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KIDZ THERAPY SERVICES, PLLC

PRESCHOOL POLICY

&

PROCEDURE MANUAL

Gayle E. Kligman

Executive Director

OVERVIEW

The Preschool Special Education Program provides evaluations and services to children who have or are suspected of having a disability pursuant to Section 4410 of Article 89 of the Education Law and funded by the NY State Education Department and municipalities with funds earmarked for special education services.

This procedure manual is to be used to clarify procedures and services as it applies to Kidz Therapy Services, PLLC. For a complete guideline on all regulations, staff should refer to Part 200.2(b)(6) of the NYS Education Dept. (see attached), NYS Medicaid in Education (see attached), FERPA (see attached), and HIPAA (see attached) regulations. In addition, staff may refer to and utilize the Nassau County Best Practice Manual (see attached) prepared by the Quality Assurance subcommittee of the LEICC, the Nassau County Preschool Special Education Program Policy and Procedure Manual (see attached) and the Suffolk County Related Services Policy and Procedure Manual (see attached) and Suffolk County Special Education Itinerant Teacher Manual (see attached).

The implementation of policies and procedures of the Preschool program is the responsibility of the Kidz Therapy Preschool Program Quality Assurance Department in collaboration with the Executive Director, Clinical Coordinators and Business Manager.

All Kidz Therapy personnel who provide Preschool services are highly qualified individuals who have demonstrated experience in the provision of services to young children and meet the qualifications of an approved provider. They are appropriately screened, licensed/certified and have been trained in Health and Safety Standards and adhere to the confidentiality practices in compliance with FERPA and HIPPA regulations.

VISIONS AND VALUES

Kidz Therapy’s goal is to provide each child with an experienced, qualified professional who will provide the highest quality of service incorporating a child’s educational needs and goals. Kidz Therapy accomplishes this by:

• Providing professional and comprehensive evaluations and services to assist preschoolers with special needs to achieve their maximum personal development, both as individuals and learners.

• Working in partnership with school districts, therapists, teachers and families to develop strategies to enhance the quality of services children with special needs and their families are receiving.

To achieve our vision, we must have a very clear idea of who we are and what we stand for. Fortunately, we at Kidz Therapy share a set of very definite values that help us determine if we are doing the right things. They fall into four categories:

• Meeting children’s educational and developmental needs

• Complying with regulations and requirements of the federal, state, and local standards and codes

• Professional ethics

• Leadership and personal accountability

We believe that every one of us is part of the larger Kidz Therapy team. The contributions of each and every person are both necessary and valued.

KIDZ THERAPY SERVICES…About Us

Kidz Therapy’s Preschool Program Calendar (see attached) follows the school year, July 1 to June 30.

Kidz Therapy providers are available to provide evaluations and services to meet the unique needs of all Districts, children and their families. In an effort to accommodate the multi-cultural needs of our families, Kidz Therapy Services actively recruits and trains staff to meet these unique needs.

Kidz Therapy Services’ employees and independent contractors meet the criteria as outlined in The State Education Department regulations and procedural guidelines. A provider checklist is used to ensure compliance with Kidz Therapy and State Regulatory Agencies.

All prospective employees and independent contractors are required to have a face to face interview with the Director of Kidz Therapy Services, PLLC and/or the Clinical Supervisor of that specific discipline. Interview packets will be emailed prior to interview or interviewees will be given an Interview Packet (see attached) upon arrival to fill out before the interview. These will be incorporated into the personnel file upon hire.

This will include:

• Resume

• Original NYS License/Certification

• State Central Register Clearance Form (Child Abuse)

• Child Abuse Course Completion

• Medicaid in Education Training Certificate

• Medical Form

• Two Reference Forms

• Two Passport Pictures (Employees Only)

• Proof of Malpractice Insurance

• Proof of Fingerprinting

• NPI Number

• Therapist Data Sheet

• Employment Eligibility Verification Form (I-9 Form)

• W-4 Form (for employees only)

• Best Practice Memo

A provider checklist is reviewed to ensure compliance with Kidz Therapy and State Regulatory Agencies.

Any employee or independent contractor who has established a relationship with Kidz Therapy Services, PLLC must have a personnel file. The Human Resource Coordinator creates an individual folder which includes the original signed Service Contract, and all submitted documentation. The Human Resource Coordinator will make a copy from the provider’s original NYS License/Certification and initial back of copy to confirm viewing of original License/Certification.

All employees will be issued a Company identification card. All employees are required to submit two passport size photographs, one of which will be used to issue the photo ID card. (The other photo will be kept in their personnel file.) Upon separation from the Company, employees are required to return their ID card before receiving their final paycheck. Independent contractors are required to obtain and wear their own identification card at all times while providing services to children through Kidz Therapy. ID badges must be worn at all times while providing services. All new hires are given a copy of the Kidz Therapy Procedure Manual, including Health & Safety, Confidentiality, and Billing Information.

Kidz Therapy Services requires that all of its employees and independent contractors, whether or not they are Mandated Reporters have a Certificate of Completion for the State Education Department’s Coursework/Training in Violence Prevention and Intervention. Employees are evaluated annually as part of their annual performance review to ensure that health and safety including policies and procedures for identifying and reporting child abuse and maltreatment or neglect and confidentiality procedures is being followed.

All employees and independent contractors are required to complete the State Central Register Clearance Form. It is mailed to New York State and until an acceptable response is received from the SCR, providers may only provide services when supervised by an employee who is in the same physical location and within direct visual contact of the child receiving services. If services are provided at home, the parent cannot supervise services. The Clearance letter received from the State Central Register Division of Development and Prevention Services is placed in the provider’s folder. Any employee or independent contractor who changes their name (ex. marriage or divorce) must complete a new State Central Register Clearance Form. If notice is received from the SCR that a person is the subject of an indicated report of child abuse or maltreatment, Kidz Therapy will contact the Office of Children and Family Services (800-342-3720), Municipality and School District to seek guidance for determination as to whether or not to allow provider to have regular or substantial contact with children. All employees and independent contractors are required to complete a new State Central Register Clearance Form every 3 years.

Kidz Therapy Services will, at a minimum, check monthly all of its employees, independent contractors and vendors through:

▪ The United States Department of Health and Human Services Office of the Inspector General’s Lists of Excluded Individuals and Entities or any successor list,

▪ The New York State Department of Health’s Office of the Medicaid Inspector General’s List of Restricted, Terminated or Excluded Individuals or Entities.

In the event an excluded party is discovered, Kidz Therapy Services will notify the Municipality and School District in writing within three (3) days after such event.

Any individual found to be ineligible to participate in the Preschool program will cease all services immediately and be replaced with an eligible Service Provider. Once that individual has been reinstated they must notify the municipality in writing of their status. Kidz Therapy will notify the school district. Only after receiving written notification from the municipality, can an individual resume services with Kidz Therapy.

The Human Resource Coordinator will complete the criminal check online at: criminaljustice.state.ny.us by going to the Level 3 Subdirectory Search and entering the provider’s last name and zip code. The provider’s license is checked at highered.tcert/certificate/cor.htm, and each special education teacher’s certificate is checked on the TEACH website, by entering last name, first name, month and day of birth, last 5 digits of their social security number and zip code. These forms are then printed out and placed in the provider’s folder.

Prior to beginning employment or an independent contractor relationship at Kidz Therapy, the Company requires all individuals who will be working directly with clients to have a physical exam by a licensed New York State physician to ensure that they are free of communicable or infectious diseases. Current employees and contractors are required to have a physical exam on an annual basis. In addition, all employees and contractors are required to have the following tests and immunizations: PPD – annually; measles, mumps, and rubella – proof of vaccination or titer, (Hepatitis B vaccine, Tetanus immunization within the past 10 years, Diphtheria, Pertussis, Varicella, and Influenza – either proof of vaccination or documentation of refusal) and a yearly physical. Written records of pre-employment and annual physicals will be kept in the employee's personnel file. All medical information including any exam or test results will be kept in a file separate from the providers personnel file and will be kept confidential to the extent possible. Emergency contact numbers for providers are kept on record at the Kidz Therapy Services offices.

All Kidz Therapy Special Education Itinerant Teachers (SEITs) are NYS Certified Teachers of Special Education with a minimum of a Birth – Grade 2 certification (if issued after 2004). All SEITs must be employees of Kidz Therapy Services, PLLC.

All SEITs are assigned a direct supervisor from the Kidz Therapy Special Education Department., Psychology Department or the Autism and Behavioral Services Department. (see attached)

Kidz Therapy supervisors are available to address questions, concerns or issues. SEITs must meet at least 3 times per year with their supervisor. Mandatory supervision is scheduled on: Orientation Day, Veteran’s Day, Martin Luther King Day. (see attached) Attendance will be taken and a Certificate of Attendance will be issued to each attendee.

During the year, the SEIT Supervisor will conduct a Direct Observation of the SEIT providing services and provide written feedback of the observation on the SEIT Performance Appraisal Form (see attached). In addition, Supervisors review all Progress Reports, Annual Reviews and Evaluations (including Functional Behavioral Assessments and Behavioral Intervention Plans). Supervisors will assure that services are provided in accordance with the IEP.

During July and August, trainings are offered for all SEIT teachers at no cost. SEIT’s are required to attend at least one (1) training as part of their professional development requirements. SEITs may attend as many of these trainings as they wish. Training Lists are emailed to providers each year in April to allow ample time for scheduling. (see attached) Attendance will be taken and a certificate of attendance will be issued to each attendee.

A SEIT Quality Assurance Checklist is sent to the Preschool or Child’s Home for home-based services, for each child being serviced each year. (see attached) Supervisors will review these with the SEIT as part of their supervision.

Occupational Therapy Assistants, Physical Therapy Assistants, and Clinical Fellows may only provide services to Preschool children in accordance with Medicaid in Education requirements and regulations in accordance with their professional practice act. PTA’s only provide services in Kidz Therapy’s offices or a site with direct supervision and monitoring available.

1:1 Aides provide services under the direction of the classroom teacher. Certified Aides and IBI Aides provide services under the supervision of Kidz Therapy’s special education teacher.

The credentials of staff/contractors are monitored monthly through compliance audits, to ensure that our providers are qualified to provide preschool services. If Kidz Therapy Services becomes aware that one of their current providers does not continue to meet the criteria of eligibility to provide preschool services, immediate action is required.

First, the provider must be contacted and told to discontinue services; immediately followed by written notice to the provider. The school district and parent are to be contacted and informed that the provider is no longer going to be available to provide services. Kidz Therapy will make every effort to replace the provider with a qualified professional as soon as possible. If a new provider cannot be found, Kidz Therapy Services will notify the school district and parent that they cannot continue to provide the service.

The Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) mandated the adoption of standard unique identifiers for health care providers and health plans. The purpose of these provisions is to improve the efficiency and effectiveness of the electronic transmission of health information. The Centers for Medicare & Medicaid Services (CMS) has developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers. All Kidz Therapy providers must have National Provider Identifier (NPI) numbers on file. These numbers have been included in our provider lists and given to both Nassau and Suffolk Counties.

Every month the Human Resources department sends a compliance letter to active providers. This letter will notify providers two months prior to the expiration of any of their needed requirements including annual physicals, continuing education, license/certification expirations, etc.

