Chapter 10: Service Providers Roles and Responsibilities

The roles and responsibilities of the service providers are detailed in this chapter.

Topics included in this chapter Page

Introduction 2
Service Delivery in EarlySteps: Recommended Practices for the Service Provider in Ongoing 2
Service Delivery
EarlySteps Providers 10
Qualifications 10
Roles and Responsibilities 10
Referral to Office of Community Services 11
Assessments and Evaluations by Service Providers 11
Provider Enrollment 11
Training Requirements 14
Certification of Enrollment by the CFO 14
The Service Matrix 14
Changing a FSC or Provider 14
Substituting Early Intervention Providers 15
Service Authorizations 15
Accessing the Online System for Authorizations 15
Submission of Claims 16
Medicaid Services 16
Documentation Requirements for Service Providers 17
Provider Contact Note 17
Provider Monthly Report 18
Documentation for Assistant Level Providers 19
Services Provided outside of the Natural Environment 19
Quality Management 20
Early Intervention Records – Additional Information 20
Opportunity to Examine Records 20
Access to Records 21
Destruction of the Early Intervention Record 22
Professional Ethics 22
Service Provider Performance Indicators 24
Service Provider Contact Note 25
Provider Monthly Report 26
Who Do You Call? 27

Chapter 10: Provider Roles and Responsibilities 1 Revised 7/2010

 Forms
Provider Contact Note (included at the end of this chapter)
Monthly Progress Report (included at the end of this chapter)
Service Authorization/Provider Status Change form
EDI Annual Certification of Electronically submitted Medicaid Claims

All EarlySteps forms are in Chapter 14 of the EarlySteps Practice manual and can be located on the
website at http://www.earlysteps.dhh.louisiana.gov, click on information for EarlySteps providers and
scroll down to the section with the Practice Manual.

For purposes of clarification, the term provider used in this chapter refers to providers of services
excluding intake and support coordination. Those services are discussed in Chapters 4 and 9
respectively.

Introduction
The EarlySteps service delivery system is a team-based interdisciplinary model which consists of the components
listed below. This interdisciplinary model refers to providers from multiple professional disciplines that represent
specific areas of expertise working together with families to accomplish the IFSP outcomes. Trandisciplinary
service delivery is supported in this model in the specific ways that team members interact. This interaction
requires that the team members collaborate and provide integrated, routines-based interventions in the child’s
natural environments. The Division of Early Childhood (DEC) Recommended Practices for the Interdisciplinary
Model of Service Delivery (Sandall, et al, 2005) identifies four Guiding Principles which are supported in the
EarlySteps System:

 Teamwork is a collective responsibility of the providers, families, FSC, and other resource providers
involved in service delivery to a child and family. This is supported in EarlySteps partially through the
team meeting process and partially through practices which support these guidelines.

 The transdisciplinary model discourages fracturing or segregating services along disciplinary lines and
supports the exchange of competencies among team members. This means that the expertise brought to
service delivery by individuals from different disciplines is enhanced through function as a team member,
rather than functioning solely as an individual, discipline-specific provider.

 Service delivery should be outcome-based and functional. This means that the interventions utilized are
necessary for the child’s engagement, independence and social relationships in the context of his home
and community environments. Providers are responsible for knowing the most effective approaches,
which support these, matching them to the child’s needs and sharing them with the team.

 Service delivery must be practical in that it supports caregivers in ways that are meaningful to them from
ongoing interactions in the natural environment rather than in relying on “isolated” contacts or sessions.
The EarlySteps system supports the belief that it is not the provider who has the direct impact on the
child, but it is the child’s natural caregivers—parents, child care providers, etc. Providers support this
guideline through service provision that involves the family in the service delivery through demonstration,
written information, and planned opportunities for practice. Additional information on best practices in
service delivery is found in Chapter 12: “EarlySteps Recommended Practices Guidelines”.

Service Delivery in EarlySteps: Recommended Practices for the Service Provider in

Ongoing Service Delivery
Practices for providing support and services in early intervention have shifted from just direct, hands-on
“treatment” to supporting families through collaboration so that they can promote their child’s development by
using identified intervention strategies effectively and confidently during their everyday activities. Critical home
visiting components include:
 the visit occurs within the context of the family’s routines,
 the visit promotes child engagement
 the visit ensures caregiver engagement in the activities
Chapter 10: Provider Roles and Responsibilities 2 Revised 7/2010
  use of early intervention strategies supports the caregiver with confidence and competence. (Keilty,
2008)
The following are guidelines for establishing and maintaining collaborative relationships with families and team
members:
1. Build on or establish trust and rapport.
• Before each visit, reflect on your own beliefs and values and how they might influence your suggestions
and strategies with this particular family or caregiver.
• Use communication styles and social behaviors that are warm and welcoming and respectful of family
culture and circumstances.
• Conduct yourself as a guest in the family’s home or caregiver’s setting.
• Respectfully provide complete and unbiased information in response to requests or questions.
• Be credible and follow through on plans you made with the family.
• If you don’t know the answer to a question, tell the family you do not know but will find out for them. Tell
them when you will get back to them with the information.

2. During the first visit, review the IFSP and plan together how the time can be spent.
• Describe the practical aspects of a visit and what the family or caregiver can expect. For example: the
length of the typical visit, that other people are always welcome at the family’s invitation, the variety of
places in which visits can occur, the program’s cancellation policy, etc.
• Describe examples of visits in various home and community settings where the family participates. You
might want to offer to share clips from commercial or videos produced by your program.
• Invite the family to reflect on their experience with the IFSP process to date and share any concerns or
questions.
• Review the IFSP document and assessment information.
• Consider each agreed upon outcome – is it what the family is still interested in; prioritize again, if
necessary, where to begin; change wording if needed; provide any explanations to help family
understand purpose, etc.
• Discuss how outcomes, activities, and strategies can be a starting place for each home visit.
• Clarify who will work on each outcome – family, friends, other caregivers, service providers.
• Talk about community activities and events that can be used to support practice and mastery for the
specific outcomes.
• Ask the family/caregiver to sign the Contact Note.
• Provide information about family-to-family support and parent groups that are available.

3. For on-going visits, use the IFSP as a guide to plan how to spend the time together.
• Begin each visit by asking-open ended questions to identify any significant family events or activities
and how well the planned routines and activities have been going.
• Ask if there are any new issues and concerns the family wants to talk about. Explore if these concerns
need to be addressed as new outcomes; if so, plan an IFSP review.
• Decide which outcomes and activities to focus on during the visit.

4. Participate with the family or other caregivers and the child in the activity and/or routine as the context
for promoting new skills and behaviors.
• Offer a variety of options to families for receiving new information or refining their routines and activities,
such as face-to-face demonstrations, video, conversations, written information, audios, CDs, diaries,
etc..
• Gather any needed toys and materials and begin the selected activity or routine.
• Listen, observe, model, teach, coach, and/or join the ongoing interactions of the family and child.
• Encourage the family to observe and assess the child’s skills, behaviors, and interests (a continual part
of on-going functional assessment). For example, ask the family if behaviors are typical, if they’ve
seen new behaviors (suggesting emerging skills), or how much the child seems to enjoy the activity.
• Use a variety of consulting or coaching strategies throughout the activity, including: observing, listening,
attending, acknowledging, expanding, responding, probing, summarizing, etc.
• Reflect with the family on what went well, what they want to continue doing, and what they would like to
do differently at the next visit.

