4/11

IFSP & Service Coordination

Baby Watch EIP

CSPD Module

Introductions

Understand the IFSP ProcessUnderstand the role of the Service

Coordinator in the IFSP ProcessFormulate developmentally appropriate

outcomesLearn to facilitate the ability of the family

to identify Concerns Priorities and Resources, and enhance the family’s capacity to meet the developmental needs of their child

Learning Outcomes

Individuals With Disabilities Education Act (IDEA)

A federally mandated lawFederal Regulations and RulesPart C—Birth to three program

Hierarchy of “Rules”

Federal LawFederal Regulations

State PlanState Policies

Program PoliciesIndividual Staff Work Practices

Purpose of IDEA Part C

To enhance development of infants and toddlers with disabilities and to minimize their potential for developmental delay

To enhance the capacity of families to meet the special needs of their infants and toddlers with disabilities

Part C is “Family Centered”

What do you think

“Family Centered”

means?

Family Centered

Respect the family

Build relationships with parents

Be flexible

Provide support to families

Individualize supports and services

Services in family friendly way

Focus on what happens between visits

Reflect on your experiences

Part C is “Family Centered”

Early InterventionProgram

Family of ChildWith Delays

Family’sLife

Early Intervention

.

Heart Of Our Discussion

IndividualizedFamilyService

Plan

IFSP Cycle

Referral

Focus on Referral

Required: Referral is a request for

evaluation of a child under age 3

Child lives in service area Voluntary

Program Choices:1. What constitutes a

“request for evaluation”

2. Who takes referral

3. Internal timelines

4. Info Collection choices

5. Referrals with <45 days until exit

6. Other?

IFSP Timeline & Safeguards

See handout

“IFSP Cycle with Timelines and Procedural Safeguards”

IFSP Cycle

Eligibility Determination

Referral

IFSP Cycle

Eligibility Determination

Referral

Family & ChildAssessment

Focus on Child Assessment:

Assessment is defined as the ongoing methods, techniques and procedures utilized to gather information about the child and family.

Focus on Family Assessment:

Family directed assessment is designed to determine the resources, priorities and concerns of the family and identify the support and services necessary to enhance the family’s capacity to meet the developmental needs of the child

IFSP Cycle

Eligibility Determination

Referral

Family & ChildAssessment

IFSP Meeting

Interim IFSP

Interim IFSP allows services to begin, as in the case of an infant who needs immediate attention

Assessment is not complete Start services within the 45 days 45 day timeline still applies for IFSP

Participants: Family

Parents As requested by

family:Other family

members as feasible

Advocate or person outside family

Program choices:

Definition of Parent

Parent means a parent,

a guardian, a person

acting as parent of a

child, or a surrogate

parent

Foster parents

A foster parent qualifies … if: Foster parent is willing to

participate in making EI decisions on behalf of child

Foster parent has no interest that would conflict with interest of child

Participants: EI Staff

Interim or regular EI Service Coordinator

Person conducting evaluation/assessment (can arrange other means than attendance)

USDB PIP Advisor if sensory loss

Appropriate qualified personnel

Program choices: Which EI Service

Provider(s) Other EI staff Arrange alternative

participation for person involved in evaluation/ assessment if needed

Participants: Others

Outside service providers

Program choices: How hard you try to

include other service providers

Exactly what their role will be in the meeting

Time, Place, Translation

Convenient time & place for family

Native language if feasible

Determine feasibility of native language

How to provide translation service

How to document translation efforts

IFSP Misc Info Needed

Payment arrangements, if any, on IFSP or attached document

Service coordinator name

Date of meeting Signatures & titles of

all parties in attendance

Program choices: How to list payment

arrangements (family fee)

IFSP Cycle

Eligibility Determination

Referral

Family & ChildAssessment

IFSP Meeting

Start Services

EI Services

Specific EI services to meet needs of child & family to achieve outcomes

Frequency (# days or sessions)

Intensity (hrs/min) Method (group or

individual) Location (home,

center, community)

Program choices: Services mix How to write

frequency How to code certain

services (Family Training vs. Special Instruction)

Other

Specific Set of Services

There is a list of formally defined services, such as:

Family training Special Instruction SLP, PT, OT, Audiology, Assistive Technology Psychological services Nursing Services, Health Services Nutrition Services Social Work Services Hearing Services; Vision Services Transportation and Related Costs

Other Services

To the extent appropriate, the IFSP must include:

Medical & other services that child needs but are not required nor covered by EI

Program choices:Define “to the

extent appropriate”

How much detail to list about other services (no requirement for duration, etc.)

