Introduction to Service Coordination

1. Introduction to Service Coordination New York State Department of Health Division of Family Health Bureau of Early Intervention Revised: May 2013 Updated: July 2014

2. Unit 1 Welcome, Introductions, Purpose and Learning Objectives 2

3. Purpose of Training To provide an overview of the role, responsibilities and knowledge necessary to comply with federal and state laws and regulations, and to perform effectively in the Early Intervention Program.

4. Learning Objectives • After completing this training, participants will demonstrate knowledge and understanding in the following areas: • The statutory and regulatory responsibilities of a service coordinator. • The role of service coordinators in delivering family-centered supports and services. • The importance of communication and information sharing with families. • The nature and scope of services available under the Early Intervention Program.

5. Activity: Pretest • Turn to the family scenario on Handout #1 that has been assigned to you or your group. • Read the scenario. • Turn to Handout #2 and fill in the Pretest side of the Handout.

6. Unit 2 Early Intervention Program: History, Overview and Municipal Role 6

7. History of the NYS Early Intervention Program • 1987 – NYS elected to participate in the Part H program and the NYS Department of Health was designated as the lead agency by Governor Mario Cuomo. • 1992 – The Early Intervention Program was established in NYS Public Health Law. • 1993 – The Early Intervention Program went into effect on July 1, 1993.

8. History of the NYS Early Intervention Program (cont’d.) • 2012 – The State Budget for State Fiscal Year 2012-13 amended the following sections of Public Health Law that impact service coordination responsibilities: • §2544(2)(c) – OPWDD Notification • §2545(10) – Implementation of IFSP in a timely manner • §2548 – Notification to CPSE • §2559(3)(a) – Claiming to third party insurance and Medicaid using NYEIS and the State Fiscal Agent

9. Early Intervention Program Mission • Identify and evaluate as early as possible those infants and toddlers whose healthy development is compromised. • Provide the appropriate interventions to improve child and family development.

10. Goals of the Early Intervention Program • To provide family-centered, community-based, and culturally-sensitive services. • To coordinate EI services with other services typically used by this population. • To deliver effective, high quality services that result in measurable outcomes for children and families. • To seek the support and involvement of health care providers (Medical Home). • To ensure consistency and accountability and clear lines of responsibility and authority throughout the Early Intervention service system.

11. Municipal Role in the EIP • NYS Public Health Law requires that each county/municipality have an Early Intervention Official (EIO) who is responsible for the administration and oversight of the Early Intervention Program in his/her municipality. • The EIO may appoint an Early Intervention Official Designee (EIO/D) to oversee the day-to-day operations of the program.

12. Municipal Role in the EIP Municipalities, as local administrators, are responsible for: • Accepting and managing referrals to the EIP and Child Find. • Designating the ISC. • Reviewing evaluations and eligibility determinations to ensure regulatory compliance. • Convening IFSP meetings and authorizing services in the IFSP. • Obtaining social security numbers of child and parents at the initial IFSP meeting, after eligibility has been established. • Monitoring service providers.

13. Municipal Role in the EIP Municipalities are no longer responsible for: • Contracting with EIP providers. • Arranging for EIP services. • Claiming third party payers for EIP services. • Notifying school districts when children are thought to be potentially eligible for preschool special education services. • Convening transition conferences. Effective April 1, 2013

14. New Service Coordinator Responsibilities: Review of Important Dates January 1, 2013: • Notification to OPWDD • Marketing Standards Requirements - 69-4.5(e) April 1, 2013: • Provider Agreements with the Department • Assignment of Service Providers • Ensuring Timely Delivery of Services • CPSE Notification and Transition Activities • Use of the State Fiscal Agent and Department’s Data System for billing and claiming 14

15. Unit 3 Common Responsibilities of Initial and Ongoing Service Coordinators

16. Federal Standard All Initial and Ongoing Service Coordinators approved to provide early intervention service coordination perform the functions and activities necessary to enable an eligible child and the child’s family to receive the rights, procedural safeguards and services that are authorized to be provided under the Early Intervention Program. 34 CFR 303.23(a)(1)

17. What is a Service Coordinator? • Provides a continuous service to families by helping them receive the rights, procedural safeguards, and services that are authorized under the Early Intervention Program. • Ensures that IFSP outcomes and strategies reflect the family's priorities, concerns and resources, and that changes are made to the IFSP as the family's priorities, concerns and resources change. • Provides families with a single point of contact to ensure communication, collaboration, and coordination among service providers.

18. A Service Coordinator is Not… • The family’s decision-maker. • A representative of the interests of his/her agency. • The “family friend.”

