Janet Thomas, MEd, OTRLToby Long, PhD, PTRachel Brady, MS

Janet Thomas, MEd, OTR/L
Toby Long, PhD, PT
Rachel Brady, MS, PT
Georgetown University
Center for Child and
Human Development
University Center of Excellence
in Developmental Disabilities
District of Columbia Early
Intervention Program
Office of Early Childhood
Development
P
Early Intervention
ersonnel
Preparation
Training Activities
Early Intervention Personnel Preparation Training Activities i
Personnel Preparation Training Activities Overview . . . . . . . . .
. . . . . . . . . . . 1

Case Studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Aaron . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Kavon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Kaila. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Assignments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
ASSIGNMENT ONE: Intervention Approaches. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . 12
for Children with Disabilities
ASSIGNMENT TWO: Research Five Journals. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . 13
Outside Your Field of Expertise
ASSIGNMENT THREE: Site Observations . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . 15
ASSIGNMENT FOUR: Describe Five Laws . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . 17
that Impact Young Children
ASSIGNMENT FIVE: Develop Helpful . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Informational Materials for Families
Games of Early Intervention. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . 19
To Tell the Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
A Natural Match. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

It’s a Great IDEA! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
What Did You Say? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Truth or Dare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Table of Contents
Early Intervention Personnel Preparation Training Activities 1
DC Early Intervention Program
Comprehensive System of Personnel Development
Personnel Preparation
Training Activities
Personnel preparation in the field of early intervention has
become a national effort. Part C ofthe Individuals with
Disabilities Education Act (IDEA) requires each state and
jurisdiction to
develop a Comprehensive System of Personnel Development or
CSPD (U.S. Code of Federal
Regulations, 1997). Each state must develop a system to ensure
that the personnel providing
services to infants, toddlers, and their families possess the
appropriate skills needed to provide
service in a comprehensive, family centered, culturally
competent, and community-based
system of care.
The purpose of the CSPD is to ensure that early intervention

providers are qualified personnel in
early intervention. Each state’s CSPD needs to include a
system-wide process for:
• developing minimum standards for personnel qualifications,
• coordinating pre-service and in-service training programs,
• identifying personnel needs, and
• disseminating promising materials.
The design of the CSPD should assist providers in identifying
professional growth activities that
support acquiring and adopting contemporary practices of
service delivery.
The DC CSPD program is part of the DC Early Intervention
Program (DCEIP). The DC CSPD
consists of three major components: Credentialing, Training,
and Resource Development.
• The Credentialing System consists of the development of a
professional portfolio
indicating that the applicant has met competency in six areas of
early intervention:
1. Infants and Toddlers with Special Needs
2. Interaction with Families
3. Legal Mandates, Regulations, and Administration
4. Evaluation and Assessment
5. Individualized Family Service Planning

6. Program Implementation
An application packet can be downloaded from
http://gucchd.georgetown.edu or
requested by contacting Toby Long, PhD, PT, Georgetown
University Center for Child
2 Early Intervention Personnel Preparation Training Activities
and Human Development, 3307 M Street, NW, Suite 401,
Washington, DC 20007,
202-687-8742, [email protected]
• The Training includes:
1. The Annual Conference
2. DC Foundations: A basic overview of early intervention
offered throughout the year
and is mandatory for all providers applying for credentialing
3. In-service trainings on a variety of issues pertinent to early
intervention
• The Resources: DC CSPD and DCEIP have developed a
variety of resources to assist
providers in meeting credentialing requirements and enhancing
knowledge in the field
of early intervention. These resources include a Resource Guide
for Professional
Development, Family Activity Brochures, and Personal
Preparation Training Activities.
These materials an be downloaded from
http://gucchd.georgetown.edu or requested by
contacting Toby Long, PhD, PT, Georgetown University Center
for Child and Human

Development, 3307 M Street, NW, Suite 401, Washington, DC
20007, 202-687-8742,
[email protected]
The following set of training activities has been developed to
assist in personnel preparation.
These materials will assist trainers of early intervention
personnel in academic and continuing
education settings. The activities include case studies, short-
term assignments, group activities,
observation and site visits, and writing assignments. The
training activities were developed by:
Janet Thomas, MEd, OTR/L; Toby Long, PhD, PT; and Rachel
Brady, MS, PT of the
Georgetown University, Center for Child and Human
Development.
For more information on DC CSPD or DCEIP please contact:
Toby Long, PhD, PT
Coordinator, DC CSPD
Georgetown University Center for
Child and Human Development
3307 M Street, NW, Suite 401
Washington, DC 20007
Phone: 202-687-8742
Fax: 202-687-8899
E-mail: [email protected]
Program Manager
DC Early Intervention Program
Department of Human Services
Office of Early Childhood Development,
717 14th Street, NW, Suite 800
Washington, DC 20005
Phone: 202-727-1839
Fax: 202-727-5218

or
Case Studies
The following case studies are designed to stimulate discussion
on a variety of issues in earlyintervention. Each case is
followed by several questions on current issues in early
intervention. These cases can be used as individual assignments,
small group assignments, or as a
part of classroom discussions. The case studies are vehicles for
enhancing knowledge in three
core areas related to early intervention: evaluation, eligibility,
and service provision within the
natural environment.
Objectives
In completing the case studies the provider will be able to:
1. Describe the evaluation process used to determine eligibility
for early
intervention services.
2. List eligibility criteria.
3. Understand the importance of the family as the focal point of
intervention.
4. Describe early intervention services that can be helpful to
families.
5. Describe the characteristics of autism and developmental
delay.

