Monitoring Priority 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)
Measurement

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.

FFY Measurable and Rigorous Target

FFY  Measurable and Rigorous Target
FFY09/SFY10 100 percent of infants and toddlers with IFSPs will receive the early intervention services on their IFSP within 30 days.

Actual Target Data for FFY09/SFY10

Indicator 1

[# 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 100

FFY09/SFY10 (18,387-1,111)/18,387 x 100 = 93.96%
FFY09/SFY10 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. 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.

The table below shows performance for the state and for each of the state's 25 CFC offices in April 2010, followed by statewide performance. It calculates performance both including and excluding delays for family reasons. Statewide, 93.96% of children with IFSPs were experiencing no delays at the end April 2010, excluding family delays. Fifteen CFC offices had 95% or more of their cases with no delays with three of these CFC offices showing no delays. Six CFC offices had between 90% and 95% of their open cases with no delays. Four CFC offices had fewer than 90 % of their open cases with no delays.

Service Delays - All Cases Open in April 2010

Calculated Including & Excluding Family Delays

No Delay Excluding Family Delays: (18,387-1,111)/18,387 = 93.96%

No Delay Including Family Delays: 17,276/18,530 = 93.23%

CFC # & Area IFSPs Family Delays Net IFSPs System Delays No Delays No Delays No System Delays
April 2010
#1 - LOVES PARK 600 0 600 117 483 80.5% 80.5%
#2 - Lake County 804 23 781 32 749 93.2% 95.9%
#3 - FREEPORT 350 0 350 72 278 79.4% 79.4%
#4 - Kane & Kendall Counties 836 4 832 42 790 94.5% 95.0%
#5 - Du Page County 1,193 3 1,190 6 1,184 99.2% 99.5%
#6 - N. Suburbs 1,607 3 1,604 15 1,589 98.9% 99.1%
#7 - W. Suburbs 1,028 14 1,014 52 962 93.6% 94.9%
#8 - SW Chicago 802 9 793 64 729 90.9% 91.9%
#9 - Central Chicago 1,110 0 1,110 132 978 88.1% 88.1%
#10 - SE Chicago 804 13 791 72 719 89.4% 90.9%
#11 - N. Chicago 2,280 52 2,228 202 2,026 88.9% 90.9%
#12 - S. Suburbs 1,057 5 1,052 32 1,020 96.5% 97.0%
#13 - MONMOUTH 357 0 357 4 353 98.9% 98.9%
#14 - PEORIA 490 0 490 36 454 92.7% 92.7%
#15 - Joliet 1,374 6 1,368 123 1,245 90.6% 91.0%
#16 - DANVILLE 670 1 669 33 636 94.9% 95.1%
#17 - QUINCY 215 0 215 0 215 100.0% 100.0%
#18 - SPRINGFIELD 358 0 358 5 353 98.6% 98.6%
#19 - DECATUR 404 0 404 12 392 97.0% 97.0%
#20 - EFFINGHAM 396 0 396 11 385 97.2% 97.2%
#21 - BELLEVILLE 676 0 676 0 676 100.0% 100.0%
#22 - CENTRALIA 357 0 357 0 357 100.0% 100.0%
#23 - NORRIS CITY 209 0 209 33 176 84.2% 84.2%
#24 - CARBONDALE 157 0 157 2 155 98.7% 98.7%
#25 - McHenry County 396 10 386 14 372 93.9% 96.4%
State 600 0 600 117 483 93.23% 93.96%
Cook County 804 23 781 32 749 92.35% 93.38%
Collar Counties 350 0 350 72 278 94.29% 95.24%
Downstate 836 4 832 42 790 93.78% 93.80%
April 2009
State 8,614 112 8,502 406 8,096 93.36% 94.33%
Cook County 4,754 78 4,676 370 4,306 93.99% 95.22%
Collar Counties 5,515 5 5,510 283 5,227 90.58% 92.09%
Downstate 8,614 112 8,502 406 8,096 94.78% 94.86%

Discussion of Improvement Activities Completed and Explanation of Progress or Slippage that occurred for FFY09/SFY10

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 94.33% in FFY08/FSY09 to 93.96% in FFY09/SFY10.

In FFY09/SFY10, 15 CFC offices had more than 95% of open cases with no delays, which is the one fewer than in FFY08/SFY09. The number of CFC offices with open cases with no delays increased from 2 to 3 over the same time periods. When looking at regions of the state, a decrease was seen in Cook County CFC office areas (from 95.22% to 93.38%) and in downstate CFC office areas (from 94.86% to 93.80%). An improvement was seen in the Collar Counties CFC office areas (from 92.09% to 95.24%). Service delays continue to be a chronic problem in northern Illinois (CFC #1 and CFC #3), although CFC #9 (central Chicago) and CFC #23 (southern counties) are also represented in the four CFC areas with less than 90% of open cases with no delays.

