Early Intervention Services In Natural Environments
Indicator 1: Percent of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner.
(20 U.S.C. 1416(a)(3)(A) and 1442)
Percent = [(# of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner) divided by the (total # of infants and toddlers with IFSPs)] times 100.Account for untimely receipt of services.
Measurable and Rigorous Target:
100 percent of infants and toddlers with IFSPs will receive the early intervention services on their IFSP within 30 days.
Actual Target Data for FFY08/SFY09:
[# of infants and toddlers with IFSPs who receive the early intervention services on their IFSPs in a timely manner/(total number infants and toddlers with IFSP - IFSPs delayed for family reasons)] X 100FFY08/SFY09: [17,629/(18,883-195)] X 100 = 94.3%FFY08/SFY09 Target = 100%
The month of April data from the service delay reporting system is used for this report. A delay is identified whenever a child waits more than 30 days to receive Early Intervention services on his/her IFSP. Experience shows that service delay varies seasonally. It is low in the first seven or eight months of the federal/state fiscal year then grows in sync with the annual spring jump in the caseload. April has been selected as a representative time period, as it is in the middle of the normal caseload rebound period.
The table below shows performance for the state and for each of the state's 25 CFC offices in April 2009, followed by statewide performance for April 2009. It calculates performance both including and excluding delays for family reasons. Statewide, 94.33% of children with IFSPs were experiencing no delays at the end April 2009, excluding family delays. Sixteen CFC offices had at least 95% of their cases with no delays with two of these CFC offices showing no delays. However, nine CFC offices had less than 95% of their open cases with no delays.
Service Delays - All Cases Open in April 2009
Calculations shown are including & excluding Family Delays
No Delay Excluding Family Delays: (18,688-1,059)/18,688 = 94.33%
No Delay Including Family Delays: 17,629/18,883 = 93.36%
|CFC # & Name
|#1 - ROCKFORD
|#2 - LAKE CO.
|#3 - FREEPORT
|#4 - KANE-KENDALL
|#6 - N SUBURBS
|#7 - W SUBURBS
|#8 - SW CHICAGO
|#9 - CENTRAL CHICAGO
|#10 - SE CHICAGO
|#11 - N CHICAGO
|#12 - S SUBURBS
|#13 - MACOMB
|#14 - PEORIA
|#15 - JOLIET
|#16 - BLOOMINGTON
|#17 - QUINCY
|#18 - SPRINGFIELD
|#19 - DECATUR
|#20 - EFFINGHAM
|#21 - BELLEVILLE
|#22 - CENTRALIA
|#23 - NORRIS CITY
|#24 - CARBONDALE
|#25 - MCHENRY CO.
Discussion of Improvement Activities Completed and Explanation of Progress or Slippage that occurred for FFY08/SFY09:
Progress or Slippage for Indicator 1: Overall, the percentage of children who receive early intervention services on their IFSPs in a timely manner, excluding delays for family reasons, dropped from 95.31% in FFY07/FSY08 to 94.33% in FFY08/SFY09. In FFY08/SFY09, 16 CFC offices that had more than 95% of open cases with no delays, which is the same number as in FFY07/SFY08. The number of open cases with no delays dropped from 5 to 2 over the same time period. In FFY07/SFY08, all 9 CFC offices that had less than 95% of their open cases with no delays were located north of Interstate 80, which runs just south of Chicago. In FFY08/ SFY09, the 9 CFC offices with less than 95% of their open cases with no delays shifted to include 2 CFCs located in central and southern Illinois.
When looking at regions of the state, some improvement is seen in Cook County CFC office areas (from 94.90% to 95.22%), while the largest drop is seen in the downstate CFC office areas (from 97.40% to 94.86%). The greatest change in "downstate" areas is seen in CFC #1/Rockford (from 95.2% to 77.9%). Service delays have been a chronic problem in the area around Rockford (CFC #1 and CFC #3), accounting for 72.6% of the downstate service delays.
Service delays are impacted by a number of factors.
- Caseload growth
- Competitive environment for limited number of available providers, particularly in urban areas where multiple job opportunities are available.
