Early Intervention & Administrative Units - Collaboration, Communication, & Teaming

Early Intervention & Administrative Units Collaboration, Communication, & Teaming
on Birth - 2 Evaluations & Transition
REGIONAL CDE MEETINGS FOR
CHILD FIND & PRESCHOOL SPECIAL EDUCATION
FALL 2015
EI CO State Systemic Improvement Plan
(SSIP)Activities Overview
2
The SSIP-(SPP/APR Indicators C11 and B17) was submitted
to the Office of Special Education Programs
(OSEP) in March, 2015 which included:
 Where do we want to be?
 In-depth data analysis,
 Infrastructure analysis,
 The selection of a state-identified measurable
result (SiMR),
 Determination of coherent improvement
strategies; and,
 Development of a theory of action
Identification of Focus for Improvement
3
EI Team met for strategic planning:
 Where do we want to be?
 What will we identify as our focus for improvement?
 What is the measureable child-based outcome(s) our
focus for improvement will impact?
 What can we realistically do with the
resources/funding/staff we have?
Identification of Focus for Improvement cont.
4
 Where do we want to be?
 Families
receive support in the same way no matter
where they are in our state
 Any provider who works with a family has the same,
measurable competencies
 Families will believe they have the necessary
knowledge to move forward (after EI)
Focus for Improvement
5
Evidence-based practices consistently
implemented from referral through
transition
State Identified Measurable Result (SIMR)
6
Infants and toddlers who receive early
intervention services in Colorado will
demonstrate increased growth in the use of
appropriate behaviors to get their needs
met
What Can We Do?
7
What can we realistically do with the
resources/funding/staff
we have?
Theory of Action
CDHS Systems
Governance
Fiscal
Professional
Quality Standards
Professional
Development
Data
If CDHS
Then
…enhances its EI
program data system
to ensure that data
will be available for
monitoring,
evaluation and
improvement
planning for both
compliance and
quality indicators
…data can be analyzed
to identify poorly
written outcomes and
possible root causes
in forming strategies
for improvement
…uses implementation
science to guide the
integration of the
IFSP/Child Outcomes
Summary (COS)
processes
…as a result of early
implementation
activities and
subsequent statewide
introduction, local and
state processes will be
aligned
…the three global
outcomes will be
used as a guiding
framework to
support how
outcomes are
written on the IFSP
and discussed with
families
…provides resources,
guidance, training and
technical assistance
regarding the use of
state identified family
a ssessment tools
…family assessments
will be conducted
consistently and with
fidelity statewide
…IFSPs will be
developed that
include functional
child and family
outcomes that are
meaningful to
families and
providers
Technical
Assistance
Accountability/
Monitoring
Then
…targeted technical
assistance can be
provided to ensure
that practices are
being implemented
and conducted
consistently
Then
…children will have
greater opportunity to
practice skills and
achieve their
individual outcomes
… families are
engaged and better
able to support their
children in meeting
their individual
outcomes
Then
…infants and
toddlers who
receive early
intervention
services in
Colorado will
demonstrate
increased growth
in the use of
appropriate
behaviors to meet
their needs
8
SSIP Improvement Strategies
9
 Develop a CDHS/DCFS EI Program data system to
ensure that data will be available for monitoring,
evaluation, and improvement planning for both
compliance and quality indicators.
 Integrate the Individualized Family Service Plan
(IFSP) Process with the Child Outcomes Summary
(COS) Process.
 Implement a Statewide System of Family
Assessment, Using Department-Approved Family
Assessment Tools and Provide Training, Technical
Assistance and Quality Assurance Monitoring.
Family Assessment
IMPROVEMENT STRATEGY 1
Purpose of Family Assessment
11
An essential practice for assessment and intervention in
natural environments is the identification of the
routines, activities, and events that occur regularly for
children and families at home and in the community.
Gathering information about where families go, what
they do, when they do it, and how they engage in the
tasks of everyday life is pivotal to the identification of
authentic outcomes and the initiation of intervention
that has the likelihood of making a difference.
(Bernheimer & Keogh, 1995;Bernheimer & Weismer, 2007;
McWilliam & Scott, 2001)
Family Assessment:
12
 Is the responsibility of the CCB EI Program;
 Is voluntary on the part of each family member
participating in the assessment;
 Is for the purpose of determining the resources,
priorities and concerns of a parent or other family
member related to the enhancement of his or her
child’s development; and,
 Is conducted for an eligible child prior to the
development of the initial IFSP.
Required components of family assessment are:
13
 Use of an appropriate family assessment tool
conducted by personnel trained to utilize the
tool;
 Facilitation of a personal, conversational
interview with the parent and/or caregiver,
which:




Is used for the purpose of understanding the priorities
and routines of the family;
Is unbiased and non-judgmental;
Uses open-ended questions to support the sharing of
information; and,
Is conducted in person.
Tools Selected for use in Colorado
14
 Routines-Based Interview (RBI)
 Scale for Assessment of Family Enjoyment
within Routines (SAFER)
 FACETS: Identifying Family Activities within
Routines
Family Assessment
15
As a required component to inform the development of
the IFSP and an identified SSIP Improvement strategy
 How can we ensure that we are avoiding redundancy
in our required activities for families?
 How will this support the work to improve quality?
Global Outcomes for Infants
and Toddlers
IMPROVEMENT STRATEGY 2
Terms
17
 IFSP outcomes: based on the concerns and priorities
of the family that are unique to the child
 The 3 global outcomes: the three child outcomes that
are reported to OSEP, the same for all children
receiving EI services



Children will have positive social emotional skills (including social
relationships)
Children will acquire and use knowledge and skills (including
communication skills)
Children will use appropriate behaviors to meet their needs
Terms , cont.
18
Early Implementation Communities: CCBs
and their partners that are piloting the initial
implementation phase of integrating the IFSP/COS
 Community Mapping Process: A way for
Communities can examine and assess their entire
local process from initial referral through transition
Big Ideas:
19
 There is a disconnect between the requirement that
states be accountable for children making progress on
the 3 global outcomes and the providers focus on the
outcomes on the IFSP
 IFSP outcomes should support the global outcomes
we are trying to achieve
 Ask: How can we best support children in making
progress so they can be active participants in all
settings in which they are a part of ????
Why Use 3 Global Outcomes?
20
 Were developed based on what families identified as




important for their children
Socially validated-reflect what we are trying to
achieve with children and families
Functional
When they are integrated-emphasize a focus on the
whole child
Flexible-not tied to one assessment, curriculum, or
level of child functioning
More Big Ideas
21
Here is what we are aiming for:
 What matters to the family is discussed in relation to
each of the 3 global outcomes
 The IFSP team considers how to write IFSP outcomes
that:
-continue to help the child progress in each of the 3 global outcomes
-support effective participation in routines identified by the family
 With the 3 global outcomes as an organizer for where
we want the child to go, use of discrete, domain
specific objectives no longer makes sense
Integration of IFSP/COS Process
22
The 3 global outcomes will be:
 Introduced from the beginning of the early
intervention process and infused throughout
 Used as a guiding framework to think about the
child’s functioning in everyday routines and
activities to support how outcomes are written on
the IFSP and how they are discussed with families,
 Part of the ongoing assessment of progress
Integration of IFSP/COS Process and IFSP/COS
Forms
23
 In addition to the activities mentioned previously,
the IFSP and COS forms have been combined and
designed to reflect the 3 global outcomes as a guiding
framework
 Instead of the 5 developmental domains, the IFSP
form is organized by routines and the 3 global
outcomes
 The Child Outcomes Summary (COS) rating will be
completed within the IFSP form itself, eliminating
the need for an additional form
Integration of the IFSP/COS Timeline
• February 2014, Convened Exploration Work Group, met monthly for ten
months, advised and made recommendations to the EI CO Team (Eight staff)
and the Colorado Interagency Coordinating Council (CICC)
• December 2014, The Exploration Work Group completed initial exploration
steps and elected to move forward
• January 2015, The integration of the IFSP/COS Process was identified as one
of the primary improvement activities within Colorado’s State Systemic
Improvement Plan (SSIP)
• February 2015-Present, Convened a larger group of stakeholders (GO 4 IT
Task Force) to address activities related to initial implementation, met twice
monthly through July 2015, currently meets monthly
• April 2015, Finalized GO 4 IT early implementation communities, developed a
communication plan (this aligns with the communication plan shared within
the SSIP)
• June-August 2015, Conducted TA and initial site visits
• Fall 2015-Provide universal training and targeted TA, data system training, GO
4 IT communities begin initial implementation of integrated IFSP/COS process
including the new form
• July 2016- Beginning of tentative staggered Statewide roll-out
24
Early Implementation Communities
25
Five CCBs and their partners are early
implementation communities:
o Inspiration Field
o Imagine!
o Mountain Valley
o North Metro
o Southern
Task Force Activities
26
 Systematically reviewed examples of integrated




