1 Community Provider Spring Meeting Space Coast Early Steps April 8, 2011

2 Welcome House Keeping Meeting Agreements Turn cell phones on silent/vibrate Turn cell phones on silent/vibrate No text messaging during meetings No text messaging during meetings One person talks at a time One person talks at a time No side conversations No side conversations Listen as an ally Listen as an ally

3 SCES Update Program Director ITN ITN Invitation To Negotiate Budgetary Expectations Budgetary Expectations TPA TPA PSP Monitoring Data PSP Monitoring Data

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5 SCES Update Billing Department Medicaid HMO Medicaid HMO Insurance Changes Insurance Changes Provider Invoices Provider Invoices

6 New Contracts will be reflective of new policies Expect new Contracts Expect new Contracts mid June 2011

7 Early Steps Statewide Proposed Policy Changes

8 Proposed Changes to ES Policy B. Children made eligible by Informed Clinical Opinion (ICO) (not standard scores) B. Children made eligible by Informed Clinical Opinion (ICO) (not standard scores) Must be re-evaluated using a standardized test in the area/s of concern no later than the end of the 6 month service authorization period Must be re-evaluated using a standardized test in the area/s of concern no later than the end of the 6 month service authorization period SCES will authorize a re-evaluation This information is then used by the team to determine the childs eligibility This information is then used by the team to determine the childs eligibility

9 Proposed Changes to ES Policy For children between 24 and 36 months of age additional testing is required when: * standard scores do not meet eligibility * scaled scores for the expressive and receptive language sub domains show receptive language sub domains show a discrepancy of 3 or more points & at a discrepancy of 3 or more points & at least one sub domain is 5 or below least one sub domain is 5 or below

10 Proposed Changes to ES Policy Eligibility based ICO is ONLY allowed at the INITIAL determination of eligibility

11 Proposed Changes to ES Policy Determination of continuing eligibility Determination of continuing eligibility Annual re-determination Annual re-determination BDI-2 Screener BDI-2 Screener Completed by Staffed SCES ITDS 1 to 2 months prior to annual IFSP meeting Completed by Staffed SCES ITDS 1 to 2 months prior to annual IFSP meeting Screen report provided to FSC for annual IFSP meeting to assist with determining continuing eligibility Screen report provided to FSC for annual IFSP meeting to assist with determining continuing eligibility If screener indicates child is functioning comparably to same-aged peers team should determine whether the child should be closed or if an additional assessment is necessary to continue eligibility If screener indicates child is functioning comparably to same-aged peers team should determine whether the child should be closed or if an additional assessment is necessary to continue eligibility

12 Proposed Changes to ES Policy b Family Service Coordinators (FSCs) b Family Service Coordinators (FSCs) Must explain to the family the basis on which the child is being made eligible Must explain to the family the basis on which the child is being made eligible Services may be provided for a limited period of up to 6 months unless the child is re- determined eligible Services may be provided for a limited period of up to 6 months unless the child is re- determined eligible

13 Proposed Changes to ES Policy 5.6.4A 5.6.4A If unable to attend the periodic review = facilitated participation through telephone conference call, designated representative, making available pertinent records via mail or fax and/or videoconferencing is acceptable s and Text messaging is NOT to be used s and Text messaging is NOT to be used

14 Proposed Changes to ES Policy When a provider is providing an update on progress of the child toward on progress of the child toward achieving the outcomes on the achieving the outcomes on the IFSP they are expected to be IFSP they are expected to be involved in the review involved in the review

15 Proposed Changes to ES Policy At the periodic or annual meeting the IFSP team may decide to close the child & family to ES if the child is functioning comparably to same aged peers and there is no reason for the child or the Family to continue in ES At the periodic or annual meeting the IFSP team may decide to close the child & family to ES if the child is functioning comparably to same aged peers and there is no reason for the child or the Family to continue in ES

16 Proposed Changes to ES Policy B B. There is a MAXIMUM travel reimbursement of 60 minutes per child per day

17 Early Steps Homepage Early Steps Homepage NewMessagetoFamilies

18 Early Steps Homepage Message Shows a focus on interventions … Shows a focus on interventions … * Services are provided to the family and child where they live, learn and play, to enable the where they live, learn and play, to enable the family to implement developmentally appropriate family to implement developmentally appropriate learning opportunities during everyday activities and learning opportunities during everyday activities and routines routines * Most services will be early intervention home visits

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20 See you in 20 minutes BREAK

21 Primary Service Provider Approach Primary Service Provider Approach

22 What does it mean to you?

23 Primary Service Provider Approach Primary Service Provider (PSP) is the identified professional on the IFSP team that works with the child/family/primary caregivers on a regular basis and with other members of the team providing services directly, through consultation and/or joint visits

