Therapy guides
Early Intervention vs Private Therapy
- Editorially Reviewed
- Evidence Based
- Patient Focused
For a child under 3, start with your state’s early intervention program: you can refer your child yourself, the evaluation is free, and the evaluation and first service plan must be done within 45 days of referral.1,2,3 Early intervention coaches you to help your child in everyday routines at home or child care, and some states charge sliding fees for its services; private therapy is billed to your insurance or to you and can mean direct sessions in a clinic.2,4,5,6 You can use both at once, and the service plan can list the private therapy so the two are coordinated.7,8
Key takeaways
- Under 3, you can refer your own child to your state’s early intervention program; a doctor’s referral is not necessary.1,9
- The evaluation, service coordination and the service plan (IFSP) are free in every state; some states charge sliding fees for services, and a family the state finds unable to pay gets every service at no cost.2
- The evaluation, assessments and first IFSP meeting must be done within 45 days of referral, and each service starts as soon as possible after you consent.3,10
- A child qualifies with a measured delay in one or more of five areas of development, or a diagnosed condition likely to cause one; each state decides how big a delay counts.11,12,13
- Early intervention most often happens at home and coaches you to use strategies in daily routines; private therapy can be direct sessions in a clinic, billed to insurance or to you.4,6
- You can do both: ask for the private therapy to be listed in the IFSP so your service coordinator can coordinate the two.7,8
- Early intervention can bill your private insurance only with your consent, unless state law protects your benefits; ask what it could cost you, including annual or lifetime caps.14
- Early intervention ends at 3 unless your state extends it; transition planning comes 90 days to 9 months before the birthday, and an IEP should be in place by then if your child qualifies for preschool services.15,16,17
Early intervention vs private therapy: a side-by-side comparison
Early intervention is your state’s public program for children under 3, run under Part C of the Individuals with Disabilities Education Act; private therapy is physical, occupational or speech therapy you arrange yourself, billed to public or private insurance or to you.6,9,11 The table sets the two side by side, and the sections below explain each row.
| Early intervention (Part C) | Private therapy | |
|---|---|---|
| Who it is for | Children under 3 with a developmental delay, as the state defines it, or a diagnosed condition likely to cause one.11,12 | Any child whose family arranges it; a health plan may ask for a referral or approval before it pays.18,19 |
| Who can refer | You can, as can doctors, hospitals and child care programs; no doctor’s referral is needed.1,9 | You contact the therapist; every state allows some direct access to physical therapy, though some plans need a referral to pay.18,20 |
| Cost | The evaluation, service coordination and the IFSP are free; some states charge sliding fees for services.2 | Billed to your insurance or to you; your deductible, copays and the plan’s network set your share.6,21 |
| How fast it starts | Evaluation, assessment and the first IFSP meeting within 45 days of referral; services as soon as possible after you consent.3,10 | Up to the clinic; families may wait weeks or months for an appointment or to start services.22 |
| Where | At home, in child care or another everyday setting, to the maximum extent appropriate.5,23 | A clinic, hospital program or private practice, and sometimes at home or by telehealth.6 |
| Who the therapist works with | Mostly you and other caregivers, coached to use strategies in daily routines.4,6 | Can be direct one-on-one work with your child, the format Part C has moved away from.6 |
| How often | Written into the IFSP: how many sessions, how long each lasts and how they are delivered.7 | Set with the therapist; your plan may need to approve it, and covered services vary by plan and state.19,24 |
| Coordination | One service coordinator for every service, including ones your child gets elsewhere.8 | Each therapist separately, unless you connect them with your early intervention team.6 |
| Written plan | An IFSP with measurable outcomes, reviewed at least every six months.7,10 | Goals the therapist sets with you after an evaluation.25 |
| After age 3 | Ends at the third birthday unless your state offers to continue it until kindergarten, which not all states do.15,26 | Continues if you choose, paid by insurance or by you.6 |
Under 3, call early intervention first, even if you also book private therapy: the evaluation costs nothing, and you can ask for it yourself today.2,9
What is early intervention?
Early intervention is the name for services and supports for babies and young children with developmental delays and disabilities, and for their families; every state and territory has a program, under Part C of the Individuals with Disabilities Education Act.9,11 Services are chosen with the parents, written into an Individualized Family Service Plan (IFSP), and given in natural environments, the settings typical for a child that age, such as home, to the maximum extent appropriate.5,27,28
Three things set it apart. It serves the family as well as the child: services are designed for the child’s developmental needs and for the family’s needs in helping the child develop. It runs on deadlines and parents’ rights set in federal regulation. And it is coordinated, with one service coordinator for everything.3,8,27
What services does early intervention include?
Therapies, family support, health, hearing and vision services, and help with learning and access: the federal rules list 17 kinds of service, and the list is not exhaustive. The assessment and the IFSP team decide which your child gets.7,27,29
- Therapies
Occupational therapy, physical therapy, speech-language pathology and psychological services.27
- Family support
Family training, counseling and home visits, social work, and service coordination.27
- Health, hearing and vision
Audiology, vision services, nursing, nutrition, health services, and medical services for diagnosis or evaluation.27
- Learning and access
Special instruction, assistive technology, sign language and cued language services, and transportation.27
Who provides early intervention services?
Qualified personnel, meaning people who meet your state’s certification, licensing or comparable requirements: among them audiologists, nurses, occupational and physical therapists, psychologists, registered dietitians, social workers, special educators, speech-language pathologists and vision specialists, with pediatricians and other physicians for diagnosis and evaluation.27,30 States differ in which agency runs the program, such as a health or education department, and in what they call it.6
What is private therapy for children?
Private therapy is pediatric physical, occupational or speech therapy arranged outside the state program, in settings such as hospitals, rehabilitation clinics, preschools and private practices, and billed to public or private insurance or to the family.6 Health plans call it habilitative care when it helps a child learn skills, such as therapy for a child who is not walking or talking at the expected age.31
- Physical therapy
Movement and motor skills, built one step at a time toward specific goals; every state allows at least some direct access to a physical therapist, without a referral.20,25
- Occupational therapy
Adaptive skills, play, and sensory, motor and postural development, so a child can do everyday tasks at home and in the community.27
- Speech-language therapy
Understanding and using communication and language, and feeding and swallowing.6,27
You choose the therapist. Look for experience with children your child’s age and concern; for physical therapy, a board-certified pediatric clinical specialist or a pediatric residency or fellowship; for speech therapy, an ASHA-certified speech-language pathologist.25,32 DrSensory’s therapist directory lists pediatric clinics by state.
How do you start private therapy?
- Check your plan. Ask whether you need a referral or preauthorization, and which therapists are in its network.18,19,33
- Find a therapist. Ask your pediatrician, or search ASHA ProFind for speech-language pathologists and APTA’s Find a PT for physical therapists.25,32
- Book an evaluation. The therapist assesses your child’s strengths and needs and asks about your concerns, routines and home.25
- Agree on goals. Ask what the goals are and how much your child should practice at home toward them.25
Who qualifies for early intervention?
A child under 3 qualifies with a developmental delay, measured with appropriate tests and procedures, in one or more of five areas (cognitive, physical including vision and hearing, communication, social or emotional, and adaptive), or with a diagnosed condition that has a high probability of causing a delay.11 Each state sets how big a delay counts, so a child can qualify in one state and not another.12,13 Income and insurance play no part in eligibility: the federal definition looks only at the delay or the condition.11
How do states define a developmental delay?