6. Describe the components of providing service in a natural
environment.
There are three case studies: Aaron, Kavon and Kaila. The story
of Aaron is written to highlight
the characteristics of autism and the various treatment
approaches and options that are available
to families. The story of Kavon highlights the eligibility
determination process and the need to
consider natural environments in the context of service delivery.
The story of Kaila describes the
evaluation process and focuses on pre-evaluation planning,
anticipating a variety of factors that
can influence services and service delivery, including mental
health services.
Aaron is an 18-month-old who wasdiagnosed with autism at 17
months of
age. His parents were devastated to learn that
Aaron had autism. He had been diagnosed
with epilepsy by a neurologist when he was 15
months old. Aaron has been on medication for
his seizure disorder since his diagnosis. His
seizures have been under control.
His birth was much anticipated and
uncomplicated. Aaron was the first born to his
young parents. His parents describe him as a
fussy baby who did not like to cuddle. His
mother and father first became concerned when
Aaron did not smile. His grandparents attributed
this to his parent’s inexperience. Aaron also
experienced some early feeding issues. These

included some vomiting and slow weight gain.
At his six-month medical checkup Aaron’s
parents brought up their concerns to his
pediatrician. Aaron’s pediatrician was also
concerned about Aaron’s slow weight gain.
Some tests were ordered. He was found to be
anemic but otherwise healthy. He was placed
on an iron supplement.
Aaron’s parents became increasingly
concerned, as he did not seem to be meeting
his developmental milestones. For example,
Aaron was 8 months old when he sat; 11
months old when he crawled; and 15 months
old when he first started to walk. Additionally,
he was not responding to his name. His
parents brought up concerns about deafness to
their pediatrician. Although he was
uncooperative with his hearing test, he did not
appear to have a significant hearing loss.
Aaron experienced his first seizure at 15
months of age while he was on vacation with
his parents. He was rushed to an emergency
facility. After running some tests, a
pediatrician made the diagnosis of epilepsy
and recommended to the family that Aaron see
a neurologist and receive an interdisciplinary
evaluation when he returned home.
Although he was seen immediately by a
neurologist, it took the family a couple of
additional months to receive the interdisciplinary
evaluation. An occupational therapist,

psychologist, and speech language pathologist
evaluated him in consultation with the
neurologist. The evaluations were conducted
in a clinical setting. The evaluation consisted
of administration of standardized tests, a series
of questionnaires, and informal observations.
During the evaluation Aaron demonstrated
fleeting eye contact. He did not respond to his
name when called by either his parents or the
examiners, nor did he follow simple
commands such as “come here”, “give me” or
“sit down”. He did not use gestures or words
to communicate during the evaluation. Aaron
was quiet, although some vocalizations, mostly
vowel-consonant combinations, were heard.
Aaron did not attempt to gain the attention of
other people. He often maintained an open
mouth posture with a protruding tongue.
Some drooling was also noted.
The mental and motor scales from the
Bayley Scales of Infant Development-II were
given to Aaron as well as the Receptive and
Expressive Emergent Language Scale (REEL).
His adaptive and social emotional abilities
were informally assessed. Results revealed that
Aaron demonstrated global developmental
delays with atypical behaviors. His cognitive
abilities were measured at the 7-month level.
His motor skills were at the 12-month level.
Aaron’s language skills were at the 6-7 month
level. His feeding skills were considered
significantly delayed. He had not started
feeding himself; ate mostly stage two baby
foods; and continued to drink from a bottle.

The atypical behaviors that were observed
included hand flapping and staring at the
lights. Additionally, he did not play with the
examiners. He did seek out his parents
occasionally for some comfort.
The evaluation concluded that Aaron
had epilepsy, autism, and global
developmental delays. Early intervention
services were recommended and Aaron was
referred to the District of Columbia Early
Intervention Program.
Case Studies
Aaron
Early Intervention Personnel Preparation Training Activities
Discussion Questions—Aaron
1. Is Aaron eligible for services through the District of
Columbia’s Early Intervention Program?
Why or why not?
2. What are some of the characteristics of autism?
3. Since the diagnosis of autism is based on clinical rather than
laboratory findings, what do you
think the clinical assessment should include? What other
assessments and or methods would
you recommend for an evaluation of a child suspected of having

autism?
4. What are some of the common and uncommon treatment
strategies used with children who
are diagnosed with autism?
5. What intervention strategies are used with children with
autism? Select one intervention
approach used with children with autism and discuss the
evidence that supports its use.
6. What are some questions you can think of that would be
appropriate to ask Aaron’s parents
in order to obtain more information about him?
5
Case Studies
Kavon is a 2
1⁄2-year-old boy whose mother
is concerned about his speech, language,
and behavior. She indicated that Kavon uses
two syllable words, but frequently cuts off the
beginning and ending of words; thus he is very
difficult to understand. Kavon’s mother also
said that her 4-year-old child had speech and
language difficulties. Her 4-year-old received
intervention services, which were helpful.
Also, Kavon’s mother reports that Kavon will
have “screaming fits” or tantrums mostly at
home that will last for 20 to 30 minutes. She
is very concerned about this and doesn’t

know what to do.
Kavon is one of many siblings. His mother
is single and has recently put her children in
child care so that she can pursue work and
school. She indicated that if Kavon is eligible
for early intervention services these services
would need to be provided for him at his
child care setting.
Kavon was born early at 34 weeks gestation.
He did not receive any type of developmental
follow-up. He had some difficulty with breast-
feeding and was put on the bottle, which he
continues to seek out. He has a younger
sibling so it is difficult to prevent him from
getting a bottle. His mother indicated that she
tries to fill the bottle with water.
Kavon had obvious dental problems at the
time he was evaluated. His mother reported
that he has had many ear infections, but he
has not seen an ear, nose and throat specialist.
Kavon also has a history of asthma and
allergies, but again has not seen any specialists
about either of these conditions.
His mother accompanied Kavon to the
evaluation. He was a friendly and engaging
little boy who had much energy. For the most
part he complied with formal testing,
especially when instructions were given with
visual cues. He was patient and persistent with
the tasks. Toward the end of the testing,
however, Kavon had a harder time attending
to the tasks and following directions. He

became active by running and jumping around
the room. When redirected and given several
breaks he was able to complete the formal
testing. His mother indicated that his behavior
during the evaluation was fairly typical of how
he is at home.
The mental and motor scales from the
Bayley Scales of Infant Development-II were
given to Kavon. The Receptive and Expressive
Emergent Language Scale (REEL) was
administered as well. His adaptive and social
emotional abilities were also determined by
use of the Vineland Adaptive Scale. The results
of the evaluation follow.
Cognitive Development: Kavon achieved
a developmental index of 81 with a
developmental age of 26 months on the
mental portion of the Bayley. Tasks that
involved thinking and problem solving with
his eyes and hands were a strength. He
struggled more with the language items on the
cognitive test. He was often echolalic. He had
difficulty with many abstract concepts
including spatial concepts, quantita tive
concepts, and descriptors.
Communication Development: Kavon
achieved a receptive language level of 20-22
months on the REEL. He also achieved an
expressive level of 20-22 months. Based on
informal assessment of his speech, Kavon’s
articulation was felt to be similar to his
language abilities. His relative language