- Lack of coverage in sparsely populated rural areas and in urban areas with high crime rates
- Lack of providers willing to provide services in natural environments
- Low reimbursement rates, when compared to other systems of care
- Payment delays
Illinois' financial situation has resulted in delays in payments to Early Intervention service providers. This situation worsened in FFY08/SFY09 and resulted in a more statewide problem with recruitment and retention of active service providers in the system. While delays are reported here with family delays removed from the calculations, the program generally treats all delays as problems that need to be looked into and addressed.
In FFY07/SFY08, 31 findings of noncompliance were identified for Indicator 1, with all findings of noncompliance corrected within one year. CFC offices submit a monthly Service Delay Report. This report includes a status code and date the delay was resolved. April 2007 and April 2008 data were used to identify findings that were reported to CFC offices in FFY07/SFY08. (See Indicator 9, Findings/Correction of Noncompliance Using Data System, for more information on the notification process.) For CFC offices with findings, reports that demonstrate implementation of corrective action plans and outcomes to those strategies were submitted. All the reports were received and reviewed and it was determined that all findings of noncompliance were corrected. Child-specific information was used to determine the status of all instances of noncompliance and their correction. Child specific data were accessed through the Service Delay Reporting system, the Cornerstone system, and file reviews. All instances of noncompliance were resolved for reasons that include the following: data entry error, service provided, family declined service, and child no longer in system,
- Discussion with CFC offices and an upgrade to the service delay reporting system, which went into effect in January 2007, have led to more accurate and uniform reporting, improving the program's ability to identify and respond to service delays. Service delays for family reasons can be identified with the new reporting system. The new system also allows the program to identify shortages of service and instances where service is being delivered in non-natural settings because no provider is available to provide service in a natural setting. This allows the program to compile a total shortfall calculation that can be translated into FTEs from the Zip code level all the way up to statewide summary reports.
- An item has been added to monthly statistical reporting to highlight service delays by CFC office. This item has also been added to the statistical report which is posted monthly on the DHS website and to the statistical report that is provided to the IICEI.
- Findings are reported to each CFC office for all children exiting Part C who did not receive timely services, based upon 12-month data. Corrective action plans to address noncompliance policies, procedures, and practices are required to be written and implemented for any finding of non-compliance, with full compliance documented within one year. Corrective action plans are reviewed to help identify statewide corrective action steps.
- Service delays are considered in setting determination scorecards if an agency fails to submit a credible corrective action plan for addressing service delays, fails to make adequate progress in service delay plans, or fails to implement major features of service delay plans.
- See a description of the IICEI Service Delay Workgroup, which is inclusive of the Northwest Illinois Service Delay subgroup provided under Overview of the Annual Performance Report Development, above. This group, in conjunction with the Bureau and the Illinois Early Intervention Training Program is working on recommendations and training strategies that will impact the level of service delay in the system, with initial efforts focused on northwestern Illinois. Membership of the Service Delay Workgroup was expanded to include representation from professional organizations (provider groups).
- On January 5, 2009, an interactive forum was held in Rockford including representation from the IICEI and its Workgroups, the Bureau, professional associations, and the local provider community to look at various service delivery models.
- The IICEI receives regular reports from the Service Delay Workgroup, makes decisions on Workgroup recommendations, and advises the Department based upon these recommendations.
- The Early Intervention Central Billing Offices has added free Insurance Billing Services for providers participating in the program. This Insurance Billing Service is specifically designed to bill primary insurance companies on behalf of the provider free of charge for new client referrals. This service will help retain small providers that consider the mandatory insurance billing requirement a burden.
Revisions, with Justification, to Proposed Targets / Improvement Activities / Timelines / Resources for FFY09/SFY10:
The improvement activities described above are ongoing efforts. The following are new improvement activities to be implemented in FFY09/SFY10.
- In FFY09/SFY10, expand Program Integrity Pilot to include three additional targeted CFC areas.
- Effective February 15, 2010, a system ombudsman position will be added to the Early Intervention Training Program to support the Program Integrity Project.
- In FFY09/SFY10, the program will work with the IICEI and its Service Delay Work Group to finalize recommendations regarding an Integrated Team Approach and pilot this strategy in a target area.