Part C Information

ND Part C Annual Performance Report

Annual Performance Report Submitted March 31, 2004

Cluster Area CI: General Supervision

Question:
Is effective general supervision of the implementation of the Individuals with Disabilities Education Act ensured through the Lead Agency’s (LA) utilization of mechanisms that result in all eligible infants and toddlers and their families having an opportunity to receive early intervention services in natural environments (EIS in NE)?

Probes:
GS.I Do the general supervision instruments and procedures (including monitoring, complaint and hearing resolution, etc.), used by the LA, identify and correct IDEA noncompliance in a timely manner?

GS.II Are systemic issues identified and remediated through the analysis of findings from information and data collected from all available sources, including monitoring, complaint investigations, and hearing resolutions?

GS.III Are complaint investigations, mediations, and due process hearings and reviews completed in a timely manner?

GS.IV Are there sufficient numbers of administrators, service coordinators, teachers, service providers, paraprofessionals, and other providers to meet the identified early intervention needs of all eligible infants and toddlers and their families?

GS.V Do State procedures and practices ensure collection and reporting of accurate and timely data?

State Goal:
The North Dakota Department of Human Services will effectively supervise the implementation of Part C of the Individuals with Disabilities Act through the utilization of mechanisms that result in all eligible infants and toddlers and their families having an opportunity to receive early intervention services in natural environments.

Performance Indicator:
CS.1 General supervision instruments and procedures (including monitoring, complaint and hearing resolution, etc.), used by the North Dakota Department of Human Services identify and correct IDEA non-compliance in a timely manner.

1. Baseline/Trend Data
OSEP’s September 14, 1999 monitoring report indicated that the only activities used by NDDHS as general supervisory mechanisms are State licensure and accreditation by a private national organization (the Accreditation Council) of the Human Service Centers. Neither process is designed to completely identify instances of non-compliance with the provisions of Part C of IDEA or to ensure corrective actions of the limited findings made. The State has failed to utilize appropriate sanctions to ensure that non-compliance identified by the Council has been addressed. NDDHS is implementing a statewide early intervention monitoring system that builds upon components that exist within the Developmental Disabilities system. However, NDDHS must ensure that its monitoring system includes those components specified in 34 CFR §303.501

2. Targets:
1) Eight Regional Interagency Coordinating Committees (RICC) will be established
2) All RICC will develop an early intervention Quality Improvement Plan (QIP).
3) Eight Human Service Center Developmental Disabilities Unit will meet licensure standards.

3. Explanation of Progress or Slippage:
RICCs were formed in all eight regions to advise the North Dakota Interagency Coordinating Council (NDICC), local early intervention providers, the Regional DD Program Administrator and Infant Development Coordinator of Early Intervention issues affecting infants and toddlers with developmental delays or disabilities or at-risk for developmental delays and their families. RICCs are charged with developing and monitoring regional early intervention QIPs. RICC membership includes: Parents, Early Head Start, Early Intervention Providers, Protection and Advocacy, Family Support Service Providers, Special Education, Referral Sources, Childcare Providers, Arc, Legislators, and other Early Intervention partners unique to the region. Membership represents the geographic areas and ethnic make-up of the region. RICCs meet at least 4 times a year. Part C funding is available to reimburse members based on state policy, publish meeting notices, pay for meetings rooms if needed and contract for RICC support staff.

Regional early intervention QIPs must address: 1) who was involved in the development of the QIP, 2) the source of the data analyzed. 3) if focus groups were used, describe groups, issues and responses, 4) percent of children under 3 years of age served, 5) average age at referral, 6) examination of data at the county level, 7) examination of special populations within the region, 8) percent of referrals from each referral sources, 9) percent of referrals found eligible by referral source and eligibility category, 10) needs of children served in pre-school that were not identified before age 3, 11) local collaborative childfind activities, 12) percent of children less than 3 that are screened by Right Track, 13) referral sources to Right Track. 14) percent of Outcomes associated with early intervention services that were achieved or progress was made, 15) benefits families see from early intervention, 16) availability, training needs and response time of early intervention personnel (PT, OT, SLP, Vision, Hearing, Assistive Technology, etc.), 17) analysis of data regarding 45 day timeline between referral and IFSP, 18) percent of 6 month IFSP reviews completed, 19) percent of multi-disciplinary evaluations completed in all areas, 20) percent of sampled IFSPs that contain activities to support natural learning opportunities and family routines in environments natural to infants and toddlers, 21) availability of childcare for infants and toddlers with developmental delays or disabilities, 22) community accessibility (playgrounds, etc.) 23) parent satisfaction with service coordination, 24) whether Infant Development services are individualized to meet each families need, 25) whether Infant Development services are scheduled at times and in settings preferred by the family, 26) percent of scheduled Infant Development home visits completed, 27) percent of sampled IFSPs that demonstrate transdisciplinary service delivery, consultation and assessments, 28) whether all services received or needed are listed on Case Plan, 29) training needs of Early Intervention personnel and family members, 30) percent of families involved in eligibility meetings, 31) family input in evaluation/assessment process, 32) family involvement in policy and procedure development, 33) material available in alternative formats and languages, 34) whether families are given a choice of DD Case Managers and Infant Development Home Visitor, 35) whether transition outcomes are in the IFSP by the time the child is 2 years of age that addresses how the child, family and receiving agency will be prepared for transition at age 3, 36) are families offered an opportunity to be connected with other families that have experienced transition, 37) transition timelines outlined in the state Memorandum of Understanding met, 38) if additional assessments were needed were they conducted jointly by early intervention and pre-school staff, 39) does the transition process look different for children who turn 3 during the spring or summer, 40) percent of children that continue to be eligible for DD Case Management after their third birthday, 41) percent of IFSPs that continued to be used after the child is three years of age, 42) how the RICC monitors and updates the QIP, and 43) training needs of RICC members

In addition to the regional early intervention QIPs, early intervention activities are monitored during the Human Service Center Licensure Review process. Eligibility determination and service coordination for early intervention services is provided by DD Case Managers located in the eight regional Human Service Centers. A Human Service Center may not operate without having a license issued by the Department of Human Services under North Dakota Century Code section 50-06-05.2. The department conducts a review of each human service center to determine if the licensure standards and procedures are met. A licensure team comprised of department representatives evaluates each regional Human Service Center. At the conclusion of the review, each center receives a report that describes strengths of the programs and services reviewed, concerns, condition; and recommendations. If the Human Service Center receives a “condition” (does not meet a standard contained in licensure) the Human Service Center has 90 days to satisfy the cited condition or to develop and implement a plan to satisfy the cited condition. If the Human Service Center does not satisfy the cited condition or does not develop and implement a plan to satisfy the cited condition, a provisional license may be issued. After the Human Service Center has corrected the cited condition(s) or has developed a plan to correct the condition, members of the licensure team shall conduct follow up visits to verify that the Human Service Center has met the conditions or completed their correction plan. Site compliance with the previous survey’s conditions and recommendations are reviewed during the next survey.

Three staff from the Developmental Disabilities Unit reviewed and evaluated the DD Case Management unit at each of the eight regional Human Service Centers in the fall of 2002 per ND Administrative Code 75-05-05. The Human Service Centers implementation of their written procedures regarding the following early intervention standards were reviewed: 1) review of parental rights, 2) assignment of a service coordinator/DD Case Manager, 3) a Quality Improvement Plan.

