1. Early Intervention Services in Natural Environments Indicators C-1, C-2 and C-7 Analysis and Summary Report of All States’ 2008-2009 Annual Performance Reports Joicey Hurth Lynda Pletcher and Betsy Ayankoya, (NECTAC) November 10, 2010, 4:00 PM EST

2. Webinar Focus National Trend Data for C-1, C-2 and C-7 Continuing Challenges Improvement activities that are contributing to improved performance Implications for –State administrators –Personnel Preparation –Local administrators and providers

3. The analysis of data across Indicators C-1, C-2, and C-7 provides a national perspective on the extent to which early intervention services are: provided within timelines in natural environments.

4. Performance does not provide measures of the quality of services, but the extent to which these requirements of IDEA are being met. These analyses yield data on performance that is necessary but not sufficient to ensure quality

5. National Trend Data

14. Challenges to Meeting Timelines and Providing Services in Natural Environments

15. Personnel Shortages Shortages of therapists Difficulties in recruitment due to a discrepancy in pay Many specialists do not have a pediatric background and are unfamiliar with the evidence base in early intervention. Shortages in developmental specialists Other personnel issues include: too few evaluators, finding interpreters, losing private providers due to decreased rates or slowdowns in billing and reimbursement, and staff turnover.

16. Fiscal Barriers Severe fiscal crisis impacting the States mandatory budget cuts, state hiring freezes, furloughs or reduced hours Costs related to travel time and expense were barriers to providing services in natural environments. Inability to negotiate Medicaid reimbursements for children served outside of medical settings.

17. Challenges in the IFSP Process Scheduling delays Communication challenges Coordination with other agencies Requirements for prior authorizations for services

18. Challenges in Service Delivery Multiple providers acting separately Inadequate or no funding for “team-time”, the IFSP Meeting and training (especially private providers)

19. Comprehensive and Targeted Improvement Activities

20. Continuous Monitoring and Review of Data Continuous focus on local performance on the timeline indicators (C-1 and C-7) Regular performance reports (quarterly, monthly or even weekly) Develop capacity at the regional or local level to regularly monitor their own performance Ongoing public reports Tied fiscal rewards and sanctions to timelines. Used monitoring information to target T&TA to specific programs and root causes

21. Increase Personnel Capacity Comprehensive multifaceted activities Secured additional funding and used ARRA funds for personnel Hire state staff cover areas with chronic shortages Use retired personnel or school or clinic-based personnel on off hours Special rates for therapist Increase travel allowances

22. Redesigning Models of Service Delivery to Improve Effectiveness and Efficiency 14 states reported working on changes to service delivery system Shift away discipline- specific multidisciplinary approaches to a more integrated approach Primary provider approach to extend the reach of scarce personnel Pilots, T&TA and a focus on evidence-based practice

23. Distance service delivery Improve efficiencies: screening, streamlining evaluation /assessment, revising IFSP forms and guidance Streamlining prior authorization and provider enrollment Redesigning Models of Service Delivery to Improve Effectiveness and Efficiency

24. Implications for Policy Makers Build capacity for continuous monitoring and reporting to assure that causes of delays are identified and corrected quickly Improvement activities -data-based, comprehensive and long term to address the personnel shortages Monitor on quality measures as well as compliance and performance Investment in quality practice

25. Implications for Personnel Preparation Lack of knowledge and experience with Infants and Toddlers Some states require inservice orientation training to become a qualified provider Preservice programs need to include competencies for infant and toddler services and share the professional association’s position statements on natural environments and inclusive settings http://www.nectac.org/topics/natenv/natenv_position.asp (link available on webinar series page)

26. Implications for Administrators and Providers Embrace the mission: Promote young children’s successful participation in family and community activities through supporting families’ and caregivers’ capacity to promote their children’s learning and development Include quality measures about effectiveness of services & the quality of IFSPs in on-going monitoring activities Use data for program improvement

27. Full Reports Available On-line Part C State Performance Plan Annual Performance Report 2009 Indicator Analysis FFY 2008-2009 http://leadershipmega-conf-reg.tadnet.org/ uploads/file_assets/attachments/460/ original_Analysis_of_Part_C_Indicators_ FINAL080910.pdf?1283446411 (link available on webinar series page)

28. Early Intervention Services in Natural Environments Indicators C-1, C-2 and C-7 Thank you for participating. Presentations from this series and their related resources are made available on the NECTAC website at: http://www.nectac.org/~calls/2010/partcapr/partcapr.asp