Guide: North Carolina’s Early Intervention System
Navigating North Carolina’s Early Intervention system can feel overwhelming. This is a step by step guide to accessing the services available to you.
Below you will find information about:
Trusting your gut
Scheduling an evaluation
What happens in an evaluation?
Therapy services
Free consultation
Trust your gut
Every year, parents take their children to family gatherings and come home worried about their kids’ development. Someone notices that the cousins seem to be more independent, more verbal, or more agile. Often grandparents say, “Don’t worry, your uncle Fred didn’t (insert skill) until he was five!” But that advice is misguided. Parents are keen observers with strong intuition. In fact, research shows that parents are usually the first to suspect any sort of developmental delay. Because of that, the federal government funds free evaluations for all children under the age of three, no doctor’s referral required. Parents who seek help early, instead of waiting to talk to their pediatrician, access help months earlier. If you are worried about your child, trust your gut and get an evaluation.
Get an evaluation
When you seek an evaluation for your child under the age of 3, you have three options:
Children’s Developmental Services Agency (CDSA)
Private providers
Clinic-based care
In this guide, we share information regarding CDSA and private providers who offer evidence-based care in children’s natural learning environments. Though many doctors refer families to clinics for care, these are not considered evidence-based care, because clinics are not a natural learning environment. Clinic-based evaluations and treatment are not recommended for children under the age of three.
CDSA offers free evaluations for all children under the age of three in five developmental domains:
Cognitive (thinking, problem solving, etc.)
Communication (gesturing, talking, following directions, etc.)
Physical (crawling, walking, etc.)
Adaptive (feeding, dressing, etc.)
Social-Emotional (social interaction, emotional regulation, etc.)
If you have any concerns in any of these areas, or any other, call the Children’s Developmental Services Agency (CDSA) for your county. You will talk to a case manager who will ask questions about concerns. They will schedule an evaluation at your home, childcare location, or anywhere else you identify as part of your child’s natural environment.
Some families prefer to go with a private evaluation. While there are fees associated, parents are able to ensure they are working with a provider they feel comfortable with. Check with your provider to make sure they provide evaluations in natural learning environments.
What happens in an evaluation?
Evaluations should always take place in your child’s natural learning environment. This means in your home, at a relative’s or friend’s home, or at your childcare facility. You get to choose the time and location that works best for you to be there, because you know your child best. On the day of the evaluation, evaluators (physical therapists, occupational therapists, speech language pathologists, or developmental play therapists) bring toys and games designed to help them observe your child’s behaviors in the five developmental domains.
For example, in one test, an evaluator might give your child a tightly closed clear plastic jar with a toy inside. Children usually struggle to open the jar then try to get help from an adult. The evaluators note if and how the child asks for help (with words or actions). Not trying to open the jar can be a sign of delay in cognition or adaptive skills; not requesting help in some way can be a sign of delay in communication; trouble using two hands to try to open the jar can be a sign of delay in physical skills; and melting or shutting down out of frustration can be a sign of delay in social-emotional skills. The evaluators will also interview you and any other adults you suggest about your child’s specific skills in all of the domain areas.
The evaluators combine their observations with your interview responses to complete standardized tests. These tests help them compare your child’s development to expected development in the five domains. The evaluators calculate and share results during the evaluation session, so there’s no waiting to find out. If you are working with the CDSA and your child is delayed by 30% or more in one domain or 25% or more in two domains, the early intervention team will offer to work with you to write an individual family service plan (IFSP). This is the plan that identifies your goals for your child and the services the team recommends to help your family reach them.
Unlike CDSA, private providers can provide services to children with less severe delays. They discuss any delay with parents to determine next steps for treatment.
Therapy services
You can get therapy services for your child whether they qualify for the CDSA or not. If your child is delayed but not severely enough to qualify for CDSA’s speech-language, occupational, physical, and/or play therapy services, you have choices. Contact a private provider. Look for one who provides routines-based caregiver coaching in natural learning environments to make sure you are getting the best quality of evidence-based care.
Young children learn best in the contexts of their everyday activities and routines, not in clinics or schools. So early intervention sessions focus on helping parents learn special skills that work in their daily routines. Therapy sessions are when adults learn new skills, and the time between therapy sessions is when kids learn new skills. For example, if your child is delayed in using words, a speech-language pathologist might help you choose the most useful and meaningful words in your daily routines, then teach you strategies for modeling those words in daily contexts. This way, you are learning a skill during your therapy session, and your child is getting many small doses of therapy when you model throughout the week.
If your child does qualify for CDSA, the case manager will give you a list of therapists to choose from and will help you schedule with them. Unlike the evaluation, therapy services are not free. They are billed to your insurance, and fees are based on a sliding scale. Like the evaluation, therapy should take place in your child’s natural environments and focus heavily on parents. Therapists should not bring a bag of toys to your house, and they should spend most of their time coaching you and other significant adults in your child’s life, rather than playing with your child.
Free consultation
Village Growth Network offers evaluations in natural learning environments. We also specialize in routines based caregiver coaching for therapy. If you have more questions, schedule a free personalized consultation with one of our experts.