States express the cutoff as a test score below the average, in standard deviations (SD), or as a percentage delay for the child’s age, and most use more than one rule. The ECTA Center’s February 2026 count of state definitions:13
| Definition | Programs using it |
|---|---|
| 2 SD below the mean in one area | 1913 |
| 1.5 SD below the mean in two or more areas | 1913 |
| A delay of 25% or more in one or more areas | 1813 |
| A delay of 30% to 40% in one area | 1313 |
| A delay of 25% or more in two or more areas | 1113 |
| 1.5 SD below the mean in one or more areas | 1013 |
| A 50% delay in one or more areas | 713 |
| Other, such as 1.3 SD, below the 7th percentile or a 12-month delay | 1413 |
The counts include territories and add up to more than the number of programs, because most states use more than one definition.13 Ask your program which rule it uses. Evaluators must also use informed clinical opinion, which can establish eligibility even when test scores do not.12,29
Which diagnosed conditions qualify a child automatically?
A child with a diagnosed physical or mental condition likely to cause a delay qualifies without waiting for the delay to show, and states keep their own lists of these conditions; medical records alone can establish eligibility.6,11,29
Conditions the federal rule gives as examples
Do premature babies qualify for early intervention?
Often, depending on the state. Low or very low birth weight counts as a qualifying condition in 15 state policies, prematurity in 3 and both in 14, while 25 list neither.13 A state may also choose to serve babies at risk of a substantial delay because of factors such as low birth weight, breathing problems as a newborn or a brain hemorrhage, and eight states currently do.13,34 A baby born early who shows a measured delay qualifies under the delay rule in any state.11
How many children who qualify get early intervention?
Far fewer than qualify. In a national sample of children born in 2001, about 13% had delays that would make them eligible, but at 24 months only 10% of the children with delays were receiving services.35 Children with a developmental delay, rather than a diagnosed disability, were less likely to use early intervention in a later national survey, and use was lower in states with narrower eligibility rules.36
How do I refer my child to early intervention?
Call your state or territory’s program yourself: parents are primary referral sources under the federal rules, and a doctor’s referral is not necessary.1,9 Professionals who identify a child, such as doctors and hospitals, must refer as soon as possible and within seven days.1,6
- Find your program. The CDC lists every state and territory’s program with its phone number, and your pediatrician can connect you.9,37
- Say why you are calling. The CDC suggests: “I have concerns about my child’s development and I would like to have my child evaluated to find out if he/she is eligible for early intervention services.”9
- Write down what you see. Note the skills that worry you and when you noticed; the CDC offers a record-keeping worksheet for this.38
- Give your consent. The program needs your written consent before any screening, evaluation or service.39
- Ask the doctor at the same time. If you or the doctor think there may be a delay, ask for a referral to a specialist while you call early intervention.38
If your child is 3 or older, call any local public elementary school, even one your child does not attend, and ask for an evaluation for preschool special education services.9
What if my child is almost 3?
If the program receives the referral fewer than 45 days before the third birthday, it passes the referral, with your consent, to the school system and does not have to evaluate your child first.16 Calling your local public school as well keeps the evaluation moving.9
How long does early intervention take to start?
The evaluation, the assessments and the meeting to write your child’s first IFSP must all be done within 45 days of the program receiving the referral, and each service in the plan must start as soon as possible after you consent to it.3,10
- ReferralYou or a professional call the program
- Evaluation and IFSP meetingBoth within 45 days of the referral
- ServicesEach one as soon as possible after you consent
The 45-day clock stops only for documented exceptional family circumstances, or while your consent is pending.
| Step | Deadline |
|---|---|
| A professional’s referral | As soon as possible, and within 7 days of identifying the child.1 |
| Screening, if your state screens first | Within the 45 days; you can ask for a full evaluation at any time.3,40 |
| Evaluation and assessments | Within 45 days of referral.3 |
| First IFSP meeting | Within the same 45 days.10 |
| Each service | On the start date in the IFSP, as soon as possible after you consent.7,10 |
| IFSP review | Every six months, or sooner if you ask.10 |
| IFSP evaluation meeting | At least once a year.10 |
Two things stop the clock: exceptional family circumstances documented in your child’s record, or consent not yet given despite repeated attempts; the program must then finish as soon as possible.3 Services can also begin before the evaluation is finished, through an interim IFSP, when your child’s needs are immediate and you consent.41
What happens at an early intervention evaluation?
A team from at least two disciplines, or one person qualified in two, looks at your child’s development in all five areas, using a test, your child’s history taken partly from you, information from others who know your child and a review of records; no single test decides eligibility.29,42 It must be done in your child’s native language unless that is clearly not feasible.29
- Evaluation: does your child qualify?
Qualified staff test and observe your child, interview you and review records, then decide eligibility; informed clinical opinion counts even when scores fall short.29
- Assessment: what does your child need?
If your child qualifies, a closer look at strengths and needs in each area identifies the services that fit; it can run alongside the evaluation.29
- Family assessment: what does your family need?
A voluntary interview about your family’s resources, priorities and concerns.29
- The IFSP meeting
You, your service coordinator, the evaluators and, as appropriate, the providers write the plan, at a time and place convenient for you.10,43
If your child does not qualify, the program must tell you in writing, with its reasons and your right to dispute the decision.44,45
Developmental evaluation vs early intervention evaluation: what is the difference?
They answer different questions. An early intervention evaluation decides whether your child is eligible for the program, and the assessment that follows decides which services would help.29 A developmental evaluation by a specialist, such as a developmental-behavioral pediatrician, child neurologist or child psychologist, looks in more depth for a diagnosis and can lead to medical treatment as well as therapy.38,46,47
- Early intervention evaluation
Decides whether your child is eligible, and the assessment then decides the services in the IFSP. A team from two or more disciplines does it, and you can ask for it yourself, with no referral.9,29,42
- Developmental evaluation by a specialist
Looks for a diagnosis, and leads to the medical and developmental care that follows. A developmental-behavioral pediatrician, child neurologist, psychologist or psychiatrist does it, often with a team; ask your child’s doctor for a referral.38,46,47
You do not have to choose: the CDC advises calling early intervention at the same time as you ask the doctor for a referral to a specialist, without waiting for a diagnosis.38 The AAP’s guidance is the same: when a problem is found, developmental and medical evaluations go ahead alongside early intervention.47
What should I expect from an early intervention evaluation in New York?
In New York the evaluation is called a Multidisciplinary Evaluation (MDE). Your county’s program, or New York City’s (dial 311), takes the referral, and an initial service coordinator helps you choose an evaluator from the state’s approved list, with the evaluation at home or at an evaluation agency.48,49,50 The MDE includes a health assessment with vision and hearing screening, a review of records with your consent, an assessment in each area of development and an interview with you.50 New York’s guide says that under state law services must be provided at no cost to parents, and families on regulated health plans pay no deductibles or copays for them.51
Is early intervention free?
The evaluation is free everywhere, along with assessment, service coordination and writing and reviewing the IFSP: federal rules require these at public expense, with no fees to parents.2 The services themselves are provided at no cost unless your state has a system of payments by families, such as a sliding fee scale, and even then a family the state finds unable to pay must receive all services at no cost.2,27
| Item | Can your family be charged? |
|---|---|
| Finding and referring children (child find) | No, never.2 |
| Evaluation and assessment | No, never.2 |
| Service coordination | No, never.2 |
| Writing, reviewing and evaluating the IFSP | No, never.2 |
| Therapy and other services | Only where your state has a written system of payments, such as sliding fees.2,52 |
| Insurance costs such as copays or deductibles | Only if your state’s system of payments lists them; otherwise not.14 |
| A family the state finds unable to pay | No: every service at no cost.2 |
Where fees apply, the state’s written policy must set out the fee schedule and how it defines ability to pay; families cannot be charged more than a service costs, and families with insurance cannot be charged disproportionately more than families without.2 Fees typically depend on family income and size, and sliding scales generally use the federal poverty level as a guide.53
Which states charge early intervention fees?
