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Upstairs, Jack is playing bingo with therapist Angela Giudice. He picks a card with a picture of a window on it, then scans his game board carefully, tracing his finger over images of a fish, a boat, a bus, until he finds his match. As he plays, he's practicing his pronouns and learning to ask questions. "One of the things we're working on is language," says Giudice. "He's come a longa very longway. He couldn't say a word when we started." Now Jack is talking, but very quietly. Giudice says that's because he's still nervous about speaking. He also has a hard time with transitions, like getting out of cars and changing clothes. "Things that come naturally to some children don't come naturally to him," she explains.
Early Start is one of the agencies that won't be doing evaluations anymore. Vetere says she was never told exactly why, but she suspects it's because the clientele in her area of the city don't usually have Medicaid. Other agencies sing the same tune. "Our clients have insurance," says Ann Marie Volte, who runs the early-intervention work at Programs for Special Children, based in Staten Island. "We took who came."
The city will still pay Early Start to treat kids like Matty and Jack, but without the ability to do evaluations, Veterewho is organizing a protest against the cuts at City Hall on June 13sees her client base drying up. "If you take away our evaluation contract, you're cutting us off at our knees," she tells the Voice. "We do believe it is the city's way of downsizing."
And the agencies who've been cut say there's more at stake than their own survival. "I think it's going to take children longer to get into the system," says Volte. And time is precious. Take a kid with torticollisa condition in which the head tilts to the side. "If that's how you start to stand, that's how you see the world," says Volte.
Kids with problems who don't enter the early-intervention system will probably end up getting special help eventuallyand perhaps needing morewhen they hit school. "If a child is serviced when the child is two we find that most of the problems a child has we can handle," says Mosesman. "If a child comes in at five or six years old, the child's going to be in the system much longer."
The city says that despite the reduced number of providers, there are no delays facing parents who want evaluations. "We're going to be serving the same number of children each year. They'll just be evaluated by agencies who understand how to reach kids who otherwise wouldn't get in the system," says Amgott. "We're totally assured that the needs of these families can be met by the remaining agencies." The affected agencies handled about a sixth of the early-intervention evaluations done last year.
But critics argue that not all providers are equal. Both Orlando boys will start nursery school next year in different special-education programs. Giudice is confident that it will be Jack's only year of special ed. The Orlando's credit their small-scale provider for that success. "If they close all the small agencies, kids are going to fall through the cracks and get lost. PDD and autism, it just comes up on you," says Melissa Orlando. "They lose things. They just start to lose skills."
As Jack played bingo the other day, a loud voice in the next room kept calling "Matty! Matty!" It was speech therapist Mindy Pottheiser trying to get him to make eye contact from his seat directly in front of her. He was working for Doritos, earning one orange-dusted chip each time he followed an instruction like "Stand up" or "Turn around." Sometimes Pottheiser stared intently at the boy to try to get him to make eye contact naturally.
Then they played a matching game. The deck was stacked with elephants of different sizes and colors to see if Matty understood their resemblance to each other. Other times of the week Matty might get massages or joint rubs, or wear a weighted vest. All the tactics are aimed at getting him to attach to the world, to connect him to the forces and feelings outside his skin.
"Every child is different," Pottheiser says, "and we just assess and reassess and reassess what's going to work."