strengths included his abilities to imitate
environmental sounds, use two word
combinations, and use some personal
pronouns. His difficulties included expanding
his understanding of the meaning of longer
verbal information, pointing to smaller body
parts, and understanding questions related to
the functional use of objects such as “What do
you eat with?”. He also needs to learn to ask
for help verbally for some of his personal needs.
Motor Development: Kavon achieved a
developmental index of 86 with a
developmental age of 27 months on the motor
portion of the Bayley. His gross motor skills
are a strength. Kavon was age appropriate in
Case Studies
Kavon
running, jumping and negotiating the stairs.
He did not do as well with fine motor skills
such as grasping small objects and
manipulating a pencil. Kavon tended to
grasp the pencil in his palm and he was not
able to imitate or copy simple lines or circles.
Adaptive Development: Kavon achieved a
standard score of 81 for an age equivalent of 2

years, 2 months on the Vineland Adaptive
Scales. Kavon can feed himself, but at 2 1⁄2 he is
still using the bottle and a sippy cup. He is
also struggling with toilet training, as he has
expressed little interest in using the toilet. This
has become an issue at his child care setting.
Social-Emotional Development: Kavon
achieved a standard score of 100 for an age
equivalent of 2 years, 6 months on the
Vineland Adaptive Scales. Kavon is described
as friendly and outgoing and plays well with
other children.
7
Case Studies
Discussion Questions—Kavon
1. How could you summarize the evaluation findings in reader
or family-friendly terms?
2. What percent delay, if any, is Kavon demonstrating in the
various areas of development for
which he was assessed?
3. In your opinion should Kavon be found eligible for early
intervention services? On what
bases are you making your judgment?
4. What services, if any, do you think would benefit Kavon and
why?
5. How could Kavon’s services be delivered?

6. What other recommendations do you have for Kavon and his
family?
The District of Columbia Early InterventionProgram has
referred Kaila to you for an
evaluation. Kaila is 15 months old. She attends
an Early Head Start program. Her mother,
who is described as having some cognitive
limitations, dropped out of high school at 15
years of age and now at 22 is attending a
program for adults with developmental
disabilities. Her mother is also homeless and
lives in transitional housing. Kaila’s mother
and her teacher at the Early Head Start
program think an evaluation is appropriate.
Although she consented to have Kaila
evaluated, her mother is not very concerned
about Kaila nor her development. She did
express some frustration with Kaila’s
“fussiness” and her lack of sleeping, however.
Kaila’s primary child care provider is
extremely concerned about Kaila’s physical
growth. Kaila appears very small for her age
of 15 months. Kaila’s mother is not sure how
much Kaila weighs but did indicate that her
pediatrician is following Kaila for her growth.
Kaila is described as being a picky eater. She is
bottle-fed and is difficult to feed. Although her
mother indicated that she has no trouble
feeding her at home, the primary child care
provider indicated that Kaila often gags and

throws up at child care.
Kaila’s primary child care provider is also
concerned about her temperament. She
describes Kaila as having a “flat” affect. Kaila
often wants to be held and cries when other
children approach her.
Her development sounds as though it has
been generally slow all around, although not
likely 50% delayed. Kaila has just started to
walk by herself. She babbles and says “ma
ma”. She will wave “bye bye” as well. She will
finger feed but will not use a spoon or drink
from a cup.
Her mother and social worker will
accompany Kaila to the evaluation. Her
primary child care provider will not be able to
attend the scheduled evaluation. The
evaluation is scheduled for the upcoming week.
Case Studies
Kaila
Discussion Questions—Kaila
1. You are assigned to be the service coordinator for this child
and family and will have the

opportunity to speak with the mother by phone prior to
conducting the evaluation. What
additional information would you like to obtain prior to
conducting the evaluation on Kaila?
Based on the information provided above make a list of
questions you would like to ask.
2. What information should you share with Kaila’s mother prior
to her visit?
3. What areas should be addressed during the evaluation and
how will you address these areas?
4. Who should conduct this evaluation?
5. Do you think there may be any mental health issues
described? If so how will these be addressed?
6. If Kaila is not 50% delayed is it possible that she may still be
found eligible for early
intervention services? On what basis?
7. Are there any other community-based personnel you would
like to talk to about Kaila and
her mother?
8. Develop a comprehensive care plan that addresses the needs
of Kaila. Include in the plan the
services that can be utilized to help meet those needs, who
should be assigned responsibility
for them, and a timeline for plan implementation.
9
Case Studies

Assignments
The following five assignments were designed to broaden an
individual’s knowledge of earlyintervention, research, program
planning, legislation and resource development. Specific
guidelines and detailed instructions are provided for each
assignment. Descriptions, purposes,
and objectives for each assignment are also given.
The overall purpose of the assignments is to provide a variety of
activities that facilitate learning
about the core areas of early intervention. The activities range
from site visits to analysis of
research, to development of new materials. The range of
learning activities caters to the styles of
the adult learner and the needs of trainers. Trainers can choose
which of the activities are useful
for their purposes.
The assignments can be used individually or as group projects.
Products such as papers and
presentations can be generated from the assignments. The
trainer should decide on how to use
and/or modify any one or all of the assignments.
Objectives
Following completion of the assignments, students of early
intervention will be able to:
1. Research traditional and non-traditional early intervention

strategies.
2. List and discuss journals outside their specific field of
expertise.
3. Describe the types of settings in which infants and young
children receive care.
4. Understand the federal legislation related to early
intervention.
5. Develop helpful tools for parents.
Assignment One: Intervention Approaches
for Children with Disabilities
Purpose
To become familiar with the variety of intervention approaches
provided to children with disabilities.
Format
Each presenter will have 10 minutes to present a succinct
review of an intervention approach.
The review should include:
• Purpose of the intervention.
• Population of children the intervention is designed for
(disability, age).
• General description of the intervention including: who
performs the intervention,
where the intervention is conducted, what the intensity level is

and the cost, equipment
needed, special expertise, certification, training, etc.
• Research related to the intervention approach.
• Critical analysis: from literature, own experience, family
experiences, etc.
• Local practitioners who practice the approach.
• Web site or other internet resources pertaining to the
intervention approach.
Documentation
Each presenter will provide a one-page summary in bulleted
format on the intervention approach
she/he examined. The summary should include the above
information as well as the names and
contact information for local practitioners, if known; and three
citations from the literature that
describe, critique, or analyze the approach.
Intervention Approaches
The following includes a partial list of early intervention
approaches. Trainers may add others.
Assignments
• Sensory Integration
• Developmental, Individual
Differences, Relationship
Based Model (DIR)
• Neurodevelopmental
Therapy (NDT)
• Developmental Optometry
• Discreet Trial Training-

