Kentucky’s Early Intervention System November, 2011

1. Kentucky’s Early Intervention System November, 2011

2. First Steps • Kentucky’s Early Intervention System (KEIS) has been in existence since 1994. The Cabinet for Health and Family Services, Department of Public Health is the lead agency. • First Steps Regulations address CAPTA: • 902 KAR 30:110 (1)(a) The point of entry (POE) staff shall serve as the local lead agency and shall coordinate child find efforts with: • 6. The local Department for Community Based Services (DCBS) office for cases with a sustained or negligent complaint;

3. Policies that address CAPTA • Section 5.4 of the First Steps Policy and Procedures Manual addresses referrals from DCBS in detail. • “The Individuals with Disabilities Education Act (IDEA) 2004 requires states participating in Part C to refer for early intervention services any child under the age of three (3) who is involved in a substantiated case of child abuse or neglect and/or is identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure. • All children referred from DCBS/foster parents with a developmental concern must be screened with both the ASQ-3 and the ASQ: SE as appropriate for age. (ASQ: SE begins at age three (3) months, ASQ-3 begins at age one (1) month).”

4. First Steps Website • Detailed procedures are found at: • http://chfs.ky.gov/NR/rdonlyres/2FA68DC3-86FD-424C-9DB3-99BE1C03021C/0/FirstStepsPolicyProceduresManual7511.pdf(page 32 of 149) • First Steps website: http://chfs.ky.gov/dph/firststeps.htm

5. Cabinet for Health and Family Services Department for Public Health Division of Maternal and Child Health Early Childhood Development Branch First Steps State Program Structure

6. First Steps • There are fifteen (15) regional Points of Entry (POEs) who serve as the local lead agency. All serve a multi-county district. • POEs accept referrals, handle all intake activities and provide ongoing service coordination. • IFSP early intervention services are provided by a network of approximately 1500 providers (independent and agency)

7. A typical day in First Steps

8. First Steps Core Concepts • First Steps providers are expected to understand and implement early intervention services by: • Focusing on the family/caregiver as the primary target for intervention • Coaching/consulting the family/caregiver using a Primary Service Provider (PSP) • Providing services and supports in settings where the family lives and plays

9. Accessing services • Anyone can call or fax the Point of Entry  (POE) office to refer a child to the First Steps service systems who may have a developmental delay or affecting medical condition.

10. Accessing Services FY11 Data Source: TOTS • 6628 Referrals • 3754 Eligible Data Source: TOTS • 651 Referrals • 515 Eligible & In service Note: Part C data collection changed to capture CAPTA referrals mid-year so data represents half a year. All Referrals CAPTA Referrals

11. Child Welfare: Department for Community Based Services (DCBS) • DCBS services are administered through a network of 9 service regions and offices in each of Kentucky's 120 counties. • Programs provided by DCBS include: family support; child care; child and adult protection; and eligibility determinations for Medicaid and food benefits. • DCBS also administers the state foster care and adoption systems and an energy cost assistance program.

12. Relationship between DCBS and First Steps • DCBS is a primary referral source for First Steps and is a required child find partner. • District Early Childhood Committees (DEICs) are required by the First Steps statute and mimic the state Interagency Coordinating Council (ICC). DCBS participates as a member of the DEIC in some regions of the state.

13. First Steps Referral Process

14. Screening • Children referred due to a suspected developmental delay are screened using two instruments: • Ages and Stages Questionaire-3 (ASQ-3) • Ages and Stages Social-Emotional (ASQ: SE)

15. First Steps Eligibility Criteria • Established Risk Condition—list of over 240 medical conditions with high probability of disability or developmental delay • Significant Developmental Delay– 2 S.D. in one area of development or 1.5 S.D. in two • Professional judgment also allowed for eligibility determination in some cases—this is currently used for children with social-emotional disorders.

16. Established Risk Condition • Children referred due to the diagnosis of an Established Risk Condition are not screened. These children move directly to evaluation for eligibility. • Established Risk Conditions include: Fetal Alcohol Syndrome/Effects, Shaken Baby Syndrome, Head Trauma with Neurological Sequale

17. Established Risk Conditions • What’s not included at this time: • Failure to thrive • Severe Attachment Disorders • Anxiety Disorders • And other social–emotional disorders • Kentucky will need to add social-emotional disorders that have a high probability for developmental delay to the Established Risk Conditions as a result of the new federal regulations for Part C.

18. Issues • Terminology..what does Referral mean? • Who is making the referral? • When is the referral made? • Data collection—definitions/standards • Understanding eligibility for First Steps

19. http://chfs.ky.gov/dph/firststeps.htm Paula E. Goff Part C Coordinator Kentucky Department of Public Health Paula.Goff@ky.gov