Indicator 6: Percent of infants and toddlers birth to 3 with IFSPs compared to national data.

Helping Families. Supporting Communities. Empowering Individuals.

See Indicator 1 for a description of this process.

In recent years, Illinois has been very successful in efforts to increase its participation rate through improved screening and child-find activities plus a performance contracting system that rewards finding children, determining eligibility quickly and maintaining involvement until they are no longer eligible or until they reach age three. All of these activities have been discussed extensively and publicly through the IICEI and with Child and Family Connections agencies. The program also has reported to the Illinois General Assembly on these steps and the progress that has been made through quarterly reports that have been posted on the DHS internet site.

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

Monitoring Priority Effective General Supervision Part C / Child Find
Indicator 6 Percent of infants and toddlers birth to 3 with IFSPs compared to national data. (20 USC 1416(a)(3)(B) and 1442)
Measurement Percent = [(# of infants and toddlers birth to 3 with IFSPs) divided by the (population of infants and toddlers birth to 3)] times 100 compared to national data.

Overview of Issue/Description of System or Process:

Local Interagency Councils (LICs) are components of the statewide infrastructure of the Early Intervention Services System and emphasize planning at the local level to identify and coordinate all resources and services available within each CFC local service area. Members of each LIC include parents; representatives from coordination and advocacy service providers; local education agencies; other local public and private service providers; and representatives from State agencies at the local level. The LIC coordinates, designs, and implements Child Find and public awareness activities for its geographic region. The CFC is responsible for staffing the local council.

The CFC and LIC assure that Child Find and public awareness activities are coordinated with comprehensive local and statewide efforts and provide information to the Department to monitor the effectiveness of the efforts and determine possible gaps in public awareness and Child Find. If gaps are determined, the CFC and the LIC increase efforts as required. The number of children screened during SFY 05/FFY 04 was 221,858.

The Illinois Part B and Part C programs work cooperatively to conduct public awareness and Child Find efforts. Child Find and public awareness efforts are supported through a partnership with CFCs, Local Interagency Councils, and the Illinois State Board of Education. The Look What I Can Do campaign is a statewide effort to identify children who may be eligible for either Part B or Part C of the Individuals with Disabilities Education Act (IDEA), through distribution of public awareness materials. In SFY 05/FFY 04, the Regional Office of Education #20 distributed 1,690,352 pieces of public awareness materials for the campaign.

The Early Intervention program in conjunction with the Illinois State Board of Education advertised the statewide Look What I Can Do/Child Find Public Awareness campaign. This advertisement takes place twice each year. The advertisements were in 19 newspapers, ran on six television stations and in Kid's Owners Manual magazine. Kid's Owners Manual is currently distributed to all new mothers at the four hospitals in Peoria and Tazewell counties. Copies of the magazine were also distributed to Pediatricians' offices and OB/GYN offices statewide.

Public awareness efforts direct families to call the Futures For Kids/Help Me Grow Helpline. Using a toll-free phone number (800/323-GROW), the caller has access to a database of local service directories for referral information by caller location. For EI services, callers are directed to the appropriate CFC. During SFY 05/FFY 04, the helpline received 3,306 calls for EI information and referral.

In Illinois, primary resources for referral include hospitals, physicians, parents, childcare programs, local education agencies, other social service agencies, and other health care providers. These referral sources are required to make referrals to the Early Intervention system no more that two working days after a potential eligible child is identified. Referrals are accepted by phone, by written correspondence, or in person. The referral initiates the 45-calendar-day time line for the development of an IFSP that meets the child's individual needs and addresses the concerns and priorities of the family.

Ongoing efforts to promote referrals from primary referral source are implemented at the local-level. Each CFC office receives funds for pediatric consultative services. These services include working with local physicians, clinics, and hospitals to promote referrals for early intervention services. Specific efforts have targeted referral of infants from neonatal intensive care units. The following are two examples of these efforts that are designed to meet the local medical community needs.

