Hellobee

I apologize that it’s taken me so long to write the second post in this Series. These posts have been difficult for me to write for some reason, but we’re wrapping up our Early Intervention Services now and I wanted to share our experience in case it helps anyone out there. You can read Part 1 here.

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A case worker from Early Intervention contacted me within days to schedule an appointment to visit us at home. Olive was 16 months old at the time. During our hour-long meeting, she observed Olive playing and we discussed our concerns. She suggested that we have Olive evaluated by a speech, occupational, special instruction, and a physical therapist. Each evaluator subsequently contacted us to set up individual meetings in our home.

T H E  E V A L U A T I O N S

Olive was present for each of the evaluations. They observed her doing some of the things we were concerned with like not responding to her name, not looking when we pointed, lack of eye contact, obsessively playing with her shoes and cars, etc. We asked tons of questions and they offered a lot of great advice. For instance if your child has a problem with making eye contact, you can hold a toy in front of your nose so that they have to look at your eyes. They also identified things that we had no idea were considered issues, like how Olive always sat in a w formation on her legs, which was very common with kids with low muscle tone. She usually stuck her tongue out which was another indicator of low muscle tone. She also stuffed her mouth full of food only to gag on it, which was a sensory issue because she couldn’t feel the food unless her mouth was very full.

All the evaluators were so knowledgeable, we learned so much just from the evaluations themselves. I was very hopeful about getting Early Intervention services if it meant getting to work with therapists as excellent as they were, but we wouldn’t know if we qualified for services until our second meeting with our case worker.

The evaluators submitted their reports to our case worker, and then we set up an appointment to go into her office to develop an ISFP (Individual Family Service Plan), where a service coordinator would approve which services we would receive. They are required to initiate services within a specific time frame, so everything happened relatively quickly. But since we had to coordinate 6 different meetings and pull Olive out of daycare for each one, it took us about a month to get through it all.

G E T T I N G  A P P R O V E D  F O R  S E R V I C E S

Once we arrived at our case worker’s office, we went over the reports the individual evaluators submitted. In order to qualify for services, Olive had to show a 33% delay in one area, or a 25% delay in 2 areas. The evaluations honestly sounded much worse than I expected! They were particularly concerned with her speech regression — she stopped using words she had been using for months. Although a speech delay is not necessarily indicative of a larger problem, kids with delays usually present with speech delays.

Our case worker acted as our advocate, and the service coordinator determined just how much services we received. We were approved for 30 minutes of speech, 30 minutes of occupational therapy, and 30 minutes of special instruction once a week. Olive did not qualify for physical therapy, but that was the one area where we weren’t concerned because she continued to make progress even if she was delayed (she eventually walked at 18 months).

Shortly after we were approved for services, our assigned therapists contacted us to set up appointments. Although services can be provided at your child’s school, our daycare didn’t really have the space for it so we opted to have all our services done at home. We are extremely lucky to work from home, so that we were able to be present for her therapy sessions. In the end, 3 sessions a week required a big time investment on our part because we had to pull Olive out of daycare and take a lot of time off of work. We have no regrets though because the sessions were so short, the most helpful part of them was learning from the therapists so we could work with Olive on our own time.

O C C U P A T I O N A L  T H E R A P Y

Our occupational therapist hit it off with Olive right away and we could tell that she was going to be awesome. She worked with Olive on things like her fine motor skills, life skills like getting dressed/feeding herself, behavioral issues like tantrums, and sensory issues. Often I would just ask her tons of questions throughout the entire session because she was such a fountain of knowledge! Olive received occupational therapy for about 6 months until our therapist suggested that we stop because she had made so much progress, and her fine motor skills were at or above her age level. I was so sad to say bye to her because she was such a great therapist.

S P E E C H  T H E R A P Y

Olive bonded quickly with our speech therapist as well. She was friendly and fun, but after a couple months of sessions, we decided it just wasn’t working out. It was a really tough decision because we really liked our speech therapist as a person, but we requested a different therapist because this was the area where we felt Olive needed the most help.

You can request to work with specific therapists, so we requested a speech therapist that our occupational therapist recommended. That speech therapist was great. She used a combination of toys and apps to work with Olive on things she should have mastered at that age (like animals and colors), and provided us with tons of resources on other ways we could work on Olive’s speech.  Even though Olive’s expressive language eventually caught up and seemed to be on par with kids her age, her receptive language appeared to be far behind where it should have been. Olive had trouble understanding basic questions and commands that she should have mastered given the level of her expressive language. But she finally started to catch up at the beginning of this year. Olive was recently tested by our speech therapist and her speech is now within the average range for kids her age (30 months). I met with our case worker yesterday and she suggested that we stop speech therapy services based on Olive’s most recent evaluation.

S P E C I A L  I N S T R U C T I O N

Special Instruction therapists focus on cognitive and social interaction, and meeting developmental goals. Olive did not hit it off with our special instruction therapist at all. She was scared of her, cried through the sessions, and the therapist just could not engage or bond with Olive. We wanted to give it a fair shot so we did a couple more sessions, but Olive never warmed up to her so we requested a new therapist.

We now have a special instruction therapist that we love. He helped us finally get Olive interested in books. Before the age of 2, Olive was only interested in lift the flap books, and even then she wasn’t listening to the story — she was just focused on lifting the flaps. Our therapist taught us tricks, like asking about the images in the book and turning pages instead of reading the story. Just getting Olive interested in books was an important step; previously Olive would just throw them! Now Olive finally likes reading.

The Special Instructor therapist tested her 4 months ago and she was still below average in some areas. But a test earlier this month showed that she has caught up and is no longer behind in any area, so we’re going to wrap up special instruction therapy very soon as well.

W H A T  D O E S  A  S E S S I O N  L O O K  L I K E ?

During a therapy session, it essentially looks like the therapist is playing with your child. They usually bring in toys and activities that are designed to work on areas where your child is delayed. For instance an occupational therapist might bring in a stacking toy to work on fine motor skills, and a special instruction therapist might bring in a doll and play food to engage in imaginative play. Sometimes it’s hard to know just how much your child is getting from each session because they’re so short and Olive only saw each of her therapists once a week. But I learned by just observing and asking the therapists questions. I also think it depends on finding a therapist that is a good fit with your child, so you need to advocate for your child if something isn’t working out.

W H E R E  W E  A R E  N O W

Has Olive stopped doing all the things we were concerned with when we first started this process? She still walks on her tip toes regularly, she still doesn’t respond to her name at least half of the time, she is still very independent and engages in parallel play most of the time (except with her immediate family).

But her speech is on par with children her age, she makes sustained eye contact, she is extremely affectionate, and she even taught herself the entire alphabet (we had no idea she knew it at all!). I still worry about her to tell you the truth, but she seems to be on track and I’m amazed at how much progress since we first started services a year ago.

I have friends that were approved for EI and ones that were turned down, but there’s nothing to lose from seeking an evaluation if you’re concerned that your child may have a marked delay. We learned so much just from the evaluations themselves. These are therapists that work with kids with all kinds of delays every day, so they really know what they’re talking about. It was very reassuring to ask them about general delays as well as specific questions about Olive that our daycare teachers and pediatricians didn’t have the answers to.

Early Intervention is the best thing you can do for your child if they really do have a delay, so I think it’s incredible that programs like this exist at low or no cost to families. Overall I have to say that I’ve been very impressed with the Early Intervention system, the quality of the therapists, and the speed and responsiveness with which they got everything done.

In my next post I’ll share what we did to help Olive that was most effective!