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Final Findings October 2012. Current EI Landscape in Ohio: What Are Counties Telling Us?. This survey and its analysis were supported by a grant from t he Ohio DD Council , “Ohio Statewide System of Services for Early Intervention,” awarded to the Ohio Association of

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final findings october 2012
Final Findings

October 2012

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

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 of

County Boards Serving People with Developmental Disabilities (OACB) .

some acronyms to remember
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
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 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
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
Mission of Part C EI

Workgroup on Principles and Practices in Natural Environments

OSEP TA Community of Practice – Part C Settings

March 2008

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.

key ebei principles of part c
Key EBEI Principles of Part C

Workgroup on Principles and Practices in Natural Environments

OSEP TA Community of Practice – Part C Settings

March 2008

Infants & toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts.

All families, with the necessary supports and resources, can enhance their children’s learning and development.

The primary role of a service provider is to work with and support family members and caregivers in children’s lives.

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.

key ebei principles continued
Key EBEI Principles (continued)

Workgroup on Principles and Practices in Natural Environments

OSEP TA Community of Practice – Part C Settings

March 2008

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

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

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

ohio early childhood cabinet council 2010
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
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
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
Challenges Identified
  • 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. 
recommendations
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 accessto 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
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
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
slide16
“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
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 C

b) The mission & principles of Part C EBEI

c) The recommendations from Ohio’s 2010 Part C Workgroup

d) The 2011 Part C Study

e) Recommendations from Ohio HMG Advisory Council (ICC)

f) Ohio County Board Core Team (without service coordinator ) survey & map

g) 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
Survey Design
  • Combination of 46 closed and open-ended questions
  • Five areas of focus:
    • Is there a full team of professionals available for children and families? (EQUAL ACCESS)
    • How are services delivered? (EBEI AND CONSISTENCY)
    • What expertise and TA capacity is available in the area? (WORKFORCE DEVELOPMENT)
    • How is family support addressed? (PART C MISSION)
    • What has happened in the last five years? What about the next five years? (WILLINGNESS AND READINESS TO CHANGE)
survey distribution
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:
    • Complete online
    • Complete hard copy & fax to project staff
    • Complete over the phone with project staff
survey analysis
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
Who responded?

Questions 1 & 2

q1 in which county do you work
Q1. In which county do you work?

“We’ll do whatever it takes to get the info!”

Project staff, 2012

  • 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
slide24

LAKE

ASHTABULA

LUCAS

FULTON

GEAUGA

OTTAWA

WILLIAMS

CUYAHOGA

ERIE

LORAIN

TRUMBULL

SANDUSKY

DEFIANCE

HENRY

WOOD

PORTAGE

SUMMIT

MEDINA

HURON

SENECA

PAULDING

PUTNAM

MAHONING

HANCOCK

ASH-LAND

WYANDOT

CRAWFORD

WAYNE

STARK

VAN WERT

COLUMBIANA

RICHLAND

ALLEN

HARDIN

CARROLL

MARION

HOLMES

AUGLAIZE

MERCER

MORROW

JEFFERSON

KNOX

TUSCARAWAS

LOGAN

COSHOCTON

SHELBY

UNION

DELAWARE

HARRISON

CHAMPAIGN

DARKE

GUERNSEY

LICKING

BELMONT

MIAMI

MUSKINGUM

FRANKLIN

CLARK

MONTGOMERY

MADISON

NOBLE

MONROE

FAIRFIELD

PREBLE

PERRY

GREENE

MORGAN

PICKAWAY

FAYETTE

WASHINGTON

HOCKING

WARREN

CLINTON

BUTLER

ATHENS

ROSS

VINTON

CLERMONT

HIGHLAND

HAMILTON

1 response per county

2 responses per county

MEIGS

PIKE

JACKSON

BROWN

ADAMS

GALLIA

SCIOTO

LAWRENCE

q2 what is your job title please choose all that apply
Q2. What is your job title? Please choose ALL that apply.

Number of responses

HMG

Project

Director

HMG Supervisor/

Other HMG

Position

CBDD EI

Administrator/

Supervisor

CBDD

Superintendent

Other

(e.g., EI

Specialist)

N = 97 participants

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

Questions 3 - 5, 7, 9 - 17

slide27
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
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.

q4 we d like to know a little about the part c service coordinators for your county1
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

slide30
Q5. Are any of your Service Coordinators serving in a dual role as CBDD Early Intervention Specialists?

N = 84 counties

slide31

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!)

slide32
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.
slide33
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
slide34
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.

Service options accessed by families

Based on total number of responses for each service option

slide35
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.

Locations of service options accessed by families

Based on total number of responses for each service option

slide36
Q7. Families in your county may go many different places to access services for their child who is eligible for Part C.

Models of service options accessed by families

Based on total number of responses for each service option

q9 what sources of payment are utilized for each of the following1
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
Q9. What sources of payment are utilized for each of the following? (Please check ALL that apply.)
slide40
Q10. Once their child is determined eligible, how long do families typically wait for services to begin?

