's Name)'s Early Intervention services will end on (day before child's third birthday). Each of (child's name)'s service providers are aware/have been notified of his/her transition.

I have enjoyed working with you and your family.

Sincerely,

Service Coordinator

Sample Letter 8: Discontinuation of One or More Services - Child No Longer an Illinois Resident

Dear (parent/guardian):

Due to (child's name)'s recent move to (new state of residence), he/she will no longer be able to receive early intervention services through the Illinois' Early Intervention Services System. I wanted to provide you with the name of the Early Intervention system coordinator in (new state of residence), in case you have not already had an opportunity to learn about (new state of residence)'s Early Intervention system. (Name of EI Coordinator in new state) is the Early Intervention system coordinator in (new state of residence). He/she can be reached at (phone number). I encourage you to contact him/her at your earliest convenience.

I have enjoyed working with you and your family.

Sincerely,

Service Coordinator

Sample Letter 9: Discontinuation of One or More Services - Voluntary Withdrawal by Parent/Guardian

Dear (parent/guardian):

As we discussed, you no longer wish to participate in Early Intervention. As a result of this decision, (child's name)'s authorized early intervention services have been discontinued effective (discontinuation date). Each of (child's name)'s early intervention service providers have been notified of (child's name)'s withdrawal from Early Intervention and the discontinuation of (child's name)'s service authorizations.

If at any time prior to (child's name)'s third birthday you wish to have him/her re-evaluated by the Early Intervention system, you may again contact us at (CFC phone number).

Sincerely,

Service Coordinator

Sample Letter 10: Discontinuation of One or More Services - No Response/Unable to Reach

Dear (parent/guardian):

We have been unable to reach you by phone and have received no response to repeated attempts to reach you by mail. It appears that your family is not interested in early intervention services at this time. I have closed (child's name)'s case record and will make no additional attempts to reach you.

If at any time prior to (child's name)'s third birthday you wish to have him/her evaluated by the Early Intervention system in order to determine his/her eligibility for services and supports, you may contact us at (CFC phone number).

Sincerely,

Service Coordinator

Sample Letter 11: Discontinuation of One or More Services - IFSP Outcomes Have Been Met

Dear (parent/guardian):

As we discussed, (child's name) has met his/her outcome(s) related to his/her (adaptive/cognitive/communication/ motor/social-emotional) development. (Child's name)'s (occupational therapist/physical therapist/speech therapist/other) as well as his/her (another member of the child's IFSP team) agree that (child's name) no longer needs (service[s] being discontinued). (Child's name)'s authorization for (service[s] being discontinued) will be discontinued effective (date of discontinuation a reasonable time after written prior notice has been given).

I am enclosing the rights booklet (State of Illinois: Infant/Toddler and Family Rights Under IDEA for the Early Intervention System) that explains your rights regarding early intervention services, including your right to contest this decision should you feel that to be necessary. If you wish to do so, the current services would stay in place while the dispute is being resolved. Please review the rights booklet at your earliest convenience. You should submit any requests to appeal the decision as quickly as possible and prior to the date of change of service. Please contact me at (Service Coordinator phone number) if you need any more information about your rights or if you would like a form to request a mediation or administrative proceeding regarding this decision.

Sincerely,

Enclosure:  Rights Booklet

Sample Letter 12: Discontinuation of One or More Services - Non-Payment of Family Fees

(Cover Letter to Revised IFSP)

Dear (parent/guardian):

The Department of Human Services indicates they are initiating collection procedures against you for family fees that are three months (90 days) past due. They have therefore instructed me to discontinue your direct Individualized Family Service Plan (IFSP) services subject to fees, including assistive technology devices. Your revised IFSP is attached and will take effect on (two weeks from the date of this letter).

As indicated in the enclosed booklet, you have the right to appeal this decision. Throughout the appeal process, the early intervention services in question will not change. However, the appeal must be made prior to the effective date of the discontinuation.

Unless you request otherwise, services not subject to fees will continue as shown on your IFSP. This includes service coordination and any authorizations for assessments, IFSP development, or family support by parent liaisons, deaf mentors and interpreters. Installments of your annual fee will be added to your account each month until your IFSP expires, and accumulated state payments will be tracked. You will not be required to pay more in annual fees than the state pays for your annual services subject to fees.

After payment of your past due account, you may contact me to request reinstatement of discontinued services. I can be reached at (Service Coordinator phone number). I will then request payment confirmation from the Department of Human Services and obtain permission to reauthorize direct IFSP services subject to fees, including assistive technology devices.

Sincerely,

Service Coordinator

Enclosure: Rights Booklet

Revised Individualized Family Service Plan provided to Family & IFSP Team Members

cc:IFSP Team Members

Sample Letter 13: Discontinuation of One or More Services - Notification that Services will Change Due to Individualized Family Service Plan Review

Dear (parent/guardian):

This is to notify you that the Early Intervention services authorized for (child's name) will change as follows: (description of change in service or levels of service). This change will be effective on (date of change to be no sooner than two weeks from the date of this letter). The change is being made pursuant to review of your IFSP and the current developmental needs of your child.

I am enclosing the rights booklet (State of Illinois: Infant/Toddler and Family Rights Under IDEA for the Early Intervention System) that explains your rights regarding early intervention services, including your right to contest this decision should you feel that to be necessary. If you wish to do so, the current services would stay in place while the dispute is being resolved. Please review the rights booklet at your earliest convenience. You should submit any requests to appeal the decision as quickly as possible and prior to the date of change of service. Please contact me at (Service Coordinator phone number) if you need any more information about your rights or if you would like a form to request a mediation or administrative proceeding regarding this decision.