Chapter 10: Provider Roles and Responsibilities 3 Revised 7/2010

5. Jointly revise, expand, or create strategies, activities or routines to continue progress toward achieving
outcomes and address any new family concerns or interests.
• Having listened throughout the visit, reflect on what you have heard that may suggest new outcomes or
activities; explore with the family if this is something they want to address soon.
• Support and encourage family decisions.
• Focus recommendations on promoting the child’s participation in everyday family
and community life.
• Explain the “why” behind recommendations that you make so the family
understands what to look for and do.
• Together, plan next steps and/or revise activities and strategies to build on the child
and family’s interests, culture, enjoyment, strengths.
• Consider any adaptations and augmentations to toys, materials, or environments
that are necessary for success.
• Try out new strategies or activities to be sure family members or caregivers can do
them on their own.
• Determine if and what type of support from other team members is needed for the
next steps (consultation, information, co-visit, etc.). Be prepared to discuss these supports at team
meetings
6. Modify services and supports to reflect the changing strategies, activities, or routines.
• Identify community activities and informal supports that will assist the outcomes and activities to be
achieved.
• With the FSC, facilitate referrals and provide any needed assistance, adaptations, or support for the
family and the child to participate in desired community activities.
• Plan what early intervention and other services and supports are needed to help the child succeed and
make progress.
• In conjunction with other team members, recommend modifications to the IFSP as appropriate. If
changes are significant (adding outcomes, or changing services, frequency, or intensity), a team
review of the IFSP is necessary. No changes can be made without prior arrangements with the FSC,
the family, and other team members.
7. Prepare and assist with formal reviews and revisions of the IFSP.
• Minimally, at 6 months and annually, and any other time the family/provider team wants to make
significant changes to the IFSP, plan the Review meeting with the family.
• Review with the family questions, recommendations, or suggestions they wish to discuss with other
service providers.
• Decide with the family the agenda for the meeting and their preferred role(s), including who should
facilitate.
• Determine together who should be included in the “formal review meeting”, when and where the meeting
should occur.
• Explain and provide written prior notice for the review meeting.
• Conduct the review meeting and evaluate progress toward outcomes. Ensure all outcomes, services,
and supports are still needed, current, and accurate. Make additions and revisions as needed.
8. Prepare families for transition out of Part C services.
• Early in the relationship with the family have conversations about what they want for their child’s future
after the early intervention program ends.
• At formal 6 month/annual IFSP reviews share written information about the “transition process” and
options (no services, community services, and Part B services) and describe that early intervention
services end at age three.
• By no later than the child’s second birthday, have conversations about the types of programs, places,
and activities the family would like their child to participate in at age three.
• Discuss and share information about ALL options available to children and families at age three.
• Provide written information about these options or assist the family as needed to explore and visit these
options.
• Jointly review the IFSP and revise/add outcomes and strategies based upon the above discussions,
according to EarlySteps practices.
• Develop a transition plan which includes the outcomes and activities to prepare the child and family for
success after early intervention.
9. Explain and follow the regulations, timelines, and procedures for transition plans, planning
conferences, and data collection.
• Help the family prepare for any formal evaluations the child may need.
• Assist in arranging the formal (transition?) meeting with the program staff who may be working with the
child after age three.
Chapter 10: Provider Roles and Responsibilities 4 Revised 7/2010
 • Assist the family to find on-going family support if needed.
• Acknowledge feelings about ending the relationship with this family and help to focus on a positive
future as the child and family move on.
• Celebrate with the family or caregiver the accomplishments and joys they have experienced with their
child.

These practices are associated with seven key principles of what service delivery in early intervention looks
like:
I 1. 1. Infants and toddlers learn best through every day experiences and interactions with familiar people in
familiar contexts.
Key Concepts
􀂾 Learning activities and opportunities must be functional, based on child and family interest and enjoyment
􀂾 Learning is relationship-based
􀂾 Learning should provide opportunities to practice and build upon previously mastered skills
􀂾 Learning occurs through participation in a variety of enjoyable activities
This principle DOES look like this This principle DOES NOT look like this

Using toys and materials found in the home or community Using toys, materials and other equipment the
setting professional brings to the visit
Helping the family understand how their toys and materials can Implying that the professional’s toys, materials
be used or adapted or equipment are the “magic” necessary for
child progress
Identifying activities the child and family like to do which build on Designing activities for a child that focus on
their strengths and interests skill deficits or are not functional or enjoyable
Observing the child in multiple natural settings, using family Using only standardized measurements to
input on child’s behavior in various routines, using formal and understand the child’s strengths, needs and
informal developmental measures to understand the child’s developmental levels
strengths and developmental functioning
Helping caregivers engage the child in enjoyable learning Teaching specific skills in a specific order in a
opportunities that allow for frequent practice and mastery of specific way through “massed trials and
emerging skills in natural settings repetition” in a contrived setting
Focusing intervention on caregivers’ ability to promote the Conducting sessions or activities that isolate
child’s participation in naturally occurring, developmentally the child from his/her peers, family members
appropriate activities with peers and family members or naturally occurring activities
Assuming principles of child learning, development, and family Assuming that certain children, such as those
functioning apply to all children regardless of disability label with autism, cannot learn from their families
through naturally occurring leaning
opportunities.

All fa2. 2 . All families, with the necessary supports and resources, can enhance their children’s learning and
development.
Key Concepts
􀂾All means ALL (income levels, racial and cultural backgrounds, educational levels, skill levels, living with varied
levels of stress and resources)
􀂾The consistent adults in a child’s life have the greatest influence on learning and development-not EI providers
􀂾All families have strengths and capabilities that can be used to help their child
􀂾All families are resourceful, but all families do not have equal access to resources
􀂾Supports (informal and formal) need to build on strengths and reduce stressors so families are able to engage
with their children in mutually enjoyable interactions and activities
This principle DOES look like this This principle DOES NOT look like this
Assuming all families have strengths and competences; Basing expectations for families on
appreciating the unique learning preferences of each adult and characteristics, such as race, ethnicity,
matching teaching, coaching, and problem solving styles education, income or categorizing families as
Chapter 10: Provider Roles and Responsibilities 5 Revised 7/2010
 accordingly those who are likely to work with early
intervention and those who won’t
Suspending judgment, building rapport, gathering information Making assumptions about family needs,
from the family about their needs and interests interests, and ability to support their child
because of life circumstances
Building on family supports and resources; supporting them to Assuming certain families need certain kinds
marshal both informal and formal supports that match their of services, based on their life circumstances
needs and reducing stressors or their child’s disability
Identifying with families how all significant people support the Expecting all families to have the same care
child’s learning and development in care routines and activities routines, child rearing practices and play
meaningful and preferable to them preferences.
Matching outcomes and intervention strategies to the families’ Viewing families as apathetic or exiting them
priorities, needs and interests, building on routines and activities from services because they miss
they want and need to do; collaboratively determining the appointments or don’t carry through on
supports, resources and services they want to receive prescribed interventions, rather than
refocusing interventions on family priorities
Matching the kind of help or assistance with what the family Taking over and doing “everything” for the
desires; building on family strengths, skills and interests to family or, conversely, telling the family what to
address their needs do and doing nothing to assist them

The 3. The primary role of the service provider in early intervention is to work with and support the family
members and caregivers in a child’s life.
Key Concepts
􀂾EI providers engage with the adults to enhance confidence and competence in their inherent role as the people
who teach and foster the child’s development
􀂾Families are equal partners in the relationship with service providers
􀂾Mutual trust, respect, honesty and open communication characterize the family-provider relationship

This principle DOES look like this This principle DOES NOT look like this

Using professional behaviors that build trust and rapport and Being “nice” to families and becoming their
establish a working “partnership” with families friends

Valuing and understanding the provider’s role as a collaborative Focusing only on the child and assuming the
coach working to support family members as they help their child; family’s role is to be a passive observer of
incorporating principles of adult learning styles what the provider is doing “to” the child

Providing information, materials and emotional support to Training families to be “mini” therapists or
enhance families’ natural role as the people who foster their interventionists
child’s learning and development

Pointing out children’s natural learning activities and discovering Giving families activity sheets or curriculum
together the “incidental teaching” opportunities that families do work pages to do between visits and
naturally between the providers visits checking to see these were done

Involving families in discussions about what they want to do and Showing strategies or activities to families
enjoy doing; identifying the family routines and activities that will that the provider has planned and then
support the desired outcomes; continually acknowledging the asking families to fit these into their routines
many things the family is doing to support their child

Allowing the family to determine success based on how they feel Basing success on the child’s ability to
about the learning opportunities and activities the child/family has perform the professionally determined
chosen activities and parent’s compliance with
prescribed services and activities

Celebrating family competence and success; supporting families Taking over or overwhelming family
only as much as they need and want confidence and competence by stressing
Chapter 10: Provider Roles and Responsibilities 6 Revised 7/2010
 “expert” services.

The e 4. The early intervention process, from initial contacts through transition, must be dynamic and
individualized to reflect the child’s and family members’ preferences, learning styles and cultural beliefs.
Key Concepts
􀂾Families are active participants in all aspects of services
􀂾Families are the ultimate decision makers in the amount, type of assistance and the support they receive
􀂾Child and family needs, interests, and skills change; the IFSP must be fluid, and revised accordingly
􀂾The adults in a child’s life each have their own preferred learning styles; interactions must be sensitive and
responsive to individuals
􀂾Each family’s culture, spiritual beliefs and activities, values and traditions will be different from the service
provider’s (even if from a seemingly similar culture); service providers should seek to understand, not judge
􀂾Family “ways” are more important than provider comfort and beliefs (short of abuse/neglect)

This principle DOES look like this This principle DOES NOT look like this

Evaluation/assessments address each family’s initial priorities, Providing the same “one size fits all”
and accommodate reasonable preferences for time, place and the evaluation and assessment process for
role the family will play each family/child regardless of the initial
concerns

Preparing the family to participate in the IFSP meeting, reinforcing Directing the IFSP process in a rote
their role as a team member who participates in choosing and professional- driven manner and presenting
developing the outcomes, strategies, activities and services and the family with prescribed outcomes and a
supports list of available services

Collaboratively tailoring services to fit each family; providing Expecting families to “fit” the services; giving
services and supports in flexible ways that are responsive to each families a list of available services to choose
family’s cultural, ethnic, racial, language, socioeconomic from and providing these services and
characteristics and preferences supports in the same manner for every
family

Collaboratively deciding and adjusting the frequency and intensity Providing all the services, frequency and
of services and supports that will best meet the needs of the child activities the family says they want on the
and family, according to the team process. IFSP

Treating each family member as a unique adult learner with Treating the family as having one learning
valuable insights, interests, and skills style that does not change