A sample of 36 case files was also reviewed from each region. The case review included infants and toddlers receiving early intervention services. The following standards specific to early intervention services were applied: 1) referral to eligibility determination timeline, 2) written notification of the eligibility decision to parent, 3) re-determination of eligibility completed by 2 years, 9 months, 4) documentation of the specific eligibility criteria that was met/not met in the eligibility determination summary, and identification of specialized and generic services the individual may be eligible for and/or benefit from. 5) current Case Plan/IFSP which must include the desired outcomes of the child and family, objectives and activities/methods to achieve the identified outcomes, a list of services authorized and received, including the provider of service and frequency of service, and identification of services that are needed but currently not received and the amount and frequency of service needed, 6) documentation of required follow up and monitoring of the Case Plan/IFSP by the DD Case Manager utilizing the Quality Enhance Review Process. (QER). The QER is completed with the family and includes a review of outcomes, progress made toward the identified consumer and family outcomes, changes or revisions to the outcomes, significant events that may impact the identified outcomes, satisfaction with services, barriers to achieving the outcomes and an action plan to address the barriers. The QER must include a face-to face contact with the child/parent each quarter. The QER is distributed to the parent and providers of service. If there are unresolved issues, the QER can be forwarded to the regional DD Program Administrator and/or the state DD Unit staff for technical assistance and identification/resolution of systemic issues.

During the 2002 review the following specific concerns, conditions and recommendations specific to early intervention services were noted during the statewide licensure review of the eight regional Human Service Centers:
1) In 4 cases, eligibility re-determination was not completed by age 2 years, 9 months,
2) In 3 cases, initial eligibility was not completed in the required timelines. In 2 of the cases, it could not determined if timelines were met since no “Referred By” information was present.
3) Although most documents were current, by history, a number of System Indicators and Case Plans were not completed in timelines required.
4) In a number of cases, the amount and frequency of services in Case Plans did not follow the protocol.
5) The DDCM should assure the “Re-determination” option is utilized in ASSIST eligibility to properly document and identify it as a re-determination prior to age 3.
6) Eligibility decision documentation was confusing or in some cases, non-existent. In some case files, the case was closed with no explanation or documentation of notification to families apparent in ASSIST. Others showed large time lapses from referral to eligibility or Referral source information was missing.
7) Some QERs contained little content as to how services were addressing individual outcome priorities or support that quarterly face-to-face contacts took place as required.

Written summaries of the review results were shared with DD Case Management staff and the Regional Director from each Human Service Center following the review. In addition, the reviewers from the Disability Services Division contacted each regional DD Case Management unit to review the overall results and recommendations. During this contact the reviewers also identified the specific cases reviewed and the findings specific to each case with the regional staff.

There were conditions identified in two of the centers that required correction. One Human Service Center satisfied the cited condition within 90 days. A provisional license was given to one Human Service Center until the cited conditions were corrected. The conditions involved: 1) development of Case Planning/IFSP and timeliness of the review of these plans and service authorization requirements. 2) Implementation of periodic record reviews and substantial non-compliance with requirements for eligibility completion, case plan development and quality enhance review. The plan of correction has since been developed and implemented and full licensure restored.

DD Unit staff provide the regional DD Case Management units with ongoing, periodic queries that contain data that can be used to measure and manage the early intervention program’s results and standards in each of the eight regions. Site compliance with the previous survey’s conditions and recommendations will be reviewed during the next survey.

All the targets were achieved.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) Develop and implement a refined monitoring model that identifies IDEA Part C quality assurance issues and tracks corrective actions.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Facilitate a workgroup of representatives from all regions to gather feedback from RICC members and early intervention personnel regarding the QIP process and RICC training needs regarding Part C compliance standards.
2) Analyze regional early intervention QIPs with regional early intervention supervisors to determine the degree to which they addressed compliance standards.
3) Work with General Supervision Enhancement Grant team to develop monitoring model that assures compliance with IDEA Part C compliance standards.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) Activity 1 will require support from North Dakota Interagency Coordinating Council and Regional Interagency Coordinating Committee members who have agreed to be part of the workgroup, the General Supervision Enhansement Grant Coordinator and the Part C Coordinator.
2) Regional early intervention supervisors, staff from the General Supervision Enhancement Grant and Developmental Disability Unit staff will be the resources needed to accomplish activity number 2.
3) General Supervision Enhancement Grant Department of Public Instruction, North Dakota Center for Persons with Disabilities and Department of Human Services partners and stakeholders will work to achieve activity number 3.
Activity 2 will be accomplished by June 30, 2004.
Activities 1 and 3 will be initiated prior to June 30, 2004.

Performance Indicator:
CS. 2 Systemic issues will be identified and remediated through the analysis of findings from information and data collected from all available sources, including monitoring, complaint investigations, and hearing resolutions.

1. Baseline/Trend Data:
The Part C Coordinator has quarterly analyzed and charted state and regional early intervention data that has then been shared with North Dakota ICC members, RICC members, and regional early intervention supervisors. The data was then used for the development and monitoring of QIPs and during the Human Service Center licensure process.

2. Targets:
1) Data from the ASSIST database will be queried and shared with regional early intervention supervisors quarterly.
2) Human Service Center licensure findings will be shared with Service Coordinators and their supervisors.

3. Explanation of Progress or Slippage:
Although the two targets were achieved, it has been noted by some personnel in early intervention leadership positions that their training has not prepared them to analyze and synthesize data.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) Regional QIPs will identify and remediate regional Part C quality assurance issues and identify areas for continuous improvement.
2) State level Part C general supervision activities will assure identification and remediation of regional and systemic issues and areas for quality improvement in an effective and efficient manner.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Analyze regional early intervention QIPs with regional early intervention supervisors to determine the degree to which they addressed issues identified through ASSIST data.
2) Analyze regional early intervention QIPs with regional early intervention supervisors to determine the degree to which they addressed issues identified through Human Service Center licensure reviews.
3) Develop and maintain a database to track complaints, mediation and appeal issues.
4) Develop and deliver data analysis training for state and regional early intervention supervisors, North Dakota ICC and RICC members.
5) Develop and deliver training for state and regional early intervention supervisors, North Dakota ICC and RICC members regarding accessing, evaluating and implementing evidence based practice literature.
6) Modify complaint procedures to include review of findings with appropriate RICCs and development of plans of correction for systemic issues to be addressed in regional Quality Improvement Plans.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) Activities 1 and 2 will require support from regional early intervention supervisors and Developmental Disabilitity Unit staff.
2) The Part C Coordinator will be responsible for activities 3 and 6.
3) General Supervision Enhancement Grant staff will be responsible for activity number 4.
4) The Part C Coordinator, General Supervision Enhancement Grant Coordinator will be responsible for activity number 5.
Activity 1, 2, 3 and 6 will be accomplished by June 30, 2004.
Activities 4 and 5 will be initiated prior to June 30, 2004.

Performance Indicator:
CS.3 Complaint investigations, mediations, and due process hearings and reviews are completed in a timely manner.

1. Baseline/Trend Data
From July 1, 2000 through June 30, 2003, there were no Part C complaints filed, mediation requested, or appeals filed.

