State Interagency Coordinating Council
Wednesday, October 24, 2007
Renton School District Office 300 SW 7th Street, Renton, WA 98031
Attendance: Members Jane Campbell, King County DD County Human Services Charles Cowan, MD, Service Provider Physician Commander Victoria Crescenzi, MD, Military René Denman, Parent Representative Mary Lou Dickerson, Legislature Melinda Dyer, OSPI/Education of Homeless Children and Youth Kathy Fortner, Service Provider, Neurodevelopmental Center Alan Garrels, Department of Services for the Blind Marijean Holland, Office of Insurance Commissioner Christine Johnson, Service Provider Head Start Karen Lindsay, Parent Sandy Loerch Morris, Program Director, DSHS/Lead Agency Darci Osborne, Parent Sharon Reddick, DSHS/Health and Recovery Services Administration (Medicaid) Bonnie Sandahl, SICC Chair Susan Sandall, Personnel Preparation Nancy Whitaker, Service Provider, Developmental Center Dawn Williams, Head Start Agency
Members Unable to Attend Molly Chavez, Washington Migrant Council Maria Nardella, Department of Health Linda Rolfe, DDD Director, DSHS/Lead Agency T Simmons, DSHS/Children‟s Administration (Foster Care) Elizabeth Stucker, Education Jodi Ward, Parent Tiffany Wheeler-Thompson, Parent
SICC Minutes October 24, 2007 Page 2 of 13
Others Attending Kelli Bohanon, Department of Early Learning Nancy Hatfield, Washington Sensory Disabilities Services Cassie Johnston, Washington PAVE, Parent Participation Coordinator Cecile Lindquist, Public Policy Committee Co-Chair Donna Obermeyer, Washington PAVE, Parent Participation Denise Rothleutner, Pierce County Human Services
Infant Toddler Early Intervention Program Staff Who Participated Kathy Blodgett, Program Liaison Linda Jennings, Program Support Karen Walker, Assistant Program Director
I. Introductions/Announcements: Bonnie Sandahl
Chair Bonnie Sandahl asked the Council to make introductions. Two newly appointed SICC members were introduced: Dr. Charles Cowan is filling the service provider, physician Council position and Christine Johnson is appointed as a service provider, Head Start. The Council welcomed both new members. Introductions were made of the visitors and national consultants also attending. Additional recommendations for council appointments will be sent to the Governor‟s office in November. Cecile Lindquist, Public Policy co-chair, noted that the afternoon recommendations of the Natural Environments Retreat were not in the minutes. Motion: A motion was made to approve the July 25, 2007 minutes, with the addition of the afternoon recommendations from the Natural Environments Retreat. The motion was seconded and passed with the addition. A motion was made to approve the October 25, 2007 Agenda. The motion was seconded and passed.
Chair Bonnie Sandahl, and Sandy L. Morris, ITEIP Director, were pleased to present a plaque to Karen Lindsay, parent representative, for ten years of service on the Council.
SICC Minutes October 24, 2007 Page 3 of 13 II. Office of Insurance Commissions Update Marijean Holland
Marijean shared with the Council that the family insurance booklet entitled “How To Appeal an Insurance Decision” is going through final approval within her agency. As part of the approval process, it is going through the Governor‟s „Plain Talk‟ review process, and upon completion the booklet will be shared with the Council and others.
III. Committee Reports
Family Leadership Team (FLT), René Denman HIGHLIGHTS: The Family Leadership Team has reviewed and made recommendations to the SICC Funding Committee on the “Parent Financial Responsibility Guidelines”. The Committee has reviewed the Natural Environment Retreat committee assignments. The three items that were assigned to the FLT will be ongoing agenda items. Cassie will move forward with suggestions to ITEIP staff. SICC will be sending Tiffany Thompson, Darci Osborne, and Rene' Denman to the 2007 OSEP National Early Childhood Conference in Arlington, Virginia. The conference will be December 1-5, 2007. Rene' will also be attending to represent Bonnie Sandahl, SICC Chair, at the meeting. FLT has reviewed committee involvement and will be adding members to the SICC standing committees: o Darci Osborne – Funding o Dani Wykes – Personnel and Training o Donna Obermeyer – Services
Data Committee, Kathy Fortner HIGHLIGHTS: The Data Committee has discussed and reviewed SPP Data and data management system changes currently in process as they relate to SPP data collection. Committee members continue to see school district participation as critical for the Data committee and request that SICC members refer school districts for participation. The committee discussed data related training issues. The committee agrees that data reporting improves following technical assistance for data entry accuracy. The Data Committee presented this recommendation to the Council: 1) The Data Committee strongly recommends the incorporation of in-depth training in use of the data management system, ITEIP website and Starting Line Newsletter into Family Resources Coordinators (FRC) training to support high quality data and an integrated information system approach.
