Docstoc

Date

Document Sample
Date Powered By Docstoc
					                                               March 14, 2007


XX XXX X XXXXX                                                                     CONFIDENTIAL
XXXX XXXXXXXX
XXXXXXXX XXXXXX XXXXX

Dear XX XXXXXX:

          The Oklahoma State Department of Education (OSDE), Special Education Services (SES),
conducted state level complaint procedures for your formal complaint against the Cleveland County (local)
early intervention unit of SoonerStart [Oklahoma’s Individual with Disabilities Education Act (IDEA) Part
C Early Intervention Program], regarding XXXX XXXX XXXX [Child] and other children served by
SoonerStart who are similarly situated in the SoonerStart program, especially those with communication
disorders/differences and possible Autism Spectrum Disorders.

         Oklahoma’s SoonerStart program is a collaborative model. The Oklahoma State Department of
Education as lead agency, in partnership with Oklahoma State Department of Health, the Oklahoma
Department of Human Services, the Oklahoma Department of Mental Health and Substance Abuse
Services, the Oklahoma Health Care Authority, the University of Oklahoma Health Sciences Center and the
Oklahoma Commission on Children and Youth make up the SoonerStart program. The bulk of the services
provided come from the Oklahoma State Department of Education (with 95 FTE in Regional and Resource
Coordinators) and the Oklahoma State Department of Health (with 254 FTE in physical therapists (PT),
occupational therapists (OT), speech language pathologists (SLP), audiologists, nutritionists, social
workers, vision consultants and nurses).

          The complaint procedures addressed allegations pertaining to requirements of the Individuals with
Disabilities Education Act (IDEA), Part C. Complaint procedures conducted by this office included
obtaining and reviewing all pertinent documentation from you and the Local Early Intervention Unit,
including written responses to complaint allegations, an on-site visit for interviews with the Local Early
Intervention Unit staff and a confidential file review. In addition to a review at the local level, confidential
file reviews and interviews with SDE staff, Health Department providers and parents were conducted
within all ten regions of the SoonerStart program. Interviews were also conducted with persons outside of
SoonerStart but related to the issues of this matter.

IDEA Issues Presented by You:

     1.   Failure to carry out early intervention functions at no charge to families as required.

             a.)20 U.S.C. § 1432 (4)(B) Definitions – Early Intervention Services 1
             b.)34 CFR § 303.520 Policies related to payment for services 2
             c.)34 CFR § 303.521 Fees.3
             d.)SoonerStart Policy 1907.0 Financial – Fees (revised 7/19/05)4
             e) OAC 210:15-13-3 Special Education assurances and certifications (Part H) 5
             f) 70 O.S. 13-124 (C) Administration of Federal and State Funds Appropriated for Early
                 Intervention Services 6
             g) OAC 340:100-3-15 SoonerStart7



                                                       1
         h) Part C funds may be used to pay for day care in certain situations. According, a state
            cannot completely bar the use of funds for day care. Letter to Frymore, 25 IDELR 830,
            ECLPR ¶ 33 (OSEP 1996).
         i) If a team determines that a certain amount of participation in a childcare setting is
            necessary and so specifies in the IFSP, SoonerStart must assume the financial
            responsibility for that portion of the childcare cost specifically associated with that
            service. Letter to Dicker, 22 IDELR 464, 2 ECLPR ¶90 (OSEP 1995).
         j) Part C of the Individuals with Disabilities Education Act (IDEA) is an entitlement
            program on behalf of each eligible child and the child’s family, based on statutory
            provisions. See Letter to Eidelman, EHLR 213:206, 1 ECLPR ¶ 38 (OSEP 1988), Letter
            to Quality, 1 ECLPR ¶ 33 (OSERS 1988) and OSEP Policy Memorandum 90-14, 16
            EHLR 708, 1 ECLPR ¶ 10 (OSEP 1990).

2.   Failing to follow procedural safeguards as required, including failure to disseminate State
     written complaint procedures and failure to provide written prior notice as required.

         a.) 20 U.S.C. §1435 (A)(10) Requirements for Statewide System 8
         a.) 34 CFR § 303.510 Adopting Complaint Procedures. 9
         b.) SoonerStart Policy 1902.0 Complaint Resolution – Lead Agency Procedure (revised
              7/19/05)10
         c.) 20 U.S.C. §1439(a)(6) Procedural Safeguards 11
         d.) 34 CFR §303.403(a) - (b) Prior notice; native language 12
         e.) SoonerStart Policy 1603.0 Prior Notice (revised 8/24/05) 13
         f.) SoonerStart Procedure 1501.14 (revised 6/28/05)14
         g.) SoonerStart Policy 1601.0 Overall Responsibility (revised 8/24/05) 15

3.    Failing to provide [child] with the early intervention services necessary to meet his unique
      needs, including:
     failure to provide individualized family service plans as required,
     failure to provide required assessment and program development,
     failure to have available appropriate early intervention services based on scientifically based
               research,
     failure to have adequate policies and procedures to ensure that to the maximum extent
               appropriate, early intervention services are provided in natural environments except
               when early intervention cannot be achieved satisfactorily in a natural environment and
     failure to provide timely delivery of needed services as required.

         a.) 20 U.S.C. § 1432(4) – Definitions – Early Intervention Services 16
         b.) 20 U.S.C. §1435 (a)(2)-(4) Requirements for Statewide System 17
         c.) 20 U.S.C. §1435 (a)(16) Requirements for Statewide System 18
         d.) 20 U.S.C. § 1436 - Individualized Family Service Plan 19
         e.) 20 U.S.C. §1437 (a)(7) – State Application and Assurances 20
         f.) 34 CFR § 303.12 Early Intervention Services 21
         g.) 34 CFR § 303.344 Content of an IFSP 22
         h.) SoonerStart Policy 1414.0 Multidisciplinary Diagnostic Evaluation–Eligible Child
              (6/20/05) 23
         i.) SoonerStart Policy 1416.0 Assessment for Individualized Family Service Plan – Purpose
              (6/20/05) 24
         j.) Sooner Start Policy 1501.0 Written, Individualized Family Service Plan (6/28/05) 25
         k) Bucks Cty. Dept. of Mental Health/Mental Retardation V. Commonwealth of Pa., Dept. of
              Public Welfare, 379 F.3d 61, n.9 (3rd. Cir. 2004)(noting that the Part C of IDEA does not
              envision parents acting as services providers, but as involved parents reinforcing the
              skills that the child has already learned from working with the therapist).
         l) Burlington School Comm. V. Dept. of Ed., 471 U.S. 359 (1985)




                                                2
Findings:

         SoonerStart is a federal and state early intervention program serving approximately
3,043 children identified with developmental delays, as reported on the Oklahoma State Department of
Education December 2006 child count. The program, primarily housed in county health departments,
serves children and families throughout ten regional offices in Oklahoma. Approximately 3,300 children
with developmental delays in communication delays and/or possible Autism spectrum disorders have been
served by the program since September of 2005.

        [Child], at all times applicable to this complaint, was a two-year-old child served by Region V of
SoonerStart. [Child] was eligible for direct services as a child with a communication delay.

         [Child] was tested and found eligible to receive SoonerStart direct services on September 7, 2005
by the Local Early Intervention Unit. At this time, documentation indicates that the parent expressed
concerns regarding [child’s] speech delay and concerns that the speech delay had a sensory component to
it. An Individualized Family Service Plan (IFSP) was drafted with input from the family, the SDE resource
coordinator and the Health Department service providers and signed by the parent on September 19, 2005.
The IFSP does not contain a statement or written explanation of [child’s] present levels of physical
development, cognitive development, communication development, social or emotional development, and
adaptive development, based on objective criteria. The September 19, 2005, IFSP contained the following
goals:

1.       I want my child to increase his vocabulary in order to produce two word phrases. What will
progress look like? Hearing [child] say 25 words within 3 months. Strategies: Increase his imitation
skills. Talk about what you and he are doing in short phrases. Do some turn taking with him with toys.
Provide modeling for [child] such as rolling a truck on the floor and making truck noise, etc. The outcome
would be measured by parent report, observation.

2.       I want my child/ family to decrease [child‟s] rocking. What will progress look like? In 2 months
[child] will only be using the rocking twice a day. Strategies: [Provider] will provide a sensorimotor
questionnaire for the parents to fill out. [Provider] and the family will try a variety of activities with [child]
to see how he responds and what activities would be effective for a “sensory diet”. The outcome would be
measured by behavioral observation, parent report.

SDE Resource Goals:
A.       I want my child/family to have coordinated Early Intervention Services. What will progress look
like? Family will continue with services in their home. The outcome would be measured by family report,
observation and RC monitoring family‟s needs.

B.       I want my child/family to have help locating and accessing services for 3 year olds. What will
progress look like? Transition services will be utilized and services in place by 9-22-06. The outcome
would be measured by completion of strategies.

          At the time the IFSP was created, September 19, 2005, the parent expressed concern to the team of
[child’s] lack of peer interaction. The SDE Resource Coordinator told the parent about free programs in
the community that she could access, such as Rhythm Babies and the Moore Library (Targeted Case
Management note, September 19, 2005). Progress Notes (October 31, 2005) stated that the Health
Department Speech Language Pathologist suggested that enrolling [child] in a Mother’s Day Out program
might help [child’s] communication skills. Later, the 2nd SoonerStart OT Health Department provider
offered to provide services in the routines of the Mother’s Day Out program (February 28, 2006). The
parent refused the services and asked that the Mother’s Day Out Program be kept a therapy free zone
(March 2, 2006).

          The sensorimotor questionnaire, referred to in the strategies of the IFSP, was not present in the
child’s file. The scored results or a summary of the results was not contained in the IFSP or [child’s] file.
The parent reports that a copy of the scored results or a written summary of the results were not given to


                                                        3
her. The 1st SoonerStart OT provider recorded her impressions in Progress Notes. These Progress Notes
were not given to the parent until the parent requested a copy of the file approximately 3½ months later.

          The 1st SoonerStart OT provider coached the parent to implement some activities with the child to
address the sensorimotor needs of the child: 1) a wheelbarrow activity, 2) using a straw cup to drink from,
and 3) using an indoor swing, on a short term loan. The parents reported to the 1st SoonerStart OT
provider that the strategies had not made sense to them and they were unsure when to use these activities
for the benefit of [child] (Progress Notes: October 18, 2005, November 14, 2005, December 6, 2005, and
Caregiver Concern, page 4). For instance, they reported that sometimes the swing relaxed the child and
sometimes the swing caused the child to become over stimulated.

