Two sentences, usually a week apart, send families into this question. The pediatrician says, "Let's get you a referral to ECI." A friend at the park says, "Don't wait for the state, just find a private speech therapist."
Those sound like two sides of one decision. They are not — they are not even the same kind of thing. Early intervention is a program: a funding and eligibility system created by federal law and run by your state. Speech therapy is a service: an hour with a speech-language pathologist. Speech therapy can happen inside early intervention, outside it, or both at once.
So the real question is not "which therapy." It is: do you go through the public program, go privately, or do both? That depends on three things nobody explains up front — the eligibility threshold, who actually shows up at the visit, and what happens on your child's third birthday.
Early Intervention Is a Program, Not a Method
Early intervention for children under three comes from Part C of the Individuals with Disabilities Education Act. Congress sets the framework; each state builds and runs its own program. In Texas, that program is Early Childhood Intervention, described by Texas Health and Human Services as "a statewide program within the Texas Health and Human Services Commission" serving families with children from birth to 36 months who have developmental delays, disabilities, or certain medical diagnoses.
A few structural features matter for comparison shopping.
Services come to you. ASHA's clinical guidance on early intervention notes that "IDEA Part C requires that EI services be provided, to the maximum extent appropriate, in natural environments." Texas HHS puts it practically: most ECI services happen at home, or in the other places a child regularly spends time, such as a grandparent's house or a daycare classroom.
A plan, not a prescription. Eligible children get an Individualized Family Service Plan — an IFSP — written at a team meeting that includes the family, a service coordinator, and providers. The IFSP decides which services a child receives and how often, and it is reviewed on a schedule or whenever any team member, parent included, asks.
The family is the target, not just the child. ASHA describes a deliberate shift "toward family-implemented interventions and collaborative consultation." Visits are built around teaching caregivers to use strategies in daily routines, rather than around a specialist working with the child while the parent waits.
Anyone can start it. Texas HHS states that "anyone who has a concern about a child's development can make a referral to ECI" and that "a referral does not have to be made by a professional." You can refer your own child, today, without a doctor. About 55 percent of ECI referrals come from physicians or other health care providers — which is exactly why so many parents believe they are supposed to wait for one. Months get lost in that gap.
The Eligibility Gate Is the Part That Decides Everything
Here is what families almost never hear before the evaluation, and it is the single most useful thing on this page.
Texas ECI eligibility runs through one of three doors, per HHS's information for families. A child must be under 36 months, live in Texas, and have either:
- "A medically diagnosed condition likely to cause a developmental delay and demonstrate a need for services"
- "A vision or hearing impairment as defined by the Texas Education Agency"
- "A developmental delay of 25 percent in one or more areas of development" — or "a 33 percent if the delay occurs only in the area of communication"
Read that last line again. A child who is behind in several areas qualifies at 25 percent. A child whose only concern is talking has to be 33 percent behind to get in.
That is not an accident of wording; it is a policy decision, and it falls hardest on exactly the child most parents are worried about. The classic late talker — walking on time, playing well, socially engaged, affectionate, and simply not using words — is the child held to the higher bar. Plenty of them test at 25 or 30 percent and are told they do not qualify. Parents hear that as "a professional evaluated my child and said nothing is wrong." It does not mean that. It means the delay measured smaller than a threshold the state wrote.
Thresholds also vary enormously by state. ASHA notes that "definitions of eligibility for Part C services can differ significantly from state to state," that "states with more restrictive eligibility criteria have lower rates of EI use," and that only six states serve children considered "at risk" for developmental challenges without a measured delay. A family that moves from one state to another can genuinely qualify in one and not the other with the same child.
None of that is a reason to skip the referral. The evaluation is free and the answer may well be yes. It is a reason to have a plan for the word "no" — because "no" from ECI is a funding answer, not a clinical one. If you are trying to judge the underlying concern on its own terms, our guide to the signs your child needs speech therapy lays out the age-banded red flags, and our review of whether speech therapy is effective for toddlers covers what the research actually shows for late talkers, including when monitoring really is the honest answer.
What Each One Costs
Early intervention is not uniformly free, and the parts that are free are protected by federal regulation rather than by state goodwill.
Under 34 CFR 303.521, these functions "must be carried out at public expense" with no parent fee: child find, "evaluation and assessment," "service coordination services," and the "administrative and coordinative activities related to" the development, review, and evaluation of IFSPs and the procedural safeguards. Texas HHS lists the same categories for ECI — evaluation and assessment, case management, IFSP development, and translation and interpreter services — as available at no direct cost.
Beyond those, Texas operates a family cost share. HHS says ECI "asks families who can afford to do so to share in the cost of services," with fees on a sliding scale based on family size and income, and families at or below the federal poverty level are not charged. There is a published monthly maximum charge scale, the figures are revised annually, and ECI may ask permission to bill your insurance.
What a state may not do is let the bill decide access. The regulation is explicit that inability to pay "must not result in a delay or denial of services," and that a family meeting the state's definition of inability to pay "must be provided all part C services at no cost." If anyone tells you otherwise, they are wrong, and that is worth saying out loud at the meeting.
