Indicator 5: Percent of infants and toddlers birth to 1 with IFSPs compared to national data.

Helping Families. Supporting Communities. Empowering Individuals.

Overview of the State Performance Plan Development:

See Indicator 1 for a description of this process.

The effort to reach children under one has been an important initiative for several years. It was prompted by OSEPs introduction of focused monitoring triggers and the program's realization that Illinois served less than the federal benchmark of 1.0% of children under one and that we also ranked very poorly in comparison to other states in how early children started service. The IICEI has received reports on the under one participation rate for several years and they have taken an active part in the process of improving performance in this area. The program also has incorporated several measures related to the age at which children start service into its performance contracting system. As a result of all this early work, it was not necessary to do much new work to develop this aspect of the State Performance Plan.

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

Monitoring Priority Effective General Supervision Part C / Child Find
Indicator 5

Percent of infants and toddlers birth to 1 with IFSPs compared to national data.

(20 USC 1416(a)(3)(B) and 1442)

Measurement Percent = [(# of infants and toddlers birth to 1 with IFSPs) divided by the (population of infants and toddlers birth to 1)] times 100 compared to national data.

Overview of Issue/Description of System or Process:

Illinois has long struggled in its efforts to reach children at younger ages. Late in 2002, a work group of the IICEI looked at data associated with participation and referral of children under the age of 1. Although the group recognized difficulties with using the EI data, because only about half of active cases report a medical diagnosis, several areas of low participation were identified, including premature infants with a birth weight of less than 1,000 grams. The work group recognized the following:

  • The proportion children under the age of 1 is quite low compared to other states of similar-sized programs and eligibility.
  • The number of children with prematurity as a diagnosis is lower than expected.
  • There is a problem with linking to children in the newborn intensive care follow-up system who are receiving therapies or being monitored.

The need to better structure a way to connect to the newborn intensive care follow-up system with the EI system was identified with the following strategies. These strategies were shared with CFC and have been effectively used.

  • Co-locate to make opportunities available for EI to be part of developmental follow-up meetings or clinics to talk to parents about EI and provide information and counseling.
  • Look at strategies specific to the developmental follow-up system to simplify intake into EI and streamline the IFSP process.
  • Do a better job of advertising the EI Program as they are discharged from intensive care. Look at providing information in a format specific for these children to be used at discharge and follow-up meetings.
  • Provide specialized training to CFCs that are not as comfortable working with these fragile infants.
  • Gather information about the newborn intensive care follow-up clinics to facilitate coordination with CFCs.
  • Better link EI to the medical community including genetic clinics, cerebral palsy clinics and others.

For a number of years, the program has had a goal of having at least 30% of its initial IFSPs starting before age one. Starting in January 2002, Illinois has used its monthly reporting system to measure and promote its efforts to reach children earlier. Each month it reports the following statewide and CFC level measures: 1) percent of initial IFSPs started before age one, 2) average age at initial IFSP, and 3) average age of all children with IFSPs. When focused monitoring emphasized under one participation rate Illinois added it to its monthly reporting. The under one caseload is measured both as participation rate and as the percent of the total caseload. This helps emphasize that a high overall participation rate does not necessarily mean children are being reached early. In fact, as will be reviewed in some detail later, Illinois reaches a large number of children but not while they are infants.

The initial performance-contracting framework for SFY 03 awarded quarterly incentive funding to the CFCs with the highest percentage of initial IFSPs started before age one. Since SFY 04, two items related to reaching children earlier have carried incentive funding: 1) under one participation rate, which is a direct match to the focused monitoring measure, and 2) average age at initial IFSP. That same idea is now strengthened by State Performance Plan and Annual Performance Report requirements. Although we continue to measure the percentage of initial IFSPs started before age one, it was felt that it is more important to emphasize the need to get services for children started as quickly as possible, even if they have passed their first birthday. Both the under one participation rate and the average age at initial IFSP are published on the internet to the CFC level each quarter.