          The 1st SoonerStart OT provider implemented a brushing technique which caused the child to
react adversely into the next day (Progress Note: November 14, 2005). At the time the brushing technique
was implemented, the 1st SoonerStart OT provider noted an adverse reaction (Progress Note: October 31,
2005). The parent reported that the 1st SoonerStart OT provider gave the parent handouts on sensory
integration techniques but did not explain to the parents the principles behind [child’s] sensory needs and
how the handouts applied to [child]. The parents were not able to understand the individual function of
[child] to make daily decisions in the natural environment regarding the time, frequency and selection of
appropriate strategies to implement throughout the week.

          The parent then sought and obtained a private independent OT assessment, based on the Infant
Toddler Sensory Profile, to obtain a written summary of [child’s] unique needs and recommendations to
assist the parent in determining the use and objectives of appropriate developmental services based on
objective data. The Infant Toddler Sensory Profile is a standardized tool to assess a child’s sensory
integrative function and how it relates to everyday performance. This assessment tool was the most
common assessment tool found in the statewide SoonerStart file review.

         The parent noted that [child] was not making progress toward his speech outcome. Also, [child’s]
pediatrician had noted the lack of progress to the parent. The Progress Notes of the Health Department
Speech Language Pathologist (SLP) indicated that techniques of echo expansion were being coached to the
parent (October 25, 2005). The parent was instructed to repeat the word of the child and add more
language to the word or words uttered by the child. For example, if the child says fish, the parent repeats
the child’s word and adds fish swims. This approach requires the child to produce a spontaneous utterance
before the parent can repeat and expand the utterance.

          The two Health Department providers (SLP and 1st OT) decided to begin seeing the child together
(November 14, 2005). These providers came to the child’s home to introduce the child to a structured
teaching program (December 6, 2005). The parent was given a handout explaining exactly how to
implement the program. The handout was type written but the type written name of another child had been
erased. [Child’s] name was handwritten in that place. The parent did not understand why the Health
Department providers had begun implementing this program. The structured teaching program was not
listed as a strategy on the IFSP. Parent inquired about the structured teaching handout and discovered that
it was part of an evaluation and recommendation that Dr. M (a private licensed psychologist that specializes
in autism) had completed for the individual needs of another child.

         On December 14, 2005, the parent filed an informal complaint procedure (Caregiver Concern)
with the SoonerStart Director at the State Department of Health and requested that SoonerStart, among
other things: 1) reimburse her for the cost of the private OT’s evaluation and assessment of [child’s] unique
needs, 2) provide center-based therapy with the private OT for one hour per week with the strategies of
the therapy generalized throughout the rest of the week in the child’s natural environment, and 3) provide
an evaluation / psychological consult, on January 30, 2005, to determine if the Structured Teaching
Program provided to her child by SoonerStart and written by Dr. M. for another child, was appropriate for
[child]. Documentation shows that the SoonerStart OT provider notes One of the last things she said to me
was that she expected us to do direct therapy and that she expected us to “step it up”. [Parent] clearly
does not agree with the philosophy of the SoonerStart program. She was clear in stating she wants direct
therapy…


                                                      4
        In response to the Caregiver Concern, a series of emails were exchanged between the parties and
an IFSP meeting arranged for January 5, 2006.

          SoonerStart informed the Parent, by email on December 21, 2005 – She is contacting [Private OT,
OTR/L] to see if she is interested in contracting. If this is the direction that we decide to go, we will do
everything possible to try and get the paperwork through as soon as possible. But please be aware that it
usually takes between two and three months to get a contract and a purchase order in place.
You stated in your letter that you were seeing [Dr. M.] on January30th. Again, please understand that we
would not be able to pay for this appointment without a contract and it would be impossible to get one in
place in this short of time. However, we do have other resources available who could complete a
comprehensive diagnostic evaluation in possibly late January or early February. Please let us know if you
are interested in using our current resources and we will check to see how soon an appointment can be
scheduled. In the mean time, we can work with [Dr. M.] to get a contract in place for the full evaluation in
April if necessary. We are familiar with [Dr. M.], have contracted with her in the past, and would be
interested in contracting with her again.

          The parents responded to the email on December 22, 2005, and stated that the parents had private
insurance to cover, at 80%, a limited number of OT/PT therapy treatments per year. The parents offered to
use their insurance to pay the cost of the OT service provided through the private OT if a contract was
secured. If SoonerStart could not secure a contract with the private OT, the parents would be willing to
consider other qualified OTR/L’s that SoonerStart already had contracts with that could begin immediately
providing the services that [child] needs.

         No prior written notice to refuse the parents request was given to the parents. No prior written
notice of an offer of services was given to the parents stating exactly who could provide a service, the
qualification of the provider and exactly when that service would occur. Because appropriate prior written
notice was not given to the parents, the parents did not receive additional procedures (procedural
safeguards - formal complaint procedures/ due process request) available to contest the decision of the
program. No documentation shows that the IFSP team refused the request because of the center-based
nature of the program as opposed to services provided in the natural environment. Documentation and the
complaint responses of the Local Early Intervention Unit indicate that the services of the private OT were
denied for contractual reasons.

         At the January 5, 2006, IFSP review; Outcome #2, related to [child’s] rocking was discontinued.
Outcome # 3 was added to the IFSP:
3.       I want my family and SoonerStart to further assess [child‟s] communication skills, oral motor,
sensory issues (processing) related to communication. What will progress look like? By the end of Feb.
2006 strategies will be started and new goals written based on assessment. The outcome would be
measured by SLP, RC and parent will monitor by documenting when strategies are completed.

          On January 5, 2006, the parent also agreed to a SoonerStart consultation by Dr. D.,OT for
consultation and program planning. At the January 10, 2006 consultation, Dr. D. relied upon the written
assessment of the Private OT to make further recommendations for appropriate developmental services
related to emotional regulation and sensory processing. Dr. D., among other recommendations, suggested:
Explore the Developmental, Individual Difference, Relationship based model (DIR) developed by
Greenspan and Weider. This model focuses on the developmental capacities of functional emotional
development, incorporates a child‟s sensory preferences and expands communication opportunities
(emphasis added). This model is more commonly known as Floortime. This specific recommendation was
written into the January 31, 2006 IFSP. The IFSP does not contain a service page indicating the amount of
consultation service and assessment that was or was to be provided by Dr. D.

         On January 14, 2006, the child began sessions with the families private OT. On January 30, 2006
[child] was evaluated by Dr. M. Dr. M. made numerous recommendations to address [child’s] needs. Dr.
M. did not recommend the structured teaching program given to [child] by the 1 st SoonerStart OT Provider.
That program handout had been developed individually for another child by Dr. M. Among the


                                                     5
recommendations to meet [child’s] unique needs, Dr. M recommended occupational therapy to address
subtle motor planning issues interfering with [child’s] ability to develop speech and also Verbal Behavior
Therapy (VBT) to teach the child to vocalize words on command.

          A new 2nd SoonerStart OT provider began providing services on January 31, 2006 to the
child/family. (The 1st SoonerStart OT provider could not continue services because of her health (Progress
Note: 1-03-06)). Because a Health Department contract with any local OT provider would take 2-3
months, the SoonerStart Local Early Intervention Unit contracted with an OT from a nearby metropolitan
area. The IFSP reflects that SoonerStart OT therapy services by this new provider would occur one time
per week for 60 minutes. During the nine week period, SoonerStart OT therapy services were only
provided 4 out of 9 occasions (only 44% of the time required). From January 1, 2006 to April 17, 2006,
Health Department Speech Language services were provided 5 out of 15 occasions (only 33% of the time
required). Floortime was never provided by the SoonerStart SLP provider or 2 nd SoonerStart OT provider.
Documentation and interviews shows that neither provider was trained in Floortime. The SoonerStart
providers continued working on echo expansion techniques – the same techniques that documentation
shows was offered since October 2005. Documentation of research shows that Echo Expansion is an
evidence based technique. The research suggests that it is not an effective technique to use with a child
until the child has a mean length utterance of 1.5 words. [Child] was still working on obtaining one word
vocabulary of 25 words.

          The 2nd SoonerStart OT provider, as another program to be used along with the echo expansion,
was developing a picture card program for use in the child’s daily routines. The parent reported, however,
that the picture cards were not sent to her by the 2nd SoonerStart OT provider until after the child left the
program on April 21, 2006. No new outcomes, related to the sensory issues for the child, were written into
the IFSP by the end of February 2006 as indicated on the IFSP.

         Notes and records made by SoonerStart providers indicate the lack of progress toward [child’s]
speech, Outcome #1. On January 17, 2006, the SoonerStart SLP lead clinician tested child in
speech/language on the Preschool Language Scale - 4. No service page for this Health Department
provider was completed for the IFSP of the child. The results showed the child functioning in total
language at the 3rd percentile. The SoonerStart lead clinician noted that the child was not using expressive
language to communicate. This clinician was not able to complete the Kaufman Speech Praxis Test
because she was unable to elicit imitation of oral motor movement or vocal imitation from [child]. On
February 2, 2006, the SoonerStart SLP provider noted that the child had said 5 words and no two word
combinations. The SLP continued to coach the parent to use Echo Expansion. On February 27, 2006, the
SoonerStart SLP provider reported to an SLP consult for assistive technology that the child had only 25
words and limited connected speech. No service page for the consult of the SLP for assistive technology
was completed for the IFSP of the child.

          The parent had requested information on providing Verbal Behavior Therapy (VBT), a technique
Dr. M. recommended to help the child produce words on command. The parent first requested information
and expressed an interest in using this technique on January 31, 2006. The SoonerStart provider notes
confirm that the parent continued to request information and help to establish a program of VBT for [child].
The record indicates that the Health Department providers and SDE resource coordinator knew of the
requests on February 27, 2006, March 2, 2006, March 8, 2006, April 17, 2006 and April 19, 2006. The
notes of the SoonerStart SLP provider indicated that she staffed the request with the Health Department
lead clinician on March 2, 2006. The parent was not a part of this discussion. The parent was never given
any response to her request for information and instruction on how to provide the VBT program to her
child. The 2nd SoonerStart OT provider, sending mixed messages, discussed the VBT program with the
parent and attempted to help her fill out some assessment forms to determine the child’s current levels.
Despite the parent’s requests, the parent received no written response denying the request for the VBT, as
recommended for [child] by Dr. M. The parent did not receive any information that the request would be
or would not be granted and services provided. The parent received no prior written notice for refusal, the
reason for the refusal, what the team would be doing otherwise to meet the child’s unique needs, nor
procedural safeguards explaining how the parent could contest the decision to refuse the services.




