Current EI Landscape in Ohio: What Are Counties Telling Us?

Current EI Landscape in Ohio: What Are Counties Telling Us?

Final FindingsOctober 2012

This survey and its analysis were supported by a grant from the Ohio DD Council , “Ohio Statewide System of Services for Early Intervention,”

awarded to the Ohio Association ofCounty Boards Serving People with Developmental Disabilities (OACB) .

Some Acronyms to Remember EI: Early Intervention EBEI: Evidence-Based Early

Intervention HMG: Help Me Grow CBDD: County Boards of

Developmental Disabilities TA: Technical Assistance SC: Service Coordinator IFSP: Individualized Family Service Plan

Background on Part C Early Intervention (EI)

Part C: The portion of the Federal Individuals with Disabilities Education Improvement Act (IDEA or IDEIA) that “assists states in operating a comprehensive statewide program of early intervention (EI) services for infants and toddlers with disabilities, ages birth through age 2 years, and their families. In order for a state to participate in the program it must assure that early intervention will be available to every eligible child and its family.”

Retrieved 10/31/12 from http://www.nectac.org/partc/partc.asp#overview.

http://www.nectac.org/partc/partc.asp

OSEP Part C Practices

OSEP sponsored TA Community of Practice-Part C Settings: www.TACommunities.org

Sponsored by the Office of Special Education Programs, US Dept. of Ed.

This community facilitated by: National Early Childhood TA Center (NECTAC); Southeast Regional Resource Center (SERRC) and Region 6 Parent Information and Training Center (PTI)

Slide taken from Key Principles and Practices for Providing EI Services in Natural Environments: Reaching Consensus. Hurth, Pletcher & Kelley, 2007.

http://www.tacommunities.org/

The Identified Need

Examine the various “models” of providing services in natural environments - how are they the same?

Reach consensus on key principles (foundations) Identify the research base on effective practices Identify common practices and leanings that the

research, model development projects and the “wisdom” from the field suggest

Describe the agreed upon practices that are “model neutral”

Describe some examples of how you would know this practice is being implemented Slide taken from Key Principles and Practices for Providing EI Services in Natural Environments:

Reaching Consensus. Hurth, Pletcher & Kelley, 2007.

Mission of Part C EI

Part C early intervention builds upon and provides supports and resources

to assist family members and caregivers to enhance children’s

learning and development through everyday learning opportunities.

Workgroup on Principles and Practices in Natural Environments

OSEP TA Community of Practice – Part C SettingsMarch 2008

Key EBEI Principles of Part C

1) Infants & toddlers learn best through everyday

experiences and interactions with familiar people in

familiar contexts.

2) All families, with the necessary supports and resources,

can enhance their children’s learning and development.

3) The primary role of a service provider is to work with and

support family members and caregivers in children’s

lives.

4) The early intervention process, from initial contacts

through transition, must be dynamic and individualized

to reflect the child’s and family members’ preferences,

learning styles and cultural beliefs.

Workgroup on Principles and Practices in Natural EnvironmentsOSEP TA Community of Practice – Part C Settings

March 2008

Key EBEI Principles (continued)

5) IFSP outcomes must be functional and based on children’s and families’ needs and family-identified priorities.

6) The family’s priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support.

7) Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.

Workgroup on Principles and Practices in Natural EnvironmentsOSEP TA Community of Practice – Part C Settings

March 2008

Ohio Early Childhood Cabinet Council (2010)

Review of current Part C policies, practices, outcomes, funding, compliance with federal regulations, leveraging resources, and providing appropriate services to families and their children

‘The Ohio Early Childhood Cabinet recognizes that Ohio’s overall approach to Part C services and supports needs to be more clearly articulated in order to eliminate glaring disparities and be consistent through the state in what is available to eligible children and their families’

Members of workgroup: Parents; State Agencies: ODADAS, DODD, ODH, ODJFS, ODMH, ODDC, OECC, OFCF; Local FCFs; Local County Boards; Community Providers; HMG Project Directors; Ohio Help Me Grow Advisory Council; University Centers for Excellence in Developmental Disabilities; Samaritan Behavioral Health; Ohio Commission on Fatherhood

2010 Recommendations

Recommendations from the Part C Early Intervention Workgroup of the Governor’s Early Childhood Cabinet Council (April 2010) All EI/Part C Services will be strength- and relationship-based. Assure that every family and their child who is eligible for Part C/EI services has

access to federally mandated, evidence-based EI services through a core team of professionals.

Maximize existing federal, state and local funding, and leverage additional funding to assure access to federally-mandated early intervention services and to implement these recommendations.

Develop a system to ensure family accessibility to core team services, regardless of the political subdivision where families reside.

Create a comprehensive, ongoing workforce development strategy for Part C/EI in partnership with other early childhood efforts in the state.

Assure family support services and the availability of family-to-family support statewide.

Provide consistent materials and public awareness messages statewide (child development, making referrals, enhancing social-emotional development, etc.).

Create a state-level centralized dynamic resource of early childhood services and supports that is available to families of young children as well as to EI service providers via live staff and the internet.