Service delays are impacted by a number of factors:

  • Payment delays;
  • Low reimbursement rates, when compared to other systems of care;
  • Lack of providers willing to provide services in natural environments;
  • Lack of coverage in sparsely populated rural areas and in urban areas with high crime rates; and
  • Competitive environments for limited number of available providers, particularly in urban areas where multiple job opportunities are available.

Illinois' financial situation has resulted in delays in payments to Early Intervention service providers. This situation worsened in FFY09/SFY10 and resulted in a more statewide problem with recruitment and retention of active service providers in the system. Although service delay data show a slight decrease, this does not mean that CFC offices have not had to address increasing challenges related to provision of specific services or coverage in particular geographic areas. It also does not reflect the increased financial burden on the EI provider community. While new providers continue to enter the system, current providers may decide to modify their practice to limit the number or eliminate services they provide to EI enrolled children.

Improvement Activities Completed

Improvement Activity Status/Timeline/Resource
In FFY09/SFY10, expand Program Integrity Pilot to include three additional targeted CFC areas. In FFY09/SFY10, two pilot projects have been added to the initial pilot of the Program Integrity Project to identify and test approaches to promote program integrity. The pilots involve the collection and analysis of data. A plan of training and technical assistance is then developed and implemented to ensure that program principles and procedures regarding eligibility determination and service plan development are being appropriately followed. Lessons learned through these pilots are shared with all CFC managers at monthly CFC managers' meetings. Plans are underway for a fourth pilot site.
Effective February 15, 2010, a system ombudsman position will be added to the Early Intervention Training Program to support the Program Integrity Project.  On February 15, 2010, a system ombudsman position was added to the Early Intervention Training Program. The system ombudsman supports the Department's Program Integrity Project to accomplish statewide program equality, fidelity to program principles and state and federal laws, and long-term program stability. Activities include: data analysis, coordination of focused monitoring activities, development of strategies to promote compliance with program principles and procedures, report writing, and development and implementation of training strategies. The system ombudsman has supported the Program Integrity Project pilots through data analysis; training and support plan development and implementation, and the transfer of strategies from the pilot sites to other CFC areas. In addition, the system ombudsman has visited CFC offices, provided resources to people in the field, reviewed data, identifying areas for clarification or training, and researched what is going on nationally, with the goals to improve program practices and communication between system entities. Strategies for reaching out to other stakeholders (i.e., providers and families) are being explored, including collecting and analyzing existing data.
In FFY09/SFY10, the program will work with the IICEI and its Service Delay Workgroup to finalize recommendations regarding an Integrated Team Approach and pilot this strategy in a target area.  In FFY09/SFY10 the Service Delay Workgroup, presented to the IICEI recommendations that would support an integrated services approach, which emphasizes collaboration among IFSP team members. CFC offices #1 and #6 are currently piloting this option. The Workgroup has also discussed provider recruitment strategies, including strategies for posting unmet service needs.

Another improvement activity includes the following:

  • Beginning in FFY09/SFY10, CFC offices began receiving a monthly report to monitor data integrity for the service delay database. This report provides the names of children who have been removed from the CFC office's service delay list, without a resolution being documented in the CFC office's service delay monthly report. The CFC office then corrects these data errors.

Illinois has greatly improved its documentation of findings and correction of noncompliance. In FFY06/SFY07, it expanded the process to utilize its data system. A system of identification and correction of noncompliance was developed, but not fully implemented until FFY07/SFY08, due to delays in sending notification of findings to CFC offices. Findings based on FFY06/SFY07 were sent in February 2008. Findings based on FFY07/SFY08 data were sent on December 2008. Illinois is now on track to provide timely notification and to monitor and document correction of noncompliance. On August 27, 2009, the Bureau sent a single letter to each CFC office that included the CFC office's determination (in accordance with 616(a)(1)(C)(i) and 300.600(a) of IDEA 2004) and the notification of findings of noncompliance, based upon FFY08/SFY09data. On September 10, 2010, the Bureau sent a single letter to CFC offices with determinations and notification of finding based upon FFY09/SFY10 data.

