Early Intervention Programs Interim Project

Transcription

1 Early Intervention Programs Interim Project OMMITTEE ON HILDREN & FAMILIES FLORIDA HOUSE OF REPRESENTATIVES FALL, 1999

2 ONTENTS I II III IV V Executive Summary Introduction What Is Early Intervention? Federal Individuals with Disabilities Education Act (IDEA) Early Intervention Programs in Florida A. Readiness for School & hild are B. Early Intervention. Health overage: Florida Kidare VI VII VIII IX School Readiness: Integration of Early Education and hild are Services hild are Developmental Assessment: Integration of Subsidized hild are and Early Intervention Services Survey of Early Intervention Programs: Issues and Resources Findings and onclusions: Issues in Florida s Early Intervention System 1. Fragmentation of Services 2. Limited Scope and Resources of Programs for hildren with Disabilities and hildren At-Risk of Developmental Delay 3. Demand for Services Exceeds apacity 4. Lack of Statewide Governance for Early Intervention X Recommendations 1. Explore Use of TANF Funds 2. Establish a Governance Structure for Early Intervention Services 3. Revise hapter 411, F.S.

3 I Executive Summary Only 1-2 percent of babies are born with disabilities, yet by school age percent need special education. The Legislature passed HB 869 in 1999 to support early childhood development and link early intervention programs to subsidized child care through developmental assessments. This interim project assesses opportunities for improving child care developmental readiness efforts and early intervention for children with developmental delays. Early intervention serves children with disabilities or developmental delays, and for children at risk of delays. Services include hearing and vision services, occupational and physical therapies, psychological and social work services, nursing, family training, home visits and counseling, and transportation. Many publicly funded programs, including child care and readiness for school, early intervention therapeutic and support services, and health care coverage, provide early intervention services in Florida. hild care and school readiness services are provided by Subsidized hild are, the PreKindergarten Early Intervention program and Federal Head Start. Early intervention therapeutic and support services are provided by the Department of Education, Department of Health, and Department of hildren and Families. Health coverage for uninsured children is provided by Florida Kidare, which combines public and private insurance in a comprehensive health insurance program using Medicaid expansions and public/private partnerships. Issues in Florida s Early Intervention System: Fragmentation of Services--Programs have different funding sources and eligibility. It is difficult for families to understand services available, and for communities to coordinate services to address gaps and reduce inefficiencies. Limited Scope and Resources of Programs for hildren with Disabilities and hildren At-risk of Developmental Delay--There is continuing concern that Florida s main early intervention program for young children, the Infants and Toddler s Early Intervention Program, supports a medical model that, along with main streaming, draws resources away from other developmental services, especially center-based care. Demand for Services Exceeds apacity. Lack of Statewide Governance for Early Intervention--There is no statewide leadership and oversight to encourage integration and improved funding options for the early intervention, as there is for the Readiness for School system. Recommendations: ontinued legislative support is needed to develop an integrated system of early intervention services. Explore use of TANF funds to increase capacity for the early intervention system. Establish a new governance structure to provide leadership and oversight to the early intervention system. Revise hapter 411, F.S., that provides the statutory framework for early intervention programs in Florida, to reflect changes in the role of the departments and their programs over the last decade. II Introduction Only 1-2 percent of babies are born with disabilities, yet by school age percent need special education. Recent research has linked poor nurturing in the first three years of life to certain types of developmental disabilities that result in the child not reaching their potential for intellectual, social, and emotional development. This form of developmental disability has been 3

4 linked to a wide range of problems such as multi generational welfare dependency, failure in school, and violent crime. Many developmental risk conditions worsen if untreated. A recent study at Florida State University found that developmental disabilities arising from the parenting deficiencies of teen parents resulted in major costs to the state. The study found that the 15-year cost to the state of just one year of births to teens at $1.2 billion in special education, criminal justice, health and other costs. The implication is that an effective early intervention system could result in significant long-term savings to the state and benefits to its residents. The objective of this interim project is to assess the opportunities for linking the school and developmental readiness efforts in child care arrangements to early intervention services for children age 0-5, when a child has been identified as having a developmental delay. III What Is Early Intervention? Early intervention services for young children include services for children with disabilities or developmental delays, and for children at risk of disabilities and delays due to hearing, vision, health or other conditions that contribute to disabilities or delays. The state of Florida has a number of programs that provide these services to children and families. A central program is the Infants and Toddlers Early Intervention Program established under Federal law PL The program serves children under three years old who have disabilities or developmental delays. When services begin early they may prevent or lessen delays in development and increase the child's potential later in life. Federal funds assist states in operating a comprehensive, interagency system of early intervention services for infants and toddlers, and their families. Based on the needs of each infant and toddler, early intervention services may include the core services of identification and screening, evaluation, family support planning, and service coordination, and specific therapeutic and support services that include: IV audiology services (hearing) occupational and physical therapies vision services special instruction nutrition services psychological services social work services health services necessary for the child to benefit from early intervention nursing services medical services (for diagnostic and evaluation purposes) assistive technology devices family training, home visits, and counseling transportation to services Federal Individuals with Disabilities Education Act (IDEA) 4