2. Targets:
Complaint investigations, mediations, and due process hearings and reviews are completed in a timely manner.

3. Explanation of Progress or Slippage:
Even though, material has been distributed regarding the availability of issue resolution options, there have been no complaints filed, requests for mediation received or appeal hearing requests received.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
Complaint investigations, mediations, and due process hearings and reviews will be completed in a timely manner.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Develop information that can be included in family newsletters regarding issue resolution options including the benefits of mediation.
2) Post information on the North Dakota Early Intervention web site regarding issue resolution options including the benefits of mediation.
3) Display information regarding Part C issue resolution options at the North Dakota Family Connections Conference.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) The Part C Coordinator and Developmental Disabilities Unit Support Staff will be responsible for activity number 3.
2) The Parent Liaison and Developmental Disabilities Unit Support Staff will be responsible for activities 1 and 2.
Activity number 1 will be accomplished by June 30, 2004.
Activities 2 and 3 will be initiated prior to June 30, 2004.

Performance Indicator:
CS.4 There will be a sufficient number of administrators, service coordinators, teachers, service providers, paraprofessionals, and other providers to meet the early intervention needs of all eligible infants and toddlers and their families.

1. Baseline/Trend Data:
Infant Development budgets are built on a ratio of 1 fte for every 11 infants and toddlers enrolled.

Human Service Center licensure standards address a 1 to 60 ratio for DD Case Managers (service coordinators).

60 percent of the time of the Administrator for Children and Family Supports position within the Disability Services Division, Developmental Disabilities Unit is devoted to Part C activities.

Data from regional early intervention QIPs indicate that families who do not live in remote areas can access direct therapy, but do encounter difficulty in finding therapists who will work with their child and family in an environment natural for other infants and toddlers.

Regional early intervention QIPs also indicate that families who live in remote areas encounter transportation, weather and time issues when accessing direct therapy.

2. Targets:
1) For every 11 infants and toddlers eligible for early intervention services there will 1 contracted or salaried Infant Development home visitors.
2) DD Case Managers will average no more than 60 consumers on their caseload.

3. Explanation of Progress or Slippage:
As the number of infants and toddlers eligible for early intervention services has significantly increased, in North Dakotan, it has been challenging to maintain the 1 to 11 and 1 to 60 ratios. With the implementation of CAPTA requirements, the ratios may need to be adjusted in order to accommodate the number of referrals that may not meet eligibility requirements.

To support the responsibilities of the state Part C Coordinator, contracts have developed for activities such material and training curriculum development.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) For every 11 infants and toddlers eligible for early intervention services there will 1 contracted or salaried Infant Development home visitor.
2) DD Case Managers will average no more than 60 consumers on their caseload.
3) Contracts will be developed for specific Part C administration support activities.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Proposals will be solicited and contracts developed for Parent and tribal liaisons.
2) Contracts will be developed for the drafting of training and informational material.
3) Video conferencing equipment will be collaboratively purchased to reduce travel time for meetings and training.
4) The feasibility of connecting family homes to regional video conferencing sites for the completion of arena based assessments and transdisciplinary consultation will be explored.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) The Part C Coordinator, Developmental Disabilities Support Staff, fiscal liaison and department contract officer will be responsible for activities 1 and 2.
2) The Part C Coordinator, Developmental Disabilities Support Staff, fiscal liaison and Division of Information Technology staff will be responsible for activity number 3.
3) The Part C Coordinator will be responsible for activity number 4.
Activities 1 and 3 will be accomplished by June 30, 2004.
Activities 2 and 4 will be initiated prior to June 30, 2004.

Performance Indicator: CS.5 Procedures and practices will ensure the collection and reporting of accurate and timely data.

1. Baseline/Trend Data: DD Case Managers and Infant Development Home Visitors utilize the ASSIST Database. The timeliness of data entry and reduction of data errors are supported through edits and an alert feature built into the data base. Data can be queried as soon as it is entered in the database.

2. Targets: Early intervention data will be collected accurately and timely.

3.Explanation of Progress or Slippage: ASSIST is the client database used by DD Case Managers and Infant Development Home Visitors. ASSIST data is stored on the state mainframe and shares common data elements with Medicaid, EPSDT, county social services, Foster Care and Child Support. Information is recorded in ASSIST as DD Case Managers and Home Visitors complete their daily activities include: referral source and date, client demographic and contact information, assignment of service coordinator and home visitor, eligibility determinations, Progress Assessment Reviews (support needs and Axis I, II and III diagnoses), Case Plans (child and family outcomes and status of outcomes, objectives, activities/methods, services needed, provider information, funding source, service amount and frequency, location/setting, authorization of services funded through Developmental Disabilities, IFSP team members and review schedule, and IEP transition information), consumer perception and satisfaction, Level of Care determinations for waiver and institutional services, and case closure information. The database also tracks timelines and alerts users of approaching activities. The security system allows users in different locations to work in a shared application file. Infant Development staff can only access files for clients enrolled in their program and Service Coordinators can only access information regarding clients in their region. DD supervisors can view the information for all the clients in their region. Central office (state level) staff can view and query information statewide. Standard queries are run quarterly and sent to the regional supervisors. They can also request additional data as needed. All data can be analyzed by region, county, staff caseload, ethnic class, age, eligibility category, diagnosis, etc. Data from the ASSIST database is transferred to a Lotus Notes database for printing and storage of formatted print documents. The Quality Enhancement Review document that is used by Service Coordinators to monitor IFSP outcomes and family needs is also located in the Notes database along with evaluation reports, and progress notes. State level staff can access information in regional Notes databases online.

Although the data is being collected in a timely manner, the accuracy can be improved and data elements refined. In order for data error patterns to be identified and corrected at the local level, supervisors need to better understand the information contained in data reports. ASSIST users need accessible help instructions.

4.Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) Early intervention data will be collected accurately and timely.

5.Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) A work request will be developed and completed to remove the IFSP date default.
2) A work request will be developed and completed to create an IFSP Outcome category feature (developmental areas, family support and transition).
3) ASSIST early intervention help text will be updated.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) The ASSIST Database Coordinator and a programmer from the Information Technology Department will accomplish activities 1 and 2.
2) The Part C Coordinator and ASSIST Database Coordinator will be responsible for activity number 3.
Activities 1, 2 and 3 will be completed prior to June 30, 2004.

Cluster Area CII: Comprehensive Child Find System

Question:
Does the implementation of a comprehensive, coordinated Child Find system result in the identification of all eligible infants and toddlers?

Probes:

CC.I Is the percentage of eligible infants and toddlers with disabilities that are receiving Part C services comparable to State and national data for the percentage of infants and toddlers with developmental delays?

CC.II Is the percentage of eligible infants with disabilities under the age of one that are receiving Part C services comparable with state and national data?

State Goal: (for reporting period July 1, 2002 through June 30, 2003): North Dakota will have a comprehensive, coordinated Childfind System resulting in the identification of all eligible infants and toddlers.

Performance Indicator(s): (for reporting period July 1, 2002 through June 30, 2003): CC. 1 North Dakota’s percentage of eligible infants and toddlers with disabilities, that are receiving early intervention services, will be comparable to state and national prevalence data.

1. Baseline/Trend Data: (for reporting period July 1, 2002 through June 30, 2003):

* Tracking includes referrals from the North Dakota Early Childhood Tracking System and the new Right Track program. Right Track was piloted and implemented at different times across the state. Some Right Track referrals were incorrectly recorded as other during the transition period.