2002, 2003 & 2004 Under 1 Participation Rates National & Similar State Eligibility

12/02

% <1

in Program

12/03

Rank

12/04

% <1

in Program

Rank

% <1 in

Program

Rank

2-Year

Change

RHODE ISLAND 1.78 5 1.85 5 1.75 4 -2.0%
IDAHO 1.03 18 1.35 10 1.66 8 60.6%
NEW YORK 1.10 16 1.06 17 1.10 21 -0.5%
ILLINOIS 0.70 34 0.93 25 1.09 22 56.3%
CONNECTICUT 1.10 17 1.01 22 1.03 24 -6.8%
CALIFORNIA 0.97 21 0.99 23 0.97 25 -0.1%
TEXAS 0.82 24 0.71 33 0.81 31 -2.2%
UTAH 0.79 29 0.73 31 0.76 34 -4.3%
NEBRASKA 0.75 32 0.71 35 0.74 35 -0.9%
TENNESSEE 1.03 19 0.71 34 0.67 39 -34.6%
SOUTH CAROLINA 0.34 49 0.51 45 0.66 41 96.0%
NEW JERSEY 0.55 39 0.60 41 0.53 48 -3.2%
OREGON 0.52 42 0.42 51 0.51 49 -2.1%
KENTUCKY 0.79 30 0.58 43 0.46 53 -41.4%
PUERTO RICO 0.40 NA 0.32 54 0.37 55 -7.8%
Subtotal 0.86 0.84 0.88 2.3%
Nationwide 0.95 0.91 0.92 -3.2%

 Under 1 Participation Rate History By CFC & Region

CFC & Number

End of

SFY 02

End of

SFY 03

End of

SFY 04

End of

SFY 05

SFY 02-05

Change

#1 - LOVES PARK 0.70% 1.23% 1.44% 1.15% 63.41%
#2 - Lake County 0.51% 0.66% 0.86% 1.00% 96.23%
#3 - FREEPORT 1.01% 1.07% 1.25% 1.59% 57.58%
#4 - Kane & Kendall Counties 0.75% 0.82% 0.76% 1.19% 58.57%
#5 - Du Page County 0.50% 0.66% 0.94% 0.97% 93.75%
#6 - N. Suburbs 0.47% 0.67% 0.93% 1.10% 136.51%
#7 - W. Suburbs 0.71% 0.75% 0.88% 0.93% 30.65%
#8 - SW Chicago 1.07% 1.08% 1.33% 1.60% 49.43%
#9 - Central Chicago 0.85% 1.27% 1.28% 1.20% 40.70%
#10 - SE Chicago 0.71% 0.93% 1.54% 1.68% 134.38%
#11 - N. Chicago 0.57% 0.72% 0.95% 1.00% 76.86%
#12 - S. Suburbs 0.81% 0.98% 1.37% 1.60% 97.70%
#13 - MONMOUTH 0.33% 0.83% 0.63% 1.38% 323.08%
#14 - PEORIA 0.50% 0.65% 0.63% 0.74% 50.00%
#15 - Joliet 0.81% 0.78% 1.15% 1.26% 56.00%
#16 - DANVILLE 0.47% 0.72% 0.69% 0.83% 76.67%
#17 - QUINCY 0.85% 0.76% 0.85% 1.28% 50.00%
#18 - SPRINGFIELD 0.61% 1.09% 1.45% 1.22% 100.00%
#19 - DECATUR 1.11% 0.78% 0.94% 1.41% 27.50%
#20 - EFFINGHAM 0.91% 1.76% 1.29% 2.13% 133.33%
#21 - BELLEVILLE 0.53% 0.79% 0.86% 1.03% 95.12%
#22 - CENTRALIA 1.24% 1.72% 1.53% 1.61% 29.41%
#23 - NORRIS CITY 3.07% 2.51% 2.88% 3.35% 9.09%
#24 - CARBONDALE 0.97% 0.57% 0.63% 1.14% 17.65%
#25 - McHenry County 0.98% 0.69% 1.36% 1.02% 4.88%
Total 0.70% 0.87% 1.06% 1.21% 71.65%
Super-Regions
Cook - 6, 7, 8, 9, 10, 11 & 12 0.70% 0.88% 1.14% 1.25% 78.42%
Collar - 2, 25, 4, 5, 15 0.66% 0.74% 0.96% 1.12% 69.46%
Balance of the State 0.74% 0.95% 1.04% 1.22% 63.68%