Acknowledging that the IFSP can be changed as often as needed Expecting the IFSP document outcomes,
to reflect the changing needs, priorities and lifestyle of the child strategies and services not to change for a
and family according to EarlySteps practices year

Recognizing one’s own culturally and professionally driven Acting solely on one’s personally held
childrearing values, beliefs, and practices; seeking to understand, childrearing beliefs and values and not fully
rather than judge, families with differing values and practices acknowledging the importance of families’
cultural perspectives

Learning about and valuing the many expectations, commitments, Assuming that the eligible child and
recreational activities and pressures in a family’s live; using IFSP receiving all possible services is and should
practices that enhance the families’ abilities to do what they need be the major focus of a family’s life.
to do and want to do for all family members

IFSP 5. IFSP outcomes must be functional and based on children’s and families’ needs and priorities
Key Concepts

Chapter 10: Provider Roles and Responsibilities 7 Revised 7/2010

  Functional outcomes improve participation in meaningful activities
 Functional outcomes build on natural motivations to learn and do; fit what’s important to families;
strengthen naturally occurring routines; enhance natural learning opportunities.
 The family understands that strategies are worth working on because they lead to practical improvements
in child & family life
 Functional outcomes keep the team focused on what’s meaningful to the family in their day to day
activities.
This principle DOES look like this This principle DOES NOT look like this

Writing IFSP outcomes based on the families’ concerns, Writing IFSP outcomes based on test results
resources, and priorities

Listening to families and believing (in) what they say regarding Reinterpreting what families say in order to
their priorities/needs better match the service provider’s (providers’)
ideas

Writing functional outcomes that result in functional support and Writing IFSP outcomes focused on
intervention aimed at advancing children’s engagement, remediating developmental deficits.
independence, and social relationships.

Writing integrated outcomes that focus on the child participating Writing discipline specific outcomes without
in community and family activities full consideration of the whole child within the
context of the family

Having outcomes that build on a child’s natural motivations to Having outcomes that focus on deficits and
learn and do; match family priorities; strengthen naturally problems to be fixed
occurring routines; enhance learning opportunities and
enjoyment

Describing what the child or family will be able to do in the Listing the services to be provided as an
context of their typical routines and activities outcome (Johnny will get PT in order to walk).

Writing outcomes and using measures that make sense to Writing outcomes to match funding source
families; using supportive documentation to meet funder requirements, using medical language and
requirements measures (percentages, trials) that are difficult
for families to understand and measure

Identifying how families will know a functional outcome is Measuring a child’s progress by “therapist
achieved by writing measurable criteria that anyone could use to checklist/observation” or re-administration of
review progress. initial evaluation measures.

6. 6 6. The family’s priorities needs and interests are addressed most appropriately by a primary provider who
represents and receives team and community support.
Key Concepts
􀂾 The team can include friends, relatives, and community support people, as well as specialized service
providers.
􀂾 Good teaming practices are used
􀂾 One consistent person needs to understand and keep abreast of the changing circumstances, needs, interests,
strengths, and demands in a family’s life
􀂾 The primary provider brings in other services and supports as needed, assuring outcomes, activities and advice
are compatible with family life and won’t overwhelm or confuse family members

This principle DOES look like this This principle DOES NOT look like this

Talking to the family about how children learn through play and Giving the family the message that the more
practice in all their normally occurring activities service providers that are involved, the more
Chapter 10: Provider Roles and Responsibilities 8 Revised 7/2010
 gains their child will make

Keeping abreast of changing circumstances, priorities and Limiting the services and supports that a child
needs, and bringing in both formal and informal services and and family receive
supports as necessary

Planning and recording consultation and periodic visits with other Providing all the services and supports
team members; understanding when to ask for additional through only one provider who operates in
support and consultation from team members isolation from other team members

Having a primary provider, with necessary support from the Having separate providers seeing the family
team, maintain a focus on what is necessary to achieve at separate times and addressing narrowly
functional outcomes defined, separate outcomes or issues

Coaching or supporting the family to carry out the strategies and Providing services outside one’s scope of
activities developed with the team members with the appropriate expertise or beyond one’s license or
expertise; directly engaging team members when needed certification

Developing a team based on the child and family outcomes and Defining the team from only the professional
priorities, which can include people important to the family, and disciplines that match the child’s deficits
people from community supports and services, as well as early
intervention providers from different disciplines

Working as a team, sharing information from first contacts Having a disjointed IFSP process, with
through the IFSP meeting when a primary service provider is different people in early contacts, different
assigned; all team members understanding each others on- evaluators, and different service providers
going roles. who do not meet and work together with the
family as a team.

Making time for team members to communicate formally and Working in isolation from other team members
informally, and recognizing that outcomes are a shared with no regular scheduled time to discuss how
responsibility things are going.

Intee 7. Interventions with young children and family members must be based on explicit principles, validated
practices, best available research and relevant laws and regulations.
Key Concepts
􀂾 Practices must be based on and consistent with explicit principles
􀂾 Providers should be able to provide a rationale for practice decisions
􀂾 Research is on-going and informs evolving practices
􀂾 Practice decisions must be data-based and ongoing evaluation is essential
􀂾 Practices must fit with relevant laws and regulations
􀂾 As research and practice evolve, laws and regulations must be amended accordingly

This principle DOES look like this This principle DOES NOT look like this

Continually updating knowledge, skills and strategies by Thinking that the same skills and strategies one
keeping abreast of research has always used will always be effective

Refining practices based on introspection to continually clarify Using practices without considering the values
principles and values and beliefs they reflect

Basing practice decisions for each child and family on Using practices that “feel good” or “sound
continuous assessment data and validating program practice good” or are promoted as the latest “cure-all”
through continual evaluation

Keeping abreast of relevant regulations and laws and using Using practices that are contrary to relevant
Chapter 10: Provider Roles and Responsibilities 9 Revised 7/2010
 evidence-based practice to amend regulations and laws policies, regulations or laws.

EarlySteps Providers
The following service providers comprise the EarlySteps System:

 Audiologist
 Counselor, licensed professional
 Counselor (in a school setting)
 Registered Dietician
 Early Intervention Consultant (a position at the SPOE)
 Interpreter for the deaf or hard of hearing
 Nurse, RN
 Nurse, LPN
 Occupational Therapist
 Occupational Therapy, Certified Assistant (COTA)
 Optometrist
 Orientation and Mobility Specialist
 Physical Therapist
 Physical Therapy Assistant (PTA)
 Physician
 Psychologist
 School Psychologist
 Intake Coordinator
 Family Support Coordinator (FSC)
 Social Worker
 Speech Language Pathologist
 Speech Language Pathologist Assistant (SLP-Assistant)
 Special Instructor
 Special Instructor for children with sensory impairments
 Behavior Consultant
 Applied Behavioral Analysis (ABA) Implementer
 Transportation Provider
 Foreign Language Interpreter

Qualifications

For qualifications, see the Provider Qualifications, Chapter 13.

Roles and Responsibilities

An EarlySteps provider has many diverse roles. However, the primary role is to work collaboratively with the
family, child, and IFSP team members so that the child can participate fully in the family and community.
EarlySteps incorporates the information from the assessment of Concerns, Priorities, and Resources into the
IFSP. This identifies the family’s priorities and needs regarding their child’s development. Providers should
utilize this information in the decision-making regarding their service delivery with the child and family.
Listed below are some of the typical roles in which a service provider will engage:
 Adhere to all federal and state policies and procedures relative to this program.
 Consult with a family member, service provider, family support coordinator, and/or a representative of a
community agency to ensure the attainment of identified outcomes.
 Teach a family member/child care worker different strategies necessary to attain an identified outcome.
 Participate at team meetings, i.e. eligibility determination, reviews and revisions, quarterly team
meetings, IFSP development, etc. to assist the team with its responsibilities.
 Conduct single domain assessments and autism screenings (by providers who are appropriately trained
and qualified..

Chapter 10: Provider Roles and Responsibilities 10 Revised 7/2010

  Complete evaluations using the format(s) provided by EarlySteps. All required evaluation, assessment,
and autism screening documentation must be submitted to the FSC, SPOE, and/or regional office as
outlined in Chapters 5 and 7 and according to the autism screening requirements.
 Understand and adhere to the “Best Practice Guidelines” as developed by EarlySteps and accurately
represent these guidelines in discussions at team meetings.
 Adhere to all reporting requirements, including completion of the Provider Contact Note and Monthly
Progress Report (to be sent to the FSC) that describes contacts with the family/child for that month.
 Maintain a file for a minimum of five (5) years, which contains documentation of contacts with the
family/child.
 Refer any child, who is suspected of having a disability or developmental delay, to the Intake agency
(SPOE in the area where the child resides) within 48 hours. [This is a requirement of the federal law. A
list of the SPOE intake agencies can be found on the website.]
 Participate and fully cooperate with any quality management activities as required by the State and this
program.
 Verify the Medicaid status of each Medicaid eligible child on a monthly basis.
 Complete required training.
 Uphold professional standards of the appropriate licensing board and/or certifying agency and submit
license, certification, and background checks according to the policy for each.