At the beginning of every school year, a Welcome Back Letter is sent to all providers. This letter includes the following information for all providers (but not limited to)

▪ Restating information found on Kidz Therapy’s website: policies, procedures, manuals, forms, etc

▪ IEP Direct information

▪ Progress Report due dates for the new school year

▪ Annual Review report due dates for the new school year

▪ Listing of any new tests that must be used for evaluations

▪ Opportunities for Continuing Education

▪ Medicaid compliance information

▪ Billing requirements

Kidz Therapy keeps in contact with providers throughout the school year. All state, county and Kidz Therapy forms, manuals, calendars, and important information are posted on Kidz Therapy’s website: . The website is updated frequently. Each month Kidz Therapy emails a memo to all providers. This includes reminders for upcoming events, such as progress reports, annual reviews, rules for Medicaid and end of year procedures, billing procedures, holidays and school vacations. Whenever Kidz Therapy receives any information, requirement, changes in forms or regulations, trainings, etc, from the state, school districts or municipality, that information is immediately passed along to all Kidz Therapy Providers through email. Each Kidz Therapy provider is required to have an active email address on record. They are encouraged to check their emails daily to ensure immediate receipt.

HEALTH AND SAFETY STANDARDS

Kidz Therapy Services, PLLC maintains strict standards to be in compliance with all applicable local, state and federal regulations.

The Comptroller maintains copies of the Current Certificate of Occupancy as well documentation and knowledge of local and state building, zoning and fire codes. The building has periodic fire alarm checks and fire drills. The office manager keeps a log of all fire alarm checks and fire drills. Several fire extinguishers are kept throughout the office and are periodically checked.

The Comptroller maintains an inventory of all furniture and equipment.

Current Federal and State Employer regulations (Labor Laws) are posted in the hallway.

Kidz Therapy’s Health and Safety manual is updated to be kept current with the Health and Safety Standards as set forth by section 807-a of NYS Education Law. All independent contractors delivering services on behalf of Kidz Therapy are instructed in appropriate health and safety standards annually prior to the beginning of the new school year. All Kidz Therapy providers are sent via email the link to Kidz Therapy’s Health and Safety manual located on the Kidz Therapy website.

All Kidz Therapy service providers receive training regarding health and safety policies and procedures at time of hire and as part of their mandated Best Practice training. Employees are evaluated annually as part of their annual performance review to ensure that health and safety and confidentiality procedures are being followed.

Fingerprinting

As required by law, prior to the first day of work, employees and independent contractors must submit proof of fingerprinting that lists Kidz Therapy as the employer or agency. This required information will be kept in their personnel file. Any costs associated with obtaining fingerprinting clearance are the employee’s or independent contractor's responsibility.

State Central Registry

All new employees and independent contractors must complete the State Central Register Clearance Form. It is then mailed to New York State. The Clearance letter received from the State Central Register Division of Development and Prevention Services is placed in the provider’s folder. Current employees and independent contractors will be notified when another inquiry is going to be made to the State Central Registry. Kidz Therapy will not make an inquiry on an employee or independent contractor more than once in any 6-month period. Kidz Therapy will submit additional inquiries to the State Central Registry in compliance with County contract requirements.

Code of Conduct

Kidz Therapy Services PLLC has established a Provider Compliance Program (see attached) which includes a Compliance Committee and a designated Compliance Coordinator. Kidz Therapy Services requires that all employees and independent contractors comply with all Rules and Regulations as stated in this manual, as well as, all applicable federal, state, and local laws, rules, regulations and professional guidelines.

Reporting of Child Abuse and/or Neglect

When child abuse or neglect is observed or suspected, the provider must immediately notify:

• The NYS Child Abuse and Maltreatment Register by telephone. Mandated Reporters must call 800-635-1522 and submit a signed, written report (LDSS-221A Report of Suspected Child Abuse or Maltreatment- available on Kidz Therapy’s website under CPSE Forms) in writing within forty-eight (48) hours of the oral report. Non-Mandated Reporters are still required to call 800-342-3720 to report any suspected child abuse and must document this in writing, The Report of Suspected Child Abuse or Kidz Therapy’s Incident Report (both are available on Kidz Therapy’s website under CPSE Forms) may be used.

• If the allegation involves non-familial abuse, the Special Victims Squad of Nassau/Suffolk County Police Department must also be contacted by telephone at Nassau -516-573-8055; Suffolk -631-852-6272.

• Kidz Therapy Services’ Preschool Coordinator at 516-747-9030 (Nassau) or 631 382-7311 (Suffolk). If it is after normal business hours, providers will leave an emergency message. This message will be automatically forwarded to the cell phone of the Comptroller, Executive Director, Office Manager or Business Manager. An Incident Report (see attached) will be completed. A copy of the Report will be filed in the child’s folder

Within 24 hours, Kidz Therapy will notify the Director of the Preschool Program at the Nassau/Suffolk County Department of Health by telephone at 516-227-8648 (8:30 a.m. to 4:15 p.m.) or at 516-742-6154 (after business hours); or Suffolk at 631-853-2318.

In accordance with the law, any employee or independent contractor who fails to report an instance of suspected child abuse or maltreatment may be guilty of a Class A misdemeanor and may be held liable for the damages caused by the failure to report. The law grants employees and other persons who report instances of child abuse immunity in good faith from any liability that might otherwise be incurred.

If a provider arrives at a home, preschool, daycare, or other setting and finds an unattended child, there are no parents/adults present 18 years old or older, a call is to be made immediately to the local police department (911), and to Nassau County at 516-227-8648 (8:30 a.m. to 4:15 p.m.) or at 516-742-6154 (after business hours); or Suffolk County 631-853-2318. The provider will stay with the child until the Police arrive. The provider must call the Kidz Therapy office and notify the Preschool Services Coordinator.

Providers should not enter a building if it does not appear to be safe. Providers should leave a building if they do not feel safe. Kidz Therapy and the department supervisor should be notified immediately of any safety concerns. Ways to make the provider’s session safer should be discussed with the family (restrain large dogs, have someone meet provider in front of the building and walk provider in, etc.).

Be sure that children do not have access to any potentially harmful objects. Children should be clean and comfortable (no wet or soiled diapers) during therapy sessions.

Service Providers will have parents complete the Child Emergency Information Form (see attached). This form is to be kept with the providers while providing services. A copy is kept on file with the child’s records. Providers are to discuss the policy and procedures regarding Health and Safety with parents at the onset of services.

HEALTH

Kidz Therapy Services provides a healthy environment for all its employees as well as for the children we service. Education, cleanliness and sanitation are an essential part of ensuring a healthy environment. All independent contractors delivering services on behalf of Kidz Therapy are instructed in appropriate health and safety standards annually prior to the beginning of the new school year. All Kidz Therapy providers are sent via email the link to Kidz Therapy’s Health and Safety manual located on the Kidz Therapy website.

The Kidz Therapy Office Buildings are smoke free environments.

Lead was used in many materials and products before the risk to young children was known. Certain products such as paints used in older houses before 1978, lead solder used in plumbing, and leaded gasoline were used before their harmful health effects were recognized. Although laws now prevent lead from being used in many products, there can still be lead hazards in and around many homes. Lead can get into the air, water, food, soil, and even dust and then can be breathed or swallowed leading to serious health problems, especially for young children. The federal Consumer Products Safety Commission (CPSC) issues recalls for many different kinds of products that pose a risk for serious injury or death. Kidz Therapy’s website provides links to the Dept. of Health’s recall lists (see attached). Providers are required to go to the website and download the list of recalled products to ensure that they are familiar with these safety risks and that none of these products are being used with any child receiving services.

The Kidz Therapy Office buildings have a cleaning service that cleans the offices every night. Each night the floors are vacuumed and every trash container is emptied and a new liner is inserted. The trash containers in the kitchen areas are always covered. The kitchen areas are cleaned daily. There is a dishwasher in each kitchen so that cups, silverware and small toys can be cleaned and sanitized.

The bathroom facilities are cleaned daily. If the bathroom does not have soap, paper towels or toilet paper, the office manager will call The Treeline Company (Garden City) at 516-837-8000 or Tritec Building Company (Hauppauge) at 631-751-5577 and notify them of what is missing. The bathroom should always have these items.

There is a diaper changing table station (Diaper Depot) in both Kidz Therapy offices. There is a sign in the waiting room notifying parents that we have a diaper depot located in the office. There are disposable changing pads so that each child gets a new sanitized pad. Disposable gloves are available as well. There is a diaper genie located next to the changing table, so that diapers can be sanitarily disposed. Instructions for the changing pads and the diaper genie are posted above the Diaper Depot. In addition to the individual pads, the changing table is sanitized weekly. The office always has cleaning supplies; including Clorox wipes and Lysol spray disinfectant.

The OT and PT gym and the Sensory gym are equipped with sinks which comply with the American Disabilities Act. A child safety step stool is provided to enable each child reach the sink to wash their hands.

Diapering/Bathroom use

If a child needs to use the bathroom, the provider will bring the child to their parent/caregiver. Providers are not to take children to the bathroom. The parent/caregiver will attend to their child’s needs and return child to their provider to continue the session.

If a child has a soiled diaper that needs to be changed during a session, the provider will notify the parent/caregiver. Providers are not to change diapers.

If a child has an accident during a session, the provider will immediately notify their parent/caregiver. The provider will wash their hands, put on disposable gloves and immediately clean and sanitize the area as necessary, including furniture and toys following the procedures for universal precautions.

Infection Control

All providers use universal precautions to prevent the spread of infections from HIV, hepatitis B and other blood-borne pathogens. Public health law in New York State prohibits disclosure of HIV information without written consent from the infected individual or the parent/guardian of that individual. As a result, providers should regard all contact with blood and body fluids as potentially infectious. The practice of universal precautions entails the use of a barrier (i.e., gloves) to prevent contact with blood and other body fluids that may be contaminated by blood. Other routine infection control measures, such as hand washing and disinfecting, should also be followed to prevent the spread of germs from communicable diseases. Guidelines are listed below.

Hand Washing

Hand washing is the single most effective practice to prevent infections. Pre-moistened wipes and waterless hand cleaners may also be used as a temporary measure but they should not be used as a substitute for washing hands with soap and running water.

Hands must be washed:

After exposure to body fluids (i.e., sneezing/coughing);

Before and after using the bathroom;

Before and after eating or handling food; and

After removing gloves used for any purpose

When washing hands, always use soap and warm running water. (Antibacterial soaps are not required.) Wet hands and apply a small amount of soap, lather and scrub hands vigorously, making sure to reach between fingers, under fingernails and tops of hands. Rinse with warm running water. Dry hands with a clean, disposable paper towel, and turn the faucet off with a clean paper towel. These instructions are posting above all sinks.

Providers should wash their hands between sessions with children. If enough time is not available, providers shall use a hand sanitizer. Every room has a hand sanitizer available and providers who provide services outside Kidz Therapy offices should carry hand sanitizer.

Gloves

Gloves are an important method of barrier protection from contact with blood and other body fluids. Gloves should always be worn when providing oral motor/feeding therapy and in any other situation that requires touching blood or body fluids (e.g., drooling, open lesions).

Gloves must be changed after contact with each child. Remember to wash hands immediately after removing gloves, as the use of gloves alone is not sufficient to prevent the spread of infection.

Exposure to body fluids:

Anything that is exposed to body fluids must be cleaned with an appropriate “Green Cleaner”. This is kept in a child proof cabinet in the kitchen. Providers should ensure that any equivalent product utilized is stated in writing to be effective against HIV and Hepatitis, and is safe for use with children.

Skin Protection

All open lesions should be covered with a Band-Aid or other bandage. If a lesion is on the hands, gloves should also be worn while working with children.