% of Cases <1 - 2001-2004 December 1 Counts National & Similar State Comparisons

2001 2002 2003 2004
IDAHO 17.2% 15.6% 18.3% 20.5%
CALIFORNIA 20.3% 20.7% 20.2% 19.6%
SOUTH CAROLINA 13.8% 11.4% 16.3% 16.3%
RHODE ISLAND 16.6% 17.4% 17.7% 16.3%
TEXAS 15.2% 14.1% 13.1% 14.8%
NEBRASKA 14.6% 15.8% 14.0% 14.7%
UTAH 17.3% 14.7% 14.3% 14.5%
GEORGIA 14.3% 14.5% 14.3% 13.8%
TENNESSEE 17.4% 14.9% 13.1% 13.3%
ILLINOIS 10.0% 11.8% 12.7% 12.8%
CONNECTICUT 11.4% 11.8% 10.6% 11.2%
OREGON 11.5% 12.2% 10.0% 11.0%
NEW YORK 7.6% 7.9% 8.0% 8.7%
NEW JERSEY 10.4% 8.7% 8.4% 8.1%
KENTUCKY 12.2% 10.3% 8.3% 6.8%
PUERTO RICO 7.4% 8.3% 7.5% 6.8%
Sub-total 13.2% 12.9% 12.7% 13.1%
National 14.8% 14.8% 13.8% 13.9%

Under 1 Proportion of All IFSPs By CFC & Region

CFC & Number

End of

SFY 02

End of

SFY 03

End of

SFY 04

End of

SFY 05

SFY 02-05

Change

#1 - LOVES PARK 9.30% 14.43% 14.24% 11.20% 20.51%
#2 - Lake County 8.82% 10.61% 10.80% 11.94% 35.40%
#3 - FREEPORT 12.18% 12.46% 12.46% 14.05% 15.41%
#4 - Kane & Kendall Counties 14.55% 13.23% 9.45% 13.41% -7.88%
#5 - Du Page County 9.13% 10.85% 11.08% 10.68% 16.98%
#6 - N. Suburbs 9.62% 11.28% 11.56% 12.39% 28.77%
#7 - W. Suburbs 10.76% 10.66% 10.10% 9.87% -8.34%
#8 - SW Chicago 16.63% 14.99% 15.32% 16.54% -0.57%
#9 - Central Chicago 14.10% 17.89% 15.17% 14.02% -0.55%
#10 - SE Chicago 11.29% 12.46% 17.53% 17.52% 55.25%
#11 - N. Chicago 12.94% 13.13% 13.62% 13.13% 1.45%
#12 - S. Suburbs 12.55% 12.77% 13.80% 15.48% 23.32%
#13 - MONMOUTH 5.70% 11.74% 8.83% 16.72% 193.20%
#14 - PEORIA 8.07% 10.15% 8.68% 8.92% 10.53%
#15 - Joliet 12.48% 11.07% 12.83% 12.77% 2.26%
#16 - DANVILLE 8.57% 10.53% 9.34% 9.72% 13.46%
#17 - QUINCY 10.91% 8.99% 10.40% 15.43% 41.43%
#18 - SPRINGFIELD 7.45% 11.26% 14.42% 11.41% 53.15%
#19 - DECATUR 14.44% 10.18% 10.18% 15.09% 4.49%
#20 - EFFINGHAM 8.46% 16.56% 10.41% 15.95% 88.44%
#21 - BELLEVILLE 9.79% 14.09% 12.71% 13.84% 41.45%
#22 - CENTRALIA 10.24% 13.99% 12.92% 12.12% 18.36%
#23 - NORRIS CITY 22.60% 13.71% 15.12% 14.46% -36.04%
#24 - CARBONDALE 12.59% 10.53% 9.17% 12.66% 0.52%
#25 - McHenry County 15.89% 9.42% 12.56% 10.07% -36.63%
Total 11.48% 12.49% 12.48% 13.10% 14.05%
Super-Regions
Cook - 6, 7, 8, 9, 10, 11 & 12 12.50% 13.28% 13.75% 13.99% 11.89%
Collar - 2, 25, 4, 5, 15 11.13% 11.36% 11.45% 12.12% 8.91%
Balance of the State 10.51% 12.27% 11.52% 12.63% 20.14%

Discussion of Baseline Data:

Illinois undertook a number of special steps to reach the federal benchmark of 1.00% of children under the age of one being served by the program. At the end of SFY 02/FFY 01, only 0.70% of children under one in the state had IFSPs. Only five of the state's 25 CFCs had under one participation rates of 1.00% or greater. Only one of those was in the Chicago area and all of those over 1.00% had relatively small caseloads. However, with rapid caseload growth the program reached the 1.00% benchmark in March 2004 and the under one participation rate was 1.06% at the end of SFY 04/FFY 03. With continued growth, that increased to 1.21% at the end of SFY 05, which makes that the SPP baseline. At that point just four CFCs have under one participation rates less than 1.00%: Peoria (CFC 14) and Bloomington/Champaign (CFC 16) in central Illinois and DuPage County (CFC 5) and the western suburbs of Chicago (CFC 7).

