Early intervention for children under age three is mandated by the Individuals with Disabilities Education Act (IDEA), the federal law governing special education. Part C of IDEA requires that infants and toddlers eligible for early intervention receive services in natural environments as much as possible. However, in some cases, services may also be provided in a clinical setting, such as a therapy clinic or a center-based program.
Natural environments are settings that are natural or typical for a same-aged infant or toddler without a disability, and may include the home or community settings. Clinic-based therapy is therapy received in a medical setting outside of your home — this may be at a doctor’s office, a hospital, a dedicated therapy clinic, or even a therapist’s home clinic. The therapy is provided in a setting that has been designed for that purpose, which gives the therapist and child access to a wider range of specialized equipment and simulated settings constructed for therapeutic use.
Another type of clinical setting is a center-based program. These early intervention programs are usually available beginning around age 18 months, although there are some programs that serve infants as well. Center-based programs mimic classrooms and teach socialization, routines, and behavior expectations, and they often have on-site OTs, SLPs, PTs, behaviorists, and feeding specialists. A center-based program can be key to setting up toddlers for success in preschool and beyond as they help kids learn and practice skills in a kid-friendly, stimulating environment.
Note: if a center-based program provides integrated therapy services, the Regional Center will sometimes consider the child’s therapeutic needs to be met by that program. However, a therapist may recommend that the child be seen both in the center-based program and for 1:1 therapy outside the program. In that case, you will need to provide documentation of medical necessity and be able to demonstrate that this is not a duplication of services due to the child’s additional needs.
The biggest benefit to getting EI services in the natural environment (usually in-home) is that kids might feel safer being in a familiar setting with familiar smells, sights, objects, and people. They can learn skills in their home environment where they spend most of their time, with people with whom they are familiar, such as parents, siblings, and caregivers. In-home therapy also helps incorporate certain daily living skills like eating or bathing more easily into the program, and it can also target specific skills to help the child access their natural environment. Children may also require home-based therapies when it is difficult to transport them due to medical complexities or significant difficulties with car rides, when they are immunocompromised, or when there is no clinic-based program within a reasonable distance from their home.
Most private insurance companies, especially HMOs, will only offer early intervention services in-clinic. But there may be cases where you will want your child’s services to take place in-home or are otherwise unable to utilize your insurance’s therapy benefits. Some examples:
Sometimes, getting services in-clinic is a better fit for kids. Clinics and centers can offer more structure in the environment as well as access to larger or more varied equipment. For example, a child with sensory integration difficulties might benefit from access to swings, hammocks, ziplines, a trampoline, areas for messy play, a ball pit, etc. A child may also require a space with a selection of adaptive equipment (such as walkers or gait trainers in various sizes, or swings or chairs designed for kids who need trunk support) and safety features, such as a large area with a thick mat to protect from falls. While therapists usually bring therapeutic supplies with them to in-home therapies, some of this equipment may be difficult to transport.
A clinic might also be more appropriate if it would be difficult to do therapy due to factors in the home environment. Lisa says, “As a parent, if there are a bunch of other siblings running around and it's distracting the child, you might want to be outside the home for early intervention therapies…Or if the family’s home doesn’t have room to do physical therapy — for example, if there isn’t a lot of open space, or somebody is renting a room with their child, they might not have a space to do certain therapies. Not everyone has access to a yard, either. So it just really depends on the family's circumstance.”
You may have specific needs or preferences regarding therapeutic setting, but ease of access will depend on your funding route, and you may need to fight for your child’s needs. The settings that are most readily available will depend on how you’re accessing and funding early intervention services. In short, Lisa explains, the starting question is, “Who’s paying for it?”
Private insurance and/or Medi-Cal
You’ll see the biggest difference when you're dealing with insurance versus Regional Center. “With early intervention,” Lisa explains, “you go through your private insurance first. And with private insurance, the in-network providers will usually be in a clinic-based setting. If it's a PPO that will accept a superbill from an out-of-network provider, you might be able to find a therapist who can come to your home and then issue superbills that you can submit to your insurance. But if it's an HMO, services are generally going to be in a clinic. So if [funding] is coming through private insurance, it's going to depend on what your insurance covers.”
