Making Referrals and Collaborating with Other Providers
For primary care providers:
Early intervention and public school special education programs are funded by the Individuals with Disabilities Education Act (IDEA). They are free, of good quality, and available throughout the US. IDEA programs provide detailed follow-up assessments and should be the first referral made when children have trouble on screens.
Your referral letter (see our templates on the next page of this module) should cover the topics below. Better still you can make use of PEDS Online which generates the following content for you).
- The status of a child’s vision, hearing, lead levels and any health-impairments/conditions that might interfere with learning. (Many IDEA programs require such documentation before they can proceed with testing);
- The types of evaluations you want administered. (Speech-language and mental health problems are insufficiently diagnosed especially in school-age children and requests for such testing, if needed, should be mentioned in your referral letter);
- A request that information about test results be sent to you. (This may not occur automatically and so it is best if you can establish two-way consent forms with IDEA programs that parents sign and thus agree to share information between services);
- A request that IDEA programs provide ongoing monitoring at regular intervals if a child is not eligible. (Some, but not all, IDEA programs monitor ineligible children)
Some children will not qualify for services once tested (criteria for enrollment are stringent and IDEA programs are not fully focused on prevention). In these cases, you will want to refer to Head Start, a quality day care or preschool program, parent training, after-school tutoring such as Boys and Girls Club, summer school, etc. Please see our referral resources page for links.
Please note that early intervention programs do not generally make a specific diagnosis. Instead, eligibility is determined by the presence of a condition associated with developmental challenges (e.g., Down Syndrome) or by determining the degree of delays across domains (e.g., a 25% delay in two domains, or a 40% delay in one domain). Although it is wise to avoid labeling a child early in life, autism spectrum disorder (ASD) is the one condition that should be diagnosed as early as possible so that highly focused interventions can be implemented. The diagnosis of ASD requires a multidisciplinary team. So when you suspect ASD, first refer to IDEA services (so that children receive prompt intervention even while waiting for a diagnosis), and simultaneously refer to specialists (e.g., developmental-behavioral pediatrician, neurodevelopmental pediatricians, private developmental psychologists, speech-language centers, autism subspecialty programs or university hospitals developmental clinics). Many private services have lengthy waiting lists so, again, it is essential to get children enrolled and treated while they wait (sometimes up to a year) for a diagnostic evaluation.
Also, it is wise to:
- Visit IDEA programs or meet with IDEA providers so that you establish a affable, collaborative relationship;
- Convey your preferences for communication (e.g., email, phone, fax) and the best hours to reach you;
- Relay your willingness to confer on health issues and management especially when children have complex health conditions;
- Identify the types of information you wish to receive. [Some clinicians only want short assessment reports while others prefer to receive Individual Family Service Plans or Individual Educational Plans (IEPs or IFSPs) which are lengthy lists of goals and activities].
For Nonmedical Providers:
It is invaluable to know the medical providers in your community. They see almost all children and so if you want to do an optimal job with child-find, it is essential to work with doctors and nurses in primary health care clinics, public health, pediatric and family practice clinics:
- Health care providers are far more likely to make referrals to services with which they are familiar. And…. they may not know that your services are even available. They are inevitably frustrated, if not suspicious, if they don’t know what is happening after they’ve made a referral.
- A helpful start is to call the clinic coordinator to ask if there’s a time you can talk about your services.
- If so, usually you’ll have ~ 20 minutes at lunchtime. So… bring pizzas!
- Plan a 10 minute talk with lots of time for questions.
- Provide handouts about your services (and maybe something to stick on the lunchroom fridge—don’t spend money on coffee mugs or pens, especially if you are in a for-profit program. Practices are not allowed to accept such gifts.)
- Better still, make a one-page handout of all referral options in your community, laminate it, and provide one to post in each exam room
- Call providers back when they’ve made a referral and let them know you received it.
- Provide status updates (e.g., if a parent has not arrived in 6 weeks, let the provider know, and/or communicate test results. You may need clinicians to authorize therapies and they’ll feel that such requests are a “run-away train” if they don’t know anything about testing outcomes.
- If possible, enable providers or their office staff to schedule appointments for parents, preferably also co-establishing two-way consent forms; parents are far more likely to keep appointments if these are scheduled for them.
- If possible, monitor children who are not eligible with follow-up testing, and whenever you determine lack of eligibility, refer for other services. If you are prohibited from making other referrals, it is wise to contact the child’s provider and make suggestions for options to which he/she can refer.
On the next page you will see a sample referral letter and a sample summary report for parents to take home. You can modify these as needed.