Indicator 7: Percent of eligible infants and toddlers with IFSPs for whom an evaluation and assessment and an initial IFSP meeting were conducted within Part C's 45-day timeline.

Helping Families. Supporting Communities. Empowering Individuals.

Illinois Department of Human Services
Division of Community Health & Prevention
Bureau of Early Intervention

Revised on 02/01/07
Second Revision on 02/01/08
Third Revision on 02/02/09
Fourth Revision on 02/01/10

Percent of eligible infants and toddlers with IFSPs for whom an evaluation and assessment and an initial IFSP meeting were conducted within Part C's 45-day timeline.


Part C State Performance Plan (SPP) for 2005-2010

Overview of the State Performance Plan Development:

See Indicator 1 for a description of this process.

Since January 2002 Illinois' EI program has placed a great deal of emphasis on compliance with the 45-day rule. It has been very open about its performance and the need to improve, not just to comply with state and federal law but as a matter of good customer service. The issue and how to deal with it has been discussed openly with Child and Family Connections agencies and the IICEI at almost every meeting since that time. A series of measures intended to improve compliance with the 45-day rule were put in place as part of the programs performance contracting system and quarterly reports to the Illinois General Assembly, which are posted to the DHS website, have included reports on progress and performance. The additional steps outlined below have been discussed publicly with the IICEI and CFCs.

(The following items are to be completed for each monitoring priority/indicator.)

Monitoring Priority: Effective General Supervision Part C / Child Find

Indicator 7:
Percent of eligible infants and toddlers with IFSPs for whom an evaluation and assessment and an initial IFSP meeting were conducted within Part C's 45-day timeline.
(20 U.S.C. 1416(a)(3)(B) and 1442)

Measurement:
Percent = [(# of infants and toddlers with IFSPs for whom an evaluation and assessment and an initial IFSP meeting was conducted within Part C's 45-day timeline) divided by the (# of infants and toddlers with IFSPs evaluated and assessed for whom an initial IFSP meeting was required to be conducted)] times 100.

Account for untimely evaluations.

Overview of Issue/Description of System or Process:

Although Illinois has yet to achieve complete compliance with the requirement that initial IFSPs meetings be held within 45 days, it has been successful in dramatically and continuously improving performance. The participants in the IFSP meeting determine the content of the IFSP.

State rules have always clearly stated that the intake process must be completed within 45 days. CFCs must provide the program with details on every child who spends more than 45 days in intake each month. This detail includes if the problem is due to a system or family reason. That can be a burdensome task if they have to explain large numbers of cases. However, when the program first launched its monthly statistical reports in January 2002, a review found that compliance had not only been poor in the past but was in freefall. Compliance had fallen sharply and had reached a statewide low of 18.1% in January 2002. It was practically zero in some areas. The new statistical report put particular emphasis on meeting the 45-day requirement. The program noted not only that this was federal and state law but also the importance of reaching EI eligible children quickly, to most effectively address the issues that made them eligible and that providing quick answers to families is good customer service.

When performance contracting was introduced for SFY 03/FFY 02, it granted quarterly incentive funding to the best performing agencies in terms of both the percent of IFSPs initiated within 45 days and for those with the lowest proportions of cases in intake for more than 45 days. The program also set standards above which a CFC would be penalized if too much of their intake was still waiting for eligibility determination after 45 days. This combination of steps had a profound impact on performance. There was rapid improvement until February 2003, when it reached 86.3%. There has slow but continued steady improvement since that time.

Another aspect of the performance contracting system that promoted both child find and quick eligibility determination was the method for determining agencies' quarterly base payments. The previous grant system was based on estimated caseload levels, which made no distinction between cases in intake and children with IFSPs. This created a disincentive to quick action and even an incentive to keep ineligible cases open in intake well past 45 days. The new system is a modified fee-for-service system. CFCs are paid based on the average number of children with IFSPs they served over a six-month period. The rates paid were adjusted to account for the intake and referral process but cases in intake are no longer included directly in payment calculations. This created an incentive for CFCs to do aggressive child find and to determine eligibility quickly. One by one, CFCs have found ways to process referrals efficiently with techniques suited to their regions. Of particular importance has been the introduction of arena assessments in Cook County and some other large urban areas. This allows a family to receive all their evaluations and assessments at one time, rather than needing to arrange multiple appointments. The IFSP meeting can also be completed at the same time because everyone is already there. Sometimes this is done at a single site. In other instances a team of evaluators goes to a family's home.