Correction of FFY 2008 Findings of Noncompliance (if State reported less than 100% compliance):

Level of compliance (actual target data) State reported for FFY 2008 for this indicator: 94.33%

  1. Number of findings of noncompliance the State made during FFY 2008 (the period from July 1, 2008, through June 30, 2009) 21
  2. Number of FFY 2008 findings the State verified as timely corrected (verified as corrected within one year from the date of notification to the EIS program of the finding) 1
  3. Number of FFY 2008 findings not verified as corrected within one year [(1) minus (2)] 20

Correction of FFY 2008 Findings of Noncompliance Not Timely Corrected (corrected more than one year from identification of the noncompliance) and/or Not Corrected:

  1. Number of FFY 2008 findings not timely corrected (same as the number from (3) above) 20
  2. Number of FFY 2008 findings the State has verified as corrected beyond the one-year timeline ("subsequent correction") 0
  3. Number of FFY 2008 findings not verified as corrected [(4) minus (5)] 20

Actions Taken if Noncompliance Not Corrected: Data 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. 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, or fails to implement major features of the plan.

Verification of Correction of FFY 2008 noncompliance or FFY 2008 findings (either timely or subsequent):

Verification of correction of noncompliance is outlined below.

Describe the specific actions that the State took to verify the correction of findings of noncompliance identified in FFY 2008: For correction of noncompliance, this APR looks at findings identified using FFY07/SFY08 data and adds "prong 2," ensuring that CFC offices have correctly implemented the specific regulatory requirement, as defined in OSEP Timely Correction Memo 09-02. Child-specific data were accessed through the Service Delay Reporting system, the Cornerstone system, and file reviews. In all 21 findings of noncompliance it was determined that the CFC has corrected each individual case of noncompliance. Noncompliance was resolved for reasons that include the following: data error, service provided, family declined service, and child no longer in the system. Illinois has identified that a CFC office had implemented the regulatory requirement for service delays using monthly statistical reports and documenting three consecutive months during which the CFC office has no service delays. In FFY08/SFY09, there were 21 findings, with one finding identified as corrected, leaving 20 findings uncorrected. In FFY09/SFY10, three new findings were identified. A new system of notification of findings and correction of noncompliance is being implemented that will assist the lead agency and the CFC offices in tracking performance and providing adequate notification when a correction has taken place

No FFY06/SFY07 or FFY07/SFY08 findings remain uncorrected.

Additional Information Required by the OSEP APR Response Table for this Indicator:

  • If the State does not report 100% compliance in the FFY2009 APR, the state must review it's improvement activities and revise them, if necessary. See the following new improvement activities.
  • Revisions, with Justification, to Proposed Targets / Improvement Activities / Timelines / Resources for FFY10/SFY11: The State Performance Plan (SPP) has been revised to specify, for each indicator, annual targets and improvement activities for each year through FFY2012 (July1, 2012 through June 30, 2013).

FFY Measurable and Rigorous Target

  • 2011 - (2011-2012) 100 percent of infants and toddlers with IFSPs will receive the early intervention services on their IFSP within 30 days.
  • 2012 - (2012-2013) 100 percent of infants and toddlers with IFSPs will receive the early intervention services on their IFSP within 30 days.

The improvement activities described in the SPP are ongoing efforts. The following are new improvement activities to be implemented through FFY12/SFY13.

New Improvement Activity Timelines & Resources

New Improvement Activity Timelines & Resources
Illinois will use a full 12 months of data for the identification of findings for Indicator 1.

This will be implemented in FFY10/SFY11 as part of the finding notification process and will continue as an ongoing strategy.

Resources include the Bureaus of Early Intervention and Performance Support Services.

The EI Monitoring Program will increase the number of service coordinators it interviews as part of the on-site monitoring process for CFC offices and will enhance interview questions to capture additional information about the IFSP decision -making process. 

These changes will be developed and implemented as part of the FFY10 SFY11 CFC monitoring process.

Resources include the EI Monitoring Program and the Bureau of Early Intervention.

The Bureau and its contractors that provide training, credentialing, monitoring, resource materials and billing/claims services will coordinate their efforts to work with professional associations and others that support the EI Program. This will be an ongoing effort through FFY12/SFY13. In FFY10/SFY11, initial work will focus on coordinating provider recruitment and on education and information sharing regarding appropriate practices for services to infants and toddlers in the EI Program. Web sites that support the EI system will work together to provide discipline-specific, nationally recognized best practice documents, recruitment materials, and information about the EI services system directed to both potential and current EI providers. Resources include the Bureau of Early Intervention and its contractors.
Expand Program Integrity Pilot to include additional targeted CFC areas. This will be an ongoing effort through FFY12/SFY13, with 2 to 4 additional CFC areas targeted each year. Resources include the Bureau of Early Intervention, the EI Training Program, EI System Ombudsman, and the EI Monitoring Program.
Additional data will be provided to CFC offices so they can monitor service delays and address child-specific and system issues in a timely way. Beginning in July 2011and on an ongoing basis, "mini APR tables" will be provided to CFC offices on a quarterly basis, so that they can monitor performance on Indicators 1, 7, and 8C. Resources include the Bureaus of Early Intervention and Performance Support Services.