1. Team-Based Early Intervention Overview

2. Agenda How did we get to Team-based Early Intervention?
What does Team-based Early Intervention look like?
What does it mean for service coordinators?
What does it mean for families?
What’s next?

3. How Did We Get to Team-Based Early Intervention Services?

4. 2007 Implemented Phase 1 AzEIP- only eligible in specific counties
2005 Community forums
2007 Implemented Phase 1 AzEIP- only eligible in specific counties
2009 Implemented Phase 2 AzEIP-only eligible children (statewide)
2013 Implement Phase 3
All children eligible for AzEIP (including ASDB and DDD) statewide
Arizona began discussions of implementing team based early intervention services almost 10 years ago in response to the early childhood research that was emerging. That research recognizes and supports the family as the most important part of a child’s life and the primary people who can effect change for the child. It also recognizes development as an integrated process – All areas of a child’s development interact and influence each other and children learn about themselves through interactions with family and caregivers as part of their daily routines. Team-based early intervention services were designed to align with the research.
In addition, AzEIP was responding to concerns expressed by families, providers, and the community (including referral sources and others) related to the current system structure, such as the system is difficult for families to understand, families have multiple providers who may or may not coordinate, services focus on attainment of specific skills and do not necessarily reflect priorities of the family or their daily routines or activities, and inconsistent service specifications, policy, and practice guidelines among the AzEIP agencies.
The United States Department of Education, Office of Special Education Programs (OSEP) also recognized the primary service provider model as one method to effectively and efficiently use personnel to ensure timely services for families and children. In parts of the state, timely services has been a challenge and moving towards team-based early intervention was another way to ensure effective use of personnel and timely services.
Around 2005, AzEIP held many community forums across the state with families, providers, and stakeholders. In 2007, Phase 1 of the changes included AzEIP-only children in Maricopa, Apache, Southern Navajo and Yuma counties. Phase 2, in 2007, included all AzEIP-only children in the remaining counties. This final phase includes all AzEIP eligible children including those who are also eligible for the Arizona State Schools for the Deaf and the Blind (ASDB) or the Department of Economic Security’s Division of Developmental Disabilities (DDD).
When AzEIP began making changes, there were about 10 states that were moving in the same direction and/or had already moved. Today, close to 30 states have a similar services approach in their early intervention program.

5. The Foundation IDEA Part C Regulations requires each State to:
include State policy that is in effect and that ensures that appropriate early intervention services are based on scientifically based research, to the extent practicable, and are available to all infants and toddlers with disabilities and their families.
Best practice has always guided early intervention programs to provide services using evidence based practice.
The Individuals with Disabilities Education Act (IDEA) now requires that early intervention systems provide services that are based on scientifically based research.
Most states are now providing early intervention services using a variation of the team based early intervention. Some states refer to it as a primary service provider, or primary coach approach or a Trans-disciplinary model.
Each of these models have specific, prescribed methods for providing services to families.

6. Evidence-Based Practices
“Practices that are informed by research, in which the characteristics and consequences of environmental variables are empirically established and the relationship directly informs what a practitioner can do to produce a desired outcome.” (Dunst, Trivette, & Cutspec, 2002)
There’s been much research in early childhood based on the research, a group of experts came together to develop the early intervention mission and key principles.
In the last decade, research has been done on the efficacy of early intervention and how to better support families in early intervention. Arizona’s team based approach is designed to reflect each of these practices – team lead, coaching, supporting natural learning opportunities and increasing a child and family’s participation in their everyday life and community.

7. The mission statement reflects the broad over-arching purpose of family- centered early intervention services provided under Part C of IDEA. Principles are the foundations necessary to support the system of family- centered services and supports.
Both the mission and principles were developed by a workgroup and reflect consensus opinion. The workgroup was made up of professional in the early intervention field who have developed different models of practice but have come to the consensus that there are 7 key principles for providing EI services in the natural environments.

