Part C State Performance Plan (SPP) for 2005-2010 Revisions Submitted February 1, 2007: The Birth to Three Early Intervention System submitted its SPP for 2005 – 2010 in November 2005 and it was approved by the US Office of Special Education Programs in March 2006. Revisions have been made to the SPP for the Early Childhood Outcomes Indicator (Indicator #3) and the Family Outcomes Indicator (Indicator #4). Descriptions of the system, baseline data and improvement activities are detailed in each section. Early Childhood Outcomes, Indicator #3, describes the child outcome system that has recently been implemented based on results from an extensive pilot conducted through the General Supervision Enhancement grant and in collaboration with the Delaware Department of Education and the Child Outcome Work Group (described in the original SPP submitted in November 2005). Targets for Indicator #3 can not be set until 2008 since both entrance and exit data are required in order to set targets. The new child outcomes system for Part C and Part B/619 under IDEA has required extensive systems change to the Birth to Three Early Intervention System. These changes involve every level of the Birth to Three Early Intervention System, including Child Development Watch service coordinators and assessors, early intervention provider staff, and our various stakeholders groups. In service training and ongoing technical assistance has been developed and provided, as well as new training is being planned for the upcoming year. A new data module was created in ISIS for tracking and reporting early childhood outcomes. Delaware continues to balance these system changes to satisfy all federal requirements while at the same time working to improve the capacity for child progress monitoring that focuses on a performance–based assessment process. Family Outcomes, Indicator #4, has also required system changes. A new method to gather family outcome data has been piloted and instituted within this past year. Baseline data was collected and measurable targets set. This data allows us to gather input from a larger sample of families and to continue to compare results and trends from previous years. There has been ongoing stakeholder input provided to revise these indicators in the SPP and that is also described in the overview of issue/description of system for each of these indicators. In many of the indicators within the SPP, improvement activities have been added and some improvement activities have been revised in order to meet the targets. The Interagency Coordinating Council (ICC) is the advisory group to the Birth to Three Early Intervention System, and includes parents, education professionals, pediatric and early intervention providers, a child care provider, advocates, and a representative from Early Head Start, a legislator, and others representing the designated state agencies. The ICC meets four times each year and the Committees meet quarterly or as necessary to develop and implement improvement activities. The ICC Executive Committee meets quarterly prior to ICC meetings. The ICC and the ICC Executive Committee are the primary stakeholders of the Birth to Three Early Intervention System and have reviewed and given input into the revised SPP. The ICC has come to consensus on the targets, activities, timelines, and resources. The revised SPP was finalized for submission to OSEP based on the input from the members of ICC. Overview of the State Performance Plan Development: The Birth to Three Early Intervention System operates under the authorization of Part C of the Individuals with Disabilities Education Improvement Act of 2004 (IDEA). Delaware Department of Health and Social Services (DHSS) is the lead agency for Part C in Delaware. The Program is administered by the Birth to Three staff within the Division of Management Services, and children and families eligible for Part C services are served through Child Development Watch (CDW) within the Division of Public Health. The Interagency Coordinating Council (ICC), is the advisory group to the Birth to Three Early Intervention System, and includes parents, education professionals, pediatric and early intervention providers, a child care provider, advocates, a representative from Early Head Start, a legislator, and others representing the designated state agencies. The ICC meets quarterly and assists with specific target areas as necessary and reviews quarterly performance. The State Performance Plan development is the result of collaboration between the Birth to Three Early Intervention Office staff, the ICC, and the following committees of the ICC and Birth to Three Early Intervention System: (see Attachment 2) Building Capacity in Natural Environments (BCNE) Ongoing Program Evaluation Committee (OPEC) Ad Hoc Health Care Committee Communication Guidelines Committee Delaware New Scripts Team Sequenced Transition to Education in the Public Schools (STEPS – New Castle County) Interagency Task Force and Interagency Committees between Department of Education (DOE); Department of Services for Children, Youth and their Families, Divisions of Family Services (DFS) and Child Mental Health (CMH); Delaware Health and Social Services (DHSS), Divisions of Developmental Disabilities Services (DDDS), Management Services (DMS) and Public Health (DPH). The ICC meets four times each year and the Committees meet quarterly or more often as necessary to develop and implement improvement activities. The ICC Executive Committee meets quarterly prior to ICC meetings and most recently met on November 17, 2005 as a special meeting to review the final SPP based on input from the various stakeholder groups. The Overview of Issue/Description of System or Process, Baseline Data, Discussion of Data and Improvement Activities/Timelines/Resources were entered into the template by staff in the Birth to Three office. A meeting was held on October 25, 2005 with the ICC to review the new template and data requirements, and to distribute the SPP. ICC members were given the opportunity to review the new requirements, ask questions, and come to consensus on the projected targets, activities, timelines, and resources. Committees provided input for specific sections of the SPP. The Interagency Committee between DOE and CDW met on October 20, 2005 and reviewed Indicator 8 of the SPP, including targets, data and activities within Effective General Supervision Part C/Effective Transition. Early Childhood Transition’s activities are also being coordinated with the Early Childhood Committee of the Partner’s Council for Children with Disabilities (PCCD) and the Part B SPP. BCNE Committee reviewed Indicator 2 within Early Intervention Services in Natural Environments of the SPP via correspondence and conference calls with its chairpersons in October 2005. Specific improvement activities relating to personnel development are coordinated through the PCCD joint comprehensive committee on personnel development and through an Ad Hoc committee on addressing shortages of speech language pathologists. The Interagency Committee between the Divisions of Management Services and Public Health, with input from the Quality Management Coordinator, reviewed the entire SPP draft. This group is acting as the Quality Management Committee since it is responsible for local implementation. All input was considered when finalizing the SPP. The SPP was finalized for submission to OSEP based on the input from the members of ICC and the Committees. ICC and the Committees will continue to meet over the next year to review data and establish targets for the new indicators. The Birth to Three office is a co-partner with DOE’s Preschool Programs for Children with Disabilities for the Early Childhood Outcomes’ General Supervision Enhancement Grant (GSEG). Through the work of the GSEG, the statewide Child Outcomes Work Group (COWG) and the three subgroups, Child Indicators, Reporting and Assessment, and Data and Programming Group have been established and include many ICC and Birth to Three stakeholders (see Attachment 2). Furthermore, OPEC is working with COWG to coordinate current work with Early Childhood and Family Outcomes into the new indicators of the SPP. Once baseline data is collected and targets are projected regarding Child and Family Outcomes within indicators 3 and 4 of the SPP, they will be presented to the ICC for discussion, approval and then included in the future Annual Performance Reports (APR). Local data for Delaware is organized by region: New Castle County is one region and Kent and Sussex Counties is the second region. Children are referred into early intervention through regional Child Development Watch programs, service coordinators are on teams based in these regions; charts and IFSPs are maintained and monitored by the Birth to Three Monitoring teams through these regions, and early intervention providers are a part of IFSP teams based on these regions. The SPP and APR due in February 2007 and regional early intervention program progress on the indicators will be distributed to the public through media announcements that copies of the reports are available at local libraries. There will also be a presentation and copies available for distribution to each Child Development Watch program site, the ICC Early Intervention Provider group, members of the ICC and PCCD, the Parent Information Center of Delaware (Delaware’s parent training information center) and to ICC and Birth to Three Early Intervention committees. These reports will also be posted to the DHSS website at: http://www.dhss.delaware.gov/dhss/dms/epqc/birth3/directry.html Monitoring Priority: Early Intervention Services In Natural Environments Indicator 1 Percent of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner. (20 USC 1416(a)(3)(A) and 1442) Data Source: Data to be taken from monitoring or State data system and must be based on actual, not an average, number of days. Include the State’s criteria for “timely” receipt of early intervention services, i.e., time period from parent consent to IFSP services initiation date. Measurement: Percent = # of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner divided by the total # of infants and toddlers with IFSPs times 100. Account for untimely receipt of services. Overview of Issue/Description of System or Process: State monitoring developed baseline data in 2003 on whether all services on the IFSP were started and whether they were started within a timely manner. Timely manner was further clarified to be a state recommended guideline. The State’s guideline for timely manner is that services start within 30 days from referral to EI providers, or documentation to explain why a service was not started within this time period. Referred for service is defined as date referred for service with parent consent as indicated on the IFSP. IFSP service initiation date is date a service starts. Technical assistance was provided to service coordinators, data entry staff, and early intervention service providers on the state guideline of thirty days, as well as the need for documentation if services are not initiated within that time frame. An additional field was added to ISIS (Integrated Services Information System, Delaware’s early intervention database) to capture the service referral date. This became a required field for data entry and is also included on the IFSP service page. This has enabled the Assistant Part C Coordinator and local data managers to generate reports from ISIS that list all services included on each IFSP. The report not only provides information on the actual number of days from referral to service initiation, but also identifies the service coordinator, early intervention provider, and county. This information helps Delaware determine if any delay is specific to individual staff persons, provider agencies, or county. County detail provides an extra measure indicating if services are available in all geographic areas of the state. Data collected from this report ensure that the methods for correction are specific to the cause. After analysis of preliminary data, it was determined that additional technical assistance was necessary to ensure that the correct referral date was being entered into the database. Identifying this need for additional assistance, the Birth to Three Monitoring Team continues to review the status of timeliness and availability of early intervention services through chart review during annual statewide monitoring and through the data provided by the Family Survey. The Family Survey, conducted every other year by the University of Delaware—Center for Disabilities Studies, also serves as a barometer for service availability by including the following questions and statements: * I am more able to get my child the services that he/she needs. * Would additional services, information, and/or assistance help you better care for your child? * We are getting the services listed on the IFSP. * I am satisfied with the services my child and family are receiving. A high percentage of families in 2004 responded that they were getting the services listed on the IFSP (97.3%) and that 93.2% of respondents indicated that families were satisfied with the services their child and family is receiving. A few families mentioned in the comments that they would like more information and services on speech development for their child. In addition to chart monitoring and the Family Survey, Birth to Three has in place Delaware Personnel Standards and Guidelines Matrix. This Matrix is part of the CDW standards and is a part of early intervention provider contracts. In this way the state assures that the highest level of academic degree and/or recognized comparable qualifications is maintained. Furthermore, training offered both by the Birth to Three office and DOE provide continuing education credits in the various disciplines whenever possible in order to assist staff to maintain licensing at the same time as updating staff in basic components of early intervention and recommended practice. The most recent example of this was the August 2004 training concerning Coaching. Birth to Three maintains a committee focusing on comprehensive system of personnel development (CSPD). CSPD is a joint committee with DOE through the Partners Council for Children with Disabilities (PCCD), primarily because personnel development is a big challenge for a small state, and joint efforts are far more effective. The CSPD subcommittee’s work to address personnel shortages during the past year included: * reviewing current personnel needs data for special educators and related service providers * identifying challenges to a comprehensive system of personnel development in the areas of recruitment, preparation, and retention * identifying strategies that are already in place to overcome the barriers * reviewing the literature to choose possible new research-based strategies to overcome these challenges * writing a strategic plan for addressing these priorities, including timeline for implementation, persons responsible and resources needs State monitoring indicates that speech language services are the service documented as most often started outside of Delaware’s state guidelines due to shortages in personnel. Three statewide initiatives have been started in order to address shortages in speech language services and other therapy services. These initiatives are: * Expand the Delaware’s Speech Language