                                                      6
          The parent, when she initially did not receive any feedback on her requests for VBT, ordered the
materials to provide her own program VBT in the beginning of February 2006. Later, the parent hired a
consultant to teach her to better implement the program. The parent began providing the program to her
child in the middle of February. The good results of the VBT were noted by the April 19, 2006 consult
with Dr. M., arranged by SoonerStart. [Child’s] vocabulary increased from 25 words to 125 words in about
2 months after beginning the VBT. Dr. M. attributed the increased communication to the addition of the
VBT program, provided by the parent to teach the child to produce words on command and the private
OT’s work in addressing subtle motor planning issues.

          On April 17, 2006, the parent reports that the 2nd SoonerStart OT provider told her that
SoonerStart would not provide VBT or any direct OT services to address the motor planning issues of
[child]. After the spring SoonerStart transition evaluation, conducted over a period of four weeks by the
Health Department service providers, was completed, the notes of the SDE resource coordinator indicate
that the team staffed the parent’s request for VBT once again. On April 19, 2006, during a discussion with
Health Department service providers, SoonerStart decided not to provide the service. The parent was not
included in this decision-making process. The parent was verbally informed on April 21, 2006 that
SoonerStart would not incorporate any VBT or OT direct therapy services to address the subtle motor
planning issues of her child into the IFSP. The parent reported that she declined any further SoonerStart
services because the services consisted only of echo expansion (the same program coached since October
2005 with no meaningful results) and a picture exchange in the daily routines of the child (a program that
had been discussed but not provided to her by this time). The pictures to use in the latter program were not
sent to her by the 2nd SoonerStart OT provider until several weeks after her request to close the file. Again,
no prior written notice or procedural safeguards were given to the parent at this time.

          Documentation shows that during the time that the family participated in SoonerStart, the records
indicate that Notice of Meetings should have been given to the family on 13 occasions (September 7, 2005,
September 19, 2005, December 15, 2005, January 5, 2006, January 17, 2006, January 31, 2006, February
27, 2006, March 2, 2006, March 20, 2006, March 27, 2006, April 3, 2006, April 14, 2006, April 17, 2006).
Notice of Meeting with Procedural Safeguards was written for only 3 of the 13 times. The parent only
received two.

         Documentation provided by the State Department of Health shows that only one SoonerStart
provider in the state has been trained in Greenspan’s model of Floortime. The documentation shows that
one team training in Floortime was provided at one local early intervention by a local private SLP and a
psychologist. The lead clinician of that team has had one additional training in using Floortime at a local
hospital. The documentation indicates that no SoonerStart providers have been trained in using Applied
Behavioral Analysis – the method used to apply a program of VBT.

         Documentation provided indicates that many training opportunities are available through the
STARS (Statewide Training and Regional Supports). Mandatory training for Health Department service
providers of SoonerStart is required only on a limited basis and on limited topics. For instance, the only
required training for the 2007 will be on two topics: Assistive Technology and Touchpoint.

Interviews:

1.                  Investigator interviewed the SoonerStart Local Early Intervention Unit OT, SLP, SDE
Regional Coordinator, SDE Resource Coordinator and County Health Department Administrator. The
results of the interviews follow:

         The 1st OT provider did not know if the sensorimotor questionnaire she gave to the parent was a
published or validated tool. A written report of results of the sensory questionnaire or assessment was not
given to the parent. The 1st OT provider wrote impressions in the progress notes but those notes were not
given to the parents until a much later time.

        The 1st OT reported that providers were not supposed to give direct therapy to an infant/ toddler in
the SoonerStart program. The 1st OT reported that it had been made clear to her that SoonerStart is a parent


                                                      7
education program only – that the role of the provider is to coach the parent on activities and strategies that
the parent will provide to the child. The 1st OT reported that once a provider in another region called and
confessed that the she had been giving direct therapy to a child that was transferring into the 1st OT
providers’ region. The Health Department provider in the other region was very upset while she was
confessing her actions to the 1st OT Provider and asked that her provision of direct service not be disclosed.

          The Health Department, thru the early intervention unit, would have contracted with the private
OT, if the private OT had accepted the SoonerStart contract rate. The Health Department, through the early
intervention unit would have provided [child] with center-based therapy at J.D. McCarty, but an OT
therapist was not available at the time.

        The SLP (Speech Language Pathologist) is not trained in the DIR Model by Greenspan and
Weider. The SLP had not read the research on Echo Expansion. SLP stated that she learned the technique
when she was in college. The SLP stated that she does direct therapy with some clients, but that she is not
supposed to do it.

        Health Department contracts with outside providers cannot be obtained for 2-3 months. It took
three months to get a contract in place with Dr. M. to provide the evaluation for [child] on April 19, 2006.

          The 2nd OT reported that she was making picture cards for the child’s program, but did not recall
when she sent them to the parent. The 2nd OT reported that she discussed the VBT with the parent and
tried to assist her in filling out the materials.

         All stated that they were trained to give prior written notice to parents only through the Notice of
Meeting. They stated that they had not been given, nor had been trained to give, any other prior written
notice and procedural safeguards to the parents at other times.


2.      Investigator interviewed Health Department providers throughout the ten Regions of SoonerStart.
The results of the interviews follow:

3/11 (27%) of providers based strategy development on scientific or evidence based research.

1/11 (9%) of providers identified measurable goals as a new requirement of the IDEA 2004.

7 /11 (63 %) of providers do not give direct therapy/services to infants and toddlers.

11/11 (100 %) of providers reported that their job was to coach or teach the family to provide services to
        their own children during the week.

7 /11 (63%) of providers reported that they offer a parent a maximum of one hour per week of service.

4/11 (36 %) of providers based strategy development on what the family would be able to implement with
         their children.

0/11 (0%) of providers identified scientific or evidence based intervention as a new requirement of
        IDEA 2004.

0/11 (0%) of providers had received training to provide prior written notice and procedural safeguards
        to families in situations where SoonerStart was denying a parent’s request for services or changes
        in service delivery. The only training was to provide the procedural safeguards on the back of the
        Notice of Meeting.

0/11 (0%) of providers had never seen any type of prior written notice form to give families, except
        the procedural safeguard form on the back of the Notice of Meeting.




                                                      8
3/11 (27%) of providers, having concerns that a child might have a diagnosis on the autism spectrum,
        would refer a family to outside resources, at their own expense, to obtain evaluation and
        recommendations.

3.      Investigator interviewed Mark Sharp, Part C Coordinator for the State Department of Education.
The result of the interview follows:

        Formal Complaint procedures, prior to the time of this complaint, were not provided to parents.
Informal Caregiver Concerns were provided to the parents.

4.        Investigator interviewed Sharon House, Director of the Parent Training Information Center. The
result of the interview follows:

        Ms. House has been employed by Oklahoma’s Parent Training Information Center for about 10
years. She is currently the director. During that time, she never saw formal complaint forms or procedures
and never distributed them to families seeking assistance with Part C issues.

5.       Investigator interviewed Traci L. Castles, Family Services Coordinator, Department of
Rehabilitation Sciences, and College of Allied Health. The result of the interview follows:

         Ms. Castles assists families in resolving concerns and obtaining Caregiver Concerns. She was
never given any Formal Complaint Forms to distribute to families, prior to the time of the filing of this
complaint.

6.       Investigator interviewed Julie Smith, Director of STARS. The result of the interview follows:

         STARS offers training in scientific or evidence based practices applicable to providing early
intervention services. Health Department service providers are free to choose whether or not they
participate in such training. SDE Resource coordinators, however, have a mandatory schedule of training
in which they must participate.

         STARS training are viewed, primarily by Health Department service providers, as only an
opportunity for continuing education to keep licensure updated. Health Department service providers may
attend STARS training, but they must have the approval of the individual administrator of the county
Health Department where they are located. Given the large number of training opportunities available,
only a small number of Health Department service providers access training (the total numbers of Health
Department persons attending training averaged about one training per Health Department provider).

        Oklahoma offers certification in SCERTS training. SCERTS training is a research based
methodology that can be used for addressing the needs of infant and toddlers with Autism Spectrum
Disorders. Only three Health Department service providers have participated in this training and, to date,
and no person has become certified to use the program.

          All Health Department service providers and SDE resource coordinators attended a Challenging
Behaviors Class I in November 2003. This class was intended as an introduction to the terminology and
concepts of working with infants and toddlers with challenging behaviors. Approximately ten persons,
within the last three years, completed the Challenging Behaviors Class II. This class is intended to train
service providers to implement programs with infants and toddlers addressing challenging behavior.

7.       Investigator interviewed Glenda Rogers, SoonerStart Director, State Department of Health. The
interview results follow:

         SoonerStart has developed an appropriate program to address the needs of infants and toddlers
with a diagnosis or possible diagnosis on the autism spectrum.




                                                      9
8.       Investigator interviewed 46 families who participated in SoonerStart services. The results of the
interviews follow:

         35/46 families were satisfied with the services provided to their family by the SoonerStart
                 program.
         11/46 families were not satisfied with the services provided to their family by the SoonerStart
                 program. Concerns listed by these families included:

                          Slow to get services initiated.
                          Health Department service providers lacked training and knowledge in autism.
                          Health Department service providers in needed disciplines (i.e. OT, PT) were
                           not available.
                          Lack of Autism programming by Health Department service providers.
                          Reluctance by Health Department service providers to identify characteristics of
                           autism.
                          Lack of Health Department service providers trained in Floortime or ABA
                           (applied behavioral analysis)
                          Frequency of services, determined by the Health Department service providers,
                           not great enough to address the individual needs of the child to work toward the
                           child’s outcomes.
                          Health Department service provider lacked the quality of a private provider in
                           performing therapy.

Written Responses to Allegations:

1.       A written response to the allegations was submitted by the Local Early Intervention Unit.

        The Targeted Case Management (TCM) note states that the family was referred to “Rhythm
Babies” and the Moore Public Library, which are free programs available in the community (see TCM note
September 19, 2005). On October 3, 2005, the 1st SoonerStart OT provider discussed results of the
Sensorimotor History (see Progress Note) and was not aware that parent was seeking additional
assessment.

         The SoonerStart team discussed the parents request for VBT and agreed that appropriate services
with qualified staff were already established and [child] was making progress with his IFSP goals. As a
SoonerStart team, we believe we have made sincere efforts to identify [child’s] needs and to provide
appropriate early intervention services. The 45-day timeline was met as follows:
    August 24, 2005: initial referral;
    September 7, 2005: initial multidisciplinary team evaluation;
    September 19, 2005: initial individualized family service plan (IFSP).

