Part C State Annual Performance Report (APR) for FFY 06/FFY 07

Overview of the Annual Performance Report Development:

Illinois' authorization system is centralized in the Cornerstone data system. The state subsequently pays all bills through its Central Billing Office. Each month a report is run based on the same logic used for the federal 618 setting report. This reflects where services are authorized, although the current data system does not always perfectly reflect the recommendations of IFSP teams.

In some cases, Individual Family Service Plans may call for services to be delivered in natural settings but authorizations reflect that services are actually being delivered in non-natural settings because no providers are available to deliver services off-site. This is a significant issue in only two areas of the state, Rockford and Peoria. While the current data system includes detail that shows what setting the IFSP team recommends, it is not stored in a way that can be queried. Planning has been underway for some time to replace the current system with one that will allow IFSP team recommendations to be queried.

The monthly predominate settings report provides both statewide and service coordination area (CFC) level data. This detail is reflected in the monthly statistical reports. The monthly reporting process was changed to mirror the new OSEP reporting requirements (i.e., to accommodate the change in federal settings reporting requirements that merged the two non-natural settings into a single group) effective January 2007. The performance contracting system grants incentive funding to the 12 CFCs (of 25) with the highest proportion of cases served predominately in natural settings at the end of each quarter. CFCs who served less than 85% of their cases in natural settings at the end of a quarter are penalized.

The state program has deemed 85% a minimum standard to demonstrate local compliance with state and federal rules regarding the delivery of services in natural settings. Natural settings performance also plays a part in determinations in two ways. It is one of the ten performance measures that factor into determining a CFCs average performance ranking and a receipt of a penalty, even if in just one quarter, is a mark against the CFC.

Because settings data is reported every month, it is constantly being evaluated by the program centrally and is an ongoing concern to all 25 CFCs. In addition, as outlined under Indicator 1, the program has implemented a more aggressive, standardized method of reporting service delay. Several elements were incorporated into this process that go beyond what is required by OSEP. One of these elements is to include information on services being delivered in a non-natural setting when the IFSP calls for a natural setting. This will provide both state and local leaders with a new tool to recruit providers willing to deliver services in natural settings in areas where that has been a significant and chronic problem.

Indicator 2: Percent of infants and toddlers with IFSPs who primarily receive early intervention services in the home or programs for typically developing children.

(20 U.S.C. 1416(a)(3)(A) and 1442)

Measurement: Percent = [(# of infants and toddlers with IFSPs who primarily receive early intervention services in the home or programs for typically developing children) divided by the (total # of infants and toddlers with IFSPs)] times 100.

FFY: 2006 (2006-2007)

Measurable and Rigorous Target: At least 87percent of all children with IFSPs active on June 30, 2007 will have their services provided predominately in the home or in community settings.

Actual Target Data for FFY 06/SFY 07:

FFY 06/SFY07 saw continued improvement in the proportion of children with IFSP services authorized predominately in natural settings, continuing steady progress over a number of years, although there was no additional progress between the October 31, 2006 619 reporting date and the end of the fiscal year, June 30, 2007. On December 1, 2005, 88.1% of open cases had services delivered predominately in natural settings. This improved to 89.26% as of October 31, 2006 (1,784-16,613)/16,613) =89.26%) but it was almost the same on June 30, 2007. [17,654-1908)/17,654x100= 89.19%] The program has taken additional steps it hopes will help address remaining issues.

All three of the larger geographic regions of the state improved between the 618 reporting periods. However, Cook County saw slippage between October 2006 and June 2007. There has been little progress in two of the largest CFCs, CFC 11/North Chicago and CFC 15/Joliet. At the end of June their caseloads represented 17.5% of the total number of IFSPs in the state. So, their lack of progress has muted the state's forward movement. The most consistent recent progress has been downstate and most of that progress resulted from improvement in the three areas that have consistently been below the state established 85% minimum compliance standard, Rockford, Peoria and Freeport.