Policies differ by state. The ECTA Center’s summary of state family-fee policies includes these:53
| State | Family fee policy |
|---|---|
| Alaska | Fees by the federal poverty level and family size.53 |
| Arizona | Family cost participation for certain services, by income and family size.53 |
| California | Cost participation only for respite, day care and camping services.53 |
| Illinois | A monthly fee by income and family size, allowing for extraordinary expenses.53 |
| Indiana | A sliding-scale co-payment per treatment, with a monthly maximum.53 |
| Missouri | A monthly fee by income and family size.53 |
| New Jersey | A monthly family cost share by family size and income.53 |
| Texas | A sliding fee scale by family size and income; no child is denied services for inability to pay.53 |
| Utah | A monthly fee by income and family size.53 |
| Virginia | A sliding scale by taxable income and family size, setting a monthly cap.53 |
| Wisconsin | A parental cost share.53 |
| Connecticut | Family fees eliminated on June 16, 2021.53 |
New York is an example of the other approach: its guide says that, under state law, services must be provided at no cost to parents.51 If you disagree with a fee, or with the state’s finding about your ability to pay, you can ask for mediation or a due process hearing, or file a state complaint.2
How much does private therapy cost?
What you pay depends on your insurance, since sessions are billed to your plan or to you.6 Before the plan pays you may owe the deductible, then a copayment or coinsurance for each covered session, and therapists outside the plan’s network usually cost you more.21,54
What sets your share of the cost of private therapy
Does insurance cover early intervention?
Your state’s program may bill your insurance, but with protections: it may not use your private insurance without your consent unless a state law shields your benefits, and it may not make you enroll in Medicaid or another public program to get services.14 Most state programs bill Medicaid for direct services, and some states require private insurers to cover early intervention.55,56
| Situation | The rule |
|---|---|
| Private insurance | Used only with your written consent, asked again whenever services increase, unless state law protects your caps, coverage and premiums.14 |
| What billing could cost you | Before using your plan, the state must give you its policy on possible costs, such as copays, deductibles or using up annual or lifetime caps.14 |
| Medicaid or other public coverage | You cannot be required to enroll; consent is needed if you are not enrolled, or if billing would cut your coverage or raise your costs.14 |
| If you say no | The state must still provide the IFSP services you consented to.14 |
| If you cannot pay | Saying no to billing cannot delay or deny services for a family the state finds unable to pay.14 |
Some states write extra protections into law. Colorado, Connecticut, Rhode Island and Virginia require coverage of early intervention up to a set amount a year; Indiana requires insurers to pay for early intervention a policy otherwise covers; and Connecticut, Indiana, Rhode Island and Virginia keep those payments from counting against lifetime caps.56 In New York, regulated plans may not charge early intervention against annual or lifetime limits, and those visits cannot reduce the visits otherwise available to your child.51
Does insurance cover private speech, occupational or physical therapy?
Marketplace plans must: rehabilitative and habilitative services are one of the 10 essential health benefits every Marketplace plan covers, though the specific services vary with state requirements.24 Habilitative services include physical and occupational therapy and speech-language pathology for a child who is not walking or talking at the expected age.31 For a child enrolled in Medicaid, the EPSDT benefit requires the state to cover medically necessary services to treat, correct or reduce a condition, even ones its Medicaid plan does not otherwise cover.57
Check your plan’s rules before the first visit: it may need a referral from your doctor, or preauthorization that the therapy is medically necessary, and an approval is not a promise to pay.18,19
What does early intervention look like week to week?
Most often at home, and much of it coaching: the provider joins an everyday routine, such as a meal, bath or play, and helps you use strategies that build your child’s skills in it.4,6 That is the model by design. The principles a national workgroup set out for early intervention in 2008 start from the idea that babies and toddlers learn best through everyday experiences with familiar people, and that the adults in a child’s life have more influence on learning than providers do.4
- Plan together
You and the provider agree on what to work on, from your priorities and the outcomes in the IFSP.4,6
- Watch and try
The provider observes a routine, may model a strategy, and you practice it with your child.6
- Reflect and adjust
You talk through what worked, get feedback, and plan how to use it until the next visit.6
Expect the provider to use your own toys and household things and to build on routines your family already has.4 Programs increasingly assign a primary service provider, one professional who sees your family most often and brings in the rest of the team as needed; ASHA notes the model is not meant to limit your access to services.4,6
How often are early intervention visits?
There is no standard schedule: the IFSP states how many sessions, how long each lasts and how they are delivered, and the team, including you, sets them from your child’s outcomes.4,7 Some families want frequent visits and more concrete support; others prefer longer intervals to practice in daily routines.6 Fewer visits do not mean a lesser service in this model, because the practice happens between them; if it is not enough for your child, ask for an IFSP review, which you can request at any time.4,10
What goes into an IFSP?
What every IFSP must include
- Your child’s present levels in each area of development7
- Your family’s resources, priorities and concerns, if you agree to include them7
- Measurable outcomes for your child and family, and how progress will be judged7
- Each service, with its length, duration, frequency, intensity, method and location7
- Why a service is not in a natural environment, if it is not7
- Payment arrangements, if any, and other services your child gets elsewhere7
- Start dates, your service coordinator’s name and the steps for the transition at 37
The plan is reviewed at least every six months and evaluated at a meeting at least once a year.10
How is private therapy different from early intervention?
The biggest differences are where therapy happens, who the therapist works with, and who decides how much your child gets.6,7
Does the therapist work with my child or with me?
Private therapy can be direct one-on-one work with your child. Early intervention has shifted toward coaching families and caregivers, which can be a new role for parents to get used to.6
Private therapy is also where to turn when your child is past 3, does not qualify for early intervention, or needs more direct work than the program provides; families can pay for it themselves or use their insurance.6,26
Can you do early intervention and private therapy at the same time?
Yes. A child can receive early intervention and therapy outside the Part C program at the same time, and the IFSP should list services your child gets from other sources so the service coordinator can coordinate them.6,7,8 Tell each provider about the other, so their work complements rather than duplicates.6
- Tell your service coordinator. Ask for the private therapy to be listed in the IFSP as another service your child receives.7
- Share what each one is working on. Coordinated teams build interventions that complement one another rather than contradict or duplicate.6
- Check your insurance before both bill it. If early intervention uses your plan, ask whether those visits count against a cap your private therapy also needs; the state must tell you the possible costs first.14
- Bring both to the six-month review. The IFSP review checks progress and whether services should change.10
Some families find the coaching model different from the direct therapy they expected, and adding private sessions for direct work or a clinic setting is a reasonable choice.6 In New York, early intervention billed to a regulated plan cannot reduce the visits otherwise available to your child.51
Does early intervention work? What the research says
Yes, for the outcomes studied, and earlier is better: the CDC says intervention is likely to be more effective earlier in life and can change a child’s developmental path.22 The AAP’s clinical report on early intervention describes best-practice models as built on learning in the natural environment and on coaching.58
| Study | What it found |
|---|---|
| Cochrane review, 2024: 44 studies of babies born preterm | Helps Programs probably improve cognitive and motor outcomes in infancy and improve cognitive outcomes at preschool age; by school age they may not.59 |
| The same review: programs aimed at parent and baby | Stronger Programs focused on both the parent-infant relationship and the baby’s development were more likely to help.59 |
| Meta-analysis, 2011: 18 studies of children 18 to 60 months with language impairments | Helps Parent-implemented language intervention improved understanding and use of language.60 |
| Cochrane review, 2003: 25 trials in children with speech and language delay | Similar No significant difference between therapy given by clinicians and by trained parents.61 |
| Comparative study, 2025: 40 Hebrew-speaking toddlers with language delay | Both helped Parent training and weekly therapist sessions both improved language; therapist sessions did better on one measure, simple sentences.62 |
| Randomized trial, 2025: 46 infants at risk of cerebral palsy | Mixed A family-engaged approach gave larger motor gains than conventional therapy; cognitive scores favored conventional therapy.63 |
Is private therapy better than early intervention?
