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.
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.
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.
* If more than one respondent per county, responses were averaged into single county response. N = 68 counties
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
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.
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
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.
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
Based on total number of responses for each service option
Locations of service options accessed by families
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.
Based on total number of responses for each service option
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
* If more than one respondent per county, responses were averaged into single county response. N = 85 counties
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
* If more than one respondent per county, responses were aggregated into single county response. N = 82 counties
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
* If more than one respondent per county, responses were aggregated into single county response. N = 84 counties
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
* If more than one respondent per county, responses were aggregated into single county response. N = 88 counties
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!
De
ve
lop
me
nta
l S
pe
cia
list.
..
OT
PT
SLP
Su
pe
rvis
or
Se
rvic
e C
oo
rdin
ato
r
Fa
mily
Su
pp
ort
Sp
eci
alis
t
Vis
ion
Sp
eci
alis
t
Re
gio
na
l In
fan
t H
ea
rin
g..
.
Ea
rly C
hild
ho
od
Me
nta
l ..
.
Ea
rly H
ea
d S
tart
Ch
ild C
are
Pro
vid
er
Fa
mily
Me
dic
al Pro
vid
er
BC
MH
/Pu
blic
He
alt
h N
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
* If more than one respondent per county, responses were averaged into single county response. N = 85 counties
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)
Each mentioned 4-7 times
Fetal Alcohol Syndrome/Prenatal Drug Exposure, Feeding, RBI, Sensory Processing
Each mentioned 2-3 times
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
* If more than one respondent per county, responses were aggregated into single county response. N = 86 counties
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
Q37. How do you define and provide Family Support in your county?
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.”
Q37. How do you define and provide Family Support in your county?
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.”
Q37. How do you define and provide Family Support in your county?
Q38. Do you have a Family Support Specialist in your county?
52.4%47.6%
YesNo
* If more than one respondent per county, responses were averaged into single county response. N = 84 counties
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.”
Q42. What triggered those changes?
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.”
Q42. What triggered those changes?
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
Q43. How did everyone (families, Service Coordinators, CBDD and others) respond?
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.”
Q43. How did everyone (families, Service Coordinators, CBDD and others) respond?
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.”
Q44. What would you like your county's EI services to look like 5 years from today?
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.”
Q44. What would you like your county's EI services to look like 5 years from today?
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.