Lovaas
• Developmentally
Appropriate Practice (DAP)
• Auditory Integration
Training: Berard, Tomatis,
Samonas
• Cognitive-Developmental
Systems Approach: Miller
Method
• Lindamood Phonemic
Sequencing Program:
Lindamood-Bell
• Movement Opportunities
Via Education (MOVE)
• Myofascial Release (MFR)
and Cranial-Sacral
Therapy (CS)
• Applied Behavioral Analysis
• MEDEX
• Fast Forward
• TEACCH
• Conductive Education
• Activity Based
Intervention (ABI)
• Phonographics/Earopics
• Nutritional Supplements/

Diets
• Advanced Neuromotor
Rehabilitation
Assignment Two: Research Five Journals
Outside Your Field of Expertise
Purpose
To become familiar with a variety of publications outside your
field.
Format
Each student/trainee will produce a summary of a journal
outside their field, but within a field
that they would potentially work.
Documentation
Generate a one-page summary on each of the journals
researched that includes the
following information:
• Name of the journal
• Purpose of the journal
• Editor of the journal
• Publication information
• Frequency of the publication
• Types of articles
• Affiliation of the journal with a professional association
• Target audience
• Subscription rate
• Critical analysis of the journal: Is it worth spending the fee

for this journal?
Why or why not?
• How to order the journal
Publications
The following includes a partial list of publications from a
variety of organizations. These
journals contain current information about topics in early
intervention from various disciplines.
Trainers can also use other relevant journals not listed here.
13
Assignments
American Journal of Mental Retardation
American Association of Mental Retardation
Washington, DC
American Journal of Occupational Therapy
American Association of
Occupational Therapy
Bethesda, MD
Archives of Disease in Children
BMJ Publishers Group
London, England
Child Development
Blackwell Publishers
Malden, MA
continued

Developmental Medicine and
Child Neurology
MacKeith Press
London, England
Exceptional Children
Council for Exceptional Children
Reston, VA
Infancy
Lawrence Erlbaum Associates, Publishers
Mahwah, NJ
Infant Behavior and Development
Elsevier Science, Inc.
New York, NY
Infant and Toddler Intervention:
The Transdisciplinary Journal
Singular Publishers
San Diego, CA
Infants and Young Children: An
Interdisciplinary Journal of Special
Care Practices
Aspen Publishers, Inc.
New York, NY
Journal of Early Intervention
Council for Exceptional Children
Reston, VA
Mental Retardation

American Association of Mental Retardation
Washington, DC
Neonatal Network: The Journal of
Neonatal Nursing
Santa Rosa, CA
Pediatric Physical Therapy
Lippincott, Williams and Wilkins
Philadelphia, PA
Physical Therapy
American Physical Therapy Association
Alexandria, VA
Physical and Occupational Therapy
in Pediatrics
Haworth Press
Binghamton, NY
The Future of Children
A Publication of the David and Lucile
Packard Foundation
Los Altos, CA
Topics in Early Childhood Special Education
Pro-ed
Austin, TX
Zero to Three
ZERO to THREE: National Center for
Infants and Families
Washington, DC
Assignments

Assignment Three: Site Observations
Purpose
The purposes of this assignment are to become familiar with the
variety of programs available in
the community that serve infants and toddlers, and to determine
how programs/services infuse
best practice philosophy/values into service provision.
Format
Each student/trainee will set up a site visit and will spend some
time observing a particular
facility or program that cares for and provides services to
infants and young children. The
following list should be used to guide the observations. The
student/trainee will then have 10
minutes to present a succinct review of the setting that they
observed.
Documentation
For each site visit, each trainee should generate a two-page
summary that includes the
following information:
• Name of the facility or program
• Ages of the children served
• History and philosophy of the facility or program
• Structure of the facility or program (Co-Op, Pre-K, etc.)
• Services provided
• Activities and routines in which the children engage
• Adult to child ratio
• Types of delays and disabilities of the children who attend this

program
• Family involvement
• Type of setting: inclusive setting, provisions for inclusion
• Curriculum used
• Would you recommend this facility to a family with a child
with a disability?
Why or why not?
Sites
The following is a list of some facilities and programs that
serve children in the District of
Columbia. Trainers could choose to use others. Trainees must
contact sites for permission to
observe and to set up dates and times for observation.
15
Assignments
Bright Beginnings
202-842-9090
128 M Street, NW
Washington, DC
Center for Mental Health, Inc.
202-889-5255
2041 Martin Luther King Jr. Avenue, SE
Washington, DC
continued

Chesapeake Center, Inc.
703-924-4100
6505 Loisdale Road
Springfield, VA
Easter Seals Child Development Center
202-387-4434
2800 13th Street, NW
Washington, DC
Edward C. Mazique Parent Child Center
202-462-3375
1719 13th Street, NW
Washington, DC
Kendall Demonstration Elementary School
202-651-5397
800 Florida Avenue, NW
Washington, DC
Lt. Joseph P. Kennedy Institute Preschool
202-529-7600
801 Buchanan Street, NE
Washington, DC
Mary’s Center for Maternal and
Child Care, Inc.
202-483-8319
2333 Ontario Road, NW
Washington, DC
National Children’s Research Center
202-363-8777
3209 Highland Place, NW
Washington, DC

National Children’s Center-Early
Intervention Program
202-279-4900
3400 Martin Luther King Jr. Avenue, SE
Washington, DC
Out Came the Sun
301-649-7170
P.O. Box 1687
Rockville, MD
Project Child
202-588-9894
2200 California Street, NW
Washington, DC
PSI Early Intervention
202-547-3870
770 M Street, SE
Washington, DC
The River School
202-337-3554
4880 MacArthur Boulevard, NW
Washington, DC
Rosemont Center
202-265-9885
2000 Rosemount Avenue, NW
Washington, DC
St. Ann’s Infant and Maternity Home
202-559-5500
4901 Eastern Avenue
Hyattsville, MD