Ohio Part C Early Intervention Study (2010-11)

DODD in collaboration with the ODH utilizing ARRA funds: Collected data on how other states have made paradigm shifts

in early intervention service delivery Outlined Ohio’s desire for information on how to implement a

Part C system that is in line with the OSEP’s Mission and Key Principles for Providing Early Intervention Services in Natural Environments using a team approach

Called for an examination of how other states have implemented EBEI practices, and a primary coach or transdisciplinary team approach to providing early intervention services to families

Provided a review of the Ohio Part C System and developed recommendations about how Ohio can create a paradigm shift in early intervention in order to implement the Mission and Key Principles for Providing Early Intervention Services in Natural Environments using a team approach

United Cerebral Palsy Association of Greater Chicago’s UCP Early Intervention Training Program

Challenges identified by the Ohio Part C Early Intervention Study (June 2011) Lack of a common statewide mission/vision

and goals that provide a unique identity for the Ohio Part C system

Lack of communication and coordination between state and local entities and within early intervention team

Inconsistency from county to county related to services, supports, training, technical assistance opportunities and funding.

Challenges Identified

Recommendations

Recommendations identified by the Ohio Part C Early Intervention Study (June 2011) Develop an agreed upon mission and key principles that will provide a

unique identity for Ohio’s Part C system. Create regionalized systems of support to provide equitable access to

training, technical assistance, monitoring and quality assurance of Ohio’s entire Part C system.

Implement a web-based system that is accessible to a broad group of stakeholders and provides a real time record of child/family characteristics, IFSPs, services and billing information as well as a centralized provider database for Ohio’s Part C system.

Expand current efforts to deliver Ohio Part C early intervention services utilizing a team approach to service delivery statewide.

Explore and access potential sources of state, local, federal and other funding.

Predecessor to Current Project

Ohio Developmental Disabilities EI Demonstration Project Grant and Advisory Council 26 teams trained by Shelden and Rush Relationships strengthened between CBDDs and HMG County Board DDs evaluated their contracts with private therapy

providers CCBDDs superintendents provided evaluative and cost data to

other superintendents attempting to figure out how to implement the practices or participate in trainings

Many counties shifted their practices either significantly or in part-even counties that were not able to shift their entire ‘paradigm’, moved from segregated to inclusive settings or to more of a team approach, or to more functional family assessments and participatory IFSP outcomes

80% of parents strongly agreed that services provided using EBEI increased their competence and confidence in meeting the special needs of their child; 89% of parents reported they agreed or strongly agreed that the one service provider helped them understand their child

A ‘leadership team of EI directors emerged and continues to meet regularly

Source:

Overarching Lessons Learned

This is hard work. Change is not easy, especially when staff believe the current way they practice serves the family and child effectively.

Leadership is the key to the successful implementation of the practices with each team. When the leadership was committed and understood the practices, the teams followed.

There needs to be a high level of accountability and expectations from the upper level management to implementation of the practices in order for the practices to be continued after the training period is completed (e.g. assuring equal access to any discipline on team as PSP).

The teaming through weekly team meetings was a key to the successful implementation of the practices. Even those who resisted the change in practices valued the support from the weekly team meetings.

There needs to be a full continuum of technical support to offer teams in the future. The grant didn’t allow for differences in levels of support, despite the varied level of supports needed by county teams. The full continuum of support will be more effective ion affecting real and sustained change for diverse needs across the state.

The turning point for staff was when they personally saw the outcomes being met.

Source: Plan for Monitoring the Fidelity to Service Delivery Approach for Teams Trained as a Result of the Interagency Agreement and Recruiting Non-CBDD Providers to Participate in Early Intervention Trans-disciplinary Service Delivery in Ohio; September 30, 2011; The Ohio Department of Developmental Disabilities

“Bridging the Gaps in Ohio Part C Service Delivery”: Ohio Statewide System of Services for Early Intervention Five-year project funded by the Ohio Developmental Disabilities

Council in January 2012, with Ohio Association of County Boards of Developmental Disabilities (OACB) serving as fiscal agent.

Major activities: Identify 3 or more areas of the state where EBEI services are not

available or accessible and readiness and interest exists. Develop networks of regional support that will facilitate local

collaboration of core team provision of EI services in underserved areas.

Network and build upon existing TA efforts to provide consistent quality training for sustainability and fidelity.

Network with state leadership and TA to do public awareness to reach the medical community, families and community providers.

Work with state and local stakeholders to find funding mechanisms that both incentivize and maintain EBEI services.

Work in collaboration with FIN of Ohio to establish family supports as a primary function within Ohio’s EBEI service delivery system.

Purpose of Survey

To give us a baseline snapshot of Early Intervention across the state from the perspective of all 88 counties in relation to

a) Part Cb) The mission & principles of Part C EBEIc) The recommendations from Ohio’s 2010 Part C Workgroupd) The 2011 Part C Studye) Recommendations from Ohio HMG Advisory Council (ICC) f) Ohio County Board Core Team (without service coordinator )

survey & mapg) Information from first DD Council grant

To identify counties who might be interested in partnering with the project to develop, enhance and sustain EBEI for eligible infants and toddlers and their families.