OSEP’s September 14, 1999 monitoring report indicated that, except for a cooperative effort with North Dakota Department of Public Instruction (NDDPI) in implementing the tracking program, the OSEP monitoring report found no evidence of coordination of Child Find activities with other agencies that have similar Child Find responsibilities (i.e., Maternal and Child Health; Early Periodic Screening, Diagnosis and Treatment; Supplemental Security income) within the State as required in 34 CFR §303.321(c). Although the IP provides several examples of how Child Find efforts are already coordinated with other agencies that have similar Child Find responsibilities, the IP does not indicate how Child Find activities will ensure that Child Find efforts of the various public agencies responsible for Child Find activities are not duplicated; and how NDDHS will make use of the resources available through each public agency in the State to implement the Child Find system in an effective manner.

OSEP’s September 14, 1999 monitoring report indicated that NDDHS’ policies and procedures are not effective to ensure that all eligible children are identified and that primary referral sources make referrals in a timely manner as required in 34 CFR §303.321(d)(2)(ii). Strategies listed on the IP do not indicate how NDDHS will ensure that primary referral sources make referrals in a timely manner.

2. Targets: (for reporting period July 1, 2002 through June 30, 2003): Two percent of the children in North Dakota who are less than 3 years of age will be identified and receive early intervention services.

3. Explanation of Progress or Slippage:(for reporting period July 1, 2002 through June 30, 2003): A variety of activities occurred to increase the percentage of children served. The North Dakota Early Childhood Tracking System which tracked at-risk infants and toddlers via a mail out parent questionnaire was replaced with the Right Track program which involves early intervention professions completing a developmental screening in the family home and addressing parental questions and concerns. Right Track services are available free of charge to all North Dakota families who have children less than 3 years of age and are not currently receiving follow-along or developmental supports through other community agencies (Early Head Start, Parents as Teachers, Newborn Home visits). Regional Interagency Coordinating Committees monitor local agreements regarding coordination and referrals between agencies. All referrals for screenings are made to the local Human Services Center. Referral sources no longer need to determine if the child is at-risk for a developmental delay or if they have a delay or high-risk diagnosis. Human Service Center staff determine if the referral will be forwarded to Right Track or if a Service Coordinator will be assigned to coordinate initial evaluations. If the child is referred to Right Track and the initial screening determines that evaluations are needed, the original referral date to the human Service Center starts the 45-day IFSP timeline. The goal of Right Track is to assure that all infants and toddlers receive a developmental screening. Right Track service providers are selected through a Request for Proposal process to determine a provider for a specific geographic region of the state. The providers must agree to a zero reject policy for all families referred to them. Each Right Track contract also requires that screening results indicating a need for further evaluation will be referred back to the Human Service Center within 2 days. Right Track services via a fee for service contract are currently provided by 3 Special Education Units, 2 individuals, 1 university, 1 hospital, 1 tribe, 1 private social service agency and 1 Human Service Center. Between July 1, 2002 and June 30, 2003 Right Track staff completed 4,852 home-based developmental screening.

The Birth Review Project is a collaborative childfind effort between the North Dakota Department of Health and the North Dakota Department of Human Services. The two state departments share resources to contact 81 percent of North Dakota families following the birth of their child. A question on the birth certificate asks if families would like health care information. Every two weeks Vital Records run a report indicating the families that have requested health care information. The Disabilities Services Division then sends a packet of information to these families. Information includes a risk factor sheet, developmental brochures, a statewide toll free childfind telephone number and a card the family can return to request specific information. The Maternal Child Health Unit staffs the telephone line. The requests for more information are returned to the Children’s Special Health Services Unit and they prepare information packets regarding the families specific concerns. One of the options a family can request is a Right Track screening, if they do so the referral is forwarded electronically to the appropriate Human Service Center. Six weeks after the first mailing a second letter is sent to all families who have not responded. Twenty-one percent of the families contacted through the Birth Review program respond to the mailings. Staff from the two departments meet quarterly to review the Birth Review project and share information regarding new program initiatives effecting young children and their families.

The Part C Lead Agency contracted with a marketing firm for the development of a childfind marketing plan. The plan recommended changing the logo to reduce confusion, developing material to target specific referral sources, increasing local early intervention program contact with primary referral sources, developing specific public awareness material and cost analysis of public awareness campaign options.

Developmental Wheels, which contain nutrition, safety, discipline, dental, hearing, vision, immunization, developmental and Human Service Center contact information have been widely distributed statewide. Developmental Wheels are distributed annually through hospitals and clinics; child care, Right Track, WIC, public health and county social service programs; churches; schools and colleges; booths at fairs, powwows, health fairs and conferences; and other community settings such as laundries, beauty salons, and convenience stores.

Data regarding the percentage of infants and toddlers receiving early intervention services are reviewed with Regional Interagency Coordinating Committees. They examine national, state, regional, county, age of referral, referral source, and local ‘Kids Count’ data before developing regional childfind action steps for their Quality Improvement Plan.

To increase consistent application of eligibility criteria, state office staff conducted regional eligibility team training regarding high-risk diagnosis, 25 percent delay in two areas, 50 percent in one and informed clinical opinion. Central office and regional supervisors now review data regarding eligibility determinations quarterly.

Although the target of serving 2 percent of the state population under the age of three was not reached, the data shows a trend in the right direction. If one more child had been served in each region, the goal would have been achieved. Some of the regional and county data is very volatile due to the low populations. The infant toddler population ranges from 4,906 to 18 per county. Of the 53 counties in North Dakota only 3 have more than 1,000 infants and toddlers, 43 have less than 500 and 20 have less than 100. The referral of triplets can create a dramatic change in the percentage served.

4. Projected Targets: (for NEXT reporting period July 1, 2003 through June 30, 2004 and on going):
1) Two percent of the children in North Dakota who are less than 3 years of age will be identified and receive early intervention services.
2) Each region will serve at least 1.5 percent of the infants and toddlers in their area.
3) Two percent of the American Indian infants and toddlers will receive early intervention services.

5. Future Activities to Achieve Projected Targets/Results: (for NEXT reporting period July 1, 2003 through June 30, 2004 and on going):
1) A Request for Proposals will be published and a contract developed for the design of additional statewide childfind marketing material.
2) The reservations that do not current have a Right Track program will be contacted and invited to submit an application to become a Right Track provider.
3) A Request for Proposals will be published to determine if additional agencies are interested in becoming Right Track Providers.
4) A joint policy will be developed and issued with the Children and Families Services Division to assure the referral of infants and toddlers with substantiated abuse, neglect or exploitation.
5) Joint training will be provided for county and regional protective service staff, service coordinators, Infant Development staff and other eligibility team members.
6) Discussions will be held and possible Memorandums of Understanding developed with Tribal Social Service agencies regarding the referral of American Indian infants and toddlers with substantiated abuse, neglect or exploitation.
7) An interactive videoconference will be held to allow Regional Interagency Coordinating Committee members and early intervention staff to share successful childfind strategies and challenges.
8) Data input errors will be reviewed with regional supervisors.
9) Two potential childfind partners, such as Healthy North Dakota and SSI, will be contacted regarding the development of collaborative procedures for early identification of infants and toddlers.