The Treatment and Learning Centers and The
Katherine Thomas School
301-424-5200
9975 Medical Center Drive
Rockville, MD
Assignments
Assignment Four: Describe Five
Federal Laws that Impact Young Children
(Birth-Three Years)
Purpose
The purpose of this assignment is to become aware of the
federal laws that impact the lives of
infants and toddlers with delays and disabilities and their
families.
Format
Each student/trainee will research a law that impacts infants,
toddlers or young children.
They will write a summary of that legislation that can be shared
with the rest of their
classmates/colleagues.
Documentation
Generate a summary that includes the following information:
• Name of the law(s) that impact infants and toddlers and their
families
• Write a description of the law(s)
• Identify what government agency has the authority to regulate

the law(s)
• Identify what types of services are provided as a result of the
legislation
• Name who is impacted and how they are impacted
• Obtain contact information (phone numbers, web sites, and
email addresses) on local,
state, and federal levels of people and agencies responsible for
the implementation of
the legislation
Laws
The following is a partial list of legislation that impacts young
children. Trainers can add others.
• IDEA (Individuals with Disabilities Education Act)
• Medicaid (Title XIX of the Social Security Act)
• EPSDT (Health Check)
• Healthy Families Program (State Children’s Health Insurance
Program (S-Chip)
• TANF (Temporary Assistance for Needy Families)
• SSI (Supplemental Security Income)
• ADA (Americans with Disabilities Act)
• CDBG (Child Care Development Block Grant)
17
Assignments
Assignment Five: Develop Helpful
Informational Materials for Families

Purpose
The purpose of this assignment is to creatively develop
materials in a family friendly format to
assist providers in relaying useful information to families about
topics and issues relevant to
early intervention.
Format
The type of material chosen will determine the format.
Materials such as those listed below,
however, should be written in audience-friendly terms using
concise language. The creative use of
symbols, design elements, and formatting will enhance the
product.
Documentation
Create one or more of the following:
• Brochures
• Fact sheets
• Worksheets
• Helpful Tips
• Posters
• Public service and awareness announcements
• Slogans
• Bumper Stickers
• Web site(s)
Assignments
The Games of
Early Intervention

The Games of Early Intervention are a set of activities that can
be used for training purposes.The Games are fun, interactive
tasks that build upon the competencies needed by early
interventionists. The Games can be used as a pre-test experience
to gather information from the
student/trainee on her/his knowledge base, as icebreaker
activities, or as a component of didactic
learning. Trainers who embellish the answers with further
details will be most successful with
this interactive approach to learning. Providing small tokens or
treats to the participants
maintains enthusiasm and supports a fun atmosphere for playing
the Games.
Objectives
In completing the Games of Early Intervention the provider will
be able to:
1. Differentiate the components of Part C, IDEA and Part B,
IDEA.
2. Appreciate the value of clear communication through active
listening.
3. Explain the rationale behind EI program implementation.
4. Discuss the variations in laws that impact service delivery to
children at-risk
or with a disability or delay.
5. Explain the basic provisions of early intervention in the
natural environment.

To Tell the Law
Purpose
To discuss the variations in laws that impact service delivery to
children at-risk for or
with disabilities/delays.
Participants
• Two participants are recruited to act as the “law”
• Three other participants will act as the “prosecutors”
• The other participants will act as the “jury”
• The facilitator/instructor will act as the “court reporter”
Materials
• Index cards with questions and answers about the following
laws
– IDEA
– Section 504
– ADA
– SSI
– Medicaid
– EPSDT
• Index cards with only the name of the law on it
Strategy
• Choose the five contestants who will be the “law”, and the
“prosecutors”
• Allow one of the “laws” to choose from the cards with the
name of the law on it
• Based on the name they choose, give the “prosecutors” the
question and answer cards for that

particular law.
• In turn each “prosecutor” will ask each “law” a question. The
“court reporter” will record
each response. The correct answer will not be given at this time.
• Following the answering of all the questions. The “jury” will
deliberate by reviewing the
answers and deciding which one of the “laws” answered the
most questions correctly. One
member of the jury will present the verdict and the reasoning
behind the verdict.
Questions/Answers for Each Law
Americans with Disabilities Act (ADA)
1. What is the ADA?
Passed in 1990 the ADA seeks to eliminate barriers to access in
buildings, transportation,
and communication.
2. What is the purpose of eliminating these barriers?
The ADA prohibits discrimination based on disability in
employment, public services,
and accommodations.
Games: To Tell the Law
3. What type of law is the ADA?
A civil rights law.

4. What is the impact of being a civil rights law?
Because it is a civil rights law there is no financial assistance to
help with assuring access
(ramps, AT, etc).
5. Who is protected by the ADA?
Any individual (adult or child) who has a physical or mental
impairment that substantially
impacts a major life activity; has a record of such an
impairment; is regarded as having
an impairment.
6. What is an example of how this law would impact an infant
or toddler eligible to receive
Early Intervention?
• Ramps into a child care center
• Sign language interpreter if a parent has a hearing impairment
so he/she can communicate
with staff
• Make available specialized equipment or adapted materials so
the child can take part in all
activities (raised toilet seat or stool with armrests for standing
at the sink or water table.
7. Does the ADA apply to religious organizations?
ADA protections apply to nonsectarian private schools, but not
to organizations or entities
controlled by religious organizations.
Developmental Disabilities Assistance and Bill of Rights Act,
Part B (DD Act)
1. What does the DD Act provide?
The DD Act provides grants to States to support the planning,

coordinating, and delivery of
specialized services to persons with DD.
2. Does the program provide services?
No. The DD Act does not fund services to individuals. The Act
provides funds to States to
support the integration of individuals with disabilities into the
community.
3. What do States use funds for?
Funds can be used to
• Enhance coordination among service providing systems
• Conduct activities, such as training and technical assistance,
to increase the capacity of
community programs to integrate individuals with DD into their
programs
• Do research
• Develop model policies and procedures
• Conduct outreach activities
• Conduct prevention activities
• Etc.
21
4. Who decides what programs to create or support?
At least 65% of the funds must be used to support one or more
of the following activities:
• Employment
• Community living

