Indicator 4 - Percent of families participating in Part C who report that early intervention services have helped the family...

Overview of the Annual Performance Report Development: See Indicator 1.

Monitoring Priority	Early Intervention Services In Natural Environments
Indicator 4	Percent of families participating in Part C who report that early intervention services have helped the family: Know their rights; Effectively communicate their children's needs; and Help their children develop and learn. (20 USC 1416(a)(3)(A) and 1442)
Measurement	Percent = [(# of respondent families participating in Part C who report that early ntervention services have helped the family know their rights) divided by the (# of respondent families participating in Part C)] times 100. Percent = [(# of respondent families participating in Part C who report that early intervention services have helped the family effectively communicate their children's needs) divided by the (# of respondent families participating in Part C)] times 100. Percent = [(# of respondent families participating in Part C who report that early ntervention services have helped the family help their children develop and learn) divided by the (# of respondent families participating in Part C)] times 100.

FFY Measurable and Rigorous Target FFY09/SFY10

• 73.5% of respondent families participating in Part C will report that early intervention services have helped the family know their rights
• 85% of respondent families participating in Part C will report that early intervention services have helped the family effectively communicate their children's needs
• 89% of respondent families participating in Part C will report that early intervention services have helped the family help their children develop and learn

Actual Target Data for FFY09/SFY10:

Weighted Survey Results: Target	Formula: [(Responses 4 or Higher/Returns) x 100]	Percent 4 or Higher	FFY09/ SFY10
To what extent has early intervention helped your family know and understand your rights?	[(609.48/775.60) x 100]	78.58%	73.5%
To what extent has early intervention helped your family effectively communicate your child's needs?	[(665.75/777.50) x 100]	85.63%	85%
To what extent has early intervention helped your family be able to help your child develop and learn?	[(644.45/773.84) x 100]	83.28%	89%

Illinois utilized the revised version of the Family Outcomes Survey (FOS-R) for the first time this year to collect the data for this indicator. A copy of the FOS-R can be found as Attachment C. The FOS-R uses a 5-point rating scale, versus a 7-point scale used in previous versions, to assess the helpfulness of early intervention. The scale includes the following responses: 1 = Not at all helpful, 2 = A little helpful, 3 = Somewhat helpful, 4 = Very helpful, and 5 = Extremely helpful. Also new with the FOS-R are 17 new helpfulness indicators, including five for "know their rights," six for "effectively communicate their children's needs," and six for "help their children develop and learn." These additional indicators have been added with the belief that the data collected would be more informative and valid than data collected from the previous version of the FOS.

Since the FOS-R contains more than one item for each of the OSEP helpfulness indicators, a mean score has been calculated for each indicator. Survey results have been weighted to correct for geographic disparities in returns, resulting in minor for all three measures.

For the second consecutive year Illinois used an all mail survey, with the result of a more representative sample overall. Families were selected in the same way as they have been in the past, based upon a representative sample of children having a six-month review or annual IFSP coming due during a given span of time. The net return rate of about 21% was lower than the 24% from the past year. It is generally agreed that the all mail approach is best for Illinois, but the program will work with the Outcomes Workgroup on ways to improve race, ethnic and geographical representativeness and return rates.

Illinois has determined that its data for Indicator 4 are valid and reliable for the following reasons:

• The Cornerstone system identifies children who are scheduled for a 6-month and annual review for survey distribution and links demographic information for those families to survey results for further analysis.
• The survey system allows families to respond anonymously.
• Distribution to families via mail has eliminated intended/unintended influence that service coordinators or EI providers might have on responses.

• Returned surveys are scanned to ensure accurate reporting of results, with written comments entered manually.
• Surveys are distributed, received, scanned, and analyzed by the EI Training Program, with statewide and CFC-specific data reported.

• The Outcomes Work Group reviews data and helps plan improvement activities.
• The Early Childhood Outcomes (ECO) Center has determined that the FOS-R exhibits excellent psychometric properties. Illinois will provide its data to the ECO Center for further analysis.

To what extent has early intervention helped your family know and understand your rights?

	Chicago	Suburban Cook	Collar Counties	Downstate	Illinois Totals
Raw Totals
Distributed	1,012	742	846	1,110	3,710
Mean Returns/Responses	172.2	143	212.4	248	775.6
Mean Return Rate/Responses	17.02%	19.27%	25.11%	22.34%	20.91%
Mean Responses 4 or Higher	119.8	112.6	175.6	207.4	615.4
% 4 or Higher	69.57%	78.74%	82.67%	83.63%	79.35%
Mean Average Response	3.87	4.08	4.25	4.27	4.12
Statewide Return %	22.20%	18.44%	27.39%	31.97%	100%
Totals Adjusted for Geography
Avg. IFSP in Period	5,078	3,695	4,592	5,228	18,592
Caseload %	27.31%	19.87%	24.70%	28.12%	100%
Adjusted Returns	211.82	154.11	191.57	218.10	775.6
Adjusted Responses 4 or Higher	147.36	121.35	158.37	182.40	609.48
% 4 or Higher	69.57%	78.74%	82.67%	83.63%	78.58%
Average Response	3.87	4.08	4.25	4.27	4.12

To what extent has early intervention helped your family effectively communicate your child's needs?