24 The primary purpose is to The primary purpose is to pool and integrate the expertise of team members so that more efficient and comprehensive assessment and intervention services may be provided Coston, ABD, CCC-SLP 9007

25 Primary Service Provider Approach In order to decide who on the IFSP team should be a particular familys PSP, the IFSP team should consider the following factors: In order to decide who on the IFSP team should be a particular familys PSP, the IFSP team should consider the following factors:IFSP teamIFSP team IFSP outcomes and strategies IFSP outcomes and strategiesoutcomes Relationship(s) with learner(s) (e.g. family members, other caregivers, other professionals) Relationship(s) with learner(s) (e.g. family members, other caregivers, other professionals)family Expertise (i.e., not solely discipline) in the areas of support needed by the child and family/caregivers Expertise (i.e., not solely discipline) in the areas of support needed by the child and family/caregivers Logistics (i.e., schedules, areas, availability) Logistics (i.e., schedules, areas, availability)

26 PSP Services determined based solely on evaluations and assessment reports = operating under a problem-centered framework Services determined based solely on evaluations and assessment reports = operating under a problem-centered framework Services determined based on family priorities and concerns = outcome-guided framework Services determined based on family priorities and concerns = outcome-guided framework Coston, ABD, CCC-SLP 9007

27 Primary Service Provider Approach The PSP is chosen after outcomes, goals, and strategies are developed and services/supports are identified

28 Benefits of the PSP model One Point of Contact Whole Child is Addressed Empowerment More Time to Be a Family

29 Service Decision Reminders

30 Service Delivery it is NOT… More is better Get as much as you can before they turn three This Diagnosis = all interventionists regardless of childs abilities Im entitled as my tax payer dollars fund your program With this XYZ insurance we can see the child 3 times per week

31 Service Delivery IS… The minimum frequency and intensity of supports to achieve MAXIMUM progress toward an outcome frequencyintensityoutcomefrequencyintensityoutcome

32 Service Decisions Reminders Early intervention services and supports decisions must not be based solely on the following: Early intervention services and supports decisions must not be based solely on the following:Early intervention servicesEarly intervention services A. A specific diagnosis – (med/dev) A. A specific diagnosis – (med/dev) B. Provider/therapist bias B. Provider/therapist bias C. Nature or severity of disability C. Nature or severity of disability D. Age of child D. Age of child E. Availability of services E. Availability of services F. Availability of space F. Availability of space G. Administrative convenience G. Administrative convenience H. Payment method or amount (private) H. Payment method or amount (private) I. Preference of any single IFSP team member I. Preference of any single IFSP team memberIFSP teamIFSP team

33 Determine PSP & Supports Coach the Family Develop Outcomes & Strategies

34 WHAT IS COACHING TO YOU?

35 COACHING Building on what the parent is currently doing and teaching them to identify and implement other ideas and strategies in the current and future situations without dependence on the coach Building on what the parent is currently doing and teaching them to identify and implement other ideas and strategies in the current and future situations without dependence on the coach Rush & Shelden 2008

36 Coaching is NOT a model of service delivery NOT a model of service delivery It IS an evidence-based adult learning strategy the practitioner uses to interact with parents and care providers to maximize child progress both when the practitioner is and is not present It IS an evidence-based adult learning strategy the practitioner uses to interact with parents and care providers to maximize child progress both when the practitioner is and is not present NOT Telling a family what they need to do or doing something only with the child NOT Telling a family what they need to do or doing something only with the child It IS purposefully interacting with another adult in order to build their capacity to support child learning and development within the context of everyday activities It IS purposefully interacting with another adult in order to build their capacity to support child learning and development within the context of everyday activities Rush & Shelden 2008

37 Coaching is... NOT something that only works with certain families NOT something that only works with certain families Promoting their strengths and abilities rather than limiting them by their presumed deficits Promoting their strengths and abilities rather than limiting them by their presumed deficits (Dunst & Trivette, 1996) NOT useful for only certain children NOT useful for only certain children Useful for all children when we focus on child participation in meaningful activities Useful for all children when we focus on child participation in meaningful activities Rush & Shelden 2008

38 Coaching is… NOT parents becoming the therapist NOT parents becoming the therapist Parents participating in the recognition, development, and use of ideas to help their children learn and grow as a natural part of family and community life Parents participating in the recognition, development, and use of ideas to help their children learn and grow as a natural part of family and community life NOT a hierarchical relationship between the practitioner and the parent NOT a hierarchical relationship between the practitioner and the parent A mutual sharing of information that defines the plan and embeds strategies to get to the destination A mutual sharing of information that defines the plan and embeds strategies to get to the destination Rush & Shelden 2008