Number of responses

slide41
Q10. Once their child is determined eligible, how long do families typically wait for services to begin?

Number of responses

q11 does your county board of dd offer early intervention services
Q11. Does your County Board of DD offer Early Intervention services?

* 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
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

slide44

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

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

Percentage of families seeking additional services

Number of counties

q14 please describe your cbdd ei program hours of operation each week weeks per year1
Q14. Please describe your CBDD EI program hours of operation each week/weeks per year:

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.”
q15 number of full time equivalent fte staff members working in your cbdd ei program
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 program1
Q15. Number of full-time equivalent (FTE) staff members working in your CBDD EI program:

* If more than one respondent per county, responses were aggregated into single county response. N = 82 counties

q17 is your county board of dd ei program following a primary service provider psp approach
Q17. Is your County Board of DD EI program following a Primary Service Provider (PSP) approach?

N = 95 responses

the first 45 days
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
slide53
Q18. Where do Early Intervention services offered by your County Board of DD take place? Please check ALL that apply.

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%.

slide54

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

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

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

slide55

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

Number of Curricula Identified

slide56

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.”
slide57

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.”
slide58

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?

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

N = 95 responses

slide59

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?

N = 95 responses

q24 do you have team meetings
Q24. Do you have team meetings?

* If more than one respondent per county, responses were aggregated into single county response. N = 88 counties

slide62

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!

N = 87 responses

q27 what information tools processes do you use to develop ifsp outcomes
Q27. What information/tools/processes do you use to develop IFSP outcomes?

Responses were coded based on four categories:

  • Child Tools Only: e.g., “Bayley, HELP and recommendations from therapists”
  • Child Tools + Discussion with Family: e.g., “Evaluation results, medical history, therapy reports, and most importantly concerns of the parent”
  • 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”
  • No Tools Mentioned: e.g., “Team approach including family members”
q27 what information tools processes do you use to develop ifsp outcomes1
Q27. What information/tools/processes do you use to develop IFSP outcomes?

N = 100 responses

Number of responses per category

slide65
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
slide66
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

slide67
Q28. How do you know that what you are doing is working for the children who are Part C eligible and their families?

Number of times mentioned

Data Sources

N = 98 responses

slide69

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.

N = 99 responses

slide70
Q30. Have you and/or your county partners identified future training topics or areas that would be important for you?

No

Yes

* If more than one respondent per county, responses were averaged into single county response. N = 85 counties

slide72

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)?

* If more than one respondent per county, responses were aggregated into single county response. N = 86 counties

slide73

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.

N = 72 responses

slide74

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.)

* 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
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
slide76
Q36. Do you have these resources available in your county for children who are eligible for Part C and their families?

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

q37 how do you define and provide family support in your county
Q37. How do you define and provide Family Support in your county?

N = 96 responses

Category of Support

Number of times mentioned

q37 how do you define and provide family support in your county1
Q37. How do you define and provide Family Support in your county?

Number of support categories per response

q37 how do you define and provide family support in your county2
Q37. How do you define and provide Family Support in your county?

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 county3
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.”
q38 do you have a family support specialist in your county
Q38. Do you have a Family Support Specialist in your county?

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

N = 48 responses

q40 how is your family support specialist funded please check all that apply
Q40. How is your Family Support Specialist funded? (Please check ALL that apply.)

Number of times mentioned

N = 50 responses

q41 how have your county s approaches to part c service delivery changed over the last 5 years
Q41. How have your county's approaches to Part C service delivery changed over the last 5 years?

Major theme: Doing more with less

Adopting EBEI

Moving services to natural environments

PSP model with supporting team

On the one hand,

On the other hand,

  • Funding cuts
  • Increased numbers of Part C children and families

N = 96 responses

q41 how have your county s approaches to part c service delivery changed over the last 5 years1
Q41. How have your county's approaches to Part C service delivery changed over the last 5 years?

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.”
q42 what triggered those changes
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

q42 what triggered those changes1
Q42. What triggered those changes?

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 changes2
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.”
q43 how did everyone families service coordinators cbdd and others respond
Q43. How did everyone (families, Service Coordinators, CBDD and others) respond?
  • People described a kaleidoscope of reactions!

Curious

Positively

Resistant

Confused

Adjusting

Excited

Angry

Skeptical

Receptive

Pleased

‘Anywhere from very well to not so good!”

N = 91 responses

q43 how did everyone families service coordinators cbdd and others respond1
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 respond2
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
Q44. What would you like your county's EI services to look like 5 years from today?

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

slide95

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

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.” 
slide96

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.”
slide97

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?

key findings conclusions
Key Findings & Conclusions

What have we learned about the current Part C EI Landscape in Ohio?

1 is there a full team of professionals available for children and families equal access
1. Is there a full team of professionals available for children and families? (EQUAL ACCESS)
  • 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.
2 how are services delivered ebei and consistency
2. How are services delivered? (EBEI AND CONSISTENCY)
    • 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 consistency1
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.
3 what expertise and ta capacity is available in the area workforce development
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
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.
slide104
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.