• Child development activities
• Case management
• Family support services
5. What impact does the DD Act have on EI providers?
The DD Act gives the EI provider an opportunity to advocate
for model services or supports.
Although provision of services can not be funded, providers can
advocate for model program
development or a particular outreach activity for infants and
toddlers and their families.
Early Periodic Screening, Diagnosis, and Treatment Program
(EPSDT)
1. What is EPSDT?
The Early Periodic Screening, Diagnosis, and Treatment
Program (EPSDT) is a component of
the Medicaid program (see below). EPSDT provides
comprehensive, well-child health care
services and medically necessary treatment.
2. Who is eligible to receive EPSDT services?
All Medicaid-eligible children from birth through age 21.
3. What kind of services are covered?
This is a more comprehensive system of services than what
Medicaid covers. EPSDT includes:
• Screening services: physical, developmental, hearing, vision
• Immunizations
• Laboratory tests
• Dental services
• Hearing and vision services such as glasses, hearing aides
• Any diagnostic or treatment service which is medically
necessary to ameliorate a condition

detected by a screen even if not offered by the state Medicaid
Plan
Individuals with Disabilities Education Act (IDEA)
1. What are the ages of individuals covered by the IDEA?
Birth through age 21 years.
2. What does FAPE stand for?
Free and Appropriate Public Education.
3. What is meant by the Least Restrictive Environment?
The educational environment closest to the typical classroom
that the child would attend if
he/she did not need special education and related services that
can accommodate, with
services and supports, a school aged child with disabilities, who
has been determined to
benefit from special education and related services.
4. What is an IEP?
Individualized Education Program
5. What is an IFSP?
Individualized Family Service Plan
6. What do the federal regulations of Part C say are the
eligibility requirements?
That it is up to the State to determine eligibility requirements
and can be based on: amount of

delay, medical condition, risk, or professional judgment.
7. What is the purpose of a due process hearing?
To have an impartial hearing officer determine a solution to an
issue that two parties cannot
agree on (usually family v. school system).
8. What is the purpose of mediation?
To have an impartial mediator, facilitate a meeting at which the
two parties determine a
mutually agreed upon solution for themselves.
9. A very good IEP will have specific goals for physical
therapy, occupational therapy, speech-
language pathology, and other related service providers as
appropriate for the child: T or F
False. A very good IEP will have a set of discipline free goals
for the child.
10. When is a child eligible to receive physical therapy under
IDEA?
Under IDEA children are eligible to receive physical therapy
services if they have been
determined eligible for special education and need PT to benefit
from their education.
Section 504
1. What is Section 504 a section of?
The Rehabilitation Act of 1973
2. What is the purpose of Section 504?
Section 504 is a non-discrimination law. It states that a person
cannot be denied access to or
excluded from participating in any program or activity receiving
Federal funds, conducted by

any Executive agency, or by the US Postal Service.
3. Historically, why is Section 504 important?
Section 504 was the first effort to address the public schools
failure to provide education for
children with disabilities.
4. Does Congress appropriate funds to schools and communities
to implement Section 504?
No. Section 504 is considered an unfunded mandate.
23
5. Who does Section 504 protect?
Students with disabilities who are not eligible under IDEA. A
student with a disability is
defined as any individual who has a physical or mental
impairment that substantially impacts
a major life activity; has a record of such an impairment; is
regarded as having an impairment.
6. What does Section 504 provide?
• Accommodations
• Modifications
• Related services
• AT
• AT Services
• Behavior management
7. Why does Section 504 concentrate on the notion that students

with disabilities should not be
denied equal opportunity to access and benefit from programs
receiving federal assistance?
Because it is a civil rights statute.
8. Are extra curricular activities covered under 504 or just
academics?
Extracurricular activities are covered. Thus, a student with a
disability cannot be denied
access to an after school activity and reasonable
accommodations and or modifications
must be available.
9. Are there procedural safeguards under 504?
Section 504 requires notice to parents regarding identification,
evaluation, and/or placement.
Written notice is recommended. Notice must be made only after
a “significant change”
in placement.
Social Security (SS)
1. What does social security have to do with a child?
Under the Social Security program a child with a disability may
be eligible for Supplemental
Security Income (SSI) benefits.
2. Who is eligible to receive SSI benefits?
A child is eligible if
• He or she has a physical or mental condition(s) that very
seriously limits his or her activities
and the condition(s) has lasted or is expected to last at least 1
year or is expected to result
in death.

• Low income
• Few resources
3. What is the link between SSI and Medicaid?
In most states children eligible for SSI are eligible for
Medicaid.
4. What is the link between SSI and Children with Special
Health Care Needs (CSHCN)?
Children eligible for SSI are referred for health services under
the CSHCN provisions of the
Social Security Act.
5. What does a child get from SSI?
SSI is a program that pays monthly benefits to the child.
6. Does the family’s income impact the SSI benefit?
Yes, the parent’s income and assets are considered when
deciding if a child qualifies for SSI.
7. How is a child determined eligible to receive SSI?
A state office called Disability Determination Service reviews
all documentation to determine
if a child is eligible.
Technology-Related Assistance for Individuals
with Disabilities Act (Tech Act)
1. What is the purpose of the Tech Act?
The program provides discretionary grants to States to develop

a statewide program to
facilitate the provision of assistive technology and assistive
technology services to individuals
with disabilities.
2. Are children eligible to receive services under the Tech Act?
Yes, children as well as adults are eligible to receive services.
To be eligible an individual must
be considered to have a disability as defined by any Federal law
or State law in the State that
the individual resides and who would benefit from AT and/or
AT Services.
3. What can this law do for an individual with a disability?
The following services and supports are covered under the Tech
Act and are available to
eligible individuals:
• Identification of needs
• Identification and coordination of resources
• Provision of AT or AT Services
4. Does the law provide any other type of services or
protections for individuals with disabilities?
Yes, the Tech Act requires that States develop a system of
services and supports for individuals
with disabilities. This system consists of (but not limited to) the
following activities:
• Conduct Statewide needs assessment
• Create and maintain support groups
• Develop and conduct public awareness programs
• Provide training and technical assistance
• Develop a system for public access to technology-related
information
• On-going evaluation of programs offered
25

Title IX of the Social Security Act (Medicaid)
1. Is Medicaid a federal or state program?
Medicaid is both a federal and state program. The federal
contribution to Medicaid is
matched by state funds. The state administers the program.
2. Who can receive Medicaid?
There are three ways that a person of low income can receive
Medicaid:
• Medical need: States define medical need
• Categorical need: Individuals can receive Medicaid if they are
already eligible to receive
services such as SSI
• Waiver programs: There are waiver programs that target
specific groups for coverage, such
as individuals with mental illness or pregnant women and
children under six.
3. What services are paid for by Medicaid?
States can decide which services they will cover. There are
some services that are mandated:
• In-patient and out patient hospital services
• Rural health clinic services
• Lab and x-ray
• Skilled nursing facilities
• Home health care for adults

