Resource - Informed Clinical Opinion
Qualified personnel must use informed clinical opinion when conducting an evaluation and assessment of the child. Informed clinical opinion may be used as an independent basis to establish a child’s eligibility under this part even when other instruments do not establish eligibility; however, in no event may informed clinical opinion be used to negate the results of evaluation instruments used to establish eligibility.
Click here for more information on what informed clinical opinion means in the context of Part C
What is Evaluation?
Evaluation in early intervention (under Part C of IDEA) means the procedures used by appropriate qualified personnel to determine a child’s initial and ongoing eligibility for early intervention and the child’s developmental status in five areas of development [COMAR 13A.13.01.03(B)(19); 34 CFR §303.321(a)(2)(i)]:
- cognitive,
- physical, including vision and hearing,
- communication,
- social/emotional, and
- adaptive.
Evaluation procedures include administering an evaluation instrument, taking the child’s history (including interviewing the child’s parent/guardian), identifying the child’s level in each developmental area, gathering information from other sources such as family members, other caregivers, medical providers, social workers, and educators, if necessary, to understand the full scope of the child’s unique strengths and needs, and reviewing medical, educational and other records [COMAR 13A.13.01.05(A)(3); 34 CFR §303.321(b)]. No single procedure may be used as the sole criteria for determining a child’s eligibility [COMAR 13A.13.01.05(A)(2); 34 CFR §303.321(b)].
An initial evaluation refers to the child’s evaluation to determine his or her initial eligibility. Once a child begins receiving early intervention services, evaluation is used to determine a child’s progress and ongoing eligibility on at least an annual basis.
Note
A child’s medical and other records may be used to establish eligibility without conducting an evaluation of the child if:
1) The records indicate the child’s level of functioning in one or more developmental areas constitutes a developmental delay; or
2) The child otherwise meets the criteria for an infant or toddler with a disability. For example the child has a diagnosed physical or mental condition with a high probability of resulting in a delay.
[COMAR 13A13.01.05(E)(5)]
While additional evaluation procedures to establish a child’s eligibility are not required, the child’s level of functioning in each developmental area, as well as their strengths and needs, must be included in a written report.
Evaluation must be:
- Multidisciplinary – involving at least two different disciplines. The multidisciplinary requirement for evaluation may be met by one individual who is qualified in more than one discipline. [COMAR 13A.13.01.03(B)(40); 34 CFR §303.24]
- Multidimensional – including more than one method and source of information to determine a child’s eligibility and level of functioning in all five developmental areas [COMAR 13A.13.01.05(A)(2); 34 CFR §303.321(b)]
- Nondiscriminatory - Evaluation and assessment procedures and materials must be nondiscriminatory with regard to race, ethnicity, and culture, and must be offered in the family’s native language, [34 CFR §303.113] and
- Timely – must be conducted within a 45 day period from the date on which the referral is received by the local Infants and Toddlers Program [COMAR 13A.13.01.07(A); 34 CFR §303.321(a)(1)(i)].
It is imperative to ask parents for their consent to obtain copies of a child’s medical records, because that information may help determine a child’s eligibility for early intervention services. For example:
- A diagnosis already made may indicate that a child has a physical or mental condition which has a high probability of resulting in developmental delay, or may result in atypical development.
- An evaluation and assessment may have recently been completed indicating that a child has at least a 25% delay in one of the five developmental areas. Qualified personnel should use informed clinical opinion to decide whether a previous evaluation still accurately reflects a child’s current developmental status.
This information, when received in writing, can be used by qualified personnel to make the determination that a child is eligible for early intervention services. Keep in mind that the legal requirement for a multidisciplinary evaluation (involvement of two or more disciplines) must still be met.
Previous assessment for Charlie, completed by a speech-language pathologist and a physical therapist in the hospital could qualify as a multidisciplinary evaluation for determining his eligibility for early intervention. If only an evaluation report from the speech-language pathologist was completed and obtained, then a second discipline (preferably someone with expertise to answer family members’ questions about how to help Charlie get safely around their home and neighborhood) from the local early intervention program should be scheduled to evaluation him.
If a child’s diagnosis automatically qualifies him or her for early intervention supports and services, or a previous multidisciplinary evaluation has addressed a child’s status in each of five developmental areas, then the early intervention tam can address the State and federal requirements for assessment. This means the process of identifying a child’s unique strengths and needs in each of five developmental areas, as well as the services and supports appropriate to assisting a family to meet those needs.