Incentive Loan Program as of June 2004 to include students who agree to work with early intervention providers as well as with local school districts. Students are entitled to awards and qualifying employment for service repayment of their scholarship. This has been widely promoted among early intervention providers to attract speech language pathologists. The next step is to promote this among master’s level graduate programs in the surrounding areas. * Implement the Delaware Guidelines for Young Children with Communication Delays approved as a pilot by ICC in April 2004 and initiated statewide in July 2004. Children with only expressive language delays will participate in Enhanced Watch and See (EWS) and not be Part C eligible. EWS offers support for these children by an EWS Coordinator who is an early childhood educator. New contract funds are available to support EWS, and consultative services by speech language pathologists (SLP) are offered as needed. Children in EWS are tracked and monitored, and families are offered monthly contacts regarding language stimulation resources. Direct speech language pathology services are not offered, thereby decreasing the demand on existing SLPs. * Birth to Three collaborated with DOE and CSPD on a DOE grant in 2005 from the National Center for Special Education and Related Service. Training was offered on recruitment and retention of a diverse and qualified work force. The early intervention team focused their work on early intervention speech language pathologists. Baseline Data for FFY 2004 (2004-2005): Figure 1-1 Children receiving services within thirty-day state guideline Source: Annual Statewide Monitoring Discussion of Baseline Data: 2005 monitoring data indicated that 71.52% of infants and toddlers received their early intervention services included on IFSPs within the state recommended guideline of 30 days from the point of referral to the initial visit. The service referral date is a new field since 2003 on the IFSP and in ISIS, and there is a need for continued training in order to have accurate and consistent data. Data integrity reports are in place to verify the accuracy of the data for 2006 state monitoring results. (See Indicator 9 for further explanation of sampling methods for chart audit reviews.) State recommended guidelines have recently been developed to quantify timely delivery of service as 30 days from referral as indicated on IFSP to start of service or justification relating to the needs of the child and family is provided to explain why a service was not started within that time period. This new state guideline has been shared through correspondence with the CDW programs and with all early intervention providers. Follow up technical assistance has been provided. More guidance is needed in the form of technical assistance memos and incorporation into CDW standards. Baseline data from monitoring indicates that 118 of 165 infants and toddlers had all services on the IFSP started within the state guidelines. Forty-seven infants and toddlers had a service started beyond the thirty days. Of these, twenty-nine were due to a service being unavailable, primarily speech-language pathology. Two of the forty-seven were due to reasons regarding communication issues with service providers. The remaining charts were not clearly documented. Technical assistance is now in place and the 2005-2006 data is expected to better capture the actual number of days when services are started beyond the thirty day timeline and to assure that reasons for extending beyond the state guideline are clearly documented in order to analyze this data both at the local and state levels. Early Intervention providers face a challenge in recruiting and retaining staff. As Delaware focuses on increasing service provision in natural environments (see Indicator 2), current providers have greater demands on their time to serve Part C eligible children in a timely manner and also in natural environments. Birth to Three has recruited four new provider agencies in 2005. Two of these providers provide targeted services to the rural areas of the state. The primary documented reason why an IFSP service is not started within the state recommended guideline is lack of available speech language services. Birth to Three has taken steps to address capacity to increase speech language pathologists in 2004, but Delaware competes with neighboring states in recruitment and retention, and early intervention providers compete with local school districts who offer more compensation for a shorter work year. The new CSPD initiatives relating to early intervention were just started in 2004 and require more time to see results from these efforts. A new committee was formed in Spring 2005 with legislative membership to address the shortages in speech language pathologists. In addition to promoting the Speech Language Incentive Loan Program and the EWS program, there is an effort underway to work with higher education to start a master’s level SLP graduate program. This is a large and expensive endeavor and may take some time to explore. Furthermore, this new committee is working more closely with the Delaware Speech, Language and Hearing Association to discuss the benefits of considering an SLP assistant program in Delaware. EWS is a program that was implemented in July 2004. While there have been relatively few children considered for EWS because of expressive language delays only (most children referred to early intervention demonstrate other delays), EWS program continues to expand and offer monthly phone contacts, parent administered assessments, and an ongoing exchange with families of language enhancement resources and activities. Preliminary evaluation of the EWS program indicates that the program is being effectively implemented and the range and variety of EWS materials are well received by families. Furthermore, EWS coordinates with the work of DOE’s State Implementation Grant in Early Literacy. Parent information sessions are available to families in EWS, and a list of child care providers with staff who complete some of the early literacy training modules are shared with CDW service coordinators, early intervention providers and EWS Coordinators. The master’s level early literacy training is also promoted with all CDW and early intervention providers. In the family survey families requested more information about promoting speech- language development in their children. In 2005, one speech language pathologist under contract received Hanen training to offer family training to families of children in Kent and Sussex Counties with an identified communication delay. Eighteen families have received training to increase their child's expressive language. Plans are underway to offer Hanen training to any early intervention providers and to help support and expand this opportunity to families throughout the state. Hanen training with families will promote families as an early intervention partner in promoting language with their children and may better utilize SLPs as a resource within the Birth to Three Early Intervention System. FFY Measurable and Rigorous Target 2005 (2005-2006) 100% of infants and toddlers with IFSPs in the Birth to Three Early Intervention System will receive the early intervention services on their IFSPs in a timely manner according to the recommended state guideline. 2006 (2006-2007) 100% of infants and toddlers with IFSPs in the Birth to Three Early Intervention System will receive the early intervention services on their IFSPs in a timely manner according to the recommended state guideline. 2007 (2007-2008) 100% of infants and toddlers with IFSPs in the Birth to Three Early Intervention System will receive the early intervention services on their IFSPs in a timely manner according to the recommended state guideline. 2008 (2008-2009) 100% of infants and toddlers with IFSPs in the Birth to Three Early Intervention System will receive the early intervention services on their IFSPs in a timely manner according to the recommended state guideline. 2009 (2009-2010) 100% of infants and toddlers with IFSPs in the Birth to Three Early Intervention System will receive the early intervention services on their IFSPs in a timely manner according to the recommended state guideline. 2010 (2010-2011) 100% of infants and toddlers with IFSPs in the Birth to Three Early Intervention System will receive the early intervention services on their IFSPs in a timely manner according to the recommended state guideline. Improvement Activities/Timelines/Resources: Improvement Activities Timelines Resources Develop semi annual data integrity checks to guide monitoring of dates for service referral and service start data. Winter 2007 Assistant Part C Coordinator; Local CDW Management Analysts; ISIS Maintenance Committee Utilize semi annual reports to monitor progress and slippage of service started within state recommended guideline between annual monitoring periods. Semi-annually CDW Leadership Teams; Local CDW Management Analysts State monitoring data will continue to track and develop trend data on whether all services on the IFSP were started within 30 days from referral date to start date, and to conduct chart audits for documentation to explain why a service was not started in this time period. Spring 2007 Birth to Three Monitoring Team Incorporate state guidelines for timely start of services on IFSP into CDW Procedural Manual. Fall 2007 Birth to Three QM Coordinator Recruit new provider agencies to offer speech language services and other services as needed. 2007 and ongoing Birth to Three QM Coordinator; CDW Clinic Managers Participate in final report and follow up from Governor’s Executive Order #84 Creating A Task Force to Study Licensed Speech/Language Pathologists. Spring 2007 Part C Coordinator; Birth to Three Training Administrator; ICC; PCCD Continue to support Hanen family groups in each county annually. 2007 and ongoing Birth to Three Training Administrator; EI providers Continue EWS program and evaluate program for effectiveness. Track children in EWS to see how they are doing in kindergarten through third grade. Maintain resource lists for families of children who are late talkers and coordinate community activities that utilize early literacy training modules supported by SPDG. Spring 2007 and ongoing Local EWS Coordinators; EWS Work Group; DOE Early Literacy training through SPDG, if awarded Work on the SPDG, including the development of joint competencies for early childhood/special educators working across birth-kindergarten in language development and in conducting child outcome assessments. January 2007 through December 2007 PCCD; DE SPDG, if awarded; Birth to Three Training Administrator Work with PCCD and DOE related committees on recruitment and retention of related services personnel for birth to Kindergarten programs serving Part C and part B eligible children. 2007 and ongoing PCCD; Part C Coordinator; Birth to Three Training Administrator Indicator 2 Percent of infants and toddlers with IFSPs who primarily receive early intervention services in the home or programs for typically developing children. (20 USC 1416(a)(3)(A) and 1442) Data Source: Data collected for reporting under section 618 (Annual Report of Children Served). Measurement: Percent = # of infants and toddlers with IFSPs who primarily receive early intervention services in the home or programs for typically developing children divided by the total # of infants and toddlers with IFSPs times 100. Overview of Issue/Description of System or Process: There are several ongoing major initiatives in Delaware to increase quality services in natural environments. Birth to Three developed Natural Environments Guidelines in 1998, and training on natural environments occurs with all new staff and periodically in more targeted workshops. In 2003, through the work of a subcommittee of Building Capacity in Natural Environments (BCNE), the Natural Environments Guidelines were revised and shared for public input. Most recently, these guidelines were incorporated in the 2004 CDW Policy Manual and will soon be added to the CDW Family Guide. Birth to Three revised its on site monitoring questions in 2004 and its family and provider surveys to document ways that the IFSP team identifies and promotes learning opportunities within natural environments. When services are not provided in natural environments, there has been an increase in documentation provided in the charts. Training in August 2004 regarding Coaching in Early Intervention and follow up regional meetings have offered ways for service coordinators and early intervention providers to discuss how to better identify and support child and family routines as a part of the child’s outcomes on the IFSP. BCNE is actively working with Part C and others to offer training and consultation services to child care providers in order to promote inclusive settings. BCNE coordinates with such initiatives as Child Care Health Consultants, Easter Seal’s Pathways to Independence grant, and training opportunities throughout the state targeted to child care providers to promote inclusive child care. BCNE has developed a display and a series of workshops to offer as part of child care training. BCNE is also working with Birth to Three to update the User's Guide to the Growing Together Portfolio designed for Early Care and Education Providers, a resource for child care providers. New sections will include materials and resources that promote inclusive child care. Delaware New Scripts works to promote families as change agents to enhance the early intervention experience for children and families. The coordinator of New Scripts is a member of BCNE. As part of her work, New Scripts parents are beginning to be co- trainers for professional development coursework for child care providers. Birth to Three is partnering with DOE and Parents as Teachers to offer mini grants to support inclusive Stay and Play groups in all three counties. A statewide group is meeting quarterly to develop an evaluation that looks at components of what is needed in order to promote inclusion within these structured community play groups. Birth to Three, DOE, Office of Child Care Licensing, and Family and Workplace Connection have supported and co-facilitated the development of Early Learning Foundations for Infants, Toddlers and their Families to promote quality in early care and education programs. The next step is to develop training and curriculum modules for professional development based on the Infant Toddler Learning Foundations through a grant opportunity. Based on the 2002 Delaware Early Care and Education Baseline Quality Study, the Delaware Early Care and Education Council, with support from ICC, has taken a lead in promoting quality child care. This study indicated that quality in infant child care is mediocre to poor. Of the total programs included in the analysis, only 23.4% had children with disabilities enrolled and collaborated to provide services. The Early Childhood Comprehensive Systems (ECCS) grant family survey also made recommendations regarding increasing the supply of high-quality child care and pre- schools in Delaware based on the 2005 Findings and Recommendations Delaware Early Childhood Focus Group Study. Furthermore, recent results from Project InSite and Project Create indicated that training and onsite consultation are needed in order to improve quality child care. The Delaware Early Care and Education 2005 Report to the Interagency Resource Management Committee has recommended that the highest priority for implementation is to improve quality through a tiered reimbursement system and increases in purchase of care reimbursement rates. Birth to Three is also participating in planning a work force study to document where improvements are necessary to increase the supply of quality early care and education professionals. Baseline Data for FFY 2004 (2004-2005): Figure 2-1 Annual Child Count Primary Service Location (Table 2) Service Location 2003 2004 Program designed for children with developmental delay or disability 80 55 Program designed for typically developing children* 69 87 Home* 655 749 Hospital (Inpatient) 7 2 Residential Facility 3 1 Service Provider Location 136 111 Other Setting 3 9 Total 953 1011 Source: Annual Child Count Figure 2-2 Primary Service Settings Source: Annual Child Count Figure 2-3 Discussions of Natural Environments with Families Source: Annual Statewide Monitoring Discussion of Baseline Data: Annual child count data indicated that in December 2003, 76% of children were receiving their primary service in their home or in a program designed for typically developing peers, such as child care. Annual Child Count data prepared for December 2004 indicate that this percentage has increased to 83%. Based on this initial data, the target for 2011 is to have 90% of children will receive their primary service in natural environments. 