5 The Federal Individuals with Disabilities Education Act (IDEA) that established the framework for serving children with disabilities has a long history. Prior to its implementation in 1975, children with disabilities were shut out of schools and many were denied appropriate services. Previously, 90 percent of children with developmental disabilities were housed in institutions. ompared with their predecessors, three times the number of young people with disabilities are enrolled in college and twice as many of today s twenty-year-olds with disabilities are working. Part B of the Individuals with Disabilities Education Act provides grants to states to assist in providing a free appropriate public education to all children with disabilities. States distribute all funds not set aside for state level activities to local educational agencies (LEAs, school districts or state agencies). Part B includes the Preschool Grants Program to assist states in providing special education and related services to children with disabilities age three through five years. At a state s discretion, services are provided to 2-year-old children with disabilities, who reach age three during the school year. Part of the Individuals with Disabilities Education Act (originally Part H) was implemented in 1986 to establish the early intervention program for infants and toddlers with disabilities. Activities supported under Part include provision of direct services for eligible children that are not provided from public or private sources, and the expansion and improvement of existing services. Funds may also support other activities, including child identification and training of early intervention personnel. Part B Support for Preschool hildren with Disabilities: For eligible children with disabilities ages three to five, there are two sources of IDEA funds (Part B and Preschool Grants). Part B of Individuals with Disabilities Education Act provides entitlement support for children with disabilities ages three to 21. Entitlement funds are awarded to local educational agencies, primarily school districts. The Preschool Grants Program was established under Part B in 1981 to provide additional grants to states to serve young children with disabilities, ages three through five years. To be eligible for Preschool Grants funds, states must implement all requirements under Part B of IDEA for special education and related services. These requirements include due process, nondiscriminatory testing and evaluation, individualized educational program (IEP), placement in the least restrictive environment, and parent participation. Florida has implemented these requirements and participates in the Preschool Grants Program. (Part ) Early Intervention for Infants and Toddlers with Disabilities: In 1986, ongress established the early intervention program to extend IDEA services to infants and toddlers under Part H (now Part ) in PL The purpose of the program is to address "an urgent and substantial need" to: Enhance the development of infants and toddlers with disabilities; Reduce educational costs by minimizing the need for special education through early intervention; Minimize the likelihood of institutionalization, and maximize independent living; and, Enhance the capacity of families to meet their child's needs. In order for a state to participate in the program it must assure that early intervention is available 5

6 to every eligible child and its family. The Governor must designate a lead agency to receive the grant and administer the program, and appoint an Interagency oordinating ouncil (I), including parents of young children with disabilities, to advise and assist the lead agency. urrently, all states and eligible territories are participating in the Part program. Annual funding to each state is based upon census figures of the number of children, birth through two, in the general population. The statute and regulations for Part contain many requirements states have to meet, including specifying the minimum components of a comprehensive statewide early intervention system. States have some discretion in setting the criteria for child eligibility, including whether or not to serve at risk children. As a result, definitions of eligibility differ significantly from state to state. States also differ concerning which state agency has been designated the lead agency for the Part program. Although established as an entitlement in Florida, the program is not funded as an entitlement as is Exceptional Education under Part B. In Florida, the lead agency for Part is the Department of Health. Part is administered by hildren's Medical Services (MS) through local Early Intervention Programs. The Florida Interagency oordinating ouncil for Infants and Toddlers (FIIT) is the advisory council to the program. The council has 25 members appointed by the Governor to represent specified stakeholders. The Parent Resource Organization (PRO), made up of parents of children with special needs is an important part of the FIIT membership. Members of PRO work together to review policies, procedures, programs, and rules that will help children with special needs, birth through age five. Other FIIT members include representatives of public and private service providers, including programs such as Healthy Start and Developmental Services, as well as educators, pediatricians, and state legislators. V Early Intervention Programs in Florida Many different types of publicly funded programs provide early intervention services to meet the needs of children in Florida. Programs include child care and readiness for school, early intervention therapeutic and support services, and health care coverage, through Florida Kid are. Readiness for School / hild are Dept. of hildren & Families Dept. of Education Federal Federal Early Intervention Dept. of Education & Federal Dept. of Health Ounce of Prevention Dept. of Health Programs Supporting Early Intervention in Florida Subsidized hild are PreKindergarten Early Intervention, (inc. early intervention) Head Start, (inc. early intervention) Early Head Start, (inc. early intervention) Exceptional Student Education (Part B), (inc. Florida Diagnostic and Learning Resource enters) Infants and Toddlers Early Intervention Program (Part ) (under hildren s Medical Services) Healthy Families Florida Healthy Start Dept. of Education First Start (0-3) 6

7 Dept. of Education Teen Parent Program Dept. of Education Title 1 Migrant PreKindergarten Programs Dept. of Education Even Start Family Literacy Program Health overage / Florida Kid are (omposed of the following programs) Dept. of Health hildren s Medical Services Network Agency for Health are Admin. Florida Healthy Kids Agency for Health are Admin. Medicaid for hildren Agency for Health are Admin. MediKids 7