By early in SFY 05/FFY 04, the number of cases in intake over 45 days, which had once exceeded 1,500 had fallen to under 100 on a regular basis and a portion of those were not real cases. They were caused by data errors but we could not easily identify those until the total number for each CFC fell to single digits. To assist CFCs in more quickly addressing these cases a new report was developed to specifically identify all cases over 45 days in intake on the last day of the month. CFCs are to address the problems before the next month or contact the program if they believe the system is in error or if they need help. This has helped produced continued improvement. The number of cases past 75 days in intake has almost completely been eliminated and the total number of overdue cases has fallen even lower.

Baseline Data for FFY 2004 (2004-2005):

IFSPs Completed Within 45-Days
By CFC & Region

SFY 04 SFY 05
CFC & Number
#1 CFC - ROCKFORD 89.5% 95.7%
#2 LAKE CHD - GRAND 91.7% 97.7%
#3 CFC - FREEPORT 85.0% 90.4%
#4 CFC - BATAVIA 85.1% 93.5%
#5 CFC - LOMBARD 97.2% 99.2%
#6 CFC - N. Suburbs 96.2% 97.4%
#7 CFC - W. Suburbs 94.4% 97.7%
#8 CFC - SW Chicago 100.0% 100.0%
#9 CFC - Central Chicago 100.0% 99.7%
#10 CFC - SE Chicago 98.3% 98.4%
#11 CFC - N. Chicago 90.7% 92.5%
#12 CFC - S. Suburbs 89.0% 98.2%
#13 CFC - MACOMB 89.6% 92.0%
#14 CFC - PEORIA 77.7% 90.1%
#15 CFC - JOLIET 76.1% 92.7%
#16 CFC - BLOOMINGTON 76.4% 76.6%
#17 CFC - QUINCY 90.8% 93.8%
#18 CFC - SPRINGFIELD 89.7% 93.2%
#19 CFC - DECATUR 100.0% 100.0%
#20 CFC - EFFINGHAM 95.6% 98.0%
#21 CFC - BELLEVILLE 88.6% 91.1%
#22 CFC - CENTRALIA 93.4% 95.7%
#23 CFC - NORRIS CITY 86.4% 87.0%
#24 CFC - CARBONDALE 96.3% 90.4%
#25 CFC - MCHENRY 92.1% 94.9%
Total 90.9% 95.0%
Super Regions
Cook - 6, 7, 8, 9, 10, 11 & 12 94.6% 97.0%
Collar - 2, 25, 4, 5, 15 88.1% 95.7%
Balance of the State 88.2% 91.3%

Illinois Early Intervention Program Monthly 45-Day Compliance

Illinois Early Intervention Program Monthly 45-Day Compliance

Description of Illinois Early Intervention Program Monthly 45-Day Compliance

Date Percent
Jul-01 31.9%
Aug-01 28.3%
Sep-01 25.7%
Oct-01 24.4%
Nov-01 23.8%
Dec-01 24.2%
Jan-02 18.1%
Feb-02 32.5%
Mar-02 33.4%
Apr-02 36.2%
May-02 49.1%
Jun-02 52.1%
Jul-02 50.8%
Aug-02 65.3%
Sep-02 74.1%
Oct-02 79.1%
Nov-02 80.0%
Dec-02 82.3%
Jan-03 74.9%
Feb-03 86.3%
Mar-03 86.2%
Apr-03 87.6%
May-03 85.7%
Jun-03 88.7%
Jul-03 86.3%
Aug-03 91.0%
Sep-03 89.4%
Oct-03 92.5%
Nov-03 91.5%
Dec-03 89.8%
Jan-04 87.4%
Feb-04 91.3%
Mar-04 92.0%
Apr-04 91.3%
May-04 91.2%
Jun-04 91.7%
Jul-04 90.7%
Aug-04 94.6%
Sep-04 94.7%
Oct-04 94.2%
Nov-04 94.2%
Dec-04 93.4%
Jan-05 93.5%
Feb-05 95.8%
Mar-05 96.5%
Apr-05 96.5%
May-05 96.6%
Jun-05 96.7%