Not in general. The research behind early intervention’s coaching model holds up: trained parents did as well as clinicians in a Cochrane review of speech and language therapy, and in a 2025 comparison parent training and therapist sessions both improved toddlers’ language.61,62 Private therapy is the better fit when your child needs what the program does not provide, such as clinic-based sessions, direct one-on-one work, or therapy your child does not qualify for, and you can use both.6
How to choose between early intervention and private therapy
Under 3, start with early intervention whatever else you decide, because the evaluation is free and you can request it yourself; then use the table to decide what to add.1,2
| If… | Then… |
|---|---|
| Your child is under 3 and you have any concern | Call early intervention now; the evaluation is free and needs no referral.2,9 |
| Your child qualifies and the coaching suits you | Early intervention may be all you need; check progress at each six-month review.4,10 |
| Your child qualifies and you want more direct sessions | Ask the IFSP team about the services first, then add private therapy if you still want more.6,10 |
| Your child does not qualify and you are still concerned | Read the reasons in the notice, ask about a re-evaluation later, and look at private therapy.26,45 |
| Your state charges fees and your plan covers therapy | Compare the fee with your copays and deductible, and ask what billing your plan could cost you.2,14 |
| Your child is turning 3 soon | Plan the move to the school district; private therapy can continue alongside.6,16 |
| Your child is 3 or older | Ask your school district for a preschool special education evaluation, and consider private therapy too.6,9 |
- Choose early intervention if
Your child is under 3, and you want a free evaluation, help at home or child care, coaching you can use every day and one coordinator for all services.2,5,8
- Choose private therapy if
Your child is 3 or older, does not qualify, or needs clinic-based or direct one-on-one therapy, and your plan or budget covers it.6,31
- Do both if
Your child qualifies for early intervention but needs more, or a service the program does not offer, and you can coordinate the two through the IFSP.6,7
What happens to early intervention at age 3?
Early intervention ends at the third birthday unless your state offers to continue it until kindergarten. Children who need more help move to preschool special education through the school district under Part B of IDEA, with an IEP, or an IFSP if your state and you agree, in place by the birthday.15,17,64
- Up to 9 months before age 3
With your approval, the program holds a transition conference with you and the school district and adds a transition plan to the IFSP, no later than 90 days before the birthday.16
- At least 90 days before
If your child may qualify for preschool services, the program notifies the school district and the state education agency.16
- The school evaluation
The district evaluates within 60 days of your consent, or your state’s own deadline, and a group including you decides eligibility.65,66
- By the third birthday
An IEP or IFSP is in effect; if the birthday falls in summer, the IEP team decides when services start.17,67
Teams often start planning when a child turns 2½; if no one has raised it by then, ask your service coordinator.6,8
Will my child qualify for preschool special education?
Not automatically. Part B covers children with one of its listed disabilities, or a state-defined developmental delay where the state uses that category for ages 3 to 9, who need special education because of it; a child who needs only a related service, such as a therapy, may not qualify unless the state counts that service as special education.68
If your state offers the option, you can instead keep early intervention after 3, until your child can enter kindergarten; the program must explain the differences, including any costs, and your child keeps the right to switch to school services at any time.15
What if my child does not qualify for preschool special education?
If the program finds your child is not likely to qualify, it must still make reasonable efforts, with your approval, to hold a conference with providers of other services your child could use.16 Whatever the school district decides, families can pay for private therapy themselves or use their insurance for services beyond what the district offers.6
Early intervention programs by state
Every state, territory and commonwealth runs its own early intervention program, with its own name and rules on eligibility and services; the CDC lists each one with its phone number.9,37 Use varies widely: among children with special health care needs and a delay or disability, the share using early intervention ranged from 6% to 87% across states in a 2009–10 national survey.36
| State | Program |
|---|---|
| Alabama | Alabama’s Early Intervention System37 |
| Alaska | Alaska Early Intervention/Early Learning Program37 |
| Arizona | Arizona Early Intervention Program (AzEIP)37 |
| Arkansas | First Connections37 |
| California | Early Start37 |
| Colorado | Early Intervention Colorado37 |
| Connecticut | Birth to Three Program37 |
| Delaware | Birth to Three37 |
| District of Columbia | Strong Start37 |
| Florida | Early Steps37 |
| Georgia | Babies Can’t Wait37 |
| Hawaii | Early Intervention Section37 |
| Idaho | Infant Toddler Program (ITP)37 |
| Illinois | Illinois Early Intervention Program37 |
| Indiana | First Steps37 |
| Iowa | Early ACCESS37 |
| Kansas | Infant Toddler Program37 |
| Kentucky | Kentucky Early Intervention System (KEIS, formerly First Steps)37 |
| Louisiana | Early Steps37 |
| Maine | Child Developmental Services37 |
| Maryland | Maryland Infants and Toddlers Program37 |
| Massachusetts | Massachusetts Early Intervention37 |
| Michigan | Early On37 |
| Minnesota | Help Me Grow37 |
| Mississippi | First Steps37 |
| Missouri | First Steps37 |
| Montana | Early Intervention Program37 |
| Nebraska | Early Development Network (EDN)37 |
| Nevada | Early Intervention Services37 |
| New Hampshire | Family Centered Early Supports and Services37 |
| New Jersey | New Jersey Early Intervention System (NJEIS)37 |
| New Mexico | Family Infant Toddler Program37 |
| New York | New York State Early Intervention Program (EIP)37 |
| North Carolina | North Carolina Infant-Toddler Program (ITP)37 |
| North Dakota | Early Intervention Program37 |
| Ohio | Help Me Grow37 |
| Oklahoma | SoonerStart37 |
| Oregon | Early Intervention and Early Childhood Special Ed37 |
| Pennsylvania | Early Intervention37 |
| Puerto Rico | Early Intervention37 |
| Rhode Island | Early Intervention Program37 |
| South Carolina | BabyNet37 |
| South Dakota | Birth to Three37 |
| Tennessee | Tennessee’s Early Intervention System (TEIS)37 |
| Texas | Early Childhood Intervention (ECI)37 |
| Utah | Early Childhood37 |
| Vermont | Early Intervention Services for Infants and Toddlers37 |
| Virginia | Infant Toddler Connection of Virginia37 |
| Washington | Early Support for Infants and Toddlers (ESIT)37 |
| West Virginia | Birth to Three37 |
| Wisconsin | Birth to 3 Program37 |
| Wyoming | Early Intervention and Education Program Unit37 |
In New York, every county and New York City has its own Early Intervention Program, and New York City takes referrals through 311.48,49
What if my child does not qualify for early intervention?
Ask for the reasons, which the program must give you in writing along with your right to dispute the decision, and keep going: you can ask for another evaluation later if concerns persist, and look for private therapy in the meantime.6,44,45
- Read the notice. It must say what was decided and why, and describe mediation, state complaints and due process.45
- Ask what the cutoff was. Your state’s definition sets the level of delay that counts; ask how your child’s results compared.12
- Dispute it if you disagree. You can use mediation, a due process hearing or a state complaint.44,69
- Look outside the program. Ask your insurer for local providers; these services are usually billed to you or your insurance.26
- Keep watching, and ask again. If concerns persist, you can request a re-evaluation later, and well-child screening continues at 9, 18 and 30 months, with autism screening at 18 and 24.6,70
Other programs may help too, such as home visiting or Early Head Start, and from age 3 your school district’s Child Find program.6,26
What are your rights as a parent in early intervention?