8 A. READINESS FOR SHOOL / HILD ARE Early childhood education has historically been defined as occurring generally between ages three and six years. However, research clarifying the critical period of learning suggests that the period between birth until age three is an even more crucial time (Education ommission of the States, 1996). Researchers have confirmed that the infant brain requires almost nonstop stimulation from birth to age three to develop properly. Participation in a quality child care program can provide preschoolers with skills and enrichment that can increase their chances of success in school. In Florida three programs provide child care and school readiness services: the Department of hildren and Families, Subsidized hild are program, the Department of Education, PreKindergarten Early Intervention program and federal Head Start. Both PreKindergarten Early Intervention and Head Start programs provide some early intervention therapeutic and support services. In 1999 the Legislature passed HB 869 to support early childhood development and link existing early intervention programs with subsidized child care through a system of developmental assessments and referral for services. Subsidized hild are: Florida has operated a subsidized child care program for approximately 20 years. Subsidized child care is a state and federally funded program. The purpose of the current subsidized child care program, administered by the Department of hildren and Families, as described in s , F.S., is "to provide quality child care to enhance the development, including language, cognitive, motor, social, and self-help skills of children who are at risk of abuse or neglect and children of low-income families." Priority for participation in the subsidized child care program is given to children less than 13 years of age who are determined to be at risk of abuse, neglect, or exploitation and who are currently clients of the department's Family Safety and Preservation Program Office; children at risk of welfare dependency, including children of participants in the WAGES Program, children of migrant farm workers, children of teen parents, and children of other families at risk of welfare dependency; and, children of working poor families. Performance measures approved for this program in FY 98/99 state that 80 percent of children age four placed with contracted providers, who have been in care for nine months, will enter kindergarten ready to learn as determined through DOE or local school systems' readiness assessment. Funding sources are Federal Temporary Assistance for Needed Families (TANF) economic assistance and child care block grants, and state general revenue. PreKindergarten (PreK) Early Intervention Program: The PreK program was created in section , F.S., to provide a program administered by district school boards that prepare children for school by providing health screening and referral, a developmentally appropriate educational program, and opportunities for parental involvement in the program. The primary target population is economically disadvantaged 4-year-old children of working parents, including migrant children and children whose parents participate in the WAGES program. In addition, up to 25 percent of children served may be: 3- and 4-year-old children with disabilities; economically disadvantaged 3-year-old children; or non-economically disadvantaged migrant preschoolers. The funding for this program is provided from lottery proceeds. Head Start is a federally funded program for children ages 3-5 whose families meet federal poverty guidelines. Ten percent of each program must be children with disabilities. Targeted services are offered through Indian and Migrant Head Start. The 1994 Head Start Reauthorization Act established Early Head Start, which serves low-income pregnant women and families with infants and toddlers. In Florida, 10 percent of children in Early Head Start must meet Florida s Part Early Intervention requirements. Federal funds go directly to local grantee 8

9 agencies. In Florida these include not-for-profit organizations, school districts, community action agencies and local governments. A twenty percent (20%) local match is required, which may be either cash or in-kind contributions. B. EARLY INTERVENTION PROGRAMS Early intervention therapeutic and support services to children and their families are provided by numerous state and federal programs so children with or at risk of developmental delays are able to learn and participate to the fullest extent of their abilities. Programs are provided by the Department of Education, Department of Health, and Department of hildren and Families. Two programs, the Infants and Toddlers Early Intervention Program and the PreKindergarten Program for hildren with Disabilities serve primarily children with disabilities and developmental delays. Other programs serve primarily children at risk of developmental delay and disabilities. Infants and Toddlers Early Intervention Program: Public Law , Part, of the Individuals with Disabilities Education Act (IDEA), provides federal funds to Florida to provide family-centered early intervention services statewide. It is administered by the hildren s Medical Services of the Department of Health, through local Early Intervention Programs for evaluation and determination of eligibility. hildren with a developmental delay or established condition from birth to thirty-six months of age and their families are eligible. Four core services are identification and referral, assessment, family support planning, and services coordination. Through the family support planning process, each child and their family are entitled to a variety of other early intervention services from a list of services the state is required to provide. ommunity providers and local school districts are contracted to provide services. Funding is from the federal Department of Education. Florida Educational Finance Program (FEFP) school funding may supplement federal funding. PreKindergarten Program for hildren with Disabilities is authorized by the Individuals with Disabilities Education Act, Part B, Public Law which mandated services to children three to five with disabilities. It entitles all children with disabilities, ages three through five to a free and appropriate public education. The program provides special education and related services based on an individual education plan. It is available in all school districts with funding from the federal Department of Education. Florida Diagnostic Learning Resource enters (FDLRS) support special education and are funded as part of Exceptional Student Education. They provide technology, training, parent support and child find services. In addition to these programs for young children with disabilities and developmental delays, the state provides programs for children at risk of developmental delays and problems that cause difficulty in school. These programs include Healthy Start, Healthy Families Florida, First Start, Teen Parent, Migrant PreKindergarten, and the Even Start family literacy programs. Healthy Start provides screening and prenatal services for women and services for children age 0-1. Some areas extend coverage to age three with additional funding. Healthy Start provides services to assure that low income pregnant women receive care both before and after their babies are born. Screening programs identify high risk pregnancies and provide enhanced services to reduce infant mortality and low birth weight infants. Medicaid provides for early prenatal care and some delivery costs. Every pregnant woman and every infant born in Florida is eligible for the screening process. Women and infants determined to be at risk by the Healthy Start screenings are offered Healthy 9