Referral to Office of Community Services

EarlySteps providers, Intake Coordinators, Family Support Coordinator's etc. are mandated reporters by
Louisiana Law to the Office of Community Services if there is a suspicion of abuse or neglect.

For more information on the Office of Community Services refer to:

http://www.dss.state.la.us/departments/ocs/OCS_Regions_Directory.html.

Assessments and Evaluations by Service Providers

Providers who meet the EarlySteps’ qualifications for enrollment may conduct assessments, evaluations, and
autism screenings. Assistant level providers may not conduct assessments or evaluations or autism screenings
(this includes OTAs, PTAs, LPNs, & SLPAs.) Providers should consult the requirements of their appropriate
licensing board regarding allowable activities which assistant level providers may conduct.

EarlySteps utilizes the Battelle Developmental Inventory 2nd Edition as the evaluation instrument for eligibility
determination. The Autism Spectrum Disorder Screening Tools (BISCUIT) and M-Chat are the instruments
utilized for Autism Screenings. The provider must meet the personnel qualifications and attend the EarlySteps
trainings for BDI-2 and Autism Screening in order to conduct these evaluations and screenings.

Providers who conduct assessments/evaluations should have college level training in the administration of such
instruments and an understanding of statistical concepts in order to interpret the results. The provider must have
a thorough understanding of the purpose of the instrument, the administration procedure, and scoring. It is the
responsibility of each provider to attend any classes or trainings in order to be competent in the administration of
the instrument.

The website for the Battelle Developmental Inventory 2 (BDI-2) is www.riverpub.com/products.

See Chapter 4 (Intake) for additional information.

Evaluation and assessment providers must also receive training in the Autism Screening process and the
protocols required. Providers are required to meet the timeline, reporting, document submission and team
participation requirements regarding evaluations, single domain assessments, and autism screenings required
by EarlySteps and outlined in Chapters 5 and 7. Providers who wish to conduct eligibility evaluations and meet
requirements must enroll as an evaluator with the Regional Coordinator.

Provider Enrollment
Listed below are the requirements to enroll and maintain enrollment in the system:
Chapter 10: Provider Roles and Responsibilities 11 Revised 7/2010
  Maintain a current criminal background check and secure a new criminal background check ( current
within three [3] years.)
 Maintain an active email address with the Central Finance Office (CFO) and notify the CFO immediately
of a change in your email address.
 Maintain a current address and phone number with the CFO and notify the CFO of any changes in this
information immediately.
 Request and submit a National Provider Identification (NPI) number with the application below.
 Complete and Submit to Unisys an Enrollment Packet for the Louisiana Medical Assistance Program
(PE–50) for the following: occupational therapist, physical therapist, speech-language pathologist,
audiologist, or psychologist.
 The application is mailed to Unisys to the address provided. The provider will be issued a unique
Medicaid Provider number. The provider is responsible for sending the number to the CFO. The CFO
must have this number before a provider may provide services to children.
 Complete and send enrollment to the CFO. The regional coordinator must sign the enrollment forms for
them to be processed by the CFO.
 Complete the required training modules prior to providing any services and submit pre and post tests as
required. The Regional Coordinator will receive a copy of the certificate or verify completion.
 Meet with the Regional Coordinator and obtain signatures as part of the enrollment process.

Listed below are the requirements to be an active provider in the system:

 Update your matrix page monthly at a minimum or as changes occur to reflect your availability.
Providers who do not have an updated matrix page cannot be accessed by families and therefore cannot
be offered as a choice for provider selection.
 Use the online system for authorizations and billing activities.
 Use the EarlySteps.com Online Access Enrollment form to make any changes in your identifying
information.
 Maintain an e-mail address, notify the CFO and Regional Coordinator of any changes and understand
that program communications with the OCDD Central Office and/or CFO will be conducted through e-
mail. Check e-mail regularly for notices and updates.
 Maintain a current criminal background check processed through the Louisiana State Police Department
and submit as instructed in the provider enrollment packet. Background checks must be updated every
3 years.
 Agrees to utilize the Provider Online System at www.laeikids.com for the processing of authorizations
and claims, reviewing and receiving communication online, and to review and update CFO information
for Part C funded claims. The provider is responsible for claims submission for Medicaid-payable
services either by billing herself or by submitting claims through a vendor.

Providers may select one of three options for service provider enrollment: enrollment as the employee of an
agency, as an independent provider, or as both.

Providers, who enroll as the employee of an agency, may receive benefits offered by the agency, such as health
insurance, disability insurance, retirement, etc. Providers, who enroll as independents, must purchase their own
health insurance, professional liability insurance, and pay federal and state taxes on the income received.

Note: Family support coordinators (FSC) must be employed by a licensed case management agency, enrolled to
provide case management to infants and toddlers. FSCs do not enroll separately as providers, but are
providers through their employing agency.

Providers will be added to the matrix when all components of enrollment are submitted and complete.

Step 1: Meet with the Regional Coordinator

Attend a meeting with your Regional Coordinator. (See the website www.earlysteps.dhh.louisiana.gov for a list of
the Coordinators in your region of the State.) The Coordinator will review the basic philosophy of the program,
review the enrollment forms and “sign off” on the Checklist so that CFO can proceed with enrollment.

Chapter 10: Provider Roles and Responsibilities 12 Revised 7/2010

Step 2: Complete all Required Forms

The following forms will be provided by the Regional Coordinator at the mandatory meeting:
 EarlySteps Checklist (with the mandatory signature of the Regional Coordinator)
 Provider/Payee Agreement
 W-9 Request for Taxpayer Identification Number and Certification form
 Certification Statement for Providers submitting claims by means other than standard paper
 EarlySteps.com Online Access Enrollment form
 Electronic Signature form
 Certification regarding Lobbying
 Criminal Background check
Note: The Criminal Background Check is required by State law for persons working with children and is
completed by the State Police. Each provider must have a background check current within 3 years. The
background check is required by State law for persons working with children and must be updated every
three years. Once the State Police receives the forms, the check will be completed. The original will be
mailed to the EarlySteps Central Office and the provider will receive a copy to keep with him/her in the
event a child care center requests a copy of the check. Providers should keep their background check
results with them in order to obtain access to child care and other centers which require them.
 CFO Provider Enrollment
 Letter from Supervisor (Assistants Only)
 DHH Case Management License for any agency providing Support Coordination services only
 Copy of applicable license, diploma, transcript or its equivalent, (to document minimum entry
level standard according to the personnel qualifications for each provider as listed in as listed in
Chapter 13 of the Practice Manual, Enrollment Packet for the Louisiana Medical Assistance
Program will be completed by OT, PT, SLP, Audiologist, and Psychologist and mailed to Unisys
to the address provided in the Packet. The provider will be issued a Medicaid Provider number.
The provider is responsible for sending verification of the number to the CFO before CFO enrollment will
be completed and the provider can provide services. The application to Medicaid requires an NPI
number.
 You agree to immediately notify the CFO via phone and mail if your password to the website is lost,
stolen, misplaced or has been compromised.
 Electronic Funds Transfer (EFT) form
 A copy of your current professional license, diploma or transcript as outlined in Chapter 13
 Assistant level personnel must attach a copy of a letter of supervision by his/her supervisor and the
supervisor must be enrolled in EarlySteps.
 Submit enrollment packet to CFO and Unisys if applicable and notify the Regional Coordinator once the
packet has been submitted. The Regional Coordinator will then enroll the provider in Essential Learning
to complete the training modules.

Step 3: Complete the EarlySteps: A New Look, Spectrum of Child Development, Making Informed
Decisions, Teaming, and Family-Centered Services modules.
Complete the modules online within 30 days. Complete the EarlySteps: A New Look module prior to accepting
any referrals.

Changes to a provider’s name, address, telephone number, email address, tax ID number, etc must be made via
the EarlySteps.com Online Access Enrollment form and to Medicaid/Unisys as appropriate.
Changes may effect a provider’s service authorizations. The SPOE or EarlySteps Regional Coordinator should
be contacted for verification.

Disenrollment of a Provider
If a provider decides to no longer provide services to children in the EarlySteps system the following activities are
necessary:
 Any authorizations must be cancelled with the appropriate end date.
 The provider must complete any paperwork due to the FSC for the child’s record within 10 calendar days
and prior to the disenrollment date.
 The provider must notify the FSC of his/her disenrollment so the FSC can assist the family with selecting
another provider.
 The provider must submit the appropriate paperwork to the CFO to disenroll from the system.

Chapter 10: Provider Roles and Responsibilities 13 Revised 7/2010

  Unisys should be contacted for the provider’s status to be changed.

Disenrollment of a Provider by Central Office

If a provider is disenrolled by Central Office, the following steps must be taken:
1. The Central Office will notify the provider by certified mail.
2. The provider must notify the FSC, who will cancel any existing authorizations for the provider. The FSC
will assist the family with selecting a new provider.
3. The FSC will submit the required forms to the SPOE.
4. SPOE will cancel existing authorizations for the disenrolled provider.
5. Central Office will notify the CFO of termination of enrollment.
6. The provider must submit all appropriate paperwork to the CFO to disenroll from the system.