For people who don’t have private primary insurance, Lisa explains, “Medi-Cal is generally not going to provide in-home services [either]. Medi-Cal provides In-Home Supportive Services (IHSS), but it’s not going to be providing in-home therapies because almost everyone has a managed care plan, which has a closed network of providers, or the plans contract with outside clinics.”
Regional Center
Lisa continues, “If the Regional Center is paying, then 1:1 therapy is usually going to be in-home as the default, unless clinic-based services are recommended. But because Regional Center is the payer of last resort, you would need to go through private insurance first regardless of which setting you’re seeking.”
Note that services from Regional Centers are for kids who have been diagnosed with, or are at risk for, developmental delays or developmental disabilities. If your child doesn’t qualify, you would need to go through private insurance, Medi-Cal, or other avenues of early intervention. Early intervention services from the local education agency are generally provided only to children with certain low-incidence disabilities, like vision or hearing impairment. SELPA funding can also be used for low-incidence needs, and only if the child has a single disability. Most children will receive their early intervention services from Regional Center. To learn more about what early intervention is and all the ways early intervention can be funded, read our article What Is Early Intervention? - The 4 Ws of Early Intervention.
As Lisa explains, “Again, sometimes with a PPO, they'll let you choose a sole practitioner who can give you a superbill and then you can submit it to the insurance, but HMOs don't work like that.” She shares that with Kaiser, for example, superbills are generally not accepted, and you would need to choose a clinic contracted with Kaiser. If you believe your child requires home-based services, you should be prepared to demonstrate to the Regional Center 1) why the in-network therapy is not appropriate and 2) that the insurance will not fund therapies in the home. For the latter, you would need to request home-based therapies from your plan and receive a written denial that you can present to the Regional Center.
Lisa gives us a similar example with diapers: “If you want the Regional Center to pay for diapers, you need to have a reason why the insurance or Medi-Cal diapers don't work. It's not just, ‘I like them better,’ or ‘They’re higher quality.’ It would have to be based on medical necessity or IPP goals, e.g. the child is allergic to the diapers, or they don’t fit the child properly or are too thin and cause frequent leaks, limiting access to community inclusion.” In the same vein, when private insurance benefits are otherwise available, Regional Center funding for in-home services won’t be approved because you just prefer having a service at home; there has to be a reason why the child needs it.
In short, then, the Regional Center will always look to the private insurance and other generic resources first, Lisa says, so the private insurance would be responsible “unless you can make a compelling argument for why the generic resource isn't appropriate for the child. And in this case, it's the reasons why your child needs the service to be at home, and the fact that the insurance won’t provide it.”
On the other hand, if you feel that services need to be in a clinic and the services are being funded by the Regional Center because your insurance isn’t covering the therapies, you should discuss your concerns with the provider who does the initial therapy assessment (or with the therapist, if you’re already receiving home-based services). If the therapist recommends clinic-based services, they should indicate that in the assessment they submit to the Regional Center. If you feel that a clinic-based environment would be more appropriate but the therapist disagrees, you may wish to have your doctor write a letter of medical necessity. As Lisa says, “The law says that they should receive services in their natural environment as much as possible, and not they must receive services always in their natural setting.”
As you can see, in-home and clinic-based services are available for all ages, and are funded in many ways: private insurance (either in-network or out-of-network, where superbills can be submitted for partial reimbursement), or government services such as Regional Centers, California Children’s Services, SELPA, or in some cases, Medi-Cal. To learn more about how early intervention is funded, read our article What Is Early Intervention? - The 4 Ws of Early Intervention.
What if your insurance offers therapy benefits but you can’t access them and still need the Regional Center’s help? Let’s look at some scenarios in which you might need the Regional Center to help fund services even if you have private insurance:
Scenario: Insurance only provides clinic services, and you believe home services are medically necessary.
See the information above about getting a letter of medical necessity from your doctor.