19. What is an Initial Service Coordinator? The initial service coordination is defined in regulation as “the service coordinator designated by the early intervention official upon receipt of a referral of a child thought to be eligible for early intervention services who functions as the service coordinator who participates in the formulation of the Individualized Family Service Plan.” 10 NYCRR 69-4.1(z)

20. What is an Ongoing Service Coordinator? • The OSC is defined in regulation as “the service coordinator designated in the individualized family service plan.” • 10 NYCRR 6904.1(ag) • The OSC is selected by the parent at the initial IFSP meeting to provide an interactive and continuous service that ensures the successful participation of eligible children and their families in the Early Intervention Program. 20

21. Provider Agreements The 2012-2013 State Budget modified existing language defining an approved provider to mean a provider who is approved by the Department in accordance with Department regulations and has entered into an agreement with the Department for the provision of evaluations, service coordination or early intervention services. Effective date for Provider Agreements is April 1, 2013. 21

22. Common Regulatory Responsibilities Assist the parent of an eligible child in gaining access to early intervention and other services identified in the IFSP. Ensure the IFSP outcomes and strategies reflect the family’s priorities, concerns and resources; and that changes are made as the family’s/child’s needs change. Coordinate the provision of all services that the child and family need or are receiving. Facilitate the timely delivery of services. Continuously seek appropriate services and situations that benefit the development of the eligible child for the duration of the child’s eligibility. 10 NYCRR 69-4.6(b) 22

23. Specific Requirements of Initial and Ongoing Service Coordinators Activity ISC or OSC Informing families of their rights and procedural safeguards Obtaining and updating family’s insurance and Medicaid information Coordinating the performance of evaluations and assessments Facilitating and participating in the development, review and evaluation of IFSPs Facilitating the timely delivery of EI services Both Both Both Both OSC 23

24. Specific Requirements of Initial and Ongoing Service Coordinators Activity ISC or OSC Coordinating and monitoring the delivery of services Informing families of the availability of advocacy services Coordinating with medical and health care providers, including a referral to appropriate primary health care providers as needed Facilitating the development of a transition plan to preschool services if appropriate or to other available supports and services OSC Both Both Both 24

25. Timely Delivery of Services The Office of Special Education Programs (OSEP), U.S. Department of Education, requires states to deliver the early intervention services contained in an IFSP in a timely manner. OSEP allows states to define timely and requires 100% compliance. New York State defines timely as within 30 days from the projected date for services to begin in the IFSP. OSEP allows discounting lateness due to documented exceptional family reasons. NYEIS captures reasons for late start of services. 25

26. Documentation: Service Coordination Notes Agency and individual providers of initial and ongoing service coordination services must document all activities related to the performance of their duties as set forth in EIP regulations sections 69-4.6 and 69-4.7. Documentation must include: recipient’s name; date of service; a description of the specific service coordination activity performed; name, date of contact, and purpose of contact for providers or others contacted on behalf of the child and family as necessary to implement the IFSP; start and end time for each contact; name, title, and signature of the service coordinator, as applicable. 10 NYCRR 69-4.26(d) 10 NYCRR 69-4.26(d) 26

27. Required Training Initial and Ongoing Service Coordinators are required to attend training as outlined in the provider’s agreement with the Department: Complete Introductory Service Coordination training sponsored orapproved by the Department of Health prior to rendering service coordination services. Participate in a minimum of one professional development activity totaling a minimum of 1½ clock hours directly related to service coordination. Participate in a minimum of 10 clock hours of professional development activities per calendar year that relate to their field of practice and increase professional skills and knowledge. 27

28. Service Coordinator Case Loads EIP Regulations do not specify a set number of cases to be maintained. Case loads will vary depending on: Life circumstances of families which can dictate a lesser or greater service need. Unique developmental needs of the child. Parent needs and strengths. In general, a full time service coordinator could have a caseload ranging from 25 to 60, with an average of 35 cases. 28

29. Contact with Families Contacts should be frequent or as the needs of the family require. Contacts can include home visits, phone contacts and meetings with the parent or service providers to foster collaboration and integration of service strategies. All contacts with families and other activities related to service coordination, whether billable or non-billable, must be documented in the child’s record. 29

30. Marketing Activities Service coordinators cannot engage in any marketing or advertising practices that: Offer incentives to the parent or relatives of an eligible or potentially eligible child; or to the service coordinator, evaluators, or other approved providers authorized to deliver services to the child. Attempt or appear to influence the selection of a service coordinator, evaluator, or provider of services. Effective January 1, 2013 30

31. Primary Referral Sources All Service Coordinators are primary referral sources for the EIP. As such, they are responsible for: Referring within two working days of identifying an infant or toddler who is less than three years of age and suspected of having a disability or at risk of having a disability. Referring the infant or toddler to the EIO/D, unless the child has already been referred or unless the parent objects to the referral. 31

32. Responsibilities of Primary Referral Sources For infants or toddlers suspected of having a disability: • Explain the early intervention program and services to the family, and the benefits for the child. • Inform the parent that, unless the parent objects, their child will be referred to the EIO for a free, multidisciplinary evaluation to determine eligibility for services. • Inform parent in dominant language or other mode of communication, whenever feasible. • Ensure the confidentiality of all information.

33. Responsibilities of Primary Referral Sources (cont’d.) For infants or toddlers at risk of developmental delay: • Explain developmental screening, home visiting, and tracking services, and the benefits to the child and family. • Inform the parent that, unless the parent objects, their child will be referred to the EIO/D for developmental screening, home visiting, and tracking services. • Inform the parent in their dominant language or other mode of communication, whenever feasible. • Ensure the confidentiality of all information transmitted at the time of referral.