Provider Training Requirements

See Chapter 1 for training requirements.

Certification of Enrollment by the CFO

Once the CFO reviews required documentation, each provider will receive a letter from the CFO confirming
enrollment. In this letter the CFO will notify the provider of a user ID & instructions on how to log on to the Matrix
website: www.laeikids.com. The CFO will also send an email to the provider to notify them of a user ID and
instructions on how to access the online system and the Service Matrix.

The Service Matrix

EarlySteps utilizes the Service Matrix to meet its requirement for a Central Directory of early intervention
services and resources in the State. The Service Matrix serves as the provider’s “bio” page in the system. It
contains information on how the provider may be contacted and is the information source about providers for
parents and others when they choose a provider.

Certain fields on the matrix can only be changed by the CFO. Other fields indicate availability and it is the
provider’s responsibility to update these fields on a regular basis. The fields must be fully completed.

Initially when a provider enrolls, the following sections must be completed:

 Contact information (address, phone numbers, email)
 Availability
 Zip codes (zip codes where the provider is willing to provide service)
 Comments (This section is where a provider describes his/her expertise.)

The Provider/Payee Agreement, which was signed upon enrollment, indicates that a provider must update
his/her matrix page at least monthly. If the matrix page has not been updated, it cannot be accessed by a family
and the provider cannot be offered as a choice for provider selection.

Changing a Provider

Parents select their early intervention providers by using the Service Matrix. Agencies are not allowed to assign
early intervention providers without the consent of the parent. Families must have Freedom of Choice in selection
of service providers. In addition, providers must use caution in engaging in any activities or of giving the
appearance of solicitation of referrals. The Family Support Coordinator must communicate on an ongoing basis
with each family to ensure that services are being provided and that the family is satisfied. If a provider must
close a case or otherwise make changes to the IFSP, the FSC must be contacted prior to the implementation of
the change. Changes of provider can only occur with appropriate communication with the team.
When changing a provider the following steps should be taken:
1. FSC assists the family in selecting a new provider based on information from the service matrix

Chapter 10: Provider Roles and Responsibilities 14 Revised 7/2010

 2. FSC ensures that the parent completes a “Freedom of Choice Provider Selection Form”, including
parent signature
3. FSC makes the appropriate changes in the IFSP
4. FSC notifies the SPOE of the changes
5. FSC calls the previous provider to advise them of the parent’s change of providers and that authorizations
will be cancelled
6. FSC sends a copy of the form to both the new provider and previous provider.
a. Originals of both forms are mailed to the SPOE and kept in the child’s early intervention record
b. Copy of IFSP and other pertinent information are sent to new provider
7. SPOE cancels the active authorizations for the previous provider
8. SPOE issues new authorizations for the new provider.
9. Provider documents changing needs/concerns/progress in the Service Provider Contact Note and
Monthly Progress Report for use for decision-making by the team.

If a parent requests a change of provider, and there is no provider available, the FSC continue to search for a
provider that will assist the child with meeting outcomes. The FSC should search the Service Matrix at least
one time per week to find a provider, and, contact a Regional Coordinator if assistance is need with locating a
provider. The FSC must document all attempts to locate a new provider. Families should not go without
needed services. If a service cannot be accessed after 30 days it may be necessary to hold a team meeting to
discuss other options by which the outcomes can be met for the family.

Substituting Early Intervention Providers

There may be instances—such as in the event of an illness or vacation—when a substitute service provider may
be needed for the child/family. In this case, the family and Family Support Coordinator should jointly develop a
plan as to how the IFSP outcomes will continue to be addressed.

 A substitution of a provider for period of less than 14 calendar days

 This would not normally be considered a substantial change in the plan of care or require a
change to the IFSP.

 A substitute provider may continue to see the child as indicated on the IFSP and may bill on
the regular provider’s authorization.
 The substitute must be enrolled with the CFO.
 The substitute must sign his/her name as the provider substituting for the regular provider.

 A substitution of a provider for period of more than 14 calendar days

 If a substitution is expected to last longer than two weeks:
 The authorized early intervention provider notifies the family's Family Support Coordinator to
discuss implications for the IFSP and options to ensure outcomes can be achieved.
 This may include a change in service provider (s) during the specified period.

Substitute providers are not to be used as way to cover staff vacancies when a provider has
terminated employment. Families MUST be offered freedom of choice to select a new provider.

Service Authorizations
Accessing the Online System for Authorizations

To make sure that the provider’s user ID is working, a provider will access the online system. If a provider is
unable to log on, please call the CFO for assistance (1-866-305-4985). All service authorizations are issued for a
maximum of 6 months except for one-time authorizations, such as evaluations and team meetings. Providers
are responsible for managing the utilizations of authorizations:
 Services will not be provided without an active authorization
 Providers should not continue to provide services if an authorization has expired. Contact the FSC if
there are questions about the timeliness of an authorization.

Chapter 10: Provider Roles and Responsibilities 15 Revised 7/2010

Once the SPOE has entered a service authorization, the provider will be able to view this authorization online at
www.laeikids.com and begin service delivery. Services should never be provided until verification of the
authorization is conducted.

WWW.LAEIKIDS.COM

The CFO provides and maintains the www.laeikids.com website.

The website has the following features:
 Communication:
o An online “bulletin board” will periodically host important notices.
o Emails will be sent from OCDD.
 Contact Information:
o Update information online.
o Receive information via email.
o Attest to future agreements online.
 Online Authorizations:
o Print authorizations.
o Search provider authorizations.
 Online Claims:
o View payment information.
o Submit claims.
o Search claims.

See Chapter 9 for additional information on Early Intervention authorizations.

Submission of Claims

Part C-only services

For children who are not eligible for Medicaid or for services not paid by Medicaid the following billing
process is used:

Billing must be submitted within 60 days of the date of service using the online provider system. If billing is not
received within this time frame, the CFO will deny payment. Adjustments are not made for late claims
submission or for post-approval for services provided without authorizations or for “make-up” sessions over the
daily service limit. The fund transfer schedule of the CFO for claims payment is posted on the website. Claims
must be submitted by midnight the preceding day for a provider to be paid for that payment cycle. Claims
submitted after that time will be paid in the next payment cycle.

Medicaid Services

For Medicaid-reimbursed services provided to Medicaid-eligible children, the provider uses the billing process
specified in the Unisys/Molina EarlySteps Provider Manual available from www.lamedicaid.com. Questions
regarding billing and payment should only be directed to Unisys/Molina at the phone numbers identified in the
manual.

It is the provider’s responsibility to verify Medicaid eligibility for every child for whom they have authorizations
monthly. The process for eligibility verification is outlined in the Medicaid provider manual.

Providers are responsible for resubmission of denied Medicaid and Part C claims. There is a help section at the
CFO’s website and in the Medicaid manual for resubmitting claims. Adjustments are not allowed for late claims
submission, for post-approval for services provided without authorizations or for “make-up” sessions over the
daily service limit. There are no exceptions.

Chapter 10: Provider Roles and Responsibilities 16 Revised 7/2010

 Documentation Requirements for Service Providers
Effective documentation is critical to the early intervention system process. It serves as a “blueprint” for service
provision as well as a means for accountability and provides:
1. a chronological record of the child’s status, which details the complete course of intervention.
2. communication among professionals and the family.
3. an objective basis to determine the appropriateness, effectiveness, and necessity of intervention.
4. the practitioner’s rationale for service methods

In the role of facilitating communication, documentation must be efficient and effective. Because the primary
audience in Part C is the family, it is important to use person-first language, avoid jargon, be respectful, and relate
comments back to performance concerns.

Each provider must use the Provider Contact Note for each child for each service date. Documentation is
required for Quality Management purposes by EarlySteps and Medicaid and any other payor. If a contact was
scheduled and did not occur, a contact note should be completed noting the missed contact and the reason that
the contact did not occur.

Each EarlySteps provider must maintain a working file of daily contact notes, therapy plans, and test protocols
used to achieve the outcomes. These files are not part of the official Early Intervention Record at the SPOE.
However, if any portion of these files is shared with another provider, that information does become part of the
official file, must be maintained in the official record, and sent to the SPOE for inclusion in the official early
intervention record.

The contact note is the way that the provider documents every individual service contact. This is retained in the
provider’s file for each child and is not sent to the FSC. EarlySteps has created a mandatory form that each
provider must use for this purpose.

Note: the provider contact note contains information regarding activities that take place at a particular contact.
The provider contact note should provide “a true reflection” of the contact. When monitored by a Quality
Assurance Specialist, the provider contact notes will be requested for review. The contact note must be filled out
completely with all information.

