Overview of the Annual Performance Report Development:

Monitoring Priority:

Effective General Supervision Part C / Effective Transition

Indicator 2:
Percent of infants and toddlers with IFSPs who primarily receive early intervention services in the home or community-based settings.

(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 community-based settings) divided by the (total # of infants and toddlers with IFSPs)] times 100.

FFY: FFY08/SFY09

Measurable and Rigorous Target:
At least 89.0% of all children with IFSPs active on June 30, 2009 will have their services provided predominately in the home or in community settings.

Actual Target Data for FFY08/SFY09:

Indicator 2
(# of infants and toddlers with IFSPs who primarily receive early intervention services in the home or community-based settings/total # of infants and toddlers with IFSPs) X 100
FFY08/SFY09 Result: (17,308/18,772) X 100 = 92.2%
FFY08/SFY09 Target = 89.0%

Predominate Settings History

Oct. 31
2006
Jun. 30
2007
Oct. 31
2007
Jun. 30
2008
Oct. 31
2008
Jun. 30
2009
Oct. 31
2009
Typically Developing 4.2% 4.4% 4.6% 4.4% 4.2% 4.7% 5.0%
Home 85.1% 84.8% 84.9% 85.5% 88.1% 87.5% 87.9%
Provider Location/Other * 10.8% 10.8% 10.5% 10.1% 7.8% 7.8% 7.1%
% Natural Settings 89.3% 89.2% 89.5% 89.9% 92.2% 92.2% 92.9%
Client Count 16,613 17,654 17,486 18,467 18,535 18,772 18,266
Centers & Provider Locations 1,784 1,908 1,841 1,860 1,439 1,464 1,306

Illinois authorization system is centralized in the Cornerstone data system. Each month a report on services provided predominately in the home or in community settings is run based on the same logic used for the federal 618 setting report and reflects where services are authorized. The IFSP must include a justification when services are authorized in a non-natural setting, along with a plan to transition to a natural setting, when available. The data for compliance with Indicator 2 is determined using the June-09 data from the following chart. FFY08/SFY09 data demonstrated continued improvement in the proportion of children with IFSP serviced authorized predominately in natural settings.

Cases Predominately in Natural Settings
By CFC & Geographic Regions

CFC # & Name Oct. 2006 Jun. 2007 Oct. 2007 Jun. 2008 Oct. 2008 Jun. 2009 Oct. 2009
By CFC
#1 - ROCKFORD 78.1% 79.4% 80.9% 82.6% 87.4% 88.1% 88.5%
#2 - LAKE CO. 95.8% 94.0% 94.5% 90.5% 91.4% 93.0% 94.6%
#3 - FREEPORT 75.6% 79.4% 79.1% 76.2% 78.5% 80.9% 79.6%
#4 - KANE-KENDALL 89.8% 87.5% 84.1% 86.2% 93.8% 95.3% 96.9%
#5- DUPAGE 93.9% 94.4% 94.8% 96.1% 98.0% 97.9% 98.3%
#6 - N SUBURBS 92.1% 92.0% 89.7% 88.3% 92.0% 93.7% 94.3%
#7 - W SUBURBS 92.4% 89.2% 91.1% 88.6% 91.9% 94.3% 94.0%
#8 - SW CHICAGO 97.5% 96.6% 97.3% 94.9% 97.5% 97.2% 97.9%
#9 - CENTRAL CHICAGO 85.3% 85.8% 86.6% 89.6% 92.8% 94.9% 95.7%
#10 - SE CHICAGO 87.4% 91.9% 91.8% 91.1% 90.5% 93.3% 92.6%
#11 - N CHICAGO 87.5% 84.6% 84.9% 86.7% 88.0% 87.3% 89.9%
#12 - S SUBURBS 93.9% 93.0% 92.5% 96.8% 98.9% 99.0% 99.7%
#13 - MACOMB 96.5% 96.8% 96.6% 97.6% 94.1% 95.3% 93.5%
#14 - PEORIA 31.7% 34.1% 38.7% 40.8% 42.7% 34.9% 32.2%
#15 - JOLIET 81.0% 85.2% 87.3% 91.3% 94.1% 92.1% 93.4%
#16 - BLOOMINGTON 90.4% 91.4% 93.8% 90.9% 92.6% 92.2% 92.1%
#17 - QUINCY 94.0% 95.1% 96.3% 91.0% 91.4% 90.9% 92.3%
#18 - SPRINGFIELD 94.4% 94.3% 93.6% 92.5% 90.8% 89.3% 90.3%
#19 - DECATUR 95.4% 93.6% 95.0% 97.1% 97.6% 95.5% 97.3%
#20 - EFFINGHAM 99.2% 99.7% 99.4% 99.5% 100.0% 99.7% 99.4%
#21 - BELLEVILLE 95.3% 98.4% 98.1% 97.9% 97.4% 99.2% 99.5%
#22 - CENTRALIA 99.1% 99.4% 98.9% 97.8% 98.8% 98.9% 98.8%
#23 - NORRIS CITY 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
#24 - CARBONDALE 99.3% 98.6% 100.0% 100.0% 99.4% 98.8% 99.4%
#25 - MCHENRY CO. 95.6% 92.2% 92.1% 93.5% 96.9% 95.3% 95.9%
By Geographic Regions
TOTAL 89.2% 89.2% 89.5% 89.9% 92.2% 92.2% 92.9%
COOK COUNTY 90.5% 89.6% 89.5% 90.1% 92.4% 93.2% 94.1%
COLLAR COUNTIES 89.9% 90.3% 90.4% 90.7% 94.9% 94.9% 95.9%
DOWNSTATE 86.6% 87.6% 88.5% 88.9% 88.6% 88.3% 88.3%

Discussion of Improvement Activities Completed and Explanation of Progress or Slippage that occurred for FFY08/SFY09):

Progress or Slippage for Indicator 2: Statewide, the proportion of children served predominately in natural settings increased from 89.9% at the end of June 2008 to 92.2% at the end of June 2009. Both Cook County and its collar counties demonstrated an increase in the proportion of children served predominately in natural settings, with all CFC offices in these areas showing increases. On the other hand, six of the downstate CFC offices realized a decrease in the proportion of children served predominately in natural settings, with the geographic area, as a whole, moving from 88.9% in June 2008 to 88.3% in June 2009.

