1. 1 STATE SYSTEMIC IMPROVEMENT PLAN Early Intervention Colorado Technical Assistance Call April 3, 2014

2. PART C STATE PERFORMANCE PLAN (SPP) Will be one document combined with the Part C Annual Performance Report (APR) Will include the following Indicators: 1 – Timely Services 2– Services provided in natural environments 3 A,B,C – Child Outcomes 4 A,B,C – Family Outcomes 5 - Birth to age 1 child count 6 – Birth to age 3 child count 7 – 45 days to evaluation and initial IFSP meeting 8 A,B,C – Transition 9 – Hearing requests that went to resolution (N/A for CO) 10 – Mediations held that resulted in mediation agreements 11 – State Systemic Improvement Plan (SSIP) 2

3. SSIP Starting Point Started with an issue and connected to outcomes, practices/services and systems E.g. children with communication delays have a higher likelihood of lower outcomes in social emotional skills Is your hypotheses substantiated by the data? What other data do you have about the issue that substantiates your hypotheses that this is a critical issue for your state? (e.g. monitoring visits, complaints data, TA requests, etc.) 3

4. Data Analysis Broad Analysis Infrastructure Analysis Broad Analysis Focus for Improvement Theory of Action (improvement strategies and outcomes) Data Analysis In-depth Analysis Related to Primary Concern Area Infrastructure Analysis In-depth Analysis Related to Primary Concern Area Phase I Components

5. Search/evaluate evidence- based solutions (Exploration Phase) Develop action steps (address barriers/use leverage points) Develop Theory of Action and Logic Model Develop Plan for Improvement (Implementation Framework) Search/evaluate evidence- based solutions (Exploration Phase) Develop action steps (address barriers/use leverage points) Develop Theory of Action and Logic Model Develop Plan for Improvement (Implementation Framework) What shall we do about it? Conduct root cause analysis (including infrastructure) to identify contributing factors For each contributing factor, identify both barriers and leverage points for improvement Conduct root cause analysis (including infrastructure) to identify contributing factors For each contributing factor, identify both barriers and leverage points for improvement Initiate Data Analysis Conduct broad Infrastructure Analysis Identify problem area (Focus for Improvement) Initiate Data Analysis Conduct broad Infrastructure Analysis Identify problem area (Focus for Improvement) Evaluation of progress annually Adjust plan as needed Evaluation of progress annually Adjust plan as needed How well is the solution working? What is the problem? What is the problem? Why is it happening? SSIP SSIP Phase I SSIP Phase I and II SSIP Phase III SSIP Phase I

6. State Identified Measurable Results (SIMR) Focus for improvement through the implementation of the SSIP Must be clearly based on the Data and State Infrastructure Analyses Must be a child-level outcome (will be tied to one or more of the three child outcomes) Can be a single result or a cluster of related results Can begin with regional, disability, ethnicity category specific which can be scaled up statewide over the five-year period Baseline data used must match focus area Must be in alignment with other early childhood statewide initiatives 6

7. SSIP Possible Priority Area 1 If we identify the right kids and provide the right services (through a coordinated early childhood system) we will improve outcomes for children and families. What do we know? How do we know it? Where kids are: ABCD Project; primary care physicians; Early Intervention; child care; Child Welfare Data: DDDWeb; some public awareness data; Childcare Resource and Referral database; Child Welfare data (Trails); Medicaid Management Information System (MMIS) 7

8. Priority Area 1 Access to Services Why is it important? The earlier children are identified, the better – less impact on special education (fiscal and other) Would make a positive impact on school readiness Long-term effects on HS graduation/crime rates/successful adults What can we do? Potential solutions? More public awareness data Provide developmental guidelines literature in newborn birth packets including the possibility of signing up families for screening while still in hospital More training for in-home and private providers on how to talk to families and how/when to refer 8

9. Priority Area 1 Access to Services What can we do? Potential solutions? cont’d… More education on screenings and how they are helpful Solution around CAPTA, better communication with consistent information between caseworkers and service coordinators How can we measure it? Will this tell us we are successful? Number of Expanding Quality in Infant Toddler Care (EQIT) people trained compared to referrals from that area Within database we can know if we are successful if number of referrals being served goes up and terminated prior to evaluation/IFSP goes down Increase in referrals from child care facilities and providers and other early childhood programs 9

10. Priority Area 1 Access to Services What do we need? Consistent data around what in-home and private child care centers are doing regarding screenings, referrals Comparison by communities with ABCD projects (have in every community) and PCP referrals (appropriate referrals) How to reach un-licensed childcare facilities/providers Reach caregivers for children who are not centers, child care 10