Federal rules give parents a say at every step, and your service coordinator must tell you about these rights.8,39
Your rights under Part C
- Nothing happens without your written consent: no screening, evaluation or service39
- Accept or decline any service, and decline one later without losing the others39
- Written notice, in your language, before the program proposes or refuses a change45
- Evaluations and assessments in your child’s native language unless clearly not feasible29
- IFSP meetings at times and places convenient for you, in your language10
- An advocate or someone outside the family at IFSP meetings, if you ask43
- An IFSP review whenever you request one10
- Mediation, a state complaint or a due process hearing in a dispute69
- Services you consented to continue during a due process complaint69
Questions to ask early intervention and a private therapist
Ask about fees, insurance, who coordinates and how often services happen before you sign anything; the answers set what you pay and what your child gets.2,7,14
Questions for your early intervention program
- Does our state charge fees for services, and how would ours be set?2
- Will you bill our insurance, and what could that cost us, including caps on visits?14
- Who is our service coordinator, and how do we reach them?7
- Where, how often and for how long will each service happen?7
- When will each service start?7
- Can our private therapy be listed in the IFSP?7
- When will we plan the transition at 3?16
Questions for a private therapist
- How much experience do you have with children my child’s age and concern?25
- Are you board-certified in pediatric physical therapy, or ASHA-certified for speech-language pathology?25,32
- Are you in my plan’s network, and do I need a referral or preauthorization?18,19,33
- What are the goals, and how much should we practice at home?25
- Will you coordinate with our early intervention team?6
Where can I find a pediatric therapist near me?
Under 3, start with your state’s early intervention program; from 3, your local school district.9 For private therapy, ASHA ProFind lists certified speech-language pathologists, APTA’s Find a PT searches physical therapists by credential, and the DrSensory directory lists pediatric physical therapists, occupational therapists and speech therapists by state.25,32
Frequently asked questions
Does early intervention cost money?
Do I need a doctor’s referral for early intervention?
Do I need a diagnosis to get early intervention?
Does family income affect early intervention?
Can early intervention happen at daycare?
Why does early intervention send one main therapist?
What does an early intervention service coordinator do?
Can I turn down an early intervention service?
Can early intervention bill my insurance without my permission?
Is early intervention available in languages other than English?
Can early intervention be done by video?
What is the difference between an IFSP and an IEP?
Related on DrSensory
Sources
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.303 Referral procedures. Checked October 7, 2026.
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Primary referral sources include hospitals, physicians, child care programs and “Parents, including parents of infants and toddlers”; they refer a child “as soon as possible, but in no case more than seven days, after the child has been identified.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.521 System of payments and fees. Checked October 7, 2026.
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“The following are required functions that must be carried out at public expense, and for which no fees may be charged to parents”: child find, evaluation and assessment, service coordination, and developing, reviewing and evaluating IFSPs; a state’s system of payments sets out “The payment system and schedule of sliding or cost participation fees that may be charged to the parent for early intervention services under this part” and its definition of ability to pay; a family unable to pay “must be provided all part C services at no cost”; “Families will not be charged any more than the actual cost of the part C service”; insured families “will not be charged disproportionately more than families who do not have public insurance or benefits or private insurance”; a fee can be contested by mediation, a due process hearing or a state complaint. - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.310 Post-referral timeline (45 days). Checked October 7, 2026.
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Any screening, the initial evaluation and assessments and the initial IFSP meeting “must be completed within 45 days from the date the lead agency or EIS provider receives the referral of the child”; the clock does not run for “exceptional family circumstances that are documented in the child's early intervention records” or while consent is pending despite repeated attempts, and the program may then use an interim IFSP. - Early Childhood Technical Assistance Center (ECTA Center, funded by the U.S. Department of Education’s Office of Special Education Programs). Early Intervention Services: Key Principles and Practices. Checked October 7, 2026.
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In 2008 the OSEP TA Community of Practice on Part C Settings “convened a national workgroup that produced several consensus documents on principles and practices”. Its seven principles for early intervention in natural environments include “Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts”; “The consistent adults in a child's life have the greatest influence on learning and development-not EI providers”; “The primary role of a service provider in early intervention is to work with and support family members and caregivers in children's lives”; looks like “Using toys and materials found in the home or community setting” and “Collaboratively deciding and adjusting the frequency and intensity of services and supports that will best meet the needs of the child and family”; a primary provider supported by the team, and does not look like “Giving the family the message that the more service providers that are involved, the more gains their child will make.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.26 Natural environments. “settings that are natural or typical for a same-aged infant or toddler without a disability, may include the home or community settings.” Checked October 7, 2026.
- American Speech-Language-Hearing Association. Early Intervention (Practice Portal). Checked October 7, 2026.
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“EI services can also be provided outside of Part C programs in settings such as neonatal intensive care units, pediatric rehabilitation hospitals or clinics, preschools, and private practices. Services in these settings may not be covered by federal or state dollars but may be billed to public or private insurance or to the family”; “States may differ in terms of which agency they designate to lead the Part C program”; “Most often, children received EI services in their homes”; “Under Part C of IDEA, there has been a shift toward family-implemented interventions and collaborative consultation, instead of direct one-on-one intervention with the child only”; coaching: joint planning, observation, action and practice, reflection, feedback; “state Part C programs are increasingly using a primary service provider (PSP) approach to service delivery”, which “is not meant to limit a family's access to EI professionals and services”; “Some families and caregivers require more frequent contact and more concrete support”, while “Others prefer longer intervals between visits”; “the delivery of services in traditional clinical or medical locations may not be eligible for reimbursement by Part C”; “Collaborative coordinated teams work to develop interventions that complement one another rather than contradict or duplicate services”; “some children may receive EI services in more than one setting and/or outside of a Part C program altogether”; “Some families and providers may need to develop a new understanding about their roles when EI service delivery approaches are more consultative and collaborative rather than traditional, child-centered treatment methods”; “Telepractice can also be used to remotely deliver synchronous EI services”; “Early exposure to multiple languages does not cause language delay or disability”; “If concerns about the need for EI services persist, families can request a reevaluation through their Part C program at a later time”; home visiting and Early Head Start; “Often, IFSP teams choose to begin the transition planning process when the child turns 2½ years”; after Part C, “families may choose to self-pay or use their medical insurance to seek private services beyond what a school district offers.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.344 Content of an IFSP. Checked October 7, 2026.
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Present levels in each area; the family’s resources, priorities and concerns, with its agreement; measurable outcomes; each service with “The length, duration, frequency, intensity, and method of delivering the early intervention services”, frequency and intensity meaning “the number of days or sessions that a service will be provided”; a natural-environment statement or justification; location; “The payment arrangements, if any”; other services: “Identify medical and other services that the child or family needs or is receiving through other sources, but that are neither required nor funded under this part”; start dates as soon as possible after consent; “the name of the service coordinator from the profession most relevant to the child's or family's needs”; the transition steps. - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.34 Service coordination services (case management). Checked October 7, 2026.
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Each child and family must have “one service coordinator who is responsible for” “Coordinating all services required under this part across agency lines” and “Serving as the single point of contact”; including “Coordinating the other services identified in the IFSP”, “Conducting referral and other activities to assist families in identifying available EIS providers”, “Informing families of their rights and procedural safeguards” and “Facilitating the development of a transition plan to preschool, school, or, if appropriate, to other services.” - Centers for Disease Control and Prevention, Learn the Signs. Act Early. Early Intervention. Checked October 7, 2026.
