Hellobee

This past week we had Juliet’s annual review — her last one ever as she will be discharged in June when she turns 3. As I talked to her service coordinator for the last time, we both remarked how much Juliet has changed from when she started the program as an eight month old baby, and is now almost three years old and has a baby sister almost the same age as she was when she started the program. Leading up to her annual review Juliet had both a full evaluation done as well as the second step in evaluating whether she would be accepted in the town’s integrated pre-school program,

In late February, about a month or so after her first initial meeting with the integrated school’s case worker, we were invited to the school to meet the team that would eventually work and determine Juliet’s eligibility in the program. We met with the case worker we had met previously, as well as the school psychologist, speech therapist, an actual teacher in the program, and a few other staffers. Previously when speaking with the case worker I was given the impression that Juliet was not delayed enough for the program, but they would go ahead with the proceedings. I knew that Juliet’s eligibility hinged on the fact that she was part of Early Intervention, and because she was in the program they had to start the proceedings of evaluation if I, as a parent, wanted them to, which I did.

When we got to the school Juliet was immediately curious. The program is held in the same school that Drake currently attends kindergarten so she is familiar with the building. When the case worker came to get us from the office, Juliet tried to talk to the case worker in her normal unintelligible speech. The gist I believe was letting her know we were at her brother’s school, but the only clear words I could manage were “Drake” and “school.” I’m not sure what else she was trying to convey, as tends to happen when she talks, but she prattled on and then was immediately distracted when we got into the meeting room and saw all the toys in the space.

I sat down with the round table of staffers and we discussed my concerns about Juliet’s delays and her weakest areas. Having met twice now, the case worker mentioned her garbled conversation in the hall, and I was given the impression that they would likely take her into their program because of how unclear she was in expressing herself. Juliet’s one year review for Early Intervention was happening the following week, and those results would determine whether she would continue to be eligible to remain in Early Intervention until she was three. Since the school’s own evaluations are quite similar to Early Intervention, I signed a paper allowing them access to the results.

We talked a little about the program and at one point Juliet was taken to see a classroom for a few minutes with one of the staffers. If she was eligible for the program, she would be able to start on the day of her 3rd birthday. Juliet’s 3rd birthday is exactly 5 days before the school year ends, so she most likely wouldn’t be enrolling until the following September. There is a summer program which was floated around in conversation, though I’m not sure Juliet is so severe in delays to qualify. I was told they would contact me again in May, closer to when Juliet was three to meet again and see where we were in qualifications.

The following week the evaluator for Early Intervention arrived. Juliet is an old pro at this point with evaluations, so she sat with the evaluator and happily played along with the tasks. Anyone who spends a good amount of time around Juliet will notice her unintelligible speech. She has come leaps and bounds since she first started speech about a year ago. She does have a good amount of basic vocabulary words and is now starting to try to connect and string them together in short sentences. The biggest difference I have noticed in the past few months is her willingness now to try to communicate uninitiated by us. Juliet used to only speak when we would engage her first. Nowadays though she asks for things, shares what she is experiencing or watching, remarks on things she notices, and my favorite is when she sings songs or reads books along with me. It’s such a difference from the silent little girl she was for much of her life, and it’s a great glimpse into her little mind finally. Most of the words she speaks aren’t very clear and we have our share of miscommunication still, but I couldn’t be happier with these results finally coming to play.

The evaluator showed me Juliet’s scores and in order to remain in Early Intervention, Juliet would need to score under -1.5 in 2 categories or a -2 in one area. For Early Intervention purposes a normal child ranges from 1 to -1 and anything in those parameters is considered normal range. Juliet scored normal for fine motor, gross motor, cognitive, and social/emotional. Her lowest score was adaptive at -1.6, but she was dinged a bit for not being potty trained yet which is something I haven’t even started with her because I never felt like she had the language to show readiness, and I hate potty training if I’m honest.

In communication Juliet scored -1.46, thus not actually qualifying her as below the -1.5 threshold but as the evaluator pointed out much of that score was helped by her receptive communication skills rather than her expressive ones. She broke it down to show that receptive Juliet was only -1.oo which fell right inside the normal range, but expressively she was -2.33 which was well out of the norm and alone would qualify her for services.

Early Intervention relies a lot on the judgment of the evaluators and therapists working with the child, and every child is seen as also an individual more than just numbers on a paper. With the additional break down of the communication category, it was clear Juliet still needed a lot of help learning to properly express herself. The evaluator thought more likely than not she would remain in the program. That was confirmed at her annual meeting with her case worker and therapist, and her therapist actually decided to bump up her services to twice a week in these last few months to really give her a better chance of more solid improvements before dismissal. Her therapist and I have discussed what will happen after her dismissal and more likely than not Juliet will continue doing speech with her on a private basis paid for through insurance.

Now that the testing is all done, we are waiting on May for our next evaluation to see if Juliet will be placed in the integrated program. Her Early Intervention case worker feels strongly that they will take her based on her scores and the lack of expressive communication being so pointedly delayed, and even mentioned she probably would get into the summer program with those scores, which I hadn’t even considered.

In all areas Juliet is normal and even advanced in her fine and gross motors as shown by her latest evaluation, and only struggles with communication. For a while I thought the integrated program would be too slow paced for her as her delays were only in one area, but as the possibility of her eligibility becomes more real I am keen on learning more about the opportunities this will have for Juliet. It would allow her speech therapy on a daily basis, which she wouldn’t get if she went to private preschool. And of course it’s a free five day program with busing, which is incredible considering we will be paying for Fiona’s preschool in a few short years. I am waiting for May now for the next steps, but I remain hopeful that we are working hard on Juliet’s behalf to get her the services and assistance she needs.