In this period, the number of children under one increased by 71.65%. All 25 CFCs saw an increase in the number of infants served. All but six CFCs at least doubled the number of children in their caseload under age one. The greatest improvement took place in Cook County, where 78.42% more infants were served at the end of SFY 05/FFY 04 than were just three years earlier. The smallest change took place downstate, with a 63.68% increase, compared to 69.46% for the collar counties. Cook County now has the highest under one participation rate at 1.25%, which is slightly above the 1.22% downstate. The collar counties still lag behind at 1.12%.

On the surface, it appears that the extensive efforts of the IICEI and the EI community in general have been extremely successful. However, a deeper look explains why the Illinois EI community is not yet satisfied with the results.

The state's underlying goal was not just to reach more infants but to reach children earlier. To achieve this goal Illinois needed to significantly increase the proportion of children with IFSPs under age 1. When we originally looked at that measure we found that Illinois had one of the lowest percentages of open IFSPs under one. Even as the caseload has mushroomed, the percent of the caseload under one was not changed much. Therefore, while we were rapidly moving up the participation rate rankings, we were not making as much progress as we wanted on our main goal. Between December 1, 2002 and December 1, 2004, Illinois moved from 12th to 4th in its under one participation rate among states with similar eligibility standards and from 34th to 22nd overall. However, in that same period, Illinois only improved from 11th to 10th in terms of the proportion of all cases under age one and it remains below the national average with just 12.8% of cases being under one, compared to 13.9% nationally.

At the end of SFY 02/FFY 01, just 12.5% of all open IFSPs were under one. There was an initial improvement in SFY 03, when the under one participation rate improved to 13.28%. However, that was probably more due to the rapid decrease in the average time it took to determine eligibility after referral than to an improvement in the kinds of referrals received. If you cut the average time it takes to determine eligibility from 80 days to 30 days, as Illinois has done, you naturally are serving more children under age one at any point in time. This continued to be a factor in the improvement in SFY 04/FFY 03 as well. The improvement in the average time it took to determine if a child was eligible only improved marginally in SFY 05/FFY 04, but the improvement in the proportion of cases under age one also only improved marginally.

Between the end of SFY 02/FFY 01 and the end of SFY 05/FFY 04, the proportion of cases under age one increased by 14.05%. However, as noted above, a large proportion of that increase can be attributed to reduced time in intake. Over that period, six CFCs actually saw a decline in the proportion of their caseloads that were under one and four more saw increases of less than 10%, in spite of the fact they were processing cases much more quickly. Based on these results, the program will continue to make reaching eligible children at younger ages a top priority. In fact, this will be the primary emphasis of renewed child find efforts.

In terms of regional differences, Cook County serves the highest proportion of children under one, 13.99%. However, the greatest improvement over the SFY 02-05/FFY 01-04 period was downstate. Their ratio of children under one improved by 20.14%, compared to the statewide average of 14.05%. The collar counties experienced the smallest increase, just 8.91%.

In spite of many extra efforts to reach children soon, the program had only limited success in increasing the proportion of the caseload comprised on children under 1 in FFY 05 and FFY 06. As a result, future targets have been reduced for FFY 07 and beyond to be more in line with the progress that has been achieved.

 FFY Measurable and Rigorous Target

FFY Measurable and Rigorous Target
2005
(2005-2006)
The percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.27% on June 30, 2006, approximately 2,293 children.
2006
(2006-2007)
The percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.33% on June 30, 2007, approximately 2,406 children.
2007
(2007-2008)
The percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.36% on June 30, 2008, approximately 2,410 children.
2008
(2008-2009)
The percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.32% on June 30, 2009, approximately 2,421 children.
2009
(2009-2010)
The percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.33% on June 30, 2010, approximately 2,420 children.
2010
(2010-2011)
On October 31, 2010, the percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.08%.
2011
(2011-2012)
On October 31, 2011, the percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.08%.
2012
(2012-2013)
On October 31, 2012, the percentage of all children in Illinois under age 1 served through an IFSP will be at least 1.08%.

The proposed performance targets for FFY10, FFY11 and FFY12 have been at the FFY09/SFY10 performance due to the factors facing the EI Program, as discussed below. With several of these factors out of the control of the program, Illinois is not confident that improvement in terms of increases in stated percentages should be expected.