Survey Design

A. Combination of 46 closed and open-ended questions

B. Five areas of focus:1. Is there a full team of professionals available for

children and families? (EQUAL ACCESS)2. How are services delivered? (EBEI AND

CONSISTENCY)3. What expertise and TA capacity is available in the

area? (WORKFORCE DEVELOPMENT)4. How is family support addressed? (PART C

MISSION)5. What has happened in the last five years? What

about the next five years? (WILLINGNESS AND READINESS TO CHANGE)

Survey Distribution

Survey Monkey link, with cover letter from the DD Council, distributed statewide to HMG Project Directors and CBDD Superintendents

Follow-up emails and phone calls from project staff

Three options for survey completion:1. Complete online2. Complete hard copy & fax to project staff3. Complete over the phone with project staff

Survey Analysis

Survey Monkey data downloaded to Excel spreadsheet

Closed-ended questions analyzed via Excel and/or SPSS

If more than one response per county: Where possible and appropriate given the

question, multiple responses within a county were aggregated/averaged into a single response for the county, i.e., N = X counties

Otherwise, N = number of individual responses Open-ended questions analyzed using

qualitative methodology Several of the open-ended questions were

primarily used to identify potential partners, and will not be reported in this presentation (Questions 6,23, and 29)

Who responded?Questions 1 & 2

22

GOAL GOAL GOAL

FOR BOTH DD COUNTY

BOARDS AND HMG TO

PARTICIPATE

SHORT TURNAROUND

REAL TIME INFORMATION

INCLUDE EVERY

COUNTY: EVERY MEANT

EVERY

Q1. In which county do you work?

ALL of Ohio’s 88 counties were represented

101 individuals responded 75 counties had one

response Either one person who responded,

or 2 or more persons who completed

the survey collectively as a group) 13 counties had 2 individual

responses

“We’ll do whatever it takes to get the

info!”

Project staff, 2012

UNION

ASHTABULA

BELMONT

BUTLER

CARROLL

CLARK

COLUMBIANA

COSHOCTON

CUYAHOGA

DARKE

DELAWARE

FAIRFIELD

FRANKLIN

GEAUGA

GREENE

GUERNSEY

HAMILTON

HARRISON

HOLMES

HURON

KNOX

LAKE

LICKING

LOGAN

LORAIN

MAHONING

MEDINA

MIAMI

MONROE

MORGAN

NOBLEPERRY

PORTAGE

PREBLE

SHELBY

STARK

SUMMIT

TRUMBULL

ADAMS

ATHENS

BROWN

CLINTON

FAYETTE

GALLIA

HIGHLAND

HOCKING

JACKSON

LAWRENCE

MEIGS

PICKAWAY

PIKE

ROSS

SCIOTO

VINTON

WARREN

WASHINGTON

WAYNE

CLERMONT

MONTGOMERY

JEFFERSON

MADISON

RICHLANDASH-LAND

TUSCARAWAS

MUSKINGUM

FULTON

ALLEN

CRAWFORD

DEFIANCEERIE

HANCOCK

HARDIN

HENRY

MARION

OTTAWA

PAULDINGPUTNAM

SANDUSKY

SENECA

VAN WERT

WILLIAMS

WOOD

WYANDOT

LUCAS

CHAMPAIGN

MORROWAUGLAIZEMERCER

1 response per

county

2 responses per

county

Q2. What is your job title? Please choose ALL that apply.

45

13

44

9

31

HMG Project Director

HMG Supervisor/Other HMG

Position

CBDD EIAdministrator/

Supervisor

CBDDSuperintendent

Other(e.g., EI

Specialist)

Num

ber

of

resp

onse

s

N = 97 participants

Topic A: Is there a full team of professionals available for children and families?

Questions 3 - 5, 7, 9 - 17

Q3. Approximately how many children who are eligible for Part C do you have in your county HMG system

Total: 15,612

Min – Max: 14 – 2400

Average: 185.9

* If more than one respondent per county, responses were averaged into single county response. N = 84 counties

Q4. We'd like to know a little about the Part C Service Coordinators for your county.

Total SCs: 345.6 (N = 82 counties)Total Number of Unfilled

Positions: 12 (N = 69 counties)Average Caseload: 41.1 (Range:

10 – 75, N = 68 counties)

* If more than one respondent per county, responses were averaged into single county response.

< 10 11 - 20 21 - 30 31 - 40 41 - 50 51 - 60 61- 70 > 71

13

13

21

17

75

1

Average SC Caseload

Nu

mb

er

of

Cou

nti

es

Q4. We'd like to know a little about the Part C Service Coordinators for your county.


Q5. Are any of your Service Coordinators serving in a dual role as CBDD Early Intervention Specialists?

Yes19%

No81%

N = 84 counties

Question 7. Families in your county may go many different places to access services for their child who is eligible for Part C. Some may be in your county; others may be across county lines. Some may use a more traditional medical model framework; others may be using an approach that emphasizes teaching/coaching families instead of working directly with the child. Please describe the options that you've seen families use. Check ALL that apply for each agency/setting. (In other words, we'd like you to work your way across the entire row!)

Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.