	Chicago	Suburban Cook	Collar Counties	Downstate	Illinois Totals
Raw Totals
Distributed	1,012	742	846	1,110	3,710
Mean Returns/Responses	172.5	143.5	213	248.5	777.5
Mean Return Rate/Responses	17.05%	19.34%	25.18%	22.39%	20.96%
Mean Responses 4 or Higher	138.8	118.67	187.67	225	670.14
% 4 or Higher	80.46%	82.69%	88.11%	90.54%	86.19%
Average Response	4.11	4.25	4.39	4.47	4.35
Statewide Return %	22.19%	18.45%	27.40%	31.96%	100%
Totals Adjusted for Geography
Avg. IFSP in Period	5,078	3,695	4,592	5,228	18,592
Caseload %	27.31%	19.87%	24.70%	28.12%	100%
Adjusted Returns	212.33	154.49	192.04	218.63	777.5
Responses 4 or Higher	170.84	127.75	169.21	197.95	665.75
% 4 or Higher	80.46%	82.69%	88.11%	90.54%	85.63%
Average Response	4.11	4.25	4.39	4.47	4.35

To what extent has early intervention helped your family? Be able to help your child develop and learn?

	Chicago	Suburban Cook	Collar Counties	Downstate	Illinois Totals
Raw Totals
Distributed	1,012	742	846	1,110	3,710
Mean Returns/Responses	172.5	143.17	211.5	246.67	773.84
Mean Return Rate/Responses	17.05%	19.29%	25.00%	22.22%	20.86%
Mean Responses 4 or Higher	141	115.17	178.17	212	646.34
% 4 or Higher	81.74%	80.44%	84.24%	85.94%	83.52%
Average Response	4.16	4.13	4.13	4.45	4.27
Statewide Return %	22.54%	19.81%	25.28%	32.37%	100%
Totals Adjusted for Geography
Avg. IFSP in Period	5,078	3,695	4,592	5,228	18,592
Caseload %	27.31%	19.87%	24.70%	28.12%	100%
Adjusted Returns	211.33	153.76	191.14	217.60	773.84
Responses 4 or Higher	172.74	123.68	161.02	187.01	644.45
% 4 or Higher	81.74%	80.44%	84.24%	85.94%	83.28%
Average Response	4.16	4.13	4.13	4.45	4.27

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

Progress or Slippage for Indicator 4:

• In FFY09/SFY10, the percentage of families that indicated a positive response for knowing and understanding their rights was 78.58%, which exceeds the target of 73.5% and demonstrates an increase from FFY08/SFY09 data (71.85%).
• In FFY09/SFY10, the percentage of families that indicate a positive response for families being able to communicate child needs was 85.63%, which exceeds the target of 85% and demonstrates an increase from FFY08/SFY09 data (83.81%).
• In FFY09/SFY10, the percentage of families for being able to help their child develop and learn was 83.28%, which fell short of the target of 89% and demonstrates a decrease from FFY08/SFY09 data (88.27%).

Implementation of the new FOS-R did "raise the benchmark" on what constituted a positive response from families. In past years, responses on the helpfulness scale of "good" and "excellent" (5, 6 or 7 on a 7 point scale) were considered positive responses. This year, responses of "very helpful" and "extremely helpful" (4 or 5 on a 5 point scale) were considered positive responses, with a response of "somewhat helpful" not considered a positive response. The change in the scale and the addition of the helpfulness indicators may have directly contributed to both progress in two measures and slippage in the third. This version of the survey provides more informative data that will help guide providers to make program improvements that will directly impact these indicators for families. The data will also help the state identify training and technical assistance needs and will support policy review and revisions, as needed.

Downstate again had the highest scores on knowing rights and communicating your child's needs. Statewide a big jump was seen in both measures, with the exception of Chicago, which saw about a 1% decrease in both areas. The Collar Counties had the highest scores for helping their children develop and learn, but, overall, these scores dropped statewide. Scores for respondents from Suburban Cook County and the Collar Counties had the biggest jump of 16.44% and 12.8% in the area of knowing rights from the previous year.