Important Dates

Significant dates: Date of IFSP meeting Projected initiation of

services as soon as possible after IFSP meeting

Anticipated duration of those services

Program choices: Specifying dates

service by service (required by BTOTS)

Natural Environment/Justification

The IFSP must include statement of the natural environments in which EI services will be provided

Must include “justification of the extent, if any, to which the services will not be provided in the natural environment”

Program choices: How to list natural

environment Standards on writing

justification statement

Parent Consent for Services

A signed written statement of consent from the parents must be included on the IFSP.

Written consent shall be obtained prior to the provision of EI services

Release of demographic information to school district

Program choices: Wording of

consent statement.

Meeting Follow Up

The family receives a copy of the signed and completed IFSP for their information and records

How & when to copy IFSP

Notifying service providers not present

Other team communication

Using IFSP to guide Services

Program chooses how:

Service providers reference the goalsShadow filesClass records, home visit reports, etc.Copies of IFSP?How to monitor whether services are

addressing goals

IFSP Cycle

Eligibility Determination

IFSP ReviewMeeting

Referral

Family & ChildAssessment

IFSP Meeting

Start Services

IFSP 6-Month Review

2 required attendees Within 30 days of 6 month

anniversary of IFSP Content

Progress toward outcomes Revisions in outcomes or

services needed Documentation of above Enter into BTOTS

Program choices: Meeting or

acceptable process

Additional attendees

Meeting agenda and facilitation

Changing Services:

Required: Written prior notice Duration, frequency,

intensity of service Date of initiation

Program choices: Process for making

changes Team

communication & decision making

Authority to commit resources

Service patterns

IFSP Cycle

Eligibility Determination

IFSP ReviewMeeting

Referral

Family & ChildAssessment

IFSP Meeting

Deliver Services

Start Services

Exit Services

IFSP Transition Plan

Transition Plan at Initial IFSP includes:

Transfer child demographic information

Steps and goals to prepare child for transition

Program choices: How to write Documenting “opt

out”

IFSP Transition Plan

Transition Plan at subsequent IFSP includes:

Steps and goals to prepare child for transition

Discuss with & train parents on placements and other related matters

Program service mix for transition

Transition Meeting

At least 90 days before 3rd birthdayAt least 120 days before 3rd birthday for PIPCan be up to 6 months before 3rd birthday

Must includeChild’s parent/guardianService coordinatorLocal education agency representativeUSDB representative (if has sensory loss)

Service Coordination

A Process

A Team Activity

Includes the Family

Service CoordinaTOR

Each eligible child & family provided with a service coordinator who is responsible for:

Coordinating all services across agency lines

Serving as the single point of contact to help parents obtain the services and assistance they need

Program choices: Service Coordinator

model Who carries out

which Service Coordination activities

Interim & Regular Service Coordinator the same?

Service CoordinaTION

Process: Assist families to gain

access to services on the IFSP

Coordinate services needed and/or provided

Facilitate timely delivery available services

Seek services & situations to benefit child’s development throughout eligibility

Program choices: How to carry out

these processes Doing more than

specified

Service Coordination Activities

Coordinate evals & assessments

IFSP developmentIdentify service

providersCoordinate &

monitor service delivery

Inform of advocacy services

Coordinate with medical and health providers

Facilitate transition plan to preschool

Service Coordination & IFSP Cycle

Eligibility Determination

IFSP 6-month review

Referral

Family & ChildAssessment

IFSP Meeting

Deliver Services

Start Services

Coordinate eval/assessment

Exit Services

Service Coordination & IFSP Cycle

Eligibility Determination

IFSP 6-month review

Referral

Family & ChildAssessment

IFSP Meeting

Deliver Services

Start Services

C

Exit Services

C

Service Coordination & IFSP Cycle

Eligibility Determination

IFSP 6-month review

Referral

Family & ChildAssessment

IFSP Meeting

Deliver Services

Start ServicesCoordinate & monitor services

Seek appropriate services

Coordinate with health providers

Exit Services

Service Coordination & IFSP Cycle

Eligibility Determination

IFSP 6-month review

Referral

Family & ChildAssessment

IFSP Meeting

Deliver Services

Start Services

Facilitate transition plan

Exit Services

Transition Planning

Facilitating development of a Transition Plan to preschool services

Organize and plan the Transition Meeting

Coordinating Services

Help Family Access Supports

ConnectFamily

To NeededSupports

Family Supports

Methods to Find Resources

Networking with professionalsNetworking with parentsResource directories by othersResource information you compileLocal mediaOther?