Other? (most to least frequently mentioned) Regional Infant Hearing Program (RIHP) Early Head Start Home Health Services Respite Services Chiropractic Services Medical Support Services



Count

y Bd

of D

D

Non-C

BDD E

I

Hospi

tal/O

utpa

tient

Privat

e Th

erap

y

Men

tal H

ealth ES

C

Other

0

20

40

60

80

100

120

95

23

8777

66

2918

3

55

9 12 2038

YesNo

Based on total number of responses for each service option

Service options accessed by families


County Bd of DD

Non-CBDD EI

Hospital/Outpatient

Private Therapy

Mental Health

ESC Other0

10

20

30

40

50

60

70

80

90

100

85

19

63 62 60

26

113

10

73

62

32

6

15

In County Out of County


Locations of service options accessed by families



Count

y Bd

of D

D

Non-C

BDD E

I

Hospi

tal/O

utpa

tient

Privat

e Th

erap

y

Men

tal H

ealth ES

C

Other

0

10

20

30

40

50

60

70

80

90

35

14

7467

31

177

82

13 14 16

31

9 7

Traditional child-centered modelEmphasis is on teaching/ coaching familiesModels of service options accessed by families

Q9. What sources of payment are utilized for each of the following?

Q9. What sources of payment are utilized for each of the following?

Examples of “Other”: WIC Waivers Mental health levy dollars

Q9. What sources of payment are utilized for each of the following? (Please check ALL that apply.)

CB

DD

EI

Earl

y in

terv

ention ...

Speech

thera

py

Occ

upational t

hera

py

Phys

ical t

hera

py

Vis

ion s

erv

ices

Audio

logy

Counse

ling o

r B

eh...

Nutr

itio

n

Nurs

ing

Oth

er

(Ple

ase

desc

r...

Other Grants and/or donations Local school district(s)CBDD local levy and ODODD dollars CBDD Family Support Services Private payBCMH Medicaid Private insuranceEISOP

Q10. Once their child is determined eligible, how long do families typically wait for services to begin?

Num

ber o

f resp

onse

s

Q10. Once their child is determined eligible, how long do families typically wait for services to begin?

County

Bd o

f D

D

Non-C

ounty

Bd .

..

Hosp

ital/O

ut-

pa..

.

Pri

vate

thera

py..

.

Menta

l healt

h .

..

ESC

Oth

er

#1

Oth

er

#2

Oth

er

#30

20

40

60

80

100

Not sure More than 2 months 1-2 months 15-30 daysLess than 14 days

Num

ber o

f resp

onse

s

Q11. Does your County Board of DD offer Early Intervention services?

97.0%

3.0%

YesNo

* If more than one respondent per county, responses were aggregated into single county response. N = 87 counties

Q12. How many children are enrolled (i.e., have a current IFSP) in your CBDD EI program on any given day?

Total: 11,847

Min – Max: 8 – 1500

Average: 141


Q13. Approximately what percentage of families in your county seek services in addition to or instead of CBDD EI services? (N = 78 counties)

Perc

en

tage o

f fa

mili

es

seeki

ng a

ddit

ional se

rvic

es

Number of counties

91-100%

71-80%

51-60%

31-40%

11-20%

0 5 10 15 20 25 30

2

0

5

3

3

6

4

20

8

27

Average across all respondents: 26.44%, but significant variation across counties.

Q14. Please describe your CBDD EI program hours of operation each week/weeks per year:

N = 94 responses N %

Full-time all-year round, with specific mention of flexible hours to accommodate families

43 46%

Full-time, all-year round, no mention of flexibility

27 29%

Full-time during “school year” with summer reductions

12 13%

Part-time: fewer than 37.5 hours or 5 days per week

8 8%

“Unsure” or response was unclear

4 4%

Examples from the continuum of responses:

“35 hours a week; 42 weeks a year ” “184 days a year; 5 days a week, and hours are 8:30-4

but flexible to accommodate families” “___BDD offers EI services year round and has flexible

hours so we can meet the needs of families being served.”

“The ___BDD operates EI services 52 weeks a year. Services are provided at the convenience of the family which means we are often operating 12-15 hours per day. We flex schedules so services are always available. Services have been provided on Saturdays when necessary. So far, we have managed to keep Sundays free of visits. However, if a family needs visits on Sundays we would accommodate them.”

Q14. Please describe your CBDD EI program hours of operation each week/weeks per year:

Q15. Number of full-time equivalent (FTE) staff members working in your CBDD EI program:

People answered this question in many different ways, so it is impossible to analyze in terms of FTEs

We are able to report the % of counties who reported that discipline working in their CBDD EI program

The counties without a CBDD EI program were removed from the aggregate results

Reported as “Other”: Service Coordinator, OTA, PTA, Family Support Specialist, Supervisor

Q15. Number of full-time equivalent (FTE) staff members working in your CBDD EI program:

EIS/DS SLP OT PT Nurse Social Worker

Other0

102030405060708090

10094.2

66.3 62.8 60.5

31.4

4.7

25.6

% Counties Reporting This Discipline Available


Q16. Are the staff CBDD employees or contractual? (N = 93 responses)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Mix of Employees and Contractual ContractualEmployees

Q17. Is your County Board of DD EI program following a Primary Service Provider (PSP) approach?

N = 95 responses

43.2%

34.7%

12.6%

9.5%Yes

No

We're in the process of shifting to a Primary Service Provider approach

Not sure

Topic B: How are services delivered?

Questions 18 - 28

The first 45 days...

