Journey into Early Steps

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Journey into Early Steps

• Phyllis Sloyer, RN, Ph.D, PAHM, FAAP
• Division Director
• Childrens Medical Services Network Related
  Programs

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Authority

• Individuals with Disabilities Education Act
• (I.D.E.A), Part C 20 USC 1431-1443
• Code of Federal Regulations 34 Part 303
• Florida Statutes 391 and 393
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Who is Eligible for Early Steps

• System serves children birth to three years of
  age that have a developmental delay or an
  established condition that has a high probability
  of resulting in developmental delay
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Eligibility Criteria

• Developmental Delay
• -1.5 standard deviations below the standard
  mean
• in one or more domains on an appropriate
  standardized assessment tool
• -At least a 25 delay in terms of months of age
  
• Developmental Domains
• -Communication
• -Self-help/Adaptive
• - Cognitive
• - Physical (including fine and gross motor and
  vision and hearing)
• -Social/Emotional.

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Eligibility Criteria

• Established conditions fall into one or the
  following categories
• a) Genetic and metabolic disorders
• b) Neurological disorder
• c) Autism Spectrum Disorder
• d) Severe attachment disorder
• e) Significant sensory impairment
  (vision/hearing)
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Eligibility Practices

• Children referred without an Established
  Condition must have a multidisciplinary
  evaluation completed to determine their
  eligibility.
• Children referred with an Established Condition
  falling in the identified categories are made
  eligible without an evaluation.
• Confirmation of an established condition must be
  provided by a licensed physician or a healthcare
  practitioner acting within his/her scope of
  practice including an audiologist in the case of
  hearing loss. 6

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Key Components

• Family Centered Services Supports within the
  natural environment
• Primary Service Provider Model
• Service Coordination
• Individualized Family Support Plans (IFSP)
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Natural Environments

• Maximizes each childs everyday natural learning
  opportunities
• Provides supports and services where children
  live, learn, and play
• Recognizes the power of the relationship between
  the parent and child
• Utilizes a routines-based approach that leads to
  functional intervention planning
• McWilliams 2001 8

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Key Characteristics

• Individualized service delivery for each child.
• Timely service delivery of identified services
• Enhance the capacity of families to care for the
  developmental needs of their child
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IFSP Team Process

• The family is integral member of the team.
• Addresses the familys priorities and their
  desired functional outcomes.
• Results in a written plan to authorize services
  (IFSP).
• Determines services on IFSP based on the
  individual needs of the child and family and the
  results of child and family evaluations and
  assessments.
• Addresses timelines for services to begin and
  end.
• Is an ongoing process. 10

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Funding

• Services authorized by the IFSP team are provided
  at no cost to families.
• There is no income requirement for the Early
  Steps.
• Commercial insurance, Medicaid and other
  community resources are utilized along with Part
  C monies to ensure service delivery.
• Part C funds must be the payer of last resort for
  services provided.
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Funding (cont)

• 37,691 children served
• 249 children identified with ASD
  
• Most children served are eligible by
  Developmental Delay
• Early Steps spent 47,512,747 or 1,261 per
  child 12

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Challenges

• Misinterpretation of the IFSP process
• Lack of available providers and funding
• Late entry of children into the program
• Under identification of children 13

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Supports

• Designated an Autism Spectrum Disorders Liaison
  in the Early Steps State Office.
• Convened an Autism Spectrum Disorders Guidance
  Workgroup to make recommendations to the Early
  Steps State Office for the creation of guidelines
  for children with autism spectrum disorders.
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Resource

• Early Steps website
• -http//www.cms-kids.com/Early Steps
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