Provider Contact Note

The Provider Contact Note Format can be found on the EarlyStep’s website: www.earlysteps.dhh.louisiana.gov
and in Chapter 14. This form is mandatory. The information includes:

 Child’s Name (full name as listed on in EarlySteps and/or on the Medicaid Card if a beneficiary)
 Date of Birth
 Provider name
 Date
 Start time & End time
 Parent/Caregiver participated in this session? (check yes or no)
 Location
 Outcome #
 Outcome Statement
 Goals/Objectives (Write the goals/objectives that are being worked on.)
 Specific Activities related to the outcome (List the activities taught/practiced this day.)
 Teaching Strategies
Indicate which strategies you used to teach the different skills:
 verbal prompting/instructing
 modeling (with verbal prompting)
 gesturing (with verbal prompting)
 physically assisting/supporting/guiding (with verbal prompting)
 other (write an explanation)
 Child/Parent response/Progress related to the activity
How did the child/parent/caregiver respond to the activity?
How many times did the child successfully complete the activity?
Chapter 10: Provider Roles and Responsibilities 17 Revised 7/2010
 Did the parent/caregiver successfully complete the activity with the child?
Describe any obstacles to today’s contact.

How did the child respond to today’s contact?

Was the child cooperative or uncooperative?
Was the child focused on the activity at hand or easily distracted?
Did the child have to be redirected occasionally or frequently?

How did the parent/caregiver respond to the activity?

Did the parent/caregiver actively participate during the activity?
Did the parent/caregiver understand the reason for the activity?
Does the parent/caregiver understand how to practice this activity between contacts with you?

Describe any obstacles to today’s contact

Indicate any information, which negatively impacted today’s contact.
For example, “Johnny had a cold today; his participation was affected. He was “slower” in learning and
repeating an activity.”

 Regular Session (check yes or no)

 Make-up Session (check yes or no)
 If yes, date of missed session (indicate the date)
 Provider signature
 Parent/Caregiver Signature
Each contact must have the signature of a parent/caregiver to verify that the service was
provided. The provider must download the form & have the parent/caregiver sign the
contact note form. If services are provided to a child at a childcare center, the child’s
teacher or the administrator may sign the form. Where required by a licensing board /certification
agency, the form should be signed by the assistant’s supervisor. This form is maintained in the
provider’s file as proof of delivery of service. If a provider is selected for monitoring, the monitor will
ask to see copies of the contact note.

Provider Monthly Report

The Provider Monthly Report must be completed by the provider and sent to the FSC monthly. This form is
mandatory. This form summarizes the progress made on IFSP Outcome(s) that the provider is working on with
the child and family. The information indicates how the child and/or family are progressing towards the
outcome(s) and is part of the supporting documentation used by the IFSP teams in the Services Decisions
process.

The provider must send a copy of the monthly progress report to the FSC monthly. The report should be
submitted by the 10th of the month containing the summary of the prior month. The FSC reviews these
progress reports and works with the family and individual provider(s) should any problems arise. If the provider
notes that an outcome has been achieved, then the FSC will schedule a meeting with all the team members. The
FSC should ask the family about progress on “other” services
The Provider Monthly Progress Report contains the following information:
 Provider name
 Provider address
 Provider phone number
 The child’s name
 The child’s date of birth
 The FSC name & Agency
 Frequency of the service per the IFSP (complete)
 Intensity of the service per the IFSP (complete)
 Date of the annual IFSP
 Month/year reporting on
 Visits per month (indicate the # of visits)
 Missed visits this month (indicate if any visits were missed)
 Make-up visits this month (indicate the #, if any)
 Outcome #
Chapter 10: Provider Roles and Responsibilities 18 Revised 7/2010
  Outcome Statement(s)
 Goals/Objectives (Indicate the goals/objective worked on.)
 Progress related to the activities (Describe any new skills acquired.)
 The service I am providing for this outcome relates to enhancing the developmental domain:
(Check the appropriate boxes.)
Social Emotional – Positive social/emotional skills (including social relationships)
 Communication/Cognitive - Acquisition and use of knowledge and skills (including early language/
Communication)
 Adaptive - Use of appropriate behaviors to meet their needs
 Physical - Moving
 Does not relate to any of the above developmental domains
 Indicate progress toward achieving the IFSP outcome you are addressing with your early intervention
service
 No progress
 Slight progress
 Making expected progress
 3 Month Skill Achieved
 6 Month Skill Achieved
 Outcome Achieved!
 Need to revise outcome
 Added New Outcome
 Other
 Notes: Indicate any additional relevant information

 Team meeting dates

 Provider Signature
 Date
 Supervisor’s signature (if applicable)
 Date
 Day and time of week child is typically seen

Documentation for Assistant Level Providers

 The supervisor will maintain a contact note for each supervisory visit with the assistant, which clearly
indicates that the visit was a supervisory visit. Supervision must occur and supervision documentation
maintained according to the rules of the appropriate licensing board. The contact note may be used for
this purpose, but should not imply that the supervisor was at the session if she was not.
 The assistant will maintain a contact note for each supervisory visit with supervisor, which clearly
indicates that the visit was a required supervisory visit.
 Documentation of services, provided by the assistant, will be sent to supervisor to keep in child’s record
for monitoring purposes.
 The supervisor is responsible for maintaining and distributing contact notes and monthly progress notes
for services provided by assistants.
 The supervisor must sign the Monthly Progress Report of the assistant’s prior to submitting to the FSC
on a monthly basis.
 The assistant will utilize the appropriate professional designation when signing required documents. Most
licensing boards specify these requirements for their disciplines. For example, the Louisiana Board of
Examiners for Speech/Language Pathology and Audiology (LBESPA) does not allow the abbreviation of
the assistant’s title. The signature must be written as: Speech Language Pathology Assistant or SLP-
Assistant.

Services in settings other than the Natural Environment

Chapter 10: Provider Roles and Responsibilities 19 Revised 7/2010

It may be necessary for a child to receive services in a clinic setting. It is the provider’s responsibility to make
sure that the skills/behaviors, which the child is learning, are such that the parent can incorporate the
skills/strategies into the child’s routine at home or at a child care center. The provider must communicate with
the parent at least every two weeks by telephone, to discuss the child’s progress and what strategies the
provider has been using. This conversation must be documented in the provider’s file. The provider must
communicate with the parent; it is not sufficient to state in the notes that contact was not made with the parent.
Three good-faith attempts are required each two weeks and attempts and/or conversations must be
documented. In addition to the contact, the provider may send home a note after each contact, describing what
occurred during the contact as per best practice.

Make up sessions for missed visits are never authorized beyond the daily service limit for a service. An extra
session must be scheduled for missed visits and must occur within the authorization period.

Quality Management

See Chapter 1 for the description of the Quality Management System used in EarlySteps. Activities may include:
chart review, on site monitoring, self-assessments, family interview, provider interviews, data system/payment
monitoring, data system reports.

References used in this chapter: Sandall, et al, DEC Recommended Practices. A Comprehensive Guide for
Practical Application in Early Intervention/Early Childhood Special Education. Division of Early Childhood.
Missoula, MT, 2005.

Early Intervention Records – Additional Information

Early intervention records are confidential. Parents must give permission to share information with others by
signing a Release of Information. The release of information must:
1. Specify the information/records that may be disclosed or released;
1. State the purpose of the disclosure; and
2. Identify the party or class of parties to whom the disclosure may be made.
3. Verify the time period of the Release of Information.

If a parent so requests, the agency or institution shall provide him or her with a copy of the records disclosed.

Opportunity to Examine Records

It is required that all participating service providers permit parents to inspect and review any early intervention
records relating to their child which are collected, maintained, or used by the SPOE and/or contracted service
providers under this part within 45 days of a request to review. The right to inspect and review records under
this section includes:

 The right to a response from the participating service provider to reasonable requests for explanations
and interpretations of the records;
 The right to request that the service provider furnish copies of the records containing the information (if
failure to provide those copies would effectively prevent the parent/legal guardian from exercising the
right to inspect and review the records); and
 The right to have a representative of the parent/legal guardian inspect and review the records.

These access opportunities as set forth in federal and state regulations apply to the clinical record maintained by
each individual early intervention provider, as well as to the early intervention record maintained and available
through the System Point of Entry. If any Early Intervention Record or any documentation includes information on
more that one child, the parents of those children shall have the right to inspect and review only the information
related to their child. The identifying information on other children/individuals must be blacked out prior to
inspection.

Chapter 10: Provider Roles and Responsibilities 20 Revised 7/2010

Under the provisions of FERPA, the early intervention record must be accessible to the parents. An effective
practice is to provide parents copies of the documents maintained in the early intervention record when those
documents are developed. However, the law does not require this unless it is the only way a parent has access to
the record.

Agencies may charge a reasonable fee for making photocopies of the early intervention record. The fees must
address only the cost of photocopying—not the time used by an employee to research and retrieve the
document(s).

Each service provider must supply to parents, at their request, a list of the types and locations of early intervention
records collected, maintained, or used by the Part C system.

All documentation related to information requests must be maintained in the early intervention record. Routine and
ongoing communications, IFSP updates, releases, and other forms of documentation (such as assessment
reports) are provided to the SPOE by the Family Support Coordinator on an ongoing basis.
There must be documentation of all record activities--including information alteration, destruction, or purging of
the formal Early Intervention Record maintained at the SPOE.

