The recommendations from the EARLY START project are directed toward parents, nutritionists, program administrators, and providers who work with children under the age of 3 years. They can be adapted and used by other states as part of their system of community-based comprehensive services for children from birth to 3 years who are served by early intervention services.

1. Involve parents and families, staff, qualified nutrition services providers, and other appropriate providers in the development and implementation of models for delivery of nutrition services in early intervention. To increase the capacity of the early intervention program to provide quality nutrition services to clients, collaboration between families and early intervention team members — including the nutritionist — is essential. Collaboration and coordination with other community nutrition services are necessary for the development of a comprehensive, effective nutrition services delivery system.
   
   
2. Collaborate with families of children who have special health care needs to ensure that the nutritional services meet family needs. Provision of high-quality nutrition services should be based on a partnership with parents as providers and consumers of health care services for their children.
   
   
3. Identify during screening and evaluation children who are at nutritional risk. Ideally, screening for feeding, growth, and diet concerns should be completed as part of the initial intake process.
   
   
4. Use standardized screening and evaluation methods to identify children who are at nutritional risk. Although staff and parents can identify some children who are at nutritional risk, many will not be identified unless standardized methods are used.
   
   
5. Develop broad-based training and education programs for families, early intervention staff, and nutrition services providers. Nutrition knowledge and skills of early intervention staff and families should be enhanced through training, education, and support activities. Training early intervention staff in growth, nutrition, and feeding will increase the capacity of programs to provide appropriate information. Training and education programs for parents, early intervention staff, and nutrition services providers should reflect the community-based nature of early intervention programs and be both family centered and culturally appropriate. A network of trained pediatric nutrition services providers should be developed to expand the scope and quality of nutrition services that are available to children who have special health care needs.
   
   
6. Establish a state or regional group to plan for the provision of consistent nutrition services. Ideally, this should occur under the personnel development subcommittee of the statewide interagency coordinating council or its equivalent. Strategies and plans to integrate nutrition services within the early intervention service model should be developed by program administrators and providers. Guidelines to coordinate key players and provide nutrition services should be developed.
   
   
7. Develop a system of referral and follow-up care among all nutrition services providers in a community to ensure comprehensive services. A number of programs provide nutrition services to the early intervention population. Although the nature and the scope of services vary, collaboration among all nutrition services providers ensures comprehensive care without duplication of services.
   
   
8. Include nutrition services within information and referral systems for children who have special health care needs. Including nutrition services within information and referral systems will help families identify quality services, forge valuable linkages, enhance collaboration between hospital and community nutrition programs, and raise awareness of the importance of nutrition among family-centered, community-based services.
   
   
9. Develop a system to integrate nutrition surveillance data into statewide data systems. A nutrition surveillance and monitoring system for children who have special health care needs is needed to aid policy development and program planning at state health departments and in the agency in each state that leads in the implementation of Part C.
   
   
10. Identify mechanisms for reimbursement of nutrition services. Nutrition services are included under federal early intervention program mandates; however, the procedures for reimbursement vary for individual programs as well as for different states. Informing policy makers, providers, and families about funding resources and gaps is an essential first step to improving coverage for nutrition services.