Research & Training Center in Service Coordination CFDA # 84.324L

1. Research & Training Center in Service CoordinationCFDA # 84.324L Service Coordination: Are We There Yet? Gloria Harbin, Ph.D. Kathleen Whitbread, Ph.D. University of Connecticut A.J. Pappanikou Center For Developmental Disabilities 263 Farmington Avenue, MC6222Farmington, CT 06030USA Phone: (860) 679-1500Fax: (860) 679-1571whitbread@nso1.uchc.edu Website: www.uconnucedd.org

2. This is a Collaborative Project Four primary sites: • Mary Beth Bruder, Ph.D., University of Connecticut • Gloria Harbin, Ph.D., University of North Carolina-Chapel Hill • Michael Conn-Powers, Indiana University • Sara Miranda, Federation for Children with Special Needs, Massachusetts Additional research being conducted by: • Richard Roberts, Ph.D., Utah State University • Carl Dunst, Ph.D., Orelena Hawks Puckett Institute

3. Principles • Collaborativemodel of integrated activities. • Families are an integral component of our project. • Stakeholderscontribute to all phases of the center activities. • Use of a Participatory Research Model.

4. Center Framework Family Service Provision System Administration I. Status II. Outcomes III. Recommended Practices IV. Measurement V. Training Model VI. Dissemination Surveys Focus Groups Delphi Technique OutcomeMeasurement Validation Studies

5. Objective 1 HOW WE DID IT: WHAT WE DID: Described current models of service coordination Series of Surveys

6. Survey Design

7. Survey Sampling

8. Survey Findings

9. System Infrastructure: WHAT IS NEEDED TO SUPPORT EFFECTIVE SERVICE COORDINATION

10. Case Study States • Dedicated and Independent • Blended with Intervention – LA • Blended with Intervention – IA

11. What Approaches are Used? • Dedicated - and Independent • Dedicated - NOT Independent • Blended with Intervention • Lead Agency (LA) • Blended with Intervention • Interagency (IA) • Variable (Harbin, Bruder, Reynolds, Mazzarella, Gabbard, & Staff, 2002.)

12. Which Model is Best? FINDINGS: • Differences in nature of some system components SERVICE COORDINATION PRACTICES SYSTEM INFRASTRUCTURE CHILD AND FAMILY OUTCOMES

13. Which Model is Best? • Not a useful question • Multiple factors – not just the model were associated with positive outcomes

14. Approaches and their Assumptions ANALYSIS REVEALED • Assumptions not always realized • Multiple factors could influence whether the original assumptions were realized

15. Dedicated Approach ASSUMPTIONS • Can spend more time on S.C. • Specialist Needed • Offer Broader Array • More Choice for Families

16. Dedicated Approach WHAT CAN GO WRONG? • Case load Too large • S.C. not knowledgeable about services and resources • Parents uninformed • S.C. not knowledgeable about disabilities

17. Blended Approach ASSUMPTIONS • Most knowledgeable about child and family needs • More effectively communicate with other providers • Family more likely to reveal needs

18. Blended Approach WHAT CAN GO WRONG? • Knowledge of needs related to own expertise • Communication doesn’t occur (no time, no mechanism) • Service provider doesn’t elicit needs

19. Variable Approach ASSUMPTIONS • No model is best • Locals know best • Individualization of approach is more likely to meet needs

20. Variable Approach WHAT CAN GO WRONG? • Pragmatic decision, not data-based • What locals “think is best” may not be • Lack of consistency confuses parents

21. Influential Factors • Empowering Relationship • Case Load • Use of Family Support Approach • Parent Choice • Array of Resources • Breadth of Service System • Interagency Linkages

22. Influential Factors • Integration of Services • Transdisciplinary • Routines-Based • Integrated Therapies • IFSPs With All Needs and Services • Interagency Training • Mechanisms to link needs to resources

23. Influential Factors • Learning Opportunities in Natural Settings • Identification of New Needs • Frequency of Contact • Case Load • Interagency Linkages

24. Influential Factors • Knowledgeable Personnel • Diverse disabilities and conditions • Resources • Capacity building

25. Objective 2 WHAT WE DID: We determined outcomes attributed to effective service coordination across stakeholders HOW WE DID IT: Focus Groups, Delphi Surveys, National Surveys, (Family and Service Coordinator Interviews and IFSP Review)

26. Outcome Focus Group Design

27. Outcome Focus Groups

28. Delphi Sampling Total of 395 surveys were distributed

29. Outcome Delphi Design

30. Outcome Delphi Design

31. Delphi Outcomes • Children and families receive appropriate supports and services that meet their individual needs • Children are healthy • Children’s development is enhanced • Children have successful transitions • Families are involved in decision making • Families are informed about resources and services • People work together as a team

32. National Outcomes Survey

33. Objective 3 WHAT WE DID: We determined practices that lead to high quality Service Coordination HOW WE DID IT: Focus Groups, Delphi Surveys, National Surveys, (Family and Service Coordinator Interviews and IFSP Review)

34. Practice Focus Group Design

35. Practice Focus Groups

36. Delphi Practice Sampling 112 PTIs distributed to 12 families each 2688 surveys distributed to families Total of 4730 surveys were distributed nationally

37. Practice Delphi Design and Findings

38. Practice Delphi Design and Findings

39. Delphi Practice Themes • Providing information • Ensuring family understanding • Being responsive to families • Developing IFSPs • Monitoring progress • Ensuring family satisfaction • Promoting child development • Addressing healthcare and safety issues • Completing administrative responsibilities • Planning for transitions • Collaborating with community organizations • Engaging in professional development activities

40. National Practices Survey

41. Objective 4 HOW WE DID IT: WHAT WE DID: Measured outcomes and practicesof effective Service Coordination Interviews with families, families’service coordinators and IFSP review

42. Interview Design

43. Interview Sampling

44. Interview Sampling

45. Family Demographics (N=98)

46. Family Demographics

47. Service Coordinator Demographics (N=76)

48. Interview Findings • Identified outcomes important to families. • Identified who assisted the family in achieving the outcomes. • Learned how service coordination helped achieve the outcomes. • Identified how long it took to achieve the outcome.

49. Outcome Methodology • Independent sort of family and SC outcomes into themed categories. • Collapsed similar themes resulting in 14 family and 13 SC outcome themes. Frequencies and percentages were calculated for each. • Second sort of outcomes into themed categories. Frequencies and percentages were calculated for each. • Comparison of interview, Delphi, and survey outcomes yielding final 8 outcomes.

50. Interview Outcomes • Children will have successful transitions. • Children and Families receive early intervention services that are • individualized, coordinated and effective. • Families make informed decisions about services and opportunities in the • community for their children with a disability. • Families acquire and/or maintain a quality of life that enhances their well-being. • Families are self-sufficient. • Families are knowledgeable of their child’s disability. • Families are satisfied. • Children’s development is enhanced. • Children are safe and healthy.