1. 1 Infant & Toddler Connection of Norfolk Integrating Outcomes into the IFSP Narrative Sandi Harrington July 31, 2010

2. 2 Introducing Infant & Toddler Connection of Norfolk 250 actively enrolled children 57% Medicaid 35% Military Contract OT, PT, ST Educators on staff Bill private and public insurances Dedicated Service Coordinators

3. 3 Where We Started December 2006 Time 2 of the pilot We made the leap that the narrative would be in 3 outcome areas not domains.

4. 4 Where We Started Rationale for the change: Wanted a functional narrative Wanted the family to be involved Acknowledged the need for family input for a variety of settings/situations Desire to streamline the process Meaningful activity vs. one more thing to do

5. 5 Where We Started Challenges: Typical development knowledge was lacking – skewed for many practitioners who work in the field Comfort level comparing children to same aged peers Cognitive processing to translate from domains to the 3 outcomes on the spot

6. 6 Aids to the Implementation Process Booklet of requirements, aids and typical development

7. 7 Aids to the Implementation Process Questions to Structure Reporting Positive Social-Emotional Development / Positive Social Relationships How does the child communicate her/his feelings? How does the child interact with parents? How does the child interact with siblings? How does the child interact with known adults / strangers? How does the child interact with children?

8. 8 Aids to the Implementation Process Language prompts to discuss each of the ratings Somewhat (5) Compared with his 18 month old peers, Johnny is somewhat where we would expect him to be at this age. This means that Johnny has some of the skills we would expect at this age in regard to (outcome) (you can list if you like), but he does not yet have all of the skills we would expect of this age across settings and situations which include (list functional skills child is lacking to be age appropriate).

9. 9 Aids to the Implementation Process Decision Tree Going to Assessments to provide coaching to staff Sample narratives as guides

10. 10 Where We Are Now Process ingrained into initial, annual and exit assessments Educators/Therapists handwriting narratives while at the assessment (some collect thoughts and write, others writing after verbally reported) Statewide professional development/ certification requires child development training for all disciplines, including Service Coordinators Online training modules for child outcomes

11. 11 Where We Are Going Upcoming Outcomes Training with all providers in our system Looking at the “b” Closing the time gap on exit ratings