Prescriptions

No prescription or over the counter medications will be administered to any child receiving services from Kidz Therapy. Any necessary medications will be administered to the child by their parent/caregiver.

No prescriptions, over-the-counter medications, etc. are to be out in the open or within the reach of any child.

No provider shall consume, or be under the influence of alcohol or any other controlled substance.

Toys and Therapy Materials

All equipment, materials and/or toys used by the provider should be appropriate for the child’s developmental age and skill level.

All toys that are mouthed by children should be cleaned with a bleach and water solution (1/4 teaspoon of bleach in 1 quart of water) before they are used again, paying special attention to toys and materials that have been used by a child that is noticeably sick (e.g., runny nose, coughing). This mixture must be made fresh daily as needed.

To disinfect a hard plastic toy:

• Wash the toy in warm, soapy water;

• Rinse in clean running water;

• Place the toy in a mild bleach solution made from 1 teaspoon of bleach and 1 gallon of water for 10-20 minutes;

• A new bleach solution should be mixed for each use as it loses its effectiveness after one day.

• Rinse well and allow to air dry.

• Plastic toys may also be washed in the dishwasher.

To clean cloth toys:

Cloth toys may be cleaned in the hot water cycle of washing machines.

Children receiving oral motor or feeding therapy should have their own toys and other materials stored in a clearly marked plastic bag before and after washing.

There is a ball pit in the Kidz Therapy gyms. The balls are sent out to be cleaned and sanitized each week, more often if a concern for sanitation exists. Lysol disinfectant is used daily.

Pillow cases, sheets, blankets, etc. are changed after each use and washed every week.

Feeding

Foods used in therapy should be nutritious and based on the child’s developmental ability, always consider and check regarding allergies. Never allow children to share drinking cups or utensils (even siblings). These items must be sanitized after each use. Highchairs may only be used for feeding purposes or therapy and is consistent with the child’s developmental status and cannot be used as a restraint.

Child/Provider Illness

Kidz Therapy's goal is to give all children the best possible learning opportunity and to maintain the health of these children and providers. Parents and providers should cancel a session if the child is ill. If the child is seen in the Kidz Therapy office, parents are asked to call the office to cancel. If the child is seen at home, preschool, or daycare, parents are asked to please call the provider directly. Providers should give parents a number to reach them at during the day. Parents are requested to cancel with as much notice as possible so other children can be serviced or make ups provided.

Providers will not service a child if the child appears to be ill, (fever, stomach ache, nausea, etc.). The following are examples of some contagious illnesses: pink eye, fever, severe colds, diarrhea, lice, flu, rash, chicken pox, vomiting and strep throat. In the event of suspected illness, the provider will bring the child immediately to the parent/caregiver. The provider will then wash their hands and clean and sanitize the room including furniture or toys the child may have been in contact with. If the child is seen at home and a child appears ill, the provider should leave the home and clean any toys or materials the child has handled and provide a make-up if possible.

If a child has a medical condition (such as a broken bone, contagious illness, or surgery) that prevents the child from receiving services, a medical clearance, copy of school form or the Permission to Resume Services form (see attached) is required.

In the event that the provider is unable to provide services (illness, emergencies, etc) the provider must call the parent. Whenever possible, 24 hour notice should be given. Make-up sessions must be offered in consultation with the family, when possible.

Employees and or independent contractors should report all occurrences of communicable or infectious diseases to their supervisor/coordinator immediately, at which time Kidz Therapy reserves the right to require the employee and or independent contractor to be examined by a physician. The physician will determine when the provider may return to work.

Providers should not provide any services if they are sick, especially if they have any illness that may be contagious. Providers must be very conscious of how easily germs can spread among young children. They must utilize universal precautions to ensure their health and the health of the children and families they service.

To protect the general health and safety of children with respect to illness, injury and emergencies, all providers are required to have readily available a portable first aid kit. The kit must contain disposable gloves, soap, hydrogen peroxide, tweezers, various sized bandages, non-allergic tape, sterile gauze, scissors, thermometer and working flashlights.

Providers will carry instructions for administering Infant/Toddler Choking First Aid (see attached); CPR (see attached), emergency system contact number for medical assistance and transportation (see attached), up-to-date information for contacting parents, and up-to-date emergency consents. Telephones to report emergency situations must be available at all times.

In case of any emergency, (ex. injury, accident, natural disaster, etc.) the provider’s first priority is to ensure the safety of the child and themselves. Once the child is safe and, comfortable the provider will call the necessary person(s), which may include, but not limited to the Kidz Therapy Preschool Coordinator and the parent. The provider shall complete an Injury/Accident Report or Incident Report as appropriate.

SAFETY

Kidz Therapy Services, PLLC provides a safe physical environment for all persons that access our premises and is in compliance with applicable federal, state and local building, fire and safety standards or codes.

Building Safety

Kidz Therapy Service’s main office is located at 300 Garden City Plaza, suite 350, Garden City, NY. The office is located on the third floor of an office building. The building is wheel-chair and handicap accessible. There is a front and rear building entrance. We have three sets of elevators and two staircases. Our office provides a secure entrance and exit through a set of double doors that open into our waiting room. A front desk receptionist has a view of the waiting room including the double door entrance into the outer hall. There is an inside door in the waiting room that leads into the inner hall and therapy rooms. This one-way door is always locked and requires a code to enter, but is open to exit into the waiting room. There is another entrance into the evaluation center which leads into the evaluation waiting room. The evaluation receptionist also has a view of the doorway and the evaluation waiting room. There is a third one-way exit door in the middle of the offices which is always locked from the outside so that a code is required to enter the office, but opens to the outside hall to be used as an emergency exit.

Kidz Therapy’s second office is located at 49 Wireless Blvd. suite 170, Hauppauge, NY. This building is one floor. There is only one entrance into the waiting room. The receptionist has a clear view of the waiting room, the front doors and another one-way inner door that leads into the therapy offices. This one-way door is always locked and requires a code to enter, but is open to exit into the waiting room. There is a second doorway in the back of the office which is always kept locked, but can be opened to allow exit in case of emergency.

We have multiple fire extinguishers and smoke detectors that are visibly placed and easily accessible throughout both offices. The Garden City building also has fire extinguishers placed in the stair wells. Our fire extinguishers are checked every month by the comptroller and a log of the testing is maintained in his office. The fire extinguishers must be in working order as demonstrated by the gauge showing full charge. If they are not, they are replaced immediately. Each fire extinguisher is tagged with a dated card showing that it was inspected by Security Fire Inspection Services, Inc.

All personnel working in the office are familiar with the location of fire extinguishers and how to operate them. In case of an emergency, instructions are clearly printed on every fire extinguisher.

Smoke detectors are maintained by the building. These are connected to the local Fire Department. Fire drills are conducted regularly throughout the year. A log of the drills is kept by the respective Office Managers. Each room has an emergency exit diagram and instructions clearly showing and stating the path to the closest exit. Providers are trained on evacuation procedures. Emergency numbers are posted at every phone in both offices.

Emergency Action Plan

The Emergency Action Plan ensures that Kidz Therapy provides a safe workplace for all employees, clients and visitors. This will be posted on all bulletin boards. Employees are familiar with emergency exits in case of an evacuation and must call 911 in serious situations. Exits signs hang above all exits and light up in cases of emergency and power failure. Evacuation plans are posted in every office.

In the event of a violent or potentially violent situation involving an intruder, visitor or family member, employees should immediately dial 911 and inform the Comptroller, Executive Director and Office Manager. All office doors should be immediately closed. All providers should remain with their children until they receive instructions from the Executive Director, Comptroller or Office Manager. The office intercom system can be utilized by lifting the telephone receiver and pressing intercom 70 to alert staff of a potentially dangerous situation and to give instructions and procedures to follow.

Fire Drill/Evacuation

Employees are familiar with emergency exits in case of an evacuation and must call 911 in serious situations. Exits signs hang above all exits and light up in cases of emergency and power failure. Evacuation plans are posted in every office. Parents are given written instructions for fire drill and emergency evacuation procedure. During a fire drill, Garden City providers are to escort children directly to the nearest exit and down the stairs and out of the building.

Kidz Therapy will notify the Garden City Fire Dept. of any Non-ambulatory persons. Non-ambulatory children will be carried by their provider down the stairs and out of the building. If needed, assistance will be provided by assigned members of the support staff. If a non-ambulatory student or any other non-ambulatory person cannot be carried down the stairs, they shall be escorted to the Evaluation Waiting room to await the arrival of the Garden City Fire Dept. If that is not a safe area, non-ambulatory persons shall be brought to stairwell “B” directly across the hall from the Evaluation Waiting room to await the arrival of the Garden City Fire Dept. Parents/Guardians or other non-ambulatory persons will be notified in advance of this procedure. Parents/Guardians will meet their children downstairs in the front of the building.

In Hauppauge, providers are to escort their children out of the nearest exit and proceed to the NE exit door of the building. Non-ambulatory children will be escorted out of the building. If needed, assistance will be provided by assigned members of the support staff. Parents are instructed to exit the waiting room doors and proceed to the NE exit door and meet their children on the grassy area away from the building. This avoids any confusion and ensures the quickest and safest exit for the children.

Video surveillance cameras are located at all three doors in the Garden City office and one at the main and rear entrance door in Hauppauge. The cameras are located inside the office and face the doors that open into the outer hallway. These cameras are monitored via the internet so that the office can be monitored at any time, from anywhere. This program is password protected.

Building Hazards

Children will not have any access to potential hazards including portable heaters, pools, ditches, or wells. Our windows are safe windows that do not open more than 6 inches. Regardless, children are never to be left alone or unsupervised in any room.

All exits and hallways shall remain clear and free of any clutter or obstruction (boxes, toys, equipment, etc.)

All toxic materials, including cleaning supplies, flammable substances, prescription drugs, over-the-counter medications, plants, lighters and matches are stored in locked cabinets in the conference room.

The offices are painted regularly to ensure that there is no peeling or any damaged paint or plaster.

All heaters and air conditioning units are housed inside metal cabinets so there is no danger of a child injuring themselves.

All the electrical outlets in Kidz Therapy offices must have child safety covers.

If there are any unknown odors, the office manager will call the Treeline Company (Garden City) at 516-837-8000 or Tritec Building Company (Hauppauge) at 631-751-5577 to have the odor investigated immediately. The Director, Comptroller, or Office Manager will decide if it is necessary to evacuate the premises until it is deemed safe to return.

If, at any time, a safety hazard or risk of safety hazard appears, the provider or staff member will notify their supervisor immediately. If it is a building hazard, the building maintenance company, the office manager will call The Treeline Company (Garden City) at 516-837-8000 or Tritec Building Company (Hauppauge) at 631-751-5577 immediately. If the office manager is not available, any staff employee can call The Treeline Company (Garden City) at 516-837-8000 or Tritec Building Company (Hauppauge) at 631-751-5577. All appropriate and necessary steps will be taken to ensure that no child is placed in a hazardous situation.

Child Safety

Children are to be supervised at all times.

No children are to be transported in a vehicle by any provider at any time, for any reason.

A parent or other authorized adult must accompany each child to Kidz Therapy for services. The parent or other authorized adult must remain in the waiting room while the child is receiving therapy; they may not leave. Parents are given a copy of Kidz Therapy’s Parent Policies and Procedures Packet (see attached) prior to their first session. Parents sign a form to acknowledge receipt; these forms are then kept in the individual child record file.

All the office furniture shall be placed in such a way so that children can safely walk down the halls and into their therapy session. Every room is furnished with a child size table and chairs so children can sit properly and safely.