2.      A joint written response to the allegations of the complaint was submitted by Misty Kimbrough,
State Department of Education and Edd Rhoades, Oklahoma State Department of Health. The response
contained the following information:

         …the SoonerStart program would like to respond to statements regarding the ability of the
SoonerStart program to provide individualized services including, when appropriate, Applied Behavioral
Analysis (ABA) and or Verbal Behavioral sciences.

         The SoonerStart program acknowledges the critical need to have a statewide system to provide
individualized, effective, evidence based services for children identified or suspected with autism spectrum
disorders. SoonerStart has historically provided training to staff and families on the subject of autism
spectrum disorders. These trainings intensified in 2003 when the SoonerStart program developed and
implements a mandatory training for all staff titled “SoonerStart Challenging Behaviors/Autism Training.”




                                                     10
         The SoonerStart program has historically and continues to offer training to all SoonerStart
services providers and families concerning the provision of effective services to children with Autism
Spectrum Behaviors and procedural safeguards for families.

         The SoonerStart program developed a Low-Incidence Disabilities and Autism Subcommittee of the
Interagency Coordinating Council (ICC) Policy and Funding Committee. This subcommittee has charged
with determining best practices in providing services to children with low-incidence disabilities and Autism
and to develop recommendations to the ICC Policy and Funding committee regarding how children would
be served and the resources needed to implement the services. This subcommittee continues to meet and
provide technical assistance to the SoonerStart program. With Attachments 1-4.

         ATTACHMENT 1:

1.       Survey of 90 Early Intervention Service Providers –selected top 7 interests.

         19/90 (21%) indicated an interest in learning about Autism and spectrum disorders.
         16/90 (17 %) indicated an interest in Challenging behaviors.
         3/90 (3%) indicated an interest in How to write an effective IEP.
         10/90 (11%) indicated an interest in Evidenced based practices.
         5/90 (5%) indicated an interest in Picture Exchange System: Intro.
         7/90 (7%) indicated an interest in Picture Exchange System: Follow-up.


2.       2005 Surveys on Team Development Needs
         In each area, the following groups responded to training needs:
                        (Health Department Lead Clinicians / rating)
                        (SDE Regional Coordinator /rating)
                        (Health Department Technical supervisors /rating )

         A.       SoonerStart Providers employed less than two years.

         Assessment (LC / high need) (RC / high need) (Tech S. /high need)
         IFSP Development (LC/ high need) (RC /high need) (Tech S. / high need)
         Learner –focused Intervention (LC / low need) (RC / high need) (Tech S. /high need)
         Evidence Based Practices (LC /low need) (RC / high need) (Tech S. / high need)

         B.       SoonerStart Providers employed more than two years.

         Assessment (LC/ low need) (RC / high need) (Tech. S. / low need)
         IFSP Development (LC / low need) (RC / high need) (Tech. S. / low need)
         Learner -focused Intervention (LC / low need) (RC / high need) (Tech. S. / high and low need)
         Evidence Based Practices (LC / low need) (RC / high need) (Tech. S. / high need)

        ATTACHMENT II
Statewide Training and Regional Supports (STARS)

         Information indicates that trainings, during 2004-2006, open to families and SoonerStart service
providers, staff, and resource coordinators of early intervention age, included:

         Six trainings on Challenging Behaviors.
         Three trainings on Picture Exchange Communication.
         Three Trainings on Sensory issues.
         One training on augmentive communication.
         One training on inclusive settings.
         One training on Family issues in dealing with Autism.
         One Training on Asperger’s Syndrome.


                                                     11
         Three trainings in parent rights.
         One training outlining the SCERTS Model.

         ATTACHMENT III
         Listing of Course offerings for 2007, including at least ten topics related to infants and toddlers on
the autism spectrum. Only one class (Touchpoint) is mandatory for all SoonerStart Staff.

          ATTACHMENT IV
          January 23, 2007 Report of Activities and Recommendations for the FY 2006-2007 of the ICC
Policy and Funding Committee. The report indicates that the committee has formed smaller workgroups
that are involved in investigating programming for children on the autism spectrum.

File Review:

         Documentation from the review of files indicated that when an outside funding source was
available for an infant/toddler, equipment to support the outcomes of the IFSP were provided. If no outside
funding source was available to the parent, then IFSP stated that parents would pay and provide
equipment/activities to support the outcomes of the IFSP.

328 files were reviewed across 10 regions:

1.       In 245/328 (75%) of files reviewed, services were not provided as indicated on the IFSP.

2.       In 99/328 (30%) of files reviewed, IFSP reviews were conducted by without notice of meetings.

3.       In 290/328 (88%) of files reviewed, objective assessment tools were not used by Health
         Department providers.

4.       In 52/328 (16%) of files reviewed, the second tool used in evaluation was not conducted in all
         areas of developmental delay as indicated by the Battelle.

5.       In 328/328 (100%) of files reviewed, no written assessment or statement of the child’s present
         levels of development in all areas, based on objective data, were contained in the IFSP or given to
         the parent.

6.       In 86/328 (26%) of files reviewed, Health Department providers gave services not indicated on the
         IFSP.

7.       In 142/328 (43%) of files reviewed, outcomes in the IFSP were not measurable.

Conclusions:

1.        Concerning the issue of provision of Part C functions at no charge to families, SoonerStart is
found in non-compliance. The file review indicates that when an outside funding source is available,
equipment to support the outcomes of the IFSP is provided through the funding source. In contrast, when
there is no outside funding source available, families are asked or told to pay for the cost. Some Health
Department service providers indicated that if they were concerned that a child had an autism spectrum
disorder, they would refer the family to outside resources, at the parent’s own expense, to obtain evaluation
and recommendations.

          Part C of the Individuals with Disabilities Education Act (IDEA) is an entitlement program on
behalf of each eligible child and the child’s family, based on statutory provisions. See Letter to Eidelman,
EHLR 213:206, 1 ECLPR ¶ 38 (OSEP 1988), Letter to Quality, 1 ECLPR ¶ 33 (OSERS 1988) and OSEP
Policy Memorandum 90-14, 16 EHLR 708, 1 ECLPR ¶ 10 (OSEP 1990). A child receiving services under
Part C is entitled to the services identified on the IFSP at no charge.




                                                      12
          The parent request for Mother’s Day Out is denied. Part C funds may be used to pay for day care
in certain situations. Accordingly, a state cannot completely bar the use of funds for day care. Letter to
Frymore, 25 IDELR 830, ECLPR ¶ 33 (OSEP 1996). If a team determines that a certain amount of
participation in a childcare setting is necessary and so specifies in the IFSP, SoonerStart must assume the
financial responsibility for that portion of the childcare cost specifically associated with that service. Letter
to Dicker, 22 IDELR 464, 2 ECLPR ¶ 90 (OSEP 1995). It is not necessary to determine whether the SLP’s
recommendation that the parent enroll the child in the Mother’s Day Out Program should have been written
into the IFSP, because the parent specifically declared the Mother’s Day Out Program be kept a
therapy/service free zone.

2.        Concerning the issue of failing to provide procedural safeguards, SoonerStart is found in non-
compliance. The SoonerStart local early intervention unit failed to give the parent prior written notice that
they refused to provide the services requested by the parent. In failing to give the parent the contents of
prior written notice, the parent was not given information of additional procedural safeguards steps she
could use to dispute the refusal by the SoonerStart local early intervention unit. The SoonerStart local early
intervention unit failed to give the parent prior written notice of services they would provide in place of the
services they were refusing. The SoonerStart Local early intervention unit did not incorporate the
consultant’s recommendations on addressing the child’s sensory needs and service to the child was
substantially not provided as specified in the IFSP. SoonerStart failed to widely disseminate state formal
written complaint procedures to parents when they have not distributed them to parents or too entities
helping parents. Only the informal Caregiver Concerns were distributed. The informal caregiver concern
and formal complaint are entirely different mechanisms by design.

          0% of Health Department providers interviewed had received training to provide prior written
notice and procedural safeguards to families in situations where SoonerStart was denying a parent’s request
for services or changes in service delivery. 0% of Health Department providers interviewed had never seen
any type of prior written notice form to give families, except the procedural safeguards form on the back of
the Notice of Meeting. Formal Complaint procedures, prior to the time of this complaint, were not
provided to parents. Informal Caregiver Concerns were provided to the parents. Formal Complaint
procedures were not widely disseminated to the IDEA parent training information center or to the Family
Services Coordinator for distribution to parents.

3.       Concerning the combined issues of failing to provide an individualized family service plan as
required and of providing required assessment and program development, SoonerStart is found in non-
compliance. Assessment tools are used infrequently by Health Department service providers in the
assessment process; only 12% of files review contained any type of assessment tool used after the child was
found eligible. Second tools used in the determining of eligibility are not used in all areas of delay as
indicated on the Battelle. [Child’s] IFSP contained a goal that was not measurable. Based on the writing of
the Outcome #1, a time certain when that outcome is met cannot be determined. 43 % of files reviewed
contained outcomes that were not measurable.

         No written explanation of the infant/toddlers present levels of physical development, cognitive
development, communication development, social or emotional development, and adaptive development,
based on objective criteria is present on [child’s] IFSP, nor on any IFSP in the statewide file review. No
written explanation of any infant toddler’s present level of performance, based on the clinical opinion of the
Health Department service provider, was present in any file reviewed, except for some instances when very
fine reports were written for toddlers, when the toddler transitioned out of the SoonerStart program.

         The parent was never given any written information regarding the assessment of her child’s unique
needs at the time the IFSP was drafted or later, by the 1 st Sooner Start OT provider as new strategies were
introduced to [child]. Also, strategies which were introduced by the 1 st SoonerStart OT provider in
program development were not explained to the parent sufficiently so that the parent could make decisions
in how to effectively implement the strategies throughout the week. Handouts were given to the parent.
For instance, at least one strategy and handout given to the family, was a program actually developed for
the needs of another child by a psychologist who later, in consult, did not find that strategy to be
appropriate for [child]. Strategies which the psychologist did find were needed by the child, were not


                                                       13
developed. Strategies recommended by the SoonerStart Consultant and written as strategies on January 31,
2006 IFSP were not developed. [Child’s] SoonerStart SLP provider indicated that she was not trained in
Floortime, the model recommended. Documentation shows that the 2nd SoonerStart OT provider was not
trained in Floortime and that neither provider was trained in ABA. Even strategies, using pictures,
discussed with the parent by the 2nd SoonerStart OT Provider were not provided to the parent until after the
child had exited the program. New outcomes were not written on the IFSP with new strategies as promised
on the January 5, 2006, IFSP, Outcome #3.