Access to Records

Provisions of IDEA regarding privacy are intended to protect the interests of families with infants and toddlers with
special needs and of the early intervention system. Three primary privacy regulations that pertain to the
exchange of personally identifiable information apply to the EarlySteps program: IDEA Part C Privacy
Regulations, the Family Education Rights and Privacy Act of 1974 (FERPA), and the Health Insurance Portability
Act of 1996 (HIPAA). These regulations govern activities describing parent consent, confidentiality and release of
information, access to records, and the requirements for maintenance, storage and destruction of records.

According to the Part C Privacy Regulations, once a child is referred to EarlySteps, the system must have written
parent consent before disclosing personal information about the child or family. Signed consent is not needed
for EarlySteps to share individual child information with an individual or entity that is an “EarlySteps participating
agency.” For example, a provider who is a member of the IFSP team for a child does not require consent to
access information about that child.

FERPA specifies that families have the right to know about the information kept as part of the child’s “educational
record.” Families are informed about the type of information EarlySteps keep in the printed record as well as the
electronic record.

HIPAA includes privacy rules to protect the privacy of individually identifiable health information and disclosure of
health information. Health organizations must notify families of the agencies or “covered entities” with whom they
may share information. HIPAA allows for covered entities, such as hospitals to share personal information to
public health authorities without consent for the sake of surveillance, investigations, and interventions regarding
the health or safety of a child.
There are two “levels” of access related to the Early Intervention Record maintained at the SPOE:

1. General Access: refers to office file access of the early intervention record. An access roster will be posted
on the outside of all filing cabinets where the child records are maintained indicating those personnel (by title) who
may have general access to the early intervention records. This access would generally apply to the supervisor,
support staff, intake coordinators, and EarlySteps employees (quality assurance specialists, regional coordinators,
central office staff, etc.). Access by EarlySteps staff is for the purpose of monitoring, program or fiscal audits, or
complaint investigation.

2. Situation-specific Access: refers to a specific request for information regarding an individual child by and
agency or individual. This request must be accompanied by a signed, dated Consent to Share and Release
Information by the parent/guardian authorizing access to that specific record or information. The SPOE agency
is required to have policies in place regarding handling of these requests according to EarlySteps privacy
regulations. This includes an access log in each child’s file indicating the date, the purpose of any and all specific
information, and signature of employee with access to the record.

Destruction of the Early Intervention Record

Chapter 10: Provider Roles and Responsibilities 21 Revised 7/2010

The Early Intervention Record must be maintained for five (5) years after the child is no longer provided services
through EarlySteps. This is true for all records—including children found to be not eligible for EarlySteps.

The SPOE shall inform parents when personally identifiable information collected, maintained, or used in
EarlySteps is no longer needed to provide Part C services to the child. The information must be destroyed at the
request of the parent, subject to the state requirement that the records be maintained for a minimum of five (5)
years after the child is no longer provided services through EarlySteps. The child record must be shredded so
that there is no identifying information after the five (5) year period expires.

Professional Ethics:

In Relation to Children
I will:
 View each child firstly as a child and value their unique abilities.
 Respect that each child is part of a family and incorporate this understanding in all my interactions with
children and their families.
 Acknowledge the major role of play in development and be sensitive to children's rights to play, their
needs for stimulation, enjoyment, choice and preference.
 Interact with children in ways which enhance their development and value their achievements.
 Identify, value and build upon the abilities and strengths of each child.
 Promote safe, healthy and stimulating environments that optimize children's well-being and
development.
 Work to ensure that children are not discriminated against on the basis of ability, diagnosis, label,
gender, religion, language, culture or national origin.
 Acknowledge the cultural and linguistic diversity of children and families and adapt practices
accordingly (e.g. cultural consultation/interpreters).
 Engage in practices that are respectful of and ensure the safety (emotional, physical and cultural) of
children and in no way degrade, endanger, exploit, intimidate or harm them.
 Act on behalf of children to protect their physical and emotional well-being including making protective
notifications where necessary. (i.e. OCS)
 Uphold appropriate privacy and confidentiality (as per HIPPA).
 Uphold the principles of partnership, participation and protection.

In Relation to
Families / Caregivers
I will:
 Uphold the principles of partnership, participation and protection.
 Respect each family's perspective and priorities for their child and make this the starting point for
intervention.
 Develop collaborative partnerships with families respecting family expertise about the children and
share my professional knowledge and understanding sensitively/respectfully.
 Work to develop positive relationships with families that are based on shared decision-making, mutual
trust and open communication.
 Acknowledge and respect the uniqueness of each family, and the significance of its culture, customs,
language, beliefs and the community context in which it operates.
 Conduct my business in a professional manner whether in private practice or in the employ of an agency
or other entity.
 Honor professional commitments and terminate assignments only when fair and justifiable grounds exist.
 Assist each family to develop a sense of trust and connection to the services in which their children
participate.
 Maintain confidentiality and respect each family's right to privacy.
 Inform the family in a timely manner when delayed or unable to fulfill assignments.
 Acknowledge, respect and support families in their native language to the maximum extent possible.

Chapter 10: Provider Roles and Responsibilities 22 Revised 7/2010

 In Relation to
Myself as a Professional
I will:
 Engage in ongoing professional development and keep up-to-date with new developments in
early intervention.
 Work within the boundaries of my profession and qualifications.
 Be an advocate for children, early intervention and the services/agencies that support the children and
their families.
 Ensure my practices are culturally appropriate and actively promote anti-racist attitudes.
 Demonstrate in my behavior and language that children are not discriminated against.
 Ensure that I maintain professional standards in all documentation.
 Ensure that I maintain personal integrity, truthfulness and honesty in all professional activities.
 Commit to upholding the standards, values and practices expressed in the Code of Ethics.
 Reserve the option to decline or discontinue assignments if working conditions are unsafe or unhealthy.
 Conduct my business in a professional manner whether in private practice or in the employ of an agency
or other entity.
 Avoid performing dual or conflicting roles in interdisciplinary (e.g. educational or mental health teams) or
other settings.
 Recognize the limits of my professional competence and promptly provide referrals to other appropriate
qualified health professionals

In Relation to Colleagues
I will:
 Work to communicate effectively, act with integrity and build professional trust, respect and openness.
 Value the personal and professional strengths that my colleagues bring to the team.
 Support Early Interventionists having access to high quality professional support and development.
 Respect the perspectives that different disciplines bring to the understanding of the needs of each child,
family, service and community.
 Maintain appropriate confidentiality.
 Actively support a working environment by assisting and encouraging colleagues with the sharing of
information and serving as mentors when appropriate.
 Support families having access to early intervention/special education training and professional support
and development.
 Approach colleagues privately to discuss and resolve breaches of ethical or professional conduct through
standard conflict resolution methods; file a formal grievance only after such attempts have been
unsuccessful or the breaches are harmful or habitual.

*This was adapted from the National Code of Ethics of the Early Intervention Association of Aotearoa New Zealand & the Registry
for Interpreters for the Deaf

The Department of Health and Hospitals, Office for Citizens with Developmental Disabilities maintains
procedures for receiving, investigating, and resolving complaints relating to violations of Part C
Chapter 10: Provider Roles and Responsibilities 23 Revised 7/2010
requirements. This process is administered through EarlySteps under DHH/OCDD. DHH ensures that the
parents of eligible children receive their procedural safeguards upon referral to the system.

The complaint process for EarlySteps can be found in the practice manual, chapter 2, pages 7-11. If at
any time you are not able to resolve a situation, please call or submit the information to the Regional
Coordinator in order for the complaint process to begin.

Service Provider Performance Indicators

Item Responsibility Performance Indicators

1 Participate in the multidisciplinary team Documentation on IFSP to verify participation.
assessment of a child and a child’s family
and in the development of strategies and
outcomes for the IFSP.
2 Participate in quarterly team meetings, 6 Documentation on IFSP which verifies participation,
month reviews and annual IFSP. Team meeting minutes
3 Participate in teaming activities which Documentation to support parent/caregiver participation in the
support providers and parents/caregivers delivery of services on the monthly report and/or IFSP outcomes which
incorporating interventions into support team-based service delivery.
family/caregiver routines.

4 Consult with parents, support Documentation to support consultation with IFSP team members and
coordinators, other service providers, and others in delivery of services to individual children as above.
representatives of appropriate community
agencies to ensure the effective provision
of services.
5 Delivery of services in accordance with Percent of services delivered in accordance to IFSP as documented in
the IFSP in a timely manner. a monthly report in a timely manner (to be sent to FSC every month).

