1. CQI for EI Liza Then & Carol Votta

2. Team Members Co-Leads: Carol Votta and Liza Then Sponsors: Ellen Amore and Brenda Duhamel Coach: Magaly Angeloni Core Team Members: Chris Robin Payne, Evan Bessette Ad Hoc: Richard Lupino and Jen Kaufman

3. EI Background Early intervention (EI)-federal program and is part of the Individuals with Disabilities Act (IDEA) Part C Part C provides regulations for infants and toddlers up to age 3 IDEA defines eligible as those with significant developmental delays (further defined by each state)

4. Con’t EI Background In Rhode Island, children are eligible for EI if they have a diagnosed medical disorder or have a developmental delay in one or more areas of development: –Cognitive –Physical –Communication –Social-emotional –Adaptive

5. EI process Referral Evaluation Individual Family Service Plan (IFSP) initial date IFSP start date Services Begin within 30 days of IFSP start date

6. EI process Once a referral is made the agency has 45 days to complete the initial IFSP according to federal guidelines Once the parent(s)/guardian(s) has signed the IFSP (start), services begin within 30 days

7. KIDSNET Data Elements/ Entry Guidelines Referral – 5 days Evaluation – 14 days IFSP (initial) – 14 days Discharge code - 30 days

8. Baseline Data Agency A –The average number of days for an IFSP initial date to be created in KIDSNET is 60 days. (Children with an IFSP date created in KIDSNET between January- June 2014, was used to calculate the baseline data for Agency A.)

9. Aim Statement Increase the percent of IFSP initial dates received in KIDSNET within 30 days reported by Agency A, from 45%-60% by December 2014.

10. Impact of Timeliness with IFSP Dates Having IFSP dates available in KIDSNET in a timely manner will improve coordination of care for children including home visitors The American Academy of Pediatrics recommends children identified with hearing loss receive early intervention services no later than 6 months of age and reach their full potential. Earlier intervention results in better outcomes for the child

11. CAUSES OF ENTRY DELAY OF IFSP DATES

12. Plan: Test the Theory for Improvement Review Early Intervention policies and procedures currently in place around data entry of IFSP dates. With the ultimate goal to see an increase in the number of IFSP dates created in KIDSNET within 30 days

13. DO: Test the Theory for Improvement Work with EI Agency A, to review data entry process into Wellignet. Had Agency A implement change strategy of eliminating the step of “supervisor review” needed for data entry of referral and IFSP dates, for the months of August – December

14. Study: Agency A

15. Adapt With this process change, the IFSP dates entered within 30 days in KIDSNET increased from 45 to 64% in August – December 2014. Try the change strategy with another EI agency of similar size with IFSP create dates in KIDSNET greater than 30 days.

16. Lessons Learned Delays in data entry of initial IFSP date were decreased with a process change; however, delays may also depend on parent or professional availability Learning more about the data systems helped staff understand and identify potential problems and solutions

17. Ideas Moving Forward Add IFSP start date to file transfer Automate file transfer Explore the use of tablets and other electronic devices to accelerate data entry in the system Conduct ongoing monitoring of data timeliness to identify possible delays