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When & Where to Refer

When and Where to Refer: Systems of Care for Children and Adolescents with Developmental Disabilities - California

0 – 2 Years 2.6 – 3 Years 3 – 5 Years 5 – 16 Years 16 – 18 Years 19 – 22 Years
If child has or is at risk for developmental delay refer for:

Diagnosis and Treatment
‐ Developmental Pediatrician
‐ Interdisciplinary Assessment Team
‐ California Children’s Services (CCS)
‐ Other specialists
Early Intervention
‐ Early Start (Regional Center* or school district)
Financial Assistance
‐ Supplemental Security Income (SSI)
In‐home Supports
‐ In Home Supportive Services
‐ Parent Training and Information Centers

Early Start services end at age three. Transition to special education services begins at age 2.6.

‐ At age 2.6, request special education p assessment. If child is a client of the Regional Center, the Regional Center will initiate special education referral. If hild i t R i child is not a Regional Center client, the child’s parent or clinician can initiate the special education referral.

If eligible, special education preschool services begin For begin. child already in school, a referral for an educational assessment can be made as soon as a problem is suspected.
Regional Center
‐ At age three, the Regional Center conducts a review determine continuing li ibilit Iff eligibility. If found eligible, the child be entitled to receive Regional Center services throughout their lifetime.

If eligible, special education services continue Referral continue. for educational assessment can be made as soon as a problem is suspected.
‐ If agreed to by the Individualized Education Program (IEP) team, transition to adult services can be added to the IEP l 14 as early as age 14.
‐ Beginning at age 16, student is required to participate in the development of their IEP.
Health Care
‐ Teach health education, selfadvocacy & self‐care skills. Include patient responsibilities, sexuality and sexual health.
‐ Transition to adult services are required in the IEP at age 16.
‐ Explore adult service options.
‐ SSI re‐evaluation at age 18.
Health care transition:
‐ Develop a health care transition plan, including a medical summary.
Legal issues:
‐ In California, age of majority is 18.
‐ Conservatorship
‐ Estate planning
‐ Power of attorney
Regional Center
‐ If not already a client, refer for a Regional Center assessment.
‐ Student receiving special education services can continue to attend school until s/he receives a diploma or up to their 22nd birthday.
‐ California Department of Rehabilitation (DOR)
Insurance, Physical and Occupational Therapies
‐ Children age out of CCS at age 21. Implement health care transition plan.
Regional Center
‐ Services continue lifelong.

*Regional Center referrals can be made at any age. Eligibility criteria is more stringent for referrals made after the age of 24 months.

California Children’s Services ( CCS) ) ccs/Pages/default.aspx ‐ Diagnostic and treatment services, (including doctor visits, hospital stays, surgery, lab tests, and x‐rays), and orthopedic appliances and medical equipment
‐ Medical case management
‐ Physical and occupational therapy*
Children under age 21 who
‐ have CCS eligible conditions, which include, but are not limited to: chronic g , , medical conditions, such as cystic fibrosis, hemophilia, cerebral palsy, heart disease, cancer, traumatic injuries and infectious diseases producing major sequelae.
‐ have family income totaling less than $40,000/year* or whose out of pocket medical expenses for the child will exceed 20% of the family’s income or who have full scope, no cost Medi‐Cal or who have Healthy Families insurance.
*Note: Income limits do not apply for services provided by the Medical Therapy Unit (MTU), a special program within CCS. The MTU provides physical and occupational therapy and medical therapy conferencing.
California Department of Rehabilitation (DOR) The Department of Rehabilitation assists Californians with disabilities to obtain and retain employment and maximize their ability to live independently in their communities through vocational rehabilitation services. Vocational rehabilitation services can include:
- Education
‐Job placement
‐ Transportation
The Department of Rehabilitation also provides ADA technical assistance and training and funds 29 Independent Living Centers.
Adolescents and adults with any disability who

‐ live in California
‐ have a valid work permit (citizenship is not a requirement)