Overall “flow” is similar, but differences in details

CBDDs frequently involved in some way The majority of evaluations and assessments

take place in the home (unless parent chooses otherwise)

Make-up of team varies across counties Some counties: Same team for all families Others: Make-up varies based on needs of

family & child

Q18. Where do Early Intervention services offered by your County Board of DD take place? Please check ALL that apply.

Location # of Countie

s

% of all Countie

s*

In the home 85 96.6%In the community 62 70.5%In child care settings 56 63.6%In Early Head Start 22 25%In the CBDD center 47 53.4%Other (e.g., HMG site, LEA, other community agency) 6 6.8%

Analysis based on all responses aggregated into 88 counties. Since CBDD EI services are not available in all counties, the percentage can never be 100%.

Q19. What "curricula" are used to guide your Early Intervention practices (planning, intervention strategies, etc.)? Please check ALL that apply.

None

HELP

Respo

nsive

Teac

hing

ELAP

PLAY

Pro

ject

PAT

Comm

unicat

ing

Partn

ers

SKI*H

I

INSI

TEAE

PS

Hanen

Carol

ina

Trip

le P

SCER

TS

Other

4

52

34 32 2821

15 14 12 9 8 3 2 28

# of Counties

Examples of “Other”: TEACCH, Floortime, Brigance, TouchPoints


Q19. What "curricula" are used to guide your Early Intervention practices (planning, intervention strategies, etc.)? Please check ALL that apply.

None 1 2 3 4 5 6 7 8 9 100

5

10

15

20

25

30

35

3.1%

29.2%

17.7%

25%

10.4%6.3%6.3%

1% 0% 0% 1%

Percent of Total ResponsesN = 96

Number of Curricula Identified

Q20. If you checked "none" when answering the previous question, how do your early intervention professionals identify strategies and ideas to use?

Examples from the continuum of responses: “We use a variety of different resources. We

identify what the family and child's priorities and needs are and discuss what services and strategies that would be most helpful for them to use within the home during their daily routines.”

“I'm not sure what our EIS uses. HMG makes sure that the EIS receives copies of the IFSP, Battelle booklet and Battelle report so she has that information to assist her.”

“Strategies and ideas used are sometimes at the suggestion or recommendation of therapists or specialists who work with the child.”

Q20. If you checked "none" when answering the previous question, how do your early intervention professionals identify strategies and ideas to use?

Examples from the continuum of responses: “Whatever needs are for child and family depending on

the IFSP. Families are involved in the planning. Work on what testing shows child needs. Whatever is necessary for child.”

“We use the ELAP for program planning. The strategies and ideas come from discussions with the families and on their needs.”

“The ELAP is used for program planning. Strategies and ideas are generated from discussion with the families and based on their needs.”

“A curricula is not really appropriate when using coaching.”

“Rush and Shelden not really a curriculum but we use their guides as a reference.”

Q21. We know that frequency of Early Intervention visits/services will vary based on each child and family. However, on the AVERAGE, what is the typical frequency (regardless of location) in your county?

7%

25%

33%

21%

10%

3%

More than once a week

Weekly

Every other week

Monthly

More than once a month

Other

e.g., based on need, weekly center/monthly home, once every 60 days

N = 95 responses

Q22. We also know that the LENGTH of visits/services may vary based on the needs of each child and family. However, on the AVERAGE, what is the typical length (regardless of location) in your county?

10%

80%

9%

More than 1 hour

Around 1 hour

N = 95 responses

Q24. Do you have team meetings?

78

6 4

Yes NoNo Response


Q25. If yes, how often?

N = 88 individual (not county) responses

Weekly45%

Every other week7%

Monthly12%

Quarterly3%

As needed24%

Other8%

Q26. We know that attendance may vary based on the child and family, but we want to know the "big picture" of who attends the team meetings. Please check ALL that apply!

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He

alt

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urs

e

Oth

er0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

N = 87 responses

Responses were coded based on four categories:1) Child Tools Only: e.g., “Bayley, HELP and

recommendations from therapists”2) Child Tools + Discussion with Family: e.g.,

“Evaluation results, medical history, therapy reports, and most importantly concerns of the parent”

3) Child Tools + Family Tools + Discussion: e.g., “ We use information from the screenings, assessment, RBI, observations, input from other service providers, and (most importantly) conversations with families about needs, concerns and priorities”

4) No Tools Mentioned: e.g., “Team approach including family members”

Q27. What information/tools/processes do you use to develop IFSP outcomes?

Q27. What information/tools/processes do you use to develop IFSP outcomes?

N = 100 responses

010203040

15

37 41

7

Num

ber

of

resp

onse

s per

cate

gory

Q28. How do you know that what you are doing is working for the children who are Part C eligible and their families? 98 people responded Responses were varied in terms of numbers

and sources of data used, e.g., One response: “Progress seen by families-tracked

by COSFs; Retention/family interest/ motivation; Exiting children when no longer needs services; Parent surveys; Children who are not eligible for Part B services at 3.”

Another response: “If they meet their goals, then great, something is working. If they don't and the parent still believes in me, then I feel comfortable in saying that what I am doing is working.”

The majority of people described only 1 or 2 sources of info used for program evaluation

Q28. How do you know that what you are doing is working for the children who are Part C eligible and their families?

