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Enhancing Early Intervention Quality: Missouri's IFSP Quality Rating Scale Initiative

This document outlines Missouri's efforts to improve the quality of early intervention services through the development and implementation of the Individualized Family Service Plan (IFSP) Quality Indicators Rating Scale (QIRS). It details the historical context, connection to the state improvement plan, key quality indicators, initial review results, and future improvement plans identified through stakeholder meetings. The document emphasizes the need for accountability in service provision, addressing financial challenges, and ensuring high-quality, family-centered services across the state.

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Enhancing Early Intervention Quality: Missouri's IFSP Quality Rating Scale Initiative

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  1. Improving Quality Practices in Early Intervention: Missouri’s IFSP Quality Rating Scale

  2. Agenda • History / Tie to State Improvement Plan • Description of IFSP Quality Indicators Rating Scale (QIRS) • Development & implementation • Selecting & Reviewing IFSPs • Preliminary Results of Review • Plans for the future

  3. SICC-Identified Needs in First Steps • SICC meetings from 3/03 – 1/04 identified a number of priorities for improvement: • A system of accountability/oversight to ensure high quality, family centered services • Provider availability and training • Financial/budgetary concerns (cost-containment) • Overall concerns about the quality of services & appropriateness of IFSPs

  4. Legislative/State Concerns • Program costs increasing • Variation in cost per child • Limited support/guidance to ensure quality services • Need cost containment without compromising quality

  5. OSEP Influences • Missouri needs a system of accountability • Service coordination concerns • Monitoring SPOEs to ensure quality

  6. Missouri’s Improvement Planning • Stakeholder meeting with NECTAC • June 28-29, 2004 • Understand challenges related to increasing service costs, appropriate provision of services, implementation of accountability strategies & incentives to change provider practices • Develop an improvement plan to address challenges • June 30 – July 1, 2004 • Develop a “Standard of Practice in Early Intervention” tool • If we know what “bad” IFSPs look like, then what do “good” IFSPs look like?

  7. IFSP Quality Indicators Rating Scale (QIRS) • Designed to be used in accountability & monitoring procedures • Specific contractual uses for 3 of 24 System Points of Entry (SPOEs) • Reviewers will rate randomly selected IFSPs on a scale of 1-5 • 1: needs improvement • 3: acceptable • 5: recommended practice

  8. IFSP QIRS Development • IFSP document: • Workgroup took sections • Identified required components • Identified poor & quality indicators • Reported initial recommendations to entire stakeholder group; gather consensus • NECTAC left with butcher block paper & a collection of concepts and ideas • NECTAC used stakeholder input to draft QIRS • Missouri stakeholders reviewed and revised

  9. IFSP QIRS Development • 8/19/04: National expert reviewed rating scale • 8/23/04: Conference Call with MO stakeholders, NECTAC & national expert • 8/31/04: IFSP Rating Scale finalized • 9/22-23/04: NECTAC provided awareness level training on EI research and the QIRS in St. Louis (videotaped for later statewide use)

  10. Developing Guidance • October 13-14, 2004: Develop exemplar for IFSP QIRS • Used IFSP for a child from Virginia • NECTAC provided introduction to developing exemplars; facilitated small group work in this area • November 3, 2004: Internal review of exemplars complete; published to workgroup for review

  11. Developing Guidance • Exemplar feedback • very positive about having exemplars • reworked some in-house revisions • clearly requested additional exemplars • Began training SPOEs using scale & exemplar in January 2005

  12. Developing QIRS Review Process • Determining Procedures • May 3 & 4, 2005 • NECTAC facilitated stakeholder group in determining process for selecting, reviewing and scoring IFSPs, and providing overall scores and feedback to SPOEs • Requested files from 3 SPOEs to pilot scoring • May 23, 2005 • Piloted scoring – scoring group + Service Coordinators from 2 SPOEs & DMH • May 27, 2005 • Conference call with 3 SPOE Directors regarding procedures

  13. Selecting IFSPs for Review • IFSPs are selected up to 10% of SPOE child count (but no more than 50 files) to sample across: • Service Coordinators (DMH & SPOE), • Initial IFSPs (minimum 5, plan for 1/3 of child count), • IFSPs that have gone through review (minimum 5, plan for 2/3), • IFSPs where the child is 2.5 years or greater (minimum 5), and • IFSPs where AT has been identified as necessary (minimum 5).

  14. IFSP Scoring • Individual IFSPs are rated on up to 17 areas. • Two areas (Assistive Technology and Review) could be not applicable on a given IFSP. • On the 5 point Likert scale, “2” and “4” are not defined because they represent mid-points. • Each IFSP will get a score of 1, 2, 3, 4, or 5

  15. IFSP Scoring Table

  16. SPOE Scoring • Each SPOE is rated on overall percentage of IFSPs scored as high quality, quality, acceptable, needs improvement, poor. • SPOEs receive a Summary Report listing the number of files receiving each score. • IFSP scores are averaged and the SPOE receives a rating based on their average IFSP score: • High Quality = 4.5 – 5.0 • Quality = 4.0 – 4.4 • Acceptable = 3.0 – 3.9 • Needs Improvement = 2.0 – 2.9 • Poor = 1.0 – 1.9

  17. Reviewing IFSPs • Each IFSP was evaluated independently by 2 reviewers • Reviewers discussed use of the Rating Scale to ensure consistency • If scores resulted in the same quality range (quality, acceptable, poor, etc.), file complete • If scores in different quality ranges (quality & acceptable; poor & needs improvement), reviewers met and came to consensus on score

  18. Preliminary Results • 1 of 3 SPOEs met “Acceptable” or higher • IFSPs varied from high quality to poor • IFSPs varied within the documents • Service Coordinators seem to have areas of expertise • General documentation / completion • Use of “stock phrases” that don’t change (transition) • Writing parent comments verbatim/no probing • Lack of tie between family’s concerns, priorities & resources and services

  19. Preliminary Results • 3 SPOEs average cost per child:

  20. Future Plans • Lead Agency and First Steps Consultants will meet: • Dec 20, 2005: Train LA & FS Consultants on QIRS review process • TBD: Review QIRS results to determine statewide and regional training needs • TBD: Develop & provide training • Jan/Feb 2006: Embed into service coordinator training for 8 new SPOEs

  21. Future Plans • Lead Agency and First Steps Consultants will meet to: • TBD: With TA from NECTAC, evaluate and revise (if needed) QIRS tool and process • TBD: Training additional reviewers for future statewide QIRS implementation • TBD: Institutionalize the QIRS reviews as part of the monitoring & accountability process

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