Illinois EI Program 45-Day Compliance - 6 Month Moving Average

Illinois EI Program 45-Day Compliance - 6 Month Moving Average

Description of Illinois EI Program 45-Day Compliance - 6 Month Moving Average

Date Percent
Dec-01 26.4%
Jan-02 24.1%
Feb-02 24.8%
Mar-02 26.1%
Apr-02 28.0%
May-02 32.3%
Jun-02 36.9%
Jul-02 42.4%
Aug-02 47.8%
Sep-02 54.6%
Oct-02 61.8%
Nov-02 66.9%
Dec-02 71.9%
Jan-03 76.0%
Feb-03 79.5%
Mar-03 81.5%
Apr-03 82.9%
May-03 83.8%
Jun-03 84.9%
Jul-03 86.8%
Aug-03 87.6%
Sep-03 88.1%
Oct-03 88.9%
Nov-03 89.9%
Dec-03 90.1%
Jan-04 90.2%
Feb-04 90.3%
Mar-04 90.7%
Apr-04 90.5%
May-04 90.5%
Jun-04 90.8%
Jul-04 91.4%
Aug-04 91.9%
Sep-04 92.4%
Oct-04 92.9%
Nov-04 93.4%
Dec-04 93.6%
Jan-05 94.1%
Feb-05 94.3%
Mar-05 94.6%
Apr-05 95.0%
May-05 95.4%
Jun-05 95.9%

Illinois Early Intervention Program
Intake Overdue Analysis - SFY 04 & SFY 05

Month Intake Past
45 Days
Past
75 Days
System
Overdue
Past
45 Days
Past
75 Days
All Intake
System
Overdue
Past 45 Days
System
Overdue
SFY 2004
Jul-03 2,005 108 17 6 5.4% 0.8% 0.3% 5.6%
Aug-03 2,064 108 30 2 5.2% 1.5% 0.1% 1.9%
Sep-03 2,319 112 25 1 4.8% 1.1% 0.0% 0.9%
Oct-03 2,368 84 17 4 3.5% 0.7% 0.2% 4.8%
Nov-03 2,071 96 13 2 4.6% 0.6% 0.1% 2.1%
Dec-03 1,709 108 17 5 6.3% 1.0% 0.3% 4.6%
Jan-04 2,337 121 24 5 5.2% 1.0% 0.2% 4.1%
Feb-04 2,611 92 11 - 3.5% 0.4% 0.0% 0.0%
Mar-04 2,729 114 18 2 4.2% 0.7% 0.1% 1.8%
Apr-04 2,655 123 17 1 4.6% 0.6% 0.0% 0.8%
May-04 2,396 134 30 2 5.6% 1.3% 0.1% 1.5%
Jun-04 2,171 136 42 - 6.3% 1.9% 0.0% 0.0%
FY04 AVG. 2,286 111 22 2.5 4.9% 1.0% 0.1% 2.2%
SFY 2005
Jul-04 2,080 98 23 2 4.7% 1.1% 0.1% 2.0%
Aug-04 2,095 97 20 5 4.6% 1.0% 0.2% 5.2%
Sep-04 2,252 81 24 5 3.6% 1.1% 0.2% 6.2%
Oct-04 2,375 125 23 9 5.3% 1.0% 0.4% 7.2%
Nov-04 2,179 90 21 1 4.1% 1.0% 0.0% 1.1%
Dec-04 1,986 94 18 1 4.7% 0.9% 0.1% 1.1%
Jan-05 2,435 94 13 1 3.9% 0.5% 0.0% 1.1%
Feb-05 2,662 61 6 1 2.3% 0.2% 0.0% 1.6%
Mar-05 2,619 49 6 - 1.9% 0.2% 0.0% 0.0%
Apr-05 2,639 45 5 5 1.7% 0.2% 0.2% 11.1%
May-05 2,530 53 2 6 2.1% 0.1% 0.2% 11.3%
Jun-05 2,351 56 1 1 2.4% 0.0% 0.0% 1.8%
FY05 AVG. 2,350 79 14 3.1 3.3% 0.6% 0.1% 3.9%