N = 98 responses

1

2

3

4 or more

40

37

15

6

Number of Responses

Nu

mb

er

of

Data

Sou

rces

Descri

bed

Q28. How do you know that what you are doing is working for the children who are Part C eligible and their families?

N = 98 responses

IFSP o

utc

om

es/

Child p

ro..

.

Pare

nt

surv

eys/

Feedback

CO

SF

Earl

y exit

/caught

up o

r n..

.

Fam

ily e

ngagem

ent

duri

...

Tim

elines

met/

Serv

ices.

..

Pare

nt

refe

rrals

/ w

anti

n..

.

81

53

1019

10 5 6

Num

ber

of

tim

es

men

tioned

Data Sources

Topic C: What expertise and TA capacity is available in the area?

Questions 8, 29 - 36

Q8. Which specialized expertise is available to your children who are Part C eligible and their families (across all agencies, including the County Bd of DD)? Please check ALL that apply.

Fa

mily

Su

pp

ort

Sp

eci

alis

...

De

ve

lop

me

nta

l S

pe

cia

lis..

.

Sp

ee

ch-L

an

gu

ag

e P

ath

olo

...

Occ

up

ati

on

al T

he

rap

ist(

s)

Ph

ysi

cal T

he

rap

ist(

s)

Vis

ion

Sp

eci

alis

t(s)

Ori

en

tati

on

& M

ob

ility

Sp

e..

.

Au

dio

log

ist(

s)

So

cia

l W

ork

er(

s)

Fa

mily

Th

era

pis

t(s)

Psy

cho

log

ist(

s)

Die

titi

an

(s)

Nu

rsin

g

Pe

dia

tric

ian

s

Oth

er0%

10%20%30%40%50%60%70%80%90%

100%

54%

92% 96% 95% 98%

66%

41%

72% 68%

46%56% 56%

82%77%

15%

N = 99 responses

Q30. Have you and/or your county partners identified future training topics or areas that would be important for you?

70%

30%

Yes

No


Q31. If yes, please describe:

Frequency Topic

Each mentioned 8-10 times

PLAY Project, Autism & other Developmental Disorders, Infant/Maternal Mental Health, EBEI, IFSP (specifically functional outcomes)


Fetal Alcohol Syndrome/Prenatal Drug Exposure, Feeding, RBI, Sensory Processing


Involving/engaging/communicating with families, Safety, Behavior Supports, Vision/Hearing, Child Abuse/Domestic Violence, PAT, Healthy Families America

Each mentioned 1 time

Responsive Teaching, Music Therapy, Teaming, Poverty, Brain Development, INSITE, DIR, etc.

Q32. Given your current IFSP outcomes/needs of children and families, are there other services/expertise needed beyond what's available through your current EI team(s)?

66%

16%

18% Yes

No


Q33. If you answered yes, please let us know what those services/expertise might be. And if you answered no or not sure, please give us a little more detail about your answer.

Fam

ily S

uppo

rt

Ther

apie

s

Vision

/Mob

ility

Spe

cial

ist

Beha

vior

Spe

cial

ist

Men

tal H

ealth

Res

ourc

es

In-d

epth

Par

entin

g Cla

sses

Tran

spor

tatio

n

Med

ical

Spe

cial

ists

Other

0

5

10

15

20

25

30

1

26

18

4

18

2

7 75

Nu

mb

er

of

Tim

es M

en

tion

ed

N = 72 responses

Q34. Have you ever considered partnering with other counties (or other agencies) to obtain those services/expertise? (e.g., sharing the cost of training, sharing a staff person, etc.)

67%

20%

13%

Yes No Not Sure* If more than one respondent per county, responses were averaged into single county response. N = 86 counties

Q35. Please give us a little more detail about your answer to the previous question . . .

Ideas/responses fell into several categories Sharing the cost of trainings Sharing staff (therapists) for core

teams Sharing specialized expertise for low

incidence disabilities (e.g., vision specialist, PLAY project)

Sharing specific tasks (e.g., developmental evaluations, ADOS)

Sharing administration and supervision

Q36. Do you have these resources available in your county for children who are eligible for Part C and their families?

0%

30%

60%

90%

67%93%

60%82%

* If more than one respondent per county, responses were averaged into single county response. N = 77-87 counties, depending on answer option.

Topic D: How is family support addressed?Questions 37-40

Q37. How do you define and provide Family Support in your county?

What professionals do as part of their job

CBDD family support $$

Support groups

What the FSS does as part of her/his job

Informally linking families to other fami-lies

FIN newsletter, webinars & trainings

Planned activities (play groups, fun nights, outings)

County newsletter/ Facebook page

Not sure

48

22

17

30

24

21

39

11

1

N = 96 responses

Num

ber o

f times m

entio

ned

Category of Support


1 2 3 4 5 or more

35

2126

85

Number of support categories per response

Examples from the continuum of responses: “Family support is a section on the IFSP that the current

service coordinators do their best to fulfill. We do not employ or contract anyone for family support services.”

“We no longer have funding for a Family Support Specialist. The SC's provide as much support as possible for the families. We have also started having monthly play group/parent meetings so families can network among themselves as well.”

“Access to and opportunities to interact with other families. We offer peer playgroups, provide families with FIN webinar information and FIN Facts and utilize our FIN Consultant.”

“Informally through service coordination. Had to terminate position due to lack of funding.”