• EPSDT (see above)
• Family planning services and supplies
• Physician services
• Mid-wife services
4. Are these the only services covered?
No, there are optional services that States can cover:
• Services by specialty providers (PT, OT, podiatry,
chiropractors, etc.)
• Drugs, dentures, prosthetic, orthotics, glasses, AT
• Screening services, preventive services, personnel care
services, ICF services, transportation,
case management, hospice, etc.
5. Are their any types of restrictions on providers?
In a way, yes. Each state sets criteria for provider certification
and enrollment. Individuals
must choose a certified/enrolled provider. Each type of service
has specific criteria.
6. Can States not choose some services?
States can choose not to offer the Optional Services. But all
mandated service categories must
be available throughout the State.
A Natural Match
Purpose
Introduces participants to the basic information regarding the

provision of early intervention
services in the natural environment,
Participants
• Two volunteers will act as matchees (contestants)
• Other participants will act as the matchers
• Instructor will act as the matchmaker
Strategy
• The matchmaker will read a card with a fill-in the blank
phrase to a matchee
• Each matchee in turn will complete the phrase and write it on
index cards
• Matchers will also complete the phrase and write it on index
cards
• Matchee will receive 10 points for each correct match.
Phrases
1. Name one of the three contexts that almost anything that
happens in an infants or toddlers
life occurs in.
• Community
• Family
• Early childhood activity
2. Name one benefit of providing intervention in the natural
environment.
• Generalization
• Communication with family
• Natural learning

• Reinforces family-centered-care
• Provides modeling and support to caregivers
3. At what point during the program planning process does the
team indicate the
intervention environment?
During the IFSP, when outcomes are decided.
4. According to Part C of IDEA what is meant by the term
natural environment?
A setting in which one would expect to see children without
disabilities.
5. Who provides intervention in the natural environment?
All EI providers.
27
Games: A Natural Match
6. Who receives intervention in natural environments?
All infants and toddlers who are receiving services and supports
from the Part C program in
their State or local jurisdiction.
7. Early interventionists who provide services within a natural
environment can be best
described as a
Coach, consultant, partner, collaborator.
8. All outcomes are practiced in the same natural environment-
True or False

False, the environment will change depending on the outcome.
9. Learning opportunities are different from natural
environments because they require
___________ type of interaction.
Active; a child can be very passive and still be in a natural
environment (sleeping in
an infant seat in a grocery cart)
10. The overall objective of early intervention is to build the
___________ of the infant or
toddler and their family.
Competency.
Games: A Natural Match
It’s a Great IDEA!
Purpose
Delineates present knowledge of Part C and Part B of IDEA.
Participants
• All participants are divided into three equal sized teams.
• The instructor acts as host
• Another instructor acts as orchestra leader, time keeper, and
score keeper
Materials
• It’s a Great IDEA! game questions

• Arts/crafts materials to make pennants
• Music (tape or CD that can be turned off and on)
Strategy
• Divide participants into three (or more) four-member teams.
• Each team will decide on a name, and make a pennant
representing the spirit of the team.
• Each team will be asked a question based on the federal
regulations from IDEA. The team will
have 15 seconds to decide on an answer while the “It’s a Great
IDEA” orchestra plays. The
orchestra leader will play the music for 15 seconds. When the
music stops, the team must
provide their answer.
• Teams will receive one point for each correct response.
Questions
1. What are the two main sections of IDEA related to services
for children called?
Part C and Part B
2. Part C of IDEA contains information on what type of
services?
Early Intervention
3. Which document uses the term outcomes as its benchmark?
Individual Family Service Plan
4. When is an IFSP reviewed?
Every six months.

5. Where are early intervention services provided?
In the Natural Environment.
29
Games: It’s a Great IDEA!
6. The team member who facilitates the development,
implementation, and evaluation of the
IFSP is called
Service Coordinator
7. Who can be a Service Coordinator?
Any EI provider with the skills and knowledge.
8. Are early intervention services free?
Some EI services are free: child find, eligibility evaluation,
service coordination, mediation,
IFSP development.
Most services are not free. The law allows States and
jurisdictions to develop a system of fees.
Billing Medicaid and other insurance providers is an option,
maintaining a sliding fee scale is
another method.
9. Who determines that a child is eligible for early intervention
services?
A multidisciplinary team.
10. Name one method a family can use to help resolve conflicts
between them and the school or

early intervention system.
Mediation
Due process
Talking to the provider
Talking to the supervisor of the provider
Talking to the Director of EI
11. Can children receive early intervention services if enrolled
in an Early Head Start Program?
Yes
12. Is transportation considered a related service?
Yes
13. At what age should the early intervention system begin the
process of transitioning a child
out of EI?
Two years, 3 months
14. Can parents refuse to allow their child to be evaluated to
determine eligibility for services?
Yes
15. Who pays for mediation services?
The Early Intervention Program
16. T or F: Early intervention programs are special places for
children with disabilities to go to
receive all necessary therapies.
F. Early Intervention is a system of supports and services.

17. Are families encouraged to participate in early interventio n?
Yes. Early intervention is a partnership between providers and
families.
18. How often does a child who receives services under Part C
need to be evaluated?
Yearly
19. What is the age range that a child could be considered to
have a developmental delay?
3 years to 9 years.
20. What does IDEA stand for?
Individuals with Disabilities Education Act
21. Which Federal Agency administers IDEA?
Department of Education, Office of Special Education and
Related Services
22. What is the difference between Part B and Part C of IDEA?
Part B describes the regulations for children receiving special
education and related services
for children from 5 through 21.
Part C describes the regulations for children receiving early
intervention for children from
birth through age 2.
23. Preschool services are covered under what
component/section of IDEA?
Section 619
24. What is meant by the term natural environment?
Environments that one would find children without disabilities.