Most of the 7 SC Activities Are Completed While:

Coordinating IFSP cycleHelping families access needed

supportsCollaborating with others who are

co-serving the family

Continuously Seek Appropriate Services

YOU become the child’s advocate

YOU become the family’s advocate

YOU actively SEEK the answers to family questions and problems

YOU are proactive while remaining strengths based

YOU are a problem solving facilitator with a vision of possible solutions

Avoiding Burnout

Clarify your role Implement boundaries and don’t

cross themFacilitate the parent’s ownership Leave the concerns at work

The HEART Of It All

1.Where the child (and family) ARE

2. Where they WANT to go

3. What they NEED to get there

In Other Words…

1. Summarize where we are (CLD & CPR)

2. Come to agreement on priorities

3. Agree on child and family goals

4. Negotiate services to meet goals

Meet Jasmine

Case Study: Jasmine

Jasmine

What is Jasmine’s current

level of functioning?

IFSP Doc: Current Levels

Description of child current level function Cognitive Physical, includes

health, motor, vision, hearing

Communication Social-emotional Adaptive

Program choices: Pre-write or not Include test scores

or not Include age-

equivalency or not

Jasmine

What are concerns about

Jasmine and the Family?

IFSP Doc: Family CPR

IFSP must include statement of family’s concerns, priorities, resources (CPR)

Identify supports & services necessary to enhance family’s capacity to meet developmental needs of child

Program choices: How to write these How to indicate

priorities

Individualized Family Service Plan

Is a living document and

should be revisited regularly

Creating Meaningful Plans

Family’s

Desired Future

For Child

MeaningfulPlan

“Before beginning a long journey,

it is wise to know where you are going….that way you will know that you’ve arrived once you get there.”

Pooh Bear

Writing Outcomes

Jasmine

Potential Outcomes for

Jasmine and Family

Outcome Writing

AimProper nounObservable action verb

RoutinesMeasurable

IFSP Outcomes

Must include statement of major outcomes expected to be achieved for the child and family

Measurable (criteria, procedures, timeline as needed for measurability)

IFSP Outcomes

What does the family want to achieve?

Why is this important to this child and their family?

Can the outcome be embedded in the child and family’s routine?

Is it measurableSo what?

So What?

Best Practices in Identifying Outcomes

Outcomes are based on the family’s priorities

Outcomes are written within the context of routines/activities

Outcomes are developed through a team process

Outcomes are worded in ways that are understood by families

Not Good Outcomes

Jimmy will successfully cross the street in 4 out of 5 time attempts.

Beverly will walk up stairs by alternating feet twice a day.

Nancy will speak in two word sentences during 30 minutes of speech weekly.

Bobby will say ‘hello’ to classmates with 100% accuracy.

Functional Child Outcomes

Short-hand version of outcome

Routines this affectsSpecific behaviorCriterion for demonstration

How to Actually Say It

Handout

“Steps to Build a Functional Child Outcome”

Developing Functional Outcomes

Out of Context

She can use a neat pincer grasp

Meaningful

Gabriella will participate in breakfast, lunch and dinner by feeding herself, using her fingers to eat 2 finger foods at each meal.

Developing Functional Outcomes

Out of Context

She can weight shift in order to go up 3 steps

Meaningful

Amy will participate in play time, bed and bath time by walking up the steps in her house. We will know she can do this when she walks up the stairs by herself holding the wall or rail 3 times a day.

Meaningful

Amy will participate in playtime, bath and bed time by walking up the stairs in her house. We will know she can do this when she walks up stairs by herself, holding the wall or rail three times a day.

Developing Functional Outcomes

Out of Context

He will understand cause-effect

Meaningful

During Kevin’s bath time and afternoon free-time A.J. will play with his pop-up and ball toy. We will know he can do this when he plays for 10 minutes with his toys by himself five times a week.

