Indicator #5 - Participation in Early Intervention For Children Under The Age Of One

Participation in Early Intervention For Children Under The Age Of One

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Part C State Annual Performance Report (APR) for FFY 07/SFY 08

Overview of the Annual Performance Report Development:

The Illinois APR documents performance data on State targets for each Child and Family Connections (CFC) office and documents CFC and state progress or slippage toward measurable and rigorous targets. The Illinois Early Intervention (EI) Program makes the Illinois APR and State Performance Plan (SPP) available on its web site and through links from the other EI web sites (the Illinois Early Intervention Training Program; Provider Connections, the Early Intervention credentialing office; and the Early Childhood Intervention Clearinghouse). The APR and SPP documents are also available to the public at each of the 25 CFC offices.

The APR is part an ongoing process of performance measurement and strategic planning for the Illinois Early Intervention Program. For a number of years, Illinois has been reporting performance data to key stakeholders including the Illinois Interagency Council on Early Intervention (IICEI), the Child and Family Connections (CFC) offices, and the general public through various reporting mechanisms. Work groups of the IICEI have been formed to address specific indicators (Service Delay Work Group and Transition Work Group) and overall operation issues (Finance Work Group). These work groups have helped analyze data and suggest improvement strategies.

Illinois utilizes a central client tracking system, Cornerstone. No activity can take place without a case being active in Cornerstone. For many years the system has provided service coordination agencies (CFCs) with reports they can pull to help them track the size and movement of their caseloads. They also have tools to compile their own reports. The EI Bureau now has the same capacity to access and analyze current client data.

Since January 2002, the program has also utilized a monthly reporting system on a series of performance measures. Since the beginning of SFY 03 (July 1, 2002), the program has operated a performance contracting system for CFCs, based on some of the more important measures found in the monthly statistical reports. The under 1 participation rate is reported for each CFC each month and this is one of the measures that carries performance contacting incentive funding. Another performance contracting measure is the average age of children at initial IFSP.

The monthly reporting system also includes the following additional measures intended to emphasize the importance of reaching more children earlier: percent of caseload under 1, percent of initial IFSPs started under age 1, the average age of all open cases and average age at initial IFSP. In addition, the program tracks the percentage of the caseload over 30 months old, both because those cases should be in the transition process and as a counter-weight to the under 1 caseload. The emphasis is on reducing the age of the caseload. The Illinois Interagency Council on Early Intervention (IICEI) has made reaching eligible children at younger ages a priority for a number of years. Performance is reported to them regularly and age related factors are one of the primary areas of discussion with CFC Managers at their periodic meetings.

As a result of this ongoing emphasis on reaching children at younger ages and reporting on performance, development of the APR just required updating existing reports to the appropriate dates, as well as identifying the appropriate data for other states to make the required performance comparisons.

For both financial and program reasons the EI program is undertaking a new, higher level form of monitoring and technical assistance called the Program Integrity Project. This project is discussed in more detail under Indicator 6. However, the goals are to foster a more uniform administration of eligibility

standards statewide, to assure that eligibility determination is being completed within the spirit of state limits, and to see that the program philosophy is being appropriately applied. It is anticipated that this project will reduce the number of children in the program. As a result, projections for the remaining years of the SPP must be adjusted downward. However, since Illinois has problems reaching the youngest children, we believe the Program Integrity Project will have less impact on the number of children in the program under age 1.

Monitoring Priority: Effective General Supervision Part C / Child Find

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

1. Other States with similar eligibility definitions; and
2. National data.

(20 U.S.C. 1416(a)(3)(B) and 1442)

Measurement:

1. 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 the same percent calculated for other States with similar (narrow, moderate or broad) eligibility definitions.
2. 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.

FFY: 2007 (2007-2008)

Measurable and Rigorous Target: 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.