IFSP/COS forms, training and technical assistance
materials
Use of implementation science principles to guide the
work
Collaborated with the EI General Supervision and Data
Unit to ensure alignment of activities and forms with the
new data system
Completion of the new integrated IFSP/COS form that
will help to support this process
Developed system for ongoing communication with
community stakeholders and partners
Early Implementation Supports
27
 Introductory materials and webinar for identified GO 4
IT early implementation communities
 Fiscal support for implementation activities
 Assignment of dedicated state team lead to
communicate and facilitate change process
o
o
o
Weekly check-in calls
Initial two-day site visit to facilitate community mapping and action
planning
Follow-up on-site universal training and targeted technical assistance
 Monthly community of practice calls for five GO 4 IT
communities
Current
Activities
28
 Early implementation communities have completed the
initial community mapping process and action steps to
identify training and technical assistance needs
 Universal and targeted training will be provided in Fall
2015 before GO 4 IT communities start changing their
current processes and begin using the integrated form
 The integrated form will be available for use by the early
implementation communities, along with the new Early
Intervention data system, in September 2015
 GO 4 IT early implementation teams meet regularly with
their Early Intervention state team leads and their
community members to assure that the new process is
understood by all community partners and that the
integrated IFSP process is meaningful for families
Action Planning
29
How are we going to get there????
Where is knowledge of the 3
Global outcomes measurement
and IFSP development strong?
Where do
we want to
be???
Who needs
foundational
training or
TA?
Ultimate goal
of full
integration:
Effective
participation
for children!
Initial Impressions
30
All five
communities identified the following areas of
needed support or further action:
 Clarification of roles and responsibilities
 How can duplication of staff efforts be avoided to
improve efficiency and the quality of the experience for
families?
 Time studies: exactly how long do the steps of the early
intervention process take for families, service
coordinators, evaluation teams, and providers?
 How can communities best conduct all required
activities in an order that supports a high quality,
integrated IFSP/COS process and still meet timelines?
“AH-HA” Moments
31
 All
communities needed time to grasp that
these changes impact their entire process, not just
the IFSP form
 Identified timeline of one year for statewide rollout
of integration of IFSP/COS process was too
ambitious-this will be adjusted based on the
feedback from the GO 4 IT communities
 Family participation and feedback on the entire
process will be extremely critical if we are going to
impact the 3 global outcomes for children
“AH-HA” Moments, cont.
32
 First reactions to the integrated form have been
positive, but ongoing adjustments will need to occur
quickly in order to support the processes
communities will need to do more work to
carefully assess current foundational practices and
procedures to ensure they align with current state
and federal requirements in order to build strong
future practices
Identified Training and Technical Assistance Needs
33
 The flow of the IFSP/COS integrated process
 Key principles for early intervention service delivery
 Facilitating family assessment through conversational





