1. Children’s Policy Conference Austin, TX February 24, 2016 1. ECI as best practice model for children 0-3 years with developmental delays / chronic identified medical conditions 2. Differences in models of care delivery 3. Pediatricians’ perspectives on ECI Programs Building a Stronger Early Childhood Intervention System Richard.Adams@TSRH.org

2. Early Intervention, IDEA Part C Services, and the Medical Home: Collaboration for Best Practice and Best Outcomes AAP Clinical Report Richard C Adams, MD & Carl Tapia, MD AAP Council on Children with Disabilities Pediatrics. Vol 132 (4).1073. 2013 http://pediatrics.aappublications.org/content/pediatrics/132/4/e 1073.full.pdf

3. Key Underlying Principles Guiding the Texas ECI 1. Infants learn best thru everyday experiences and interactions with familiar people in familiar contexts. 2. With support & resources all families can enhance the child’s development 3. The primary role of the ECI Professional is to work with & support family members. 4. The ECI process must be dynamic and individualized to reflect the child and family.

4. Key Underlying Principles Guiding the Texas ECI 5. Individualized Family Service Plans (IFSP) are just that. 6. The family’s priorities, needs, supports are addressed best by a primary professional who receives team and community support. 7. Interventions are based on explicit principles, validated practices, best evidence, relevant laws.

5. Models of therapy “Medical” Model Focus on the child and the impairment Goal to improve or prevent regression of functional ability Frequently reimbursed by private medical insurance “Developmental” Model Focus on the child – caregiver dyad: relationship and learning Goal to promote the development of the child in the context of their natural environment Rarely reimbursed by private medical insurance

6. Models for Intervention Translating Evidence-Based Neuroscience into “Best Practice” Early Childhood Services 1. Creation of frequent opportunities that allow for “learning in the natural environment”. 2. Utilizing methods of “coaching” as a model ● families ● medical home ● early intervention programs

7. “Best Practice” Models for E.I. Services 1. Creation of frequent opportunities that allow for “learning in the natural environment”. Learning takes place in the context of relationships Intervention strategies should enhance – not disrupt – typical activities unique to the family Key agents for infant’s development parents / siblings / extended family / others Emphasis is on supporting those change agents and their abilities during everyday activities Focus is on function

8. “Best Practice” Models for E.I. Services 2. Utilizing methods of “coaching” as a model Build capacities of parent / caretaker Support strategy for use by therapists / early childhood specialists / care coordinators Requires confidence in specific roles being played by each of the participants in the infant’s learning Active – not passive – process, with close collaboration being a key component

9. D. S. Therapy Family-Centered Care Through Part C of IDEA - A Two-Generation Intervention Resilient Child Resilient Child Nurturing relationships, safe environments, rich experiences Services promoting physical, emtional, mental health Supports that strengthen relationships, engage families, enhance their capacity to and confidence

11. Services Based on Eligibility Type

12. Child Outcomes Reflect the global functioning of a child across settings and situations. The 3 outcomes are: *Positive social emotional skills – including (+) social relationships *Acquisition and use of knowledge and skills – including early language and communication *Use of appropriate behaviors to meet needs

14. Family Outcomes, 2013: How helpful has ECI been in….. Sharing ideas on how to include your child in daily activities 91.2%*4.5 Showing you how to work with your child when the service providers are not there 93.0%*4.6 Giving you chances to practice skills and learn from a service provider 91.4%*4.5 Indicates the value of:  Learning in the natural environment, which occurs in the context of relationships, and enhances, not disrupts, daily activities  Utilizing methods of coaching as a model to build capacities of the parents  Collaboration between the parent and service providers is key

15. 15 3 A: Positive Socio-Emotional Skills Greater than expected growth

16. What are “Value Added” Services for Which Neither Family nor Insurer Pays  Evaluation & assessment of child & family  Activities related to: development, review, & evaluation of IFSPs & interim IFSPs  Service coordination services  Conducting child find  Use of procedural safeguards  All Part C services for a child & family if parents are determined “unable to pay”

17. Family Outcomes Survey – Indicator 3 (Helping child develop and learn) How ECI helps your babies and their parents Giving them information about how to help your child get along with others Giving them useful information on how to help your child learn new skills? Giving them useful information about how to help your child take care of his/her needs? Providing services that your child and family need? Identifying things they can do that help your child learn and grow? Sharing ideas on how to include your child in daily activities? Showing how to work with your child when the ECI providers are not there? Giving them chances to practice skills and learn from a service provider? Working with them to know when their child is making progress?

18. Advocacy roles for Support of the ECI Program Note: there are state-to-state differences in policies (eligibility criteria, assessment, & services provided) Awareness of potential costs to family (public or private third parties; self pay; etc) Be cognizant of resources (fiscal / profession / staff) available within the state and region Assign time to meet staff from local / regional Part C Work with state AAP Chapter for policy-level involvement in the Part C Program

19. TPS specifically support policies that exclude treatments that are not supported by medically peer-reviewed literature and do not result in practical functional improvements for the patient In addition to the current draft policies, TPS would also like to see an emphasis on children under 3 years of age entering into the Early Childhood Intervention (ECI) program as a first choice for developmental delays. The evidence base supporting ECI as a best practice model to improve and alleviate delays in children is clear Submitted Comments on “Draft Therapy Policy Changes” by the TPS

20. Maintaining, Growing, and Better Supporting a Stronger Texas ECI Program Constant Advocacy Thank You !