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Early intervention “May include speech therapy, physical therapy, and other types of services based on the needs of the child and family”; “Each state, territory, or commonwealth has its own early intervention program and rules about eligibility and services”; “These publicly funded programs provide services for free or at reduced cost for any child who is eligible”; “A doctor's referral is not necessary”; the words to use when you call; from age 3, “call any local public elementary school (even if your child does not go to school there).” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.342 Procedures for IFSP development, review, and evaluation. Checked October 7, 2026.
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The initial IFSP meeting within the 45 days; “A review of the IFSP for a child and the child's family must be conducted every six months, or more frequently if conditions warrant, or if the family requests such a review”; “A meeting must be conducted on at least an annual basis to evaluate and revise” the IFSP; meetings “In settings and at times that are convenient for the family” and in the family’s native language; “Each early intervention service must be provided as soon as possible after the parent provides consent for that service.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.21 Infant or toddler with a disability. Checked October 7, 2026.
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A child under three who needs early intervention because of a developmental delay “as measured by appropriate diagnostic instruments and procedures, in one or more of the following areas” (cognitive; physical, including vision and hearing; communication; social or emotional; adaptive), or a diagnosed physical or mental condition that “Has a high probability of resulting in developmental delay”, such as chromosomal abnormalities, genetic or congenital disorders, sensory impairments and congenital infections; it may include, “at a State's discretion, an at-risk infant or toddler.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.111 State definition of developmental delay. Each system must include “the State's rigorous definition of developmental delay”, which must “Specify the level of developmental delay in functioning or other comparable criteria” that counts as a delay. Checked October 7, 2026.
- Early Childhood Technical Assistance Center (ECTA Center, funded by the U.S. Department of Education’s Office of Special Education Programs). Summary of State and Jurisdictional Eligibility Definitions for Infants and Toddlers with Disabilities Under IDEA Part C. Updated February 18, 2026. Checked October 7, 2026.
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“Eight states currently serve infants and toddlers at risk”; low or very low birth weight is a qualifying condition in 15 state policies, prematurity in 3 and both in 14, and neither in 25; the frequency of developmental delay definitions, led by “2 SD below the mean in one area” (19), 1.5 SD in two or more areas (19) and a 25% delay in one or more areas (18), the counts exceeding the number of states “Because most states include more than one definition in their eligibility policies.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.520 Policies related to use of public benefits or insurance or private insurance to pay for Part C services. Checked October 7, 2026.
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“The State may not use the private insurance of a parent of an infant or toddler with a disability to pay for part C services unless the parent provides parental consent”, asked again whenever services increase, unless a state statute protects coverage caps, availability and premiums; the state must give parents its policy on potential costs, such as copays, deductibles or “the loss of benefits because of annual or lifetime health insurance coverage caps under the insurance policy”; for public benefits it “May not require a parent to sign up for or enroll in public benefits or insurance programs as a condition of receiving part C services”; without consent, “the State must still make available those part C services on the IFSP to which the parent has provided consent”; for a family unable to pay, “the lack of consent may not be used to delay or deny any services under this part to that child or family.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.211 State option to make services under this part available to children ages three and older. Checked October 7, 2026.
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A state may let a parent “choose the continuation of early intervention services under this part for his or her child after the child turns three until the child enters, or is eligible under State law to enter, kindergarten or elementary school”; parents get an annual notice explaining the differences, including possible costs; the child “has the right, at any time, to receive FAPE” under Part B instead. - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.209 Transition to preschool and other programs. Checked October 7, 2026.
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Notice to the state education agency and school district at least 90 days before the third birthday for a toddler who may be eligible for preschool services; with the family’s approval, a conference and a transition plan in the IFSP “not fewer than 90 days—and, at the discretion of all parties, not more than 9 months—before the toddler's third birthday”; for a toddler referred fewer than 45 days before turning three, referral on to the school system, and “the lead agency is not required to conduct an evaluation, assessment, or an initial IFSP meeting under these circumstances”; for a toddler not potentially eligible, the program “makes reasonable efforts to convene a conference among the lead agency, the family, and providers of other appropriate services.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.124 Transition of children from the Part C program to preschool programs. Checked October 7, 2026.
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“By the third birthday of a child described in paragraph (a) of this section, an IEP” (or an IFSP) has been developed and is being implemented; school districts take part in transition planning conferences. - Centers for Medicare & Medicaid Services, HealthCare.gov. Referral (glossary). In many HMOs a referral is needed before seeing anyone but the primary care doctor: “If you don't get a referral first, the plan may not pay for the services.” Checked October 7, 2026.
- Centers for Medicare & Medicaid Services, HealthCare.gov. Preauthorization (glossary). “A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary”; “Preauthorization isn't a promise your health insurance or plan will cover the cost.” Checked October 7, 2026.
- American Physical Therapy Association. Direct Access Advocacy. “As of July 1, 2025, all 50 states, the District of Columbia, and the U.S. Virgin Islands have either provisional or unrestricted direct access to physical therapist services for evaluation and treatment”; some states still attach conditions to treatment without a referral. Checked October 7, 2026.
- Centers for Medicare & Medicaid Services, HealthCare.gov. Deductible (glossary). “The amount you pay for covered health care services before your insurance plan starts to pay”; after it, usually a copayment or coinsurance. Checked October 7, 2026.
- Centers for Disease Control and Prevention, Learn the Signs. Act Early. Why Act Early if You’re Concerned about Development?. Checked October 7, 2026.
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Intervention “is likely to be more effective when it is provided earlier in life rather than later”; “Early intervention services can change a child's developmental path and improve outcomes for children, families, and communities”; “Families may have to wait many weeks or months for an appointment to see a specialist or start intervention services for their child.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.126 Early intervention services in natural environments. Services in natural environments to the maximum extent appropriate, and in other settings “only when early intervention services cannot be achieved satisfactorily in a natural environment.” Checked October 7, 2026.
- Centers for Medicare & Medicaid Services, HealthCare.gov. What Marketplace health insurance plans cover. All Marketplace plans cover 10 essential health benefits, among them “Rehabilitative and habilitative services and devices”; “Specific services covered in each broad benefit category can vary based on your state's requirements.” Checked October 7, 2026.
- American Physical Therapy Association, ChoosePT. Physical Therapy Guide to Developmental Delay. Checked October 7, 2026.
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“Physical therapists help children build motor skills one step at a time to reach specific goals”; “Family who can practice daily with a child have the greatest impact on that child's development toward achieving each new skill”; “Your physical therapist will explain how much your child should practice toward achieving specific milestones”; look for “A physical therapist who is a board-certified pediatric clinical specialist or has completed a residency or fellowship in pediatric physical therapy”; “You can search for physical therapists in your area who have these and other credentials by using Find a PT”; “Ask about the physical therapists' experience helping infants and children with developmental delay.” - American Speech-Language-Hearing Association. Early Intervention Services. Checked October 7, 2026.
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“Families do not have to wait for a referral from professionals”; “Early intervention services must be in the language(s) you and your child use”; “Some states may allow early intervention services past your child's third birthday, but not all states do this”; if your child is not eligible: “Ask for another evaluation”, look for services outside the program, and ask your insurer for local providers; “These services are usually billed to you or your insurance”; from age 3, “Each school district has a program called Child Find that can help.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.13 Early intervention services. Checked October 7, 2026.
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Services that “Are selected in collaboration with the parents”; that are provided at no cost except “where Federal or State law provides for a system of payments by families, including a schedule of sliding fees”; that meet the child’s needs and “the needs of the family to assist appropriately in the infant's or toddler's development”; and that, “To the maximum extent appropriate, are provided in natural environments.” Lists 17 types of service, among them occupational therapy, physical therapy, speech-language pathology, special instruction, service coordination and transportation, and the qualified personnel who provide them. - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.20 Individualized family service plan. The IFSP is “a written plan for providing early intervention services” to the child and family, and “Is implemented as soon as possible once parental consent for the early intervention services in the IFSP is obtained.” Checked October 7, 2026.
