Delaware County Early Intervention Partnership Agreement

Parent or Guardian First Name*
Parent or Guardian Last Name*
Phone Number*
Email Address*
Early Intervention is designed to support and inform caregivers and parents, and to impact their ability to promote their child's development.

Early Interventionists agree to:
1. Use the toys and materials that are already available to the child and incorporate them into strategies for learning.
2. Avoid cell phone use for the duration of the session.
3. Encourage parents and caregivers to try suggested strategies during sessions and offer feedback and support that will build confidence.
4. Ask the family questions about daily activities and routines at each session to more effectively embed strategies in the family's lifestyle.
5. Create an interactive environment where parents, siblings, caregivers and others who are important to the child are valued and engaged during sessions.
6. Accompany children and their caregivers to locations inside and outside of the home, as agreed upon by the team, where learning strategies can be incorporated.
Parents and caregivers agree to:
1. Be actively involved in each Early Intervention session. During the session, practice the strategies suggested by the Early Interventionist to get feedback and support.
2. Ask questions. Share your concerns and challenges about your daily routines with your interventionist.
3. Identify the routines that are important to your family so that strategies can be identified to support your needs.
4. Feel free to tell the Early Interventionist when strategies will not fit into your routines and lifestyle. Help come up with solutions and alternative strategies.
5. Agree to identify other important people in the child's life who participate in the family routines so that strategies can be shared to support the family's needs.
6. Agree to inform the Service Coordinator and Early Interventionist of changes in needs, priorities, and/or routines so that outcomes and strategies can be revised to support the changes.
The responsibilities and expectations of the Service Coordinator are explained in the Service Coordinator Support Plan.
Child's Name:
Early Interventionist Signature:

To be signed after form is submitted
Service Coordinator:
Date:
MM slash DD slash YYYY