Rose McLean_NPN_Contributor

As a pediatric physical therapist, something I hear quite often in new assessments with families is that they "knew something wasn't quite right and had questions on it, but were told to wait and see if it was still a problem" at their next pediatrician visit. Many times, things do work themselves out with development for a variety of factors. Unfortunately, it's not every time. If gaining anything from this article, my advice as a physical therapist and as a parent myself is to trust your instincts. YOU know your child best. Early intervention has been statistically proven to shorten overall intervention times as well as improve results across all disciplines with children. The challenge with the “wait and see” recommendation is that earlier in your child's medical care at their primary pediatrician, you are seeing each other every four weeks. By the time you may have concerns, your check-in period is every three months. Three months is a long time in a child's first year of development: it's a quarter of their life! [Related: Preschool, or therapeutic preschool?] So how does a family pursue occupational, physical, or speech therapy for their child? There are a multitude of different ways to access services, which move along their corresponding timelines for each path. Here are some of your options: 1. Call a reputable, outpatient center or home-based service to provide therapy services. Turn around time to services: one to two weeks Look at online reviews, ask for others’ experiences in local parenting groups, access NPN’s referral list — any of these areas could be a good starting point to contact for an assessment for services. Most places will directly call a pediatrician for the prescription to be on file prior to the assessment. In Illinois, you do not need a prescription for physical therapy, as it is a direct-access state. This means that patients can refer themselves and receive ongoing treatment without an initial referral. Reputable outpatient service locations will still gain a referral and share treatment plans and evaluation results with a primary pediatrician, regardless of the state requirement. You can also ask for this to be done! This is the most direct and fastest way to receive services. This can also be the most costly, especially if you still have to meet an insurance deductible or do not have private insurance to access. If you are in a rush to prioritize services, an important question during this process is whether the outpatient center or private-based therapy service site providers are also in network with Illinois's Early Intervention system. (We'll review how to access both services down below.) 2. Call the Illinois Early Intervention program. Turn around time to services: six to 12 weeks, depending on availability Illinois has a robust Early Intervention program offered for children ages 0 to 3. Services included in Early Intervention are speech therapy, occupational therapy, physical therapy, developmental therapy, developmental vision therapy, developmental hearing therapy, feeding therapy, social work, nutrition services, and diagnostic referral services, to name a few. Services are typically provided in home, in a daycare, or via teletherapy, depending on a family's preference. [Related: What to look for in a therapeutic preschool] Families can call the child and family connection facility associated with their home address ZIP code to obtain an assessment and report concerns related to their child's development. Pediatricians or other physicians related to your child's care can also directly refer to the Early Intervention system. To begin Early Intervention services, your pediatrician must agree with and sign off on all recommended services after the assessment. After calling to schedule an assessment, it typically takes two weeks to receive a scheduled assessment. Following the evaluation, recommendations are made and new providers are searched for to provide the recommended frequency of services. This process in finding your child's provider team can at times be lengthy to get set up, depending on availability of clinicians in your area. Despite the issues with timely services, the benefits to using the Early Intervention system are great for families! Monthly family fees are assessed based on number of family members and overall household income. This family fee is set from $0 to $200 max per month. Early Intervention can act as your primary insurance (as in, the only insurance plan that is billed for therapy services), or it can act as your secondary insurance (e.g., the insurance to handle any unpaid amounts after visits are processed by your primary insurance plan). Because of this set up, Early Intervention can provide an extremely affordable and accessible means for therapy services for children up to the age of three. 3. Combination of utilizing private insurance and the Early Intervention system through the state of Illinois. Turn around time: one to two weeks to get started; up to three months to bring on Early Intervention coverage At times, when a problem has been identified, waiting several months for services can feel like a lifetime. This is where a provider that can initially work with your insurance plan, that has providers certified through the Early Intervention program, can work nicely. Think of it as billing just your primary insurance for the first weeks before Early Intervention can "kick in." Early Intervention can then be used primarily as your benefits plan or to help supplement your insurance plan. Finding an initial provider that provides both services is also helpful so that you do not have to get services started and then switch providers to a different facility. Hopefully this has been a useful guide to accessing services and pursuing early intervention for your child. Again, listen to your instincts, pursue help when needed, and don’t rely on “wait and see”: it could prove to take even more time to make gains with this approach.