Early Start Provided through Regional Centers (see agency description on page 4). Early Start services include, but are not limited to:
‐ Assistive technology
‐ Audiology or hearing services
‐ Family training, counseling, & home visits
‐ Health services
‐ Medical services
‐ Nursing services
‐ Nutrition services
‐ Occupational therapy
‐ Physical therapy
‐ Psychological services
‐ Respite services
‐ Service coordination
‐ Social Work services
‐ Special instruction
‐ Speech‐language pathology
‐ Transportation
‐ Vision services
Infants or toddlers, birth – 36 months who have established risk conditions or have a developmental delay.
Eligibility for Early Start services is determined by a multi‐disciplinary team that includes the parents. Eligibility criteria for determining a developmental delay is as follows:
‐ For children 0‐23 months, a significant delay is a 33% delay in one or more areas of development.
‐ For children 24‐36 months, a significant delay is 50% in one area of development or 33% in two or more areas of development.
‐ Areas of delay are: adaptive development, cognitive development, communication development, physical or motor development, or social or emotional development.
Most children receive Early Start services through the Regional Center. However, for children identified as having a “sole low incidence disability,” services are provided through the school district. A sole low incidence disability is defined as a visual, hearing, or orthopedic disability, or any combination thereof.
Independent Living Centers (ILCs) 0PDIoE/b.735475/k.3345/L ist_of_California_Independ ent_Living_Centers.htm - Housing referrals
‐ Independent living skills training
‐ Individual and systems change advocacy
‐Information and referrals
‐ Peer counseling
‐ Personal Assistant services
In addition, centers may provide benefits counseling, employment readiness training, assistive technology services and legal aid.
Adolescents and adults with disabilities.
In Home Supportive Services (IHSS) sweb/PG139.htm ‐Accompaniment to medical appointments
‐ House cleaning
‐ Laundry Laundry, grocery shopping
‐ Meal preparation
‐ Personal care services (i.e., bathing)
‐ Protective supervision
‐ Medi‐Cal
Individuals who are disabled or blind or over 65 years old, who
‐ Are U.S. citizens or qualified aliens
‐ Are California residents
‐ Live at home or in an abode of their own choosing
‐ Have personal property not exceeding $2,000 for an individual or $3,000 for a couple
‐ Meet SSI eligibility requirements
Parent Training and Information Centers (PTIs) ‐ Training and information for parents of infants,
toddlers, children, and youth with disabilities
‐ Training and information for professionals
None. Most Parent Training and Information Centers provide services free of charge to both parents and professionals.
Regional Centers .cfm The Regional Center provides case coordination and funding for services and supports for individuals with disabilities. Services can begin from birth and if eligible, the individual may continue to receive services throughout their lifetime.
Services include, but are not limited to:
‐ Adaptive equipment services
‐ Behavior modification
‐ Daily living skills training
- Mental health services
‐ Recreation
‐ Respite
‐ Supported living arrangements
‐ Transportation
‐ Disability that originates before an individual attains age 18 years, continues, or can be expected to continue, indefinitely, and constitutes a substantial disability for that individual.

‐ Substantial disability" means the existence of significant functional limitations in three or more of the following areas of major life activity, as determined by a regional center, and as appropriate to the age of the person: 1) self‐care, 2) receptive and expressive language, 3) learning, 4) mobility, 5) self‐direction, 6) capacity for independent living, 7) economic self‐sufficiency.
‐ Includes mental retardation, cerebral palsy, epilepsy, autism, and disabling conditions found to be closely related to an intellectual disability or to require treatment similar to that required for individuals with an intellectual disability.

Supplemental Security Income (SSI) i.htm ‐ In Home Support Services
‐ MediCal
‐ Monthly income
‐ Protective services
‐ Person must have low income/resources and must be blind or disabled or over age 65
‐ A child may be eligible for SSI disability benefits as early as the date of birth until age 18. When the child turns 18 s/he is evaluated again under the definition of disability for adults
Special Education Specially designed instruction to meet the unique needs of a child with disabilities. Instruction can be provided in a classroom, in the home, hospitals, and other settings.
Related services include, but are not limited to:
‐ Adapted physical education
‐ Audiological services
‐ Counseling and guidance
‐ Health and nursing services
‐ Instruction in the home or hospital
‐ Interpreting services
‐ Language and speech development and remediation
‐ Orientation and mobility instruction
‐ Parent counseling and training
‐ Physical and occupational therapy
‐ Psychological services
‐ Recreation services
‐ Social worker services
‐ Specialized driver training instruction
‐ Specialized services for low‐incidence disabilities, such as readers, transcribers, and vision and hearing services
‐ Specially designed vocational education and de elopment career development
‐ Vision services
‐ Age 0 through 21 years
Has one or more of the following conditions:
‐ Autism
‐ Deaf‐blindness
‐ Deafness
‐ Emotional disturbance
- Hearing impairments
‐ Mental retardation
‐ Multiple disabilities
‐ Orthopedic impairment
‐ Other health impairment (includes ADD/ADHD)
‐ Specific learning disability
- Speech or language impairment
‐ Traumatic brain injury
‐ Visual impairment
‐ In California, a child may also be found eligible under the category of established medical disability.
‐ Needs special education and related services.
‐ Requires instruction and services which cannot be provided with modification of the regular school program in order to ensure that the individual is provided a free appropriate public education.

* The information contained in this document has been collected from a number of sources. Changes to eligibility and services occur frequently. Please check with individual agencies for the most up‐todate information. If you find that any information is incorrect please email us at: [email protected]. More information available at:


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