First Aid

In an effort to protect the general health and safety of all children, all providers are required to have readily available a portable first aid kit. The kit must contain disposable gloves, soap, hydrogen peroxide, tweezers, various sized bandages, non-allergic tape, sterile gauze, scissors, thermometer and working flashlights.

First Aid kits are available in each kitchen as well as the sensory playroom and the OT/PT gym at both offices. A box of disposable gloves is kept with each kit.

The OT gym and PT gym are both furnished with state of the art therapy equipment. No child is ever to be left unattended; the provider must always be in close proximity to the child to ensure that every measure is taken to assure the child’s safety.

Children should be clean and comfortable (no wet or soiled diapers) during therapy sessions. Be sure that children do not have access to any potentially harmful objects (small objects, plastic bags, styrofoam).

Kidz Therapy has a policy of zero tolerance for illegal drugs in the workplace. To help ensure a safe, healthy and productive work environment for our employees and others, and to ensure efficient operations, Kidz Therapy has adopted a policy of maintaining a workplace free of drugs and alcohol. This policy applies to all employees and providers regardless of where services are provided.

The unlawful or unauthorized use, abuse, solicitation, possession, transfer, purchase, sale or distribution of controlled substances, drug paraphernalia or alcohol by any individual anywhere on the Company’s premises, while on the Company’s time (whether or not on company premises) or while otherwise representing the Company, is strictly prohibited. Providers are prohibited from reporting to work or working while they are using any controlled substances, except when the use is pursuant to a licensed medical practitioner’s instructions and the licensed medical practitioner authorized the employee or individual to report to work.

The Company is dedicated to maintaining a drug-free workplace. All our employees and providers are required to perform their job duties unimpaired by illegal drugs, alcohol, or the improper use of legal substances. Providers are responsible for complying with our policies on professional behavior, harassment and violence-free workplace.

No pets are allowed on Kidz Therapy premises while children are being serviced.

Child Injury or Accident

In the event a child is injured during the course of treatment, the provider must notify the parent/caregiver immediately. If a child needs medical help, the provider will make sure that the child’s condition is stabilized. Depending on the situation this may involve calling for emergency medical help, 911, and using First Aid to assure that the child is satisfactory and safe. An Injury/Accident Report (see attached) must be obtained from the Kidz Therapy Preschool Coordinator, completed and signed by the provider and parent/caregiver. This report is to be returned to the Kidz Therapy Preschool Coordinator. Four copies of the Injury/Accident report shall be made. One copy shall be given to the child’s parent or legal guardian. The second copy shall be forwarded to the child’s district. The third copy shall be kept in the child’s record. The fourth copy shall be kept in an injury log that is periodically reviewed by a staff member for injury patterns. This fourth copy shall be retained by the agency or individual provider for the period required by the state’s statute of limitations.

Company Closings/Delayed Openings

Kidz Therapy has a consistent policy that provides for the office to remain open during inclement weather for those employees who can make it to work. In inclement weather, the building maintenance will shovel and lay salt or sand. If the Director decides that the roads are unsafe, a decision to close Kidz Therapy or delay opening until the roads are clear and the parking lot and entrance to the building are safe for all to enter will be made.

If it becomes necessary for the office to close and/or for the opening of the office to be delayed, we will make every effort possible to notify employees via a telephone chain as follows: The Executive Director will notify all department supervisors and administrative personnel, who in turn will notify their designated departments. All providers are responsible for notifying their clients of an office closing or delayed opening. For this reason, professional staff should always have with them a copy of their schedule as well as a current list of their children, the parent’s name, and home, work, or cell phone numbers.

In addition to the telephone notification outlined above, office closings and delayed openings will be posted on Kidz’ Therapy’s website. Professional staff should notify clients that they can obtain this information on Kidz Therapy’s website ().

At times, emergencies such as severe weather, fires, or power failures, can disrupt Company operations. In extreme cases, these circumstances may require the closing of a work office. The determination to close the facility will be made at the sole discretion of Kidz Therapy management.

If Kidz Therapy’s office or a school district closes due to inclement weather and/or other emergency, the provider can decide if they want to provide services that day or make up the session in accordance with appropriate Municipality’s make-up policy.

Identification and Security

All providers observe the following ID card security rules:

• the photo ID tag must be visible and worn at all times;

• use of the identification card is mandatory when providing services to children of Kidz Therapy;

• loss of an identification card must be reported immediately.

CONFIDENTIALITY OF RECORDS

FERPA

In accordance with the Federal Educational Rights and Privacy Acts (FERPA) all office personnel and professional staff must adhere to FERPA. The Health Insurance Portability and Accountability Act (HIPAA) privacy regulations clarify that educational records covered by FERPA are excluded from HIPAA privacy regulations. Billing records must meet the requirements of HIPAA.

The Executive Director, Comptroller, Business Manager and the Preschool Services Dept. are responsible for ensuring the confidentiality of all personal information, including but not limited to: requests from school districts, evaluations, IEP’s, progress reports, annual reviews, prescriptions, medical information and treatment logs. Kidz Therapy Services’ providers are sensitive to the privacy rights of all children and their parents.

Each child’s records are kept in an individual folder. All agency records are to be kept in locked file cabinets and are made available only to authorized individuals. The Executive Director, Preschool Services Coordinators and Office Managers are responsible for maintaining keys for these files. Only the Executive Director, Preschool Services Dept., Clinical Directors, Office Managers and Business Manager will have access to these files. Other authorized employees, including but not limited to supervisors, providers and direct providers, will have access to children’s records on a need-to-know basis and will document access on the Child Record Access Log (see attached) with date, reason for access and signatures.

No staff member may duplicate or remove from the premises any personally identifiable data relating to any child receiving services from Kidz Therapy Services PLLC without the explicit permission of the Kidz Therapy Services PLLC administrative staff. If a file is to be removed it may only be transported in a locked container. Only information that will be used for the express purpose of facilitating the child’s participation in the CPSE Program will be authorized to be released. The PS Services coordinators will be responsible to identify such persons and send or make available the information to the providers or other individuals. Kidz Therapy providers are instructed to protect the privacy of the children and families they service. It is stated in their service contract and the Kidz Therapy employee manual.

Requests for access to a child’s record by a person other than an authorized employee shall be directed to the coordinator of each program and be documented in writing. If request for access is approved, a record of such access shall be maintained in the child’s file, which will indicate the date, person and reasons for the access. Only information appropriate to a request should be released. Extraneous or sensitive information about the child and family must always be protected.

Written parental consent, in the parent’s dominant language, an Authorization for Release of Records Form (see attached) must be obtained before personally identifiable information is disclosed to anyone other than authorized individuals; it must include the name of the entity, the specific record(s) that will be obtained or released and the purpose for which these records will be used, the date the parent signed the consent, and the parent’s signature and relationship to the child. If the purpose is for any other reason (ex. other than listed on a general release), the parent must be informed of the names of the individuals that request access, and provide written consent for such access. If consent is given, those individuals must also be informed and must adhere to all legal requirements that protect the child’s records containing sensitive information (such as sexual or physical abuse, HIV status, treatment for mental illness, the child’s parentage, etc).

Access to and Amending Records

Parents may request to review their child’s records or ask for an explanation of material included in any record pertaining to their child at any time. At the time of their child’s evaluations, parents are informed of the process by which they can review or obtain copies of their child’s records. Records can be reviewed by the parent or a representative on behalf of the parent. If a parent requests preschool records and it contains information about multiple children, only information pertaining to their child/family will be released. Parents have the right to request an amendment to their child’s record when the parent believes the information contained in the record is inaccurate, misleading or violates the privacy or any other rights of their child.

When such a request for an amendment to their child’s record is made, a decision will be made based on a review of all the information available. If information is found to be inaccurate, misleading or to violate the privacy of the child/family, changes are to be made as soon as possible. Amended copies will be sent to the parent and school district.

If Kidz Therapy decides not to amend the record as requested, the parent and child’s school district will be informed of this decision.

To receive copies of their child’s records, parents must send a request in writing to the Preschool Services and/or Evaluation Coordinator. The Parent Request for Child Records Form (see attached) will be given to Parent’s. Parents can call the Kidz Therapy office at any time to request copies of their child’s records. The Preschool Services and/or Evaluation Coordinator will ask the parent’s to send a written request. Kidz Therapy Services does not charge for records related to evaluations, assessments, and/or treatment.

If a representative on behalf of the parents requests copies of records, Kidz Therapy Services requires written consent from the parents authorizing Kidz Therapy Services to release information to such representative. Kidz Therapy will send copies within 10 days of receipt of the written request (5 days if the request is made as part of mediation or impartial hearing). The fee for such records is 10 cents per page for the first copy and 25 cents per page for additional copies.

Parents have the right to review and inspect their child’s records. Parents can call the Preschool Services and/or Evaluation Coordinator and schedule an appointment to review their child’s records. A provider, supervisor or coordinator will be available to explain the records, answer any questions and ensure that all concerns and priorities are addressed.

Maintenance of Records

Kidz Therapy’s various programs have specific record retention requirements as outlined below.

All current children’s records are maintained in the Kidz Therapy office and kept in locked file cabinets in the Preschool Evaluation and/or Services Department.

Records that are not current are maintained in a secure storage facility. Entry to the facility is password protected and the storage unit where the files are kept locked at all times. Only the Comptroller, Business Manager and Human Resources Coordinator have keys to the Storage Units.

Preschool Program records are maintained until the child’s 21st birthday. Each box is labeled chronologically according to the last date of service. This is in compliance with the requirements for Medicaid eligible children, those records must be maintained until the child reaches twenty-one (21) years of age.

Financial records are maintained for 7 years. Records are kept at the Garden City Location for 2 years, then moved to the secure storage facility.

All individual preschool providers who are licensed, registered or certified under state education law must retain records in accordance with the laws and regulations that apply to their professions. Professionals are not released from these obligations for children who are receiving preschool services under the CPSE Program.

Initial and Supplemental protocols – must be maintained and retained for a period of one (1) year following the date of testing. All providers are responsible for maintaining and retaining all test protocols per these requirements. After one year these protocols, as well as any other unnecessary papers that may contain confidential information are shredded, using a shredding machine.

Procedural safeguards will be utilized to ensure that no records are destroyed or altered in any way during the required retention periods. Access to retained records will be overseen by the Comptroller.

Records will be stored by the Comptroller. Any questions on records should be directed to the Comptroller.

When a child has reached the age of 21, the Executive Director will make the decision as to when the child’s record is no longer needed to be maintained. Kidz Therapy will make every attempt to contact the parent by certified mail notifying them that we will no longer be maintaining their child’s file. Parents can choose to either pick up their child’s records, have their child’s file mailed to them for the cost of the postage, or request that their child’s records be destroyed. It is recommended that parents retain their child’s records as they may be needed at some point in the future (ex. for Social Security benefits).

Electronic Records

All faxes include a cover letter on Kidz Therapy letterhead with the name of the intended recipient of the fax. The bottom of every fax also contains the following disclaimer:

The information contained in this facsimile is privileged and confidential information intended only for the use of the individual entity named above. If the reader of this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us immediately.

When providers send faxes to the Kidz Therapy office, they must use a cover letter addressed to the appropriate Preschool coordinator.

