Kentucky’s Early Intervention System November, 2011

 Kentucky’s Early Intervention System (KEIS) has been in existence since The Cabinet for Health and Family Services, Department of Public Health is the lead agency.  First Steps Regulations address CAPTA: ◦ 902 KAR 30:110 (1)(a) The point of entry (POE) staff shall serve as the local lead agency and shall coordinate child find efforts with: ◦ 6. The local Department for Community Based Services (DCBS) office for cases with a sustained or negligent complaint;

 Section 5.4 of the First Steps Policy and Procedures Manual addresses referrals from DCBS in detail.  “ The Individuals with Disabilities Education Act (IDEA) 2004 requires states participating in Part C to refer for early intervention services any child under the age of three (3) who is involved in a substantiated case of child abuse or neglect and/or is identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure.  All children referred from DCBS/foster parents with a developmental concern must be screened with both the ASQ-3 and the ASQ: SE as appropriate for age. (ASQ: SE begins at age three (3) months, ASQ-3 begins at age one (1) month).”

 Detailed procedures are found at:  99BE1C03021C/0/FirstStepsPolicyProceduresManual7511.p df (page 32 of 149) 99BE1C03021C/0/FirstStepsPolicyProceduresManual7511.p df  First Steps website:

Cabinet for Health and Family Services Department for Public Health Division of Maternal and Child Health First Steps Early Childhood Development Branch

 There are fifteen (15) regional Points of Entry (POEs) who serve as the local lead agency. All serve a multi-county district.  POEs accept referrals, handle all intake activities and provide ongoing service coordination.  IFSP early intervention services are provided by a network of approximately 1500 providers (independent and agency)

First Steps Phase of ServiceNumber of Children Referral & Screening903 Evaluation220 Eligibility Determination65 IFSP (ongoing services)4675 Total touched by First Steps on a typical day5863

 First Steps providers are expected to understand and implement early intervention services by: ◦ Focusing on the family/caregiver as the primary target for intervention ◦ Coaching/consulting the family/caregiver using a Primary Service Provider (PSP) ◦ Providing services and supports in settings where the family lives and plays

 Anyone can call or fax the Point of Entry (POE) office to refer a child to the First Steps service systems who may have a developmental delay or affecting medical condition.Point of Entry

All ReferralsCAPTA Referrals Data Source: TOTS  6628 Referrals  3754 Eligible Data Source: TOTS  651 Referrals  515Eligible & In service Note: Part C data collection changed to capture CAPTA referrals mid-year so data represents half a year.

 DCBS services are administered through a network of 9 service regions and offices in each of Kentucky's 120 counties.  Programs provided by DCBS include: family support; child care; child and adult protection; and eligibility determinations for Medicaid and food benefits.  DCBS also administers the state foster care and adoption systems and an energy cost assistance program.

 DCBS is a primary referral source for First Steps and is a required child find partner.  District Early Childhood Committees (DEICs) are required by the First Steps statute and mimic the state Interagency Coordinating Council (ICC). DCBS participates as a member of the DEIC in some regions of the state.

InquiryScreeningEligibility

 Children referred due to a suspected developmental delay are screened using two instruments: ◦ Ages and Stages Questionaire-3 (ASQ-3) ◦ Ages and Stages Social-Emotional (ASQ: SE)

◦ Established Risk Condition—list of over 240 medical conditions with high probability of disability or developmental delay ◦ Significant Developmental Delay– 2 S.D. in one area of development or 1.5 S.D. in two ◦ Professional judgment also allowed for eligibility determination in some cases—this is currently used for children with social-emotional disorders.

 Children referred due to the diagnosis of an Established Risk Condition are not screened. These children move directly to evaluation for eligibility.  Established Risk Conditions include: Fetal Alcohol Syndrome/Effects, Shaken Baby Syndrome, Head Trauma with Neurological Sequale

 What’s not included at this time: ◦ Failure to thrive ◦ Severe Attachment Disorders ◦ Anxiety Disorders ◦ And other social–emotional disorders  Kentucky will need to add social-emotional disorders that have a high probability for developmental delay to the Established Risk Conditions as a result of the new federal regulations for Part C.

 Terminology..what does Referral mean?  Who is making the referral?  When is the referral made?  Data collection—definitions/standards  Understanding eligibility for First Steps

Paula E. Goff Part C Coordinator Kentucky Department of Public Health