2005 State monitoring data indicated that 91% of the IFSPs included services that were provided in natural environments or documentation existed for justification based on the child’s needs to be met in a setting not considered a natural environment. Monitoring indicates that justifications for services not in the natural environment by the IFSP team often include children who are medically fragile and those children in need of highly structured environments. Documentation will continue to track the movement of services to natural environments based on the needs of children. A high percentage of IFSP teams are discussing natural environments and 96.4% of IFSPs monitored indicate that families are identifying natural environments. 91% of charts reviewed in 2005 include evidence of strategies that families can use to promote child’s development. This is a positive trend to have families a part of discussions throughout the IFSP process and families continuing to report that service coordinators and providers are sharing strategies to use at home and other places where their child spends time. The 2004 Family Survey indicated that 96.7% of families indicated that Child Development Watch gave them information that they can use on a daily basis with their child. This increased from the 2002 Family Survey from 93.5%. This positive trend can be a result of many training efforts including coaching, follow-up from statewide monitoring, and PIWI (Parents Interacting With Infants) training, provided by Partners In Excellence (PIE). The PIWI model is a framework founded on the relationship-based, family centered, developmental perspective of early intervention. PIWI believes that parent-child relationships are critical foundations for early development. Participants included home childcare providers, Early Head Start, Parents As Teachers, home visitors, family service coordinators, and early intervention providers. FFY Measurable and Rigorous Target 2005 (2005-2006) 83.2% percent of infants and toddlers with IFSPs primarily receive early intervention services in the home or programs for typically developing children. 2006 (2006-2007) 83.4% percent of infants and toddlers with IFSPs primarily receive early intervention services in the home or programs for typically developing children. 2007 (2007-2008) 84% percent of infants and toddlers with IFSPs primarily receive early intervention services in the home or programs for typically developing children. 2008 (2008-2009) 86% percent of infants and toddlers with IFSPs primarily receive early intervention services in the home or programs for typically developing children. 2009 (2009-2010) 88% percent of infants and toddlers with IFSPs primarily receive early intervention services in the home or programs for typically developing children. 2010 (2010-2011) 90% percent of infants and toddlers with IFSPs primarily receive early intervention services in the home or programs for typically developing children. Improvement Activities/Timelines/Resources: Improvement Activities Timelines Resources As part of Expanding Opportunities, generate a shared vision and action plan to improve inclusive opportunities for young children with disabilities and their families. July 2006-June 2007 Expanding Opportunities team, Part C, Part B, Head Start, child care, family members and higher education State monitoring will continue to track whether all services are provided in natural environments, describe justifications why children are not receiving services in natural environments, and track the movement of services to natural environments. Annually Spring 2006- 2011 Birth to Three Monitoring team Revised statewide IFSP will be piloted in the northern region of the state and formally adopted; including revisions designed to promote family directed information regarding natural learning opportunities and functional goals. June 2007 IFSP Working Group Data collected in ISIS regarding provision of early intervention services in natural environments will continue to be reviewed for accuracy. Ongoing ISIS Maintenance Committee, Assistant Part C Coordinator Families will continue to be asked for their input concerning how early intervention helps with and fits into family routines. Spring 2007 (See Indicator 4) Family Survey, OPEC, University of Delaware–Center for Disabilities Studies Early intervention providers will implement new partnerships with early care and education providers through grant opportunities and through other early care and education initiatives such as Parents As Teachers’ Stay and Play. Individual providers will implement other strategies to increase the number of services provided in natural environments. June 2007 and annually thereafter BCNE; Part C and Assistant Part C Coordinator; Part C Training Administrator; meetings with EI Providers; Parents as Teachers Statewide Committee and results from mini-grant evaluations BCNE will continue to promote service coordinator and provider participation in early care and education initiatives. BCNE will provide inclusive child care training strands and a display as part of child care conferences throughout the state. Annually BCNE Print and distribute the updated Growing Together User’s Guide for Early Care and Education, which includes resources and materials concerning approaches, activities, and skills in caring for children with disabilities within early care and education settings. Spring 2007 BCNE; University of Delaware— Cooperative Extension Services ICC will continue to promote quality in child care as one of its six priority areas for FY2007, collaborating with the recommendations from the Delaware Early Care and Education Council. Ongoing ICC ICC will collaborate with pilot implementation of a tiered rating system of program quality for early care and education. June 2007 ICC, Delaware Early Care and Education Office—Department of Education (DOE); Interagency Resource Management Committee 2005 Annual Report, www.doe.state.de.us/early%5Fchildhood/, and select ‘Research’ from the left menu bar to view the latest IRMC report Training and curriculum modules will be developed for professional development based on Early Learning Foundations for infants and toddlers and their families. Summer 2006 through Spring 2007 DOE, Birth to Three Early Intervention System, Birth to Three Training Administrator with grantees of Project RELATE (Family and Workplace Connection and Delaware Early Childhood Center) Indicator 3 Percent of infants and toddlers with IFSPs who demonstrate improved: A. Positive social-emotional skills (including social relationships); B. Acquisition and use of knowledge and skills (including early language/ communication); and C. Use of appropriate behaviors to meet their needs. (20 USC 1416(a)(3)(A) and 1442) Measurement: A. Positive social-emotional skills (including social relationships): Percent of infants and toddlers who reach or maintain functioning at a level comparable to same-aged peers = # of infants and toddlers who reach or maintain functioning at a level comparable to same-aged peers divided by # of infants and toddlers with IFSPs assessed times 100. a. Percent of infants and toddlers who improve functioning = # of infants and toddlers who improved functioning divided by # of infants and toddlers with IFSPs assessed times 100. b. Percent of infants and toddlers who did not improve functioning = # of infants and toddlers who did not improve functioning divided by # of infants and toddlers with IFSPs assessed times 100. If children meet the criteria for a, report them in a. Do not include children reported in a in b or c. If a + b + c does not sum to 100%, explain the difference. B. Acquisition and use of knowledge and skills (including early language/communication): a. Percent of infants and toddlers who reach or maintain functioning at a level comparable to same-aged peers = # of infants and toddlers who reach or maintain functioning at a level comparable to same-aged peers divided by # of infants and toddlers with IFSPs assessed times 100. b. Percent of infants and toddlers who improved functioning = # of infants and toddlers who improved functioning divided by # of infants and toddlers with IFSPs assessed times 100. c. Percent of infants and toddlers who did not improve functioning = # of infants and toddlers who did not improve functioning divided by # of infants and toddlers with IFSPs assessed times 100. If children meet the criteria for a, report them in a. Do not include children reported in a in b or c. If a + b + c does not sum to 100%, explain the difference. C. Use of appropriate behaviors to meet their needs: a. Percent of infants and toddlers who reach or maintain functioning at a level comparable to same-aged peers = # of infants and toddlers who reach or maintain functioning at a level comparable to same-aged peers divided by # of infants and toddlers with IFSPs assessed times 100. b. Percent of infants and toddlers who improved functioning = # of infants and toddlers who improved functioning divided by # of infants and toddlers with IFSPs assessed times 100. c. Percent of infants and toddlers who did not improve functioning = # of infants and toddlers who did not improve functioning divided by # of infants and toddlers with IFSPs assessed times 100. If children meet the criteria for a, report them in a. Do not include children reported in a in b or c. If a + b + c does not sum to 100%, explain the difference. Overview of Issue/Description of System or Process: Birth to Three, through the work of the Ongoing Program Evaluation Committee (OPEC) and the University of Delaware, Center for Disabilities Studies, developed an ongoing child change evaluation that started in 2000 and will end in 2006. Data was reported from a random sample of children who are Part C eligible and received early intervention services in order to report their rates of development in motor, cognitive and their functional play development and the impact of CDW services on that development. Data was used from a combination of assessments administered during the initial evaluation for eligibility, a play assessment tool, and some family and child demographic information. This child change evaluation reported results to CDW staff, ICC, and in the Interagency Resource Management Committee’s (IRMC) annual report. From October 2004 – June 2006, Delaware developed an early childhood outcome system for infants, toddlers and preschoolers with disabilities. This outcome system will allow Part C to report progress on the three new child outcomes: percent of infants and toddlers with IFSPs who demonstrate improved positive social-emotional skills (including social relationships); acquisition and use of knowledge and skills (including early language/ communication); and use of appropriate behaviors to meet their needs. Birth to Three was a part of a General Supervision Enhancement Grant and planning occurred with DOE on how to collect, rate and report on these child outcomes from a combination of ongoing progress monitoring, parent and early intervention professional observations, interviews and assessments, and multidisciplinary initial evaluations and reevaluations. Birth to Three and DOE engaged in a pilot outcome measurement system from Fall 2005 – Summer 2006. The pilot project involved trying out a series of early childhood assessment measures across a variety of settings and professionals and used with children with different disabling conditions. 90 Part C eligible children were initially included in the pilot and represented children receiving services across delivery options; a mix of children with different disabling conditions including children with mild involvement, children with moderate involvement and children with multiple disabilities. We also targeted low-incidence populations to ensure we include all possible assessment scenarios. Several assessment measures that cross ages (0-5 years) and several measures that were appropriate for children ages birth to 36 months were included in the pilot. The Child Outcome Summary Form (COSF), developed by the Early Childhood Outcomes Center, was piloted on a smaller sample. Data from the pilot was reviewed in May 2006 to determine which measures we will begin using statewide. The intent was to have a menu of assessments available for use, and to allow for some assessments that may be more specialized for certain disabling conditions. As the final part of the pilot project, professionals received statewide, regional and local professional development opportunities in August and September 2006. Based on the pilot, the Child Outcomes Work Group and Birth to Three developed the following plan: Observations of the infant and toddler will be made in his/her natural environment, such as home, child care, Early Head Start, etc. Observations may be conducted by a primary service provider such as the early childhood educator or therapist, or other involved professionals. Progress monitoring will also include interviews with parents and early care and education professionals. Our focus is to ensure the information from on- going progress monitoring will be useful for intervention planning. A system will be developed to link progress monitoring data to our state’s early learning guidelines. This should enable early intervention providers to utilize the outcome data for intervention planning. Entry status assessment (status on entry): An initial evaluation of a child's needs will be conducted in conjunction with determining a child’s eligibility for early intervention. Eligibility determination includes the use of multiple sources of data. In many cases it will be possible to use some of the information from the initial multidisciplinary evaluation to inform the entry status of children who are eligible under Part C and begin early intervention. The Birth to Three office has established a time period for data collection. Requirements for data collection are