Early Intervention as a Psych

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Psych20122

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I am a NYC school psychologist who was recently licensed. Since assessment has been my specialty for the past 9 or so years, I am planning to also begin testing for Early Intervention (ages 0-3). Does anyone have any experience or insight on working as a diagnosing psychologist evaluator for this level? What the pay working for agencies was like? Which instruments were most useful? I do have a lot of experience assessing in general, but mostly ages 3-11. I am familiar with a lot of the batteries that can be used as young as birth, but I know that tests are super expensive. I am hopeful to be ADOS-2 trained soon. As a general developmental battery, I have been looking at the DP-4. There is always the Bayley-4.. but some of my colleagues aren't big fans.

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I work almost exclusively with an EI population. Biggest differential DX in this age group is going to be between ASD, language disorder, and global delays in development. Also important to identify the extent to which cognitive delays might be impacted either (hint- they probably aren't, but you should check anyways!). For standardized direct tests, i use the Bayley-4 Cognitive and Language Scales, and will occasionally do the Bayley-4 Motor Scales if indicated, largely to get a baseline and aid with identifying/ruling out more global delays. I use the criterion referenced ADOS-2 (be sure to get REAL training, including on the Toddler Module). For parent quenstionnaires, for kiddos up to 2-6 I use the Bayley-Social Emotional Behavior Questionnaire (if kiddo is older than 2 and ASD is not primary rule out, I may use Vineland-3 and Behavior Assessment Scale for Children (BASC-2). Kiddo's older than 2-6 I use the Vineland-3 and the Social Responsiveness Scale (SRS-2). If there is any chance that you will be seeing kiddos older than 42 months (max age for Bayley Scales), you'll also need a preschool-primary aged cognitive battery, like the WPPSI-IV or Stanford Binet, as well as a language measure (If language obvious very low, I use Preschool Language Scale (PLS-5), if they are taking more, I really like the Comprehensive Assessment of Spoken Language (CASL-2), as it really does a good job of identifying between kids with a good receptive-expressive vocabuary for words who have difficulties with more complex language abilities (e.g., graphical morphemes; sentences; pragmatic language).


You should also be informed enough about traits related to more common genetic conditions to know when you should definitely refer to to a developmental pediatrician or neurologist. Most general pediatricians are pretty comfortable with ASD, so when I diagnose it I will typically direct families to inform the pediatrician and have a discussion about the need, if any for additional referrals. If I get a kiddo with potential signs of genetic or medical conditions (e.g, hallmark facial features; over 18 months and not waking), who the general pediatrician has not looked into a little bit more, I STRONGLY recommend the family ask for referral to a developmental Ped or Neurologist.

As far a salary expectation, EI assessments can work different in every state. In MA, where I am, the assessment needs to be done by a licensed psychologist health services provider or a pediatrician to qualify the child for insurance reimbursed ABA services (though there are some exceptions for kiddos in EI who are awaiting a more formal assessment). In CT, a Licensed Worker can do the assessment for EI (called "birth-three" there), and does the assessment in the child's home (!), but that won't qualify kiddo for after 3 ABA services for ASD. You mention you are a licensed school psychologist. Are you licensed at the doctoral level as a health services provider (or NY equivalent)? That will definitely impact salary range, as will experience, additional certifications (e.g. BCBA), other things you can offer the agency. Expect a lot of medicaid clients in EI.
 
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I work almost exclusively with an EI population. Biggest differential DX in this age group is going to be between ASD, language disorder, and global delays in development. Also important to identify the extent to which cognitive delays might be impacted either (hint- they probably aren't, but you should check anyways!). For standardized direct tests, i use the Bayley-4 Cognitive and Language Scales, and will occasionally do the Bayley-4 Motor Scales if indicated, largely to get a baseline and aid with identifying/ruling out more global delays. I use the criterion referenced ADOS-2 (be sure to get REAL training, including on the Toddler Module). For parent quenstionnaires, for kiddos up to 2-6 I use the Bayley-Social Emotional Behavior Questionnaire (if kiddo is older than 2 and ASD is not primary rule out, I may use Vineland-3 and Behavior Assessment Scale for Children (BASC-2). Kiddo's older than 2-6 I use the Vineland-3 and the Social Responsiveness Scale (SRS-2). If there is any chance that you will be seeing kiddos older than 42 months (max age for Bayley Scales), you'll also need a preschool-primary aged cognitive battery, like the WPPSI-IV or Stanford Binet, as well as a language measure (If language obvious very low, I use Preschool Language Scale (PLS-5), if they are taking more, I really like the Comprehensive Assessment of Spoken Language (CASL-2), as it really does a good job of identifying between kids with a good receptive-expressive vocabuary for words who have difficulties with more complex language abilities (e.g., graphical morphemes; sentences; pragmatic language).


You should also be informed enough about traits related to more common genetic conditions to know when you should definitely refer to to a developmental pediatrician or neurologist. Most general pediatricians are pretty comfortable with ASD, so when I diagnose it I will typically direct families to inform the pediatrician and have a discussion about the need, if any for additional referrals. If I get a kiddo with potential signs of genetic or medical conditions (e.g, hallmark facial features; over 18 months and not waking), who the general pediatrician has not looked into a little bit more, I STRONGLY recommend the family ask for referral to a developmental Ped or Neurologist.

As far a salary expectation, EI assessments can work different in every state. In MA, where I am, the assessment needs to be done by a licensed psychologist health services provider or a pediatrician to qualify the child for insurance reimbursed ABA services (though there are some exceptions for kiddos in EI who are awaiting a more formal assessment). In CT, a Licensed Worker can do the assessment for EI (called "birth-three" there), and does the assessment in the child's home (!), but that won't qualify kiddo for after 3 ABA services for ASD. You mention you are a licensed school psychologist. Are you licensed at the doctoral level as a health services provider (or NY equivalent)? That will definitely impact salary range, as will experience, additional certifications (e.g. BCBA), other things you can offer the agency. Expect a lot of medicaid clients in EI.
I do a ton of EI referrals. My process is a little different that ClinicalABA because my state allows for an "at-risk" for autism, ID, etc., diagnosis to qualify for early intervention until age six or so. My state is def bass ackwards in many ways, but we kind do early intervention right. Basically any kid zero to 3 can get it if they qualify. The early intervention peeps do their own evals.

So when a kid is under six, I'm pretty minimalist. When ASD is suspected, I'll generally throw an ADOS-2, good developmental interview, ASRS, ABAS, and maybe a WPPSI/PTONI if they show ability to participate in testing. I try to get collateral info via rating scales when feasible. For those under three, the homies who created the MCHAT just came out with TASI, which I've been digging.

The most challenging part about the three to six population is crafting reports in such a manner, you know including the correct phrases, so that insurance will cover ABA and they'll get services.

I'm kinda spoiled bc i'm in a pediatric setting and usually get referrals from genetics/neuro/etc.
 
Have you worked in this area yet? If not, are you planning on getting additional supervision?
I’ve mostly been assessing children aged 3-11 for the past 9 years. Probably over 1000 assessments. I have some experience in my practice (school based) assessing 2 year olds but not as much. I’m familiar with all of those instruments.
 
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