CFC 1/Rockford improved from 73.5% on December 1, 2005 to 79.4% on June 30, 2007. Its problem is primarily a chronic shortage of providers willing to deliver services in natural settings. CFC 3/Freeport improved from 76.2% to 79.4%. Its problem is linked to a shortage of providers willing to deliver service in natural settings in some of its rural service area. CFC 14/Peoria, which has long faced the most serious problems, improved from 31.6% to 34.1%. It reported negligible problems in finding enough providers but continues to face resistance to the concept of natural settings.

As was discussed in detail under Indicator 1 - Service Delay, the EI Bureau implemented a new, more aggressive system for reporting service delays and has included reporting on service delivery problems beyond what is required for APR reporting. This includes reporting on instances where services are being delivered in a non-natural setting because no provider is available to deliver service in a natural setting and the number of hours needed. This allows the program to produce a cumulative number of hours a CFC, or a contiguous group of CFCs, is looking to fill for each service.

The inclusion of natural settings in the performance-contracting framework, as both a penalty and a reward, had some impact but guidance letters from the Bureau clarifying policy appear to have had the most impact. Overall, as of June 30, 2007, eight CFCs met or exceeded the federal 95% substantial compliance standard, 13 were under 95% but above the state establish minimum standard of 85%, and four were below 85%.

?Predominate Settings
History Dec. 1
2003
Nov. 30
2004
Jun. 30
2005
Nov. 30
2005
Jun. 30
2006
Oct. 31
2006
Jun. 30
2007
Developmental Centers 6.9% 3.9% 3.5% 2.8% 2.0% NA NA
Typically Developing 3.8% 4.4% 4.0% 4.0% 4.4% 4.2% 4.4%
Home 78.3% 77.9% 80.8% 83.8% 84.5% 85.1% 84.8%
Provider Location/Other * 11.0% 13.8% 11.6% 9.5% 9.2% 10.8% 10.8%
% in Natural Settings 82.1% 82.3% 84.8% 87.7% 88.8% 89.3% 89.2%
Client Count 13,140 15,318 16,361 16,175 16,799 16,613 17,654
Centers & Provider Locations 2,352 2,717 2,482 1,982 1,875 1,784 1,908

* Provider locations & developmental centers merged to meet new OSEP definitions.