SICC Minutes October 24, 2007 Page 4 of 13 III. Committee Reports Continued
Personnel and Training Committee, Susan Sandall HIGHLIGHTS: The Committee is focusing its attention on professional development issues that arise from the State Performance Plan, as well as requirements in IDEA 2004. In particular, current agenda items are: o Development of a sustainable early intervention professional development system o Follow-up on issues from the Natural Environments Retreat Personnel shortages and retention Sharing information about and providing training on evidence-based practices in early intervention Identifying resources for training directly related to natural environments The Personnel and Training Committee has developed a plan for using the $40,000 earmarked for training the in 2007-08 ITEIP budget. The committee‟s recommendations are: 1) Enhance the existing Personnel and Training website so that it can be used as an ongoing mechanism for: a. Information sharing – especially among providers b. A digital library for archiving video of trainings c. A site for instruction modules 2) Implement quarterly provider meetings. The location for these meetings would rotate around the state. The purpose of the meeting would be to: a. Hear from a speaker (preference for in-state speakers) on a topic of need b. Have an opportunity for providers to respond to the speaker and topic c. Network with each other In addition, a portion of each meeting would be set aside for IDEA early intervention/ITEIP policy implementation. In this way, providers would receive clear statements about IDEA early intervention/ITEIP policy affecting program implementation. 3) Hold once-a-year higher education meeting. This meeting would be open to all higher education faculty who have a role in personnel preparation. The meeting would be an opportunity to network; share ideas and information on issues related to personnel shortages, retention, and quality; and to provide advice to the Personnel and Training Committee, and to ITEIP. 4) Implement a once-a-year web-based needs survey for all Part C personnel. This survey would help inform the topics and issues to be addressed in items 1-3 above, as well as to identify needs for direct technical assistance from ITEIP (or other resource). Item 4 directly addresses the CSPD requirement of IDEA 2004. Discussion occurred related to this recommendation. Motion: A motion was made for the SICC to adopt the Personnel and Training recommendations as the Council‟s position. A friendly amendment was made to have training attendees share in the cost of the training. The motion was seconded and passed with the friendly amendment.
SICC Minutes October 24, 2007 Page 5 of 13 III. Committee Reports Continued
Public Policy Committee, Cecile Lindquist HIGHLIGHTS: Discussion with the OSPI Special Education Department has resulted in a Frequently Asked Questions (FAQ) document on districts serving birth to three, which is available on the OSPI Special Education web page at http://www.k12.wa.us/SpecialEd/pubdocs/EC/B-2_FAQs.pdf The OSPI Apportionment Department has made a list available to ITEIP regarding the percentage of indirect cost limits for each school district in the state. It is called the “state recovery rate”. It may be a helpful tool at the local level when discussion contracting out school services. The Public Policy Committee recommends: o ITEIP, SICC, and stakeholders develop concise regulations on school district participation as soon as possible. Regulations could also apply to the other public agencies who are early intervention partners, as appropriate. Discussion occurred related to this recommendation. Motion: A motion was made for the SICC to accept/adopt concise regulations dealing with all school district and public bodies subject to regulation. The motion was seconded and passed.
Members of the Public Policy Committee and the WEECARE Coalition met with Representative Mary Lou Dickerson to discuss state developmental disability funding. They met to talk about the allocation of county dollars designated for Part C eligible children and the need for these dollars to be allocated at a fair rate. The Public Policy Committee recommends: o SICC endorse the bill that Representative Dickerson will sponsor. This bill will be called “ITEA” – the Infant Toddler Equity Act. Motion: A motion was made for the SICC to endorse the ITEA – the Infant Toddler Equity Act. The motion was seconded and passed.