6. Projected Timelines and Resources: (for NEXT reporting period July 1, 2003 through June 30, 2004 and on going):
1) Activities 1 and 3 will require the Part C Coordinator, DD Unit support staff, Fiscal Liaison and the department contract officer.
2) Activities 2 and 6 will require action by the Part C Tribal Liaison and the Part C Coordinator.
3) Activities 4 and 5 will require staff collaboration from the Children and Family Services and Disability Services Divisions.
4) Activity 7 will require support from Regional Interagency Coordinating Committee Coordinators, North Dakota Interagency
Coordinating Council Chair and Vice-Chair, Part C Coordinator and DD Unit Support Staff.
5) Central office staff and regional supervisors will be needed for activity number 8.
6) The North Dakota Interagency Coordinating Council and Part C Coordinator will work towards achieving activity number 9.
Activities 1, 3, 4, and 5 will be accomplished by June 30, 2004.
Activities 2, 6, 7, 8 and 9 will be initiated prior to June 30, 2004.

Performance Indicator(s): (for reporting period July 1, 2002 through June 30, 2003):
CC. 2 North Dakota’s percentage of eligible infants under the age of one, that are receiving early intervention services, will be comparable to state and national prevalence data.

1. Baseline/Trend Data: (for reporting period July 1, 2002 through June 30, 2003):
See Baseline/Trend Data presented in CC.1

2. Targets: (for reporting period July 1, 2002 through June 30, 2003):
One percent of the children in North Dakota who are less than 1 year of age will be identified and receive early intervention services.

3. Explanation of Progress or Slippage: (for reporting period July 1, 2002 through June 30, 2003):
One percent of the population less than one year of age is being identified and served by early intervention services in North Dakota. Due to relatively small total population it is extremely difficult for regions to maintain a stable percentage. The population of infants less than one year of age ranges from 1,631 to 6 per county. Of the 53 counties in North Dakota only 1 has more than 1,000 infants, 49 have less than 500 and 37 have less than 100.

4. Projected Targets: (for NEXT reporting period July 1, 2003 through June 30, 2004 and on going):
1) The statewide percentage of infants served will remain more than 1 percent.
2) Each region will serve at least .8 percent of the infants less than one year of age in their area.

5. Future Activities to Achieve Projected Targets/Results: (for NEXT reporting period July 1, 2003 through June 30, 2004 and on going):
1) Awareness training will be provided for physicians and medical students regarding prevalence data and the importance of early identification.

6. Projected Timelines and Resources: (for NEXT reporting period July 1, 2003 through June 30, 2004 and on going):
1) Activity 1 will be accomplished with support from the Part C Coordinator, DD Unit Support Staff, a contract presentor and regional early intervention staff.
The training for medical students and two sessions for physicians will be completed by May 1, 2004

Cluster Area CIII: Family Centered Services

Question:
Do family supports, services and resources increase the family’s capacity to enhance outcomes for infants and toddlers and their families?

State Goal:
Family supports, services, and resources will increase North Dakota’s family’s capacity to enhance outcomes for their children and themselves.

1. Baseline/Trend Data

System Indicators are a series of 10 questions Service Coordinators annually ask each family receiving early intervention services. Data from 2003 indicates the following results:
1) Do you receive information about services and supports available to you, rather than having to search for information? 89% responded yes
2) Is the information easy to understand? 85% responded yes
3) Do the DD supports authorized reflect the needs of your family, as well as your child with a developmental delay or disability? 97% responded yes
4) Do you choose which staff you work with? 66% responded yes
5) Is there consistency in who works with you? 98% responded yes
6) Are DD authorized supports available when your family wants and needs them? 94% responded yes
7) Do the people that help you access supports help you identify a variety of informal and formal support options such as family, friends, recreation programs, churches, service organizations? 83% responded yes
8) Are your choices and preferences respected? 98% responded yes
9) Have your rights been explained to you in a manner that you understand? 97% responded yes
10) Do you receive the information you need regarding your child’s progress? 95% responded yes

In the spring of 2003, in order to prepare for anticipated training following the reauthorization of IDEA, 200 families with children in early intervention were asked to complete a mail survey. Students from the Physical Therapy Department at the University of North Dakota School of Medicine developed the survey tool and analyzed the data. The survey was distributed with the assistance of the Developmental Disabilities Unit of the Department of Human Services. The survey tested three null hypothesis’s 1) Families with children eligible for early intervention services in North Dakota are not in need of further information regarding rights and regulations under Part C of IDEA, 2) Families are satisfied with the services provided by the state of North Dakota, and 3) Families are receiving information about early intervention services and their child’s progress in the method they prefer. The summary, based on the responses of 70 families (35 % return rate), indicate that although families are satisfied with the information they receive and the manner in which they receive information, they still want more information. The one area in which all families wanted more information was how they were expected to be involved in their child’s services. When asked to rank 13 information sources, families indicated that their DD Case Manager was the source from which they received the most information. Followed by occupational therapists and physicians. When asked to rank their two most preferred methods of receiving information, from a choice of 6 methods, families indicated they preferred receiving verbal information from service providers and written material given to them. Families also indicated that this is how they currently receive information.

OSEP’s September 14, 1999 monitoring report indicated no areas of non-compliance in the Family Centered Services Cluster.

2. Targets:
North Dakota families will report that early intervention services have increased their capacity to enhance outcomes for their children and themselves.

3. Explanation of Progress or Slippage:
A number of activities have occurred to increase the voice of families in the North Dakota early intervention system. The North Dakota Interagency Coordinating Council amended their by-laws to increase the percentage of parent representation to at least 30 percent. Regional Interagency Coordinating Committees (RICC) have been formed and they must also contain at least 30 percent parent representation. Some RICCs have amended their by-laws to require a parent representative as a Co-chair.

Experienced Parents have been hired/contracted in three of the eight regions. Experienced Parents must have or have had a child in early intervention. They are available to assist families and early intervention staff. They may meet with a family to explain the intake or transition process from a parent’s perspective, create a newsletter regarding regional training opportunities for families and provide a family friendly overview of regulations and policies. Experienced Parents are also available to provide feedback regarding early intervention procedures or informational material, provide mentoring for new staff or connect families to support networks. Within a broad framework regions are encouraged to design the job description or contract so that it meets the needs of their families and staff.

The North Dakota Department of Human Services contracts with the North Dakota Family To Family Network. The network is a structure similar to other state parent-to-parent networks, but also matches grandparents and siblings in addition to parents. The fee for service contract reimburses the network every time they match a North Dakota family member of an infant or toddler with developmental delays or disabilities with another trained family member who has experienced similar challenges.

Through a contract with the University of North Dakota, family members are recruited, trained and financially supported as co-instructors in early intervention classes on campuses across the state. The faculty co-instructor is also provide with information on how to use support and maximize the family members impact on the educational experience of future early intervention personnel.

A variety of training materials have been developed through the Family Support Grant at the North Dakota Center for Persons with Disabilities. Three that enhance early intervention personnel’s ability to support American Indian families, families new to the United States, and families headed by persons with developmental disabilities have been distributed with support from Part C.

To increase awareness of family issues, Part C funds were utilized for the development of a collection of family stories entitled ‘From the Heart, North Dakota Families Tell Their Stories’. Copies have been distributed to families, early intervention personnel, referral sources, policy makers and faculty for use in pre-service settings. Family representatives on the North Dakota Interagency Coordination Council and the IDEA Part B Advisory Committee are invited to share their store when the two advisory committees meet jointly to address common issues. Committee members feel beginning meeting in this manner, keeps the focus on the issues of primary importance to the advisory bodies.

