United states deparment of education office of special education and rehabilitative services
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III. PART C: EARLY INTERVENTION SERVICES IN NATURAL ENVIRONMENTSIn creating the Part C legislation, Congress recognized the urgent need to ensure that all infants and toddlers with disabilities and their families receive early intervention services according to their individual needs. Three of the principles on which Part C was enacted include: (1) enhancing the child’s developmental potential, (2) enhancing the capacity of families to meet the needs of their infant or toddler with disabilities, and (3) improving and expanding existing early intervention services being provided to children with disabilities and their families. To assist families in this process, Congress also requires that each family be provided with a service coordinator, to act as a single point of contact for the family. The service coordinator’s responsibilities include assisting families in understanding and exercising their rights under Part C, arranging for assessments and IFSP meetings, and facilitating the provision of needed services. The service coordinator coordinates required early intervention services, as well as medical and other services the child and the child’s family may need. With a single point of contact, families are relieved of the burden of searching for essential services, negotiating with multiple agencies and trying to coordinate their own service needs. Part C requires the development and implementation of an IFSP for each eligible child. The evaluation, assessment, and IFSP process is designed to ensure that appropriate evaluation and assessments of the unique needs of the child and of the family, related to the enhancing the development of their child, are conducted in a timely manner. Parents are active members of the IFSP multidisciplinary team. The team must take into consideration all the information gleaned from the evaluation and child and family assessments, in determining the appropriate services to meet the child’s needs. The IFSP must also include a statement of the natural environments in which early intervention services will be provided for the child. Children with disabilities should receive services in community settings and places where normally-developing children would be found, so that they will not be denied opportunities that all children have - to be included in all aspects of our society. Since 1991, IDEA has required that infants and toddlers with disabilities receive early intervention services in natural environments. This requirement was further reinforced by the addition of a new requirement in 1997 that early intervention can occur in a setting other than a natural environment only when early intervention cannot be achieved satisfactorily for the infant or toddler in a natural environment. In the event that early intervention cannot be satisfactorily achieved in a natural environment, the IFSP must include a justification of the extent, if any, to which the services will not be provided in a natural environment. Validation Planning and Data Collection OSEP with the Steering Committee identified five recurring themes about early intervention services in Nebraska leading to the validation data collection phase: (1) What is the State’s understanding of natural environments and how are natural environments requirements being implemented by regional providers? (2) To what extent are infants and toddlers and their families not receiving services based on their needs and on a continuous basis? (3) Why are families declining service coordination? (4) What procedures/projects are in place to encourage capacity building of services in community settings? (5) Do funding mechanisms impact the availability of services in natural environments? OSEP reviewed and analyzed data and identified the following strengths, areas of noncompliance, and suggestions for improved results for infants and toddlers and their families.
1. Medicaid reimbursement for natural environment settings Nebraska’s State Medicaid Plan supports the provision of early intervention services in natural environments. Since 65 percent of the infants and toddlers are eligible for Medicaid funded services, this provision affects a large number of children. A respite care subsidy program for Medicaid eligible children allows respite services to be provided in a family’s natural environment. 2. Regional Initiatives Regional initiatives are a key component of the early intervention system in Nebraska and complement the State initiatives. The planning region teams have ongoing projects to enhance early intervention services in natural environments. One planning region team provided information and training to 1,200 licensed child care providers about developmental milestones and referrals to early intervention. Seven planning region teams collaborated to develop, implement, and evaluate respite care and child care services. Respite care networks have also been developed in four other planning regions. 3. Telemedicine To address the needs of infants and toddlers in rural communities, the Co-Lead Agencies have recently initiated a Telemedicine service, connecting health and medical specialists, primary care physicians, and families through video conferencing to better meet the needs of infants and toddlers and their families. This service is crucial to Nebraska in that 50% of the children enrolled in early intervention services reside in areas outside of metropolitan locales and may not have easy access to specialized services they need. B. AREA OF NONCOMPLIANCE1. Continuous Services and Individualized Family Service Plans (IFSPs) Federal regulations specify that early intervention services are services designed to meet the developmental needs of each eligible child and the needs of the family related to enhancing the child’s development. Early intervention providers may not interrupt, modify or otherwise change early intervention services for reasons unrelated to the child’s needs, such as service availability or changes in providers’ schedules. 34 CFR §§303.12(a)(1) and 303.344(d) and (f). The IFSP, a required component of the early intervention system, must include specific information about the frequency, intensity, projected initiation dates and projected duration of services. 34 CFR §§303.344(d) and (f). OSEP finds that the State has not effectively ensured that public agencies provide early intervention services that are designed to meet the developmental needs of each eligible child consistent with 34 CFR §303.12(a)(1) and (2); and in accordance with the content of the child and family’s IFSP consistent with 34 CFR §§303.344(d) and (f). The Co-Lead Agencies had verified to OSEP, prior to OSEP’s validation data collection visit, that direct services are not being provided or are decreased during the months of June, July and August due to operating procedures rather than individualized needs. State monitoring findings confirmed noncompliance with the provision of continuous services in four of the five Regions the State visited subsequent to OSEP’s visits. The Nebraska Interagency Coordinating Council identified interruption of IFSP services as a major concern. In all areas of the State, OSEP’s review of IFSPs showed that services were interrupted, modified or decreased in frequency, and intensity consistently during the months of June, July and August. For example, IFSPs stated that services would be reduced in intensity and frequency during the summer months. IFSPs for three children referred in June stated that initiation of services would begin in September. These changes were made regardless of the needs of the child or parent, or services specified on the IFSP. In all areas of the State OSEP visited, administrators, service coordinators, service providers, and parents reported that early intervention services during the summer months were either reduced or were nonexistent based on administrative configuration of the service delivery system and availability of staff. Service coordination, however, is available on a continuous basis. Superintendents in several rural areas told OSEP that they believed provision of continuous services is problematic because they could not commit to spending funds for services that had not been approved by their local School Board for the regular school year, regardless of whether the State would later reimburse these costs. The local School Board approves budgets for special education and related services provided to Part C eligible children during the summer months. |