The Public Policy Committee recommends asking clinics and hospitals the following questions: 1) How many children birth to one, and birth to three, are they serving? 2) How many of these children have an IFSP? 3) When are they referred to Part C? The Public Policy Committee recommends that the SICC Chair and ITEIP staff request a meeting with DSHS Secretary Robin Arnold-Williams to discuss health provider issues and DD County funding issues. The committee recommends the following people attend: ITEIP, Representative Dickerson, Bonnie Sandahl, Maryanne Barnes, Jane Campbell, Rene' Denman, Judi Moore, Dr. Charles Cowan, Cassie Johnston, and Cecile Lindquist.
SICC Minutes October 24, 2007 Page 6 of 13 III. Committee Reports Discussion occurred around this recommendation. Motion: A motion was made to have the SICC Chair and ITEIP staff arrange a meeting with DSHS Secretary Robin Arnold-Williams and DOH Secretary Mary Selecky to discuss (1) health care provider issues, (2) DD County funding issues, and (3) how to link ITEIP with the Governor‟s healthcare program for kids. The motion was seconded and passed. Continued
The Public Policy Committee has discussed the targets on the state performance plan related to natural environments. The committee concluded that consistent data collection must first be ensured. The committee recommended that ITEIP send a memo as soon as possible for the December 1 count. The memo should address appropriate justifications, integrated playgroups, service location issues created when private insurance is accessed, and other topics to ensure consistency. The Public Policy Committee recommends the SICC send a letter to President Bush protesting the SCHIP veto. Motion: A motion was made for the SICC to send a letter to President Bush protesting his veto of SCHIP. The motion was seconded and passed.
A note of caution and clarification is needed to assure the SICC is not in a position of lobbying as it is not allowed by a supported federal or state board or council. However, individuals and private organizations may do what they need or want to do. Services Committee, Jane Campbell HIGHLIGHTS: The Services Committee will continue to meet the third Thursday of each month from 10 a.m. to 2 p.m. In order to facilitate the participation of members across the state, every effort will be made to schedule locations that have conference call capabilities. The Natural Environment Retreat Topics conversations were rich and ideas and recommendations were abundant. The Committee maintained a focus on keeping recommendations relevant to providing services in natural environments, recording other ideas for future committee work. The following are the recommendations to the SICC for the topics assigned to the Services Committee: o Have the SICC Committee Chairs meet regularly, and periodic meetings of all committee members, to improve coordination and collaboration across topics. o Improve mental health for children birth to six. Establish collaboration with mental health professionals statewide to: Develop a shared understanding of infant mental health services Define the roles of early interventionists and mental health professionals with the goal of breaking down funding silos and collaborating on providing services and supports to families in their homes and in community-based settings.
SICC Minutes October 24, 2007 Page 7 of 13 III. Committee Reports ◦ Continued
Identify assessment tools for early identification and intervention strategies that are not clinically based ◦ Identify collaborative programs that are working ◦ Develop cross-training opportunities Not all counties have staff/resources needed to deliver services. Coordinate with the Personnel and Training Committee to: Develop and provide ongoing statewide training and technical assistance on developing functional outcomes that are not domain specific ◦ Train administration and direct services staff on strategies for assigning staff and providing services and supports in homes and community settings, based upon functional outcomes, not domain specific service delivery models Develop web-based “Ask the Experts” where staff can share information and get technical assistance on an ongoing basis How can we minimize transition issues? The Retreat had asked specifically that birth to six services be established. The Committee recognizes that this might be a positive solution to transition concerns. However, there is a long history and rationale for why birth to six services cannot occur in Washington State. Therefore, the Committee recommends: As part of implementing school participation, that Local Lead Agencies (LLA) and School Districts be required to establish or revise transition agreements in order to strengthen and formalize transition policies and practices. Statewide training on IDEA, Part C including natural environments and transition, should be conducted for LLA and School Districts.. Families receive information about organizations and trainings to support them in the transition process that may include the resources outside the early intervention system (PAVE). Culturally and linguistically responsive services to diverse families Strengthen requirements in LLA Three-Year Plans to address unique local needs as it relates to providing culturally and linguistically competent services in homes and community settings, barriers to meeting those needs, local services/resources to address the needs, and gaps in resources/services Include representatives from ethnic service organizations/interpreter services on County Interagency Coordinating Councils Establish training/information for interpreters about early intervention Assure licensed childcare facilities will not exclude or expel early intervention children Develop a Joint Task Force at the state level between the Department of Early Learning (DEL), ITEIP, and other entities as appropriate; to look at systemic supports needed to ensure inclusion of children with disabilities in childcare and that early intervention services and supports are available to childcare providers. These supports would include but not be limited to QRIS reimbursement rates, pre-services and in-service trainings of childcare providers and early intervention staff Future “Conversations with Families” should include childcare challenges and successes