Out of Context

She can follow a 2 step direction

Developing Functional Outcomes

Meaningful

Charese will participate in getting ready to go by getting her shoes and her coat when asked. We will know she can do this when she is asked, she takes her coat and shoes to Alisha or John one time a day for a week.

Family Outcomes

Outcomes for finding information or resources“Learn more about Dandy-Walker

Syndrome”Outcomes for family social-

emotional support “Get a break from caring for Jason”

Network and Infrastructure Outcomes

Further assessment outcomes“Find out if Mary’s condition has a

diagnosis”Acquisition of equipment or material

outcomesObtain a wheelchair and learn how to

use it”

Jasmine

Identifying services

IFSP Doc: EI Services

Specific EI services to meet needs of child & family to achieve outcomes

Frequency (# days or sessions)

Duration (hrs/min) Intensity (group or

individual) Setting (home, center,

community)

Program choices: Services mix How to write

frequency How to code certain

services (Family Training vs. Special Instruction)

Other?

Pointers about Services

The plan can (and will) be changed to meet changing child and family needs

The program is obligated to provide the services they promise on the IFSP

We are mandated to “enhance child’s development & minimize potential for developmental delay”

Natural Environment

“Natural Environments” means settings that are natural or normal for the child’s age peers who have

no disabilities.

Identified by the child’s multidisciplinary team, which

includes the parents

IFSP Doc: Natural Environment

The IFSP must include statement of the natural environments in which EI services will be provided.

Must include “justification of the extent, if any, to which the services will not be provided in the natural environment”

Pointers on Natural Environment

Justification statement is only needed for services which are provided to the CHILD and which are not provided in the natural environment

No Justification statement is needed for services to PARENTS

Must Make Sense!

Reasonable justification statement:Links to concernsLinks to outcomesThe service can actually address the

reason stated in the justification

Some Loose Ends

Other Services on IFSP

Family preparation for the IFSP meeting

How staff prepares for the IFSP

Main Purposes of Early Intervention

To meet the developmental needs of each child with a disability or developmental delay

Meet the needs of the family related to enhancing the child’s development

Linking parents, service providers and community agencies to ensure effective provision of services

Training parents and others regarding the provisions of those services

Recognize the family’s strengths Value and respect the family’s role The family knows their child best Encourage families to share their opinions

and ideas Share information Give families choices . . . . . . then respect the choice

the family has made Be open and honest

Developing Family Capacity

“A partnership is an association/relationship between two parties (families and professional) working together (collaborating) toward a common goal (meeting the needs of the family and child)”

-Dunst & Paget

Partnerships

Partnerships

One mom, Phyllis Magrab, declares:

“It is the system of services that is the case in need of management not the family or the child. Systems are best managed by communities and families are best managed by themselves!”

Home Visit Documentation

The HV report is MORE than

a record of service

It is actually a PART of the service

we provide to the family

Overall Standards

ProfessionalRelevantUsefulClear

Professional

Legible handwritingNeat and readableGrammar, spelling, punctuationAppropriate vocabularyObjective Strength based—positive

Relevant

Relates to family outcomesRelates to program purposesRelates to family situation

Useful

Has information of value to the family and program

Clear

Specific as to:Where WhenWhoWhyWhat

S – O – A – P

StatusObservations

ActivitiesPlan

Status – O – A – P

Purpose:Report on previous planUpdate family/child status

Delineates observed vs. reportedObjectiveUse “quotation marks”Includes family and child

S – Observations – A – P

Purpose:Document continued progressObjective data to support choice of

interventionsObjectiveRelevantWhat’s happening—what’s NOT

happening

S – O – Activities – P

Purpose:Document what was done at the

visit to show appropriate services

What was done—action words Pair it with observations

S – O – A – Plan

Purpose:Accountability—parent and staff

understand agreed plan of actionProvides continuity

Suggestions to familyAgreed action by staffAgreed action by familyNext visit time/dateNext visit content planning

Home Visit Report

HV Content:All form prompts

PLUS:Status ObservationsActivitiesPlan

Judged by these Standards:

ClearProfessionalRelevantUseful

JEOPARDY

The End!

Fill out Evaluation Forms

Certificates of attendance will be mailed to your program