10 Start Services. All county public health departments have established systems of care coordination designed to ensure participants receive appropriate services. Depending on a client s need and the availability of local resources, other services may include outreach and participant identification; nutritional support and education; smoking cessation and psychosocial counseling; childbirth, breast-feeding and parenting support and education; and home visiting. A vital component of Healthy Start is the community-based Healthy Start Prenatal and Infant Health are oalitions. These local coalitions consist of business and political leaders, health care providers, educators, and representatives from professional and community associations. They design and monitor local needs-based service delivery systems, and serve as advocates for improved maternal and infant health care services. Thirty Healthy Start Prenatal and Infant Health are oalitions have been established, collectively representing every county in the state. Healthy Families Florida is a community-based, voluntary program designed to prevent child abuse and neglect and other poor childhood outcomes. The program is modeled after the highly successful national Healthy Families America Initiative, based on more than two decades of research and experience with home visitor programs. Healthy Families Florida offers home visiting services by trained family support workers to families of newborns who are living in geographically targeted areas and experiencing stressful life situations. The family support worker visits the family to promote positive parent-child relationships, healthy child development, family functioning and problem-solving skills. Family support workers provide linkages to health and support services families may need. Services may begin at the birth of the baby or prenatally and are offered to families for up to five years. Healthy Families Florida builds on and coordinates with existing home visiting and family support services that are available in the targeted service delivery area (such as Florida's Healthy Start Initiative, Head Start, Florida First Start and Family Preservation and Support Services). Funding is from the state and local match. Florida First Start Program is established by section F.S., to provide early family intervention to at-risk infants and toddlers and their families through the school districts. Florida First Start programs are established as home-school partnerships designed to give infants and toddlers below the age of four years the best possible start in life and to support parents in their role as the child's first teacher. Monthly home visits by a parent educator and the establishment of a parent resource center are required components of the program. The program is available in 24 school districts in Florida. Funding is from the Florida Lottery and General Revenue. Teen Parent Program State law requires district school boards to establish and implement teenage parent programs which are designed to provide a specialized curriculum and other services to meet the needs of students who are pregnant, or students who are mothers or fathers, and the children of these students. Health care, social services, parent education, transportation, and necessary child care are required ancillary service components. hildren enrolled in child care provided by the district are funded at the basic cost factor for grades K-3 if the parents are enrolled full time in a public school. The program is funded through the Florida Educational Finance Program (FEFP). Title 1 Migrant PreKindergarten Programs Section , F.S., authorizes the Department of Education to plan, fund, and administer educational programs for migrant children in the state, beginning at age three. The Migrant PreKindergarten Program is operated through grants to local school districts, or through contracts with other public agencies or nonprofit corporations. Even Start Family Literacy Program is authorized by Part B, hapter 1, of Title 1 of the 10

11 Elementary and Secondary Education Act of Florida began implementation of this program in Even Start Family Literacy Programs help to break the cycle of poverty and illiteracy by improving the educational opportunities for families by integrating early childhood education, adult literacy or adult basic education, parenting education and home visits. Even Start emphasizes collaboration among school districts and community providers of literacy services and early childhood education. Twenty-eight school districts provide this program. Funding is from the Federal Department of Education.. FLORIDA KIDARE HEALTH OVERAGE Another program to provide support for children that enables them to be ready for school is Florida Kidare that provides medical care coverage. Florida Kidare provides health coverage for uninsured children. It is an "umbrella" program that combines public and private insurance into a comprehensive health insurance program for children. The program combines Medicaid expansions and public/private partnerships, and a wraparound system serving children with special health care needs. The Florida Kidare program was created by the 1998 Legislature in response to the enactment of Title XXI and the large number of uninsured children in Florida. The component programs are: The hildren's Medical Services Network--for children birth to age 19, who meet criteria for children with special needs Florida Healthy Kids--health care coverage for children ages five to 19, available through the Florida Healthy Kids orporation Medicaid for hildren--for lower income children under age 19 MediKids--a new program for children under age five Employer-Sponsored Dependent overage (future) These combined elements form a predominately privatized program administered in a cooperative fashion by multiple state agencies in combination with private business. The Kidare program is designed to maximize coverage for eligible children and Federal funding participation for Florida, while avoiding the creation of an additional entitlement program under Medicaid. It provides 12-month continuous eligibility for Medicaid, birth through age four, and 6- month continuous eligibility for Florida Kidare, birth through age 18. The employer sponsored dependent coverage component of Kidare (when implemented) will allow the state to subsidize purchase of children s coverage through the parent s employer sponsored group health plan. Employer-sponsored dependent coverage will not take effect until it is approved by the Federal Department of Health and Human Services. hildren s Medical Services Network serves the health care needs of children with serious or chronic physical or developmental conditions, who require extensive preventive and maintenance care beyond that required by typically healthy children. The MS network is a capitated managed system of care that links community-based health care with multidisciplinary, multidisciplinary pediatric care. It provides prevention and early intervention services, primary and specialty care, as well as long term care for medically complex, fragile children. A subcomponent, the Behavioral Specialty are Network, provides behavioral health care services for children with severe mental health problems. Kidare Outreach is part of the hildren s Medical Services Network for identifying children in need of more intensive medical services. Florida Healthy Kids is the largest non-entitlement component under the Florida Kidare Act. It 11

