New ESIT Guidance: #2021-01 COVID-19 Documenting Natural Environments and Virtual Services during the Pandemic

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ESIT HEADER

New ESIT Guidance: #2021-01 COVID-19 Documenting Natural Environments and Virtual Services during the Pandemic

Purpose

The purpose of this guidance is to outline options for documenting natural and non-natural environments on the IFSP during the pandemic.

Background

On July 31, 2020 ESIT released the COVID-19 Individualized Family Service Plan (IFSP) Review Form with the intent of offering Early Support for Infants and Toddlers (ESIT) providers an efficient alternative to documenting an IFSP review/update if a child is to receive more than three visits held in non-natural environment settings. The current guidance is designed to further highlight options for reducing the paperwork burden as well as clarify documentation requirements for providers when in-person services must be provided in non-natural environments during the pandemic.

Methods and Settings

In order to document virtual services accurately, it is important to understand how the ESIT Data Management System (DMS) distinguishes between service methods and service settings. A method is a service modality and may take place in a variety of settings. Remote service delivery options such as videoconference calls, emails and recorded video are methods and are often accessed in the natural environment of the family’s home. In-person visits are methods, which might take place in a natural environment service setting such as a community park or in a non-natural environment a such as a clinic or Early Intervention Provider Agency (EIPA) office. The service setting is a location and is determined by where the caregiver and child are when services are provided. Service settings include both natural and non-natural environments.

See the table below for more explanation of how methods and settings intersect.

General Term

Definition

Methods Included in Term

Service Settings

Tele-practice

Services provided through audio and video equipment permitting real-time, interactive communication

Virtual face-to-face visit, interactive webinar, virtual play group

Setting: (Home, Community, Other) wherever the caregiver is while accessing the service

Non-video Communication

 

Virtual services provided via voice or written text without a video component

Telephone, text messaging, email, mail, facsimile, conference call

Setting: (Home, Community, Other) wherever the caregiver is while accessing the service

Pre-recorded, Store and Forward

Supplemental services provided through pre-recorded audio and/or video that do not support real-time, interactive communication

Pre-recorded video, webinar, podcast

Setting: (Home, Community, Other) wherever the caregiver is while accessing the service

IFSP Reviews and Updates

If pandemic-related circumstances necessitate a switch from natural to non-natural environments, the child’s IFSP must be reviewed. This section clarifies when to complete a full IFSP review in the DMS and when to it is allowable to use the expedited COVID-19 IFSP Review Form.

  1. When three or fewer visits will take place in a non-natural environment:
  • The COVID-19 IFSP Review Form may be used.
    • The COVID-19 IFSP Review Form is intended to expedite the IFSP Review documentation for families and providers.
    • If the service will be provided in a combination of natural and non-natural settings, include that information in the answer to Question 2 on the form, regarding why visits require a non-natural environment.
    • The pandemic may be used as a justification (in the explanation section of the DMS) when in-person services are required to address the needs of the child, and no safe natural environment options are available.
  1. When more than three visits will take place in a non-natural environment:
  • The full IFSP review must be documented in the DMS.
  • Document the service setting as a non-natural environment.
    • The pandemic may be used as a justification when in-person services are required to address the needs of the child, and no safe natural environment options are available.
    • If the service is being provided in a combination of settings and any of those is a non-natural environment, include that information in the justification text box.
    • If movement between a natural (e.g. virtual with the family in their home) and non-natural environment (e.g. periodic in-person clinic setting) is anticipated, providers should list the service setting as a non-natural environment until a permanent return to natural environments is feasible.

Service Scenario

Type of IFSP Review Documentation

A 24-month old child is receiving weekly physical therapy through virtual visits. The parent brings the child to the EIPA’s clinic to see the therapist in-person twice to fit the child for adaptive equipment.

Use the COVID-19 IFSP Review Form. Include the pandemic as a justification for the non-natural environment. Note the combination of natural and non-natural environments in the justification.

A 7-month old child is receiving weekly physical therapy coaching through virtual visits. The parent brings the child to the EIPA’s clinic to see the therapist in person every other week to provide hands on therapy to address her torticollis.

Complete a full IFSP review in the DMS. Include the pandemic as a justification for the non-natural environment. Note the combination of natural and non-natural environments in the justification.

Documentation in the Data Management System

Keep in mind that multiple methods and settings may be used to deliver a service and that all methods and settings used should be documented. See the screen shot below for example documentation. 

Add-Part-C

If you have questions please contact DCYF ESIT Training and Technical Assistance Manager, Adrienne O'Brien, at adrienne.obrien@dcyf.gov.