Discussion of Baseline Data:

In SFY 02/FFY 01, the proportion of new IFSPs completed within 45 days dropped sharply to just 33.5%. This included reaching a low of 18.1% in January 2002. After implementation of the steps outline previously in late SFY 02/FFY 01 and early SFY 03/FFY 02, there was a substantial improvement in SFY 03 to 79.4%. There was further improvement in SFY 04/FFY 03 to 90.9% and to 95.0% for the baseline period, SFY 05/FFY 04. In SFY 04, 11 CFCs failed to complete at least 90% of initial IFSPs within 45 days. Since the beginning of SFY 05, 19 CFCs completed all of their IFSPs within 45 days in at least one month. The CFCs for Decatur (CFC 19) and Southwest Chicago (CFC 8) completed 100% of their IFSPs within 45 days for all of SFY 05/FFY 04. CFC 9 (Central-West Chicago) failed for only one of 748 new cases opened in SFY 05/FFY 04. Only Bloomington/Champaign (CFC 16) and Norris City (CFC 23), in far southeastern Illinois, failed to complete at least 90% within 45 days.

Based on the performance for both SFY 04/FFY 03 and SFY 05/FFY 04, it appears on the surface that CFC 16's performance was unchanged in SFY 05/FFY 04. However, they experienced a difficult transition to a new lead agency in SFY 05/FFY 04. This was mainly due to an almost complete turnover in Service Coordinators. However, they have improved significantly. In the most recent six-month period they completed 91.7% of IFSPs within 45 days. CFC 23, located in the far southeast corner of Illinois, is completely rural and is not close to any large urban areas. With no large pockets of clients, their problem is effectively coordinating the evaluation process with scattered and limited resources, although, their delays have almost universally been for family reasons.

Although Illinois has yet to complete a month with 100% of IFSPs started within 45 days, it now commonly completes 95% or more on-time and the moving average chart shows that we continue to make progress towards complete elimination of the problem. We do find that there is some seasonality in the proportion of cases who do not complete the eligibility process within 45 days. As with several other EI performance issues, summer and the holidays present problems keeping families engaged in the process.

Of greater significance are geographic differences. The best performance is in Cook County, where all CFCs can utilize arena assessment. The collar counties have traditionally had the greatest problem. However, since Joliet (CFC 15) implemented arena assessment in their core area, the collar counties have been performing almost as well as Cook County. The remaining problems are increasingly concentrated downstate. We already reviewed the problems of CFCs 16 and 23. As noted, CFC 16 has not resolved all its problems but they have reduced them significantly.

However, CFC 23 represents a better example of the problems the program will need to address to achieve 100% compliance with the 45-day rule. First, almost no downstate CFC has a large enough concentration of intake to regularly offer arena assessment. This means they generally have to arrange multiple meetings with a family to determine eligibility. Second, the number of providers eligible to do assessments in rural areas is always small and they must travel significant distances to complete their work. Third, getting everyone together for IFSP meetings is more of a challenge when providers will again need to travel to a home or to another set location. In general, the need to travel is a drain on limited resources in rural areas. The program does work to attract additional providers to these areas. This affords us wider and overlapping coverage to facilitate ease of scheduling. However, in the most rural areas we can only promise part-time work. That complicates the achievement of our goal.

The process put in place by the Illinois EI program and its service coordination agencies has dramatically reduced the number of cases that go past 45 days in intake and we continue to see progress in that area. We have almost completely eliminated cases that appear on overdue reports two months in a row (past 75-days). However, the largest challenge to 100% compliance with the 45-day rule is that almost all remaining cases are overdue for family reasons. During SFY 05, Illinois averaged 2,350 cases in intake and an average of 79, or 3.3%, were past 45 days. An average of just 3.9% of the overdue cases were due to system reasons, usually provider delays. This means that 96.1% of the remaining problems are due to family issues. Put another way, on average statewide just 0.1% of cases open in intake at any point in time are past 45 days for system reasons.

