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Audio (MP3) File Size: 13296 kb File Type: pdf Listen in New Window Presentation (PDF) File Size: 13296 kb File Type: pdf Open in new window First Steps SSIP and related updates Cathy Robinson Director, Indiana First Steps First of All….THANKS - April 2014 First Steps Provider Meeting - INARF Child and Family Section (Feb, May…all of ‘em) - First Steps ICC Meetings (Jan, May) - DDRS Provider Meetings - July First Steps provider section SSIP Process • Where are we today? - Stakeholder input - ICC Executive Committee Prioritization of program areas of improvement Several Common Themes… In the table below: Yellow – items that are currently getting addressed or activities are underway to work on…. Blue – areas of continued questioning and data gathering needed – some of the questions extend beyond and outside of First Steps Green - These are all areas around the service delivery approach and structure in First Steps…. Larger Question Number Original Question/Comment Timeline for Addressing Question How are initial/exit child assessment data collected and calculated? What are possible data quality issues? 8 Consistency between regions in terms of data collection 1-2 months to collect data " 6 Concern about quality of data and data collection " Why are more children going into special education? 4 % of kids going into special ed going up across eligibility categories Immediately " 2 Amount of services x Outcome to see if there is a relationship with kids going to special ed " " 18 Decrease in the number of service amounts by year- correlation with service amount and transition outcomes- there is a relationship " Why is there an increase in the percentage of families declining services? 17 Look at demographics – number of families who decline FS? For example, looked at race and differences. Try to understand differences: look at how long they were in the system for example; try to understand why and look at various factors " " 47 For families who decline/drop, do we know if they have maxed insurance and decline because of that? Data Does Not Exist " 5 Number of families leaving FS not due to transition (e.g., move, decline) Immediately Why do differences among the outcome areas appear to be narrowing over time, yet some children do well? 9 Why is gross motor and Outcome 2 Acquire declining between 2009-2013 " " 26 Does appear to be gap in outcomes but may be narrowing over time? " " 27 And if there is a narrowing of gaps, then why/what’s going on? More investigation of what/why " ImmediatelyWhy are lower income families receiving fewer services and experiencing fewer gains? 29 Income levels and outcomes- concern is why families from lower income do less well than families from upper income? Why lower rates of progress? " " 30 Income level (<251%) can be broken down; perhaps look at the low low level of income (e.g., 150%) " " 3 Lower SES are getting less services- still concern about this trend " " 48 How many families are referred to FS because they have maxed out insurance through medical? Don’t have this data now Data Does Not Exist Why are some children (e.g., Black/African American children, Hispanic/Latino children) making less progress in some areas as compared with children from other races? 7 Do African American children enter more severely behind than other children? Immediately " 24 Racial differences- Why do more than 20% of Black children decline services? " " 25 Why do Black children make lower rates of progress? – Hypothesis- do black children receive same amounts/quality of services; cultural match between providers and children/families? Immediately Except for Cultural Match " 28 For Hispanic children, outcomes in communication area were less than other children? Why is progress less for Hispanic children? (Language on database is the family’s primary language) Immediately " 36 How is race entered? How is that call made (e.g., 2 or more races)? Are the differences among races statistically significant? 1-2 months to collect data Why are there differences in services (types, amounts) across regions of the state? 1 Rural versus metro across services and outcomes Immediately " 16 Look at discipline specific services and differences across regions; there are differences- Why? Due to different service models? Accessibility to providers? What is too little / too much? 1-2 months to collect data How well are we finding and serving children before the age of 1 year? 20 Where are we as a state in serving children under 1? Immediately " 22 Look at domains (e.g., gross motor) that is difficult to determine eligibility with AEPs for children under 10 months " " 21 For children who begin <1 year, how long do they receive services? Are there differences across demo variables? " Who are children with medical conditions? What are relationships between this group and outcomes? 10 Relationship between child outcomes and children with medical conditions (can this category be broken down more in terms of extent of delay) " " 38 For eligibility determination, what does medical condition include and how defined? " Why are the amount of services declining over time? What factors may be affecting the average amount of services children receive each month? 