Scenario: Insurance provides clinic services and you’re fine with clinic services, but there are no in-network providers available, or there is a long wait list.
Sometimes, health plans are more prepared to provide therapy to children and adults who have suffered acute injuries, and they aren’t equipped to provide ongoing services to children with developmental disabilities. If your plan doesn’t have an available provider, or the only provider is far away, you may be able to request that the Regional Center fund the therapies instead.
If your plan has available providers, but they have a long wait list, you can request that the Regional Service provide gap funding so that your child doesn’t miss critical months of early intervention due to provider wait times. You will still need to get onto the wait list with an in-network provider and transition to them when your child comes off of the wait list.
Scenario: Insurance provides services but limits annual visits.
Some plans have an annual cap on the number of therapy visits a patient can utilize. Usually, you will need to exhaust your plan benefits before the Regional Center will take over funding services. However, if your plan has a very low visit cap and your child has difficulty adapting to change or developing rapport with new providers, you may wish to ask the Regional Center to consider covering services immediately as an exception, without having to exhaust insurance visits first.
Scenario: Insurance covers the services, but the copays add up.
Even if your per-visit copayment is not too high, those out-of-pocket expenses add up when your child has multiple therapies per week, sometimes even per day. If your copayments are becoming a financial hardship, Regional Center may be able to assist.
Benefits
For in-home therapy, the therapist travels to you! This can be especially important if you have a medically complex child, for example, and need monitors, feeding tubes, and other medical equipment you can’t travel with. It’s also helpful by reducing the amount of germs your child is exposed to, compared to going to a clinic or center. Home-based therapies can also help you see how you can incorporate the therapies at home when you’re alone with your child. Kids can also receive services in a familiar environment with familiar smells, sights, objects, and people.
For clinic-based programs, therapists have more access to specialized equipment such as therapy swings, walkers, standers, etc. If your child is in a center-based program, you can also have multiple therapists seeing your child in one visit, such as a OT, PT, and speech therapist, and they can collaborate on goals and have an integrated treatment plan. Clinics may also be more controlled settings, which can reduce sensory input from distractions that might be happening at home. They can also incorporate socialization goals that can’t be met while working in the home setting.
Who funds these services?
Clinic-based services are typically paid through insurance (i.e. private insurance or Medi-Cal), and based on your insurance coverage, there may be a copay. If there is no insurance coverage, then your Regional Center should provide services. For in-home therapy, services are usually through the Regional Center, or insurance if medically necessary, and the insurance allows for in-home therapies. If the insurance only allows clinic visits, you will need to demonstrate medical necessity in order to get Regional Center to provide home-based therapies instead.
How long can a child receive early intervention services?
When going through private insurance, a child can get services as long as they are medically necessary and your child qualifies based on insurance. With Regional Center, early intervention is until the age of 3. After this, your child would continue services through the school district. However, children over 3 can still be eligible for Regional Center services if they have a qualifying developmental disability that is expected to continue indefinitely and that constitutes a substantial disability.
In California, early intervention services are provided to infants and toddlers with disabilities through Early Start. The statewide system of early intervention services is available throughout California and can be accessed through Regional Centers for developmental disabilities, county offices of education, local school districts, health or social service agencies, and family resource centers.
The first step is to tell your child’s provider and ask for appropriate assessments and screenings. Your child’s provider may refer you to a specialist if further assessment is required. Read our article The 4 Ws of Early Intervention: WHO Do You Go to for Help? for more information on building a care team. With early intervention services, professionals such as developmental-behavioral pediatricians, occupational therapists, physical therapists, and speech therapists will evaluate your child to identify areas of concern, such as delays in socialization, behavior, development, or learning. They’ll then put together a plan to address those areas with different types of therapy.
You can contact your state or territory’s early intervention program to find out if your child can get services to help. In California, this would be Early Start. California parents can also request a screening for services directly through Regional Center, who will evaluate the child to determine their eligibility for early intervention services; a referral from a professional is not needed.
Save your favorite resources and access a custom Roadmap.
Get Started