          Required program services were not provided according to the IFSP. Only 5 out of 15 required
interventions were provided by the SoonerStart SLP and only 4 out of 9 required interventions were
provided by the 2nd SoonerStart OT provider. At least three services provided to [child] were not
documented on the IFSP (Dr. D; an SLP (Lead Clinician) and K.W., SLP). Documentation indicates that
the 2nd SoonerStart OT provider attempted to work with parent on some of the requested VBT. The
continuing parental requests for the VBT are documented in the SoonerStart documents. The documents
indicate that the discussion of the provision of those services was discussed among SoonerStart staff and
providers alone. The parent was not a part of any of those discussions. Therefore, the IFSP team was not
making the decisions for the child’s programming. When the program was finally denied to the parent, the
parent was verbally told that direct therapy by an OT would not be provided and no VBT would be
provided.

          Evidence shows that in 75% of files reviewed, services were not provided as indicated on the
IFSP. In 30% of files reviewed, IFSP reviews were conducted without notice of meetings. In 88% of files
reviewed, objective assessment tools were not used. In 16% of files reviewed, the second tool used in
evaluation was not conducted in all areas of developmental delay as indicated by the Battelle. In 100% of
files reviewed no written assessment or statement of the child’s present levels of development in all areas,
based on objective data, were contained in the IFSP or given to the parent. In 26% of files reviewed,
providers gave services not indicated on the IFSP.

         Currently, no Health Department provider is certified to implement a SCERTS program. Only 10
service providers have completed the Challenging Behaviors Class II since 2003. Only 9% of Health
Department service providers interviewed identified measurable goals as a new requirement of the IDEA
2004. 63% of Health Department service providers interviewed do not give direct therapy/services to
infants and toddlers. 100% of service providers interviewed reported that their job was to coach or teach
the family to provide services to their own children during the week. 63% of Health Department service
providers interviewed reported that they offer a parent a maximum of one hour per week of service.

4.       Concerning the issue of using early intervention services based on scientifically based research,
SoonerStart is found in non-compliance. While echo-based expansion is scientifically based, the
SoonerStart providers did not use this strategy with the child as the evidence suggests. When the child did
not make adequate progress within three months, the providers should have used another approach. Later,
a new approach, Floortime, suggested by the SoonerStart consultant was written as a strategy on the IFSP,
but was not attempted. The SoonerStart SLP and OT providers were not trained in the approach
recommended by the SoonerStart consultant and listed on the IFSP. SoonerStart did not locate a provider
that was trained in the approach to provide the service. The Health Department providers continued with
the echo based expansion and never fully developed another program to use with the child. In the
meantime, the parent, based on the recommendations of Dr. M., implemented a program in Verbal
Behavior Therapy. The parent requested assistance from SoonerStart in implementing the Verbal Behavior
Therapy. The 2nd SoonerStart OT provider attempted to discuss the VBT program with the parent and
help her to fill out the initial skill evaluation. After the program in Verbal Behavior Therapy (a program
based on scientific research) was implemented, the child made immediate language gains.

        Only 27% of Health Department providers based development of strategies on scientific or
evidence based research. 36% of providers based strategy development on what the family would be able
to implement with their children. 0% of providers identified scientific or evidence based intervention as a
new requirement of IDEA 2004. According to documentation, only one Health Department provider is




                                                     14
trained in Greenspan’s model of Floortime and no Health Department provider is trained in implementing a
program of Applied Behavioral Analysis.

5.        Concerning the issue of not having adequate policies and procedures in place to ensure, that when
early intervention services cannot be achieved in the natural environment to the maximum extent
appropriate, that appropriate service for an infant/toddler can be obtained, SoonerStart is found in non-
compliance.

         While documentation indicates that 4 children in SoonerStart receive services in environments that
are not natural, financial policies and procedures are not in place which permit contracts to be made within
15 days of the identified need within any given community. Upon discovery that any particular child
would need timely services in an environment that is not natural, contracts to arrange for those services
would take 2-3 months to approve – except in those circumstances where contracts might already exist.

6.       Concerning the issue of providing timely delivery of needed services as required, SoonerStart is
found in non-compliance. SoonerStart must provide timely delivery of needed services to children.
Contracts to provide local services, to families in communities throughout Oklahoma, which take 2-3
months to approve, prevent the timely provision of services. Because providers are in short supply and
SoonerStart cannot fully employ needed providers, financial arrangements must be in place to obtain
needed services in a timely manner. The State Department of Education now defines the timely delivery of
services as 15 days. (See State Performance Plan 2007).

Corrective Action:

1.       The State Department of Education shall reimburse the parents a total of $941.55, including:
         A) $36.00, the cost of the January 30, 2006 psychological consultation;
         B) $37.50, the cost of the assessment procedures on 11-09-05;
         C) $655.20, the cost of OT services;
         D) $112.85, the cost of materials on Verbal Behavior Therapy; and
         E) $100.00, the cost of consultation on Verbal Behavior Therapy.

2.       The State Department of Education shall ensure that the State Department of Health has a policy
and financial mechanism in place for contracting with public or private service providers to provide early
intervention services in a timely manner or within 15 days for identified need.

3.      The State Department of Education shall widely disseminate State Formal Written Complaint
procedures in accordance with 34 C.F.R §303.510(a)(2).

4.         The State Department of Education shall require attendance of all SDE early intervention staff and
Health Department services providers at training to ensure:
-that staff and providers of early intervention services understand that Part C is an entitlement program of
           services to infant/toddlers with disabilities and families;
-that providers of early intervention services appropriately conduct multidisciplinary assessment of the
           unique needs of the infant or toddler, after eligibility is determined, and identify services
           appropriate to meet those needs;
-that the contents of the IFSP are fully explained to the parent and that the parent may refuse consent to
           particular portions of the early intervention services offered;
-that the IFSP is written to contain measurable results or outcomes expected to be achieved and the criteria,
           procedures and timelines used to determine the degree to which progress toward achieving the
           results or outcomes is being made;
-that the IFSP is written to include a statement on infant/toddler’s present levels of development in all
           areas, based on objective data;
-that services are properly provided according the IFSP;
-that all services providers must be identified on the IFSP;
-that all services provided are evidence based to the extent practicable;
-that direct services are provided to the infant/toddler;


                                                     15
-that frequency and intensity and method of direct service is developed based on the unique needs of the
          child;
-that prior written notice and procedural safeguards are given to families in accordance with law; and
-that direct services are provided to families at no cost.

5.        The State Department of Education shall ensure that recurring, mandatory substantive training in
the provision of services is provided and that all SDE Staff and Health Department providers are required
to attend to ensure that the SoonerStart program will implement consistently the same throughout all
regions of the SoonerStart program;

6.        The State Department of Education shall develop appropriate IFSP forms which permit a
statement of the infant’s or toddler’s present levels of physical development, cognitive development,
communication development, social or emotional development, and adaptive development, based on
objective criteria; a statement of the measurable results or outcomes expected to be achieved for the infant
and toddler and family, including pre-literacy skills and language skills, as developmentally appropriate
for the child, and the criteria, procedures, and timelines use to determine the degree to which progress
toward achieving the results or outcomes, parent signature when changes are made and all other
requirements of 20 U.S.C. §1436(d).

7.        Due to the systemic nature of the non-compliance, the State Department of Education shall
identify and hire an out of state consultant, with expertise in Part C, who can represent all stakeholder
interests in a thorough review of all aspects of the delivery system of Early Intervention to include: a
financial review, a financial policy review, a policy review, eligibility determinations, assessment & IFSP
development, service delivery methodologies, quality assurance (monitoring) and personnel training and
technical assistance and any other compliance issues that emerge as a result of this analysis.

8.        Due to the systemic nature of the non-compliance identified and related issues, the State
Department of Education shall convene a panel to fully investigate all components of the service delivery
system to children under Part C of the Individuals with Disabilities Education Act [20 U.S.C. §§ 1431 thru
1444], its implementing regulations, and the Oklahoma Early Intervention Act [70 O.S. 13-121, et seq.],
provision to children and families by the State Department of Health, Department of Human Services,
Department of Mental Health and the Commission of Children and Youth. The State Department of
Education shall direct the manner in which the ICC Council may advise and assist the State Department of
Education. The panel and panel activities will be directed by the State Superintendent of Public
Instruction, or designee. The remainder of the membership shall be composed of:

a.       Legal Counsel of the State Department of Education;
b.       Assistant State Superintendent – Special Education Services or designee;
c.       Commissioner of the State Department of Health, or designee;
d.       Director of the Department of Human Services, or designee;
e.       Chief Executive Officer of the Oklahoma Health Care Authority, or designee;
f.       Insurance Commissioner, or designee;
g.       Commissioner of the State Department of Mental Health and Substance Abuse Services, or
         designee;
h.       Director of the Parent Training Information Center or designee;
i.       3 parents of children, no older than 6 years of age, who participated in SoonerStart Services; and
j.       and any others, as determined necessary by the State Department of Education.

9.       Due to the systemic nature of the non-compliance identified and related issues, the State
Department of Education shall thoroughly review and revise, if necessary, all of it’s interagency
agreements, contracts and memorandums of understanding with the Oklahoma State Department of Health,
the Oklahoma Department of Human Services, the Oklahoma Department of Mental Health and Substance
Abuse Services, the Oklahoma Health Care Authority, the University of Oklahoma Health Sciences Center
and the Oklahoma Commission on Children and Youth to ensure that Part C is administered according to
law.




                                                     16
10.       It is recommended that the State Department of Education promulgate rules as necessary to
establish and implement Oklahoma’s plan for meeting the requirements of 20 U.S.C. §§1431-1445
and it’s implementing regulations.



Comments:

         The right to request mediation and due process continue to be options to the parents and the Local
Early Intervention Unit in resolving disputes. A statewide mediation system is available at no cost to the
parents or the Local Early Intervention Unit. The State Department of Education can assist in making
arrangements for mediation if both parties are willing to participate in the process. If you have remaining
concerns or need further information, you may contact the Office of Special Education at (405)521-4871.