Private therapy is simpler to describe and usually more expensive: you pay a session rate, or your insurance does, or some combination. Our speech therapy cost guide breaks down the typical ranges and the ways families offset them, and insurance coverage for speech therapy covers what plans commonly do and do not pay for.
The comparison that actually matters is not price per session. It is this: early intervention is cheaper and eligibility-gated; private therapy costs more and is not gated at all.
What Private Speech Therapy Does Differently
Four differences are real. The rest is noise.
You choose the clinician. In ECI, the program assigns providers. Privately, you pick the person, which means you can pick for a specific credential or specialty — a PROMPT-trained clinician for a motor speech concern, someone who uses DTTC for suspected childhood apraxia of speech, or a therapist who also holds orofacial myofunctional credentials when feeding and oral development are tangled together.
There is no eligibility threshold. No percentage to clear. If you are concerned, you can be seen. That is the whole value of private care for the family whose child tested at 28 percent.
Frequency is a clinical decision, not a committee one. IFSP service levels are set by a team working inside a funded system. A private plan sets frequency from the clinical picture and what the family can sustain. Sometimes that means more often; sometimes it honestly means less.
It does not end on a birthday. More on that below, because it is the part that catches families off guard.
What private therapy does not get you is a service coordinator, a free evaluation, or the home-based, routines-embedded model that Part C is specifically built around. Those are genuine advantages of the public program, and they are not available for purchase.
The Question to Ask at the IFSP Meeting
This is the detail families find out six weeks in, and it deserves to be said plainly: your child's early intervention visits may not be delivered by a speech-language pathologist, even when the concern is speech.
ASHA explains that "state Part C programs are increasingly using a primary service provider (PSP) approach to service delivery," in which one provider carries the visits while consulting the wider team, and that "audiologists and SLPs may serve as PSPs, which sometimes requires role release and role extension." The primary provider might be a developmental specialist, an occupational therapist, a physical therapist, or an SLP.
This is a defensible design, not a bait and switch. One familiar face in a family's home beats four strangers rotating through, and the model is built around coaching caregivers, which is where most of a toddler's progress comes from anyway. ASHA also says the SLP "should be considered a primary provider when the child's needs are communication."
So ask, at the meeting, in these words: Who will be coming to our visits, what is their discipline, and how often will a speech-language pathologist see my child directly? The answer is not a verdict on the program. It is information you need to decide whether to add anything privately — and it is a question you are entitled to ask, because you are a member of the team that writes the plan.
Doing Both Is Normal
Nothing in Part C prohibits private therapy, and nothing about private therapy makes a family ineligible for ECI. The two are funded separately.
The common pattern looks like this: ECI provides the service coordination and the weekly or biweekly home visit; private therapy adds direct SLP contact at a higher frequency, or covers a specific area the IFSP is not addressing, such as feeding therapy or a motor speech method. Some families run both for a few months and then drop one. That is a normal outcome, not a failure.
The one thing worth doing deliberately is making the two talk to each other. Tell each provider the other exists, and ask that goals be coordinated rather than duplicated. Two professionals targeting the same five words from different angles is fine. Two professionals who do not know the other is there is how a family ends up doing twice the homework for half the progress.
And if your child is under three and you have not made the ECI referral yet, make it. It is free, you can make it yourself, and the evaluation costs nothing regardless of the outcome. Private therapy is not a reason to skip a free evaluation.
The Third Birthday Is a Cliff, and It Comes With a Deadline
Texas HHS states it in four words: "ECI services end when your child turns 3." There is no extension, no grace period, and no partial continuation.
Federal regulation builds a handoff, and the timeline is specific. Under 34 CFR 303.209, the lead agency must notify the state and local education agencies at least 90 days before the third birthday for any toddler who may be eligible for Part B preschool services. A transition conference with the family and the school district must be convened "not fewer than 90 days" before the birthday, and — with everyone's agreement — may happen as early as nine months before.
Two things about that handoff deserve emphasis.
First, the school district makes its own eligibility decision, under its own criteria. Qualifying for ECI does not mean qualifying for school-based services. A child can age out of one system and not be admitted to the next, which is how a family ends up with therapy one month and nothing the next.
Second, the regulation anticipates exactly that case. For a toddler who is not potentially eligible for Part B, it still requires the lead agency to make "reasonable efforts to convene a conference" with the family and "providers of other appropriate services." In practice, "other appropriate services" frequently means private therapy — which is why the months before a third birthday are the right time to find out what private care would look like, rather than the weeks after.
If your child is approaching three and you are not sure what comes next, that conversation is worth having early, while the ECI team is still at the table.
How to Decide
Under three, with any concern: refer to ECI first. Free evaluation, free regardless of outcome, and you can do it yourself without waiting on a pediatrician.
If the answer is no, do not read it as "nothing is wrong." It means the measured delay did not clear a state threshold — a threshold that is higher for a communication-only delay, and that would be a different number in a different state.
If the answer is yes, take it, and ask who is coming. Then decide whether the plan needs something added, rather than replaced.
