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Early Intervention Speech Therapy

Qualifying for Early Intervention Services

Published October 19, 2009 3:56 PM by Stephanie Bruno-Dowling
Recently, a reader inquired on the blog about the specific requirements needed to qualify for services. Her question reads as follows:

"...I need an explanation of what qualifies as a "25%" delay. I typically am not involved in the eligibility process but was recently put in the position.  How is the 25% delay determined?  Does the child have to score below a certain percentile or be a certain number of standard deviations below?"

Like our reader, I am usually not a key player in the eligibility process. I am not part of an initial evaluation team; however I do assess the children on my caseload prior to their annual review to determine their levels of development and if they indeed continue to qualify for speech and language services. Before responding to this question, I did some additional research to see if what we do here in Delaware County, Pennsylvania is uniform with what is happening across the country and beyond. Here is some of the information I found:

According to the Lancaster County (PA) Early Intervention Web site, a child is eligible for early intervention if they have a 25 percent delay in one or more areas of development.

The 5 primary developmental areas are:
  • Physical Development—Ability to move, see, and hear
  • Speech and Language Development—Ability to talk, express needs
  • Social and emotional development—Ability to relate to others
  • Self help (or adaptive skills)—Ability to eat, dress, and take care of themselves
  • Cognitive development—Ability to think and learn

On the Wisconsin Birth to 3 Program Web site, the process is further outlined and reads as follows: 

  • a) A diagnosed physical or mental condition with a high probability of resulting in a developmental delay, based on the early intervention team's informed clinical opinion and supported by a physician's report documenting the condition.
  • b) A developmental delay of 25 percent (or 1.3 standard deviation below the mean) in one or more areas of development. This delay is documented from a number of perspectives (i.e., observations in natural environments, testing procedures, review of records, parent report and informed clinical opinion) by a qualified early intervention team that includes the parents.
  • c) Atypical development that is based on the informed clinical opinion of the early intervention team. When testing results closely approach but do not demonstrate a delay (25 percent or -1.3 S.D.) and observations indicate that some aspect of the child's development is atypical and adversely affecting the child's overall development, the early intervention team may use alternative procedures to document atypical development and conclude that the child should be considered developmentally delayed.

Washington State also mandates that the child must have a 25 percent delay; however they qualify this as "1.5 standard deviations below his or her age in one or more of the developmental areas. A child may also be eligible if he or she has a physical or mental condition such as Down Syndrome that is known to cause a delay in development". This is different from Wisconsin which equates 25 percent as 1.3 standard deviations. Not a huge difference but it could be the deciding factor for whether or not a child qualifies for services.

Based upon the research and websites I've reviewed, it seems as though the most educated response I can give to our reader(s) regarding eligibility is to FIND OUT WHAT THE SPECIFIC GUIDELINES IN YOUR COUNTY ARE and FOLLOW THEM. Although it appears that the 25 percent delay is standard throughout the US, there seems to also be more detailed instructions and deciding factors that are state and county specific. If you are entering a new position and are part of an evaluation team, make sure you know your facts so that the law in your area is being followed.

Please write in and share your thoughts and experiences regarding this topic! Also please send in topic requests and issues YOU would like to see addressed on the blog!

8 comments

My question is to Emily in Oakland, CA.  

The Rossetti speech language test gives a range of delay (like 46% to 54% for example).  

If 50% is in the child's speech delay range then does that meet the 50% eligibility criteria?

Elaine Kirk April 6, 2011 6:41 PM

In response to the discussion about qualifying for speech-language pathology services in early intervention, both parents and professionals should be aware that practices may vary from state to state and even from one county to another within a state. However, the IDEA Part C, which comprises the Federal regulations for services, is the over-riding regulation.  States MUST follow the Federal regulations

February 4, 2010 9:50 AM

In Wisconsin the entry criteria are more reasonable than I have seen in some other states.  The 25% delay refers to criterion-referenced tests which give an age equivalent score.  If a child is 24 months old, for example, a 25% delay is 6 months, or an 18 month age equivalent score.  We all know that age equivalent scores can be very unreliable and misleading.  With criterion referenced tests, however, they are more reliable because the score is based on achieving specific criterion behaviors rather than on the total number of items.  On the Rossetti, for example, the manual specifies that for a child to meet a specific age level, s/he must pass all items at that level.

