Carlena Lowell

SEI 513 Activity #3 Intake Visits

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Activity #3: Complete at Least Three Part C Intake Visits
Carlena Lowell
SEI 513
Spring 2014












Carlena Lowell
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*All names have been changed or covered in order to maintain confidentiality.
Introduction
When I do a complete intake visit, it typically takes 1 to 2 hours. This is the
way in which my intake visits happen:
1. Introductions
2. Parents sign the Authorization to Screen and Share results after I explain that
I will write a one page Screening Summary after we are through with the visit
3. Part C Vision Screening is completed
4. Part C Hearing Screening is completed
5. Modified Checklist for Autism in Toddlers (M-CHAT) is complete for children
16-30 months old
6. Denver Developmental Screening-II is completed for some children (generally
not for referrals from doctors, unless the caregivers are in disagreement)
7. Decide with the parents if an evaluation is warranted (if not, discuss rights,
explain next stepsWN and Screening Summaryand finish visit)
8. Discuss rights, parents sign Notice of Receipt of Procedural Safeguards
9. Discuss the evaluation and how billing works, parents sign Parent Consent for
Evaluation and Financial Resources Form
10. Discuss the Authorizations to Share and/or Request Information and have
them sign them as neededif they want, generally always for doctors
11. Complete the routines worksheet and the childs likes and dislikes worksheet
12. Schedule the evaluation
After the intake visit happens, I write the Written Notice and complete the
Screening Summary, which get mailed to the parents or caregivers, given to the
evaluators, and faxed to the doctor. In addition to those two things, I also fax the
Authorization to Screen and Share Results and the Authorization to Request and/or
Share Information (with the doctor). I also send, and request back the prescription for
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the evaluation, and the medical history form. I make referrals to the evaluators,
containing the referral, the update form, and all the information I have gathered thus far.
I also enter all the information I can into CASE-E, our electronic file system.
Going to someones house Ive never met before is something I thought I would
be incredibly uncomfortable with; however, I find now it is quite the opposite. It took me
a long time as a teacher (Head Start teacher do home visits to each family twice a year)
to be comfortable with home visiting at all, even if I knew the family. I am pleased with
the way in which I have acclimated to completing home visits, particularly the intake
visits as they are with complete strangers. One of my better qualities as a person, and
specifically as a professional in this field, is my ability to be non-judgmental. This is a
crucial characteristic to employ when doing what I do, particularly during intake visits.
For each family I do intake visits with, the only previous knowledge I have of the family
is whatever information is on the referral intake sheet, and a roughly fifteen minute
phone call. Intake visits are one of my stronger abilities in this position as I have
completed many of them from the start of this position. I was also able to attend
multiple with the previous service coordinator in the month I trained.
Intake Visit #1
This child was referred to CDS on January 28, 2014 by his day care provider due
to concerns with his communication, aggressive behaviors, and fine motor
development; the parents share the day care providers concerns. He is approximately
28 months old, and lives with his mother, father, maternal grandparents, and four month
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old brother, who recently underwent a major surgery. He attends a day care five days a
week from 7:30 am to 4:30 pm.
Given the age and referral parameters, after getting the Authorization to Screen
and Share Results signed, I did all four screenings. During the Part C Hearing
Screening, I learned the child failed his newborn hearing screening, but when he went
back at three months old, he passed. He was also referred for a hearing evaluation last
summer; the results of that indicated a small amount of fluid, but that his hearing was
within typical limits. This Part C Hearing Screening did not indicate a need for follow up.
The Part C Vision Screening did not indicate a need for follow-up, and the parents are
not concerned with his vision. He passed every question on the Modified Checklist for
Autism in Toddlers-Revised (M-CHAT-R), indicating no need for follow-up. He also
passed each item on the Denver Developmental Screening-II, which included items
such as uses a spoon/fork, removes garments, uses 6 words, combines words, kicks a
ball forward, and walks up steps.
At this particular home visit, the screenings did not indicate a need for follow-up
and I did not think he would qualify based on the BDI-II; however, there are serious
behavior concerns with the child. This is when I let the parents decide to pursue an
evaluation, as that is one of their rights. I let them know he passed all the screenings,
and that I did not think he will qualify based on the developmental evaluation, but they
do have the right to proceed with it; they chose to proceed.
Because they chose to proceed with the evaluation, we did the full intake visit.
Following this conversation, we discussed their parental rights. I gave them a one page
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summary of their procedural safeguards, and had them sign the Notice of Receipt of
Procedural Safeguards. Discussion of parental rights is an area I feel I could improve
upon; I feel I need to spend more time discussing them. I would like to work on
developing a better script for this part of the visit.
After the parental rights were briefly discussed, the mother signed the Parental
Consent for Evaluation and the Financial Resources Form, followed by Authorizations to
Request and/or Share Information and Records for the day care and the childs
pediatrician. From there we discuss the child and familys daily activities, and the childs
likes, dislikes, strengths, needs, and the familys concerns and priorities. I have two
sheets that I use for this part of the intake visit. These were created by the previous
service coordinator, and I feel I could tweak them to better suit the information I would
like to obtain, and the way in which I ask to obtain it. Once CDS finalizes the use of the
RBI with all families, which will happen eventually but not for quite some time, these two
papers will be obsolete. Once we completed these two sheets, which typically take