  • Large primary care practices, in areas of low referrals, were offered an education opportunity focusing on screening and referral.
  • A quarterly physician newsletter was developed in collaboration with CFC and LIC staff and distributed to pediatricians and family practitioners.

Illinois' child find process is supported by a performance contracting system for service coordination agencies that foster growth in several ways. First, the previous system was based on estimated caseloads that included cases open in intake. This created little incentive to conduct child find except near the period when the next year's grants were to be calculated and it created no incentive to move cases through the process quickly. In fact, it created an incentive to keep cases open in intake for extended periods of time. The new system provides quarterly payments to CFCs based on a six-month average number of children served with IFSPs. This creates an incentive to find children and to complete the intake process quickly. It also creates the incentive to keep families engaged. The proportion of cases that closed from intake, as well as from IFSP, for family reasons fell sharply. The process rewards agencies for doing good work and for providing good customer service.

Second, performance contracting includes incentive funding each quarter for those agencies that show the best performance in various areas. One incentive rewards those who complete the highest percentage of IFSPs within the mandated 45 days. This reduced the time it takes to determine eligibility from an average of about 80 days to under 30 days, where it is today. In SFY 05/FFY 04 the program initiated approximately 43 new IFSPs per day. At that rate the reduction in the time cases spend in intake amounts to 2,100 more children receiving services.

The reduction in the numbers of families the program loses contact with or who leave on their own also accounts for several hundred cases more than would be getting services had performance remained unchanged. Performance contracting also includes incentive funding to the top agencies in terms of overall participation rate. That makes it an exact match to this indicator. In summary, the performance contracting system creates an environment that constantly promotes and rewards effective child find and good customer service. The system creates motivation for CFCs and their local EI communities to pay attention to all of the normal aspects of the child find process and to fine-tune them in ways that foster improvement.

2002, 2003 & 2004 Participation Rate Comparisons National & Similar Eligibility States*

STATE

12/02

% of

Population

Rank

12/03

% of

Population

Rank

12/04

% of

Population

Rank

2-Year

% Change

States with Moderately Restrictive Eligibility Criteria
NEW YORK 4.79 3 4.42 3 4.26 3 -11.00%
RHODE ISLAND 3.5 5 3.48 5 3.56 6 1.80%
CONNECTICUT 3.06 9 2.96 9 3.1 11 1.10%
ILLINOIS 2 27 2.42 20 2.86 16 42.90%
IDAHO 2.22 23 2.44 19 2.73 21 22.90%
KENTUCKY 2.67 13 2.37 22 2.29 25 -14.10%
NEW JERSEY 2.12 24 2.36 23 2.21 26 4.30%
TEXAS 1.93 28 1.81 33 1.84 33 -4.60%
PUERTO RICO * 1.59 NR 1.42 45 1.8 36 12.90%
UTAH 1.86 31 1.69 39 1.77 38 -4.70%
NEBRASKA 1.62 36 1.7 38 1.74 39 7.30%
TENNESSEE 2.32 21 1.81 34 1.71 41 -26.20%
CALIFORNIA 1.72 34 1.63 40 1.67 35 -3.30%
OREGON 1.42 41 1.38 48 1.55 45 8.50%
SOUTH CAROLINA 1.03 49 1.04 53 1.36 50 33.00%
GEORGIA 1 50 1.19 50 1.33 51 32.10%
Subtotal 2.21 2.14 2.2 -0.50%
Nationwide 2.18 2.18 2.24 2.40%

*OSEP tables did not rank outlying areas such as Puerto Rico for 2002.

