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

1. 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) .

2. 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

3. 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.

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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

10. 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.

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

12. 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. 

13. 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.

14. 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:

15. 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

16. “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.

17. 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.

18. 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)

19. 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

20. 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)

21. Who responded? Questions 1 & 2

23. 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

24. 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

25. 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

26. Topic A: Is there a full team of professionals available for children and families? Questions 3 - 5, 7, 9 - 17

27. 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

28. 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.

29. 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

30. Q5. Are any of your Service Coordinators serving in a dual role as CBDD Early Intervention Specialists? N = 84 counties

31. 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!)

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

33. 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

34. 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

35. 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

36. 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

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

38. Q9. What sources of payment are utilized for each of the following? • Examples of “Other”: • WIC • Waivers • Mental health levy dollars

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

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

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

42. 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

43. 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

44. 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

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

46. 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.”

47. 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

48. 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

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

50. Q17. Is your County Board of DD EI program following a Primary Service Provider (PSP) approach? N = 95 responses