Sincerely,



Jo Anne Pool

cc: Sandy Garrett, State Superintendent of Public Instruction
    Misty Kimbrough, Assistant State Superintendent of Public Instruction


1
  20 U.S.C. § 1432 (4)(B) Definitions – Early Intervention Services
 (4) EARLY INTERVENTION SERVICES.--The term early intervention services means developmental
services that--
          (B) are provided at no cost except where Federal or State law provides for a system of payments
          by families, including a schedule of sliding fees;
2
    34 CFR § 303.520 Policies related to payment for services.
         (a) General. Each lead agency is responsible for establishing State policies related to
         how services to children eligible under this part and their families will be paid for under
         the State's early intervention program. The policies must--
              (1) Meet the requirements in paragraph (b) of this section; and
              (2) Be reflected in the interagency agreements required in Sec. 303.523.
          (b) Specific funding policies. A State's policies must--
              (1) Specify which functions and services will be provided at no cost to all parents;
               (2) Specify which functions or services, if any, will be subject to a system of
              payments, and include--
                      (i) Information about the payment system and schedule of sliding fees that
                     will be used; and
                     (ii) The basis and amount of payments; and
               (3) Include an assurance that--
                      (i) Fees will not be charged for the services that a child is otherwise entitled
                     to receive at no cost to parents; and
                      (ii) The inability of the parents of an eligible child to pay for services will not
                     result in the denial of services to the child or the child's family; and
                (4) Set out any fees that will be charged for early intervention services and the
              basis for those fees.
          (c) Procedures to ensure the timely provision of services. No later than the beginning of
         the fifth year of a State's participation under this part, the State shall implement a
         mechanism to ensure that no services that a child is entitled to receive are delayed or
         denied because of disputes between agencies regarding financial or other
         responsibilities.



                                                        17
          (d) Proceeds from public or private insurance.
                (1) Proceeds from public or private insurance are not treated as program income
               for purposes of 34 CFR 80.25.
               (2) If a public agency spends reimbursements from Federal funds (e.g., Medicaid)
               for services under this part, those funds are not considered State or local funds for
               purposes of the provisions contained in Sec. 303.124


3
 34 CFR § 303.521 Fees.
(a) General. A State may establish, consistent with Sec. 303.12(a)(3)(iv), a system of payments for early
    intervention services, including a schedule of sliding fees.
(b) Functions not subject to fees. The following are required functions that must be carried out at public
    expense by a State, and for which no fees may be charged to parents:
     (1) Implementing the child find requirements in Sec. 303.321.
     (2) Evaluation and assessment, as included in Sec. 303.322, and including the functions related to
         evaluation and assessment in Sec. 303.12.
    (3) Service coordination, as included in Secs. 303.22 and 303.344(g).
    (4) Administrative and coordinative activities related to--
          (i) The development, review, and evaluation of IFSPs in Secs. 303.340 through 303.346;
               and
          (ii) Implementation of the procedural safeguards in subpart E of this part and the other
               components of the statewide system of early intervention services in subparts D and F of this
               part.
(c) States with mandates to serve children from birth. If a State has in effect a State law requiring the
    provision of a free appropriate public education to children with disabilities from birth, the State may
    not charge parents for any services (e.g., physical or occupational therapy) required under that law
    that are provided to children eligible under this part and their families.


4
  SoonerStart Policy 1907.0 Financial – Fees (revised 7/19/05):
The following early intervention functions, as required by P.L. 99-457, as amended by P.L. 108-446, Part
C, will be carried out at no charge to the family. No fees may be charged directly to the family for:
• Implementing the child find requirements.
• Evaluation and assessment, including functions related to evaluation and assessment.
• Service coordination.
• Administrative and coordinative activities related to:
           ∗ development, review and evaluation of IFSPs;
           ∗ implementation of procedural safeguards; and
           ∗ components of the statewide system of Early Intervention services.
• Services that were required by Oklahoma law to be provided to infants and toddlers with disabilities from
birth prior to Oklahoma's implementation of early intervention services.
Fees will not be charged for services that a child is otherwise eligible to receive at no cost to parents.
If it is determined that parents or their insurance will be charged for early intervention services other than
those listed in EI Policy 1907.0, the Oklahoma State Department of Education as lead agency will establish
and submit to the U.S. Department of Education the following:
• Information about the payment system, including a schedule of sliding fees; and
• The basis and amount of payments.
That the inability of the parents of an eligible infant or toddler to pay for services will not result
in the denial of early intervention services. No fees are currently being charged for any SoonerStart Early
Intervention service.



5
    OAC 210:15-13-3 Special education assurances and certifications (Part H)


                                                     18
  The SDE will not use its Part H funds to satisfy a financial commitment for services which would have
been paid for from another public or private source but for the enactment of Part H except that whenever
considered necessary to prevent a delay in the timely provision of services to an eligible child or family, the
Part H funds may be used to pay the provider of services, pending reimbursement from the agency which
has the ultimate responsibility for the payment. [ 20 U.S.C. §1481] Emphasis applied.
6
  70 O.S. 13-124 (C) Administration of Federal and State Funds Appropriated for Early Intervention
   Services
   …Funds provided for implementation of the Oklahoma Early Intervention Act, Sections 13-121 through
13-129 of this title, shall not be used to satisfy a financial commitment for services which would have been
paid for or provided by another public or private sources, but shall be utilized solely for the enactment of
Part H of the Individuals with Disabilities Education Act (IDEA) and the Oklahoma Early Intervention Act.
Such funds may be used whenever considered necessary to prevent delay in the receipt of appropriate early
intervention services by the infant or toddler or family in a timely fashion. Funds provided for
implementation of the Oklahoma Early Intervention Act may be used to pay the provider of services
pending reimbursement from the agency which has the ultimate responsibility. Emphasis applied.
7
  OAC 340:100-3-15(g) SoonerStart
  There is no direct cost to families. Funding sources include Individuals with Disabilities Education Act,
Section 631 through 640 of Part H of Title 20 of the USC, Medicaid (Title XIX), Maternal and Child
Health (Title V), and State appropriated dollars.


8
  20 U.S.C. §1435 (A)(10) Requirements for Statewide System
 (a) IN GENERAL.--A statewide system described in section 633 shall include, at a minimum, the following
components:
     (10) A single line of responsibility in a lead agency designated or established by the Governor for
     carrying out--
              (A) the general administration and supervision of programs and activities receiving
              assistance under section 633, and the monitoring of programs and activities used by the State
              to carry out this part, whether or not such programs or activities are receiving assistance
              made available under section 633, to ensure that the State complies with this part;
              (B) the identification and coordination of all available resources within the State from
              Federal, State, local, and private sources;


9
   34 CFR § 303.510 Adopting complaint procedures.
(a) General. Each lead agency shall adopt written procedures for—
      (1) Resolving any complaint, including a complaint filed by an organization or individual from
     another State, that any public agency or private service provider is violating a requirement of Part C
     of the Act or this Part by—
            (i) Providing for the filing of a complaint with the lead agency; and
            (ii) At the lead agency's discretion, providing for the filing of a complaint with a public agency
           and the right to have the lead agency review the public agency's decision on the complaint; and
         (2) Widely disseminating to parents and other interested individuals, including parent training
        centers, protection and advocacy agencies, independent living centers, and other appropriate
        entities, the State's procedures under §§ 303.510-303.512.
 (b) Remedies for denial of appropriate services. In resolving a complaint in which it finds a failure to
provide appropriate services, a lead agency, pursuant to its general supervisory authority under Part C of
the Act, must address:
        (1) How to remediate the denial of those services, including, as appropriate, the awarding of
        monetary reimbursement or other corrective action appropriate to the needs of the child and the
        child's family; and




                                                      19
        (2) Appropriate future provision of services for all infants and toddlers with disabilities and their
       families



10
   SoonerStart Policy 1902.0 Complaint Resolution – Lead Agency Procedure (revised 7/19/05) The
State Department of Education as lead agency will:
• receive and resolve any complaint that one or more requirements of this part are not being met.
• inform parents and other interested individuals about the complaint procedures.
     Procedure: Parents are informed about the complaint procedures at the initial family interview and
     IFSP meeting. They also receive the information at the periodic and annual review meetings.
     Interested individuals are informed through Public Awareness activities, the State Plan and Policy and
     Procedures Manuals. The outlined procedures are available at any time upon request from the Lead
     Agency and/or the Oklahoma State Department of Health.


11
  20 U.S.C. §1439 (a)(6) Procedural Safeguards:
(a) MINIMUM PROCEDURES.--The procedural safeguards required to be included in a
statewide system under §635(a)(13) shall provide, at a minimum, the following:
     (6) Written prior notice to the parents of the infant or toddler with a disability whenever the State
     agency or service provider proposes to initiate or change, or refuses to initiate or change, the
     identification, evaluation, or placement of the infant or toddler with a disability, or the provision of
     appropriate early intervention services to the infant or toddler.


12
  34 CFR § 303.403(a) - (b) Prior notice; native language:
(a) General. Written prior notice must be given to the parents of a child eligible under this part a
    reasonable time before a public agency or service provider proposes, or refuses, to initiate or change
    the identification, evaluation, or placement of the child, or the provision of appropriate early
    intervention services to the child and the child's family.
(b) Content of notice. The notice must be in sufficient detail to inform the parents about—
   (1) The action that is being proposed or refused;
   (2) The reasons for taking the action;
   (3) All procedural safeguards that are available under §§. 303.401-303.460 of this part; and
   (4) The State complaint procedures under §§ 303.510-303.512, including a description of how to file a
         complaint and the timelines under those procedures.


13
   SoonerStart Policy 1603.0 Prior Notice (revised 8/24/05) Written prior notice will be given to the
parents of an eligible child a reasonable time before a public agency or service provider proposes, or
refuses, to initiate or change the identification, evaluation, or placement of the child, or the provision of
appropriate early intervention services to the child and the child's family.
The notice must be in sufficient detail to inform the parents about:
• the action that is being proposed or refused;
• the reasons for taking the action; and
• all procedural safeguards that are available under this part.


14
  SoonerStart Procedure 1501.14 (revised 6/28/05) All EI activities related to IFSP development will
comply with the prior notice requirements outlined in EI Policy 1603.0 and 1604.0.