Participation Rate History By CFC & Region *

CFC & Number

End of

SFY 02

End of

SFY 03

End of

SFY 04

End of

SFY05

Change
#1 - LOVES PARK 2.53% 2.86% 3.38% 3.43% 35.60%
#2 - Lake County 1.90% 2.03% 2.61% 2.75% 44.93%
#3 - FREEPORT 2.76% 2.86% 3.34% 3.76% 36.53%
#4 - Kane & Kendall Counties 1.78% 2.15% 2.77% 3.06% 72.14%
#5 - Du Page County 1.76% 1.95% 2.73% 2.92% 65.62%
#6 - N. Suburbs 1.58% 1.92% 2.60% 2.90% 83.66%
#7 - W. Suburbs 2.17% 2.30% 2.87% 3.09% 42.53%
#8 - SW Chicago 2.12% 2.38% 2.86% 3.19% 50.29%
#9 - Central Chicago 1.93% 2.28% 2.71% 2.73% 41.48%
#10 - SE Chicago 1.98% 2.32% 2.75% 2.99% 50.97%
#11 - N. Chicago 1.43% 1.79% 2.28% 2.49% 74.33%
#12 - S. Suburbs 2.10% 2.50% 3.23% 3.37% 60.32%
#13 - MONMOUTH 1.88% 2.32% 2.33% 2.71% 44.30%
#14 - PEORIA 2.03% 2.11% 2.40% 2.76% 35.71%
#15 - Joliet 2.21% 2.41% 3.07% 3.37% 52.56%
#16 - DANVILLE 1.79% 2.24% 2.41% 2.79% 55.71%
#17 - QUINCY 2.51% 2.71% 2.63% 2.66% 6.06%
#18 - SPRINGFIELD 2.65% 3.14% 3.24% 3.46% 30.59%
#19 - DECATUR 2.51% 2.49% 3.02% 3.06% 22.02%
#20 - EFFINGHAM 3.52% 3.46% 4.02% 4.35% 23.82%
#21 - BELLEVILLE 1.80% 1.86% 2.26% 2.48% 37.95%
#22 - CENTRALIA 3.99% 4.03% 3.90% 4.36% 9.34%
#23 - NORRIS CITY 4.58% 6.19% 6.44% 7.82% 70.55%
#24 - CARBONDALE 2.59% 1.82% 2.30% 3.03% 17.04%
#25 - McHenry County 2.08% 2.49% 3.67% 3.45% 65.50%
Total * 2.04% 2.30% 2.84% 3.07% 50.50%
Super-Regions
Cook - 6, 7, 8, 9, 10, 11 & 12 1.81% 2.14% 2.68% 2.89% 59.46%
Collar - 2, 25, 4, 5, 15 1.93% 2.16% 2.87% 3.06% 58.66%
Balance of the State 2.54% 2.75% 3.06% 3.38% 33.01%

* Rates include cases remaining open until up to 30 days to facilitate final transition, equal about 1% of total open IFSPs. Only Service Coordination provided in this period. Such cases are excluded from all other federal reporting.

Discussion of Baseline Data:

Illinois' Early Intervention program has experienced dramatic period of growth extending back to January 2002. This followed a sharp decline stemming from a budget crisis and mandated program changes, including the introduction of insurance and fee requirements. The reversal coincided with the introduction of an aggressive effort to use data to drive program improvement. This included monthly reports to the regional (CFC) level and the introduction of performance contracting. Performance contracting formally started with SFY 03/FFY 02 but its outlines were known months before that and performance during SFY 02 drove initial SFY 03 grants and thus it guided CFC efforts at program improvement during the second half of SFY 02/FFY 01.

As was noted previously, much of the growth in the number of IFSPs can be attributed to the way performance contracting enhanced and supported the existing child find structure. If the program were still averaging 80 days to process initial IFSPs instead of its current less than 30 days it would be serving about 2,100 fewer children with ongoing services. Several hundred more cases can be attributed to a reduction in the number of families who are lost or who chose to leave on their own. That is more difficult to assess. Any calculation would include duplication with the estimate of cases added by quicker eligibility determination. In fact, it is logical to assume the two are linked. Families are less likely to get frustrated and leave on their own if they are getting answers quickly. CFCs have an additional motivation to keep families happy and involved and to keep track of them, even if they move.