618 Report Period: [ (16,613-1,784)/16,613] x 100 = 89.26% of IFSPs predominately in natural settings

CASES PREDOMINATELY IN NATURAL SETTINGSBY CFC & GEOGRAPHIC REGIONS
CFC & Number Dec-04 Jun-05 Dec-05 Jun-06 Oct-06 Jun-07
#1 CFC - ROCKFORD 60.8% 64.7% 73.5% 74.1% 78.1% 79.4%
#2 LAKE CHD - GRAND 91.4% 93.2% 93.8% 93.7% 95.8% 94.0%
#3 CFC - FREEPORT 77.6% 73.8% 76.2% 74.8% 75.6% 79.4%
#4 CFC - BATAVIA 73.4% 77.2% 85.8% 90.0% 89.8% 87.5%
#5 CFC - LOMBARD 86.6% 87.6% 90.6% 93.5% 93.9% 94.4%
#6 CFC - N. Suburbs 76.7% 83.3% 90.4% 92.4% 92.1% 92.0%
#7 CFC - W. Suburbs 81.3% 85.8% 89.4% 91.0% 92.4% 89.2%
#8 CFC - SW Chicago 91.1% 91.2% 94.8% 95.6% 97.5% 96.6%
#9 CFC - Central Chicago 83.2% 85.9% 86.9% 86.5% 85.3% 85.8%
#10 CFC - SE Chicago 89.5% 88.8% 89.4% 89.4% 87.4% 91.9%
#11 CFC - N. Chicago 84.4% 84.5% 87.4% 86.4% 87.5% 84.6%
#12 CFC - S. Suburbs 82.3% 87.8% 91.6% 92.1% 93.9% 93.0%
#13 CFC - MACOMB 94.8% 94.0% 96.2% 95.0% 96.5% 96.8%
#14 CFC - PEORIA 23.5% 27.2% 31.6% 29.3% 31.7% 34.1%
#15 CFC - JOLIET 84.2% 84.3% 84.5% 83.7% 81.0% 85.2%
#16 CFC - BLOOMINGTON 72.1% 73.6% 90.2% 90.2% 90.4% 91.4%
#17 CFC - QUINCY 97.2% 98.2% 97.2% 93.7% 94.0% 95.1%
#18 CFC - SPRINGFIELD 93.0% 93.3% 96.1% 95.8% 94.4% 94.3%
#19 CFC - DECATUR 94.0% 93.7% 93.7% 96.4% 95.4% 93.6%
#20 CFC - EFFINGHAM 97.3% 98.6% 99.7% 100.0% 99.2% 99.7%
#21 CFC - METRO E. ST. LOUIS 92.5% 94.0% 95.0% 94.8% 95.3% 98.4%
#22 CFC - CENTRALIA 97.5% 97.8% 97.5% 98.5% 99.1% 99.4%
#23 CFC - NORRIS CITY 99.5% 99.6% 99.5% 100.0% 100.0% 100.0%
#24 CFC - CARBONDALE 100.0% 100.0% 99.3% 98.7% 99.3% 98.6%
#25 CFC - MCHENRY 81.1% 80.0% 86.8% 91.9% 95.6% 92.2%
TOTAL 83.1% 84.8% 88.1% 88.8% 89.2% 89.2%
COOK COUNTY 83.6% 86.3% 89.6% 90.0% 90.5% 89.6%
COLLAR COUNTIES 83.9% 85.3% 88.2% 89.8% 89.9% 90.3%
DOWNSTATE 81.6% 82.4% 85.8% 86.2% 86.6% 87.6%

NOTE: Bolded cells = below 85% state established minimum standard, Shaded cells = below federal 95% substantial compliance standard, Black cells = Above federal 95% substantial compliance standard

Discussion of Improvement Activities Completed and Explanation of Progress or Slippage that occurred for FFY 06/SFY 07:

The increase in the percentage of children with open IFSPs who are served predominately in natural settings exceeded the established goal of at least 87%. The following steps contributed to this progress:

  • The program's continued and consistent message about the meaning of state and federal rules regarding the preference for the delivery of services in natural settings.
  • The program's continued and consistent message about the definition of what constitutes natural settings.
  • Consistent training on natural settings and what is necessary to document ANY services delivered in other than natural settings.
  • Reinforcement of the memos to field staff (CFCs) and to providers on the meaning and importance of natural settings and how rules should be implemented.
  • Continued inclusion of a natural settings performance element in the CFC performance contracting system, providing incentive funding to the 12 CFCs with the highest level of IFSPs authorized predominately in natural settings at the end of each quarter.
  • Enforcement of a performance contracting penalty on any CFC with less than 85% of IFSPs authorized predominately in natural settings at the end of each quarter.

Revisions, with Justification, to Proposed Targets / Improvement Activities / Timelines / Resources for SFY08/FFY07

A new activity was implemented starting in January 2007 that the program anticipates will help foster improvement, particularly in areas with the greatest problems identifying providers to deliver services in natural settings. The new, more robust system of reporting and tracking service delays goes beyond the kinds of delays that must be reported to OSEP. It includes all types of problems that result in a CFC being unable to deliver services exactly in the manner set out in a child's IFSP. This includes situations where the IFSP indicates services should be delivered in a natural setting but they are being delivered in a non-natural setting because no provider can be found to deliver services in the home or community. This new system should provide an important new tool for recruitment and it incorporates this kind of problem for the first time.

Among the tasks for the Illinois Interagency Council on Early Intervention's workgroup on service delay will be consideration of settings data and how to respond where issues remain.