Although some states make a distinction between cases overdue for system reasons and those overdue for family reasons, Illinois does not make such a distinction in its monthly and quarterly reporting. This is because we are concerned that exempting cases overdue for family reasons reduces the incentive for service coordination agencies to keep working closely with families and kids are the losers. The number of cases overdue for system reasons does not exactly match the number of IFSPs that did not get started within 45 days but it is close. If we did exempt cases overdue for system the proportion of initial IFSPs stated within 45 days would have been about 99.8% in both SFY 04 and SFY 05. In some months we are already seeing no initial IFSPs that took more than 45 days due to system reasons.

FFY: 2005 (2005-2006)
Measurable and Rigorous Target: 100% of eligible infants and toddlers with IFSPs will have evaluations and assessments and an initial IFSP meeting within 45 days of referral.

FFY: 2006 (2006-2007) 
Measurable and Rigorous Target: 100% of eligible infants and toddlers with IFSPs will have evaluations and assessments and an initial IFSP meeting within 45 days of referral.

FFY: 2007 (2007-2008) 
Measurable and Rigorous Target: 100% of eligible infants and toddlers with IFSPs will have evaluations and assessments and an initial IFSP meeting within 45 days of referral.

FFY: 2008 (2008-2009) 
Measurable and Rigorous Target: 100% of eligible infants and toddlers with IFSPs will have evaluations and assessments and an initial IFSP meeting within 45 days of referral.

FFY: 2009 (2009-2010) 
Measurable and Rigorous Target: 100% of eligible infants and toddlers with IFSPs will have evaluations and assessments and an initial IFSP meeting within 45 days of referral.

FFY: 2010 (2010-2011) 
Measurable and Rigorous Target: 100% of eligible infants and toddlers with IFSPs will have evaluations and assessments and an initial IFSP meeting within 45 days of referral.

Improvement Activities/Timelines/Resources:

  • Procedures will be maintained that require all steps in the eligibility determination process be completed within 45 days.
  • CFCs shall continue to be required to submit the names of all cases which go past 45 days in intake during the previous month and the reasons for those delays.
  • The program shall continue to report on 45-day compliance by CFC in monthly reports in several different ways, including: 1) % of intake over 45 days, 2) % of intake over 75 days, 3) average days between referral and initial IFSP date for new IFSPs, 4) % of new IFSPs initiated within 45 days of referral.
  • The program shall post annually on its internet site performance of CFCs on: 1) average days to IFSP and 2) the % of IFSPs started within 45 days.
  • The program shall pay quarterly incentives to the CFCs which perform the best in terms of: 1) average time between referral and initial IFSP and 2) the % of IFSPs started within 45 days.
  • If more than 12 CFCs complete all of their IFSPs within 45 days for the six-month period on which quarterly payments are based, all CFCs who meet that standard will receive incentive funding.
  • For SFY 06, a 1% reduction will be made to the quarterly base payment if the proportion of cases in intake over 45 days exceeds 10% over the most recently completed quarter and a 2% reduction will be assessed if the percent over 45 days exceeds 20%.
  • For SFY 07, a 1% reduction will be made to the quarterly base payment if the proportion of cases in intake over 45 days exceeds 7.5% over the most recently completed quarter. A 2% reduction will be assessed if the percent over 45 days exceeds 15%.
  • For SFY 08 and beyond, a 1% reduction will be made to the quarterly base payment if the proportion of cases in intake over 45 days exceeds 5% over the most recently completed quarter. A 2% reduction will be assessed if the percent over 45 days exceeds 10%.
  • Quarterly CFC base grants are calculated based on the average number of open IFSPs over a six-month period. Effective with SFY 07, any instance where an IFSP was initiated in more than 45 days will be subtracted from the case count for that month, which will reduce the CFCs grant for the next two quarters.
  • By March 2006, a new data element will be added to the client data system (Cornerstone) to indicate why it took more than 45 days to initiate an IFSP as follows: 1) Within 45 days, 2) CFC reason, 3) Provider reason, 4) Family reason. This will allow the program to know exactly which cases opened past 45 days did so for system reasons, rather than estimating based on data from intake past 45 days.