SICC Minutes October 24, 2007 Page 8 of 13 III. Committee Reports Continued
DEL and ITEIP collaborate on presenting a pre-conference session at the Early Childhood Conference in May. Sandy L. Morris
IV. OSEP State Determinations/SICC Stakeholders Discussion
Sandy Morris introduced Anne Lucas and Cesar D‟Agord, both Education Consultants with the Western Regional Resource Center (WRRC). Anne and Cesar provided a PowerPoint presentation:
Overview of Federal Accountability Requirements Washington‟s Status Determination Level Getting to “Meets Requirements” Feedback on Proposed Local Determination Process Other ICC Recommendations Next Steps
Indicator #1 – Percent of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner. Concerns: Within 30 days of IFSP IFSP/documentation may not be clear Documentation not automated for when services actually begin FRCs entering the data? FRCs monitor data/services delivery? Results indicate problem areas are rural Counties versus school district Lack of funding Strategies: Increase technical assistance to LLA Pursue additional county funding School Districts Serving – additional training and coordination, increase child find activities Public Policy Committee to follow up on issues Indicator #2 – Percent of infants and toddlers with IFSPs who primarily receive early intervention services in the home or programs for typically developing children. Concerns: Home Health License, expensive to keep it up. Explore models/other models for service delivery Consistency on data collections on natural environment reporting – clarification Target Group Health to change policy on in-home care Identify carriers in particular areas for home coverage Increased rates for Medicaid Watch for insurances limiting coverage on OT, PT, and Speech
SICC Minutes October 24, 2007 Page 9 of 13 IV. OSEP State Determinations/SICC Stakeholders Discussion Continued
Training and technical assistance – create fact sheets Incorporate recommendations from the Personnel and Training committee Strategies: Home Health License waiver or elimination of requirement for EI Services Medicaid Strategies Consistent Data Work with HMO Providers Increase incentives for travel to home and community settings Managed Care Organizations - pursue amending contracts Identify health plans that stop coverage in/won‟t allows kids to be served at home. Modify contracts to address IDEA indicators and Part C Requirements Increase knowledge base with technical assistance fact sheets Ask providers for a list of insurance carriers issues, review and implement improvement strategies Recruit professionals that embrace Part C and current national practice Encourage Personnel and Training Committee to continue focus on issues and strategies Indicator #7 – Percent of eligible infants and toddlers with IFSPs for whom an evaluation and assessment and an initial IFSP meeting were conducted within Part C’s 45-day timeline. Concerns: Doing all evaluations for school districts. So doing twice as many evaluations as other region o Additional evaluation teams, but shortage of providers for discipline specific evaluations o Increased staff awareness of urgency to schedule evaluations/IFSP meetings o Watch for new regulations and revise referral process as published: (Draft regulations indicated start 45 days when parent gives consent) A physician‟s assessment can be one of the two disciplines needed to establish eligibility; must have a written document. Record review/clinical judgment Should follow definitions and ensure standardization of what constitutes initial evaluation and when 45 day timeline starts, what is intake process – with flexibility LLAs must track and watch 45-day timeline Screening included in evaluation process Review data entry at “referral”; are policy/definitions followed? T & TA going to those beyond LLA Consider and review changes on data entry - autodate is not filled in but date must be manually entered For rural areas: Training and technical assistance on service provision and documentation process School districts alignment by 2009 Strategies: Added local team members
SICC Minutes October 24, 2007 Page 10 of 13 IV. OSEP State Determinations/SICC Stakeholders Discussion Continued
Added an additional evaluation team Increase relationships with pediatricians Consistent evaluations – provide TA Make sure current policies are followed (T & TA) Difference between initial evaluation and ongoing assessment (clarify) (T & TA)