During the last Legislative Session, the asset disregard that had been approved in the previous session with a sunset clause was passed. This allows families of infants and toddlers with developmental delays of disabilities to have their assets disregarded when they apply for Medical Assistance, as well as, not having their income deemed when they meet the Level of Care criteria for the Developmental Disabilities Home and Community Based Services waiver. Service Coordination and Infant Development services are covered through the North Dakota HCBS waiver. To assist families in applying for Medical Assistance, a Frequently Asked Questions brochure was developed specifically for family with infants and toddlers with developmental delays or disabilities.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going): North Dakota currently has many measures of family perception. We believe data based decision making requires information regarding outcomes, demographics, process and perception. Future activities will address collecting information regarding family outcomes, but data will not be available for the next reporting period.

During the next reporting period, the projected targets will include measuring an increase in parent leadership by: 1) Increasing to six the number of regions that have implemented Experienced Parent positions. 2) Creating a Parent Liaison position at the state level.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) The Department of Human Services will collaborate with the North Dakota Center for Person’s with Disabilities through the state Family Support Grant to determine the correlation between data collected by Service Coordinators, results from the National Core Indicators (mail survey) and the results obtained by a telephone survey conducted by someone not involved in delivering early intervention services. The Department of Human Service will then consider if procedures used to collect System Indicator information need modification.
2) Increase the number of Experienced Parents.
3) A Request for Proposals will be published and a contract developed for a state level Early Intervention Parent Liaison. Responsibilities for the Parent Liaison will include: providing support to the parents on the North Dakota ICC, facilitating statewide parent leadership activities, reviewing policy and procedures regarding early intervention services, drafting parent information material, and completing other activities note in this report.
4) Create an outcome category indicator within the ASSIST Database that will allow for the tracking of the status (achieved, progress made continue, etc) of outcomes associated with a family’s capacity to enhance outcomes their child and family.
5) A family guide to early intervention services in North Dakota will be developed and distributed.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) Activity number 1 will require the support of the Part C Coordinator, Developmental Disabilities Unit support staff and the Family Support Grant Coordinator.
2) Assistance will be needed from Regional Developmental Disabilities Program Administrators, Infant Development Coordinators, Regional Interagency Coordinating Committees, Part C Coordinator, Regional Human Service Center Directors, Regional Business Managers and the department Contract Officer to accomplish activity number 2.
3) Activity 3 will require the Part C Coordinator, DD Unit support staff, Fiscal Liaison and the department contract officer.
4) The ASSIST Database Coordinator and a programmer from the Information Technology Department will be needed to accomplish activity number 4.
5) The North Dakota Early Intervention Services sub-committee Co-chairs, Part C Coordinator and Developmental Disabilities support staff will accomplish activity number 5.
Activities 3 and 4 will be accomplished by June 30, 2004.
Activities 1, 2 and 5 will be initiated prior to June 30, 2004.

Cluster Area CIV: Early Intervention Services in Natural Environments

Question: Are early intervention services provided in natural environments meeting the unique needs of eligible infants and toddlers and their families?

Probes:

CE.I Do all families have access to a Service Coordinator that facilitates ongoing, timely early intervention services in natural environments?

CE.II Does the timely evaluation and assessment of child and family needs lead to identification of all child needs, and the family needs related to enhancing the development of the child?

CE.III Do IFSPs include all the services necessary to meet the identified needs of the child and family? Are all the services identified on IFSPs provided?

CE.IV Are children receiving services primarily in natural environments? If not, do children have IFSPs that justify why services are not provided in natural environments?

CE.V What percentage of children, participating in the Part C program, demonstrates improved and sustained functional abilities? (Cognitive development; physical development, including vision and hearing; communication development; social or emotional development; and adaptive development

State Goal: North Dakota’s early intervention services will be provided in natural environments, built upon naturally occurring learning opportunities within family routines and meet the unique needs of eligible infants and toddlers and their families.

Performance Indicator:
CE. 1 All North Dakota families will have access to a service coordinator that facilitates ongoing, timely early intervention services in natural environments.

1. Baseline/Trend Data
OSEP’s September 14, 1999 monitoring report indicated that the State’s procedures contain provision for both a service coordinator and a Developmental disability case manager to be appointed for each eligible child and family, and these two share the responsibilities specified in Part C. Interagency linkages at both the State and local levels related to service coordination appear to be non-existent. OSEP found no evidence that early intervention service coordinators were working with service coordinators or case managers from other agencies that may also be providing services to the child. There also appears to be no mechanism for a service coordinator employed by another public agency, but already working with a Part C eligible child and the child’s family, to also serve as the child’s early intervention service coordinator under Part C. NDDHS must ensure that each family has one service coordinator who acts as the single point of contact for a child and family to assist the family will all service coordination activities required in Part C. The IP indicates that a position paper clarified that the Developmental Disabilities case manager is responsible for service coordination responsibilities.

2. Targets:
All North Dakota families will have access to a service coordinator that facilitates ongoing, timely early intervention services in natural environments.

3. Explanation of Progress or Slippage:
The DD Case Management Handbook was changed to clarify that the DD Case Manager would be responsible for the completion of all early intervention service coordination activities. When asked to rank 13 information sources, families indicated that their DD Case Manager was the source from which they received the most information (see Cluster Area III).

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) DD Case Managers will support families as they increase their competency and confidence in their capacity to enhance outcomes for their children and themselves.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Training will be offered for DD Case Managers regarding adult learning theory. 2) Material will be developed and presented to DD Case Managers regarding how they can support and enhance parent’s abilities to explore, identify and access supports.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) Activity number 1 will be accomplished with support from the Family Support Grant Family Connections Conference.
2) Activity number 2 will be completed with support from the Part C Coordinator, Parent Liaison and curriculum contractor.
Activity number 1 will be accomplished prior to June 30, 2004.
Activity number 2 will be initiated prior to June 30, 2004.

Performance Indicator:
CE. 2 Timely multi-disciplinary evaluations and assessments are conducted leading to the identification of child and family preferences, strengths and needs.

1. Baseline/Trend Data:

OSEP’s September 14, 1999 monitoring report indicated that the State has not effectively ensured that each child referred for early intervention services receives a timely multidisciplinary evaluation in all of the developmental areas. The IP indicated the development of guidelines that clarified required evaluation areas and that those guidelines would be distributed to all eligibility teams regarding high-risk diagnosis. The State’s Eligibility Administrative Code will also address the required evaluation areas.

2. Targets:
All infants and toddlers referred for early intervention services will receive a timely multidisciplinary evaluation in all of the developmental areas.

3. Explanation of Progress or Slippage:
Guidelines that clarified required evaluation areas and possible high-risk diagnosis were developed and eligibility teams trained. A brochure was also developed for families regarding the benefits of having their child evaluated in al developmental areas.