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.321 Evaluation of the child and assessment of the child and family. Checked October 7, 2026.
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“no single procedure may be used as the sole criterion for determining a child's eligibility under this part”; the evaluation includes an instrument, “Taking the child's history (including interviewing the parent)”, the child’s level in each area, information from others and a review of records; “informed clinical opinion may be used as an independent basis to establish a child's eligibility under this part even when other instruments do not establish eligibility”; “A child's medical and other records may be used to establish eligibility (without conducting an evaluation of the child)”; the family assessment must “Be voluntary on the part of each family member participating in the assessment”; “Unless clearly not feasible to do so, all evaluations and assessments of a child must be conducted in the native language of the child.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.31 Qualified personnel. Personnel who have “met State approved or recognized certification, licensing, registration, or other comparable requirements” for the work they do. Checked October 7, 2026.
- Centers for Medicare & Medicaid Services, HealthCare.gov. Habilitative/Habilitation Services (glossary). Services that help keep, learn or improve skills for daily living: “Examples include therapy for a child who isn't walking or talking at the expected age”, including physical and occupational therapy and speech-language pathology. Checked October 7, 2026.
- American Speech-Language-Hearing Association. Find Certified Audiologists and Speech-Language Pathologists (SLPs). “ASHA ProFind is your connection to over 20,000 ASHA-Certified audiologists and speech-language pathologists” who are accepting referrals. Checked October 7, 2026.
- Centers for Medicare & Medicaid Services, HealthCare.gov. Network (glossary). “The facilities, providers and suppliers your health insurer or plan has contracted with” to provide care. Checked October 7, 2026.
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.5 At-risk infant or toddler. Checked October 7, 2026.
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A child under three who “would be at risk of experiencing a substantial developmental delay if early intervention services were not provided”; a state may include factors such as “low birth weight, respiratory distress as a newborn, lack of oxygen, brain hemorrhage, infection, nutritional deprivation.” - Rosenberg SA, Zhang D, Robinson CC. Prevalence of developmental delays and participation in early intervention services for young children. Pediatrics. 2008;121(6):e1503–e1509. doi:10.1542/peds.2007-1680 (PMID 18504295).
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A national sample of children born in 2001: “approximately 13% of children in the sample had developmental delays that would make them eligible for Part C early intervention”; “At 24 months, only 10% of children with delays received services.” - McManus BM, Magnusson D, Rosenberg S. Restricting state part C eligibility policy is associated with lower early intervention utilization. Maternal and Child Health Journal. 2014;18(4):1031–1037. doi:10.1007/s10995-013-1332-8 (PMID 23929559).
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923 children with special health care needs aged 0 to 3 with a delay or disability (2009/10 national survey): use of early intervention ranged from 6% to 87% across states, a developmental delay (rather than a diagnosed disability) lowered the odds of using it, and “Significant state variation in EI rates exists that can be explained, in part, by the restrictiveness of state eligibility criteria.” - Centers for Disease Control and Prevention, Learn the Signs. Act Early. Early Intervention Contact Information. Each state’s and territory’s early intervention program by name, with its telephone numbers, from Alabama’s Early Intervention System to Wisconsin’s Birth to 3 Program. Checked October 7, 2026.
- Centers for Disease Control and Prevention, Learn the Signs. Act Early. Concerned About Your Child’s Development?. Checked October 7, 2026.
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Ask the doctor for a referral to “a specialist who can do a more in-depth evaluation of your child”, such as a developmental pediatrician, child neurologist, or child psychologist or psychiatrist; “At the same time as you ask the doctor for a referral to a specialist”, call for a free evaluation; “You do not need to wait for a doctor's referral or a medical diagnosis to make this call”; “Use this recordkeeping worksheet to help you keep track of your notes.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.420 Parental consent and ability to decline services. Checked October 7, 2026.
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Consent before screening, evaluations and assessments, services and the use of insurance; parents “Determine whether they, their infant or toddler with a disability, or other family members will accept or decline any early intervention service under this part at any time” and “May decline a service after first accepting it, without jeopardizing other early intervention services under this part.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.320 Screening procedures (optional). A state may screen first, with consent; the notice must describe “the parent's right to request an evaluation”, and an evaluation must be done if the parent asks for one at any time during screening. Checked October 7, 2026.
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.345 Interim IFSPs—provision of services before evaluations and assessments are completed. Checked October 7, 2026.
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“Early intervention services for an eligible child and the child's family may commence before the completion of the evaluation and assessments”, with parental consent and an interim IFSP naming the service coordinator and “The early intervention services that have been determined to be needed immediately by the child and the child's family.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.24 Multidisciplinary. “the involvement of two or more separate disciplines or professions”; for the evaluation it “may include one individual who is qualified in more than one discipline or profession.” Checked October 7, 2026.
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.343 IFSP Team meeting and periodic review. Checked October 7, 2026.
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Participants include the parents, other family members the parent asks for, “An advocate or person outside of the family, if the parent requests that the person participate”, the service coordinator, the evaluators and, as appropriate, the providers. - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.322 Determination that a child is not eligible. “the lead agency must provide the parent with prior written notice”, with the right to dispute the decision, “such as requesting a due process hearing or mediation or filing a State complaint.” Checked October 7, 2026.
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.421 Prior written notice and procedural safeguards notice. Checked October 7, 2026.
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Notice before the program proposes or refuses a change, stating “The action that is being proposed or refused”, “The reasons for taking the action” and the procedural safeguards, written understandably and “Provided in the native language” of the parent unless clearly not feasible. - American Academy of Pediatrics, HealthyChildren.org. What is a Developmental-Behavioral Pediatrician?. “Developmental-behavioral pediatricians are medical doctors who have completed” pediatric residency, board certification and subspecialty training; they evaluate, counsel and treat problems including “Delayed development in speech, language, motor skills and thinking ability”; “Often a developmental-behavioral pediatrician works collaboratively with a team of professionals.” Checked October 7, 2026.
- Lipkin PH, Macias MM; Council on Children With Disabilities, Section on Developmental and Behavioral Pediatrics. Promoting optimal development: identifying infants and young children with developmental disorders through developmental surveillance and screening. Pediatrics. 2020;145(1):e20193449. doi:10.1542/peds.2019-3449 (PMID 31843861).
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The AAP clinical report: screening at 9, 18 and 30 months; “The identification of problems should lead to developmental and medical evaluations, diagnosis, counseling, and treatment, in addition to early developmental intervention.” - New York State Department of Health. Early Intervention Steps: A Parent’s Basic Guide to the Early Intervention Program. Checked October 7, 2026.
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“All counties in New York State (NYS) and New York City have an EIP”; “Parents can refer their own child to the EIP if they have a concern about their child's development”; “EIP services must be provided at no cost to you and will not affect your insurance coverage.” - New York State Department of Health. Referral: The First Step. Refer through your county’s program or the Growing Up Healthy hotline, or, “in New York City dial 311.” Checked October 7, 2026.
- New York State Department of Health. Your Child’s Evaluation. Checked October 7, 2026.
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“This evaluation is called a Multidisciplinary Evaluation (MDE)”; the initial service coordinator discusses options “from a list of New York State Department of Health approved evaluators”, including the “setting for the evaluation (home or evaluation agency)”; the MDE includes “A health assessment, including vision and hearing screening”, records, an assessment in each area and an interview with the parent. - New York State Department of Health. Health Insurance Information. Checked October 7, 2026.