12 is administered by the nonprofit Florida Healthy Kids orporation created by the 1990 Legislature in s , F.S., to provide comprehensive health insurance to school age children. The package includes benefits and services that are most appropriate for school age children. It covers well child checkups, all other doctor visits and specialty care, vision and hearing screening, eyeglasses and hearing aids, prescriptions, durable medical equipment, hospitalization and behavioral health services (including substance abuse and drug rehabilitation services). Healthy Kids operates with a combination of county, state, and Federal dollars, and family contributions. It offers health insurance coverage to children who are uninsured, not eligible for Medicaid or hildren s Medical Services and who meet the age criteria for a particular county. For families whose incomes are below 200 percent of the federal poverty level, the cost is $15 per family per month. For families above 200 percent of the poverty level, the cost ranges from $53 per child per month to $104 per child per month. The cost is based on the county where the child resides. Medicaid for hildren includes the existing Medicaid program with the following eligibility limits: for children 0-1 to 185 percent of the federal poverty level (FPL), children 1-6 to 133 percent of the FPL. (The current federal poverty level for a family of four is $16,700.) overage is provided for children until age 19 with increased limitations on income eligibility. MediKids is a state non-entitlement program for families who pay a low monthly premium. It provides the Medicaid benefit package for children age 0-5 who are not otherwise eligible for Medicaid, up to 200 percent of the Federal Poverty Level. MediKids uses the Medicaid administrative infrastructure, paying Medicaid reimbursement rates and using Medicaid providers. It requires use of Medicaid HMO s, except in areas where only one may be available in which case enrollees may choose MediPass (a primary care case management program). VI School Readiness: Integration of Early Education and hild are In 1999, the Legislature passed SB 366 to integrate child care and early education programs. The bill established a statewide program for the state s at-risk birth-to-kindergarten population that integrates Subsidized hild are, PreKindergarten Early Intervention, Head Start, and First Start, Even Start, Migrant PreKindergarten, and Teen Parent early intervention programs. The school readiness partnership includes many of the programs that serve children at risk of developmental delay or disabilities, but it does not include programs that serve children with disabilities. Only at the local level are provisions made to include programs for children with disabilities in local coalitions. The Legislature intends the school readiness program: Is developmentally appropriate and research-based, with parental/family involvement, to enhance educational readiness and provide necessary elements to prepare at-risk children for school. Accommodates parents work schedules and their endeavors to become financially selfsufficient. oordinates and integrates funding for full effectiveness, and cooperates with other programs for young children. Is locally designed, operated and managed, with the state board approving and periodically reviewing local coalition plans, and establishing performance standards and outcome measures. Operates in conjunction with but not as part of the public school system--as a separate 12

13 program that is separately funded and utilizes a mandatory sliding fee scale and retains the Federal child care income tax credit. The Florida Partnership for School Readiness (16 members: six named, 10 appointed from the private sector) is created as the state governing board, responsible for adopting and maintaining coordinated programmatic, administrative and fiscal policies and standards. The partnership will establish a unified approach and strategies to enhance school readiness and a uniform system for objective measurement of school readiness, as well as a plan for combining funding streams. Local school readiness coalitions (18 to 25 members, more than 1/3 from the private sector) and implementation plans will be phased in and are subject to the partnership s approval. ounties serving less than 400 children must join in a coalition with another county, share a fiscal agent, or demonstrate efficiency and effective plan implementation. Each coalition must implement a plan for a comprehensive program of school readiness services to enhance the cognitive, social, and physical development of children and achieve performance standards and outcome measures specified by the partnership. The program must include: a developmentally appropriate curriculum, character development, age-appropriate assessment of each child s development, pre- and post-tests upon entering and leaving each program, appropriate staff-tochild ratios, safe and healthful environments, and a resource and referral network to assist informed parental choice. Each plan must also provide for parental co-payment through a sliding fee scale, parental choice of settings and locations, trained instructional staff, and eligibility priority for at-risk and economically disadvantaged children (once in the program, the child may remain until kindergarten). The plan must include reimbursement rates developed by the coalition, systems support and direct enhancement services, a business plan, strategies to meet the needs of unique populations, and a fiscal agent who acts on policy direction from the coalition. VII hild are Developmental Assessment: Integration of Subsidized hild are and Early Intervention Services In 1999 the Legislature also passed HB 869 that encourages child care providers to pursue quality as embodied in the Gold Seal designation. The bill also promotes child development by requiring the child staff to receive training on child development and developmental observation and establishing a process to assess the development of children in subsidized child care. The bill created s , F.S., that establishes a framework for the observational and developmental assessment of young children and linkage to early intervention services. It creates an assessment system based on three levels. Level I.- The purpose of Level I assessment is to identify and monitor normal development or possible developmental delay using a behavioral checklist. All 1-, 2-, 3-, and 4-year-old children in care must be screened every six months using a department approved, developmental observation checklist. The results indicated by the checklist must be reviewed by a center s child development associate or the community child care coordinating agency. Level II.- The purpose of Level II assessment is to determine whether a delay identified in the Level I assessment can be addressed by the child care center or home or whether a special program or further assessment is needed. A Level II assessment must be conducted by trained professional staff. The department is required to establish procedures to develop individualized learning plans, implement intensive language and/or math activities provided by a visiting 13