If you want a specific method or credential, that is a private-practice question. Programs assign providers; they do not take requests for a particular training.
If your child is turning three, start early. The 90-day notification is a floor, not a plan, and the school district's decision is separate.
If the concern is feeding, oral development, or structure, say so explicitly. Those cross disciplines, and they are easy for a generalist plan to route around. Our comparison of speech therapy vs. occupational therapy covers where those boundaries usually fall.
What Bloom Does and Does Not Do
Bloom Speech and Myofunctional Therapy is a private practice. We are not a state ECI program, we are not an ECI contractor, and we do not determine Part C eligibility — those decisions belong to the program. If your child is under three and you have a concern, we would genuinely rather you make the ECI referral than skip it on our account.
What we provide is the other half of the picture: direct therapy with Laura Friedman, MS, CCC-SLP, QOM, specialty training in PROMPT and motor speech approaches, language delay and pediatric speech therapy services, feeding and orofacial myofunctional care under one roof, and a plan that does not end on a birthday. Sessions run in person at our Dallas office or through online speech therapy nationwide — and telehealth is often the practical answer for a family whose nearest specialist is an hour away.
Frequently Asked Questions
What is the difference between early intervention and speech therapy?
They are different kinds of things, which is why the comparison confuses people. Early intervention is a publicly funded program for children under three, created by Part C of the federal IDEA law and run by each state — in Texas, Early Childhood Intervention, administered by Texas Health and Human Services. Speech therapy is a service delivered by a speech-language pathologist, and it can sit inside an early intervention plan, be purchased privately, or both. The real question is public program or private practice, and the honest answer is usually to start the state referral first, because finding out costs nothing.
Who qualifies for ECI in Texas?
A child must be under 36 months, live in Texas, and meet one of three eligibility types: a medically diagnosed condition likely to cause a developmental delay, a vision or hearing impairment as defined by the Texas Education Agency, or a measured developmental delay. The threshold is "a developmental delay of 25 percent in one or more areas of development," or "a 33 percent if the delay occurs only in the area of communication." A toddler whose only concern is talking is held to the higher bar.
Does early intervention cost anything?
Some of it can never be charged for. Federal regulation requires that child find, evaluation and assessment, service coordination, and the administrative work of developing and reviewing the IFSP be carried out at public expense. Beyond those, Texas operates a family cost share — a monthly maximum on a sliding scale by family size and income, with families at or below the federal poverty level not charged — and ECI may ask to bill your insurance. Money may not decide access: inability to pay "must not result in a delay or denial of services," and a family meeting the state's definition of inability to pay receives all Part C services at no cost.
Do I need a doctor's referral for ECI?
No. Texas HHS states that "anyone who has a concern about a child's development can make a referral to ECI" and that "a referral does not have to be made by a professional." You can refer your own child. About 55 percent of referrals come from physicians or other health care providers, which is why many families assume a pediatrician has to start it — and waiting for one is a common way to lose months.
Will an SLP provide my child's early intervention speech therapy?
Sometimes. ASHA notes that state Part C programs increasingly use a primary service provider approach, in which one professional carries the visits and consults the rest of the team behind the scenes. That provider may be a developmental specialist, an occupational therapist, or an SLP. It is a deliberate design built around coaching caregivers, not a shortcut — but it means the right question at the IFSP meeting is who will be in your living room, and how often a speech-language pathologist sees your child directly.
Can my child do ECI and private speech therapy at the same time?
Yes, and many families do. The two are funded separately with no rule against each other. The usual pattern is ECI for home-based coaching and service coordination, with private therapy added for higher frequency, a specific method such as PROMPT or DTTC, or an area the IFSP is not addressing. Make sure both providers know about each other so goals are coordinated rather than duplicated.
What happens when my child turns three?
ECI ends on the third birthday, with no extension. Federal rules require the lead agency to notify the school district at least 90 days beforehand for a toddler who may be eligible for Part B preschool services, and to hold a transition conference not fewer than 90 days before the birthday — as early as nine months before, if everyone agrees. The district then applies its own criteria, so qualifying for ECI does not guarantee qualifying for school services. For children not potentially eligible for Part B, the regulation still calls for reasonable efforts to convene a conference about other services, which often means private therapy.
Is Bloom an ECI provider?
No. Bloom is a private practice, not a state ECI program or contractor, and we do not determine Part C eligibility. If your child is under three and you have a concern, make the ECI referral — it is free and you can make it yourself. What we offer is what sits alongside or after it: direct therapy with a speech-language pathologist, specialty methods, feeding and orofacial myofunctional care, and services that do not stop on a birthday.
Not Sure Which Door to Knock On?
If you have been told your child does not qualify, or you are waiting on a referral and watching the calendar, a conversation costs you nothing. Schedule a free consultation with Laura Friedman, MS, CCC-SLP, QOM — in person in Dallas or online nationwide — to talk through what your child is actually doing, what the ECI route would look like from here, and whether private therapy belongs in the plan now or later. If the answer is "make the ECI referral and call us back," you will hear that too.