15
   SoonerStart Policy 1601.0 Overall Responsibility (revised 8/24/05)
The Oklahoma State Department of Education, as lead agency, is responsible for:
• establishing or adopting procedural safeguards that meet the requirements of this subpart, and


                                                       20
• ensuring effective implementation of the safeguards by each public agency in Oklahoma that is involved
in the provision of early intervention services under this part.
16
   20 U.S.C. § 1432 (4) -- Definitions.
(4) EARLY INTERVENTION SERVICES.--The term `early intervention services „
means developmental services that--
(A) are provided under public supervision;
(B) are provided at no cost except where Federal or State law provides for a system of payments by
      families, including a schedule of sliding fees;
(C) are designed to meet the developmental needs of an infant or toddler with a disability, as identified by
      the individualized family service plan team, in any 1 or more of the following areas--:
 (i) physical development;
        (ii) cognitive development;
        (iii) communication development;
        (iv) social or emotional development; or
        (v) adaptive development;
(D) meet the standards of the State in which the services are provided, including the
requirements of this part;
(E) include--
        (i) family training, counseling, and home visits;
         (ii) special instruction;
        (iii) speech- language pathology and audiology services, and sign language and cued language
              services;
        (iv) occupational therapy;
        (v) physical therapy;
        (vi) psychological services;
        (vii) service coordination services;
        (viii) medical services only for diagnostic or evaluation purposes;
        (ix) early identification, screening, and assessment services;
        (x) health services necessary to enable the infant or toddler to benefit from the other early
              intervention services;
        (xi) social work services;
        (xii) vision services;
        (xiii) assistive technology devices and assistive technology services; and
        (xiv) transportation and related costs that are necessary to enable an infant or toddler and the
              infant‟s or toddler‟s family to receive another service described in this paragraph;
(F) are provided by qualified personnel, including--
        (i) special educators;
         (ii) speech-language pathologists and audiologists;
         (iii) occupational therapists;
         (iv) physical therapists;
         (v) psychologists;
        (vi) social workers;
        (vii) nurses;
        (viii) registered dietitians ;
        (ix) family therapists;
        (x) vision specialists, including ophthalmologists and optometrists;
        (xi ) orientation and mobility specialists; and
        (xii ) pediatricians and other physicians;
(G) to the maximum extent appropriate, are provided in natural environments, including the home, and
        community settings in which children without disabilities participate; and
 (H) are provided in conformity with an individualized family service plan adopted in accordance with
        section 636.




                                                     21
17
  20 U.S.C. §1435 (a) (2)-(4) Requirements for Statewide System.
(a) IN GENERAL.--A statewide system described in section 633 shall include, at a minimum, the following
components:
      (2) A State policy that is in effect and that ensures that appropriate early intervention services based
          on scientifically based research, to the extent practicable, are available to all infants and toddlers
          with disabilities and their families, including Indian infants and toddlers with disabilities and their
          families residing on a reservation geographically located in the State and infants and toddlers
          with disabilities who are homeless children and their families .
     (3) A timely, comprehensive, multidisciplinary evaluation of the functioning of each infant or toddler
          with a disability in the State, and a family- directed identification of the needs of each family of
          such an infant or toddler, to assist appropriately assist in the development of the infant or toddler.
     (4) For each infant or toddler with a disability in the State, an individualized family service plan in
          accordance with section 636, including service coordination services in accordance with such
          service plan.


18
  20 U.S.C. §1435 (a)(16) Requirements for Statewide System.
(a) IN GENERAL.--A statewide system described in section 633 shall include, at a minimum, the following
components:
  (16) Policies and procedures to ensure that, consistent with section 636(d)(5)--
       (A) to the maximum extent appropriate, early intervention services are provided in natural
            environments; and
       (B) the provision of early intervention services for any infant or toddler with a disability occurs in a
            setting other than a natural environment that is most appropriate, as determined by the parent
            and the individualized family service plan team, only when early intervention cannot be
            achieved satisfactorily for the infant or toddler in a natural environment.

19
  20 U.S.C. § 1436 – Individualized Family Service Plan.
(a) ASSESSMENT AND PROGRAM DEVELOPMENT.--A statewide system described in section 633 shall
     provide, at a minimum, for each infant or toddler with a disability, and the infant‟s or toddler‟s family,
     to receive--
     (1) a multidisciplinary assessment of the unique strengths and needs of the infant or toddler and the
          identification of services appropriate to meet such needs;
     (2) a family- directed assessment of the resources, priorities, and concerns of the family and the
          identification of the supports and services necessary to enhance the family‟s capacity to meet the
          developmental needs of the infant or toddler; and
     (3) a written individualized family service plan developed by a multidisciplinary team, including the
          parents, as required by subsection (e), including a description of the appropriate transition
          services for the infant or toddler .
(b) PERIODIC REVIEW.--The individualized family service plan shall be evaluated once a year and the
     family shall be provided a review of the plan at 6- month intervals (or more often where appropriate
     based on infant or toddler and family needs).
(c) PROMPTNESS AFTER ASSESSMENT.--The individualized family service plan shall be developed
     within a reasonable time after the assessment required by subsection (a)(1) is completed. With the
     parents‟ consent, early intervention services may commence prior to the completion of the assessment.
(d) CONTENT OF PLAN.--The individualized family service plan shall be in writing and contain--
     (1) a statement of the infant‟s or toddler‟s present levels of physical development, cognitive
          development, communication development, social or emotional development, and adaptive
          development, based on objective criteria;
     (2) a statement of the family‟s resources, priorities, and concerns relating to enhancing the
          development of the family‟s infant or toddler with a disability;
     (3) a statement of the measurable results or outcomes expected to be achieved for the infant or toddler
          and the family, including pre-literacy and language skills, as developmentally appropriate for the
          child, and the criteria, procedures, and timelines used to determine the degree to which progress


                                                       22
         toward achieving the results or outcomes is being made and whether modifications or revisions of
         the results or outcomes or services are necessary;
    (4) a statement of specific early intervention services based on peer-reviewed research, to the extent
         practicable, necessary to meet the unique needs of the infant or toddler and the family, including
         the frequency, intensity, and method of delivering services;
    (5) a statement of the natural environments in which early intervention services will appropriately be
         provided, including a justification of the extent, if any, to which the services will not be provided
         in a natural environment;
    (6) the projected dates for initiation of services and the anticipated length, duration, and frequency of
         the services;
    (7) the identification of the service coordinator from the profession most immediately relevant to the
         infant‟s or toddler‟s or family‟s needs (or who is otherwise qualified to carry out all applicable
         responsibilities under this part) who will be responsible for the implementation of the plan and
         coordination with other agencies and persons, including transition services ; and
    (8) the steps to be taken to support the transition of the toddler with a disability to preschool or other
         appropriate services.
(e) PARENTAL CONSENT.--The contents of the individualized family service plan shall be fully explained
    to the parents and informed written consent from the parents shall be obtained prior to the provision of
    early intervention services described in such plan. If the parents do not provide consent with respect to
    a particular early intervention service, then only the early intervention services to which consent is
    obtained shall be provided.
20
  20 U.S.C. §1437 (a)(7) -– State Application and Assurances.
(a) APPLICATION.--A State desiring to receive a grant under § 633 shall submit an application to the
     Secretary at such time and in such manner as the Secretary may reasonably require. The application
     shall contain--
     (7 ) a description of the procedure used to ensure that resources are made available under this part for
          all geographic areas within the State;
21
  34 CFR § 303.12 - Early Intervention Services.
(a) General. As used in this part, early intervention services means services that--
     (1) Are designed to meet the developmental needs of each child eligible under this part and
     the needs of the family related to enhancing the child's development;
     (2) Are selected in collaboration with the parents;
     (3) Are provided--
         (i) Under public supervision;
         (ii) By qualified personnel, as defined in §303.21, including the types of personnel listed
         in paragraph (e) of this section;
         (iii) In conformity with an individualized family service plan; and
         (iv) At no cost, unless, subject to §303.520(b)(3), Federal or State law provides for a
         system of payments by families, including a schedule of sliding fees; and
     (4) Meet the standards of the State, including the requirements of this part.
(b) Natural environments. To the maximum extent appropriate to the needs of the child, early
intervention services must be provided in natural environments, including the home and
community settings in which children without disabilities participate.
(c) General role of service providers. To the extent appropriate, service providers in each area of
early intervention services included in paragraph (d) of this section are responsible for--
     (1) Consulting with parents, other service providers, and representatives of appropriate
     community agencies to ensure the effective provision of services in that area;
     (2) Training parents and others regarding the provision of those services; and
     (3) Participating in the multidisciplinary team's assessment of a child and the child's family,
     and in the development of integrated goals and outcomes for the individualized family service
     plan.
(d) Types of services; definitions. Following are types of services included under ``early
intervention services,'' and, if appropriate, definitions of those services:


                                                     23
(1) Assistive technology device means any item, piece of equipment, or product system,
whether acquired commercially off the shelf, modified, or customized, that is used to increase,
maintain, or improve the functional capabilities of children with disabilities. Assistive
technology service means a service that directly assists a child with a disability in the
selection, acquisition, or use of an assistive technology device. Assistive technology services
include--
    (i) The evaluation of the needs of a child with a disability, including a functional
    evaluation of the child in the child's customary environment;
    (ii) Purchasing, leasing, or otherwise providing for the acquisition of assistive technology
    devices by children with disabilities;
    (iii) Selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing,
    or replacing assistive technology devices;
     (iv) Coordinating and using other therapies, interventions, or services with assistive technology
     devices, such as those associated with existing education and rehabilitation plans and programs
    (v) Training or technical assistance for a child with disabilities or, if appropriate, that
    child's family; and
    (vi) Training or technical assistance for professionals (including individuals providing
    early intervention services) or other individuals who provide services to or are otherwise
    substantially involved in the major life functions of individuals with disabilities.
(2) Audiology includes--
    (i) Identification of children with auditory impairment, using at risk criteria and
    appropriate audiologic screening techniques;
    (ii) Determination of the range, nature, and degree of hearing loss and communication
    functions, by use of audiological evaluation procedures;
    (iii) Referral for medical and other services necessary for the habilitation or
    rehabilitation of children with auditory impairment;
    (iv) Provision of auditory training, aural rehabilitation, speech reading and listening
    device orientation and training, and other services;
    (v) Provision of services for prevention of hearing loss; and
    (vi) Determination of the child's need for individual amplification, including selecting,
    fitting, and dispensing appropriate listening and vibrotactile devices, and evaluating the
    effectiveness of those devices.
(3) Family training, counseling, and home visits means services provided, as appropriate, by
social workers, psychologists, and other qualified personnel to assist the family of a child
eligible under this part in understanding the special needs of the child and enhancing the
child's development.
(4) Health services (See §303.13).
(5) Medical services only for diagnostic or evaluation purposes means services provided by a
licensed physician to determine a child's developmental status and need for early intervention
services.
(6) Nursing services includes--
    (i) The assessment of health status for the purpose of providing nursing care, including
    the identification of patterns of human response to actual or potential health problems;
    (ii) Provision of nursing care to prevent health problems, restore or improve functioning,
    and promote optimal health and development; and
    (iii) Administration of medications, treatments, and regimens prescribed by a licensed
    physician.
(7) Nutrition services includes--
    (i) Conducting individual assessments in--
           (A) Nutritional history and dietary intake;
           (B) Anthropometric, biochemical, and clinical variables;
           (C) Feeding skills and feeding problems; and
           (D) Food habits and food preferences;