Actual Target Data for FFY07/SFY08: On June 30, 2008, the percentage of children in Illinois under age 1 served through an IFSP was 1.24%, 2,267 children.(2,267/182,781)*100=1.24%

Actual Target Data for FFY07/SFY 08:

<1 Participation Rate Goals & Actual Caseloads	June 30, 2007	FFY06/SFY 07 Goal	June 30, 2008	FFY07/SFY08 Goal
Children with IFSPs	2,356	2,406	2,267	2,410
Participation Rate	1.29%	1.33%	1.24%	1.36%

Illinois EI ProgramChildren with IFSPs < 1

	% of Pop.	% of Caseload
December 1, 2002	0.70%	11.84%
June 30, 2003	0.84%	12.49%
December 1, 2003	0.61%	12.75%
June 30, 2004	1.06%	12.48%
December 1, 2004	0.89%	12.76%
June 30, 2005	1.21%	13.10%
December 1, 2005	0.82%	12.01%
June 30, 2006	1.20%	12.78%
Oct. 31, 2006	1.17%	12.48%
June 30, 2007	1.33%	13.14%
Oct. 31, 2007	1.20%	12.31%
June 30, 2008	1.24%	12.08%

FFY07/SFY08 Participation Rates

Illinois was serving 2,267 children under 1 on June 30, 2008, falling short of the target by 143. The change between the federal (October 31, 2007: 2,185/182,781 x 100=1.20%) reporting points showed a small increase. However, the end of year counts showed a significant decline and it has continued to decline since the end of June.

For a number of years Illinois has put a particular emphasis on trying to reach children at younger ages. The under 1 participation rate increased substantially for a number of year as overall caseload increased. However, between June 30, 2007 and June 30, 2008 the total number of children in the program increased by 4.6% but the number of children under 1 fell by 3.8%. This creates the curious situation where the national comparison tables show that Illinois improved its under 1 participation rate for the year and even moved from 20th to 19th in the rankings but based on the year end numbers on which Illinois sets its targets there was a decline. Although that is notably lower than the 13th place ranking for the overall participation rate.

Illinois is 4th out of the 14 states with moderately restrictive eligibility criteria, including Puerto Rico. It is interesting to note that having eligibility rules that OSEP deem moderately restrictive does not seem to adversely affect the overall participation rates. As a group, moderately restrictive states have consistently had higher participation rates than the national average. In fact, the participation rate in for 2007 reporting was almost 19% higher than the national average. However, it does seem to affect reaching infants. The under 1 participation rate for moderately restrictive states is 8.5% lower than the national average. With this in mind, it is frustrating to the program that its many efforts to reach children sooner have only been modestly successful. On the positive side, over the last five years, Illinois has at least been able to buck the national trend that shows slower growth in the under 1 participation rate than in the overall participation.

2002 - 2007 Participation Rate ComparisonsNational & Similar Eligibility States

	2002		2006		2007		Change
State	% of Pop.	Rank	% of Pop.	Rank	% of Pop.	Rank	1-Year % Change	5-Year % Change
States with Moderately Restrictive Eligibility Criteria
Rhode Island	1.78	6	2.04	5	2.29	5	12.3%	14.6%
Louisiana	0.49	45	0.84	30	1.27	15	51.2%	71.4%
Indiana	2.10	3	1.40	14	1.25	16	-10.7%	-33.3%
ILLINOIS	0.70	36	1.17	20	1.20	19	2.6%	67.1%
South Dakota	0.59	40	1.21	19	1.15	21	-5.0%	105.1%
Alaska	0.80	29	0.76	31	1.14	22	50.0%	-5.0%
New York	1.10	18	1.09	23	1.04	24	-4.6%	-0.9%
Delaware	1.84	5	0.99	38	1.03	25	4.0%	-46.2%
North Carolina	0.63	39	0.84	29	0.89	32	6.0%	33.3%
Colorado	0.68	37	0.73	33	0.71	36	-2.7%	7.4%
Kentucky	0.79	32	0.60	45	0.65	40	8.3%	-24.1%
New Jersey	0.55	42	0.63	40	0.65	41	3.2%	14.5%
Puerto Rico	0.46	NA	0.61	44	0.63	43	3.3%	32.6%
Minnesota	0.73	35	0.63	40	0.62	44	-1.6%	-13.7%
Moderate States #	0.91		0.93		0.97		4.0%	2.5%
Nationwide ^	1.03		1.04		1.06		2.2%	0.7%

#: For states with moderately restrictive eligibility rules in that year.