dependent upon the status of the child. Newly eligible Part C children will be observed and their initial outcome assessment completed preferably within 60 days, of beginning service (beginning service is defined as the start of service on the IFSP). When using a performance–based observation assessment process and serving children in natural environments, there may be times when it takes up to 120 days to complete this initial assessment. Our focus will be to ensure entry child outcome assessment information will inform intervention planning. Assessment procedures may include, but are not limited to, observations, interviews, behavior checklists, structured interactions, play assessment, adaptive and developmental scales, criterion-referenced and norm referenced instruments, clinical judgment, and tests of basic concepts or other techniques and procedures as deemed appropriate by the professional(s) conducting the assessments. Annual/Exit assessments: All children having received at least six months of intervention will then be reassessed annually, using a similar performance-based observation assessment process. Due to the mobility of children and families and the likely attrition rate, this process will help to ensure that we are able to capture an adequate percentage of children on an annual basis, and to determine which annual data collection point is closest to when the child exits from Part C. Whenever possible, the collection period will also coincide with the child’s annual IFSP to inform intervention planning and the exit outcome will inform transition planning. The exit outcome assessment will be preferably within 90 days when the child exits Part C. Birth to Three will assure that children at entry and near exit will be assessed and data reported. There will be no random assignment process. Child Outcomes process: Birth to Thee has identified a recommended list of assessments based on the pilot. Each of the measures were validated through a comprehensive process. A key element was the strength of the alignment of the assessment measure with the state’s Infant and Toddler Early Learning Foundations. The tools chosen include: Bayley Scales of Infant and Toddler Development, Third Edition (in conjunction with observations and interviews), Creative Curriculum Continuum for Infants and Toddlers, Carolina Curriculum for Infants and Toddlers with Special Needs, Callier-Azusa Scale, Developmental Assessment for Individuals with Severe Disabilities, and the Vineland Adaptive Behavior Scales, Second Edition. CDW assessors or early intervention providers will use a performance assessment structure, using mostly ongoing progress monitoring information. In some cases, where the necessary information can be obtained from the initial diagnostic assessment, we will use this data. For most children, we will utilize information obtained from criterion referenced measures administered by the early intervention provider professional(s) involved with the children. The information obtained from the performance-based assessment process will then be utilized to determine each individual child’s status on each of the three child outcomes on the Child Outcome Summary Form (COSF). The COSF is a seven point rating scale designed to summarize information related to a child’s developmental status on each of the three OSEP outcome statements. The COSF is designed with the perspective that the highest end of the scale (7) represents age-expected or age-appropriate functioning with each lower point being a degree of distance from age expectation. Rating scores will be required at the time of entry into the program, and at each subsequent assessment time period. Because Birth to Three is recommending a set of different assessments that can be used by early intervention programs, the results from the assessments will be different. An analysis structure needed to be established to bring equity to the different assessment results so the data could be aggregated for state reporting purposes. The COSF provides the mechanism for programs to report children’s developmental status using the same rating platform, thus aggregating data across programs. Birth to Three, in consultation with the computer programmer for the Birth to Three data system, ISIS, and Dr. John Vacca, a University of Delaware professor with expertise in early childhood assessment, has developed an outcome module added onto ISIS that allows for data and reporting of both assessments by domains. It includes a formula for the recommended assessments that will allow programs to make the determination of a child’s status on each of the three child outcomes within the framework of the COSF. The COSF will be reviewed by the IFSP team and revised if needed based on observations and additional sources of information. The ISIS outcome module also allows for the COSF to be entered directly with sources of information listed. Birth to Three is training programs on the use of COSF. Delaware Building Blocks Guidelines for Infants and Toddlers outlines requirements for the early childhood outcomes. This has been shared with the regional CDW programs, CDW leadership teams, each early intervention provider agency, at regional early intervention provider meetings, and at ICC. This is available on the Birth to Three and DOE web sites and is periodically updated, including a document of frequently asked questions. Birth to Three monitoring procedures will be revised to include strategies for examining outcome rating activities during record reviews and focused monitoring activities. It is anticipated that Birth to Three will work with CDW and early intervention providers to carefully examine outcome data and use this information for local program reform where necessary. The ISIS Outcome module will be able to calculate the five OSEP reporting categories as required from the entry and exit COSF data [ratings] for all individual children for each of the three child outcomes. A report will aggregate this data and report the number of children in each of the five reporting categories for each of the three child outcomes. Entry status data will be formally collected during the 2006-2007 year. Annual/exit data will also be collected during the 2006-2007 year. Baseline data will be calculated from the entry COSF rating matched to the exit COSF ratings for each outcome for children at the regional and state level. Birth to Three contracts with early intervention providers and monitoring procedures will be revised to include strategies for examining outcome rating activities during chart audit reviews and focused monitoring activities. It is anticipated that Birth to Three will work with early intervention providers and regional CDW programs to carefully examine outcome data and use this information for local program reform where necessary. Once results are available from the new early childhood outcomes system they will be shared with OPEC, regional CDW staff, ICC and available on the DHSS and DOE web sites. A comprehensive statewide early childhood measurement-outcome professional development system, in conjunction with DOE, will be established to support professional development requirements. Baseline Data for FFY 2004 (2004-2005): Preliminary entry status data has been submitted in the Annual Performance Report submitted February 2007. Baseline data is not available; however, the strategies for measurement are outlined below. Outcome measures will be collected on all children with IFSPs who receive services for at least 6 months before exiting from Part C. Predetermined tools and methods, in accordance with Birth to Three and CDW’s evaluation policies (to be included in early intervention provider contracts), will be used to inform ratings in each of the three outcome areas. Teams (where applicable) composed of, at minimum, an early intervention professional (preferably the primary interventionist) and a parent, will determine outcome ratings according to procedural guidelines. They will base ratings on existing data on the child, including assessments and information provided by the parents of the child, current assessments and observations, and observations by early intervention professionals and other early childhood professionals to determine the present levels of performance. Outcome ratings will be determined and discussed and included at initial IFSP development (where possible), at periodic rating points coinciding with ongoing progress monitoring activities, at subsequent IFSP or progress monitoring reviews, and at exit where possible. The initial outcome ratings will be matched to exit outcome ratings for individual children. At the regional and state level, analysis of matched scores will yield for each of the three outcomes: a) Percent of infants and toddlers who did not improve functioning. b) Percent of infants and toddlers who improved functioning but not sufficient to move nearer to functioning comparable to same-aged peers. c) Percent of infants and toddlers who improved functioning to a level nearer to same- aged peers but did not reach it d) Percent of infants and toddlers who improved functioning to reach a level comparable to same-aged peers e) Percent of infants and toddlers who maintained functioning at a level comparable to same-aged peers Discussion of Baseline Data: Baseline data will be available during the 2006-2007 year. FFY Measurable and Rigorous Target 2005 (2005-2006) Targets will be set once baseline data are available. 2006 (2006-2007) Targets will be set once baseline data are available. 2007 (2007-2008) Targets will be set once baseline data are available. 2008 (2008-2009) Targets will be set once baseline data are available. 2009 (2009-2010) Targets will be set once baseline data are available. 2010 (2010-2011) Targets will be set once baseline data are available. Improvement Activities/Timelines/Resources: Improvement Activities Timelines Resources Development and implementation of a statewide professional development process for all individuals involved in the assessment of children as a part or the state’s early childhood accountability system. Training will focus on assessment measures and assessment practices. 8/06 – Ongoing Birth to Three & SEA IDEA/619 Collect and review Entry Status data for reporting. Analyze and share analysis with CDW assessors and Early intervention providers to discuss issues in conducting assessments, reporting results, and reviewing ratings on COSF. 9/06 - ongoing Birth to Three, CDW assessors and leadership team, Regional Early Intervention Providers, OPEC Birth to Three monitoring procedures will be implemented to include strategies for examining assessment practices and outcome rating activities during record reviews and focused monitoring activities. It is anticipated that Birth to Three will work with CDW and early intervention providers to carefully examine outcome data and use this information for local program reform where necessary. 1/07 – ongoing Birth to Three monitoring team; CDW Management Analysts Participate in any listserv, conference calls and training offered by the ECO Center on professional development experiences focused on effective use of the COSF. 12/06 – ongoing Birth to Three, OPEC, IDEA/619; CDW Leadership Teams, DE Early Intervention Providers Incorporate the COSF calculator into the ISIS outcome module in order to report baseline data. Review baseline data for quality and timeliness. 1/07 - ongoing Birth to Three office; ISIS Maintenance Committee; CDW Management Analysts Develop, distribute and update the Delaware Building Blocks Guidelines for Infants and Toddlers and associated Frequently Asked Questions document to reflect current requirements and procedures. 7/06 and ongoing Birth to Three and DOE web site; CDW assessors and leadership team; Early Intervention Providers Indicator 4 Percent of families participating in Part C who report that early intervention services have helped the family: A. Know their rights; B. Effectively communicate their children's needs; and C. Help their children develop and learn. (20 USC 1416(a)(3)(A) and 1442) Data Source: State selected data source. State must clarify the data source in the State Performance Plan. Measurement: A. Percent = # of respondent families participating in Part C who report that early intervention services have helped the family know their rights divided by the # of respondent families participating in Part C times 100. B. Percent = # of respondent families participating in Part C who report that early intervention services have helped the family effectively communicate their children's needs divided by the # of respondent families participating in Part C times 100. C. Percent = # of respondent families participating in Part C who report that early intervention services have helped the family help their children develop and learn divided by the # of respondent families participating in Part C times 100. Overview of Issue/Description of System or Process: In 2006, the survey tool that has been used since 1990 to assess the experience of families who have children who participate in Child Development Watch; the state’s early intervention program for children with disabilities; was adjusted to also assess for the three outcomes required to be addressed in the Federal Report on the state’s activities. In 1990, the Interagency Resource Management Committee (IRMC); a committee of Department Secretaries from the state’s Department of Education, Health and Social Services, and Children, Youth and their Families, the Budget Office and Controller General’s Office; sponsored a study of the early intervention system in Delaware with the purpose of developing recommended program evaluation practices for statewide early intervention programs. The Family Survey was designed and tested in 1996. In the pilot study, the construct validity of the survey was confirmed by the results and modifications to the instrument were made based on the feedback from the families and from analyses of the survey items. Since 1996, the survey has been used five times to evaluate the experience of families receiving Birth to Three Early Intervention System’s early intervention services. The University of Delaware, Center for Disabilities Studies, has been the contractor for the Family Survey to develop, revise, administer, analyze results, and complete written reports and presentations to key stakeholders. Follow up on targeted issues has been conducted through Family Focus Groups in 2001 and 2004, with representation in all three counties and with families who are Spanish speaking. Survey results are annually shared with the regional Child Development Watch staff, the statewide ICC, and as part of the IRMC Annual Report. The IRMC Annual Report is also shared with the Joint Finance Budget Committee of the Delaware Legislature. Birth to Three Early Intervention System will continue to report to these stakeholders on results from the six family clusters: overall satisfaction; perceptions of change in self/family; perceptions of child’s change; positive family program relations; decision making opportunities; accessibility and receptiveness; and perceptions of quality of life. One of the clusters, “Families’ Perceptions of children’s change” is also a state agency performance measure that is reported annually to the Department of Health and Social Services and to the Budget Office. Throughout the use of the Family Survey, there have been many