  • Of the 10 CFC offices with the greatest drop in under 1 participation rates, all but one office borders on another state. For these CFC offices, the change in the use of census estimates for the population of infants and toddlers birth to 1, rather than birth data, may have contributed to these decreases.
  • System stresses aggravated by the State's fiscal situation and the resulting delays in payments to providers may have diverted CFC office from efforts to target the under 1 population.
  • Economic stressors on families may result in fewer families accessing program services.
  • During FFY08/SFY09, the Early Intervention program initiated the Program Integrity Project to accomplish statewide program equality; fidelity to program principles and state and federal laws; and long-term program stability. As a result of the Program Integrity Project, the program anticipated a reduced growth rate or a decline in overall enrollment in the program in FFY09/SFY10. Initial efforts focused on eligibility determination to make sure that process was being conducted according to policy and procedure, so that appropriate determinations will be made.

Improvement Activities/Timelines/Resources:

  • The program will continue to include the items in its monthly report related to reaching children at younger ages: 1) % of initial IFSPs started under age 1, 2) average age at initial IFSP, 3) % of open IFSPs under age one, and 4) under one participation rate.
  • The program will continue to grant quarterly incentive funding to CFCs with the highest under one participation rates.
  • The program will continue to grant quarterly incentive funding to CFCs with the lowest average age of children at initial IFSP. The program will evaluate referrals sources, relative to what we would anticipate, and report its findings to the IICEI for recommendations and assistance in reaching children earlier, no latter than May 1, 2006.
  • In FFY08/SFY09, the Early Intervention Program is coordinating efforts with the Illinois Department of Public Health to ensure that all infants who are registered in the Illinois Adverse Pregnancy Outcomes Reporting System (APORS), a registry of Illinois infants born with adverse pregnancy outcomes including birth defects, have been referred to Early Intervention. Referral information is being sent to the Bureau of Early Intervention and is then forwarded to the appropriate CFC office. The CFC office will contact the family if the infant is not already enrolled in the program.

The program will implement steps recommended by the IICEI to reach children at younger ages, as appropriate, by no later than July 1, 2007. The program hopes that these steps will continue to result in increased numbers and proportions of infants entering the program. However, regular monthly reports and other monitoring will be used to continuously assess performance. Additional steps to help bring younger children into the program earlier will be developed and implemented as appropriate.

  • Participate in advisory groups and pilot activities to promote the referral of infants to the Early Intervention Program, such as the Assuring Better Child Health and Development (ABCD) III project, the EI/Medical Home project, and the development of an early childhood community referral pilot system in select communities.

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
The Adverse Pregnancy Outcome Reporting System (APORS) referral process will be reviewed to ensure that it has been successfully implemented.

By December 2010, the CFC offices will be surveyed to determine if the process is being implemented appropriately and is responsive to the needs of CFC offices and families identified through the APORS. Information from the survey will be discussed with CFC offices.

Resources include APORS, the Bureau of Early Intervention, and the CFC offices.

Continue participation in Assuring Better Child Health & Development (ABCD) III, IHB2 project, including CFC office participation in pilot project activities and data sharing between the HFS and the IL Department of Humans Services/EI.

Selection of pilot sites will be completed by January 2011. Pilot activities and the development and implementation of data sharing activities will be an ongoing activity.

Resources include HFS and its IHB2 Project Management Committee and subcommittees, Bureau of Early Intervention, and CFC offices.

Continued participation in Children's Health Insurance Program Reauthorization Act (CHIPRA) Child Health Quality Demonstration Grant.

Bureau staff will continue participation in work groups and assist in the development and implementation of strategies throughout the grant period (i.e., 2015).

Resources include HFS and its CHIPRA Child Health Quality Demonstration Grant work groups, Bureau of Early Intervention, and CFC offices.

Continue participation in Enhancing Developmentally Oriented Primary Care (EDOPC).

Bureau and EI Training Program staff will continue participation in the EDOPC advisory group and CFC offices will participate in pilot project activities.

Resources include the Advocate Health Care Steps Program, Illinois Chapter, American Academy of Pediatrics, Bureau of Early Intervention, EI Training Program, and CFC offices.

Utilize Program Integrity pilot project efforts to identify barriers to participation of infants in the program and develop strategies that can be shared with other CFC offices.

A CFC office with low under 1 participation rate will be chosen as a pilot project in FFY10/SFY11. Identification of barriers, implementation of strategies, and sharing strategies with other CFC offices will be an ongoing effort. Resources include the Bureau of Early Intervention, the EI Training Program, EI System Ombudsman, and the EI Monitoring Program.