Phyllis Sloyer


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  • Early Steps of the Florida Department of Health under Children’s Medical Services is the lead agency for implementation of Part C of the Individuals with Disabilities Education Action (IDEA). The program is funded by both federal and state monies.
  • Early Steps recognizes and respects the pivotal role of the family in the lives of children. Our goal is to support family and primary caregivers in their natural care-giving roles and promotes normal patterns of living. Early Steps uses the Primary Service Provider (PSP) Model as its service delivery system. This approach requires an intervention team that works as in integrated whole, rather than a collection of separate disciplines. This structure supports a high degree of interaction and collaboration between the team members as they design and intervention plan detailing the recommended consultation and caregiver training. The IFSP team is required to select a primary service provider for each child and family. This decision is based on the presenting needs for the child and family, the IFSP outcomes, relationships with the family/caregivers, and expertise in the areas of support needed by the child and family.
  • While not all children are evaluated for eligibility, all enrolled children must have an assessment that identifies their unique needs. The IFSP team combines the results of the assessments with the families’ identified priorities and concerns to develop functional outcomes or goals to work towards. It is critical to point out that sometimes the developmental milestones and families priorities may not be the same!
  • The funding methodology for Part C and Part B (the Local Education Agency/school system) is different. Funding for the LEA/school system is determined by child counts that occur during select times in the year. Part C funds are based on an application process.
  • During the 2006-2007 fiscal year, Early Steps served 37,691 children statewide. A total of 249 children were identified with the diagnosis during the calendar year of 2007. Of this number 62 had the diagnosis at referral and 187 received the diagnosis while enrolled. The budget amount given for 2006-2007 is the legislative appropriation for DOH.  Early Steps services are also funded through Medicaid, Private Insurance and local funds. 
  • Concerns regarding the IFSP process include the belief that more is better and the desire to pile on services. Misunderstanding that services are based on functional outcomes and not just a prescribed treatment.
  • Phyllis Sloyer

    1. 1. Journey into Early Steps Phyllis Sloyer, RN, Ph.D, PAHM, FAAP Division Director Children’s Medical Services Network & Related Programs
    2. 2. Authority <ul><li>Individuals with Disabilities Education Act </li></ul><ul><li>(I.D.E.A), Part C – 20 USC 1431-1443 </li></ul><ul><li>Code of Federal Regulations – 34 Part 303 </li></ul><ul><li>Florida Statutes 391 and 393 </li></ul><ul><li></li></ul>
    3. 3. Who is Eligible for Early Steps <ul><li>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 </li></ul><ul><li></li></ul>
    4. 4. Eligibility Criteria <ul><li>Developmental Delay </li></ul><ul><li>-1.5 standard deviations below the standard mean </li></ul><ul><li>in one or more domains on an appropriate standardized assessment tool </li></ul><ul><li>-At least a 25% delay in terms of months of age </li></ul><ul><li>Developmental Domains: </li></ul><ul><li>-Communication </li></ul><ul><li>-Self-help/Adaptive </li></ul><ul><li>- Cognitive </li></ul><ul><li>- Physical (including fine and gross motor and vision and hearing) </li></ul><ul><li>-Social/Emotional . </li></ul>
    5. 5. Eligibility Criteria <ul><li>Established conditions fall into one or the following categories: </li></ul><ul><li>a) Genetic and metabolic disorders; </li></ul><ul><li>b) Neurological disorder; </li></ul><ul><li>c) Autism Spectrum Disorder; </li></ul><ul><li>d) Severe attachment disorder; </li></ul><ul><li>e) Significant sensory impairment (vision/hearing) </li></ul><ul><li></li></ul>
    6. 6. Eligibility Practices <ul><li>Children referred without an Established Condition must have a multidisciplinary evaluation completed to determine their eligibility. </li></ul><ul><li>Children referred with an Established Condition falling in the identified categories are made eligible without an evaluation. </li></ul><ul><li>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. </li></ul>
    7. 7. Key Components <ul><li>Family Centered Services & Supports within the natural environment </li></ul><ul><li>Primary Service Provider Model </li></ul><ul><li>Service Coordination </li></ul><ul><li>Individualized Family Support Plans (IFSP) </li></ul><ul><li></li></ul>
    8. 8. Natural Environments <ul><li>Maximizes each child’s everyday natural learning opportunities </li></ul><ul><li>Provides supports and services where children live, learn, and play </li></ul><ul><li>Recognizes the power of the relationship between the parent and child </li></ul><ul><li>Utilizes a routines-based approach that leads to functional intervention planning </li></ul><ul><li>McWilliams 2001 </li></ul>
    9. 9. Key Characteristics <ul><li>Individualized service delivery for each child. </li></ul><ul><li>Timely service delivery of identified services </li></ul><ul><li>Enhance the capacity of families to care for the developmental needs of their child </li></ul><ul><li></li></ul>
    10. 10. IFSP Team Process <ul><li>The family is integral member of the team. </li></ul><ul><li>Addresses the family’s priorities and their desired functional outcomes. </li></ul><ul><li>Results in a written plan to authorize services (IFSP). </li></ul><ul><li>Determines services on IFSP based on the individual needs of the child and family and the results of child and family evaluations and assessments. </li></ul><ul><li>Addresses timelines for services to begin and end. </li></ul><ul><li>Is an ongoing process. 10 </li></ul>
    11. 11. Funding <ul><li>Services authorized by the IFSP team are provided at no cost to families. </li></ul><ul><li>There is no income requirement for the Early Steps. </li></ul><ul><li>Commercial insurance, Medicaid and other community resources are utilized along with Part C monies to ensure service delivery. </li></ul><ul><li>Part C funds must be the payer of last resort for services provided. </li></ul><ul><ul><ul><ul><ul><li>11 </li></ul></ul></ul></ul></ul>
    12. 12. Funding (cont…) <ul><li>37,691 children served </li></ul><ul><li>249 children identified with ASD </li></ul><ul><li>Most children served are eligible by Developmental Delay </li></ul><ul><li>Early Steps spent $47,512,747 or $1,261 per child </li></ul>
    13. 13. Challenges <ul><li>Misinterpretation of the IFSP process </li></ul><ul><li>Lack of available providers and funding </li></ul><ul><li>Late entry of children into the program </li></ul><ul><li>Under identification of children </li></ul>
    14. 14. Supports <ul><li>Designated an Autism Spectrum Disorders Liaison in the Early Steps State Office. </li></ul><ul><li>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. </li></ul>
    15. 15. Resource <ul><li>Early Steps website: </li></ul><ul><li>- Steps </li></ul><ul><li></li></ul>