modifications, including the most recent adaptation to measure the defined Federal Outcomes. The Ongoing Program Evaluation Committee (OPEC) for the Birth to Three Early Intervention System made decisions to continue to use the Family Survey as the method to collect the information from families, to incorporate questions that would address the three Federal Outcomes, and to use a six-point Likert scale for the responses. In order to assure a representative sample of the families being served by Child Development Watch, OPEC did support a pilot study of a revised Family Survey and testing of two different methodologies for administering the survey. One method was to have the survey distributed to families by service coordinators and the other was to conduct a telephone interview with families. As a result of the pilot study, it was determined that a greater diversity of families could be cost effectively reached by a telephone survey rather than by having service coordinators distribute the survey tool to families. Thus, the survey has also changed from a mail survey format that has been used until 2004 to the telephone interview that was used in 2006. In the 2006 Family Survey, questions were identified to measure each of the Federal Outcomes. Some questions were very similar to the questions proposed by the National Center for Special Education Accountability Monitoring (NCSEAM). Some were new questions added to the survey, some questions have been used since the administration of the first Family Survey. Following the pilot survey, an Alpha reliability coefficient was used to determine the strength of the questions being used to measure the cluster concept. Statewide chart audit monitoring continues to report on evidence of family centered practices within the early intervention program. State monitoring reports on documentation of child and family strengths and needs in the IFSP, indication that family assessments occur to identify families’ unique strengths and needs, evidence that family rights are distributed, and evidence that activities used to meet identified concerns are integrated into the child’s family daily routine. Family centered practices are a part of the entire early intervention program and system. Family information is available in Spanish. Family-centered practices are explained and outlined in the Family Guide to CDW, a booklet distributed to all families evaluated for early intervention; in CDW standards; in the 2004 CDW Policy Manual; and in all training offered to new and current staff. A family rights booklet, available in Spanish and Creole, and other languages as needed, is explained and distributed when families consent to participate in CDW and is offered to families at every annual IFSP meeting. Birth to Three employs two part-time family support specialists to act as liaisons to CDW service coordinators on family support issues, and to offer various family support activities such as Family Forums and parenting classes in each region. Staff, parents and the family support specialists have most recently updated the Family Guide to expand family centered practices into this document. Since 2000, families are members of Birth to Three and CDW committees, participate in clinical issues and staff meetings, participate on the hiring panel for new CDW staff, and review CDW brochures, policies and procedures. Families learn of these opportunities through the CDW Family Newsletter, and through New Scripts, a group that supports families to co-facilitate in- service and pre-service teaching and training. ICC also supports families to participate in Partner’s in Policymaking, a parent advocacy training sponsored by the Developmental Disabilities Planning Council. Birth to Three supports these various ways of family participation in early intervention through family stipends. Having families participate in many different aspects of early intervention helps to assure family centered practices are implemented and maintained. Training is offered to all CDW staff through the state diversity training classes, and CDW staff offers ongoing training in diverse cultures, minority health issues, and needs of families through the Division of Public Health, in-house expertise, and other groups who have expertise in home visiting. Interpreters are available to assist CDW staff in evaluations and IFSP meetings. The Birth to Three office periodically updates an Interpreter Issues Report that is readily available to the community. Baseline Data for FFY 2005: Baseline data for the new telephone interview methodology support the use of a telephone interview for the following family surveys. The new Federal Outcomes indicated that Child Development Watch has helped families: a. Know their rights. b. Effectively communicate their children’s needs; and c. Help their children develop and learn. Figure 4-1 Family Outcome Indicators Cluster/Subscale: 2006 Results Very Strongly Agree Strongly Agree Agree Disagree Strongly Disagree Very Strongly Disagree Federal Outcome 1: Families Know Rights 14.9% 30.4% 45.8% 7.3% 0.9% 0.7% Federal Outcome 2: Families Effectively Communicate Children’s Needs 12.4% 42.0% 40.7% 4.0% 0.4% 0.5% Federal Outcome 3: Families Help Children Develop and Learn 15.2% 38.1% 40.1% 3.7% 2.2% 0.6% Source: 2006 Family Survey Discussion of Baseline Data: To measure the Federal Outcomes, Federal Outcome 1: “Families Know Their Rights” included four questions, two of which were new to the 2006 Family Survey and two of which were also asked in the 2004 Family Survey. The Alpha reliability coefficient, .846, indicates that this set of questions is a reliable measure of this outcome. Federal Outcome 2: “Families Effectively Communicate Their Children’s Needs” included five questions, all of which were new to the 2006 Family Survey. The Alpha reliability coefficient, .715, indicates that this set of questions is a reliable measure of this outcome. Federal Outcome 3: “Families Help Their Children Develop and Learn” included four items, two of which were new to the 2006 Family Survey and two of which were also asked in the 2004 Family Survey. The Alpha reliability coefficient, .808, indicates that this set of questions is a reliable measure of this outcome. There was much discussion with members of OPEC, University of DE’s Center for Disabilities Studies, and through conference calls and workshops offered by NCSEAM as to where to set the baseline. Delaware has decided to set the actual baseline for those families who indicated they strongly agree or very strongly agree. According to the 2006 Family Survey, 45.3% of families report that they understand their rights (14.9% “very strongly agree,” 30.4% “strongly agree”); 54.4% of families report that they effectively communicate their children’s needs (12.4% “very strongly agree,” 42.0% “strongly agree,”); and 53.3% of families report that they help their children develop and learn (15.2% “very strongly agree,” 38.1% “strongly agree”). If the baseline included those families who indicate that they agree, strongly agree and very strongly agree, then the 2006 Family Survey results would report that 91.1% of families report that they understand their rights (14.9% “very strongly agree,” 30.4% “strongly agree,” and 45.8% “agree”); 95.1% of families report that they effectively communicate their children’s needs (12.4% “very strongly agree,” 42.0% “strongly agree,” and 40.7% “agree”); and 93.4% of families report that they help their children develop and learn (15.2% “very strongly agree,” 38.1% “strongly agree,” and 40.1% “agree”). Sampling for the Ongoing Family Survey: Telephone interviews were used to collect information regarding the Family Outcomes. From all the families who have received Child Development Watch services for 6 months or more, families were divided into the cells of this sampling matrix: North South African- American Less than 24 months old African- American Less than 24 months old More than 24 months old More than 24 months old Caucasian Less than 24 months old Caucasian Less than 24 months old More than 24 months old More than 24 months old Hispanic and Other Less than 24 months old Hispanic and Other Less than 24 months old More than 24 months old More than 24 months old This sampling matrix was used to make sure that the sample for the 2006 Family Survey was representative of the population of CDW. In general, the demographic data indicated that the families who completed the 2006 Family Survey were representative of the population of families receiving CDW services based upon region, ethnic background, and length of time in the program. The proportion of the responses from families more closely matches the population enrolled in the program in 2006 than it did in 2004 when a mailed surveying strategy was used The creation of six cells in the North and six cells in the South, with each cell having 30 families, resulted in a total of 360 families to be sampled. Telephone calls were made to families asking them to complete the telephone interview. In total, 149 families in the North and 75 families in the South completed the telephone interview. This is a 62% response rate; these 224 families represent 38.9% of the 576 eligible families to be surveyed who have had children participate in Child Development Watch. The diversity of the sample reflects the geographic, gender, and ethnic diversity within the program. See Table 4.2 for the proportion of families who responded to the 2006 and 2004 Family Surveys from each of the ethnic groups. Figure 4-2 Self-identified ethnic background of families receiving CDW services Race/Ethnicity 2006 Results 2004 Results CDW Enrollment Rate3 Number Percent Number Percent Caucasian 126 58.9% 62 72.1% 59.3% Hispanic 19 8.9% 5 5.8% 10.5% African- American 44 20.6% 14 16.3% 27.8% Asian 9 4.2% 1 1.2% 2.0% Other 16 7.5% 4 4.7% 0.4% Total 2141 100.0% 862 100.0% 100.0% 1 2006 total does not equal 224 because 10 families chose not to identify their ethnic background 2 2004 total does not equal 96 because 10 families chose not to identify their ethnic background 3 Based on the 2005 CDW Enrollment Rate Source: 2006 Family Survey An analysis of the data was also done to assess the data by ethnic group, length of time in the program, and geographic region where the family received the services. The analysis did not indicate that there were any differences due to any of these factors. Thus, it was concluded that families’ experiences are similar regardless of the family’s ethnicity, length of time in the program, and region where services are received. Distribution for the Ongoing Family Survey: Prior to the telephone interview, individualized letters were mailed to families using Child Development Watch’s letterhead explaining that they had been randomly selected to have a telephone interview and asking for their cooperation in completing a telephone interview at a mutually convenient time. The telephone interview was conducted by the Center for Disabilities Studies. A Spanish translator called families who speak Spanish if this was needed, and other methods for translation were available for other languages as needed. The next Family Survey will be conducted in the spring of 2007. This survey will use the telephone interview format and will utilize to questions regarding the Federal Outcomes, similar to the methods that were used in the 2006 Family Survey. Analysis of the Family Survey Data to Set Targets and Improvement Strategies The analysis of setting the targets and how to determine the actual baseline data will continue to be reviewed throughout the upcoming year. There are varying opinions as to whether the targets should be set inclusive of the percent of families who agree vs. only including the percent of families who strongly or very strongly agree. The analysis of the responses families provided to the 2006 Family Survey indicated that there were some areas which could be improved. These were questions which had a higher proportion of families who had responded with an answer that indicated that they disagreed with the statement. Of the questions used to define Federal Outcome 1: “Families Know their Rights,” two questions indicated areas for improvements. These were the questions: “You know who within Child Development Watch you need to speak with if you feel your family’s rights are not being addressed,” and “You know who within Child Development Watch you need to speak with if you have other complaints/concerns about the Child Development Watch program.” Of the questions used to define Federal Outcome 2: “Families Effectively Communicate Their Children’s Needs,” three questions indicated areas for improvements. The questions “Activities and resources that are offered through Child Development Watch are sensitive to your cultural and ethnic needs” and “The program communicates with you in a way that is sensitive to your culture and your ethnic group,” indicated a need to learn more about the expectations that families had related to cultural values and norms. The question, “As part of the Child Development Watch program, you feel that you have the opportunity to discuss your family’s strengths, needs, and goals,” was identified as an area to also improve. Of the questions used to define Federal Outcome 3: “Families Help Their Children Develop and Learn,” two questions indicated areas for improvement. The questions, “You are more able to get your child the services that he or she needs,” and “You feel that you have more of the knowledge you need to best care your child and your family,” was seen as related to the needs identified by the questions in Federal Outcome 2. It was determined that to address the concepts of these questions would improve the responses from families in the future surveys. The Ongoing Program Evaluation Committee (OPEC) discussed the improvement activities to be used to achieve greater family outcomes and set targets to be achieved. Further discussions occurred with the CDW regional staff, especially regarding improvement activities. The ICC Executive Committee and entire ICC gave input into setting the targets and improvement activities. The targets were set using confidence intervals. Confidence intervals of +/- 5% were estimated and a target of a 7% increase over five years was projected for each Federal Outcome. This 7% increase was then divided into the five years to obtain the target goals for each year. The targets are presented here. FFY Measurable and Rigorous Target 2005 (2005-2006) As measured by the 2006 Delaware Family Survey, current proportion of families who report strongly agreeing and very strongly agreeing to questions used to measure the outcomes. Federal Outcome 1: Families Know Their Rights 45.3% Federal Outcome 2: Families Effectively Communicate Their Children’s Needs 54.4% Federal Outcome 3: Families Help Their Children Develop and Learn 53.3% 2006 (2006-2005) Federal Outcome 1: Families Know Their Rights 46.3% Federal Outcome 2: Families Effectively Communicate Their Children’s Needs 54.9% Federal Outcome 3: Families Help Their Children Develop and Learn 54.3% 2007 (2007-2008) Federal Outcome 1: Families Know Their Rights 47.3% Federal Outcome 2: Families Effectively Communicate Their Children’s Needs 55.4% Federal Outcome 3: Families Help Their Children Develop and Learn 55.3% 2008 (2008-2009) Federal Outcome 1: Families Know Their Rights 48.3% Federal Outcome 2: Families Effectively Communicate Their Children’s Needs 