When comparing the distribution of surveys by race/ethnicity to the data for the children enrolled in the program, there was good representation for Whites (54% of surveys/53% of children enrolled), Blacks (14% of surveys/15% of children enrolled), and Hispanics (27% of surveys/27% of children enrolled). Concerns continue about the responses of Hispanics and Blacks. This year the return rates for both Spanish and English speaking Hispanic families were 14.72% and 13.59% respectively and return rate for Black families was 10.87%, all significantly less than the 25.11% return rate for White families.

Local/CFC level data continue to illuminate the differential return rate problem. Weighting the four large regions helps adjust for this, but there are also disparities within those larger regions. For instance, CFC offices 9 and 10, which serve Chicago, had the lowest rating scores and the lowest return rate. CFC offices 9 and 10 are in an economically poor area. At the other end of that spectrum, CFC offices 4 and 5, Kane, Kendall, and Du Page counties, represents more middle class and wealthier areas and they had the state's highest return rate. Responses from these CFC areas were slightly higher than the state average. Their responses did not differ as much as those for the collar counties as a whole but their results do pull up the averages somewhat.

Unlike previous years, Spanish language survey results came in much higher than the average, both in average scores and in the percentage responding with scores of 4 or higher. Spanish speaking families responded with a 4 or higher at a rate of 94.6% for helpfulness in knowing their rights, 90.95% for helpfulness in communicating their child's needs and 93.56% for helping their child develop and learn.

As was the case last year, the program focused on taking steps that would improve outcomes for families. However, there were several changes in the program environment that help explain the decline in the area of helping your child develop and learn:

• Service delays, discussed in Indicator 1, may foster a sense of dissatisfaction with the program in families who are waiting to receive services for their child.
• Provider payment delays may contribute to unease for families.
• As noted before, the change in the scale and the addition of the helpfulness indicators in the survey directly contributed to both progress in two areas and slippage in one area. It is believed that these results are more informative and valid than in years past.

Improvement Activities Completed:

Improvement Activity Status/Timeline/Resource

The System Ombudsman will work to enhance high-level conformity with the spirit of Early Intervention rules, laws and philosophy. The System Ombudsman also will observe and make recommendations on local practice as it relates to the three family outcomes. On February 15, 2010, a system ombudsman position was added to the Illinois EI Training Program. The ombudsman has visited each of the CFCs to assess areas of strengths and concerns and is work to provide plans for training and technical assistance opportunities to address identified challenges. Other Program Integrity Project strategies have been piloted, with some system impact realized.

The IICEI will create a workgroup to study issues related to Hispanics. This workgroup will recommend program changes that will have a positive impact on the way Hispanics experience the program and thus their outcomes. This activity was not completed due to additional Workgroups that were formed around a special Early Intervention Legislative Taskforce. An IICEI Workgroup to study issues related to Hispanics will be created by December, 31, 2011 and will issue a report no later than June 30, 2012.

The program will do whatever it can to limit provider payment delays. Effective January 1, 2010 the state has included EI payments under its state Prompt Payment Act, which says the state must make an additional payment if bills are not paid within 60 days. This situation was monitored daily by Bureau staff and every effort was made to utilize all available funds, including state general revenue, federal Part C, Medicaid reimbursement, and family fee funds. Payments were made as funds became available.

The ECO/Illinois/Texas survey tool is being revised to make it appear shorter and less intimidating to families. It is anticipated this will improve the response rate. A revised version of the Family Outcomes Survey was used to collected data from Illinois families.

 Illinois chose to use this new survey format in order to better measure family outcomes and determine the helpfulness of early intervention programs. The revised version contains more detailed information to guide program improvement activities and uses a modified survey format.

The Outcomes Workgroup will recommend steps to be taken that will help increase survey return rates and help make returns more representative of the caseload for FFY09/ SFY10 and following years.  The Outcomes Workgroup discussed child and family outcomes data and made recommendations for improvement activities.

In addition, as part of minority outreach strategies, the Early Intervention Clearinghouse began developing bilingual information for families and will develop and maintain translated program documents for use by CFC offices.

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). A revision to the targets for FFY10/SFY11 is also proposed.

