When to Refer

Infants and toddlers, birth to 3 years old, may qualify for the Early Start Program and should be referred, if they present with any of the following:

Suspected developmental delay in any of the five developmental areas (motor, language, cognition, social-emotional or adaptive skills), or
Medical condition that has high probability of resulting in a developmental delay*, or
Combination of two or more biomedical risk factors**, or
Parent with a developmental disability
*Medical conditions with high probability of resulting in a developmental delay include:

  • Children with an orthopedic, vision, or hearing impairment.
  • Children with a genetic syndrome or medical condition with high probability of developmental delay, such as Down syndrome.

**Biomedical risk factors include:

  • Neonatal risk factors include prematurity less than 32 weeks or birth weight of less than 1500 grams, neonatal asphyxia, prolonged assisted ventilation, small for gestational age, neonatal seizures
  • Exposure to toxic substances, including fetal alcohol syndrome or prenatal exposure to known teratogens
  • Multiple congenital anomalies
  • Central nervous system infection, trauma, anomaly, lesion or afebrile seizures
  • Severe and persistent metabolic abnormality
  • Persistent hypertonia or hypotonia
  • Failure to thrive

How To Refer

Children Birth to Age Three:

The Early Start Program

Department of Developmental Services (DDS) is the lead agency for Early Start, California’s early intervention program under Part C for the Individuals with Disabilities Education Act (IDEA). DDS provides early intervention services in collaboration with the California Department of Education (CDE).

Early Start referral begins by contacting the regional center in your area. The regional center will connect the family to the local educational agency if appropriate. Ask to speak to the Early Start intake person. Anyone can make an Early Start referral to the regional center.

Note: Parent consent is a part of the referral process. Be sure to inform parents that they will need to give their consent to the regional center in order to start the evaluation process.

To find the regional center closest to the family’s residence:

  1. Search for the Regional Center Early Start Intake and Family Resource Centers on the DDS Website.
  2. Call the Babyline at 800-515-2229 (BABY) and leave a message. A DDS staff person will return the call during business hours. English and Spanish speaking staff are available and other languages may be requested in the message.

When making the referral, you will need to provide the child’s full name, date of birth, and zip code of residence.

For more information, visit the CIETAN Early Start Central Directory or DDS Early Start Website.

Children Age Three & Older:

Local School District Special Education Department

Access to intervention services and supports for children age three and older is guaranteed through the special education department of the local school district.

Parents, not the physician, must make the referral for further evaluation to determine eligibility for services. Primary care providers can support parents by providing them with information and resources to help them through this process.

Parents should contact their local elementary school or local education agency district office to determine where they should refer. They may also access the online California School District Directory to locate the appropriate school district for referral.

Primary care providers can provide a generic referral letter that parents can bring to their local school district. A sample referral letter is available here for download.

Referral Resources for Families

Primary care providers can direct parents to connect with their local Family Resource Center (FRC) for more information and support related to referral and early intervention services. Family Resource Centers provide peer-to-peer support for the child’s family and may offer activities, classes, community resources and transition assistance for families.

To locate the nearest FRC, families can search the online Resource Center Early Start Intake and Family Resource Centers, or leave a message with the Babyline at 800-515-2229 (BABY).

Resources to Help Families Track Developmental Milestones

CDC Learn the Signs. Act Early. has resources to help families to track and understand their child’s development including a Milestone Tracker mobile app.

Follow-Up After Referral

Follow-up with parents to ensure they have been in contact with agencies and community resources and have a plan for evaluation and early intervention services.
For children who do not qualify for services, routine surveillance screening is an essential component of each subsequent visit.
For children who do not qualify for services, provide age-specific developmental milestone sheets and activities.

If your county has a Help Me Grow (HMG) program, you can contact them for assistance. You can locate the a listing of HMG county affiliates in California by following this link: Help Me Grow California.