Dispute Resolution in NJ Early Intervention System

1. ~ Part C Dispute Resolution ~If It Ain’t Broke, How Will We Know? (National DR Data and An Examination of One State System) Dick Zeller & Marshall Peter, CADRE Terry Harrison, NJ Department of Education ~ ~ ~ ~ ~ ~ ~ ~ ~ OSEP National Early Childhood Conference Presented on December 3, 2006

2. Session Overview • CADRE and Dispute Resolution Context • New Jersey Experience • ADR Database Development • Summary “Active States” • National Summary of Activity • Activity Level Part B and Part C • Observations/Discussion

3. About CADRE • Mission • Support to States • Research-based practice: RAISE • National ADR Database • CADRE Website: http://www.directionservice.org/cadre/

4. Influences on the Use of Dispute Resolution • Quality of early intervention programs • Culture with respect to contention • Community or service system size • Awareness of dispute resolution options • Availability of legal representation • Parental education/SES variables • PTI/SEA & PTI/Lead Agency relationships • Investment in DR systems

6. New Jersey Early Intervention System (NJEIS)

7. NJEIS Website www.nj.gov/health/fhs/eis www.state.nj.us/health/fhs/eis/procsafeguards.shtml

8. GENERAL SUPERVISION NJEIS COMPONENTS • Central Management Office (Data Collection) • Data Desk Audit & Inquiry • Self-Assessment • Focused On-site Monitoring • Targeted Technical Assistance • Procedural Safeguards/Dispute Resolution • Enforcement

9. NJEISINFRASTRUCTURE • Lead Agency-Quality Assurance Team • Contracts • Procedural Safeguards • Central Management Office • Monitoring • Personnel Development • Regional Early Intervention Collaboratives (4) • Service Coordination Units (21) • EIP Provider Agencies (80+)/Practitioners (4000+) • Targeted Evaluation Teams • Comprehensive EIPs • Service Vendors

10. CMO FEATURES • Child Specific Data Collection • State access to timely statewide data • Local Access to Data • Data Verification (Accuracy) • Provides Accountability • Timely system of payment • Maximization of funding resources • Supports Monitoring • Personnel Enrollment/Matrix • Reports

11. DISPUTE RESOLUTIONPROCEDURAL SAFEGUARDSOFFICE

12. INFORMAL RESPONSE • The Procedural Safeguards Office and designated consultant parent liaisons respond to parent issues/concerns and document contacts on state logs for review and analysis. • Parents can contact the Procedural Safeguards Office through a toll-free hotline and the nature and scope of their concerns are gathered by a consultant parent liaison within two (2) business days. • Most informal matters are resolved within 10 to 15 business days and only on rare occasions, where the Procedural Safeguards Office is awaiting documentation to support/dispel the complainant’s allegations, does the matter go unresolved beyond ten (10) business days from the date of the complainant’s call to the hotline.

13. SFY’07 Informal Resolutions • About 500 contacts are received each year in the Procedural Safeguards Office. Most of these are technical assistance calls from parents, practitioners and agencies. • Of these, last year, 142 calls resulted in the need for informal resolution of issues identified. • These are recorded in a database and can be disaggregated by issues, sub-issues, service coordinator, family information, time to reach resolution, entities involved, and resolution, etc.

14. Summary of SFY’07 Issues Resolved(Not an Unduplicated Count) • Make-up service before age three – 58 • Delay of services – 54 • No provider available – 51 • Disruption of services – 47 • Reimburse out-of-pocket – 43 • Compensatory services – 39 • Timely services/30 days – 33 • Appropriate services – 22 • Provider of choice-EIP/therapist/discipline – 22

15. Informal Issues (cont) • Autism issues/conflicts – 17 • Family cost share/non-payment – 14 • Change of services – 8 • Services beyond age 3 – 7 • Service coordinator issue – 7 • Make up services after age three – 6 • Other – 45 day/IFSP/transition – 13

16. FORMAL RESPONSE • The Procedural Safeguards Coordinator directly intervenes to resolve an informal dispute if the matter cannot be resolved within ten (10) business days, the family specifically requests that the Procedural Safeguards Coordinator directly investigate the matter, or the consultant parent liaison determines that the Procedural Safeguards Coordinator should resolve the matter due to the complexity of the dispute. • Complainants who call are always advised of their right to file a request for formal dispute resolution at any time.

