Family-Centered Early Intervention Services for Children Evaluated for Autism: Developing a State-Wide Model to Build Capacity Jill Rigsby, M.S. Director of Early Intervention Programming Tennessee's Early Intervention System Alacia Stainbrook, Ph.D., LBA, BCBA-D Associate Director, Vanderbilt Kennedy Center’s Treatment and Research Institute for Autism Spectrum Disorders (VKC TRIAD)

2019 OSEP Leadership Conference OSEP Disclaimer 2019 OSEP Leadership Conference DISCLAIMER: The contents of this presentation were developed by the presenters for the 2019 OSEP Leadership Conference. However, these contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. (Authority: 20 U.S.C. 1221e-3 and 3474)

Objectives Overview a collaborative early identification and intervention model in Tennessee Discuss rationale for the development of each component Share family, child and provider impact data Consider next steps for Tennessee

440 Miles/ 708 Kilometers wide State Perspective 440 Miles/ 708 Kilometers wide 120 mi 196 km tall Population (2016): 6,651,194 Mello, Urbano, Goldman, & Hodapp (2016)

Local Perspective How is TEIS currently meeting the Individualized Family Service Plan (IFSP) goals of families with children diagnosed with Autism and/or displaying challenging behaviors? What IDEA required services are currently being provided throughout the state? What services are parents requesting to meet their child’s IFSP identified goals? Met with TEIS Point of Entry (POE) staff to discuss their concerns/limitations with providing services for children with Autism and/or challenging behaviors.

Considerations for Program Development? 2. How do we improve access to intervention? 3. How do we improve capacity of local providers? 1. How do we improve access to diagnostics and services?

Program Development Timeline 2014 2015 2016 2017 2018 Caregiver follow-up Co-treating Professional Development & Tele-consultation Tele-diagnostic Consultation & Curriculum Development

Increasing Access to Early Identification 75% certainty and 100% agreement Psychologists conducting an assessment Technological equipment 89% increase in total referrals 65% decrease to Nashville 15% increase in show rates

Tele-diagnostic Consultation Services A referral is made: Milo is 23 months. He tantrums when transitioning between activities, is a selective eater, doesn’t have any spoken words and walks on his toes. The family travels to Jackson to connect with a TRIAD consultant and VUMC psychologist. A TRIAD consultant connects with the family for further screening and scheduling. 62 mi. 192 miles

Increasing Access to Specialized Early Intervention Services Caregiver training Telemedicine services Curriculum modules

Early Intervention Services: Caregiver Education and Support Intervention sessions are scheduled and implemented in collaboration with the family’s early intervention provider. Early Intervention providers serve several counties and 20-30 families at a time. Children are eligible for services due to a variety of developmental concerns. Sophie’s mom is concerned about her challenges with communication. Mom is often “playing guessing games” to figure out what Sophie needs and wants. Sophie lives in Middle TN and was recently diagnosed with ASD at VUMC. A TRIAD consultant connects to the family and EI provider to plan services.

Capacity Building and Teaming Professional Development Provider notes Co-treatment

Capacity Building and Teaming

Family Demographics

Curriculum Use

Family functioning She believed in working as a team. Being able to help myself to give my son the best attention/help he needs. She believed in working as a team. "Take home plans" were easy to follow 1 (poor) > 5 (excellent) So many useful long term tool/ideas to improve my child’s home life Child Development Diagnosis Resources/ Services How to Help Routine Errands Community Outings PRE 3.8 3.9 3.2 2.9 POST 4.5 4.6 3.5 3.3 Child Development Diagnosis Resources/ Services How to Help Routine Errands Community Outings PRE 3.8 3.7 3.3 3.1 POST 4.2 4.0 Learning to differentiate between being parents/therapists

Child Growth 1 = very much improved 2 = much improved **Significant at the .01 level 1 = very much improved 2 = much improved 3 = minimally improved 4 = no change 5 = minimally worse 6 = much worse 7 = very much worse 1 = no challenges 2 = some challenges 3 = mild challenges 4 = moderate challenges 5 = marked challenges 6 = severe challenges 7 = very severe challenges

Child Growth

Provider Impact Satisfaction/Impact Category Average Score Satisfaction with consultants 3.95 Satisfaction with service model 3.80 Satisfaction with family and child outcomes 3.70 Impact on service provision 3.34 The consultant was knowledgeable about intervention strategies The consultant provided recommendations that were useful and feasible I was pleased with the outcomes of the services for myself and the family Participation in these services has impacted my service delivery approach

Why Does it Work? Close collaboration with the Part C service system Development of scalable pilot programs Emphasis on program evaluation Ongoing assessment of community specific needs

Program Development Timeline 2014 2015 2016 2017 2018 2019 Caregiver follow-up Co-treating Professional Development & Tele-consultation Tele-diagnostic Consultation & Curriculum Development Tele-extensions and district level experts

Contact Us Jill Rigsby Alacia Stainbrook Jill.Rigsby@tn.gov https://www.tn.gov/education/early-learning/tennessee-early-intervention- system-teis.html Alacia Stainbrook Alacia.Stainbrook@vumc.org https://vkc.mc.vanderbilt.edu/vkc/triad/home

2019 OSEP Leadership Conference OSEP Disclaimer 2019 OSEP Leadership Conference DISCLAIMER: The contents of this presentation were developed by the presenters for the 2019 OSEP Leadership Conference. However, these contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government. (Authority: 20 U.S.C. 1221e-3 and 3474)