Eligibility teams at the Human Service Centers determine eligibility for DD Case Management services (Part C eligibility criteria) in the following fashion: first they consider if the child has a diagnosis that places them in the high-risk category for developing a developmental delay, they next consider if the child has a 25 percent delay in two or more areas or a 50 percent delay in one area. In order to determine if the child is eligible in the last two areas they must consider evaluation reports and in doing so review the reports to determine if all developmental areas were evaluated and if a multidisciplinary team was involved in the evaluation process. When a Human Service Center receives a referral for a child less than 3 years of age, the assigned DD Case Manager completes the intake section of the ASSIST Database. During that process, the date of the referral is recorded along with other referral source information. In order to complete the eligibility determination process, the eligibility section of ASSIST must be completed indicating when the team made their decision and on what they based their decision . The two dates (referral and eligibility) are tracked with an ASSIST Database query. DD Case Managers also receive an alert to remind them of approaching timelines. Even though, the eligibility summary section of the database does not currently contain entry fields to record the developmental areas evaluated nor does it capture the evaluation team disciplines, in order for the eligibility team to find a child eligible in the 25 percent delay or 50 percent areas they must review evaluation material that contains percent delay information in all developmental areas. 56 percent of all children are found eligible based on such evaluation reports.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
All infants and toddlers referred for early intervention services will receive a timely multidisciplinary evaluation in all of the developmental areas.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) A work request will be developed and completed add data elements to the ASSIST Database to capture evaluation information (developmental areas and disciplines involved).
2) Training will be developed and delivered to regional eligibility teams and Infant Development Coordinators regarding the requirement of timely multidisciplinary evaluations in all areas.
3) Regional early intervention supervisors will be requested to provide copies of evaluations and assessment reports for a sample of children enrolled in Infant Development to document areas addressed, the disciplines involved and the timeliness of the reports.
4) The Parent Liaison will develop family sampling techniques to determine if evaluations and assessments identify the needs of the child and family.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going): 1) The ASSIST Database Coordinator and a programmer from the Information Technology Department will be responsible for activity number 1.
2) The Part C Coordinator will be responsible for activity number 2.
3) The Part C Coordinator, regional supervisors of early intervention and Chair and vice–chair of the Early Intervention Services Sub-Committee will be responsible for the completion of activity number 3.
4) The Parent Liaison will be responsible for activity number 4.
Activity number 1 will be accomplished by June 30, 2004.
Activity number 2, 3 and 4 will be initiated by June 30, 2004.

Performance Indicator:
CE.3 IFSPs will contain all the services identified and necessary needed to meet the identified needs of the child and family.

1. Baseline/Trend Data

OSEP’s September 14, 1999 monitoring report indicated that the State’s policies violate the requirement that IFSPs include the specific early intervention services necessary to meeting the unique needs of the child and the family. In addition, given the State’s policy and practice, some children with IFSPs may not be receiving certain needed services at all. The IP indicates that this area of non-compliance is being addressed through the implementation of changes in policy and procedures regarding natural environments and IFSP development.

OSEP’s September 14, 1999 monitoring report indicated that the services provided to infants and toddlers with disabilities are limited by State policy including the type of service provided, the frequencies and intensities of services provided, and the settings in which services may be provided. By State policy, parents of children enrolled in Infant Development Programs receive parent training “home visits,” and services and locations are not individualized to the needs of each child and family. There is no strategy mentioned in the IP to make necessary changes to existing State policy and procedures in order to ensure compliance with 34 CFR §303.344(d)(1)(ii).

OSEP’s September 14, 1999 monitoring report indicated that medical and other services needed by eligible infants and toddlers and being provided by public or private programs other than the Infant Development Program, or paid for by parents, were not identified on some IFSPs reviewed. The IP addresses this issue by making a clarification to policy regarding completion of the Care Plan. The Care Plan lists services and supports a consumer receives or needs and information in a Care Plan is also included in the IFSP. Training will be provided regarding IFSP development.

OSEP’s September 14, 1999 monitoring report indicated that the Infant Development Program manual states that children enrolled in full time Infant Development Services will receive one parent training home visit per week for one hour. Children receiving half time Infants Development Services will receive one home visit for one hour every other week. The IP indicates that changes in policy and procedures regarding natural environments and IFSP development have been implemented by NDDHS over time, in addition to various training activities.

OSEP’s September 14, 1999 monitoring report indicated that, although the State assures OSEP that it does not charge a fee for early intervention services, when needed early intervention services were not available through a public program, or the family did not have insurance, or was unable to pay for the service, the child would not receive the service even though the need was documented. In addition, those services that NDDHS did not pay for were not included on the IFSP. NDDHS’ Part C Application has since been amended to include a system of payment for services.

2. Targets:
All services necessary to meet the needs of the child and family in supporting their child will be identified and recorded in the IFSP.

3. Explanation of Progress or Slippage:
DD Case Managers and Infant Development Home Visitors identify service needs through evaluations, family assessments and on-going interaction with the family. This information is recorded in the Case Plan section of the ASSIST Database including the disposition (receiving or needed), provider, funding source, amount, frequency and location). ASSIST queries have been run and reviewed with regional early intervention supervisors to track the increase in the number of IFSPs that include a variety of supports needed by the family and success in helping the families access the needed supports. The Human Service Center licensure review also addressed the documentation of all serves received and needed.

The frequency and intensity of Infant Development home visits was never restricted and that fact has been clarified with regional early intervention personnel. ASSIST Database queries are run and shared with regional early intervention supervisors to track the frequency of Infant Development services to assure that services are individualized to the child’s and families needs.

Policies have been developed to clarify what early intervention services are provided at no cost to families and what services parents may be financially responsible for. Data will be collected to determine what impact will be with the July 1, 2003 implementation of a mandatory Medicaid policy for children receiving Infant Development serves.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) The percent of plans that contain a variety of early intervention support services will increase.
2) The percent of early intervention support services received will increase.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) The Parent Liaison will develop a sampling technique to determine the percentage of parents reporting their plan contains all the services they are receiving and the supports they need but are not receiving.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) The Parent Liaison will accomplish activity number 1.
Activity number 1 will be initiated prior to June 30, 2004.

Performance Indicator:
CE.4 Children will receive services that support routine based learning opportunities in their natural environments. All services not in the child’s natural environment will have a justification included in the child’s IFSP.

1. Baseline/Trend Data:

2. Targets: All children will receive services that support routine based learning opportunities in their natural environments. All services not in the child’s natural environment will have a justification included in the child’s IFSP.

3. Explanation of Progress or Slippage: Due to the spares population of North Dakota, the large area over which it’s citizens are dispersed and the climate; early intervention services have always been delivered in environments where the children are already located. This has created many travel and scheduling and re-scheduling challenges.

Assisting families in locating childcare settings that will serve infants and toddlers with developmental delays or disabilities is a challenge identified in some Regional Early Intervention Quality Improvement Plans.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going): 1) All IFSPs will support routine based learning opportunities in the child's family and community environments.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Training and mentoring will be provided for regional early intervention supervisors regarding ways to support and encourage professional growth of staff who are working in natural environments.
2) Training will be provided regarding adult learning techniques to improve early intervention personnel’s skills in coaching the child’s primary caregivers.
3) Material will be developed for Experienced Parents to share with families regarding the benefits of routine based interventions that support natural learning opportunities and the families’ role in early intervention.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) Activity number 1 will require support from the Part C Coordinator and curriculum development contractor.
2) Activity number 2 will be accomplished with support from the Family Support Grant Family Connections Conference.
3) Activity number 3 will be the responsibility of the Part C Coordinator and the Parent Liaison.
Activity number 2 will be accomplished by June 30, 2004
Activities 1 and 3 will be initiated by June 30, 2004

Performance Indicator:
CE.5 Infants and toddlers receiving early intervention services will demonstrate improved and sustained cognitive, physical, communication, social or emotional and adaptive functional abilities.