11 Why is 12 months as average time in FS magic – what else may be going on?- Are we holding on to children too long or too soon: is this a training issue Immediately Root causes may take time " 12 Average service amount/month- is this still declining or will it bounce back/flatten: Why? Is this access to providers? Compensation issue? Is this a concern of meeting FS budget? 1-2 months to collect data " 40 Amount of services has declined- is that where it should be? Where we want it to be? Is it appropriate? Immediately Discussion may take time " 15 Correlate age of entry with how long they are in FS? Immediately " 19 Why did service amounts decrease over time? Costs? Resources? Providers? 1-2 months to collect data " 34 Could look at authorization data to see some gross measures of what services and type/frequence " " 23 Look at age breakdown by eligibility and initial assessment by domain and then look at association with service types and are there differences by demographics- Look at how this might related to the federal outcomes and services Immediately " 39 Root causes of disparities of service amounts- availability, training, and look at other regions/states ; if child didn’t receive services, is it because of availability or family involvement or ? 1-2 months to collect data " 42 Look at number of providers on average that comprise the service amounts and look across demographics " What are common/typical service delivery models used in First Steps (e.g., 1 hr/week per provider)? 43 Could we look at what was authorized and what was delivered in terms of frequency of services? This would help us to look at service models " " 41 Is our service delivery method the best method/model or ?? Data Does Not Exist " 33 Tracking information on service delivery models- doesn’t exist now " Future Work: Develop a means to track children and families after they leave First Steps to determine long term outcomes 13 (Trends)- How do we track children who leave FS and how do we know if they continue to need services ? " " 14 Should we create a follow up system to track children/families after they leave FS? For example STN " Future Work: How should we define and measure family involvement? 31 Demographic variables to add: age at intake; child care participation? Look at proportion of FS services in home, child care, etc.; Immediately " 35 Outcomes and how they relate to family income- do we know the number of wage earners in the family; might give us an indicator of family engagement Unsure " 32 Data on family involvement- data doesn’t exist right now Data Does Not Exist " 44 How do we quantify family involvement/engagement? Doesn’t happen now? " Next Steps…. • Analysis of State • Are we effectively Infrastructure approaching stakeholders and are we evaluating current mechanisms in place to support efforts? • State – identified Measurable Result (SIMR) for Part C children & families • Indiana’s SIMR must be aligned with a results indicator, and does it address root causes? First Steps Data -Updates • Program trends over time • Transition project • Exit Data Reporting Period 4/1/10 - 3/31/11 4/1/11 - 3/31/12 4/1/12 - 3/31/13 4/1/13 - 3/31/14 Average age at referral 14 14 14 14 Annual count of children with an IFSP 20,997 20,222 20,001 19,878 One Day Count of children 0-3 9,111 9,171 9,082 9,054 One Day Count of children 0-1 1,206 1,310 1,329 1,186 Children moving to Preschool Special Ed 33% 34% 37% 40% Average cost per child $1,942.42 $1,575.88 $1,573.06 $1,590.85 FFY 13 – Number of Children Exiting Needing Special Education by County Adams: 12 Allen: 145 Bartholomew: 38 Benton: 5 Blackford: 3 Boone: 54 Brown: n/a Carroll: 9 Cass: 28 Clark: 73 Clay: 14 Clinton: 26 Crawford: 2 Daviess: 15 Dearborn: 8 Decatur: 8 DeKalb: 19 Delaware: 60 Dubois: 26 Elkhart: 92 Fayette: 7 Floyd: 44 Fountain: 6 Franklin: 10 Fulton: 12 Gibson: 25 Grant Capts: 33 Greene: 20 Hamilton: 164 Hancock: 41 Harrison: 17 Hendricks: 100 Henry: 22 Howard: 36 Huntington: 10 Jackson: 14 Jasper: 10 Jay: 12 Jeffersonson: 8 Jennings: 10 Johnson: 91 Knox: 15 Kosciusko: 40 LaGrange: 7 Lake: 255 La Porte: 38 Lawrence: 12 Madison: 104 Marion: 637 Marshall: 9 Martin: 2 Miami: 13 Monroe: 32 Montgomery: 29 Morgan: 32 Newton: 9 Noble: 19 Ohio: 2 Orange: 4 Owen: 5 Parke: 7 Perry: 9 Pike: 5 Porter: 74 Posey: 21 Pulaski:10 Putnam: 15 Randolph: 16 Ripley: 15 Rush: 4 Scott: 4 Shelby: 17 Spencer: 12 Starke: 6 St. Joseph: 145 Steuben: 11 Sullivan: 6 Switzerland: 2 Tippecanoe: 89 Tipton: 5 Union: 4 Vanderburgh: 116 Vermillion: 2 Vigo: 45 Wabash: 10 Warren: 1 Warrick: 26 Washington: 6 Wayne: 37 Wells: 13 White: 11 Whitley: 10 Why do children exit First Steps? (Number of all children exiting) - Move on to SPED - Does Not Need First Steps - Familes Decline - Age 3 No SPED - Moved/Lost Residence
Larger Question
Number
Original Question/Comment
Timeline for Addressing Question
How are initial/exit child assessment data collected and calculated? What are possible data quality issues?
8
Consistency between regions in terms of data collection
1-2 months to collect data
"
6
Concern about quality of data and data collection
Why are more children going into special education?