39 Coaching is… Federally Compliant

40 Coaching is… NOT a technique to get people to do what you want NOT a technique to get people to do what you want Building on the familys current activities and teaching them to identify and implement other ideas/strategies in the current and future situation without dependence on the coach Building on the familys current activities and teaching them to identify and implement other ideas/strategies in the current and future situation without dependence on the coach NOT the same as consultation which is an indirect model of service delivery NOT the same as consultation which is an indirect model of service delivery Not showing a difference between direct or indirect, hands– on or hands-off intervention Not showing a difference between direct or indirect, hands– on or hands-off intervention Rush & Shelden 2008

41 Coaching is… Purposefully interacting with another adult in order to build their capacity to support child learning and development with everyday activities Purposefully interacting with another adult in order to build their capacity to support child learning and development with everyday activities Rush & Shelden 2008

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43 Expectations Tell the family exactly what you will be providing Tell the family exactly what you will be providing Tell the family exactly what you expect of them during visits Tell the family exactly what you expect of them during visits Involvement Involvement Follow up activities Follow up activities Having them show you what they worked on and how Having them show you what they worked on and how

44 EXPECTATIONS SCES SCES Drafting a letter that will go out to all families explaining the PSP model and coaching Drafting a letter that will go out to all families explaining the PSP model and coaching Currently partnering with: Currently partnering with: Early Learning Coalition Early Learning Coalition Early Head Start Early Head Start To promote education of the PSP model and how that can positively affect not only the child and the teacher/provider but the whole class Provide at least half of your visit in the natural environment with the child instead of pull out Possible liability issues

45 HIPAA & CONFIDENTIALITY Text Facebook Professional Courtesy Judgments Friendships Personal Turmoil Comments

46 Outcomes and Goals Determine the PSP & Supports & youre ready to Coach….

47 EMBEDEMBEDEMBED

48 EMBED With the family outcome and their challenge in mind With the family outcome and their challenge in mind Provide activities to family that can help reduce the challenge Provide activities to family that can help reduce the challenge Then ask the family; are there routines they already do that they could use some of the activities in? Then ask the family; are there routines they already do that they could use some of the activities in? Diaper changing Diaper changing Walking to the mail box Walking to the mail box Eating a meal with the family Eating a meal with the family Grocery shopping Grocery shopping Embed Embed

49 GAME TIME With Rewards!

50 ITDS EMBEDDED ROUTINE GO

51 PT EMBEDDED ROUTINE GO

52 SLP EMBEDDED ROUTINE GO

53 OT EMBEDDED ROUTINE GO

54 FSC EMBEDDED ROUTINE GO

55 LMHC/LSW EMBEDDED ROUTINE GO

56 WILD CARD EMBEDDED ROUTINE GO

57 Who Can Support You?

58 Family Service Coordinator

59 The role of a Family Service Coordinator is….. Spokesperson Spokesperson

60 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family

61 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper

62 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate

63 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact

64 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator

65 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator Facilitator Facilitator

66 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator Facilitator Facilitator Investigative reporter Investigative reporter

67 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator Facilitator Facilitator Investigative reporter Investigative reporter Support network Support network

68 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator Facilitator Facilitator Investigative reporter Investigative reporter Support network Support network Counselor Counselor

69 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator Facilitator Facilitator Investigative reporter Investigative reporter Support network Support network Counselor Counselor Mediator Mediator

70 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator Facilitator Facilitator Investigative reporter Investigative reporter Support network Support network Counselor Counselor Mediator Mediator Connector Connector

71 The role of a Family Service Coordinator is….. Spokesperson Spokesperson Representative for the family Representative for the family Record keeper Record keeper Advocate Advocate Point of first contact Point of first contact Idea generator Idea generator Facilitator Facilitator Investigative reporter Investigative reporter Support network Support network Counselor Counselor Mediator Mediator Connector Connector Active Essential Team Member Active Essential Team Member

72 Research Indicates that children learn through opportunities to use their skills within the context of real life activities they find interesting and their families find important. Dunst, Hamby, Trivette, Raab, & Bruder 2000

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74 REMINDERS Interpreters Spanish Creole Deaf Provider Management Unit Must be current on you! ESSO WEEKLY MEMO Have G FORM authorization in hand prior to service provision

75 How Do I Know You? Let Me Count the Genes… What: Genetics Training sponsored by Space Coast Early Steps When: April 15, 2011 (Friday) Time: 9am-3pm Where: Viera Childrens Medical Services/Early Steps office Cost: $40 for the course to include 5 CEUs. Checks are the only form of payment and must be made payable to CATCH/Early Steps Instructor: Karlene B. Coleman, RN, MN, CGC (registered nurse and certified genetics counselor); clinical instructor at Emory University in Atlanta; and credited with more than 30 publications in her field RSVP:Must respond by April 11, 2011 at x 203 or

76 QUALITY ASSURANCE AWARDS OCTOBER 2010 MARCH 2011