The -1.3 standard deviation score refers to norm-referenced tests which give a standard score.

I find the "atypical development" entry criterion a very valuable one for children who have severe phonological or articulation disorders.  It is very hard to find a test to measure speech skills accurately at this age, particularly conversational skills.  Being able to qualify them under "atypical development" has allowed me to provide services much earlier than might otherwise be possible.  I don't use it a lot because I feel there is a real potential for abuse, but for some kids it is a lifesaver.

David Harper, B-3 - SLP, Home-based October 22, 2009 8:53 PM
Superior WI

Dear Alexandra of Tumwater, WA,

At the facility that I work at, with, we attempt to tell the parent that we have some concerns and that we would like for them to speak to their pediatricians about.  We are not allowed to tell them that we feel their child may be on the autism spectrum since we are not Phd's but we can tell them that we see some red flags that concern us. If they feel that their pediatrician does not understand their concerns that they make an appointment with a Developmental Pediatrican, who could look at the whole child, from birth on and including all developmental areas.  This would include possible syndromes, disorders, etc.

Lisa , Peds - Speech Language Path. October 22, 2009 7:25 PM
Rydal PA

EI in California is totally different and the law is changing now, so that less children qualify for services.  At this point, the eligibility criterion calls for a 33.33% delay in one or more areas prior to 24 months and 50% in one area or a continued 33.33% in two or more areas after 24 months.  It's actually putting lots of OTs, PTs, and SLP's in danger of losing their jobs.

Emily Vincent, EI - SLP October 22, 2009 10:42 AM
Oakland CA

Stephanie

I have a question for you. I work in a developmental preschool at an elementary school.

We struggle with how much to tell parents, in as far as if we think the child may be on the spectrum, have language delays as a result of a developmental syndrome, etc. If you feel there is an undiagnosed medical cause for developmental delays, do you talk to parents about this in a direct manner?  

I'd be interested in your input!

Alexandra, SLP October 21, 2009 10:26 PM
Tumwater WA

I, agree, that each state will likely differ somewhat.  In Illinois, the percent of delay is 30%.  However, there are approximately 5 other ways a child can meet eligibility requirements.

Jodie, , Pediatric Speech-Language Pathologist Private Practice October 21, 2009 8:15 PM
Evanston IL

The criteria in SD changed a year ago to:

Infants and toddlers, birth to 36 months of age, inclusive, are eligible for services under this chapter if identified by providers of licensed health care and education services as:

         (1)  Demonstrating at least a 1.5 standard deviation below the mean; or

         (2)  Children who are born at 28 weeks gestation or less; or

         (3)  Having a diagnosed physical or mental condition that has a high probability of resulting in developmental delay.

         Determinations of developmental delay shall be based on medical diagnoses, including Down's syndrome and other chromosomal abnormalities; sensory impairments, including vision and hearing; inborn errors of metabolism; microcephaly; severe attachment disorders, including failure to thrive; seizure disorders; and fetal alcohol syndrome.

When we were allowed to use 25% delay to qualify a child, it meant that a child who was 24 months was only performing at an 18 month age equivalency or less. Or, say a 14 month old would only be performing at 10-11 months. You calculate 25% of the child's chronological age and that's the cut-off point.

Karla, , Speech Therapist Chamberlain Schools October 21, 2009 5:58 PM
Chamberlain SD

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About this Blog


    Stephanie Bruno Dowling, M.S. CCC-SLP
    Occupation: Speech-Language Pathologist
    Setting: Early Intervention in Delaware County, PA
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