Improvements in the process help explain much, but not all, of the growth in the caseload in SFY 03/FFY 02 and SFY 04/FFY 03. However, by SFY 05/FFY 04 the improvements in performance relate to the time it takes to move cases to IFSP and the proportion of cases closed for family reasons had leveled off. Things have generally continued to get better but at a much slower rate. The continued growth experienced in SFY 05/FFY 04 is best explained by the steady increase in referrals that can be traced back at least to 1999. (See the first chart on the 12-Month moving average number of referrals.)

When no case can stay in care for more than three years, rapid turnover is inescapable. If referrals were flat and customer service measures were not improving the caseload would soon become flat due to rapid turnover. Reaching children at younger ages could produce caseload growth as well. As will be discussed elsewhere, Illinois has tried to reach children at younger ages but so far with limited success. Although, we do plan to take additional steps to reach younger children and this will help foster future growth.

The chart displaying the average number of case openings and closings shows the wide gap between the two during the period of rapid growth in SFY 03/FFY 02 and SFY 04/FFY 03. It also shows that the gap has been steadily narrowing. It was 154 at the end of SFY 04/FFY 03 but just 100 at the end of SFY 05/FFY 04. We anticipate this will continue to slow during the plan period. Already we see significant seasonality setting in. There is caseload decline in the first quarter of the fiscal year, slow net growth in the second quarter, tied to reopening schools, and then growth in the last two quarters, driven mainly by special child find efforts by school districts.

NATIONAL COMPARISONS

As has been noted, Illinois participation rate has increased rapidly. In the December 1, 2002 federal reports the program was serving 2.00% of children under 3, compared to 2.18% nationwide and ranked Illinois 27th among all states. Among states with moderately restrictive eligibility criteria, Illinois ranked 8th out of 16 states and territories. In the December 1, 2003 federal report Illinois' caseload had grown by 20.9% and that pushed its participation rate to 2.42%, while the national rate remained at 2.18%. Illinois' rank improved to 20th among all states and territories and to fifth among the 16 with moderately restrictive eligibility criteria.

Caseload growth has continued to increase the Illinois' participation rate. For the December 1, 2004 report Illinois' participation rate had increased by an additional 16.6% to 2.86% of children under 3, compared to 2.24% nationally. This improved the state's rank to 16th overall and 4th among the 16 states having moderately restrictive eligibility standards.

At the June 30, 2005 baseline, the participation rate stood at 3.07%. While other state caseloads are also increasing, this will probably move Illinois to about tenth or eleventh overall.

REGIONAL COMPARISIONS

NOTE: CFC level comparisons detail is inflated by 1-2% overall because it includes cases CFCs may keep open for up to 30 days after a child's third birthday for service coordination only to assure finalization of the transition process.

When Illinois introduced its regular monthly reporting and performance contracting it emphasized OSEP focused monitoring triggers, including exceeding the 2.00% benchmark for participation rate. At the end of SFY 02/FFY 01, the state was right at the benchmark, once the cases over 3 are factored out. At that time, ten CFCs were under the mark, as were Cook County and the collar county region overall. Downstate was the only area exceeding the benchmark. Several CFCs were so far below 2.00% the program doubted all could reach it in the foreseeable future. However, by the end of SFY 04/FFY 03, just two years later, all 25 CFCs exceeded 2.00%. By the end of SFY 05/FFY 04, the participation rate had increased by 50.5% from three years earlier. The caseload grew in all 25 regions over that period. At the benchmark period (End of SFY 05/FFY 04) it is likely that all 25 CFCs have participation rates higher than the December 1, 2004 national average.

Downstate has experienced the slowest caseload growth but continues to have an overall participation rate that is significantly higher than Cook County or the collar counties. Overall, growth has been almost identical in Cook County and the collar counties, although they face very different challenges. The Cook caseload is generally poor and mobile. CFCs must keep families engaged in the eligibility determination process and during the term of the IFSP. Collar county families are generally much better off financially and not very mobile. They tend to be easier to engage once they have entered the system. However, many have the means to deal with their children's disabilities and delays without state subsidies and that results in fewer referrals per capita. Also, some resist entering the program if insurance will pay most service costs and they will be required to pay fees.