4
% of kids going into special ed going up across eligibility categories
Immediately
2
Amount of services x Outcome to see if there is a relationship with kids going to special ed
18
Decrease in the number of service amounts by year- correlation with service amount and transition outcomes- there is a relationship
Why is there an increase in the percentage of families declining services?
17
Look at demographics – number of families who decline FS? For example, looked at race and differences. Try to understand differences: look at how long they were in the system for example; try to understand why and look at various factors
47
For families who decline/drop, do we know if they have maxed insurance and decline because of that?
Data Does Not Exist
5
Number of families leaving FS not due to transition (e.g., move, decline)
Why do differences among the outcome areas appear to be narrowing over time, yet some children do well?
9
Why is gross motor and Outcome 2 Acquire declining between 2009-2013
26
Does appear to be gap in outcomes but may be narrowing over time?
27
And if there is a narrowing of gaps, then why/what’s going on? More investigation of what/why
ImmediatelyWhy are lower income families receiving fewer services and experiencing fewer gains?
29
Income levels and outcomes- concern is why families from lower income do less well than families from upper income? Why lower rates of progress?
30
Income level (<251%) can be broken down; perhaps look at the low low level of income (e.g., 150%)
3
Lower SES are getting less services- still concern about this trend
48
How many families are referred to FS because they have maxed out insurance through medical? Don’t have this data now
Why are some children (e.g., Black/African American children, Hispanic/Latino children) making less progress in some areas as compared with children from other races?
7
Do African American children enter more severely behind than other children?
24
Racial differences- Why do more than 20% of Black children decline services?
25
Why do Black children make lower rates of progress? – Hypothesis- do black children receive same amounts/quality of services; cultural match between providers and children/families?
Immediately Except for Cultural Match
28
For Hispanic children, outcomes in communication area were less than other children? Why is progress less for Hispanic children? (Language on database is the family’s primary language)
36
How is race entered? How is that call made (e.g., 2 or more races)? Are the differences among races statistically significant?
Why are there differences in services (types, amounts) across regions of the state?
1
Rural versus metro across services and outcomes
16
Look at discipline specific services and differences across regions; there are differences- Why? Due to different service models? Accessibility to providers? What is too little / too much?
How well are we finding and serving children before the age of 1 year?
20
Where are we as a state in serving children under 1?
22
Look at domains (e.g., gross motor) that is difficult to determine eligibility with AEPs for children under 10 months
21
For children who begin <1 year, how long do they receive services? Are there differences across demo variables?
Who are children with medical conditions? What are relationships between this group and outcomes?
10
Relationship between child outcomes and children with medical conditions (can this category be broken down more in terms of extent of delay)
38
For eligibility determination, what does medical condition include and how defined?
Why are the amount of services declining over time? What factors may be affecting the average amount of services children receive each month?
11
Why is 12 months as average time in FS magic – what else may be going on?- Are we holding on to children too long or too soon: is this a training issue
Immediately Root causes may take time
12
Average service amount/month- is this still declining or will it bounce back/flatten: Why? Is this access to providers? Compensation issue? Is this a concern of meeting FS budget?
40
Amount of services has declined- is that where it should be? Where we want it to be? Is it appropriate?
Immediately Discussion may take time
15
Correlate age of entry with how long they are in FS?
19
Why did service amounts decrease over time? Costs? Resources? Providers?
34
Could look at authorization data to see some gross measures of what services and type/frequence
23
Look at age breakdown by eligibility and initial assessment by domain and then look at association with service types and are there differences by demographics- Look at how this might related to the federal outcomes and services
39
Root causes of disparities of service amounts- availability, training, and look at other regions/states ; if child didn’t receive services, is it because of availability or family involvement or ?
42
Look at number of providers on average that comprise the service amounts and look across demographics
What are common/typical service delivery models used in First Steps (e.g., 1 hr/week per provider)?
43
Could we look at what was authorized and what was delivered in terms of frequency of services? This would help us to look at service models
41
Is our service delivery method the best method/model or ??
33
Tracking information on service delivery models- doesn’t exist now
Future Work: Develop a means to track children and families after they leave First Steps to determine long term outcomes
13
(Trends)- How do we track children who leave FS and how do we know if they continue to need services ?
14
Should we create a follow up system to track children/families after they leave FS? For example STN
Future Work: How should we define and measure family involvement?
31
Demographic variables to add: age at intake; child care participation? Look at proportion of FS services in home, child care, etc.;
35
Outcomes and how they relate to family income- do we know the number of wage earners in the family; might give us an indicator of family engagement
Unsure
32
Data on family involvement- data doesn’t exist right now
44
How do we quantify family involvement/engagement? Doesn’t happen now?