57.4% Federal Outcome 3: Families Help Their Children Develop and Learn 56.3% 2009 (2009-2010) Federal Outcome 1: Families Know Their Rights 50.3% Federal Outcome 2: Families Effectively Communicate Their Children’s Needs 59.4% Federal Outcome 3: Families Help Their Children Develop and Learn 58.3% 2010 (2010-2011) Federal Outcome 1: Families Know Their Rights 52.3% Federal Outcome 2: Families Effectively Communicate Their Children’s Needs 61.4% Federal Outcome 3: Families Help Their Children Develop and Learn 60.3% Improvement Activities/Timelines/Resources: Improvement Activities Timelines Resources Develop talking points and a staff in service training for service coordinators to focus on providing families with their rights and with telephone numbers of who to contact if the families have questions or concerns. Winter & Spring 2007 Quality Management Coordinator, Birth to Three Training Administrator and CDW Leadership teams Incorporate the talking points regarding family rights into the CDW Procedure manual. Fall 2007 Quality Management Coordinator, Birth to Three Training Administrator and CDW Leadership teams Add prompts to the questions in the survey asking what the program could do to communicate and offer resources and activities in ways that are more sensitive to the cultural and ethnic needs of families. Based on results, new improvement activities will be recommended. Spring 2007 OPEC; CDW Leadership teams Work with DE’s Expanding Opportunities grant to promote access to resources through early intervention providers, early care and education programs, and primary care physicians so that more families have access to the knowledge to best care for their child and family. Fall 2007 DE Expanding Opportunities Committee, Delaware Early Care and Education Council; ICC Continue improvement activities under Indicator #1 focusing on recruitment and retention for personnel, namely speech language pathologists and early childhood educators, so that families report their child gets services that he or she needs. Summer 2007-2009 DE Governor’s Speech Language Pathology Task Force with participation by Part C Coordinator and Birth to Three Training Administrator; Partners Council for Children with Disabilities’ Early Childhood Committee; Discuss results of Family Outcomes and Child Outcomes and ways to link these results and improvement activities increasing results. Spring 2008 OPEC; CDW Leadership Teams; ICC Encourage ongoing parent participation on OPEC. Spring 2007 OPEC; New Scripts Review sampling distribution plan of Family Survey to verify returned results are reflective of Part C populations who receive services. Spring 2007 OPEC and CDW Leadership Teams Conduct annual Family Survey. Based on results, revise survey and sampling as necessary to conduct annual Family Survey to report three federal family outcomes. Spring 2007; and Annually OPEC, PCCD’s Early Childhood Subcommittee; ICC Review analysis for setting the targets as to whether the targets should be set inclusive of the percent of families who agree vs. only including the percent of families who strongly or very strongly agree. Summer 2007 OPEC, NCSEAM conference calls; ICC Based on results from Family Survey, develop improvement activities. Fall 2007; and Annually OPEC; CDW staff meetings and leadership teams; ICC; IRMC Annual report Monitoring Priority: Effective General Supervision Part C/Child Find Indicator 5 Percent of infants and toddlers birth to 1 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. (20 USC 1416(a)(3)(B) and 1442) Measurement: A. Percent = # of infants and toddlers birth to 1 with IFSPs divided by the population of infants and toddlers birth to 1 times 100 compared to the same percent calculated for other States with similar (narrow, moderate or broad) eligibility definitions. B. Percent = # of infants and toddlers birth to 1 with IFSPs divided by the population of infants and toddlers birth to 1 times 100 compared to National data. Overview of Issue/Description of System or Process: Delaware has maintained a comprehensive child find system that is coordinated with Delaware's Home Visiting Program for First Time Parents, Public Health Community Services, the Departments of Education and Services for Children, Youth and their Families. A central point of entry to the Birth to Three Early Intervention System is maintained through the Division of Public Health's Central Intake system. Referrals into the system continue to originate from a range of sources and continue to be reported monthly from ISIS. This is reviewed by the Part C Coordinator and distributed to CDW Leadership Teams. These statewide and regional data reports are also distributed on a quarterly basis to the ICC. Delaware provides comprehensive multidisciplinary assessments through a team of highly qualified staff of CDW service coordinators whose function is also to provide developmental assessments (see Indicator 7). Delaware also coordinates its MDAs with neonatal follow-up provided by major hospitals throughout the state. Delaware also provides comprehensive follow up programs for at risk infants and toddlers. Children receive periodic follow up through ongoing assessments. These programs are coordinated with the Neonatal Intensive Care Units at the major hospitals and primarily follow low birth weight and premature infants. CDW staff participate in these follow up programs and help determine if the status of the infant involved has changed with respect to the eligibility of the infant and toddler. At risk infants and toddlers are identified and evaluated, and when not eligible for Part C, receive periodic follow up. The fundamental public awareness vehicle in Delaware is the Growing Together Portfolio. Distribution is maintained through hospitals to all families of children born in Delaware. The parent packet provides developmental, health and safety, nutrition, immunization, child care, fatherhood and referral information to parents by means of a developmental calendar. The Growing Together Portfolio is currently available in English and Spanish. Additionally, program brochures and the Family Guide are also available in English and Spanish. Individuals needing program information in alternative formats are addressed on an individual basis. The Birth to Three office also maintains a comprehensive listing of persons in the community who are available for translation on a case-by-case basis. The Birth to Three website remains under construction; however, the site does include a link to the Central Directory of Services and a link to the Internet Guide to Services. The race and ethnicity of infants and toddlers determined eligible for Part C continues to be consistent with State and national demographic data. The ICC, the Division of Child Mental Health and the Developmental Disabilities Council are drafting a letter to request that the Division of Public Health conduct an epidemiological study in Delaware to obtain accurate prevalence data to achieve a more accurate count of infants and toddlers with disabilities in Delaware. Based on this data, Delaware anticipates adjusting the measurable and rigorous target for this indicator. In April 2005, the Birth to Three Early Intervention System first collaborated with First Signs, Inc., the University of Pennsylvania School of Medicine, the Autism Society of Delaware, and the Delaware Developmental Disabilities Council and offered a training program educating regional healthcare professionals on routine screenings that identify developmental delays and disorders, especially in the area of autism. This training was included in a statewide public awareness and educational initiative that coincided with the Center for Disease Control’s “Learn the Signs. Act Early.” national awareness campaign. Follow up trainings have been provided to further educate physicians and other early childhood professionals. For the past several years, Delaware was considered to have broad eligibility criteria. In October 2005, OSEP had identified Delaware as having moderate eligibility criteria. Baseline data has been revised accordingly. Baseline Data for FFY 2004 (2004-2005): Figure 5-1 Birth Projections Source: Delaware Population Consortium, Center for Applied Demography and Survey Research, University of Delaware Figure 5-2 Number of Children Served by Child Development Watch Reporting Year Actual Served Age 0-1 2000 194 2001 179 2002 205 2003 201 2004 148 Source: Annual Child Count Figure 5-3 Comparison to States with Similar Eligibility Sources: US Department of Education, Office of Special Education Programs, Data Analysis System (DANS) Figure 5-4 Comparison to National Baseline Sources: Annual Child Count, US Department of Education, Office of Special Education Programs, Data Analysis System (DANS) Discussion of Baseline Data: Based on the Annual Child Count in 2004, 1.3% of Delaware's birth to one population was determined eligible for Part C. A. Among other states with moderate eligibility criteria, Delaware ranks second with an identification rate of 1.3% (both Indiana and Rhode Island both report identification rates of 1.7%). B. US Department of Education’s Table 8-6 “Infants under 1 year of age (excluding infants at risk) receiving early intervention services under IDEA, Part C, by state”, as based on the Annual Child Count, indicates that Delaware had ranked 0.41 above the current national baseline (0.9%) in the percent of children, from birth to age one, receiving early intervention services. Although baseline data for 2004 reflects a decrease in the percent of 0-1 years olds receiving early intervention services, Delaware maintains a high identification rate and a comprehensive child find system. Data indicates that this is a cyclical trend. The overall number served is anticipated to increase slightly by 2010 due to a projected increase in the Delaware birth rate. Delaware is reexamining its established conditions as part of its eligibility criteria as a result of strengthened collaborative efforts with these follow up programs available in Delaware. Specifically, the Ad Hoc Health Care Committee has recommended to ICC that some established conditions be eliminated where a child demonstrates no significant developmental delays and the condition does not have a high probability resulting in one. One proposed change is to revise low birth weight to those under 1000 grams (currently low birth weight is an established condition for those less than 1250 grams for any gestational age and less than 2000 grams at term). The Ad Hoc Health Care Committee and ICC are also reviewing other established conditions, such as sickle cell anemia and where the child demonstrates no significant development delays. Periodic follow up through ongoing assessments is coordinated through existing programs in Delaware. FFY Measurable and Rigorous Target 2005 (2005-2006) The Birth to Three Early Intervention System will identify 1.31% of infants and toddlers birth to 1 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2006 (2006-2007) The Birth to Three Early Intervention System will identify 1.32% of infants and toddlers birth to 1 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2007 (2007-2008) The Birth to Three Early Intervention System will identify 1.33% percent of infants and toddlers birth to 1 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2008 (2008-2009) The Birth to Three Early Intervention System will identify 1.34% of infants and toddlers birth to 1 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2009 (2009-2010) The Birth to Three Early Intervention System will identify 1.35% of infants and toddlers birth to 1 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2010 (2010-2011) The Birth to Three Early Intervention System will identify 1.36% of infants and toddlers birth to 1 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. Improvement Activities/Timelines/Resources: Improvement Activities Timelines Resources Further analyze and redetermine targets based on stakeholder discussions, eligibility revisions, and population statistics. June 2007 ICC; Part C Coordinator, Assistant Part C Coordinator Continue to coordinate Growing Together Portfolio information distributed from all hospitals and through the home visiting programs. Ongoing Birth to Three Office; DSCYF—Child Care Licensing; Family and Workplace Connection—Child Care Resource Centers and Vans; Hospitals Continue to coordinate Growing Together User’s Guide for Early Care and Education Programs in order to promote identification of children within child care and other early education programs. Ongoing Birth to Three Office; DSCYF—Child Care Licensing; Family and Workplace Connection—Child Care Resource Centers and Vans Collaborate with the Division of Public Health, Division of Child Mental Health, and the Developmental Disabilities Council to create a epidemiological study to obtain accurate prevalence data. Revise measurable and rigorous targets. Draft letter – Winter 2007; Compile data and revise targets as necessary ICC; DPH; CMH; DD Council; Part C Coordinator; Assistant Part C Coordinator Continue to offer training through First Signs to physicians on the importance of early identification and screening tools. Ongoing First Signs; Autism Society of Delaware; CDW Staff; E.I. Providers; Community Physicians Review revised eligibility pilot data and revise policies governing eligibility. February 2008 ICC: Part C Coordinator Indicator 6 Percent of infants and toddlers birth to 3 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. (20 USC 1416(a)(3)(B) and 1442) Measurement: A. Percent = # of infants and toddlers birth to 3 with IFSPs divided by the population of infants and toddlers birth to 3 times 100 compared to the same percent calculated for other States with similar (narrow, moderate or broad) eligibility definitions. B. Percent = # of infants and toddlers birth to 3 with IFSPs divided by the population of infants and toddlers birth to 3 times 100 compared to National data. Overview of Issue/Description of System or Process: The Birth to Three Early Intervention System in Delaware maintains a comprehensive child find system that is coordinated with Division of Public Health's (DPH) Central Intake and Delaware's Home Visiting Program for First Time Parents, the Departments of Education (DOE) and Services for Children, Youth and their Families (DSCYF), Christiana Care Health Services, and Alfred I duPont Hospital for Children (see Attachment 3). Delaware maintains a high percentage of children birth to three with IFSPs compared to other states with a moderate eligibility definition. This is a result of the comprehensive child find system and the extensive public awareness activities that have been in place for over ten years, with ongoing improvements to these activities in order to increase effectiveness. Birth to Three also has had in place an effective system for identification of children covered under the Child Abuse Prevention and Treatment Act (CAPTA). DHSS and DSCYF (the Department responsible for children under CAPTA) have had an ongoing mechanism since 1996 to support screening and a description of policies and procedures for referrals to early intervention for children involved in a substantiated case of child abuse and /or identified as affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug exposure. There has been some recent increase in referrals because of IDEA Improvement Act of 