As we begin to talk about the “s” word again ("school"), you may be weighing some options for your kids coming into the fall. If you have a toddler at home, you may also be entertaining the idea of preschool to help get your little one reintroduced to the world, interacting with peers — as well as adults other than your immediate family — and just beginning to develop social skills again as we emerge from our homes. [Related: What to look for in a therapeutic preschool] While preschool is not a requirement or necessary for later success in school, experts agree it provides an environment for children to explore, play with peers, build self-confidence, and strengthen their social and emotional development, all while having fun and learning routines. If you’re ready to send them off for more of these social experiences, you’ve likely fallen into a lot of options in Chicago for early learning. One factor to also consider in your search is whether your child would be appropriate for a “standard” preschool or a “therapeutic” preschool. It's a good idea to explore some differences in choosing a preschool or a therapeutic preschool for your youngster, as there are several distinctions that separate these two early learning options. Ratios In Illinois, preschools and daycares are mandated to follow predetermined adult-to-child ratio guidelines. Most stick to these minimum recommendations, which is a great question to inquire about when doing your research! These ratios are as follows: • For 2-year-olds a 1:8 ratio, with a maximum group size of 16 • For 3- to 5-year-olds, 1:10 ratio, with a maximum group size of 20 • For children 5 and above, 1:20, with a maximum group size of 30 In a therapeutic preschool setting, most classrooms are much smaller than the recommended maximums. Ratios are also much lower. A typical therapeutic preschool has a class size of 6-8 children, with ratios of adult support anywhere from 1:1 to 1:3. [Related: Preschool vs pre-k: What's the difference?] Therapy If your child receives speech, feeding, occupational, physical and/or behavioral therapy, a therapeutic preschool might be the way to go. This environment has these specialized therapists guiding interventions, providing individual therapy sessions, and helping to generalize different skills among peers. For example, a speech therapist may work individually with a child on answering questions or forming multiple word responses, and then bring the child back to the classroom to practice this new skill with their friends. Naps Here’s where therapeutic preschools may fall short. Therapeutic preschools are very therapy driven and most do not allow for a 2-hour mid-day nap, as a preschool or daycare set up would offer. If your little one is a power napper, a full day program at a therapeutic preschool may not be the best option for them. Diapers Some Early Learning programs require enrolled children to be fully toilet trained. This can be a real limitation for some families who feel their children are ready for the social and emotional benefits of preschool, but are not quite ready to spend the day in undies. At a therapeutic preschool, there are potty training programs implemented with each child, as this is a skill most are able to work on because of the low teacher to student ratios they maintain. Communication Both a preschool and a therapeutic preschool likely offer a lot of great communication options between the teachers and families. Notes going home, apps to receive updates, and face to face interactions help parents feel in touch and in the know about the day to day events with their children. However, if your child’s communication seems to be behind their age-matched peers, this can be a high frustration level for many toddlers who have a good understanding of what’s being discussed, but aren’t quite able to get their thoughts and feelings out effectively yet. A preschool classroom can be a frustrating experience when there are challenges expressing your wants and needs, or advocating for yourself. Important questions to consider: Is my child easy to understand? Can they ask for help when they need it? Are they able to speak up to advocate for themselves? Am I the only one who can understand my child? Reflecting on some of these questions may help lead you to the proper enrollment for your child. Enrollment Every child can be assessed and receive an IEP (individualized educational plan) at age three in order to have recommendations for placement at a CPS preschool. But did you know that your IEP is good for three years, and you are not required to join a CPS preschool at that time? Students in Illinois are not even required by law to attend kindergarten; however, they must be enrolled in either a home schooling program or a school district by age 6. Therefore, many families opt to pause enrollment from CPS to join a therapeutic preschool and reap the benefits of intensive therapeutic intervention, low student to teacher ratios, and engaging social and peer interactions. But don’t worry: Whether they graduate from preschool or therapeutic preschool, they can still join their peers in either a kindergarten or first grade classroom when they are ready! Making a Switch There are a handful of preschools in Chicago that enroll in the fall for the entirety of the year. Some have more strict guidelines on classroom placement based on birth date and ability level. However, many allow for enrollment throughout the school year, depending on birth date, availability and current ratios in their classrooms. Most therapeutic preschools enroll throughout the entire school year, and base these enrollments on the needs of the children and their families. So, if you are on the fence about what is most appropriate for your child, ask about enrollment commitments or cancellation fees, should you opt to enroll in a more therapeutic setting later in the year. Having this option may make enrollment in either program an easier commitment. Regardless of what you choose for your child, you want this early learning experience to be positive for everyone involved. Ask lots of questions, explore every option, and don’t limit yourself to only your neighborhood school. There may be a better fit for your child and their developmental needs that can get them well prepared to be independent little learners!