34. Information Transmitted in a Referral • Child's name, sex, race, ethnicity, and birth date. • Name, address and telephone number of the parent and/or the person in parental relation to the child. • When applicable, the name and telephone number of another person through whom the parent may be contacted. • If the referral is for a child at risk of developing a disability, include an indication that the child is not suspected of having a disability, but is at risk of developing a disability in the future. • Name and telephone number of the primary referral source.

35. Parent Objects to the Referral When a parent objects to the referral, the primary referral source: • Maintains written documentation of the parent's objection to the referral and follow-up actions taken by the primary referral source. • Provides the parent with the name and telephone number of the EIO should the parent decide to refer at a later date. • Within two months makes reasonable efforts to follow-up with the parent and, if appropriate, refer the child unless the parent objects.

36. Unit 4 Role of the Initial Service Coordinator: Receipt of Case to Initial Home Visit

37. Designation of the ISC • Upon receiving a referral to the Early Intervention Program, the EIO must “promptly” designate the ISC. • EI Regulations require the ISC to make their first contact with the parent “promptly” following the EIO’s designation to arrange for a meeting at a time, place and manner that is convenient to the parent and is consistent with timeliness requirements.

38. What is “Promptly?” • The EIO should designate the ISC immediately upon the child’s referral to the EIP, but in no case later than 5 business days from referral. • The ISC should contact the family within 2 days of receiving notification of their designation to schedule the initial home visit at a time, place, and manner reasonably convenient to the parent, but within the next 5 business days.

39. Initial Home Visit: ISC Responsibilities • Ensure the parent has received the “Early Intervention Parents’ Guide” and review it with the parent. • Describe EIP steps and services. • Discuss the role of the initial service coordinator. • Inform parent of their rights, responsibilities, and entitlements. • Discuss the family’s Medicaid and/or third party insurance status and obtain insurance information. • Review options and process for evaluations. • Obtain parental consent to provide the evaluator with existing health/developmental status information. 10 NYCRR 69-4.7

40. Initial Home Visit: ISC Responsibilities (cont’d.) • Determine whether the child and family are presently receiving case management services and obtain consent for the release of information for the purpose of collaboration between EI and the case management service, if appropriate. 10 NYCRR 69-4.7(d) • Following municipal procedures, the ISC is responsible for informing the parent of the availability of interim services for a child with a known developmental delay or diagnosed condition, for whom there is an apparent immediate need for services.

41. Interim IFSP • A temporary plan developed for a child with a known developmental delay or disability who has apparent immediate need for EI services between the child's referral and the completion of the MDE. • Parental consent must be obtained and the parent and EIO must agree to the interim IFSP. • Required federal timelines for the completion of the evaluation and development of the initial IFSP apply.

42. Interim IFSP (cont’d.) Interim IFSP includes: • name of the ISC. • early intervention services needed immediately by the child and the child's family, including the location, frequency, intensity of services. • identification of service providers. • a script or written order for services, as required.

43. Explanation of Rights and Entitlements • The ISC explains to the parent their rights and entitlements under the EIP and documents the information they provided in the child's record. • All information provided to the parent is presented in their dominant language or other mode of communication and in a way that is understandable to them. • All information obtained from the parent is confidential and disclosed only upon written consent, or if required under law.

44. Consent for Release of Information The parent can sign either a General or Selective Release: General Release: allows information in the record to be shared at any time with all early intervention providers involved in providing services to the child and family, and possibly to other parties. Selective Release: allows the parent to specify what information can be released and the parties it can be released to. 44

45. Late Referrals to the EIP A child referred to the EIP when they are already age eligible for CPSE is considered a “late referral.” If a child is referred after the 120-day timeline for making notification to CPSE and convening a transition conference, but prior to 45 days before the child turns 3, the EIP can still accept the referral, but the child should also be immediately referred to CPSE if they are thought to be eligible. If a child is referred less than 45 days before the child’s third birthday, the EIP is not obligated to accept the referral, but must facilitate a referral to the CPSE. 45

46. Late Referrals to the EIP (cont’d.) The EIO must designate an ISC. ISCs perform all required duties and responsibilities, including transition activities. ISC informs parent that the child must also be referred to and evaluated by the CPSE, if the child is thought to be potentially eligible for CPSE services. ISCs must be particularly mindful of all required timelines regarding the development of the IFSP within 45 days of the referral and of the timelines for transition and CPSE eligibility determination. 46

47. BREAK Please return on time

48. Unit 5 Children in Foster Care

49. EIP Definition of “Parent” • In the EIP, the term “parent” means parents by birth, adoption, a person in parental relation to the child, or an appointed surrogate. • “In parental relation” means a child’s legal guardian, standby guardian, custodian, or person acting in the place of a parent (grandparent or stepparent). • 10 NYCRR 69-4.1(ah) and (ai)

50. Child in Foster Care System Referred to the EIP • When a child in foster care is referred to the EIP, the EIO appoints an ISC and consults with the social service district to determine the status of parental rights, and if the parent is available to participate in the EIP process. • Pursuant to EIP Regulations, the EIO then determines if the appointment of a surrogate parent is necessary.