2004 and changes to CAPTA, and that is described in Indicator #7. In 2003, a child find study was carried out entitled, “Opportunities for Early Identification of Children who Received Special Education after Kindergarten Entrance”. The report was commissioned by the Exceptional Children and Early Childhood Education Work Group within DOE to look at the experiences of children who were referred to special education after they entered kindergarten. The study was carried out by the Center for Disabilities Studies at the University of Delaware. One of the research questions asked was if children had been receiving early intervention services previously, why were they dismissed from specialized services. The findings indicated that there were not any families in the study who had children who were dismissed from early intervention services. Findings also indicated that there appear to be potential leverage points on which a comprehensive assessment system might be built. A large majority of children and families participated in (1) Women, Infants and Children (WIC) services, (2) had regular contact with medical professionals, and (3) sustained contact with early care and education professionals. Recommendations emerged from the study to indicate that Child Find materials should be available at these locations and that screening for developmental delays should be promoted. This is a focus for First Signs and for the Early Childhood Comprehensive Grant. On June 28, 2005, the Birth to Three Part C Coordinator and the Training Administrator, along with representatives from key state agencies, participated in a Head Start/ECAP five-year strategic planning session. National speakers presented information regarding Head Start re-authorization, including a focus on serving homeless children and youth which has additional implications under IDEA 2004. Throughout the day, small groups worked to identify challenges, opportunities and action steps related to health, child care, welfare reform, literacy, disabilities, child welfare, and the homeless. See also Overview of Issue/Description of System or Process section of Indicator 5. Baseline Data for FFY 2004 (2004-2005): Figure 6-1 Number of Children Served by Child Development Watch Reporting Year Actual Served Age 0-3 2000 1003 2001 907 2002 1034 2003 953 2004 1006 Source: Annual Child Count Figure 6-2 Comparison to States with Similar Eligibility Sources: US Department of Education, Office of Special Education Programs, Data Analysis System (DANS) Figure 6-3 Comparison to National Baseline Sources: Annual Child Count, US Department of Education, Office of Special Education Programs, Data Analysis System (DANS) Discussion of Baseline Data: Based on the Annual Child Count in 2004, 3.1% of Delaware's birth to three population was determined eligible for Part C. A. Among other states with moderate eligibility criteria, Delaware ranks fourth with an identification rate of 3.1% (Delaware follows New York, reporting 4.3%, Indiana, reporting 3.9%, and Rhode Island, reporting 3.6%). B. US Department of Education’s Table 8-5 “Infants and toddlers ages birth through 2 (excluding children at risk) receiving early intervention services under IDEA, Part C”, as based on the Annual Child Count, indicates that Delaware had ranked 0.83 above the current national baseline (2.2%) in the percent of children, from birth to age three, receiving early intervention services. Through CDW monthly progress reports produced from ISIS, CDW Leadership Teams and Birth to Three staff review regional and statewide referral sources and eligibility data to determine that children continue to be identified from a variety of referral sources and there is evidence of similar trends from previous years. Delaware projects that there will be only a slight increase by 2010 in the percentage of children birth to three with IFSPs. The ICC, the Division of Child Mental Health and the Developmental Disabilities Council are drafting a letter to request that the Division of Public Health conduct an epidemiological study in Delaware to obtain accurate prevalence data to achieve a more accurate count of infants and toddlers with disabilities in Delaware. Based on this data, Delaware anticipates adjusting the measurable and rigorous target for this indicator. Delaware has in place many effective child find and outreach activities. Furthermore, Delaware has initiated a pilot project in July 2004 called Enhanced Watch and See (EWS). The purpose is to serve children with only expressive language delays through ongoing follow up (see Indicator #1). These children will not become eligible under Part C. In addition, there are other recommendations from the Ad Hoc Health Care Committee to ICC regarding revisions to established conditions that have been explained in Indicator #5. These changes will allow Delaware to provide follow up to at risk infants and toddlers and maintain a moderate Part C eligibility definition to serve those children with IFSPs with a high probability of resulting in developmental delay. FFY Measurable and Rigorous Target 2005 (2005-2006) The Birth to Three Early Intervention System will identify 3.11% of infants and toddlers birth to 3 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2006 (2006-2007) The Birth to Three Early Intervention System will identify 3.12% of infants and toddlers birth to 3 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2007 (2007-2008) The Birth to Three Early Intervention System will identify 3.13% of infants and toddlers birth to 3 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2008 (2008-2009) The Birth to Three Early Intervention System will identify 3.14% of infants and toddlers birth to 3 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2009 (2009-2010) The Birth to Three Early Intervention System will identify 3.15% of infants and toddlers birth to 3 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. 2010 (2010-2011) The Birth to Three Early Intervention System will identify 3.16% of infants and toddlers birth to 3 with IFSPs compared to: A. Other States with similar eligibility definitions; and B. National data. Improvement Activities/Timelines/Resources: Improvement Activities Timelines Resources Further analyze and redetermine targets based on stakeholder discussions, eligibility revisions, and population statistics. June 2007 ICC; Part C Coordinator, Assistant Part C Coordinator Continue to analyze trends in referral activities as they are reported through the CDW Monthly Progress reports. Utilize data from Delaware Vital Statistics and ISIS annually for reporting purposes. Annually Data Management Analysts; Assistant Part C Coordinator Continue to monitor where families first heard about the program (when families are referral source, track in database where families indicated that they first heard about Child Development Watch). Annually Central Intake Specialists; Assistant Part C Coordinator; ISIS Maintenance Committee, DPH/DMS Working Group and Birth to Three State Monitoring Team Based on results from the 2003 Child Find Study, maintain active distribution of program materials to agencies working with families eligible for WIC services and to community centers. Annually Family Support Specialists; Birth to Three Office; CDW Leadership Team Utilize results from the Family Survey to track perception of ease of access into program. Annually University of Delaware—Center for Disabilities Studies Collaborate with the Division of Public Health, Division of Child Mental Health, and the Developmental Disabilities Council to create an epidemiological study to obtain accurate prevalence data. Draft letter – Winter 2007; Compile data and revise targets as necessary ICC; DPH; CMH; DD Council; Part C Coordinator; Assistant Part C Coordinator Based on new requirements under IDEA, disseminate Child Development Watch parent brochures through the statewide meetings organized by the Office of the Coordinator of Education of Homeless Children and Youth. Annually or more frequently as needed ICC Representative from the Office of the Coordinator of Education of Homeless Children and Youth; Birth to Three Training Administrator Continue to offer training through First Signs to physicians on the importance of early identification and screening tools. Ongoing First Signs; Autism Society of Delaware; CDW Staff; E.I. Providers; Community Physicians Work with Head Start Collaboration Project to update Interagency Agreement with Early Head Start and Head Start to assure early intervention and special education child find materials are disseminated and those programs reach out and involve programs for children who are homeless. June 2007 Head Start Collaboration Project; DOE; Part C Coordinator Indicator 7 Percent of eligible infants and toddlers with IFSPs for whom an evaluation and assessment and an initial IFSP meeting were conducted within Part C’s 45-day timeline. (20 USC 1416(a)(3)(B) and 1442) Measurement: Percent = # of eligible infants and toddlers with IFSPs for whom an evaluation and assessment and an initial IFSP meeting was conducted within Part C’s 45-day timeline divided by # of eligible infants and toddlers evaluated and assessed times 100. Account for untimely evaluations. Overview of Issue/Description of System or Process: Child Development Watch Service Coordinators document each contact with families, including, but not limited to, contacts pertaining to evaluations, referrals, services, and family concerns regarding their child. Documentation is found in the child’s chart within the progress notes and/or the correspondence section. Consent for the multidisciplinary evaluations (MDA), date of MDAs and date of IFSP meetings are found in the charts and in ISIS. The Birth to Three Monitoring Team conducts annual statewide chart audits, which includes a comprehensive review of the progress notes, the correspondence section, and the IFSP. This monitoring provides verification of timely evaluations for Part C eligibility. It also provides assurances that the 45 day IFSP timeline is met. Technical assistance was provided to Child Development Watch staff on the importance of providing justification if either timeline was not able to be upheld. The Birth to Three Monitoring Team has seen increased evidence of documentation regarding when initial IFSP meetings are held in longer than the 45 day timeline and why, including explanations of various family circumstances, that may require IFSP meetings to be delayed. To automate the data reporting process, the Assistant Part C Coordinator and local data managers are able to generate reports from ISIS that report on the timelines for the multi-disciplinary evaluation and the IFSP meeting. The report provides information on the actual number of days for each child and identifies the service coordinator, referral source, and demographic information. This information helps Delaware determine if any delay is specific to individual staff persons, referral agencies, or demographics. County detail provides an extra measure indicating if timely evaluations are available in all geographic areas of the state. Data collected from this report ensure that the methods for correction are specific to the cause. Technical assistance was provided to service coordinators and data entry staff. After analysis of preliminary data, it was determined that additional technical assistance was necessary as evaluations were not being consistently or accurately entered into the database. Identifying this need for additional assistance, the Birth to Three Monitoring Team continues to review the timeliness of evaluations for eligibility through chart review during annual statewide monitoring, and follow up with sharing results with CDW Leadership teams. Technical assistance was also provided to the Child Development Watch Staff to readdress the initial IFSP meeting within the 45-day timeline and the need for documentation when that timeline cannot be met. To further ensure policies and procedures are understood and followed, the DPH/DMS Management Teams have updated a 2004 Child Development Watch Policy Manual. Additionally, the Quality Management Coordinator, Birth to Three Training Administrator, and designated staff at CDW will be compiling and distributing procedure manuals to each service coordinator. Training by the Birth to Three Training Administrator is provided to all new CDW staff on policies and procedures, and new service coordinator are often paired with current staff in order to reinforce training. CDW staff schedule the MDAs and utilize the ICAT system within ISIS for scheduling. ISIS also produces caseload reports by service coordinators so that both supervisors and service coordinators can monitor their own caseloads in order to assure timely evaluations and IFSP meetings. Families are informed of the right to an MDA within the 45 day timeline and to an initial IFSP meeting through their Family Rights booklet. The MDA and IFSP are further explained in the Family Guide to CDW and by service coordinators when families are referred to early intervention and receive initial information about CDW. Through federal and state funds, and through support from Divisions Developmental Disabilities Services, Management Services and Public Health, CDW staff provide comprehensive multidisciplinary assessments. Staff includes early childhood educators, advanced practice and public health nurses, and others. There is also a developmental pediatrician for Kent and Sussex Counties as part of the CDW team who consults with the CDW team and participates in MDAs. In addition, contracts are in place with the two major hospitals in New Castle County for providing MDAs and Neonatal Intensive Care follow up on children who are at risk but not eligible for Part C. Various specialists such as developmental pediatricians, geneticists, neonatologists, neurologists, speech language pathologists, and occupational and physical therapists are included. In 2004, Birth to Three increased its funding for contracts to support additional service coordination and MDAs. Baseline Data for FFY 2004 (2004-2005): Figure 7-1 MDA Timeline Source: Annual Statewide Monitoring Figure 7-2 Number of Charts Monitored for MDA Timeline Monitoring Year # charts Monitored # MDAs within 45 days 2003 124 100 2004 149 122 2005 177 134 Source: Annual Statewide Monitoring Figure 7-3 IFSP Timeline Source: Annual Statewide Monitoring Figure 7-4 Monitoring Year # IFSPs Monitored # IFSPs signed within 45 days 2003 138 90 2004 148 100 2005 168 124 Source: Annual Statewide Monitoring Discussion of Baseline Data: Based on annual statewide monitoring, data is collected and reported separately for MDA and IFSP timelines. The Birth to Three Monitoring Team will review the chart audit tool to determine feasibility of reporting these as a single item. The baseline for percent of eligible infants and toddlers with IFSPs for whom an evaluation and an assessment were conducted within the 45 day timeline is 76%. The baseline for percent of infants and toddlers with IFPS for whom the initial IFSP meeting was conducted within the 45 day timeline is 74%. There has been some progress in the percent of IFSP meetings conducted within the 45 day timeline (up from 68% in 2004). There are two primary explanations regarding challenges in making progress to increase the percent of timely evaluations. Efforts underway are expected to improve both timely evaluations and timely initial