Journey into Journey into Early StepsEarly Steps

Phyllis Sloyer, RN, Ph.D, PAHM, FAAP

Division Director

Children’s Medical Services Network & Related Programs

AuthorityAuthority

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 Who is Eligible for Early StepsSteps

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 CriteriaEligibility Criteria Developmental Delay

-1.5 standard deviations below the standard meanin 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.

Eligibility CriteriaEligibility 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 PracticesEligibility 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.

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Key ComponentsKey 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 EnvironmentsNatural Environments

Maximizes each child’s 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 planningMcWilliams 2001 8

Key CharacteristicsKey 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 ProcessIFSP Team Process

The family is integral member of the team. Addresses the family’s 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

FundingFunding

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 Funding (cont…)(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

ChallengesChallenges

Misinterpretation of the IFSP process

Lack of available providers and funding

Late entry of children into the program

Under identification of children13

SupportsSupports

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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ResourceResource

Early Steps website:

-http://www.cms-kids.com/Early Steps

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