11. SSIP cont’d… Possible Priority Area 2 If we could improve the way evidence-based practices are implemented to fidelity, we could improve outcomes for children and families. What do we know? How do we know it? Research tells us what evidence-based practices are: E.g. Autism Guidelines; Pyramid Model; DEC Practices; Routines-Based Early Intervention; Coaching model; Medical home model; Nurse Family partnership; Parents as Teachers; Safe Care; Strengthening Families; APTA, ASHA, OT Guidelines 11

12. Priority Area 2 Evidence-Based Practices What do we know? How do we know it? cont’d… Data of each program – overall performance level compared to their performance on the 3 child outcomes compared to overall program profile such as contractors vs. employed providers, Medicaid %, etc. Data on identified social emotional delays and diagnoses We don’t have evidence-based practices implemented consistently to fidelity statewide Study in Minnesota gathered data that could predict school graduation from social emotional predictors with 77% accuracy When families are brought into the process through a family approach, outcomes improve Plans that identify other services [besides EI] show increase in outcomes 12

13. Priority Area 2 Evidence-Based Practices What can we do? Potential solutions? More public awareness data Provide developmental guidelines literature in newborn birth packets including the possibility of signing up families for screening while still in hospital More training for in come and private providers on how to talk to families and how/when to refer Develop IFSPs that empower parents in building capacity to support their children Make sure transdisciplinary team is communicating 13

14. Priority Area 2 Evidence-Based Practices What can we do? Potential solutions? Cross-training and transdisciplinary model Use teaming and coaching support Multi-tiered system of support ECTA Dathan Rush and M’Lisa Sheldon training More Data – frequency and intensity of services in IFSP and what was delivered Number of providers active in plan Initiate in pilot sites, then go statewide Develop IFSPs that empower parents in building capacity to support their children Make sure transdisciplinary team is communicating 14

15. Priority Area 2 Evidence-Based Practices How can we measure it? Will this tell us we are successful? Measure through goals on the IFSP – are they comprehensive and looking at the whole child and family? What do we need? Better data system More resources to support training and technical assistance on implementing evidence-based practices to fidelity statewide System/strategies for measuring fidelity Data on social emotional delays and needs – Child Find data beyond SE services and percent of delay 15

16. Priority Area 2 Evidence-Based Practices What do we need? cont’d… Multi-tiered system of support Leadership development at all 20 CCBs System to measure competencies - service coordinators and providers Hard-core data to support measuring quality Data from Family Partnership Durham study More support to facilitate teaming (Medicaid issues, use of alternative meeting methods) More funding? 16

17. Why is it happening? How well is the solution working? What is the Problem? Why is it happening? What shall we do about it? SSIP Define the Problem

18. Priority Areas Identified by the CICC 1. If we identify the right kids at the right time and provide the right coordinated early intervention we will improve outcomes for children and families. 2. If we improve the way evidence-based practices are implemented to fidelity, we will improve outcomes for children and families. 18

19. Improved Outcomes for Children and Families Routines-Based Early Intervention and/or Coaching model: Autism Guidelines; Pyramid Model; DEC Practices; Medical home model; Nurse Family partnership; Parents as Teachers; Safe Care; Strengthening Families; APTA, ASHA, OT Guidelines 19

20. Routines-Based Early Intervention The provision of early intervention services within the child and family’s everyday routines, activities and places Includes Routines-Based [family] Interview 20

21. Coaching Model Coaching Model: Is an evidence-based strategy a practitioner uses to interact with parents, care givers and other early intervention providers to maximize child progress both when the practitioner is and is not present. recognizes what they are already doing that works to support child's learning and development as well as building upon existing or new ideas. recognizes the strengths and assets of parents, and uses these capabilities as the basis for promoting and building the parent's ability to support the participation of their child in the chosen activities of their day. The coach’s and learner’s primary goal is for the learner to demonstrate the competence and confidence for him or her to engage in self reflection, self correction, and generalization of newly acquired skills and strategies to situations without ongoing coaching. 21

22. Next Steps Engage in further infrastructure analysis and description based on required components for Phase I Broaden stakeholder involvement and partnering activities to select SIMR (required in all phases of the SSIP) Identify coherent improvement strategies Create theory of action 22

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24. Timelines Completion of described activities will be necessary by November 2014 to complete clearance process Phase I : SSIP submitted as part of the SPP/APR by February 2, 2015 Opportunities for stakeholder involvement: EI Statewide Meeting May 14 th & 15 th CICC Meeting - Denver, June 4 th Alliance Summit - Steamboat Springs June 19th & 20th 24

25. QUESTIONS? 25

26. Joint CDE/EI TA Calls – April 22 & 23 Required and Permitted Roles of CCBs and AUs for Early Intervention Colorado Implementation of Birth to Age 3 Child Find Requirements (side-by-side) Will be going over changes and edits to the side-by-side - please review prior to the call Notable clarifications will include: Family assessment responsibilities and timeline to conduct the assessment Post-referral screening Process when AU and/or CCB cannot meet the 45 day timeline to complete evaluation 26