about 30 minutes, and the evaluation was scheduled, the visit was complete. I am
always sure to thank the family for their time and for having me in their home. I let them
know I would send a Written Notice of the visit and the Screening Summary in a few
days, and that I would see them the following week at the evaluation.
Intake Visit #2
This child was referred by his pediatrician due to concerns with prematurity; the
infant is now six months old and was two months premature. Considering the child
spent six weeks in the hospital after birth, I was a bit confused as to why the referral due
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to prematurity was just now being made. When I made the initial call, the mother
shared my confusion, but for a different reason: she had absolutely no concerns about
her babys development. During the initial call, I like to start by asking the family if they
have concerns and if so what are they, as well as how Part C of CDS works, and finally
about the packet I will send them in the mail. During this initial call, the mothers tone of
voice indicted she was a bit upset about the referral; she let me know she had no
concerns. I made sure to let her know our service is voluntary, and if she did not want
to have the intake visit that was her choice. Despite her confusion about the referral,
she did say it was fine for me to come out to her house.
When I arrived, the baby was sitting on the mothers knees facing her as she
held his hands; his head was straight and strong. This came as a bit of a surprise to
me. I completed the screenings, which for this visit included the Part C Hearing
Screening, the Part C Vision Screening, and the Denver-II. I complete the Denver-II
when it is a doctor referral, only if the parents are in strong disagreement with the
doctor, which this mother was.
The child passed all the screenings with flying colors based on the few things I
administered with him, and parent report. The Denver-II corrects for prematurity and
this child was two months premature; therefore, I screened for a four month old.
However, in looking at the indicators to the right of the line, and he was able to do quite
a few of those items as well. At six months, four corrected, he was able to work for a
toy, smile both spontaneously and responsively, reach for things, hold his hands
together, grasp a rattle, turn to voice, use single syllable consonant sounds as well as
vowel sounds, bear weight on his legs, hold his chest up with arm support during tummy
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time, and sit with his head steady. The Part C Hearing and Vision Screenings did not
indicate need for further follow-up, per parent report. I let the parent know I do not see
a need for an evaluation at this point, but if in the future she becomes concerned with
his development she could certainly call me back. I also let her know I would send a
Written Notice and a Screening Summary to her, and his pediatrician. I ended with a
thank you to her for letting me come out to her house.
Intake Visit #3
During a late afternoon on a Tuesday, I completed an intake visit with a family
who has an 11 month old son. Their son has a seizure disorder involving his bodys
ability to metabolize or not metabolize P5P, or B6, that began when he was just three
days old. He spent three weeks in the NICU before coming home. After that he
continued to have seizures for four more months before multiple trips to Portland and
Boston finally gave way to doctors finding the right medications to control them. He has
now been seizure free since last June; however, his parents estimated he had well over
a hundred seizures in those first few months of life. He has been receiving PT in home
since coming home from the hospital at three weeks old. I could clearly see the parents
respond well to coaching from professionals as they continuously corrected his sitting
and standing positions throughout the visit.
I felt confident in the way the technicalities (screenings, paper work, etc.) of this
intake visit went; however, even though we are going through with the evaluation, I am
not so sure he will qualify for CDS services. I would love nothing more than to offer
these parents early intervention services, as I know they would really like them.
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However, at this point, their son is developing within average limits in all areas of
development, which is a wonderful thing considering his first four months of life were
rattled with seizures. After the intake visit, I looked up a list of established conditions.
Maine does not have its own list of established conditions for Part C; however, I
sometimes refer to Colorados list just to check if certain disorders are on it. I was
unable to find any seizure disorder on their list. I do believe this would fall under the at-
risk category; however, Maine does not provide services to children who are at-risk for
developing delays.
The child recently had an evaluation, the Bayley, completed in Portland and the
results indicated borderline scores in the area of cognition. The parents also have
concerns regarding his speech and language development. After the January
evaluation, it was recommended they contact CDS for further evaluation, which they
promptly did. When I completed the screenings, I found he passed all of the items on
the Part C Vision Screening and the Denver Developmental Screening-II. Since he was
in the NICU for more than 48 hours and the parents have speech and language
concerns, the Part C Hearing Screening indicated a need for monitoring, which in this
case, will be follow-up with a Battelle Developmental Inventory-II.
I did explain to them my findings in the screenings and that I was unsure if he
would qualify or not. During the intake visit, they expressed an interest in learning more
about young childrens development and milestones so they know what they need to
look for as red flags in his development, if any were to occur. Regardless of whether or
not he qualifies for services, finding resources for this is something we will help them
with. Overall I felt good about this intake visit. The more I do them, the more
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comfortable I feel with explaining the ins and outs of the referral process, CDS services,
how third party payments work, among other things.






















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Documentation
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Four of these were signed for the childs various doctors and therapist.
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