1. Baseline/Trend Data:

2. Targets:
Infants and toddlers receiving early intervention services will demonstrate improved and sustained cognitive, physical, communication, social or emotional and adaptive functional abilities.

3.Explanation of Progress or Slippage:
Because standardize evaluation instruments are not required as part of the eligibility process nor is annual re-determination required, North Dakota does not have evaluation to show improved and sustained abilities. Data elements we collect indicate that infants and toddlers show improve abilities as measured through the ASSIST Progress Assessment Review (PAR). The PAR data displayed in the previous chart compares the first and last PAR Summary scores for 109 children who received early intervention services. Five PAR Summary Scores areas were analyzed (Adaptive, Social, Motor and Receptive and Expressive Communication). The DD Case Manager and family rated the child’s need for support in excess of what would be need for peers without developmental delays or disabilities. The scores range from 1 to 6 with 6 indicating no support needs and 1 indicating maximum support needed. Total individual scores ranged from 5 to 26 with a maximum of 30. The average initial PAR score was 14.69, while the average last score was 16.76.The average increase per child was 2.06 points. The majority of the improvement occurred in the communication and motor skills areas.

The status or progress towards achieving outcomes is measured through the ASSIST Database. During the last three years the percent of IFSP outcomes achieved ranged from 68% to 78%.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) Children that receive early intervention services will display increased and sustained functional abilities.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Solicit proposals for the analysis of the effectiveness of the Progress Assessment Review as a measurement of change in the functional abilities of infants and toddlers.
2) Develop mechanism to collect data regarding the percent of children that received early intervention that did not qualify for continued DD Case Management services.
3) In order to track types of developmental areas in which children achieved their IFSP outcomes, a work requests will be developed and completed to create an IFSP Outcome category feature (developmental areas, family support and transition).
4) Collaborate with Natural Allies Project partners to develop Early Childhood Standards

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) The Part C Coordinator will be responsible for activities 1 and 4.
2) The ASSIST Database Coordinator and programmers from the Information Technology Department will accomplish activities 2 and 3.
Activity number 1 and 4 will be initiated prior to June 30, 2004
Activities 2 and 3 will be accomplished prior to June 30, 2004.

Cluster Area CV: Early Childhood Transition

Question:
Do all children exiting Part C receive the transition planning necessary to support the child’s transition to preschool and other appropriate community services by their third birthday?

State Goal:
All children and families exiting early intervention services will receive transition planning needed to support their transition to preschool and other appropriate community services.

1. Baseline/Trend Data

OSEP’s September 14, 1999 monitoring report indicated that transition plans were not included in the IFSP, generally notes in children’s records indicated that information about transition had been discussed with parents. The meeting to develop transition plans was conducted just before the child’s third birthday, rather than the 90 days required by Federal regulations for children who may be eligible for Part B. The IP indicates several strategies to address the area of transition, however, there is no mention of training on new procedures nor is there mention of monitoring and enforcement activities to ensure that these strategies will lead to full compliance.

2. Targets:
1) 100 percentage of children will have transition outcomes in their IFSP 90 days before their third birthday.
2) 100 percent of families will have eligibility for Part B services determined 90 days before their child’s third birthday.

3. Explanation of Progress or Slippage:
To remind early intervention staff to include IFSP transition outcomes addressing the needs of the child, family and receiving agency; the following reminder was added to the ASSIST IFSP Outcome window.

A sample of 5 percent of IFSPs for toddlers over 2 years of age indicated 80 percent contained transition outcomes. Due to a default IFSP date feature that was inadvertently added to the ASSIST database, a query couldn’t reliably determine if transition outcomes are present at 2 years 9 months of age for the entire population.

December Child Count Data from 2002 indicates that over 96 percent of the child had Part B eligibility determined. Due to the default IFSP date we cannot measure with any certainty when the Part B eligibility was determined. In 2002, a row was added to the regional child count tables to distinguish the number of child on Table 3, Section A, Row 5 who did not have Part B eligibility determined due to parent choice. Parent choice accounted for 100 percent of the children who did not have Part B eligibility determined.

To facilitate the transition of the IFSP with the child, sections were added to the ASSIST IFSP to meet IEP requirements. Site, setting, extended school year, length of day, school district, school of enrollment, federal child count setting, and primary and secondary disability categories were added. This change has not remarkably changed the transition of a plan with a child.

Part C and 619 jointly sponsored a statewide workshop for preschool personnel and early intervention staff. As a result of that workshop, Part C and 619 supported the development of a parent video that addresses the transition process outlined in the Memorandum of Understanding between the Department of Public Instruction and the Department of Human Services. Both departments have worked together with technical assistance from NEC*TAC and Mountain Plains Regional Resource Center, to develop a joint transition monitoring process. As a result of that work a parent transition workbook has been drafted.

A contract with a parent organization to conduct focus groups with families and early intervention and preschool personnel regarding the transition process was jointly funded by 619 and Part C. The information gathered was used to assist with Special Education monitoring and the development of regional Quality Improvement Plans. A workgroup was formed to address issues in addition to transition concerns on one of the reservations.

4. Projected Targets: (for July 1, 2003 through June 30, 2004 and on going):
1) 100 percentage of children will have transition outcomes in their IFSP 90 days before their third birthday.
2) 100 percent of families who want Part B eligibility determined will know the results 90 days before their child’s third birthday.

5. Future Activities to Achieve Projected Targets/Results: (for July 1, 2003 through June 30, 2004 and on going):
1) Remove the default IFSP Date from the ASSIST Database.
2) A stakeholders group will be gathered to advise the two departments regarding monitoring the transition process.
3) A task force of family members, early intervention personnel, teachers, and Special Education Directors will be convened by the Department of Public Instruction and the Department of Human Services to develop joint transition guidelines to be jointly issued by the two departments.
4) The draft Family Transition Workbook will be finalized, printed and distributed following the completion of the Joint Transition Guidelines.
5) A parent telephone survey will be jointly developed to determine compliance with transition guidelines included in the Memorandum of Understanding between the Department of Public Instruction and the Department of human Services.
6) A Request for Proposals will be published and a contract developed for a state level Early Intervention Parent Liaison. One of the responsibilities of the Parent Liaison will be the completion of a telephone survey with parents, 3 months after their child transitions to Part B services.

6. Projected Timelines and Resources: (for July 1, 2003 through June 30, 2004 and on going):
1) The ASSIST Database Coordinator and a programmer from the Information Technology Department will accomplish activity number 1.
2) Department of Public Instruction and Department of Human Services staff with technical assistance from NEC*TAC and Mountain Plains Regional Resource Center will facilitate activity number 2.
3) The 619 and Part C Coordinators will facilitate activities 3 and 5.
4) The North Dakota Early Intervention Services sub-committee Co-chairs, Part C Coordinator and Developmental Disabilities support staff will accomplish activity number 4
5) Activity 6 will require the ND Part C Coordinator, DD Unit support staff, Fiscal Liaison and the department contract officer.
Activities 1, 2, 5 and 6 will be accomplished by June 30, 2004.
Activities 3 and 4 will be initiated prior to June 30, 2004.