Examples from the continuum of responses: “We no longer have a formal system of family support

services in our county. The only way families in Part C services receive family support services are by attending trainings offered by our Head Start/Early Head Start Programs.”

“We define it at parent to parent support. We are working on expanding what we do. Parents have identified parent to parent support as a gap/need.”

“We probably need to work on this area- Individual service providers provide support to families as appropriate to their needs.”

“Giving families the opportunity to connect and support one another through phone, email, web and/or face-to-face contacts. Our county has an AWESOME Family Support Specialist, supported by FCFC and grant dollars. She hosts 2 support groups and sends out a Parent Pages newsletter to all families in HMG. The Family Information Network has really evolved and offers many great training/information opportunities to parents through their wonderful webinars.”


Q38. Do you have a Family Support Specialist in your county?

52.4%47.6%

YesNo


Q39. If yes, does your Family Support Specialist wear other "hats" (e.g., is also a Service Coordinator)?

N = 48 responses

39.6%

60.4%

YesNo

Q40. How is your Family Support Specialist funded? (Please check ALL that apply.)

HMG $$ Other agency (e.g., CBDD)

$$

Grants Other

32

13

2

7

Num

ber

of

tim

es

menti

oned

N = 50 responses

Topic E: Last five years Next five years

Questions 41-44

Q41. How have your county's approaches to Part C service delivery changed over the last 5 years?

MAJOR THEME: DOING MORE WITH LESS

Funding cuts Increased numbers

of Part C children and families

Adopting EBEI Moving services to

natural environments

PSP model with supporting team

On the one hand, On the other hand,

N = 96 responses

Examples from the continuum of responses: “It has not changed.” “Moved from facility based/medical model to home based/primary

service provider/evidence based model” “We have completely transitioned from a central based Early

Intervention Program with limited parent involvement to an Evidence Based Practice/Primary Service Provider model which focuses on providing services to family in natural environments. Families have been very pleased with this approach.”

“We have gone from a complete traditional program with 2 EIS and 1 part time SLP (very minimal services) to a Transdisciplinary model (or moving in the direction of becoming one) and increasing service delivery to families. Over the past 3-5 years, the number of EI children has grown, therefore limiting the amount of time the EIS could spend with families. The Evidenced based model has really opened some doors for us in how we can effectively provide services to families and with the addition of service providers.”

“I feel that we are moving away from the traditional medical model. It is so much more important and effective to work with the parents and the child. To teach and support the parents in helping their child develop to the best of their abilities has become our priority. That is the biggest change I have seen...........and probably the most important change for Part C children in Ohio.”

Q41. How have your county's approaches to Part C service delivery changed over the last 5 years?

Q42. What triggered those changes?

TOP DOWN BOTTOM UP

Meeting needs of children & families

Reading the research

Trainings and networking

Changes in policies and rules

Budget cuts Emphasis

on compliance

N = 92 responses

Examples from the continuum of responses: “Funding/money cuts” “Lack of funding” “Funding cuts have been the main trigger. Program and rule

revisions have also played a part.” “Recommendation from Family and Children First Council.” “Sensitivity to families, their lifestyles and their personal

concerns and needs.” “Research! Training. Support. Tired of families not being

engaged. Tired of families canceling visits. Kids not making progress...... Those are things of the past :)”

“The need to be in alignment with federal and state compliance as well as what is best for our county's children and their families.”

“We were aware this was the direction early intervention was going in some states. We attended the McWilliam ODH Leadership conference presentation.”


Examples from the continuum of responses: “Changes at the state level and local monitoring visits” “Program policy-rules within DD and HMG, parent

concerns and programs working together to change” “Desire to provide the best services we can-strength

based and family driven.” “I think the need for these changes has been present for

a while. Those at the state level have the vision to see the benefits of revamping the way we provide services to families.”

“Hearing about it from other counties, EIS's have always provided services in the natural environment. Staff drove the initiative as they researched and went to some trainings, visited other counties.”


Q43. How did everyone (families, Service Coordinators, CBDD and others) respond?

People described a kaleidoscope of reactions!

Excited

Curious

Receptive

Resistant

Adjusting

Confused

AngrySkeptical

Positively

‘Anywhere from very well to not so good!”Pleased

N = 91 responses


Examples from the continuum of responses: “Response is positive a year later. Initially it was difficult. It

would be helpful if PSP training was initially provided for all service coordinators as well as EI, as they are the first point of contact for families. The process was explained, however everyone struggled with the process initially.”

“This is a challenging and on-going process. I believe it is becoming more accepted. Try to stress the importance of the parents being the child's best teacher. As stated above, ___BDD contracts with therapists, so don't always have the same people year to year, which makes it difficult, just when you have a good team and everyone is on the same page, things change. Still working on getting some parents recognize their important role.”

“Parents recognize the importance of what they do with their children in everyday routines and how small changes make a big difference.”


Examples from the continuum of responses: “Change is always hard but families seem to be happy,

service coordinators like the new approach but it has been an adjustment; EI staff were very resistant to any change but have very slowly been adjusting.”

“I feel that everyone came together and has worked very well together. We are lucky in our county and we do have a wonderful working relationship between HMG and --BDD, as well as the local private therapies/programs.”