14 specialist, and implement parent training and home visits. Level III.- At this level the child is referred to an early intervention program. The purpose of Level III assessment is to determine eligibility for early intervention programs. It is conducted by providers such as Medicaid\Early Periodic Screening Diagnosis and Testing (EPSDT), hildren s Medical Services, and Florida Diagnostic and Learning Resource Services (FDLRS). The National Association of Education of Young hildren (NAEY), the leading national organization regarding education and young children, has developed a set of principles to guide child care and educational professionals in standardized testing of young children that differentiates between developmental screening, school readiness tests, and developmental assessment. Developmental screening tests are designed to indicate which children should proceed further to a multidisciplinary assessment. Only after the multi-disciplinary assessment can a decision regarding special education placement be made. School readiness tests are designed to assess a child's level of preparedness for a specific academic program. As such, readiness tests should not be used to identify children potentially in need of special education services or for placement decisions. Diagnostic assessments are designed to identify children with specific special needs, determine the nature of the problem, suggest the cause of the problem, and propose remediation strategies. According to NAEY, testing of young children should follow these principles: All standardized tests used in early childhood programs must be reliable and valid according to the technical standards of test development. Decisions that have a major impact on children, such as enrollment, retention, or assignment to remedial or special classes, should be based on multiple sources of information and should never be based on a single test score. It is the professional responsibility of administrators and teachers to critically evaluate, carefully select, and use standardized tests only for the purpose for which they are intended and for which data exists demonstrating the test's validity (the degree to which the test accurately measures what it purports to measure). It is the professional responsibility of administrators and teachers to be knowledgeable about testing and to interpret test results accurately and cautiously to parents, school personnel, and the media. Selection of standardized tests to assess achievement and/or evaluate how well a program is meeting its goals should be based on how well a given test matches the locally determined theory, philosophy, and objectives of the specific program. Testing of young children must be conducted by individuals who are knowledgeable about and sensitive to the developmental needs of young children and who are qualified to administer tests. Testing of young children must recognize and be sensitive to individual diversity. The Framework for Assessing hildren in are in HB 869 Level Purpose Staff role/training Results 14

15 Level I--Assessment observation To identify: Assessment and Feedback to care givers and in the child's natural environment Normal development observations conducted by parents using a developmental screening and readiness for primary care giver Enhanced language and/or math checklist school at age 4 validated by a DA activities All 1-,2-,3-, and 4-year-old Developmental delays Readiness for school children in care would be screened every six months Parent training Level II--Formal developmental To identify whether Trained professional Individualized learning plans assessment using a recognized delay can be assessment or team implemented by primary care giver scale or instrument addressed by the Intensive language and/or math child care center or activities provided by visiting home or whether a specialist special program or further assessment is Parent training and home visits needed Referral to FDLRS, EPSDT, MS, other health services Level III--Assessment to Placement in special Trained and licensed IEP or other plans as required by determine eligibility for: Part program professional or team law programs, Exceptional Student conducting assessment to Intensive intervention Education, hildren's Medical determine eligibility Services and other early Medical services intervention services 15