^: Totals excluding children classified as eligible because they are at-risk

While the overall participation rate has increased steadily the under 1 participation rate has grown more slowly and erratically.

Description of Early Intervention Under 1 Participation Rate - IFSPs / All Children less than 1

Under Age 1 Participation Rate History *By CFC & Region

CFC # & Name	End of SFY 02	End of SFY 03	End of SFY 04	End of SFY 05	End of SFY 06	End of SFY 07	End of SFY 08	Rank	FY 08% Change	6 Year Change
#1 ROCKFORD	0.70%	1.23%	1.44%	1.15%	1.28%	1.46%	1.22%	10	-16.3%	73.5%
#2 LAKE COUNTY	0.51%	0.66%	0.86%	1.00%	0.91%	0.75%	0.88%	25	17.4%	72.0%
#3 FREEPORT	1.01%	1.07%	1.25%	1.59%	1.10%	1.50%	1.25%	8	-16.5%	24.2%
#4 KANE-KENDALL	0.75%	0.82%	0.76%	1.19%	1.01%	1.20%	0.97%	19	-18.9%	29.7%
#5 DUPAGE COUNTY	0.50%	0.66%	0.94%	0.97%	0.92%	0.99%	0.95%	20	-4.1%	90.2%
#6 N. SUBURBS	0.47%	0.67%	0.93%	1.10%	1.28%	1.38%	1.43%	12	3.6%	206.5%
#7 W. SUBURBS	0.71%	0.75%	0.88%	0.93%	1.10%	1.25%	1.30%	17	4.0%	82.8%
#8 SW CHICAGO	1.07%	1.08%	1.33%	1.60%	1.40%	1.44%	1.42%	11	-1.1%	32.9%
#9 CENTRAL CHICAGO	0.85%	1.27%	1.28%	1.20%	1.53%	2.05%	1.68%	2	-17.9%	97.7%
#10 SE CHICAGO	0.71%	0.93%	1.54%	1.68%	1.67%	1.90%	1.42%	4	-25.1%	98.6%
#11 N. CHICAGO	0.57%	0.72%	0.95%	1.00%	1.20%	1.33%	1.21%	13	-8.9%	113.7%
#12 S. SUBURBS	0.81%	0.98%	1.37%	1.60%	1.45%	1.30%	1.22%	14	-5.9%	50.8%
#13 MACOMB	0.33%	0.83%	0.63%	1.38%	1.01%	1.24%	1.16%	18	-6.4%	255.6%
#14 PEORIA	0.50%	0.65%	0.63%	0.74%	0.98%	0.94%	1.13%	23	20.3%	128.0%
#15 JOLIET	0.81%	0.78%	1.15%	1.26%	1.01%	0.96%	1.13%	22	18.0%	40.2%
#16 BLOOMINGTON	0.47%	0.72%	0.69%	0.83%	0.95%	1.28%	1.31%	15	2.0%	180.2%
#17 QUINCY	0.85%	0.76%	0.85%	1.28%	1.29%	1.84%	1.84%	5	-0.1%	115.8%
#18 SPRINGFIELD	0.61%	1.09%	1.45%	1.22%	1.39%	1.49%	1.30%	9	-12.5%	113.1%
#19 DECATUR	1.11%	0.78%	0.94%	1.41%	1.29%	1.60%	1.51%	7	-5.6%	36.1%
#20 EFFINGHAM	0.91%	1.76%	1.29%	2.13%	1.61%	1.99%	1.99%	3	-0.2%	117.6%
#21 BELLEVILLE	0.53%	0.79%	0.86%	1.03%	0.94%	0.78%	0.97%	24	25.0%	83.4%
#22 CENTRALIA	1.24%	1.72%	1.53%	1.61%	1.39%	1.60%	1.56%	6	-2.5%	25.6%
#23 NORRIS CITY	3.07%	2.51%	2.88%	3.35%	4.27%	2.65%	2.75%	1	3.6%	-10.4%
#24 CARBONDALE	0.97%	0.57%	0.63%	1.14%	1.33%	1.28%	1.11%	16	-13.1%	14.1%
#25 MCHENRY CO.	0.98%	0.69%	1.36%	1.02%	0.94%	0.99%	1.28%	21	29.9%	31.1%
Statewide	0.70%	0.87%	1.06%	1.21%	1.20%	1.30%	1.24%		-4.15%	77.71%
Cook (6-12)	0.70%	0.88%	1.14%	1.25%	1.35%	1.48%	1.36%		-8.4%	94.5%
Collar (2, 4, 5, 15, 25)	0.67%	0.72%	0.97%	1.09%	1.05%	1.07%	1.11%		4.3%	67.0%
Downstate (Others)	0.75%	1.00%	1.03%	1.26%	1.12%	1.24%	1.22%		-1.5%	63.3%