25. Does a child who receives early intervention services
always transition into special
education services?
No, a child could transition into a child-care center, Head Start
program, any other type
of pre-school or could stay at home. Child may or may not
receive any special services
or supports.
31
What Did You Say?
Purpose
To appreciate the value of clear communication through active
listening
Participants
• The group should be divided into groups of 7 to 9 team
members.
• All members sit in a large circle.
• One member will act as a parent of a child about to receive
early intervention services.
Materials
• Index cards with a variety of “parent wants” written on them.
• Chairs placed in a circle

Strategy
• Team member who is acting like the parent will select a card.
• This person will initiate a conversation by whispering into the
ear of the team member sitting
next to her the statement written on the card.
• This person will whisper what she has heard to the person next
to her and so forth.
• The last person in the circle will announce what she heard to
the group.
• The group will ascertain how close this is to the original and
how many interpretations
occurred along the way.
What Parents Want
• I would like to see my child talk to my husband when he
comes in the house after work.
• I would like my child to play with his brother.
• I would like my child to sit in a high chair without tipping
over or sliding out.
• I would like my child to sit by himself while eating dinner.
• I’m exhausted; I would like the baby to sleep through the
night.
• I can’t find a babysitter because the baby cries all the time.
• I would like to go back to work but the baby takes so long to
feed, my babysitter can’t take

the time.
• My son is 15 months old, he should be walking but the
therapist says he is not ready.
Games: What Did You Say?
• Her twin can do so much more-I want her to do the same
things.
• I want to go to the playground but I don’t know what to do, he
can’t play on the equipment
like the other kids.
• The childcare worker likes the children to play instruments;
Andi can’t hold any of the
instruments so she doesn’t participate.
• I hurt my back, it would make my life easier if she I didn’t
have to carry her everywhere.
• We haven’t gone to church as a family since she was born. I
would like to leave her with the
church nursery program so I can participate in the service with
my wife.
• You have to be so patient with him. The therapists expect him
to follow directions
immediately. I don’t think they know what to do with Sam.
• I swim a lot. I’d like to take him with me so we can do
something together.

33
Games: What Did You Say?
Truth or Dare
Purpose
To explain the rationale behind EI program implementation.
Participants
In turn each participant will act as the “truthsayer” while all
other participants will act as those
who would dare.
Materials
Index cards with statements regarding the implementation of
early intervention services.
Strategy
The participant acting as the “truthsayer” will chose a card and
read the statement aloud. This
“truthsayer” will then announce if the statement is true or false.
The other participants, “Those
who would dare”, can then “dare” the “truthsayer “ to provide
evidence for her conclusion.
Each participant will have an opportunity to play the
“truthsayer”. If there is disagreement there
can be a discussion involving all participants to determine if the
statement is true.
Truth or Dare Statements

• Early intervention consists of physical therapy, speech-
language pathology, and
occupational therapy.
• The home is the best place to provide early intervention.
• Early interventionists should support natural learning
opportunities.
• When providing family centered care the therapists provide
parents all the therapy parents ask for.
• Like special education, early interventio n is individualized to
meet the needs of the child.
• It is important for therapists to bring their own equipment
with them when they make home visits.
• It is better to have a special place to do the therapy.
• Early interventionists need to be very flexible.
• If families and providers disagree about the services the
children are receiving they can request
a mediator to help them resolve their difficulty.
• Children with CP will receive therapy throughout their lives.
• Specialized care centers provide the “best” service to children
with disabilities.
• EI services can begin when a child is still in the hospital.
• Assistive Technology is inappropriate for infants and toddlers.

• All the providers should give home programs to families.
Games: Truth or Dare
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/DownsampleColorImages true
/ColorImageDownsampleType /Bicubic
/ColorImageResolution 300
/ColorImageDepth -1
/ColorImageDownsampleThreshold 1.50000
/EncodeColorImages true
/ColorImageFilter /DCTEncode
/AutoFilterColorImages true
/ColorImageAutoFilterStrategy /JPEG
/ColorACSImageDict <<
/QFactor 0.15
/HSamples [1 1 1 1] /VSamples [1 1 1 1]
>>
/ColorImageDict <<
/QFactor 0.15
>>

/JPEG2000ColorACSImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/JPEG2000ColorImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/AntiAliasGrayImages false
/DownsampleGrayImages true
/GrayImageDownsampleType /Bicubic
/GrayImageResolution 300
/GrayImageDepth -1
/GrayImageDownsampleThreshold 1.50000
/EncodeGrayImages true
/GrayImageFilter /DCTEncode
/AutoFilterGrayImages true
/GrayImageAutoFilterStrategy /JPEG
/GrayACSImageDict <<
/QFactor 0.15
>>
/GrayImageDict <<
/QFactor 0.15
>>
/JPEG2000GrayACSImageDict <<
/TileWidth 256
/TileHeight 256
/Quality 30
>>
/JPEG2000GrayImageDict <<
/TileWidth 256
/TileHeight 256

/Quality 30
>>
/AntiAliasMonoImages false
/DownsampleMonoImages true
/MonoImageDownsampleType /Bicubic
/MonoImageResolution 1200
/MonoImageDepth -1
/MonoImageDownsampleThreshold 1.50000
/EncodeMonoImages true
/MonoImageFilter /CCITTFaxEncode
/MonoImageDict <<
/K -1
>>
/AllowPSXObjects false
/PDFX1aCheck false
/PDFX3Check false
/PDFXCompliantPDFOnly false
/PDFXNoTrimBoxError true
/PDFXTrimBoxToMediaBoxOffset [
0.00000
0.00000
0.00000
0.00000
]
/PDFXSetBleedBoxToMediaBox true
/PDFXBleedBoxToTrimBoxOffset [
0.00000
0.00000
0.00000
0.00000
]
/PDFXOutputIntentProfile ()
/PDFXOutputCondition ()
/PDFXRegistryName (http://www.color.org)
/PDFXTrapped /Unknown

/Description <<
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/ENU (Use these settings to create PDF documents with
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documents can be opened with Acrobat and Reader 5.0 and
later.)
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/ESP
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/SUO
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/ITA
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/NOR
<FEFF004200720075006b0020006400690073007300650020006
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/SVE
<FEFF0041006e007600e4006e00640020006400650020006800e
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0e40072006d006500640020006600e50020006200e40074007400
7200650020007500740073006b00720069006600740073006b007
60061006c0069007400650074002e0020005000440046002d0064
006f006b0075006d0065006e00740065006e0020006b0061006e0
02000f600700070006e006100730020006d006500640020004100
630072006f0062006100740020006f00630068002000520065006

100640065007200200035002e003000200065006c006c00650072
002000730065006e006100720065002e>
>>
>> setdistillerparams
<<
/HWResolution [2400 2400]
/PageSize [612.000 792.000]
>> setpagedevice

Janet Thomas, MEd, OTRLToby Long, PhD, PTRachel Brady, MS

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