                                                24
    (ii) Developing and monitoring appropriate plans to address the nutritional needs of
    children eligible under this part, based on the findings in paragraph (d)(7)(i) of this
    section; and
    (iii) Making referrals to appropriate community resources to carry out nutrition goals.
(8) Occupational therapy includes services to address the functional needs of a child related to
adaptive development, adaptive behavior and play, and sensory, motor, and postural development.
These services are designed to improve the child's functional ability to perform tasks in home, school,
and community settings, and include--
    (i) Identification, assessment, and intervention;
    (ii) Adaptation of the environment, and selection, design, and fabrication of assistive and
    orthotic devices to facilitate development and promote the acquisition of functional skills;
    and
    (iii) Prevention or minimization of the impact of initial or future impairment, delay in
    development, or loss of functional ability.
(9) Physical therapy includes services to address the promotion of sensorimotor function
through enhancement of musculoskeletal status, neurobehavioral organization, perceptual
and motor development, cardiopulmonary status, and effective environmental adaptation.
These services include--
    (i) Screening, evaluation, and assessment of infants and toddlers to identify movement
    dysfunction;
    (ii) Obtaining, interpreting, and integrating information appropriate to program planning
    to prevent, alleviate, or compensate for movement dysfunction and related functional
    problems; and
    (iii) Providing individual and group services or treatment to prevent, alleviate, or
    compensate for movement dysfunction and related functional problems.
(10) Psychological services includes--
    (i) Administering psychological and developmental tests and other assessment
    procedures;
    (ii) Interpreting assessment results;
    (iii) Obtaining, integrating, and interpreting information about child behavior, and child
    and family conditions related to learning, mental health, and development; and
    (iv) Planning and managing a program of psychological services, including psychological
    counseling for children and parents, family counseling, consultation on child
    development, parent training, and education programs.
(11) Service coordination services means assistance and services provided by a service
coordinator to a child eligible under this part and the child's family that are in addition to the
functions and activities included under §303.23.
(12) Social work services includes--
    (i) Making home visits to evaluate a child's living conditions and patterns of parent-child
    interaction;
    (ii) Preparing a social or emotional developmental assessment of the child within the
    family context;
    (iii) Providing individual and family-group counseling with parents and other family
    members, and appropriate social skill-building activities with the child and parents;
    (iv) Working with those problems in a child's and family's living situation (home,
    community, and any center where early intervention services are provided) that affect the
    child's maximum utilization of early intervention services; and
    (v) Identifying, mobilizing, and coordinating community resources and services to enable
    the child and family to receive maximum benefit from early intervention services.
(13) Special instruction includes--
    (i) The design of learning environments and activities that promote the child's acquisition
    of skills in a variety of developmental areas, including cognitive processes and social
    interaction;




                                                25
         (ii) Curriculum planning, including the planned interaction of personnel, materials, and
         time and space, that leads to achieving the outcomes in the child's individualized family
         service plan;
         (iii) Providing families with information, skills, and support related to enhancing the skill
         development of the child; and
         (iv) Working with the child to enhance the child's development.
     (14) Speech-language pathology includes--
         (i) Identification of children with communicative or oropharyngeal disorders and delays
         in development of communication skills, including the diagnosis and appraisal of specific
         disorders and delays in those skills;
         (ii) Referral for medical or other professional services necessary for the habilitation or
         rehabilitation of children with communicative or oropharyngeal disorders and delays in
         development of communication skills; and
         (iii) Provision of services for the habilitation, rehabilitation, or prevention of
         communicative or oropharyngeal disorders and delays in development of communication
         skills.
     (15) Transportation and related costs includes the cost of travel (e.g., mileage, or travel by
     taxi, common carrier, or other means) and other costs (e.g., tolls and parking expenses) that
     are necessary to enable a child eligible under this part and the child's family to receive early
     intervention services.
     (16) Vision services means--
         (i) Evaluation and assessment of visual functioning, including the diagnosis and appraisal
         of specific visual disorders, delays, and abilities;
         (ii) Referral for medical or other professional services necessary for the habilitation or
         rehabilitation of visual functioning disorders, or both; and
         (iii) Communication skills training, orientation and mobility training for all environments,
         visual training, independent living skills training, and additional training necessary to
         activate visual motor abilities.
(e) Qualified personnel. Early intervention services must be provided by qualified personnel,
including--
     (1) Audiologists;
     (2) Family therapists;
     (3) Nurses;
     (4) Nutritionists;
     (5) Occupational therapists;
     (6) Orientation and mobility specialists;
     (7) Pediatricians and other physicians;
     (8) Physical therapists;
     (9) Psychologists;
     (10) Social workers;
     (11) Special educators; and
     (12) Speech and language pathologists.


22
     34 CFR § 303.344 Content of an IFSP.
          (a) Information about the child's status.
               (1) The IFSP must include a statement of the child's present levels of physical
               development (including vision, hearing, and health status), cognitive development,
               communication development, social or emotional development, and adaptive
               development.
               (2) The statement in paragraph (a)(1) of this section must be based on professionally
               acceptable objective criteria.
          (b) Family information. With the concurrence of the family, the IFSP must include a
          statement of the family's resources, priorities, and concerns related to enhancing the
          development of the child.


                                                      26
(c) Outcomes. The IFSP must include a statement of the major outcomes expected to be
achieved for the child and family, and the criteria, procedures, and timeliness used to
determine--
     (1) The degree to which progress toward achieving the outcomes is being made; and
     (2) Whether modifications or revisions of the outcomes or services are necessary.
(d) Early intervention services.
     (1) The IFSP must include a statement of the specific early intervention services
     necessary to meet the unique needs of the child and the family to achieve the
     outcomes identified in paragraph (c) of this section, including--
          (i) The frequency, intensity, and method of delivering the services;
          (ii) The natural environments, as described in §303.12(b), and §303.18 in which
          early intervention services will be provided, and a justification of the extent, if
          any, to which the services will not be provided in a natural environment;
          (iii) The location of the services; and
          (iv) The payment arrangements, if any.
     (2) As used in paragraph (d)(1)(i) of this section--
          (i) Frequency and intensity mean the number of days or sessions that a service will be
          provided, the length of time the service is provided during each session, and whether the
          service is provided on an individual or group basis; and
          (ii) Method means how a service is provided.
     (3) As used in paragraph (d)(1)(iii) of this section, location means the actual place
     or places where a service will be provided.
(e) Other services.
     (1) To the extent appropriate, the IFSP must include--
          (i) Medical and other services that the child needs, but that are not required
          under this part; and
          (ii) The funding sources to be used in paying for those services or the steps that
          will be taken to secure those services through public or private sources.
     (2) The requirement in paragraph (e)(1) of this section does not apply to routine
     medical services (e.g., immunizations and ``well-baby'' care), unless a child needs
     those services and the services are not otherwise available or being provided.
(f) Dates; duration of services. The IFSP must include--
     (1) The projected dates for initiation of the services in paragraph (d)(1) of this
     section as soon as possible after the IFSP meetings described in § 303.342; and
     (2) The anticipated duration of those services.
(g) Service coordinator.
      (1) The IFSP must include the name of the service coordinator from the profession
     most immediately relevant to the child's or family's needs (or who is otherwise
     qualified to carry out all applicable responsibilities under this part), who will be
     responsible for the implementation of the IFSP and coordination with other agencies
     and persons.
     (2) In meeting the requirements in paragraph (g)(1) of this section, the public agency
     may--
          (i) Assign the same service coordinator who was appointed at the time that the
          child was initially referred for evaluation to be responsible for implementing a
          child's and family's IFSP; or
          (ii) Appoint a new service coordinator.
     (3) As used in paragraph (g)(1) of this section, the term profession includes ``service
     coordination.''
(h) Transition from Part C services.
      (1) The IFSP must include the steps to be taken to support the transition of the child,
     in accordance with §303.148, to--
          (i) Preschool services under Part B of the Act, to the extent that those services
          are appropriate; or
          (ii) Other services that may be available, if appropriate.


                                            27
             (2) The steps required in paragraph (h)(1) of this section include--
                  (i) Discussions with, and training of, parents regarding future placements and
                  other matters related to the child's transition;
                  (ii) Procedures to prepare the child for changes in service delivery, including
                  steps to help the child adjust to, and function in, a new setting; and
                  (iii) With parental consent, the transmission of information about the child to the local
                  educational agency, to ensure continuity of services, including evaluation and assessment
                  information required in § 303.322, and copies of IFSPs that have been developed and
                  implemented in accordance with §§ 303.340 to 303.346.



23
    SoonerStart Policy 1414.0 Multidisciplinary Diagnostic Evaluation–Eligible Child (revised
6/20/05):
If the child is determined to be eligible for services, an assessment for individual program planning will be
completed.
24
  SoonerStart Policy 1416.0 Assessment for Individualized Family Service Plan – Purpose (revised
6/20/05): The purpose of the assessment for program planning is to gather information needed to write the
Individualized Family Service Plan (IFSP).
25
   Sooner Start Policy 1501.0 Written, Individualized Family Service Plan (revised 6/28/05)
The lead agency shall ensure that a written Individualized Family Service Plan (IFSP) will be developed
for each eligible child and family in accordance with P.L. 99-457, as amended by P.L. 108-446, Part C and
must:
• be developed jointly by the family and appropriate qualified personnel involved in the provision of early
intervention services;
• be based on the multidisciplinary evaluation and assessment of the child and the assessment of the child's
family;
• include services based on scientifically based research, to the extent practicable, necessary to enhance
the development of the child, including Indian infants and toddlers and their families residing on a
reservation geographically located in the State and infants and toddlers with disabilities who are homeless
children and their families, and infants and toddlers with disabilities who are wards of the state and the
capacity of the family to meet the special needs of the child;
• the contents of the Individualized Family Service Plan shall be fully explained to the parents and
informed written consent from the parents shall be obtained prior to the provision of early intervention
services described in such plan. If the parents do not provide consent with respect to a particular early
intervention service, then only the early intervention services to which consent is obtained shall be
provided; and
• in the event a dispute between agencies regarding development or implementation responsibility for
IFSPs, the State Department of Education, as lead agency, will resolve the dispute or assign responsibility.

In accordance with IDEA Part C requirements, the lead agency will ensure that:
• the IFSP is developed;
• service coordination services are available to each child and family;
• an IFSP is in effect and implemented for each eligible child and family; and
• the contents of the IFSP shall be fully explained to parents.




                                                     28

				
DOCUMENT INFO