No private or personally identifiable information is ever to be emailed outside of the intra-office email (emails to and from any @). All emails are directed through our own email servers (one in Garden City and one in Hauppauge). The two servers communicate through a T1 line, this as well as all other internet service, is protected by Cisco firewall. Every computer is protected by Symantec Antivirus. In addition, Kidz Therapy monitors all internet access with Cymphonix Network Composer. Kidz Therapy retains SolarusTechnologies as its IT technicians. They are responsible for 24 hour monitoring of our system, which includes maintenance of all computers and programs as well as all updates for Microsoft Windows, Symantec Antivirus and any other needed software. All @ emails are available from the internet using a secured web-server and is password protected.

All Kidz Therapy’s preschool email addresses used by the preschool evaluation and preschool services departments: kidzaba, suffolk, annualreviews, kidzservices, and preschool are protected with an encryption certification by SecureMail from DataMotion. SecureMail by DataMotion is HIPPA compliant. Whenever emails containing any child information are to be sent, the coordinators from each preschool department simply click on the “Send Certified” button and the email is encrypted. In order to read the email, providers simply click on the link in their personal email and they are automatically directed to a secure website to read the email. No child identifiable information is ever received in a personal email (yahoo, aol, hotmail, etc). Each provider sets up their own password to further protect these emails. When the providers reply to these emails (through the Datamotion website), their emails are also encrypted. Kidz Therapy’s preschool coordinators must also supply a password to read these emails.

All emails from Kidz Therapy email addresses also contain the disclaimer:

The information contained in this email is privileged and confidential information under the Family Education Rights and Privacy Act and is intended only for the individual entity named above. The contents must be secured in accordance with all applicable state and federal requirements and guidelines related to the privacy and confidentiality of information. If the reader of this message is not the intended recipient, you are hereby notified that any distribution or copying of this communication is strictly prohibited; delete this email and please notify us immediately at Kidz Therapy Services, (516) 747-9030.

Parents may request the use of e-mail to communicate with their child’s providers and teachers rather than using a communication notebook. Parents must complete the Parental Consent to Use E-mail to Exchange Personally Identifiable Information form (see attached). A completed copy of this form must be kept on file in the child’s folder.

When providers want to submit reports, evaluations or any other documentation containing confidential information, they upload their files directly from their computer to the appropriate email address through our secure website. The Kidz Therapy website is a secure domain server (protected by ChrystalTech). Each employee is given a unique username and password to access our forms and to upload files. Once the files have been uploaded, the preschool Coordinators must log in with their own email and password to retrieve the uploaded files. All forms are available on our website assuring provider’s easy access to all necessary documentation.

All Kidz Therapy staff and on-site providers have their own user name and password to log into any of the computers in the Kidz Therapy office. There are different levels of security which determine what access a user is given. Evaluators and providers only have access to their individual files.

Kidz Therapy utilizes CLAIMS (County Linked Agency Information Management System) as the database for all evaluations and services provided. Each administrative staff member has a separate username and password to log into the CLAIMS system. There are different levels of security which determine what access each user is given.

All electronic records are maintained in accordance with the Federal Educational Rights and Privacy Acts (FERPA) all office personnel and professional staff must adhere to FERPA. All records containing sensitive information (such as sexual or physical abuse, treatment for mental illness or mental health problems, HIV status, communicable disease status, the child’s parentage, etc.) must be protected. When consent is given by a parent or guardian to release information, only information appropriate to a request will be released.

CPSE EVALUATIONS

Parent Referrals

Parents who contact Kidz Therapy Services regarding concerns about their preschool child’s development are referred to their local school districts’ Committee on Pre-school Special Education. They are informed that all evaluations and services are provided at no cost to families based on the individual needs of the preschool child if found to have a disability as determined by the CPSE of the local school district. Parents are informed that they must register their child to their home school district and request an evaluation. Parent’s can choose any 4410 approved evaluation site. Specific contact information, for their local school district, is given to parents, if needed.

Evaluation Requests

An Initial Evaluation Request or Supplemental Evaluation Request is processed upon the receipt of a signed and dated Parental Consent and Authorization to Evaluate from the school district. Upon receipt, the request is date stamped. The Preschool Evaluation coordinator will ensure the child’s date of birth meets CPSE age eligibility requirements.

All pertinent information is entered into the CLAIMS system. A child folder is created for each child for whom an evaluation is requested. Nassau County requests are filed in the Blue Folders; Suffolk County requests are in the Orange Folders. An intake sheet containing all information included in the request is printed and stapled to the right side of child’s folder, right on top of the school district’s request. All contact with parent, providers and school district is dated and documented on this intake sheet.

A Child Record Access Log is stapled to the inside back cover of the file. The file also contains an Initial or Supplemental CPSE Meeting Recommendation form (see attached).

Note: Evaluations must be completed within 30 Calendar days from the date that Parental Request for the evaluation was submitted to the school district. If the evaluation request includes a CPSE meeting date, the evaluation report must be submitted to the school district and parent at least five (5) business days prior to the meeting date. If for any reason evaluations are not completed and sent to parent and district within these time constraints, a letter of explanation will be sent to the school district.

Initial Evaluation Packet sent to Parents

The following are mailed to the parents immediately upon receipt of request for evaluation:

Cover letter

Authorizations for Evaluations & Records

Medical Evaluation Summary

Medicaid Parental Consent Form

Any required prescription forms

Home Language Survey

Social History

Supplemental Evaluation Packet sent to Parents

The following are mailed to the parents immediately upon receipt of request for supplemental evaluation:

Cover letter

Authorizations of Evaluations & Records

Medicaid Parental Consent Form

Any required prescription forms

Initial Contact

The Preschool Evaluation coordinator contacts parents immediately upon receipt of the consent from District to ensure compliance with mandated timelines.

For Initial Evaluations:

The Preschool Evaluation Coordinator elicits the families concerns for the child in order to ensure the evaluations conducted address the concerns of the family. For children transitioning from Early Intervention, with the consent of the parents, approved evaluators and committees shall obtain the most recent evaluation and/ or progress reports and services provided to the child.

Parents are requested to complete evaluation packet forms and return prior to the initiation of the evaluation process.

Scheduling of evaluations should take into consideration family schedules in order to allow for optimal testing results and family participation.

Parents are informed that they are an integral part of the evaluation process and will be provided with an opportunity to share their input during the evaluation process.

Parents are informed that a Psychological evaluation, Social history and Observation of their child are the only mandated components of the initial evaluation.

Parents are informed that an Observation must be conducted. It will be scheduled at the child’s educational setting, if child attends preschool or daycare or an environment appropriate for a child of that age. If parents refuse an observation, they must complete the Renunciation of Required Classroom Observation form (see attached).

A current physical examination is required.

All contacts by the evaluators with parents or others involved in the process are dated, documented, signed and placed in the child’s record.

Only evaluations requested from the district can be scheduled and conducted. If an Audiological, OT or PT evaluation is requested, a prescription from the child’s physician is required. Evaluators and providers may use an evaluation referral checklist (see attached) to determine if a request for an evaluation is appropriate. An evaluator may submit a Request for Additional Evaluations form, if appropriate, to the Preschool Evaluation Coordinator. The CPSE committee will determine what additional evaluations may be needed. All evaluations, observations and reports are at no cost to families.

After parents have signed the Release for Child Photograph form (see attached), children who are evaluated at Kidz Therapy’ office are photographed and their picture is stapled to the inside front cover of their folder.

Languages

The parent completes the Home Language Survey. The evaluation coordinator confirms the primary language spoken at home. If it is not English, the evaluations are provided and administered in the child’s native language or other mode of communication and in the form most likely to yield accurate information on what the child knows and can do academically, developmentally and functionally, unless it is clearly not feasible to provide or administer. If the request from the school district is not for a Bilingual Evaluation, the school district will be contacted and notified. Parents must fill out a Request for Bilingual Evaluation form, and placed in the child’s folder. If the request from the school district is for a Bilingual Evaluation and upon review it is concluded that although the child has or was exposed to another language, the child’s primary and dominant language is English, the Preschool Evaluation Coordinator will contact the CPSE to discuss. Parents have the right to refuse a Bilingual evaluation. CPSE makes the decision as to whether or not a Bilingual Evaluation will be done. If the District has decided that a Bilingual Evaluation must be conducted, Parents can withdraw from the CPSE process if they still do not agree.

If the parents are not English dominant, the summary report will be translated into their primary language. The parent must sign a Request for Translation form (see attached) prior to the evaluation. The bilingual evaluator or interpreter will ensure that the parents understand their rights, the evaluation process and evaluation results.

EI Evaluations

If the child is receiving EI services, the district may submit recent progress reports or evaluations. If not already received, with signed parental consent, the evaluation coordinator will contact the child’s Ongoing Service Coordinator to make sure that the child has not recently been evaluated as part of a 6 month progress review. If a recent evaluation was conducted, the evaluation coordinator will request a copy of any evaluations with signed parental consent. Upon review, the appropriate evaluator will determine if these evaluations may be accepted and submitted to the CPSE.

All Kidz Therapy evaluators are appropriately licensed and certified. Assessment tools are chosen and administered based on the individual needs of the child. Only the most current and not culturally biased assessment instruments are used.

Bilingual Evaluations

Kidz Therapy is an approved evaluator for bilingual Spanish evaluations. If a request is received for a bilingual evaluation other than Spanish, Kidz Therapy will submit a Request for Authorization for Bilingual Evaluation (see attached), indicating how Kidz Therapy will be able to conduct the requested bilingual evaluations. Kidz Therapy will wait for either approval to continue or receipt of re-assignment of the evaluations.

Bilingual assessments, valid testing instruments:

• are normed on the child’s cultural-linguistic group.

• are designed in the primary language of the child or at minimum, have versions that have been translated into this language.

• are standardized.

• contain only culturally appropriate items.

In many instances these criteria are not available for certain cultural/linguistic groups. At these times, the evaluations may rely upon clinical interpretations of observations, age equivalents instead of standardized scores, behavior and language samples, play-based assessments and interview with parent’s/caregivers to determine the child’s developmental status.

Using a Translator/Interpreter

Only in situations when an evaluator fluent in the primary language of the child and the family cannot be found will an evaluation be conducted using an evaluator and translator team. First choice is always a bilingual professional. If this is not possible, the next choice of translator is a person not known to the family. Both the evaluator and interpreter need to be specially trained to conduct evaluations in this manner. This team must have knowledge of child development, characteristics of early language development, evaluator behavior and procedures during testing session, rapport building with the child and family, test stimuli, accurate interpretation of the child’s test responses and suggestions when modifications are appropriate.

Testing in which parents or caregivers function in the translator role may not give an accurate and objective evaluation of the child’s skill and will only occur when all other options have been exhausted.

Interpreter

An interpreter may be used to assist an evaluator when speaking with a parent or caregiver. It is important that parents understand what is being asked when completing such evaluations as the Social History, Sensory Profile, Conner’s Rating Scale or other component requiring parental input.

Psychological testing assesses a preschooler’s behavior, cognitive skills and adaptive behavior. Behavioral observation information is as important at this age as standardized testing. If the presenting problem is behavior, a functional behavioral assessment (FBA) will be included. A functional behavioral assessment means the process of determining why a student engages in behaviors that impede learning and how the student’s behavior relates to the environment. The FBA must include, but is not limited to: Identification of the problem behavior; definition of the behavior in concrete terms; identification of the contextual factors that contribute to the behavior and formulation of a hypothesis regarding the general conditions under which a behavior usually occurs and probable consequences that serve to maintain it. The FBA must, as appropriate, be based on multiple sources of data (such as structured interviews, behavior rating scales, standardized assessments, checklists) and must include: information obtained from direct observation of the student; information from the student, the student’s teacher and/or related service provider and a review of available data and information from the student’s record and other sources including any relevant information provided by the student’s parent. A teacher and parent rating scale are completed to evaluate the child’s behavior at school and in the home. An FBA is an evaluation requiring parental consent.