8. Key Principles for Early Intervention Services
1. Infants and toddlers learn best through everyday experiences and interactions with familiar people in familiar contexts.
2. All families, with the necessary supports and resources, can enhance their children’s learning and development.
3. The primary role of a service provider in early intervention is to work with and support family members and caregivers in children’s lives.
4. The early intervention process, from initial contacts through transition, must be dynamic and individualized to reflect the child’s and family members’ preferences, learning styles and cultural beliefs.
Workgroup on Principles and Practices in Natural Environments (November, 2007) Mission and principles for providing services in natural environments. OSEP TA Community of Practice-Part C Settings.
These seven Principles are the foundations necessary to support the system of family- centered services and supports. You have seen these principles as part of every training topic over the last year and will continue to see the principles at each training as we continue to move forward in providing evidence based early intervention services.

9. Key Principles for Early Intervention Services
5. IFSP outcomes must be functional and based on children’s and families’ needs and family-identified priorities.
6. The family’s priorities, needs and interests are addressed most appropriately by a primary provider who represents and receives team and community support.
7. Interventions with young children and family members must be based on explicit principles, validated practices, best available research, and relevant laws and regulations.
Workgroup on Principles and Practices in Natural Environments (November, 2007) Mission and principles for providing services in natural environments. OSEP TA Community of Practice-Part C Settings.

10. What do Team-Based Early Intervention Services Look Like?

11. Arizona adapted the three components above to create its team-based early intervention services.
Primary coach teaming practices, includes the team lead approach and creates an approach that allows all team members to have the opportunity to share ideas, strategies and coach each through through teaming.
Coaching supports families and other caregivers to increase their ability to support their children to develop and grow.
Natural Learning environment practices recognizes that children develop and grow each and every day with those individuals and in those settings where they spend the most time.

12. Team-Based Early Intervention
What it looks like:
What it doesn’t look like:
The next few slides describe what team-based early intervention looks like (and does not look like).

13. Team-Based Early Intervention
What it looks like…
What it doesn’t look like…
Family-centered
Strength based
Natural environments
Coaching
Team decision making
Team lead and joint home visits
Child centered
Deficit based
Center-based
Directing
Professional driven
Separate home visit by each team member

14. AzEIP Core Team DSI SLP PT OT
Every family in early intervention has access to a team, which includes these core team members: developmental special instruction, occupational therapy, physical therapy and speech-language pathology. There is no hierarchy of disciplines on a team. All members of the core team share the same core team responsibilities, including acting as a team lead. (Every family also has a service coordinator, as discussed on the next slide.)
Each regional, DES/AzEIP contractor is required to ensure the availability of each discipline. DDD and ASDB will not have a separate vendor or contracting system for providers to serve children 0-3 and their famlies who are eligible for DDD or ASDB. There will be one contract for all service providers.
Clipart by Picsburg -

15. Early Intervention Team
ASDB Hearing or Vision Specialist
Service Coordinator
Psychologist
Social Worker
In addition to the Core Team, families will have one service coordinator. The service coordinator plays an integral role with the core team and these other team members and is always a member of the IFSP team supporting the child and family.
ASDB/DDD service coordinators are part of the team for children and families they serve. Depending on the child’s eligibility, the service coordinator can be from the AzEIP contractor, DDD, or ASDB
The core team will have access to Psychology and Social Worker services as needed to support families. These team members are employed or contracted by the AzEIP Contractor.
The ASDB Hearing and Vision Specialist function like a core team member, but is not employed by the AzEIP contractor.

16. Other IDEA, Part C Services
Assistive technology
Audiology
Family training, counseling, and home visits
Health services necessary to enable the child to benefit from another early intervention service
Medical services only for diagnostic or other evaluation purposes
Nursing
Nutrition
Transportation and related costs necessary for child and family to receive early intervention services
Vision services
Sign language and cued language
When the IFSP team identifies the need for other early intervention services, the service coordinator assists with accessing these services for the family, whether through their health plan or through a contract with the state.
In addition, when the child is eligible for DDD/Arizona Long-Term Care System (ALTCS), the DDD service coordinator will ensure ALTCS service(s) are put in place for the family.

17. How is a team lead identified? What is the role of a team lead?
Who is a team lead?
How is a team lead identified?
What is the role of a team lead?