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“Under New York State Public Health Law, EI services must be provided at no cost to parents”; “Private insurance and Medicaid are part of NYS' system of payments for EI services”; with regulated plans, “Parents do not pay any out-of-pocket costs, such as deductibles or co-payments for EI services”, benefits are not charged against annual or lifetime limits, and “EI visits reimbursed by the insurer cannot reduce the number of visits otherwise available to the child and family for health care.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.500 Use of funds, payor of last resort, and system of payments. Checked October 7, 2026.
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A state may establish “a system of payments for early intervention services under part C of the Act, including a schedule of sliding fees or cost participation fees (such as co-payments, premiums, or deductibles)”, meeting 303.520 and 303.521. - Early Childhood Technical Assistance Center (ECTA Center, funded by the U.S. Department of Education’s Office of Special Education Programs). Family Fees. Checked October 7, 2026.
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“Sliding fee scales generally utilize the Federal Poverty Level (FPL) as guidance to implement a fee schedule”; what a family pays is “typically dependent upon the family's income and family size”; state policies for Alaska, Arizona, California (respite, day care and camping only), Illinois, Indiana, Missouri, New Jersey, Texas (“Provisions are in place to adjust income for unusual expenses so no child will be denied services because of a family's inability to pay”), Utah, Virginia and Wisconsin; Connecticut: “Family Cost Participation Fees were eliminated effective June 16, 2021.” - Centers for Medicare & Medicaid Services, HealthCare.gov. Out-of-network coinsurance (glossary). “Out-of-network coinsurance usually costs you more than in-network coinsurance.” Checked October 7, 2026.
- Early Childhood Technical Assistance Center (ECTA Center, funded by the U.S. Department of Education’s Office of Special Education Programs). Public Insurance. “Most state IDEA systems access Medicaid to cover IDEA direct services”; EPSDT is the child health component of Medicaid, required in every state. Checked October 7, 2026.
- Early Childhood Technical Assistance Center (ECTA Center, funded by the U.S. Department of Education’s Office of Special Education Programs). Use of Private Insurance for Early Intervention Services. Checked October 7, 2026.
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State laws: Colorado, Connecticut, Rhode Island and Virginia require coverage of Part C services up to an annual amount; Indiana “Requires insurers to reimburse early intervention services if they are otherwise covered under a policy” and, like Connecticut, Rhode Island and Virginia, keeps these payments from counting against lifetime caps (Rhode Island “exempts these costs from counting against any lifetime cap”). - Centers for Medicare & Medicaid Services, Medicaid.gov. Early and Periodic Screening, Diagnostic, and Treatment. Checked October 7, 2026.
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The benefit “provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid”; states must provide services “found to be medically necessary to treat, correct, or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan.” - Adams RC, Tapia C; Council on Children With Disabilities. Early intervention, IDEA Part C services, and the medical home: collaboration for best practice and best outcomes. Pediatrics. 2013;132(4):e1073–e1088. doi:10.1542/peds.2013-2305 (PMID 24082001).
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The AAP clinical report: the medical home and Part C share a family-centered focus; “Best practice models for early intervention services incorporate learning in the natural environment and coaching models.” - Orton J, Doyle LW, Tripathi T, Boyd R, Anderson PJ, Spittle A. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database of Systematic Reviews. 2024;(2):CD005495. doi:10.1002/14651858.CD005495.pub5 (PMID 38348930).
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“Forty-four studies met the inclusion criteria (5051 randomly assigned participants)”; programs “probably improve cognitive and motor outcomes during infancy (low-certainty evidence)” and improve cognitive outcomes at preschool age (high certainty); read in full: “By school age, the intervention may not improve cognitive or motor outcomes”; “Interventions that focus on both the parent-infant relationship and infant development are more likely to have an effect.” - Roberts MY, Kaiser AP. The effectiveness of parent-implemented language interventions: a meta-analysis. American Journal of Speech-Language Pathology. 2011;20(3):180–199. doi:10.1044/1058-0360(2011/10-0055) (PMID 21478280). 18 studies of children 18 to 60 months: “parent-implemented language interventions have a significant, positive impact on receptive and expressive language skills.”
- Law J, Garrett Z, Nye C. Speech and language therapy interventions for children with primary speech and language delay or disorder. Cochrane Database of Systematic Reviews. 2003;(3):CD004110. doi:10.1002/14651858.CD004110 (PMID 12918003). 25 trials: effective for phonological and vocabulary difficulties; “No significant differences were shown between clinician administered intervention and intervention implemented by trained parents.”
- Schertz M, Mansour-Adwan J, Provizor N, Haskin A, Ogran I, Icht M. Empowering language development: a comparative analysis of parent-implemented intervention and therapist-implemented intervention in preschoolers with language delay. American Journal of Speech-Language Pathology. 2025;34(3):1352–1365. doi:10.1044/2025_ajslp-24-00335 (PMID 40268722).
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40 Hebrew-speaking toddlers with language delay: 12 weekly parent-training group sessions or 12 weekly individual therapy sessions; “Both PII and TII groups demonstrated significant improvement after intervention”; “Differences between the groups were limited to only one measure, simple sentences.” - Yildiz R, Yildiz A, Apaydin U, Efkere PA, Gucuyener K, Hirfanoglu IM, et al. Long-term neurodevelopmental outcomes of the SAFE early intervention in infants at risk: a randomised controlled trial. Journal of Paediatrics and Child Health. 2025;61(10):1662–1670. doi:10.1111/jpc.70191 (PMID 40891629).
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46 infants at risk of cerebral palsy, a family-engaged approach against conventional neurodevelopmental treatment: motor scores favored the SAFE group and cognitive scores the control group; “Its focus on active infant participation, family engagement, and enriched environments supports improved motor development outcomes.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.323 When IEPs must be in effect. Checked October 7, 2026.
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For children three through five, “The IFSP may serve as the IEP of the child, if using the IFSP as the IEP is” consistent with state policy and agreed by the agency and parents, who must first get “a detailed explanation of the differences between an IFSP and an IEP.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.301 Initial evaluations. A parent may request an initial evaluation, which “Must be conducted within 60 days of receiving parental consent for the evaluation”, or within the state’s own timeframe. Checked October 7, 2026.
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.306 Determination of eligibility. “A group of qualified professionals and the parent of the child determines whether the child is a child with a disability.” Checked October 7, 2026.
- Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.101 Free appropriate public education (FAPE). Checked October 7, 2026.
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FAPE from the third birthday, with an IEP or IFSP in effect by then; “If a child's third birthday occurs during the summer, the child's IEP Team shall determine the date when services under the IEP or IFSP will begin.” - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 300.8 Child with a disability. Checked October 7, 2026.
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A child with one of the listed disabilities “who, by reason thereof, needs special education and related services”; a child who “only needs a related service and not special education, the child is not a child with a disability under this part”, unless state standards count the service as special education; for “Children aged three through nine experiencing developmental delays”, a state-defined delay may qualify. - Individuals with Disabilities Education Act regulations, Electronic Code of Federal Regulations. 34 CFR § 303.430 State dispute resolution options. Checked October 7, 2026.
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Written procedures for the “timely administrative resolution of complaints through mediation, State complaint procedures, and due process hearing procedures”; during a due process complaint “the child must continue to receive the appropriate early intervention services in the setting identified in the IFSP that is consented to by the parents.” - Centers for Disease Control and Prevention, Learn the Signs. Act Early. Developmental Monitoring and Screening. Checked October 7, 2026.
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The AAP recommends developmental screening at 9, 18 and 30 months and autism screening at 18 and 24 months; “If your child misses one of these well-child visits, or a screening was not done at those times, it should be completed at the next visit”; for early intervention, “Families can also refer themselves directly.”
Medical disclaimer. This page is for general educational purposes and does not constitute medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider about your child. Costs, coverage rules and programs change and vary by location; confirm details locally.