In addition to the formal psychological assessment, psychologists are required to write a separate social history report for preschool evaluations that is submitted in conjunction to the psychological evaluation report. Birth, medical, and developmental history including information highlighting social/emotional development and family constellation is integrated in this report.

Speech-Language Evaluations assess receptive language, expressive language, pragmatic, articulation and oral motor skills; the evaluation will also include a language sample analysis.

Occupational Therapy Evaluations assess fine motor functioning: control and coordination of the hands and fingers, as well as tactile, kinesthetic perception, and motor performance. An OT evaluation also measures postural control, bilateral motor integration, and reflex integration. The Sensory Profile assesses sensory processing, modulation, and behavior.

Physical Therapy Evaluations measure motor proficiency: bilateral coordination, locomotion, running speed and agility, and strength.

Special Education Evaluations must include the following components: Cognitive Skills, Communication (Receptive and Expressive Language), Physical Development (Fine and Gross Motor Skills), Adaptive Self-Help Skills and Social/Emotional Development. A preschool evaluation must include a classroom observation or a behavioral observation (if child does not attend school).

Upon completion of each evaluation component, the evaluators will submit their comprehensive evaluation report to the Kidz Therapy Evaluation Dept. Each evaluator will contact the parent to explain and discuss the results of their evaluations and to address any concerns that they may have concerning their child. Results will be discussed with the parent in their dominant language. Evaluations results may be interpreted to ensure that parent’s understand and have an opportunity to ask questions. The evaluator will date and document their conversations in the child’s individual evaluation folder. Evaluators may not make verbal recommendations during the evaluation or any subsequent contact regarding specific services, frequency, duration or special providers. Evaluators will discuss with parents and will include a statement in the written report indicating that determination of eligibility for services will be made by the CPSE.

Written Reports and Content

All evaluation results from all evaluators will be integrated in order to present a clear picture of the child’s functioning and needs. Any differences in findings must be explained in full and reconciled. The evaluator must include a statement whether the parent/caregiver felt the evaluation was a typical picture of their child.

Kidz Therapy will provide copies of the multidisciplinary evaluation reports, summary, and the New York State Child Outcomes Summary Form to the parents, school district and Municipality and EIOD. The written/oral summary will be translated into the parent’s dominant language. Written reports will not include recommendations regarding eligibility, specific services, frequency, duration or special providers. A Parent Survey (see attached) is sent to the parents with the evaluations.

Outcome Summaries

School districts are required to collect assessment entry data on all preschool children who receive an initial evaluation.

Approved preschool evaluators must ensure that the initial individual evaluation of all preschool children provides entry assessment status for each child in each outcome area identified:

• Positive social-emotional skills.

• Acquisition and Use of Knowledge and Skills

• Use of Appropriate Behaviors to meet his/her needs

This information is entered into the Outcome Summary form. A copy is sent to the school district and parent. Original is placed in child’s folder.

A clinical member of the Kidz Therapy evaluation department will attend the CPSE to present the results of the evaluations.

If the child is deemed eligible for CPSE services, the evaluator will enter goals into IEP Direct and update MAPS and SPAMS. Annual goals and short term goals are created based on the child’s educational needs and in a way that allows monitoring of progress toward goals.

CPSE SERVICES

Requests for CPSE services can come from a Parent or school district. When the request comes from the school district, the Preschool Services Coordinator will contact the parent to arrange for services. Typically the location of service is either, Kidz Therapy’s office, the child’s home, preschool or daycare. If services are to be provided at Kidz Therapy’s office, the Preschool Services Coordinator will be able to schedule immediately. The Parent Policy and Procedure packet is emailed to the parents so they can fill it out and bring it with them to the first session.

If services are to be provided at the child’s home, preschool, or daycare, the child’s schedule and availability is obtained so that the Preschool Services Coordinator can find an appropriate provider. Upon finding a provider with appropriate qualifications, availability and up to date compliance, all information is given to the provider to contact the family. If services are at the preschool or daycare the provider will also have to call the preschool or daycare to arrange services at an appropriate time. Once scheduled, the Preschool Services Coordinator will contact the school district, confirm the services and start date, and request the IEP.

Upon receipt of the finalized IEP from the District, the Preschool Services Coordinator will check the start date of the IEP. If the start date of the IEP does not reflect the actual start date for Kidz Therapy Services, the coordinator will contact the district and request that the start date for Kidz Therapy Services on the IEP be changed accordingly. If the district does not change the start date on the IEP, Kidz Therapy’s PS coordinator will maintain detailed documentation to explain the discrepancy in IEP start date and actual start date (see attached). The Preschool Services Coordinator will give a copy of the IEP to the provider with an Assignment Letter (see attached) informing provider of their responsibility to implement the recommendations on the IEP, other required responsibilities and documentation, as well as timelines for Progress Reports and Annual Review reports. Provider will sign the Attestation letter (see attached) and return it to the Preschool Services Coordinator, provider will include location, frequency and duration, and their schedule. There is to be no delay in the implementation of the IEP. Services will be provided to the extent (start and end dates) and at the frequency and duration mandated by the IEP. If there is any delay in the implementation of the IEP, this will be documented on the child’s treatment log (ex. Child absences, no prescription) and the school district will be notified.

The child’s record folder is created and the IEP is placed in it, the Child Access Record Log is stapled to the back of the folder. Providers cannot begin services until they receive a copy of the IEP from Kidz Therapy. The child’s folder shall include:

▪ IEP

▪ Assignment Letter

▪ Attestation Letter

▪ Schedule of services

▪ Parent Acknowledgement Form

▪ Parental Consent Form

▪ Child Emergency Information

▪ Allergy/Emergency Plan

▪ Parental Consent to Email form

▪ Alternate Signature Consent Form

▪ Prescription Form

▪ Initial Evaluation

▪ Authorization to speak to Teacher

▪ Notifications of Non-delivery of Service (if needed)

▪ Progress Reports

▪ Annual Review report

▪ Any requests or other communication with the school district regarding the child

▪ Parental Request for Records

▪ Child Record Access Log

Home/Community/Office Services

The IEP specifies the provider, location, frequency, duration, mode of delivery, goals, etc. Services must be provided in strict accordance with the child’s IEP. Two sessions of the same related service, may not be provided on the same day. Services provided in the Kidz Therapy offices and services scheduled by outside providers are scheduled with consideration given to child, family schedules and child nap times. Regularly scheduled appointments should be maintained to guarantee maximum progress toward the child’s IEP goals. Unless otherwise stated, service providers will follow the school district calendar. All services provided by Kidz Therapy through the CPSE process are at no cost to parents or caregivers. No provider shall render any additional services to children they are servicing through the CPSE. In addition, all related services are provided and documented in accordance with NYS Medicaid in Education and municipality requirements (see attached).

Absences

Child and provider absences must be documented on the child’s treatment log. SEIT’s and Suffolk Related Service provider must submit an Absent Note for each absence. Nassau Related Service providers do not need to submit an Absent Note, but they still must document the reason for the absence and whether or not a make-up was offered, and if it was scheduled, date of make-up, or if it was declined by parent.

Make-Up Sessions

Missed sessions should be made up. Related Service make-ups may not be added on to a session and a make-up of the same service type may not be given on the same day. Make-up sessions can only be scheduled after a session has been missed. When a session has been missed, make-ups must be provided within 10 working days of the missed session. Nassau County related service providers may only provide one make-up session per week. Suffolk County allows more than one make-up session per week. The make-up session must fall within the authorized service dates on the IEP.

Providers must have time incorporated into their schedules to be able to offer make-ups. Providers must offer make-ups for their absences. Providers are encouraged to offer make-ups for child absences whenever possible. Make-ups offered must be documented in the absence log note; scheduled make-up or parent declined make-up should also be included.

If a session is rescheduled on a different day within the same week of services, this is not considered a make-up session. Providers must follow the municipalities’ rules for make-ups as outlined in Kidz Therapy’s Billing Manuals and the Municipalities’ Policy and Procedure Manuals.

SEIT make-up sessions should follow the guidelines set forth by the Municipality and outlined in Kidz Therapy’s SEIT Billing Manual (see attached).

School Calendar and Holidays

Kidz Therapy providers will strictly adhere to the calendar designated on the IEP.

No services may be provided on the following legal holidays:

New Year’s Day Columbus Day

Martin Luther King Birthday Election Day (optional-check school district calendar)

Presidents Day * Veterans Day

Memorial Day Thanksgiving Day

July 4th Christmas Day

Labor Day

*President’s Day (AKA Washington’s B’day) – there are exceptions for Washington’s and Lincoln’s Birthday. School districts are almost always closed, but can choose to be open.

Log Notes

Every scheduled session must be documented on a treatment log note. Each municipality has its own log notes. There are different log notes for SEIT and Related Services. Related Service log notes are Medicaid compliant. All log notes must be filled out completely and accurately. A parent or caregiver must sign the log note at the end of each and every session. If services are provided at a preschool or daycare, or if the parent is not available, an Alternate Signature form (see attached) signed by the parent is required. This form is signed by the Parent/guardian and allows another adult other than a parent/guardian to sign attendance logs. If caregiver is not listed on the Alternate Signature form, provider will use a Record of Service form (see attached). Then have Parent sign log note. Log notes must be submitted monthly with billing.

The Nassau Related Service log note, Nassau SEIT log note, Suffolk Related Services log note and Suffolk SEIT log note (see all attached) are all found on the Kidz Therapy website for convenient access by all providers. Specific guidelines for completing all log notes and other billing rules are found in Kidz Therapy’s Billing Manuals (see attached).

Kidz Therapy’s providers are expected to conduct themselves, at all times, in a professional manner consistent with health, safety and sanitation standards as expressed in this Policy and Procedure Manual.

When beginning services in the home/daycare/nursery school, it is important to establish specifics such as where to park, whose materials (toys) will be used (child’s or the family’s/caregiver’s), and what location to work with the child. Ask the parent/caregiver to remain within close proximity during the session and to be available as needed. A responsible adult (18 or over) must be present at all times. Do not close a door or go into another area without permission.

Providers should refrain from all use of cell phones and electronic devices and refrain from sharing any personal information, problems or billing issues with parents/caregivers. Professional boundaries are encouraged at all times and allowing the focus to remain on working with the child. If parent/caregiver shares their personal problems with the provider, the provider will encourage them to seek out the appropriate professional to discuss their concerns.

Establish professional boundaries. Provider should introduce themselves as they would like to be addressed. Providers will use appropriate titles to address the parents/caregiver unless otherwise instructed. Kidz Therapy providers are professionals, not friends.

Providers may use the bathroom if needed, but should not ask to use other facilities in the home (i.e., refrigerator, telephone). Provider will not bring any food or beverage for personal consumption during a session.

Providers do not bring their children, other family members, friends or other non-professionals to a treatment session. Written parental consent must be obtained before bringing a supervisor, student/intern or other professional to the treatment session. (see attached)

Do not take pictures or video of any child without written parental consent (see attached).

All employee providers are to wear visible photo identification that has been provided by Kidz Therapy. Independent providers must supply their own photo ID to include name, picture, and professional title. If requested, a Letter of Introduction (see attached) will be sent to a preschool or daycare to introduce a new provider.