Sincerely,

Service Coordinator

Enclosure:  Rights Booklet

Sample Letter 14: Ineligible - Initial Eligibility Determination

Dear (parent/guardian):

As we discussed, (child's name) has been found ineligible for Early Intervention because the comprehensive evaluation indicates that he/she is not currently exhibiting an eligible diagnosis, level of delay or risk condition. I am enclosing a Rights booklet, which explains your right to appeal this decision should you feel that to be necessary. Please review the Rights booklet at your earliest convenience.

If at any time prior to (child's name)'s third birthday you feel he/she should be re-evaluated by the Early Intervention system, you may again contact us at (CFC phone number). If you have questions or concerns about this decision, please contact me at (Service Coordinator phone number).

Sincerely,

Service Coordinator

Enclosure: Rights Booklet

Sample Letter 15: Ineligible - Annual Eligibility Determination

Dear (parent/guardian):

As we discussed, (child's name) has been found ineligible for Early Intervention because the comprehensive annual evaluation indicates that he/she is not currently exhibiting an eligible diagnosis, level of delay or risk condition and services are not necessary in order to continue developmental progress. This change will be effective on (date of change - no sooner than two weeks from the date of this letter).

I am enclosing the rights booklet (State of Illinois: Infant/Toddler and Family Rights Under IDEA for the Early Intervention System) that explains your rights regarding the early intervention services, including the right to contest this decision should you feel that to be necessary. If you wish to do so the current services would stay in place while the dispute is being resolved. Please review the rights booklet at your earliest convenience. You should submit any requests to appeal the decision as quickly as possible and prior to the date of change of service. Please contact me at (Service Coordinator phone number) if you need more information about your rights or if you would like a form to request a mediation or administrative proceeding regarding this decision.

If at any time prior to (child's name)'s third birthday you feel he/she should be re-evaluated by the Early Intervention system, you may again contact us at (CFC phone number). If you have questions or concerns about this decision, please contact me at (Service Coordinator phone number).

Sincerely,

Service Coordinator

Enclosure: Rights Booklet

Sample Letter 16: Eligible - Further Assessment Needed

Dear (parent/guardian):

As we discussed, (child's name) has been found eligible for the Early Intervention system because he/she is exhibiting an eligible level of delay/has been diagnosed with a medically eligible condition/is at risk of substantial delay. (Child's name)'s evaluation(s) indicate that further assessments are needed in order to ensure that his/her Individualized Family Service Plan (IFSP) meets all of his/her developmental needs. Once these assessments are completed we can proceed with (child's name)'s IFSP development.

I have enclosed an additional Rights booklet for your review. Please feel free to contact me if you have any questions or concerns. I can be reached at (Service Coordinator phone number).

Sincerely,

Service Coordinator

Enclosure: Rights Booklet

Sample Letter 17: Eligible - No Further Assessment Needed

Dear (parent/guardian):

As we discussed, (child's name) has been found eligible for the Early Intervention system because he/she is exhibiting an eligible level of delay/has been diagnosed with a medically eligible condition/is at risk of substantial delay. You have indicated that you are interested in participating in Early Intervention. Since we have all of the information necessary to develop (child's name)'s IFSP, I will begin to coordinate the IFSP meeting. Please let me know of some dates and times that are convenient for you to meet.

I am enclosing an additional Rights booklet for your review. Please feel free to contact me if you have any questions or concerns. I can be reached at (Service Coordinator phone number).

Sincerely,

Service Coordinator

Enclosure: Rights Booklet

Sample Letter 18: Confirmation of IFSP Meeting

Dear (parent/guardian):

The purpose of this letter is to confirm the meeting to (plan/review) (child's name)'s IFSP. The meeting has been scheduled for (date of meeting) at (time of meeting) and will be held at (location of meeting). The (plan/review) process and meeting may result in a change in recommended services. In addition to you and I and (child's name)'s evaluators, I have invited (persons requested to be in attendance by the parent/guardian) to attend at your request.

If you need to reschedule this meeting, please contact me immediately at (Service Coordinator phone number).

Sincerely,

Service Coordinator

Enclosure:  Rights Booklet

cc:

Sample Letter 19a: Pros and Cons to Evaluation/Assessment and IFSP being held on same day versus different day

Dear (parent/guardian):

Certain activities in Early Intervention need to occur in a particular order. For example, evaluations and assessments must occur prior to the development of an Individualized Family Service Plan (IFSP). The evaluation/assessment process involves a professional using a tool to understand your child's developmental strengths and weaknesses. The evaluator examines the information collected through his/her tool and compares your child to his/her same-age peers. The provider completes a report with their findings and shares it with you so that you can be well-informed when making your decision about whether or not to participate in Early Intervention.

The evaluation/assessment process is not intended to overwhelm you or your child but rather to help your team understand your child's ability to participate in his/her daily routines and environments. Gaining an accurate picture involves collecting a lot of information and this need must be balanced with the busy lives of families with infants/toddlers. You have the option of scheduling the evaluations/assessments on the same day as the meeting to create the IFSP if your child is eligible. You can also choose to have these events occur on different days. The chart below can help you make your decision about the timing of these events. You can also change your decision at any time by speaking to your Service Coordinator.

EVALUATION/ASSESSMENT and IFSP DEVELOPMENT

Rev.02/01/2016