16 Implementation of the Developmental Assessments for Subsidized hild are: The Department of hildren and Families, the agency responsible for the implementation of the assessment framework in HB 869, has established a work group to develop procedures for this process. The department of is charged with developing a statewide multilevel assessment system to measure the global development of young children utilizing valid and reliable standardized instruments. The multilevel assessment should identify the developmental abilities of each child and aid the referral process toward more comprehensive assessment and possible intervention. The statute outlines the following procedures: Evaluators must be parents, trained child care staff, or early childhood professionals who understand the needs and abilities of young children. Parents should be active participants in the assessment process and parental consent must be obtained prior to Level II and Level III assessments. hild care directors and staff are expected to be knowledgeable of child development and the assessment of young children. All testing instruments must be standardized and demonstrate adequate reliability and validity. The assessment process will be implemented with a six-month pilot in six counties. The pilot will determine the most effective ways to do assessment and the number of children referred for services. It will build a tracking system and database for the assessment process. urrent Task Workforce Recommendations: Level I: Every six months, the preschool teacher or parent will complete a standardized twopage checklist, called Ages and Stages, that assesses child development in the areas of motor, communication, cognition, and social-emotional skills. The completed checklists and results will be forwarded to central agencies. hildren with low scores in one or more areas of development will be referred for a Level 2 assessment. Level II: Professionals associated with the central agencies will choose from a list of recommended measures to administer to a given child. All of the recommended measures are standardized and assess multiple domains of child development, e.g., fine motor, gross motor, communication, social-emotional skills. Most of these assessment tools involve a parent interview and include individual testing of the child. hildren who perform poorly in one or more areas of development will be referred for a Level 3 evaluation. Level III: Specialists will conduct a diagnostic evaluation using whatever measures they deem appropriate. hildren found delayed will enter existing early intervention programs. Issues that continue to be addressed by the workgroup include: What to do about English as a Second Language (ESL) kids failing the language portion of assessments. Preschool teacher compliance with completing Level 1 assessment is likely to be low because the test takes about 15 minutes per child. A means to enforce teacher/parent compliance with Level 1 assessment has not been established. There is no parent education planned, despite the bill s mandate. As a result of this entire process, there will be an increase in the amount of assessment and the organizational responsibilities placed on both preschool staff and central agency staff. The current Early Intervention system may not be able to handle the increased number of children identified as having delays. Some extent procedures related to Level I assessment may leave some children unassessed. 16

17 hildren from low socio-economic backgrounds not enrolled in a subsidized child program will not be assessed. care VIII Survey of Early Intervention Programs: Issues and Resources House Bill 869 enables child care programs and early intervention programs to be linked to address the developmental needs of children. A survey was developed to obtain information from major early intervention programs in the state to better understand the nature of this service delivery system and how to improve linkage of the child care and early intervention program systems. Survey information regarding program service coverage, eligibility, and funding are summarized in the following table. The many programs involved provide services to all age groups from prenatal to school age. Programs vary in who is eligible based on income and diagnosed or atrisk condition. Most programs provide an array of child development, health or family support services based on assessed need. Some programs provide only one or two of these components. The programs vary in size based on their target populations and funding. Not all areas or clients have equal access to services. Issues raised in the survey include: Need for continued funding or additional funding for child development services Ensuring adequate provider coverage in rural areas Integration of children with disabilities in inclusive settings with typically developing children The effects of inclusion on center-based programs The effects on continuity of care (consistent primary care giver for children ages 0-5) from high staff turnover rates in early childhood settings Linkage to the new school readiness governance structure which calls for a partnership to administer the program 17

18 Program Program Early Intervention Programs for hildren to Age 5 Prenatal Pre- Birth- Age 1 Age Age Age Age Schoo Age Birth- Age 1 Age 2 Age 3 Age 4 School Eligibility Requirements Services Provided Number Funding Source State Age Diag- Income Other hild hild Family Served Fed. State Local Other wide Eligibility Requirements mo. mo. mo. mo. Services Provided Number Funding Source State natal Age l Age Age nosis/ Diag- Income Other Develop- hild Health hild Support Family Served Fed. ($ State in millions) Local Other wide mo. mo. mo. mo. at-risk nosis/ ment ($ in millions) Develop- Health Support Dept. of at-risk ment hildren Ounce of & Families Prevention Subsidized (Public/Private) hild are X X X X X X X X X 132,000 $14.5 $3 $14 $47 X Healthy Families X X X X X X X X X 7,000 $22 $5 43 hild are Resource Parents & hild care providers Information & referral 217,000 $3.5 $.85 X & Head Referral Start Network Substance Abuse X X X X X 154,000 $84 $58 $24 $8 X Program Head Start X X X X 10% child. X X X 29,459 $ % X 22 Adult Mental Health X w disabilities/dev.delay X X $27 $217 (+migrant/ Native Am.progs.) X hildren s Early Head Mental Start X X X X X X X X X X 10% child. X X X X X 53,000 1,337 $20 $11.7 $60 20% Health w disabilities/dev.delay X Dept. Florida of Kid are Education (Medical overage) PreKindergarten hildren s Medical Early X X X X X X X X X 0-21, 0-19 X X X X X 28,000 44,845 $79.7 $97 $47.1 X Intervention Services Network for XXI funds Even Kidare Start Outreach Family X X X X X X X X X 0-18 Parents X X X 37,000 33,000 $5.7 $4.4 $.5 X 36 Literacy of Uninsured 0-7 yr olds/teen <200% parents poverty First Florida Start Healthy (0-3) Kids X X X X X X X X X 101,057 27,000 $51.5 $3 $27.4 $10 $ (expanded in some X X X X X X X 5-18, Uninsured, Not eligible for Medicaid Migrant Medicaid Preschool X X X X X X X X X X X X X X 230,000 26,000 $17.3$13.3 $3.3 X 35 Programs hildren of migrant workers PreKindergarten MediKids X X X X X X X X X Qualified X X X 263,000 12,830 $18 $118 X Program for hildren with Special Needs alien, not dependent of state employee, & not an inmate Teen Other Parent Local and X X Teen parents X X X 15,000 $35 X Programs ommunity Dept. Agencies of Health Healthy Start Drug Substance abusing pregnant X X X 13,000+ $.08 $.5 $.14 $.17 1 Free Families women & newborns Healthy Start X X X Pregnancy X X 235,000 $6.5 $27.5 X Number Number of ounties of ounties Florida Directory of Early hildhood Services Early Intervention Program (Part ) X X 32,000 $.182 X X X X X X X X X 28,000 $17 $17 X 18