17. FORMAL RESPONSE (cont.) • If a complainant requests formal dispute resolution, the Procedural Safeguards Office explains to the complainant how to download the Formal Dispute Resolution Request form off the Procedural Safeguards Office website, and provides families with flowcharts describing the formal dispute resolution processes to help families to understand the processes and timelines for dispute resolution. • In SFY’07, there were 3 mediations and one complaint

18. Procedural Safeguards Information & Forms • NJ Procedural Safeguards Handbook • Family Rights Handbook • State Informal Case History Form • State Formal Case History Form • NJ Dispute Resolution Request Form • NJ Withdrawal of Complaint Form

19. INCIDENT REPORTS • Incident Reports may be used to follow-up on specific issues identified by parents, provider agencies, or practitioners to ensure that an individual incident is not indicative of a systemic problem. • If a NJEIS provider agency responds with insufficient/non-conclusive documentation or identifies performance issues, the lead agency proceeds with an appropriate next step that may include: desk audit performance review, on-site focused monitoring, improvement plan or corrective action plan.

20. Procedural Safeguards Reports • Quality Assurance Team • Regional Early Intervention Collaboratives • State Interagency Coordinating Council • OSEP • Public Reporting • Ability to drill down reporting by: County, Region, SCU, EIP, Service Coordinator, Family, Issue, Time Period

21. New Jersey Part C Dispute Resolution System Informal Concerns: Parent Liaison (toll-free hotline) Early “Complaint” Resolution (by Procedural Safeguards Coordinator)

22. CADRE’s National ADR Database • Longitudinal database development • Three years of “verifiable” APR/SPP data collection (2003-04, 04-05, 05-06; changes each year; new IDEA 04 data elements) • Support to states to report clean data (TA, error checker) • ADR data collection (Table 4) is now under Section 618, the new Data Accountability Center

23. Five Years of DR Data Reporting What hasn’t changed: • Complaints filed, reports issued, pending • Mediations held and agreements reached • Hearing requests, hearings held, pending What has changed: • Timeliness measures for complaints & hearings • Report period and pending dates now prescribed • “Mediations not held” now include “mediations pending” • Resolution sessions • Reported & calculated values • [Expedited hearings (B only)]

24. Example: 2006-07 Error Checker

25. Dispute Resolution Data Summary • We are hesitant to display data identifiable by state at this point • We believe we have all Part C data from all states for three years • We doubt the comparability of some data elements across years without revision • We intend to eventually publish summaries that are state identifiable • What follows are partial summaries (B & C) that suggest the data have value in examining DR activity and system performance

26. # States Reporting Part C Complaint Activity

27. # of States Reporting Part C Mediation Activity

28. # States Reporting Part C Hearings Activity

29. Part C Total Dispute Resolution Events (56 Entities) Italicized cells with yellow shading may be less dependable numbers.

30. Dispute Resolution Event Rates • Dispute Resolution Events (“DR Events”): Complaints Filed + Mediations Held + Hearings Requested • We calculate a comparable measure across States and Programs (B & C): DR Events per 10,000 served = ( ) # of DR Events X 10,000 # Served

31. National Means - Dispute Resolution Events Per 10,000 Part C Child Count

32. State Reported Dispute Resolution Performance Indicators

33. “National” Rates of Part B and Part C

34. C C C C C C B B B B B B “National” Part B & Part C Rates

35. Only 28 states had 05-06 Part C activity

36. NJ If every state added one event in 05-06…

37. Why So Little Part C DR Activity? Hypotheses*: • Parents of infants are overwhelmed • Parents don’t know the EI system or their rights • Fear of reprisal or… Don’t dump your one best friend • Time is short; transition is nigh Mean IFSP age = 17 months (NEILS, 2001) * 18 interviews with Part C Coordinators from Gittler & Hurth (1998) Conflict management in early intervention: Procedural safeguards and mediation. Inf & Yg Children.11(1)

38. Why So Little Part C DR Activity? Hypotheses** (continued): • By law, early intervention is voluntary • Parents are the primary decision-makers: Accept or reject any recommended EI service • Infant and toddler programs are family- centered, in home and intimate • Prevention and informal complaint resolution mechanisms resolve concerns • Population is smaller (between 17 months and 36 months vs. between 36 months and 21 years) ** Not from Gittler & Hurth (1998)

39. Making the “C” Data Public • Part B State Data Reports are posted on the CADRE Web site; CADRE has received requests for comparable Part C reports. • What can we do together to ensure the data are as good as they can be when they are posted? • CADRE could: • Provide each state access to a summary of their data • Identify any clear errors or possible concerns (“common sense” issues) • Request state review and corrections within a reasonable period prior to public posting • Append “data notes” from states where desired

40. Discussion • Questions/Comments? • What’s happening in your state? • How can CADRE be of assistance to you?