2026 ICAAP Early Childhood Survey
Please take this brief anonymous survey to help inform ICAAP's Early Childhood programming and our advocacy for improved statewide systems.
I am a:
*
Physician
Dentist
Nurse
Allied health professional
Non-health professional
Clinic/office zip code(s):
*
Do you refer patients to Early Intervention (EI)?
*
Yes
No
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2026 ICAAP Early Childhood Survey
How often do you refer patients to EI?
*
1-5 times a month
6-10 times a month
11-15 times a month
More than 15 times a month
How do you refer patients to the EI program?
(check all that apply)
*
Standard EI referral form
Specific CFC handout/phone number (based on zip code)
General EI handout/phone number
Prescription form unique to practice
Call CFC to refer patient
EPIC template email
Share EI connection information with parents and ask them to call
Other
What method(s) do you use to refer patients to the EI program?
(check all that apply)
*
Phone
Fax
Email
Electronic Medical Record (EMR)
Other
Who in your office administers and submits the referral?
(check all that apply)
*
Pediatrician
Medical Assistant/Nurse
Care Coordinator
Social Worker/Patient Navigator
Other
What is the most common reason for you to refer a child to EI?
*
Elevated lead levels (>3.5 micrograms per deciliter)
Developmental delay
Parental mental health
Low birth weight (<1 kilogram, or 2.2 pounds) and admitted to the NICU
Other
How often do you receive communication from the EI program after referring a patient?
*
Always
Often
Seldom
Never
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2026 ICAAP Early Childhood Survey
Why do you not refer patients to EI?
(check all that apply)
*
I do not know how to navigate the EI referral system.
I do not feel confident in my ability to identify EI candidates.
I have not had positive past experiences referring patients to EI.
Other
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2026 ICAAP Early Childhood Survey
What are the biggest barriers you face in referring patients to the EI program?
(check all that apply)
*
Time constraints
Unfamiliarity with types of programs that are available
Unfamiliarity with availability of services locally
Confidentiality concerns
Complicated referral process
Inability to follow up on referrals
Lack of confidence in the system
Other
Oftentimes an EI referral originates from another source, such as a daycare provider or teacher, but still requires a physician sign-off before clinical
treatment
can begin. Are you comfortable signing the EI authorization (for OT, PT, Speech, etc.) if the referral was made by another person or agency?
*
Yes
No
Sometimes
Other
What would make you feel more comfortable?
*
What do you tell caregivers about receiving EI services via Live Video Visits (telehealth/telemedicine)?
*
They are a good option if in-person services are not possible.
They are not a good option and parents should refuse them.
They are helpful in coaching parents on various therapy elements.
I do not mention Live Video Visits when referring patients to EI.
Other
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2026 ICAAP Early Childhood Survey
Are you familiar with Early Childhood Home Visiting in Illinois?
*
Yes
No
Do you refer patients to Home Visiting?
*
Yes
No
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2026 ICAAP Early Childhood Survey
How often do you refer patients to Home Visiting? (HV)?
*
1-5 times a month
6-10 times a month
11-15 times a month
More than 15 times a month
How do you refer patients to HV?
(check all that apply)
*
I contact Coordinated Intake.
I contact HV programs directly.
My clinic's patient navigator, care coordinator, or social worker handles the referral.
I give the information to parents and ask them to call for a referral.
Other
Which Coordinated Intake do you contact?
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2026 ICAAP Early Childhood Survey
Why do you not refer patients to Home Visiting (HV)?
(check all that apply)
*
I do not know how to navigate the HV referral system.
I do not feel confident in my ability to identify HV candidates.
I have not had positive past experiences referring patients to HV.
Other
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2026 ICAAP Early Childhood Survey
What do you need to facilitate a better Early Intervention referral process?
*
What do you need to facilitate a better Home Visiting referral process?
*
What do you need to facilitate a better transition from Early Intervention to school-based special education?
*
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2026 ICAAP Early Childhood Survey
Which of the following Early Childhood Development topics are of greatest concern to you in your practice?
(choose a maximum of
three
)
*
Early Intervention
Home Visiting
Evaluation for Developmental Delays
Referral to support services for children with a diagnosis of autism (such as ABA)
Social Determinants of Health
Early Relational Health / Social-Emotional Development
Breastfeeding Support
Parental Mental Health
Trauma-Informed Care
Other
As of July 1, 2026, Illinois has a new agency – the
Illinois Department of Early Childhood (IDEC)
. It will be the lead state agency for Early Intervention, Home Visiting, Child Care Licensing, Head Start, and a range of other early childhood programs. What additional information would you like about IDEC?
(check all that apply)
*
How to engage with IDEC workgroups
How IDEC ensures medical compliance of its programs
EI referral instructions for pediatric providers
How to file an EI complaint
Home Visiting referral instructions for pediatric providers
Where to direct families for more information on IDEC programs
How to get involved in IDEC committees or workgroups
Information about IDEC news and events
Other
Are you interested in joining ICAAP's Early Childhood Committee?
*
Yes
No
First Name
Last Name
Email
Please enter your contact information or email rpikelny@illinoisaap.com.
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