Birth to Three West Virginia

Birth to Three is West Virginia's early intervention program for infants and toddlers from birth through age 35 months who have developmental delays or diagnosed conditions. It is funded through Part C of the Individuals with Disabilities Education Act (IDEA) and is coordinated through WVU's Center for Excellence in Disabilities. For foster and adoptive families in West Virginia — particularly those caring for infants with neonatal abstinence syndrome (NAS) — Birth to Three is one of the most important resources available.

Why This Matters for West Virginia Foster and Adoptive Families

West Virginia has one of the highest rates of NAS in the country. In some reporting years, the state recorded 37 NAS cases per 1,000 live births — compared to a national average of approximately 7 per 1,000. Infants born with prenatal opioid exposure are at elevated risk for motor delays, language delays, feeding difficulties, and sensory processing challenges in their first years of life.

The good news: research consistently shows that stable, responsive caregiving is the single strongest predictor of outcomes for NAS and substance-exposed infants. A retrospective cohort study of 387 NAS infants found that with stable home environments, developmental outcomes in cognitive, social-emotional, and language-communication domains were similar between infants who required pharmacological NAS treatment and those who did not. The caveat is that motor and language delays are the most frequently observed challenges between ages 2 months and 4 years — and early intervention is most effective when started early.

Birth to Three is free, community-based, and available regardless of family income or insurance status. For foster and adoptive families managing the complex needs of substance-exposed infants, there is no good reason to delay a referral.

Who Qualifies

A child from birth through 35 months qualifies for Birth to Three if they meet one of the following criteria:

• Established condition: A diagnosed physical or mental condition that has a high probability of resulting in developmental delay (e.g., Down syndrome, prematurity, NAS, prenatal drug exposure, genetic conditions, hearing loss)
• Developmental delay: A measured delay in one or more of the following domains: cognitive development, physical/motor development, communication/language, social-emotional development, or adaptive (self-care) development
• Informed clinical opinion: In West Virginia, a qualified evaluator can determine eligibility based on professional judgment even when standardized testing results don't meet delay thresholds

For children with diagnosed prenatal opioid or substance exposure, an established condition determination is typically straightforward. You do not need to wait for observable delays to appear — an NAS diagnosis alone is sufficient to qualify.

How to Make a Referral

Any person may refer a child to Birth to Three. You do not need to be a medical provider or a state employee.

Step 1: Contact the Child Find Referral Line
Call the WV Birth to Three statewide referral line. The number is maintained by the WVU Center for Excellence in Disabilities (CED). Referrals can also be made online through the WV Birth to Three website.

Step 2: Initial Contact Within 7 Days
Once a referral is received, the program must make initial contact with the family within 7 calendar days.

Step 3: Evaluation and Eligibility Determination
A multidisciplinary evaluation is conducted within 45 days of referral. It is free of charge and is conducted in the child's natural environment — typically your home. The evaluation team may include a speech-language pathologist, occupational therapist, physical therapist, or developmental specialist depending on the child's presenting needs.

Step 4: IFSP Development
If the child is found eligible, an Individualized Family Service Plan (IFSP) is developed. The IFSP outlines the child's current levels of development, the family's priorities and concerns, specific outcomes and goals, and the services to be provided. Services are delivered in the child's natural environment — home, childcare, wherever the child spends their time.

What Services Birth to Three Provides

Services are tailored to each child's IFSP and may include:

• Speech-language therapy: Addressing feeding difficulties (common in NAS infants), language delays, communication development
• Occupational therapy: Sensory processing, fine motor skills, self-regulation
• Physical therapy: Gross motor development, muscle tone issues common in NAS infants
• Developmental instruction: Structured activities and coaching for caregivers on how to support the child's development throughout daily routines
• Service coordination: A dedicated service coordinator manages the IFSP process, coordinates providers, and helps families navigate the system

Services are provided at no cost to families in West Virginia. Transportation assistance may be available if in-home services are not feasible.

NAS-Specific Considerations for Caregivers

Infants coming home from an NAS hospital stay have specific needs that Birth to Three providers are equipped to address. If you are bringing an NAS infant home, here is what to expect and how Birth to Three can help:

Feeding difficulties: NAS infants often have poor latching, excessive sucking reflex, and gastrointestinal symptoms including vomiting and loose stools. A speech-language pathologist specializing in feeding can assess and address these issues in your home setting.

Sensory hypersensitivity: Many NAS infants are hypersensitive to stimulation — loud sounds, bright lights, and even normal handling can trigger inconsolability. An occupational therapist can teach caregivers techniques for reducing sensory load and supporting self-regulation (swaddling methods, low-stimulation environments, holding positions).

Motor delays: High muscle tone (hypertonia) is common in NAS infants. Physical therapists can monitor tone, provide exercises, and identify when referral to a specialist is needed.

Language development: Even if there are no concerns in infancy, a language evaluation at 18–24 months is valuable for substance-exposed children, as delays sometimes emerge in the toddler period.

Request a Birth to Three evaluation as soon as possible after bringing an NAS infant home — the 45-day evaluation window means you could have services in place within two months of the referral, ideally during the period when the infant is still in acute withdrawal recovery.

Transition From Birth to Three to Preschool Services

At age 3, a child "ages out" of Birth to Three and transitions to the school-based special education system under Part B of IDEA. This transition is planned — the Birth to Three service coordinator works with the local school district's child find team to evaluate the child for continued services.

Children with ongoing developmental needs may qualify for preschool special education services (ages 3–5) through their local school system. Children who no longer meet special education eligibility thresholds may still access general preschool or Head Start programs.

The transition planning process begins at age 2 years 6 months, so families have time to prepare. Do not wait until the child turns 3 to ask your service coordinator about the transition process.

Birth to Three and the Right From the Start Program

West Virginia's Right From the Start program coordinates care specifically for NAS infants discharged from the NICU. Infants enrolled in Right From the Start are assigned a Designated Care Coordinator who ensures medical follow-up appointments are kept, monitors developmental milestones, and coordinates referrals to Birth to Three and other community services.

If you are taking an NAS infant home from the NICU, ask the hospital discharge team about Right From the Start enrollment. This program and Birth to Three work together — the Care Coordinator can initiate the Birth to Three referral if it has not already been made.

Getting Help

For foster and adoptive families in West Virginia navigating the early months with a substance-exposed infant, Birth to Three removes one major variable: you do not have to figure out developmental services on your own. Make the referral early, participate actively in the IFSP process, and lean on the service coordinator to help you navigate any additional programs or evaluations the child needs.

The West Virginia Adoption Process Guide includes a post-placement resource section with Birth to Three referral information and an NAS preparation checklist for families bringing substance-exposed infants home from the NICU.

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