interviewing
Roles in the IFSP/COS integrated process (family,
evaluators, service coordinators, service providers)
Developing meaningful IFSP outcomes
Using information gathered to determine global
outcomes (child outcomes) ratings
Alignment with the CO EI data system-UNICORN
Billing requirements and procedures
Unified Child Outcome Reporting
Network(UNICORN)
IMPROVEMENT STRATEGY 3
Background – Why Change??
35
 Since 2007, the EI Colorado program has used the
DDDWeb Community Contract and Management System
(CCMS)
 The DDDWeb was not designed as a system to meet the
needs of EI data collection
 The DDDWeb was fraught with system errors and
maintained by another state agency – Health Care Policy
and Financing (HCPF)
 Current data collected by the EI program does not include
sufficient data to measure quality indicators for EI services
- IFSP data will now be collected
Where we are going
36
 Monitoring activities will be enhanced by additional
capabilities available through new data system
 Automation of many functions to take focus away from
“data chasing” and instead quality assurance

Ex. - Automation of Child Abuse Prevention and Treatment
Act (CAPTA) referrals and Medicaid utilization information
 New C-Stat measure activities: Children reach their
individual IFSP outcomes
What Does This Mean for Part B & Part C
Collaboration???
37
 As a result of these improvement strategies there will be
higher accountability related to ensuring that IFSP
outcomes are family–driven and functional. Information
gathered as part of the evaluation is a valuable
component of identifying and writing appropriate IFSP
outcomes
 There will be a need to communicate more frequently
about requirements and timelines in order for everyone
to accomplish their work
 Identifying opportunities to engage in joint training and
technical assistance will promote open communication
and shared understanding of roles
Complexities of our System
38
 Referrals for children under the age of three to EI Colorado totaled
12,897 (July 1, 2014-June 30, 2015)
 Overall, the state is experiencing a growth rate of 6.6% in Early
Intervention
 Funding for 0 – 3 evaluations conducted by AUs are not funded with EI
funding; Spec Ed funding does not cover actual costs
 AUs often allocate Child Find FTE prior to a school year, so adjusting
capacity through the year may be challenging, capacity for evaluations
may not keep pace

Resources and duties vary from AU to AU
 Both systems (Part B & Part C) experience staff turnover which
impacts training, knowledge of system, collaborative efforts, and
effectiveness
Complexities, cont.
39
 Both parts of the system have required activities and timelines,
both are working toward compliance and quality

Activities that need to be completed within the 45 day timeline impact referral
and intake staff, service coordinators, Child Find team members, service
providers, and most importantly….children and families!
 How can we all work together to not only meet required timelines
but provide the family with a meaningful and high quality
experience?
What Can We Do?
40
Communication
Collaboration
Teaming
Continuum of Teaming Implementation for
Problem Solving
 Teaming is
 Effective teaming
ineffective.
Select a Percentage
practices and a
 A process for
Problem Solving
that represents your
Problem Solving is
Process is used
not in place.
level of
 Meetings are
 Fully-developed
implementation
not regularlymeeting structures
scheduled.
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% are known by all
 Meeting flow and
stakeholders.
progression are
 Responsibilities and
determined at
meeting time.
roles are clear.
 Decisions and
 Agreements are
discussions are
followed; protocols
owned by (a)
exist for dissension
certain
individual(s).
and consensus.
 Documentation is
 Documentation is
inconsistent if
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
efficient and accurate.
present.
Memorandums of Understanding
42
 Individualized to the community process with sufficient






detail
Developed Collaboratively (Negotiated, not prescribed)
Documents commitments of each partner to support and
accomplish our joint work…result should be an effective
system for families
Should be developed together and reviewed each year
and updated to reflect current agreements and practices
Involves all relevant parties in the negotiation and review
processes
CCBs: MOUs are due to EI CO by Jan 4, 2016
AUs: CDE may require upload to DMS in future
Communication
43
 In order to be effective partners it is important that
we communicate frequently:



Does your community have regularly scheduled meetings
(face-to-face or via phone)?
Are the correct participants involved ?
How are changes, concerns, or questions communicated?
Frames for Assessing Communication,
Collaboration and Teaming
44
DEC Recommended Practices: Leadership & Teaming
http://dec.membershipsoftware.org/files/Recommend
ed%20Practices/DEC%202014%20Recommended%2
0Practices.pdf
45