18. Team Lead
PT, OT, SLP, DSI, Psych, SW, ASDB Vision or Hearing Specialist can be a team lead
Identified by the IFSP team, which includes the parents
Primary provider who represents and receives team support
The team lead is not intended to limit a family’s access to supports and services, but instead, is intended to expand support for families by using core teams of individuals representing multiple disciplines who are accountable to the family as well as one another. The team lead has expertise relevant to the child’s needs and the outcomes on the Individualized Family Service Plan (IFSP).
The team lead’s focus is on collaborative coaching of families as the primary intervention strategy to implement jointly-developed, functional IFSP outcomes in natural environments with ongoing coaching and support from other team members.
The team lead does not meet all the service needs of the child. The other team supports the team lead, through regular team meetings and joint visits with the family as identified on the IFSP. Families participate in the team meetings through in-person attendance, calling-in to the meeting, or asking the team lead to share their questions/concerns.

19. Dual Role Not just DSI/SC
Occupational, Physical, or Speech Therapist, DSI, ASDB Hearing or Vision Specialist
Team Lead
Coordination
Service
providing
Also
To serve in a dual role means that a Core Team member, or ASDB Hearing and Vision Specialist, has been chosen by discussion during the IFSP, based on the priorities, interests and concerns of the family, as the Team Lead, and will also be providing Service Coordination for that family.
Dual role is not possible when DDD is the service coordinator, as DDD service coordinators are dedicated service coordinators (they do not act in any other role with the family)
Not just DSI/SC

20. ASDB Hearing and Vision Specialists (formerly Outreach Coordinator or Certified Parent Advisor)
ASDB Hearing and Vision Specialists are generally certified Teachers of the Deaf or Teachers of the Visually Impaired, qualified to provide:
Service Coordination
Special Instruction
Vision Services: Functional Vision Assessment, Orientation and Mobility
Sign Language and Cued Language

21. Opportunity for team members to: Collaborate Coach one another
Team Meeting
Opportunity for team members to:
Collaborate
Coach one another
Share information/Updates
Brainstorm
The purpose of team meetings is to share information among team members about children and families enrolled in AzEIP, provide coaching opportunities, and ensure that services are provided in accordance with the IFSP.
Microsoft Free ClipArt Images

22. Coaching
Building the capacity of care providers to promote child learning and development in family, community, and early childhood settings
Also occurs between team members to increase a practioner’s ability to reflect upon and learn from their practices
An adult learning stategy that recognizes every person’s ability to think about their actions/inaction and work with another person to create new or different possibiities for engagement with each other and the children with whom they interact.
Coaching develops the competence and confidence to implement strategies to increase the child’s learning opportunities and participation in daily life, knowing when the strategies are successful and making changes in current situations, as well as, generalizing solutions to new and different circumstances, people, and settings. (Bruder & Dunst, 1999; Fenichel & Eggbeer, 1992; Flaherty, 1999; Kinlaw, 1999)

23. All children receive service coordination, and the frequency, intensity, methods vary by family. At minimum, the service coordinator has monthly contact with the family. Each child/family will also have quarterly reviews of IFSP with the team.
Supports and services are based on the individual needs of each child and family.
Services are not limited to one service.

24. This is another example of a service page with team-based early intervention services.
Both of the examples reflect the teaming priority of this approach with different services provided to a family through joint visits. While separate visits may occur, this should be the exception, for exmple, when the two professionals are not able to schedule a joint visit.

25. What Does Team-Based Early Intervention Mean for ASDB and DDD Service Coordinators?

26. Service Coordination
DDD retains service coordination for Targeted (AHCCCS Acute Care Eligible) and ALTCS eligible children
ASDB retains service coordination for ASDB eligible children
AzEIP Contractor provides service coordination for AzEIP-only and DDD only eligible (non ALTCS non-Targeted) children
Under certain circumstances ASDB and DDD may request AzEIP Contractor provide service coordination

27. What remains the same for ASDB and DDD service coordinators?

28. Coordination of child and family assessments
Coordinating and monitoring services
Family Rights; Family Cost Participation, Consents
Accessing other services
Coordinating with community resources
Coordination and documentation of transition activities for children exiting AzEIP
Review the above responsibilities and note those that were shared by the audience to illustrate those that stay the same.