The table below gives a perspective on the differences between the three large regions of the state. The collar counties differ dramatically from the rest of the state on all factors. They are more likely to have health insurance, less likely to be Medicaid eligible and more likely to have income over 185% of poverty, which is the bar that determines if a family will be assessed a fee. In terms of Medicaid and fees, Cook County and downstate look very similar. However, downstate families are more likely to have access to health insurance than those in Cook County.

Caseload Economic Factors - End of SFY 05 By Geographic Super-Region

Medicaid Family Fees Health Insurance
Cook County 65.1% 23.6% 33.9%
Collar Counties 36.3% 45.6% 57.0%
Downstate 69.7% 29.1% 46.3%
Statewide 58.6% 31.2% 43.8%

Measurable and Rigorous Target

FFY Measurable and Rigorous Target

2005

(2005-2006)

The percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.14% on June 30, 2006, approximately 17,025 children.

2006

(2006-2007)

The percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.24% on June 30, 2007, approximately 17,593 children.

2007

(2007-2008)

The percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.32% on June 30, 2008, approximately 18,020 children.

2008

(2008-2009)

The percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.38% on June 30, 2009, approximately 18,339 children.

2009

(2009-2010)

The percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.37% on June 30, 2010, approximately 18,020 children.

2010

(2010-2011)

On October 31, 2010, the percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.37%.
2011 (2011-2012) On October 31, 2011, the percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.37%.

2012

(2012-2013)

On October 31, 2012, the percentage of all children in Illinois under age 3 served through an IFSP will be at least 3.37%.

The proposed performance targets for FFY10, FFY11 and FFY12 maintain the FFY2009 target value of 3.37%, due to the factors facing the EI Program, including the following. 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.

  • 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 increase participation rates.
  • 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 existing child find framework as outlined previously has proven very successful. As long as referrals continue to grow it will be maintained with minimal changes.
  • Since Illinois is still concerned about its relative inability to reach children at younger ages, particularly infants, refinements in recruitment efforts will focus on increased efforts to reach infants. This will include implementing steps based on an assessment of referral patterns as outlined under indicator 5.
  • The program will continue to utilize a modified fee-for-service system to pay CFCs for service coordination, based on actual children served with IFSPs. This rewards effective child find and retention. 
  • The program will continue to include overall and by CFC participation rate on its monthly statistical reports and will continue to grant quarterly incentive funding to the top 12 of 25 CFCs with the highest average participation rates over the most recent six-month period. This rewards effective child find and retention. 
  • The program will continue to grant quarterly incentive funding to the top 12 of 25 CFCs with the lowest average percentage of cases closing from intake for family reasons over the most recent six-month period. This rewards good customer service and retention.
  • The program will continue to grant quarterly incentive funding to the top 12 of 25 CFCs with the lowest average percentage of cases closing from IFSP for family reasons over the most recent six-month period. This rewards good customer service and retention.
  • The program will continue to grant quarterly incentive funding to the top 12 of 25 CFCs with the highest average percentage of initial IFSPs started within 45-days over the most recent six-month period. This rewards good customer service and follow-through with child find.
  • The program will continue to grant quarterly incentive funding to the top 12 of 25 CFCs with the lowest average number of days between referral and initial IFSPs over the most recent six-month period. This rewards good customer service and follow-through with child find.
  • The program anticipates that existing systems will continue to result in more caseload growth. However, data will be reviewed regularly to determine if additional measures are needed to reach unmet needs throughout the life of this plan.

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
Continue participation in 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 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 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.

In order to bring the state into full compliance with CAPTA, the Department of Children and Family Services (DCFS) will implement a process to screen children that reside in intact families and refer to EI, when appropriate.

DSCF staff hiring will be completed in FFY10/SFY11 and screening of children that reside in intact families will begin. CFC office staff will receive training as the screening process is rolled out statewide. This screening will be an ongoing strategy.

Resources include DCFS and Bureau of Early Intervention staff, CFC offices and the Early Intervention Training Program.