19 IX Findings and onclusions: Issues in Florida s Early Intervention System ommittee staff reviewed statutes and research literature, surveyed stakeholders, and interviewed key legislative, governor s office and department staff, and advocacy group representatives, to identify issues and recommendations. Four issues could improve the integration and effectiveness of early intervention and child care programs. These include fragmentation of existing services, the limited scope and resources of programs for children with disabilities and children at-risk of developmental delay, opportunities to increase access to funding to address limited capacity, and lack of statewide governance for early intervention. Issues in Florida s Early Intervention System 1. Fragmentation of Services: Programs with different funding sources provide early intervention services to children and families. It is difficult for families to understand services and resources available. It is also difficult for communities to coordinate services to address gaps in services and reduce inefficiencies due to duplication. The Infants and Toddlers Early Intervention Program for hildren with Disabilities is in the second year of a three-year stakeholder process to improve service delivery, and local Readiness for School coalitions will be able to address fragmentation. 2. Limited Scope and Resources of Programs for hildren with Disabilities and hildren At Risk of Developmental Delay: Florida supports two types of early intervention programs. Programs provide services to children with disabilities or significant developmental delays, and to children who are at risk of developmental delay. There is continuing concern that the state s core early intervention program for young children, the Infants and Toddler s Early Intervention Program, Part, administered by hildren s Medical Services, supports an assessment process and system of services dominated by a medical model. This includes concern the program has higher administrative costs and draws resources away from other family and developmental services. Infants and Toddlers Early Intervention Program is in the second year of a system redesign process to address these and other issues. Main streaming children with disabilities into regular environments with normally developing children, such as child care settings, has also drawn resources away from center-based care for children with developmental disabilities. These center based programs, such as Easter Seals, AR, and others have provided excellent care to children with developmental disabilities for many years, but are now being defunded. A system of services for children at risk of developmental delay is not in place as it is for children with disabilities who under Federal law must be provided services if they are needed. While services for children at risk of developmental delay are less expensive and can prevent long-term costs, they are not readily available. Subsidized child care has the potential to meet the needs of many children with and at risk of developmental delays, but it does not have an early intervention component similar to PreKindergarten Early Intervention and Head Start. Linkages to early intervention services need to be developed. The developmental assessment and referral to early intervention services, required in HB 869 will increase the capacity of subsidized child care to identify and get services to 19

20 children with developmental problems. 3. Demand for Services Exceeds apacity: aseloads for early intervention services, such as the Infants and Toddlers Early Intervention Program (Part ) of hildren s Medical Services have increased without equal increases in funding. Funding for services are exhausted before the end of the year so that some children do not receive continuing and needed care. Although the Infants and Toddlers Early Intervention Program services are an entitlement under Federal law (IDEA, Part ) Florida has not provided a funding mechanism to support the entitlement. Many providers of developmental services have disappeared or redefined their services as child care to survive. Additional revenue may be accessible from TANF to fund early intervention services for eligible children to make current funding available for more children. This would allow the state to maximize the expenditure of Part funds. States that serve smaller populations or fund early intervention services differently use TANF funds to pay for some services, such as child care, for eligible clients served under Part. Florida is currently reviewing options for funding. Funding and client eligibility need to be tracked to implement these options. 4. Lack of Statewide Governance for Early Intervention: X There is no statewide leadership and oversight for all parts of the early intervention system to encourage integration and improved funding options, as there is for Readiness for School system. Readiness for School has leadership and oversight by the Partnership for School Readiness and the advisory State oordinating ouncil. The State oordinating ouncil and the FIIT council for part plan to meet jointly to address coordination issues. Local Readiness for School oalitions include participation of programs for children with disabilities and children at risk of developmental delay, but the statewide partnership does not. hapter 411, F.S., that provides Florida s statutory framework for programs for at-risk children and children with disabilities, includes sections made obsolete by changes made to establish the Partnership for School Readiness, and includes functions no longer implemented by the Departments of Education and hildren and Families. Recommendations Legislative support is needed to continue to develop an integrated system of early intervention services. Existing services are fragmented and access is uneven across the state. ontinued integration is needed to improve the efficiency and effectiveness of existing capacity and resources and make the system of different services transparent to parents and children. The Legislature may wish to explore the following options. 1. Access TANF funding to increase early intervention capacity for children with developmental delays as other states have done. 2. Establish a new governance structure to provide leadership and oversight to the early intervention system. This may involve increased integration with the Readiness for School Partnership, establishing a governance structure for early intervention that parallels the partnership, or some other alternative. oordination is currently provided for at the local level by inclusion of representatives of programs for children with disabilities on the 20