FFY Measurable and Rigorous Target

• 2010 - (2011-2012) 78% of respondent families participating in Part C will report that early intervention services have helped the family know their rights
  • 8% of respondent families participating in Part C will report that early intervention services have helped the family effectively communicate their children's needs
  • 0% of respondent families participating in Part C will report that early intervention services have helped the family help their children develop and learn
• 2011 - (2011-2012) 78.5% of respondent families participating in Part C will report that early intervention services have helped the family know their rights
  • 2% of respondent families participating in Part C will report that early intervention services have helped the family effectively communicate their children's needs
  • 0% of respondent families participating in Part C will report that early intervention services have helped the family help their children develop and learn
• 2012 - (2012-2013) 79% of respondent families participating in Part C will report that early intervention services have helped the family know their rights
  • 5% of respondent families participating in Part C will report that early intervention services have helped the family effectively communicate their children's needs
  • 2% of respondent families participating in Part C will report that early intervention services have helped the family help their children develop and learn

Illinois' baseline data (from FFY05/SFY06) included the weighted values of 76.8% of respondent families reported that early intervention services have helped the family know their rights; 86.5% of respondent families reported that early intervention services have helped the family effectively communicate their children's needs; and 90.2% of respondent families reported that early intervention services have helped the family help their children develop and learn. The proposed target values maintain the baseline target for two indicators (effectively communicate your child's needs and able to help your child develop and learn) in FFY2012/SFY2013, as the baseline values are well over current performance. Interim years demonstrate a gradual

increase to baseline values. Improvement over baseline for the third indicator (know and understand your rights) has been demonstrated and should continue as improvement activities are implemented. Survey data are still stabilizing as strategies to increase both the number of surveys distributed and return rates will have an impact on the ability of the data to be representative across CFC office areas and populations served.

Revisions to proposed targets and improvement activities were discussed with the Outcomes Workgroup. The Workgroup includes parent representatives from the IICEI, CFC office managers, Early Intervention providers, and research and training staff. 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 Outcomes Workgroup will develop a guidance document to help CFCs report the local results of the FOS to the community. Based on what is learned from the survey data statewide and locally, providers and programs will have an opportunity to reflect on the data and may choose to make changes or adjustments in their practice with families to see an improvement in family outcomes and/or individual indicators.	This will be completed in FFY10/SFY11. Resources include the Outcomes Workgroup, the EI Training Program and the Bureau of Early Intervention.
The Illinois EI Training Program will imbed training on the FOS indicators in both their online training modules and as a part of face-to face training opportunities for providers. The intent of this training will be to highlight the importance of what is asked of families as a part of the FOS, and to highlight how data from the FOS can help states see how their families are doing, identify any areas in need of improvement, and then, after program adjustments, assess the impact of those changes-with the goal of moving to ever higher percentages of families reporting outcomes attained.	This will be completed in FFY10/SFY11 and will continue as an ongoing activity. Resources include EI Training Program and the Bureau of Early Intervention.
The IICEI will create a Workgroup to study issues related to Hispanics. This Workgroup will recommend program changes that will have a positive impact on the way Hispanics experience the program and thus their outcomes. The focus of this group will be expanded to include African American families.	This Workgroup will be created by December, 31, 2011 and will issue a report no later than June 30, 2012. Resources include the IICEI, the EI Training Program, and the Bureau of Early Intervention.
Illinois will discontinue the use of mailing to a sampling of families participating in the program. All families enrolled in the program during a designated month will be sent a Family Outcomes Survey.	This will be initiated in FFY10/SFY11 and will continue as an ongoing activity. Resources include the EI Training Program and the Bureau of Early Intervention.
An online survey will be developed as an option for families to complete the Family Outcomes Survey. The online option will be available in both English and Spanish. The online option will not replace the paper version of the FOS. It is the hope that by offering an online option for FOS completion Illinois will see an increase in the overall return rate.	This will be completed in FFY10/SFY11 and will remain as an ongoing activity. Resources include the EI Training Program and the Bureau of Early Intervention.
To increase the return rate for African American and Hispanic families surveyed statewide and for all families' surveyed living in the City of Chicago, targeted phone calls will be made to families who have not returned a completed survey two weeks following the distribution of the surveys. Phone calls will be made by the EI Training Program staff and will be done for both English and Spanish speaking families. Families will be given the option to complete the survey over the phone at the time of the phone call.	This will be completed in FFY10/SFY11 and will remain as an ongoing activity. Resources include the EI Training Program.
The Illinois EI Training Program will develop a specific online training module for providers focused on cultural competency with the goal of increasing the percentage of African American and Hispanic Families reporting outcomes attained.	This will be completed in FFY11/SFY12. Resources include the EI Training Program and the Bureau of Early Intervention.
The EI Clearinghouse will develop materials for distribution to families and update information on its website to help ensure that families are well informed or their rights.	This work will begin in FFY10/SFY11 and will continue as on ongoing activity. Resources include the EI Clearinghouse, the EI Training Program, CFC offices and the Bureau of Early Intervention.
Graduate student research on issues that may impact family outcomes will be approved and the resulting information considered for future improvement activities.	This work will begin in FFY10/SFY11 and will continue as on ongoing activity. Resources include the Bureau of Early Intervention and Illinois graduate programs who contact the program for support and approval of research topics.