“HMG service coordinators have many questions. Some have difficulty understanding that the traditional medical model may not be the most effective method. Families are very excited about it. Others are curious and very receptive to the change.”

Q44. What would you like your county's EI services to look like 5 years from today?

312

26

214

7

13 9Number of responses per category

Always based on families More collaboration More staff/options

PSP and/or EBEI Expanded eligibility We still exist

"The Way We Were/Are Now" Other

N = 95 responses. Each response was sorted into one of the major categories below.

Examples from the continuum of responses: “We continue to support the family’s right to choose a

service option that may or not follow the research.” “To be able to provide direct therapy to more children

within our community” “We wouldn't change a thing. We have good relationships

with families, Help Me Grow and Head Start. We offer a wonderful program for true Part C children of ----------- County and their families.”

“Moving more towards the PSP model with teams evaluating and meeting to make recommendations”

“Medical community would value services provided in the home versus a medical model of service delivery.”

“We would like to see stable funding that allows for all children with delays and disabilities to have access to all services and specialists as needed.”


Examples from the continuum of responses: “To be more fully funded in order to meet all required

mandates and provide comprehensive quality services.” “We would like EI policies and structure to have more stability

and continuity across counties. We would like to have more different services and/or professionals available.”

“Five years from today I would like to be able to assemble a core team of professionals (OT, PT, SLP, EIS, SC and others) to review referrals and assign a PSP. I would also like to have a strong family support group that is organized and driven by families, meeting regularly to address needs/concerns of families with children with disabilities. I would like to have full-time EIS and full-time SC....no dual roles.”

“I would like to have a transdisciplinary model of services where we have access to OT, PT and speech professionals on our team.”


Q45. We can't thank you enough for sharing your thoughts with us. Once we've compiled all the information, would you like a summary of what's happening across Ohio in terms of Part C services?

99.0%

1.0%

Yes

No

Key Findings & ConclusionsWhat have we learned about the current Part C EI Landscape in Ohio?

Service coordinator caseloads vary widely from county to county, ranging from 10 to 75 families per Service Coordinator. 30 of 68 counties reported caseloads of 40 families and higher. In some counties, the CBDD EIs play a dual role as both an EI and a SC.

Multiple sources of payment are being used, and appear to be complicated and multi-layered.

Almost (but only) half of the CBDDs report year-round, flexible access to EI services.

More than half of the counties reported access to a full core team as defined in this project (SC, EIS, SLP, OT, and PT).

For the CBDDs, OTs and PTs were more likely to be contractual than salaried staff. Some counties mentioned the challenges of turnover and implementation of EBEI when the therapists are contractual.

Less than half of the CBDDs are employing a Primary Service Provider model.

1. Is there a full team of professionals available for children and families? (EQUAL

ACCESS)

Counties report that families seek multiple services from multiple agencies.

Families are traveling many places for services, in and out of county. Based on the perceptions of the survey respondents, families are receiving services that vary widely in terms of adherence to the principles of EBEI. Families who are accessing multiple services may be experiencing conflicting approaches in service delivery.

Multiple sources of payment are used to pay for EI services, and those sources vary from service to service and county to county.

CBDDs have the capacity to provide services in natural settings such as the home and community, but this is not yet a consistent practice across all counties.

Some comments reflected confusion between the HOW (coaching) and the (WHAT) curriculum. Many “curricula” were mentioned, but over 30% of the counties reported using no or only one curriculum (one size fits all).

2. How are services delivered? (EBEI AND CONSISTENCY)

What is most consistent across counties? Length of visit (one hour) and frequency (the majority were either weekly or every other week)

78 of 88 counties reported having team meetings. The good news? More than half meet every or

every other week, and the most likely persons to be present represent the core team concept.

40% of participants described a process of developing IFSP outcomes that included not only “child tools” and discussion with families, but also “family tools” (e.g., RBI) that are likely to elicit functional outcomes.

Counties are inconsistent in terms of how they define, evaluate and measure progress.

2. How are services delivered? (EBEI AND CONSISTENCY)

3. What expertise and TA capacity is available in the area? (WORKFORCE

DEVELOPMENT)

Ohio has an abundance of specialized expertise available across agencies.

A majority of counties have identified specific needs for training and additional expertise

A majority of counties have thought of partnering with other counties to meet those and other needs.

Counties have very different and inconsistent interpretations of key terminology: EBEI, coaching, curriculum, functional outcomes, primary service provider, etc.

4. How is family support addressed? (PART C MISSION)

Family support is not defined consistently across counties.

As a result, how family support is offered differs markedly from county to county.

Only half of the counties have a Family Support Specialist, and this position was often described as part-time or in combination with another position.

The most frequent reference to family support was “what professionals do as part of their job.”

The move to natural environments for some counties meant that family to family support disappeared.

5. What has happened in the last five years? What about the next five years?

(WILLINGNESS AND READINESS TO CHANGE)

Counties are struggling to do more with less, in both negative and positive ways.

Changes have been triggered not only from the top (cuts in funding, emphasis on compliance) but also from the bottom (people wanting to adopt EBEI).

Reactions to change have been mixed, but counties have persevered.

The majority of counties want to continue to evolve toward evidence-based practices on behalf of their families.

Current EI Landscape in Ohio: What Are Counties Telling Us?

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