29. What Will be New? Work as Part of a team:
Assigned team available to provides services – no more Service Inquiries
Participate in regular team meetings
Participate in quarterly reviews for children/families
Coordinate and schedule with team members
Collaborate with other team members
IFSP team members participate in IFSP reviews and are available for assessments
The service coordinator helps families access services, resources, capacity building. The role does not change, the people you will interact with does and the level of communication will increase with participation in team meetings.
Communication with the team will make it easier to ensure services are timely and make changes to services in response to the child and families changing resources, interests and concerns.
Timely Services Procedures implemented in 2011 will end because teams will be in place from referral to serve children and families

30. Team Meetings What if I can’t be there? Who should attend?
Do we talk about every family EVERY week?
How is ASDB involved?
How is DDD involved?
During team meetings, coaching between IFSP team members enables non-team lead members to support the team lead in exploring and incorporating developmental approaches and techniques into early intervention strategies with families and caregivers to ensure that development is supported as an integrated and holistic process.
Who should attend?
Core team members and ASDB and DDD should attend the core team meeting for each family/child they work with, when that family/child is being discussed. Psychologists and social workers may attend when they are working with a family too.
All team members must be present for team meetings, especially when a child they are seeing is discussed during the quarterly review.
Parents are part of the team; therefore they must be invited to attend their child’s quarterly reviews. Parents may choose to attend the meeting in-person or via conference call. If parents chose not to participate in the quarterly review, then the team must ask the parents if they can proceed with the review without them. If the parents say it is okay to complete the review without them, then the team must ensure the family has an update from the review. If the parents prefer to reschedule the review to a time that’s convenient to them, then the team reschedule the review during another team meeting. If there is a need to discuss a family/child more often, a team member, including the service coordinator, can request that they be added to the agenda for that week
Parents should be invited to participate in their child’s segment of the meeting in person or by phone
Service coordinator supervisors will coordinate to assign service coordinators to teams in the regions.
What if I work with multiple AzEIP teams?
What if I need to talk about a child/family NOW?
How are parents involved?
Microsoft Office Clip Art

31. This is what a Team Meeting Agenda look like
This is what a Team Meeting Agenda look like. This form (and the blank form) are available on the AzEIP website.
Team meeting agendas follow a structure which includes planning and scheduling of various visits with the family and also includes time for quarterly updates of children and coaching opportunities of children.
AzEIP’s requirement for a quarterly update of a child includes a brief discussion of the current activities for that child and family. Families are invited to participate by phone or in person for just that part of the team meeting. It is a brief discussion usually no more than 5 to 10 minutes. Teams ensure a summary is prepared and kept in the child’s record. Teams have an option to develop one form capturing many children and then cutting it up to insert the appropriate section in each individual file or developing a form that records several consecutive quarterly updates for each individual child. Children being seen by the team rotate through the quarterly updates based on their initial/annual IFSP dates.
Coaching opportunities are longer discussions typically lasting minutes. This is a structured discussion for which the person presenting a child (usually the team lead) has prepared ahead of time to share with the team. Typically, the team lead is facing a challenge with a child or family outcome and strategies and is seeking additional support and information from the other team members. Teams discuss what is happening now within the challenge and what seems to be working and not working within that specific activity or routine. They discuss options and formulate a plan of action for the team lead and family to try. Sometimes, if the suggestions are not seeming to help, the option to have a joint visit with the family, team lead and another team member is planned.
Any team member can ask for a child to be placed on the coaching opportunities section of the team agenda. It is then her/his responsibility to prepare for the discussion in order to keep the meeting on track.

32. Team Meeting Minutes – Sample
Date:
10/27/04
Team Name:
TV Land
Beginning Time: 
9:00 
Ending Time:
10:30 
Team Members Present:
Richard Cunningham, SLP; Potsie Weber, OT; Laverne DeFazio, ECSE;  Ralph Malph, Service Coordinator; Shirley Feeney, PT; 
Primary Coach:
Shirley Feeney, PT 
Child Name: 
BamBam Rubble
9:15 
9:25 
Topic:
Shirley asked for help regarding BamBam’s behavior during mealtime.  He has been hitting his sister and she wants to make sure she’s not missing any information that will help BamBam participate in mealtime with his family and not get sent to the naughty corner every meal. Shirley explained all of the ideas she and Mrs. Rubble have tried, what they  are planning on…..
Ending Time: 
9:45 
Shirley asked for help identifying resources in TVLand for families who do not speak English. Ralph used  coaching strategies to assist Shirley in identifying some additional resources in the
Here is an example of the notes taken during a team meeting. This example and also the blank form are available on the AzEIP website.
This is an example of documenting a coaching opportunity. The information would later be added to a child’s file.
Quarterly notes