Discussion of the child’s progress and parent involvement is considered an essential part of the therapy process. Providers and parents establish the most convenient and effective form of communication. This communication is documented on the child’s treatment log. Prior to the first session, providers will give the parent a copy of the Parent Policy and Procedure Packet. They will explain procedures and forms and make sure the parents understand them before asking parents to complete, sign and return the appropriate forms prior to the first session.

Parent Policy and Procedure Packet contains:

▪ Parent Acknowledge Form

▪ Medicaid Consent Form

▪ Child Emergency Information

▪ Allergy/Emergency Plan

▪ Parental Consent Email

▪ Alternate Signature Consent Form

▪ Prescription Form

▪ Authorization to speak to Teacher

▪ Parental Request for Records

Copies of these forms are to be sent to the Kidz Therapy Preschool Services Coordinator and maintained in the individual child’s record. If the child has any allergies or any other Medical Alerts, the provider must discuss with parents a plan for emergency treatment to be utilized until medical personnel arrive. Documentation of the allergy, prevention of exposure and plan to treat an allergic reaction must be attached to the Child Emergency Information form. This form is to be kept with providers at all times as it includes emergency contact numbers for medical assistance and transportation.

If a child should have an allergic reaction or another medical situation, the provider’s first priority is to attend to the medical needs of the child following the procedures as outlined on the Child Emergency Information form. Depending on the child’s needs, providers may call 911 to request emergency medical help, administer first aid as appropriate (including use of epinephrine, if this has been included in the child’s emergency plan). In addition, providers will have been trained in administration of such techniques. to ensure that the child is stabilized until either the parent or other medical help arrive. The Kidz Therapy office must be notified immediately of any such incident and the Kidz Therapy Incident Report must be completed and submitted.

Program Wide Behavior Management

Kidz Therapy providers are prohibited from using aversive interventions with preschool students with disabilities without exception in accordance with Section 200.7(b)(8)ii.

Self-Injurious Behaviors

Self-injurious behavior (SIB) is any instance in which an individual engages in an act that can potentially cause self-inflicted bodily harm. Self-injurious behavior may occur in the form of hitting, biting, scratching, cutting, head banging, or any other action directed towards oneself that can result in injury. Although SIB is more commonly associated with children who have a pervasive developmental disability (e.g., children with moderate to severe autism), it is not limited to such conditions. Children with emotional disorders, for example, are also more prone to engaging in such behaviors. Even children with less pervasive disabilities or children who are not diagnosed with any disability at all can engage in SIB. On a more individual level, the reasons why a child may engage in SIB can vary greatly and the level of potential bodily harm also varies depending on many factors such as the nature of the SIB, intensity of the behavior, and the strength and size of the child.

Aggressive behavior (AGG) is defined as any action directed towards others that can result in bodily injury. Examples of aggressive behaviors in children are, but limited to, biting, hitting, kicking, throwing object at another person, scratching, and pinching. Similar to SIBs, aggressive behaviors are exhibited by children of varying levels of disability, and are even exhibited by children who do not have a specific disability. The reasons for the aggressive behaviors can vary greatly, but can put others at risk of injury.

It is important that clear and concise procedures are implemented in addressing self-injurious and aggressive behaviors. Professionals working with children who engage in SIB and/or AGG, should understand when and how to address such behaviors. Furthermore, the underlying function of the SIB/AGG should always be considered when developing a specific plan of action towards intervening with the behavior. Finally, appropriate documentation and reporting to parents must occur in response to each episode of SIB and AGG. All three of these areas of concern are outlined herein, as well as other considerations related to these behaviors.

Dr. Leonard Caltabiano is a certified trainer of Nonviolent Crisis Intervention®. This program is considered a worldwide standard for crisis prevention and intervention training to:

• Reduce the risk of injury.

• Comply with legislative mandates.

• Meet regulatory/accreditation standards.

All providers that work with children who exhibit or have the potential to exhibit serious behaviors (i.e. aggression, self injurous, elopement, etc.) are trained in this technique.

Assessing the Function of the Self-Injurious & Aggressive Behaviors

Current research and regulations strongly emphasize the use of functional behavioral assessment (FBA) in addressing SIB and AGG (Ryan & Peterson, 2004; Harding et al., 2002; NYS Part 200 Regulations). An FBA will be conducted if the underlying function of the SIB is not readily evident and the child’s respective school district requests a functional assessment. The FBA indentifies antecedents or setting events related to the behavior, allowing the practitioners to better predict the conditions in which the behaviors are likely to occur. This allows for the development of proactive/preventative procedures that can circumvent the behaviors.

When and How to Address Self-Injurious and Aggressive Behaviors

The professional adult (e.g., teacher, therapist, aide, etc.) working directly with the child is always responsible for the health and safety of the child. Self-injurious and aggressive behaviors must always be addressed when there is a risk of injury. Any behavior that can result in bruising, an open wound, fracture, or loss of consciousness should be addressed accordingly.

As with any problematic behavior, the first-order of intervention should always be related to prevention and the implementation of proactive procedures that incorporate the use of positive reinforcement and address the underlying function of the behavior. Therefore a specific plan should be formulated that identifies motivating rewards and the use of the rewards as a means of reinforcing the absence of SIB/AGG. The designated rewards (reinforcers) should be based on the child’s preferences and interests (Harding, Wacker, Berg, Barretto, Rankin, 2002).

Upon the occurrence of a SIB/AGG, the following guidelines will be adhered to. These guidelines are not presented in any particular order, but the intervening staff will always implement the least intrusive methods relative to the severity of the behavior and the level of presenting danger:

□ The adult should immediately redirect the child in an unobtrusive fashion. This may include reminding the child what they can earn for positive behaviors or simply changing the demands of the situation so that child can gain a momentum of positive compliance.

□ Clear the immediate environment of any objects that may increase the risk of injury (e.g., table, chairs, sharp objects, etc.). In the case of aggressive behavior, this may require the need for the removal of other students from the environment in order to ensure their safety.

□ In the case of head banging, place a cushion, pillow, or soft mat between the child’s head and hard surface.

□ If the child is standing, wandering, or running around, direct the child to sit in a chair or on the floor. Many behaviors can be defused or reduced by establishing a seated position.

□ If the child is engaging in a SIB that involves the use of the hands (e.g., hitting, scratching, etc.) try providing the child with something to hold or something that will occupy his/her hands, but not something that can be used as weapon (e.g., stress ball).

□ If the child continues to engage in the SIB or is in imminent danger because of the SIB, physical restraint may need to be implemented in order to ensure the safety of the child:

o Restraint is defined as any physical method of restricting an individual’s freedom of movement, physical activity or normal access to his or her body (International Society of Psychiatric and Mental Health Nurses, 1999).

o New York State has put forth some regulations regarding the use of restraint with children (NYS Part 200 Regulations; see also Ryan & Peterson, 2004):

▪ Staff implementing restraint procedures should be properly trained in the appropriate restraint techniques.

▪ Only the minimal amount of restraint needed to contain the behavior should be implemented.

▪ Once restraint is used it should be discontinued as soon as possible.

▪ No restraint should be administered in a manner that prevents breathing or speaking.

▪ Restraint is not to be administered as a punishment procedure or as a means of gaining an overall decrease in behavior (i.e., it is not part of the child’s behavior intervention plan – it is used for the sole purpose of ensuring the child’s safety).

▪ Proper documentation and parent notification should be conducted (see related section below).

□ If restraint is deemed necessary due to the severity of the situation, then the following procedures should be implemented:

o Escort or physically direct the child to a seated position, preferably in a chair. When escorting a child, the adult should place their arms underneath the child’s arms from behind and hold the child’s wrists. This type of procedure effectively allows the adult to lift the child (if needed) under the arms (armpit). Never lift a child by pulling on their hands as this can lead to a dislocated hand, elbow, or shoulder.

o Once the child is in a seated position, the adult should stand or sit behind the child, gently fold the child’s arms across his/her body (lower torso area) and hold the child’s hands from behind. Once the child’s arms are folded, very little pressure is typically needed to hold the child’s hands in place.

o If the child is not seated in a chair and is sitting on the floor, or if the child is severely lashing out. The adult can perform the above restraint while also wrapping his/her legs across the child’s legs in order to prevent the legs from kicking (this is sometimes referred to as a full-wrap restraint).

o A restraint should only be implemented for 30 consecutive seconds at most. At 30 seconds, the adult should release the restraint allowing the child to move. If the child engages in the severe SIB again, repeat the above procedures.

o While the restraint is implemented, the adult should encourage the child to take deep breaths.

□ Physical Restraint is only used for severe SIB. Staff can use certain items such as pillow/cushion to block and deflect the aggressive behaviors. If a child attempts to aggress towards another

□ If time-out procedures are included in a child’s behavior plan, the following procedures should be implemented:

o It should be specified if an inclusionary or exclusionary time-out procedure will be implemented. Inclusionary is when the child is still present with the group, but is not permitted to take part in the activity at hand. Exclusionary time-out is when the child is completely removed from the situation and directed to another location.

o A time-out procedure should only occur at a maximum of five consecutive minutes. As a general rule, 3 to 5 minutes for 3 years of age or older.

o If the child is brought to another area (exclusionary time-out), the adult should always be able to see the child and should not lock a child in a closed room.

o Ideally, it is best to use a timer, so that the child is aware of when the time out is over.

Appropriate Documentation and Parent Notification

All interventions should be documented on a behavior intervention plan, which is to be sent to the school district to be reviewed and accepted by the CPSE at a CPSE meeting. Parents must agree to the BIP as indicated on the IEP before the BIP can be implemented. Any restraint procedures are documented on a separate document, as they are not considered an inherent part of the intervention plan. Once again, any restraint is in place to ensure safety, not to treat behaviors.

Every episode of SIB/AGG will be documented on a Kidz Therapy incident report. On this report, the staff will describe the behavior, indicate if an injury has occurred as a result of the behavior, and will indicate if restraint was required. If restraint was implemented, then the staff will describe the restraint strategy that was implemented and which parts of the child’s body was restrained (e.g., “Gracie was sitting in a chair and the staff stood behind her, holding her hands at her side.”).

The parent or guardian of the child will be notified of the incident as soon as possible, no later than 24 hours after the incident occurred. The parent will be provided with documentation of the incident, and will be fully informed of any restraint procedures that were implemented.

Additional Considerations

As per the NYS Part 200 regulations, no aversive (positive) punishment procedures will be implemented by Kidz Therapy staff to address the self-injurious behavior. Aversive behavioral interventions are defined as:

• Application of noxious, painful, intrusive stimuli or activities intended to induce pain.

• Withholding sleep, shelter, bedding, bathroom facilities or clothing.

• Withholding meals or limiting essential nutrition or hydration or intentionally altering staple food or drink in order to make it distasteful.

• Movement limitation used as punishment, including but not limited to helmets and mechanical restraint devices.

• The placement of a child unsupervised or unobserved in a room from with the student cannot exit without assistance.

• Other stimuli or actions similar to the interventions described above.

Aversive behavioral interventions do NOT include the following:

• Voice control (loud, firm demands made by the adult)

• Time-limited ignoring of specific behaviors (extinction)

• Token fines as part of a token economy system (response cost).

• Brief physical prompts to interrupt or prevent specific behavior

• Interventions medically necessary for the treatment or protection of the student

• Inclusionary and Exclusionary time-out procedures are not considered an aversive.