Indicator #8A – Percent of all children exiting Part C who received timely transition planning to support the child’s transition to preschool and other appropriate community services by their third birthday including; A) IFSPs with transition steps and services Concerns: Add more detail in ITEIP data management system (DMS) Transition as part of IFSP Provide information about IFSP transition steps and services FRC training – including parent to talk about what parent needs on a transition plan Need resources on community resources for “other services” Need close relationship with school district (one key person at school) Local lead agency/school districts agreement – call state if issue Strategies: Update the transition book DMS – ad hoc reports for six months out for kids needing transition plan Provide samples of good examples of transition plans Family Leadership Team help with transition – fact sheet on transition (example transition plan) Work with Parent Training Centers, i.e. PAVE Provide parent education on transition options Go to parent groups in districts where problems PTI – work closely around transition (concrete agreement) o Bring back to state (Cassie) Look at ITEIP DMS Birth to Three School Bill – Bring schools to table and discuss transitions Include school districts into policy Use parent groups in specific area for issues regarding transitions Indicator #8C - Percent of all children exiting Part C who received timely transition planning to support the child’s transition to preschool and other appropriate community services by their third birthday including; C) Transition conference, if child potentially eligible for Part B. Concerns: Medicaid rates low – Washington has worked on increasing these rates Watch private providers (private insurance rates decrease, affect Indicator 7 as well) Strategies: Examine consistency of strategy and penetration for service delivery across carriers (GHC)
SICC Minutes October 24, 2007 Page 11 of 13 IV. OSEP State Determinations/SICC Stakeholders Discussion Also examine the carriers Periodic report of progress Increased access to insurance is needed Information dissemination; training/TA/fact sheets/best practice Tickler system for meeting Continued
Indicator #9 – General supervision system (including, monitoring, complaints, hearings, etc.) identifies and corrects noncompliance as soon as possible but in no case later than one year from identification. Concerns: Enforcement for noncompliance not corrected in timely manner Technical assistance required Worked with them and prescribe strategies, e.g. prove that made efforts to increase capacity, provided Some contracts would be rewritten/strengthened to ensure Part C requirements OSPI frequently asked questions (FAQ) letter Providers/LLA identified training and technical assistance needs Strategies: Shorten timeliness for plans of correction – more frequent reporting Partnered with County Association regarding training and technical assistance dollars Training and technical assistance for stronger enforcement o Provide training o Prescribed strategies o Shorten timelines Set aside $40,000 for targeted training and technical assistance LLA meet with state quarterly Continue to partner with the Association of County Human Services for training and technical Pursue how all funding sources, how all will follow Part C Set aside training dollars Local lead agencies should identify areas of training need. SPP data is public information – all can see where each local lead agency is in relationship to others, use for local strategies and improvement activities Strict timelines will help with follow through Public reporting of data on program performance Add monthly reporting of progress re: CAP Timelines for responses following audit – planning together o Information flow local to state and state to local (joint problem solving) Monthly reports show if things are working correctly Local determinations must be done annually. Each state must use the same four levels as OSEP, in making their determinations: 1. Meets requirements
SICC Minutes October 24, 2007 Page 12 of 13 IV. OSEP State Determinations/SICC Stakeholders Discussion 2. Needs assistance 3. Needs intervention 4. Needs substantial intervention The Council was asked to email recommendations to Sandy as quickly as possible. Much discussion occurred related to process and state status including: Information required by OSEP? Major areas of focus? Information to be provided by local lead agencies. Information to be provided by the state. Continued
A motion was made to make local determination on the minimal requirements (Indicators 1, 7, 8, and maybe 2). Revisit in one year. The motion failed. A motion was made to use the Washington version of the Virginia forms to make the local determinations on the same indicators as the state reports. A friendly amendment was added to review for the 2009 determinations. The motion was seconded and passed with the friendly amendment.
SICC Announcement: Have had one citizens complaint (Pierce County), which has been investigated and is being resolved through plan of correction process.
V. Emerging Issues and Agenda Building
A handout of proposed meeting dates for the SICC 2008 calendar year was discussed. The dates proposed are: January 17, 2008 – Olympia April 23, 2008 – TBD July 23, 2008 – TBD October 22, 2008 - TBD Motion: A motion was made to accept the proposed 2008 annual calendar of SICC meetings. The motion was seconded and passed.
SICC Minutes October 24, 2007 Page 13 of 13
Next SICC Meeting Date: Thursday, January 17, 2008
8:30 a.m. – 3:30 p.m. with a working lunch
Charlie Reed Building - ADSA Headquarters
640 Woodland Square Loop SE Lacey, WA 360-725-3500
ITEIP Website: www1.dshs.wa.gov/ITEIP