6 Continuously collect data to determine Documentation of child specific data regarding developmental
child’s developmental progress. progress in the contact notes and on periodic assessments

7 Provide appropriate levels of service Average cost of services per child within acceptable range, provided
based on child’s developmental level, best according to service guidelines, and within authorization limits.
practice guidelines and family concerns.
8 Provide services in a way which supports Percent of families who report their agreement with their ability to meet
family’s ability to meet the needs of their child’s needs according to Indicator 4 of the Annual Performance
child Report

9 EarlySteps providers are mandated For more information on the Office of Community Services refer
reporters by Louisiana Law to the Office of to:
Community Services if there is a suspicion http://www.dss.state.la.us/departments/ocs/OCS_Regions_Directo
of abuse or neglect. ry.html

Chapter 10: Provider Roles and Responsibilities 24 Revised 7/2010

 Service Provider Contact Note
(Mandatory)
Child’s Name: DOB: Provider Name:
Date: Start Time: End Time: Parent/Caregiver participated in the session?  Yes  No Location:

Outcome #: Outcome Statement(s):

Goals/Objectives
Specific Activities related to the outcome * Teaching Strategies Child/Family response/progress related to the activity
How did the child/parent/caregiver respond to the activity?
V How many times did the child successfully complete the activity?
Did the parent/caregiver successfully complete the activity?
M Describe any obstacles to today’s contact.
G
PA
O

* V-Verbal Prompting/instructing M-Modeling (with verbal prompting) G-gesturing (with verbal prompting) PA-physically assisting/supporting/guiding(with verbal prompting) O-Other

Is this the first visit after parental consent on the IFSP (date of first visit after any new authorization: IFSP, 6 month review, or any revisions to IFSP)?
 No  Yes: date__________________ .

Regular session?  Yes  No Make-up session?  Yes  No If yes, date of missed session: _____________
Provider Signature: Parent/Caregiver Signature:

7/2010
 Directions: Complete this form with the parent/caregiver and send the original to the Family Support Coordinator designated for the child. Keep a copy
for your records and send a copy to the parent/caregiver. This form is due to the Family Support Coordinator monthly by the 10th . *If goal or
outcome is achieved you will need a new goal or outcome for services to continue. Contact the FSC to discuss the need for a new outcome.
Date Sent to FSC: __________________

Provider Monthly Progress Report

(Mandatory)
Provider name: Address: Phone #:

Child’s Name: DOB: FSC Name and Agency:

Frequency of the service per the IFSP? _________________ Intensity of the service as per the IFSP? ___________ Date of Annual IFSP:____________
Month/Year reporting on: _________ # of Visits this month: _______ # of Missed Visits this month: ________ # of Make up Visits this
month: ___
Outcome/s #: Outcome Statement(s):

What is the child or family doing now that he/she/they weren’t doing before? (Note outcome and describe progress, new skills, etc. If you use
technical/medical terms, you must also describe this information in family-friendly language.) (Use additional pages if needed.)
Goals/Objectives Progress related to the activities * The service I am providing Indicate progress toward
(Describe any new skills acquired.) for this outcome relates to achieving the IFSP outcome
enhancing the developmental you are addressing with your
domain: early intervention service:
 Social Emotional  No progress
 Communication/Cognitive  Slight progress
 Adaptive  Making expected progress
 Physical  3 Month Skill Achieved
 6 Month Skill Achieved
 Outcome Achieved!
 Need to revise outcome
 Added New Outcome
 Other_________________
Notes:

 Social Emotional  No progress

 Communication/Cognitive  Slight progress
 Adaptive  Making expected progress
 Physical  3 Month Skill Achieved
 6 Month Skill Achieved
 Outcome Achieved!
 Need to revise outcome
 Added New Outcome
 Other_________________
Notes:

I participated in team meeting(s) on: ___________________________£Telephone £Written £Attended ______________________________£Telephone £Written £Attended
* Social Emotional – Positive social/emotional skills (including social relationships) Communication/Cognitive - Acquisition and use of knowledge and skills (including early language/
communication) Adaptive - Use of appropriate behaviors to meet his/her needs Physical - Moving
Provider Signature: Date: Supervisor Signature, if applicable: Date:

Day and time of week child is typically seen:______________________________________________

7/2010
7/2010
 Who Do You Call?
Following the Chain of Command:
Issues with Service Coordinator: Contact the FSC, then the Agency FSC Supervisor, then the FSC Agency
Director.
Issues with a provider: Contact the provider, then contact the Regional Coordinator. Regional Coordinator will
complete the complaint process if necessary.
Issues with Regional Coordinator: Contact the Regional Coordinator and then contact Brenda Sharp.

Issue Contact How to find In Practice Manual

EarlySteps http://www.earlysteps.dhh.louisiana.gov Chapter 1
Website
CFO Website 1-888-305-4985 https://www.laeikids.com. Chapter 1
Fax: 913-888-
6683
Service Family Support http://www.eikids.com/la/matrix/ Chapter 9 & 10
Authorization Coordinator
Complaint OCDD Regional Website: Chapter 1 & 2
Office http://www.dhh.louisiana.gov/offices/page.asp? Family Rights
Complaint ID=77&Detail=3259 Handbook
Contact
Regional http://www.earlysteps.dhh.louisiana.gov, click on
Coordinator Regional Coordinators on the left side in Red
Parent-to- Regional http://www.earlysteps.dhh.louisiana.gov, click on Chapter 1 & 12
Parent Contact Community Community Outreach Specialists on the left side
Outreach in Red
Specialist (COS)
Regional http://www.earlysteps.dhh.louisiana.gov, click on
Coordinator Regional Coordinators on the left side in Red
Families Helping http://fhfgbr.org/
Families
Parent Support Regional http://www.earlysteps.dhh.louisiana.gov, click on
Group Community Community Outreach Specialists on the left side
Outreach in Red
Specialist (COS)
Regional http://www.earlysteps.dhh.louisiana.gov, click on
Coordinator Regional Coordinators on the left side in Red
Families Helping http://fhfgbr.org/
Families
Billing/ Billing/Payment-Medicaid Chapter 9 & 10
Payment-
Medicaid
Billing/Payment Billing/Payment –Non-Medicaid/Part C Chapter 9 & 10
–Non-
Medicaid/Part
C
Provider Regional http://www.earlysteps.dhh.louisiana.gov, click on Chapter 10/13
Enrollment Coordinator Regional Coordinators on the left side in Red and
click on Information for EarlyStep Providers
Training/E- Regional http://www.earlysteps.dhh.louisiana.gov, click on Chapter 10
learning Coordinator Regional Coordinators on the left
http://
earlysteps.training.essentiallearning.
com
Service http://www.earlysteps.dhh.louisiana.gov Chapter 1
Delivery

Find FSC http://www.eikids.com/la/matrix/ Chapter 9

Parish name, then Family Support Coordinator or
FSC’s name

7/2010
Issue Contact How to find In Practice Manual
Find Service http://www.eikids.com/la/matrix/ Chapter 10
Provider Parish name, then type of provider or provider’s
name
Forms http://www.earlysteps.dhh.louisiana.gov, click on Chapter 14
Information for EarlyStep Providers, scroll to the
end of page
General Regional Contact your regional Coordinator Chapter 10/13
Information for Coordinator http://www.earlysteps.dhh.louisiana.gov, click on
Service Regional Coordinators on left hand side in red
Providers area.
Make a 1-866-327-5978 http://www.earlysteps.dhh.louisiana.gov, Chapter 3
Referral to ES
Regional OCDD Regional http://www.earlysteps.dhh.louisiana.gov, Central
Coordinator Office office information on this page.
Click on Regional Coordinators on left hand side
in red area for Regional Coordinators contact
information.
When is System Point of http://www.earlysteps.dhh.louisiana.gov, click on Chapter 3
someone Entry EarlySteps SPOE
coming out? Or Contact http://www.earlysteps.dhh.louisiana.gov, Central
Regional office information on this page.
Coordinator Click on Regional Coordinators on left hand side
in red area
How do I Contact your http://www.eikids.com/la/matrix/ Chapter 9 & 10
change Family Support Parish name, then Family Support Coordinator or
providers? Coordinator FSC’s name

I am moving or Contact your http://www.eikids.com/la/matrix/ Chapter 2 & 10

have a new Family Support Parish name, then Family Support Coordinator or
phone number. Coordinator FSC’s name
Who do I tell?
My FSC won’t Contact the http://www.earlysteps.dhh.louisiana.gov, Central
call me back? FSC, then the office information on this page.
Agency FSC Click on Regional Coordinators on left hand side
Supervisor, then in red area
the FSC Agency
Director. If not
resolved contact
the Regional
Coordinator.
There is an Contact your http://www.eikids.com/la/matrix/
Autism concern FSC in order for Parish name, then Family Support Coordinator or
who do I see a screening to FSC’s name
now? be scheduled.
What do I need Contact your http://www.earlysteps.dhh.louisiana.gov, Central
to do with the OCDD Regional office information on this page.
papers I office or your Click on Regional Coordinators on left hand side
received from FSC. in red area
OCDD? http://www.eikids.com/la/matrix/
Parish name, then Family Support Coordinator or
FSC’s name

Can you help Yes, your FSC http://www.eikids.com/la/matrix/

me fill out my can assist you Parish name, then Family Support Coordinator or
SSI papers, with this or offer FSC’s name
find housing, other resources
etc? for you to
contact.

7/2010
Issue Contact How to find In Practice Manual
I have Contact your http://www.eikids.com/la/matrix/
questions about FSC Parish name, then Family Support Coordinator or
my explanation FSC’s name
of benefits

7/2010