United states deparment of education office of special education and rehabilitative services
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C. SUGGESIONS FOR IMPROVED RESULTS FOR INFANTS, TODDLERS AND THEIR FAMILIESOSEP made the following observations about improving services in natural environments. 1. Designation of natural environments on IFSPs. Federal regulations require that public agencies include in each individualized family service plan (IFSP) a statement of the natural environments in which services are to be provided and a justification of the extent, if any, to which services will not be provided in a natural environment. 34 CFR §303.344(d)(1)(ii). Natural environments “means settings that are natural or normal for the child’s age peers who have no disabilities.” In reviewing seven IFSPs developed after July 1, 1998 and other records, OSEP found that the Statewide IFSP form had not been modified to include the natural environment requirement, nor had the State Co-Lead Agencies provided training or written guidance to the IFSP teams about the need to justify the location of a service if it was not going to be provided in the child’s natural environment. All IFSP forms OSEP reviewed were based on the State model. The Co-Lead Agencies acknowledged the need to provide training and information about the requirements for natural environments, to include issues of funding, liability, and broadening functional learning opportunities to infants and toddlers with disabilities. Subsequent to OSEP’s visit to the State, the Co-Lead Agencies have initiated a number of training and technical assistance initiatives to ensure that the natural environments requirements are being met across the State. However, given the prevalence of the use of the State model form, OSEP recommends that the form be revised to reflect the natural environment requirement and training be conducted to assure understanding of the use of the form and its purpose. 2. Early intervention services in rural communities and under-represented populations In the rural areas OSEP visited, OSEP saw many examples in which community and natural family support systems, such as extended families, religious and community organizations were being used to provide early intervention services in natural environments. However, according to administrators, service coordinators, and service providers in the rural areas, access to medical specialists, transportation, respite care, child care, speech, physical and occupational therapists, are challenges. According to the results of at least one Quality Improvement Review, “severe shortages of professionals, especially in occupational therapy, physical therapy, speech therapy, and medical specialties is a significant issue” in [that] area. Rural communities may have other unique challenges as well. Data from the Statewide Special Education Data System (SESIS) indicate that nineteen rural counties report providing special education to fifteen to twenty two percent of their enrolled children and youth. The State personnel pointed out that these areas of the State may have economic and other variables that contribute to relatively high number of special education students as compared to other areas of the State. It is unknown whether a concomitant proportion of infants and toddlers require early intervention services as well. The NDE has established an early childhood team within the Department to coordinate Head Start, early childhood special education programs, early intervention, and other State-initiated early childhood programs, e.g., services to teen parents and traditionally under served groups in the State. At the time of OSEP’s visits, the team was in the process of revising the State’s interagency agreement to include Migrant, Indian, and Early Head Start Programs that also serve infants and toddlers with disabilities in natural environments. The results of one Quality Improvement Process indicated that “Native American and Hispanic children are not referred at an early age. These children are discovered in kindergarten.” OSEP encourages the State to continue to work within this team, the State Interagency Coordinating Council and others to address the issue of services to rural and underrepresented populations. 3. Service Coordination Service coordination is a key component to ensure that eligible infants and toddlers and their families receive prompt, appropriate, and coordinated services. Parents and administrators, who participated in the State’s Self-Study reported positive results from the statewide service coordination system. Some examples of the effectiveness of the Nebraska system include: (1) low turnover of service coordinators and their contracting agencies; (2) each service coordinator and their supervisor has a professional development plan based on State competencies emphasizing family-centered practices; (3) the Co-Lead Agencies have ensured that each service coordinator has only 30 families at any point in time; and (4) the State has a strong funding base for service coordination. However modifications in procedures could make the system even stronger. The Nebraska Self-Study cited a concern that when service coordination is declined by a parent, it results in families not having adequate information about all the services available in the early intervention system. Administrators in one densely populated area of the State told OSEP that half of the families enrolled in early intervention services declined service coordination. Participants of the public forums confirmed that in some areas of the State, service coordination is a fluid process in that families decide when they need service coordination. Administrators and parents in some areas of the State told OSEP that families who had an active service coordinator had a smoother transition to other services when the child reached age 3. Results from one regional “Quality Improvement Process” indicate that Native American families decline service coordination in large numbers. Part C 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, arranging for assessments and IFSP meetings, and facilitating the provision of needed services. Nebraska procedures require a family to decide at the initial IFSP meeting whether to request or decline service coordination. A family can request service coordination in subsequent IFSP meetings, should they decline these services during the initial IFSP. While this procedure is not inconsistent with the requirement that families may accept or decline any early intervention service, OSEP encourages the Co-Lead Agencies to continue to provide training for parents, service providers and service coordinators on the importance and functions of service coordination. Families who must decide whether to accept or decline service coordination during the initial IFSP may not fully understand the long term implications of declining service coordination. Anecdotal data in early intervention suggests that at an initial IFSP meeting, a family may not be ready to make all decisions that impact upon their child and their family. |