Applied Behavior Analysis (ABA)/ Behavior Intervention Services

Our ABA Providers ensure that children requiring behavioral-based services make progress toward their IEP goals. Providers monitor school/home programs/curriculum to ensure appropriateness of goals and/or the Behavior Intervention Plan (BIP) to child’s current functioning. Providers also bridge the gap between the school and home programs, allowing for generalization of goals across all settings. Our comprehensive approach utilizes the expertise of board certified behavioral analysts, special education teachers, psychologists, social workers and para-educators.

Our behavior analytic programming is designed specifically for each child utilizing the principles of ABA. Our comprehensive program incorporates the components of ABA and Verbal Behavior Analysis that have been proven to be effective in the enhancement of skills in a vast range of domains. Methods of instruction may include but are not limited to: discrete trial training (see attached), incidental teaching, direct instruction, natural environment teaching, and community based training. Errorless teaching strategies are highly emphasized in order to maximize the child’s success while minimizing frustration.

Here at Kidz Therapy, a strong emphasis is placed on providing behavior analytic services relative to the individual’s developmental level and needs. Providers are required to implement programming in a developmentally sensitive manner. In order ensure this process, baseline measures are used to assess the current status of skills. Tools such as the Assessment of Basic Language and Learning Skills – Revised (ABLLS-R; Partington, 2006) and the Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP; Sundberg, 2008) are used to ensure this process. The information gathered from these baseline assessments are then used to establish a programming curriculum for that particular child. The following core areas of skill acquisition are targeted for most of our new students:

• Instructional Readiness Skills (i.e., attending skills)

• Imitation Skills – fine motor, gross motor, and oral motor imitation

• Self-Help Skills

• Matching Skills

o Matching Identical Items/ Pictures

o Matching Similar Items/Pictures

o Matching By Feature, Function, & Class

• Receptive and Expressive Language Skills

o Mand (request)

o Tact (label)

o Intraverbal (answering questions, etc.)

• Discrimination Skills

• Pre-Academic Skills

o Color ID

o Shape ID

o Number ID

o Letter ID

o Mathematical Concepts (e.g., more/less; large/small, etc.)

For all of our students, especially those on the autism spectrum, special emphasis is placed on language/ communication development. If a student is demonstrating vocal communication skills, shaping procedures will be used to help the student form words vocally. However, if vocal communication is not displayed or is just emerging, alternative communication systems must be considered by the team. This usually includes the use of sign language, a Picture Exchange Communication System (PECS), and/or an augmentative device. The goal here is to assist the student in developing a functional use of communication so that basic needs can at least be expressed. Research has demonstrated that functional communication training will result in fewer maladaptive behaviors (e.g., tantrum, aggression, etc.). As the student continues to develop his/her language skills, more advanced communications are shaped and targeted.

Individual targets are set for each skill area, and all skills are tracked via trial-by-trial data, probe data, and/or task analysis sheets. The type of data collection that is used directly relates to the type of instructional strategies being implemented. A target is only considered “mastered” when the pre-set criterion is reached (e.g., 80% accuracy or higher for 4 consecutive trials across two different teachers, and two different days). When the criterion is reached, the target is either put into a retention probe or entered into a maintenance tracking data sheet. Parents are encouraged to target mastered skills in the natural home environment and community setting.

Kidz Therapy Services is approved by the New York State Education Department to provide mandated training in the needs of children with autism to new special education teachers seeking certification and new administrators and supervisors of special education. All Kidz Therapy Special Education Teachers that fall under this requirement have completed the Training in the Needs of Students with Autism.

FBAs and BIPs

A Functional Behavioral Assessment (FBA) (see attached) means the process of determining why a student engages in behaviors that impede learning and how the student’s behavior relates to the environment. The FBA must include, but is not limited to: identification of the problem behavior; definition of the behavior in concrete terms; identification of the contextual factors that contribute to the behavior; and formulation of a hypothesis regarding the general conditions under which a behavior usually occurs and probable consequences that serve to maintain it. For more details on FBA’s, see Psychological Evaluations. After the FBA is completed and sent to the school district, the CPSE must have a meeting to review the FBA and determine if a BIP is warranted.

A Behavior Intervention Plan (BIP) (see attached) will be created for a student who has been identified on their IEP as needing a BIP. BIPs cannot be created unless a Functional Behavioral Assessment (FBA) has been conducted. The BIP must include a description of the problem behavior, global and specific hypotheses as to why the problem behavior occurs and intervention strategies that include positive behavioral supports and services to address the behavior. (see attached – Quick Tips for Preschool Behavior Intervention Plans)

According to the policy brief issued in May, 2011 by the University of the State of New York, the Behavioral Intervention Plan must identify:

- the baseline measure of the problem behavior, including frequency, duration, intensity, and/or latency of the targeted behaviors.

- if practicable it must include data taken across activities, settings, people and times of the day.

- this baseline data must be used to establish performance criteria and against which to evaluate intervention effectiveness.

- intervention strategies to be used to alter antecedent events to prevent the occurrence of the behavior, teach individual alternative and adaptive behaviors to the student, and provide consequences for the targeted inappropriate behavior(s) and alternative acceptable behavior(s); and

- a schedule to measure the effectiveness of the interventions, including the frequency, duration and intensity of the targeted behaviors at scheduled intervals.

Upon completion, the BIP is sent to the school district for review at a CPSE meeting and acceptance by the CPSE. Behavior Intervention Plans cannot be implemented until Kidz Therapy has received the new IEP from school district. The implementation of the student’s behavioral intervention plan must include regular progress monitoring of the frequency, duration and intensity of the behavioral interventions at scheduled intervals (Quarterly Progress Reports) specified in the BIP and the student’s IEP. BIP’s must be reviewed annually to ensure appropriateness to the child’s current needs.

Coordination of Services

If a child is receiving 2 or more related services (and no SEIT services) the CPSE must designate one of the providers as the Coordinator of Services. If a child is receiving SEIT and related services, a special educator is automatically the Coordinator of Services. If a child is attending a center based program and receiving SEIT services, or receiving SEIT services from 2 agencies, the CPSE must designate the Coordinator of Services.

The Coordinator of Services (see attached) is responsible for:

▪ Sharing appropriate information with all service providers for the integration of services and to assess the progress of the child.

▪ Gathering all progress reports and anecdotal information relating to the child’s progress from all providers ensuring that the coordinator has a general knowledge of the child’s progress, as well as any significant problems, in the implementation of the IEP.

▪ Developing interim reports as needed.

▪ Attending CPSE meetings

IEP Changes

If the provider determines that the current service plan does not meet the child’s needs, the provider must complete a Request for Review report which includes a rationale for any requested changes. This must be submitted to Kidz Therapy’s Preschool Services Coordinator. The Preschool Services Coordinator will submit the Request for Review report to the school district. Any changes in services must be decided by the CPSE and changed on the IEP before any changes can take place.

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Progress Reports

All providers must submit quarterly progress reports for each child receiving services. Quarterly progress reports cover the periods:

▪ September – November

▪ November – January

▪ February – April

▪ April – June

▪ July – August

Prior to the beginning of each school year, providers are given Kidz Therapy due dates for submission of Progress Reports in accordance with the dates requested by the municipalities. These due dates are on Kidz Therapy’s website and reminders are sent out to providers throughout the school year.

Nassau and Suffolk Counties require that copies of the progress reports are given to the school district, the parent, and the coordinator of services. The original is to be filed in the child’s record file.

The IEP goals are maintained in IEP Direct. There is an Annual Goal and four – quarterly, short term goals. Providers must update the IEP in IEP Direct each quarter by reporting on the progress achieved toward the child’s goal. IEP Direct uses specific codes. Once the goals in IEP Direct have been updated for the quarterly progress report, the provider shall complete the Nassau or Suffolk Progress Report form (see attached) and submit it to the Kidz Services Coordinator.

If a child has a BIP, a written Progress Report must be submitted for the BIP which includes documenting the effectiveness of the interventions used and a summary of the data collected.

Annual Review Testing

Prior Written Notice must be given and a consent signed by the parents to allow testing for annual review. School districts are responsible for giving Prior Written Notice and obtaining consent from the parent. Providers may not conduct any formal testing and/or assessment (ex. Functional Behavioral Assessment) for annual reviews unless they have received a copy of the parental consent.

Annual Review Report

All providers must submit an Annual Review report for each child receiving services. If a child has a BIP, a separate Annual Review report must be written for the BIP. Annual Review reports must be submitted to the Annual Review Coordinator in March. The specific date each year is given to the provider at the beginning of the school year and all progress report and annual review due dates are posted on Kidz Therapy’s website. A reminder is emailed to all providers in January and February. This will assist the Annual Review Coordinator in assuring that the Annual Review report will be submitted to the school district in a timely fashion.

If an Annual Review meeting is scheduled prior to the March due date, the Annual Review coordinator will notify the provider immediately. Annual Review reports must be submitted to the school district 5 business days prior to the scheduled meeting.

The Annual Review can include a recommendation to continue, decrease, increase or discharge services. Recommendations for frequency and duration cannot be made. Final determination is to be made by the Committee on Preschool Special Education (CPSE). If the provider is recommending consideration for extended year services, provider must include a statement of regression. Nassau County has a Regression Measurement Tool that may be used (see attached).

Nassau and Suffolk Counties require that copies of the Annual Review report are given to the school district, the parent, and the coordinator of services. The original is to be filed in the child’s record file. Suffolk County also requires that a copy is sent to the Suffolk County Dept. of Health.

Prior to the Annual Review meeting, providers will go over their Annual Review report with the parents. Kidz Therapy providers are expected to either attend or be available via phone conference to participate in the annual review meetings for their students. The Coordinator of Services always attends annual review meetings. If not available, the school district will be notified and providers will make themselves available at another time prior to the meeting, so the district may ask any questions or needed clarification before the meeting. Immediately following the CPSE meeting, providers will complete the CPSE Meeting Recommendation form (see attached). If attending the meeting, providers will obtain the CPSE chairperson’s signature. If not attending, providers will contact the school district, as soon as possible after the meeting to complete the CPSE Meeting Recommendation form.

Moving – From one District to Another District

Parents are asked to notify Kidz Therapy one month prior to moving, even if it is within the same school district. Kidz Therapy will notify the current school district immediately, to verify that address is still within the same district. If moving from one district to another district, parents must register in the new school district and bring a copy of their child’s current IEP, as soon as possible, to ensure no lapse in services. Kidz Therapy will contact the school district to make sure that Kidz Therapy will receive the new IEP within 30 days. If the child is moving from one County to another County or out of state, Kidz Therapy will explain that services must end on the day that the child moves out of the district. Services cannot continue or resume unless Kidz Therapy has received an IEP from the new school district.

Discharge and Declassification

If at anytime during the school year, the provider believes that the child has mastered all goals and no longer requires services, the provider will notify the Preschool Services Coordinator. The provider will write a progress report indicating this and request for a CPSE Review. The Preschool Services Coordinator will submit it to the school district. The CPSE will determine if further testing is needed. Testing is not required to discharge a child from services. However, a child may not be declassified from the CPSE process without an evaluation. CPSE determines what testing is needed, obtains parental consent to evaluate, and arranges for the evaluation(s) with an approved evaluator chosen by the parent. Determination for discharging and/or declassification is made by the CPSE after a review of all data.

Signatures

All providers-must sign all documentation, including but not limited to: evaluations, progress reports, log notes, summary reports, etc, with their full name and professional credentials (ex. MA CCC, OT, PT, MSEd, LMSW). Signatures for evaluations must also include license numbers. Use of electronic signatures is permissible in accordance with Medicaid guidelines, but not on log notes.

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