First Steps in Missouri: What It Covers and What Changes When Your Child Turns 3

First Steps at a glance

Who is eligible for First Steps in Missouri?

Children from birth to 36 months who qualify one of three ways.

1. A diagnosed condition linked to developmental disabilities. DESE lists "Autism Spectrum Disorders."
2. A condition with a high chance of causing a developmental delay.
3. Delayed development: half the level expected for their age in communication, adaptive, physical, cognitive or social-emotional skills.

Being "at-risk" alone does not qualify. For babies born early, First Steps uses an adjusted age. The eligibility criteria come from Part C of the federal Individuals with Disabilities Education Act (IDEA).

How do you make a First Steps referral in St. Louis?

Parents can refer their own child. So can doctors, hospitals, child care programs and schools. No diagnosis is needed to refer.

• Online through DESE's referral form, or call 866-583-2392, ext. 3.
• St. Louis area intake office (SPOE): 680 Craig Rd., Suite 308, St. Louis, 314-453-9203. It covers St. Louis County, St. Louis City and St. Charles County.

How long does First Steps take to start?

The evaluation, assessments and first family plan meeting must all happen within 45 days of the referral. The plan is called an Individualized Family Service Plan (IFSP).

The IFSP is reviewed every six months, or sooner if your child's needs change or you ask.

What does First Steps provide?

Early intervention services chosen with your family and delivered at home or in everyday places. DESE: "First Steps services are built into the family's normal routines rather than provided as direct therapy."

The state list includes occupational therapy, physical therapy, speech-language pathology, special instruction, service coordination, family training, assistive technology, audiology and vision services.

Does First Steps pay for ABA?

ABA is not a named First Steps service. Behavior analysts and registered behavior technicians can be enrolled First Steps providers when the IFSP calls for behavior support.

Families can also get ABA outside First Steps. MO HealthNet covers ABA under age 21 with an autism diagnosis, and Missouri law requires most private plans to cover it. Latitude's centers start at age 2.

What does First Steps cost?

• Always free: "evaluations, assessments, service coordination, IFSP meetings, transportation and translation/interpretation services."
• Other services: a monthly family fee of $5 to $100, set on a sliding scale by income and family size. It is one fee per family, not per child.
• $0: families on Medicaid, SSI or SNAP, or a child in foster care.
• Private insurance: billed only with your written consent. Saying no does not reduce services.

What happens when your child turns 3?

First Steps ends and your school district's early childhood special education (ECSE) decides eligibility for ages 3 to 5.

• Transition conference: between nine months and 90 days before the third birthday.
• IEP: must be in effect by the third birthday if your child qualifies.
• Summer birthdays (April 1 to August 15): you can stay in First Steps until the school year starts, or move to ECSE at 3.
• Late referrals: DESE warns that if the district gets your child's information less than 90 days before the third birthday, "a gap in services may occur."

In 14 St. Louis County districts, ECSE is SSD Early Childhood. If your child does not qualify, community preschools, Head Start and private services are still open.

Why start early?

Earlier usually works better. The CDC: "Intervention is likely to be more effective when it is provided earlier in life rather than later."

Geraldine Dawson, then chief science officer of Autism Speaks, said in a 2009 University of Washington release on a toddler study: "By starting as soon as the toddler is diagnosed, we hope to maximize the positive impact of the intervention." Read about early intervention ABA at Latitude.