33. What Does This Mean for Families?

34. What We Know Now!
New AzEIP contracts will serve all AzEIP eligible children using Team Based Early Intervention Services
Children birth-3 years old enrolled in ASDB and ASDB will be transitioned to the new AzEIP Contractors to receive their early intervention services
Most families currently ASDB or DDD eligible will experience a change in the organizations/agencies and/or the individuals who are currently providing early intervention services for their family
As service coordinators, you will have the biggest job of responding to families’ questions on the changes to team-based early intervention! Staying attuned to information as it comes out and asking questions will help you provide families the most up to date information.

35. What Do EI Services Look Like Now?
What Will EI Services Look Like in the Team-Based Early Intervention?
More than one, regularly occurring IFSP service may be identified for a child and family
One primary service provider (team lead) with skills to best meet the family’s needs works with the child/family on a regular basis with support from core team and the psych, social worker and ASDB Vision/Hearing Specialist as appropriate
DDD/ASDB searches for service providers among their existing contracts and family chooses a provider, if available, for each service
AzEIP Contractor provides core team services (PT, OT, SLP, DSI), social work and psychology. Team Lead is selected from the AzEIP Contractor or ASDB Vision/Hearing Specialist, as appropriate
Family receives support from the IFSP team, which includes service coordinator and the individual providers identified on the IFSP
Family receives support from IFSP team, which includes service coordinator, the Team Lead, others identified on the IFSP, other core team members (PT, OT, SLP, DSI), and as needed, psychologist, social worker, and ASDB Vision/Hearing Specialist

36. What Do EI Services Look Like Now?
What Will EI Services Look Like in the Team-Based Early Intervention?
After DDD/ASDB identifies and puts in place IFSP service providers, AzEIP Contractor closes record, and family no longer has contact with them
AzEIP Contractor will provide on-going IFSP services, and child’s record remains open. Family will also have support from other core team members and the pscyhologist, social worker and ASDB’s Vision/Hearing Specialist, as appropriate
IFSP service providers may work for different agencies resulting in fragmented services
IFSP service providers on core team, psychologst, amd social worker all work for AzEIP Contractor
IFSP service providers work independently and are generally unable to collaborate/communicate to meet needs of the child/family. Families have to share information/updates multiple times, with each provider
IFSP service providers and other team members will meet and share information with each other regularly, so everyone will have the same information. Families only have to share information with team lead who will share with other team members. Families can participate in team meetings by phone or in person as much as they like

37. How Will Families Be Notified of Changes?
Notifications sent to families by November 2012
Additional notifications of team serving family’s zip code will be sent to families
DDD/ASDB service coordinators will receive copies of letters to prepare for questions from families
***Ensure parent’s mailing addresses are up to date
DDD and ASDB service coordiantors can assist with notification by sending via if they have families address.
Families will receive a letter notifying them of the changes. Service coordinators should go over the letter with families and answer their questions if they can, remember it is ok to say I do not have an answer at this time, let families know you will follow up.
You will receive other resources to guide you as the state transitions.

38. How Will the Transition from Current Providers to New Providers Happen?
New Contracts will be awarded in December of 2012
New AzEIP Contractors will begin accepting referrals February 2013
DES/AzEIP, DDD, and ASDB will work with the current providers and the newly contracted providers to prepare for the transition of existing families to the new AzEIP Contractors
Full transition of families already enrolled with DDD or ASDB to new AzEIP Contractors is expected to take a few months

39. How Can We Best Support Families During Transition?
Familiarize yourself with the Key Principles of Early Intervention
Be timely in responding to questions from families
Answer questions if you know the answer
If you don’t know the answer(s), let the family know that you will look into it and get back to them

40. Change
Our attitude about the changes will come through to the families we serve; if we seek to be positive, it will help the family in the long term

41. Take care of yourself Being okay not knowing everything
Focus on what is known and learn all you can about it
Talk to others who are experiencing the same change
Change takes time and is a process

42. THANK YOU!