Referral to California Early Start

The first five years of a child’s life are critical to the child’s growth and development. The sooner a developmental concern is identified, the sooner a child and family can be referred to the appropriate agency to determine eligibility for specialized services that support growth and development.

The Referral Process chart illustrates the process of being referred to and entering the Early Start system.

The person who identifies a concern about a child’s development might be a parent, a physician or other health care professional, a caretaker or other individual involved with the family and infant or child in question. The local Department of Developmental Services regional centers are the point of entry into the system that serves all people with developmental disabilities, including infants and toddlers. (Infants and toddlers who have vision, hearing, and severe orthopedic impairments, or a combination of these disabilities, receive individually designed early intervention services from local education agencies such as school districts and county offices of education.) This directory lists all California regional centers, or contact the Department of Developmental Services to find your local regional center.

Regional centers provide, arrange for, or purchase services and supports at the local level. Once contact is made with a regional center (or school district or county office of education in the case of an infant or toddler with vision, hearing, or severe orthopedic impairment or a combination of these), a representative of the agency will make a referral to the appropriate agency for an evaluation of eligibility for services and assessment for services planning. Parents must give written permission for the child to be assessed and to receive early intervention services, which are confidential and provided at no cost to the family. The family can also receive information about local family resource centers and family empowerment centers, which provide parent-to-parent support, resource materials, and other information.

The following information can help you determine whether your child or a child in your care may need to be referred to a regional center or local education agency for an evaluation and assessment to determine if the child is eligible to receive early intervention services.

RISK FACTORS
The following factors may place children at greater risk for health and developmental concerns:

  • Prematurity or low birth weight
  • Vision or hearing difficulties
  • Prenatal exposure or other types of exposure to drugs, alcohol, or tobacco
  • Poor nutrition or dif culties eating (lacks nutritious foods, vitamins, proteins, or iron in diet)
  • Exposure to lead-based paint (licking, eating, or sucking on lead-base painted doors, floors, furniture, toys, etc.)
  • Environmental factors, such as abuse or neglect

BEHAVIORS AND RELATIONSHIPS
Some of the following behaviors may be cause for con- cern in any child regardless of age:

  • Avoids being held, does not like being touched
  • Resists being calmed, cannot be comforted
  • Avoids or rarely makes eye contact with others
  • By age 4 months, does not coo or smile when inter-acting with others
  • By age 1, does not play games such as peek-a-boo or pat-a-cake or wave bye-bye
  • By age 2, does not imitate parent or caregiver doing everyday things, such as washing dishes, cooking, or brushing teeth
  • By age 3, does not play with others
  • Acts aggressively on a regular basis, hurts self or others

HEARING

  • Has frequent earaches
  • Has had many ear, nose, and/or throat infections
  • Does not look where sounds or voices are coming from or react to loud noises
  • Talks in a very loud or very low voice or voice has an unusual sound
  • Does not always respond when called from across a room, even when it is for something that the child is usually interested in or likes
  • Turns body so that the same ear is always turned toward a sound

SEEING

  • Has reddened, watery eyes, or crusty eyelids
  • Rubs eyes frequently
  • Closes one eye or tilts head when looking at an object
  • Has difficulty following objects or looking at people when talked to
  • Has difficulty focusing or making eye contact
  • Usually holds books or objects very close to face or sits with face very close to television
  • Has an eye or eyes that look crossed or turned, or eyes do not move together

MOVING

  • Has stiff arms or legs
  • Pushes away or arches back when held close or cuddled
  • By age 4 months, does not hold head up
  • By age 6 months, does not roll over
  • By age 1, does not sit up or creep using hands and knees, does not pick up small objects with finger and thumb
  • By age 2, does not walk alone, has difficulty holding large crayons and scribbling
  • By age 3, shows poor coordination and falls or stumbles a lot when running, has difficulty turning pages in a book
  • By age 4, has difficulty standing on one foot for a short time
  • By age 5, does not skip or hop on one foot, has difficulty drawing simple shapes

COMMUNICATING

  • By age 3 months, does not coo or smile
  • By age 6 months, does not babble to get attention
  • By age 1, does not respond differently to words like “night night” or “ball”
  • By age 1, does not say words to name people or objects, such as “mama” or “bottle,” or shake head “no”
  • By age 2, does not point to or name objects or people to express wants or needs
  • By age 2, does not use two-word phrases, such as “want juice” or “mama go”
  • By age 3, does not try to say familiar rhymes or songs
  • By age 3, cannot follow simple directions
  • By age 4, does not tell stories, whether real or make-believe, or ask questions
  • By age 4, does not talk so that adults outside of the family can understand

THINKING

  • By age 1, has difficulty finding an object after seeing it hidden
  • By age 2, does not point to body parts when asked such questions as “Where’s your nose?”
  • By age 3, does not play make-believe games
  • By age 3, does not understand ideas such as “more” or “one”
  • By age 4, does not answer simple questions such as “What do you do when you are hungry?” or “What color is this?”
  • By age 5, does not understand the meaning of today, yesterday, or tomorrow

For additional information about local resources regarding children birth to 3 years of age, contact the Department of Developmental Services, 1600 9th Street | Sacramento, CA 95814 800/515-BABY (2229) www.dds.ca.gov/earlystart | earlystart@dds.ca.gov.