* Based on birth data rather than estimated population used for 618 reporting because estimated population data is not available to local levels.

Discussion of Improvement Activities Completed and Explanation of Progress or Slippage that occurred for FFY 07/SFY 08:

Illinois continued to utilize the same practices that have helped promote increased under 1 child-find over a number of years. No new improvement activities were introduced during FFY07/SFY08 because existing steps seemed to be achieving the desired results. The state has other programs to serve children seen as at risk at birth due to low birth weight and other factors. State rules require referral to the EI program as

well but that sometimes is not done. While that helps explain the state's long-term problem in reaching infants, there were no changes in that situation that might explain the decline in the number of infants coming into the program. Financial problems are presenting challenges to both families and the state but that has not seemed to have impacted child find overall or under 1 child find specifically.

In fact, the program cannot identify anything that explains the decline, particularly since the overall caseload continued to increase. It is possible that FFY06/SFY07 was an anomaly on the high side and FFY07/SFY08 was an anomaly on the low side. The under 1 caseload is a small fraction of the overall caseload which increases the impact of oddities in referral patterns.

The program will reinforce its existing efforts and find new ways to reach out to the medical community and others with the message of the importance of getting children screened and referred sooner.

Revisions, with Justification, to Proposed Targets / Improvement Activities / Timelines / Resources for FFY 07/SFY 08:

Revisions to the proposed targets have been discussed with the IICEI and are provided below. As is presented elsewhere in this APR, the program is undertaking a Program Integrity Project to promote a more uniform administration of eligibility standards and the program's philosophy. While we anticipate this will result in a decline in new children entering the program through FFY09/SFY10 we do not anticipate it having much impact on the number of infants entering. So, the following revised targets mainly reflect a lower starting place than they do the impact of the Program Integrity Project. Rather, we anticipate that renewed effort on reaching the youngest children will increase the proportion of the caseload under 1 and the under 1 participation rate. In addition, a new data sharing effort with the Illinois Department of Public Health, described below, will ensure that a known group of infants potentially eligible for the program are appropriately referred.

• FFY 08/SFY 09 - 1.32% of children under 1, approximately 2,421 IFSPs on June 30, 2009
• FFY 09/SFY 10 - 1.33% of children under 1, approximately 2,420 IFSPs on June 30, 2010
• FFY 10/SFY 11 - 1.35% of children under 1, approximately 2,472 IFSPs on June 30, 2011

New Improvement Activity:

• 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.