Slippage in six downstate CFC offices can be attributed to the increased shortage of EI service providers overall, and a specific need for providers willing to work in natural settings. During FFY08/SFY09, the State's fiscal crisis has resulted in lengthy delays in payment for services and made provider shortages more critical. This situation is discussed in more detail in the response to

Indicator 1. CFC office #14/Peoria continues to lag well behind the rest of the state on children served predominately in natural settings because of an insufficient number of providers willing to provide services in natural settings.

Slippage in these areas was offset by improved performance by CFC offices, overall, and big gains for specific CFC areas. Two areas, CFC 1/Rockford and CFC 3/Freeport, which had been problem areas for services in natural setting over the years, improved from June 2008 until June 2009 by 6.7% and 6.2%, respectively, and continue to make improvements even with provider availability challenges. Another northern CFC area, CFC #4/Batavia, one of the collar counties, demonstrated a 10.6% increase during the same time period. Cook County CFC areas with large increases include CFC areas #6, #7, and #9. Increases in the proportion of children served predominately in natural settings can be attributed to ongoing efforts to operate the program within EI Principles and guidance about services in natural settings. CFC offices work diligently to obtain written justification based on the needs of the child, with a plan to transition interventions into natural settings is soon as possible.

Overall, as of June 30, 2009, 12 CFC areas met or exceeded the federal 95% substantial compliance standard, up from 9 CFCs in June 2008. Only two CFC offices, #3/Freeport and #14/Peoria, remain under 85%, as CFC #1/Rockford has moved above this level.

For Indicator 2, Illinois uses its data system and a formal system of notification, as described in Indicator 9, to identify findings and document correction of noncompliance. In SFY07/FFY08, 9 findings of noncompliance were identified for Indicator 2, with all findings of noncompliance corrected within one year.

Improvement Activities

  • The monthly predominate setting report provides both statewide and CFC office area level data. This information is included in the CFC office monthly statistical reports.
  • The percentage of service occurrences delivered in natural settings is a measure that incentive funding is granted to the top 12 performing CFC offices each quarter.
  • A penalty adjustment is made if less than 85% of children with open service plans have their services authorized predominately in a natural setting, with targeted technical assistance provided to CFCs that have not met the minimum level.
  • Findings are reported to each CFC office for children who did not receive services in the home or programs for typically developing children, based upon IFSPs in place on a specific date. Corrective action plans to address noncompliance policies, procedures, and practices are required to be written and implemented, with full compliance documented within one year.
  • As part of designation of determinations, the score of a CFC office is negatively impacted if it receives a penalty adjustment for less than 85% of children with open service plans have their services authorized predominately in a natural setting and if it is ranked in the bottom 5 CFC offices for all 10 measures that carry incentive funding, including the percentage of service occurrences delivered in natural settings.
  • The outcome page of the IFSP specifically asks whether or not all EI services are provided in natural environments. If the answer is no, then effective July 1, 2005, as directed in guidance letter to CFC offices and EI providers, all Service Coordinators began using general guidance and a Natural Environment worksheet in IFSP meetings when developing the justification for services outside of a natural learning environment. Written justification is based on the needs of the child and includes why the recommended setting is necessary to achieve the identified outcome, as well as why no other natural learning environment is appropriate. A plan to transition interventions into natural settings is incorporated into the justification.
  • Discussions of provider strategies from the IICEI Service Delay Workgroup (discussed in Indicator 1) have focused on CFC areas facing particular challenges with children being served predominately in natural settings. On January 5, 2009, the Service Delay Workgroup held an interactive forum on models of EI Service Delivery. Providers from CFC area #1 and #3 participated, along with representatives from professional associations, the IICEI and the Service Delay Workgroup, and the Bureau of Early Intervention, along with its Monitoring and Training contractors.
  • As part of a contractual agreement with the lead agency, the Illinois EI Monitoring Program conducts annual on-site monitoring visits to the 25 CFC offices. There are several elements of the CFC monitoring file review tool that relate to services in natural setting, including documentation that 1) the current IFSP contains a statement of natural environments in which early interventions services shall be provided: a justification of the extent, if any, to which the service(s) are provided in non-natural settings and 2) all IFSPs that indicate "no" for natural environment have completed the natural environment justification worksheet.
  • The new service delay reporting system includes all instances where a CFC is looking for service to comply with the provision of an IFSP, including instances where services are being delivered in a setting other than the one designated in the IFSP because a provider is not available to deliver services in a natural setting. The full picture of delays is used both locally and by the EI Bureau to aid in provider recruitment.

Revisions, with Justification, to Proposed Targets / Improvement Activities / Timelines / Resources for FFY09/SFY10):

The improvement activities described above are ongoing efforts. Illinois has made continued improvements to the proportion of children served predominately in natural settings, with the impact of service delays being the greatest challenge to future progress. The IICEI Service Delay Workgroup is currently considering recommendations for strategies to address these issues. (See Indicator 1.)