IFSP meetings. The two primary explanations include: there continue to be vacant state positions in CDW (especially nurse positions who have the role of service coordinator and assessor) and there is a higher rate of referral into early intervention (9.64% increase from 2004 to 2005), thereby requiring more evaluations to be completed within the 45 days. Regarding CDW staff, the State continues to not have fully recovered from the State of Delaware’s hiring freeze that was lifted in July 2004. The hiring process is slow and it is still difficult to hire Public Health and Advanced Practice Nurses. The state’s compensation does not compete with the private sector for nurses, as is the case nationwide. There are efforts underway to improve the hiring process and to attract nurses: pay scale was somewhat increased in 2005; CDW now has permission to hire directly from applications and can by-pass the DHSS application rating and act more immediately on applications; advertising is now occurring specifically for nurses within CDW beyond what currently occurs by Public Health’s recruitment efforts. In 2005 there have been three nurses and one senior medical social worker hired in positions previously vacant since July 2004. The hiring process is underway for other service coordinator positions. Birth to Three provided additional federal dollars for a new part time contract in 2005 for service coordination and for more assessments to occur in New Castle County. These new staff and new contract will help to improve timely evaluations and timely initial IFSP meetings. In 2005, Birth to Three met with Child Development Watch Team Leaders to readdress the initial IFSP meeting within the 45-day timeline and the need for documentation when that timeline cannot be met. Documentation for why initial IFSPs were not conducted in the timeline included the following: 21 out of 44 due to family scheduling difficulties or child illness; 2 out of 44 due to child’s eligibility status in question resulting in IFSP meeting postponed; and 21 either had no reason documented or were due to staff scheduling difficulty. The chart audit tool did not capture documentation when the evaluations were conducted beyond the 45 day timeline. New reports have been developed from ISIS to report on the timelines for the multi- disciplinary evaluation and the initial IFSP meeting. The report provides information on the actual number of days for each child and identifies the service coordinator, referral source, and demographic information. This information has to be generated quarterly and shared with CDW Data Managers and service coordinators with follow up to ensure that the methods for correction are specific to the cause. Efforts are underway to understand the higher referral rate and to reexamine the eligibility criteria in order to maximize existing resources for children with conditions that have a high probability of resulting in developmental delay. In March 2005, Birth to Three and ICC reestablished the Ad Hoc Health Care Committee to review Part C eligibility criteria and make recommendations for revisions. Some established conditions originally included in Delaware’s eligibility include conditions when no significant developmental delay is present. IDEA allows and Delaware has currently in place a program that offers ongoing assessment and follow-up as indicated by the assessment team in order to monitor and track these children (program in CDW called WATCH) instead of making them Part C eligible. Ad Hoc Health Care Committee has recommended to ICC and ICC has approved a pilot to eliminate some established conditions where a child demonstrates no significant developmental delay. Furthermore, the Ad Hoc Committee is looking at reviewing and developing exit criteria for when a child could be exited from Part C before the age of three based on having met developmental milestones. The pilot data will be available to ICC in April 2006 in order for ICC to recommend a policy change to the Delaware Eligibility Criteria. The Communication Guidelines Committee and its work with the EWS program (described in Indicator 1) is having a small impact in reducing the number of eligible children, thereby freeing up some time from service coordination. This could also reduce the number of MDAs conducted as reevaluations for children with expressive language delays only. Additionally, there have been some increases in referrals for children covered under the Child Abuse Prevention and Treatment Act (CAPTA). An Operations Agreement and a Memorandum of Understanding regarding CAPTA currently exits in Delaware. Screening occurs within the Division of Family Services and there has been an increase in referrals for evaluations based on the training and information from IDEA. The Interagency Work Group between Child Development Watch and the Division of Family Services is working to improve screening protocols within DFS and to establish consistent criteria for referrals to CDW for MDAs. The GSEG, as described in Indicator #3, is providing more training in alternative methods and new assessment tools. While the purpose is to use these tools once the child is eligible and as part of monitoring progress during intervention, it will increase the number of professionals trained, the range of assessment tools used, and help to inform the multidisciplinary evaluation process. More training is being offered to increase the number of staff trained to conduct MDAs. Current staff received Bayley training in Fall 2004, and will receive additional training on the Bayley III in November 2005. This training is open to CDW assessors and to assessors in the early intervention provider community. CDW is relying on its early intervention providers to conduct reevaluations and reassessments. FFY Measurable and Rigorous Target 2005 (2005-2006) 100% of eligible infants and toddlers will receive an evaluation and assessment and an initial IFSP meeting will be conducted within Part C’s 45-day timeline. 2006 (2006-2007) 100% of eligible infants and toddlers will receive an evaluation and assessment and an initial IFSP meeting will be conducted within Part C’s 45-day timeline. 2007 (2007-2008) 100% of eligible infants and toddlers will receive an evaluation and assessment and an initial IFSP meeting will be conducted within Part C’s 45-day timeline. 2008 (2008-2009) 100% of eligible infants and toddlers will receive an evaluation and assessment and an initial IFSP meeting will be conducted within Part C’s 45-day timeline. 2009 (2009-2010) 100% of eligible infants and toddlers will receive an evaluation and assessment and an initial IFSP meeting will be conducted within Part C’s 45-day timeline. 2010 (2010-2011) 100% of eligible infants and toddlers will receive an evaluation and assessment and an initial IFSP meeting will be conducted within Part C’s 45-day timeline. Improvement Activities/Timelines/Resources: Improvement Activities Timelines Resources Provide follow up technical assistance when sharing FFY2005 Annual Performance Report to Child Development Watch staff on the importance of providing justification when either the evaluation or initial IFSP timeline was not upheld. Share local aggregate information on justifications from 2006 monitoring in order to improve documentation. Spring 2007 Part C and Assistant Part C Coordinators; Quality Management Coordinator; CDW Management Analysts; CDW Leadership Teams Continue to conduct annual chart monitoring for timely evaluations and initial IFSPs to occur within the 45 day timeline. Annually Birth to Three Monitoring team Develop and distribute procedure manuals based on the 2004 CDW Policy Manual and train new and current service coordinators on procedures relating to timelines. Fall 2007 Quality Management Coordinator; Birth to Three Training Administrator; designated staff at CDW Continue efforts to hire all vacant positions for CDW responsible for service coordination and assessments. June 2007 CDW Leadership teams Pilot recommendations from Ad Hoc Health Care Committee and report results to ICC at April 2007 meeting. June 2007 CDW Clinic Managers and CDW Assessors; ICC Continue to improve screening by DFS for children involved in a substantiated case of abuse or neglect and/or affected by illegal substance abuse or withdrawal symptoms resulting from prenatal drug. June 2007 CDW/DFS Interagency Work Group Based on the Early Childhood Outcomes pilot, coordinate professional development and use of new assessments with conducting timely evaluations. June 2007 Delaware Building Blocks; Part C Coordinator and Part B/619 Monitor contracts for evaluations in order to assure timely and complete evaluations and assessments. June 2007 CDW Leadership teams; QM Coordinator Monitoring Priority: Effective General Supervision Part C/Effective Transition Indicator 8 Percent of all children exiting Part C who received timely transition planning to support the child’s transition to preschool and other appropriate community services by their third birthday including: A. IFSPs with transition steps and services B. Notification to LEA, if child potentially eligible for Part B C. Transition conference, if child potentially eligible for Part B (20 USC 1416(a)(3)(B) and 1442) Measurement: A. Percent = # of children exiting Part C who have an IFSP with transition steps and services divided by # of children exiting Part C times 100. B. Percent = # of children exiting Part C and potentially eligible for Part B where notification to the LEA occurred divided by the # of children exiting Part C who were potentially eligible for Part B times 100. C. Percent = # of children exiting Part C and potentially eligible for Part B where the transition conference occurred divided by the # of children exiting Part C who were potentially eligible for Part B times 100. Overview of Issue/Description of System or Process: Delaware has agreements in place to implement transition planning for all children exiting early intervention and to support transition planning for all children exiting Part C and potentially eligible for Part B Preschool Programs for Children with Disabilities. The Interagency Agreement for the Delaware Early Intervention System under Part C of the Individuals with Disabilities Education Act has a specific section on transition. This will be reviewed when the entire Agreement is revised October 2006. There is an Operations Agreement defining roles and responsibilities between DHSS, Divisions of Management Services and Public Health and DOE. Specifically, this Operations Agreement defines the roles of the two regional DOE/CDW liaisons that are employed by DOE and funded by Birth to Three state funds. These liaisons are both service coordinators and liaisons with the local school districts in order to facilitate transition. Representatives from this Operations Agreement, the DOE/CDW Work Group, meet quarterly to discuss and implement ways to improve transition. Most recently this Work Group developed and implemented the new Plan for Transition from the Birth to Three System to Preschool Special Education or Other Appropriate Services (known as the Transition Plan as part of the IFSP). The Transition Plan has provided transition planning information available to families and to others. Furthermore, this transition Plan is now used in monitoring to document convening of transition conferences and necessary follow up. The DOE/CDW Work group continues to explore barriers and improvement activities regarding transition. In the winter of 2004-2005, the Chart Audit tool, Transition section, was used to conduct focused monitoring of children who are potentially eligible for Part B and 30 months and older within a designated time period. Based on these results, the Chart Audit Tool, Transition section was revised for state monitoring. State monitoring in 2005 continued to collect transition data to document whether transition conferences were occurring but in more than 90 days from exiting CDW, and included reasons why the 90 day timeline was not met. A technical assistance guidance memorandum developed by DOE on a variety of early childhood issues, including beginning and ending dates for preschool services, was officially distributed in FY04 to all local school districts and CDW in order to clarify when services must begin, role of contractors, and extended school year (ESY). This guidance memorandum was discussed at CDW staff meetings, county Special Education Leadership meetings, and STEPS meetings (Sequenced Transition to Education in the Public Schools). Revised referral forms and closing data entered into ISIS accurately and comprehensively report referrals upon exit from CDW. ISIS notification reports are available on the children who may be eligible for Part B by school district and these reports are shared with local school districts for planning purposes. These are distributed to the local school districts by the DOE/CDW liaisons. ISIS reports also on the number of children who may be eligible for Part B school district services by service coordinator and by district. These are used by service coordinators as working lists of who may need transition conferences. New Castle County continues to operate STEPS, a regional workgroup to offer joint training, discuss barriers to timely transitions, and suggest collaborative ways for local school district child find coordinators, early intervention providers, service coordinators, family representatives, and other early care and education professionals to come together. Most recently, STEPS has offered opportunities to dialogue to make sure all information is gathered to have effective transition conferences in order to improve timely transition conferences. STEPS is facilitated by the NCC DOE/CDW Liaison. Regional planning occurs in Kent and Sussex Counties through the work of the Kent /Sussex DOE/CDW liaison and the local school districts. Family Forums on transition occur annually and there is ongoing training with service coordinators and local school district staff through staff meetings. Materials regarding early childhood transition are available and specific to the regions. There is an effort underway to update these materials and make them more available through web sites and through the Parent Information Center of Delaware (PIC of DE). DOE and Birth to Three support PIC of DE to provide local training and information through their newsletter to parents regarding early childhood transition. Delaware has developed a method to enter DELSIS (unique identifier for children in Delaware local school districts) into the ISIS tracking system. The purpose was to use the ISIS and DELSIS identification numbers to ensure that those children eligible for Part B start services on their third birthday or the start of school. While a method is in place to enter the DELSIS number into ISIS, it is neither efficient nor feasible to produce reports from this data at this time. DELSIS numbers need to be individually entered into ISIS through data entry. Reports need to be written to accept an electronic monthly tape from ISIS to track children exiting CDW and eligible for Part B start services on their third birthday or at the start of school. ISIS Maintenance Committee, DOE Data Management Staff and the DOE/CDW Leadership Team continue to discuss better options on how to generate and enter DELSIS numbers into ISIS for all children exiting CDW and potentially eligible for Part B services. O